Pub Date : 2017-09-03DOI: 10.1080/23809000.2017.1391049
E. D’Amico, T. Piccione, A. Biondo, G. Trizzino
There have been significant advances in accessing the benefits of palliative care for incurable illness. However, there are disparities in access to palliative care (PC), with the majority of services being offered by non-profit organizations (NPOs). In this short letter, we describe the PC services provided by SAMOT, which is a NPO operating in Sicily, Southern Italy. In 2014, the World Health Assembly Resolution on PC claimed to incorporate PC services into every health care system [1]. Briefly, PC can be described as a multidisciplinary approach with the goal to relieve the suffering of people with life-limiting illnesses and their families by the comprehensive assessment and treatment of physical, psychosocial, and spiritual symptoms [1,2]. Historically, PC services have focused on patients with incurable cancer, but the current view is that access to PC should be based on need rather than diagnosis [3]. Unfortunately, in many health care systems in Europe, PC services are not yet available to all patients with serious incurable diseases. In Sicily, the biggest island of Southern Italy with about 5 million inhabitants, a service of home PC (SAMOT onlus) was introduced in the 1980s with the goal of providing a comprehensive PC approach for people suffering from incurable diseases (and to their caregivers). SAMOT provides its PC services in five out of the nine regional areas of Sicily. In this short letter we describe the situation in the Palermo district. Our home PC services may be required by persons:
{"title":"Access to home palliative care services in Italy: the experience of the ‘SAMOT Onlus’ home care unit","authors":"E. D’Amico, T. Piccione, A. Biondo, G. Trizzino","doi":"10.1080/23809000.2017.1391049","DOIUrl":"https://doi.org/10.1080/23809000.2017.1391049","url":null,"abstract":"There have been significant advances in accessing the benefits of palliative care for incurable illness. However, there are disparities in access to palliative care (PC), with the majority of services being offered by non-profit organizations (NPOs). In this short letter, we describe the PC services provided by SAMOT, which is a NPO operating in Sicily, Southern Italy. In 2014, the World Health Assembly Resolution on PC claimed to incorporate PC services into every health care system [1]. Briefly, PC can be described as a multidisciplinary approach with the goal to relieve the suffering of people with life-limiting illnesses and their families by the comprehensive assessment and treatment of physical, psychosocial, and spiritual symptoms [1,2]. Historically, PC services have focused on patients with incurable cancer, but the current view is that access to PC should be based on need rather than diagnosis [3]. Unfortunately, in many health care systems in Europe, PC services are not yet available to all patients with serious incurable diseases. In Sicily, the biggest island of Southern Italy with about 5 million inhabitants, a service of home PC (SAMOT onlus) was introduced in the 1980s with the goal of providing a comprehensive PC approach for people suffering from incurable diseases (and to their caregivers). SAMOT provides its PC services in five out of the nine regional areas of Sicily. In this short letter we describe the situation in the Palermo district. Our home PC services may be required by persons:","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"233 - 234"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1391049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44134217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-03DOI: 10.1080/23809000.2017.1388165
Ramy Sedhom, Justin M Lebenthal, Daniel Sedhom
ABSTRACT Introduction: The scope of palliative care includes goal setting, management of symptoms in advanced illness, and psychosocial support for both patients and caregivers. Palliative care has gained appreciation as a necessity for end of life care for patients with several malignancies. Areas covered: In this review, we present a role for palliative care in the care of any cancer patient. Patients undergoing treatment for malignancy have many questions regarding life expectancy, tolerance of treatment, functional status, and social support deserving of personalized medicine. There have been many barriers from providers including poor training in communication and prognostication that limit advance care planning. Early integration of palliative care into cancer treatment is evidence based and has been shown to significantly improve morbidity and mortality, while allowing patients to maintain a greater quality of life. This review explores the challenges in cancer care, current trends in end of life care, and strategies to improve early integration of palliative care into cancer care. Expert commentary: The challenge of providing palliative care should be recognized as a national priority. Despite high quality evidence, there has been limited adoption in both the outpatient and inpatient setting. Integration is both a research and clinical priority.
