Search

Managing cancer and living meaningfully (CALM) is a brief, semi-structured individual and couple-based intervention designed to alleviate distress and promote well-being in individuals living with advanced cancer. CALM emerged from a longitudinal program of research and the theoretical traditions of relational, attachment, and existential theory. Through a therapeutic process that supports affect regulation, attachment security, and reflective functioning, CALM addresses four content domains: symptom management and communication with healthcare providers; changes in self and relations with close others; spiritual well-being, sense of meaning and purpose; and preparing for the future, sustaining hope, and facing mortality. Caregivers are invited to participate to provide an additional perspective and help address strains and strengths in the spousal relationship, the impact of the illness on the family, and planning for the future. Qualitative research demonstrates that CALM provides the experience of a safe place to explore fears, feel more fully seen in human terms, and face the challenges and threats of advancing disease. Quantitative research demonstrates that CALM is effective in reducing and preventing depressive symptoms, alleviating death anxiety, and facilitating communication of patients with healthcare providers, preparation for the end of life, and clarification of feelings and values. Healthcare providers from multiple disciplines in more than 20 countries have been successfully trained in CALM through didactic and experiential workshops and ongoing supervision. The semi-structured nature of CALM has allowed its adaptation and delivery in diverse cultural and clinical contexts.

Background The ability to identify genetic alterations in cancers is essential for precision medicine; however, surgical approaches to obtain brain tumor tissue are invasive. Profiling circulating tumor DNA (ctDNA) in liquid biopsies has emerged as a promising approach to avoid invasive procedures. Here, we systematically evaluated the feasibility of profiling pediatric brain tumors using ctDNA obtained from plasma, cerebrospinal fluid (CSF), and urine. Methods We prospectively collected 564 specimens (257 blood, 240 urine, and 67 CSF samples) from 258 patients across all histopathologies. We performed ultra-low-pass whole-genome sequencing (ULP-WGS) to assess copy number variations and estimate tumor fraction and developed a pediatric CNS tumor hybrid capture panel for deep sequencing of specific mutations and fusions. Results ULP-WGS detected copy number alterations in 9/46 (20%) CSF, 3/230 (1.3%) plasma, and 0/153 urine samples. Sequencing detected alterations in 3/10 (30%) CSF, 2/74 (2.7%) plasma, and 0/2 urine samples. The only positive results were in high-grade tumors. However, most samples had insufficient somatic mutations (median 1, range 0-39) discoverable by the sequencing panel to provide sufficient power to detect tumor fractions of greater than 0.1%. Conclusions Children with brain tumors harbor very low levels of ctDNA in blood, CSF, and urine, with CSF having the most DNA detectable. Molecular profiling is feasible in a small subset of high-grade tumors. The level of clonal aberrations per genome is low in most of the tumors, posing a challenge for detection using whole-genome or even targeted sequencing methods. Substantial challenges therefore remain to genetically characterize pediatric brain tumors from liquid biopsies.

Purpose To describe a novel surgical technique for implanting eyelid weights via a sutureless transconjunctival approach. In comparison to the traditional supratarsal crease approach, this technique does not involve any external incisions or suture placement. The procedure can reduce surgical time and complications associated with the traditional external approach. Methods This case series includes 13 patients who underwent eyelid weight placement via the transconjunctival approach for paralytic lagophthalmos secondary to facial nerve paralysis (12 patients had unilateral paralysis and 1 patient had bilateral) with a total of 14 eyelid weights placed. The procedures were performed at an outpatient office-based surgical center. All procedures were performed or supervised by the same surgeon. Patients were followed for an average 6-month postoperative period for postoperative complications. Results The sutureless transconjunctival approach to eyelid weight insertion was successful in achieving the desired functional and aesthetic outcomes. Patients undergoing this technique avoided the discomfort of postoperative suture removal. All patients achieved comparable outcomes postoperatively. There were no complications reported across the 13 patients throughout the 6-month postoperative period. Conclusions This case series demonstrates that the transconjunctival approach for metal eyelid weight insertion is practical, relatively easy to perform, and associated with functional outcomes that are comparable to those achieved with the traditional approach, however, without external incision or placement of sutures.