Health-related quality of life in high-grade glioma patients

Gliomas are malignant primary brain tumors and yet incurable. Palliation and the maintenance or improvement of the patient's quality of life is therefore of main importance. For that reason, health-related quality of life(HRQoL) has become an important outcome measure in clinical trials, next to traditional outcome measures such as overall and progression-free survivals, and radiological response to treatment. HRQoL is a multidimensional concept covering physical, psychological, and social domains, as well as symptoms induced by the disease and its treatment. HRQoL is assessed by using self-reported, validated questionnaires. Various generic HRQoL questionnaires, which can be supplemented with a brain tumor- specific module, are available. Both the tumor and its treatment can have a negative effect on HRQoL. However, treatment with surgery, radiotherapy, chemotherapy, and supportive treatment may also improve patients' HRQoL, in addition to extending survival. It is expected that the impact of HRQoL measurements in both clinical trials and clinical practice will increase. Hence, it is important that HRQoL data are collected, analyzed, and interpreted correctly. Methodological issues such as selection bias and missing data may hamper the interpretation of HRQoL data and should therefore be accounted. In clinical trials, HRQoL can be used to assess the benefits of a new treatment strategy, which should be weighed carefully against the adverse effects of that treatment. In daily clinical practice, HRQoL assessments of an individual patient can be used to inform physicians about the impact of a specific treatment strategy, and it may facilitate the communication between the physicians and the patients.

Familial versus Sporadic Breast Cancer: Different Treatments for Similar Tumors?

Objective: It is unclear if and to what extent family history of breast/ovarian cancer or BRCA1/2-mutation carriership influences breast cancer treatment strategy. We investigated whether treatment differed between patients from BRCA1/2 families and those unselected for family history. Methods: We included 478 BRCA1/2-related patients referred for genetic testing before or after diagnosis. Two references were used: 13,498 population-based and 6896 hospital-based patients. Surgical treatment and adjuvant chemotherapy use was analyzed using logistic regression models, stratified by tumor size, nodal status, age at and period of diagnosis, and estrogen receptor status (ER). Results: BRCA1/2 cases aged 35 - 52 years at diagnosis and/or with tumors < 2 cm were more likely to have undergone a modified radical mastectomy (Odd Ratios (OR) ranging from 2.8 to 5.1) compared to the references. This effect was most pronounced in patients treated after 1995 (OR 5.7 to 10.3). Compared to the reference groups, chemotherapy was more often administered to BRCA1 and ER-negative BRCA1/2-cases irrespective of age and nodal status (OR 1.9 to 24.3). Conclusion: After 1995 treatment of BRCA1/2-associated patients consisted notably of more mastectomies and adjuvant chemotherapy than their population-based counterparts with the same tumor characteristics. There is a need to be aware of such differences in daily practice and interpretation of survival studies on BRCA1/2 mutation carriers.

Effects of prolonged methylphenidate treatment on amygdala reactivity and connectivity:a randomized controlled trial in stimulant treatment-naive,male participants with ADHD

Background:Problems with emotional processing are widely reported in individuals with attentiondeficit/hyperactivity disorder(ADHD).Although methylphenidate(MPH)effectively alleviates inattention and hyperactivity symptoms in ADHD,its effects on emotional processing and internalizing symptoms have remained elusive.While we previously found that acute MPH administration modulated neural mechanisms underlying emotional processing in an age-dependent manner,the effects of prolonged administration remained unknown.Objectives:Therefore,we investigated:(i)whether prolonged MPH treatment influences neural substrates(amygdala reactivity and connectivity)of emotional processing,and(ii)whether these effects are modulated by age.Methods:The“effects of Psychotropic drugs On Developing brain-MPH”(“ePOD-MPH”)randomized controlled trial was a 16-week double-blind,placebo-controlled,multi-center trial with MPH in 50 boys(10–12 years of age)and 49 men(23–40 years of age),all stimulant treatment-naive and diagnosed with ADHD.Participants performed an emotional face-matching task during functional magnetic resonance imaging.We assessed their symptoms of ADHD and internalizing symptoms at baseline,during the trial(8 weeks),and 1 week after the trial end(17 weeks).Results and Conclusions:We did not find effects of prolonged MPH treatment on emotional processing,as measured by amygdala reactivity and connectivity and internalizing symptoms in this trial with stimulant treatment-naive participants.This differs from our findings on emotional processing following acute MPH administration and the effects of prolonged MPH treatment on the dopamine system,which were both modulated by age.Interestingly,prolonged MPH treatment did improve ADHD symptoms,although depressive and anxiety symptoms showed a medication-independent decrease.Furthermore,our data indicate that baseline internalizing symptoms may be used to predict MPH treatment effects on ADHD symptoms,particularly in(male)adults with ADHD.