Palliative chemotherapy with trofosfamide in advanced prostate cancer.

BACKGROUND: A phase II study with trofosfamide in hormone-refractory prostate cancer was conducted to test the palliative efficacy. PATIENTS AND METHODS: Twenty patients suffering from advanced prostate cancer were treated with per os trofosfamide after progression on androgen ablation and/or estramustine. The mean age was 72 years. The patients were treated with 150 mg/day as continuous treatment. The treatment was continued until progressive disease or severe toxicity. RESULTS: A decline in the prostate specific antigen (PSA) level was observed in 5 patients (27%) with a 0-25% decline in 2 patients and a >50% decline in 3 patients (16%, 95% confidence interval 3.4-39.6). There were no clinical or radiological complete (CR) or partial (PR) responses in 19 evaluable patients. Some toxicity was observed: 15 patients developed anaemia and grade 2-4 adverse effects were observed in 16 patients. One patient died of cardiac event. CONCLUSION: Trofosfamide has some activity in hormone-refractory advanced prostate cancer. When used in fragile or heavily pre-treated patients, careful monitoring for haematological and cardiac effects is recommended.

Survival markers related to bone metastases in prostate cancer.

Prognostic value of a bone resorption marker, tartrate-resistant acid phosphatase isoform 5b (TRACP 5b), and two matrix metalloproteinases (MMP-2 and MMP-9) was compared with the standard clinical analyses of total alkaline phosphatase (tALP) and prostate-specific antigen (PSA), in prostate cancer (PC) patients with (BM+) or without (BM-) bone metastases. Diagnostic accuracy evaluation showed the highest area under the curve for tALP (AUC=0.98), followed by PSA (AUC=0.87), TRACP 5b (AUC=0.82), MMP-9 (AUC=0.62) and MMP-2 (AUC=0.53). Significantly shorter survival was observed for patients with tALP (p<0.001), TRACP 5b (p=0.002) and PSA (p<0.001) levels, above the determined cut-off values compared with lower marker levels. In multivariate Cox regression analysis, only tALP and PSA, in addition to Gleason score were independent prognostic factors for survival. Of the three novel markers tested, only TRACP 5b proved to be predictive of survival in PC with bone metastases. MMP-2 and -9 are thus not recommended for further studies in this context.

Xylitol vs glucose: effect on the rate of gastric emptying and motilin, insulin, and gastric inhibitory polypeptide release.

The effect of xylitol and glucose on the rate of gastric emptying and intestinal transit and on motilin, gastric inhibitory polypeptide (GIP), and insulin release were studied in human volunteers. A single oral dose of 200 mL water containing 30 g glucose or 30 g xylitol, mixed with a 99mtechnetium-tin (99mTc-Sn) colloid, was used. Similar dosing without the label was used in motilin, GIP, and insulin studies. Xylitol decreased the rate of gastric emptying but concomitantly accelerated intestinal transit compared with glucose. The half-times for gastric emptying were 77.5 +/- 4.6 and 39.8 +/- 3.4 min after ingestion of xylitol and glucose solutions, respectively. Glucose suppressed motilin and stimulated GIP secretion; xylitol stimulated motilin secretion but had no effect on GIP, which is currently the main candidate for the role of enterogastrone. The accelerated intestinal transit and increase in plasma motilin observed after xylitol ingestion were thought to be causally related to the diarrhea and gastrointestinal discomfort produced by it.

The outcome of > or = 70-year-old non-Hodgkin's lymphoma patients.

PURPOSE: The outcome of treatment of 98 over 70-year-old patients with nonHodgkin's lymphoma (NHL) is presented. METHODS AND MATERIALS: Analysis of treatment outcome of non-Hodgkin's lymphoma patients age 70 years and more was carried through with special emphasis on fatal complications occurring during treatment. Study patients mainly represented intermediate or high degree of malignancy. RESULTS: Complete response rate (CR) was 54% after combination chemotherapy, 22% after single agent chemotherapy, and 56% after radiotherapy (used for local disease). The overall 5-year survival was 38% for all patients and 57% for CR patients. Stage had a significant effect on both the complete response rate and survival. Survival was also significantly influenced by the malignancy grade. Fifteen patients (15%) died during treatment, many of them had another predisposing disease and markers of poor prognosis. CONCLUSION: The evaluation of individual prognostic features of each old patient should be completed prior to treatment planning.

Does breast cancer change patients' dietary habits?

