M.A. Dominguez

Cuestionario de calidad de vida QLQ-C30 (versión 3.0): Estudio de validación en español con pacientes con cáncer de próstata

Resumen en: Objective: The EORTC Quality of Life Group has developed a questionnaire for evaluating Quality of Life in international clinical trials: EORTC QLQ-C30, ...

Calidad de vida relacionada con la salud en los servicios de Oncología del Hospital de Navarra: Grupo de Calidad de Vida de la EORTC

Quality of life assessment is one of the key elements of the care that is offered to cancer patients. The aim of this work is to present the research line on quality of life that has been carried out since 1992 in the Oncology Departments of the Hospital de Navarra. These departments actively collaborate with the European Organisation of Research and Treatment of Cancer – EORTC – Quality of Life Group in creating questionnaires and also in other projects of this group. Our institution has coordinated the development process of the EORTC information module. Different EORTC questionnaires have been validated for use in our country. Quality of life studies have been carried out in the main tumour sites and in other areas, such as patients’ satisfaction with care. This research line has a direct benefit on the attention that patients receive.

Concomitant boost radiation and concurrent cisplatin for advanced head and neck carcinomas. Preliminary results of a phase II, single-institutional trial

IntroductionThis study aims to asses the effectiveness and toxicity of boost radiotherapy concomitant and concurrent cisplatin for patients with locally-advanced head and neck cancer (LAHNC).Material and methodsThere were 30 patients included in a prospective, phase II single-institution trial and of whom, 29 were at AJCC stage IV and 1 at stage III. Treatment consisted of radiotherapy-acceleration fractionation with concomitant boost, 72 Gy, and 2 cycles of concomitant cisplatin (20 mg/m2/day continuous infusion; days 1–5 and 29–33). Amifostine, (i.v. 200 mg/m2) was administered to 26 prior to the first fraction of radiotherapy. Endpoints of the study were quality-of-life (QL), overall survival, and local control of disease.ResultsComplete response (CR) was achievedin 23 patients (77%), 2 patients had partial response (PR) (7%), 4 had no response (13%), and 1 was not evaluated for response. The 2-year overall survival and loco-regional control were 60% and 56%, respectively. Main toxicity was grade 3 or 4 mucositis in 93% of the patients. QL scores (questionnaire QLQ-C30; version 3.0) and the HN cancer module QLQ-HN35) showed a worsening in areas related to the treatment e.g. dry mouth, problems stretching the mouth, and sticky saliva.Conclusionsthis combination modality is active, but toxic, in the treatment for LAHNC. Concomitant boost radiotherapy is probably, not the best radiotherapy schema for combining with chemotherapy in LAHNC.

Neutropenia y fiebre en el paciente con cáncer

Infection in the immunocompromised host is a serious clinical situation due to its high morbi-mortality and is one of the most frequent complications in the patient with cancer. In patients treated with chemotherapy, the risk of infection basically depends on the duration and intensity of the neutropenia. It is essential to evaluate, the most probable pathogen involved to initiate, a priori, the most suitable treatment, and also to evaluate the general clinical situation of the patient, because from the very beginning the treatment is quite aggressive. Outpatient care is possible for patients at “low risk” of complications. By evaluating the antecedents and clinical history of the patient, through physical exploration and from the data of laboratory and radiological explorations these points can be acknowledged. The early start of broad spectrum antibiotherapy is crucial, and in this chapter we review the most recent therapeutical recommendations.

Disfagia aguda de causa oncológica: Manejo terapéutico

Dysphagia is one of the most frequent syndromes in patients with tumours of the head and neck, and the oesophagus. This can be the initial symptom or, more frequently, related to the oncological treatment. We review the most important therapeutic and physio-pathological aspects of acute dysphagia of oncological origin. Deglutition is a complex process in which numerous muscular-skeletal structures intervene under the neurological control of different cranial nerves. The complex neuro-muscular coordination needed for a correct deglutition can be affected by numerous situations, both from the effect of the tumours and from their treatment, basically surgery or radiotherapy. In conclusion, it can be affirmed that for a suitable treatment of oncological dysphagia, a correct initial evaluation and an active treatment are required, since not only the patient’s quality of life but, on numerous occasions, the possibility of continuing the treatment and thus maintaining the possibilities of a cure depend on control of the dysphagia.

