scholarly journals Interest and Attitudes of Patients With Advanced Cancer With Regard to Secondary Germline Findings From Tumor Genomic Profiling

2017 ◽  
Vol 13 (7) ◽  
pp. e590-e601 ◽  
Author(s):  
Jada G. Hamilton ◽  
Elyse Shuk ◽  
Margaux C. Genoff ◽  
Vivian M. Rodríguez ◽  
Jennifer L. Hay ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Medical Science ◽  
Genomic Profiling ◽  
Inherited Disease ◽  
Science And Society ◽  
Secondary Findings ◽  
Potential Health ◽  
Patients With Cancer ◽  
Semistructured Interviews ◽  
Disease Risks

Purpose: Tumor genomic profiling (TGP) can reveal secondary findings about inherited disease risks in a patient with cancer. Little is known about how patients with advanced cancer, currently the primary users of TGP, perceive the benefits and harms of secondary germline findings. Methods: We conducted semistructured interviews with 40 patients with advanced breast, bladder, colorectal, or lung cancer who had TGP. Qualitative interview data were evaluated by using a thematic content analysis approach. Results: Most participants expressed interest in the prospect of learning their secondary germline findings (57%), although a minority was equivocal (29%) or disinterested (14%). Reasons for these preferences varied but were influenced by participants’ perceptions of diverse benefits and harms of this information, which they regarded as relevant to themselves; their families; and other patients with cancer, medical science, and society. These attitudes were uniquely shaped by participants’ personal disease experiences and health status. Conclusion: Many patients with advanced cancer are interested in learning secondary germline findings and hold optimistic and perhaps unrealistic beliefs about the potential health benefits. Patients also have important concerns about clinical and emotional implications of this information. These perceptions are necessary to address to ensure that patients make informed decisions about learning secondary germline findings.

scholarly journals Decision-Making Preferences About Secondary Germline Findings That Arise From Tumor Genomic Profiling Among Patients With Advanced Cancers

2017 ◽  
pp. 1-13 ◽  
Author(s):  
Jada G. Hamilton ◽  
Elyse Shuk ◽  
Margaux Genoff Garzon ◽  
Vivian M. Rodríguez ◽  
Joy Westerman ◽  
...  
Keyword(s):  
Decision Making ◽  
Information Needs ◽  
Vital Role ◽  
Optimal Decision ◽  
Specific Information ◽  
Genomic Profiling ◽  
Inherited Disease ◽  
Decision Making Processes ◽  
Disease Risks ◽  
Communication Interventions

Purpose In patients with advanced cancers, tumor genomic profiling (TGP) can reveal secondary germline findings (SGFs) with regard to inherited disease risks. This study examined the process by which patients with advanced cancers would decide about whether to learn these SGFs and their preferences about specific challenging decision scenarios, including whether patients should be required to receive SGFs and whether SGFs should be returned to the family after a patient’s death. Patients and Methods We conducted qualitative semistructured interviews with 40 patients with advanced breast, bladder, colorectal, or lung cancer who had undergone TGP. Data were collected on participants’ perspectives about the hypothetical decision to learn their SGFs, including their anticipated approach to the decision-making process, and their preferences about challenging decision scenarios. Data were evaluated by thematic content analysis. Results We identified themes with regard to participants’ preferred degree of decisional autonomy, perceived vital role of doctors, information needs, and anticipated process of deliberation. Although participants reported that this decision was ultimately their own, many wanted input from family and trusted others. Oncologists were expected to provide decision guidance and key clarifying information. Most participants stated that patients should be able to make a choice about receiving actionable SGFs, and a majority stated that SGFs should be available to family after a patient’s death. Conclusion These results provide insight into SGF decision-making processes of patients with advanced cancers, which can allow clinicians to provide patients with optimal decision support in this context. Patients with advanced cancers have specific information needs and decision-making preferences that educational and communication interventions should address to ensure that patients make informed choices about learning SGFs.

STEROIDSTOFFWECHSEL BEI BRUSTKREBS. III.

