单纯强阿片类治疗肺癌与姑息性化疗联合强阿片类治疗肺癌的生活质量对比研究

目的 比较单纯强阿片类治疗肺癌与姑息性化疗联合强阿片类治疗肺癌的生活质量对比.方法 共60例中晚期肺癌患者,强阿片类药物选择吗啡、芬太尼;姑息性化疗药物选择替吉奥.前15天单纯使用强阿片类药物治疗,观察肺癌患者生活质量评分;后15天加用姑息性化疗药物联合强阿片类药物治疗,观察肺癌患者生活质量评分.生活质量评分包括患者的食欲、精神、睡眠、疲乏、疼痛、家庭理解与配合、同事的理解与配合、自身对癌症的认识、对治疗的态度、日常生活、治疗的副作用、面部表情.生活质量满分为60分,生活质量极差的为＜20分,差的为21～30分,一般为31 ～40分,较好的为41～50分,良好的为51～60分.结果 60例中晚期肺癌患者使用姑息性化疗联合强阿片类药物治疗后,患者的生活质量评分有上升,差异有统计学意义（P＜0.05）.结论 姑息性化疗联合强阿片类药物治疗肺癌,患者的生活质量有明显提高.     

老年人群晚期非小细胞肺癌患者表皮生长因子受体酪氨酸激酶抑制剂的疗效预测因素分析

目的 进行老年人群晚期非小细胞肺癌患者表皮生长因子受体酪氨酸激酶抑制剂（TKI）的疗效预测因素分析.方法 98例老年晚期非小细胞肺癌患者,每日口服厄洛替尼150mg 1次,或每日口服吉非替尼250mg 1次,直至病情进展停药,至少1个月以上评价疗效,然后进行分层分析,及单因素和多因素分析.结果 分层分析显示,对于治疗的有效率、性别（P =0.0056）、吸烟（P =0.024）、病理类型（P=0.003）,均具有统计学差异,而其余因素（P＞0.05）,无统计学意义.对于疾病控制率、性别（P=0.021）、吸烟（P=0.031）、病理类型（P=0.002）、脑转移（P =0.001）,均具有统计学差异;而其余因素（P＞0.05）,无统计学意义.Logistic回归分析结果,客观有效率结果显示,性别OR=2.01;病理类型OR=3.82;吸烟OR=2.12.其余因素均P＞0.05,没有统计学意义.对于疾病控制率结果显示,性别OR =1.78,病理类型OR=2.13,吸烟OR=2.42,脑转移OR=3.67;其余因素均P＞0.05,没有统计学意义.结论 晚期老年NSCLC的TKI客观有效率与性别、病理类型、吸烟情况有关.疾病控制率与性别、病理类型、吸烟情况、脑转移等因素有关.     

Listening to the Voices of Lesbians Diagnosed with Cancer

Abstract

This paper focuses on the operations of heterosexism and strategies to counter it in a particular service context: the context of psychosocial support services for women with cancer. The paper draws on findings from a participatory, qualitative study set in Ontario, Canada in which 26 lesbians were interviewed about their experiences of cancer diagnosis, treatment, health care and social support, and their feelings and perceptions about shifts in identity, body, sexuality and relationships. This paper focuses on findings related to the changes research participants perceived as necessary in the provision and organization of cancer support services, in order to increase access and ensure equity for lesbians with cancer and their families.     

Stochastic Estimates of Exposure and Cancer Risk from Carbon Tetrachloride Released to the Air from the Rocky Flats Plant

