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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe the surgical management and followup of 11 patients with local recurrence of renal cell carcinoma in the renal fossa, 10 of whom demonstrated no evidence of distant metastatic disease at the time of recurrence. Average interval to recurrence was 31 months from nephrectomy, with the majority of patients presenting with symptoms of weight loss, fatigue and lumbar discomfort. A total of 13 resections of recurrent carcinoma was performed with 3 immediate postoperative complications, including a retroperitoneal abscess, jejunal necrosis requiring resection and a duodenal obstruction requiring duodenojejunostomy. There were 2 postoperative deaths, 2 patients died of disseminated disease at 8 and 22 months, and 3 died of causes unrelated to cancer recurrence at 4 months, 6 months and 10 years. Four patients were without disease at a followup of 35, 46, 48 and 211 months. We include in this review a report on 1 patient who maintains a disease-free survival of 17 years after resection of a recurrent spindle cell carcinoma. We conclude that an aggressive surgical approach to recurrent renal cell carcinoma within the renal fossa can produce long-term disease-free survival and is justified when compared to the results reported for chemotherapy.
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PMID:Experience with fossa recurrence of renal cell carcinoma. 159 72

Despite significant advances in surgical oncourology, local recurrence of renal cell carcinoma (RCC) remains a serious problem both for the doctor and the patient. Our study of treatment outcomes in local recurrent RCC consisted in a retrospective analysis of 13 patients with a local RCC recurrence in the renal fossa treated with surgical resection alone between 1991 and 2003. Twelve patients demonstrated no evidence of distant metastases at the time of the recurrence. One patient had a synchronous metastasis to the contralateral adrenal gland. A mean recurrence-free interval was 14.6 months (range 2-96 months) after nephrectomy. 46% patients demonstrated symptoms of weight loss, fatigue and lumbar pains. The source of local recurrence in 2 patients was metachronous metastases to the ipsylateral adrenal gland, in 1 patients--a tumor thrombus in the remnant of the left renal vein, in 3--soft tissues of the renal fossa and in 7--metastases to the regional lymph nodes. 13 resections were performed with one intraoperative death and one immediate postoperative death. Splenectomy was made in 2 patients, resection of the stomach in 1, distal pancreatectomy in 1, resection of the inferior vena cava in 3, aorta in 1. The average blood loss was 800 ml (300-4500 ml). Up to now 6 patients survived. Of 5 decreased patients 4 died of progressive disease in 1, 4, 10 and 16 months. 1 patient died of cause unrelated to cancer recurrence in 14 months. Out of 6 alive patients 4 have no signs of the disease for, on the average, 31.6 months (range 4-78 months) and 2 patients have obvious progression of the disease (1--repeated local recurrence, 1--distant metastases) 9 and 15 months after the operation. We believe that an aggressive surgical approach to a local RCC recurrence can produce an increase in disease-free survival and significantly improve quality of life for such patients.
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PMID:[Local recurrence of renal cell carcinoma after nephrectomy]. 1470 37

With the increase in the number of cancer survivors, there is a need to understand the effect of physical activity (PA) on cancer prognosis. The purpose of this paper is to evaluate methods used to assess PA and energy expenditure (EE) in exercise interventions following cancer diagnosis and to evaluate the outcomes of these interventions. A literature search of studies up to and including June 2003 was conducted. To be included in the review, studies had to examine the effects of a PA intervention following cancer diagnosis. Forty-three studies met the selection criteria; 21 were randomized controlled trials and 22 were quasi-experimental study designs. The studies vary in terms of the purpose, subjects, study design, variables measured, and level of detail reported in the study manuscript. A focus of most studies was on the feasibility of performing PA interventions in cancer survivors and the effect on psychosocial processes. Very few studies examined the effect of PA on physiological or biological processes, and no studies examined the effect of PA on cancer recurrence or survival. Overall, the studies consistently demonstrated that PA has a positive effect on psychosocial processes, including fatigue and nausea. Many challenges remain pertaining to the study of PA following cancer diagnosis to include subject recruitment and compliance, delivery and assessment of PA, and the measurement of study variables. Future studies are needed that use a randomized controlled design with process, short-term impact, and long-term outcome measures to identify a dose-response effect of increased PA and physical fitness on cancer recurrence and survival.
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PMID:Physical activity interventions following cancer diagnosis: methodologic challenges to delivery and assessment. 1506 62

