Aleksandra Czerw

Assessment of pain, acceptance of illness, adjustment to life with cancer, and coping strategies in colorectal cancer patients

Introduction Every year more than 15,000 newly diagnosed cases of colorectal carcinoma are recorded in Poland. Aim The objective of the study was an assessment of coping strategies and pain management, acceptance of illness, and adjustment to cancer in patients diagnosed with colorectal carcinoma. The analysis was extended to include the effect of socioeconomic variables on the above-mentioned issues. Material and methods The study included 238 colorectal cancer patients treated on an outpatient basis at the Centre of Oncology, the Maria Skłodowska-Curie Institute in Warsaw in the year 2013. The questionnaire interview comprised demographic questions (socioeconomic variables) and the following four psychometric tests: BPCQ (Beliefs about Pain Control Questionnaire), CSQ (Coping Strategies Questionnaire), AIS questionnaire (Acceptance of Illness Scale), and the Mini-Mac scale (Mental Adjustment to Cancer). Results The source of pain control depends on the respondents level of education. An increase in patient income was associated with a lower mean result in the “power of doctors” subscale. The coping self-statements and increased behavioural activity are the two most frequently selected strategies of coping with pain. The most commonly followed ways of mental adjustment to cancer in the study group were a fighting spirit (23.42) and positive re-evaluation (22.31). Conclusions Colorectal cancer patients believe that the greatest role in pain management is played by internal factors. The locus of pain control depends on the level of education. The study patients feature a constructive way of struggling with disease differentiated by the place of residence, professional status, and income.

Incidence and mortality rates in breast, corpus uteri, and ovarian cancers in Poland (1980–2013): an analysis of population-based data in relation to socio-economic changes

Objectives This study aimed to analyze incidence and mortality trends in breast cancer (BC), corpus uteri cancer (CUC), and ovarian cancer (OC) in Poland in the context of sociodemographic changes. Materials and methods Incidence and mortality data (1980–2013) were retrieved from the Polish National Cancer Registry, while socioeconomic data (1960–2013) were obtained from the World Bank. Age-standardized incidence and mortality rates were calculated by direct standardization, and join-point regression was performed to describe trends using the average annual percentage change (AAPC). Results A significant decrease in birth and fertility rates and a large increase in gross domestic product were observed together with a decrease in the total mortality rate among women, as well as an increase in life expectancy for women. A large, significant increase in BC incidence was observed (AAPC1980–1990 2.14, AAPC1990–1996 4.71, AAPC1996–2013 2.21), with a small but significant decrease in mortality after a slight increase (AAPC1980–1994 0.52, AAPC1994–2013 −0.66). During the period 1980–2013, a significant increase in CUC incidence (AAPC1980–1994 3.7, AAPC1994–2013 1.93) was observed, with an initial mortality-rate reduction followed by a significant increase (AAPC1980–2006 −1.12, AAPC2006–2013 3.74). After the initial increase of both OC incidence and mortality from 1994, the incidence rate decreased significantly (AAPC1980–1994 2.98, AAPC1994–2013 −0.49), as did the mortality rate (AAPC1980–1994 0.52, AAPC1994–2013 −0.66). Conclusion After 1994, a decrease in OC incidence was found, while the incidence of BC and CUC continued to increase. A reduction in mortality rate was observed for BC and OC predominantly at the end of the study period, while for CUC, after a long decreasing mortality trend, a significant increase was observed.

