Search

Background: Women with a first-degree relative with breast cancer are at increased risk of developing this disease. The optimal medical management of these women is unclear, with options including close breast cancer screening, bilateral prophylactic mastectomy, or participation in chemoprevention trials. Among women who undergo prophylactic bilateral mastectomy, very little is known about satisfaction with this surgery. Also, we know very little about variables related to prophylactic mastectomy decision making., Methods: Participants were women at increased risk of breast cancer due to family history. These women were categorized by self-report as not interested in prophylactic mastectomy (n = 58), interested but deciding against surgery (n = 92), or subsequently having a bilateral prophylactic mastectomy (n = 14). Information on screening practices, risk perception, level of depression, and cancer-related worry was collected. Women completing prophylactic mastectomy reported on their satisfaction with the surgery and breast reconstruction., Results: Women selecting surgery reported more breast cancer worry. The group expressing no interest in surgery reported fewer biopsies and lower risk estimates. Women completing surgery were satisfied with their decision, although satisfaction with reconstruction was mixed., Conclusion: Factors influencing surgical decision making may include breast-cancer-related worry, biopsy history, and subjective breast cancer risk.

A multicenter study of CA549, a marker for breast cancer, was conducted using sera from 1721 patients with benign and malignant conditions by an immunoradiometric assay, BRESMARQ. Acceptable assay performance was demonstrated by studies of intra-assay (2.2% to 12% coefficient of variation [CV]), interassay (4.1% to 11.8% CV), and interlaboratory (4.8% to 8.7% CV) precision; sensitivity (.3 kU/L); linearity; recovery; high-dose hook effect (up to 10,000 kU/L); and interferences (human antimouse antibodies; protein, bilirubin, hemoglobin levels; lipid and cancer therapeutic agents). A reference interval of 0-12.5 kU/L (women) and 0-11.9 kU/L (men) was established from 746 healthy persons. The distribution of values exceeding the reference range for benign conditions was as follows: pregnant and lactating women (2%); benign breast disease (5%); and seven other benign diseases, including liver (24%), lung (19%), prostate (14%), colon, endometrial, gastric, and ovarian (< 10%). For nonbreast cancers, the distribution was Hodgkin's (7%), colon (10%), endometrial (15%), gastric (15%), lymphoma (15%), prostate (20%), ovarian (39%), and liver (45%). For breast cancer, the distribution was stage I (5%), stage II (14%), stage III (32%), and stage IV (74%). The receiver-operating characteristic analysis demonstrated the usefulness of CA549 as a marker in stage IV breast cancer.

Four patients developed abnormal liver function tests and focal defects on liver scan while receiving cyclophosphamide, methotrexate and 5-fluorouracil as adjuvant chemotherapy following mastectomy for breast cancer. Liver biopsies showed severe focal inflammation. The biopsy findings and the subsequent clinical course of the patients strongly suggest that these abnormalities were due to hepatic toxicity of the chemotherapy and not metastic breast cancer. A review of serial liver function tests performed on 24 patients in that chemotherapy program revealed that four out of eight patients with elevated alkaline phosphatase prior to therapy developed early metastatic cancer. Elevated alkaline phosphatase occurring during chemotherapy on the other hand was quite common but more likely due to hepatic toxicity of the drugs. The development of abnormal liver function tests even in association with focal defects on liver scan is not sufficient to diagnose metastatic breast cancer in patients receiving adjuvant chemotherapy.

To determine the incidence of anticipatory vomiting (AV) and postchemotherapy nausea and vomiting (PCNV) in women receiving cyclophosphamide, methotrexate, and 5-FU (CMF) adjuvant chemotherapy for breast carcinoma, we studied 52 women randomized to two regimens (standard-dose and low-dose) of CMF. Charts were reviewed for the cycle of onset of AV and PCNV, the severity of PCNV, and relationships of these syndromes to CMF dose and protocol compliance. Among the 52 patients, AV occurred in 17 (33%), while PCNV was experienced by 46 (88%). Severe PCNV (defined as uncontrolled nausea and/or vomiting interfering with performance of daily activities) occurred in 22 of 52 (42%) women. Eighteen of 23 (78%) women receiving standard-dose CMF experienced severe PCNV, and 13 of these had AV. Patients in whom severe PCNV began before cycle 4 were more likely to develop AV than women in whom PCNV began later (P less than 0.01). Ten of 52 (19%) patients discontinued CMF adjuvant chemotherapy because of nausea and vomiting; seven of the ten (70%) were receiving standard-dose CMF and seven had experienced AV. This study demonstrates that both AV an PCNV are significant toxic effects that not only affect the quality of life of a woman receiving CMF chemotherapy for breast cancer but also limit the ability of the clinician to provide maximum therapy to woman at high risk of recurrence of breast carcinoma.

