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To study the effect of the financial crisis in Greece, with a population of drug users approaching the Therapy Center for Dependent Individuals (KETHEA) between 2009 and 2014.It includes two differ...

Aims: The aim of this study is to investigate and compare distress and quality-of-life parameters among head-and-neck cancer patients who underwent intensity-modulated radiotherapy (IMRT). Subjects and Methods: The patients' sample consists of 55 individuals under IMRT treatment. Three questionnaires (Quality of Life Questionnaire [QLQ]-C30 and QLQ-H and N35) of the European Organization for the Research and Treatment of Cancer and the Greek Hospital Anxiety and Depression Scales were used. Results: Functioning and symptoms scales measured a week before the scheduled treatment worsen significantly until the end of the treatment and at the 3-month follow-up, tend to revert to their pretreatment values. Conclusions: Our results showed that all parameters (functioning scales, symptoms scales, and G-HAD subscales) worsen from the start to the end treatment and tend to revert to their pretreatment values after a 3-month period.

Cancer pain; Naloxegol; Ppioid-induced constipation Dolor por cáncer; Naloxegol; Estreñimiento inducido por opioides Dolor per càncer; Naloxegol; Restrenyiment induït per opioides The Naloxegol Cancer Study (NACASY) was a multinational European study aimed to evaluate the 4-week safety and efficacy of naloxegol in a real-world setting in patients with cancer pain diagnosed with opioid-induced constipation. The primary safety endpoint was the incidence of adverse events leading to study discontinuation. We recruited 170 patients who received at least one dose of naloxegol (i.e., safety population). Out of 170 patients, 20 (11.8%, 95%CI 6.9–16.6) discontinued the study due to adverse events, and, of them, 12 (7.1%, 95%CI 3.2–10.9%) were study discontinuations due to naloxegol-related adverse events. From 76 patients subjects who had completed both 4 weeks of treatment and 28 days of the diary, 55 patients (72.4%, 95% CI 62.3–82.4%) were regarded as responders (i.e., showed ≥3 bowel-movements per week and an increase of ≥1 bowel-movement over baseline) to naloxegol treatment. The Patient Assessment of Constipation—Quality of Life Questionnaire total score and all its subscales improved from baseline to 4 weeks of follow up. Our findings support and provide new evidence about the beneficial effect of naloxegol in terms of improvement of constipation and quality-of-life in patients with cancer-related pain and opioid-induced constipation and show a safety profile consistent with previous pivotal and real-world studies. This project was funded by Kyowa Kirin International. Role of the funding source: The funder of the study and its employees and assignees were involved in study design, data collection, data analysis, data interpretation, and writing of all related reports and publications.

Living with a chronic disease constitutes a biographical reversal characterized by change and loss. The aims of this study are to conceptualize the meaning of breast cancer, of its burden, to explore the patient's needs and expectations while being admitted to a palliative care unit, and to evaluate the fulfillment of those expectations. Two semistructured interviews were conducted, audio taped, transcribed verbatim, and subjected to the qualitative method of Interpretative Phenomenological Analysis. The first interview was conducted at the first visit of the patient to the palliative care unit, and the second after 2 weeks of receiving palliative care services. Qualitative findings indicated that the meaning of cancer can be interpreted as a transition of fading away. The transition began with redefining cancer from “my difficult moment” to “fortunately to its final destination”; struggling with the paradox of “the will to see the development of yourself and your child” and “wishing to die” while being able to “adapt” to “a balanced” day to day leaving and preparing for death. The need for interdisciplinarity is expressed.

In populations with serious chronic illness, sleep disturbances represent frequent distressing symptoms. The more common disorders include insomnia, excessive daytime sleepiness, and circadian rhythm sleep disorders. Primary sleep disturbances are thought to be a disorder of hyperarousal. Hypothalamic–pituitary–adrenal axis dysfunction has also been confirmed. Secondary sleep disorders may occur as a result of the advanced disease or its treatments. It has been associated with a large number of potential causes, both physical and psychological. Chronic medication use, neurological or psychiatric disorders, and environmental factors can also contribute. This chapter discusses the diagnosis of sleep disturbances, and both pharmacological and non-pharmacological treatments.

