A randomized controlled trial of expressive writing for patients with renal cell carcinoma (RCC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9029-9029
Author(s):  
Timothy Burnight ◽  
Christopher G. Wood ◽  
Nizar M. Tannir ◽  
Eric Jonasch ◽  
Louis L. Pisters ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Expressive Writing ◽  
Renal Cell ◽  
Statistical Significance ◽  
Intrusive Thoughts ◽  
Small Sample ◽  
Group Differences ◽  
Sf 36 ◽  
Time Point

9029 Background: Most previous research examining the efficacy of brief expressive writing interventions have used small sample sizes and followed people for no more than 3 months. We conducted a large randomized trial to examine an expressive writing intervention for patients with renal cell carcinoma and followed them for 10 months after the end of the writing sessions. Methods: Two hundred patients with RCC were randomly assigned to either write their deepest thoughts and feelings about their cancer (EW) or to write about neutral topics (NW) on four separate occasions over 10 days for a maximum of 20 minutes at each writing session. Patients completed the MD Anderson Symptom Inventory (MDASI), Brief Fatigue Inventory, SF-36, IES, CES-D, and PSQI at baseline and then again 1, 4, and 10 months after the writing sessions. Results: The mean age of the participants was 58 (range 34-82 years), 41% were women, and staging data were 39% stage I, 15% stage II, 19% stage III, and 27% stage IV. The groups were well balanced on all demographic and medical characteristics. Examination of group differences 1 month after the writing sessions, controlling for the respective baseline measure, revealed decreased IES scores for the EW group (intrusive thoughts: EW, 5.0 v NW, 7.2; p<.02; avoidance behaviors: EW, 6.3 v NW, 8.7; p<.07). By 4 months after the intervention, the EW group reported higher levels of SF-36 Social Functioning scores (EW: 52.6 v NW: 49.7; p<.04). At the 10 month time point, the EW group reported fewer cancer-related symptoms (EW: 20.8 v NW: 30.8; p<.04), higher levels of SF-36 Role Physical scores (EW: 69.6 v NW: 54.0; p<.02), and fewer sleep disturbances (subscale of the PSQI; EW: 1.4 v NW: 1.6; p<.05). Means for the other SF-36 subscales at 10 months were in the expected, but did not reach statistical significance. There were no group differences for CES-D or fatigue scores at any time point. Mediation analyses revealed that IES scores at 1 month mediated the effects of EW on cancer-related symptoms (F= 1.85, p<.06) at the 10 month follow up. Conclusions: These findings indicate expressive writing leads to short-term reduction in intrusive thoughts about the cancer experience and results in long-term improvement in aspects of quality of life.

scholarly journals Randomized Controlled Trial of Expressive Writing for Patients With Renal Cell Carcinoma

2014 ◽  
Vol 32 (7) ◽  
pp. 663-670 ◽  
Author(s):  
Kathrin Milbury ◽  
Amy Spelman ◽  
Christopher Wood ◽  
Surena F. Matin ◽  
Nizar Tannir ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Randomized Controlled Trial ◽  
Cell Carcinoma ◽  
Expressive Writing ◽  
Renal Cell ◽  
Controlled Trial ◽  
Group Differences ◽  
Significant Group ◽  
Randomized Controlled ◽  
Sf 36

Purpose This randomized controlled trial examined the quality-of-life benefits of an expressive writing (EW) intervention for patients with renal cell carcinoma (RCC) and identified a potential underlying mechanism of intervention efficacy. Patients and Methods Patients (N = 277) with stage I to IV RCC were randomly assigned to write about their deepest thoughts and feelings regarding their cancer (EW) or about neutral topics (neutral writing [NW]) on four separate occasions. Patients completed the Center for Epidemiologic Studies Depression Scale (CES-D), MD Anderson Symptom Inventory (MDASI), Brief Fatigue Inventory (BFI), Pittsburgh Sleep Quality Index (PSQI), Medical Outcomes Study Short Form-36 (SF-36), and Impact of Event Scale (IES) at baseline and 1, 4, and 10 months after the intervention. Results The mean age of participants (28% stage IV; 41% female) was 58 years. Multilevel modeling analyses, using a Bonferroni-corrected α = .021 for six outcomes adjusted for the correlation among outcomes, revealed that, relative to the NW group, patients in the EW group reported significantly lower MDASI scores (P = .003) and higher physical component summary scores on the SF-36 (P = .019) at 10 months after the intervention. Mediation analyses revealed that significant group differences for MDASI scores at 10 months were mediated by lower IES scores at 1 month after the intervention in the EW group (P = .042). No significant group differences were observed in the BFI, CES-D, PSQI, and mental component summary of the SF-36. Conclusion EW may reduce cancer-related symptoms and improve physical functioning in patients with RCC. Evidence suggests that this effect may occur through short-term improvements in cognitive processing.

