Evaluation of Quality of Life (QOL) in Pancreaticoduodenectomy Survivors

Annals of Surgery. Feb, 2002  |  Pubmed ID: 11807377

Indications and Use of Palliative Surgery-results of Society of Surgical Oncology Survey

Annals of Surgical Oncology. Jan-Feb, 2002  |  Pubmed ID: 11829424

Despite increasing attention to end-of-life care in oncology, palliative surgery (PS) remains poorly defined. A survey to test the definition, assess the extent of use, and evaluate attitudes and goals of surgeons regarding PS was devised.

Immunogenicity of a P210(BCR-ABL) Fusion Domain Candidate DNA Vaccine Targeted to Dendritic Cells by a Recombinant Adeno-associated Virus Vector in Vitro

Cancer Research. Jun, 2002  |  Pubmed ID: 12036931

Chronic myelogenous leukemia (CML) is characterized by a t(9;22) translocation, which results in the expression of chimeric BCR-ABL fusion oncoproteins that are necessary for oncogenesis, unique to the leukemic clones, and represent enticing targets for immunotherapy. As a strategy for the immunotherapy of CML, we constructed a recombinant adeno-associated virus vector encoding the p210(BCR-ABL) b3a2 variant fusion region with flanking sequences (CWRBA) and used it to express the BCR-ABL fusion region within primary human dendritic cells (DCs), the most potent antigen-presenting cells currently known. Peripheral blood mononuclear cells from healthy donors were primed and restimulated in vitro with autologous DCs transduced with purified CWRBA, CWRAP (negative control), or pulsed with a peptide corresponding to the fusion domain (positive control). No specific responses were generated using DCs transduced with CWRAP. In contrast, CWRBA-transduced DCs primed autologous T cells in an antigen-specific, MHC-restricted fashion to levels comparable with the positive control. CWRBA-transduced DCs elicited both cytotoxic CD4+/Th1 and CD8+ responses, although the former were more readily detected in this system. Cytotoxicity against a tumor cell line endogenously expressing the p210(BCR-ABL) b3a2 variant fusion region was also demonstrable. In addition, HLA-DRB5(*)0101+DRA (DR2a) was identified as a new restriction element capable of presenting the b3a2 BCR-ABL fusion region epitope. Thus, the construct developed herein may serve as a candidate vaccine for gene-based antigen-specific immunotherapy of CML and may serve as a paradigm for the use of DCs transduced with recombinant adeno-associated virus vectors encoding multiepitope immunogens for vaccine development.

When the Sun Can Set on an Unoperated Bowel Obstruction: Management of Malignant Bowel Obstruction

Journal of the American College of Surgeons. Jul, 2002  |  Pubmed ID: 12113535

Decision Making in Palliative Surgery

Journal of the American College of Surgeons. Sep, 2002  |  Pubmed ID: 12229950

Palliative surgery for advanced cancer patients involves complex decision making. Surgeons with a cancer-focused practice were surveyed to determine the extent to which palliative surgery was currently practiced, to identify ethical dilemmas and barriers they faced in performing palliative surgery, and to evaluate their treatment choices in four different clinical scenarios.

Clinical Research for Surgeons in Palliative Care: Challenges and Opportunities

Journal of the American College of Surgeons. Jan, 2003  |  Pubmed ID: 12517566

Ethical Considerations and Barriers to Research in Surgical Palliative Care

Journal of the American College of Surgeons. Mar, 2003  |  Pubmed ID: 12648701

Association Between Cyclooxygenase Expression and Colorectal Adenoma Characteristics

Cancer Research. Jul, 2003  |  Pubmed ID: 12873979

The cyclooxygenase (COX) pathway is important in colorectal carcinogenesis with the majority of cancers overexpressing COX-2; however, the role of COX-2 in the development of colorectal adenomas is less well defined. Accordingly, we analyzed 108 colorectal adenomas for COX-1 and COX-2 transcription in archival formalin-fixed, paraffin-embedded tissue using by real-time PCR and normalized to beta-actin. Neither COX-1 nor COX-2 mRNA expression differed with regard to age or gender of the subject. COX-2 mRNA expression was significantly higher in distal adenomas (2.2 +/- 1.9) compared with proximal (0.7 +/- 0.5) adenomas (P < 0.0001) and in larger (>/=7 mm) compared with smaller (<7 mm) adenomas (2.3 +/- 2.2 and 1.7 +/- 1.3, respectively, P = 0.04). COX-2 expression did not differ significantly in tubular compared with tubulovillous adenomas, although there appeared to be a trend toward higher COX-2 expression in tubulovillous adenomas with increasing villous content. Additionally, there was not a significant difference in either COX-1 or COX-2 based on the degree of dysplasia Therefore, if COX-2 inhibitors work through a COX-2 mechanism, these agents may have differential effects on colorectal adenomas that are distal and larger.

