[Changes in immune reactivity in cancer patients]. / Zmeny imunologické reaktivity u onkologických pacientu

It appears that the long-accepted paradigm that cytostatic and radiation therapy cause only immunosuppression, is not so clearly true. With regard to new knowledge in cancer immunology field, it seems that not only cytostatic and radiation therapy plays an important role in the alteration of immune system. There are many other factors influencing immunity like tumour environment itself, the use of immunomodulatory drugs or even the mental condition of cancer patients. The aim of review is to familiarize physicians with possible alterations of the immune system in cancer patients.

[Palliative cancer care within the Hradec Králové Region Health Care System: own experience]. / Paliativní onkologická péce v systému poskytování zdravotní péce v Královéhradeckém kraji: vlastní zkusenosti.

Palliative cancer care is an active treatment and nursing intervention in patients in whom cancer therapy has been withdrawn due to untreatable progression of the cancer disease. The main aim of palliative cancer care is to ensure the best possible quality of life of a cancer patient and the patient's family members. Palliative cancer care is provided in two basic forms, general and specialized. In the present paper, the authors discuss palliative cancer care and its implementation into clinical practice with reference to their own experience in providing this care.

Sexual dysfunction in females treated with peripheral blood progenitor cell transplantation: review of literature.

BACKGROUND: Peripheral blood progenitor cell transplantation (PBPCT) is a therapeutic modality used in the anti-tumorous treatment of hemato-oncological diseases and solid tumors. Apart of that, it is also used in therapy of non-malignant and hereditary diseases. AIM: As is the case with other treatments, PBPCT also affects not only the disease process but also the quality of life (QoL). MATERIALS AND METHODS: In the last decade of 20th century, several QoL studies among patients treated with PBPCT were undertaken and an influence on particular dimensions of QoL was observed. One of closely watched aspects was sexuality in patients treated with PBPCT. RESULTS: Sexuality and its expression belong to very important aspects of human behavior. It is also a very sensitive and sensible aspect, so with no doubts it is affected by the diagnosis of neoplasm and cancer treatment. CONCLUSION: Physical and psychosocial factors of PBPCT do affect patient's sexuality and sexual functioning as part of QoL. They remain in focus because of the complex care of patients treated with PBPCT (Fig. 2, Ref. 21).

Screening for depression in survivors of metastatic ovarian cancer in a programme of palliative cancer care.

BACKGROUND: Depression is seen in many cancer patients. It occurs in approximately 25% of palliative care patients. MATERIALS AND METHODS: This study was local, prospective and cross-sectional. It was carried at Department of Clinical Oncology and Radiation Therapy of Charles University Hospital and Faculty of Medicine in Hradec Králové, Czech Republic. RESULTS: The incidence of depression was 83.3% (25 of all 30 survivors). The relevance of depression is characterized: severely depressed was proved in 9 of all 30 survivors, the moderately depressed in 5 of all 30 survivors, the mildly depressed in 11 of all 30 survivors and normal range in 5 of all 30 survivors. The statistical evaluation not presents statistically significant dependence of ZSRDS on smoking abuse, marital status, age, number of associated diseases and type of palliative cancer care. CONCLUSION: The results of the pilot depression study showed that subsist clear association between metastatic ovarian cancer and depression (Fig. 2, Ref. 30). Full Text (Free, PDF) www.bmj.sk.

Depression symptoms and health-related quality of life among patients with metastatic breast cancer in programme of palliative cancer care.

