Positive consequences of cancer: exploring relationships among posttraumatic growth, adult attachment, and quality of life.

AIMS AND BACKGROUND: Cancer can be a life-threatening illness; however, it can also be a source of positive life changes, the posttraumatic growth (PTG) that comes from struggling with this serious illness. This cross-sectional study examines the sociodemographic and cancer-related predictors of PTG following a diagnosis of cancer. In addition, the relationships among adult attachment, health-related quality of life, and PTG are investigated. Measuring adult attachment is important because it can greatly influence the response to a highly distressing event, like facing cancer. METHODS AND STUDY DESIGN: Immediately before undergoing radiotherapy, 152 patients with breast or prostate cancer (mean = 59.1 years old, SD = 10.7) who had received a positive diagnosis within an average of 3.5 months prior to treatment were tested for measures of PTG, adult attachment, and health-related quality of life. Patients also completed a questionnaire regarding medical and sociodemographic characteristics. Hierarchical multiple regression analyses were conducted to reveal the significant predictors of PTG total score and PTG subscale scores. RESULTS: Younger age was a significant predictor of the PTG total score and New Possibilities subscale score. Subjective severity of cancer was positively associated with the PTG total score and scores on the Appreciation of Life and New Possibilities subscales. Regarding health-related quality of life, analyses indicated that greater social/family well-being significantly predicted greater PTG total score and higher scores on the New Possibilities, Spiritual Change, Appreciation of Life, and Relating to Others subscales. Finally, dismissive attachment style predicted fewer scores on the Personal Strength and Relating to Others subscales. CONCLUSIONS: These findings suggest that in addition to quality of life and adult attachment, sociodemographic and cancer-related variables may significantly contribute to positive growth.

Early micro-rheological consequences of single fraction total body low-dose photon irradiation in mice.

Despite of the studies on widespread biological effects of irradiation, surprisingly only little number of papers can be found dealing with its in vivo hemorheological impact. Furthermore, other studies suggested that low-dose irradiation might differ from high-dose in more than linear ways. On Balb/c Jackson female adult mice hematological and hemorheological impacts of total body irradiation were investigated 1 hour following 0.002, 0.005, 0.01, 0.02, 0.05 and 0.1 Gy dose irradiation. In case of 0.01 Gy further groups were analyzed 30 minutes, 2, 4, 6, 24 and 48 h after irradiation. According to the results, it seems that the dose-dependent changes of blood micro-rheological parameters are not linear. The irradiation dose of 0.01 Gy acted as a point of 'inflexion', because by this dose we found the most expressed changes in hematological parameters, as well as in red blood cell aggregation, deformability and osmoscan data. The time-dependent changes showed progressive decrease in pH, rise in lactate concentration, further decrease in erythrocyte aggregation index and deformability, with moderate shifting of the optimal osmolarity point and modulation in membrane stability. As conclusion, low-dose total body irradiation may cause micro-rheological changes, being non-linearly correlated with the irradiation dose.

Autologous dendritic cell based adoptive immunotherapy of patients with colorectal cancer-A phase I-II study.

Dendritic cell-based active immunotherapies of cancer patients are aimed to provoke the proliferation and differentiation of tumor-specific CD4(+) and CD8(+) T-lymphocytes towards protective effector cells. Isolation and in vitro differentiation of circulating blood monocytes has been established a reasonable platform for adoptively transferred DC-based immunotherapies. In the present study the safety and tolerability of vaccination by autologous tumor cell lysates (oncolysate)- or carcinoembriogenic antigen (CEA)-loaded DCs in patients with colorectal cancer was investigated in a phase I-II trial. The study included 12 patients with histologically confirmed colorectal cancer (Dukes B2-C stages). Six of the patients received oncolysate-pulsed, whereas the other six received recombinant CEA-loaded autologous DCs. The potential of the tumor antigen-loaded DCs to provoke the patient's immune system was studied both in vivo and in vitro. The clinical outcome of the therapy evaluated after 7 years revealed that none of the six patients treated with oncolysate-loaded DCs showed relapse of colorectal cancer, whereas three out of the six patients treated with CEA-loaded DCs died because of tumor relapse. Immunization with both the oncolysate- and the CEA-loaded autologous DCs induced measurable immune responses, which could be detected in vivo by cutaneous reactions and in vitro by lymphocyte proliferation assay. Our results show that vaccination by autologous DCs loaded with autologous oncolysates containing various tumor antigens represents a well tolerated therapeutic modality in patients with colorectal cancer without any detectable adverse effects. Demonstration of the efficacy of such therapy needs further studies with increased number of patients.