PURPOSE: The results of epidemiological studies on diet and cancer are often difficult to interpret on an individual level and may influence patients' beliefs, attitudes and behaviour. This study investigated the behaviour of breast cancer patients and their attitudes to dietary changes and the need of dietary advice during their disease. PATIENTS AND METHODS: The study population consisted of breast cancer patients visiting the Department of Oncology in Turku University Hospital for treatment or follow-up in August and September 1999. A questionnaire was given to a total of 123 subjects. RESULTS: The majority, 65%, were attending the clinic for treatment, 35% for follow-up. Ninety-seven patients (86%) consumed a normal Finnish diet, six (5.3%) were vegetarians and 10 (8.1%) vegetarians consuming fish and chicken occasionally. Eleven patients (8.9%) considered diet a factor contributing to their breast cancer and 38 (31.9%) had changed their dietary habits after the diagnosis of breast cancer. The numbers were higher in younger patients with higher educational background. The main reason for change in diet was the desire to be cured of cancer (52.9% of those patients who had changed their dietary habits), in 11.8% to alleviate the symptoms of nausea and 11.8% were advised by health care professionals. The main changes reported included a reduction in the consumption of animal fat, sugar and red meat and increased consumption of fruit, berries and vegetables. Forty-nine patients (39.8%) used vitamin and mineral supplements and 27 (21.9%) consumed dietary supplements including natural products and probiotics. The source of information on how to change the diet was for 33.3% the mass media, 19.4% were advised by doctors and nurses and 11.1% by dietitians. One-third of the patients expressed a need for more information on dietary factors. CONCLUSION: Breast cancer patients' need of control over their own life prompts an interest in alternative dietary habits after diagnosis, the focus being on a healthier diet. Expert dietary information is considered important. Many patients mentioned a lack of precise dietary recommendations for their individual disease situation and depended on information from outside their treatment centre.

Short-term effects of radiotherapy on attention and memory performances in patients with brain tumors.

BACKGROUND: The objective of the current study was to evaluate the short-term effects of radiotherapy on attention and memory performance in patients with brain tumors. METHODS: Thirteen patients underwent a neuropsychologic examination on three occasions: at baseline before radiotherapy, which lasted for 6 weeks; within 2 weeks after the completion of radiotherapy; and 3 months after the completion of radiotherapy. Thirty healthy individuals were studied at baseline as a control group. Verbal, visuomotor, and memory tests were administered. Attentional performances were examined using CogniSpeed reaction time software. RESULTS: At baseline, the patients scored significantly lower than the controls in tests of semantic memory (Similarities; P = 0.002), visuoconstructive skill (Block Design; P = 0.028), and visual and verbal memory (recall of 20 objects: immediate, P = 0.017; delayed, P = 0.002; recall of 30 paired word associates: immediate, P = 0.002; delayed, P = 0.005). The patients performed significantly more poorly than the control group on the Two-Choice Reaction Time test (P = 0.047), the Subtraction test (P = 0.042), and the Vigilance test (P = 0.023). After radiotherapy, the performance of the patients did not worsen on any measure, whereas their conscious cognitive processing was improved (P = 0.002). CONCLUSIONS: Treatment with radiotherapy did not cause negative short-term effects on attentional and memory functions in patients with brain tumors who received a radiation dose of 54.5 grays. The cognitive deficits found in these patients were evident at baseline before radiotherapy. Thus, it seems likely that the deficits were associated with the tumor itself and/or the surgical procedures.

Clinical judgement and information seeking by nurses and physicians working with cancer patients.

This study examined and compared the processes of information collection and clinical judgement by nurses (n=107) and physicians (n=27) working with cancer patients. The data was collected in two university hospitals by means of a computer-simulated case description and the thinking-aloud method. Data interpretation was based on SPSS statistical software and the method of content analysis. Statistical differences between the two groups were tested with non-parametric Kruskal-Wallis Anova or the Mann-Whitney U-test. The Wilcoxon test was applied in pairwise comparisons. Independent questions were analysed by cross-tabulation and Pearson's chi(2). According to the results nurses and physicians apply different approaches to clinical judgement and problem-solving. On the basis of the status statement they received in the program both groups pointed to similar problems and sought a great deal of additional information. However the type of information required was different in the two groups. There were also significant differences in the knowledge base applied for purposes of clinical judgement: nurses tended to rely on personal knowledge, physicians on theory. Physicians were able to identify their patient's major clinical problems, but nurses had more difficulty doing this. On the other hand, nurses took a broader view on the general well-being of patients than physicians did.

Impairment of heart rate variability during paclitaxel therapy.

BACKGROUND: Paclitaxel, which has been reported to be effective in treating metastatic breast carcinoma and advanced ovarian carcinoma, has been associated with cardiac side effects. Therefore, the effect of paclitaxel on cardiovascular autonomic regulation was studied. METHODS: Twenty-four-hour ambulatory electrocardiogram measurements were recorded twice from 14 women with breast or ovarian carcinoma: once before paclitaxel treatment and once on the day after the second chemotherapy course. Heart rate variability (HRV) was assessed with spectral analysis. For the frequency domain analysis, HRV was assessed in the very low (0.005-0.040 hertz [Hz]), low (0.040-0.150 Hz), and high frequency (0.150-0.400 Hz) spectral components. RESULTS: The ratio between low frequency and high frequency HRV decreased (daytime values of 2.7% [standard deviation (SD) 1.6] vs. 1.7% [SD 0.91; P = 0.0098) after 2 courses of paclitaxel. The circadian fluctuation of HRV also decreased in all studied frequency components. CONCLUSIONS: The observed changes in spectral characteristics suggest that autonomic modulation of the heart rate is impaired after paclitaxel therapy. However, from these data it is not clear whether the observed changes are permanent or whether autonomic cardiac function returns to normal some time after treatment. Further studies are needed to examine whether these indices based on HRV can be used to detect those patients at risk for cardiac side effects during chemotherapy.