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Volum 03, Numarul 3-4, 1997

Editor’s note

This issue is dedicate to the different aspects of the psycho-oncology with special refferences to the quality of life of oncologic patient and the informed consent of patient in diagnostic and treatment options.

In the first article „Quality of life, quality of care and dignity of self’, N. Ghilezan, make a presentation ofthemt „quality of life” and of factors which define it. The medicine of today, disease centred, is more and more spe-

cialised and sophisticated, delivered in highly specialised institutions where even if the disease is very professionally managed, the patient as an individual is often overlooked, and his personal problems and priorities are ignored. The medicine of the future, patient centred and not on the disease, should provide a satisfactory quality of life, according to the preference and the priorities of the individual patient. The end of life and the dying patient are two important aspects who are debated. Finally is presented the integration of quality of life in the clinical practice, as an end point criteria in clinical trials.

In the next article, „The infomted consent of the cancer patient”, Dana Cernea, relief the importance of a good communication patient-physician, but also the role of the fanlily and friends who must be more and more involved in the difficult problems of the diagnostic and therapeutic decision. This communication implies a lot of psycho social fac- tors which detemtine the capacity of understanding and decision of patient. The informed consent of the patient must be a priority in ethics in oncology in our Institute too.

„The peculiarities of evaluation of quality of life in oncology” is an article in which A. Sec1reanu debate the multifactorial detemtination of the item „quality of life”, the necessity of the optimisation of the therapeutical approach in temts of risks and benefits for the patient. This is in fact a key position to appreciate the quality of patient’s life.

Adriana Bahan, in her article „Psycho-oncology: the biopsychosocial approach of the malignant disease” show that this new subspecialty is emerge from the need of understanding the role of psycho social, social, and behavioural factors in ethiology and evolution of the malignant disease. The article argue why the development of psycho-oncology is contributing substantially to the enhancement of quality of life and well-being of patients with cancer.

„Hospice: principles, history and actuality” is signed by Ileana Hica, who present the main principles of palli- ation care for people with cancer and some turning points in the history of hospice movement and the state of the art in our country.

„Psychological aspects in paediatric oncology” of Sempronia Filipoi, show that for the child patient the diag- nosis of cancer interferes with fundamental developmental tasks involved in understanding and copying with the illness. The content of the article is related to the psychological progranl of „Baylor University Medical Center” from Dallas, Texas, in paediatric clinics from Cluj, with some specific target aspects involving clinical psychology in paediatric oncology.

Antone/la Matei and col. in „The psychotherapeutic approach of pain in paediatric oncology”, relief the psy- chological factors that contributes to the maintaining or increasing of pain and those which determine its inhibition. They also describe the psychotherapeutic strategies that can be used to improve the pain management, emphasising the nece- ssity of their individualisation depending on cognitive or emotional status of the child.

The article of B. Glinsky „Radiation therapy for incompletely resected meningiomas” debate the question of where radiation therapy is beneficial in the management of partially resected meningioma.

  1. Raica and col. in „Diagnostic and prognostic value of imunohistochemical identification of prostate speci- fic antigen” studies the value of prostate specific antigen in benign prostate hyperplasia and in prostate cancer and his significance in differential diagnosis.

Maria Retegan-Turdeanu and col. present a „Semiquantitative evaluation of specific deposits of S-protein, Vitronectin, Decay Accelerating Factor and CR 1 in breast cancer samples and their relation with C5b-9 complex”.

The final article of J J Mazeron, is a presentation of the 39-th Congress of the American Society for Therapeutic Radiology and Oncology.

– Dana Cernea

Quality of life, quality of care & dignity of self

  1. Ghilezan

University of Medicine and Pharmacy „I. Haţieganu” Cluj-Napoca

Institute ofOncology „I.Chiricuţă” Cluj-Napoca

The increase awareness of the public, the progress of the medical care and the number of cancer survivors together with the economic constraints of today, are leading to conceptual transformations of the present health care systems which should strive for improved quality and optimisation in resources utilisation. The main goal of these attempts is the offer- ing a maximal satisfaction to the patient. The medicine of today, disease centred, is more and more specialised and sophisticated, delivered in highly specialised institutions where even if the disease is very professionally managed, the patient as an individual is often overlooked, and his personal problems and priorities are ignored. The medicine of the future, patient centred and not on the disease should provide a satisfactory quality of life according to the preferences and the priorities of the individual patient. The main components and characteristics of the quality of life, health related quality of life, functional model of care, principles of communication and the integration of these concepts in the spe- cific management of the cancer patient are described.