[Cancer as psychological trauma and its effects on positive illusions]. / A daganatos betegség okozta trauma és annak pozitiv illuziókra gyakorolt hatása.

Cancer as a psychological trauma can result in development of psychopathological disorders (e.g. depression), and also positive changes experienced in numerous domains of life (e.g. greater appreciation of life). Cognitivists tried to explain the potential traumatic impact of the adversities with the phenomenon that most of the people's world concepts are full of positive illusions and they mostly lack the idea that tragedies can occur also with them. However, this naive worldview can be altered by a trauma in a negative way. Moreover, according to the theory of cognitive adaptation certain positive illusions (perception of personal control, self-enhancement, unrealistic optimism, search for meaning) become even more activated by traumatic life events helping the adjustment to the adversity. More recently, researches have succeeded in proving the role of positive illusions in maintaining mental and physical health. The aim of the present study is to review the potential psychological consequences of cancer as a trauma and to display the schema-changes of trauma victims through the phenomenon of positive illusions.

[The emotions of oncologists]. / Az onkológusok érzelmei.

Emotions are parts of organizational reality to an ever increasing extent. Importantly, they are not just tools in the hand of healthcare workers to achieve better physician / healthcare professional-to-patient interactions but intrinsic processes and characteristics with psychic, cognitive and somatic actions. For a thorough investigation of the issue, a PANAS-X questionnaire was used to examine the emotions of 187 physicians and other healthcare professionals, all engaged in oncology, in 2009. The research succeeded in exploring the overall emotional state oncology professionals had assumed in relation with their job as well as enabled the authors of this study to draw the respondents' emotional map and assess their fundamental emotional attitudes. Furthermore, the authors managed to identify groups of respondents that had felt more intense positive, and/or less intense negative emotions that are socially accepted than others. They included those of senior experienced oncologists, males, individuals with families, childless individuals, ward workers, and skilled professionals. According to the findings, the range of emotions an oncologist experiences / feels intently during his everyday work is dependent upon a great number of factors.

[Study of career motivators affecting the emotional labour of health care professionals in oncology]. / Az onkológiai szakdolgozók érzelmi munkájának vizsgálata a pályaválasztási motivációk tükrében.

In the course of their everyday work health care professionals (HCPs) often have to change their true feelings. The literature labels this performance as emotional labor. This article is presenting data on the characteristics of HCPs' most endangered by the negative consequences of emotional labor. Our simple choice question survey was conducted at Debrecen University Medical Healthcare Center with the help of 50 oncology HCPs volunteers. Nearly 90% of the HCPs examined change their true feelings in the course of work. It is very difficult to classify those threatened by the negative upshot of this emotional labor. Due to our research we found appalling differences of work motivation that were tightly interconnected with the respondents' emotional labor and their perceived role/emotional expectations. We succeeded in establishing three clusters and defining each cluster's characteristics. Figures suggest that only somewhat more than the half of the HCPs is authentic professional helper, and 45% of them does not or only slightly perceive the patients' demands concerning their work. Therefore, it is important that the work environment does not only assist the work of HCPs by professional means, but along emotional dimensions as well.

[Significance of the intraductal component in local recurrence after breast-conserving surgery]. / Az intraductalis komponens jelentôsége az emlôrák emlômegtartó mûtétei után fellépô lokális recidívák létrejöttében.

