ABSTRACT
We have previously identified a single-item measure for baseline overall quality of life (QOL) as a strong prognostic factor for survival, and that fatigue was an important component of patient QOL. To explore whether patient-reported fatigue was supplemental or redundant to the prognostic information of overall QOL, we performed a patient-level pooled analysis of 43 North Central Cancer Treatment Group (NCCTG) and Mayo Clinic Cancer Center (MCCC) oncology clinical trials assessing the effect of baseline fatigue on overall survival (OS). 3,915 patients participating in 43 trials provided data at baseline for fatigue on a single-item 0-100 point scale. OS was tested for association with clinically deficient fatigue (CDF, score 0-50, n = 1,497) versus not clinically deficient fatigue (nCDF, score 51-100, n = 2,418). We explored whether fatigue contributed to overall survival in the presence of performance status and overall QOL. We used Cox proportional hazards models that adjusted for the effects of overall QOL, performance score, race, disease site, age and gender. Baseline fatigue was a strong predictor of OS for the entire patient cohort (CDF vs. nCDF: 31.5 months vs > 83.9 months, p < 0.0001). The effect sizes of fatigue on survival were more variable across different disease sites than was seen for overall QOL (GI, esophageal, head and neck, prostate, lung, breast and others). After controlling for covariates, including performance status and overall QOL, baseline fatigue remained a strong prognostic factor in multivariate models (CDF vs. nCDF: HR = 1.23, p = 0.02). Baseline fatigue is a strong and independent prognostic factor for OS over and above performance status (PS) and overall QOL in a wide variety of oncology patient populations. Single-item measures of overall QOL and fatigue can help to identify vulnerable subpopulations among cancer patients. We recommend these single-item measures for routine inclusion as a stratification factor or key covariate in the design and analysis of oncology treatment trials.
ABSTRACT
BACKGROUND: Significant efforts have been made to increase access and accrual to clinical trials for minority cancer patients (MP). This meta-analysis looked for differences in survival and baseline quality of life (QOL) between MP and non-minority cancer patients (NMP). MATERIALS AND METHODS: Baseline QOL and overall survival times from 47 clinical trials (6513 patients) conducted at Mayo Clinic Cancer Center/North Central Cancer Treatment Group were utilized. Assessments included Uniscale, Linear Analogue Self Assessment, Symptom Distress Scale (SDS), Profile of Mood States and Functional Assessment of Cancer Therapy - General, each transformed into a 0-100 scale with higher scores indicating better outcomes. This transformation involves subtracting the lowest possible value from the assessment, dividing by the range of the scale (the maximum minus the minimum), and multiplying by 100. Analyses included Fisher's Exact tests, linear regression, Kaplan-Meier curves, and Cox proportional hazards models. RESULTS: Eight percent of patients self-reported as MP (0.45% American Indian/Alaskan Native, 0.7% Asian, 5% Black/African American, 1.5% Hispanic, 0.1% Native Hawaiian and 0.3% Other). MP had no meaningful deficits relative to non-MP in overall QOL but were slightly worse on FACT-G total score, physical, social/family, functional, and SDS nausea severity. MP with lung, neurological or GI cancers had significantly worse mean scores in nausea (58 vs. 69), sleep problems (34 vs. 54); emotional (53 vs. 74); and social/family (60 vs. 67), respectively. Regression models confirmed these results. After adjusting for disease site, there were no significant differences in survival. CONCLUSION: MP on these clinical trials indicated small deficits in physical, social, and emotional subscales at baseline compared to NMP. Within cancer sites, MP experienced large deficits for selected QOL domains that bear further attention.
