Birgita Slováčková

Quality of life in oncological and hematooncological patients after hematopoietic stem cell transplantation: The effect of selected psychosocial and health aspects on quality of life: A review of the literature

Summary Haematopoietic stem cell transplantation is a therapeutic method which is not only used for the treatment of haematooncological diseases but also as a therapy for solid tumours and non-malignant diseases. Haematopoietic stem cell transplantation influences the further course of the disease and therefore the quality of life for patients in the same way as other therapeutic methods. The authors describe the evaluation possibilities for the quality of life and effect of selected aspects on quality of life of patients undergoing haematopoietic stem cell transplantation in the form of a review of the literature.

Psychosocial, health and demographic characteristics of quality of life among patients with acute myeloid leukemia and malignant lymphoma who underwent autologous hematopoietic stem cell transplantation.

CONTEXT AND OBJECTIVE This study evaluated the effect of selected psychosocial, health and demographic characteristics of quality of life (QOL) among patients treated with autologous hematopoietic stem cell transplantation (HSCT). DESIGN AND SETTING This was a retrospective study at Charles University Hospital, Hradec Kralove. METHODS The Czech version of the international generic European Quality-of-Life questionnaire (EQ-5D) was applied to evaluate QOL among patients with acute myeloid leukemia (AML) and malignant Hodgkins and non-Hodgkins lymphoma (ML). The total number of respondents was 36: 12 with AML (seven males and five females) and 24 with ML (11 males and 13 females). The mean age of AML respondents was 46 years and the mean age of ML respondents was 44.5 years. RESULTS Age, smoking status and education level had statistically significant effects on QOL among AML respondents (p < 0.05), and age had a statistically significant effect on QOL among ML respondents (p < 0.05). The overall QOL among AML and ML respondents was generally good: the mean EQ-5D score among AML respondents was 71.5% and among ML respondents it was 82.7%. CONCLUSION The QOL among AML and ML respondents treated with autologous HSCT was good. However, patients more than 50 years old, smokers and patients with lower education levels presented worse QOL. These findings need to be better evaluated in longitudinal studies, using large samples.

Quality of life in patients with multiple myeloma and malignant lymphoma undergoing autologous progenitor stem cell transplantation: The effect of selected psychosocial and health aspects on quality of life: A retrospective analysis

Summary Background Quality of life (QoL) is defined as “a patients subjective evaluation of his life situation”. QoL evaluation is carried out by means of generic and specific questionnaires. Generic QoL questionnaires generally evaluate a patients overall condition regardless of his disease. Specific QoL questionnaires are designed to evaluate a patients overall condition for a particular type of disease. Aim The study analyses the effect of selected psychosocial and health aspects on quality of life in patients with multiple myeloma and malignant lymphoma undergoing autologous progenitor stem cell transplantation. Materials/Methods The total number of respondents undergoing transplantation between 2001 and 2003 was 56:32 respondents (18 male and 14 female) with multiple myeloma, and 24 respondents (11 male and 13 female) with malignant lymphoma. The average age of patients with multiple myeloma was 60 years and the average age of patients with malignant lymphoma was 44.5 years. The Czech version of the international generic European Quality of Life Questionnaire, Version EQ-5D, was used. The effect of selected psychosocial and health aspects (age, sex, level of education, marital status, number of associated diseases, smoking abuse, religion, type of disease and time since the transplantation) on quality of life in patients was determined by means of analysis of variance. Results The above-mentioned aspects proved statistically significant dependence of quality of life on age, smoking abuse in patients with multiple myeloma and on type of disease. EQ-5D score (dimensions of quality of life) and EQ-5D VAS (subjective health condition) significantly decrease with increasing age in both groups of patients and with smoking abuse in patients with multiple myeloma, and are significantly higher in patients with malignant lymphoma. The effect of other aspects on quality of life was not proven as statistically significant. The quality of life in patients with multiple myeloma undergoing autologous progenitor stem cell transplantation is at a lower level (mean EQ-5D score 68.9%, mean EQ-5D VAS 66.6%) than in patients with malignant lymphoma after the transplantation (mean EQ-5D score 82.7%, mean EQ-5D VAS 76.7%) at the Department of Clinical Haematology of the Department of Medicine of Charles University Hospital in Hradec Kralove, Czech Republic. Conclusion The global quality of life in our patients with multiple myeloma and malignant lymphoma undergoing autologous progenitor stem cell transplantation is at a good level.

Sexuality of men treated with haematopoietic stem cell transplantation: a review of the literature

Summary Haematopoietic stem cell transplantation (HSCT) is a therapeutic modality used in anti-tumour treatment of haematological malignancies as well as solid tumours. Apart from that it is also used in therapy of non-malignant and hereditary diseases. As well as all the other treatments, HSCT also affects the disease process and with that also the patient’s quality of life (QoL). In the last decade of the 20 th century several studies about QoL in patients after HSCT were undertaken and the infl uence in particular dimensions of QoL was observed. One of the closely observed aspects was sexuality in patients after HSCT. Sexuality and its expression is a very important aspect of human behaviour. It is also a very sensitive aspect, so without doubt it is affected by diagnosis of neoplasm and cancer treatment. Physical and psychosocial factors of HSCT affect patients’ sexuality and sexual functioning, and with that also their QoL. They remain in focus because of the complex care concerning patients after HSCT.

