Emmanuela Katsouda

Cancer information disclosure in different cultural contexts.

The relationship between truth telling and culture has been the subject of increasing attention in the literature. The issue of whether, how and how much to tell cancer patients concerning diagnosis is still approached differently depending on country and culture. The majority of physicians tell the truth more often today than in the past, in both developed and developing countries, but most of them prefer to disclose the truth to the next of kin. Nurses in Anglo-Saxon countries are considered to be the most suitable health-care professionals for the patients to share their thoughts and feelings with. Nevertheless, in most other cultures the final decision on information disclosure lies with the treating physician. Regardless of cultural origin, the diagnosis of cancer affects both family structure and family dynamics. In most cases patients’ families, in an effort to protect them from despair and a feeling of hopelessness, exclude the patient from the process of information exchange. The health-care team–patient relationship is a triangle consisting of the health-care professional, the patient and the family. Each part supports the other two and is affected by the cultural background of each of the others as well as the changes that occur within the triangle.

Randomized, open label, prospective study on the effect of zoledronic acid on the prevention of bone metastases in patients with recurrent solid tumors that did not present with bone metastases at baseline

AbstractObjectives: Bisphosphonates have been used successfully in the treatment of hypercalcemia and to reduce skeletal-related complications of bone metastases. Recent in vitro and in vivo evidence suggest that they may also have direct antitumor effects via induction of apoptosis, inhibition of the invasive potential of tumor cell lines in vitro, inhibition of angiogenesis, and reduction in tumor growth indirectly via effects on accessory cells. This is a randomized, open label, prospective study that examined the effect of preventive zoledronic acid treatment on the development of bone metastases in patients with recurrent solid tumors, without bone metastases at the time of randomization. Methods: Forty patients with recurrent or metastatic advanced cancer, without bone metastases, were randomized into the trial to either receive zoledronic acid or no treatment. Patients were followed up until bone metastases were established. Results: The percentage of patients being bone metastases free at 12 mo was 60% in the zoledronic acid and 10% in the control group (p<0.0005), while the percentages at 18 mo were 20% and 5% respectively (p=0.0002). Conclusions: The results have shown that bisphosphonates as adjuvant treatment might be useful for the prevention of bone metastases; however, there is need for blinded randomized data before such an approach would be confirmed. In the meantime preventive use of bisphosphonates in patients without any bone metastases should not be used outside the scope of a clinical trial.

The Hospital Anxiety and Depression Scale in Greek cancer patients: psychometric analyses and applicability

Goals of workThe aim of the present study was to validate the Greek version of the Hospital Anxiety and Depression Scale (HAD) in a palliative care unit.Patients and methodsThe scale was translated with the “forward-backward” procedure to Greek. It was administered twice, with a 1-week interval, to 120 patients with advanced cancer. Together with the HAD scale, the patients also completed the Spielberger State-Anxiety Scale (STAI-S).Main resultsFactor analyses identified a two-factor solution corresponding to the original two subscales of the HAD, which were found to be correlated. The Greek version of the HAD had Cronbach’s alphas for the anxiety and depression scales of 0.887 and 0.703, respectively. Validity as performed using known-group analysis showed good results. Both anxiety and depression subscales discriminated well between subgroups of patients differing in disease severity as defined by ECOG performance status. Correlations between the HAD scale and the STAI-S was 0.681 for the anxiety subscale and 0.485 for the depression subscale.ConclusionsThese psychometric properties of the Greek version of the HAD scale confirm it as a valid and reliable measure when administered to patients with advanced cancer.

Oral transmucosal fentanyl citrate: overview of pharmacological and clinical characteristics.

Oral transmucosal fentanyl citrate (OTFC; brand name Actiq®, Cephalon, UT) is a new opioid formulation that incorporates fentanyl into a lozenge and allows drug delivery through the buccal mucosa. This kind of absorption avoids first-pass metabolism, yielding a bioavailability substantially greater than oral administration. OTFC has a rapid onset of action and a short duration of effect. These characteristics, which resemble the course of a typical breakthrough pain episode, resulted in making OTFC the first opioid analgesic formulation specifically developed and approved for control of breakthrough pain in cancer patients. Apart from that, OTFC has been used in a variety of clinical situations of noncancer pain. This review article presents the synthesis; clinical pharmacology; pharmacokinetic and pharmacodynamic properties, toxicity, and clinical efficacy of this novel agent.

Greek M.D. Anderson Symptom Inventory: Validation and utility in cancer patients

Objective: The M.D. Anderson Symptom Inventory (MDASI) is a brief assessment of the severity and impact of cancer-related symptoms. The purpose of this study was the translation and validation of the questionnaire in Greek (G-MDASI). Methods: The translation and validation of the assessment took place at a Pain Relief and Palliative Care Unit. The final validation sample included 150 cancer patients (61 males, 89 females, age range 31–88 years, mean age 63.32). The patients completed the questionnaires at the outpatient clinic. Assessing the validity and reliability constituted the actual validation of the G-MDASI. Results: The item ‘diarrhea’ had a score of 0 in 139 patients and, thus was omitted from the ‘core’ list. Consequently, the core questionnaire consisted of 14 items. Factor analysis resulted in a 3-factor model, in both validation and cross-validation samples. The examination of the sensitivity of the MDASI revealed that there were differences between patients with poor-to-good performance status but no differences were found between patients in different treatment groups. Conclusions: The results showed that the G-MDASI is a reliable and valid measure in Greek cancer patients. It has proved to be a comprehensive symptom assessment tool.

Oral transmucosal fentanyl citrate for the treatment of breakthrough pain in cancer patients: an overview of its pharmacological and clinical characteristics.