Depression is seen in many cancer patients. It occurs in approximately 25% of palliative care patients. The quality of life term contains the information on an individual's physical social and spiritual condition. The study evaluated incidence and relevance of depression symptoms and level of health-related quality of life (HRQoL) among patients with metastatic breast cancer in programme of palliative cancer care. This study was local prospective and cross-sectional. It was carried at Department of Clinical Oncology and Radiation Therapy of Charles University Hospital in Hrader Králové, Czech Republic. Dates were obtained during year 2008 among 41 patients with metastatic breast cancer in programme of palliative cancer care. The mean age for all 41 subjects was 58 years old (aged 41 - 80 years old). The Czech version of Zung self-rating depression scale was performed for evaluation of depression symptoms. The Czech version of genetic EuroQol questionnaire EQ-5D was performed for evaluation of level of HRQoL. The statistical evaluation presents that mean ZSDS (Zung self-rating depression score) certifies the presence of signs of moderately depression symptoms among patients with metastatic breast cancer (ZSDS range was 60-69). The mean ZSDS in all patients was 60,6. The mean ZSDS is group of healthy females was 38,9 (normal range of ZSDS). The incidence of depression was 61% (25 of all 41 subjects). The relevance of depression is characterized: severely depressed was proved in 5 of all 25 subjects, the moderately depressed in 10 subjects of all 25 subjects and mildly depressed in 10 of all 25 subjects. The statistical evaluation not presents statistically significant dependence of ZSDS on age, number of associated diseases and type of palliative cancer care. The HRQoL among patients with metastatic breast cancer is on very low level. The mean EQ-5D score (dimension of quality of life) was 55%. The mean EQ-5D VAS (subjective health condition) was 59,2%. The mean EQ-5D score in group of healthy female was 78,4% and the mean EQ-5D VAS was 85% (both QoL parameters show very good of QoL level). The statistical evaluation not presents statistically significant dependence of EQ-5D score and EQ-5D VAS on age, number of associated diseases and type of palliative cancer care. The results showed that subsist clear association between metastatic breast cancer in programme of palliative cancer care and depression. Also, the results showed that subsist low level of HRQoL of patients with metastatic breast cancer.

Sibutramine--its impact on health-related quality of life and depression among adult obese non-diabetic patients.

BACKGROUND: Obesity is a multifactorial, chronic disorder that has reached epidemic proportions in most industrialised countries and is threatening to become a global epidemic. AIMS: The pilot study evaluates the effect of sibutramine therapy on health-related quality of life and occurence of depression symptoms among adult obese non-diabetic patients. PATIENTS AND METHODS: This study was prospective and longitudinal. It was conducted at the Department of Hygiene of Faculty of Military Health Sciences in Hradec Králove, Czech Republic. Dates were obtained during year 2007. Twenty two adult obese non-diabetic patients (6 males and 16 females) were treated with sibutramine in dose of 10 mg daily. All of these 22 patients were over 18 years old. The European Quality of Life Questionnaire--EQ-5D Version was used for evaluation of health-related quality of life. The self-assessement Zung-SDS was applied for evaluation of occurrence of depression. RESULTS: The statistical evaluation demonstrated that health-related quality of life (EQ-5D score and EQ-5D visual analogue scale) presents highly significant statistical dependence on sibutramine therapy (p < 0.05). The statistical evaluation demonstrated that index of depression (SDS index) presents highly significant statistical dependence on sibutramine therapy (p < 0.05). CONCLUSION: The results show that sibutramine therapy has a highly positive effect on health-related quality of life among adult obese non-diabetic patients. Also, the results show that sibutramine therapy has a highly positive effect on occurence of depresion symptoms among adult obese non-diabetic patients (Fig. 2, Ref. 10).

Cancer and depression: a prospective study.