scholarly journals Examination of moderators of expressive writing in patients with renal cell carcinoma: the role of depression and social support

2016 ◽  
Vol 26 (9) ◽  
pp. 1361-1368 ◽  
Author(s):  
Kathrin Milbury ◽  
Gabriel Lopez ◽  
Amy Spelman ◽  
Christopher Wood ◽  
Surena F. Matin ◽  
...  
Keyword(s):  
Social Support ◽  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Expressive Writing ◽  
Renal Cell

Histopathology in surgically treated renal cell carcinoma: Is there a survival difference when stratified by stage?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5089-5089
Author(s):  
K. A. Keegan ◽  
N. J. Hellenthal ◽  
K. Chamie ◽  
T. M. Koppie
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Clear Cell ◽  
Collecting Duct ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Cancer Specific Survival ◽  
Stage Disease ◽  
The Impact

5089 Background: The impact of renal cell carcinoma histopathology (RCC) on survival has been conflicting and limited to retrospective institutional studies. Therefore, we sought to determine the role of RCC histopathology on stage-specific survival rates in a population-based cohort. Methods: We utilized the National Cancer Institute's Surveillance, Epidemiology, and End Results database and identified 21,258 patients who underwent partial or radical nephrectomy for RCC between 1996 and 2004. Patients were stratified based on histopathologic diagnosis (clear cell, papillary, chromophobe, sarcomatoid, and collecting duct) and pathologic stage. We performed Cox-proportional hazard modeling and Kaplan-Meier survival analyses to determine overall- and cancer-specific survival. Results: Using univariate analysis, histopathology significantly impacted overall- and cancer-specific survival (p< 0.001). Specifically, patients with papillary and chromophobe variants had lower stage disease at the time of surgery and had improved survival compared to clear cell subtypes, (HR: 0.50; 95% CI, 0.42–0.60 and HR: 0.31; 95% CI, 0.22–0.44, respectively). When controlled for stage, improved outcomes for chromophobe and papillary histologies persisted, although it did not achieve statistical significance at all stages. On the other hand, patients with sarcomatoid disease were more likely to present with high stage disease and invariably had worse survival compared to clear cell carcinoma (HR: 8.74; 95%, CI 7.70–9.91). When controlled for stage, this difference achieved statistical significance across all stages (p< 0.001). Conclusions: Histopathologic subtype in patients with RCC does predict overall- and cancer-specific survival. Patients with sarcomatoid RCC, even those presenting with low-stage disease, have poor survival. These findings may give further value to recent data suggesting the increased utility of percutaneous renal biopsy and its potential impact on management. [Table: see text] No significant financial relationships to disclose.

Comparison of the 2002 and 2010 version of the TNM classification system regarding the prediction of metastasis-free survival in patients with renal cell carcinoma.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 448-448
Author(s):  
Georg C. Hutterer ◽  
Martin Pichler ◽  
Thomas F. Chromecki ◽  
Johanna Jesche ◽  
Karin Kampel-Kettner ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Classification System ◽  
Primary Tumor ◽  
Renal Cell ◽  
Tnm Classification ◽  
Statistical Significance ◽  
Predictive Ability ◽  
Pairwise Comparisons ◽  
Free Survival

