Publications by authors named "Tuğba Yavuzşen"

45 Publications

Association of illness perception with chemotherapy-induced nausea and vomiting: a Turkish Oncology Group (TOG) study.

Future Oncol 2021 May 18;17(15):1933-1942. Epub 2021 Feb 18.

Department of Medical Oncology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Adana, TR-01170, Turkey.

Chemotherapy-induced nausea and vomiting (CINV) may be linked to the psychological status of cancer patients. Therefore, the authors aimed to better understand the underlying risk factors for CINV using the Brief Illness Perception Questionnaire. A total of 238 patients were recruited during three cycles of chemotherapy. Patient, disease and treatment characteristics were noted at the onset of chemotherapy. The Brief Illness Perception Questionnaire was administered face-to-face prior to chemotherapy. The relationship between illness perceptions and CINV was analyzed using Spearman's rank correlation. Positive illness perception parameters, including personal and treatment control, were negatively correlated, whereas negative illness perception parameters, including consequences, timeline, identity, concern and emotions, were positively correlated with CINV after adjusting for age, sex and emetogenic potential of chemotherapy (p < 0.001). Illness perception may be an underlying risk factor for CINV.
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http://dx.doi.org/10.2217/fon-2020-0939DOI Listing
May 2021

Worse patient-physician relationship is associated with more fear of cancer recurrence (Deimos Study): A study of the Palliative Care Working Committee of the Turkish Oncology Group (TOG).

Eur J Cancer Care (Engl) 2020 Nov 30;29(6):e13296. Epub 2020 Aug 30.

Medical Oncology, Ankara University School of Medicine, Ankara, Turkey.

Objective: Fear of cancer recurrence (FCR) is an important psychological trauma associated with reduction in the quality of life, disruptions in the level of adjustment, emotional distress and anxiety. The purpose of the study was to evaluate the impact of patient-physician relationship on FCR.

Methods: The study was designed as a multicentre survey study. The cancer survivors, who were under remission, were evaluated with structured questionnaires. Patient-physician relationship (PPR) scale in which higher scores indicate better relationship and FCR inventory was used.

Results: Between January and April 2019, 1,580 patients were evaluated. The median age was 57.0 (19-88), and 66% were female. There was high level of FCR scores in 51% of participants. There was a negative correlation between PPR and FCR scores (r = -.134, p < .001). In multivariate analysis, young age, female gender, history of metastasectomy and worse PPR were associated with high levels of FCR.

Conclusion: It is the first data showing the adverse impact of worse PPR on FCR. The strategies to improve the PPR should be practised. In addition, the cancer survivors, who are under the risk of FCR, should be evaluated and managed.
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http://dx.doi.org/10.1111/ecc.13296DOI Listing
November 2020

Factors influencing physical activity in patients with colorectal cancer.

Ir J Med Sci 2021 May 9;190(2):539-546. Epub 2020 Aug 9.

Oncology Institute, Division of Medical Oncology, Dokuz Eylul University, Izmir, Turkey.

Background: Physical activity (PA) is a modifiable health behaviour in patients with colorectal cancer (CRC). Knowing the possible predictors of PA will contribute to producing physical and psychological benefits for CRC patients.

Objective: To investigate the factors that influence PA in patients with CRC.

Methods: This cross-sectional study was conducted with 47 participants with CRC. Demographic and clinical characteristics, neuropathic pain (Douleur Neuropathique 4 (DN4)), peripheral muscle strength (knee extensor and flexor, hip extensor and flexor, and ankle dorsiflexor muscle strength), balance (Balance Master System (BMS) and Berg Balance Scale (BBS)), fatigue (Brief Fatigue Inventory (BFI)), PA (International PA Questionnaire Short Form (IPAQ-SF)), and quality of life (36-item Short Form Health Survey (SF-36)) were evaluated. Multiple linear regression analysis was used to determine the variables that have the greatest influence on PA.

Results: IPAQ-SF score had moderate correlations with knee extensor muscle strength (r = 0.310, p = 0.034), BBS (r = 0.361, p = 0.013), and limit of stability test (movement velocity) score (r = 0.385, p = 0.008), BFI- severity of fatigue (r = - 0.488, p = 0.001), impact of fatigue on daily functioning (r = - 0.421, p = 0.003), and the SF-36 sub-parameters (role limitations due to physical health problems, physical functioning, general health perceptions and vitality) (p < 0.05). Role limitations due to physical problems, knee extensor muscle strength, and severity of fatigue had the greatest influence on PA in patients with CRC with explaining 43% of the variance in PA.

Conclusions: This study suggests that quality of life, knee extensor muscle strength, and fatigue have the greatest influence on PA in patients with CRC.
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http://dx.doi.org/10.1007/s11845-020-02338-9DOI Listing
May 2021

The Reliability and Validity of Quality of Life Questionnaire Upper Limb Lymphedema (ULL-27) Turkish Patient With Breast Cancer Related Lymphedema.

Front Oncol 2020 12;10:455. Epub 2020 May 12.

Physiotherapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.

Breast cancer is the most common cancer amongst women both in Turkey and in the world. Lymphedema, which negatively affects the quality of life, is one of the most prevalent problems reported by breast cancer survivors. Upper Limb Lymphedama 27 () questionnaire is a valid and reliable tool that assesses the quality of life in patients with breast cancer-related lymphedema. Until now, a Turkish-language version was lacking. The aim of this study was to perform a cross-cultural validation and reliability of the Turkish version of the ULL-27 questionnaire. This cross-sectional study involved forward- backward translation, and cross-cultural adaptation. 81 women (mean age and body mass index 54.96 ± 11.35 years and 29.50 ± 5.74 kg/m) who had breast cancer related-upper extremity lymphedema were evaluated using the ULL-27 Quality of life questionnaire-Turkish version. Assessment of limb size was quantified by using circumferential limb measurements. European Organization for Research and Treatment of Cancer (EORTC) 30-item Quality of Life Questionnaire and Quality of Life Questionnaire breast cancer-23 (QLQ-BR23) were analyzed by Pearson's correlation analysis with the ULL-27 Turkish Version to indicate the convergent validity. Cronbach's alpha (internal consistency) and exploratory factor analysis were used to assess the questionnaire's reliability. The mean of lymphedema duration and severity were 23.12 ± 30.88 months. Mild lymphedema was reported in 42% (34 people) of the cases included in the study. It was observed that 33.3% (27 people) had moderate lymphedema and 24.7% (20 people) had severe lymphedema. The alpha coefficient (internal consistency) for the Turkish total score was high (alpha = 0.93). Content validity was good because all questions were understandable for all participants (The alpha coefficient for the subgroups of the scale of physical, psychological, social scores, were 0.90, 0.87, and 0.75, respectively). External construct validity was highly confirmed by expected correlations with comparator scales, EORTC-30, and QLQ-BR23 ( < 0.01). The Turkish version of the ULL-27 Questionnaire is a valid and reliable tool for evaluating QoL in women with upper limb lymphedema related to breast cancer.
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http://dx.doi.org/10.3389/fonc.2020.00455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235329PMC
May 2020

Quality of life study of patients with unresectable locally advanced or metastatic pancreatic adenocarcinoma treated with gemcitabine+nab-paclitaxel versus gemcitabine alone: AX-PANC-SY001, a randomized phase-2 study.

