Peter W. Plaisier

Efficacy of Cognitive Behavioral Therapy and Physical Exercise in Alleviating Treatment-Induced Menopausal Symptoms in Patients With Breast Cancer: Results of a Randomized, Controlled, Multicenter Trial

PURPOSE The purpose of our study was to evaluate the effect of cognitive behavioral therapy (CBT), physical exercise (PE), and of these two interventions combined (CBT/PE) on menopausal symptoms (primary outcome), body image, sexual functioning, psychological well-being, and health-related quality of life (secondary outcomes) in patients with breast cancer experiencing treatment-induced menopause. PATIENTS AND METHODS Patients with breast cancer reporting treatment-induced menopausal symptoms (N=422) were randomly assigned to CBT (n=109), PE (n=104), CBT/PE (n=106), or to a waiting list control group (n=103). Self-report questionnaires were completed at baseline, 12 weeks, and 6 months. Multilevel procedures were used to compare the intervention groups with the control group over time. RESULTS Compared with the control group, the intervention groups had a significant decrease in levels of endocrine symptoms (Functional Assessment of Cancer Therapy-Endocrine Symptoms; P<.001; effect size, 0.31-0.52) and urinary symptoms (Bristol Female Lower Urinary Tract Symptoms Questionnaire; P=.002; effect size, 0.29-0.33), and they showed an improvement in physical functioning (36-Item Short Form Health Survey physical functioning subscale; P=.002; effect size, 0.37-0.46). The groups that included CBT also showed a significant decrease in the perceived burden of hot flashes and night sweats (problem rating scale of the Hot Flush Rating Scale; P<.001; effect size, 0.39-0.56) and an increase in sexual activity (Sexual Activity Questionnaire habit subscale; P=.027; effect size, 0.65). Most of these effects were observed at both the 12-week and 6-month follow-ups. CONCLUSION CBT and PE can have salutary effects on endocrine symptoms and, to a lesser degree, on sexuality and physical functioning of patients with breast cancer experiencing treatment-induced menopause. Future work is needed to improve the design and the planning of these interventions to improve program adherence.

Effectiveness of a hospital-based work support intervention for female cancer patients - a multi-centre randomised controlled trial.

Objective One key aspect of cancer survivorship is return-to-work. Unfortunately, many cancer survivors face problems upon their return-to-work. For that reason, we developed a hospital-based work support intervention aimed at enhancing return-to-work. We studied effectiveness of the intervention compared to usual care for female cancer patients in a multi-centre randomised controlled trial. Methods Breast and gynaecological cancer patients who were treated with curative intent and had paid work were randomised to the intervention group (n = 65) or control group (n = 68). The intervention involved patient education and support at the hospital and improvement of communication between treating and occupational physicians. In addition, we asked patients occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. Outcomes at 12 months of follow-up included rate and time until return-to-work (full or partial), quality of life, work ability, work functioning, and lost productivity costs. Time until return-to-work was analyzed with Kaplan-Meier survival analysis. Results Return-to-work rates were 86% and 83% (p = 0.6) for the intervention group and control group when excluding 8 patients who died or with a life expectancy of months at follow-up. Median time from initial sick leave to partial return-to-work was 194 days (range 14–435) versus 192 days (range 82–465) (p = 0.90) with a hazard ratio of 1.03 (95% CI 0.64–1.6). Quality of life and work ability improved statistically over time but did not differ statistically between groups. Work functioning and costs did not differ statistically between groups. Conclusion The intervention was easily implemented into usual psycho-oncological care and showed high return-to-work rates. We failed to show any differences between groups on return-to-work outcomes and quality of life scores. Further research is needed to study which aspects of the intervention are useful and which elements need improvement. Trial Registration Nederlands Trial Register (NTR) 1658

Efficacy of Internet-Based Cognitive Behavioral Therapy in Improving Sexual Functioning of Breast Cancer Survivors: Results of a Randomized Controlled Trial.

