Altered metabolism and mortality in patients with colon cancer receiving chemotherapy.

To identify the metabolic effects of 5-fluorouracil and hydrazine sulfate therapy, 22 patients with colon cancer were admitted prospectively to a Clinical Research Center for serial measurement of counter-regulatory hormones, fasting hepatic glucose production (HGP), intravenous glucose tolerance test, plasma leucine appearance (LA) and leucine oxidation. Combined therapy was associated with a significant reduction in fasting glucose level (98 +/- 2 mg/dL to 94 +/- 2, P < 0.025) without a significant fall in fasting HGP (2.09 +/- 0.11 mg/kg/min versus 2.03 +/- 0.13; P > 0.05). The decreased fasting glucose value was associated with a mild but not statistically improved glucose disposal rate in response to the intravenous glucose tolerance test (1.34 +/- 0.07 %/min vs 1.47 +/- 0.11, P = 0.15). Plasma leucine appearance was significantly reduced after 2 months of therapy (63.3 +/- 3.0 mumol/kg/hr vs 57.1 +/- 3.9 mumol/kg/hr; P < 0.025), but leucine oxidation (11.5 +/- 1.1 mumol/kg/hr vs 11.2 +/- 1.1 mumol/kg/hr) was not altered. Despite the fact that plasma triiodothyronine concentrations significantly increased with therapy, it was not associated with plasma LA. Half of the patients with cancer died 14 +/- 4 months after the study, and the other half were alive 58 +/- 2 months later. Survival time can be estimated with 59% accuracy using plasma LA, HGP, carcino-embryonic antigen, and insulin concentration. Multiple regression analysis identified that plasma LA was related directly to length of survival time, and baseline HGP, carcino-embryonic antigen, and insulin concentration were related inversely to length of survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors influencing nurses' breast cancer control activity.

A needs assessment survey of 2800 registered nurses in a major metropolitan area was performed to identify: (1) knowledge about breast cancer risk and screening; (2) attitudes toward cancer prevention and early detection; (3) practice of breast cancer control activities; and (4) perceived barriers to practice. Responses from 1,117 nurses were obtained. Nurses reported knowledge deficits regarding breast cancer risk factors (36%) and signs and symptoms of breast cancer (35%). Compared with physicians, nurses reported more favorable attitudes toward cancer prevention and early detection. More than 85% of nurses believed that nursing had a role in breast cancer screening and early detection, and 60% believed that nursing activity in this area would increase in the future. The most common breast cancer control activity performed by nurses was assessment of breast cancer history (61%). The least frequent early detection activity was performance of a breast examination (27%). Approximately 50% of nurses taught women about breast self-examination and mammography. Common barriers limiting practice included work setting obstacles (64%), knowledge and skill deficits (57%), lack of patient education materials (51%), uncertainty about nurses' versus physicians' role in breast cancer control (52%), and time constraints (42%). It is important to note that 70% of nurses viewed themselves as resources for breast cancer screening and early detection, particularly in reducing fears and misconceptions about cancer, assessing and informing patients about individual cancer risk, and developing a plan for screening. Based on the results of this survey, nurses may represent a key potential resource for implementing breast cancer screening and early detection activities if barriers limiting practice can be overcome.

Current attitudes and practice of American Society of Clinical Oncology-member clinical oncologists regarding cancer prevention and control.

PURPOSE AND METHODS: A nationwide needs assessment survey including a validated Cancer Prevention and Early Detection Attitude Inventory of 1,500 randomly selected American Society of Clinical Oncology (ASCO)-member clinical oncologists was conducted via a 67-item, mailed questionnaire to assess practice and attitudes regarding cancer prevention and control. RESULTS: Responses of 729 physicians from 48 states representing medical (57%), radiation (17%), surgical (16%), and pediatric oncology (6%), and hematology/other (4%) fields were obtained. Except for ambivalence regarding an important role for diet in cancer causation, cancer prevention and control recommendations were widely endorsed despite skepticism about their impact on reducing deaths from cancer. Surprisingly, a significantly (P less than .001) more favorable attitude for cancer prevention and control issues was found in physicians with greater than 20 years practice compared with younger oncology colleagues, as measured by a 22-item Cancer Prevention and Early Detection Attitude Inventory. Among all physicians, participation in cancer therapy trials exceeded that in cancer prevention and control trials (91% v 27%, P less than .01). Formal instruction during postgraduate training in cancer screening (34%) or prevention (23%) was received by few oncologists; nonetheless, 69% considered themselves a resource for cancer prevention and control issues in their practice communities. Of potential barriers to cancer prevention and control activity, only lack of patients without cancer (53%) and difficulty in including such activity economically into clinical practice (65%) were majority selections. Importantly, 64% agreed they could "motivate their patients to change lifestyle to reduce cancer risk." CONCLUSION: Clinical oncologists may represent a potential resource for implementation of cancer prevention and control objectives if economically feasible models for their use in practice settings can be identified.

Nurses' practice of breast cancer screening and early detection: results of a pilot survey.

Nursing has a professional responsibility to participate in cancer screening and early detection. Nurses represent the largest professional group in the health care workforce and are presently an underutilized potential resource for implementing breast cancer screening and early detection. Development of a reliable and valid instrument which could be used to evaluate the effectiveness of mechanisms designed to increase nursing's role in breast cancer screening and early detection is needed. The questionnaire tested in this pilot study represents an initial attempt at fulfilling this need. This questionnaire in its present form may be used to evaluate the results of intervention studies aimed at increasing nurses' practice of breast cancer screening and early detection. For example, the questionnaire could be used as an evaluation tool to examine the effectiveness of educational programs regarding breast cancer screening and early detection. It may also be used as an outcome measure to evaluate change in practice activities such as the effect on nursing practice of including questions on the nursing history and assessment form related to BSE, clinical breast exam and mammography. Results of nursing action in breast cancer screening and early detection could have a significant impact on the achievement of the NCI's year 2000 goal of a 30% reduction in breast cancer mortality.