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Clinical Oncology

APRIL 10, 2019

[Metals and cancer]

VETLÉNYI Enikő, RÁCZ Gergely

[We often tend to forget about our environment when looking for the origin of a disease. Inhaled air, drinking water and food, substances in contact with the skin all have an effect on the human body. Metals are indispensable parts of our everyday lives, their mining, processing and use cause a continuous exposure to them. Metal exert their effects on the body in various ways. Many of them are essential for maintaining homeostasis, but excessive or harmful metal intake can lead to health damage, including tumour formation through multiple attack points. Metals substitute each other during different transport processes and in the structure of proteins, they cause oxidative stress and bind to DNA, thereby damaging it. Applying them appropriately, the proapoptotic effect of the metal compounds is brought to the fore, thus becoming a therapeutic tool for tumours. Nowadays, platinum(II) compounds are widely used as chemotherapeutic agents and there are many ongoing studies to fi nd metal compounds with an ideal therapeutic and side-effect profi le. The aims of this article were to draw the attention to the dangers of metals in relation to cancer and to highlight their diverse application possibilities in current and future cancer therapy and diagnostics.]

Clinical Neuroscience

JANUARY 30, 2021

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Journal of Nursing Theory and Practice

APRIL 30, 2020

[Survey of Medication Habits in Hypertensive Adults]

VARGA Bernadett, FUSZ Katalin, CSIMA Melinda, LUKÁCS-HORVÁTH Marianna, DEÁK András, STROMAJER-RÁCZ Tímea

[Hypertension is the best known risk factor in development of cardiovascular diseases and stroke. Survey has assessed –in hypertensive patients over 40, - the illness representation, lifestyle and medicine taking habits. Quantitative, cross-section descriptive research was conducted in 2017 with online questionnaire among hypertensive people over 40 (n=267) using shortened version of Brief Illness Perception Questionnaire, Morisky Medication Adherence Scale (8-item) and our questionnaire. Therapy adherence is typical for older individuals in surveyed population. (r= 0,26; p<0,001). Who were advised by general practitioners (GP) to implement lifestyle changes show more inclination following therapy. (p=0,032). Those with higher blood pressure (r-0,18; p=0,003) has harder time living with hypertension. (r=0,15; p=0,014). Quality of living with hypertonia and therapy adherence can be influenced by health behaviour and the information provided by general practitioners (GP). Beside the, general practitioners (GP) advanced practice nurse can have significant role in increasing the level of health behaviour and therapy adherence. ]

Journal of Nursing Theory and Practice

APRIL 30, 2020

[The Effectiveness of Pain Control in Cancer]

BÖGYÖS Dorina Viola, KIRÁLY Edit

[Introduction: Cancer diseases pose a serious public health issue nowadays, as they are among the leading causes of death. As today it is possible to live with this disease for a long time, the quality of life, which is greatly affected by pain, becomes a very important factor. Objective: The purpose of the research is to investigate and explore potential existing problems in the field of cancer pain relief in Hungary and to propose solutions to these problems. In our questionnaire survey, we asked patients suffering from tumors who were in pain and living their lives at home. The research was an anonymous cross-sectional study using descriptive and comparative statistical methods. The average age of respondents was 55 and most of them were women. Answers showed that primary tumors appear mostly in breasts (n=25) or the lungs (n=13). Metastasis developed by almost 30% of the patients. 42% of the respondents experienced severe pain (VAS ≥7 point), which they estimated to last for 1-2 (n=40) or rather 4-5 hours daily (n=30). Almost two third of the respondents were using products containing NSAID (n=64). The number of mild (n=18) versus strong painkiller (n=15) users were almost equal. There was a significant difference between groups of patients experiencing “mild-medium” (p=0,01) versus “mild-strong” pains (p=0,004) due to the usage of medication containing stronger opioids. From this revealed that individuals with greater pain used potent analgetics. More than half of the patients use some sort of sleep or relax aid as a supplement to their medication. Patients with metastasis (n=28) use strong (n=7) as well as mild analgesics (n=10) in greater numbers than those without metastasis. The results reveal that in Hungary, relatively few patients with cancer diseases use strong opioid-containing drugs despite of the fact that their pains are severe. Therefore, a nearly precise estimate of pain levels would be important. Fear of side effects is often unjustified and cannot limit the choice of appropriate therapy. ]

