Hakan Bozcuk

Does treatment delay affect survival in non-small cell lung cancer? A retrospective analysis from a single UK centre

We analysed survival in relation both to time to treatment and other clinical parameters in the care pathway of non-small cell lung cancer (NSCLC) patients. Medical notes of 189 patients diagnosed with NSCLC presenting in 1998 were reviewed. Median time to treatment in all patients was 48 days. In multivariate analysis, time to treatment did not affect survival in patients with any stage of disease. Referral from general practitioner to chest department (P=0.032, HR=0.08), and absence of use of surgery (P=0.006, HR=30.30) were independently significant predictors of survival in stages 1 and 2 subgroup. In stage 3 patients, absence of laboratory abnormality (P=0.002, HR=0.39), and use of combined treatment (P=0.015, HR=0.17) were independent prognosticators. Lastly, in patients with stage 4 disease, presence of bone and/or liver metastasis (P=0.005, HR=2.65), and absence of use of chemotherapy (P<0.001, HR=6.25) were significantly associated with shorter survival. As survival is dependent on classical prognosticators, but not on time from referral to treatment (hospital delay), expanding resources in oncology (equipment, drugs and personnel), and, perhaps, reducing patient delay, rather than reducing hospital delay alone, could be better strategies to improve NSCLC survival.

“Do not tell”: what factors affect relatives’ attitudes to honest disclosure of diagnosis to cancer patients?

Disclosure of the diagnosis of cancer to patients is a difficult task for physicians in developing countries. Family members often oppose truth telling. The aim of this study was to evaluate the incidence of the “do not tell” attitude in a general population of cancer patients and to explore the factors affecting the attitude of cancer patients’ relatives about honest disclosure. Using a questionnaire, relatives of 150 patients with recently diagnosed cancer were interviewed. Of the relatives, 66% did not want the diagnosis to be disclosed. Male gender of the patient, a diagnosis of a non-breast cancer malignancy, the presence of stage IV disease, no previous request for disclosure by the patient, insufficient knowledge of the relative about cancer in general, and stronger religious belief of the relative were associated with greater likelihood of the relative having a “do not tell” attitude in univariate analyses (P=0.032, P=0.000, P=0.051, P=0.021, P=0.128, and P=0.058, respectively). In a multivariate analysis, the diagnosis of a non-breast cancer malignancy, and insufficient knowledge of the relative about cancer in general retained their significance (exp(B)=14.77, P=0.000; exp(B)=3.04, P=0.01, respectively). Differences among different countries and cultures are discussed.

Does awareness of diagnosis make any difference to quality of life? Determinants of emotional functioning in a group of cancer patients in Turkey.

Abstract. The object of this study was to investigate how the information status with regard to diagnosis, in addition to social and clinical factors, influenced emotional functioning and quality of life in a group of cancer patients in Turkey. A consecutive sample of 100 cancer patients being treated for different diagnoses in a tertiary care centre were prospectively evaluated. Data on patient disease and social characteristics, clinical factors, and scores on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were analysed by logistic regression models. A significant proportion (44%) of the patients did not know of their diagnosis of cancer. The scores on functional and symptom scales and global health status/quality of life according to QLQ-C30 did not differ according to the information given or not given on diagnosis. However, the independently significant determinants of good emotional functioning were male gender (P=0.002), low serum alanine transferase levels (P=0.025), good social functioning (P=0.002), and the absence of constipation (P=0.005). In Turkey, it is still common for cancer patients not to be informed of their diagnosis, and there is a great need to improve this situation. Honest disclosure of the truth does not worsen any dimension of quality of life in general or emotional functioning in particular. On the contrary, those with hepatic dysfunction, female gender, poor social functioning and constipation are the ones at increased risk of poor emotional functioning, and these patients may benefit from psychological screening.

Does maintenance/consolidation chemotherapy have a role in the management of small cell lung cancer (SCLC)? : A metaanalysis of the published randomized controlled trials

The role of maintenance/consolidation chemotherapy was assessed in the management of small cell lung cancer (SCLC) via a metaanalytic approach.

Cisplatin cytotoxicity is enhanced with zoledronic acid in A549 lung cancer cell line: Preliminary results of an in vitro study

We tested whether zoledronic acid, a biphosphonate with proposed apoptotic activity, augmented the cytotoxicity of cisplatin and/or gemcitabine in A549 lung cancer cell line. This cell line was subjected to different concentrations of the above chemotherapeutic agents and zoledronic acid. Cytotoxicity was assessed by the MTT (3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyl tetrasodium bromide) assay. Particularly, zoledronic acid in 100 micromolar (μM) concentration augmented the cytotoxicity by cisplatin 1 μg/ml from 25% to 70% (Z= 3.22, P= 0.0072). A significant portion of cells underwent apoptosis with or without zoledronic acid, but more so with the combination treatment as assessed by an Annexin V‐FITC apoptosis detection kit. However, 100 μM zoledronic acid showed 50% cytotoxicity on its own, but failed to improve cytotoxicity by Gemcitabine. Thus, we show for the first time in a lung cancer cell line that zoledronic acid bears cytotoxic potential on its own and in conjunction with cisplatin. The clinical potential of this finding should be further studied.