1959 ◽  
Vol XXXII (I) ◽  
pp. 23-32 ◽  
Author(s):  
Kurt Schubert ◽  
Hans Schröder
Keyword(s):  
Advanced Cancer ◽  
Liver Damage ◽  
Adsorption Chromatography ◽  
Hepatic Insufficiency ◽  
Loading Test ◽  
Patients With Cancer ◽  
Urinary Steroids ◽  
Normal Women

ABSTRACT A testosterone test using two different dosages was carried out simultaneously in 7 women suffering from metastasizing carcinoma of the mamma and in 3 normal women. In each case the urinary steroids were estimated before the beginning of the test and after administration of 50 mg and 100 mg of testosterone respectively; the interval between the single estimations being one week. The use of fractionated hydrolysis enabled a mild fission of the conjugates and the classification of the products into free steroids, glucuronosides, sulfates and unknown conjugates. The 17-ketosteroids and the testosterone were estimated by means of Girard's separation and adsorption chromatography. During the loading test with testosterone different behaviours became evident, which had not been realized before. The behaviour of the 17-ketosteroids rendered possible the differentiation of normal women from patients with cancer of the breast yet without hepatic insufficiency, and furthermore of these latter ones from those with a liver damage in addition to the cancer of the breast. The glucuronosides of the 17-ketosteroids are only depressed, when there exists a pronounced damage of the liver; the loading test making possible an extension of the range of recognizable damages. Furthermore, the behaviour of dehydroepiandrosterone (II/III), of androsterone (IV), and of aetiocholanolone (V) lends itself to this differentiation. In advanced cancer of the breast the values of II/III are invariably low, whilst IV and V often increase temporarily. The relation of IV to V may be altered in a different way. The excretion of not transformed testosterone is less in patients than in normal women and especially low in patients with liver damage.

Age affects the efficacy of immune checkpoint inhibitors in patients with advanced cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 2638-2638
Author(s):  
Yongjie Wang ◽  
Ronghua Yang ◽  
Dong Wang ◽  
Donghua Zhao ◽  
Peng Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Advanced Cancer ◽  
Immune Checkpoint ◽  
Older Patients ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Sign Test ◽  
Patients With Cancer ◽  
The Impact ◽  
Effect Of Age

2638 Background: Immune checkpoint inhibitors (ICIs), such as programmed death(ligand)1 (PD-(L)1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors, have dramatic effects on treatment in patients with various malignancies. High tumor mutation burden (TMB) is predictive of clinical response to ICI in multiple cancer types. Although age-related immune dysfunction might induce difference on the efficacy of ICIs between younger and older patients, the potential effect of age on the efficacy of ICIs remains little known and controversial. Herein, we aimed to analysis the association between age and the efficacy of ICIs based on MSKCC cohort. Methods: We screened out 1661 patients having complete information with advanced cancer, whose tumors underwent next-generation sequencing (NGS) detection and who were treated with at least one dose of ICI in MSKCC cohort. All patients were divided into two groups according to age, the younger group (age ≤50-year old) and the older group (age > 50-year old). We further analyzed the differences in overall survival (OS) and TMB between the two groups. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated via Cox regression model for OS and P-values were calculated via the Wilcoxon sign test for TMB. We analyzed the effect of age on ICI in lung cancer using the same way. Results: In 1661 patients with cancer in our study, 312 (19%) younger and 1349 (81%) older patients were found. The pooled HRs for OS was 1.28 (95% CI: 1.09-1.52) in younger group compared with older group. In 1661 patients with cancer, there was 350 (21%) patients with lung cancer, including 30 (9%) younger and 320 (91%) older patients. The pooled HRs for OS was 1.45 (95% CI: 0.95-2.23) in younger group compared with older group in lung cancer. In addition, TMB in older group was higher than in younger group and significant difference of TMB was found via the Wilcoxon sign test (p = 2.6e-10) between the two groups, especially in lung cancer (p = 1e-4). Conclusions: Our study assessed the impact of age on the efficacy of ICIs using the threshold of 50 years old for the first time and we founded that patients in older group had higher TMB and longer OS than younger group.