ABSTRACT
OBJECTIVES: Alcoholic soft drinks have become increasingly popular and have high concentrations of citric acid and alcohol so might have the potential to cause dental erosion. This study aimed to investigate the erosive potential of alcopops on bovine enamel in vitro. METHODS: Six bovine upper incisors were prepared and sectioned to give six slabs per tooth, 4mm x 4mm each. Each slab was covered with nail varnish, leaving an exposed window (2mm x 2mm). Samples were immersed in 20ml of each of the test solutions for 20min, 1h, and 24h under gentle agitation (100rpm). Enamel surface loss was determined using Quantitative Laser Fluorescence (QLF), Non-contact Profilometry (NCP) and Transverse Microradiography (TMR). RESULTS: Enamel loss occurred with all test drinks and the positive control (p<0.05), and the depth of lesion correlated with pH and time. No significant difference was observed between 20min and 1h exposure, although both times had significantly (p<0.05) greater erosion when compared with baseline. Within each alcopops group significant erosion had occurred at 24h exposure compared with the baseline and previous times. CONCLUSION: All the tested alcopops resulted in significant enamel loss at 24h (p<0.001) with direct correlation between degree of enamel loss and both pH and increasing exposure time.
Subject(s)
Alcoholic Beverages/adverse effects , Carbonated Beverages/adverse effects , Dental Enamel/drug effects , Tooth Erosion/chemically induced , Animals , Cattle , Fluorescence , Hydrogen-Ion Concentration , Lasers , MicroradiographyABSTRACT
OBJECTIVE: To review literature documenting associations between pesticide use and cancer. DATA SOURCES: We searched MEDLINE, PreMedline, CancerLit, and LILACS to find studies published between 1992 and 2003 on non-Hodgkin lymphoma, leukemia, and 8 solid-tumour cancers: brain, breast, kidney, lung, ovarian, pancreatic, prostate, and stomach cancer. STUDY SELECTION: Each title and abstract was assessed for relevance; disagreements among reviewers were resolved by consensus. Studies were assessed by a team of 2 trained reviewers and rated based on methodologic quality according to a 5-page assessment tool and a global assessment scale. Studies rated below a global score of 4 out of 7 were excluded. SYNTHESIS: Most studies on non-Hodgkin lymphoma and leukemia showed positive associations with pesticide exposure. Some showed dose-response relationships, and a few were able to identify specific pesticides. Children's and pregnant women's exposure to pesticides was positively associated with the cancers studied in some studies, as was parents' exposure to pesticides at work. Many studies showed positive associations between pesticide exposure and solid tumours. The most consistent associations were found for brain and prostate cancer. An association was also found between kidney cancer in children and their parents' exposure to pesticides at work. These associations were most consistent for high and prolonged exposures. Specific weaknesses and inherent limitations in epidemiologic studies were noted, particularly around ascertaining whether and how much exposure had taken place. CONCLUSION: Our findings support attempts to reduce exposure to pesticides. Reductions are likely best achieved through decreasing pesticide use for cosmetic (non-commercial) purposes (where children might be exposed) and on the job.
Subject(s)
Environmental Exposure/adverse effects , Neoplasms/chemically induced , Pesticide Residues/adverse effects , Adult , Brain Neoplasms/chemically induced , Breast Neoplasms/chemically induced , Child , Female , Humans , Kidney Neoplasms/chemically induced , Leukemia/chemically induced , Lung Neoplasms/chemically induced , Lymphoma, Non-Hodgkin/chemically induced , Male , Ovarian Neoplasms/chemically induced , Pancreatic Neoplasms/chemically induced , Pregnancy , Prostatic Neoplasms/chemically induced , Stomach Neoplasms/chemically inducedABSTRACT
BACKGROUND: A one-stage phase II trial was conducted to assess the tumor response rate and toxicity profile of single agent oral vinorelbine as first or second-line chemotherapy for women at least 65 years of age with metastatic breast cancer. PATIENTS AND METHODS: Twenty-five patients with metastatic breast cancer aged > or = 65 years of age were enrolled to receive oral vinorelbine on a weekly basis. The oral vinorelbine was given at 60 mg/m2 weekly for the first four doses and was increased to 70 mg/m2 for the subsequent administrations if there was no grade 4 neutropenia or no more than one episode of grade 3 neutropenia. Therapy was continued until progression or intolerable toxicity. RESULTS: Twenty-five patients were included and evaluable for analysis. One patient (4%) achieved a partial response (PR) that lasted for more than 13 months. Two additional patients remained stable for at least 6 months for a clinical benefit rate (PR + stable disease) of 12%. The 1-year survival rate was estimated to be 48% (95% CI 30% to 74.5%). Median time to progression was estimated to be 4.7 months (95% CI 2.0-5.5 months) and the 9-month disease progression-free rate was estimated to be 8% (95% CI 30.9% to 74.5%). The treatment was fairly well tolerated with grade 3 neutropenia in 12.5%, fatigue in 12.5% of the patients, and grade 2 neuromotor and neurosensory toxicities in 12.5% and 8.3%, respectively. CONCLUSION: Oral vinorelbine as a single agent at these dose and schedule in this population of women > or = 65 years is well tolerated but has a low level of objective efficacy for the treatment of metastatic breast cancer.