Carbon tetrachloride is a degreasing agent that was used at the Rocky Flats Plant (RFP) in Colorado to clean product components and equipment. The chemical is considered a volatile organic compound and a probable human carcinogen. During the time the plant operated (1953-1989), most of the carbon tetrachloride was released to the atmosphere through building exhaust ducts. A smaller amount was released to the air via evaporation from open-air burn pits and ground-surface discharge points. Airborne releases from the plant were conservatively estimated to be equivalent to the amount of carbon tetrachloride consumed annually by the plant, which was estimated to be between 3.6 and 180 Mg per year. This assumption was supported by calculations that showed that most of the carbon tetrachloride discharged to the ground surface would subsequently be released to the atmosphere. Atmospheric transport of carbon tetrachloride from the plant to the surrounding community was estimated using a Gaussian Puff dispersion model (RATCHET). Time-integrated concentrations were estimated for nine hypothetical but realistic exposure scenarios that considered variation in lifestyle, location, age, and gender. Uncertainty distributions were developed for cancer slope factors and atmospheric dispersion factors. These uncertainties were propagated through to the final risk estimate using Monte Carlo techniques. The geometric mean risk estimates varied from 5.2 x 10(-6) for a hypothetical rancher or laborer working near the RFP to 3.4 x 10(-9) for an infant scenario. The distribution of incremental lifetime cancer incidence risk for the hypothetical rancher was between 1.3 x 10(-6) (5% value) and 2.1 x 10(-5) (95% value). These estimates are similar to or exceed estimated cancer risks posed by releases of radionuclides from the site.     

Environmental Tobacco Smoke Revisited: The Reliability of the Data Used for Risk Assessment

Several epidemiological studies have found a weak, but consistent association between lung cancer in nonsmokers and exposure to environmental tobacco smoke (ETS). In addition, a purported link between such exposure and coronary heart disease (CHD) has been of major concern. Although it is biologically plausible that ETS has a contributory role in the induction of lung cancer in nonsmoking individuals, dose-response extrapolation-supported by the more solid database for active smokers-gives an additional risk for lung cancer risk that is more than one order of magnitude lower than that indicated by major positive epidemiological studies. The discrepancy between available epidemiological data and dosimetric estimates seems, to a major part, to reflect certain systematic biases in the former that are difficult to control by statistical analysis when dealing with risks of such low magnitudes. These include, most importantly, misclassification of smoking status, followed by inappropriate selection of controls, as well as certain confounding factors mainly related to lifestyle, and possibly also hereditary disposition. A significant part of an association between lung cancer and exposure to ETS would disappear, if, on the average, 1 patient out of 20 nonsmoking cases had failed to tell the interviewer that he had, in fact, recently stopped smoking. In the large International Agency for Research on Cancer (IARC) multicenter study even lower misclassification rates would abolish the weak, statistically nonsignificant associations that were found. In the former study an apparent significant protective effect from exposure to ETS in childhood with respect to lung cancer later in life was reported, a most surprising finding. The fact that the mutation spectrum of the p53 tumor suppressor gene in lung tumors of ETS-exposed nonsmokers generally differs from that found in tumors of active smokers lends additional support to the notion that the majority of tumors found in ETS-exposed nonsmokers have nothing to do with tobacco smoke. The one-sided preoccupation with ETS as a causative factor of lung cancer in nonsmokers may seriously hinder the elucidation of the multifactorial etiology of these tumors. Due to the high prevalence of cardiovascular disease in the population, even a modest causal association with ETS would, if valid, constitute a serious public health problem. By pooling data from 20 published studies on ETS and heart disease, some of which reported higher risks than is known to be caused by active smoking, a statistically significant association with spousal smoking is obtained. However, in most of these studies, many of the most common confounding risk factors were ignored and there appears to be insufficient evidence to support an association between exposure to ETS and CHD. Further, it seems highly improbable that exposure to a concentration of tobacco smoke at a level that is generally much less than 1% of that inhaled by a smoker could result in an excess risk for CHD that-as has been claimed-is some 30% to 50% of that found in active smokers. There are certainly valid reasons to limit exposure to ETS as well as to other air pollutants in places such as offices and homes in order to improve indoor air quality. This goal can be achieved, however, without the introduction of an extremist legislation based on a negligible risk of lung cancer as well as an unsupported and highly hypothetical risk for CHD.     

