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PubMed1989

Social competence and behavioral adjustment of children who are long-term survivors of cancer.

Relatively little is known about the special needs of long-term survivors of childhood cancer or the factors that make this growing population vulnerable to chronic psychologic disorders. We therefore surveyed 183 children who had been treated for cancer at St Jude Children's Research Hospital and were free of the disease for greater than or equal to 2 years after completing therapy. Parental responses to the Child Behavior Checklist, a standardized inventory of social competence and behavioral problems, were analyzed in relation to demographic and medical variables, as well as the children's appearance and functional status. School-related problems and somatic complaints of undetermined origin were increased fourfold relative to age- and gender-adjusted rates for peer groups in the general population. The presence of functional but not cosmetic impairments increased the risk of academic and adjustment problems. An older age at evaluation, treatment with cranial irradiation, and residence in a single-parent household were also associated with an increased risk of psychologic problems. General pediatricians must eventually assume responsibility for the extended follow-up care of children who have survived a malignancy. Their awareness of the high-risk groups described in this report should facilitate more timely identification of problems and referral of the children to appropriate services.

Achievement↗

PubMed1994

Does abortion increase the risk of breast cancer?

According to this hypothesis, an early FFTP [first full-term pregnancy] would provide the greatest protection against breast cancer by drastically reducing, early on, the presence of undifferentiated and hence vulnerable breast cells, thereby decreasing the risk of subsequent transformation ... Other types of pregnancies, however, might increase the risk of breast cancer. If a woman's first pregnancy resulted in a first trimester abortion, the dramatic rise in undifferentiated cells that takes place during the first trimester would not be followed by the marked differentiation occurring during the second and third trimesters. The consequent sharp increase in the number of vulnerable cells would thus elevate breast cancer risk.

Abortion, Induced↗

PubMed1976

Respiratory disease mortality among uranium miners.

A mortality analysis of a group of white and Indian uranium miners was done by a life-table method. A significant excess of respiratory cancer among both whites and Indians was found. Nonmalignant respiratory disease deaths among the whites are approaching cancer in importance as a cause of death, probably as a result of diffuse parenchymal radiation damage. Exposure-response curves for nonsmokers are linear for both respiratory cancer and "other respiratory disease." Cigaret smoking elevates and distorts that curve. Light cigaret smokers appear to be most vulnerable to lung parenchymal damage. The predominant histologic cancer among nonsmokers is small-cell undifferntiated, just as it is among cigaret smokers.

Adult↗

PubMed2006

Management of cancer in the elderly.

With the aging of the Western population, cancer in the older person is becoming increasingly common. After considering the relatively brief history of geriatric oncology, this article explores the causes and clinical implications of the association between cancer and aging. Age is a risk factor for cancer due to the duration of carcinogenesis, the vulnerability of aging tissues to environmental carcinogens, and other bodily changes that favor the development and the growth of cancer. Age may also influence cancer biology: Some tumors become more aggressive (ovarian cancer) and others, more indolent (breast cancer) with aging. Aging implies a reduced life expectancy and limited tolerance to stress. A comprehensive geriatric assessment (CGA) indicates which patients are more likely to benefit from cytotoxic treatment. Some physiologic changes (including reduced glomerular filtration rate, increased susceptibility to myelotoxicity, mucositis, and cardiac and neurotoxicity) are common in persons aged 65 years and older. The administration of chemotherapy to older cancer patients involves adjustment of the dose to renal function, prophylactic use of myelopoietic growth factors, maintenance of hemoglobin levels around 12 g/dL, and proper drug selection. Age is not a contraindication to cancer treatment: With appropriate caution, older individuals may benefit from cytotoxic chemotherapy to the same extent as the youngest patients.

Age Factors↗

PubMed2003

The population genetics of multistage carcinogenesis.

