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991.
Vicente Valentín Maganto Maite Murillo González María Valentín Moreno 《Clinical & translational oncology》2004,6(7):448-457
Continuous care for the cancer patient is an open concept that is not only applicable only to the terminal stage. Such a simplification
could generate inequities of therapy and discrimination. Historically, oncology services have been structured as networks
dispensing chemotherapy and radiotherapy rather than services dedicated to the integrated care of the cancer patient. This
situation has changed in a continuous and progressive manner over the past few years, as reflected in the latest Spanish Libro
Blanco de Oncología. We are still far from reaching the optimum level of integrated care, possibly because we have not, as
yet, achieved services that are structured and appropriate for the care-needs of the patient and, perhaps, to the lack of
the necessary personnel. We must always make sure that cancer patients receive the best possible treatment, irrespective of
whet-her the disease is in relapse. Oncologists must not “give up”, indicating that, in addition to using the most effective
anticancer treatments available, they should deploy their best knowledge and experience to control the symptoms of cancer
while providing psycho-social help to the patient and family. This is best conducted with a communication that is adjusted
to the changing needs of the patient over the longterm clinical process, and should be provided by a multidisciplinary team,
according to the needs of the patient and the family.
Within a program of integrated care, it is possible to coordinate the existing care structures without creating parallel health
networks so as to cover the needs of the greatest number of cancer patients in advanced stage of the disease. 相似文献
992.
Beata Gawdis-Wojnarska Marek Brzosko Jacek Fliciński Krzysztof Marlicz Teresa Starzyńska Rodney J Scott Jan Lubiński 《Hereditary cancer in clinical practice》2004,2(2):65-68
Gastric cancer is the second most frequently diagnosed malignancy worldwide and therefore represents a significant healthcare burden. Environmental and genetic factors are involved in the development of gastric cancer. To date only one clear genetic predisposition has been identified involving mutations in the E-cadherin gene. The disease phenotype in patients harbouring E-cadherin mutations appears to be specifically related to diffuse gastric cancer. Little is known genetically about the other forms of gastric cancer. Since there is a growing awareness about the necessity of early intervention criteria have been developed that aid the identification of hereditary forms of gastric cancer. The aim of the current study was to identify minimal inclusion criteria so that nuclear pedigree families can be provided with risk assessment and/or genetic testing.The results reveal that inclusion features described herein such as (a) gastric cancer diagnosed before 46 years of age; (b) two gastric cancers among first degree relatives diagnosed over the age of 50 are useful in identifying suspected hereditary gastric cancer patients. 相似文献
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998.
Mitch Dowsett 《Breast cancer research and treatment》2004,87(1):11-18
cDNA arrays and proteomic analyses have allowed the rapid identification of specific genes and proteins implicated in multiple
tumor types. These molecules must then be validated as clinically relevant prognostic and predictive markers, and this translational
research is best conducted in the context of clinical trials. Outcomes data and clinical specimens collected in the ‘Arimidex’,
Tamoxifen, Alone or in Combination (ATAC) study, for example, can now be used to compare the expression of biomarkers with
clinical outcomes. In this study, adjuvant tamoxifen and anastrozole (‘Arimidex’) were compared alone and in combination in
more than 9000 women with breast cancer. Anastrozole was found to be superior to tamoxifen in terms of disease-free survival,
time to recurrence, and reduction in the incidence of contralateral tumors. Importantly, tissue specimens from surgical excision,
local relapse, and contralateral breast cancer were collected and paraffin-embedded for storage. In the TA01 (TransATAC) program,
these specimens will be studied (after obtaining patient consent) using tissue microarrays; tissue biopsy cores 0.6 mm in
diameter will be removed from donor blocks and placed on recipient blocks, which will be sectioned to allow the simultaneous
analysis of the same samples for multiple biomarkers. These analyses can help determine differential benefits of treatment
with anastrozole or tamoxifen, depending on the expression of particular biomarkers in tumor cells. This research also should
clarify de novo and acquired resistance mechanisms, and the validation of relevant molecular pathways could guide the development of new
drugs. Ultimately, the TA01 program has the potential to favorably impact treatment choices for breast cancer.