Objectives: This study aims to develop the Greek version of the Herth Hope Index (HHI) and assess its psychometric properties to a palliative care patient sample, using a cross-sectional design. Materials and Methods: The HHI was translated into Greek (HHI-Gr) using the ‘forward-backward’ procedure. It was administered to 130 eligible cancer patients, while for the stability of patients’ responses, 40 of these patients completed the HHI-Gr 3 days later. Along with the HHI-Gr, patients also completed the Hospital Anxiety and Depression Scale (HADS) and the Beck Hopelessness Scale (BHS). The HHI-Gr internal consistency reliability (Cronbach’s a), stability (intraclass correlation coefficient [ICC]), factor structure (factor analysis) and convergent validity (correlation with the HADS and the BHS questionnaires) were examined using the Eastern Cooperative Oncology Group (ECOG) performance status. Results: The HHI-Gr yielded a one-factor model and a Cronbach alpha (0.860) with excellent internal consistency reliability and stability ICC (>0.90). Satisfactory convergent validity was supported by the correlation analysis between the HHI-Gr and BHS (r = 0.718, P < 0.001). Overall test-retest reliability was satisfactory with a range between 0.77 and 0.96 (P < 0.001). Conclusion: These results demonstrate that the HHI-Gr is an instrument with satisfactory psychometric properties and is a valid research tool for the measurement of the levels of hope among Greek oncology patients.

Objectives: The goal of this article is to investigate the correlation between sexuality and depression of cervical cancer (CC) patients. Methods: A bibliographical search was carried out in the databases CINAHL, PubMed, and Cochrane Library with the following terms in English for the years 2006 to 2017: sexuality, sexual function, sexual dysfunction, sexual problems, mood, depression, emotional distress, cervical cancer. Results: Fourteen studies were included. They present heterogeneity in the stage of the disease, the selected treatments, and their sample. From the studies, only 7 are evaluated as good methodologically. Sexual dysfunction and depression of CC patients persist for many years after treatments. The younger women, those who underwent radiotherapy, and those who had chronic fatigue, as an aftereffect of treatments, had increased depression. Women that underwent surgery and adjuvant therapy experienced the highest rates of depressive symptoms. There is a positive relationship between sexuality and depression in patients with CC. Conclusions: Sexuality and depression οf women with CC are affected by their therapies to a significant extent. There is a positive correlation between the two variables. The existing methodologically good studies are scarce, and for this reason the results cannot be generalized in all CC patients.

The objectives of the study were to evaluate the relationship between depression, preparatory grief, and loss of dignity in patients with advanced cancer and whether depression has a mediator and/or a mediator role between preparatory grief and dignity. The participants were 120 patients with advanced cancer who completed the Greek version of the Patient Dignity Inventory, the Greek Hospital Anxiety and Depression Scale, and the Preparatory Grief in Advanced Cancer Patients questionnaire. Depression was highly correlated with preparatory grief and loss of dignity. Additionally, strong relationship was found between preparatory grief and loss of dignity. Mediation analyses revealed that preparatory grief influenced loss of dignity as well as indirectly by its effect on depression. However, there was not any affect of depression as moderator. The effect of depression on preparatory grief in patients with advanced cancer and dignity emphasizing the need for further research to confirm the current relationship as well as the need for treatment of depression.

Previous findings have shown that depression in advanced stages of cancer is associated with hopelessness and frequently with wishes for hastened death. The current study tries to investigate the relationship between hopelessness and desire for hastened death and if depression may be a moderator and/or mediator role in patients with advanced cancer. The participants were 102 patients with advanced cancer which they completed the Beck Hopelessness Scale (BHS), the Greek Schedule of Attitudes towards Hastened Death (G-SAHD), and the Greek Beck Depression Inventory (BDI). Depression was highly correlated with hopelessness and desire for hastened death. Mediation analyses revealed that hopelessness influenced desire for hastened death as well as indirectly by its effect on depression. Similarly, depression was found as moderator in the relationship between hopelessness with desire for hastened death. Hopelessness and desire for hastened death in patients with advanced cancer should be diagnosed and treated by taking into consideration the optimum care of depression as a priority in palliative care.

This systematic review aims to investigate the relationship between sexuality and quality of life (QoL) of patients with hematological malignancies that underwent hematopoietic stem cell transplantation (HSCT).A bibliographic search was carried out through PubMed database with the following terms for the years 2008 to 2019: sexuality, sexual function, quality of life, hematopoietic stem cell transplantation.Fourteen studies were included in the review. They present heterogeneity regarding measurement tools, time of measurement and type of HSCT. The common theme that emerged from most studies is that sexual dysfunction is reported after years of HSCT and it negatively impacts QoL. Women and allogenic HSCT with its consequences (graft versus host disease) were risk factors for sexual dysfunction. Sexual activity of HSCT patients was decreased at first but resumed after the first year. The most common sexual problems reported were erectile dysfunction for men and lack of desire for women. In the majority of studies the amelioration of physical, psychological symptoms and sexual function lead to improvement in QoL over time.Sexuality and QoL of patients are affected by HSCT in varying degrees, and seems to be a significant and positive correlation between sexuality and QoL. However, with weaknesses and shortcomings in the revised studies' methodology (sample sizes, type of HSCT, attrition rates etc.), results are difficult to generalize.

