Young women's experiences with breast cancer: an imperative for tailored information and support.

This work was undertaken to provide a basis for determining the type of assistance young women living with breast cancer would find useful. In-depth interviews were conducted with 28 women diagnosed with breast cancer before the age of 45 years about their experiences with breast cancer. They ranged in age from 28 to 42 years at the time of diagnosis. Three overarching themes emerged from the analysis--"everything depends on acting now," "everything is out of sync," and "cancer invaded my whole life." These women shared perspectives similar to those of older women, but also held perspectives unique to being young, with young families and busy career lives. Many found services did not match their requirements and they urged the creation of services tailored to their unique needs.

Aminohexane diphosphonate in the treatment of Paget's disease of bone.

We studied the effects of the intravenous or oral administration of aminohexane diphosphonate (AHDP) in 42 patients with active Paget's disease of bone. Treatment of mouth (400 mg daily for 1 month) or intravenously (25 mg or 50 mg daily for 5 days) induced marked suppression of biochemical indices of disease activity. Urinary excretion of hydroxyproline fell to 39 and 42% of pretreatment values (oral and IV treatments respectively), and was followed by a similar decrease in the serum activity of alkaline phosphatase. In both groups of patients, disease activity remained suppressed for the 6 months of followup, and pain improved in 34 out of 37 patients who had bone pain attributed to Paget's disease. Both biopsies indicated that osteoblast and osteoclast numbers decreased with no adverse effects on mineralization. Neither regime was associated with significant side effects. We conclude that short courses of AHDP provide a promising treatment for the long-term control of Paget's disease.

Identification of a 66 KDa protein associated with yeast mitochondrial ATP synthase as heat shock protein hsp60.

A 66 kDa protein, denoted P66, not hitherto classified as an integral component of yeast mitochondrial ATPase, is often observed in preparations of this enzyme complex. A physical association exists between P66 and the assembled ATPase complex since both components are coimmunoprecipitated by anti-F1 beta monoclonal antibody. Two recombinant clones expressing proteins immunologically similar to P66 were isolated from a yeast genomic library in lambda gt11 by screening with a polyclonal anti-holo-ATPase antibody. Based on restriction site mapping and partial nucleotide sequence analysis, both clones encompass the gene encoding the yeast heat shock protein hsp60. The identification of P66 with hsp60, taken together with its demonstrated association with the mitochondrial ATPase complex, is consistent with recent suggestions that hsp60 is involved in assembly of the ATP synthase complex.

Paget's disease of bone and unvaccinated dogs.

The etiology of Paget's disease is unknown, but several observations suggest a viral cause. Since canine distemper virus is among those proposed to be a causal agent, we investigated the hypothesis that dog ownership may increase the risk of Paget's disease of bone by means of a case control study. One hundred and fifty patients with Paget's disease and 185 controls were interviewed using a structured questionnaire administered by the same interviewer. Participants were asked about their socioeconomic background and their exposure to pets. The risk of Paget's disease was not significantly increased in individuals. However, ownership of a mongrel dog was associated with a significant increase in risk (OR = 1.6; 95% CI = 1.0-2.4) and the risk increased still further with the ownership of an unvaccinated dog (OR = 2.8; 95% CI = 1.8-4.5). Additionally, ownership of cats and birds excluding dog owners, increased the risk of Paget's disease (OR = 2.5; 95% CI = 1.0-5.0; OR = 2.3; 95% CI = 1.0-5.3, respectively). These data suggest that previous exposure to cats, birds, and dogs unvaccinated for canine distemper may increase the risk of an individual developing Paget's disease of bone.

Clodronate in the medical management of hyperparathyroidism.

The skeletal manifestations of hyperparathyroidism are due to the stimulation of osteoclast-mediated bone resorption by high circulating concentrations of parathyroid hormone (PTH). Since diphosphonates inhibit PTH-mediated bone resorption, we assessed the effects of clodronate in 42 patients with hypercalcaemia and increased bone resorption due to primary hyperparathyroidism (20 patients), secondary hyperparathyroidism in chronic renal failure (12 patients on haemodialysis replacement therapy) and tertiary hyperparathyroidism following successful renal transplantation (10 patients). Clodronate (0.8-1.6 g daily by mouth or 300 mg given as an intravenous infusion following five consecutive dialysis treatments) significantly decreased serum calcium and biochemical indices of bone resorption in the three groups studied. In primary and tertiary hyperparathyroidism, serum calcium values remained above the upper limit of the reference range despite suppression of bone resorption due to the unopposed effect of PTH on renal tubular reabsorption of calcium. Prolonged treatment (3 months) was associated with a partial recurrence of hypercalcaemia in 8 of 12 patients with primary hyperparathyroidism despite continued effects on bone resorption, possibly due to a secondary decrease in bone formation. These studies indicate that clodronate is capable of suppressing PTH-mediated bone resorption in disorders of parathyroid secretion and may prove to be a useful adjunct in their medical management.

