Incidence, appropriateness, and consequences of recommendations for additional imaging tests in oncological PET/CT reports

Incidence, appropriateness, and consequences of recommendations for additional imaging tests in oncological PET/CT reports

Publication year: 2012
Source:Clinical Radiology
A.B. Shinagare, P.B. Shyn, C.A. Sadow, E.J. Wasser, P. Catalano
Aim To assess the incidence, appropriateness, and outcomes of recommendations for additional imaging tests (RAI) in oncological combined 2-[¹⁸F]-fluoro-2-deoxy-d-glucose positron-emission tomography and computed tomography (FDG-PET/CT) reports. Material and methods In this retrospective study, conducted with institutional review board approval, the first oncological FDG-PET/CT reports in 2008 for 250 consecutive patients were reviewed to identify RAI. PET/CT reports containing RAI were retrospectively reviewed by two blinded readers. PET/CT findings prompting RAI, appropriateness of RAI, results of additional imaging tests actually performed, and the ultimate clinical significance of findings prompting RAI were recorded. Confirmation of clinical significance required pathology confirmation, unequivocal imaging progression, imaging stability for 12 months, or clinical follow-up for 24 months or end of life. Results Eighty-four RAI were identified for 88 PET/CT findings in 29.6% (74/250) of PET/CT reports, of which 51.2% (43/84) were deemed unnecessary by reviewers. Referring clinicians only followed 31% (26/84) of RAI by requesting additional imaging tests, and these tests resolved the PET/CT question in 76.9% (20/26) of those cases. Only 11.4% (10/88) of all findings prompting RAI proved to be clinically significant. Only 4.7% (2/43) of RAI deemed unnecessary by reviewers and 5.2% (3/58) of RAI not pursued by clinicians were found to be clinically significant; however, PET/CT alone was sufficient for diagnosis or guiding appropriate clinical management in each of these cases. Conclusion RAI were found in 29.6% of oncological PET/CT reports. No potential adverse impact on patient management or outcome, by not issuing or following RAI, was identified in the 51.2% of RAI deemed unnecessary by study readers or in the 69% of RAI not pursued by referring clinicians.

Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomised triall

Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomised trial

Publication year: 2012
Source:European Journal of Cancer
Mia Fahlén, Tommy Fornander, Hemming Johansson, Ulla Johansson, Lars-Erik Rutqvist, Nils Wilking, Eva von Schoultz
Background The management of hormonal deficiency symptoms in breast cancer survivors is an unsolved problem. While hormone replacement therapy (HRT) may increase the risk of breast cancer in healthy women, its effects on recurrence is unclear. Observational studies have suggested decreased recurrence rates from HRT. The few clinical trials in this field have all been closed preterm. Methods The Stockholm trial was started in 1997 and designed to minimise the dose of progestogen in the HRT arm. Disease-free women with a history of breast cancer were randomised to HRT (n =188) or no HRT (n =190). The trial was stopped in 2003 when another Swedish study (HABITS, the Hormonal Replacement After Breast Cancer – Is it Safe?) reported increased recurrence. However the Stockholm material showed no excess risk after 4years of follow-up. A long term follow-up has now been performed. Findings After 10.8years of follow-up, there was no difference in new breast cancer events: 60 in the HRT group versus 48 among controls (hazard ratio (HR)=1.3; 95% confidence interval (CI)=0.9–1.9). Among women on HRT, 11 had local recurrence and 12 distant metastases versus 15 and 12 for the controls. There were 14 contra-lateral breast cancers in the HRT group and four in the control group (HR=3.6; 95% CI=1.2–10.9; p =0.013). No differences in mortality or new primary malignancies were found. Interpretation The number of new events did not differ significantly between groups, in contrast to previous reports. The increased recurrence in HABITS has been attributed to higher progestogen exposure. As both trials were prematurely closed, data do not allow firm conclusions. Both studies found no increased mortality from breast cancer or other causes from HRT. Current guidelines typically consider HRT contraindicated in breast cancer survivors. Findings suggest that, in some women symptom relief may outweigh the potential risks of HRT.