Objectives: Comparison of the effects of reflexology and relaxation on pain, anxiety, and depression, and quality of life (QoL) of patients with cancer. Design: A stratified random sample was selec...

Purpose: The present study assesses the relationship between patient dignity in advanced cancer and the following variables: psychological distress, preparatory grief, and sociodemographic and clinical characteristics. Methods: The sample consisted of 120 patients with advanced cancer. The self-administered questionnaires were as follows: the Preparatory Grief in Advanced Cancer Patients (PGAC), the Patient Dignity Inventory–Greek (PDI-Gr), the Greek Schedule for Attitudes toward Hastened Death (G-SAHD), and the Greek version of the Hospital Anxiety and Depression Scale (G-HADS). Results: Moderate to strong statistically significant correlations were found between the 4 subscales of PDI-Gr (psychological distress, body image and role identity, self-esteem, and social support) with G-HADS, G-SAHD, and PGAC ( P < .005), while physical distress and dependency was moderately correlated with depression. Multifactorial analyses showed that preparatory grief, depression, and age influenced psychological distress, while preparatory grief, depression, and performance status influenced body image and role identity. Conclusions: Preparatory grief, psychological distress, and physical symptoms had significant associations with perceptions of dignity among patients with advanced cancer. Clinicians should assess and attend to dignity-distressing factors in the care of patients with advanced cancer.

Context The patient dignity inventory (PDI) is an instrument to measure dignity distressing aspects at the end of life. Objectives The aims of the present study were the translation of the PDI in Greek language as well as to measure its psychometric aspects in a palliative care unit. Methods A back-translation method was obtained at the Greek version. One hundred twenty advanced cancer patients completed the Greek version of the PDI, the Greek hospital anxiety and depression scale, the Greek schedule of attitudes toward hastened death (SAHD-Gr), and the Greek 12-item short form health survey. Results Confirmatory factor analysis failed to fit to the original instrument's structure and exploratory factor analysis was conducted revealing five factors ("Psychological Distress," "Body Image and Role Identity," "Self-Esteem," "Physical Distress and Dependency," and "Social Support"). The psychometric analysis of the PDI-Gr demonstrated a good concurrent validity, and the instrument discriminated well between subgroups of patients regarding age differences. Cronbach α were between 0.71 and 0.9 showing a good internal consistency. Conclusion The Greek version of the PDI showed good psychometric properties in advanced cancer patients, supported the usefulness of the instrument assessing the sense of dignity distressing aspects of the terminally ill cancer patients.

To assess the effect of cancer patients' attachment patterns on their satisfaction of medical care.This was a cross-sectional design study performed in an outpatient palliative care clinic. The sample consisted of 100 cancer patients. Participants completed the Greek versions of patients' satisfaction, and attachment orientation to close others (Family, Close Friends, Medical Care Providers)."Information/interaction with health-care professionals" subscale positively correlated with "disease duration". "Availability of care" subscale was negatively correlated with "discomfort with closeness", "anxiety", and "avoidance". "Information/interaction with health-care professionals" positively correlated with "metastasis", "chemotherapy", and "hormonotherapy", while "availability of care" had positive correlations with "education", "chemotherapy", and "hormonotherapy". Multiple regression model showed that "discomfort with closeness" was associated with "information/interaction with health-care professionals". Similarly, "chemotherapy" and "surgery" were positively associated with "information/interaction with health-care professionals". Disease duration was associated with increased satisfaction with "information/interaction with health-care professionals". Predictors of "availability of care" were "discomfort with closeness", "education", and "avoidance"."Chemotherapy", "surgery" and "discomfort with closeness" predicted low satisfaction with "information/interaction with health-care professionals", while "discomfort with closeness" and "avoidance" predicted low satisfaction with "availability of care" and at the same time a high level of "education" predicted patients' satisfaction with "availability of care".

