NCOG-43. RELATIONSHIPS BETWEEN MOOD DISTURBANCE, SYMPTOM INTERFERENCE, AND DISEASE PROGRESSION IN GLIOMA PATIENTS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi161-vi161
Author(s):  
Kayla Roche ◽  
Elizabeth Vera ◽  
Alvina Acquaye ◽  
Nicole Briceno ◽  
Anna Choi ◽  
...  
Keyword(s):  
Stable Disease ◽  
Psychological Symptoms ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Anxiety Symptoms ◽  
Mood Disturbance ◽  
Cross Sectional ◽  
Illness Trajectory ◽  
Change Scores ◽  
Imaging Results

Abstract Cross-sectional studies indicate that patients with gliomas report significant depressive/anxiety symptoms and symptom-related interference with daily activities at diagnosis and throughout the illness trajectory. Our study aimed to explore relationships between these mood disturbances and symptom interference with respect to progressive disease (PD) in glioma patients. Demographic, clinical characteristics, MDASI-Brain Tumor (interference items), and PROMIS Anxiety and Depression Short-Forms were collected at the time of imaging surveillance, before discussing imaging results. Comparisons between patients with/without PD and respective change scores were calculated at study entry and at subsequent assessments. Independent t-tests, Chi-square tests, and paired sample t-tests were used to report results. The sample included 438 glioma patients (62% male, 84% Caucasian, 82% high-grade) with median age of 51 years (range 18-82); 42% had PD with 60% reporting past recurrence(s); 45% had poor Karnofsky Performance Status (KPS); and median time from diagnosis was 2 years (range: 0-30). On average, patients with PD on imaging at time of assessment reported significantly greater anxiety (p = 0.008), depression (p < 0.001), and symptom interference (p < 0.001) than those with stable disease. Additionally, more patients with PD reported moderate-severe anxiety (25%) and depression (22%) than patients with stable disease (15% and 12%, respectively). When evaluating change scores, patients with PD reported worse symptom interference (p < 0.001) but stable mood disturbance, while patients with stable disease reported improved depression (p = 0.018) and unchanged anxiety symptoms compared to baseline. Although mood disturbance is higher for patients with PD, some of these patients do not experience worsening, but rather a continuation of ongoing psychological symptoms, which may portend a worse illness trajectory. Identifying these patients early in this trajectory to evaluate potential biologic correlates between mood and prognosis is warranted to validate these findings.

Multi-center, single arm phase II study of the dual mTORC1/mTORC2 inhibitor vistusertib for patients with recurrent or progressive grade II-III meningiomas.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 2024-2024
Author(s):  
Scott Randall Plotkin ◽  
Priya Kumthekar ◽  
Patrick Y. Wen ◽  
Frederick G. Barker ◽  
Anat Stemmer-Rachamimov ◽  
...  
Keyword(s):  
Adverse Events ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Progression Free Survival ◽  
Response Assessment ◽  
Duration Of Treatment ◽  
Cross Sectional ◽  
Pathway Activation ◽  
Grade Ii ◽  
Correlative Studies

2024 Background: Grade II/III meningiomas represent about 20% of tumors and have increased rates of recurrence with no approved medical therapies. Historically, the progression-free survival at 6 months (PFS-6) for these tumors is 25%. The Response Assessment in Neuro-Oncology (RANO) group identified a PFS-6 rate of > 35% to be of interest for trials of grade II/III meningioma. Methods : NF2 gene inactivation occurs in the majority of meningiomas and is associated with mTORC1 activation. Human studies of everolimus for neurofibromatosis 2 patients documented growth arrest in only a minority of tumors. Based on our studies showing mTORC2/SGK1 pathway activation in NF2-deficient meningiomas and the known paradoxical activation of the mTORC2/AKT pathway in meningiomas, we hypothesized that dual inhibition of mTORC1/2 would be superior in meningiomas. Treatment of primary meningioma cells with vistusertib led to decreased cell proliferation and showed greater efficacy than rapamycin, regardless of NF2 expression. We studied the effect of vistusertib in patients with progressive or recurrent grade II/III meningiomas (NCT03071874). Vistusertib was administered orally at 125mg twice daily on two consecutive days each week. MRIs were obtained every 2 cycles (1 cycle = 28 days). Tumor size was defined as the largest cross-sectional area. Progression was defined as ≥25% increase in the sum of products of all measurable lesions over smallest sum observed. The primary endpoint was PFS-6. Secondary endpoints included toxicity, radiographic response, and correlative studies including immunohistochemistry for mTORC1/2 pathway activation and genetic biomarkers. Results: Twenty-eight patients (13 female), with a median age of 58 years (range, 32 to 77 years), were enrolled in this multicenter study. The median Karnofsky performance status was 80. Twenty-five patients have been followed to six months or to tumor progression. The median duration of treatment was 6.5 month (range, 1-18 months). Four patients chose to discontinue treatment, 1 withdrew to intercurrent illness, and 1 was withdrawn due to non-compliance. PFS-6 is 51.5% (CI, 29.3% - 70.0%). Adverse events at least possibly related to vistusertib with frequency > 10% include nausea (54%); fatigue (36%); hypophosphatemia (29%); diarrhea, anorexia, dry mouth, and hypertriglyceridemia (all 14%); hypertension, vomiting, increased ALT, constipation, and weight loss (all 11%). Conclusions: Vistusertib treatment was associated with a PFS-6 rate that exceeds the RANO target of 35% for recurrent high-grade meningioma. The follow-up data continue to mature. Adverse events were tolerable in this patient population. Correlative studies to identify biological factors that correlate with response are under way. These data support the initiation of larger randomized studies of vistusertib in this setting. Clinical trial information: NCT03071874.