The impact of individualised nutritional therapy according to DASH diet on blood pressure, body mass, and selected biochemical parameters in overweight/obese patients with primary arterial hypertension: a prospective randomised study

BACKGROUND AND AIM The aim of the study was to assess the impact of individualised nutritional intervention based on the DASH diet (Dietary Approaches to Stop Hypertension) on the nutritional status, blood pressure, and selected biochemical parameters of obese/overweight patients with primary arterial hypertension. METHODS A total of 131 participants were randomised to the DASH intervention group (DIG; n = 69, 33 males) or the control group (CG; n = 62, 32 males). A three-month nutritional intervention was carried out in the DIG group, while the control group received only standard recommendations. Body weight, height, waist and hip circumference, body composition, blood pressure, serum glucose, and insulin and leptin concentrations were measured at the baseline and after the intervention. RESULTS Sixty-four (92.8%) participants in the intervention and 62 (100%) in the control group completed the study. In the DIG group a significant decrease in body mass, systolic and diastolic blood pressure, body fat content, fasting glucose, insulin, and leptin concentrations were observed in comparison to the control group (p < 0.05). CONCLUSIONS The DASH dietary intervention provides significant benefits to overweight/obese patients with primary hyper¬tension.

DNA fragmentation factors 40 and 45 (DFF40/DFF45) and B-cell lymphoma 2 (Bcl-2) protein are underexpressed in uterine leiomyosarcomas and may predict survival

Objectives DNA fragmentation factors 40 and 45 (DFF40 and DFF45) are responsible for final DNA-laddering during apoptosis, whereas Bcl-2 (B-cell lymphoma 2) is an apoptosis inhibitor. Our aim was to investigate the expression of DFF40, DFF45, and Bcl-2 in uterine leiomyosarcomas (uLMS), leiomyomas (uLM), and the normal myometrium. Furthermore, the correlation between DFF40, DFF45, and Bcl-2 expression and clinicopathological parameters in leiomyosarcomas was assessed. Their prognostic value in disease-free survival (DFS) and overall survival (OS) was also calculated. Materials and methods This study included 53 cases of uLMS from patients matched for age and menopausal status with 53 cases of uLM and 53 controls of normal myometrium (uM). Case samples of uterine myometrium from leiomyosarcomas (uLMS-M) and leiomyomas (uLM-M) were also studied. Immunohistochemical scoring was undertaken for DFF40, DFF45, and Bcl-2. Results DFF40, DFF45, and Bcl-2 were significantly underexpressed in uLMS compared with uLMS-M and uM. In uLMS samples, no correlation between the analyzed proteins was observed. Negative DFF40 and Bcl-2, but not DFF45, staining was a predictor of poorer DFS and OS in women with uLMS. uLM showed DFF40 and Bcl-2 overexpression compared with uM and uLM-M, with a significant positive correlation between DFF40 and DFF45. No differences in DFF40, DFF45, and Bcl-2 expression were observed between the uLMS-M, uLM-M, and uM samples, with a significant positive correlation between DFF40 and DFF45 expression. Conclusion DFF40, DFF45, and Bcl-2 are significantly underexpressed in uLMS, but only a lack of DFF40 and Bcl-2 negatively influences DFS and OS. Disruption of DFF40 and DFF45 expression was observed in uLMS, but not in uLM or control and case myometrium; this may play a role in tumor pathogenesis.

Analysis concerning nutritional behaviors in the context of the risk of orthorexia

Orthorexia is recognized as an eating disorder, an obsessive–compulsive spectrum disorder, or a somatoform disorder. The aim of our research was to analyze nutritional behaviors for the assessment of the risk of orthorexia. The authors developed a questionnaire in which 981 respondents participated and used it as a research method. Both men and women ate mostly 4–5 meals per day (46.30% women versus 34.74% men); however, more men than women ate 1–2 meals daily (18.95% men versus 7.9% women). Both place of birth and field of study did not differ in terms of the number of meals. Moreover, it was observed that the number of meals per day was correlated with the declared time spent on planning a diet. People who ate over 3 meals per day more often indicates that they spent >3 h per day on planning their diet in comparison with people who ate only 1–2 meals. Only 17.6% of the respondents declared that they most often ate meals in a company of someone, whereas 45.3% indicated that there was no rule. The remaining 37.1% of the respondents most often consumed their meals alone. Almost twice as many men as women never paid attention to the qualitative composition of nutrition. Women followed a slimming diet more often than men (20.3% versus 5.8%) and this indicated >4 attempts of losing weight. Around one-third of all the respondents suffered or suffer from eating disorders. Owing to insufficient information on orthorexia, it is essential to conduct further research to determine the characteristics of high-risk groups. Taking the growing interest in a healthy lifestyle into account, there is a need to address the problem of orthorexia in the public space.