Lege Artis Medicinae

DECEMBER 21, 2020

[Family therapy encounters with the philosophy of dialogue – Ivan Boszormenyi-Nagy was born 100 years ago]

KELEMEN Gábor

[This paper deals with the significant therapeutic innovations of Ivan Boszormenyi-Nagy in the light of their philosophical foundations. The greatest Hungarian family therapist, Boszormenyi-Nagy’s work evolved in America. The author, referring to Bo­szormenyi-Nagy’s career, presents the phi­losophical roots of his theory. Par­ti­cu­larly Martin Buber’s philosophy of dialogue including the concept of existential guilt, violanting the justice of human order. Bo­szormenyi-Nagy, who elaborated contextual therapy and its main dimension, the ethics of fairness, assumes that family life, ethical questions of truthworthiness and res­ponsibity for the consequences of our actions are inseparable. Contextual therapy was groundbreaking in its time with the therapeutic attitude and method of multidirected partiality, and is relevant even today. This guideline, requiring to include all people with their humanity, solidarity and accountability who are potentially affected remains sound clinical unifying principle of comprehensive psychotherapeutic practice. ]

Clinical Oncology

APRIL 30, 2020

[Biological clock and cancer]

VELLAINÉ Takács Krisztina, SZTANKOVICS Dániel, HOFFMANN Gyula, KOPPER László, GÁLOSI Rita

[In the present paper, we are giving a review about the circadian rhythm of the biological rhythm, its regulation and relation to tumorigenesis. The circadian rhythm is an approximately 24-hour cycle in biochemical, physiological processes in organisms from unicellular to vertebrates. This biological rhythm is generated by the synchronization of our endogenous clocks and the light as the main “Zeitgeber”. The nucleus suprachiasmaticus (SCN) of the hypothalamus is the region, which is considered to be the circadian “main clock” of the organism and is responsible for coordinating peripheral clocks in different organ systems. At the cellular level, the regulation of the circadian rhythm is basically provided by the so-called “circadian locomotor output cycles kaput” the CLOCK genes. The discovery of those cellular mechanisms was awarded with Nobel Prize in 2017. The CLOCK genes, acting on other effector genes, regulate diurnal rhythm of protein synthesis. More and more data are available, which suggest that there is an association between circadian genes and tumor development. Furthermore, many studies show a link between the shift work and the development of breast and prostate cancer and between mutations in some circadian genes and development of carcinomas. More data suggest a relationship between tumor metabolism and CLOCK genes and their regulations. Based on all these data, the circadian rhythm, so the time of day, may need to be taken into account during cancer therapy.]

Clinical Oncology

APRIL 30, 2020

[Immunotherapy of hepatocellular carcinoma]

DEMETER Gyula

[The systemic treatment of HCC was based exclusively on sorafenib near 10 years. In the past 2-3 years some new molecules demostrated their effectivites in phase III clinical trials. So the immuncheckpoint-inhibitors (ICI) demands their place in systemic treatment of HCC. Nivolumab and pembrolizumab are recommended already in second line in NCCN and ESMO clinical guidelines. Nivolumab demostrated his effectivity against the standard treatment sorafenib in a phase III clinical trial, although the results were not signifi cant. However, the combination treatment of atezolizumab and bevacizumab seems better than sorafenib in a phase III clinical trial, so the combination is recommended already in fi rst line in the NCCN guideline. There are more clinical trials with ICIs in progress as in monotherapy as in combination therapy with other modalities.]

Clinical Oncology

APRIL 30, 2020

[Hormone replacement therapy in cancer survivors – Review of the literature]

