Factores que intervienen en la sobrecarga del cuidador primario del paciente con cáncer / Factors involved in the burden of the primary caregiver of cancer patients

Objetivo. Identificar los factores que intervienen en la sobrecarga y calidad de vida del cuidador primario del paciente con cáncer. Material y métodos. Se realizó un estudio transversal en un hospital de segundo nivel de atención que incluyó 100 cuidadores primarios de pacientes con cáncer. Se determinó el nivel de sobrecarga con la escala de Zarit, y la percepción de calidad de vida con el cuestionario World Health Organization Quality of Life. Se categorizó la calidad de vida como alta o baja y se comparó entre grupos según su nivel de sobrecarga. Se realizó estadística descriptiva para las variables de estudio y se analizaron las diferencias entre grupos según su nivel de sobrecarga. Resultados. Al evaluar la sobrecarga se encontró que el 31% de cuidadores presentó sobrecarga. El 76% de los cuidadores percibió una buena calidad de vida, mientras que el 24% restante la percibió como mala. Para identificar la asociación entre estas 2 variables se utilizó la Chi cuadrado, encontrando una asociación con una p≤0,05. Para identificar correlación entre calidad de vida y sobrecarga del cuidador primario se realizó una correlación de Spearman, obteniendo un valor r de 0,321 con una p≤0,05, encontrando una correlación levemente positiva. Conclusiones. Los factores que inciden en mayor medida para una buena calidad de vida a pesar de tener sobrecarga fueron: el ser casado, el dedicarse al hogar y el parentesco (ser familiar directo: cónyuge, padres e hijos). De manera contraria el tipo de cáncer, las horas de sueño y las horas de cuidado influyen en la percepción de una mala calidad de vida (AU)

Objective. The aim of the study was to identify the factors involved between burden in the primary caregiver of cancer patients and their quality of life. Material and methods. A cross-sectional study was conducted in a secondary level hospital on 100 primary caregivers of cancer patients. The level of burden was determined using the Zarit scale and the perception of quality of life using the World Health Organisation Quality of Life questionnaire. Quality of life was categorised as high or low and compared between groups according to their level of burden. Descriptive statistics were performed on the study variables, and differences between groups were analysed according to their level of burden. Results. In assessing the overload, it was found that 31% of caregivers had burden. A good quality of life was perceived by 76% of caregivers, while the remaining 24% perceived it as poor. To identify association between these two variables Chi squared (X2) was used to determine whether there was any association between quality of life and overloading of the primary caregiver, giving a P≤.05. A Spearman correlation was also performed, obtaining an r-value of .321 with a P≤.05, finding a slightly positive correlation. Conclusions. The factors that have a bearing on a good quality of life despite having burden were: being married, dedicated to the home, and kinship (to be immediate family: spouse, parents and children). Conversely, the type of cancer, sleep hours, and hours of care influence the perception of a poor quality of life (AU)

[Factors involved in the burden of the primary caregiver of cancer patients]. / Factores que intervienen en la sobrecarga del cuidador primario del paciente con cáncer.

OBJECTIVE: The aim of the study was to identify the factors involved between burden in the primary caregiver of cancer patients and their quality of life. MATERIAL AND METHODS: A cross-sectional study was conducted in a secondary level hospital on 100 primary caregivers of cancer patients. The level of burden was determined using the Zarit scale and the perception of quality of life using the World Health Organisation Quality of Life questionnaire. Quality of life was categorised as high or low and compared between groups according to their level of burden. Descriptive statistics were performed on the study variables, and differences between groups were analysed according to their level of burden. RESULTS: In assessing the overload, it was found that 31% of caregivers had burden. A good quality of life was perceived by 76% of caregivers, while the remaining 24% perceived it as poor. To identify association between these two variables Chi squared (X2) was used to determine whether there was any association between quality of life and overloading of the primary caregiver, giving a P≤.05. A Spearman correlation was also performed, obtaining an r-value of .321 with a P≤.05, finding a slightly positive correlation. CONCLUSIONS: The factors that have a bearing on a good quality of life despite having burden were: being married, dedicated to the home, and kinship (to be immediate family: spouse, parents and children). Conversely, the type of cancer, sleep hours, and hours of care influence the perception of a poor quality of life.

