Equine-assisted psychotherapy: a mental health promotion/intervention modality for children who have experienced intra-family violence.

Equine-assisted psychotherapy (EAP) is a specialized form of psychotherapy using the horse as a therapeutic tool. This modality is designed to address self-esteem and personal confidence, communication and interpersonal effectiveness, trust, boundaries and limit-setting, and group cohesion. Substantial numbers of children witness family violence. There is evidence that violence between parents has adverse effects on the children in the family. These children are at greater risk of behavioural problems and mental health disorders, including anxiety, anger, depression and suicidal ideations, withdrawal, low self-esteem, and attention deficit hyperactivity disorder. The purpose of the present pilot study was to test the efficacy of EAP in a cross-sectional group of children referred to a psychotherapist for various childhood behavioural and mental health issues over an 18-month period (June 2003-January 2005). Sixty-three children received a mean number of 19 EAP sessions. Scores on the Children's Global Assessment of Functioning (GAF) Scale were determined pre- and post-treatment. The mean (+/- standard deviation, SD) pretreatment score was 54.1 (SD 3.2) and post treatment mean score was 61.7 +/- 5.0 (t = 9.06, d.f. = 96, P < 0.001). All children showed improvement in GAF scores, and there was a statistically significant correlation between the percentage improvement in the GAF scores and the number of sessions given (r = 0.73, P = 0.001). Univariate analysis showed that the greatest improvement in the GAF scores occurred in the youngest of the subjects. Children in the group who had a history of physical abuse and neglect had a statistically significant greater percentage improvement in GAF scores after treatment than those who did not have a history of abuse and neglect. This study has demonstrated a quick response to EAP, especially in younger children, but it remains to be determined what kind of long-term effects this type of intervention may provide.

Hearing loss among cancer survivors.

Cancer therapies may cause hearing loss (HL) in some patients. The purpose of this study is to examine at risk factors for HL and its impact on the health of a large cohort of cancer survivors. This is a descriptive, cross-sectional study of long-term cancer survivors who reported that they have experienced HL as a result of their cancer. Of 3571 respondents who answered a mailed survey, 243 (6.8%) reported HL. We analyzed the responses to discern the potential impact of demographics, cancer type or disease treatments on hearing, as well as the potential impact of HL on socioeconomic parameters (education, family and work). Survivors of head and neck cancer, sarcoma and testicular cancer reported HL most frequently. Among the younger survivors, the frequency of HL was higher than age-matched persons from the general U.S. population. Cancer survivors with HL were more likely to report that cancer had affected their overall health (71 vs. 32%) and were unable to work. While cisplatinum exposure was noted more frequently in respondents with HL, no other treatments, including radiotherapy, were shown to have a significant impact on hearing. There were no differences with respect to age, gender or family dynamics. Hearing loss affects a minority of long-term cancer survivors and may have an impact on their education, ability to work and overall health.

Breast cancer: relationship between menopausal symptoms, physiologic health effects of cancer treatment and physical constraints on quality of life in long-term survivors.

AIMS AND OBJECTIVES: The purpose of this study is to describe the relationship between menopausal symptoms, physiologic health effects of cancer treatment and the physical contributors to quality of life in long-term survivors of breast cancer. BACKGROUND: The treatment of menopausal symptoms is hotly debated, especially for women with breast cancer. Common treatments for menopausal symptoms are considered to be contraindicated in women with breast cancer. DESIGN: This is a descriptive, cross-sectional study of long-term breast cancer survivors; a subset of a study that responded to a mailed survey targeting long-term cancer survivors treated at The University of Texas M.D. Anderson Cancer Center. METHODS: In 291 breast cancer patients information was available that included items that commonly relate to menopausal symptoms including hot flushes, painful sexual intercourse, inability to concentrate, fatigue and sleep disturbances. RESULTS: Ninety per cent were Caucasian American and the mean time since diagnosis was 16 +/- 8 years. All patients had been treated with surgery, (60%) with radiotherapy, (68%) with chemotherapy and (37%) with hormonal therapy. Forty-six per cent of the breast cancer survivors indicated that having breast cancer affected their overall health. Self-reported health effects were more common in those survivors who had received a combination of chemotherapy and radiotherapy. A menopausal quality of life score was determined using the items about hot flushes, ability to concentrate, painful sexual intercourse, fatigue, unhappiness and sleep disturbances. CONCLUSIONS: This study reminds us that breast cancer and menopause are independent issues. Quality of life parameters need to be rigidly defined and time sensitive. There are complex interactions between quality of life indicators and specific physiologic consequences of treatment. However, menopausal signs and symptoms may not be different for the breast cancer survivor and they should not be confused with the quality of life/psychosocial issues of the cancer survivor. RELEVANCE TO CLINICAL PRACTICE: Menopause is not a disease process but a normal developmental stage for women. It is important for nurses not only to understand the client needs of the menopausal woman, but also to be able to differentiate between quality of life issues related to menopause and to cancer treatment in order to provide holistic nursing care.