BMC Cancer 2020 Mar 30;20(1):259. Epub 2020 Mar 30.

Hacettepe University Cancer Institute, Ankara, Turkey.

Background: Combination of gemcitabine and nab-paclitaxel has superior clinical efficacy than gemcitabine alone. Nevertheless, health-related quality of life. (QoL) associated with this combination therapy when administered at first-line in advanced pancreatic adenocarcinoma is unknown.

Methods: A total of 125 patients were randomized to combination therapy (1000 mg/m2 gemcitabine + 125 mg/m2 nab-paclitaxel) and single-agent gemcitabine (1000 mg/m2) arms to take treatment weekly for 7 of 8 weeks, and following 3 of 4 weeks, until progression or severe toxicity. Primary endpoints were three-months of definitive deterioration free percent of patients, and QoL.

Results: Overall QoL analyses showed that 34 and 58.3% of cases in gemcitabine and gemcitabine+nab-P arms had no deterioration in 3rd month QoL scores (p = 0.018). These proportions were 27.3 and 36.6% in 6 month assessments, respectively (p = 0.357). Median overall survivals in combination and single-agent arms were 9.92 months and 5.95 months, respectively (HR: 0.64, 95% CI: 0.42-0.86, p = 0.038). Median progression free survivals in these treatment arms were 6.28 and 3.22 months, respectively (HR: 0.58, 95% CI: 0.39-0.87, p = 0.008). Median time-to-deterioration were 5.36 vs 3.68 months, and objective response rates were 37.1% vs 23.7% (p = 0.009), respectively in combination and single-agent arms.

Conclusions: Combination therapy with gemcitabine + nab-paclitaxel had better overall and progression-free survival than gemcitabine alone. Also, combination therapy showed increased response rate without toxicity or deteriorated QoL. Combination treatment with gemcitabine and nab-paclitaxel may provide significant benefit for advanced pancreatic cancer.

Trial Registration: This study has been registered in ClinicalTrials.gov as NCT03807999 on January 8, 2019 (retrospectively registered).
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http://dx.doi.org/10.1186/s12885-020-06758-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106641PMC
March 2020

Effectiveness of Kinesio Taping on Anastomotic Regions in Patients with Breast Cancer-Related Lymphedema: A Randomized Controlled Pilot Study.

Lymphat Res Biol 2019 12 1;17(6):655-660. Epub 2019 Aug 1.

Institute for Oncology, Dokuz Eylul University, İzmir, Turkey.

The purpose of the study was to investigate the effect of using Kinesio Taping (KT) on anastomotic regions along with complex decongestive physiotherapy (CDP) in patients with breast cancer-related lymphedema (BCRL). Patients with unilateral BCRL were divided into two groups in this randomized controlled study: Group 1 (CDP,  = 14) and Group 2 (CDP+ KT,  = 18). Assessment of limb size was quantified by using circumferential limb measurements and then calculated for each segment by using the frustum formula. CDP included manual lymphatic drainage, compression bandages, exercises, and skin care. KT was applied to lymphatic anastomosis. All patients received treatment for 1 hour per day, 5 days per week for 4 weeks. The outcome measure was difference in the reduction of limb volumes between the groups. There was a significant difference in both groups before and after treatment ( < 0.05), but there was no significant difference between the two groups regarding changes in limb volume ( > 0.05). The results suggest that applying KT to lymphatic anastomotic regions is not effective in reducing limb volume in the management of BCRL.
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http://dx.doi.org/10.1089/lrb.2019.0003DOI Listing
December 2019

Can Inflammatory and Nutritional Serum Markers Predict Chemotherapy Outcomes and Survival in Advanced Stage Nonsmall Cell Lung Cancer Patients?

Biomed Res Int 2019 28;2019:1648072. Epub 2019 Feb 28.

Division of Oncology, Dokuz Eylul University School of Medicine, Inciralti, Izmir 35340, Turkey.

To determine the values of prognostic nutritional and inflammatory markers in chemotherapy outcomes and survival in the patients with advanced nonsmall cell lung cancer (NSCLC) and also in the secondary malnutrition and cachexia. Twenty-five patients with diagnosis of aNSCLC were registered for the prospective study. Malnutrition was determined by the Subjective Global Assessment (SGA) and performance status by criteria of the Eastern Cooperative Oncology Group (ECOG). Before treatment, serum levels of albumin, prealbumin, vitamin D, zinc (Zn), C-reactive protein (CRP), IL-6, IL-1 , TNF-, lipoprotein lipase (LPL), and the Glasgow Prognostic Score (GPS) were recorded. Patients were followed prospectively for treatment outcomes and survival. Due to the deaths of 18 patients during the 4-month follow-up period, no adequate measurements of inflammatory and nutritional markers could be performed. However, seven patients completed the treatment period and evaluations of these markers could be performed during the three periods. Eighty-four percent of patients were male with a mean age of 63.3 ± 8.7 years. Evaluation of the malnutrition by SGA showed that 5 (20%) patients were well nourished (A), 12(48%) were moderately malnourished (B), and 8(32%) were severely malnourished (C). Low levels of serum albumin (<3.5g/dl), prealbumin (<20 mg/ml), 25-hydroxycholecalciferol (<30 ng/ml), and Zn (<70mg/ml) were detected in 15(60%), 17(68%), 24 (96%), and 22 (88%) patients, respectively. Elevated levels of CRP (≥10 mg/L), IL6 (≥18pg/ml), TNF- (≥24pg/ml), IL-1 (≥10pg/ml), and LPL (<12pg/ml) were found in 24 (96%), 11(44%), 9(36), 13(52%), and 11(44%) patients, respectively. Moderate and severe malnutrition, acute phase response, and reduced survival were determined in patients with NCSLC. In 7 patients that completed the treatment period, there was an association between elevated serum levels of IL-6, IL-1, TNF-, CRP, and LPL and also the reduced serum levels of albumin, prealbumin, Zn, vitamin D, and GPS, respectively. Similarly, Friedman analysis indicated that prealbumin significantly increased (p=0.007) in the follow-up period. But the serum levels of CRP (mean 37.3±22.3; Wilcoxon test P=0.368) in the seven patients were lower than those of the 18 patients that expired (mean 75.82±56.2). . Malnutrition and cachexia negatively influence oncological outcomes in patients with NSCLC. These nutritional/inflammatory markers may be useful for selection of high risk and reduced survival in patients with aNSCLC undergoing adjuvant chemotherapy.
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http://dx.doi.org/10.1155/2019/1648072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421052PMC
July 2019

Is advanced age a hesitation for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in colorectal cancer?