scholarly journals Longitudinal Effects of Stress and Cognitive Fusion in Anxiety and Depressive Symptoms of Family Caregivers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 278-278
Author(s):  
Samara Barrera-Caballero ◽  
Rosa Romero-Moreno ◽  
Carlos Vara-García ◽  
Javier Olazarán ◽  
María del Sequeros Chaparro ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Functional Capacity ◽  
Behavioral Problems ◽  
Psychological Symptoms ◽  
Anxiety Symptoms ◽  
Care Recipient ◽  
Psychological Consequences ◽  
Cognitive Fusion ◽  
Cross Sectional ◽  
And Gender

Abstract Dementia caregiving has been commonly associated with negative psychological consequences in caregivers. Cognitive fusion, that is, the tendency for been overly influenced by cognition, has been linked to psychological distress in caregivers in cross-sectional studies. Female caregivers and those who are exposed to more stressors such as behavioral and psychological symptoms of dementia report higher levels of distress. However, longitudinal analysis of predictors of caregivers levels of distress are sparse, with no available study analyzing the longitudinal effect of cognitive fusion. The aim of this study is to analyze the longitudinal effect of cognitive fusion in depressive and anxiety symptoms of family dementia caregivers, after controlling for other relevant variables. Face to face interviews were conducted each year through a two-year period (three assessments) with 143 caregivers. Linear mixed models analysis were used to analyze the associations between time-varying values for cognitive fusion, frequency and reaction to care-recipient behavioral problems and depressive and anxiety symptoms, after controlling for caregivers’ age and gender, daily hours and time caring, care-recipient functional capacity and caregivers’ transitions (cessation of caregiving). Results suggest that increases in cognitive fusion and in reaction to behavioral problems, being a female caregiver and being younger, significantly predicted increases in anxiety symptoms over time. Also, increases in cognitive fusion and in reaction to behavioral problems, decreases in care-recipient’s functional capacity and ending of the caregiving role significantly predicted increases in depressive symptoms. Psychological strategies aimed at reducing cognitive fusion and stress levels may be especially helpful for reducing caregivers’ distress.

scholarly journals Chronic Diseases and Associated Factors among Older Adults in Loja, Ecuador

2020 ◽  
Vol 17 (11) ◽  
pp. 4009 ◽  
Author(s):  
Patricia Bonilla-Sierra ◽  
Ana-Magdalena Vargas-Martínez ◽  
Viviana Davalos-Batallas ◽  
Fatima Leon-Larios ◽  
Maria-de-las-Mercedes Lomas-Campos
Keyword(s):  
Arterial Hypertension ◽  
Functional Status ◽  
Chronic Diseases ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Joint Disease ◽  
Poor Performance Status ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Targeted Interventions