Purpose We evaluated the effect of Internet-based cognitive behavioral therapy (CBT) on sexual functioning and relationship intimacy (primary outcomes) and body image, menopausal symptoms, marital functioning, psychological distress, and health-related quality of life (secondary outcomes) in breast cancer survivors (BCSs) with a DSM-IV diagnosis of a sexual dysfunction. Patients and Methods We randomly assigned 169 BCSs to either Internet-based CBT or a waiting-list control group. The CBT consisted of weekly therapist-guided sessions, with a maximum duration of 24 weeks. Self-report questionnaires were completed by the intervention group at baseline (T0), midtherapy (T1), and post-therapy (T2) and at equivalent times by the control group. We used a mixed-effect modeling approach to compare the groups over time. Results Compared with the control group, the intervention group showed a significant improvement over time in overall sexual functioning (effect size for T2 [EST2] = .43; P = .031), which was reflected in an increase in sexual desire (EST1 = .48 and EST2 = .72; P < .001), sexual arousal (EST2 = .50; P = .008), and vaginal lubrication (EST2 = .46; P = .013). The intervention group reported more improvement over time in sexual pleasure (EST1 = .32 and EST2 = .62; P = .001), less discomfort during sex (EST1 = .49 and EST2 = .66; P = .001), and less sexual distress (EST2 = .59; P = .002) compared with the control group. The intervention group reported greater improvement in body image (EST2 = .45; P = .009) and fewer menopausal symptoms (EST1 = .39; P = .007) than the control group. No significant effects were observed for orgasmic function, sexual satisfaction, intercourse frequency, relationship intimacy, marital functioning, psychological distress, or health-related quality of life. Conclusion Internet-based CBT has salutary effects on sexual functioning, body image, and menopausal symptoms in BCSs with a sexual dysfunction.

Adductor longus tendon rupture mistaken for incarcerated inguinal hernia.

An incarcerated inguinal hernia is a common diagnosis, since the risk of an inguinal hernia incarcerating or strangulating is around 0.3-3%. An acute rupture of the adductor longus tendon is rarely seen and mostly affects (semi-) professional sportsmen. We present a case of a patient with an assumed incarcerated inguinal hernia which turned out to be a proximal adductor longus tendon rupture. If patients without a history of inguinal hernia present themselves with acute groin pain after suddenly exorotating the upper leg, a rupture of the adductor longus tendon should be considered. Both surgical and non-surgical treatment can be performed.

A remarkable outcome after video-assisted thoracoscopic resection of a giant bulla

A 56-year-old woman visited our hospital for mild exertional dyspnea. Radiological investigations revealed a giant bulla of the left lung that was treated with video-assisted thoracoscopic bullectomy. The result of treatment was a better stamina, and, more strikingly, a major change of voice.

Internet-based Cognitive Behavioral Therapy Realizes Long-term Improvement in the Sexual Functioning and Body Image of Breast Cancer Survivors: Internet-based CBT for sexual dysfunctions

ABSTRACT The study aim was to evaluate the long-term efficacy of Internet-based cognitive behavioral therapy (CBT) for sexual dysfunctions in 84 breast cancer survivors. The positive effects of the intervention on overall sexual functioning, sexual desire, sexual arousal, vaginal lubrication, discomfort during sex, sexual distress, and body image observed immediately posttreatment were maintained at three- and nine-month follow-ups. Although sexual pleasure decreased during follow-up, it did not return to baseline levels. Our findings provide evidence that Internet-based CBT has a sustained, positive effect on sexual functioning and body image of breast cancer survivors with a sexual dysfunction.

Performance indicators for lung cancer surgery in the Netherlands

OBJECTIVES In the Netherlands, surgery for lung cancer is traditionally performed in low-volume hospitals. To assess the need for centralization, we examined early outcome measures and compared results between hospitals and with other European countries. METHODS Data on patient, tumour and treatment characteristics were retrieved from the Netherlands Cancer Registry. Results were tabulated for 30-day postoperative mortality (POM), major morbidity rate (intrathoracic empyema, bronchopleural fistula or rethoracotomy) and pneumonectomy proportion. Hospital variation was projected using funnel graphs in which the results for individual hospitals are plotted against volume. RESULTS The study comprised a series of 9579 patients with primary non-small cell lung cancer, diagnosed from 2005 through 2010 and operated in 79 different hospitals. The POM was 2.7% on average and age, gender, period and type of surgery were determined as prognostic factors. Multivariable analysis did not reveal an association with hospital volume (P = 0.34). The POM was higher for operations on Fridays (4.0%) or during weekends (6.8%). Major morbidity was observed after 8.3% of operations and was more frequent after bilobectomy (11.6%) or right pneumonectomy (22%). The pneumonectomy proportion decreased from 18% in 2005 to 11% in 2010. Funnel plots revealed a limited number of significant outliers, despite combining data over a 6-year period. CONCLUSIONS Results for the Netherlands were similar to those from other European countries. Hospital volume was not associated with early outcome indicators. Quality assessment at the hospital level remains a major challenge given the low frequency of adverse events and the impediments of chance variation.