Parathyroid carcinoma: a 22-year experience.

PURPOSE: Because parathyroid carcinoma is rare, clear consensus is not available regarding the optimal management of patients with this condition. Treatment strategies generally derive from clinical and anecdotal experiences. We report our experience with this entity. METHODS: We included all patients with parathyroid carcinoma seen at The University of Texas M. D. Anderson Cancer Center since January 1, 1980. The medical records and pathology specimens were reviewed and verified in all cases. RESULTS: Since 1980, 27 patients (16 men and 11 women) registered at M. D. Anderson Cancer Center with parathyroid carcinoma and a minimum follow-up of 2 years. The age at initial diagnosis (mean +/- SD) was 46.7 +/- 15.3 years. All patients were seen with hypercalcemia (mean calcium, 13.4 +/- 1.5 mg/dL). Eighteen patients had locally invasive disease, eight had localized disease, and one had distant metastasis. Parathyroid cancer was treated with complete surgical excision with curative intent in 18 patients. In the other nine patients, who had clinical and/or radiographic evidence of soft tissue extension, the tumor was treated by comprehensive "en bloc" soft tissue resection. Of six patients who received adjuvant radiotherapy after initial surgery, only one had a local relapse. In contrast, of 20 patients who did not receive adjuvant radiotherapy, 10 had a local relapse, excluding the one patient who had distant metastases. The 5-year survival was 85%, and the 10-year survival was 77%. Five patients died of parathyroid carcinoma; all deaths were hypercalcemia related. CONCLUSIONS: Parathyroid carcinoma can be an indolent disease with morbidity and mortality related to hypercalcemia. Adjuvant radiotherapy may improve local control and limit the occurrence of local relapse. A comprehensive multidisciplinary approach with surgery, radiation therapy, and medical treatment for hypercalcemia is needed to optimize patient outcome.

A novel point mutation of the RET protooncogene involving the second intracellular tyrosine kinase domain in a family with medullary thyroid carcinoma.

Hereditary medullary thyroid carcinoma, a tumor that arises from the parafollicular cells of the thyroid gland, occurs in isolation (as in familial medullary thyroid carcinoma), in association with hyperparathyroidism and pheochromocytoma (as in multiple endocrine neoplasia type 2A), or in association with pheochromocytoma, marfanoid habitus, and mucosal neuromas (as in multiple endocrine neoplasia type 2B). These genetic syndromes are associated with germline-activating mutations of the RET protooncogene, a cell surface tyrosine kinase receptor, which is believed to modulate specific intracellular signaling pathways involved in the regulation of C cell proliferation and apoptosis. RET-activating mutations involve two important functional areas of the receptor: the cysteine-rich extracellular domain and the intracellular tyrosine kinase domain. Multiple endocrine neoplasia type 2A and familial medullary thyroid carcinoma are more commonly associated with mutations in the cysteine-rich extracellular domain, whereas multiple endocrine neoplasia type 2B is exclusively associated with mutations involving the second intracellular tyrosine kinase domain. Here, we describe a novel missense mutation of the RET protooncogene that substitutes arginine for proline at codon 912 of the intracellular tyrosine kinase domain in a family with medullary thyroid carcinoma.

Ethnic/racial influences on the physiologic health of cancer survivors.

BACKGROUND: Improvements in early detection, treatment, and general supportive care allow more people to survive cancer. Information regarding the long-term health impact of cancer and cancer treatments on these survivors of adult-onset malignancies is gradually accumulating. Although information is limited overall, it is apparent that the cancer experience differs across ethnically/racially diverse populations. METHODS: In the current report, the authors characterized and compared health profiles among ethnic/racial groups within a large cohort (n > 6000) of long-term survivors of cancer. In addition, the authors focused on survivors of cervical carcinoma, because they constitute a substantial and relatively homogeneous portion of the overall cohort. RESULTS: The authors observed significant differences among African American, Hispanic American, and Caucasian American cancer survivors in terms of age at diagnosis, time since diagnosis, family dynamics, education, type of malignancy, and perceived influences of cancer on specific physiologic health problems. Among survivors of cervical carcinoma, there were significant ethnic/racial differences in terms of disease histology as well as the impact of the disease on overall health. CONCLUSIONS: The current study reveals significant ethnic/racial differences among cancer survivors and highlights the need for further investigation of the relation between cancer survivorship and ethnicity/race.

Health profiles and quality of life of 518 survivors of thyroid cancer.