The development of new chemotherapeutic agents and regimens has contributed to reduced risk of cancer recurrence and prolonged patient survival. However, mild cognitive impairment (MCI), also known as ''chemofog'' or ''chemobrain'' following adjuvant chemotherapy for breast cancer has been reported since the late 1980s. Unfortunately, little is known about it's mechanism, type, severity, and episode length. This article reviewed related studies on the subject, and found that chemotherapy-induced MCI appears to occur in 10-40% of patients, and memory loss and lack of concentration are the most frequent symptoms. The symptoms are apparently transient, but take at least several years to disappear. Reviewed studies show a lack of clear understanding of what causes MCI directly. There is also a lack of consistency in symptom measurement. We point to the need to conduct well-designed studies which begin with a proper hypothesis. Future research needs to be randomized and longitudinal with a base measurement point before the chemotherapy cycle starts. Future studies must adopt an effective and sensitive method to measure MCI. The latest imaging technique, positron emission tomography (PET) may be a powerful tool. Also, all confounding factors, such as age, education, intelligence quotient (IQ), fatigue and depression, hormonal therapy and other treatments should be controlled within the study design. It is hoped that the results of such future studies will allow medical professionals to contemplate effective prevention, treatment and rehabilitation for MCI.
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PMID:Mild cognitive impairment after adjuvant chemotherapy in breast cancer patients--evaluation of appropriate research design and methodology to measure symptoms. 1628 8

The survivor uncertainty management intervention study is a randomized controlled study designed to test the efficacy of an intervention that combines training in audiotaped cognitive behavioral strategies to manage uncertainty about cancer recurrence with a self-help manual designed to help women understand and manage long-term treatment side effects and other symptoms. Specifically, women were taught to recognize their own personal triggers of uncertainty (places, events or surroundings, that bring back memories, feelings, or concerns about breast cancer), and then use coping skills such as relaxation, distraction, and calming self-talk to deal with uncertainty. Also, women were taught to use the manual as a resource for dealing with fatigue, lymphedema, pain and other symptoms. Treatment outcome data (Mishel et al., in press) indicated that the uncertainty management intervention resulted in improvements in cognitive reframing, cancer knowledge, social support, knowledge of symptoms and side effects, and coping skills when compared to a control condition. The purpose of the present paper was to report on the use and helpfulness of the intervention components by the 244 women who were in the intervention. Findings indicated that women regularly used the intervention components to deal with triggers of breast cancer recurrence and long-term treatment side effects and most women found the strategies very helpful.
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PMID:Uncertainty management intervention for older African American and caucasian long-term breast cancer survivors. 1649 49

The diagnosis and treatment of breast cancer in women has undergone profound changes in the past century. Although much research and clinical attention has been focused on saving the lives of women with this condition, less focus has been on rehabilitation aspects. This postacute care should be a distinct phase of treatment. The field of physical medicine and rehabilitation has much to offer women who undergo extremely toxic although life-prolonging therapies for breast cancer. The focus of rehabilitation should include improving strength and cardiovascular conditioning, alleviating pain and improving fatigue. With respect to exercise, this can help women to physically recover from treatment and potentially prevent cancer recurrence. Many exciting opportunities will be available for rehabilitation specialists to improve the care of women with breast cancer and to participate in research in the field of oncology rehabilitation.
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PMID:Rehabilitation in women with breast cancer. 1767 65

Elevations in cancer treatment-induced circulating inflammatory cytokines may be partially responsible for the development of significant symptom burden (e.g., pain, fatigue, distress, disturbed sleep) during concurrent chemoradiation therapy (CXRT). Sixty-two patients undergoing CXRT for locally advanced non-small cell lung cancer (NSCLC) reported symptoms weekly for 15 weeks via the M. D. Anderson Symptom Inventory (MDASI). Serum inflammatory cytokines were assessed weekly during therapy via enzyme-linked immunosorbent assay. Dynamic changes in cytokines and associated symptom profiles were estimated using mixed-effect models. MDASI symptom severity increased gradually as CXRT dose accumulated and peaked at week 8. Serum concentrations of interleukin (IL)-6, IL-10, and serum soluble receptor 1 for tumor necrosis factor (sTNF-R1) increased significantly by week 8 (all p<.05). During CXRT, controlled for age, sex, race, body mass index, cancer recurrence, previous treatment status, total radiotherapy dose, and CXRT delivery technique, an increase in sTNF-R1 was significantly related to an increase in the mean score for all 15 MDASI symptoms (estimate, 1.74; SE, 0.69; p<.05) and to a larger radiation dose to normal lung volume (estimate, 1.77; SE, 0.71; p<.01); an increase in serum IL-6 was significantly related to increased mean severity for the five most severe symptoms (pain, fatigue, disturbed sleep, lack of appetite, sore throat) (estimate, 0.32; SE, 0.16; p<.05). These results suggest a role for over-expressed pro-inflammatory cytokines in significant worsening of symptoms in NSCLC patients undergoing CXRT, and warrant further study to identify biological targets for ameliorating treatment-related symptom burden.
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PMID:Inflammatory cytokines are associated with the development of symptom burden in patients with NSCLC undergoing concurrent chemoradiation therapy. 2035 17