Subject(s)
Antineoplastic Agents, Phytogenic/therapeutic use , Breast Neoplasms/drug therapy , Neoplasm Metastasis , Vinblastine/analogs & derivatives , Administration, Oral , Aged , Aged, 80 and over , Antineoplastic Agents, Phytogenic/administration & dosage , Antineoplastic Agents, Phytogenic/adverse effects , Breast Neoplasms/pathology , Disease Progression , Female , Humans , Neutropenia/chemically induced , Survival Analysis , Survival Rate , Vinblastine/administration & dosage , Vinblastine/adverse effects , Vinblastine/therapeutic use , VinorelbineABSTRACT
During the last two decades extraordinary progress in developing and using effective cancer prevention strategies, early detection interventions, and cancer treatments has been made. This progress has resulted in an overall decline in mortality rates for all cancers combined. Nonetheless, cancer is the second most common cause of death in the United States. Although cancer is a diagnosis that many survive, cancer experiences across populations may vary considerably. These differences in cancer experiences have created an unequal disease burden that presents distinct professional and moral challenges to our nation. Many cancer control plans suggest specific strategies that prioritize eliminating cancer-related disparities. This article describes certain cancer-related disparities in the United States and gives several examples of how communities and disenfranchised populations are using comprehensive cancer control (CCC) approaches to eliminate these disparities. One or two interventions are highlighted in each example.
Subject(s)
Delivery of Health Care/organization & administration , Health Services Accessibility/organization & administration , Neoplasms/prevention & control , Ethnicity , Humans , Population Surveillance , United States/epidemiologyABSTRACT
Oviposition site choice by female mosquitoes, Aedes aegypti (L) (Diptera: Culicidae), was affected by rearing them in water treated with 0.016% of the repellent Mozaway trade mark containing citronella and neem. Given a choice between a bowl of repellent-treated and a bowl of untreated water, Ae. aegypti reared in untreated water strongly preferred to oviposit on the clean water (93-98%) instead of repellent-treated water. This demonstrates effective deterrence of oviposition by dilute Mozaway trade mark. Those reared in repellent-treated water were less deterred: 38-46% of their eggs were laid on the repellent-treated water and 54-62% on the clean water. Evidently the female mosquitoes reared in repellent-treated water were conditioned against oviposition site deterrence, as shown when choice tests were conducted 6 days post-emergence from the treated water. This demonstrates learning and memory in the mosquito Ae. aegypti, with implications for dengue vector surveillance and control.
Subject(s)
Aedes/physiology , Insect Repellents/pharmacology , Learning , Memory , Oviposition/physiology , Animals , Female , Mosquito Control/methods , Water/chemistryABSTRACT
Calciphylaxis is a rare disorder of small-vessel calcification and cutaneous infarction associated with chronic renal failure. Rare cases of calciphylaxis not associated with chronic renal failure have been reported with breast cancer, hyperparathyroidism, and alcoholic cirrhosis. To our knowledge, we report the first case of calciphylaxis without chronic renal failure associated with cholangiocarcinoma and the first attempt to treat calciphylaxis with vitamin K. A 56-year-old woman presented with necrotic leg ulceration. She was treated initially with low-molecular-weight heparin, with no effect. A coagulation work-up showed vitamin K deficiency. During vitamin K therapy, the patient had fulminant progression of the calciphylaxis. She died, and an autopsy showed metastatic cholangiocarcinoma. Thrombosis and protein C deficiency have been implicated in the pathophysiology of calciphylaxis. Functional protein C deficiency may be one of several factors contributing to the development of calciphylaxis. Vitamin K therapy was ineffective in our patient and may have been detrimental.