{"title":"How can timing and efficacy of palliative care referrals be improved?","authors":"Ramy Sedhom, Justin M Lebenthal, Daniel Sedhom","doi":"10.1080/23809000.2017.1388165","DOIUrl":"https://doi.org/10.1080/23809000.2017.1388165","url":null,"abstract":"ABSTRACT Introduction: The scope of palliative care includes goal setting, management of symptoms in advanced illness, and psychosocial support for both patients and caregivers. Palliative care has gained appreciation as a necessity for end of life care for patients with several malignancies. Areas covered: In this review, we present a role for palliative care in the care of any cancer patient. Patients undergoing treatment for malignancy have many questions regarding life expectancy, tolerance of treatment, functional status, and social support deserving of personalized medicine. There have been many barriers from providers including poor training in communication and prognostication that limit advance care planning. Early integration of palliative care into cancer treatment is evidence based and has been shown to significantly improve morbidity and mortality, while allowing patients to maintain a greater quality of life. This review explores the challenges in cancer care, current trends in end of life care, and strategies to improve early integration of palliative care into cancer care. Expert commentary: The challenge of providing palliative care should be recognized as a national priority. Despite high quality evidence, there has been limited adoption in both the outpatient and inpatient setting. Integration is both a research and clinical priority.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"263 - 274"},"PeriodicalIF":0.0,"publicationDate":"2017-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1388165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46692850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-04DOI: 10.1080/23809000.2017.1368390
M. Raffaelli, L. Sessa, R. Bellantone
SummaryLymph node involvement is common in patients with papillary thyroid carcinoma. The knowledge of surgical techniques and classifications of the lymph node levels and of the surgical procedures is essential. Some concerns still exist regarding the indications and the extension of lymph node dissection both for central and lateral neck dissection. Central neck dissection is mandatory in case of macroscopic central neck nodal involvement. In patients with clinically node negative papillary thyroid carcinoma the role of prophylactic central neck dissection remains matter of debate. Regarding the lateral neck dissection the majority of guidelines recommend that it should be performed only with therapeutic intent. In spite of this consensus regarding the indications, the extension of therapeutic lateral neck dissection is still debated. In case of reoperation surgical strategy should be adequately planned in order to reduce the risk of potential complications achieving an optimal locoregional control of t...
{"title":"Concerns in patients undergoing neck dissection surgery","authors":"M. Raffaelli, L. Sessa, R. Bellantone","doi":"10.1080/23809000.2017.1368390","DOIUrl":"https://doi.org/10.1080/23809000.2017.1368390","url":null,"abstract":"SummaryLymph node involvement is common in patients with papillary thyroid carcinoma. The knowledge of surgical techniques and classifications of the lymph node levels and of the surgical procedures is essential. Some concerns still exist regarding the indications and the extension of lymph node dissection both for central and lateral neck dissection. Central neck dissection is mandatory in case of macroscopic central neck nodal involvement. In patients with clinically node negative papillary thyroid carcinoma the role of prophylactic central neck dissection remains matter of debate. Regarding the lateral neck dissection the majority of guidelines recommend that it should be performed only with therapeutic intent. In spite of this consensus regarding the indications, the extension of therapeutic lateral neck dissection is still debated. In case of reoperation surgical strategy should be adequately planned in order to reduce the risk of potential complications achieving an optimal locoregional control of t...","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"203 - 205"},"PeriodicalIF":0.0,"publicationDate":"2017-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1368390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42340325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-04DOI: 10.1080/23809000.2017.1347483
A. G. Guerreiro Stucklin, M. Zápotocký, V. Ramaswamy, E. Bouffet
ABSTRACT Introduction: Medulloblastoma is the most common malignant brain tumor in children but rare in adults. While pediatric tumors have been heavily studied, adult medulloblastoma remains an orphan disease, lacking dedicated studies. Older adolescents and young adults, in the gap between adult and pediatric treatment philosophies, represent an especially vulnerable population of patients. There is currently no consensus on the best treatment and virtually no data on impact on quality of life of patients with medulloblastoma diagnosed in adulthood. Areas covered: In this review, we summarize recent findings that illustrate the differences between pediatric and adult medulloblastoma, discuss treatment approaches, outline challenges and contemplate future directions of care for adolescents and adults with medulloblastoma. Expert commentary: Recent studies showed that adult and pediatric tumors are biologically and clinically distinct, as is the spectrum of treatment-related toxicities between the two age groups. While we should use lessons learned from pediatric studies to improve care of older patients, it is important to take into account age-specific prognostic factors and response to therapy. Given the rarity of the disease and the many questions that remain unanswered, it seems crucial to address them in multi-institutional prospective trials, ideally through cooperation between pediatric and adult institutions.
