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Journal Issue: Vol.9, No.1 - January 2010

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Editorial

Editorial: Successful Australia-India Cancer Research Program Expands to Bring Benefits to other Diagnostic Groups

A direct outcome of the Australia-Asia publication "Austral-Asian Journal of Cancer"(www.ajcancer.ipp-shr.cqu.edu.au) has been the establishment of the Australia-India Research Program, a collaborative initiative between the "International Program of Psycho-Social Health Research" (www.ipp-shr.cqu.edu.au) and "International Research Promotion Council" (www.irpc.org). The program focus is on the human experience of serious illness with a vision to developing holistic strategies to assist patients, their families and the professionals who care for them. Initial success has been in research exploring cross-cultural issues in palliative care for cancer patients, now completed and published (McGrath et al., 2009). The research not only affirms the benefits in cross-cultural work but showcases the positive outcomes that can be achieved by international collaboration in psychosocial research. Importantly, this psychosocial cancer research is a role model for similar psychosocial research in other diagnostic groups as demonstrated by the recent expansion of the program to include work on HIV/AIDS. As the following discussion illuminates, though diagnostically different HIV/AIDS, like cancer, has many significant psychosocial issues that need to be addressed. Two decades into the global HIV/ AIDS epidemic there is no cure and a high fatality rate. The disease is as much a social phenomena as a biological disease associated with fear, stigma and discrimination. The introduction of Anti-retroviral Therapy (ART) has prolonged life expectancy transforming HIV infection into a long-term chronic disease. Prevention of transmission, quality of life issues, access to affordable medical treatment, addressing community attitudes and misconceptions, and the need for ongoing social support to patients and their families have emerged as key health care issues in developing countries. In India, for example, estimates are of 2.5 HIV/AIDS infected persons (NAC0 2006) which has prompted the development and implementation of a national response. In 2007 the Indian Government launched its National AIDS Control Plan III, the third stage of a national strategy employing a decentralised response to halt and reverse transmission rates, increase treatment, care and support, and surveillance. The strategy has been hampered by pervasive poverty, low levels of education, and high gender stratification (Bloom et al 2007). Women are more disadvantaged than men when coping with the medical and psycho-social impacts of the disease. They have less access to medical treatment, less capacity and knowledge to engage in transmission prevention behaviours, and are often expulsed from family and social support resulting in greater isolation. Research highlights that the impact of the disease on women's health is not well understood, and calls for more gender sensitive approaches and prevention programs, and multi-sectorial health care programs (Bloom et al 2007; Majumdar 2004; Miles et al 2001; Subramanian et al 2009). Community Care Centres (CCCs) are an integral part of a suite of new initiatives and services established by the Indian Government under its National Aids Control Program (II and III) to address the transmission, treatment and support of HIV/AIDS nationally. The CCCs have been progressively rolled out across the country in the last few years. There are currently 122 CCCs providing services with the full complement of 350 expected to be operational nationally by 2012. They are administered in each state by local non-government organisations and are overseen by the State AIDS Control Societies (SACS). The CCCs are staffed by a variety of health care practitioners including nurses, doctors, counselors, educators, outreach and auxiliary workers. They provide a range of community based services including medical treatment, short-stay bed care, social support, counseling, referral, and linkages to the Anti-retroviral Centres. Research evidence shows that health care practitioners play a central role in the provision of services to people living with HIV/AIDS (PLWA) including medical, nursing, counseling, education and home support (Majumdar 2004; Mignone et al 2007). In conjunction with the availability of affordable medical treatment, psycho-social support is vital in achieving a good quality of life for PLWA (Solomon 2009; Subramanian et al 2009; Tarakeshwar et al 2007). Health care practitioners at the CCCs are the primary providers of services to PLWA. Yet, compared to patient population research, far less research has been conducted with health care practitioners. Where research has been done it has focused on practitioner competence, transmission fears, and the place of traditional medicine (Chomat et al 2009; Mignone et al 2007; Kielmann et al 2005). The International Program of Psycho-Social Health Research (IPP-SHR) in conjunction with the International Research Promotion Council (IRPC) is currently engaged in a study to explore the psycho-social health care needs for women attending the newly established Community Care Centres in the southern Indian state of Kerala. Outcomes