DELI Tamás, OROSZ Mónika, JAKAB Attila

[Rapid advance in oncology leads to increasing survival of oncologic patients. More and more of them live long enough to reach either the natural age of menopause or, as a side effect of their oncotherapy, experience the cessation of gonadal function, leading to premature ovarian insuffi ciency, with disturbing vasomotor symtoms and long-term negative cardiovascular and skeletal effects. Thus, an ever increasing number of cancer survivors search endocrinologic help in the form of hormone replacement therapy (HRT). The misinterpretation of the WHI (Women’s Health Initiative) Study has lead to an irrational fear of female hormone replacement, both by the general population and medical professionals. It has seemed the logical and safe conclusion to many physicians to avoid HRT, supposing that this attitude defi nitely causes no harm, whereas the decision of prescribing estrogen alone or with progestins might bear oncologic and thromboembolic risks and may even lead to litigation in case of a potentially related complication. However, it was known even before the WHI results that premature menopause and hypogonadism decreases the life expectancy of women by years through its skeletal and cardiovascular effects, and this negative effect correlates with the length of the hypoestrogenaemic period. Yet, the oncologic risk of HRT is extremely diffi cult to assess. In this work we review the latest evidence from in vitro experiments to clinical studies. We group tumours regarding the oncologic risk of properly chosen female hormone replacement therapy in cancer survivors as follows: ’HRT is advanageous’ (e.g. endometrial cancer type I, cervical adenocarcinoma, haematologic malignancies, local cutaneous malignant melanoma, colorectal cancer, hepatocellular cancer); ’HRT is neutral’ (e.g. BRCA 1/2 mutation carriers without cancer, endometrial cancer type II, uterinal carcinosarcoma and adenosarcoma, certain types of ovarian cancer, cervical, vaginal and vulvar squamous cell carcinoma, prolactinoma, kidney cancer, pancreatic cancer, thyroid cancer); ’HRT is relatively contraindicated’ for various reasons (e.g. leiomyosarcoma, certain types of ovarian tumours, brain tumours, advanced metastatic malignant melanoma, lung cancer, gastric cancer, bladder cancer); ’HRT is diasadvantageous and thus contraindicated’ (e.g. breast cancer, endometrial stroma sarcoma, meningioma, glioma, hormone receptor positive gastric and bladder cancer).]

Clinical Oncology

APRIL 30, 2020

[Tumor induction by chemotherapy]

[Without chemotherapy, the fi ve-year survival rate of detected cancers would be between 0 and 15%, depending on the tumor, and between 17 and 85% with current therapy. Several warnings call attention to the dangers of chemotherapy-induced side effects, most notably the potential for tumor-inducing ability, which can affect 5-10% of patients who have recovered beyond fi ve years. Some systematically applied drugs used in chemotherapy (alkylating agents, etoposide, arsenic trioxide) are able to cause mutations in healthy cells of the patients, increasing the likelihood that the mutated cells will start a later (secondary) tumor formation. In addition to mutagenic effects, some chemotherapeutic agents exert their effects on normal myeloid and epithelial cells of the body, which, by altering the tissue microenvironment, create the potential for malignant transformation. Tumor-associated macrophages (TAMs), which can alter gene expression patterns by tumor cell secreted factors and promote the survival and invasiveness of tumor cells by pro-carcinogenic signals, are very important in this process. It is of utmost importance that doctors, pharmacists, technicians and nurses working with cancer-causing materials do not come into direct contact with dangerous substances and wear appropriate protective equipment.]

Lege Artis Medicinae

NOVEMBER 30, 2020

[Lung cancer – a review of thirty years. Thoughts about the past struggles, the present results and promises of the future]

OSTOROS Gyula

[In the past thirty years there was a huge development in the complex treatment of lung cancer. This development is due mostly to the last decade. Nihilism of lung cancer treatment is over and it is a reality that even patients in advanced stage turn out curable by appropriate therapy and their condition may be changed for a chronic disease while using anti-tumour therapy. Thirty years ago, the realistic life expectancy of six to eight months in advanced stage mounted nowadays significantly, and may surpass even five years in a number of cases. It required adequate diagnostic background, which provided the biomarker based treatment. In early stage surgical resection has a fundamental role, coupled with modern complex neoadjuvant and adjuvant treatment, while new surgical techniques also contributed to the improvement of therapeutic results. The same is true for radiation therapy. The same complex strategy is prevailing also in pharmaceutical options, which are dominated by modalities of cytotoxic chemotherapies and targeted immunothe­rapies. Multidisciplinary teams play a significant role in strategic decisions of lung cancer treatment. The future ways are indicating repeated innovations of tar­geted therapies and extended indica­tions of immunotherapy in terms of precision medicine. However, we must keep in mind also the primary and secondary prevention with effective smoking cessation programs and low-dose chest CT scree­ning applied as usual soon in the risk groups. ]