Purpose: To investigate the psychometric properties of the Greek 13-item measure of patients’ satisfaction (FAMCARE-P13) in palliative care setting. Methods: A hundred patients completed the FAMCARE-P13. Exploratory factor analysis and confirmatory factor analysis (CFA) have been conducted. Two factors’ solution was revealed from CFA. The questionnaire was administered to an initial validation sample and then for test–retest in a sample of 40 patients 3 days later. The Rosenberg Self-Esteem Scale measuring global self-esteem has been also used as a gold standard for construct validity. Subscale and known groups validity have also been tested for FAMCARE-P13s’ validity. Results: A reduced 13-item version of our measure (FAMCARE-P13) possessed 2-factor structure with high reliability. Patient satisfaction was correlated with physical distress, communication and relationship with health-care providers, and caregiver satisfaction. Conclusions: We recommend the use of the Greek FAMCARE-P13 to assess care satisfaction of patients with advanced-stage cancer.

In recent years intellectual disability has changed from the individual quality of life to an evaluation of the quality concerning the whole family. The aims of the present study were to examine the psychometric properties of the Greek version of Family Quality of Life Scale (FQoL). A total of 180 caregivers of people with intellectual disabilities participated in the current study. The participants were all informal caregivers of adults with disabilities and comorbidities (other chronic diseases), belonging to the intimate family context (cousins, uncles, neighbours, professional in-home caregivers, neighbours, etc.). The Beach Center Family Quality of Life Scale (FQoL) was administered twice, with a 7 day interval to 44 eligible caregivers. Factor analysis yielded a three-factor solution, explaining explaining 71.63 % of the total variance. Cronbach alpha for the three factors were between 0.883 to 0.960. Construct validity showed a high correlation between FQoL factors and APGAR scores. More specifically high correlations were found between “Family interaction and support” (r = 0.855), “Family care” (r = 0.630), “Disability related support” (r = 0.683) and APGAR scores (p < 0.0005 respectively). The test/retest reliability indicated that the scales scores were remarkably consistent between the two occasions. The current results support that the Greek version of FQoL is a measure with satisfactory psychometric properties, and is a valid research tool for Greek caregivers supporting people with intellectual disabilities.

Aims: The aim of this study was to validate the Greek translation of the University of California, Los Angeles Loneliness Scale (UCLA) in Greek adults with HIV. Methods: The UCLA Loneliness scale (version 3) was administered to 140 people with HIV. Participants also completed the Greek Hospital Anxiety and Depression Scale (G-HADS). Validity and reliability analyses were performed. Results: The Cronbach’s α coefficient for the total UCLA score was 0.9. Test-retest reliability analysis in a subgroup of patients (n = 40) revealed good short-term stability over a 2-week interval (ICC 0.8 - 0.9, p < 0.0005). Exploratory factor analysis generated a three factors structure for the Greek translation. Convergent validity was supported through the scale’s high correlations with G-HADS anxiety (0.382, p < 0.01) and depression (0.524, p < 0.005). Conclusion: The Greek UCLA Loneliness scale (version 3) is a valid and reliable instrument that can be usefully implemented into clinical practice in order to diagnose and treat loneliness among the Greek HIV positive patients.

Background Psychosocial well-being in the workplace may increase retention of oncology nurses, while a lack of social support has been a predictor of occupational stress in nurses. Purpose To further explore this phenomenon by examining the psychometric properties of the Multidimensional Scale of Perceived Social Support in Greek nurses working in oncology and mental health settings. Methods A cross-sectional design was used. The sample consisted of 150 nurses (70 oncology nurses and 80 mental health nurses) from the area of greater Athens who joined the study. The scale was translated to Greek using the “forward-backward” procedure. The Multidimensional Scale of Perceived Social Support’s internal consistency reliability (Cronbach’s α), stability (intraclass correlation coefficient), factor structure (factor analysis), and convergent validity (correlation with Ways of Coping Questionnaire) were examined. Results A three-factor (significant others, family, and friends) model was confirmed. The subscales representing the three factors demonstrated excellent internal consistency reliability (Cronbach’s αs > .90) and stability intraclass correlation coefficient (>.90). Conclusions The measure is reliable and valid, and it can be used to assess nurses’ social support; the results of such an assessment could be helpful when selecting strategies for assisting nurses.

