Wen-Tsung Huang

The Effect of Yoga Exercise on Improving Depression, Anxiety, and Fatigue in Women with Breast Cancer: A Randomized Controlled Trial

Background: Depression, anxiety, and fatigue are among the most significant problems that influence the quality of life of patients with breast cancer who receive adjuvant chemotherapy. Although evidence has shown yoga to decrease anxiety, depression, and fatigue in patients with cancer, few studies on the effects of yoga have targeted patients with breast cancer. Yoga interventions should be tested to promote the psychological and physical health of women with breast cancer. Purpose: This study examines the effectiveness of an 8-week yoga exercise program in promoting the psychological and physical health of women with breast cancer undergoing adjuvant chemotherapy in terms of depression, anxiety, and fatigue. Methods: A sample of 60 women with nonmetastatic breast cancer was recruited. Participants were randomly assigned into either the experimental group (n = 30) or the control group (n = 30). A 60-minute, twice-per-week yoga exercise was implemented for 8 weeks as the intervention for the participants in the experimental group. The control group received standard care only. Results: Analysis using the Johnson–Neyman procedure found that the yoga exercise reduced overall fatigue and the interference of fatigue in everyday life for the experimental group participants. Significant reductions were obtained after 4 weeks of intervention participation for those experimental group patients with relatively low starting baseline values (baseline item mean value < 3.31 and 3.22, respectively) and after 8 weeks for most patients (approximately 75%) with moderate starting baseline values (baseline item mean value < 7.30 and 5.34, respectively). The 8-week intervention did not significantly improve the levels of depression (F = 1.29, p > .05) or anxiety (F = 2.7, p > .05). Conclusions/Implications for Practice: The 8-week yoga exercise program developed in this study effectively reduced fatigue in patients with breast cancer but did not reduce depression or anxiety. Oncology nurses should strengthen their clinical health education and apply yoga to reduce the fatigue experienced by patients with breast cancer who undergo adjuvant chemotherapy.

Factors predicting survival of patients with gastric cancer.

BACKGROUND Gastric cancer is one of the most common causes of cancer death in Taiwan. The literature has previously shown that age, tumor site, T categories, and number of metastatic nodes significantly affect prognosis. The aim of this study was to determine the long-term survival of patients with gastric cancer, as well as the effect of particular prognostic factors on survival. MATERIALS AND METHODS This was a survival analysis study with retrospective design. We reviewed the records of 64 patients with adenocarcinoma of the stomach who had undergone gastrectomy with curative intent between 2009 and 2012 at a teaching hospital in southern Taiwan. Data extracted from patient documents included age, gender distribution, tumor location, and pathological grading. RESULTS The median follow-up time was 4 years, and there were 31 deaths attributed to gastric cancer. Kaplan-Meier analysis revealed that retrieval of less than 15 lymph nodes from a patient was a significant predictor of survival. A significant predictor of poorer survival was higher pathological grading. CONCLUSIONS Our results indicate that the number of lymph nodes retrieved and pathological grading could be viewed as crucial prognostic factors affecting the survival of individuals with gastric cancer.

Rapid engraftment of mast cells of donor origin in a case of acute myeloid leukemia with mast cell leukemia after allogeneic stem cell transplantation

Summary:Mastocytosis is a rare disease characterized by an abnormal increase of mast cells in tissues. We report a case of acute myeloid leukemia (AML) with t(8;21) and mast cell leukemia (MCL) in which the mastocytosis persisted after standard chemotherapy and allogeneic stem cell transplantation, although the myeloid leukemia achieved molecular complete remission soon after induction chemotherapy. Donor-type mast cells were noted on d31 after transplant. No c-kit mutation was found before or after the transplant. This represents the first reported case in which rapid engraftment of mast cells of donor origin was documented. Thus, the possibility that the mast cell originates from a common myeloid precursor cell may be questioned and a reactive process should be considered in some cases of systemic mastocytosis.