Strategies of Coping with Pain in Cancer on the Basis of Lung, Breast, Colorectal, and Prostate Carcinoma.

BackgroundThe selection of an illness coping strategy has a major effect on the quality of life preconditioned by health status.ObjectivesThe objective of the study was to assess the influence of the primary site and socioeconomic factors on strategies of coping with pain in patients diagnosed with breast, lung, colorectal, and prostate carcinoma.MethodsThe study included 902 patients treated at the outpatient’s department of the Maria Sklodowska-Curie Memorial Cancer Center—Institute of Oncology in Warsaw. A questionnaire included demographic-type questions and the Coping Strategy Questionnaire (CSQ) designed to assess patient use of strategies of coping with pain.ResultsThe best results in six of the seven CSQ subscales were observed in the colorectal patient group. The lowest scores in all CSQ subscales were recorded in patients with prostate as the primary site. Results in individual patient groups were further juxtaposed with a chemotherapy variable. The only differences were found in the colorectal primary site patient group.ConclusionsA strategy the patient selects in order to cope with disease considerably mediates both pain sensation and the quality of patient life. The study findings demonstrate that CSQ scores are significantly differentiated by the primary site, education, and income.

Immunoexpression of DNA fragmentation factor 40, DNA fragmentation factor 45, and B-cell lymphoma 2 protein in normal human endometrium and uterine myometrium depends on menstrual cycle phase and menopausal status

Introduction DNA fragmentation factors 40 and 45 (DFF40 and DFF45) are final executors of apoptosis, and B-cell lymphoma 2 (Bcl-2) is a well-recognized apoptosis inhibitor. We aimed to evaluate DFF40, DFF45 and Bcl-2 immunoexpression in the normal human endometrium with respect to the glandular and stromal layer and in uterine myometrium. Material and methods DFF40, DFF45, and Bcl-2 expression was assessed via immunohistochemistry in the endometrium and myometrium collected postmenopausally and premenopausally during the proliferative and secretory phases of the menstrual cycle. Results Compared to the myometrium and stroma, endometrial glands showed the highest DFF40 and DFF45 expression in pre- and postmenopausal specimens. DFF45, but not DFF40, glandular expression dependent on menstrual cycle phase and DFF40 and DFF45 scoring was significantly lower in postmenopausal specimens. Significantly higher Bcl-2 expression was observed in proliferative glandular endometrium compared to secretory and postmenopausal specimens. No cycle- or menopause-dependent changes were reported for stromal or myometrial DFF40, DFF45 or Bcl-2 expression. DFF40, DFF45 and Bcl-2 expression was independent of age, age at menarche and menopause, BMI, menstrual cycle and menses lengths, parity and gravidity. Conclusions The study provides important evidence regarding menstrual cycle-dependent changes in the expression of DFF40, DFF45 and Bcl-2 in the normal human endometrium, especially in the glandular layer, and shows that their levels are stable in the normal uterine myometrium.

The assessment of the impact of socio-economic factors in accepting cancer using the Acceptance of Illness Scale (AIS)