Purpose: Pain is prevalent in cancer patients, appearing to be moderate to severe in more than one third of them. Despite the fact that fentanyl is widely used with effective analgesic results, some patients do not correspond to treatment, resulting in opioid change. Methods: This is a cohort study, performed in Greek patients with cancer. Its scope was to identify potential reasons responsible for opioid change, due to transdermal-fentanyl intolerance, resulting from inadequate analgesia (pain relief

Background The aim of this study was to assess the patients’ global impression (PGI) after symptom management, as well as the achievement of personalized symptom goals (PSG). The secondary outcome was to assess related factors. Subjects, Materials, and Methods Advanced cancer patients admitted to palliative care units rated symptom intensity by using the Edmonton Symptom Assessment Score (ESAS) at admission and then after 1 week. For each symptom, patient-reported PGI and PSG, as well as the rate of PSG response, were evaluated. Results Eight hundred seventy-six patients were taken into consideration for this study. A mean of 1.71–2.16 points was necessary to perceive a bit better improvement of symptom intensity. Most patients had a PSG of ≤3. A statistically significant number of patients achieved their PSG after starting palliative care. Patients with high intensity of ESAS items at admission achieved a more favorable PGI response. In the multivariate analysis, symptom intensity and PSG were the most frequent factors independently associated to a best PGI, whereas high levels of Karnofsky had a lower odd ratio. Conclusion PSG and PGI seem to be relevant for patients’ assessment and decision-making process, translating in terms of therapeutic intervention. Some factors may be implicated in determining the individual target and clinical response. Implications for Practice Personalized symptom goals and global impression of change are relevant for patients’ assessment and decision-making process, translating in terms of therapeutic intervention. Some factors may be implicated in determining the individual target and clinical response.

The authors sought to determine the reliability and validity of psychometric properties of the Greek Patient-Generated Subjective Global Assessment (PG-SGA) in cancer patients attending a palliative care unit. The scale was translated into Greek. The study took place in an outpatient palliative care unit and 238 cancer patients completed the nutrition assessment. For treatment effect, the index was administered to 164 patients, whereas for the test of the instrument's robustness to 100 patients. Both assessments took place 15 days after the baseline assessment. Ninety-three patients were well-nourished, 104 were moderately malnourished, and 41 were severely malnourished. Reliability was assessed by the internal consistency and test-retest of the instrument. Validity was assessed with construct validity using the PG-SGA items, treatment effect, and criterion validity. Weight loss, physical examination, activities and function, and symptoms were predictors to the classification. Mean values in male patients classified as severely malnourished had the lowest values in all objective parameters except serum albumin, whereas severely malnourished female patients had the lowest values in all objective parameters except serum albumin and arm muscle circumference (AMC). Values of serum transferrin, AMC, and body mass index were significantly lower in patients classified as severely malnourished. The Greek PG-SGA is a psychometrically sound assessment in Greek cancer patients.

Background: The aim of the study was to determine whether the expression of baseline phosphorus (P) and magnesium (Mg) levels were prognostic in terms of stage and overall survival (OS) in newly diagnosed non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients. Materials and Methods: Retrospectively, 130 patients were selected at the time of diagnosis oflung cancer (100 with NSCLC and 30 with SCLC), before the initialization of any chemo-radiotherapy. The median age was 67 (range 29-92). IA, IB, IIA, IIB, IIIA, IIIB and IV stages were present in 3, 4, 19, 6, 25, 8, and 65 patients, respectively. After centrifugation, the levels of serum P and Mg were measured using the nephelometric method/ photometry and evaluated before any type of treatment. Results: Higher than normal levels of P were found in 127/130 patients, while only four patients had elevated Mg serum values. In terms of Spearman test, higher P serum values correlated with either stage (rho=0.334, p

This review of the literature on elderly cancer patients and their psychiatric disorders was undertaken to determine the extent of the problem. It consists of articles with elderly cancer patients. Keyword terms included "cancer", "elderly", "aging", "geriatric", "psychiatric disorders", "psychiatric symptoms", "psychological problems", "aged >60 years", "sucidal ideation, geriatric, cancer", "suicide geriatric cancer". We conducted searches on the following databases: PubMed; PsychINFO (1980-2013); finally, 102 publications were suitable for the current review. Depression in elderly cancer patients is the most common disorder in elderly cancer patients associated with disability, morbidity and mortality. Anxiety disorders may be less frequent in geriatric patients; however, it seemed to be a major problem in late life. Psychiatric disorders are common in geriatric patients with cancer especially at advanced stages of the disease. In addition, health care professionals can help provide treatment and emotional support. Future research should aim to provide data about the real prevalence and severity of psychiatric disorders in elderly patients with cancer, for the improvement of patients' quality of life and their caregivers.

