Prevalence of Anxiety and Depression and Their Impact on the Quality of Life of Cancer Patients Treated with Palliative Antineoplasic Therapy - Results of the PALINT Trial.

BACKGROUND: Anxiety, depression, and psychological distress are common syndromes of advanced cancer; all have a negative impact on overall quality of life. However, these symptoms are not monitored explicitly and they are managed only by pharmacotherapy. Given the complex etiology of these symptoms, this biomedical approach is inadequate and inefficient. MATERIALS AND METHODS: Here, we present the results of a longitudinal assessment of distress, anxiety, and depression in a sample of 126 patients treated with palliative systemic therapy for advanced cancer in the PALINT trial. Symptoms and quality of life were assessed regularly using the Hospital Anxiety and Depression Scale (HADS) and The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), respectively. RESULTS: The baseline prevalence of significant distress, anxiety, and depression was 32,6; 35,9; and 56,5%, respectively. A decreasing trend in the prevalence of distress and anxiety occurred after 2 and months - distress (19.4 and 16.3%), anxiety (20.9 and 16.3%), and depression (46.3 and 46.9%). However, these changes did not reach statistical significance. The presence of anxiety and depression correlated negatively with overall quality of life. CONCLUSION: High rates of distress, anxiety, and depression are a strong argument for implementation of systematic screening for psychological distress, and for comprehensive psychosocial support for all patients with advanced cancer throughout the disease trajectory. The HADS questionnaire is a suitable tool for this type of screening. This work was supported by the grant of Ministry of Health AZV 15-33590A. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 3. 12. 2018 Accepted: 24. 3. 2019.

[Early Integration of Palliative Care into Standard Oncology Care -  Benefits, Limitations, Barriers and Types of Palliative Care]. / Casná integrace paliativní péce do standardní onkologické péce -  benefit, limitace, bariéry a druhy paliativní péce.

Patients with advanced cancer experience a significant number of physical symptoms and psychological distress, which worsen their quality of life (QOL). Palliative care is oriented to prevent and relieve suffering and promote QOL of patients with advanced cancer. In oncology, the role of palliative care is traditionally perceived to be the treatment after the antineoplastic therapy is finished. A concept of early integration of palliative care into standard oncology practice has been recently introduced. There is a lot of data supporting this concept of parallel application of both oncology care and palliative care. Early palliative care has been shown to provide benefits in QOL, mood, symptoms, health care utilization and survival. In this review, we summarize published data about benefits and difficulties of early palliative care. We also discuss the model of general and specialized palliative care integrated into oncological practice, their differences and consequences.

[Management of chronic and acute pain in patients with cancer diseases]. / Management chronické a akutní bolesti u pacientu s nádorovými chorobami.

Pain is one of the most important and most frequent symptoms of malignancy. Its intensity and prevalence is growing with disease status. Pain should be present in early stage cancer patients also. Pain is, together with other symptoms (anorexia, nausea, depression, anxiety, sleep disturbances), factor of patients quality-of-life and proper therapy is responsible for overall patient satisfaction and activity. Right pain management is always multidimensional and pain should be assessed at each contact. In review article we would like to bring some alerts of pain context in complexity of cancer and we would like to stress some forms of acute pain management.

[Squamous cell carcinoma in localized scleroderma]. / Spinocelulárny karcinóm v lozisku cirkumskriptnej sklerodermie.

We present a case of a young 26-year-old woman, who has been suffering from localised scleroderma (morphea) for 15 years. Recently, a lesion on the dorsum of her right foot ulcerated. Based on a CT scan and X-ray a diagnosis of ulcerative osteomyellitis was established. The patient was treated with a combination of antibiotics. Subsequent histological examinations showed granulomatous tissue and chronic inflammatory changes on top of pseudoepiteliomatous hyperplasia. The patients status was deteriorating, which resulted in a limb amputation under the knee. Three months later, there was a metastasis of squamous cell carcinoma found in the patients inguinal lymph node. In spite of combined therapy (surgery, radioterapy and systemic chemotherapy), new metastases occurred and the patient succumbed to the disease several months afterwards. The case was concluded as a squamous cell carcinoma camouflaged by osteomyelitis. Malignant turn of localised sclerodema is very rare. It usually occurs on the lower extremities of patients with a long course of the disease and is associated with pansclerotic or generalised variants of morphea.