{"title":"Why it’s time for a change in the management of adolescent and adult medulloblastoma","authors":"A. G. Guerreiro Stucklin, M. Zápotocký, V. Ramaswamy, E. Bouffet","doi":"10.1080/23809000.2017.1347483","DOIUrl":"https://doi.org/10.1080/23809000.2017.1347483","url":null,"abstract":"ABSTRACT Introduction: Medulloblastoma is the most common malignant brain tumor in children but rare in adults. While pediatric tumors have been heavily studied, adult medulloblastoma remains an orphan disease, lacking dedicated studies. Older adolescents and young adults, in the gap between adult and pediatric treatment philosophies, represent an especially vulnerable population of patients. There is currently no consensus on the best treatment and virtually no data on impact on quality of life of patients with medulloblastoma diagnosed in adulthood. Areas covered: In this review, we summarize recent findings that illustrate the differences between pediatric and adult medulloblastoma, discuss treatment approaches, outline challenges and contemplate future directions of care for adolescents and adults with medulloblastoma. Expert commentary: Recent studies showed that adult and pediatric tumors are biologically and clinically distinct, as is the spectrum of treatment-related toxicities between the two age groups. While we should use lessons learned from pediatric studies to improve care of older patients, it is important to take into account age-specific prognostic factors and response to therapy. Given the rarity of the disease and the many questions that remain unanswered, it seems crucial to address them in multi-institutional prospective trials, ideally through cooperation between pediatric and adult institutions.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"207 - 213"},"PeriodicalIF":0.0,"publicationDate":"2017-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1347483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46213033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-04DOI: 10.1080/23809000.2017.1369045
L. Vanoverbeke, B. Sprangers
ABSTRACT Introduction: Checkpoint inhibitors have revolutionized the treatment of malignancies and are increasingly used in clinical practice. By inhibiting negative co-stimulatory signaling, checkpoint inhibitors result in augmented T cell activation and are, not surprisingly, commonly associated with various immune-related adverse events. Although renal immune-related adverse events are considered to be rare, these can be severe and sometimes require immunosuppressive treatment with or without discontinuation of checkpoint inhibitor therapy. Areas covered: In this review, we will focus on the diagnosis and management of checkpoint inhibitor-associated immune-related adverse events. We compile available data from published case reports and case series identified through an extensive search of PubMed, Web of Science and the Cochrane Library, and review of references of identified articles. Based on these data, we provide recommendations regarding renal monitoring in patients receiving checkpoint inhibitors and the treatment of these renal immune-related adverse events. Renal dysfunction in patients receiving checkpoint inhibitor treatment should not be readily attributed to checkpoint inhibitor treatment and a careful diagnostic work-up is needed in every affected patient. Expert commentary: We recommend performing a renal biopsy whenever important treatment decisions need to be taken to prevent unnecessary initiation of steroids and/or cessation of checkpoint inhibitory treatment.
