Managing cancer‐related fatigue in men with prostate cancer: A systematic review of non‐pharmacological interventions

The aim of this systematic review was to synthesize the best available evidence informing the effectiveness of non‐pharmacological interventions for managing cancer‐related fatigue in men treated for prostate cancer. This review considered experimental studies that included men with prostate cancer (regardless of staging, previous treatment or comorbidities), aged 18 years and over who were undergoing any treatment, or had completed any treatment for prostate cancer within the previous 12 months. Three interventions were identified for the management of cancer‐related fatigue in men with prostate cancer. Evidence from five studies including 447 participants demonstrates the effectiveness of physical activity, both aerobic and resistance exercise, and from three studies including 153 participants suggesting the benefits of psychosocial interventions including education and cognitive behavioural therapy. Health professionals require knowledge of a range of effective interventions aimed at reducing cancer‐related fatigue in men with prostate cancer and should incorporate those interventions into their patient management. Although physical activity appears to show the greatest benefit, other non‐pharmacological interventions such as education and cognitive behavioural therapy have demonstrated benefit and should also be considered as a strategy in treating this debilitating side effect of cancer and its treatment.     

Comparison of Molecular Markers of Hypoxia and Imaging with <Superscript>60</Superscript>Cu-ATSM in Cancer of the Uterine Cervix

Purpose To determine if hypoxia-related molecular markers are associated with ⁶⁰Cu labeled diacetyl-bis (N ⁴-methylthiosemicarbazone); (⁶⁰Cu-ATSM) imaging of tumor hypoxia in cervical cancer. Procedures Fifteen patients were enrolled in a prospective study and underwent evaluation of tumor hypoxia with positron emission tomography (PET) using ⁶⁰Cu-ATSM. ⁶⁰Cu-ATSM-PET imaging was compared with the expression of tissue molecular markers, which included vascular endothelial growth factor (VEGF), cyclo-oxygenase-2 (COX-2), epidermal growth factor receptor (EGFR), carbonic anyhdrase IX (CA-9), and apoptotic index. Results Six patients had hypoxic tumors determined by ⁶⁰Cu-ATSM, and nine had non-hypoxic tumors. The 4-year overall survival estimates were 75% for patients with non-hypoxic tumors and 33% for those with hypoxic tumors (p = 0.04). Overexpression of VEGF (p = 0.13), EGFR (p = 0.05), CA-9 (p = 0.02), COX-2 (p = 0.08), and the presence of apoptosis (p = 0.005) occurred in patients with hypoxic tumors. Cox proportional hazards modeling demonstrated hypoxia as determined by ⁶⁰Cu-ATSM to be a significant independent predictor of tumor recurrence (p = 0.0287). Conclusions ⁶⁰Cu-ATSM hypoxia was correlated with overexpression of VEGF, EGFR, COX-2, CA-9, an increase in apoptosis, and a poor outcome.     

Detection of Occult Medullary Thyroid Cancer Recurrence with 2-Deoxy-2-[F-18]fluoro-<Emphasis Type="SmallCaps">d</Emphasis>-glucose-PET and PET/CT

Purpose 2-Deoxy-2-[F-18]fluoro-d-glucose (FDG)-positron emission tomography (PET) has an established role in restaging of various cancers, including papillary and undifferentiated thyroid carcinoma. However, controversies exist regarding its ability to reliably assess recurrent medullary thyroid cancer (MTC). We were therefore prompted to review our experience with FDG-PET for detection of occult MTC. Methods This is a retrospective study (Apr 1, 1997–Mar 31, 2004) of 13 patients with histologic diagnosis of MTC, who had PET examinations. The group included six men and seven women, 15–62 years old (average: 48 ± 13). The PET scan request was triggered by rising levels of calcitonin and negative anatomical imaging studies. Results Recurrent/metastatic disease was identified by PET in seven (54%) of the 13 patients. The lesions were located in superior mediastinum (4), cervical lymph nodes (3), thyroid bed (2), lung (1) and liver (1). The calcitonin levels ranged from 52 to 5,090 pg/ml (average: 1,996 pg/ml) in patients with negative PET scans and from 132 to 9,500 pg/ml (average: 3,757 pg/ml) in patients with positive studies. The sensitivity and specificity of FDG-PET for disease detection in this cohort were 85.7% (95% CI: 48.7–97.4) and 83.3 % (95 % CI: 43.6–96.9), respectively. Conclusion Our findings suggest a significant role for FDG-PET in patients with suspected MTC recurrence, with sensitivity of 85.7% and specificity of 83.3% for disease detection. FDG-PET provides additional information in a significant fraction of cases (54%) and could be used for restaging of patients with MTC and elevated levels of biomarkers (calcitonin). Additional studies are necessary to further evaluate the role of FDG-PET in MTC.     