J BUON 2018 12;23(7):77-83

Department of General Surgery, Medipol University, 34320, Istanbul, Turkey.

Purpose: The purpose of this study was to assess the feasibility and safety of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in elderly patients with peritoneal carcinomatosis of colorectal cancer.

Methods: Patients who underwent curative complete CRS and HIPEC for peritoneal carcinomatosis of colorectal cancer with minimum follow-up of 24 months were included in the analysis. Charlson comorbidity index and ECOG performance status were used to evaluate preoperative condition. Patients were tiered into two groups according to age (<65 and ≥65 years). Postoperative morbidity, mortality, recurrence, and overall survival were compared between groups.

Results: One-hundred patients were meeting the inclusion criteria. Median age was 56 years (ranging, 20-86). The origin of peritoneal carcinomatosis (PC) was colon in 77 and rectum in 23 patients. There were 31 patients in the elderly group. Mean hospital stay was 1711.8 and 16.814.3 days in young and elderly groups (p=0.937). In young patients, postoperative morbidity was seen in 26 (37.6%) patients versus 9 (29%) patients in elderly group (p=0.272). Mortality was higher in elderly group (n=4, 12.9%) than in the younger group (n=5, 7.2%), but the difference was not statistically significant (p=0.287). Median follow-up was 25 months (ranging, 2-112). Local and/or distant recurrence occurred in 30 (43.4%) patients in the young group and 9 (29%) patients in elderly group (p=0.169). Two-years disease-free survival was similar: 67.1% in the young and 74% in the elderly groups (p=0.713).

Conclusions: CRS and HIPEC offer comparable oncologic outcome in meticulously selected medically-fit elderly patients without increased postoperative morbidity and mortality.
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December 2018

Perspective of Turkish Medicine Students on Cancer, Cancer Treatments, Palliative Care, and Oncologists (ARES Study): a Study of the Palliative Care Working Committee of the Turkish Oncology Group (TOG).

J Cancer Educ 2020 02;35(1):69-75

Faculty of Medicine, Department of Medical Oncology, Mugla Sıtkı Kocman University, Mugla, Turkey.

Cancer is one of the most common causes of death all over the World (Rahib et al. in Cancer Res 74(11):2913-2921, 2014; Silbermann et al. in Ann Oncol 23(Suppl 3):iii15-iii28, 2012). It is crucial to diagnose this disease early by effective screening methods and also it is very important to acknowledge the community on various aspects of this disease such as the treatment methods and palliative care. Not only the oncologists but every medical doctor should be educated well in dealing with cancer patients. Previous studies suggested various opinions on the level of oncology education in medical schools (Pavlidis et al. in Ann Oncol 16(5):840-841, 2005). In this study, the perspectives of medical students on cancer, its treatment, palliative care, and the oncologists were analyzed in relation to their educational status. A multicenter survey analysis was performed on a total of 4224 medical school students that accepted to enter this study in Turkey. After the questions about the demographical characteristics of the students, their perspectives on the definition, diagnosis, screening, and treatment methods of cancer and their way of understanding metastatic disease as well as palliative care were analyzed. The questionnaire includes questions with answers and a scoring system of Likert type 5 (absolutely disagree = 1, completely agree = 5). In the last part of the questionnaire, there were some words to detect what the words "cancer" and "oncologist" meant for the students. The participant students were analyzed in two study groups; "group 1" (n = 1.255) were phases I and II students that had never attended an oncology lesson, and "group 2" (n = 2.969) were phases III to VI students that had attended oncology lessons in the medical school. SPSS v17 was used for the database and statistical analyses. A value of p < 0.05 was noted as statistically significant. Group 1 defined cancer as a contagious disease (p = 0.00025), they believed that early diagnosis was never possible (p = 0.042), all people with a diagnosis of cancer would certainly die (p = 0.044), and chemotherapy was not successful in a metastatic disease (p = 0.003) as compared to group 2. The rate of the students that believed gastric cancer screening was a part of the national screening policy was significantly more in group 1 than in group 2 (p = 0.00014). Group 2 had a higher anxiety level for themselves or their family members to become a cancer patient. Most of the students in both groups defined medical oncologists as warriors (57% in group 1 and 40% in group 2; p = 0.097), and cancer was reminding them of "death" (54% in group 1 and 48% in group 2; p = 0.102). This study suggested that oncology education was useful for the students' understanding of cancer and related issues; however, the level of oncology education should be improved in medical schools in Turkey. This would be helpful for medical doctors to cope with many aspects of cancer as a major health care problem in this country.
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http://dx.doi.org/10.1007/s13187-018-1441-6DOI Listing
February 2020

Effect of Bandage Compliance on Upper Extremity Volume in Patients with Breast Cancer-Related Lymphedema.

Lymphat Res Biol 2018 12 19;16(6):553-558. Epub 2018 Oct 19.

4 Institute for Oncology, Dokuz Eylul University , İzmir, Turkey .

Background: Complex decongestive physiotherapy (CDP) is an effective treatment for patients with breast cancer-related lymphedema (BCRL). Bandaging is an important component of CDP. Although the literature suggests that bandages must be kept on for about 24 hours, some patients cannot tolerate keeping them on for this length of time. Also, it has been observed that limb volume decreased in patients who did not keep bandages on for 24 hours in clinical trials. But there is no evidence that this reduction in time is statistically significant. Our purpose was to compare the effectiveness of bandage compliance for a longer or a shorter period on limb volume in patients with BCRL.

Methods And Results: We retroprospectively reviewed the medical records of 39 patients who received CDP. Twenty-eight eligible patients were divided into two groups, group 1 (n = 18) and group 2 (n = 10), according to the average number of hours of bandage compliance, which was 13-24 and 7-12 hours, respectively. The primary outcome was the change in limb volume between groups. The values for the limb volumes showed a statistically significant decrease in both groups. There was no significant difference in volume reduction between the groups.

Conclusion: This study shows that keeping bandages on for between about 12 and 24 hours has the same effect on patients with BCRL as receiving CDP.
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http://dx.doi.org/10.1089/lrb.2017.0060DOI Listing
December 2018

An Evaluation of the Information Sources of Cancer Patients' Relatives. A Prospective Survey.