Subject(s)
Adenocarcinoma/pathology , Anticoagulants/therapeutic use , Bile Duct Neoplasms/pathology , Bile Ducts, Intrahepatic , Calciphylaxis/drug therapy , Calciphylaxis/etiology , Cholangiocarcinoma/pathology , Heparin, Low-Molecular-Weight/therapeutic use , Liver Neoplasms/pathology , Lung Neoplasms/secondary , Neoplasms, Multiple Primary/pathology , Vitamin K Deficiency/complications , Vitamin K Deficiency/drug therapy , Vitamin K/therapeutic use , Biopsy , Calciphylaxis/diagnosis , Fatal Outcome , Female , Humans , Leg Ulcer/etiology , Leg Ulcer/pathology , Lung Neoplasms/diagnosis , Middle Aged , Necrosis , Prognosis , Sepsis/etiology , Vitamin K Deficiency/bloodABSTRACT
PURPOSE: We examined the role of paclitaxel and cisplatin as first line therapy for metastatic urothelial cancer. MATERIALS AND METHODS: A total of 34 patients were enrolled in this study, and all were eligible for treatment and assessable for response. Patients received 135 mg./m.2 paclitaxel intravenously for 3 hours followed by 70 mg./m.2 cisplatin for 2 hours every 3 weeks to a maximum of 6 cycles. RESULTS: Of the patients 70% experienced a major response to treatment, which was partial/regression in 38% and complete in 32%. Toxicity was manageable with no episodes of grade 4 leukopenia or thrombocytopenia. Nonhematological toxicities included primarily nausea, anorexia and neuropathy, which rarely were severe. CONCLUSIONS: This regimen of paclitaxel and cisplatin is effective, safe and convenient to administer in an outpatient setting for advanced urothelial cancer.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Transitional Cell/drug therapy , Cisplatin/therapeutic use , Kidney Neoplasms/drug therapy , Paclitaxel/therapeutic use , Ureteral Neoplasms/drug therapy , Urinary Bladder Neoplasms/drug therapy , Aged , Female , Humans , Kidney Neoplasms/mortality , Kidney Pelvis , Male , Middle Aged , Tomography, X-Ray Computed , Ureteral Neoplasms/mortality , Urinary Bladder Neoplasms/diagnostic imaging , Urinary Bladder Neoplasms/mortalityABSTRACT
BACKGROUND: The cervical cancer mortality rate for American Indian and Alaska Native women is twice that of all races in the United States. To date the only published national breast and cervical cancer-screening rates for American Indian and Alaska Native women are based on self-reported data. When the Indian Health Service (IHS) conducts an annual audit on patients with diabetes, it includes cancer screening. This observational study presents national breast and cervical cancer-screening rates for American Indian and Alaska Native women with diabetes. METHODS: Cancer-screening rates were extracted from the 1995 diabetic audit for the 12 IHS areas. These rates were compared with rates for women without diabetes of the same age, 50 to 69 years, by chart review, at four IHS hospitals in the Aberdeen IHS area. RESULTS: Screening rates for women with diabetes in the 12 areas varied: mammogram (ever) 35% to 78%; clinical breast examination (last year) 28% to 70%, and Papanicolaou smear (last year) 26% to 69%. The Aberdeen IHS area women with diabetes had 51% more clinic visits per year than women without diabetes, but the groups had similar screening rates. CONCLUSION: Cancer-screening rates for American Indian and Alaska Native women vary by region. In the Aberdeen IHS area, women with diabetes had more visits (missed opportunities) but similar screening rates as women without diabetes. The diabetic audit could be used to monitor national IHS cancer-screening trends for women with diabetes and in the Aberdeen IHS area for all women aged 50 to 69 years.