Despite the many successes of cancer research, we lack the framework necessary to predict the ratio of familial (inherited) to sporadic (non-inherited) cancers. An evolutionary model of multistage carcinogenesis provides this framework by demonstrating that the number of tumour suppressor loci (TSLs) preventing cancer in a given tissue is expected to depend upon the tissue's vulnerability to pre-reproductive somatic mutation. Since this vulnerability increases with tissue size, single gene control of human cancer may be restricted to retinoblastoma, a cancer of the tiny embryonic retina. The model is used to estimate the frequency of mutant alleles causing inherited cancers, based on the population genetics of the mutation-selection balance between new mutations arising and selection that eliminates them. For each specific cancer, this balance is determined by the effectiveness with which pre-reproductive cancer is suppressed in the non-mutant genotype characteristic of that population. Effectiveness depends on an interaction between the number of TSLs suppressing the cancer and factors determining the tissue-wide somatic mutation rate, such as tissue size and number of pre-reproductive cell divisions. The model predicts that the commonest pre-reproductive cancers will have the lowest proportion of familial cases, and that cancers associated with the most TSLs will have the highest post-reproductive incidence but no elevated pre-reproductive risk (a pattern seen in human epithelial cancers).

Age of Onset↗

PubMedDate not supplied

Communication and the patient/physician relationship: a phenomenological inquiry.

All interaction between patient and medical team is mediated through communication. In working with advanced cancer patients, troubled communication between the patient and healthcare team is sometimes evident. The current study examined the perspective of seven advanced cancer patients on this communication. The patients were under the care of an urban cancer research center, and each had expressed, at least once, a desire for hastened death. Using a phenomenological form of inquiry, serial, "in-depth semistructured" interviews were conducted (mean = 3; range = 2-6) at a place convenient to the patient. The interviews were audiotaped, transcribed, coded, and organized into themes. The study findings suggest that the most important aspects of communication between the advanced cancer patient and medical team at an urban cancer research center are the extreme vulnerability of the patient to both style and content of the communication; the extreme sensitivity of the communication itself, because it concerns issues vital to the patient; and the complexity of the communication, encompassing and expressing both verbal and non-verbal messages, as well as intended and unintended messages. Conflict inherent in almost all communication between patient and medical team involved disagreement about goals of care and the participants' perception of not being treated with respect. Harm caused to the participant by communication missteps included loss of hope, a sense of abandonment, and diminished feelings of personal dignity and worth. The findings may not be representative of advanced cancer patients being cared for in a different treatment setting.

Adult↗

PubMed1992

Effect of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) on the incidence of invasive cervical cancer.

The Clinical Laboratory Improvement Act of 1988 (CLIA '88) mandates strict, new quality-control measures for laboratories that interpret cervical cytology smears. Proposed regulations include proficiency testing of cytotechnologists and remediation for technologists and laboratories that fail to meet proposed proficiency standards. Proponents of the new regulations argue that these measures will reduce deaths from cervical cancer by reducing the false-negative rate of the Papanicolaou (Pap) test, but opponents argue that the regulations will increase the price of processing Pap tests and thereby reduce access to cervical cancer screening for high-risk, vulnerable populations. To examine these claims the authors used David Eddy's published simulation to model the natural history and detection of cervical neoplasia, and developed a new model to examine the health consequences of diminished access to Pap testing. The authors estimated the false-negative rate of the Pap test and the price elasticity of demand for preventive services on the basis of the published literature, and modeled the entire range of published or quoted predictions about the impact of CLIA '88 on accuracy and price. The results show that, if effects on access are ignored, reducing the false-negative rate from 15% to 5% would prevent 66 invasive cancers per 100,000 average risk women screened. However, under moderate assumptions regarding the effect of price on access, the regulations would prevent only 11 (instead of 66) cancers per 100,000 eligible women. The regulatory effect is very sensitive to the degree of improvement in the false-negative rate and increase in price that the regulations cause. Over the range of assumptions and predictions encountered in the literature and tested in our analysis, the proposed regulations could greatly reduce or greatly increase the incidence of invasive cancer, especially among high-risk and uninsured women. The implementation of the regulations should be delayed until new information regarding the actual false-negative rate of the Pap test allow a more precise estimate of the potential impact on the incidence of cervical cancer.