J Cancer Educ 2019 Oct;34(5):913-919

School of Medicine, Department of Medical Oncology, Dokuz Eylul University, Inciralti, Izmir, Turkey.

Patients followed up with a cancer diagnosis must be well-informed about cancer to be able to cope with it. Besides, informing the relatives of the cancer patients who are also experiencing the same process about the diagnosis and follow-up period of cancer is highly important. In the current study, it was aimed to evaluate the information sources about cancer which are referred to by relatives of cancer patients. Three hundred ninety-one cancer patient relatives were included in medical oncology clinic between May 1 and June 30, 2015. A questionnaire was applied to the participants, comprising 12 questions to elicit demographic information and 11 questions about the information sources to which they referred. The study included 183 female and 208 male participants with a mean age of 47.9 ± 13.6 years. While the oncologists were the primary information sources referred to by 87%, the Internet was the second most preferred information source by 72%. The websites most frequently referred were the official websites (70%), the websites of oncology associations (53%), and social networks and forums (32%). The primary factors affecting the Internet preference were age, education level, income level, and place of residence. The Internet was the second most referred information source about cancer by family caregivers following oncologists. Therefore, it is of crucial importance that physicians inform patients and their relatives comprehensively as well as guiding them to correct and reliable information sources.
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http://dx.doi.org/10.1007/s13187-018-1395-8DOI Listing
October 2019

Treatment of intraoperatively detected peritoneal carcinomatosis of colorectal origin with cytoreductive surgery and intraperitoneal chemotherapy.

World J Surg Oncol 2018 Mar 27;16(1):70. Epub 2018 Mar 27.

Department of Surgery, Dokuz Eylul University School of Medicine, Balcova, 35340, Izmir, Turkey.

Background: Diagnosis of peritoneal carcinomatosis (PC) may be missed by preoperative imaging. We are presenting our experience with incidentally detected PC of colorectal origin treated with cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) at the same operation.

Methods: Between January 2010 and September 2016, 19 patients underwent CRS and IPC due to incidentally detected PC of colorectal origin. Data were analyzed from a prospectively collected database.

Results: The median age was 59 (29-78). In three patients, PC was diagnosed during emergency surgery. The primary tumor was located in the rectum (three patients; one with recurrent disease), left colon (9 patients), and right colon (7 patients). All patients underwent CRS and IPC, and one patient operated laparoscopically. Median peritoneal cancer index (PCI) was 5 (range, 3-14), and complete cytoreduction (CC-0) was achieved in 14 patients. After CRS, 8 patients received early postoperative intraperitoneal chemotherapy (EPIC), 7 patients received hyperthermic intraperitoneal chemotherapy (HIPEC), and 4 patients received both HIPEC and EPIC. The median hospital stay was 9 (6-29) days. Postoperative complications occurred in 6 patients. There was no postoperative mortality. Median follow-up was 40.2 (12-94) months. Five-year overall survival was 63.2%. Estimated mean survival time is longer in patients who underwent complete cytoreduction compared to patients having CC-1 or CC-2 cytoreduction (87.7 vs. 20.3 months; p < 0.001).

Conclusion: Cytoreductive surgery and IPC can be performed safely in patients with intraoperatively detected incidental PC of colorectal origin.
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http://dx.doi.org/10.1186/s12957-018-1369-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870809PMC
March 2018

Effects of Clinical Pilates Exercises on Patients Developing Lymphedema after Breast Cancer Treatment: A Randomized Clinical Trial.

J Breast Health 2017 Jan 1;13(1):16-22. Epub 2017 Jan 1.

Department of Clinical Oncology, Dokuz Eylül University Institute of Oncology, İzmir, Turkey.

Objective: The aim of the present study was to compare the effects of clinical Pilates exercises with those of the standard lymphedema exercises on lymphedema developing after breast cancer treatment.

Materials And Methods: The study comprised 60 female patients with a mean age of 53.2±7.7 years who developed lymphedema after having breast cancer treatment. The patients were randomized into two groups: the clinical Pilates exercise group (n=30), and the control group (n=30). Before, and at the 8th week of treatment, the following parameters were measured: the severity of lymphedema, limb circumferences, body image using the Social Appearance Anxiety Scale, quality of life with the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-BR23), and upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Both groups performed one-hour exercises three days a week for 8 weeks.

Results: After treatment, the symptoms recovered significantly in both groups. Reductions in the severity of lymphedema, improvements in the social appearance anxiety scale scores, quality of life scores, and upper extremity functions scores in the clinical Pilates exercise group were greater than those in the control group. Clinical Pilates exercises were determined to be more effective on the symptoms of patients with lymphedema than were standard lymphedema exercises.

Conclusions: Clinical Pilates exercises could be considered a safe model and would contribute to treatment programs.
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http://dx.doi.org/10.5152/tjbh.2016.3136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351459PMC
January 2017

A Case of a Gastrointestinal Stromal Tumor Diagnosed at the Postpartum Period.

Case Rep Obstet Gynecol 2016 10;2016:3621802. Epub 2016 Nov 10.

Dokuz Eylul University School of Medicine, Department of Pathology, Izmir, Turkey.

. We discuss a rare gastrointestinal stromal tumor (GIST) case detected at the 10th postpartum week and we want to pay attention to the challenges and improvements in the diagnosis, surgery, chemotherapy, and follow-up of this rare tumor accompanied with the review of the current literature. . A 32-year-old multiparous woman presented with abdominal swelling 10 weeks after her second vaginal birth. Abdominal examination revealed a mass starting from the pelvic level and extending to the right upper quadrant. Radiological examinations showed a solid, multiloculated, and hypervascular mass starting from the pelvis and extending to the transverse colon. mass with a 20 cm jejunal segment resection and a left pelvic side wall peritonectomy with omentectomy was performed. The pathologic examination revealed a high-risk GIST which originated from the jejunum and disseminated to the peritoneum. The patient has been given imatinib 400 mg/day since then. She did not reveal any progression during the 15-month follow-up postoperatively. . GIST tumors are rare and there is not sufficient information in the literature regarding its management. In this patient having high risk GIST and GIST sarcomatosis we successfully treated the patient by surgery and adjuvant imatinib chemotherapy.
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http://dx.doi.org/10.1155/2016/3621802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121446PMC
November 2016

The Effect of Education on Upper Extremity Function in Patients with Lymphedema after Breast Cancer Treatments.

Lymphat Res Biol 2016 09 6;14(3):142-7. Epub 2016 Jun 6.

4 Department of Medical Oncology, Faculty of Medicine, Dokuz Eylul University , Izmir, Turkey .

Background: The aim of this study was to evaluate the effects of education on the upper extremity functions of patients with lymphedema (LE) after breast cancer treatments.