Subject(s)
Breast Neoplasms/prevention & control , Diabetes Mellitus, Type 2 , Indians, North American/statistics & numerical data , Inuit/statistics & numerical data , Mass Screening/statistics & numerical data , Uterine Cervical Neoplasms/prevention & control , Aged , Female , Humans , Mammography/statistics & numerical data , Medical Audit , Middle Aged , Papanicolaou Test , Population Surveillance/methods , Retrospective Studies , United States/epidemiology , Vaginal Smears/statistics & numerical dataABSTRACT
BACKGROUND: Many American Indian and Alaska Native women have lower incidence rates of breast carcinoma than other racial/ethnic groups in the United States. The rates in most areas, however, have increased in recent years. The author reviews the migration patterns and effects that might contribute to this change. METHODS: A review of the literature on migration and breast carcinoma incidence was conducted. RESULTS: Migration significantly impacts on breast carcinoma incidence in all groups of women studied. CONCLUSIONS: Research must be designed that will explore the components of host, life-styles, and environment on breast carcinoma rates in American Indian and Alaska Native women to elucidate mechanisms of breast carcinoma etiology.
Subject(s)
Breast Neoplasms/ethnology , Carcinoma/ethnology , Emigration and Immigration , Alaska , Environment , Ethnicity , Female , Humans , Incidence , Indians, North American , Life Style , Racial Groups , United StatesABSTRACT
Palliative care and hospice programs are points on the continuum of comprehensive patient care. Unfortunately, provision of care for terminally ill patients is suboptimal. There are many new approaches to improving the skills of all physicians to fulfill the needs of patients, including better education for house staff, "train-the-trainers" programs for physicians in practice, research into methods of symptom control, and better access to established hospice programs. This review covers the history, current status, and practical suggestions for improving palliative care and hospice programs in primary care settings.
Subject(s)
Hospices , Palliative Care , Advance Directives , Education, Medical, Continuing , Ethics, Medical , Humans , Pain Management , United Kingdom , United StatesABSTRACT
BACKGROUND: Screening for breast carcinoma is a Healthy People 2000 objective and physical examination is an important component of the screening process. However, many women do not have access to a high quality breast examination. To help address this problem for Native American women, the authors developed the Nurses Providing Annual Cancer Screening (NPACS) training program, a week-long training session conducted at the nurses' clinical site. The goal of the current study was to demonstrate that, after receiving training, the nurses can detect masses in breast models at acceptably high rates. METHODS: Thirty-four nurses who had completed the NPACS training program performed examinations of a test set of six silicone breast models. True-positive and false-positive rates of lump detection were calculated. RESULTS: The nurses were able to detect more lumps in the simulated breasts than both untrained and trained physicians tested in previous trials using the same methodology. On the average, nurses found 76% of the 18 lumps in the 6 breast models. However, their rate of false-positive detections also was somewhat higher. Although the modal number of false-positive detections for both physicians and nurses was 0, the median number of false-positive detections was 0 for the physicians and 1.0 for the nurses. CONCLUSIONS: In the current study, trained nurses were able to detect masses in breast models at high rates. This observation suggests that widespread training of nurses to perform screening breast examinations might be considered as a response to the breast carcinoma screening needs of adult women.
Subject(s)
Breast Neoplasms/prevention & control , Education, Nursing, Continuing/methods , Mass Screening/methods , False Positive Reactions , Humans , Models, Anatomic , Palpation , Silicone ElastomersABSTRACT
Literature regarding cancer patterns in American Indians and Alaska Native women is reviewed and attention is paid to promising research initiatives to improve cancer prevention and control as well as approaches to enhance exchange of knowledge through a new national resource center. Lung, breast, and colorectal cancer are the leading cause of cancer deaths in American Indians and Alaska Native women. There continues to be a disproportionate death rate from cervical cancer. Enhanced availability for breast and cervical cancer screening in conjunction with community education is showing promising trends toward reversing the patterns of late diagnosis. Communities can benefit from sharing their collective resources in a new national resource center called "Native C.I.R.C.L.E." housed in the Mayo Cancer Center.
