Predictors of physician nonadherence to chemotherapy regimens.

Physician nonadherence to cancer treatment regimens may diminish treatment efficacy and compromise clinical research. The influence of clinical, demographic, and psychosocial patient characteristics on physician adherence to breast cancer chemotherapy was investigated, as was the role of the clinician's attitudes concerning the chemotherapy. One hundred seven women recently diagnosed with breast cancer were followed for 26 weeks of treatment. Fifty-six (52%) of the patients experienced unjustified modification for at least one chemotherapeutic agent. Stepwise multiple regression revealed independent contributions of increased patient age, treatment setting (clinic versus academic or community private practice), and stage of disease to physician nonadherence. Regimen complexity, delay in seeking treatment, and presence of psychiatric disorder did not contribute, in general, to unjustified regimen modifications. Patient psychological and psychiatric factors, however, did influence prescribing behavior for vincristine. Physician awareness of factors contributing to unnecessary treatment modifications may reduce the frequency of such behaviors.

Patient noncompliance with self-administered chemotherapy.

The contribution of patient factors to nonadherence with self-administered cancer chemotherapy along with its prevalence was studied. Fifty-one patients with breast cancer enrolled in protocols that included the orally administered medications Cytoxan (cyclophosphamide) and/or prednisone were interviewed and assessed at five points in time over a 6-month period. Two summary measures of patient nonadherence derived by self-report were developed: (1) dosage, the overall percentage of drug missed during 26 weeks of treatment; and (2) behavioral, the percentage of behavioral events or prescribing occasions on which a criterion level of drug was missed. Twenty-two patients (43%) met criteria for noncompliance according to both behavioral and dosage definitions. Univariate analyses showed more nonadherence in the clinic and private community settings than in the academic setting. Stepwise multiple logistic regression analyses assessed the contribution of patient demographic, psychologic, and physical symptom factors on patient noncompliance. In the regression analyses patient noncompliance was associated with (1) treatment location, more nonadherence in the private community-based treatment sector than in the academic setting; and (2) income, more nonadherence among those having lower incomes. In assessing total dose requirements in clinical research trials, rates of patient nonadherence need to be considered, and treatment location controlled.

Voluntary vaginal musculature contractions as an enhancer of sexual arousal.

In a study of the effects of vaginal musculature contractions (Kegel's exercises) on both subjective and physiological measures of sexual arousal, 30 normal females were randomly assigned to one of three groups. The first group was informed about these exercises and was asked to practice them both during lab sessions and during the week intervening between sessions. The second group was informed concerning the effects of Kegel's exercises but did not practice contractions. A control group received no information regarding these exercises. Measures of vaginal vasocongestion and subjective ratings of sexual arousal were obtained during two 31-minute lab sessions. Vaginal contractions enhanced both subjective ratings and physiological measures of arousal. When combined with self-generated fantasy, tensing further augmented arousal. These effects were not further enhanced after 1 week of practice. The present study provides empirical support for the prescription of Kegel's exercises to normal women as an enhancer of sexual arousal. Further study of the effects of Kegel's exercises on a sample of dysfunctional women is necessary to determine the applicability of these results to a clinical population.