[Acupuncture in the treatment of symptoms of oncological diseases in the Western world]. / Akupunktura v lécbe symptomu onkologického onemocnení v západním svete

Acupuncture is one of the methods of traditional Chinese Medicine (TCM). In Asia, methods of TCM are quite often used in oncological patients in combination with classical medicine. In Europe and North America, the position of the TCM is not so clear. In the last few years, some studies were done which were supposed to verify scientifically the effectiveness of acupuncture in the treatment of some symptoms in oncological patients and adverse effects of oncological treatment. Results of these studies indicate that acupuncture is effective in the treatment of pain, nausea, vomiting and xerostomia. The International Society of Integrative Oncology formulated some recommendations for using methods of TCM in oncological patients. In this field, there is still a lot of possibilities for further studies which could help acupuncture to become an important therapeutic method even in our region.

[Cost analysis of radiotherapy provided in inpatient setting -  testing potential predictors for a new prospective payment system]. / Analýza nákladu na radioterapii v luzkové péci - hledání vhodných prediktoru pro potreby nového prospektivního úhradového modelu.

BACKGROUND: As a part of the development of a new prospective payment model for radiotherapy we analyzed data on costs of care provided by three comprehensive cancer centers in the Czech Republic. Our aim was to find a combination of variables (predictors) which could be used to sort hospitalization cases into groups according to their costs, with each group having the same reimbursement rate. We tested four variables as possible predictors -  number of fractions, stage of disease, radiotherapy technique and diagnostic group. METHODS: We analyzed 7,440 hospitalization cases treated in three comprehensive cancer centers from 2007 to 2011. We acquired data from the I COP database developed by Institute of Biostatistics and Analyses of Masaryk University in cooperation with oncology centers that contains records from the National Oncological Registry along with data supplied by healthcare providers to insurance companies for the purpose of retrospective reimbursement. RESULTS: When comparing the four variables mentioned above we found that number of fractions and radiotherapy technique were much stronger predictors than the other two variables. Stage of disease did not prove to be a relevant indicator of cost distinction. There were significant differences in costs among diagnostic groups but these were mostly driven by the technique of radiotherapy and the number of fractions. Within the diagnostic groups, the distribution of costs was too heterogeneous for the purpose of the new payment model. CONCLUSION: The combination of number of fractions and radiotherapy technique appears to be the most appropriate cost predictors to be involved in the prospective payment model proposal. Further analysis is planned to test the predictive value of intention of radiotherapy in order to determine differences in costs between palliative and curative treatment.

[Management of breakthrough cancer pain]. / Lécba prulomové bolesti u onkologických pacientu

Breakthrough cancer pain has been defined as a transitory increase in pain intensity that occurs despite relatively stable and adequately controlled background pain. More than half of cancer patients with chronic pain suffer by some form of breakthrough cancer pain. The management of breakthrough cancer pain is comprehensive and includes pharmacological and nonpharmacological approaches. The principal treatment strategies are optimization of regular analgesic medication combined with effective rescues medication. The new transmucosal forms of fentanyl represent an important improvement in our treatment options.

[Quality of life and tolerance of maintenance therapy in patients with multiple myeloma]. / Kvalita zivota a tolerance udrzovací lécby u pacientu s mnohocetným myelomem. Ceska myelomova skupina.