Development and Application of Telephone Counseling Services for Care of Patients with Colorectal Cancer

BACKGROUND The number of colorectal cancer (CRC) patients in Taiwan has increased in recent years; therefore, the effective dissemination of information related to symptom care has become especially important. Previous studies indicated that the physical and psychological status of cancer patients can be effectively improved by telephone counseling services (TCS). Thus, determining the most effective means of establishing a TCS to support the clinical practice of oncology has become a crucial goal for nursing. The purposes of this study were to analysis the content of the TCS for CRC and explore stratification of the TCS. MATERIALS AND METHODS The study design was retrospective. A total of 850 calls were made to CRC patients in the cancer center of Southern Taiwan during the period of January 2007- December 2011. A structure questionnaire was adopted to analysis satisfaction. RESULTS Responses provided by the TCS included information regarding nutrition, side effects resulting from chemotherapy and pain. Moreover, 28.7% of CRC patients needed advanced treatment. More than 90% satisfaction with all aspects of the calls was found. CONCLUSIONS The TCS coulkd be shown to provide an effective means by which to expand the reach of nursing care to different times, places and patients, allowing for greater cost efficiency and more rapid service.

Hyperthyroidism as a latent complication of autologous hematopoietic stem cell transplantation

Thyroid dysfunction after hematopoietic stem cell transplantation has been investigated in many studies. Most post-transplant thyroid disorders such as hypothyroidism are recognized as a late complication whilst hyperthyroidism is infrequent and transient, and usually happens early at the onset after transplant. Here, we report two rare hyperthyroid cases, developing more than 2 years after autologous stem cell transplant. We suggest that hyperthyroidism be alerted in the post-transplant care, and special attention be paid to any latent events.

Clinical Response of Antilymphocyte Globulin-Based Treatment in Patients in Taiwan with Aplastic Anemia: Positive Hepatitis C Antibody May Represent a Response Predictor

Immunosuppression (IS) therapy with antilymphocyte globulin (ALG) is currently the treatment of choice for patients with aplastic anemia who do not have histocompatible sibling donors or who are not candidates for allogeneic bone marrow transplantation. Thirty-eight patients with aplastic anemia who received ALG-based therapy at a single institute in Taiwan were analyzed, and 28 were followed up for more than 6 months. Four patients (10.5%) had a complete response, and 11 (28.9%) had a partial response. The overall response rate was 39.4%. The significant prognostic factor that affected the response to IS therapy was a positive test result for antibodies to the hepatitis C virus. The rate of early mortality (death within 90 days after initiation of ALG-based therapy) was 15.8%, and most deaths were secondary to infection. Factors influencing the risk of early mortality were old age, hypotension, and bacteremia. In conclusion, ALG-based IS therapy was effective for aplastic anemia in Chinese patients. The role of hepatitis C associated with aplastic anemia and its relationship to IS need to be clarified by further investigations.

Effects of a Psychoeducational Intervention in Patients With Breast Cancer Undergoing Chemotherapy

Background: Compelling evidence has yet to be published regarding the positive effect of psychoeducational interventions (PEIs) on psychological distress in patients with breast cancer. The impact of PEIs on self-efficacy, resilience, and quality of life is also unclear. Purpose: The aim of this study was to assess the effects of a PEI on anxiety, depression, disease-specific care knowledge, self-efficacy, resilience and quality of life in patients with breast cancer during and after chemotherapy. The intervention was administered before and during five rounds of chemotherapy treatment. Methods: A randomized controlled trial was conducted. Patients with breast cancer (N = 40) were randomly assigned to either the experimental or control group. The experimental group participated in PEI, a brief and highly structured program consisting of two parts: (a) an educational manual that addressed depression, anxiety, disease-specific care knowledge, self-efficacy, and resilience and (b) a self-assessment of learning. The control group received only traditional pamphlet education. Data were collected at four time points: before the first chemotherapy session (T1), during the third chemotherapy session (T2), during the fifth chemotherapy session (T3), and at 2 weeks after the final chemotherapy session (T4). Results: Anxiety, depression, resilience, and quality of life in the experimental group showed significant differences at T4. Significant differences became apparent at T2 for knowledge and at T3 for self-efficacy. The effects of knowledge, resilience, and quality of life remained significant when group and time interactions were included in the model, showing a positive relationship between PEI and the variables of knowledge, resilience, and quality of life. Conclusions/Implications for Practice: Face-to-face PEI for patients with breast cancer is potentially effective in improving knowledge, resilience, and quality of life during and after chemotherapy. In the current study, PEI significantly improved disease care techniques, reduced chemotherapy-related discomfort, and improved quality of life for participants in the experimental group.