An Evolving Strategy for Surgical Care

Journal of the American College of Surgeons. Jan, 2004  |  Pubmed ID: 14698322

Clinical Palliative Care for Surgeons: Part 1

Journal of the American College of Surgeons. Feb, 2004  |  Pubmed ID: 14759788

Clinical Palliative Care for Surgeons: Part 2

Journal of the American College of Surgeons. Mar, 2004  |  Pubmed ID: 14992751

Palliative Care Research: Issues and Opportunities

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. Mar, 2004  |  Pubmed ID: 15006905

Terminal Care in Head and Neck Cancer Patients: a Framework for Medical Decision Making

Journal of the American College of Surgeons. May, 2004  |  Pubmed ID: 15110819

Palliation As a Core Surgical Principle: Part 1

Journal of the American College of Surgeons. Jul, 2004  |  Pubmed ID: 15217643

Surgical Management of Malignant Bowel Obstruction

Surgical Oncology Clinics of North America. Jul, 2004  |  Pubmed ID: 15236730

MBO is a common but difficult problem for surgeons caring for cancer patients. Nonsurgical interventions should be considered in all patients with MBO, especially inpatients with limited survival or for whom surgery will have little effect on disease control. Although there is no algorithm for all patients with MBO, decision-making is based on reasonable expectations of survival and treatment-related success. Surgical options can be helpful in the setting of MBO as long as reasonable goals and realistic outcomes are clear.

Advances in Palliative Surgery for Cancer Patients

The Journal of Supportive Oncology. Jan-Feb, 2004  |  Pubmed ID: 15330375

Revision and Psychometric Testing of the City of Hope Quality of Life-Ostomy Questionnaire

Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. Oct, 2004  |  Pubmed ID: 15503840

Ostomies may be performed for bowel or urinary diversion, and occur in both cancer and non-cancer patients. Impact on physical, psychological, social and spiritual well-being is not unexpected, but has been minimally described in the literature. The City of Hope Quality of Life (COH-QOL)-Ostomy Questionnaire is an adult patient self-report instrument designed to assess quality of life. This report focuses on the revision and psychometric testing of this questionnaire.

MGMT Promoter Methylation and Field Defect in Sporadic Colorectal Cancer

Journal of the National Cancer Institute. Sep, 2005  |  Pubmed ID: 16174854

Sporadic colorectal cancers often arise from a region of cells characterized by a "field defect" that has not been well defined molecularly. DNA methylation has been proposed as a candidate mediator of this field defect. The DNA repair gene O6-methylguanine-DNA methyltransferase (MGMT) is frequently methylated in colorectal cancer. We hypothesized that MGMT methylation could be one of the mediators of field cancerization in the colon mucosa.

Colon Cancer Presenting As Upper-GI Bleeding

Gastrointestinal Endoscopy. Feb, 2006  |  Pubmed ID: 16427955

Surgical Palliation of Bowel Obstruction

Gastroenterology Clinics of North America. Mar, 2006  |  Pubmed ID: 16530117

MBO is a common but difficult problem for surgeons caring for cancer patients. Nonsurgical interventions should be considered in all patients who have MBO, especially in those with limited expected survival time or for whom surgery will have little effect on disease control. Surgical options can be helpful in the setting of MBO, as long as reasonable goals and realistic out-comes are clear. There is no defined algorithm for all patients with MBO, and decision-making is based on reasonable estimates of survival and treatment-related success. Therefore, better prospective data need to be collected for this population of patients. In addition, a randomized prospective trial comparing treatments based on the clinical scenario could help practitioners who care for patients with this condition.

The VA Ostomy Health-Related Quality of Life Study: Objectives, Methods, and Patient Sample

Current Medical Research and Opinion. Apr, 2006  |  Pubmed ID: 16684439

To present the design and methods of a multisite study of health-related quality of life (HR-QOL) in veterans living with ostomies. Research design and methods: Veterans from Tucson, Indianapolis, and Los Angeles VA Medical Centers were surveyed using the validated City of Hope ostomy-specific tool (mCOH-QOL-Ostomy) and the SF-36V. Cases (ostomates) had a major gastrointestinal procedure that required an intestinal stoma, while controls had similar procedures for which an ostomy was not required. Ostomy subjects were recruited for four focus groups in each of two sites divided by ostomy type (colostomy versus ileostomy) and overall mCOH-QOL-Ostomy HR-QOL score (highest versus lowest quartile). The focus groups further evaluated barriers, concerns, and adaptation methods and skills.

