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Chow E.,University of Toronto | Nguyen J.,University of Toronto | Zhang L.,University of Toronto | Tseng L.-M.,Taipei Veterans General Hospital | And 9 more authors.
Cancer | Year: 2012

Background: The objective of this international field study was to test the reliability, validity, and responsiveness of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BM22 module to assess health-related quality of life (HRQOL) in patients with bone metastases. Methods: Patients undergoing a variety of bone metastases-specific treatments were accrued. The QLQ-BM22 was administered with the QLQ-C30 at baseline and at 1 follow-up time point internationally. A debriefing questionnaire was administered to determine patient acceptability and understanding. Results: Large-scale field testing of the QLQ-BM22 in addition to the QLQ-C30 took place in 7 countries: Brazil, Canada, Cyprus, Egypt, France, India, and Taiwan. A total of 400 patients participated. Multitrait scaling analyses confirmed 4 scales in the 22-item module. The scales were able to discriminate between clinically distinct patient groups, such as between those with a poor and those with a better performance status. The QLQ-BM22 was well received in all 7 countries, and the majority of patients did not recommend any significant changes from the module in its current form. Conclusions: The final QLQ-BM22 module contains 22 items and 4 scales assessing Painful Sites, Painful Characteristics, Functional Interference, and Psychosocial Aspects. Results confirmed the validity, reliability, cross-cultural applicability, and sensitivity of the 22-item EORTC QLQ-BM22. It is therefore recommended that the QLQ-BM22 be used in addition to the QLQ-C30 in clinical trials to assess HRQOL in patients with bone metastases. © 2011 American Cancer Society.

Vassiliou V.,Bank of Cyprus Oncology Center | Kardamakis D.,University of Patras
Strahlentherapie und Onkologie | Year: 2010

Background: Bisphosphonate (BP) use has increased dramatically in recent years, becoming an integral part of the overall antineoplastic management of patients with metastatic bone disease. Even though their application has shown to be effective in reducing pain and minimizing the risk of skeletal-related events, their administration may bring also adverse events such osteonecrosis of the jaws (ONJ). Methods: After a thorough review of the literature, important aspects of the pathophysiology, diagnosis, prevention, and treatment of ONJ are presented. Results: ONJ is evident in up to 10% of patients receiving intravenous BP treatment. Despite the fact that its exact pathophysiology is unknown, it is characterized by bone necrosis that can occur either spontaneously or after dental surgery or tooth extraction. Panoramic radiographs are useful for the diagnosis and routine assessment of patients and computed tomography can differentiate between ONJ and metastatic disease. Additionally, magnetic resonance imaging depicts local disease extension readily, and scintigraphy is the most sensitive imaging modality for detecting early involvement. Preventive measures and routine dental evaluations are essential components of the overall patient management. In the event of ONJ, stage I or II should be managed conservatively, whereas more advanced stages (III and IV) should be treated surgically. Conclusion: ONJ is a well-defined clinical entity that all medical and dental doctors should be aware of, since if it is not dealt with readily and effectively, it may deteriorate the clinical status and quality of life of affected patients. © 2010 Urban & Vogel, Muenchen.

Giannousi Z.,Bank of Cyprus Oncology Center | Karademas E.C.,University of Crete | Dimitraki G.,University of Crete
Journal of Behavioral Medicine | Year: 2016

The aim was to examine the impact of the dyadic, interaction and dissimilarity effects of the illness representations on the psychological health of recently diagnosed cancer patients and spouses in Greece. The sample consisted of 298 individuals nested in 149 couples. Effects were examined with the Actor–Partner Interdependence Model. Both actor (i.e., within person) and partner (i.e., between partners) effects were detected for both patients’ and spouses’ psychological symptoms. The negative association of patients’ psychological symptoms with their representations of illness coherence was weak at the higher and medium levels, and stronger at the lower levels of spouse corresponding representations. Patient–partner discrepancy in perceived illness consequences was associated with more psychological symptoms in patients. Adaptation to cancer is a dyadic process within the context of which patient and partner psychological well-being is affected by each other’s understanding of illness. Thus, the parallel examination of the illness representations of both partners is needed from the early phases of the illness trajectory. © 2015, Springer Science+Business Media New York.