(1) Background: This study aimed to explore the symptoms, functional status, and depression in patients with chronic diseases in Loja, Ecuador. (2) Methods: A cross-sectional study was carried out with patients over 60 years old having at least one chronic disease and cared for in healthcare centers of the Health Ministry of Ecuador or living in associated geriatric centers. (3) Results: The sample comprised 283 patients with a mean age of 76.56 (SD 7.76) years. The most prevalent chronic diseases were chronic obstructive pulmonary disease, followed by arterial hypertension and diabetes. Patients with a joint disease had the worst scores for the majority of the symptoms assessed with the Edmonton Scale. Cancer, dementia, and arterial hypertension contributed the most to the dependence levels assessed with the Barthel Index. Dementia contributed the most to the poor performance status evaluated with the Karnofsky Performance Status. Cancer and diabetes contributed the most to depression. Patients with a higher number of chronic diseases reported worse functional status. (4) Conclusions: Targeted interventions to address symptoms, functional status, and depression in patients with chronic diseases are needed.

scholarly journals Relationship Between Perceptions of Treatment Goals and Psychological Distress in Patients With Advanced Cancer

2020 ◽  
Vol 18 (7) ◽  
pp. 849-855 ◽  
Author(s):  
Areej El-Jawahri ◽  
Deborah Forst ◽  
Alyssa Fenech ◽  
Keri O. Brenner ◽  
Amanda L. Jankowski ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Psychological Symptoms ◽  
Depression Scale ◽  
Cross Sectional Study ◽  
Anxiety Symptoms ◽  
Treatment Goal ◽  
Treatment Goals ◽  
Incurable Cancer ◽  
Cross Sectional ◽  
Patients With Cancer

Background: Studies have shown gaps in prognostic understanding among patients with cancer. However, few studies have explored patients’ perceptions of their treatment goals versus how they perceive their oncologist’s goals, and the association of these views with their psychological distress. Methods: We conducted a cross-sectional study of 559 patients with incurable lung, gastrointestinal, breast, and brain cancers. The Prognosis and Treatment Perception Questionnaire was used to assess patients’ reports of their treatment goal and their oncologist’s treatment goal, and the Hospital Anxiety and Depression Scale was used to assess patients’ psychological symptoms. Results: We found that 61.7% of patients reported that both their treatment goal and their oncologist’s treatment goal were noncurative, whereas 19.3% reported that both their goal and their oncologist’s goal were to cure their cancer, 13.9% reported that their goal was to cure their cancer whereas their oncologist’s goal was noncurative, and 5% reported that their goal was noncurative whereas their oncologist’s goal was curative. Patients who reported both their goal and their oncologist’s goal as noncurative had higher levels of depression (B=0.99; P=.021) and anxiety symptoms (B=1.01; P=.015) compared with those who reported that both their goal and their oncologist’s goal was curative. Patients with discordant perceptions of their goal and their oncologist’s goal reported higher anxiety symptoms (B=1.47; P=.004) compared with those who reported that both their goal and their oncologist’s goal were curative. Conclusions: One-fifth of patients with incurable cancer reported that both their treatment goal and their oncologist’s goal were to cure their cancer. Patients who acknowledged the noncurative intent of their treatment and those who perceived that their treatment goal was discordant from that of their oncologist reported greater psychological distress.

Plasma pharmacokinetics and cerebrospinal fluid concentrations of erlotinib in high-grade gliomas: A novel, phase I, dose escalation study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 2054-2054 ◽  
Author(s):  
L. W. Buie ◽  
C. Lindley ◽  
T. Shih ◽  
M. Ewend ◽  
J. K. Smith ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Partial Response ◽  
Disease Progression ◽  
Dose Escalation ◽  
Stable Disease ◽  
Peak Plasma ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Plasma Concentrations ◽  
High Grade

2054 Background: Erlotinib (ERL) is an inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase. EGFR is overexpressed in glioblastoma multiforme (GBM). The primary objectives of this study were to determine the maximum tolerated dose (MTD), dose limiting toxicity (DLT) and to evaluate plasma and cerebrospinal fluid (CSF) ERL concentrations using a novel every 72 hour ERL dosing schedule. Methods: Patients = 18 years of age with GBM or high grade glioma with evidence of disease progression following first line therapy (surgery/XRT/chemotherapy) and Karnofsky performance status = 60 % were included. Patients were stratified based on use of enzyme-inducing antiepileptic drugs (EIAED). Patients not on EIAED were initiated on ERL 450 mg PO every 72h, while those on EIAED were initiated on 900 mg PO every 72 h. Results: Six patients have been enrolled and assessed for safety, 5 for plasma PK and 3 for CSF concentrations. For ERL, the area under the plasma concentration versus time curve (AUC) was greater and the half-life longer in patients not receiving EIAED. However, the AUC of OSI-420, the major metabolite of ERL, was lower in patients not receiving EIAED. The OSI-420 AUC: ERL AUC ratio was increased 3 fold among patients receiving EIAED, indicative of increased hepatic metabolism and increased clearance. CSF concentrations were detectable and ranged from 1 to 3% of peak plasma concentrations. Neither group has experienced a DLT or reached the MTD. The most common side effects (grade 1/2) have been diarrhea (83%), rash (100%) and fatigue (33%). To date, there has been 1 partial response, 1 patient with stable disease and 4 patients with disease progression. The partial response and stable disease have occurred in patients with GBM. Conclusions: ERL is a well tolerated therapy. Patient enrollment and subsequent dose escalation is ongoing and updated results will be presented at the ASCO 2007 meeting. [Table: see text] No significant financial relationships to disclose.