Comment on gastrointestinal quality of life in patients with symptomatic or asymptomatic cholelithiasis before and after laparoscopic cholecystectomy

I read with great interest the recently published article, Gastrointestinal Quality of Life in Patients with Symptomatic or Asymptomatic Cholelithiasis before and after Laparoscopic Cholecystectomy, by Bülent Menteş et al. [3]. Although the results of this study are quite convincing, some remarks have to be made. A minor criticism is the length of follow-up. Although statistical significance has been reached within 4 months, it has been established elsewhere that a minimum of 12 months may be needed to assess all effects of gastrointestinal surgery on health-related quality of life [8]. A major criticism is that the discussion lacks some essential information. First, the authors’ major finding—that quality of life is improved by laparoscopic cholecystectomy—is, in fact, nothing new. This has already been shown by several authors [1, 7, 9], and, in my opinion, these results should have been referenced. Second, the hypothesis that quality of life may also benefit from open cholecystectomy has also been tested. We and others found this to be true[2, 5–7], whereas some could not demonstrate any benefit [9]. I agree with the authors that the Gastrointestinal Quality of Life Index (GIQLI) is (as are other validated quality of life questionnaires) a promising tool to predict the outcome of surgery from the patient’s perspective. However, I do not agree that the authors have shown in this particular study that GIQLI provides a valid definition for asymptomatic gallstone patients. Finally, I emphasize that although this study showed that laparoscopic cholecystectomy improves quality of life in asymptomatic gallstone patients, there is a worldwide acceptance of the fact that asymptomatic gallstones, in fact, should (still) not be treated [4]. References

Complications in Abdominoplasty Patients After Bariatric Surgery

Body contouring is an important aspect of the overall treatment of the morbidly obese patient [1]. Quality of life improves after bariatric surgery and is significantly enhanced after further body contouring, with improved body image [2–4]. Bariatric surgery, as opposed to dietary or lifestyle changes or pharmacologic interventions, offers sustained long-term weight reduction. After massive weight loss, the pannus can interfere with clothing, physical activity, and hygiene, as well as be a cause for recurrent infection. There are, therefore, clear advantages to the excision of remaining excess tissue. The literature is reviewed with the results from our institution to evaluate the incidence and types of complications that occur after abdominoplasty following bariatric surgery. Specifically, the aim was to find the commonly cited correlations between complications and known pre-operative risk factors and to find whether the post-bariatric surgery population is more susceptible to post-operative complications than the general population seeking abdominal body contouring. The results are summarized from the largest published series and provide an overview on the current debate surrounding the question of whether there is evidence that the post-bariatric surgery patient is at a higher risk for post-operative complications.

Letter-to-the-editor on Yang et al. Surg Endosc 2008;22:1620–1624

Dear Sir, We read with great interest the article by Yang et al. on biochemical predictors of common bile duct (CBD) stones [1], not least because we wrote a review article on the very same subject 15 years ago [2]. Obviously, the authors are to be congratulated on the enormous amount of data they have gathered on this interesting subject. Still, they have left us with some questions. First, since it is known that a combination of clinical and biochemical parameters increases the probability of CBD stones up to [90% [3], we wonder if it was specifically asked whether there were any signs of CBD obstruction (jaundice, light faeces, dark urine)? Second, since more than 7% of the patients did not undergo ultrasonography: was this not the first diagnostic imaging technique in the authors’ clinic in all cases, or were some patients asymptomatic? Third, for reasons of costs and radiation safety: why was the number of computed tomography (CT) scans so enormously high (almost one in every four patients)? This is especially interesting as the authors themselves state that this diagnostic tool is usually not recommended as the diagnostic modality of choice to predict absence or presence of CBD stones [1]. Finally, did the authors test the combination of more than twofold elevated total bilirubin and alkaline phosphatase as a predictor for CBD stones, which works well in our experience?