Methods: Thirty-eight patients with LE after breast cancer treatments participated in the study. The patients were separated into two groups. Group 1 (n = 19) was educated about the causes and symptoms of LE and the methods for minimizing complications from LE, such as skin care, changes that must be made in daily life activities, exercises, and protective clothing. Group 2 (n = 19) was treated through standard means (surgical, chemotherapy, radiotherapy). A universal goniometer was used to assess the range of motion of the upper extremity of the patients. The Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the Shoulder Pain and Disability Index (SPADI) were used to assess shoulder function. The measures were carried out once by the same physiotherapist. The chi-square and Mann-Whitney U tests were used to analyze the data.

Results: Group 1, educated about LE, performed better than the other group in shoulder flexion range. When shoulder abduction, internal-external rotation, and elbow flexion motions were compared by using the DASH and SPADI, no significant difference was observed between the groups (p > 0.05). However, when shoulder function was compared, Group 1 was better. There was no significant difference between the groups when the severity of LE was compared.

Conclusion: This study underscores the need to develop and implement strategies for LE prevention and education for all breast cancer patients.
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http://dx.doi.org/10.1089/lrb.2015.0010DOI Listing
September 2016

Breast cancer survivors suffer from persistent postmastectomy pain syndrome and posttraumatic stress disorder (ORTHUS study): a study of the palliative care working committee of the Turkish Oncology Group (TOG).

Support Care Cancer 2016 09 2;24(9):3747-55. Epub 2016 Apr 2.

Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey.

Purpose: Persistent postmastectomy pain syndrome (PMPS) is one of the most important disturbing symptoms. Posttraumatic stress disorder (PTSD) is an anxiety disorder which is characterized by reactions to reminders of the trauma that has been experienced. The purpose of this study is to evaluate the predictors of PMPS and PTSD in Turkish breast cancer survivors and the correlation between PMPS and PTSD.

Method: The study is designed as a multicenter survey study. Breast cancer patients in remission were evaluated. Patients were evaluated with structured questionnaires to assess the PMPS and clinical parameters associated with it. The Turkish version of the posttraumatic stress disorder checklist-civilian version (PCL-C) was used.

Results: Between February 2015 and October 2015, 614 breast cancer survivors in outpatient clinics were evaluated. The incidence of PMPS documented is 45.1 %. In the multivariate analysis low income, presence of PTSD and <46 months after surgery were associated with increased risk of PMPS. PTSD was documented in 75 %, and the mean PCL-C score was 32.4 ± 11.1. PMPS and being married at the time of the evaluation were linked with PTSD.

Conclusions: It is the first data about the association between PMPS and PTSD. The clinicians should be aware of PMPS and PTSD in breast cancer survivors.
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http://dx.doi.org/10.1007/s00520-016-3202-6DOI Listing
September 2016

Evaluation of kinesthetic sense and hand function in women with breast cancer-related lymphedema.

J Phys Ther Sci 2015 Jun 30;27(6):1671-5. Epub 2015 Jun 30.

Oncology Institute, Dokuz Eylul University, Turkey.

[Purpose] This study evaluated the functional ability and kinesthetic sense of the hands of women with breast cancer-related lymphedema. [Subjects and Methods] Fifty-seven women experiencing lymphedema after breast surgery and adjuvant radiotherapy were included. The patients were divided into two groups: women with hand edema (HE+, n = 29) and without hand edema (HE-, n = 28) after breast cancer treatment. Arm edema severity, hand size, functional mobility and kinesthetic sense of the hand, and daily living skills were evaluated. [Results] The mean age of the patients was 55.8 years. In both groups, functional mobility, kinesthetic sense, and daily living skills decreased significantly with increasing edema severity. However, there was no significant difference between groups with respect to functional mobility or daily living skills. The kinesthetic sense of the hand was better in the HE- group than the HE+ group. There was a significant negative relationship between the severity of edema and hand function. [Conclusion] Breast cancer-related lymphedema can negatively impact women's functional mobility and kinesthetic sense of the hands as well as daily living skills.
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http://dx.doi.org/10.1589/jpts.27.1671DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499958PMC
June 2015

Long-term outcomes and prognostic factors of high-risk malignant melanoma patients after surgery and adjuvant high-dose interferon treatment: a single-center experience.

Chemotherapy 2014 10;60(4):228-38. Epub 2015 Apr 10.

Division of Medical Oncology, Tepecik Education and Research Hospital, Izmir, Turkey.

Background: Surgical excision constitutes an important part of the treatment of local advanced malignant melanoma. Due to the high recurrence risk, adjuvant high-dose interferon therapy is still the only therapy used in stage IIB and III high-risk melanoma patients.

Methods: One hundred two high-risk malignant melanoma patients who received high-dose interferon-α-2b therapy were evaluated retrospectively. The clinicopathological features, survival times, and prognostic factors of the patients were determined.

Results: The median disease-free and overall survival times were 25.2 and 60.8 months, respectively. Our findings revealed that male gender, advanced disease stage, lymph node involvement, lymphatic invasion, the presence of ulceration, and a high Clark level were significant negative prognostic factors.

Conclusion: In light of the favorable survival results obtained in this study, high-dose interferon treatment as adjuvant therapy for high-risk melanoma is still an efficient treatment and its possible side effects can be prevented by taking the necessary precautions.
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http://dx.doi.org/10.1159/000371838DOI Listing
November 2015

Perspectives and practical applications of medical oncologists on defensive medicine (SYSIPHUS study): a study of the Palliative Care Working Committee of the Turkish Oncology Group (TOG).

Med Oncol 2015 Apr 7;32(4):106. Epub 2015 Mar 7.

Department of Medical Oncology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla Universitesi Egitim ve Arastirma Hastanesi, Onkoloji Poliklinigi, 48000, Mugla, Turkey,

Defensive medicine occasionally indulges unnecessary treatment requests to defend against lawsuits for medical errors and the use of unapproved medical applications. This study determines the attitudes and orientations of medical oncologists on defensive medicine. A cross-sectional survey was sent by e-mail to medical oncologists. The survey was designed to determine the participants' demographic characteristics and defensive medicine practices. The survey measured the attitudes about defensive medicine practices of the oncologists based on a five-point Likert scale (never, rarely, sometimes, often, and always). One hundred and forty-six of a total of 402 physicians serving in oncology were fully filled, and the rate of return invitation was 36 %. The majority of participants were male, with a duration of between 7 and 9 years of work as university hospital officials, and the mean age was 46 ± 9 (years). International guidelines were followed in the most common is NCCN, and the majority of respondents felt that the application of these guidelines improves their defensive medicine. All participants of defensive medicine who stand on the basis of the definition were found to be more afraid of complaints by patients' relatives. Physicians of 45 % was noted that applying defensive medicine. Among the participants were the most frequent checkups of positive defensive approach is defined as increasing or shortening the follow-up period, while avoiding high-risk patients were detected as described in the definition of negative defensive medicine. Both professional groups in both the positive and negative defensive medicine approach defensive medicine approach, academic tasks, work experience and job time, there was a significant correlation between the location. Made in single- and multi-variable analyses, positions were identified both positive and negative defensive medicine is an independent risk factor for direction. Improving the working conditions of young physicians to protect against medical error may require additional educational opportunities.
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http://dx.doi.org/10.1007/s12032-015-0555-5DOI Listing
April 2015

Evaluation of sleep disorders in cancer patients based on Pittsburgh Sleep Quality Index.