Several predictors of local recurrence (LR) after breast conservation in early stage (stage I and II) breast cancer have been reported in the literature, but the importance of the individual factors does not appear to be clear. The presence of intraductal component (IC) is one of those factors; some authors regard it to be a predictor of LR, while others do not, or the latter have found a relationship with LR only if IC and certain other factors were present simultaneously. The authors investigated the impact of the presence of IC of various degrees on LR rate in various tumour sizes and degrees of histological anaplasia. Between 1996 and 2002, 701 patients with early stage breast cancer underwent breast conserving surgery. Based on the presence of IC, the tumours were divided into three groups: IC negative, MIC (IC < 25%) and EIC (IC > 25%). During the 65-month mean follow-up period, LR was discovered in 13.5% of the patients. Local recurrence in tumours without IC was found in 8.7% (recurrence rate: 0.017, 95% CI: 0.012-0.012). The relevant figures in MIC and EIC were 16.8% (recurrence rate 0.032, 95% CI: 0.021-0.047) and 25.6% (recurrence rate: 0.046, 95% CI: 0.033-0.064), respectively (p = 0.0001). If the size of the tumour was T1, the above figures were found to be 6.4%, 11% and 24.3%, while in size T2 tumours they were 11.5%, 22.9% and 27% (p < 0.005). If EIC was associated with G3 degree of differentiation, in IC-free tumours of size T1, the LR rate elevated from 6.1% to 31% (p = 0.008), while in size T2 the elevation was from 15.7% to 33.% (p = 0.02). Based on the above results, the authors concluded that the presence of the intraductal component predicts a greater risk to develop LR. This risk increases significantly if EIC is associated with G3 histological grade. Physicians must consider this fact in designing individually tailored adjuvant therapy for their patients. Special attention should also be paid to the follow-up of this group of patients.

[Introduction of emotional labour into oncology]. / Az érzelmi munkavégzés fogalmának bevezetése az onkológiába.

Health care professionals do not have emotional labour obligations in their employment contract. However, in everyday work it is often inevitable for them to change their true feelings. This is critically true for professionals treating chronic or cancer patients. The suitable emotional state of the treatment staff does not only influence the practitioner-patient relationship but the process of recovery as well. Depending on the way one might get into the appropriate emotional state, the literature distinguishes between surface, deep and genuine acting. While surface and deep emotional labour has numerous negative psychological consequences genuine acting is usually accompanied by positive side effects. For those working in the field of oncology, emotional labour is a part of the role expectations of the professionals. This is how the appropriate attitude is a fundamental part of the professionals' essence. For the in depth analysis of subjects related to emotional labour, the authors adopted ideas from L. Festinger 's cognitive dissonance theory. The best way to alleviate cognitive dissonance and the negative side effects of emotional labour is to prevent the emergence of them. Oncology professionals should fit their role expectations genuinely, without particular efforts. If this was impossible, or the particular life situations did not allow genuine acting, it is the employer's and the workmates' common duty to help professionals, to ease the load of emotional labour, to diminish the occurring cognitive dissonance with the help of appropriate recompense.

[The role of emotional labour in oncology]. / Az érzelmi munka szerepe az onkológiában.

Oncologists and related health care professionals (HCPs) do not only have to follow professional protocols in their everyday work, but also have to communicate proper attitudes towards patients suffering from malignant diseases. This task is often a heavier load than the implementation of professional activities themselves. The present article is based on a survey on HCP work motivation, employment parameters and correlations with emotional labour. Fifty oncology HCPs at Debrecen University Medical Health Sciences Centre volunteered to participate in this survey containing 20 simple-choice questions. More than 90 percent of HCPs make an effort to hide their emotional state, giving way to possible negative side effects. The survey showed significant differences between the level of emotional labour of those working in the field of oncology longer or shorter than ten years. Surface and deep emotional labour is more frequent among professionals already working in oncology for a longer period of time. This can serve us with explanation to the burn-out syndrome so frequent in this profession. To diminish the load of emotional labour, healthcare institutes have to aim at hiring employees that spontaneously fit the emotional and behavioural norms facing them, and do not need officially prescribed behavioural norms for everyday work. Their constant need for respect and appreciation of their values must be kept in mind, because the capability of genuine emotional labour diminishes parallel to the number of years spent in work.

[Incidence of local recurrence after breast preserving surgery]. / A lokális recidíva elofordulása emlo-megtartásos mutéteink után.

Breast preserving surgery combined with adjuvant radiotherapy became more frequent in the last 20 years in the surgical treatment of early stage (Std. I-II) breast cancer in Hungary. Those who refuse this method usually allude to the frequent multifocality and the high recurrence rate of breast cancer. In the 1st Department of Surgery, Medical and Health Science Center, University of Debrecen, 825 patients underwent breast preserving surgery with a recurrence rate of 9.1% between January 1996 and December 2003. The time of appearance of recurrence varied between 5 and 102 months after surgery. There was no difference between the premenopausal and postmenopausal group. The 6.7% rate in pT1N0 tumors elevated to 16.7% in patients with pT2N1. According to histological grade the Grade 1 tumors had a recurrence rate of 2.3%, in Grade 2 we found 6.2% and in Grade 3 as high as 15.8%. Other unfavorable histo-morphological signs are the absence of estrogen receptors, the presence of extensive intraductal component and vessel invasion. Their opinion is that in case of local recurrence with favorable prognostic factors excision should be performed if acceptable cosmetic result can be achieved.