Macrophage colony stimulating factor (M-CSF) within cord blood sera may be partially responsible for the reduced proliferation of cord blood T cells.

We show that there are differences in the soluble factors in cord blood (CB) and adult serum and that these differences play a role in T cell function. Thus, the mitogen and alloantigen-specific proliferative response of adult T cells was enhanced with increasing concentrations of adult serum and CB serum, but to a lesser extent with CB serum. In addition, proliferation of T cells induced by stimulation through the T cell receptor alone (via CD3 stimulation), could be enhanced with adult but not CB serum. However, CB serum enhanced the IL-2-specific proliferative response of pure T cells whereas adult serum did not. To determine whether there was an anti-inflammatory cytokine within CB serum which could induce these results, we assayed our serum samples for anti-inflammatory cytokines. IL-13 could not be detected in any serum sample, whereas IL-10 could be detected in adult but not CB serum (P < 0.002). However, there was a significant difference in the levels of macrophage colony stimulating factor (M-CSF) detected in adult and CB serum samples (P < 0.01). M-CSF was detected in 6/7 CB serum samples (mean +/- SD was 3.8 +/- 2.3 ng/ml) and 0/5 adult serum samples. Furthermore, anti-M-CSF antibody restored the reduced allo-response of T cells incubated in CB serum. Thus, M-CSF may act as a suppressor factor in CB serum. Whether this is sufficient to explain the lack of an allo-response by the foetus to the mother, or the reduced graft-versus-host disease when CB is used instead of bone marrow in stem cell transplantation, is yet to be determined.

Cord blood serum does not increase lymphocyte responses in comparison to adult serum.

To date, over 1000 cord blood (CB) transplants have been reported from different centers worldwide and it is generally agreed that CB represents an encouraging alternative to bone marrow (BM) transplantation. There are a variety of reasons for this, however, possibly the two most controversial aspects are (a) whether there is less graft versus host disease (GVHD) with CB compared to BM transplantation, and (b) whether we can use more HLA mismatches with CB transplantation. The major theory regarding the reduced immunological response of CB lymphocytes is that CB T and NK cells are naive and, therefore, not primed for activation. However, the naive phenomena that has been noted in vitro may be bypassed in vivo by unforeseen factors. We show evidence that there are differences in the soluble factors present in CB and adult serum and that these differences play a role in T cell function. Thus, adult serum will enhance both mitogen and IL-2 specific T cell growth whereas CB serum has no effect, suggesting that there is an activation/growth factor present in adult sera, which is absent in CB sera. This work could enable us to identify the molecular mechanisms which are associated with a lower GVHD in CB compared to BM transplanted individuals.

Naive T cells from cord blood have the capacity to make Types 1 and 2 cytokines.

We wanted to determine whether naive T cells could make the Types 1, 2 and 0 defining cytokines Interleukin (IL)-4 and Interferon (IFN)gamma. We show that stimulation of naive T cells (CD3+ CD45RA+) derived from cord blood by phorbol ester (phorbol-12-myristate-13-acetate: PMA) plus lonomycin induced detection of Types 1, 2 and 0 cells. Conversely, when we stimulated the naive T cells through the T cell receptor (with anti-CD3 monoclonal antibody alone) there was no detection of IFNgamma or IL-4 producing cells. Stimulation with PMA and CD3 induced detection of only Type 2 cells. This unexpected finding shows that there is a high frequency of Type 2 cells within the naive T cell population, contrary to previously published reports. The highest percentage of Type 2 naive cells (10.5%) was obtained with 50 ng/ml PMA plus 50 microg/ml anti-CD3. Thus, we have shown that naive T cells derived from cord blood have the capacity to make both Types 1 and 2 cytokines and the frequency of cells producing these cytokines can be greater than 20%, depending on the stimulus used.

