RESUMEN
AIM: To study the effects of menopausal hormone therapy (HT) on health-related quality of life in women after breast cancer. PATIENTS AND METHODS: In the Stockholm trial, breast cancer survivors were randomized to HT (estradiol and progestogen) or to a control group (no treatment). A subgroup of 75 women was studied (38 with HT, 37 controls). Fifty patients were on concomitant tamoxifen. Patients completed three questionnaires (EORTC QLQ C-30, EORTC QLQ-BR 23 and the Hospital Anxiety and Depression Scale (HADS)) during 1 year of treatment. RESULTS: A significant group-by-time interaction was found for improvement of insomnia in the HT group (p < 0.001). Within the HT group, but not in the control group, there was significant improvement for HADS anxiety, HADS depression, emotional, cognitive, and social functions and global quality of life. When HT was added to tamoxifen, the increase in global quality of life was significant (p < 0.01). CONCLUSION: The effects of HT on quality of life in breast cancer survivors have not previously been reported. The present data suggest that this controversial treatment may improve quality of life after breast cancer.
Asunto(s)
Neoplasias de la Mama/psicología , Terapia de Reemplazo de Hormonas , Calidad de Vida , Adulto , Anciano , Ansiedad/tratamiento farmacológico , Neoplasias de la Mama/terapia , Cognición , Depresión/tratamiento farmacológico , Fatiga/tratamiento farmacológico , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéutico , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Encuestas y Cuestionarios , Suecia , Tamoxifeno/uso terapéuticoRESUMEN
Objectives To investigate the attitudes of breast cancer patients who accepted or declined participation in a randomized trial with hormone replacement therapy that might increase their risk of recurrence (the Stockholm trial). Methods A total of 115 patients free from breast cancer recurrence were interviewed; 57 were participants and 58 were non-participants in the Stockholm trial. Patients answered five questionnaires regarding information needs (two), attitudes to participation in trials (two) and patient role in treatment decisions (one). Results Participants in the Stockholm trial had a lower risk of breast cancer recurrence (measured by node-positive disease and tumor size) and were older than non-participants. Their information needs were the same. Participants in the trial were more prepared to accept uncertainty, to have an altruistic attitude, to accept risks including an increased risk of recurrence of breast cancer, if their quality of life or general health was improved. Most patients preferred a collaborative role in relation to their physician but participants often wanted more influence than they had in treatment decisions. Conclusion A patient's decision to accept or decline participation in the Stockholm trial was influenced by her objective risk of breast cancer recurrence and reflected her attitude to risk, uncertainty and preference to be active in treatment decisions.
Asunto(s)
Actitud Frente a la Salud , Neoplasias de la Mama , Terapia de Reemplazo de Estrógeno/psicología , Recurrencia Local de Neoplasia , Prioridad del Paciente , Posmenopausia , Anciano , Neoplasias de la Mama/terapia , Terapia de Reemplazo de Estrógeno/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/inducido químicamente , Investigación , Factores de Riesgo , Encuestas y Cuestionarios , SueciaRESUMEN
AIM: To compare the effects of tamoxifen and megestrol acetate on liver proteins, androgens, and glucocorticoids during adjuvant treatment for postmenopausal breast cancer. METHODS: A subgroup of women within a large prospective multicenter trial were followed with blood sampling every 3 mo during 2 yr. Women were randomized to receive either continuous tamoxifen 40 mg/d or repeated sequential treatment with tamoxifen and megestrol acetate (MA) 160 mg/d. RESULTS: We found profound and distinct differences between the two regimens. Tamoxifen increased steroid-binding proteins (SHBG and CBG) and suppressed circulating androgens and IGF-I. In contrast, the metabolic effects of tamoxifen were clearly antagonized by MA. There was a rise in IGF-I and marked suppression of steroid-binding proteins. Levels of free testosterone were reduced by 70%. MA also caused apparent adrenal suppression. CONCLUSION: The different effects on anabolic/catabolic balance and adrenal function may relate to certain clinical effects during treatment.
Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Acetato de Megestrol/uso terapéutico , Tamoxifeno/uso terapéutico , Anciano , Antineoplásicos Hormonales/administración & dosificación , Antineoplásicos Hormonales/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/patología , Quimioterapia Adyuvante , Femenino , Humanos , Factor I del Crecimiento Similar a la Insulina/análisis , Acetato de Megestrol/administración & dosificación , Acetato de Megestrol/efectos adversos , Persona de Mediana Edad , Posmenopausia , Estudios Prospectivos , Globulina de Unión a Hormona Sexual/análisis , Tamoxifeno/administración & dosificación , Tamoxifeno/efectos adversos , Testosterona/sangreAsunto(s)
Proteínas Portadoras/genética , Proteínas de Ciclo Celular , Deleción Cromosómica , Cromosomas Humanos Par 9/ultraestructura , Eliminación de Gen , Factores Inmunológicos/uso terapéutico , Interferón-alfa/uso terapéutico , Proteínas de Neoplasias/genética , Células Madre Neoplásicas/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Proteínas Supresoras de Tumor , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cromosomas Humanos Par 9/genética , Inhibidor p15 de las Quinasas Dependientes de la Ciclina , Inhibidor p16 de la Quinasa Dependiente de Ciclina , Ciclofosfamida/administración & dosificación , Citarabina/administración & dosificación , Daunorrubicina/administración & dosificación , Dexametasona/administración & dosificación , Doxorrubicina/administración & dosificación , Resistencia a Antineoplásicos , Etopósido/administración & dosificación , Resultado Fatal , Humanos , Masculino , Proteínas de Neoplasias/deficiencia , Reacción en Cadena de la Polimerasa , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Prednisona/administración & dosificación , ARN Mensajero/genética , ARN Neoplásico/genética , Terapia Recuperativa , Vincristina/administración & dosificaciónAsunto(s)
Dermatosis del Pie/diagnóstico , Dermatosis de la Mano/diagnóstico , Melanoma/diagnóstico , Onicomicosis/diagnóstico , Neoplasias Cutáneas/diagnóstico , Adulto , Anciano , Diagnóstico Diferencial , Errores Diagnósticos , Humanos , Masculino , Melanoma/patología , Melanoma/terapia , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapiaRESUMEN
Patient participation in treatment decisions presupposes well-informed patients. The purpose of this study was to determine Swedish breast cancer patients' information needs and their preferences for participation in treatment decisions. Patients (n = 201) were interviewed on nine categories of information and five patient roles, using paired comparisons. Patients gave priority to facts about disease and treatment (chances of cure, stage of disease, treatment options). A collaborative role in treatment decisions was preferred by 87% of the patients. Most patients (56%) preferred a passive form of collaboration: I prefer that my doctor makes the final decision about my treatment but seriously considers my opinion. Younger and better educated patients tended to prefer a more active role. Many patients wanted to be more active (20%) and some more passive (8%) than they actually were. Patients gave priority to disease-specific information, but this reflected needs other than taking control of treatment decisions.