PET imaging of prostate tumors with 18F‐Al‐NOTA‐MATBBN

Overexpression of the gastrin‐releasing peptide receptor (GRPR) in prostate cancer provides a promising target for detection the disease. MATBBN is a new bombesin analog originating from the GRPR antagonists with a hydrophilic linker. In this study NOTA‐conjugated MATBBN was labeled by the Al¹⁸F method and the potential of ¹⁸F‐Al‐NOTA‐MATBBN for prostate tumor PET imaging was also evaluated. NOTA‐MATBBN was radiolabeled with ¹⁸F using Al¹⁸F complexes. Partition coefficient, in vitro stability and GRPR binding affinity were also determined. PET studies were performed with ¹⁸F‐Al‐NOTA‐MATBBN in PC‐3 tumor‐bearing mice. ¹⁸F‐Al‐NOTA‐MATBBN can be produced within 30 min with a decay‐corrected yield of 62.5 ± 2.1% and a radiochemical purity of >98%. The logP octanol–water value for the Al¹⁸F‐labeled BBN analog was ?2.40 ± 0.07 and the radiotracer was stable in phosphate‐buffered saline and human serum for 2 h. The IC₅₀ values of displacement for the ¹⁸F‐Al‐NOTA‐MATBBN with MATBBN was 126.9 ± 2.75 nm . The PC‐3 tumors were clearly visible with high contrast after injection of the labeled peptide. At 60 min post‐injection, the tumor uptakes for ¹⁸F‐Al‐NOTA‐MATBBN and ¹⁸F‐FDG were 4.59 ± 0.43 and 1.98 ± 0.35% injected dose/g, and tumor to muscle uptake radios for two tracers were 6.77 ± 1.10 and 1.78 ± 0.32, respectively. Dynamic PET revealed that ¹⁸F‐Al‐NOTA‐MATBBN was excreted mainly through the kidneys. GRPR‐binding specificity was also demonstrated by reduced tumor uptake of ¹⁸F‐Al‐NOTA‐MATBBN after coinjection with excess unlabeled MATBBN peptide at 1 h post‐injection. NOTA‐ MATBBN could be labeled rapidly with ¹⁸F using one step method. ¹⁸F‐Al‐NOTA‐MATBBN may be a promising PET imaging agent for prostate cancer. Copyright © 2014 John Wiley & Sons, Ltd.     

Apixaban used for the management of heparin‐induced thrombocytopenia in a 72‐year‐old woman with lung cancer

Heparin‐induced thrombocytopenia (HIT) is a serious adverse reaction to heparin treatment with a high risk of thrombosis. Heparin must be discontinued immediately and replaced with alternative anticoagulants that do not interact with HIT antibodies. In this case, a lung cancer patient, diagnosed with HIT was successfully treated with apixaban.     

Psychosocial adjustments in patients with prostate cancer from pre‐diagnosis to 6 months post‐treatment

We evaluated changes in psychosocial adjustment over time and its associated factors in prostate cancer patients. A total of 69 patients with prostate cancer were surveyed at pre‐diagnosis, 1 month and 6 months post‐treatment. The questionnaires distributed to the patients consisted of the Psychosocial Adjustment to Illness Scale and the UCLA Prostate Cancer Index. The generalized estimating equations were used to analyse the collected data. The results of adjustments to psychological distress, the domestic environment and the social environment worsened post‐treatment. However, the adjustment to health‐care orientation was worst at the time of pre‐diagnosis and improved during post‐treatment. Patients who perceived an unfavourable health status reported poor adjustment in psychological distress. Patients exhibiting poor urinary function poorly adjusted to the domestic environment. Patients with sexual dysfunction exhibited poor adjustment to the social environment. Patients with low education demonstrated poor adjustment to health‐care orientation. Further studies should assess the psychosocial adjustment among prostate cancer patients and provide interventions following pre‐diagnosis.     

Multiple sebaceous tumors in a 58‐year‐old man with colorectal cancer

The Muir‐Torre Syndrome is a rare genodermatosis, defined by the occurrence of sebaceous neoplasia and internal malignancies and caused by mutations in the mismatch repair gene. We describe the case of 58‐year‐old man who, over the course of several years, had multiple skin lesions and colon cancer. The syndrome was diagnosed using Sanger sequencing, which allowed us to find the causative mutation.     

Cancer nurses narrating after conversations with cancer outpatients: how do nurses’ roles and patients’ perspectives appear in the nurses’ narratives?

Aim: The aim of this study was to contribute to knowledge of nursing practice in the cancer care field by exploring cancer nurses’ perceptions of conversations with cancer outpatients. Background: Current practice at cancer outpatient clinics in Norway is that nurses have planned conversations with patients and relatives as a follow‐up after patient–physician conversations about assessment and medical treatment. Little is known about nurses’ experiences of conversations in the ambulatory context. This study reports the experiences of initial patient–nurse consultations. Data were collected in 2006–2007. Design: A qualitative phenomenological hermeneutic study was performed. A purposive sample of 12 cancer nurses was selected for qualitative interviews where nurses were narrating about conversation experiences. Significance and meaning of conversation experiences were analysed within a hermeneutic perspective, inspired by Ricoeur. Anonymity and voluntary participation procedures were followed. Ethical approval for the study was obtained from the Regional Committee for Medical Research Ethics of the region. Findings: There were plots of nurses experiencing conversations as hard work, routine work or artistry. The nurses’ conceptualizations of their roles as an information provider, or patient‐centred caring role were rooted in rules of the nursing community or in humanistic caring ethics. Differences of nurses’ perceptions and experiences of conversations are explained by different attitudes and role appreciations. Conclusion: Cancer nurses’ role appreciation and meaning horizons are guiding their perceptions of patient–nurse communication. Feeling free to act in interplay with patients’ voices, the patients’ perspectives become foreground. There is an educational challenge here in terms of developing methods to help nurses to discover how their mental work and meaning horizons guide conversational practice.