Iliopoulou E.G.,Cancer Immunology and Immunotherapy Center | Kountourakis P.,Saint Savas Cancer Hospital | Kountourakis P.,Bank of Cyprus Oncology Center | Karamouzis M.V.,Saint Savas Cancer Hospital | And 7 more authors.
Cancer Immunology, Immunotherapy | Year: 2010

HLA-mismatched natural killer (NK) cells have shown efficacy in acute myeloid leukemia, and their adoptive transfer in patients with other malignancies has been proven safe. This phase I clinical trial was designed to evaluate safety (primary endpoint) and possible clinical efficacy (secondary endpoint) of repetitive administrations of allogeneic, in vitro activated and expanded NK cells along with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). Patients with unresectable, locally advanced/metastatic NSCLC receiving 1st/2nd line chemotherapy were eligible to receive 2-4 doses of activated NK cells from two relative donors. Donor's CD56+ cells were cultured for 20-23 days with interleukin-15 (IL-15) and hydrocortisone (HC) and administered intravenously between chemotherapy cycles. Premedication with corticosteroids and/or H1 inhibitors was allowed. Sixteen patients (performance status 0-1) with adenocarcinoma (n = 13) or squamous cell carcinoma (n = 3) at stage IIIb (n = 5) or IV (n = 11) receiving 1st (n = 13) or 2nd (n = 3) line treatment were enrolled. Fifteen patients received 2-4 doses of allogeneic activated NK cells (0.2-29 × 10 6/kg/dose, median 4.15 × 106/kg/dose). No side effects (local or systemic) were observed. At a median 22-month follow-up (range, 16.5-26 months) 2 patients with partial response and 6 patients with disease stabilization were recorded. Median progression free survival and overall survival were 5.5 and 15 months, respectively. A 56% 1-year survival and a 19% 2-year survival were recorded. In conclusion, repetitive infusions of allogeneic, in vitro activated and expanded with IL-15/HC NK cells, in combination with chemotherapy are safe and potentially clinically effective. © 2010 Springer-Verlag.

The life expectancy of Western populations has risen in the last few decades, resulting in a steep increase in the number of elderly cancer patients. Metastatic bone disease (MBD) is an important problem in such patients as it is associated with the development of skeletal-related events (SREs), such as fractures and spinal cord compression. These complications do not only deteriorate the quality of life of affected patients, but can also reduce expected survival. Due to the fact that elderly patients have an increased risk of SREs, maintaining bone health and implementing effective treatments for managing MBD is of vital importance. Bisphosphonates have been shown to be effective in reducing the risk of SREs considerably in patients with MBD. Moreover, they have been shown to reduce pain and improve the quality of life of affected patients. Bisphosphonates should be used with caution in elderly patients due to the fact that their use can bring about renal function deterioration. Several preventive measures need to be followed in order to minimise the risk of this complication. Denosumab is a monoclonal antibody inhibiting receptor activator of NF-kB ligand and has shown superiority over zoledronic acid in reducing the risk of SREs. In the three comparative trials between denosumab and zoledronic acid, survival and disease progression were similar between the two groups. Denosumab has been shown not to affect renal function and can therefore be safely used in the elderly. Osteonecrosis of the jaws is a devastating complication that may occur after treatment with either denosumab or zoledronic acid. The incidence rates between the two are comparable and percentage differences not statistically significant. In the three randomised trials, hypocalcaemia occurred more frequently in denosumab-treated patients than in those managed with zoledronic acid, with the corresponding percentages being 5.5-13% versus 3.4-6%. In order to minimise the risk of osteonecrosis of the jaws and hypocalcaemia, all precautionary measures and treatment guidelines should be followed closely. Several studies have investigated the cost-effectiveness of denosumab versus zoledronic acid when used for SRE prevention. These studies reported contradictory results due to the application of different analytical perspectives and model parameters. © 2013 The Royal College of Radiologists.

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