Using a Whole Person Approach to Support People With Cancer: A Longitudinal, Mixed-Methods Service Evaluation

Introduction. Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this article is to (a) evaluate short- and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC) and (b) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods. Longitudinal mixed-methods service evaluation (n = 135). Data collected included health-related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity–MYCaW); lifestyle behavior (bespoke questionnaire), and participants' experiences over 12 months postcourse. Results. Statistically and clinically significant improvements from baseline to 12 months in severity of MYCaW Concerns (n = 64; P < .000) and mean total HRQoL (n = 66; P < .000). The majority of MYCaW concerns were "psychological and emotional" and about participants' well-being. Spiritual, emotional, and functional well-being contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. Three to 6 months postcourse was identified as the time when more support was most likely to be needed. Conclusions. Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behavior change were also identified. These data then informed wider and more person-centered clinical provision to increase the maintenance of positive long-term behavior changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed.

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High body mass index and cancer risk—a Mendelian randomisation study

Abstract

High body mass index (BMI) has been associated with increased risk of some cancer. Whether these reflect causal associations is unknown. We examined this issue. Using a Mendelian randomisation approach, we studied 108,812 individuals from the general population. During a median of 4.7 years of follow-up (range 0–37), 8002 developed non-skin cancer, 3347 non-melanoma skin cancer, 1396 lung cancer, 637 other smoking related cancers, 1203 colon cancer, 159 kidney cancer, 1402 breast cancer, 1062 prostate cancer, and 2804 other cancers. Participants were genotyped for five genetic variants associated with BMI. Two Danish general population studies, the Copenhagen General Population and the Copenhagen City Heart Study. In observational analyses, overall risk of non-melanoma skin cancer was 35 % (95 % confidence interval 28–42 %) lower and risk of lung cancer 32 % (19–43 %) lower in individuals with a BMI ≥ 30 versus 18.5–24.9 kg/m². Corresponding risk of breast cancer was 20 % (0–44 %) higher in postmenopausal women. BMI was not associated with risk of colon, kidney, other smoking related cancers, prostate cancer, or other cancers. In genetic analyses, carrying 7–10 versus 0–4 BMI increasing alleles was associated with a 3 % higher BMI (P < 0.001), but not with risk of cancer. In instrumental variable analysis for a 10 kg/m² higher genetically determined BMI the odds ratio for any non-skin cancer was 1.16 (0.64–2.09), with a corresponding observational estimate of 0.94 (0.88–1.01). Using 108,812 individuals from the general population, we found that observationally high BMI was associated with lower risk of lung and skin cancer overall and with higher risk of breast cancer in postmenopausal women, but not with other types of cancer. BMI increasing alleles were not associated with risk of cancer, and results do not support causal associations. Power to test associations for some cancer sites was low.

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Outcomes of patients with loco-regionally recurrent or new primary squamous cell carcinomas of the head and neck treated with curative intent reirradiation at Mayo Clinic

Abstract

Background

We reviewed outcomes of patients with loco-regionally recurrent (LRR) or new primary (NP) squamous cell carcinoma of the head and neck (SCCHN) treated at our institution with reirradiation (RRT).

Methods

Patients received definitive RRT (DRRT) or post-operative RRT following salvage surgery (PRRT) from 2003 to 2011. Measured survival outcomes included loco-regional relapse free survival (LRFS) and overall survival (OS).

Results

Among 81 patients (PRRT, 42; DRRT, 39), median PRRT and DRRT doses were 60 Gy (12–70 Gy) and 69.6 Gy (48–76.8 Gy). The majority of patients received IMRT-based RRT (n = 77, 95 %). With median follow-up of 78.1 months (95 % CI, 56–96.8 months), 2-year OS was 53 % with PRRT and 48 % with DRRT (p = 0.12); 23 % of patients were alive at last follow-up. LRFS at 2 years was 60 %, and did not differ significantly between PRRT and DRRT groups. A trend toward inferior LRFS was noted among patients receiving chemotherapy with RRT versus RRT alone (p = 0.06). Late serious toxicities were uncommon, including osteoradionecrosis (2 patients) and carotid artery bleeding (1 patient, non-fatal).

Conclusions

OS of PRRT- and DRRT-treated patients in this series appears superior to the published literature. We used IMRT for the majority of patients, in contrast to several series and trials previously reported, which may account in part for this difference. Future studies should seek to improve outcomes among patients with LRR/NP SCCHN via alternative therapeutic modalities such as proton radiotherapy and by incorporating novel systemic agents.

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Desperation surgery for a chemorefractory lung lesion in a patient with an extragonadal germ cell tumor

Abstract

We report a case of recurrent and chemorefractory extragonadal germ cell tumor successfully treated with desperation surgery. A 25-year-old man presented with a mediastinal tumor with multiple lung metastases. Serum human chorionic gonadotropin (hCG) level was elevated. He was diagnosed with a mediastinal germ cell tumor (GCT) with multiple lung metastases. After second-line chemotherapy, serum hCG levels normalized. After a total of 10 cycles of chemotherapy, the mediastinal tumor was resected, with no viable tumor detected in the resected tissue. One month after the resection, serum hCG increased, accompanied by the appearance of a new lesion in the lung. After various regimens of salvage chemotherapies, serum hCG failed to normalize. Then, salvage surgery for the lung metastasis was performed. The resected tissue contained a viable choriocarcinoma. The patient remained free of disease without adjuvant therapy at 38 months after pneumonectomy.