Meaning-Centered Psychotherapy

2021 ◽  
pp. 489-494
Author(s):  
Melissa Masterson Duva ◽  
Wendy G. Lichtenthal ◽  
Allison J. Applebaum ◽  
William S. Breitbart
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Psychosocial Care ◽  
Well Being ◽  
Cancer Center ◽  
Existential Psychology ◽  
Patients With Cancer ◽  
Spiritual Well Being ◽  
The Face

Existential concerns carry significant distress, particularly among patients with advanced cancer. For patients who are facing death, a sense of meaning—and the preservation of that meaning—is not only clinically and existentially important but also central to providing holistic, high-quality end-of-life care. Nearly two decades ago, the authors’ research group at Memorial Sloan Kettering Cancer Center began to understand that a meaning-centered approach to psychosocial care was imperative to alleviate the existential distress that plagued many patients with advanced cancer. Based on Viktor Frankl’s work on the importance of meaning and principles of existential psychology and philosophy, they developed Meaning-Centered Psychotherapy (MCP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace, and purpose in their lives in the face of terminal cancer. This chapter provides an overview of MCP in working with patients with cancer. It summarizes the ever-growing body of research that has demonstrated the effectiveness of MCP in improving meaning, spiritual well-being, and quality of life and in reducing psychological distress and despair at end of life. Adaptations of MCP for other purposes and populations, such as cancer survivors, caregivers, and bereavement, are mentioned but are elaborated on in other specific chapters related to these issues in this textbook.

Integrated genomic profiling expands clinical options for patients with cancer

2019 ◽  
Vol 37 (11) ◽  
pp. 1351-1360 ◽  
Author(s):  
Nike Beaubier ◽  
Martin Bontrager ◽  
Robert Huether ◽  
Catherine Igartua ◽  
Denise Lau ◽  
...  
Keyword(s):  
Genomic Profiling ◽  
Patients With Cancer

scholarly journals Patterns of Opioid Prescription, Use, and Costs Among Patients With Advanced Cancer and Inpatient Palliative Care Between 2008 and 2014

2019 ◽  
Vol 15 (1) ◽  
pp. e74-e83 ◽  
Author(s):  
Sriram Yennurajalingam ◽  
Zhanni Lu ◽  
Suresh K. Reddy ◽  
EdenMae C. Rodriguez ◽  
Kristy Nguyen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
Patient Characteristics ◽  
Opioid Prescription ◽  
Patients With Cancer ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
Symptom Changes

PURPOSE: An understanding of opioid prescription and cost patterns is important to optimize pain management for patients with advanced cancer. This study aimed to determine opioid prescription and cost patterns and to identify opioid prescription predictors in patients with advanced cancer who received inpatient palliative care (IPC). MATERIALS AND METHODS: We reviewed data from 807 consecutive patients with cancer who received IPC in each October from 2008 through 2014. Patient characteristics; opioid types; morphine equivalent daily dose (MEDD) in milligrams per day of scheduled opioids before, during, and after hospitalization; and in-admission opioid cost per patient were assessed. We determined symptom changes between baseline and follow-up palliative care visits and the in-admission opioid prescription predictors. RESULTS: A total of 714 (88%) of the 807 patients were evaluable. The median MEDD per patient decreased from 150 mg/d in 2008 to 83 mg/d in 2014 ( P < .001). The median opioid cost per patient decreased and then increased from $22.97 to $40.35 over the 7 years ( P = .03). The median MEDDs increased from IPC to discharge by 67% ( P < .001). The median Edmonton Symptom Assessment Scale pain improvement at follow-up was 1 ( P < .001). Younger patients with advanced cancer (odds ratio [OR[, 0.95; P < . 001) were prescribed higher preadmission MEDDs (OR, 1.01; P < .001) more often in the earlier study years (2014 v 2009: OR, 0.18 [ P = .004] v 0.30 [ P = .02]) and tended to use high MEDDs (> 75 mg/d) during hospitalization. CONCLUSION: The MEDD per person decreased from 2008 to 2014. The opioid cost per patient decreased from 2008 to 2011 and then increased from 2012 to 2014. Age, prescription year, and preadmission opioid doses were significantly associated with opioid doses prescribed to patients with advanced cancer who received IPC.