Eur J Cancer Care (Engl) 2015 Jul 1;24(4):553-9. Epub 2015 Mar 1.

Medical Park, Izmir University, Division of Medical Oncology, Izmir, Turkey.

Insomnia, poor sleep quality and short sleep durations are the most common problems seen in cancer patients. More studies are needed about sleep disorders in cancer patients. In our study, we aimed to investigate the prevalence of sleep disorders and the impact of these problems on the quality of life in cancer patients. Pittsburgh Sleep Quality Index (PSQI) was given to a total of 314 patients. The psychometric evaluation of the Turkish version of PSQI in cancer patients revealed that 127 (40.4%) patients had global PSQI scores >5, indicating poor sleep quality. There was no statistically significant relationship between PSQI scores and sexuality, marital status, cancer stage and chemotherapy type (P > 0.05); while the patients with bone and visceral metastasis had much lower PSQI scores (P = 0.006). Patients with Eastern Cooperative Oncology Group performance scores of 3 or more had also significantly lower PSQI scores (P = 0.02). In conclusion, PSQI questionnaire may be used to evaluate the sleep disorders in cancer patients. Consistent use of multi-item measures such as PSQI with established reliability and validity would improve our understanding of difficulties experienced by cancer patients with chronic insomnia.
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http://dx.doi.org/10.1111/ecc.12296DOI Listing
July 2015

Adulthood hepatoblastoma.

Turk J Gastroenterol 2015 Jan;26(1):73-4

Department of Medical Oncology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.

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http://dx.doi.org/10.5152/tjg.2015.6544DOI Listing
January 2015

Predictors of functional capacity in colorectal cancer patients.

Support Care Cancer 2015 Sep 8;23(9):2747-54. Epub 2015 Feb 8.

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Inciralti, Izmir, Turkey,

Purpose: The aim of this study is to determine the predictors of functional capacity and explore the relationship between functional capacity, performance status, fatigue, quality of life, anxiety, and depression in colorectal cancer (CRC) patients.

Methods: Forty-two patients diagnosed as stage II-III CRC according to tumor, node, metastasis (TNM) classification were included the study. Functional capacity, performance status, fatigue, quality of life, anxiety, and depression of CRC patients were assessed using six-minute walk distance (6MWD) in the six-minute walk test (6MWT), Eastern Cooperative Oncology Group Performance Status (ECOG-PS), Brief Fatigue Inventory (BFI), Functional Assessment of Cancer Therapy-Colorectal (FACT-C), and Hospital Anxiety and Depression Scale (HADS), respectively. A multiple linear regression model was used to identify independent predictors of functional capacity.

Results: The six-minute walk distance (6MWD) was intermediately and negatively correlated with ECOG-PS score (p = 0.001, r = -0.415), BFI-impact of fatigue on daily functioning score (p = 0.013, r = -0.379), and age (p = 0.040, r = -0.319). An intermediate and positive correlation was found between 6MWD and FACT-C score (p = 0.016, r = 0.369). The multiple regression analysis revealed that only ECOG-PS score was significant and independent predictor of the 6MWD, accounted for 34.8 % of the variance.

Conclusion: Performance status was found to be the only significant predictor of functional capacity in this study. Assessing performance status may have an essential role in order to predict functional capacity in CRC patients. Future studies that include a larger sample size would more clearly elucidate the predictors and relationships of functional capacity.
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http://dx.doi.org/10.1007/s00520-015-2639-3DOI Listing
September 2015

The Perspective of Non-oncologist Physicians on Patients with Metastatic Cancer and Palliative Care (ALONE Study): A Study of the Palliative Care Working Committee of the Turkish Oncology Group (TOG).

J Cancer Educ 2015 Jun;30(2):253-9

Department of Medical Oncology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla Universtesi Egitim ve Arastirma Hastanesi, Onkoloji Poliklinigi, 48000, Mugla, Turkey,

The aim of our study was to determine the perspective of non-oncologist physicians regarding their attitudes and beliefs associated with palliative care for patients with metastatic cancer. The study was planned as a cross-sectional survey, and non-oncologist physicians were reached via e-mail and social networking sites. The first part of the questionnaire involved demographic properties, the second part inquired as to the perspectives of participants regarding metastatic disease, and the third part was used to determine beliefs and attitudes about palliative care. All of the questions were five-point Likert-type questions. A total of 1734 physicians completed the questionnaire. The majority of participants were general surgeons or internal medicine specialists (21 and 18%, respectively), were male (61%), were younger than 50 years of age (54%), worked in the town center (67%), had more than 11 years of professional experience (57%), and worked in a hospital without an active oncology service (86%). A total of 71% of participants identified all patients with metastatic cancer as being terminal stage, 62% were unaware of palliative care techniques, 64% did not know about common supportive care options, 59% were against hospice, and 63% had no opinion on resuscitation. We determined that non-oncologist physicians believed that all patients with metastatic cancer are at the terminal stage and that palliative/supportive care is the oncologist's task. These data suggest that non-oncologist physicians would benefit from additional graduate and postgraduate courses on these topics.
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http://dx.doi.org/10.1007/s13187-015-0794-3DOI Listing
June 2015

Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors.

Contemp Oncol (Pozn) 2014 22;18(4):279-84. Epub 2014 Jul 22.

Dokuz Eylül University, School of Physical Therapy and Rehabilitation, Sağlık Kampusü, Izmir, Turkey.

Aim Of The Study: There is little known about any change in postural balance caused by asymmetrical volume increase due to unilateral upper extremity lymphedema in patients who underwent breast surgery. The aim of this study was to determine whether there is a change in postural balance by measuring postural sway velocity (PSV), center of gravity (CoG) displacement and directional control (DCL) in patients with unilateral upper extremity lymphedema in breast cancer survivors.

Material And Methods: Eighteen females 38-60 (M = 53) years old diagnosed with upper extremity lymphedema due to breast cancer surgery, and 18 healthy females with similar ages (M = 52.5) were assessed using the Balance Master system (Neuro Com, Clackamas, USA). Unilateral stance (US) and bilateral stance (BS) tests in eyes open and closed conditions and the limit of stability (LOS) test were applied to quantify postural sway velocity (PSV), CoG displacement, and directional control (DCL).