Exploring the Association Between Dispositional Cancer Worry,Perceived Risk,and Physical Activity Among College Women

Abstract

Objective: In this study, the authors explored the association between dispositional cancer worry (DCW), risk perceptions (RP), and physical activity (PA) among college females. Participants: Four hundred fifty-one females from a midwestern university completed an online survey in September/October 2012. Methods: DCW severity, DCW frequency, RP, and PA were measured along with qualitative data about PA as cancer prevention. Results: Sixty-nine percent of participants did not meet PA recommendations. DCW severity was a significant predictor of meeting PA recommendations (odds ratio = 1.2, 95% confidence interval [1.00, 1.38]; p = .05). Qualitative data revealed a lack of knowledge about breast cancer risk and PA as cancer prevention. Conclusions: College women do not engage in enough PA nor feel at risk for developing breast cancer. A lack of knowledge exists about the cancer prevention benefit of PA. Results indicate a need for PA interventions that both educate breast cancer risk and motivate health protective behaviors.     

Body mass index and functional status in community dwelling older Turkish males

Abstract

Objectives: To assess sex hormones in men with obesity and prostate cancer (PCa) and to study association between androgens and the pathogenesis biology of PCa in vitro.

Subjects and methods: One hundred and eighty-one men older than 45?years selected from of a population attending to Urology departments screening for PCa, (78 participants without PCa and 103 patients with PCa). All participants were assessed for body mass index (BMI), age, Gleason score, and PSA. Endocrine profile was determined for LH, total testosterone (TT), 17β-estradiol (E2), prolactin and leptin. Biochemical profile (HbA1c, triacylglycerols and lipoproteins) was also determined. In vitro experiments were also performed, involving the study of 5α-dihydrotestosterone (DHT) and E2 in the presence of adipocyte-conditioned medium (aCM).

Results: All variables were continuous and described a Gaussian distribution unless mentioned. To determine the relation of aggressiveness, variable were transformed into categories. Thus, PCa aggressiveness is associated with the increase of age and BMI (p?<?.0001) but with is decreased with TT and E2 (p?<?.05). Moreover, adipocyte-secreted molecules increase aggressiveness of PCa cells in vitro. Lastly, DTH but not E2 enables invasiveness in vitro.

Conclusions: It was observed a coexistence of hormone axis profile alteration with sex hormones and BMI in PCa patients, in accordance with the new perspective of PCa pathogenesis.     

Proactive Screening for Health Needs in United Way's 2-1-1 Information and Referral Service

ABSTRACT

Cancer disproportionately affects the underserved. United Way 2-1-1 is an information and referral system that links underserved populations to community services. This study explores the feasibility of integrating proactive screening and referral to health services into 2-1-1. A cancer risk assessment was administered to callers (n = 297), measuring their need for 6 cancer control services. A subset of respondents was randomized to receive generic or tailored referrals to needed services. Nearly all participants (85%) needed at least one of the services. Those who received tailored referrals were more likely to make appointments. Future research will explore approaches to address and eliminate health disparities through 2-1-1.     

Cancer Screening Barriers for Community-based Older Hispanics and Caucasians

Despite advances in screening and early detection, ethnic minority populations, ages 65 and older, are less likely than Caucasians to participate in cancer screening services. Empirical research indicates that older ethnic minorities have cultural values that influence their behaviors. Addressing culturally relevant communication to better understand those values may increase participation in cancer screening. The study reported is a secondary analysis of qualitative data gathered from focus groups. Utilizing an interdisciplinary analytical lens, we compared older Hispanic and Caucasian's cultural values and their screening behaviors. Suggested psychosocial interventions are discussed to assist providers in their ongoing efforts to promote cancer screening.     

In life and in death: the story of people living with metastatic cancer

ABSTRACT

Advances in the treatment of metastatic cancers such as melanoma enable patients to live for many years. However, melanoma patients are under constant threat of a recurrence or a new growth, are under intensive follow-up, and must avoid exposure to the sun. These factors engender anxiety, a constant fear of recurrence, and a reduction in routine activity, thus requiring patients to develop mechanisms for coping simultaneously with the illness and the threat of death. This study uses content analysis of the documentation of a support group for metastatic melanoma patients to examine how they cope with both. The findings suggest that they are able to cope with both simultaneously. However, perhaps because they recognise their total lack of control over the illness, they exercise control in how they cope with death. The findings suggest that support groups like the one documented in this article could serve as sheltered and effective therapeutic spaces for coping with the threat of death.