Subject(s)
Attitude to Health/ethnology , Indians, North American/psychology , Indians, North American/statistics & numerical data , Neoplasms/ethnology , Neoplasms/prevention & control , Women's Health , Female , Humans , Incidence , Mass Screening/methods , Needs Assessment , Population Surveillance , Prevalence , Quality of Life , United States/epidemiologyABSTRACT
PURPOSE: Vaginal dryness and dyspareunia are significant estrogen-depletion symptoms that affect many breast cancer survivors. The present trial was developed to evaluate the nonhormonal vaginal lubricating preparation, Replens, for alleviating these symptoms. MATERIALS AND METHODS: A double-blind, crossover, randomized clinical trial was developed. Patients received 4 weeks of Replens (Columbia Research Laboratories, Rockville Centre, NY) followed by a 1-week washout period followed by 4 weeks of a placebo lubricating product, or vice versa. Weekly patient-completed diaries were used for measuring efficacies and toxicities of therapy. RESULTS: The 45 assessable patients provided well-balanced treatment groups. During the first 4 weeks, average vaginal dryness decreased by 62% and 64% in the placebo and Replens groups, respectively (P = .3). Average dyspareunia scores also improved by 41% and 60%, respectively (P = .05). Crossover analysis indicated that the bulk of the beneficial effects appeared within the first 2 weeks of the first treatment and remained constant thereafter. Both treatments were relatively well tolerated. CONCLUSION: Both Replens and the placebo appear to substantially ameliorate vaginal dryness and dyspareunia in breast cancer survivors.
Subject(s)
Dyspareunia/drug therapy , Vagina/drug effects , Vaginal Creams, Foams, and Jellies/therapeutic use , Adult , Cross-Over Studies , Double-Blind Method , Female , Humans , Lubrication , Middle Aged , Vagina/metabolismABSTRACT
Cancer has recently become a major health problem for American Indians and Alaska Natives. Surveillance, Epidemiology, and End Results data showed that Native American survival rates at 1, 3, and 5 years from cancer diagnosis are the poorest of any minority population studied. The causes for this finding are multifactorial and include a lack of awareness of cancer risks and symptoms, fatalism, and lack of access to screening services. Cancer survivors in native communities can be invaluable resources to educate others, raise cancer awareness, and most importantly prove that cancer is not always fatal.
Subject(s)
Indians, North American , Neoplasms/ethnology , Survivors/psychology , Adaptation, Psychological , Attitude to Health , Cultural Characteristics , Female , Humans , Indians, North American/psychology , Indians, North American/statistics & numerical data , Male , Neoplasms/mortality , Neoplasms/psychology , Neoplasms/therapy , Survival Rate , United States/epidemiologySubject(s)
Home Care Services/trends , Indians, North American , Medical Oncology/trends , Alaska , Forecasting , HumansSubject(s)
Family Health , Indians, North American , Neoplasms/ethnology , Social Support , Female , Humans , Neoplasms/diagnosis , Neoplasms/therapy , North DakotaABSTRACT
Previous literature reports have suggested that sublingually administered morphine sulfate results in an improved bioavailability of the drug when compared to orally administered morphine. To investigate this possibility further, we studied six cancer patients all of whom received 10 mg doses of morphine sulfate by intramuscular, oral and sublingual routes. Pharmacokinetic analyses failed to suggest an advantage of sublingual administration when compared with oral dosing. Bioavailability of morphine following intramuscular administration appeared superior to both oral and sublingual routes.
Subject(s)
Morphine/administration & dosage , Morphine/pharmacokinetics , Neoplasms/physiopathology , Pain/drug therapy , Administration, Oral , Administration, Sublingual , Adult , Biological Availability , Female , Humans , Injections, Intramuscular , Male , Middle Aged , Morphine/blood , Pain/blood , Pain/etiologyABSTRACT
A 2.6 kb covalently closed circular plasmid has been isolated from clinical and environmental isolates of Aeromonas sobria and A. hydrophila. The possibility that the plasmid carries genetic determinants that mediate resistance to a variety of anti-microbial agents has been eliminated. The plasmid is stable at approximately 20-25 copies per chromosome equivalent which, together with its relatively small size and the presence of unique restriction sites, makes it a good candidate for development as a cloning vector.