Background: The Zarit Burden Interview is one of the most common tools used in the research field measuring burden. The aims of the present study were to translate and validate the Zarit Burden on caregivers of adults with intellectual disabilities in Greece. Methods: One hundred and eighty family caregivers of adults with intellectual disabilities were recruited. All participants completed: the Zarit Burden Interview and the revised 15-item Bakas Caregiving Outcomes Scale. Reliability was assessed by the internal consistency and test/retest of the instrument. Validity was assessed with construct validity using Bakas Caregiving Outcomes Scale and known groups validity. Results: Factor analysis resulted in a 4-factor model. Construct validity has shown satisfactory correlations with Bakas Caregiving Outcomes Scale (p

The objectives of this study were to investigate self-efficacy and its relationship with posttraumatic stress symptoms and growth in advanced cancer patients. The General Perceived Self Efficacy Scale (GSE), the Greek version of the Impact of Event Scale (IES-Gr), and the Greek version of the Posttraumatic Growth Inventory (PTGI-Gr) were completed by 115 patients. Statistically significant associations were found between GSE score, patients' performance status, intrusions, hyperarousal, and PTGI-Gr score. The multiple regression analysis revealed that self-efficacy was influenced by intrusions and PTGI-Gr score. In advanced cancer patients, factors that seem to influence self-efficacy are intrusion and posttraumatic growth.

Health-care professionals may serve as attachment figures, nevertheless little research has been made in the palliative context. The psychometric properties of the brief ECR-M16 in Greek cancer patients were explored.The ECR-M16 was translated into Greek (G-ECR-M16), and was administered to 100 patients before starting palliative care and 7 days later to test its stability. Patients (N=35) also completed the EORTC QLQ-C30 scales.Cronbach's alphas for the discomfort for closeness, anxiety and avoidance scales were 0.871, 0.762, and 0.761, respectively. Test-retest reliability was very satisfactory (p0.0005). Factor analysis yielded three factors (58.75% of the variance). Known-groups validity showed that discomfort with closeness had a statistically significant correlation with advanced disease stage (p=0.022).The G-ECR-M16 is a valid research tool for the attachment patterns' impact in Greek cancer patients.

Background Context Few data exist concerning the natural history of degenerative osteoarthritis (OA) of the spine and its associated gene investigation. Degenerative spinal OA demonstrates an international prevalence of 15% in the general population. Purpose The aim of this Greek case-control study is to examine gene polymorphisms that have been previously shown or hypothesized to be correlated to degenerative OA. Gene polymorphisms, especially for OA, have never been previously studied in the Greek population. Study Design/Setting The study was conducted from May 2009 to December 2012. Eligible subjects who agreed to take part in the study were Greek adults from all of Greece, referred for consultation to the Palliative Care and Pain Relief Unit of Aretaieion University Hospital, in Athens, Greece. Patient Sample A total of 601 matched pairs (cases and controls) participated in the study, 258 patients (188 women and 70 men) with clinically and radiologically confirmed degenerative OA and 243 control subjects (138 women and 105 men). Outcome Measures All patients presented with chronic pain at the spine (cervical, thoracic or lumbar) caused by sympomatic osteophytes or disc narrowing, whereas clinical diagnosis of OA was based on the presence of both joint symptoms and evidence of structural changes seen on plain conventional X-rays. Methods We investigated genetic variation across candidate OA gene GDF5, CDMP1, CDMP2, Asporin, SMAD3, and chromosomal region 7q22, in a sample of 258 patients with clinically and radiologically confirmed degenerative OA, and 243 control subjects from the Greek population. All subjects (patients and controls) were subsequently matched for the epidemiologic, demographic, and clinical risk factors, to prevent selection biases. A tagging single nucleotide polymorphism (SNP) approach was pursued to cover variation across all targeted loci. Single marker tests as well as haplotypic tests of association were performed. There is no conflict of interest, and also, there are no study funding sources. Results We found significant association of spine OA with SNPs and haplotypes along the 7q22 chromosomal region and the SMAD3 gene. At 7q22, single marker association tests showed SNPs rs3801954 and rs2023685 to be associated with the disorder (p-value .0312 and .0041, respectively), but only SNP rs2023685 retained a significant p-value (.046) after performing 1,000 permutation tests. At the SMAD3 gene, SNP rs422342 was also found to be statistically associated (p-value .0282) to intervertebral disc degeneration (permutation p-value .042). Conclusions This is the first study to investigate genetic variation in relation to spine OA in the Greek population. Our results indicate that the genetic basis of the disease may differ in the Greek population in relation to populations of Asian origin, although larger sample sizes are required to underpin the full extent of the involvement of analyzed loci.

The findings of previous studies attracted our interest in searching and defining the percentage of deaths from cancer in 'heroin regular addicts' i.e. those who had never stopped taking the drug since they started.The archives of the Greek Reitox Focal Point of the years 2001 to 2010 were retrospectively searched, focusing on the number of deaths from cancer of the regular heroin addicts.The records from 2,321 regular heroin addicts showed that none of them died from cancer. It seems that heroin might act as a "barrier" against cancer.Further studies are needed to confirm our results and to explore the potential cause for this surprising finding.