Analysis of the cytokine production by cord and adult blood.

To date, over 400 human umbilical cord blood cord blood (CB) transplants have been reported from different centres world-wide and it is generally agreed that CB represents an encouraging alternative to bone marrow (BM) transplantation. There are a variety of reasons for this which include the wider availability and easier access of CB compared to BM. In addition it has been suggested that there is a reduced graft-versus-host-disease (GvHD) with CB compared to BM transplantation. The explanations for this implied benefit are numerous, but research into this area is only just beginning. Nevertheless, it is clear that both T cells and natural killer (NK) cells have reduced function when isolated from CB compared to adult and both these cell types have been implicated in GvHD pathogenesis. How and why the function is reduced is yet to be determined. Many laboratories have tried to answer these questions and the majority have done this by comparing the function of lymphocytes obtained from adult blood with those compared with CB. Since cytokine production by a cell is an indication of the cells function it is important to determine the differences between adult and CB with respect to production of these soluble factors. Here, we have reviewed the current research regarding these CB and adult cell comparisons with an emphasise on cytokine production. Our aim is to obtain a clearer understanding of the mechanisms which may be involved in causing a reduced GvHD in CB compared to BM transplantation.

Effect of renal dialysis therapy modality on T cell cytokine production.

INTRODUCTION: Dialysis has been associated with acute changes in the complement activation status, granulocyte markers, macrophage function, T cell activation and the release of pro-inflammatory cytokines. The most common analysis of cytokine production in patients on dialysis has focused on the changes in monokines (particularly IL-1 and TNF alpha), however it is becoming clear that T cell cytokines play a major role in the impaired lymphocyte function of dialysis patients. METHODS: To assess the effect of dialysis modality on T cell function we analysed the ability of T cells within peripheral blood mononuclear cell populations (PBMC) to produce cytokines after mitogen (phorbol-12-myristate-13-acetate; PMA and lonomycin; I) stimulation in patients on peritoneal dialysis (PD) compared to low flux haemodialysis (HD) and normal individuals (controls). RESULTS: In control PBMC, PMA + I stimulation significantly increased the percentage of CD3+ cells expressing IL-2, IFN gamma, TNF alpha, IL-4 and IL-10, as expected. However, although mitogen stimulation significantly enhanced the percentage of the classical Th1 cytokines (IL-2, IFN gamma and TNF alpha) in the low flux HD PBMC, it had no effect on CD3+ IL-2 or CD3+ TNF alpha producing cells in the PD group. In contrast, the percentage of T cells producing Th2 cytokines (IL-4 and IL-10) could not be consistently enhanced by mitogen in either dialysis group. CONCLUSIONS: We suggest that PD alters the ability of T cells to produce cytokines, possibly by causing an 'exhaustion' of the Th1 cells, thereby preventing cells to produce cytokine on ex vivo stimulation. Furthermore, since T cells from both low flux HD and PD groups could not be induced to produce Th2 cytokines we suggest that uraemia or dialysis per se inhibits T cells from producing Th2 cytokines.

Foetal lymphocytes are more sensitive to freezing than adult lymphocytes within a mononuclear cell environment.

Previous studies have reported reduced natural killer (NK) cell activity in cord blood (CB) compared to adult blood mononuclear cell populations. We suggest that foetal NK cells have the capacity to kill, but this is suppressed in vitro. This hypothesis is strengthened by our observation that CB mononuclear cell populations had their NK activity restored by freeze/thawing, whereas adult PBMC had a reduced killing ability on freeze/thawing. Thus, either NK cells are activated to kill by the freeze/thawing or there is an NK cell suppressor factor in CB which is lost through freeze/thawing. This report shows clear differences between NK cells within the adult periphery and CB, and may help toward a better understanding of events occurring in vitro.