Results: The lymphedema group showed a significant increase in PSV in the US test on the ipsilateral leg with eyes open (p = 0.02) and eyes closed (p = 0.005) as well as on the contralateral leg with eyes open (p = 0.004) and eyes closed (p = 0.0001). Average displacement and position of the CoG were 25% of LOS (p = 0.0001) towards the lymphedema side and 60.6 degrees respectively. DCL in the lymphedema group was significantly lower in forward (p = 0.0001), back (p = 0.003), ipsilateral (p = 0.002), and contralateral (p = 0.03) directions.

Conclusions: These findings suggest that unilateral upper extremity lymphedema may have challenging effects on postural balance.
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http://dx.doi.org/10.5114/wo.2014.44120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171475PMC
September 2014

Intra-peritoneal cisplatin combined with intravenous paclitaxel in optimally debulked stage 3 ovarian cancer patients: an Izmir Oncology Group study.

Asian Pac J Cancer Prev 2014 ;15(15):6165-9

Department of Internal Medicine, Ataturk University, Erzurum, Turkey E-mail :

Background: The advantage of intra-peritoneal (IP) chemotherapy (CT) in the initial management of ovarian cancer after cytoreductive surgery is well known. The feasibility and toxicity of a treatment regimen with an IP+intravenous CT (IPIVCT) for optimally debulked stage III ovarian cancer were here evaluated retrospectively.

Materials And Methods: A total of 30 patients were treated in our institution between October 2006 and February 2011. Patients received IV paclitaxel 175 mg/m2 over 3 hours followed by IP cisplatin 75 mg/m2 on day 1; they also received IP paclitaxel 60 mg/m2 on day 8. They were also scheduled to receive 6 courses of CT every 21 days.

Results: The median age of the patients was 55 years (35-77), and the majority had papillary serous ovarian cancer (63.3%). The patients completed a total of 146 cycles of IPIVCT. Twenty-eight were able to receive at least three cycles of IPIVCT and 18 (60%) completed the scheduled 6 cycles. Two patients discontinued the IPIVCT because of toxicity of chemotherapy agents and 6 had to stop treatment due to intolerable abdominal pain during IP drug administration, obstruction and impaired access. Grade 3/4 toxicities included neutropenia (6 patients; 20%), anemia (2 patients; 6.7%) and nausea-vomiting (2 patients; 6.7%). Doses were delayed in 12 cycles (8%) for neutropenia (n=6), thrombocytopenia (n=3) and elevated creatinine (n=3). Drug doses were not reduced. The median duration of progression-free survival (PFS) was 47.7 months (95%CI, 38.98-56.44) and overall survival (OS) was 51.7 months (95%CI, 44.13-59.29). Two and five-year overall survival rates were 75.6 % and 64.8%, respectively.

Conclusions: IPIVCT is feasible and well-tolerated in this setting. Its clinically proven advantages should be taken into consideration and more efforts should be made to administer IPIVCT to suitable patients.
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http://dx.doi.org/10.7314/apjcp.2014.15.15.6165DOI Listing
January 2017

Sexual satisfaction, anxiety, depression and quality of life in testicular cancer survivors.

Med Oncol 2014 Jul 10;31(7):43. Epub 2014 Jun 10.

Medical Oncology Clinic, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35360, Izmir, Turkey,

We aimed to investigate anxiety, depression and sexual satisfaction levels of testicular cancer survivors (TCSs) and compare the scores with healthy men's. The Hospital Anxiety and Depression Scale (HADS), Golombok-Rust Inventory of Sexual Satisfaction (GRISS) and European Organization for Research on Treatment of Cancer Questionnaires Quality of Life-C30 were used. Forty-one TCSs and thirty-eight healthy men were participated in this study. The total HADs scores of TCSs (12.21 ± 8.19) were less than the healthy group (14.44 ± 6.53; p > 0.05). The high depression scores rate was 29.2 and 55.2, and high anxiety scores rate was 24.4 and 28.9 for TCSs and healthy group, respectively. When we evaluated GRISS subscores and anxiety levels, we found significantly increase only in avoidance subscores in the TCSs (p = 0.04). When we evaluated GRISS subscores and depression levels, GRISS subscores of the TCSs who had high depression scores were also high. However, statistical significance was found in satisfaction (p = 0.009), touch (p = 0.04), avoidance (p = 0.01) and erectile dysfunction (p = 0.04) subscores in the TCSs. In the TCSs whose anxiety scores were high, emotional functioning (p = 0.009) and global QoL (p = 0.01) subscores of GRISS was found significantly low. In the TCSs whose depression scores were high, physical (p = 0.01), cognitive (p = 0.04), emotional (p = 0.03), social functioning (p = 0.02) and global QoL (p < 0.001) subscores of GRISS were found significantly low. Anxiety, depression and sexual satisfaction levels of TCSs were found to be similar with the control population.
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http://dx.doi.org/10.1007/s12032-014-0043-3DOI Listing
July 2014

Clinical and pathologic features of patients with rare ovarian tumors: multi-center review of 167 patients by the anatolian society of medical oncology.

Asian Pac J Cancer Prev 2014 Jan;14(11):6493-9

Department of Medical Oncology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey E-mail :

Background: Non-epithelial malignant ovarian tumors and clear cell carcinomas, Brenner tumors, transitional cell tumors, and carcinoid tumors of the ovary are rare ovarian tumors (ROTs). In this study, our aim was to determine the clinicopathological features of ROT patients and prognostic factors associated with survival.

Materials And Methods: A total of 167 patients with ROT who underwent initial surgery were retrospectively analyzed. Prognostic factors that may influence the survival of patients were evaluated by univariate and multivariate analyses.

Results: Of 167 patients, 75 (44.9%) were diagnosed with germ-cell tumors (GCT) and 68 (40.7%) with sex cord-stromal tumors (SCST); the remaining 24 had other rare ovarian histologies. Significant differences were found between ROT groups with respect to age at diagnosis, tumor localization, initial surgery type, tumor size, tumor grade, and FIGO stage. Three-year progression-free survival (PFS) rates and median PFS intervals for patients with other ROT were worse than those of patients with GCT and SCST (41.8% vs 79.6% vs 77.1% and 30.2 vs 72 vs 150 months, respectively; p=0.01). Moreover, the 3-year overall survival (OS) rates and median OS times for patients with both GCT and SCST were better as compared to patients with other ROT, but these differences were not statistically significant (87.7% vs 88.8% vs 73.9% and 170 vs 122 vs 91 months, respectively; p=0.20). In the univariate analysis, tumor localization (p<0.001), FIGO stage (p<0.001), and tumor grade (p=0.04) were significant prognostic factors for PFS. For OS, the univariate analysis indicated that tumor localization (p=0.01), FIGO stage (p=0.001), and recurrence (p<0.001) were important prognostic indicators. Multivariate analysis showed that FIGO stage for PFS (p=0.001, HR: 0.11) and the presence of recurrence (p=0.02, HR: 0.54) for OS were independent prognostic factors.