Treatment of the hypercalcaemia of malignancy with intravenous clodronate.

We studied the effects of intravenous clodronate (100-300 mg daily for 3-10 days) in 27 episodes of hypercalcaemia due to malignancy. Comparisons were also made between responses in patients with haematological malignancies and those with solid tumours. Following extracellular volume expansion, clodronate induced a significant decrease in serum calcium within 2 days of the start of treatment which was maximal at 7 days. This was associated with a decrease in bone resorption as judged by decreases in urinary excretion of hydroxyproline and calcium. Hypercalcaemia recurred 5-7 days after stopping treatment. Patients with solid tumours had higher pretreatment serum calcium values than those with haematological malignancies despite comparable values for fasting urinary excretion of calcium suggesting that renal tubular reabsorption of calcium was more markedly increased in patients with solid tumours. No difference was observed in the final calcium values between patients with solid tumours and haematological malignancies except in those patients in whom renal tubular reabsorption of calcium was markedly increased before treatment. We conclude that intravenous clodronate provides a safe and effective treatment of hypercalcaemia due to a wide range of tumour types provided that increased bone resorption contributes significantly to the hypercalcaemia. When increased renal reabsorption of calcium is the predominant mechanism for the maintenance of hypercalcaemia, the response to clodronate is incomplete.

Effects of intravenous etidronate disodium on skeletal and calcium metabolism.

The induction of hypercalcemia in malignant disease is almost invariably associated with increased bone resorption. However, tumor-induced changes in bone formation and renal tubular resorption of calcium are also important factors that induce hypercalcemia in some patients. In addition, alterations in calcium fluxes to and from the extracellular fluid secondary to hypercalcemia are important in maintaining or aggravating the hypercalcemic effects of increased bone resorption. These factors significantly affect the responses to treatment of hypercalcemia with inhibitors of bone resorption. This study examined the relative importance of these factors and the effects of intravenous etidronate disodium (etidronate) in neoplastic bone disease with and without hypercalcemia and in Paget's disease of bone. It is concluded that intravenous etidronate is an effective inhibitor of bone resorption, which accounts in large measure for its effects on serum calcium concentrations. These studies of etidronate in hypercalcemia suggest the response is sustained for several weeks.

Mu opioid receptor efficacy and potency of morphine-6-glucuronide in neonatal guinea pig brainstem membranes: comparison with transfected CHO cells.

The major side effect of morphine and its active metabolite, morphine-6-glucuronide (M6G), is respiratory depression, which is mediated by mu opioid receptors in the medulla and pons. Although the effect of morphine on coupling between mu opioid receptors and G proteins has been studied, the effect of M6G on this coupling has not. Therefore, stimulation of guanylyl-5'-O-([gamma(35)S]-thio)-triphosphate ([(35)S]-GTPgammaS) binding by these two narcotic analgesic drugs was compared to the mu-specific synthetic opioid peptide [D-Ala(2), N-MePhe(4), Gly-ol(5)]enkephalin in Chinese hamster ovarian cells stably transfected with the murine mu opioid receptor and in brainstem membranes prepared from 3-, 7-, and 14-day-old guinea pigs. All three agonists stimulated [(35)S]-GTPgammaS binding in transfected cells and neural tissue, and the stimulation was antagonized by naloxone. In brainstem membranes, but not transfected cells, M6G was less efficacious but more potent than morphine, which may be due to differences between murine and guinea pig mu opioid receptors or in the G proteins in these two tissues. Efficacy of the agonists did not change during development, but overall potency decreased between 3 and 14 days after birth. In vivo potency differences for respiratory depression between morphine and M6G are qualitatively similar to in vitro potency differences of these drugs to stimulate [(35)S]-GTPgammaS binding in neonatal guinea pig brainstem membranes. Tolerance to opioid effects on [(35)S]-GTPgammaS binding developed in transfected cells incubated with morphine with the maximum decrease in potency occurring 18 h later than the maximum decline in efficacy.

The information needs of well, longer-term survivors of breast cancer.

Nine focus groups for well, longer-term survivors of breast cancer were held in Ontario, Canada. Prevalent themes identified through analysis of focus group transcripts fell into two broad categories, one reflecting the context within which women seek information and the other reflecting the content of information desired and sought. Themes related to context included: the ongoing impact on women of their initial disease experience and continued uncertainty about possible recurrence; womens' lack of information and understanding about processes involved in developing medical knowledge; prevailing mistrust about the impact of cost curtailment policies; and, concerns related to how professional communication can aid or hinder the goal of obtaining information. Themes related to content issues included: follow-up protocols, tamoxifen, detecting signs of possible recurrence, prevention for daughters, neglected side effects of treatment, insurance, lifestyle, and unconventional therapies.