Breast disease is a common problem found in approximately one of four women from puberty to old age. Of greatest importance to the health care provider is identifying the type of breast disorder and its relative seriousness. Precancerous mastopathy is of major concern, as are other significant forms of benign breast disease, both symptomatic and asymptomatic. Awareness of the many facets of benign breast disease on the part of the health care provider and the patient can heighten sensitivity to subtle changes in breast tissue. Identification of precancerous mastopathy has its greatest impact for early diagnosis of breast cancer. The patient with benign breast disease can be offered reassurance, support and symptomatic treatment for the benign breast disorder by the primary health care provider.

Performance appraisal can be an emotionally charged experience for both the supervisor and the employee. The accuracy of the appraisal is dependent not only upon the evaluator, but also upon the appropriateness of the tool being used for the task. An employee's career advancement, professional development, monetary remuneration and self-esteem often may depend upon the final outcome of the process. A group of nurse practitioners practicing in a wide variety of clinical and administrative roles at the Johns Hopkins Hospital formed a task force to develop a performance appraisal tool that would adequately reflect the nurse practitioner role and that could be individualized according to the work setting. A general overview of the development process, the tool, its scoring system and instructions for implementation are presented.

We studied the prevalence of anticipatory nausea (AN) and anticipatory nausea and vomiting (ANV) in an ambulatory medical oncology population by self-report questionnaire over 7 weeks. Thirty-eight of 123 (31%) patients receiving parenteral chemotherapy reported anticipatory symptoms (AN or ANV). Twenty-one (17%) patients reported ANV and 17 (14%) reported AN only. Patients receiving parenteral chemotherapy (N = 123) with anticipatory symptoms (N = 38) were younger (45.1 +/- SE 1.9 vs 55.5 +/- 1.45, P less than 0.001) and more likely to be female (82% vs 61%, P = 0.04), unmarried (47% vs 26%, P = 0.03), and receiving adjuvant chemotherapy for breast cancer (42% vs 7% P less than 0.001) than patients without anticipatory symptoms (N = 85). A greater proportion of patients with both postchemotherapy nausea and vomiting and anticipatory symptoms reported greater than 12 hours of postchemotherapy nausea (65% vs 39%, P = 0.01) and postchemotherapy nausea and vomiting (37% vs 12%, P = 0.01) after their most recent cycle of chemotherapy than did patients with postchemotherapy symptoms only. In structured interviews with 23 patients with anticipatory symptoms, 16 identified specific stimuli associated with AN or ANV, taste being the most frequently mentioned (ten of 16 patients) sensory modality. In our clinic, patients receiving adjuvant chemotherapy for breast cancer develop anticipatory symptoms frequently and represent a relatively homogenous sample for further studies.

We employed a structured interview to retrospectively study tastes and vomiting associated with the parenteral components of cyclophosphamide, methotrexate, and 5-FU in 45 patients with stage II-IV breast cancer. Sixteen patients (36%) reported tastes which generally occurred in each cycle within 30 minutes of parenteral drug administration, lasted less than or equal to 1 hour, and were bitter. Five patients recalled that tastes seemed to produce vomiting. Tasting was significantly associated with postchemotherapy (P less than 0.01) but not anticipatory vomiting. Employing logistic regression techniques, tasting did not significantly improve prediction of anticipatory vomiting by postchemotherapy vomiting. Tastes may be produced by the action of plasma or salivary cyclophosphamide, methotrexate, and 5-FU on taste buds. While tastes might cause some vomiting, they are not necessary for it. Because this was a retrospective study with a small sample, these findings require confirmation.