Hospice Use Among Patients With Cancer: Trends, Barriers, and Future Directions

2020 ◽  
Vol 16 (12) ◽  
pp. 803-809
Author(s):  
Mihir N. Patel ◽  
Jonathan M. Nicolla ◽  
Fred A.P. Friedman ◽  
Michala R. Ritz ◽  
Arif H. Kamal
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Hospice Care ◽  
Rapid Development ◽  
Spiritual Needs ◽  
Life Care ◽  
General Acceptance ◽  
Patients With Cancer ◽  
Hospice Use

Patients with advanced cancer and their families frequently encounter clinical and logistical challenges related to end-of-life care. Hospice provides interdisciplinary and holistic care to meet patients’ biomedical, psychosocial, and spiritual needs in the last phases of life. Despite increasing general acceptance and use among patients with cancer, hospice remains underused. Underuse stems from ongoing misconceptions regarding hospice and its purpose, coupled with the rapid development of novel anticancer treatments, such as immunotherapies and targeted therapies, that have changed the landscape of possibilities. Furthermore, rapid evolutions in how end-of-life care is structured and reimbursed for will affect how oncology patients will intersect with hospice care. In this review, we explore the current and future challenges to greater integration of hospice care in the care of patients with advanced cancer and propose five recommendations as part of the path forward.

Reproduction in dogs part 1: surgical and non-surgical de-sexing options

2020 ◽  
Vol 25 (7) ◽  
pp. 1-9
Author(s):  
Vicki J Adams
Keyword(s):  
Population Control ◽  
Gonadotropin Releasing Hormone ◽  
Common Method ◽  
Potential Health ◽  
Releasing Hormone ◽  
Gonadotropin Releasing Hormone Agonist ◽  
Surgical Methods ◽  
Surgical Options ◽  
Disease Risks ◽  
Control Disease

This article summarises the surgical and non-surgical options for desexing dogs, using standardised terminology by defining the meaning of commonly used terms. Desexing has been historically recommended to help with population control, disease prevention and behaviour modification. Surgical methods of gonadectomy are the most common method for desexing in both owned and unowned dogs, with orchiectomy being the most common method of desexing male dogs. Surgical methods of desexing in females may refer to ovariohysterectomy, ovariectomy, salpingectomy or hysterectomy with or without an ovarian autograft (referred to as a so-called ‘ovary-sparing spay’). Non-surgical desexing methods include three broad categories: hormonal, immunological, and chemical or physical methods. The use of a gonadotropin-releasing hormone agonist as a method of inducing reversible infertility in dogs is discussed in detail, including a review of the physiological effects of surgical gonadectomy compared to a gonadotropin-releasing hormone agonist and potential health effects of each. There is a growing body of literature on the disease risks associated with whether a dog is intact or desexed, and by which method it has been desexed. This will be discussed in the next article.

Identifying the public health benefits of livestock-dependent, agro-ecosystems under climate change

2013 ◽  
Vol 14 (2) ◽  
pp. 155-158 ◽  
Author(s):  
Shana Gillette
Keyword(s):  
Public Health ◽  
Urban Areas ◽  
Health Benefits ◽  
Cost Savings ◽  
Small Scale ◽  
Disease Avoidance ◽  
Potential Health ◽  
The Public ◽  
Disease Risks ◽  
Livestock Systems

AbstractAs the demand for meat continues to grow in South Asia and Africa and access to communal sources of water and forage shrinks, intensification of small-scale livestock systems in peri-urban areas is expected to expand. In South East Asia, smallholder transition to livestock intensification has been transformative, increasing economic opportunities while also introducing new disease risks. While we have an understanding of the emerging disease burden from livestock intensification; we have just begun to understand the possible public health benefits of sustainable landscapes and the potential health savings accrued from disease avoidance. To date, few studies have attempted to quantify the health benefits attributable to sustainable agro-ecosystems, especially in regard to livestock systems. In this paper, I will examine what is needed to measure and communicate the public health benefits and cost-savings (from disease avoidance) of sustainable agro-ecosystems.

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