Innovation in Human Research Protection: the AbioCor Artificial Heart Trial

The American Journal of Bioethics : AJOB. Sep-Oct, 2006  |  Pubmed ID: 16997807

Quality of Life Outcomes in 599 Cancer and Non-cancer Patients with Colostomies

The Journal of Surgical Research. Mar, 2007  |  Pubmed ID: 17196990

A colostomy is known to impact negatively on a patient's quality of life (QOL). Concerns include incontinence, rectal discharge, gas, difficulties in returning to work, decreased sexual activity, and travel and leisure challenges. Reports have described QOL outcomes in cancer patients with colostomies and inflammatory bowel syndrome with colostomies, but little has been written regarding a comparison of cancer and non-cancer populations. The purpose of this study was to describe QOL issues of colostomy patients and compare these issues in cancer and non-cancer participants.

Prospective Integration of Cultural Consideration in Biomedical Research for Patients with Advanced Cancer: Recommendations from an International Conference on Malignant Bowel Obstruction in Palliative Care

Journal of Pain and Symptom Management. Jul, 2007  |  Pubmed ID: 17532174

In the setting of an international conference on malignant bowel obstruction as a model for randomized controlled trials (RCTs) in palliative care, we discuss the importance of incorporating prospective cultural considerations into research design. The approach commonly used in biomedical research has traditionally valued the RCT as the ultimate "way of knowing" about how to best treat a medical condition. The foremost limitation of this approach is the lack of recognition of the impact of cultural viewpoints on research outcomes. We propose that interest relevant to cultural viewpoints should be emphasized in conceptualizing and interpreting research questions, designs, and results. In addition to recognizing our cultural biases as individuals and researchers, we recommend two major shifts in designing and implementing RCTs: 1) inclusion of a multidisciplinary team of researchers to inform the diversity of perspectives and expertise brought to the research, and 2) use of mixed methods of inquiry, reflecting both deductive and inductive modes of inference.

Ethical Issues in Research to Improve the Management of Malignant Bowel Obstruction: Challenges and Recommendations

Journal of Pain and Symptom Management. Jul, 2007  |  Pubmed ID: 17532176

Research to improve the care of patients with malignant bowel obstruction (MBO) is urgently needed. In particular, there is an urgent need for high-quality descriptive research, including prospective cohort studies, as well as randomized controlled trials to define optimal management strategies. However, investigators and clinicians face numerous barriers in conducting high-quality research in this patient population. These barriers include lack of funding, difficulties in identifying eligible patients, and a variety of practical and methodological challenges of designing these studies. In addition, there are a variety of ethical challenges that arise in the design and conduct of studies of MBO and particularly in the conduct of clinical trials. In this article, we address four categories of ethical issues: study design, recruitment, informed consent, and Institutional Review Board review. For each, we outline salient issues and suggest recommendations for enhancing the ethics of MBO studies, including interventional trials.

Measuring Outcomes in Randomized Prospective Trials in Palliative Care

Journal of Pain and Symptom Management. Jul, 2007  |  Pubmed ID: 17532180

Palliative care aims to improve the quality of life of patients and their families and reduce suffering from life-threatening illness. In assessing palliative care efficacy, researchers must consider a broad range of potential outcomes, including those experienced by the patient's family/caregivers, clinicians, and the health care system. The purpose of this article is to summarize the discussions and recommendations of an Outcomes Working Group convened to advance the palliative care research agenda, particularly in the context of randomized controlled trials. These recommendations address the conceptualization of palliative care outcomes, sources of outcomes data, application of outcome measures in clinical trials, and the methodological challenges to outcome measurement in palliative care populations. As other fields have developed and refined methodological approaches that address their particular research needs, palliative care researchers must do the same to answer important clinical questions in rigorous and credible ways.

Report of the Clinical Protocol Committee: Development of Randomized Trials for Malignant Bowel Obstruction

Journal of Pain and Symptom Management. Jul, 2007  |  Pubmed ID: 17544243

Malignant bowel obstruction (MBO) is a commonly encountered palliative care problem. There have been very few comparative trials in this area, and consequently there is very little clinical evidence upon which therapy can be rationally based. The purpose of this paper is to highlight the discussion and decision-making process that was undertaken by the Clinical Protocol Subcommittee during the development of a proposed clinical trial of best medical care versus surgical or endoscopic treatment for MBO. The development of the proposed clinical trials followed an orderly process. The first step taken was a discussion of a specific definition for MBO. Once agreed upon, this definition helped identify inclusion and exclusion criteria for the proposed trial. This was followed by an extensive literature review, which helped define both surgical and endoscopic approaches to MBO as well as what constituted best medical care. An extensive discussion was then undertaken concerning the best outcome measure of success for medical, surgical, and endoscopic interventions. All of the above steps culminated in two proposed protocols, one for MBO of the small intestine distal to the ligament of Treitz and a second for colonic obstructions. The small intestinal trial is designed to compare surgical intervention versus best medical care, whereas the colonic trial seeks to compare surgery with endoscopically-placed intraluminal stents coupled with best medical care.