Breakthrough pain is a transitory flare of pain occurring in most cancer patients against a background of otherwise controlled persistent pain. Treatment of breakthrough pain is a challenging phenomenon. Oral transmucosal fentanyl citrate (Actiq ® , Cephalon, Inc., West Chester, PA), a new opioid formulation with a unique delivery system, reflects the characteristics of breakthrough pain (rapid onset of action and short duration), making it an effective treatment for cancer patients who already receive opioids and experience flares of pain. This review article aims to present the role of oral transmucosal fentanyl citrate in the management of breakthrough pain in cancer patients. In particular, it is going to discuss the synthesis, clinical pharmacology, pharmacokinetic and pharmacodynamic properties, toxicity, and clinical efficacy of this novel agent.

Pain and desire for hastened death in terminally ill cancer patients.

The purpose of this study was to assess the relationship between pain and the desire for hastened death in terminally ill cancer patients. The participants were 120 terminally ill cancer patients under palliative treatment from June 2003 to November 2004. Patients completed a pain assessment tool, the Greek Brief Pain Inventory (G-BPI), and a self-report measure of the desire for hastened death, the Greek Schedule of Attitudes Toward Hastened Death (G-SAHD). Moderate but statistically significant associations were found between some of the severity and interference items of G-BPI and G-SAHD; more specifically, between G-SAHD and G-BPI3, “worst pain in the last 24 hours” (r = 0.279, P = .002); G-SAHD and G-BPI4, “least pain in the last 24 hours” (r = 0.253, P = .005); and G-SAHD and G-BPI5, “average pain in the last 24 hours” (r = 0.283, P = .002). A stronger association was revealed between G-SAHD and G-BPI8, “relief provided by pain treatment and medications in the last 24 hours” (r = −0.326, P = .000). Multiple regression analyses including the enter model and the forward model were conducted. According to the enter model, the strongest predictors of hastened death were items G-BPI6, “current pain”; G-BPI8, “relief provided by pain treatment and medications in the last 24 hours”; G-BPI9i, “interference of pain in general activity”; and G-BPI9iii, “interference of pain in walking.” According to the forward model, significant predictors of the desire for death were items G-BPI5, “average pain in the last 24 hours”; G-BPI6, “current pain”; G-BPI9i, “interference of pain in general activity”; and G-BPI9ii, “interference of pain in mood,” all of which were statistically significant (P = .000–.042). Pain appeared to have a statistically significant relationship with the desire for hastened death. Effective treatment by healthcare professionals should be provided to reduce pain and cancer-related symptoms as well as the desire for hastened death.

Prophylactic tropisetron versus rescue tropisetron in fractionated radiotherapy to moderate or high emetogenic areas: a prospective randomized open label study in cancer patients.

AimA prospective randomized open label study was carried out to evaluate the efficacy and effectiveness of prophylactic tropisetron versus rescue tropisetron in fractionated radiotherapy.Patients and MethodsThe study sample consisted of 288 cancer patients randomly allocated (3∶4 ratio) into two treatment groups: 120 patients received prophylactic antiemetic treatment with tropisetro and 168 patients received rescue tropisetron. To determine the efficacy of prophylactic antiemetic treatment, nausea and vomiting were evaluated 1 d before radiation therapy (RT), at 24 and 72 h, at the end of every week during RT, and finally 1 wk after RT. Diary cards were used to record the intensity of nausea and vomiting as well as the incidence of adverse effects.ResultsIn the odds of nausea and vomiting, statistically significant differences were found between the two treatment groups over time. The incidence of nausea and vomiting were 1.89 (p=0.009) and 2.19 (p=0.001) times higher in the rescue tropisetron group than in the prophylactic tropisetron group. Factors that related significantly with increased nausea were primary cancer, rescue tropisetron, and radical RT. Moreover, factors for vomiting were primary cancer type, metastasis, palliative RT, and rescue tropisetron.ConclusionsHigher numbers of patients receiving prophylactic tropisetron completed RT with lower incidence of nausea and vomiting than those in the rescue tropisetron group.

Death and Grief in the Greek Culture

None would disagree that death is the great separator. Death has many meanings, and they change with culture and society. In the Greek mythology, the dead journeyed to the Afterlife, ruled by Hades. Death was not perceived as an end in and by itself, but rather as another “world” to belong to. By Classical times there was a rise to burial rituals and commemorative practices, carried out throughout the centuries. Christian religion attempted to change the way the dead were mourned, and preached the immortality of the soul and resurrection of the dead. Nevertheless, the way people grieved and buried their dead has not changed much. The only change is a difficulty in the receptiveness of burial procedures, observed in large cities and in younger population. Today in Greece, the perceptions and practices on grief and death derive both on the ancient and the Christian Orthodox traditions.

A prospective randomized controlled clinical trial of zoledronic acid for bone metastases

In this study, we assessed the safety, tolerability, and effectiveness of two therapeutic regimens relating to the frequency of zoledronic acid (ZOL) infusion. Sixty adult patients with bone metastases were randomly assigned to two study groups. The first group (group A) received 4 mg ZOL every two weeks, and the second group (group B) received 4 mg ZOL every four weeks. Assessment measures included C-telopeptide (CTX) rate, the Greek Brief Pain Inventory (GBPI), the linear analogue scale assessment (LASA) of quality of life, and biochemical markers. Assessments were made at weeks 12, 24, 36, and 48. Clinical endpoints included effective decrease in bone resorption markers, pain relief, and improvement of mobility status. The follow-up period was 48 weeks. No statistically significant differences between groups A and B were found in overall profile of biochemical markers, Eastern Cooperative Oncology Group (ECOG) performance status, and GBPI score at the end of the follow-up period. Assessment of bone metastases revealed a slight difference between the two groups, however this difference was not statistically significant. These findings indicate that administering zoledronic acid at four rather that two weeks has no significant impact on overall outcome.