摘要简介：检查点抑制剂已经彻底改变了恶性肿瘤的治疗，并越来越多地应用于临床实践。通过抑制负共刺激信号，检查点抑制剂导致T细胞活化增强，并且毫不奇怪，通常与各种免疫相关的不良事件有关。尽管肾脏免疫相关不良事件被认为是罕见的，但这些不良事件可能是严重的，有时需要免疫抑制治疗，无论是否停止检查点抑制剂治疗。涵盖领域：在这篇综述中，我们将重点关注检查点抑制剂相关免疫相关不良事件的诊断和管理。我们通过对PubMed、Web of Science和Cochrane图书馆的广泛搜索，以及对已鉴定文章的参考文献的审查，汇编了已发表的病例报告和病例系列的可用数据。基于这些数据，我们提供了关于接受检查点抑制剂的患者的肾脏监测以及这些肾脏免疫相关不良事件的治疗的建议。接受检查点抑制剂治疗的患者的肾功能障碍不应轻易归因于检查点抑制剂的治疗，需要对每个受影响的患者进行仔细的诊断检查。专家评论：我们建议在需要做出重要治疗决定时进行肾活检，以防止不必要地开始使用类固醇和/或停止检查点抑制性治疗。
{"title":"Management of checkpoint inhibitor-associated renal toxicities","authors":"L. Vanoverbeke, B. Sprangers","doi":"10.1080/23809000.2017.1369045","DOIUrl":"https://doi.org/10.1080/23809000.2017.1369045","url":null,"abstract":"ABSTRACT Introduction: Checkpoint inhibitors have revolutionized the treatment of malignancies and are increasingly used in clinical practice. By inhibiting negative co-stimulatory signaling, checkpoint inhibitors result in augmented T cell activation and are, not surprisingly, commonly associated with various immune-related adverse events. Although renal immune-related adverse events are considered to be rare, these can be severe and sometimes require immunosuppressive treatment with or without discontinuation of checkpoint inhibitor therapy. Areas covered: In this review, we will focus on the diagnosis and management of checkpoint inhibitor-associated immune-related adverse events. We compile available data from published case reports and case series identified through an extensive search of PubMed, Web of Science and the Cochrane Library, and review of references of identified articles. Based on these data, we provide recommendations regarding renal monitoring in patients receiving checkpoint inhibitors and the treatment of these renal immune-related adverse events. Renal dysfunction in patients receiving checkpoint inhibitor treatment should not be readily attributed to checkpoint inhibitor treatment and a careful diagnostic work-up is needed in every affected patient. Expert commentary: We recommend performing a renal biopsy whenever important treatment decisions need to be taken to prevent unnecessary initiation of steroids and/or cessation of checkpoint inhibitory treatment.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"215 - 223"},"PeriodicalIF":0.0,"publicationDate":"2017-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1369045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45224848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-04DOI: 10.1080/23809000.2017.1369850
L. Fallowfield, E. Nadler, I. Gilloteau, M. Greaney, A. Gater, L. Orsini, M. Subar, G. Lyman
ABSTRACT Background: Improved cancer care means that more patients are surviving longer, but there is a need to examine how well patients survive. We conducted an exploratory analysis of a new conceptual framework termed ‘quality of survival’ (QoS) that delineates the quality of patients’ experience. Methods: This project included an electronic database search to investigate the survivorship landscape and to create a visual QoS map and semi-structured interviews with patients (n = 35), clinicians (n = 40), and payers (n = 7) to support the QoS map. QoS was discussed in the context of two tumor types, metastatic non-small cell lung cancer and metastatic melanoma. Results: Despite increased long-term survival, no specific definition of QoS exists. Patients reported many impacts that affect QoS, clinicians viewed QoS as relevant to treatment decisions, and payers felt it could help communicate different aspects relevant to the patient. Four interconnected QoS dimensions were developed (quality of life, survival, side effects, and economic impact), which vary in importance along the care continuum. Conclusion: QoS is a patient-centric concept that could help decision-making and patient communication. The QoS map could provide a framework to monitor patient experience and help patients frame what treatment attribute is most important to them at any point in the cancer continuum.