from the study are anticipated to identify the specific needs of women patients and their families, and provide some commentary of the existing approaches and procedures and how these could be adjusted to better meet patient needs. The study will provide some of the first qualitative research findings to be obtained from the Community Care Centres about the specific health care needs of women. It will do this by engaging health care practitioners in semi-structured interviews on what they have observed and encountered in their practice. The perspectives of health care practitioners regarding these issues have not previously been reported. This project resonates with the strategies of the Indian Government, as outlined in the National AIDS Control Program III, to utilize both local and national evidence-based data to plan and implement care and support services. Researchers continue to search for a cure and vaccination for HIV/AIDS. In this environment prevention, addressing barriers to treatment and increased life expectancy have emerged as significant international issues. Collaborative research projects such as the one between IPP-SHR and IRPC have the potential to contribute to these issues in several ways. These include the capacity of the findings to shape efforts to respond to the psycho-social impacts of HIV/AIDS in developing countries experiencing similar social, psychological, cultural, and economic inhibitors. The project also has the potential to map and model the processes and requirements necessary for successful collaborative research across research institutes and countries. A sometimes overlooked but pivotal component is the need for a mutual commitment to the betterment of humanity by all members of the research team that is reflected in both the desired outcomes for the participant community and a process of ethical and respectful engagement between all parties. IPP-SHR and IRPC have invested considerable time into this aspect of the process to date. Conclusion Cancer research has intrinsic and direct benefits for patients, their carers and the health professionals who provide treatment and supportive care. As this discussion demonstrates, the positive contribution from psychosocial research is that it can extend beyond oncology to provide a role model for other diagnostic groups. Although initiated as psycho-oncology with an exclusive concern with cancer patients, psychosocial research is now a broad discipline that creates links across cultures, continents and diagnostic groups. REFERENCES * Bloom, S., & Griffiths, P. (2006). Female autonomy as a contributing factor to women's HIV-related knowledge and behaviour in three culturally contrasting states in India. Journal of Biosocial Science(39), 557-573. * Chomat, A. M. B., Wilson, I. B., Wanke, C. A., Selvakumar, A., John, K. R., & Isaac, R. (2009). Knowledge, Beliefs, and Health Care Practices Relating to Treatment of HIV in Vellore, India. AIDS Patient Care and STDs, 23(6), 477-484. * Kielmann, K., Deshmukh, D., Deshpande, S., Datye, V., Porter, J., & Rangan, S. (2005). Managing uncertainty around HIV/AIDS in an urban setting: Private medical providers and their patients in Pune, India. Social Science & Medicine, 61(7), 1540-1550. * Majumdar, B. (2004). An Exploration of Socioeconomic, Spiritual, and Family Support Among HIV-Positive Women in India. Journal of the Association of Nurses in AIDS Care, 15(3), 37-46. * McGrath, P., Holewa, H., Koilparampil, T., Koshy C., George, S., (2009) Learning from each other: cross-cultural insights on palliative care in Indian and Australian regions, International Journal of Palliative Nursing, 15, (10), 499-509. * Mignone, J., Washington, R. G., Ramesh, B. M., & Blanchard, J. F. (2007). Formal and informal sector health care providers in Southern India: role in the prevention and care of sexually transmitted infections, including HIV/AIDS. AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 19(2), 152-158. * Miles, M., Gillespie, J. V., & Holditch-Davis, D. (2001). Physical and mental health in African American mothers with HIV. Journal of the Association of Nurses in AIDS Care, 12(4), 42-50. * National AIDS Control Organisation (2006). HIV/AIDS epidemiological, surveillance and estimation report for the year 2006. New Delhi: Ministry of Health and Family Welfare, Government of India. * Soloman, S., Bativia, A., Venkatesh, K., Brown, L., Verma, P., Cecelia, J., et al. (2009). A longitudinal quality-of-life study of HIV-infected persons in south India: the case for comprehensive clinical care and support services. AIDS Education and Prevention, 21(2), 104-112. * Subramanian, T., Gupte, M. D., Dorairaj, V. S., Periannan, V., & Mathai, A. K. (2009). Psycho-social impact and quality of life of people living with HIV/AIDS in South India. AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 21(4), 473 - 481. * Tarakeshwar, N., Srikrishnan, A. K., Johnson, S., Vasu, C., Soloman, S., Merson, M., et al. (2007). A social cognitive model of health for HIV-positive adults receiving care in India. AIDS Behaviour(11), 491-504. Dr Sue Rice, B.A, Grad Dip Ed, M.SocWk, PhD Adjunct Research Fellow, International Program of Psycho-Social Health Research, Central Queensland University. Dr Pam McGrath B.Soc.Wk., MA., PhD, Director, International Program of Psycho-Social Health Research, Central Queensland University.