Whole mind and shared mind in clinical decision-making

Whole mind and shared mind in clinical decision-making

Publication year: 2012
Source:Patient Education and Counseling
Ronald Mark Epstein
Objective To review the theory, research evidence and ethical implications regarding "whole mind" and "shared mind" in clinical practice in the context of chronic and serious illnesses. Methods Selective critical review of the intersection of classical and naturalistic decision-making theories, cognitive neuroscience, communication research and ethics as they apply to decision-making and autonomy. Results Decision-making involves analytic thinking as well as affect and intuition ("whole mind") and sharing cognitive and affective schemas of two or more individuals ("shared mind"). Social relationships can help processing of complex information that otherwise would overwhelm individuals' cognitive capacities. Conclusions Medical decision-making research, teaching and practice should consider both analytic and non-analytic cognitive processes. Further, research should consider that decisions emerge not only from the individual perspectives of patients, their families and clinicians, but also the perspectives that emerge from the interactions among them. Social interactions have the potential to enhance individual autonomy, as well as to promote relational autonomy based on shared frames of reference. Practice implications Shared mind has the potential to result in wiser decisions, greater autonomy and self-determination; yet, clinicians and patients should be vigilant for the potential of hierarchical relationships to foster coercion or silencing of the patient's voice.

Addressing the Financial Consequences of Cancer: Qualitative Evaluation of a Welfare Rights Advice Service

Addressing the Financial Consequences of Cancer: Qualitative Evaluation of a Welfare Rights Advice Service

by Suzanne Moffatt, Emma Noble, Martin White

Background

The onset, treatment and trajectory of cancer is associated with financial stress among patients across a range of health and welfare systems and has been identified as a significant unmet need. Welfare rights advice can be delivered effectively in healthcare settings, has the potential to alleviate financial stress, but has not yet been evaluated. We present an evaluation of a welfare rights advice intervention designed to address the financial consequences of cancer.

Methods

Descriptive study of welfare outcomes among 533 male and 641 female cancer patients and carers aged 4–95 (mean 62) years, who accessed the welfare rights advice service in North East England between April 2009 and March 2010; and qualitative interview study of a maximum variation sample of 35 patients and 9 carers.

Results

Over two thirds of cancer patients and carers came from areas of high socio-economic deprivation. Welfare benefit claims were successful for 96% of claims made and resulted in a median increase in weekly income of £70.30 ($109.74, €84.44). Thirty-four different types of benefits or grants were awarded. Additional resources were perceived to lessen the impact of lost earnings, help offset costs associated with cancer, reduce stress and anxiety and increase ability to maintain independence and capacity to engage in daily activities, all of which were perceived to impact positively on well-being and quality of life. Key barriers to accessing benefit entitlements were knowledge, system complexity, eligibility concerns and assumptions that health professionals would alert patients to entitlements.

Conclusions

The intervention proved feasible, effectively increased income for cancer patients and was highly valued. Addressing the financial sequelae of cancer can have positive social and psychological consequences that could significantly enhance effective clinical management and suitable services should be routinely available. Further research is needed to evaluate health outcomes definitely and assess cost-effectiveness.

"The Coach And The Critic" Blog Comes To Life Online: A Discussion About Caregivers That I Will Never Forget

http://m.cancer.org/AboutUs/DrLensBlog/post/2011/04/26/The-Coach-And-The-Critic-Blog-Comes-To-Life-Online-A-Discussion-About-Caregivers-That-I-Will-Never-Forget.aspx

Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer.

Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer.

Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer.

Br J Cancer. 2012 Aug 9;

Authors: Harding V, Fenu E, Medani H, Shaboodien R, Ngan S, Li HK, Burt R, Diamantis N, Tuthill M, Blagden S, Gabra H, Urch CE, Moser S, Agarwal R

Abstract

Background:Paracentesis for malignant ascites is usually performed as an in-patient procedure, with a median length of stay (LoS) of 3-5 days, with intermittent clamping of the drain due to a perceived risk of hypotension. In this study, we assessed the safety of free drainage and the feasibility and cost-effectiveness of daycase paracentesis.Method:Ovarian cancer admissions at Hammersmith Hospital between July and October 2009 were audited (Stage 1). A total of 21 patients (Stage 2) subsequently underwent paracentesis with free drainage of ascites without intermittent clamping (October 2010-January 2011). Finally, 13 patients (19 paracenteses, Stage 3), were drained as a daycase (May-December 2011).Results:Of 67 patients (Stage 1), 22% of admissions and 18% of bed-days were for paracentesis, with a median LoS of 4 days. In all, 81% of patients (Stage 2) drained completely without hypotension. Of four patients with hypotension, none was tachycardic or symptomatic. Daycase paracentesis achieved complete ascites drainage without complications, or the need for in-patient admission in 94.7% of cases (Stage 3), and cost £954 compared with £1473 for in-patient drainage.Conclusions:Free drainage of malignant ascites is safe. Daycase paracentesis is feasible, cost-effective and reduces hospital admissions, and potentially represents the standard of care for patients with malignant ascites.British Journal of Cancer advance online publication, 9 August 2012; doi:10.1038/bjc.2012.343 www.bjcancer.com.

