Colin S. McArdle

Emergency presentation of colorectal cancer is associated with poor 5-year survival.

Previous studies have reported that emergency presentation of colorectal cancer is associated with poor outcome. Many of these studies were small and most were not adjusted for case mix. The aim of this study was to establish, after adjusting for case mix, the magnitude of the differences in postoperative mortality and survival between patients undergoing elective surgery and those presenting as an emergency.

Psychological support for patients undergoing breast cancer surgery: a randomised study.

Abstract Objective: To evaluate the effect of support from a nurse specialising in breast care and a voluntary support organisation on prevalence of psychological morbidity after surgery for breast cancer. Design: Prospective randomised study. Setting: Three teaching hospitals in Glasgow with established breast clinics. Subjects: 272 women aged less than 70 years undergoing surgery for breast cancer. Interventions: Patients were randomly allocated to receive routine care from ward staff, routine care plus support from breast care nurse, routine care plus support from voluntary organisation, or routine care plus support from nurse and organisation. Main outcome measures: Prevalence of psychological morbidity as assessed by self rating scales: 28 item general health questionnaire and its subscales, and hospital anxiety and depression scale. Measurements were made at first postoperative clinic visit and at three, six, and 12 months after surgery. Results: On each self rating scale, psychological morbidity tended to fall over the 12 month period. For each scale, scores were consistently lower in patients offered support from breast care nurse alone compared with the other groups, which were similar to each other. Differences were significant or nearly so: P values were 0.015 (28 item general health questionnaire), 0.027 (anxiety and insomnia), 0.072 (severe depression), 0.053 (somatic symptoms), 0.031 (social dysfunction), 0.093 (hospital anxiety), and 0.003 (hospital depression). Conclusion: Support from breast care nurse can significantly reduce psychological morbidity, as measured by self rating scales, in women undergoing breast cancer surgery. Key messages Key messages The value of different forms of psychological support for breast cancer patients is uncertain We compared effect of four different types of support for patients undergoing surgery for breast cancer: routine care from ward staff, routine care plus support from specialist breast care nurse, routine care plus support from voluntary organisation, or routine care plus support from nurse and organisation Scores of psychological morbidity were consistently lower in patients offered support from breast care nurse alone compared with the other groups, which were similar to each other Psychological support from an experienced breast care nurse can reduce psychological morbidity in patients undergoing surgery for breast cancer

Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss

The association between hypoalbuminemia and poor prognosis in patients with cancer is well recognized. However, the factors that contribute to the fall in albumin concentrations are not well understood. In the present study, we examined the relationship between circulating albumin concentrations, weight loss, the body cell mass (measured using total body potassium), and the presence of an inflammatory response (measured using C-reactive protein) in male patients (n = 40) with advanced lung or gastrointestinal cancer. Albumin concentrations were significantly correlated with the percent ideal body weight (r = 0.390, p < 0.05), extent of reported weight loss (r = -0.492, p < 0.01), percent predicted total body potassium (adjusted for age, height, and weight, r = 0.686, p <0.001), and log10 C-reactive protein concentrations (r = -0.545, p < 0.001). On multiple regression analysis, the percent predicted total body potassium and log10C-reactive protein concentrations accounted for 63% of the variation in albumin concentrations (r2 = 0.626, p < 0.001). The interrelationship between albumin, body cell mass, and the inflammatory response is consistent with the concept that the presence of an ongoing inflammatory response contributes to the progressive loss of these vital protein components of the body and the subsequent death of patients with advanced cancer.

Influence of volume and specialization on survival following surgery for colorectal cancer

Previous studies have shown that significant surgeon‐related differences in survival exist following surgery for colorectal cancer. It is not clear whether these differences were due to differences in caseload or degree of specialization.

Prognostic factors in advanced gastrointestinal cancer patients with weight loss.

There are few reports on factors that determine survival in advanced gastrointestinal cancer with weight loss. In these patients (n = 91, median weight loss 16.6%), we prospectively examined the importance of metastatic spread, anthropometry, blood parameters, Karnofsky performance status, appetite, and the acute-phase response as predictors of survival. Survival was calculated from date of assessment to the most recent clinic attendance (≥30 mo) or until death. On multivariate analysis, metastatic spread (p < 0.05), Karnofsky performance status (p < 0.01), and C-reactive protein concentration (p < 0.001) had independent prognostic value. In locally advanced disease (n = 64), Karnofsky performance status and C-reactive protein concentration remained significant. There was a significantly lower survival in patients with an acute-phase response (median 136 days) than in patients with no response (median 466 days; p < 0.01). Performance status and the acute-phase response are associated, independent of weight loss, with survival duration in advanced gastrointestinal cancer patients.