Implementing Palliative Care Studies

Journal of Pain and Symptom Management. Jul, 2007  |  Pubmed ID: 17544245

This session focused on issues related to implementation of randomized clinical trials in palliative care studies. Topics discussed included what kinds of clinical sites and patient populations were suitable, what types of clinical investigators (clinical specialty) should be involved in or lead the studies, what multisite mechanisms could be used to conduct the trials, and what funding issues were related to these studies. A trial of operative versus nonoperative management for small bowel obstruction caused by recurrent intra-abdominal cancer was considered. The feasibility of such a trial was examined in terms of whether there was "equipoise" for a majority of likely investigators in the field around the trial question, what other issues might impact accrual to the trial, and how many patients would be required to answer which of these two treatment arms was better. This last question is related to selection of a primary endpoint for the trial and was a modestly contentious issue for the trial design group. Both sensible compromises in endpoint selection and the education of the community of investigators for a particular randomized trial in palliative care are crucial steps for successful implementation. A major conclusion of this session is that implementation considerations are intimately related to the architecture of a specific trial and should be addressed practically and early in the design phase of any randomized trial addressing a palliative care question. In this respect, randomized trials in palliative care are no different than in other fields.

Lessons Learned from a Collaborative Meeting to Construct a Palliative Care Protocol

Journal of Pain and Symptom Management. Jul, 2007  |  Pubmed ID: 17544248

As the treatment of advanced illness necessitates a multidimensional and culturally sensitive approach, a conference of international leaders in affected disciplines (quality of life research, ethno-cultural variability, palliative medicine, surgical oncology, gastroenterology, major consortium research, medical ethics, and patient advocacy/cancer survivors) was organized to provide the necessary expertise and broad ethnic and racial perspectives. During the course of the two-day conference, participants first deliberated in small groups focused on specific areas of concern to palliative care research: outcome measures, ethical dilemmas, barriers, and solutions, cross-cultural issues, palliative care study implementation, and protocol development. Each group presented the results of their meetings, and the conference as a whole worked out the final details of a research protocol for malignant bowel obstruction. Lessons learned in the process of conceiving and organizing the meetings, implementing, and disseminating the results of the conference provide insight into the usefulness of this method for developing workable palliative care research methodologies.

The International Conference on Malignant Bowel Obstruction: a Meeting of the Minds to Advance Palliative Care Research

Journal of Pain and Symptom Management. Jul, 2007  |  Pubmed ID: 17544251

There is a dearth of well-designed clinical research focusing on palliative care in cancer patients, especially those who are near the end of life. Reasons for this include ethical dilemmas in conducting such trials, communication barriers between specialties, and unclear standards for best care practices. To ensure that patients with incurable illnesses are offered the best available care, it is essential to develop and disseminate research methodologies well suited to this population. Given the multidimensional and culture-dependent nature of the end-of-life experience, it is necessary to adopt an interdisciplinary approach to developing research methods. As a means of initiating the process of palliative clinical research methodology development, malignant bowel obstruction (MBO) was used as a model to develop a research protocol. Although many treatment options for MBO have been proposed, existing literature offers little guidance with regard to algorithms for optimal management. To this end, an international leaders in quality-of-life research, ethnocultural variability, palliative medicine, surgical oncology, gastroenterology, major consortium research, medical ethics, and patient advocacy/cancer survivors was convened in Pasadena, California, on November 12-13, 2004. Participants also represented the broad ethnic and racial perspectives required to develop culturally sensitive research methods. Consensus on methodological approaches was attained through vigorous debate. Using the conference-developed MBO model to implement trials will advance palliative care research.

A Mixed-methods Evaluation of Health-related Quality of Life for Male Veterans with and Without Intestinal Stomas

Diseases of the Colon and Rectum. Dec, 2007  |  Pubmed ID: 17701071

Intestinal stomas have a major impact on Cases' lives. It is essential to better understand the areas in which interventions may help to minimize the negative consequences.

Overall Quality of Life and Difficulty Paying for Ostomy Supplies in the Veterans Affairs Ostomy Health-related Quality of Life Study: an Exploratory Analysis

Medical Care. Sep, 2007  |  Pubmed ID: 17712260

To explore whether there was a significant relationship between difficulty paying for ostomy supplies and overall quality of life among a sample of ostomates receiving care from the Veterans Health Administration (VHA).

Demographic, Clinical, and Quality of Life Variables Related to Embarrassment in Veterans Living with an Intestinal Stoma

Journal of Wound, Ostomy, and Continence Nursing : Official Publication of The Wound, Ostomy and Continence Nurses Society / WOCN. Sep-Oct, 2007  |  Pubmed ID: 17876215

The study aims were to identify demographic, clinical, and quality of life variables related to embarrassment for people living with ostomies and to determine the experiences and/or feelings of veterans who were embarrassed by their ostomy.

