ABSTRACT
Different systems exist currently in the provision of breast care to low-income, uninsured women. We assessed the efficacy of screening, diagnosis, and treatment of breast cancer in this patient population through a decentralized network of providers. We retrospectively reviewed charts of all patients referred for evaluation and treatment under the Cancer Detection Program: Every Woman Counts (CDP:EWC), the California equivalent of the National Breast and Cervical Cancer Detection and Prevention Program, in a suburban area of Los Angeles County. A total of 972 CDP:EWC screening mammograms was performed in the Antelope Valley during a 7-year study period (2000 to 2007). Sixty-two screened women aged 40 to 64 years were referred for further evaluation. Breast cancer detection rate per screening mammogram was 0.8 per cent; 80 per cent were early-stage breast cancer. The majority of the women (nine of 15) underwent breast conservation surgery. The axilla was staged using sentinel lymph node dissection and/or axillary lymph node dissection. Adjuvant chemotherapy and radiation were administered to all eligible patients. Compliance with published practice guidelines was high. This suggests that a decentralized community-based network of providers may be an effective model to deliver breast care to a low-income, uninsured patient population.
Subject(s)
Breast Neoplasms/epidemiology , Mammography/methods , Mass Screening/methods , Medically Uninsured , Poverty , Adult , Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , California/epidemiology , Combined Modality Therapy , Female , Humans , Middle Aged , Morbidity , Reproducibility of Results , Retrospective StudiesABSTRACT
Despite their use of prophylactic antiemetic therapies, cancer patients continue to consider chemotherapy-induced nausea and vomiting (CINV) to be a significant problem. Patients frequently use various "breakthrough" medications for these symptoms. Unfortunately, there is a paucity of trials regarding treatment of breakthrough CINV. This study investigated the efficacy of "ABH," a topical gel containing lorazepam (Ativan), diphenhydramine (Benadryl), and haloperidol (Haldol), in reducing breakthrough CINV. Adults receiving standard recommended prophylactic antiemetics as outpatients were instructed to use 0.5 mL of the gel topically when they experienced significant CINV. Patients then were contacted retrospectively to respond to a questionnaire rating their nausea and/or vomiting and their response to ABH-gel treatment. The results were collected during two trials: Trial I began in April 2003, and Trial II began in March 2006. During Trial I, 23 patients were evaluated; 17 patients (74%) reported that use of the gel decreased their CINV, with 15 (70%) reporting relief within 30 minutes of its application. Three patients believed that the gel caused sedation; no troubles with skin irritation or muscle spasms were reported. In Trial II, all 10 patients believed that the treatment was effective. When the severity of CINV was quantified on a scale of 0-10, the mean CINV score decreased significantly from a 6.1 before gel application to a 1.7 as evaluated 30 minutes following gel application (P < 0.005). Topical use of ABH gel appears to be a promising and safe rescue therapy for breakthrough CINV that occurs despite prophylactic antiemetic therapy. These results warrant further confirmation in a large, randomized, placebo-controlled trial.
Subject(s)
Antiemetics/administration & dosage , Diphenhydramine/administration & dosage , Haloperidol/administration & dosage , Lorazepam/administration & dosage , Nausea/prevention & control , Skin/metabolism , Vomiting/prevention & control , Administration, Cutaneous , Adult , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Clinical Trials as Topic , Drug Delivery Systems , Gels , Humans , Nausea/chemically induced , Neoplasms/complications , Neoplasms/drug therapy , Pilot Projects , Skin/chemistry , Surveys and Questionnaires , Vomiting/chemically inducedABSTRACT
The development of brain metastases originating from colorectal cancer (CRC) is an infrequent phenomenon occurring in < 5% of patients. Yet, it is feasible that physicians will be diagnosing more patients with brain metastases because of the prolonged survival in our current patient population. The anti-angiogenic agent bevacizumab is currently approved in bevacizumab-naive patients with metastatic CRC (mCRC). Initially, precautionary measures regarding the use of bevacizumab were recommended for patients at risk of bleeding based on earlier incidents of intracranial hemorrhage, hemoptysis, and pulmonary hemorrhage. However, recent data support the use of bevacizumab in the treatment of high-grade gliomas. We present a challenging case of a treatment-naive patient with mCRC with brain metastases and the challenges involved in weighing the risks and benefits of systemic chemotherapy when combined with a biologic agent.