Aim of the study The paper presents the results of examining the level of acceptance of the illness in cancer patients using the Acceptance of Illness Scale (AIS). Material and methods The study involved cancer patients treated at the Central Clinical Hospital of the Ministry the Interior in Warsaw in 2014. The questionnaire comprised basic demographic questions (socio-economic factors) and the AIS test estimating the level of illness acceptance in patients. Results For the group of patients in the research group, the arithmetic mean amounted to 27.56 points. The period of time that elapsed between the first cancer diagnosis and the start of the study did not influence the score of accepting illness. The acceptance of illness in patients diagnosed with metastases differed from the acceptance of illness by patients diagnosed with metastatic cancer. Females obtained the average of 29.59 in the AIS test, whereas the average in male patients was 26.17. The patients’ age did not impact the AIS test. There were no differences in the AIS test results between a group of people with secondary education and a group of people with higher education. There were no differences in the AIS test results between employed individuals versus pensioners. The inhabitants of cities were characterized by the highest degree of acceptance of their health condition. The lowest degree of acceptance of illness was observed in the group with the lowest average incomes. In the group of married individuals the average degree of acceptance of illness amounted to 27.37 points. The average degree of acceptance of illness in patients that declared themselves as single amounted to 25.75. Conclusions The average degree of acceptance of illness in the study group was 27.56 points, which is a relatively high level of acceptance of cancer. The main socio-economic factor, which influenced the AIS test results was whether metastases were diagnosed or not. There were no differences between patients in groups where the time that elapsed from the first diagnosis of cancer varied. There were no statistical differences between female and male patients as well as patients of different age. Additionally, the level of education and patients’ professional status did not impact in the AIS test results.

Diagnosis of hepatitis C virus infection in pregnant women in the healthcare system in Poland: Is it worth the effort?

AbstractThe hepatitis C virus (HCV) is globally recognized as a serious public health concern. Current statistics indicate that approximately 2% of people worldwide and 1.9% of people in Poland suffer from HCV infection.This study was conducted to assess the anti-HCV seroprevalence in pregnant women in Poland and subsequently provide recommendations on the rationale for obligatory screening.A total of 42,274 women participated in our study, of which 16,130 were pregnant. We were granted access to their health data stored in the form of electronic medical records kept by the network of outpatient clinics throughout Poland.The lowest rate of positive anti-HCV test results was found in women ages 25 to 34 (0.73%); however, younger and older age groups had similar rates (15–24 = 0.86%; 35–44 = 0.84%). Additional analysis of data from the period between 2011 and 2014 revealed a downward trend in the proportion of positive anti-HCV tests among pregnant women (mean positive anti-HCV = −0.001 × year + 1.9451; R2 = 0.7274). Regardless of the gradual increase in the number of female patients undergoing screening between 2004 and 2015, there has been a constant decrease in the rate of positive cases. The rate of pregnant women potentially infected with HCV was twice as lower than that in a control group of women undergoing tests for other medical circumstances: 0.76% vs 1.67% (P < 0.0001).Analysis of real-world data of female patients in Poland provides evidence that screening based on an individuals medical history and behavioral risk factors in clinical circumstances would be more effective than obligatory testing of all pregnant women.

Use of the mini-MAC scale in the evaluation of mental adjustment to cancer

Aim of the study The objective of the study was to evaluate mental adjustment to cancer in patients diagnosed with an oncologic disease through identification of the coping strategies they had adopted. Material and methods Seventy-four patients of the Clinic of Oncology and Haematology at the Central Clinical Hospital (CSK) of the Ministry of Interior (MSW) in Warsaw were included in the study. The degree of adaptation to cancer was evaluated with the use of the mini-Mental Adjustment to Cancer (mini-MAC) scale. The individual subscales, i.e. fighting spirit, positive redefinition, helplessness-hopelessness, and anxious preoccupation, were collated with socio-demographic characteristics. Results Study findings indicate that: 1) tumour patients typically manifest behaviour that allows one to identify their adjustment to cancer; 2) in malignant tumour patients constructive behaviour prevails over destructive behaviour; 3) the helplessness-hopelessness response is more pronounced in men than women; 4) metastatic patients manifest stronger helplessness-hopelessness response than patients with locally limited tumours; 5) pensioners more often than people of working age adopt the helplessness-hopelessness strategy; and 6) patients with the shortest disease period manifest the strongest fighting spirit. Conclusions Cancer patients employ various strategies of coping with disease depending on socio-demographic factors.