Comorbidities Play a Larger Role in Predicting Health-related Quality of Life Compared to Having an Ostomy

American Journal of Surgery. Dec, 2007  |  Pubmed ID: 18005770

Previous research suggests an ostomy worsens health-related quality of life (HR-QOL), but comorbidities also can affect HR-QOL.

Karyometry of the Colonic Mucosa

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. Dec, 2007  |  Pubmed ID: 18086777

The study summarizes results of karyometric measurements in epithelial cells of the colorectal mucosa to document evidence of a field effect of preneoplastic development among patients with colorectal adenocarcinoma or adenoma.

Portomesenteric Reconstruction During Whipple Procedures: Review and Report of a Case

Vascular and Endovascular Surgery. Dec-2008 Jan, 2007  |  Pubmed ID: 18166637

A 60-year-old man undergoing a Whipple procedure to treat a pancreatic cancer was found to have tumor adherence to the portal vein. An en block pancreaticoduodenectomy with segmental portal vein resection (PVR) was performed. A primary portal vein anastomosis was initially attempted but failed. Hemodynamic deterioration led the authors to perform a temporary prosthetic portal vein interposition graft and abdominal closure. The following morning, once stable, the patient was brought back to the operating room for autologous reconstruction with femoral vein and completion of the pancreaticoduodenectomy. The role of PVR for vein invasion or tumor adherence during a Whipple procedure is still under debate. However, there is growing evidence that the perioperative morbidity and long-term survival in patients who undergo a pancreaticoduodenectomy with PVR are similar to those of patients without vein resection. Therefore a combined resection of the pancreatic head and the portal vein has been suggested in the absence of other contraindications for resection to be able to offer a curative surgical intervention to a larger number of patients. The authors herein report the details of a patient's case and also review the currently available methods for PVR and reconstruction.

The Value of a Systematic Approach to Malignant Bowel Obstruction

The Journal of Supportive Oncology. Mar, 2008  |  Pubmed ID: 18402302

The Greatest Challenges Reported by Long-term Colorectal Cancer Survivors with Stomas

The Journal of Supportive Oncology. Apr, 2008  |  Pubmed ID: 18491686

This paper presents a qualitative analysis of the greatest challenges reported by long-term colorectal cancer survivors with ostomies. Surveys that included an open-ended question about challenges of living with an ostomy were administered at three Kaiser Permanente regions: Northern California, Northwest, and Hawaii. The study was coordinated at the Southern Arizona Veterans Affairs Health Care System in Tucson. The City of Hope Quality of Life Model for Ostomy Patients provided a framework for the study's design, measures, data collection, and data analysis. The study's findings may be generalized broadly to community settings across the United States. Results replicate those of previous research among veterans, California members of the United Ostomy Association, Koreans with ostomies, and colorectal cancer survivors with ostomies residing in the United Kingdom. The greatest challenges reported by 178 colorectal cancer survivors with ostomies confirmed the Institute of Medicine's findings that survivorship is a distinct, chronic phase of cancer care and that cancer's effects are broad and pervasive. The challenges reported by study participants should inform the design, testing and integration of targeted education, early interventions, and ongoing support services for colorectal cancer patients with ostomies.

The Health-related Quality of Life in Long-term Colorectal Cancer Survivors Study: Objectives, Methods and Patient Sample

Current Medical Research and Opinion. Jul, 2008  |  Pubmed ID: 18544186

The objective of this paper is to describe the complex mixed-methods design of a study conducted to assess health-related quality of life (HRQOL) outcomes and ostomy-related obstacles and adjustments among long-term (>5 years) colorectal cancer (CRC) survivors with ostomies (cases) and without ostomies (controls). In addition, details are provided regarding the study sample and the psychometric properties of the quantitative data collection measures used. Subsequent manuscripts will present the study findings.

Influence of Intestinal Stoma on Spiritual Quality of Life of U.S. Veterans

Journal of Holistic Nursing : Official Journal of the American Holistic Nurses' Association. Sep, 2008  |  Pubmed ID: 18664602

To examine spiritual quality of life (QOL) of veterans with intestinal ostomies.

Demographic and Clinical Factors Related to Ostomy Complications and Quality of Life in Veterans with an Ostomy

Journal of Wound, Ostomy, and Continence Nursing : Official Publication of The Wound, Ostomy and Continence Nurses Society / WOCN. Sep-Oct, 2008  |  Pubmed ID: 18794701

The purpose of this study is to describe demographic, clinical, and quality-of-life variables related to ostomy complications (skin irritation, leakage, and difficulty adjusting to an ostomy) in a veteran population in the United States.