Clinical Competence↗

PubMed1980

Hospital variations in metastatic breast cancer.

Data from the tumor abstracts of 25,535 female breast cancer patients in California were analyzed to measure hospital differences in the rates of metastatic disease at diagnosis. For white patients the metastatic rates varied from 38 to 68 per cent as hospital affiliation varied, and for blacks they ranged from 48 to 76 per cent. Tests for normality showed that the distribution of rates for white patients in private facilities was not merely due to random variation. The metastatic rates for both racial groups tended to be inversely related to the proportion of whites among the patient populations and positively related to total patient load. Hospitals affiliated with medical schools had relatively high rates for white private patients. Several explanations of the data are suggested. They consider the possible effects of patient and physician health care practices and host vulnerability to the spread of breast cancer.

Black or African American↗

PubMed1999

Psychological aspects of ovarian cancer.

Ovarian cancer presents a range of physical and psychological symptoms during stages of diagnosis, treatment, and survival. Women at risk for ovarian cancer who attend screening programs are vulnerable to high levels of depression and anxiety, particularly young women with poor social support. Multiple physiological stressors of surgical menopause, steroid therapy, and pain present during active treatment that place women at high risk of depression and anxiety during this time. Symptoms of anxiety and depression are also prevalent immediately after chemotherapy and during palliative care. Screening for psychological distress may be useful to identify women who will benefit from psychological counseling. They should be referred to a mental health professional affiliated with the hospital at which they are receiving oncology services. Brief group or individual supportive psychotherapies are effective in relieving psychological distress. Face-to-face psychological intervention should be tailored to the patient's degree of physical mobility. Pain, discomfort, and severe mood symptoms should be addressed pharmacologically, when possible, by a psychiatric consultant knowledgeable in oncology psychiatry. Survivors experience chronic fear of recurrence, sexual dysfunction, and identity disturbance. Reports that ovarian cancer can result in positive life changes, such as closer interpersonal relationships, are encouraging and may provide hope to patients who become despairing about the future.

Adaptation, Psychological↗

PubMed2026

Mitochondrial DNA in lung cancer: From biology to clinical implications.

Mitochondrial DNA (mtDNA) is emerging as a relevant component of the molecular landscape in non-small cell lung cancer (NSCLC). Due to its inherent vulnerability to environmental carcinogens, the mitochondrial genome accumulates alterations-such as D-loop and Electron Transport Chain variants- increasingly identified as potential mediators of tumor development and metabolic shifts. Recent findings highlight potential clinical applications of mtDNA. In diagnostics, emerging models based on cf-mtDNA fragmentomics and tRNA-derived fragments have shown promising capabilities for early-stage diagnosis. Prognostically, somatic variants in Complex I and specific mitochondrial lncRNA signatures have been evaluated as independent indicators of overall survival and metastatic risk. Furthermore, mitochondrial mass may potentially support chemotherapy election. Additionally, horizontal transfer of mitochondria to tumor-infiltrating lymphocytes offers a novel framework for understanding resistance to immunotherapy. While these preliminary results provide a promising roadmap for molecular stratification, their integration into routine practice remains a goal that requires further prospective validation in larger, multi-ethnic cohorts to ensure reproducibility and to distinguish functional drivers from passenger variants. Collectively, these emerging findings suggest that mtDNA analysis represents a valuable complementary approach to precision oncology in lung cancer.

Humans↗

PubMed1997

Tobacco use among pediatric cancer patients: recommendations for developing clinical smoking interventions.