This revised version was published online in August 2006 with corrections to the Cover Date. 相似文献
999.
Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy. 总被引:4,自引:0,他引:4
Charles Given Barbara Given Mohammad Rahbar Sangchoon Jeon Ruth McCorkle Bernadine Cimprich Andrzej Galecki Sharon Kozachik Albert Brady Mary Jo Fisher-Malloy Kathy Courtney Elizabeth Bowie 《Journal of clinical oncology》2004,22(3):507-516
PURPOSE: To describe a randomized trial of a cognitive behavioral intervention on reducing symptom severity among patients diagnosed with solid tumors and undergoing a first course of chemotherapy and to determine whether the intervention had an additive or interactive effect on symptom severity in the presence of supportive care medications. PATIENTS AND METHODS: Patients (N = 237) were accrued from comprehensive and community cancer centers, interviewed, and randomly assigned to either the experimental intervention (n = 118) or conventional care (n = 119). A symptom severity index, based on summed severity scores across 15 symptoms, was the primary outcome. Each patient's site of cancer, stage at diagnosis, chemotherapy protocols, and use of supportive medications were learned from medical records. RESULTS: Groups were equivalent at baseline, and attrition by characteristics by group was not different. The proportion of patients not receiving chemotherapy at 10 and 20 weeks did not differ by group. At the 10- and 20-week observations, there was a significant interaction between the experimental group and baseline symptom severity. Patients in the experimental group who entered the trial with higher symptom severity reported significantly lower severity at 10 and 20 weeks. Controlling for chemotherapy treatment status at follow-up and supportive care medications did not alter the effect of the experimental intervention. CONCLUSION: Compared with conventional care alone, the experimental intervention was effective among patients who entered the trial with higher levels of symptom severity. Age, sex, site or stage of cancer, and supportive medications did not modify the effect of this cognitive behavioral intervention on symptom severity. 相似文献
1000.
Marilie D Gammon Mary Beth Terry Nadir Arber Wong-Ho Chow Harvey A Risch Thomas L Vaughan Janet B Schoenberg Susan T Mayne Janet L Stanford Robert Dubrow Heidrun Rotterdam A Brian West Joseph F Fraumeni I Bernard Weinstein Hanina Hibshoosh 《Cancer epidemiology, biomarkers & prevention》2004,13(1):34-39
This study was undertaken to determine whether selected risk factors for esophageal and gastric cancer are associated with tumors that overexpress cyclin D1. Archived tumor tissue was available for 630 esophageal and gastric cancer patients who participated in a population-based case-control study. Patients were categorized into case groups based on whether protein overexpression of the cyclin D1 gene, as assessed by immunohistochemistry, was present (cyclin D1+, n = 285) or not (cyclin D1-, n = 345) in the tumor. The distribution of risk factors in each of these case groups was then compared with the distribution among the 695 controls. Multivariate-adjusted odds ratios (OR) for esophageal adenocarcinoma were reduced in relation to use of aspirin and other nonsteroidal anti-inflammatory drug (NSAID) use but only among patients with cyclin D1+ tumors (0.45, 95% confidence interval [CI] = 0.26, 0.79) and not among those with cyclin D1- tumors (1.12, 95% CI = 0.67, 1.86). A similar pattern was observed for gastric cardia adenocarcinomas. In contrast, ORs for esophageal squamous cell carcinoma and noncardia gastric adenocarcinomas in relation to NSAID use were reduced, regardless of cyclin D1 status. ORs did not vary with cyclin D1 status in relation to alcohol, body size, or cigarette smoking, with the following exception; for noncardia gastric adenocarcinomas the cyclin D1- tumors showed a 2-fold elevation in the OR with ever smoking. These data suggest that the reduction in risk associated with NSAID use may be restricted to those esophageal and gastric cardia adenocarcinomas that overexpress cyclin D1. 相似文献