Multiple Myeloma Presenting with a Colonic Obstruction and Bony Lesions: a Clinical Dilemma

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. Dec, 2008  |  Pubmed ID: 18981461

Actinic Damage in Histopathologically Normal Skin

Analytical and Quantitative Cytology and Histology / the International Academy of Cytology [and] American Society of Cytology. Dec, 2008  |  Pubmed ID: 19160696

To establish measures of sun damage in histopathologically normal skin.

Sexual Health and Quality of Life Among Male Veterans with Intestinal Ostomies

Clinical Nurse Specialist CNS. Jan-Feb, 2008  |  Pubmed ID: 18091126

This secondary analysis was conducted to expand our understanding of the challenges men with ostomies face regarding intimate relationships and sexual functioning. We examined quantitative and qualitative data to examine sexual functioning, intimate relationships, and health-related quality of life (HR-QOL) among military veterans who are living with an intestinal stoma.

Regulation of Deoxycholate Induction of CXCL8 by the Adenomatous Polyposis Coli Gene in Colorectal Cancer

International Journal of Cancer. Journal International Du Cancer. May, 2009  |  Pubmed ID: 19173296

Elevated deoxycholic acid (DCA), mutations in the adenomatous polyposis coli (APC) gene and chronic inflammation are associated with increased risk of colorectal cancer. APC status was manipulated to determine whether DCA mediates inflammatory molecules in normal or initiated colonic mucosa. DCA increased steady state mRNA and protein levels of CXCL8 in cells which do not express wild-type APC. Steady-state CXCL8 mRNA and protein were suppressed when cells with conditional expression of wild-type APC were exposed to DCA. Immunostaining did not detect CXCL8 in normal human colonic mucosa. CXCL8 was expressed in adenomatous polyps and adenocarcinomas. CXCL8 expression correlated with nuclear beta-catenin localization in epithelial cells of adenomas, but was associated with endothelial cells and neutrophils in the adenocarcinomas. DCA-mediated CXCL8 promoter-reporter activity was elevated in a mutant APC background. Wild-type APC suppressed this effect. Mutation of activator protein-1 (AP-1) or nuclear factor kappa B (NF-kappaB) sites suppressed the activation of the CXCL8 promoter-reporter by DCA. Chromatin immunoprecipitation revealed that AP-1 and NF-kappaB binding to the 5'-promoter of CXCL8 was induced by DCA. The beta-catenin transcription factor was bound to the 5'-promoter of CXCL8 in the absence or presence of DCA. Phenotypic assays determined that DCA-mediated invasion was blocked by antibody-directed against CXCL8 or wild-type APC. CXCL8 exposure led to matrix metalloproteinase-2 production and increased invasion on laminin-coated filters. These data suggest that DCA-mediated CXCL8 occurs in initiated colonic epithelium and neutralizing CXCL8 could reduce the invasive potential of tumors.

Coping and Acceptance: the Greatest Challenge for Veterans with Intestinal Stomas

Journal of Psychosomatic Research. Mar, 2009  |  Pubmed ID: 19232235

Intestinal stomas (ostomies) create challenges for veterans. The goal of this qualitative analysis was to understand better patients' perspectives regarding their greatest challenge.

Progression of Skin Lesions from Normal Skin to Squamous Cell Carcinoma

Analytical and Quantitative Cytology and Histology / the International Academy of Cytology [and] American Society of Cytology. Feb, 2009  |  Pubmed ID: 19320189

To assess the changes in the nuclear chromatin pattern concomitant with progressive sun damage in skin biopsies ranging from sun-exposed, normal-appearing skin to squamous cell carcinoma (SCC).

The Influence of Husbands' or Male Partners' Support on Women's Psychosocial Adjustment to Having an Ostomy Resulting from Colorectal Cancer

Journal of Wound, Ostomy, and Continence Nursing : Official Publication of The Wound, Ostomy and Continence Nurses Society / WOCN. May-Jun, 2009  |  Pubmed ID: 19448512

Some patients with colorectal cancer (CRC) require a permanent ostomy, which changes bodily function and can create psychosocial distress. However, little is known about the influence of men's support on women's psychosocial adjustment to having an ostomy as a result of CRC.

Health-related Quality of Life Among Long-term Rectal Cancer Survivors with an Ostomy: Manifestations by Sex

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. Oct, 2009  |  Pubmed ID: 19720920

Intestinal stomas can pose significant challenges for long-term (> or = 5 years) rectal cancer (RC) survivors. Specifying common challenges and sociodemographic or clinical differences will further the development of tailored interventions to improve health-related quality of life (HRQOL).