Recurrent acute proptosis in atypical systemic lupus erythematosus.

A patient is described who developed acute proptosis, a rare complication of systemic lupus erythematosus, 16 years after the onset of the disease. Treatment with intravenous methylprednisolone produced rapid improvement, but swelling recurred a few days later. Intravenous corticosteroid was again effective and was continued orally without further episodes of proptosis. This patient is unusual in the long period of mild disease before the development of systemic complications, and in having antibodies to nuclear ribonucleoprotein but persistently normal titres of DNA-binding antibodies in her serum.

Women's perspectives regarding the impact of ovarian cancer: implications for nursing.

Ovarian cancer is the fourth leading cause of cancer-related death in women. Ovarian cancer and its treatment have a considerable effect on the quality of life of women diagnosed with the disease. Currently, little is known about the perspectives of women regarding their experiences of living with ovarian cancer or the impact of recurrent disease. This article presents data from a national study of Canadian women living with ovarian cancer and describes the impact of the disease and its treatment. In this study, 93 women had recurrent disease, and 170 had not experienced recurrent disease. Women in both groups were similar, ranging in age from 21 to 61 years. Two-thirds of the women were married, and all were white. A greater proportion of the women with recurrent disease reported bowel problems; fears of dying, pain, getting around; and feelings of self-blame. On the average, women with recurrent disease reported experiencing more problems since diagnosis than those without recurrent disease (p = 0.01). The proportion of women who perceived that they received adequate help for their problems ranged from 20% to 85%. Implications for oncology nurses regarding assessment, referral for assistance, and patient education are apparent from the study findings.

Nurses' perspectives on unconventional therapies.

Unconventional therapies have become increasingly popular with health care consumers in recent years. As patients seek information and attempt to make decisions about unconventional therapies, they often turn to nurses, asking the nurse's opinion about certain therapies. The nurse's attitudes and beliefs about unconventional therapies quite likely will influence the response to the patient's inquiries. This article represents the findings of interviews with 20 nurses regarding their perspectives on unconventional therapies. Without exception, all nurses who were interviewed emphasized that information regarding unconventional therapies needs to be available readily for both patients and health care professionals. Other themes identified in the interviews included the following: Various people use unconventional therapies; people seek unconventional therapies for a variety of reasons; communication about unconventional therapies needs to be open, and a place should be found for unconventional therapies. The interviewees saw a clearly defined role for nurses regarding unconventional therapies.

Oncology nurses' perspectives on unconventional therapies.

Unconventional therapies have become increasingly popular with health care consumers in recent years. As patients seek information and attempt to make decisions about unconventional therapies, they often turn to nurses, asking their opinion about certain therapies. The nurse's attitudes and beliefs about unconventional therapies very likely will influence the response to the patient's inquiries. This work represents the findings of interviews with 48 nurses regarding their perspectives on unconventional therapies. Without exception, all nurses interviewed emphasized the need for information regarding unconventional therapies to be readily available for patients and health care professionals. The other themes identified in the interviews included the following: various people use unconventional therapies; people seek unconventional therapies for a variety of reasons; communication about unconventional therapies needs to be open; and conventional and unconventional practitioners ought to work collaboratively. The participants interviewed saw a clearly defined role for nurses regarding unconventional therapies.

Perspectives on living with ovarian cancer: older women's views.

PURPOSE/OBJECTIVES: To describe the perspectives of older women regarding their experiences living with ovarian cancer. DESIGN: Retrospective survey. SETTING: Canada. SAMPLE: 146 women, 61 years of age or older, diagnosed with ovarian cancer. METHODS: Questionnaire distributed by oncologists and nurses in 26 cancer clinics across Canada to eligible patients during a six-week period. MAIN RESEARCH VARIABLES: Patient problems experienced, help received for problems, impact of illness, quality of life, importance of and satisfaction with information received, and helpfulness of others. FINDINGS: Women experienced, on average, 5.2 problems since diagnosis. The most frequently identified problems were side effects (54%), fear of recurrence (45%), bowel difficulties (43%), and difficulty sleeping (36%). Of the women who experienced problems, the proportion who felt they received adequate help ranged from 36%-74%. Approximately half (57%) of these women reported a lifestyle change. A significant difference was observed in quality of life before and after the diagnosis of ovarian cancer (p = 0.0002). When asked about the desire to talk about their difficulties with cancer, only 54% indicated that they wanted to talk. Approximately one-quarter of the women were satisfied with the information they received regarding complementary (25%) and alternative (23%) therapies, and how to speak with other women living with ovarian cancer (28%). Thirty-five percent were satisfied with the information they received about self-help groups. CONCLUSION: Ovarian cancer has a significant impact on older women, and many perceive they are not receiving adequate assistance for problems they experience. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses should conduct comprehensive assessments of the needs of older women with ovarian cancer, refer those who require specialized counseling, and provide information desired by patients with ovarian cancer about available resources.

