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1.
Support Care Cancer ; 26(2): 643-650, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28921241

RESUMO

BACKGROUND: Women with estrogen deficiencies can suffer from vaginal symptoms that negatively impact sexual health. This study evaluated vaginal dehydroepiandrosterone (DHEA) for alleviation of vaginal symptoms. METHODS: This three-arm randomized, controlled trial evaluated DHEA 3.25 mg and DHEA 6.5 mg, each compared to a plain moisturizer (PM) over 12 weeks, to improve the severity of vaginal dryness or dyspareunia, measured with an ordinal scale, and overall sexual health using the Female Sexual Function Index (FSFI). Postmenopausal women with a history of breast or gynecologic cancer who had completed primary treatment, had no evidence of disease, and reported at least moderate vaginal symptoms were eligible. The mean change from baseline to week 12 in the severity of vaginal dryness or dyspareunia for each DHEA dose was compared to PM and analyzed by two independent t tests using a Bonferroni correction. RESULTS: Four hundred sixty-four women were randomized. All arms reported improvement in either dryness or dyspareunia. Neither DHEA dose was statistically significantly different from PM at 12 weeks (6.25 mg, p = .08; 3.25 mg, p = 0.48), although a significant difference at 8 weeks for 6.5 mg DHEA was observed (p = 0.005). Women on the 6.5 mg arm of DHEA reported significantly better sexual health on the FSFI (p < 0.001). There were no significant differences in provider-graded toxicities and few significant differences in self-reported side effects. CONCLUSION: PM and DHEA improved vaginal symptoms at 12 weeks. However, vaginal DHEA, 6.5 mg, significantly improved sexual health. Vaginal DHEA warrants further investigation in women with a history of cancer.


Assuntos
Desidroepiandrosterona/uso terapêutico , Doenças Vaginais/tratamento farmacológico , Administração Intravaginal , Sobreviventes de Câncer , Desidroepiandrosterona/farmacologia , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa
2.
Clin Lymphoma Myeloma ; 6(2): 140-2, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16231853

RESUMO

Primary bone lymphoma is rare. The majority of cases are diffuse large B-cell non-Hodgkin's lymphomas. Classification, staging, and treatment are controversial. The relatively small number of cases has led to many case reports and series describing institutional experiences but precludes the use of randomized clinical trials to address the question of optimal management. This article will review clinical and radiologic presentations, diagnostic techniques, and histologic characteristics. Most important, it will present what limited information we do have regarding effective treatment options for this unusual type of lymphoma.


Assuntos
Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/patologia , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/patologia , Neoplasias Femorais/terapia , Humanos , Linfoma não Hodgkin/terapia , Radiografia , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
J Psychosom Res ; 55(5): 445-51, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14581099

RESUMO

OBJECTIVE: The purpose of this study was to (1) assess the quality of life (QOL) of the primary caregivers of hospice patients and (2) to analyze the ability of the hospice staff to accurately judge caregiver QOL. METHODS: A longitudinal pilot study of QOL of caregivers of patients entering hospice was undertaken. Caregivers and hospice personnel completed numerous questionnaires every 2 weeks until patient death. Global QOL and component constructs, as well as the demands of illness on the caregiver and profile of moods, were assessed. Simple descriptive statistics at each time point and summary measures (area under the curve) were calculated to describe the QOL profile of caregivers and staff perceptions of the caregivers. Cronbach's alpha coefficient was applied to verify tool internal consistency in a hospice population. Correlation coefficients were supplemented by Bland-Altman procedures for comparing scales measuring the same construct to compare the scores given by caregivers about themselves and staff ratings of the caregivers. The study had 80% power to detect an intracase difference between caregiver and staff ratings of the caregiver of 0.4 times the standard deviation using a two-sided paired t test with a 5% type I error rate. RESULTS: Caregiver QOL was relatively high and stable over time. Caregiver's QOL was correlated with the patient's overall QOL/hospice staff accurately evaluated caregiver QOL. CONCLUSIONS: By drawing attention to issues that affect the caregiver, we can improve delivery of hospice care and positively impact QOL for both caregiver and patient. Linear analog self-assessment scales are valuable tools for hospice staff to assess caregivers.