The exact effect of opioid analgesics on sleep is to be determined. Although literature data are sporadically reported, the aim of this review is to summarize the already known effects of such medications on sleep. A variety of effects, both positive and negative, has been suggested, when opioids are used for pain treatment, but in the absence of pain as well. Although often thought to promote restful sleep, the reality is much more complicated. Sleep disturbances and alterations of sleep quantity and quality have been reported. In addition, their sedative effects have been relatively well established and opioids can cause respiration to slow and become irregular, leading to hypercapnia and hypoxia. As a result, their usage has been linked to irregular or ataxic breathing (Biot's breathing) and their use has been associated with both central and obstructive sleep apnea. One could estimate that central apnea is a common complication of such chronic therapy, affecting between 30% and 90% of patients. Thus, sleep disturbances can be induced or deteriorated. On the other hand, extended release opioid formulations have been suggested to improve sleep due to no analgesic gaps and less walking because of breakthrough pain. Furthermore, several reports have shown significantly improved sleep quantity and adequacy, with reduced sleep disturbances. Still, as no prospective trials on the effect of opioid therapy on sleep are available and evidence is scarce, definitive conclusions cannot be drawn. Future studies with their effect on sleep as primary end-point are needed to draw permanent conclusions.

This study examined the relationship between caregivers' anxiety supporting a patient with advanced cancer and self-efficacy and their socio-demographic characteristics, and then whether these variables could influence their self-efficacy. One hundred and seven caregivers of advanced cancer patients participated in the study and completed the Greek versions of the State-Trait Anxiety Inventory (STAI) and the General Perceived Self-efficacy Scale (GSE). Significant comparisons were found between State anxiety and female gender (P= 0.009), cohabitation (P= 0.002) and relationship with the patient (P= 0.004); statistically significant associations were found between State, Trait anxiety and self-efficacy scores of caregivers (P < 0.0005 respectively). A multiple regression model (enter method) showed women (P= 0.005), spouses (P= 0.01) and self-efficacy (P= 0.02) as the significant predictors of State anxiety. Furthermore, self-efficacy seemed to be the strongest contributor of trait anxiety (P < 0.0005). Female caregivers and spouses of advanced cancer patients experience more state anxiety levels than men and other caregivers respectively. In addition, caregivers with low self-efficacy are more likely to have elevated anxiety scores than self-efficacious caregivers. These findings can help healthcare professionals focus on some problems common to caregivers of cancer patients and plan appropriate interventions.

Aim: The aims of the current study were to evaluate geriatric depression and its risk factors in advanced cancer patients. Methods: A cross-sectional study was carried out in a palliative care unit in Greece. Patients completed the Geriatric Depression Scale, the M. D. Anderson Symptoms Instrument (MDASI), the Activities of Daily Living and the Mini-Mental State Examination. Patients were included if they were aged >65 years, if they had cancer, were able to communicate and had agreed to sign informed consent. The final sample consisted of 92 elderly advanced cancer patients. Results: The prevalence of depression was found to be 67.4%. The univariate comparison between the depressed elderly and non-depressed group showed that patients with metastases were found to be 2.2-fold more likely to suffer from geriatric depression compared with those without metastases (P = 0.074). Patients with moderate or severe cognitive impairment were found to be 3.61-fold more likely to suffer from geriatric depression in comparison with those with normal cognitive function (P = 0.019). In the multiple logistic regression analysis, elderly with cognitive impairment were 3.3-fold more likely to have geriatric depression than those without (adjusted odds ratio = 3.3 [95% CI 0.99–10.74], P = 0.052) and MDASI factor 1 was consistently a significant risk factor for depression in the elderly; when MDASI factor 1 increased by 1 unit, the odds of being classified as depressed increased by 7.6%. Conclusions: The present study found that cognitive impairment and symptoms such as enjoyment of life, walking, relationship with people, general activity, sadness and pain (MDASI F1) are strong independent predictors of depression in the elderly. Geriatr Gerontol Int 2013; 13: 281–288..