Quality of life in breast cancer patients assessed using the EORTC questionnaires

The aim of the present study was to evaluate the quality of life in a sample of breast cancer patients during treatment.To that end, one hundred and seventy seven consecutive patients at different stages of the disease and who had previously undergone surgery were recruited. Patients completed the EORTC QLQ-C30 (version 2.0) and the breast cancer module (QLQ-BR23) at three different points of time during treatment and follow-up. Demographic and clinical variables were also recorded. We have compared groups according to stage and surgery. We have studied the changes in their quality of life over time.The quality of life scores reflect moderate limitations in some dimensions at the three assessments. At the second and third assessment, there were also limitations related to treatment side effects. There were differences on most of the quality of life dimensions between patients at different stages of the disease. The differences between surgery modalities were limited to body image. Quality of life seems relatively stable across the first and second assessments and has improved in some areas at the third in the patients who have filled in the three assessments (n=141). Therapies thus cause some deterioration in quality of life at the second assessment, which has improved by time of the third assessment.The quality of life scores and the clinical variables indicate that the situation of these patients is generally satisfactory. A comparison of scores over time of the patients who have filled in the three questionnaires indicates that these women receive treatment that, in general, they can tolerate adequately.ResumenEl objetivo de este trabajo es evaluar la calidad de vida de una muestra de pacientes con cáncer de mama durante el tratamiento.Ciento setenta y siete pacientes con cáncer de mama en diferentes estadios de la enfermedad y que habían recibido cirugía previamente han contestado el cuestionario EORTC QLQ-C30 (versión 2.0) y el módulo de mama QLQ-BR23 en 3 puntos a lo largo del tratamiento y seguimiento. Se han recogido además datos demográficos y clínicos. Se han comparado grupos formados en función del estadio y la cirugía, y se han estudiado los cambios en la calidad de vida a lo largo del tiempo.Las puntuaciones de calidad de vida muestran limitaciones moderadas en algunas dimensiones en las 3 evaluaciones. En la segunda y tercera medición había también limitaciones relacionadas con los efectos secundarios de los tratamientos. Se daban diferencias en la mayoría de las dimensiones de calidad de vida entre los pacientes agrupados según los estadios de la enfermedad. Las diferencias entre las modalidades de cirugía se limitaban a la imagen corporal. La calidad de vida se ha mantenido relativamente estable entre la primera y segunda medición, y ha mejorado en algunas áreas en la tercera en las pacientes que han completado las 3 mediciones (n=141). Los tratamientos, por tanto, causan algún deterioro en la calidad de vida de estos pacientes en la segunda medición que mejora en el momento de la tercera.Las puntuaciones de calidad de vida y las variables clínicas indican que la situación de estos pacientes es generalmente satisfactoria. Una comparación de las puntuaciones a lo largo del tiempo de las pacientes que han completado las 3 mediciones indica que reciben un tratamiento que en general pueden tolerar adecuadamente.

Radioterapia guiada por imagen: Impacto clínico

Image guided radiotherapy (IGR) is a concept that encompasses the most modern way of administering radiotherapy treatment. The aim is to maximise the dose deposited in the target volume, minimising the dose in healthy organs. This would not be possible without the continuous development of technology and software, above all in the following areas: deformable image registration, replanning new treatments, real time image and calculation of accumulated dose. While the clinical impact is evident, little is said about the impact on the reorganisation of the Radiotherapy Oncology services. IGR supposes training all team members involved, with a training and a starting period. With the experience acquired, the time dedicated to each patient (in all stages of treatment: simulation, planning, starting out, systems for verifying position, on-line, off-line corrections, replanning, periodic clinical controls) is far higher than that required in conventional radiotherapy, which gives rise to new responsibilities and roles.

Obstrucción maligna de la vena cava superior

The present paper offers a review of the malign syndromes of the superior vena cava, their clinical expressions related to the anatomical characteristics of the compartment where the superior vena cava runs, the diagnostic requirements for realising treatment under the best conditions and the ensemble of measures that must be adopted in dealing with this.