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Clinical features and prognostic factors of WHO II and III adult spinal meningiomas: analysis of 25 cases in a single center

Abstract

Spinal World Health Organization (WHO) II and III meningiomas are relatively rare, and often associated with great clinical aggressiveness and poor overall survival. There are controversies over factors affecting the prognosis of this disease. The aim of this retrospective study was to evaluate factors that may affect the therapeutic outcome and prognosis of adult high-grade spinal meningiomas by reviewing the medical records of 25 patients who were surgically treated in our hospital between 2001 and 2014. Univariate and multivariate analyses were performed to identify prognostic variables relative to patient and tumor characteristics, and treatment modalities. All 25 patients (14 men and 11 women; mean age 46.6 ± 16.1 years) underwent surgical resection. Local recurrence was occurred in 13 (52.0 %) patients, and 10 (40.0 %) patients died during the follow-up periods. The 5-year recurrence rate was 60.0 % and the 5-year survival rate was 68.0 %. The results of statistical analysis suggested that Simpson resection grade and the number of involved segments were prognostic factors related to progression-free survival and that sex, age, preoperative Frankel score, the number of involved segments and WHO grade were closely correlated with survival. Furthermore, we confirmed that the number of involved segments was the major independent factor affecting recurrence of patients with adult spinal high-grade meningiomas, and that sex, age and WHO grade were prognostic factors affecting survival but not recurrence.

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Cognitive functioning in meningioma patients: a systematic review

Abstract

This systematic review evaluates relevant findings and methodologic aspects of studies on cognitive functioning in meningioma patients prior to and/or following surgery with or without adjuvant radiotherapy. PubMed and Web of Science electronic databases were searched until December 2015. From 1012 initially identified articles, 11 met the inclusion criteria for this review. Multiple methodological limitations were identified which include the lack of pre-treatment assessments, variations in the number and types of neuropsychological tests used, the normative data used to identify patients with cognitive deficits, and the variety of definitions for cognitive impairment. Study results suggest that most of meningioma patients are faced with cognitive deficits in several cognitive domains prior to surgery. Following surgery, most of these patients seem to improve in cognitive functioning. However, they still have impairments in a wide range of cognitive functions compared to healthy controls. Suggestions are given for future research. Adequate diagnosis and treatment of cognitive deficits may ultimately lead to improved outcome and quality of life in meningioma patients.

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High body mass index and cancer risk—a Mendelian randomisation study

Abstract

High body mass index (BMI) has been associated with increased risk of some cancer. Whether these reflect causal associations is unknown. We examined this issue. Using a Mendelian randomisation approach, we studied 108,812 individuals from the general population. During a median of 4.7 years of follow-up (range 0–37), 8002 developed non-skin cancer, 3347 non-melanoma skin cancer, 1396 lung cancer, 637 other smoking related cancers, 1203 colon cancer, 159 kidney cancer, 1402 breast cancer, 1062 prostate cancer, and 2804 other cancers. Participants were genotyped for five genetic variants associated with BMI. Two Danish general population studies, the Copenhagen General Population and the Copenhagen City Heart Study. In observational analyses, overall risk of non-melanoma skin cancer was 35 % (95 % confidence interval 28–42 %) lower and risk of lung cancer 32 % (19–43 %) lower in individuals with a BMI ≥ 30 versus 18.5–24.9 kg/m². Corresponding risk of breast cancer was 20 % (0–44 %) higher in postmenopausal women. BMI was not associated with risk of colon, kidney, other smoking related cancers, prostate cancer, or other cancers. In genetic analyses, carrying 7–10 versus 0–4 BMI increasing alleles was associated with a 3 % higher BMI (P < 0.001), but not with risk of cancer. In instrumental variable analysis for a 10 kg/m² higher genetically determined BMI the odds ratio for any non-skin cancer was 1.16 (0.64–2.09), with a corresponding observational estimate of 0.94 (0.88–1.01). Using 108,812 individuals from the general population, we found that observationally high BMI was associated with lower risk of lung and skin cancer overall and with higher risk of breast cancer in postmenopausal women, but not with other types of cancer. BMI increasing alleles were not associated with risk of cancer, and results do not support causal associations. Power to test associations for some cancer sites was low.

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Statin use and risk of glioma: population-based case–control analysis

Abstract

Statins have been reported to decrease the incidence of cancer, but the risk of glioma among statin users has been investigated in only two prior observational studies, both of them suggesting a modest protective effect of statins. We conducted a matched case–control study using data from the UK-based Clinical Practice Research Datalink to analyse use of statins among 2469 cases with glioma and 24,690 controls. We performed conditional logistic regression analysis to calculate relative risks, estimated as odds ratios (ORs) with 95 % confidence intervals (CIs) adjusting for multiple confounding factors. As compared with non-use of statins, use of statins was not associated with risk of glioma (OR for ≥90 prescriptions=0.75; 95 % CI 0.48–1.17). Our findings do not support previous sparse evidence of a possible inverse association between statin use and glioma risk.

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Sunitinib and Sorafenib Ineffective as Adjuvant Therapies for Kidney Cancer

Results from a recent clinical trial show that adjuvant therapy with sunitinib (Sutent®) or sorafenib (Nexavar®) does not improve progression-free survival for patients with renal cell (kidney) cancer and may cause serious side effects.

Findings from the randomized, double-blind, placebo-controlled trial were published March 8 in The Lancet.

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Sunitinib and Sorafenib Ineffective as Adjuvant Therapies for Kidney Cancer

Results from a recent clinical trial show that adjuvant therapy with sunitinib (Sutent®) or sorafenib (Nexavar®) does not improve progression-free survival for patients with renal cell (kidney) cancer and may cause serious side effects.

Findings from the randomized, double-blind, placebo-controlled trial were published March 8 in The Lancet.

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