Conclusions: ROTs should be evaluated separately from epithelial ovarian cancers because of their different biological features and natural history. Due to the rarity of these tumors, determination of relevant prognostic factors as a group may help as a guide for more appropriate adjuvant or recurrent therapies for ROTs.
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http://dx.doi.org/10.7314/apjcp.2013.14.11.6493DOI Listing
January 2014

Evaluation of the efficacy of modified De Gramont and modified FOLFOX4 regimens for adjuvant therapy of locally advanced rectal cancer.

Asian Pac J Cancer Prev 2011 ;12(12):3181-6

Dokuz Eylul University, Department of Internal Diseases, Izmir, Turkey.

Objective: To evaluate the efficacy of modified De Gramont (mDG) and FOLFOX4 (mFOLFOX4) regimens in patients with locally advanced rectal cancer (LARC).

Methods: Patients that received adjuvant chemotherapy (CT) for the treatment of LARC (stage II and III) were retrospectively evaluated.

Results: A total of 231 patients were examined. Median age was 58 (range, 18-83) and, of these patients, 36 (15.6%) had stage II and 195 (84.4%) had stage III disease. While the patients with stage II disease received only mDG regimen (36, 100.0%), of the patients with stage III disease, 71 (36.5%) received mDG and 124 (63.5%) received mFOLFOX4 regimen. Patients with stage III disease showed recurrences more often, but this difference was not statistically significant. Similarly, for the patients with stage III disease, there was no statistically significant relation between the adjuvant CT regimen received and the rate of recurrence. In patients with stage II disease, who received mDG, median DFS was 101 months and median OS was 106 months. For the patients with stage III disease, the patients that received mDG showed a median DFS of 78 months and a median OS of 96 months, while the patients that received mFOLFOX4 had a median DFS of 51 months and a median OS of 78 months. Although, for the patients with stage III disease, there are major differences between the two different regimens of CT in terms of DFS and OS, this difference was not statistically significant.When the results were evaluated from the perspective of toxicity, the patients that received mFOLFOX4 showed more toxicity. Neurotoxicity, which was seen in the patients that were given mFOLFOX4, was the most prominent toxicity.

Conclusions: mDG and mFOLFOX4 regimens are applicable regimens as adjuvant CT for the treatment of LARC.
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August 2012

Validation of a simplified anorexia questionnaire.

J Pain Symptom Manage 2009 Nov;38(5):691-7

The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA.

Context: Anorexia is a common symptom in cancer and is usually assessed by multiple questions and multidimensional questionnaires. A simplified questionnaire would be less burdensome to patients and abbreviate the process.

Objectives: We compared the reliability at one point in time, sensitivity to change over time, and prognostic accuracy of a two-item questionnaire with the Functional Assessment of Anorexia and Cachexia Therapy shortened 12-question version (A/CS-12).

Methods: Individuals with cancer, who were cognitively intact and verbally agreed to participate, completed a two-item questionnaire and A/CS-12 in random order and again seven days later. We compared the direction of response to the summated two-item questionnaire to the validated A/CS-12 score at a single point in time, then intra-patient changes over a seven-day period of time. Scores of both questionnaires were divided into poor, moderate and good appetite and compared to survival using Kaplan-Meyer curves. Bootstrapping was used to construct confidence intervals for estimated probability agreement. Survival analysis also used hazard ratios from a Cox Proportional Hazards model.

Results: One hundred seventeen individuals from a single institution participated, who were either admitted to an inpatient palliative unit or seen in an outpatient/palliative medicine unit. Median age was 58.8 (range 10.7-87.1 years). Agreement at one point in time was 0.64 (95% confidence interval [CI] 0.63 - 0.66). Agreement over time was 0.53 (CI 0.41 - 0.64). The A/CS-12 predicted survival based on scores on Days 1 and 7 (P<0.001), (P=0.003) (HR 0.97 day 1, HR 0.95 day 7), whereas the simplified questionnaire failed to predict survival.

Conclusions: A simplified questionnaire has moderate correlation with the A/CS-12 at one point in time but loses sensitivity over time, and lacks the ability to predict survival. A change in the questionnaire may improve reliability. Changing question 2 of the simplified questionnaire to a neutral form (better, same or worse appetite) may improve sensitivity and prognostic capability.
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http://dx.doi.org/10.1016/j.jpainsymman.2009.03.012DOI Listing
November 2009

Cancer-related fatigue: central or peripheral?

J Pain Symptom Manage 2009 Oct 9;38(4):587-96. Epub 2009 Jun 9.

The Harry R Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio 44195, USA.

To evaluate cancer-related fatigue (CRF) by objective measurements to determine if CRF is a more centrally or peripherally mediated disorder, cancer patients and matched noncancer controls completed a Brief Fatigue Inventory (BFI) and underwent neuromuscular testing. Cancer patients had fatigue measured by the BFI, were off chemotherapy and radiation (for more than four weeks), had a hemoglobin level higher than 10 g/dL, and were neither receiving antidepressants nor were depressed on a screening question. The controls were screened for depression and matched by age, gender, and body mass index. Neuromuscular testing involved a sustained submaximal elbow flexion contraction (SC) at 30% maximal level (30% maximum elbow flexion force). Endurance time (ET) was measured from the beginning of the SC to the time when participants could not maintain the SC. Evoked twitch force (TF), a measure of muscle fatigue, and compound action potential (M-wave), an assessment of neuromuscular-junction transmission were performed during the SC. Compared with controls, the CRF group had a higher BFI score (P<0.001), a shorter ET (P<0.001), and a greater TF with the SC (CRF>controls, P<0.05). This indicated less muscle fatigue. There was a greater TF (P<0.05) at the end of the SC, indicating greater central fatigue, in the CRF group, which failed to recruit muscle (to continue the SC), as well as the controls. M-Wave amplitude was lower in the CRF group than in the controls (P<0.01), indicating impaired neuromuscular junction conduction with CRF unrelated to central fatigue (M-wave amplitude did not change with SC). These data demonstrate that CRF patients exhibited greater central fatigue, indicated by shorter ET and less voluntary muscle recruitment during an SC relative to controls.
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http://dx.doi.org/10.1016/j.jpainsymman.2008.12.003DOI Listing
October 2009