448 Background: A new version of the TNM classification system for renal cell carcinoma (RCC) has been introduced in 2010 by the American Joint Committee on Cancer (AJCC). However, data for it’s ability to predict metastasis-free survival in RCC patients from validation studies of independent cohorts are sparse. Therefore, we decided to compare the predictive ability of the 2010 vs. the 2002 version of the TNM classification system. Methods: Pathological reports of 2595 patients with uni- or bilateral synchronous non-metastatic (pT1-4N0M0) RCCs, treated with radical nephrectomy or nephron sparing surgery between 1984 and 2010 at a single tertiary academic center, were re-evaluated. Metastasis-free survival (MFS) was assessed using the Kaplan-Meier method and pairwise log-rank tests. Results: Mean follow up was 95 (0-322) months and 430 (16.6%) patients were found to develop metastatic disease from RCC. Pairwise comparisons revealed statistically significant differences in MFS between adjacent 2002 primary tumor classifications, including pT1a vs. pT1b (p<0.001), pT1b vs. pT2 (p=0.029), pT3a vs. pT3b (p<0.001), and pT3c vs. pT4 (p=0.007) but excluding, pT2 vs. pT3a (p=0.963) and pT3b vs. pT3c (p=0.968). With the changes to the 2010 primary tumor classification different trends in statistical significance were observed in pairwise comparisons, including pT1a vs. pT1b (p<0.001), pT3a vs. pT3b (p=0.001) but excluding pT1b vs. pT2a (p=0.062), pT2a vs. pT2b (p=0.856), pT2b vs. pT3a (p=0.395), pT3b vs. pT3c (p=0.891) and pT3c vs. pT4 (p=0.933). Conclusions: The 2010 version of the TNM classification system remains a robust predictor of MFS compared to the 2002 version. However, the 2010 version showed less discriminative power in higher pT-stages compared to the 2002 version of the TNM classification system.

Active surveillance in asymptomatic or minimally symptomatic renal cell carcinoma: Retrospective analyses of a cohort of three oncological centers from Spain.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 441-441
Author(s):  
Maria Jove ◽  
Olatz Etxaniz ◽  
Nuria Sala ◽  
Albert Font ◽  
Laura Jimenez Colomo ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Active Surveillance ◽  
Renal Cell ◽  
Cox Regression ◽  
Statistical Significance ◽  
Descriptive Analysis ◽  
Sequential Therapy ◽  
Therapy Strategy ◽  
The Impact

441 Background: Some patients (pt) with metastatic renal cell carcinoma (mRCC) have an indolent course. Treatment toxicities can worsen quality of life. Active surveillance (AS) in paucisymptomatic pts is an option often used but few data is available. Our aim is to analyze the impact of initial AS in a sequential therapy strategy in terms of overall survival (OS). Methods: Data frompt diagnosed with mRCC from January 2005 to December 2013 in 3 centres of Spain were retrospectively analyzed. AS subgroup was defined as pt with ≥6 months (m) between diagnosis and first-line (L) treatment (tto) start. A descriptive analysis and median OS (mOS) were performed comparing pt with or without AS (AS vs. tto <6m). OS curve and medians were estimated using Kaplan Meier Method. A multivariate cox regression analyses with different prognostic factors was also realized. Results: From a cohort of 277 pt with mRCC, 69 pt (25%) were on initial AS and 208 pts on tto <6m (75%). Median time on observation until systemic tto was started on pt on AS was 14 m 95%CI (17.6-26.02). Pt characteristics of AS vs tto <6 m were: median age 63/60; males 70/72%; histology: 94/76% clear cell, 3/12% papillar, 0/4% chromophob; M1 at diagnosis: 22/48%; prognosis (Heng risk criteria): 0/17.% poor, 38.5/57% intermediate, 61.5/25% good; prior nephrectomy: 93/73%; number of metastatic locations (loc): 87/68% ≤2 loc, 12.5/32.5% ≥3 loc; lines of treatment: first L 46/53%, second L 38/23%, and third L 16/24%. When comparing exposure in months to each tto L, pt on AS had longer period of tto in second L (10.06/4.14 m, p=0.014). mOS were: 62 m 95%CI (52.97-71.03) vs. 22 m 95% CI (19.87-24.12) for AS/tto <6 m respectively (p<0.001) with statistical significance after multivariate analysis (Cox regression, HR=0.39; 95% CI, 0.25-0.63). Factors that independently influence on OS were: ≥2 M1 sites and papillar histology, negatively, and prior nephrectomy and >1 year from diagnosis to M1, positively. Conclusions: Our results suggest that AS before starting first L of tto is not a detrimental action in a selected population of mRCC pt with good risk characteristics allowing them to remain free of therapy’s toxicity during a long time period.