Profile

Profile: Dr. Arkadiusz Zbignew Dudek

Dr. Arkadiusz Zbignew Dudek is a world renowned medical oncologist in the field of thoracic malignancies, renal cell carcinoma, malignant melanoma, and also an expert in medical oncology phase I and clinical trials. He is presently working as a medical oncologist and is the leader of Solid Tumor Oncology Team in Cancer Experimental Therapeutics Initiative of the Masonic Cancer Center at the University of Minnesota. Dr. Dudek, an American and Polish citizen, was born in December 1963 in Warsaw, Poland. He received his pre-university education in Lyceum Number 14 in Warsaw, Poland. His high school diploma focused in mathematics, physics and biology. After schooling, he studied medicine at the Medical University of Warsaw, Poland, during which time he completed a clinical internship rotation in the Cardiology Department at the Pitie-alpetriere hospital in Paris, France. He received a diploma to practice as a physician in Poland in 1989, and he received an Internal Medicine Board Certification in United States in 1994. He went on to complete a medical residency in 1994 in Internal Medicine at the Polyclinic Medical Center in Harrisburg, PA. During that time, he also completed clinical rotations in Gastroenterology, Oncology, Hematology, Rheumatology, and Pulmonary Medicine at the Milton S Hershey Medical Center in Philadelphia, PA. An additional clinical rotation was completed in bone marrow transplantation at Johns Hopkins Hospital in Baltimore MA in 1993. A year later Dr. Dudek began his fellowship training in medical oncology and hematology at the University of Minnesota's Department of Medicine in the Division of Hematology, Oncology and Transplantation. During that fellowship, he was exposed to basic research focused on hematopoiesis under the guidance of Dr. Arne Slungaard and Dr. Catherine Verfaille. During work in the laboratories of both Drs. Slungaard and Verfaille, his research was focused on the role of platelet factor VI in coagulation and hematopoiesis. This resulted in a publication in the Journal of Biological Chemistry (1997). The first publication was focused on the role of platelet factor IV in clotting, with additional publications in Blood in 1998 and 2003 describing platelet factor IV adhesion of hematopoietic progenitor cells. During this time, he also actively participated in research leading to the publication of a paper in Blood (1998) on how structurally specific heparan sulfates support primitive human hematopoiesis by formation of a multi-molecular stem cell niche. Dr. Dudek's work on platelet factor IV was further carried out in the laboratory of Dr. Kevin Mayo, where the heterodimer information was described between platelet factor IV and interleukin 8. In 1997, Dr. Dudek completed the fellowship in medical oncology and Hematology and then became a faculty member as an Instructor of Medicine in the Division of Hematology, Oncology and Transplantation. The main focus of Dr. Dudek's initial research was on bone marrow transplantation. During this time, his work focused on bronchiolitis obliterans in recipients of bone marrow transplantation, which resulted in a publication in the Biology of Blood and Bone Marrow Transplantation. Further review of this topic was published in Current Opinion in Oncology. He continued work on hematopoiesis and also started focusing on endothelial cell progenitors together with Dr. Verfaille. He published an original article in the Journal of Clinical Investigation where he described the origin of endothelial progenitors in human postnatal bone marrow. Starting in 2002, his research re-focused over the treatment of solid oncology tumors and from that time he participated in numerous clinical trials. His work on pancreatic cancer resulted in a publication with Drs. Rocha-Lima and Green in the Journal of Clinical Oncology in the year 2002. He also published studies in recurrent small cell lung cancer in Lung in 2005 and analyzed the circulating and angiogenic cytokines in patients with non-small cell lung cancer in Cancer Investigation in 2005. He correlated clinical benefits of gefitinib with skin rash in Lung Cancer (2006). In 2005, he started collaboration with Professor Witold Dzwinel and Dr. Tomasz Arodz from the Institute of Computer Science, AGH University of Science and Technology, Krakow, Poland, focusing on computational methods in developing quantitative structure-activity relationships. The work was published in Combination Chemical High Throughput Screen. Focus on new drug development resulted in a number of other publications, looking at the protein kinase C-_ inhibitor enzastaurin in combination with radiation. This work was done together with Dr. Peter Jasinski from the University of Vienna, Austria. At the same time, Dr. Dudek worked on bevacizumab radiation enhancement and published this work in the International Journal of Cancer (2007), as well as a novel quinoline, MT477, a PKC and a Ras inhibitor (2007). His interest in immunotherapy under the guidance of Dr. Jeffrey Miller resulted in a publication in clinical immunology on vaccines and later on a novel systemic toll-like receptor 7 agonist in a phase I clinical trial in Clinical Cancer Research (2007). Work on autologous large multi-valent immunogen vaccines for patients with metastatic melanoma and renal cell carcinoma was described in the American Journal of Clinical Oncology (2008). His interest in kidney cancer resulted in multiple collaborations on international studies. He was acknowledged as a participant on Record One study group in Lancet, 2008 and Target study group in the Journal National Cancer Institute of 2008. His original contribution of sequential therapy in renal cell carcinoma resulted in publication in Cancer (2008). This work was done in collaboration with Professor Cezary Szczylik from the Military Medical School in Warsaw, Poland. Basic laboratory research in recent years has focused on using endothelial cell precursors for systemic delivery of cancer gene therapy. This work was published in the British Journal of Cancer. During his research activities, Dr. Dudek has been a mentor to numerous physicians and researchers from India, Iran and Poland, with these mentorships resulting in numerous publications of case reports from Dr. Dudek's clinical practice in the Masonic Cancer Clinic of the University of Minnesota. His current work continues to focus on systemic delivery of gene therapy using a cell-based system. In addition, he continues to work on clinical research in lung cancer, mesothelioma, kidney cancer, melanoma, and in the development of phase I clinical trials.