Cancer diagnosis and treatment often produce psychologic stresses resulting from the actual symptoms of the disease, as well as from perceptions of the disease and its stigma. Depression is seen in many cancer patients. Depression occurs in approximately 25% of palliative care patients. It is widely recognised by clinicians that depression is a difficult symptom to identify amongst patients with advanced illness. The study is aimed for screening of depression among palliative care female patients. This study was local, prospective and cross-sectional. It was carried at Department of Clinical Oncology and Radiation Therapy of Charles University Hospital in Hradec Kralove, Czech Republic. Dates were obtained during year 2007 - 2008 in 64 palliative care female patients. The mean age for all 64 subjects was 60,5 years old (aged 29 - 88 years old). The Czech version of Zung self-rating depression scale was performed. The statistical evaluation presents that mean SDS (self-rating depression score) certifies the presence of signs of mildly depression among palliative care female patients (SDS range was 50-59). The mean SDS in all subjects was 56. The mean SDS in group of healthy females was 38,9 (normal range). The incidence of depression is 71,8% (46 of all 64 subjects). The relevance of depression is characterized: severely depressed was proved in 8 of all 46 subjects, the moderately depressed in 21 subjects of all 46 subjects and mildly depressed in 17 of all 46 subjects. The statistical evaluation not presents statistically significant dependence of SDS on smoking abuse, marital status, age, number of associated diseases and type of palliative care. The statistical evaluation presents that patients with cancer of lung, with cancer of endometrium, with cancer of gallbladder and with melanomas are moderately depressed (SDS 60-69), patients with cancer of ovary, with cancer of breast, with primary brain tumour, with cancer of ventricle, with cancer of pancreas head and with cancer of bucall cavity are mildly depressed (SDS 50-59). The results show that subsists clear association between oncological disease in palliative care and depression.

Quality of life and arterial endovascular intervention by means of balloon angioplasty.

AIM: The aim of this study was to evaluate the quality of life (QoL) and the effect of arterial balloon angioplasty (ABA) on QoL of patients with peripheral arterial occlusive disease (PAOD). METHODS: The study is a prospective and longitudinal one and was carried out at the 2nd Internal Clinic of Charles University Hospital in Hradec Kralove, Czech Republic. Forty-two patients with PAOD, hospitalized for the endovascular intervention by means of percutaneous transluminal angiography, were evaluated for QoL. Thirty patients with PAOD (20 male, 10 female) were treated by endovascular intervention by means of ABA. The evaluation of QoL was performed by means of the Czech version of the international generic European Quality of Life Questionnaire EQ-5D. Statistical analysis was determined by means of analysis of variance and paired t-test. The QoL questionnaires were evaluated by means of descriptive analysis. RESULTS: The study has shown the following results: patients with PAOD had low global QoL; a statistically significant relation between QoL of patient with PAOD and the their age (P<0.01); a statistically significant relation between global QoL and stage of PAOD by Fontaine classification (P<0.01); and a statistically significant relation between global QoL and ABA (P<0.0001). CONCLUSION: The QoL of patients with PAOD is low. The QoL is lower with increasing age and with severity of PAOD. The results show the existence of a positive effect of ABA on QoL in patients with PAOD.

Health-related quality of life in multiple myeloma survivors treated with high dose chemotherapy followed by autologous peripheral blood progenitor cell transplantation: a retrospective analysis.

A pilot study analyses an effect of selected demographic, psychosocial and health aspects on quality of life (QoL) in multiple myeloma survivors treated with high-dose chemotherapy followed by autologous peripheral blood progenitor cell transplantation (PBPCT). The total number of respondents with multiple myeloma treated with high-dose chemotherapy followed by autologous PBPCT between years 2001-2003 at the Department of Clinical Haematology of the 2nd Department of Internal Medicine of Charles University Hospital and Faculty of Medicine in Hradec Králové, Czech Republic was 32 (18 male, 14 female). The average age of respondents was 60 years old. The Czech version of an international generic European Quality of Life Questionnaire - Version EQ-5D was used. The effect of selected demographics, psychosocial and health aspects on QoL was determined by means of analysis of variance (ANOVA). The QoL questionnaires were evaluated by means of descriptive analysis. The above-mentioned aspects proved statistically significant dependence of QoL on respondents age and on smoking abuse. EQ-5D score (dimensions of QoL) and EQ-5D VAS (a subjective health condition) significantly decrease with increasing age and with smoking abuse. The effect of other aspects on QoL was not proven as statistically significant. Prevailing complaints in respondents with multiple myeloma were: 1. regular activity with complaints 81,2 % (26/32 respondents), 2. medium serious pain / discomfort 68,8 % (22/32 respondents), 3. movement with complaints 59 % (19/32 respondents), 4. medium serious anxiety / depression 59 % (19/32 respondents). The QoL in patients with multiple myeloma treated with high-dose chemotherapy followed by autologous PBPCT was on low level (mean EQ-5D score was 68,9 %, mean EQ-5D VAS was 66,6 %). The results had shown that with an increasing age, the QoL of patients with multiple myeloma treated with high-dose chemotherapy followed by autologous PBPCT, declines. The smokers and former smokers have lower QoL than non smokers. The global QoL in all studied patients with multiple myeloma treated with high-dose chemotherapy followed by autologous PBPCT was on low level.