{"title":"Quality of survival: a new concept framework to assess the quality of prolonged life in cancer","authors":"L. Fallowfield, E. Nadler, I. Gilloteau, M. Greaney, A. Gater, L. Orsini, M. Subar, G. Lyman","doi":"10.1080/23809000.2017.1369850","DOIUrl":"https://doi.org/10.1080/23809000.2017.1369850","url":null,"abstract":"ABSTRACT Background: Improved cancer care means that more patients are surviving longer, but there is a need to examine how well patients survive. We conducted an exploratory analysis of a new conceptual framework termed ‘quality of survival’ (QoS) that delineates the quality of patients’ experience. Methods: This project included an electronic database search to investigate the survivorship landscape and to create a visual QoS map and semi-structured interviews with patients (n = 35), clinicians (n = 40), and payers (n = 7) to support the QoS map. QoS was discussed in the context of two tumor types, metastatic non-small cell lung cancer and metastatic melanoma. Results: Despite increased long-term survival, no specific definition of QoS exists. Patients reported many impacts that affect QoS, clinicians viewed QoS as relevant to treatment decisions, and payers felt it could help communicate different aspects relevant to the patient. Four interconnected QoS dimensions were developed (quality of life, survival, side effects, and economic impact), which vary in importance along the care continuum. Conclusion: QoS is a patient-centric concept that could help decision-making and patient communication. The QoS map could provide a framework to monitor patient experience and help patients frame what treatment attribute is most important to them at any point in the cancer continuum.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"225 - 232"},"PeriodicalIF":0.0,"publicationDate":"2017-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1369850","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48491228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-04DOI: 10.1080/23809000.2017.1331705
S. McSorley, R. Dolan, C. Roxburgh, D. McMillan, P. Horgan
ABSTRACT Introduction: The presence of an innate host systemic inflammatory response has been reported to be a negative prognostic factor in a wide group of solid tumour types in both the operable and advanced setting, both local and distant. In addition, this host systemic inflammatory response is associated with both clinician reported patient performance status and self-reported measures of quality of life in patients with cancer. Areas covered: A variety of mechanisms are thought to underlie this, including the influence of the host immune response on physical symptoms such as pain and fatigue, its effect on organ systems associated with physical ability and well being such as skeletal muscle, and bone marrow. Furthermore, this innate inflammatory response is thought to have a direct negative impact on mood through its action on the central nervous system. Expert commentary: It is clear that the host systemic inflammatory response represents a target for intervention in terms of both improving quality of life and prognosis in patients with advanced cancer. Based on this paradigm, future research should focus both on pathways which might be targeted by novel agents, but also on whether existing anti-inflammatory drugs might be of benefit.