scholarly journals Interconnection: A qualitative analysis of adjusting to living with renal cell carcinoma

2017 ◽  
Vol 16 (2) ◽  
pp. 146-154 ◽  
Author(s):  
Isabel Leal ◽  
Kathrin Milbury ◽  
Joan Engebretson ◽  
Surena Matin ◽  
Eric Jonasch ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Qualitative Analysis ◽  
Cell Carcinoma ◽  
Expressive Writing ◽  
Renal Cell ◽  
Nonlinear Process ◽  
Psychosocial Needs ◽  
Ongoing Process ◽  
Finding Meaning ◽  
Living With Cancer

ABSTRACTObjective:Adjusting to cancer is an ongoing process, yet few studies explore this adjustment from a qualitative perspective. The aim of our qualitative study was to understand how patients construct their experience of adjusting to living with cancer.Method:Qualitative analysis was conducted of written narratives collected from four separate writing sessions as part of a larger expressive writing clinical trial with renal cell carcinoma patients. Thematic analysis and constant comparison were employed to code the primary patterns in the data into themes until thematic saturation was reached at 37 participants. A social constructivist perspective informed data interpretation.Results:Interconnection described the overarching theme underlying the process of adjusting to cancer and involved four interrelated themes: (1) discontinuity—feelings of disconnection and loss following diagnosis; (2) reorientation—to the reality of cancer psychologically and physically; (3) rebuilding—struggling through existential distress to reconnect; and (4) expansion—finding meaning in interconnections with others. Participants related a dialectical movement in which disruption and loss catalyzed an ongoing process of finding meaning.Significance of results:Our findings suggest that adjusting to living with cancer is an ongoing, iterative, nonlinear process. The dynamic interactions between the different themes in this process describe the transformation of meaning as participants move through and revisit prior themes in response to fluctuating symptoms and medical news. It is important that clinicians recognize the dynamic and ongoing process of adjusting to cancer to support patients in addressing their unmet psychosocial needs throughout the changing illness trajectory.

scholarly journals Survival Outcomes and Tumor IMP3 Expression in Patients with Sarcomatoid Metastatic Renal Cell Carcinoma

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Srinivas K. Tantravahi ◽  
Daniel Albertson ◽  
Archana M. Agarwal ◽  
Sowmya Ravulapati ◽  
Austin Poole ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Small Sample Size ◽  
Mtor Inhibitors ◽  
Risk Groups ◽  
Small Sample ◽  
Cancer Center ◽  
Survival Outcomes

Metastatic renal cell carcinoma with sarcomatoid histology (SmRCC) is associated with poor survival. No data is available from randomized trials on the efficacy of vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) inhibitors in SmRCC. We identified SmRCC patients from a single institutional database. To identify predictive and prognostic biomarkers, immunohistochemistry (IHC) analysis was performed on the tumor samples for downstream targets of VEGF and mTOR pathways. Survival outcomes were stratified by IHC analysis, extent of sarcomatoid component, Memorial Sloan-Kettering Cancer Center (MSKCC), and Heng risk criteria. Twenty-seven patients with SmRCC were included. First line therapy included targeted therapy (n=19), immunotherapy (n=4), cytotoxic chemotherapy (n=1), and no treatment (n=3). Median OS was 8.2 months (95% CI 3.8–14.2 months). Median survival in months, based on MSKCC and Heng risk groups, was favorable 89.3 versus 84.5, intermediate 9.5 versus 12.7, and poor 3.9 versus 5.1. None of the IHC markers predicted outcomes of treatment with VEGF or mTOR inhibitors. Only tumor IMP3 expression was associated with inferior OS, although not statistically significant (IMP3 negative 14.2 versus IMP3 positive 4.9 months; HR 0.46, 95% CI 0.16–1.21;P=0.12). The study was limited by small sample size.

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