PMID: 22878372 [PubMed - as supplied by publisher]

Factors Associated with Publication of Plenary Presentations at the Society of Gynecologic Oncologists Annual Meeting

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Factors Associated with Publication of Plenary Presentations at the Society of Gynecologic Oncologists Annual Meeting

Publication year: 2012

Objective To determine the rate and factors associated with publication of plenary abstract presentations from the Society of Gynecologic Oncologists annual meeting. Methods Plenary presentations were reviewed from 2000 to 2005. A Pubmed search was performed to identify subsequent peer-reviewed publication of these presentations. Chi-squared test and logistic regression were used for statistical analyses. Results Of 378 main, focused or express plenary presentations, 173 (45.8%) involved multiple and 205 (54.2%) single institutions. The types of study include: chart review (29.4%), cohort study (28.0%), translational (23.5%), and randomized clinical trial (6.9%). 309 (81.7%) of presentations were subsequently published. The median time from presentation to publication was 14months (range: 1–85). Studies from multiple vs. single institutions were more likely to be published (87.9% vs. 76.6%; p=0.005). In addition, randomized controlled trials were more likely to be published compared to chart review, cohort, and translation research (92.3% vs. 83.8%, 77.4%, and 74.2%; p<0.01). On multivariate analysis, multi-institutional studies (OR=2.28, 95% CI=1.28-4.04; p=0.005) and type of study (OR=1.64, 95% CI=1.19-2.26; p=0.002) were independent factors associated with publication. In addition, multi-institutional studies had longer times from presentation to publication compared to their counterparts. Conclusions A high percentage of plenary presentations at the Society of Gynecologic Oncologists annual meeting resulted in subsequent publication. Multi-institutional studies and randomized clinical trials were more likely to be published.

Highlights

► Over 80% of presentations at the annual Society of Gynecologic Oncologists meeting were published in peer-reviewed journals ► Single-institution studies were associated with a lower likelihood of publication ► Multi-institutional studies had a higher publication rate compared to other studies

Psychological treatment outcomes for cancer patients: what do meta-analyses tell us about distress reduction?

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Psychological treatment outcomes for cancer patients: what do meta-analyses tell us about distress reduction?

Psychological treatment outcomes for cancer patients: what do meta-analyses tell us about distress reduction?

Psychooncology. 2012 Apr;21(4):343-50

Abstract

OBJECTIVE: The effectiveness of psychological treatment for distress reduction in cancer patients has been frequently studied and reviewed in systematic reviews but reviewer conclusions vary considerably. Clear and consistent evidence is needed to assist clinicians and administrators with their decision-making. We hypothesized that uneven handling of confounding methodological features are at least partly the reason for disagreements and reviewed the literature in this light.

METHOD: A systematic review of 14 published meta-analyses was conducted to determine whether due consideration of moderating variables in psycho-oncological treatments permits clearer recommendations. Quality of the reviews, treatment type, dosage, therapist qualities, outcomes at follow-up, and screening versus not screening for elevated distress were examined as moderator variables.

RESULTS: Treatment effects are consistently positive but also vary greatly in magnitude. There is lacking evidence for many important questions, in particular, differential treatment effects for different cancer types and stages. Regarding moderators of outcome, quality of review had no impact on results for depression but including lower quality reviews actually lead to underestimation of treatment effects for anxiety. The most potent negative moderator variable, however, is a floor effect that arises when patients are recruited for treatment studies without being selected for high levels of distress. Such indiscriminate recruitment is very frequent in psycho-oncology and leads to small reported treatment effects; when, however, patients are first screened for elevated distress, the ratio of observed treatment effects sizes is roughly three times greater.

CONCLUSION: Sweeping judgments about the effectiveness of psycho-oncological treatments for distress reduction are somewhat misleading and counter-productive. Among moderator variables, floor effects are particularly pervasive and have a large suppressor effect on observed outcomes.

PMID: 21882287 [PubMed - indexed for MEDLINE]

Management of highly emetogenic chemotherapy