PURPOSE AND METHODS: The current status of tobacco use among young cancer patients and the acute and chronic complications associated with tobacco use in these patients is reviewed. RESULTS AND CONCLUSION: Studies report that adolescent cancer survivors use tobacco as much as their peers who have never been treated for cancer, despite the adverse consequences of engaging in this unhealthy habit. Health care professionals have the opportunity and responsibility to incorporate tobacco counseling as a routine component of medical care delivery. Nurse/physician-delivered smoking interventions have been found to promote smoking cessation in adults, although little effort has been devoted to the development of similarly effective smoking interventions for pediatric cancer patients who smoke. Components of existing smoking prevention/cessation curricula from successful school-based interventions and physician-delivered smoking interventions can be adapted and tailored to pediatric cancer patients in medical settings. Smoking interventions that educate patients about their increased vulnerability to tobacco-related consequences, relative to their healthy peers, may have an enhanced impact. Guidelines for conducting a comprehensive assessment of tobacco use and implementing smoking interventions with pediatric cancer patients is provided. Strategies for modifying the cancer patient's perceived vulnerability to tobacco-related consequences is also discussed.

Adolescent↗

PubMedDate not supplied

The health of older-adult, long-term cancer survivors.

Research indicates that cancer-related health problems persist for decades among survivors. The combination of late effects of cancer or its treatment and age-related health problems may add to the vulnerability of older survivors. This research reports on the health and functioning of a sample of long-term (5+ years), older-adult (>60 years) survivors of breast, prostate, and colorectal cancer. Data were derived from 321 in-person interviews with a sample randomly selected from a tumor registry at a comprehensive cancer center. Descriptive data analyzed comorbid health conditions and continued cancer symptoms reported by survivors. Correlational analysis examined the association among demographic cancer-related factors and a range of health quality-of-life outcomes, including functioning and illness impact. Nearly 40% of respondents have at least 1 symptom attributed to cancer/treatment. Pain was the most commonly reported symptom, with 21% attributing it to cancer. More than 40% of breast cancer survivors and nearly 20% of prostate cancer survivors reported pain. Being African American or female was significantly associated with more current symptoms and greater functional difficulty. Survivors who had chemotherapy and survivors with more types of treatment reported significantly more symptoms both during treatment and currently. Many older-adult survivors are more vulnerable due to both cancer-related symptoms and comorbid health conditions. Women and African Americans are at special risk. This combined vulnerability is an important factor for clinicians treating long-term survivors.

Activities of Daily Living↗

PubMed1995

Marital crises in oncology patients. An approach to initial intervention by primary clinicians.

Life-threatening illnesses such as cancer may precipitate marital crises in vulnerable relationships, and oncology clinicians often feel uncertain about how to approach them. This paper presents a framework for initial intervention based on the nature of the principal threat to the relationship. Immature relationships need distance and support for their identity as a couple; hostile dependent couples need to find consensus in order to structure communication; physically abusive relationships require monitoring in order to promote safety; and estranged couples need help in understanding their disappointment and identifying available support. Clinicians working in oncology can help couples in crisis by promoting a realistic balance of independence and dependence, clarifying the complexity of factors contributing to the crisis, considering referral for couples treatment, communicating with the team while respecting patients' confidences, and by choosing clear and compatible clinical roles. Primary clinicians can stabilize and treat marital crises, but need access to medically knowledgeable couples' therapists.

Adaptation, Psychological↗

PubMed2006

Insomnia and its treatment in women with breast cancer.

Insomnia is a common complaint in breast cancer patients and has been shown to have a host of psychological and medical correlates and consequences. Typically insomnia is treated pharmacologically, however more recent findings from randomized controlled clinical trials support the use of cognitive behavioral therapies. The aim of this article is to review the empirically supported breast cancer literature on insomnia, briefly present and explain the insomnia treatment options available, and extrapolate research guidelines for future directions in this growing field. Behavioral therapeutic approaches for insomnia seem particularly suitable to use in the breast cancer populations because they have lower risk of interacting with the cancer treatment, do not burden the patients with additional pharmacological treatments, and can target the treatment towards ameliorating specific symptoms, like fatigue, that are characteristic in this population. However, there is a need for replication of efficacy studies of cognitive behavioral treatments for insomnia in breast cancer, as well as studies investigating vulnerability, risk and protective factors that might ultimately lead to insomnia prevention programs for use in this population.

Breast Neoplasms↗

PubMed1998

Survivorship and the cancer follow-up clinic.