A simple and accurate prediction model to estimate the intrahospital mortality risk of hospitalised cancer patients

We aimed to form a risk prediction model to assess the probability of intrahospital death in cancer patients at the time of hospitalisation. The medical records and the relevant clinical parameters of cancer patients who died in or who were discharged from a teaching hospital between 1997 and 2000 (n = 334) were reviewed to explore the determinants of intrahospital death, which later were verified prospectively (n = 131). Eastern Cooperative Oncology Group (ECOG) performance status of four, short duration of disease (on a logarithmic scale), emergency admission, low haemoglobin (Hb) value (on a linear scale) and lactate dehydrogenase (LDH) value greater than 378 µ/ml were significantly and independently associated with the risk of intrahospital death. This model had a receiver operating characteristic area of 0.88 in the derivation cohort and 0.82 in the validation cohort. Using readily available clinical parameters, it is possible to devise an accurate and applicable risk prediction model for the hospitalised cancer patients.

Predictors of distant metastasis at presentation in breast cancer: a study also evaluating associations among common biological indicators

AbstractBackground. To investigate the correlation among some of the commonly used clinical, pathological factors and newer biological indicators, and to identify the independent predictors of distant metastasis at presentation in patients with breast cancer. Methods. The pathological specimens from 73 patients with breast cancer were retrospectively evaluated by immunohistochemistry. Data on 13 biological indicators; ER, PR, P53, c-erbB-2, PCNA, CEA, Ki-67, Vimentin, Ulex, Nm23, Cathepsin D, Factor VIII, PS2 together with clinical and pathological factors were collected. Results. A number of highly significant correlations were found among the biological indicators studied. By logistic regression analysis, the predictors of distant metastasis at presentation in univariate tests were tumor diameter, number of lymph nodes involved, P53, c-erbB-2 and grade. In multivariate analysis, tumor diameter (P=0.042, HR: 1.88(1.02–3.44)), c-erbB-2 expression (P=0.035, HR: 18.20 (1.23–268.66)) and grade (P=0.010, HR: 8.05(1.66–39.00)) retained their significance. Conclusion. Our findings show that inactivation of suppressor genes, expression of oncogenes, loss of differentiation, augmentation of proliferative activity, metastatic potential, angiogenesis and hormone receptor status are all interrelated facets of breast cancer pathogenesis. Patients with tumors overexpressing c-erbB-2 or with bigger or higher-grade tumors probably need to be more carefully evaluated for the presence of distant metastasis, thus be better staged, at presentation. This may be a new reason to test c-erbB-2 routinely in all patients with breast cancer in addition to its well-known prognostic and predictive uses.

Platelet to lymphocyte ratio as a new prognostic for patients with metastatic renal cell cancer

The objective of this study was to evaluate the blood platelet–lymphocyte ratio (PLR) for its prognostic value in patients with metastatic renal cell cancer (RCC).

Quality of Life in Patients With Advanced Non-small Cell Lung Cancer

Quality of life (QOL) has been shown to improve with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC), but the determinants of this improvement have not been thoroughly explored. Fifty consecutive NSCLC patients starting chemotherapy with measurable disease and with an Eastern Co-operative Oncology Group (ECOG) performance status of ≤2 were evaluated for change in QOL by European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). The status of global QOL before chemotherapy influenced the degree of change in physical functioning (F = 8.71, P =.001), global QOL (F = 23.82, P <.001), and fatigue (F = 7.92, P =.001), whereas age of the patient was again linked with the change in global QOL (F = 4.68, P =.014), and type of chemotherapy administration (1st vs. 2nd line) was associated with the change in fatigue (F = 7.82, P =.001). Our findings show that patient age and baseline QOL assessed by EORTC-QLQ-C30, but not ECOG performance status, may help predict the amount of improvement in certain aspects of QOL in patients with advanced NSCLC undergoing chemotherapy. Conversely, in this cohort, patients who are likely to have deteriorating QOL on chemotherapy may benefit from closer follow-up and nursing care to optimize supportive measures.

Hope in people with cancer: a multivariate analysis from Turkey

AIM The study was planned to determine the hope levels of people with cancer and the variables affecting hope. BACKGROUND Hope is essential for patient well-being and positively correlated with improved coping skill. DESIGN A descriptive and exploratory design. METHODS The study sample included 240 consecutive patients treated with chemotherapy and attending the Day Chemotherapy Unit of a University Hospital in Turkey. The study was conducted between December 2009-January 2010. Personal Information Form and Herth Hope Scale were used for data collection. The determinants and subscales of hope were evaluated with univariate and multivariate regression analyses. RESULTS These mean scores showed high levels of hope among the patients included in the study. It was found that net family income, knowledge level about the disease, feeling of improvement, perception of satisfactory family support by the patient, mouth ulcers, feeling anxious or worried and presence of fear were independently related with the total hope score. CONCLUSIONS The study results showed high levels of hope among the participating patients. It is concluded that physical, financial and psychological well-being and information and support needs are directly and independently related with hope in people with cancer. These findings support the need for clinicians to continue to practise and implement hope fostering/hindering interventions among their patients.