Assuntos
Cuidadores/psicologia , Cuidados Paliativos na Terminalidade da Vida/psicologia , Qualidade de Vida , Análise por Conglomerados , Feminino , Humanos , Estudos Longitudinais , Masculino , Minnesota , Projetos Piloto , Autoavaliação (Psicologia)
4.
J Support Oncol ; 2(4): 323-34; discussion 334-7, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15357517

RESUMO

Malignant bowel obstruction is the cause of death in the majority of women who die of ovarian cancer. Some patients are considered acceptable surgical candidates for relief of the obstruction. For many patients, however, lack of such surgical options has spawned a broad range of medical interventions, including palliative strategies to target pain and nausea and vomiting. This review discusses the general approach to patients with ovarian cancer and inoperable malignant bowel obstruction, with an emphasis on such palliative strategies.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Neoplasias Intestinais/complicações , Obstrução Intestinal/fisiopatologia , Obstrução Intestinal/terapia , Neoplasias Ovarianas/patologia , Cuidados Paliativos , Corticosteroides/uso terapêutico , Analgésicos Opioides/uso terapêutico , Antieméticos/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Feminino , Fármacos Gastrointestinais/uso terapêutico , Humanos , Neoplasias Intestinais/secundário , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/tratamento farmacológico , Octreotida/uso terapêutico , Cuidados Paliativos/métodos , Prognóstico , Stents , Estados Unidos/epidemiologia
6.
Cancer ; 112(8): 1805-11, 2008 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-18300237

RESUMO

BACKGROUND: Embryonal central nervous system (CNS) tumors (medulloblastoma, cerebral neuroblastoma, pineoblastoma, and primitive neuroectodermal tumors) are rare in adults. Recurrent disease has an extremely poor outcome. The use of high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) has demonstrated promising results in children with recurrent disease, but there are only limited data regarding its role in adults. The purpose of the current study was to evaluate adult patients with embryonal CNS tumors who were treated with HDC with ASCT and compare their outcomes with those of patients who received conventional-dose chemotherapy. METHODS: The authors reviewed the medical records of 23 adult patients (age >or= 18 years) who were treated at the Mayo Clinic for recurrent embryonal CNS tumors between 1976 and 2004. The authors compared treatment with HDC with ASCT (10 patients) with an historic control of patients treated with conventional-dose chemotherapy (nitrosourea based, cisplatin based, or both) (13 patients). RESULTS: HDC with ASCT was associated with increased survival (P= .044) and a longer time to disease progression (TTP) (P= .028). The conventional-dose chemotherapy group had a median TTP of 0.58 years and a median survival of 2.00 years. The HDC with ASCT group had a median TTP of 1.25 years and a median survival of 3.47 years. When restricted to patients receiving ASCT after first disease recurrence, the median TTP was 2.5 years and the median survival was 4.16 years. Toxicities were similar in both groups. CONCLUSIONS: Improvements in the median TTP and survival noted with the administration of HDC with ASCT, as well as the acceptable toxicity of this regimen, supports consideration of its use in adults with recurrent embryonal CNS tumors.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Meduloblastoma/tratamento farmacológico , Terapia Neoadjuvante , Recidiva Local de Neoplasia/tratamento farmacológico , Transplante de Células-Tronco/métodos , Adulto , Antineoplásicos/administração & dosagem , Antineoplásicos Alquilantes/administração & dosagem , Antineoplásicos Fitogênicos/administração & dosagem , Carmustina/administração & dosagem , Cisplatino/administração & dosagem , Estudos de Coortes , Progressão da Doença , Etoposídeo/administração & dosagem , Feminino , Seguimentos , Humanos , Lomustina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Procarbazina/administração & dosagem , Estudos Retrospectivos , Taxa de Sobrevida , Tiotepa/administração & dosagem , Transplante Autólogo
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