Gender Differences in Sleep Disruption and Fatigue on Quality of Life Among Persons with Ostomies

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine. Aug, 2009  |  Pubmed ID: 19968011

The aim of this study is to examine differences in sleep disruption and fatigue of men and women colorectal cancer (CRC) survivors with intestinal ostomies and associated health-related quality of life (HR-QOL).

Invasive Treatment Options for Malignant Bowel Obstruction #119

Journal of Palliative Medicine. Dec, 2009  |  Pubmed ID: 19995293

Exploring Household Income As a Predictor of Psychological Well-being Among Long-term Colorectal Cancer Survivors

Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. Mar, 2009  |  Pubmed ID: 19132550

The purpose of this analysis was to determine the unique contribution of household income to the variance explained in psychological well-being (PWB) among a sample of colorectal cancer (CRC) survivors.

Figuring out Sex in a Reconfigured Body: Experiences of Female Colorectal Cancer Survivors with Ostomies

Women & Health. Dec, 2009  |  Pubmed ID: 20183104

Colorectal cancer survivors with ostomies can face complex concerns regarding sexuality. We used an anthropological perspective to examine the experiences of 30 female colorectal cancer survivors with ostomies to shed light on the sexual challenges and adaptations made in the wake of cancer surgery and treatment. Participants fell into four categories with regard to their sexual experience post surgery; however, not all women found their altered sexuality to be particularly problematic. This type of phenomenological examination can inform a more patient-centered, less biomedically focused paradigm for assessing and improving the sexual health of cancer survivors.

Loss of Inositol Polyphosphate 5-phosphatase is an Early Event in Development of Cutaneous Squamous Cell Carcinoma

Cancer Prevention Research (Philadelphia, Pa.). Oct, 2010  |  Pubmed ID: 20876729

Cutaneous squamous cell carcinoma (SCC) occurs commonly and can metastasize. Identification of specific molecular aberrations and mechanisms underlying the development and progression of cutaneous SCC may lead to better prognostic and therapeutic approaches and more effective chemoprevention strategies. To identify genetic changes associated with early stages of cutaneous SCC development, we analyzed a series of 40 archived skin tissues ranging from normal skin to invasive SCC. Using high-resolution array-based comparative genomic hybridization, we identified deletions of a region on chromosome 10q harboring the INPP5A gene in 24% of examined SCC tumors. Subsequent validation by immunohistochemistry on an independent sample set of 71 SCC tissues showed reduced INPP5A protein levels in 72% of primary SCC tumors. Decrease in INPP5A protein levels seems to be an early event in SCC development, as it also is observed in 9 of 26 (35%) examined actinic keratoses, the earliest stage in SCC development. Importantly, further reduction of INPP5A levels is seen in a subset of SCC patients as the tumor progresses from primary to metastatic stage. The observed frequency and pattern of loss indicate that INPP5A, a negative regulator of inositol signaling, may play a role in development and progression of cutaneous SCC tumors.

Positive Correlation of Employment and Psychological Well-being for Veterans with Major Abdominal Surgery

American Journal of Surgery. Nov, 2010  |  Pubmed ID: 21056133

Intestinal stomas (ostomies) have been associated negatively with multiple aspects of health-related quality of life. This article examines the relationship between employment status and psychological well-being (PWB) in veterans who underwent major bowel procedures with or without ostomy.

Overcoming Challenges: Life with an Ostomy

American Journal of Surgery. Nov, 2010  |  Pubmed ID: 21056145

Studies have demonstrated decreased health-related quality of life in patients with stomas.

Cancer and Age Related Colonic Crypt Deficiencies in Cytochrome C Oxidase I

World Journal of Gastrointestinal Oncology. Dec, 2010  |  Pubmed ID: 21191537

To investigate whether deficiency of expression of cytochrome c oxidase I (CcOI) in colonic crypts is associated with colon cancer.

Laparoscopic Resection of a Small Bowel Lipoma with Incidental Intussusception

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons. Oct-Dec, 2010  |  Pubmed ID: 21605536

Small bowel tumors are rare entities that often present with nonspecific symptoms. The diagnosis is more likely in patients with occult gastrointestinal bleeding of unknown origin or in adults with small bowel intussusception. Even with exhaustive diagnostic testing, small bowel tumors are often not diagnosed preoperatively. Because 60% to 70% of small bowel tumors are malignant, surgical excision is always recommended.

Going with the Flow: Quality-of-life Outcomes of Cancer Survivors with Urinary Diversion

Journal of Wound, Ostomy, and Continence Nursing : Official Publication of The Wound, Ostomy and Continence Nurses Society / WOCN. Jan-Feb, 2010  |  Pubmed ID: 20075694

The purpose of this descriptive study was to describe health-related quality of life (HRQOL) concerns among cancer patients with continent urinary diversion (UD) and incontinent UD.