In recent years there has been growing interest in the needs of those individuals who have survived cancer. It is now possible to describe the adjustments that these individuals will make, predict when such difficulties will arise, and identify those most vulnerable to adjustment difficulty. The value of the cancer follow-up clinic has also received scrutiny, drawing on work previously undertaken in the cancer screening clinic setting. Issues discussed in the literature include the purpose of follow-up, the most appropriate health care professional to undertake the follow-up clinic, and the financial cost of cancer follow-up. There exists an opportunity for cancer nurses at present to develop roles in the clinic setting, offering patient-centred and cost-effective alternatives to physician-led follow-up.

Aftercare↗

PubMed2002

The association of health literacy with cervical cancer prevention knowledge and health behaviors in a multiethnic cohort of women.

OBJECTIVE: Our purpose was to describe the relationship between health literacy, ethnicity, and cervical cancer screening practices and to evaluate physician recognition of low literacy. STUDY DESIGN: We studied a prospective cohort of English-speaking patients > or =18 years (n = 529) in ambulatory women's clinics. Univariate and multivariate analyses were used to evaluate demographics, health practices and beliefs, and knowledge regarding cervical cancer screening and prevention. Physicians' assessments of patient reading skills were obtained. RESULTS: Low health literacy (<9th grade) was found among 40% of participants. Minority women were half as likely to know the purpose of the Papanicolaou test (9% vs 21%; P <.03) and were significantly more likely to have low literacy levels compared with white women (46% vs 15%; P <.05). Literacy was the only factor independently associated with knowledge related to cervical cancer screening (adjusted odds ratio, 2.25; 95% CI, 1.05-4.80). Physicians detected only 20% of the lowest readers. CONCLUSION: Poor health literacy was a better predictor of cervical cancer screening knowledge than ethnicity or education, yet physicians infrequently recognized low literacy. Improved physician awareness and development of low literacy interventions may improve cervical cancer screening, particularly for the most vulnerable women.

Adult↗

PubMed1999

The psychologic assessment and psychosocial recovery of the patient with an amputation.

The purpose of this paper is to introduce the surgical clinician to the importance of psychosocial issues in those patients undergoing amputation. Although fundamental, obtaining a good recovery for the patient means far more than providing a technically superb surgical outcome. This paper reviews the necessity of a thorough preoperative assessment in those psychosocial areas most likely to impact how the patient perceives, reacts to, and, ultimately, accepts the recommendation for amputation. Patients who undergo amputations as a result of chronic illness, of trauma, or of cancer have common concerns and special vulnerabilities that the astute surgeon should recognize. After reading this paper, the clinician should know how to assess patients in many dimensions, how to formulate a comprehensive treatment plan for psychosocial recovery, to be familiar with and to appreciate expected emotional responses in their patients, and to look for and recognize complications and stress points that require interventions either from the clinician or via a consultation. The referring surgeon should be familiar with the aims of psychotherapeutic treatment modalities and be comfortable in asking the goals and progress being made by their patients. They should have continuing input and receive timely updates.

Amputation, Surgical↗

PubMed1991

Psychosocial needs of long-term childhood cancer survivors: a review of literature.

With improved medical treatment for childhood cancer, many patients are enjoying long disease-free remission or cure. It is important to address the psychosocial adjustment of the survivor's life. There are two approaches to the study of psychosocial adjustment: study of psychiatric disturbances and assessment of quality of life. Incidences of psychiatric disturbances were reviewed with the most commonly reported difficulties being depression, anxiety and chemical dependency for older survivors and school attendance problems and learning difficulties for school age survivors. The assessment of quality of life focused on school performance, social adjustment, employment status, independent living and marital status. In addition, family coping has received increasing emphasis with regard to the effects on marital relationship and financial difficulties, although there is no consistent evidence to suggest an increased divorce rate in these families. Healthy siblings of cancer survivors are also subject to vulnerability. However, there is evidence to suggest most siblings will resolve their feelings of jealousy, fear of abandonment and establish a normal sibling relationship with the survivor.

Adaptation, Psychological↗