{"title":"How and why systemic inflammation worsens quality of life in patients with advanced cancer","authors":"S. McSorley, R. Dolan, C. Roxburgh, D. McMillan, P. Horgan","doi":"10.1080/23809000.2017.1331705","DOIUrl":"https://doi.org/10.1080/23809000.2017.1331705","url":null,"abstract":"ABSTRACT Introduction: The presence of an innate host systemic inflammatory response has been reported to be a negative prognostic factor in a wide group of solid tumour types in both the operable and advanced setting, both local and distant. In addition, this host systemic inflammatory response is associated with both clinician reported patient performance status and self-reported measures of quality of life in patients with cancer. Areas covered: A variety of mechanisms are thought to underlie this, including the influence of the host immune response on physical symptoms such as pain and fatigue, its effect on organ systems associated with physical ability and well being such as skeletal muscle, and bone marrow. Furthermore, this innate inflammatory response is thought to have a direct negative impact on mood through its action on the central nervous system. Expert commentary: It is clear that the host systemic inflammatory response represents a target for intervention in terms of both improving quality of life and prognosis in patients with advanced cancer. Based on this paradigm, future research should focus both on pathways which might be targeted by novel agents, but also on whether existing anti-inflammatory drugs might be of benefit.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"167 - 175"},"PeriodicalIF":0.0,"publicationDate":"2017-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1331705","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49568334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-04DOI: 10.1080/23809000.2017.1337469
S. Grammatico, F. Vozella, E. Scalzulli, G. D. Angelis, Maria Teresa Petrucci
ABSTRACT Introduction: The newer treatments approved for multiple myeloma patients have markedly improved the outcome and length of their lives. Areas covered: Over the last few years, based on these considerations, the evaluation of quality of life during cancer treatment has become extremely important. Symptoms due to myeloma at the onset, such as pain, fatigue, nausea, weight loss, disability, as well as the side effects of the treatment, can have a significant negative impact on their well-being and functioning. The development of multidimensional self-report quality of life instruments has allowed investigators to measure the adverse impact of the disease and its treatment. This can guide the physician in the choice of the most appropriate treatment and permits the refining of interventions to prevent or treat the adverse effects. Expert commentary: The routine use of quality of life instruments in clinical practice can improve the quality of care that patients receive, as well as their health status.
{"title":"Myeloma; living better and living longer - a look at the advances","authors":"S. Grammatico, F. Vozella, E. Scalzulli, G. D. Angelis, Maria Teresa Petrucci","doi":"10.1080/23809000.2017.1337469","DOIUrl":"https://doi.org/10.1080/23809000.2017.1337469","url":null,"abstract":"ABSTRACT Introduction: The newer treatments approved for multiple myeloma patients have markedly improved the outcome and length of their lives. Areas covered: Over the last few years, based on these considerations, the evaluation of quality of life during cancer treatment has become extremely important. Symptoms due to myeloma at the onset, such as pain, fatigue, nausea, weight loss, disability, as well as the side effects of the treatment, can have a significant negative impact on their well-being and functioning. The development of multidimensional self-report quality of life instruments has allowed investigators to measure the adverse impact of the disease and its treatment. This can guide the physician in the choice of the most appropriate treatment and permits the refining of interventions to prevent or treat the adverse effects. Expert commentary: The routine use of quality of life instruments in clinical practice can improve the quality of care that patients receive, as well as their health status.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"153 - 166"},"PeriodicalIF":0.0,"publicationDate":"2017-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1337469","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46750754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-04DOI: 10.1080/23809000.2017.1345308
G. Bates, J. Mostel, M. Hesdorffer
ABSTRACT Introduction: Mesothelioma is one of the only malignancies that has a direct correlation to asbestos exposure. Utilizing electron microscopy, asbestos fibers can be ascertained in the lungs of indviduals who have been exposed; through these means, approximately 80% of mesothelioma cases can be linked to asbestos exposure. Areas covered: The quality of care for mesothelioma survivors has yet to result in national guidelines, and there is a dearth of literature on the lived experience of the mesothelioma patient. This article will explore the challenges unique to mesothelioma, transitioning to long-term care, and the benefits of support network engagement. Expert commentary: Individuals diagnosed with mesothelioma are often challenged with having to navigate their post-active treatment care on their own. Complicated by the lack of support networks and clear guidelines, this results in poor emotional health. As treatments for mesothelioma and other cancers continue to be based on druggable targets rather than disease specific treatment, survivorship will need to redefined as those who are surviving a particular treatment rather than those surviving a mesothelioma diagnosis.