Key words: quality-of-life/QL, health-related-QL/HRQL, models of care, communication, evaluation

Radioterapie & Oncologie Medicală, 1997,3-4: 109-117

Informed consent of the cancer patient

Dana Cernea

Institute of Oncology „Prof 1. Chiricuţă” Cluj-Napoca, Department of Radiotherapy

The signification of patient-physician relationship is as important as the moment of diagnostic or treatment decision. There are involved a lot of psycho. social factors who are related to the capacity of understanding and decision of patient, the communication of the diagnostic to the patient and the family, the informed consent of the patient concerning the treatment possibilities. An open communication between patient and physician would enhanced the patient trust in the results of the treatment and his life expectation. The patient must be stimulate to ask often about the illness and his treat- ment. The informed consent of patient must be an important part of ethics in oncology.

Key words: cancer, open communication, competence, informed consent

Radioterapie & Oncologie Medicală, 1997, 3-4: 118-126

The peculiarities of evaluation of quality of life in oncology

  1. Secăreanu

UMPh, „I. Haţieganu” Cluj-Napoca, Psychiatric and Medical Psychology Department

The notion of quality of life has a multifactorial determination and entail also a reference to the notion of health. The evaluation of quality of life in oncology suppose the consideration of all the factors that can affect it, but also the opti- misation of the therapeutical approaches, in terms of risks and benefits for the patient, who in fact is in a key position to appreciate the quality of his/here own life.

Key words: quality of life, health, cancer

Radioterapie & Oncologie Medicală, 1997,3-4: 127-129

The psycho-oncology: A biopsychosocial approach of the malignant disease

Adriana Băban

The Faculty of Psychology, Babeş-Bolyai University, Cluj-Napoca

The aim of this paper is to outline the field of psycho-oncology, a new subspeciality which emerged from the need of understanding the role of psychological, social and behavioural factors that may influence cancer morbidity and morta- lity. Psycho-oncology is attaining subspeciality status by bringing a set of clinical skills in counseling, by providing training curricula which teach knowledge in the area, and through creating a body of research data and information about clinically relevant issues in the care of patients with cancer. The development of psycho-oncology is contributing sub- stantially to the enhancement of quality of life and well-being of patients with cancer.

Key words: psycho-oncology, personality, life style, stress, emotional reactions, quality of life, burnout syndrom, holis-

tic approach

Radioterapie & Oncologie Medicală, 1997,3-4: 130-141

Hospice: principles, history and actuality

Ileana Hica

Institute of Oncology „Prof Dr. I. Chiricuţă” Cluj-Napoca

We present the main principles of palliative care for people with cancer, some turning points in the history of hospice movement and the state of the art in Romania.

Key words: palliative care, hospice

Radioterapie & Oncologie Medicală, 1997,3-4: 140-144

Psychological aspects in pediatric oncology

Sempronia Filipoi

Catedra de psihiatrie a copilului şi adolescentului, U. M F. Cluj-Napoca

Clinical observation indicates diverse patient-family treatment dynamic patterns in cancer.For the child patient in par- ticular the diagnosis of cancer interferes with fundamental developmental tasks involved in understanding and coping with the ilness. Baylor University Medical Center from Dallas Texas is sustaining a 2 years psychological programm in pediatric clinics from Cluj-Napoca. The content of this article in related to this programm, summaring some specific tar- get aspects involving clinical psychology in oncopediatrics.

Key words: oncopediatry, clinical phsychology

Radioterapie & Oncologie Medicală, 1997, 3-4: 145-149

The psychotherapeutic approach of pain in pediatric oncology

Antonella Matei*, Antonela Nicoară**, Anca Chivoiu**

* Institutul Oncologic „Prof I. Chiricuţă” Cluj-Napoca **Clinica de Psihiatrie, Spitalul Clinic Judeţean Cluj-Napoca

The present paper refers to the necessity ofa multidimensional approach of pain in oncopaediatric department. We start with the defmition of pain, emphasising the link between physiological and psychological parts of pain complex. We mention the psychological factors that contribute to the maintaining or increasing of pain, and those which determine its inhibition. We also describe the psychotherapeutic strategies that can be used to improve the pain management in onco- logical patients, emphasising the necessity of their individualisation depending on cognitive or emotional status of the child, on constitutional and environmental factors. After a brief review of various psychotherapeutic methods applica- ble in pain management, we insist on hypnosis, which, in recent studies, is considered to have immediate effectiveness both in chronic pain and acute pain caused by invasive medical procedures.