Managing the Impact of Illness: The Experiences of Men with Prostate Cancer and their Spouses.

This qualitative study explored issues of support and coping for couples where the man had been diagnosed with prostate cancer. Thirty-four men with prostate cancer and their spouses were interviewed separately at three points in time: prior to surgery; 8 to 10 weeks post-surgery; and 11 to 13 months post-surgery. The core category for the couples' experience with diagnosis and treatment for prostate cancer was Managing the Impact of Illness. Five major domains emerged, including: dealing with the practicalities; stopping illness from interfering with everyday life; keeping relationships working; managing feelings; and making sense of it all. While it was clearly important for couples to manage illness and to reduce its potential intrusion into everyday life, this strategy had psychological costs as well as benefits. Men struggled to stay in control of their emotions and their lives, typically vacillating between the pulls of fierce self-reliance and fearful neediness. Women were constrained from employing their usual strategies of coping and were distressed by the complicated requirements of being supportive while also honoring their partners' need for self-reliance.

Persons with cancer speak out: reflections on an important trend in Canadian health care.

In this paper I have described some of the recent developments in the growth of a patient/survivor movement in Canada. Arguments for the value of increased patient participation include providing a needed balance to the traditional medical perspective, addressing patient needs free from other vested interests, providing insights available only to cancer survivors, and facilitating empowerment. A number of current and potential difficulties related to increasing cancer survivor involvement have been raised, ranging from deliberate opposition from health administrators to disapproval from professionals of survivors' emotional expression to patient unwillingness. The greatest challenge is to move beyond token patient representation to substantive participation.

Heroic self-healing and cancer: clinical issues for the health professions.

Increasingly over the last few decades, persons with cancer are being cured or surviving longer. As a result, the popular press has given more attention to the possibilities for "beating" cancer. The role of personal control in overcoming cancer has been promoted via a heroic formula that includes positive thinking, healing imagery, and personal growth. Empirical support for a psychospiritual influence on cancer illness is tenuous. Nevertheless, the psychological implications of belief in such influence are important in their own right. In this paper, the positive and negative consequences for patients of popular conceptions of the heroic cancer survivor are explored. Clinical and ethical issues related to the health professional's responses to patients' belief in heroic self-healing are discussed, and a rationale is presented for adopting a non-judgmental, person-centered approach.

Empowerment and persons with cancer: politics in cancer medicine.

Persons with cancer are likely to encounter a loss of personal control as a result of their illness experience. An empowerment perspective, which emphasizes the possibility of patients "owning their own lives", is useful for understanding the interpersonal and social dynamics of patients' loss of control and for guiding the development of strategies aimed at maximizing control. Because the factors influencing an individual's sense of control are multi-leveled, optimal empowerment occurs when strategies are employed at several levels of social organization. In this paper, a number of barriers to the empowerment of cancer patients are identified and strategies recommended to enhance patient empowerment in cancer care. The empowerment needs and strategies discussed here include: (a) the provision of optimal care, (b) the enhancement of individual patient power, (c) the development of a strong consumer voice in policy decision-making processes, and (d) societal attitude change.

Interviews with men with prostate cancer about their self-help group experience.

This study reports on the results of semi-structured interviews with 12 men involved in prostate cancer self-help groups in three Canadian cities. Overall, participants reported their group involvement to be helpful, especially in terms of accessing information. Additional benefits included finding commonality with others, being able to talk about difficult issues, being productive and accomplishing tasks, advocating to make a difference, and engaging with family members around health issues. We conclude that the recent growth of self-help groups speaks to the challenge inherent for men in dealing with prostate cancer and counteracts tendencies to minimize the suffering which they experience.

Physician perspectives on unconventional cancer therapies.

The popularity of unconventional therapies has grown dramatically in recent years. This paper reports on the results of a pilot study investigating the perspectives of physicians involved with cancer care regarding their reactions to this trend and their ways of trying to meet associated challenges. Nine oncologists, nine general practitioners, and one surgeon were interviewed over the telephone, employing open-ended questions. The physicians were unanimously interested in having information available about unconventional therapies. They also expressed a desire to be supportive of patient choices in this area, provided conventional therapy was not compromised. However, there was little interest in initiating communication about unconventional therapies, with most seeing such discussions as a poor use of their time. Suggestions for future research, as well as educational and policy strategies, are addressed.