Questionnaires on the quality of life and tolerance of different parts of maintenance treatment were sent to a total of 83 patients with multiple myeloma. All patients were for more than one year on maintenance treatment which involved either interferon alpha monotherapy (I), 3 million u. three times per week till signs of relapse developed or sequence administration of interferon alpha and dexamethazone 40 mg on day 1 to 4, 10 to 13 and 20 to 23 and then after a four-week interval again interferon alpha, again till progression of the disease occurred. The patients evaluated the presence or absence of different undesirable effects of treatment during the first two weeks of treatment and throughout the year and listed their intensity into four categories defined in the questionnaire. The quality of life was evaluated by means of a basic module of the questionnaire of the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire version 3.0 (EORTC QLQ-C30). The results of the questionnaire are to a certain extent surprising as from the patients' answers ensues that this maintenance treatment is associated with more numerous undesirable effects than the physicians realized when in contact with the patient. In this summary we can list only the most frequent effects (deterioration of eyesight, impaired sleep, depressions, irritability and unrest, chill, pain in muscles and joints, general weakness and dyspnoea). From the questionnaires on the quality of life ensues a markedly poorer quality of life of these patients as compared with the healthy population. There are however no basic differences between individual groups. The questionnaires were handed only to patients who had maintenance treatment for more than one year and thus patients were eliminated where maintenance treatment was discontinued because of undesirable effects. To give a general idea of the tolerance of the above maintenance treatment the authors mention that to the date of Aug. 31, 2001 113 patients were randomized into one of the branches of maintenance treatment. Maintenance treatment had to be discontinued in 6% patients (in two instances on account of severe hypothyroidism, in one case on account of hallucinations, in three instances on account of severe mental depression caused by this treatment). Reduction of interferon doses in 20% patients usually because of cytopenia but also on account of psychic problem. To the question what length of prolongation of life compensates the undesirable effects of maintenance treatment the following replies were obtained from patients receiving ID, possibly I: 3 months--47.6 and 38.3%, 6 months--4.3 and 10.6%, 9 months--0 and 4.3%, 12 months--47.6 and 46.8% of the addressed patients. In reply to the question whether the patients would prefer, assuming equal effectiveness, a maintenance monotherapy with interferon alpha or dexamethazone more patients preferred interferon to dexamethasone. For practice ensues from this article informing on undesirable effects of maintenance treatment and the effect of maintenance treatment on the quality of life: 1. the necessity of thorough knowledge of physicians of all possible undesirable effects as only a doctor knowing possible undesirable effects of treatment can recognize them, 2. regular monitoring not only of the activity of the basic disease, but also undesirable effects of maintenance treatment and the influence of treatment on the patients' quality of life, 3. the necessity to assess the quality of life in clinical trials as an important parameter for deciding on the way of treatment.

[Informing the patient of the oncological diagnosis]. / Sdelování onkologické diagnózy.

Communication with the patient on various aspects of his disease is one of the most important skills of every doctor. Despite this for some doctors informing on the diagnosis in diseases which potentially endanger the patient's life is a great problem. In everyday practice open and sensitively presented information on the diagnosis and prognosis leads to better acceptance of the disease by the patient and his family. At the same time it arouses in the patient realistic expectations and plans, promotes his feeling of autonomy and also confidence in the doctor. It creates also a framework for effective collaboration and communication between the patient, his family and health works. In our department we published repetedly so-called "ten commandments on information about oncological diagnoses". We are presenting its modfication based on the experience assembled during the past ten years.

[Incurable oncological patient?]. / Inkurabilní onkologický pacient?

Despite the significant advances in oncology achieved during the last two decades more than half the patients die as a result of the tumour or associated complications. When we are unable to cure the patient, he is described as incurable. The word is however frequently conceived in a distorted way, i.e. unfit to be treated. If the objective of our treatment is only the tumour. Then active treatment really ends with the possibilities of anti-tumour treatment. If however the objective of our therapeutic efforts is man - the oncological patient, we must conceive active treatment and care as a certain continuous process where from the very beginning anti-tumourous treatment is combined by supporting and palliative treatment as regards bodily symptoms, psychosocial and existential needs. Termination of anti-tumourous treatment then does not imply termination of active treatment, in conjunction with changed therapeutic objectives only the ratio and relative importance of different elements of supportive treatment changes. The presented work deals with some unfortunate consequences when the term unfit to be treated is mistaken for incurable and is the concept of a model of an active team approach to incurable patients.

The influence of "biorhythm" on the incidence of injuries among forest workers.

The paper investigates effects of the three basic cyclic rhythms including a 23-day physical cycle, a 28-day emotional cycle and a 33-day intellectual cycle on the incidence of injuries among 322 forest workers, using the mathematical system of Khalil and Kurucz (1977). Results of the present work based on the examination of samples representing another sphere of human activity in two out of five cases studied support the conclusions of the above mentioned authors. In the remaining three cases the application of the method neither confirmed nor disproved the statement that biorhythms do not affect the incidence of injuries.