Impact of weight loss, appetite, and the inflammatory response on quality of life in gastrointestinal cancer patients

The relationship between weight loss, appetite, the inflammatory response, and quality of life in patients with advanced gastrointestinal cancer was examined. Height, weight, and skinfold anthropometry were measured in 119 patients. Blood was taken for analysis of C-reactive protein and albumin. Appetite, performance status, and quality of life were assessed using EuroQol EQ-5D and EORTC QLQ-C30 questionnaires. Weight loss was > 5% (median 17.1%) of their preillness weight in 97 patients; the remaining 22 patients were weight stable. Anthropometric measurements and circulating albumin concentrations were significantly lower (p < 0.01) and circulating concentrations of C-reactive protein were significantly higher in the weight-losing than in the weight-stable group (p < 0.001). Appetite scores, performance status, and EuroQol EQ-5D and EORTC QLQ-C30 scores were also lower in the weight-losing group (p < 0.01). When the weight-losing cancer patients were divided on the basis of whether they had a marked inflammatory response, albumin concentrations, appetite, and Karnofsky performance status were significantly lower (p < 0.05) in the group with a marked inflammatory response. The results of the present study are consistent with weight loss, reduction of appetite, and an elevated inflammatory response being important related factors in lowering the quality of life of gastrointestinal cancer patients.

Male gender adversely affects survival following surgery for colorectal cancer

Previous studies have suggested that survival following surgery for colorectal cancer is better in women than men. However, the findings were inconsistent and few studies adjusted for case‐mix. The aim of the present study was to establish whether there were gender differences in survival following surgery for colorectal cancer after adjusting for case‐mix.

Longitudinal study of body cell mass depletion and the inflammatory response in cancer patients

There is recent evidence that the inflammatory response may be important in the disproportionate loss of body cell mass in cancer patients. To examine this further, 18 male patients with lung or gastrointestinal cancer were studied over a 12-week period. In addition to weight, anthropometry, C-reactive protein (marker of the inflammatory response), albumin, and total body potassium were measured at baseline and 12 weeks. When those patients who lost total body potassium were compared with those who had not, there was a significant increase in the baseline and 12-week C-reactive protein concentrations (p < 0.05). The reduction in total body potassium was also associated with a reduction in triceps skinfold thickness (p < 0.05). There were significant correlations between the mean C-reactive protein concentration and the relative (r = -0.846, p < 0.001) and absolute (r = -0.806, p < 0.001) change in total body potassium over the follow-up period. This study demonstrates the association of a chronic inflammatory response with the rate of loss of body cell mass observed in cancer patients.

The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer

Previous studies have drawn attention to the high postoperative mortality and poor survival of patients who present as an emergency with colon cancer. However, these patients are a heterogeneous group. The aim of the present study was to establish, having adjusted for case mix, the size of the differences in postoperative mortality and 5‐year survival between patients presenting as an emergency with evidence of blood loss, obstruction and perforation.

Obesity and cancer

Obesity is increasing at an alarming rate throughout North America and Europe and is associated with substantial morbidity and mortality. The condition has long been recognised as a risk factor for diabetes and cardiovascular disease, but not for developing cancer. A recent survey of the public by the American Cancer Society found that less than 5% of respondents were aware of the increased cancer risk associated with overweight and obesity. A recent meta-analysis showed that more than 70 000 of the 3.5 million new cases of cancer each year in the European Union are attributable to overweight or obesity. This is likely to be a conservative estimate for two reasons. Firstly, only those tumours for which there was existing evidence to suggest a link between obesity and cancer (namely, for breast, colon, endometrium, prostate, kidney, and gallbladder) were included in the study. Secondly, the number of cancers attributable to obesity is likely to have increased because obesity levels have increased substantially since the publication of many of the studies included in this meta-analysis. More recently, the American Cancer Societys prospective population based study of about 900 000 subjects confirmed that obesity was directly associated with an increased risk of death from a variety of cancers. In both men and women, obesity was significantly associated with higher death rates from cancer of the oesophagus, colon and rectum, gallbladder, pancreas, and kidney, independently of smoking. Obesity was also associated with an increased risk of death from cancers of the stomach and prostate in men and from cancers of the breast (postmenopausal), uterus, cervix, and ovary in women. The increased risk of cancer has been most clearly defined in the common cancers. For example, in males the risk of colorectal cancer increased up to 80% in those whose body mass index (weight in kilograms divided by height in metres squared) was greater than 30.