Purpose Treatment-related symptoms can increase psychological and physical distress and alter the patient's quality of life. The present study evaluates prospectively treatment-related symptoms, general self-efficacy, anxiety and quality of life (QoL) in patients with different types of cancer undergoing external beam radiotherapy (RT) and the relationship of patients' general self-efficacy with the assessed measures, at the baseline and their absolute change 1 month after the end of the treatment. Methods The sample consisted of 90 cancer patients. General self-efficacy was assessed using the General Perceived Self-efficacy (GSE). QoL was evaluated using the Linear Analogue Scale Assessment (LASA), anxiety with the Anxiety subscale of the Hospital Anxiety and Depression (HAD) scale, whereas symptom severity and interference were assessed using the MD Anderson Symptom Inventory (MDASI). The instruments were administered first at the beginning of the RT and then 1 month after the completion of the RT. Results At post-treatment, general self-efficacy was reduced (28.86 ± 6.42), anxiety scores were elevated (9.56 ± 4.42), QoL scores were reduced (6.74 ± 1.81) and symptoms severity were deteriorated (3.24 ± 2.62). Pre-treatment and post-treatment absolute change scores revealed statistically significant negative correlations between general self-efficacy absolute scores and anxiety (p

The purpose of this study was to investigate posttraumatic stress disorder (PTSD) in advanced cancer patients, their reported traumatic experiences, and the relationship between patients with PTSD and non-PTSD as well as between cancer as trauma versus other traumatic experiences. A descriptive analysis revealed that 195 advanced cancer patients had anxiety disorders; 170 had PTSD, while 25 had other anxiety disorders. The majority of the patients (66.7%) with PTSD reported that their cancer diagnosis was the traumatic event for them. In addition, 10.8% reported that they had experienced a death of a loved one, and the rest (22.5%) reported other traumatic events. Death of a loved one and cancer seemed to be the most traumatic events for patients in advanced stages of cancer, and thus psychotherapeutic treatment is essential.

Objective The study aimed to assess the psychometric properties of the Cancer Locus of Control (CLOC) scale on a Greek sample of advanced cancer patients. Methods The scale was translated with the forwardbackward procedure to Greek. The CLOC scale was administered to 140 advanced cancer patients. It was administered twice, with a 3-day interval, to 100 (of the 140) eligible patients with advanced cancer. Together with the CLOC scale, the patients also completed the Greek Mental Adjustment to Cancer (G-MAC) scale. Confirmatory factor analysis was carried out using the AMOS 7.0 analysis. The reliability was assessed by the internal consistency (Cronbach's a coefficients), testretest (Spearman's r value) of the instrument, and inter-item correlations. Construct validity was assessed using the G-MAC scale, interscale correlations, itemscale correlations, and scalestotal correlations. Results The homogeneity of the subscales proved to be satisfactory (a coefficient ranged from 0.713 to 0.786). Overall testretest reliability was satisfactory at p

Breakthrough pain, a transitory flare of pain in patients with otherwise controlled chronic pain, has been well characterized in cancer patients but despite medical awareness, sometimes remains underdiagnosed and therefore undertreated.Oral transmucosal fentanyl citrate (OTFC) and fentanyl buccal tablets are the first medications developed specifically for the treatment of breakthrough pain in opioid-tolerant patients. Since oral administration of fentanyl is not an option for many cancer patients, the development of intranasal fentanyl spray (INFS) emerged as a more effective method of administration. Intranasal administration of fentanyl has several advantages over the oral/gastrointestinal route and clinical trials have shown that it is superior to OTFC while being well tolerated and more acceptable by the majority of patients.The aim of this review is to summarize the pharmacological characteristics and data obtained from clinical studies of INFS in the past few years, and present Fentanyl Pectin Nasal Spray (PecFent), which uses an innovative delivery system and is now approved in the EU. Finally, we discuss the impact that it may have in the future management of breakthrough pain in cancer patients, because an accurate diagnosis followed by the best treatment is crucial for effective pain alleviation.

Surgery remains the mainstay of melanoma therapy at all sites. Melanoma is widely believed to be a radioresistant tumor, a misconception that has historically led to the limited use of RT for its treatment. We searched pubmed from 1978 until 2010 by means of prospective randomized trials. The aim was to assess the potential impact of radiotherapy (RT) on local control, quality of life and overall survival. Radiotherapy should be considered in lentigo maligna, especially in elderly patients with extensive or unresectable disease in difficult areas on the face, with adequate tumor control with good cosmetic and functional results. In addition, radiation therapy provides effective palliation in patients with metastatic malignant melanoma. Doses up to 30 Gy or BED > 39.0Gy were found to be associated with prolonged palliation. These findings should be viewed with caution because the lack of data regarding performance status as well as other unknown confounding factors limits the applicability of retrospectives studies. We recommend that higher doses of RT be considered when using RT for the palliation of patients with metastatic melanoma and a performance status that could tolerate such therapy. In the futute, the combination of radiation therapy with hyperthermia may be a reasonable therapeutic option.