[Ischemic disease of the lower extremities versus depression symptoms and quality of life]. / Ischemická choroba dolních koncetin versus depresivní symptomatika a kvalita zivota.

BACKGROUND: The study has three main aims: 1. it evaluates occurrence of depression symptoms in patients with peripheral arterial occlusive disease (PAOD), 2. it evaluates global quality of life (QoL) in patients with PAOD and 3. it evaluates effect of age and stage of PAD on seriousness of depression symptoms and on the QoL in patients with PAOD. PATIENTS AND METHOD: the study is local, prospective and cross-sectional. It was carried out at the 2nd Internal Clinic of University Hospital in Hradec Králové. Data were obtained during the year 2006. METHODS AND RESULTS: The total number of respondents with PAOD was 42 (28 male, 14 female). The average age of all respondents with PAOD was 65.4 years and age range was 45-79 years. The evaluation of occurrence of depression symptoms in patients with PAOD was performed by means of self-assessment Zung-SDS and evaluation of QoL in patients with PAOD was performed by means of Czech version of international generic European Quality of Life Questionnaire-EQ-5D Version. Statistical significance was determined by means of analysis of variance. Main The mean SDS index certifies the presence of signs of minimum or light depression in patients with PAOD. The QoL in patients with PAOD is on the low level. The above-mentioned aspects proved statistically significant dependence of QoL in patients with PAOD on depression (p<0.001), on age (p<0.01) and on stage of PAOD (p<0,01). We proved statistically significant dependence of depression in patients with PAOD on age (p<0.01) and on stage of PAOD (p<0.01). CONCLUSIONS: The results show the existence of the association between PAOD and depression symptoms with its negative effect on QoL in patients.

Global quality of life in patients who have undergone the hematopoietic stem cell transplantation: finding from transversal and retrospective study.

AIM: To analyse the factors which influence global quality of life in patients after the hematopoietic stem cell transplantation at the Department of Clinical Hematology of the Second Internal Clinic of the University Hospital and Medical Faculty of Charles University in Hradec Kralove, Czech Republic. PATIENTS AND METHODS: The total number of respondents after the transplantation from 2001 to 2003 was 95 and the return rate of questionnaires was 72.1% (71 respondents - 39 men and 32 women, average age - 55.5 years). The Czech version of an international generic European Quality of Life Questionnaire - Version EQ-5D was used. The influence of monitored factors (type of transplantation - autologous, allogenous, age, sex, education, poly-morbidity, marital status, religion and the time lapse from the hematopoietic stem cell transplantation) on the global quality of life in patients was determined by means of dispersion analysis. RESULTS: The above-mentioned factors proved statistically significant dependence of EQ-5D index and EQ-5 VAS on age (in both cases p<0.01), poly-morbidity (in both cases p<0.01) and on religion (in both cases p<0.01). EQ-5D index (dimensions of quality of life) and EQ-5D VAS (a subjective health condition) significantly decrease with increasing age and with a higher number of associated diseases, and are significantly higher in patients who believe in God compared to patient without religious beliefs. The influence of other factors on EQ-5D index and EQ-5D VAS was not proven as statistically significant. CONCLUSION: The global quality of life in patients who underwent the hematopoietic stem cell transplantation at the Department of Clinical Hematology of the Second Internal Clinic of the University Hospital and Medical Faculty of Charles University in Hradec Kralove, Czech Republic, is very high, which is seen from EQ-5D index (72.5%) and EQ-5D VAS (76.5%) values.