Association between prayer activity, inflammation, and survival in advanced cancer patients (ACPs): A preliminary study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19602-e19602
Author(s):  
Carlos Eduardo Paiva ◽  
Bianca Sakamoto Ribeiro Paiva ◽  
Camila Souza Crovador ◽  
Sriram Yennurajalingam ◽  
David Hui
Keyword(s):  
Cox Regression ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Rank Test ◽  
Advanced Cancer Patients ◽  
Cancer Treatments ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Treatment Type ◽  
Spearman Test

e19602 Background: Prayers represent an important coping strategy among ACPs. The Religion Practice Questionnaire (RPQ) is a self-reported measure of religiosity validated in the Brazilian population, and includes a question assessing prayer activity. In this cross sectional prospective study, we determined the association among prayer activity, inflammation and survival in ACPs. Methods: Consecutive ACPs presenting for initial consultation at our Palliative Care Outpatient Clinic between March and December 2011 were enrolled. RPQ was administered by a research nurse, and consists of 15 items rated on a 5-point Likertscale (0=none, 5=very much). High prayer score (HPS) was defined as >3/5 for question 11 ("I make personal prayers – spontaneous communications with God"). Inflammatory markers included white blood cell (WBC), albumin and C-reactive protein (CRP). Correlation analysis was performed using Spearman test. Survival was calculated from study enrolment until death, and analyzed with log rank test and Cox regression model including age, sex, KPS, treatment type and HPS. Results: 112 patients were enrolled: average age 59 y (range 21-85), female 53% (N=59), Karnofsky performance status (KPS) ≤70 46% (N=51), most common cancers breast and upper GI (N=41, 37%), no longer on active cancer treatments 48% (N=54). All patients were Christians, and 77 (69%) had HPS. RPQ was not associated with WBC, albumin, CRP nor survival. HPS correlated with WBC (r=-0.24, p=0.02), and CRP (r=-0.26, p=0.01) but not albumin (r=0.18, p=0.08). Patients with HPS survived longer (median 198 d vs. 121 d, p=0.040), which remained significant in multivariate analysis (Table). Conclusions: The act of praying was associated with decreased inflammation and improved survival in ACPs. Further studies are necessary to confirm these findings. [Table: see text]

Hope in end-of-life cancer patients: A cross-sectional analysis

2021 ◽  
pp. 1-7
Author(s):  
Andrea Bovero ◽  
Marta Opezzo ◽  
Rossana Botto ◽  
Francesco Gottardo ◽  
Riccardo Torta
Keyword(s):  
End Of Life ◽  
Rating Scales ◽  
Depressive Symptomatology ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Depression Scale ◽  
Well Being ◽  
Religious Practice ◽  
Oncology Patients ◽  
Cross Sectional

Abstract Objective Hope promotes oncology patients’ adaptability to their illness, regardless of the stage of cancer. This study aimed to determine the prevalence of hope in a sample of end-of-life patients and to investigate the possible relationships between hope and a set of clinical and psychosocial measures. Method Three hundred and fifty end-of-life oncology patients, with a presumed life expectancy of 4 months or less and a Karnofsky Performance Status (KPS) of 50 or lower, were administered the Italian validated versions of a set of rating scales during their first consultation with a psychologist. This included the Herth Hope Index (HHI), Patient Dignity Inventory (PDI), Demoralization Scale (DS), Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy (FACIT-Sp), and the Visual Analogue Scale for pain (VAS). Results On average, the sample scored between moderate and high on the HHI and the average level of spirituality was high. However, most patients had clinically relevant anxious and depressive symptomatology and high levels of demoralization. Other than the pain scale, the total HHI score significantly correlated with the total scores of all rating scales and their subscales, as well as with the measure of personal religious practice. The “Meaning” FACIT-Sp subscale was found to be the main predictor of hope. Significance of results Since hope represents a core need and a tool for patients dealing with their illness, it is essential to implement stage-specific and realistic hope-facilitating interventions and support patients in their search for meaning, which promotes spiritual well-being and appears relevant in fostering hope.