Manuscript

Endoscopic Ultrasound Guided Anti-Cancer Therapy

Dr Manoop S. Bhutani

  1. Dr Manoop S. Bhutani
    MD
    Unit 1466, UT MD Anderson Cancer Center, Faculty Center

Endoscopic ultrasound is an imaging modality that is a marriage of flexible endoscopes with high frequency ultrasound transducers that can be passed into the gastrointestinal tract providing high-resolution images of thoracic and abdominal organs. Interventions are possible with echoendoscopes as needles can be passed under ultrasonic guidance into various organs. Endosonography has been utilized to perform fine needle aspiration of a variety of lesions. A number of efforts are being made to utilize the targeting abilities of endosonography in a minimally invasive fashion for anti-cancer therapy and this paper will discuss the possibilities and emerging data in the field.


Development of Multi-disciplinary Approach for Bone and Soft-tissue Sarcomas in Japan

Dr Takafumi Ueda

  1. Dr Takafumi Ueda
    MD
    Department of Orthopaedic Surgery, Osaka National Hospital

Recent development of multidisciplinary approach, comprising wide surgical tumor resection, chemotherapy, and radiotherapy, as well as modern radio-graphic diagnostic modalities such as CT and MRI to evaluate extent of disease and staging, for the treatment of bone and soft-tissue sarcomas has dramatically improved patients' survival, and limb-salvage surgery for extremity sarcomas is now an established standard procedure. In this review article, we describe the development of multidisciplinary approach for patients with bone and soft-tissue sarcoma mainly progressed in Japan over the last 30 years, and a prospect for the future.


Family Therapy Training on a Clinical Psychology Programme in Ireland

Prof Alan Carr

  1. Prof Alan Carr
    Professor of Clinical Psychology, School of Psychology, University College Dublin,

The report describes a family therapy training unit developed for postgraduates in clinical psychology. The teaching method includes reading, video modelling, and simulated practice. The academic material and practice exercise are contained in a text book.


The Experience of Caring for a Person with a Mental Illness: A Grounded Theory Study

Dr Dianne Wynaden

  1. Dr Dianne Wynaden
    RN, RMHN, PhD
    Associate Professor (Mental Health)/Director, Research and Development School of Nursing and Midwifery, Curtin University of Technology

A substantive theory that explained the experience of caring for a person with a mental illness was developed using grounded theory methodology. When participants began caring they were overwhelmed by the role and consumed by what was happening to the ill family member, to themselves and to their family. This state was conceptualised as a social psychological problem called being consumed. In managing the experience of being consumed, all carers engaged in a social psychological process, call seeking balance. During this process, carers moved to a state where their commitment to the ill family member was more balanced and proportionate to other areas of their lives. The implications of this research include the need for increased collaboration between health professionals, policy makers and carers along with the recognition that mental illness impacts on the individual, their family and the community at many levels. The findings also provide health professionals with a valuable insight into caring. The need to decrease the stigma directed towards people with a mental illness is important to facilitate the person's integration into the community and sustain a cohesive level of family life. To support this, the general population requires increased education to be better prepared at a community level to effectively support the ill person and their family.