Spouses of cancer patients are at-risk for poor psychological and physical health as they cope with the complex nature of the disease and fears of losing their partner. Moreover, spouses often serve as patients' primary informal caregivers, a group that evidences poor outcomes across a variety of domains. The present study examines the relative contributions of cancer recurrence - a cancer-specific stressful event - and the subjective experience of cancer-specific stress (IES) in a sample of male spouses of breast cancer survivors. We hypothesized that stress would contribute to poorer physical health and compromised immune function. Spouses (recurrence; n=16) of patients who were coping with their first recurrence were matched to spouses of patients with no evidence of disease (disease-free; n=16). Self-reported physical health (physical symptoms and fatigue) and immune function [T-cell blastogenic response to the mitogens Concanavalin A (ConA) and phytohemagglutanin (PHA) and T3 monoclonal antibody (T3 Mab)] were included as outcomes. Results indicated that patient recurrence status was not a significant unique predictor of physical health or immune function; rather, among all spouses, cancer-specific stress symptoms were associated with increased physical symptoms and altered T-cell blastogenesis. These data suggest that the health implications of caregiving for spouses of cancer survivors is more strongly linked to their subjective experience of cancer as stressful, rather than simply the patients' disease status.
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PMID:Impact of breast cancer recurrence and cancer-specific stress on spouse health and immune function. 2180 90

Lifestyle factors have been linked to the risk of developing many common malignancies and, increasingly, to prognosis. Observational evidence has shown a relationship between so-called energy balance factors (ie, diet, physical activity, and body weight) and risk of cancer recurrence and mortality in cancers of the breast, prostate, colon and, perhaps, other cancers. Interventional work has shown that individuals who make favorable changes in these lifestyle factors after cancer diagnosis feel better, experience less fatigue, and may possibly even decrease risk of cancer recurrence. Other lifestyle behaviors, such as smoking and alcohol consumption, have also been linked to the development of common cancers and may have important health consequences for cancer survivors. This article reviews the evidence that links lifestyle factors to cancer outcomes, provides clinical recommendations for cancer survivors, and describes future directions for lifestyle research in cancer survivors.
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PMID:Lifestyle factors in cancer survivorship. 2300 16

Breast cancer survivors may experience long-term treatment complications, must live with the risk of cancer recurrence, and often experience psychosocial complications that require supportive care services. In low- and middle-income settings, supportive care services are frequently limited, and program development for survivorship care and long-term follow-up has not been well addressed. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert panel identified nine key resources recommended for appropriate survivorship care, and developed resource-stratified recommendations to illustrate how health systems can provide supportive care services for breast cancer survivors after curative treatment, using available resources. Key recommendations include health professional education that focuses on the management of physical and psychosocial long-term treatment complications. Patient education can help survivors transition from a provider-intense cancer treatment program to a post-treatment provider partnership and self-management program, and should include: education on recognizing disease recurrence or metastases; management of treatment-related sequelae, and psychosocial complications; and the importance of maintaining a healthy lifestyle. Increasing community awareness of survivorship issues was also identified as an important part of supportive care programs. Other recommendations include screening and management of psychosocial distress; management of long-term treatment-related complications including lymphedema, fatigue, insomnia, pain, and women's health issues; and monitoring survivors for recurrences or development of second primary malignancies. Where possible, breast cancer survivors should implement healthy lifestyle modifications, including physical activity, and maintain a healthy weight. Health professionals should provide well-documented patient care records that can follow a patient as they transition from active treatment to follow-up care.
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PMID:Supportive care after curative treatment for breast cancer (survivorship care): resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. 2400 41


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