BACKGROUND: Available literature describes the long-term outcome of thyroid cancer survivors with respect to thyroid cancer but not their overall medical and social well-being. METHODS: Five hundred eighteen thyroid cancer survivors responded to a survey regarding medical and social impacts of their cancer experience. RESULTS: All had surgery, and 417 (80.5%) also had some radiation. Two thirds (64.5%) reported that cancer created health effects varying by gender and passage of time; neurologic, musculoskeletal, and psychologic problems seemed most prominent. They reported more memory loss and psychologic problems than other cancer survivors and more migraine headaches than both other cancer survivors and the general population. Regarding family and work, they integrated well in society overall. However, unsolicited comments by 24.5% of responders disclosed symptoms reminiscent of thyroid hormone imbalance. CONCLUSION: Thyroid cancer survivors generally report good health long term but describe distinct, lasting medical problems including symptoms of thyroid dysregulation. The extent and manner in which cancer therapy contributes to the health profile of the group merits further inquiry.

Health profiles in 5836 long-term cancer survivors.

Increasingly, prolonged survival follows the diagnosis of cancer. Cancer therapies result in complex and lasting health effects that create unique health-care needs for the survivors but are poorly understood (especially in survivors of adult cancers). Cancer survivors were asked to respond to a mailed health survey and provide medical and social information pertaining to their cancer experience. Information about demographics and perceived disease-related medical problems was analyzed. We analyzed the response of 5,836 survivors of adult cancers. Two-thirds of the responses came from women, and the response rate was 51% in both sexes. The mean interval since cancer diagnosis was 18.0 +/- 8.5 years. Younger survivors and men were more likely to report that cancer had affected their health. The health effect most commonly reported by survivors was arthritis/osteoporosis (26% of respondents). Survivors of Hodgkin's disease prominently reported thyroid and lung problems (33.8% of responders with the diagnosis). Prior diagnosis of lymphoma was associated with frequent mention of memory loss (14.7%). The passage of time decreased some perceived effects (memory loss) but increased others (arthritis/osteoporosis, cataracts). Compared with the general population, the incidence of several age- and gender-adjusted health conditions in cancer survivors is different. This group of cancer survivors reported generally good health but outlined multiple lasting medical problems. The health survey described represents 1 approach to the development of comprehensive information about the health needs of cancer survivors.

Internet message board use by patients with cancer and their families.

The Life After Cancer Care (LACC) Internet Web site and message board were created at a comprehensive cancer center to provide up-to-date information about different types of cancer, treatments, late effects, and research findings. The message board enables patients with cancer to exchange information on a more personal basis. During the 16-month period since the creation of the Web site, 972 people logged on to the message board and 284 people posted 619 messages. Most (64%) posted only one message. The posted messages were related most frequently to cancers of the breast, gastrointestinal system, lung, gynecologic system, head and neck, and colon. Sixty percent of the people posting messages were cancer survivors; the remaining 40% were family or friends of survivors. The most frequent query themes were concerns about treatment, support, and long-term side effects of treatment. Individuals with cancer were significantly more likely to post messages about long-term side effects of treatment than family and friends. Message boards are a useful tool for sharing information with others who have similar experiences. Message board entry data also provide valuable information that can be used to refine the boards. Message boards have not been used traditionally in healthcare research but hold considerable promise as an information resource for people affected by cancer.

Providing information to patients with a rare cancer: using Internet discussion forums to address the needs of patients with medullary thyroid carcinoma.

Medullary thyroid carcinoma (MTC) is a rare disease, and specific experience with the condition is not commonly found outside of major cancer centers. Because of the rarity and slow-growing natural history of the disease, patients with MTC frequently have many questions concerning prognosis, treatment, and follow-up care. Many of these patients have joined an e-mail group on the Internet through which they share information and concerns. The author has joined this group and shares her expert clinical knowledge about the disease. When individuals are armed with accurate and expert information, they can make informed decisions. The source of this information can be diverse. Nurses with expert knowledge can use opportunities such as e-mail groups to answer questions and respond openly about subjects about which they have unique perspectives.

Cancer survivors. Work related issues.

New and more effective treatments for cancer have resulted in individuals living longer with a better quality of life. Many more survivors are employed in the workplace. Cancer is no longer only an issue for survivors and their families; it has become an issue for the employer and the workplace. This article describes survey results of 4,364 long term cancer survivors in which they were asked to respond to items describing their ability to work, job discrimination, and quality of life. Thirty-five percent of survivors were working at the time they completed the survey, and 8.5% considered themselves unable to work. This research has shown that age, gender, ethnic group, and cancer type affected the working status of the survivors. Of survivors continuing to work, 7.3% indicated they had experienced job discrimination. The results indicate most cancer survivors do not perceive employment related problems, and are readily assimilated into the work force. Job discrimination and the ability to work is a quality of life issue.