[Prognostic role of microvascularization in surgically treated lung cancer]. / A mikrovaszkularizáltság prognosztikai jelentôsége operált tüdôrák esetén.

OBJECTIVE: The aim of our study was the determination of microvascularization and its prognostic significance in lung cancer patients. METHODS: Histological sections were prepared from paraffin-embedded tissues removed from the peripheral part of the tumor of 450 radically operated non-small cell and small cell lung cancer patients. Immunohistochemical staining was performed with antibody against factor VIII-associated antigen. During computer imaging, the absolute and relative parameters of vascularization were determined, as was the density of tumor cells situated to the nearest neighboring vessels. The results were compared with TNM status, the cell type and survival. RESULTS: T2 and T4 tumors demonstrated an enhanced vascularization, however, except for the surface fraction, statistically significant difference was not found. The microvascularization parameters did not differ significantly between tumors with different N status. In small cell lung cancer cases, the vascularization was stronger than in non-small cell lung cancer cases, while cell density was lower, however, these differences did not prove statistically significant. The survival rate decreased significantly with the increasing tumor cell density in the interval of 0-20 microm. CONCLUSIONS: A clear connection could not be demonstrated between vascularization and the appearance of lymph node metastases. The density of tumor cells measured in the direct vicinity of vessels proved an important prognostic factor.

[Therapy of brain metastasis based on the RPA classification]. / Agyi metasztázisok kezelése RPA klasszifikáció alapján.

RPA classification of patients suffering from brain metastases is not widely used in Hungary. The authors reviewed the RPA disposition-based therapeutic recommendations in the literature. Retrospective analysis of their 123 brain metastatic cases showed 3.8 months median, 34.1% 1-year and 7.9% 2-year overall survival. Patient number and median survival in subgroups: RPA 1: 42/14 months, RPA 2: 38/6,2 months, RPA 3a: 6/3.1 months, 3b: 13/2 months, 3c: 10/0.7 months. Median survival of patients with brain metastases from cancer of unknown primary (CUP) was 3 months. In RPA class 1 and 2, 10% undertreatment has been found for solid brain metastases, and all of the 3c patients were over-treated according to literature recommendations. The authors strongly recommend the use of RPA classification in the management of brain metastases and in contemplation of the capacity of radiotherapy/neurosurgery and oncology.

Prognostic significance of endogenous adhesion/growth-regulatory lectins in lung cancer.

OBJECTIVE: To determine the expression of endogenous adhesion/growth-regulatory lectins and their binding sites using labeled tissue lectins as well as the binding profile of hyaluronic acid as an approach to define new prognostic markers. METHODS: Sections of paraffin-embedded histological material of 481 lungs from lung tumor patients following radical lung excision processed by a routine immunohistochemical method (avidin-biotin labeling, DAB chromogen). Specific antibodies against galectins-1 and -3 and the heparin-binding lectin were tested. Staining by labeled galectins and hyaluronic acid was similarly visualized by a routine protocol. After semiquantitative assessment of staining, the results were compared with the pT and pN stages and the histological type. Survival was calculated by univariate and multivariate methods. RESULTS: Binding of galectin-1 and its expression tended to increase, whereas the parameters for galectin-3 decreased in advanced pT and pN stages at a statistically significant level. The number of positive cases was considerably smaller among the cases with small cell lung cancer than in the group with non-small-cell lung cancer, among which adenocarcinomas figured prominently with the exception of galectin-1 expression. Kaplan-Meier computations revealed that the survival rate of patients with galectin-3-binding or galectin-1-expressing tumors was significantly poorer than that of the negative cases. In the multivariate calculations of survival lymph node metastases (p < 0.0001), histological type (p = 0.003), galectin-3-binding capacity (p = 0.01), galectin-3 expression (p = 0.03) and pT status (p = 0.003) proved to be independent prognostic factors, not correlated with the pN stage. CONCLUSION: The expression and the capacity to bind the adhesion/growth regulatory galectin-3 is defined as an unfavorable prognostic factor not correlated with the pTN stage.