scholarly journals Exploring demoralization in end-of-life cancer patients: Prevalence, latent dimensions, and associations with other psychosocial variables

2019 ◽  
Vol 17 (5) ◽  
pp. 596-603 ◽  
Author(s):  
Andrea Bovero ◽  
Rossana Botto ◽  
Beatrice Adriano ◽  
Marta Opezzo ◽  
Valentina Tesio ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Rating Scales ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Well Being ◽  
Physical Symptoms ◽  
Psychosocial Variables ◽  
Cross Sectional ◽  
Spiritual Well Being

AbstractObjectiveDemoralization is an existential distress syndrome that consists of an incapacity of coping, helplessness, hopelessness, loss of meaning and purpose, and impaired self-esteem. It can affect cancer patients, and the Demoralization Scale is a valid instrument to assess it. The present study aimed to investigate the prevalence of demoralization in end-of-life cancer patients and its associations with the medical and psychosocial variables. In addition, the latent dimensions of demoralization emerging in this distinctive population were explored.MethodThe study is cross-sectional. The sample consisted of 235 end-of-life cancer patients with a Karnofsky performance status (KPS) lower than 50 and a life expectancy of a few weeks. For each patient, personal and medical data was gathered by a palliative physician and a set of validated rating scales, assessing demoralization, anxiety, depression, physical symptoms, pain, spiritual well-being, and dignity, was administered by a psychologist during the first consultation.ResultSixty-four participants (27.2%) had low demoralization, 50.2% (n = 118) had medium demoralization, and 22.6% (n = 53) had high demoralization. Factor analysis evidenced a five-factor solution that identified the following demoralization factors: Emotional Distress and Inability to Cope, Loss of Purpose and Meaning, Worthlessness, Sense of Failure, and Dysphoria. All the considered variables were associated with demoralization, except for pain, nausea, breathing problems, and sociodemographic and clinical variables.Significance of resultsEnd-of-life cancer patients showed higher levels of demoralization than has been reported in other studies with advanced cancer. These data could suggest that demoralization could increase in proximity to death and with impaired clinical condition. In particular, the five demoralization dimensions that emerged could represent the typical concerns around which the syndrome evolves in end-of-life cancer patients. Finally, spiritual well-being could play a protective role with respect to demoralization.

scholarly journals Impact of mechanical ventilation on quality of life and functional status after ICU discharge: A cross-sectional study

2018 ◽  
Vol 64 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Patrini Silveira Vesz ◽  
Rafael Viegas Cremonese ◽  
Regis Goulart Rosa ◽  
Juçara Gasparetto Maccari ◽  
Cassiano Teixeira
Keyword(s):  
Quality Of Life ◽  
Mechanical Ventilation ◽  
Barthel Index ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Icu Discharge

Summary Objective: To evaluate the impact of the need for mechanical ventilation (MV) and its duration throughout ICU stay on the quality of life (QoL) and physical functional status (PFS) after the immediate ICU discharge. Method: This was a cross-sectional study including all subjects consecutively discharged from the ICU during 1-year period. During the first week after ICU discharge, QoL was assessed through WHOQoL-Bref questionnaire and PFS through the Karnofsky Performance Status and modified-Barthel index, and retrospectively compared with the pre-admission status (variation [Δ] of indexes). Results: During the study, 160 subjects met the inclusion criteria. Subjects receiving MV presented PFS impairment (Δ Karnofsky Performance Status [-19.7 ± 20.0 vs. -14.9 ± 18.2; p=0.04] and Δ modified-Barthel index [-17.4 ± 12.8 vs. -13.2 ± 12.9; p=0.05]) compared with those who did not receive MV. Duration of MV was a good predictor of PFS (Δ Karnofsky Performance Status [-14.6-1.12 * total days of MV; p=0.01] and Δ modified-Barthel index [-14.2-0.74 * total days of MV; p=0.01]). QoL, assessed by WHOQoL-Bref, showed no difference between groups (14.0 ± 1.8 vs. 14.5 ± 1.9; p=0.14), and the duration of MV did not influence QoL (WHOQoL-Bref scale [14.2-0.05* total days of MV; p=0.43]). Conclusion: Need for MV and duration of MV decrease patient PFS after ICU discharge.

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