Health-related quality of life in acute myeloid leukaemia and multiple myeloma survivors undergoing autologous progenitor stem cell transplantation: a retrospective analysis

Summary Background Haematopoietic stem cell transplantation (HSCT) is a specific therapeutic method used for biomodulation antitumour therapy of haematological malignancies and of solid tumours. It is also used for the therapy of non-tumour and hereditary diseases. Aim To analyse the selected psychosocial, health and demographic aspects of quality of life (QoL) in acute myeloid leukaemia (AML) and multiple myeloma (MM) survivors undergoing autologous progenitor stem cell transplantation (PSCT). Materials/Methods The total number of AML survivors was 12 (7 male, 5 female). The total number of MM survivors was 32 (18 male, 14 female). The average age of AML survivors was 47.5 years old. Average age of MM survivors was 60 years old. The Czech version of the international generic European Quality of Life Questionnaire, Version EQ-5D, was used. The effect of selected psychosocial, health and demographic aspects of QoL was determined by means of analysis of variance. The descriptive analysis was used for evaluation of QoL questionnaires. Results The above-mentioned aspects proved statistically significant dependence of QoL (EQ-5D score and EQ-5D VAS) on age in both cohorts (p Conclusions Low QoL correlates with increasing age of survivors treated with autologous PSCT. QoL in survivors who underwent autologous PSCT and believed in God was higher than in survivors who were non-believers. Low QoL correlates with smoking abuse. In both cohorts of survivors we proved lower QoL in smokers in comparison with non-smokers or former smokers. Low QoL in AML survivors with low level of education, meaning survivors with elementary and apprentice level education, has been proved. Low QoL correlates with increasing number of associated diseases in both cohorts of survivors.

Palliative care among elderly cancer patients: Own experience

BACKGROUND Annually, more than 27,000 persons die of cancer in the Czech Republic. It is known that in addition to the demographic aging of the Czech population, the cancer burden is increased. AIM These data clearly demonstrate the need for affordable and good follow-up care for patients, especially for older patients and/or patients with no other cancer treatment due to irreversible progression of tumor. MATERIALS AND METHODS We are talking about so-called palliative cancer care, which can be provided at different levels. One of the most common forms of palliative cancer care is hospice care. RESULTS Our clinic in the years 2008-2010 received a total of 446 patients. 288 of them were women and 158 men. The average age of women was 61 years (age range 20-81 years). The average age of men was 56 years (age range 18-96 years). The performance status was in the fitness category PS-0 (8%), PS-1 (54%), PS-2 (33%) and PS-3 (5%). CONCLUSION Currently the outpatient palliative cancer care are coming more into the forefront. This type of care allows patients to stay as long as possible at home among their close relatives. Prerequisite for a well working outpatient palliative care is cooperation with general practitioners and home health care agencies.

Nivolumab induced encephalopathy in a man with metastatic renal cell cancer: a case report

BackgroundGreat progress has recently been made in the treatment of metastatic renal cell carcinoma, including the introduction of nivolumab, an immune checkpoint inhibitor. Despite promising results, this treatment brings a completely new spectrum of adverse events, distinct from those experienced with small-molecule kinase inhibitors. Neurologic immune-related adverse events may be serious and potentially life-threatening complications requiring immediate immunosuppressive therapy. Only a few cases of immune-related encephalitis induced by checkpoint inhibitors have been described and the data regarding the management of this serious adverse event are limited.Case presentationWe report the case of a 63-year-old white man with metastatic renal cancer who developed severe chorea-like dyskinesia during nivolumab therapy. The findings on brain magnetic resonance imaging and flow cytometry of cerebrospinal fluid, and the positivity of anti-paraneoplastic antigen Ma2 immunoglobuline G class autoantibodies were consistent with a diagnosis of immune-related encephalitis. High-dose intravenous corticosteroid therapy was started immediately, with no signs of improvement, even when infliximab was added. Our patient refused further hospitalization and was discharged. Three weeks later, he presented with signs of severe urosepsis. Despite intensive treatment, he died 4 days after admission.ConclusionsThe management of less frequent immune-related adverse events has not been fully established and more information is required to provide uniform recommendations. Immune-related encephalitis is a severe and potentially fatal complication requiring immediate hospital admission and extensive immunosuppressive therapy. The examination of cerebrospinal fluid for paraneoplastic antibodies, such as anti-N-methyl-D-aspartate receptor and anti-Ma2 antibodies, in order to distinguish autoimmune etiology from other possible causes is essential and highly recommended.

Quality of life in adult patients treated with peripheral blood progenitor cell transplantation: the effect of selected psychosocial, demographics and health aspects on quality of life: a retrospective analysis.

AIM this retrospective study analyses the effect of selected psychosocial, demographics and health aspects on quality of life (QoL) in adult patients treated with peripheral blood progenitor cell transplantation (PBPCT). PATIENTS AND METHODS The total number of respondents treated with PBPCT between the years 2001-2003 was 95. The return rate of QoL questionnaires was 72.1 % (71 respondents). There were 100 % ratable QoL questionnaire. The average age of all respondents was 55.5 years old. The Czech version of an international generic European Quality of Life Questionnaire - Version EQ-5D was used. The effect of selected aspects on QoL of patients was determined by analysis of variance. The QoL questionnaires were evaluated with descriptive analysis. RESULTS The above-mentioned aspects proved statistically significant dependence of QoL (EQ-5D score - QoL dimensions, EQ-5D VAS - subjective health condition) on age, increasing number of associated diseases, religion and type of disease. The effect of other aspects on QoL was not proven statistically significant. The QoL in adult patients treated with PBPCT declines with increasing age and with the increasing number of associated diseases. People of faith have a higher level of QoL than non-believers. Patients with multiple myeloma treated with PBPCT have the most low QoL. CONCLUSION The global QoL in an adult patients treated with PBPCT is on a good level.