Early and Late Complications Among Long-term Colorectal Cancer Survivors with Ostomy or Anastomosis

Diseases of the Colon and Rectum. Feb, 2010  |  Pubmed ID: 20087096

Among long-term (>or=5 y) colorectal cancer survivors with permanent ostomy or anastomosis, we compared the incidence of medical and surgical complications and examined the relationship of complications with health-related quality of life.

Prognostic Criteria for Squamous Cell Cancer of the Skin

The Journal of Surgical Research. Mar, 2010  |  Pubmed ID: 19375720

Non-well-differentiated cutaneous squamous cell carcinomas may display a more aggressive behavior. It is important to better define prognostic criteria for these tumors.

Nuclear Morphometry Identifies a Distinct Aggressive Cellular Phenotype in Cutaneous Squamous Cell Carcinoma

Cancer Prevention Research (Philadelphia, Pa.). Nov, 2011  |  Pubmed ID: 21636541

By identifying aggressive cutaneous squamous cell carcinoma (cSCC) in patients who are at high risk for recurrences or second primaries after resection, intensive surveillance and therapy may decrease morbidity and mortality. We investigated the role of nuclear morphometry (karyometry) in differentiating between aggressive and nonaggressive cSCC. We retrospectively analyzed cSCC lesions from 40 male patients. Twenty-two patients had evidence of aggressive cSCC (local/regional recurrence or a second primary cSCC), and 18 patients were identified with similar ages and sites of disease as control patients with nonaggressive cSCC (no evidence of recurrence, metastasis, or second primary). We carried out karyometric analysis to identify nuclear features that discriminate between aggressive and nonaggressive cSCC nuclei. We used statistically significant differences (Kruskal-Wallis test, P < 0.0001) to compose a quantitative aggressive classification score (proportion of aggressive nuclei from 0% to 100%). For comparisons, we used Fisher's exact test or Student's t test. The mean age was 79 ± 7 years for aggressive cSCC and 80 ± 9 years for nonaggressive cSCC (P = 0.66). We analyzed a mean of 96 nuclei in each group. The mean classification score for aggressive cSCC was significantly higher (69% ± 6%) than for nonaggressive cSCC (28% ± 5%, P = 0.00002). Overall, the classification score accurately categorized 80% of our patients (P = 0.0004). In most patients, karyometry differentiated between aggressive and nonaggressive cSCC. We found that classification scores, which provide information on individual lesions, could be used for risk stratification.

Radiographic and Clinical Factors Associated with Improved Outcomes in Advanced Cancer Patients with Bowel Obstruction

Journal of Palliative Medicine. Sep, 2011  |  Pubmed ID: 21767166

The purpose of this study was to identify preoperative clinical and radiographic factors relevant to treatment selection and outcomes in patients with advanced cancer presenting with bowel obstruction.

Gender Differences in Quality of Life Among Long-term Colorectal Cancer Survivors with Ostomies

Oncology Nursing Forum. Sep, 2011  |  Pubmed ID: 21875846

To describe how gender shapes the concerns and adaptations of long-term (i.e., more than five years) colorectal cancer survivors with ostomies.

Untreated Peristomal Skin Complications Among Long-term Colorectal Cancer Survivors with Ostomies

Clinical Journal of Oncology Nursing. Dec, 2011  |  Pubmed ID: 22119975

This ethnography of family caregiving explored why peristomal skin complications are common and undertreated among colorectal cancer survivors with intestinal ostomies. Data were collected through in-depth interviews with 31 cancer survivors and their family caregivers, fieldwork, structured assessments, and medical records review, and analyzed with qualitative theme and matrix analyses. Survivors who received help changing the skin barrier around their stoma had fewer obstacles to detection and treatment of peristomal skin complications. Half of the survivors received unpaid help with ostomy care, and all such help came from spouses. Married couples who collaborated in ostomy care reported that having assistance in placing the ostomy appliance helped with preventing leaks, detecting skin changes, and modifying ostomy care routines. In addition, survivors who struggled to manage ostomy care independently reported more obstacles to alleviating and seeking treatment for skin problems. Oncology nurses can improve treatment of peristomal skin problems by asking patients and caregivers about ostomy care and skin problems, examining the peristomal area, and facilitating routine checkups with a wound, ostomy, and continence nurse.

Chronicling Strides in Understanding and Managing Rectal Cancer

Oncology (Williston Park, N.Y.). Dec, 2011  |  Pubmed ID: 22329184

Complications Among Colorectal Cancer Survivors: SF-6D Preference-weighted Quality of Life Scores

Medical Care. Mar, 2011  |  Pubmed ID: 21224741

Societal preference-weighted health-related quality of life (HRQOL) scores enable comparing multidimensional health states across diseases and treatments for research and policy.