{"title":"Mesothelioma survivorship: challenges in delivering quality care","authors":"G. Bates, J. Mostel, M. Hesdorffer","doi":"10.1080/23809000.2017.1345308","DOIUrl":"https://doi.org/10.1080/23809000.2017.1345308","url":null,"abstract":"ABSTRACT Introduction: Mesothelioma is one of the only malignancies that has a direct correlation to asbestos exposure. Utilizing electron microscopy, asbestos fibers can be ascertained in the lungs of indviduals who have been exposed; through these means, approximately 80% of mesothelioma cases can be linked to asbestos exposure. Areas covered: The quality of care for mesothelioma survivors has yet to result in national guidelines, and there is a dearth of literature on the lived experience of the mesothelioma patient. This article will explore the challenges unique to mesothelioma, transitioning to long-term care, and the benefits of support network engagement. Expert commentary: Individuals diagnosed with mesothelioma are often challenged with having to navigate their post-active treatment care on their own. Complicated by the lack of support networks and clear guidelines, this results in poor emotional health. As treatments for mesothelioma and other cancers continue to be based on druggable targets rather than disease specific treatment, survivorship will need to redefined as those who are surviving a particular treatment rather than those surviving a mesothelioma diagnosis.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"2 1","pages":"177 - 180"},"PeriodicalIF":0.0,"publicationDate":"2017-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2017.1345308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41353279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-04DOI: 10.1080/23809000.2017.1324300
W. Gwin, L. Standish, M. Disis
The HER2+ breast cancer subtype accounts for 20–30% of cases and represents a particularly aggressive form of breast cancer. As this type of breast cancer is dependent on the HER2 receptor for proliferation, the introduction of the antiHER2 monoclonal antibody (mAb) trastuzumab revolutionized the management of HER2+ disease and remains the foundation of anti-HER2 treatment [1]. Despite this improvement in treatment, patients with advanced HER2+ disease will progress on trastuzumab. The primary antitumor activity of trastuzumab is mediated by the immune process of antibody (Ab)-dependent cellular cytotoxicity (ADCC) [2]. Functionally, ADCC occurs when the Fc portion of an Ab binds to the Fcg receptor of a natural killer (NK) cell, inducing NK cell cytokine release (interferon gamma (IFN-γ) and cytolysis of the Ab-bound cell. In HER2+ breast cancer, studies have shown that the functional activity of NK cells impacts the antitumor effects of trastuzumab [3]. In addition, treatment with trastuzumab affects the localization of NK cells as was shown in patients undergoing neoadjuvant chemo and trastuzumab therapy, where trastuzumab treatment was associated with a significant increase in the numbers of tumor-associated NK cells [4]. Despite these observations, NK cell function is inhibited in cancer patients by multiple mechanisms, including the secretion of the immunosuppressive transforming growth factor-beta cytokine release by tumors [5] and the downregulation of the activating NK cell CD16 receptor [6] (a critical receptor for ADCC). The presence of HER2-specific Type I or Th1 immunity is critical to antitumor efficacy in HER2+ disease as it represents an adaptive immune response that mediates a direct cytotoxic effect on tumor cells [7]. A recent study has documented that there is a progressive loss of a HER2specific Th1 immune response through growth of HER2+ breast cancer [8]. It has been demonstrated that trastuzumab induces HER2-specific Th1 immunity in a minority of patients (30%), and that levels of the induced HER2-specific T cell immunity are variable [9]. We have shown that HER2 vaccination can induce additional immune response above what is generated with trastuzumab such that 70% of patients develop HER2-specific immunity following trastuzumab and vaccination [9]. Clinically, this is an important observation as measurable HER2-specific immunity has been linked to improved survival in HER2+ breast cancer [10]. This finding has been shown in several studies, including a recent investigation that revealed in patients who received chemo + trastuzumab, Th1-nonresponsive patients had a worse disease-free survival (median, 47 vs. 113 months; P < .001) compared with Th1-responsive patients [10]. Our investigation into interventions to augment trastuzumab-mediated ADCC and HER2-specific Th1 immunity led us to polysaccharide krestin (PSK), an extract from the mycelium of the mushroom Trametes versicolor. First approved in the 1970s, PSK has been
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