Clinicopathologic features of BRCA-linked and sporadic ovarian cancer.

CONTEXT: Most hereditary ovarian cancers are associated with germline mutations in BRCA1 or BRCA2. Attempts to define the clinical significance of BRCA mutation status in ovarian cancer have produced conflicting results, especially regarding survival. OBJECTIVE: To determine whether hereditary ovarian cancers have distinct clinical and pathological features compared with sporadic (nonhereditary) ovarian cancers. DESIGN AND SETTING: Retrospective cohort study of a consecutive series of 933 ovarian cancers diagnosed and treated at our institution, which is a comprehensive cancer center as designated by the National Cancer Institute, over a 12-year period (December 1986 to August 1998). PATIENTS: The study was restricted to patients of Jewish origin because of the ease of BRCA1 and BRCA2 genotyping in this ethnic group. From the 189 patients who identified themselves as Jewish, 88 hereditary cases were identified with the presence of a germline founder mutation in BRCA1 or BRCA2. The remaining 101 cases from the same series not associated with a BRCA mutation and 2 additional groups (Gynecologic Oncology Group protocols 52 and 111) with ovarian cancer from clinical trials (for the survival analysis) were included for comparison. MAIN OUTCOME MEASURES: Age at diagnosis, surgical stage, histologic cell type and grade, and surgical outcome; and response to chemotherapy and survival for advanced-stage (II and IV) cases. RESULTS: Hereditary cancers were rarely diagnosed before age 40 years and were common after age 60 years, with mean age at diagnosis being significantly younger for BRCA1- vs BRCA2-linked patients (54 vs 62 years; P=.04). Histology, grade, stage, and success of cytoreductive surgery were similar for hereditary and sporadic cases. The hereditary group had a longer disease-free interval following primary chemotherapy in comparison with the nonhereditary group, with a median time to recurrence of 14 months and 7 months, respectively (P<.001). Those with hereditary cancers had improved survival compared with the nonhereditary group (P=.004). For stage III cancers, BRCA mutation status was an independent prognostic variable (P=.03). CONCLUSIONS: Although BRCA-associated hereditary ovarian cancers in this population have surgical and pathological characteristics similar to those of sporadic cancers, advanced-stage hereditary cancer patients survive longer than nonhereditary cancer patients. Age penetrance is greater for BRCA1-linked than for BRCA2-linked cancers in this population.

Patient guide to peripheral neuropathy.

PURPOSE/OBJECTIVES: To describe a booklet used to educate patients who experience peripheral neuropathy secondary to neurotoxic chemotherapy treatment. DATA SOURCES: Journal articles, neurologic physical assessment, symptom management books. DATA SYNTHESIS: The booklet defines peripheral neuropathy, the types of nerves most often affected, common causes and symptoms, and management strategies with an emphasis on safety issues. It contains a list of referral sources for additional management information and a glossary of terms related to peripheral neuropathy. CONCLUSIONS: The booklet is useful for patients in their daily management of peripheral neuropathy that has occurred as a side effect of neurotoxic chemotherapy treatment. IMPLICATIONS FOR NURSING PRACTICE: Nurses can use this information to educate patients and their caregivers about peripheral neuropathy. The booklet offers strategies to manage this side effect and maintain a safe home environment and workplace. It also offers sources of information and referrals that may benefit patients with peripheral neuropathy.

The diagnosis and management of hypomagnesemia: a unique treatment approach and case report.

Hypomagnesemia is a common but frequently overlooked electrolyte disorder that occurs as part of a complex metabolic profile. It often is associated with a spectrum of nonspecific symptoms secondary to other electrolyte deficiencies. These symptoms then are associated with the primary illness, thereby masking the presence of this disorder. In most clinical situations, magnesium deficiency is transitory and responds well to short-term supplementation. Certain populations of patients with cancer may have an increased risk of developing severe hypomagnesemia requiring continued supplementation; patient populations receiving aminoglycoside antibiotics or cisplatin therapy are considered to be high-risk groups. This paper describes the causes, signs, and symptoms of chronic hypomagnesemia; patient populations at risk of developing this disorder; and a unique treatment approach using a subcutaneous pump infusion system. A case study illustrates the complexity of clinical and nursing management of this disorder.