Anastomotic Leak as a Surrogate Marker for Shorter Disease Free Survival in Gastro Intestinal Malignancies

Dr A.V.S Suresh Attili, C Ramachandra, P.S Prabhakaran, V Ravichandra, P.P Varma, C Obula Reddy

  1. Dr A.V.S Suresh Attili
    Department of Medical Oncology, Kidwai memorial institute of Oncology
  2. C Ramachandra
  3. P.S Prabhakaran
  4. V Ravichandra
  5. P.P Varma
  6. C Obula Reddy

Objective: Anastomotic leak has long been identified as an independent risk factor for early relapses and overall diminished survival in colon cancer patients. However its significance in other GI malignancies was not studied in detail. Methods: We evaluated cases from September 2003 to 2004. It is a retrospective study to evaluate the outcome of patients having anstomotic leak in different GI malignancies. All the patients with leak have been enrolled as patients. We have chosen one control, who had been operated at the closest time having similar clinical stage and other prognostic factors as per the malignancy. The disease free survival was calculated and compared. Results: All the baseline parameters were similar in both groups. We found that the risk of relapse is 6.8 times more in patients having anastomotic leak compared to those who did not have a leak (95% CI 3.8- 16.8). The risk is uniform in all types of GI malignancies. Conclusion: It is observed that anastomotic leak in patients of GI malignancies predicts poor DFS. It warrants an attention to surgical detail to reduce anastomotic leak to achieve better results in oncological surgery.


Ewing Sarcoma as a Second Malignant Neoplasm After Acute Lymphoblastic Leukemia: A Case Report

Dr Vinay Vyas, S Al Awadi, A El Khodary, A.O Adesina, P Kukaweski

  1. Dr Vinay Vyas
    MD, DM
    Vyas Cancer Care, Jodhpurr
  2. S Al Awadi
  3. A El Khodary
  4. A.O Adesina
  5. P Kukaweski

Second malignant neoplasm in treated cases of cancers in the pediatric age group is being increasingly recognized. We report a case of 21 year old boy with a history of acute lymphoblastic leukemia who presented with a mass in his gluteal region diagnosed as having Ewing sarcoma. This case is being reported for its rarity.


Prevalence and Associated Factors for Non-Resectable Lung Cancer at Presentation

Dr Che Wan A Hashim, Azza Omar, Shaharudin Abdullah, T Alina, T Ismail

  1. Dr Che Wan A Hashim
    Senior Lecturer, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia
  2. Azza Omar
  3. Shaharudin Abdullah
  4. T Alina
  5. T Ismail

Background: Lung cancer is on the rise in many Asian countries. It has poor prognosis, with overall five-year survival figures varying between 5 and 10% worldwide. Our local data on lung cancer is limited. Therefore we conducted this study to know the prevalence and associated factors for non-resectable lung cancer at presentation in Hospital Universiti Sains, Malaysia. We also would like to know the patients blood profile at presentation and to determine the association of histology subtype with the cancer stage at presentation. Method: This study was a retrospective review of all confirmed diagnosis of lung cancer in Hospital Universiti Sains, Malaysia from 1996 to 2007. Patients who fulfilled our selection criteria were included in the study. Result: The total of 245 patients were included in this study. Forty-two patients (17.1%) were resectable (stage I, IIA, IIB and IIIA) and 203 patients (82.9%) were non resectable (stage IIIB and IV). The proportion of male was 65.3% and the mean age 60.3 1 11.6 years. The patients included in the study consisted of 78.8% Malays and 21.2% non-Malays. We found that patients with an increase in 1mmol/l se calcium and 1 unit serum LDH will have 5.12 times and 0.004 times odd of being non-resectable respectively. Adenocarcinoma has 2.17 times odds of being non-resectable at presentation compared to other histology subtype. Conclusion: Serum calcium and serum lactate dehydrogenase (LDH) were two significant laboratory findings at presentation. Adenocarcinoma remained the most common histology findings in our study and significantly correlates to advanced cancer stage at presentation.


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