The Survival of Stage II Colorectal Cancer Patients is Significantly Affected by the Numbers of Lymph Node Retrieval

Objective: Lymph node removal has been an important component in surgical treatment of colorectal cancer (CRC). The diagnosis of a lymph node negative CRC should imply a good prognosis. However, the relationship between the metastatic to examined lymph nodes and overall survival in CRC patients is worth investigation, especially on numbers of retrieved lymph nodes less than 12. Methods: We retrospectively reviewed the records of 486 patients with adenocarcinoma of the CRC who had surgical intervention with curative intent between 2006 and 2011. Patients were divided into two groups: group I patients had ＜12 (n=107) and group II patients had ≧12 (n=379) LN reported. Results: The two groups were similar in age, gender distribution, tumor locations and pathological grading. The median survival was 52 and 60 months for groups I and II, respectively. In stage II patients (n=120), median survival was 56 months for group I (n=20) and 72 months for group II (n=100) (P=0.03). Group II patients also had more T3 depth of tumor invasion (P =0.04) and tumor location in the sigmoid colon (P=0.01). Conclusions: For stage II disease, removal of ≧12 LN appears to contribute to a considerable survival. For patients with stage II CRC, lymph node removed might be considered as a crucial prognostic factor. Especially, while the number of retrieved nodes is under 12, we suggest recommend in curative resections of CRC.

Intrathecal Trastuzumab for Meningeal Carcinomatosis Secondary to HER2-Overexpressing Breast Cancer

We report a 57-year-old woman with left breast cancer with lung, liver, and leptomeningeal metastasis. She received methotrexate (MTX) intrathecal injection for initial therapy, but neutropenia occurred and her neurological symptoms improved only mildly. She received intrathecal trastuzumab of 20 mg bi-weekly, and neurological symptoms improved gradually, especially dysphagia and consciousness. However, neurological symptoms worsened two months later. Intrathecal trastuzumab of 85~100 mg was given weekly, and neurological symptoms improved again. No obvious side effect was observed, and persistence of tumor-negative CSF cytology was noted after that. We also review the literature regarding intrathecal trastuzumab for leptomeningeal carcinomatosis.

Alveolar Soft Part Sarcoma: Clinical Outcome of Two Patients and Review of the Literature

Alveolar soft part sarcoma (ASPS) is a very rare soft tissue tumor which usually occurs in the lower extremity of young adults. We described two cases of ASPS in terms of natural history and clinical outcome. The first case was a female patient who noticed a painless swelling in her left thigh at the age of 33. She underwent total removal of the tumor followed by post-operative radiation therapy for 50 Gy in 25 fractions. The diagnosis was ASPS. Five years after surgery, CXR showed multiple nodules which were proved to be metastasis by open lung biopsy. Brain metastasis developed three months later and was irradiated by Gamma-knife. Six months after radiosurgery for metastatic brain lesion, the patient underwent surgical excision for recurrent and newly developed metastatic brain lesions, followed by chemotherapy with Epirubicin, Ifosfamide and Mesna. Follow-up brain CT scan 6 months later revealed multiple nodules. The patient received radiation therapy to the whole brain but could not complete the course. She died of lung and brain metastases one month later. The second case was a 26-yearold man presented with low back pain. MRI of T-L spine revealed multiple lesions in the vertebral bodies with thecal sac compression at T11. ASPS was confirmed by a surgical decompression with partial removal of the extradural tumor. Routine CXR revealed multiple lung nodules. A meticulous clinical search led to find the primary tumor located at lateral aspect of the left thigh. He underwent T-L spine irradiation for 40.5 Gy in 17 fractions and systemic chemotherapy with Epirubicin and Cyclophosphamide for 3 months. However, no response was shown. The patient died of the disease 15 months after diagnosis. ASPS tends to metastasize both early and late. Surgical excision is the mainstay of therapy. Radiation therapy may enhance local control after surgery or provide meaningful palliation for metastasis.