Keywords: pain, oncopaediatry, psychotherapy, hypnosis

Radioterapie & Oncologie Medicală, 1997, 3-4: 151-157

Radiation therapy for incompletely resected meningiomas

  1. Glinski, P. Dymek, G. Miller, J. Skolyszewski

Department of Radiation Oncology of Maria Sklodowska-Curie Memorial Centel; Krakow, Poland

To addres the question of whether radiation therapy is beneficial in the management of partially resected meningioma we reviewed the records of 34 patients with the diagnosis of benign intracranial meningioma admitted to the Maria Sklodowska-Curie Memorial Center in Krak6w, between 1974-1984. The patients were divided into two groups: 9 patients had subtotal resection and did not receive radiation therapy (S-group) and 25 patients had subtotal resection fol- lowed by radiation therapy (SR-group). The 10-year actuarial local control and overall survival rates for patients treat- ed with S were 45% and 78% respectively, and they were 67% and 85% for the SR group. At 5 years 33% of non irra- diated patients had a reccurence, compared with only 16% of the SR group. The patients treated with SR did not survive significantly longer that S patients had.

Key words: meningioma, radiotherapy

Radioterapie & Oncologie Medicală, 1997, 3-4: 158-162

Diagnostic and prognostic value of immunohistochemical identification of prostate specific antigen

  1. Raica***, F. Miclea*, Alice Dema**, P. Dragan*,O. Mederie***, Marieta Toma***

U.MF. Timişoara, * Clinica de Urologie, ** Disciplina de Morfopatologie, ***Catedra de Histologie

We studied tissue prostate-specific antigen (PSA) expression in 9 patients admitted with benign prostate hyperplasia and 71 cases with prostate cancer. Biopsies were taken by transurethral resection, in paraffin-embedded, and sections were stained with haematoxylin-eosin for the pathological diagnosis and Gleason score. PSA was immunohistochemically identified with specific monoclonal antibody/HRP Dako Epos. In cases with benign prostate hyperplasia there were positive only principal cells whereas basal, stromal, neuroendocrine and urothelial cells were negative. There were pos- itive all carcinoma of glandular origin and a direct relationship between the intensity of the reaction and the Gleason score was noticed. Invasion of the perineural space was identified by the expression of PSA in 6 cases, unsuspected on haematoxylin-eosin stained sections. In prostate intraepithelial neoplasia a strong reaction was noticed. Epidermoid car- cinoma, transitional cell carcinoma and small cell carcinoma were negative. It is assumed that immunohistochemical reaction for PSA is useful in the primary and differential diagnosis of prostate cancer.

Key words: prostate cancer, Gleason score, PSA, immunohistochemistry

Radioterapie & Oncologie Medicală, 1997,3-4; 163-167

Semiquantitative Evaluation of S-proteinNitronectin, DAF (Decay Accelerating Factor) and CR 1 in Breast Cancer and their Relation with C5b-9 Complex

Maria Retegan- Turdean1, F. Niculescu2, H. Rus2

1 Radiological Clinic, Cluj-Napoca, Romania

2 Department of Pathology, University of Maryland; School of Medicine, Baltimore USA

Normal and neoplastic cells are protected from antologous complement (C) attack by different cell-surface C-inhibitory proteins including: S-protein/Vitronectin (Spiv), OAF (Decay Accelerating Factor) and CRI. We have shown on sam- ples of breast cancer, using immunohistochemistry, that the complement activation is presented on breast tumor cells. We also determined the distribution of Spiv, DAF and CRt on the same samples. Now we present a semiquantitative evaluation of specific diposits of Spiv, DAF and CRt in breast cancer samples and their relation with C5b-9. Our results show that the breast cancer variably express Spiv, DAF and CRt. We are not able to demonstrate any inverse correla- tion between complement inhibitors expression by tumor breast cells and C5b-9 complex. This suggests that the Spiv, OAF and CR 1 offer a limited protection for breast cancer cells from complement attack and maybe the other inhibitors and/or mechanisms are involved in this process.

Key words: breast cancer, C5b-9, complement inhibitors

Radioterapie & Oncologie Medicală, 1997,3-4: 168-176

176. Account of the 39 th reunion of the American Society for Therapeutic Radiology and Oncology