Hormone replacement therapy after breast cancer: attitudes of women eligible in a randomized trial.

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.

Effect of endocrine treatment on sexuality in premenopausal breast cancer patients: a prospective randomized study.

PURPOSE: To study the sexual effects of the 2-year adjuvant goserelin (Zoladex [Zeneca AB, Södertälje, Sweden]) alone, tamoxifen alone, and Zoladex and tamoxifen in combination (ZT) versus no adjuvant endocrine therapy among premenopausal breast cancer patients with or without chemotherapy in a controlled clinical trial (a European multicenter trial: Zoladex in Premenopausal Breast Cancer Patients). PATIENTS AND METHODS: This prospective study examined several aspects of sexuality through the use of self-administered questionnaires, which were completed by patients at seven points of assessment for 3 years after randomization. RESULTS: Patients treated with chemotherapy had a higher level of sexual dysfunction than did patients who received no systemic treatment. The addition of endocrine treatment did not alter this result. In contrast, among patients who did not receive chemotherapy, Zoladex and ZT produced a significantly higher level of dysfunction from 1 to 2 years after inclusion, as compared with those who received no endocrine treatment. Tamoxifen alone did not produce side effects. After termination of endocrine treatment, sexual dysfunction began to diminish. Those with chemotherapy had high and frequently increasing levels of dysfunction even after 2 to 3 years of independent of endocrine treatment. Zoladex had a negative effect on sexual fear, which was reduced by the addition of tamoxifen. CONCLUSION: Zoladex increased sexual dysfunction during treatment among patients without chemotherapy, but the disturbances of sexual functioning were reversible. The use of adjuvant chemotherapy was associated with continued sexual problems, even at 3 years after randomization.

One-year follow-up of the 'Starting Again' group rehabilitation programme for cancer patients.

In a randomised prospective study, a brief structured rehabilitation programme, 'Starting Again', was evaluated over a follow-up year. 98 patients were assigned to the programme, and 101 to the control condition. The 11, 2-h sessions emphasised physical training, information and coping skills. Patients in the programme improved significantly more than the controls with respect to appraisal of having received sufficient information, physical training, physical strength and fighting spirit. Results indicate improvement with respect to the three areas focused on in the 'Starting Again' programme: physical training, information and coping skills training.

Lack of correlation between anxiety parameters and oestrogen receptor status in early breast cancer.

Correlation between anxiety parameters and oestrogen receptor levels (ER) were investigated in 89 patients with primary breast cancer. Patients were divided into two groups, ER poor (< 0.05 fmol/microgram DNA) and ER rich (> 0.05 fmol/microgram DNA). No differences were found between anxiety levels, determined by a modified Hospital Anxiety and Depression (HAD) scale, in the two groups. This report does not support the findings from other studies, claiming an association between psychological parameters and oestrogen receptor status, which is believed to be a prognostic predictor.

Psychological effects of participation in a prevention programme for individuals with increased risk for malignant melanoma.

The Swedish Melanoma Study Group runs a programme aimed at prevention and early detection of premalignant and malignant melanoma in families with two or more members having malignant melanoma. Psychological consequences of participation in this programme were studied. A questionnaire containing items concerning cognitive and emotional responses to the programme was completed by 115 consecutive individuals at their first visit to the clinic. The same questionnaire was administered by mail 7 months later. The levels of psychological and psychosomatic problems were relatively low at both points of assessment. No negative psychological effects were found, neither in the group with dysplastic naevus syndrome (DNS) with increased risk for malignant melanoma, nor in the group without dysplastic naevi. Only one variable, "emotional responses to the visit" differentiated between the groups, with higher scores in the group without DNS. A majority of the individuals expressed positive attitudes to the clinic.

Psychological reactions in public melanoma screening.

Participants in public screening for malignant melanoma (n = 190) completed a questionnaire containing items regarding cognitive and emotional responses to skin examination on two occasions, before screening and 7 months later. The results suggest subjective susceptibility to melanoma in participants in public screening, especially in women. No increase in psychosomatic problems, anxiety or depressive symptoms or signs of "false security" were seen as an effect of the screening, neither in the total sample nor in those who at the screening were recommended further medical procedures.

Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients.

Late effects of adjuvant treatment on perceived health and quality of life were assessed through a questionnaire mailed to 448 premenopausal and postmenopausal breast cancer patients, free from recurrence 2-10 years after primary therapy. The patients had been randomised to postoperative radiotherapy or adjuvant chemotherapy as adjuncts to primary surgery. The differences between the two treatments were generally small. However, the radiotherapy patients had significantly greater problems with decreased stamina, symptoms related to the operation scar and anxiety. The chemotherapy patients had significantly more problems with smell aversion. Activity level inside and outside the home, anxiousness and depressive symptoms were similar in both groups. The chemotherapy patients scored their overall quality of life higher than the radiotherapy patients.

Increased suicide rate in cancer patients. A cohort study based on the Swedish Cancer-Environment Register.

Using the Swedish Cancer-Environment Register, 424,127 cancer patients were followed in the national cause-of-death register with the aim of analyzing the suicide rate among cancer patients compared with the general population. The overall Standardized Mortality Ratio (SMR) in suicide was 1.9 (95% confidence interval 1.8-2.1) for males and 1.6 (1.5-1.8) for females. The suicide rate was highest during the first year after cancer diagnosis, with an SMR of 16.0 (13.5-18.9) in males and 15.4 (11.2-20.6) in females. There were no substantial differences in suicide rate between different sites of tumor, although higher suicide rates were observed in patients with cancer in the lungs and upper airways (both sexes) and with gastro-intestinal tumors (males). Our results corroborate previous findings of an increased suicide rate among cancer patients, and indicate a need for further attention to social and psychological aspects of the care and treatment of cancer patients.

Information to patients with malignant melanoma: a randomized group study.

An information programme for patients with cutaneous malignant melanoma, Stage 1, aiming at increasing satisfaction with information, was carried out at the Department of Oncology (Radiumhemmet). The programme consisted of a group meeting and a brochure. A total of 231 consecutive patients were included, and 149 (65%) reported interest in participation and were randomized to the Information group (n = 77) or to the Control group. A total of 67 patients (29%) were not interested (the NI-group). To evaluate the programme, the patients in the three groups completed questionnaires regarding satisfaction with information, knowledge of melanoma and psychological and psychosomatic variables before randomization and at the first visit for follow-up at Radiumhemmet. After the information programme, the Information group was significantly more satisfied with information, had a higher level of knowledge and a lower proportion requested further information as compared with the Control group. No differences were found on the psychological and psychosomatic variables.

Influence of gene 55 on the regulation of synthesis of some early enzymes in bacteriophage T4-infected escherichia coli.

In Escherichia coli B infected with phage T4 with mutations in gene 55 the shut-off of synthesis of two early enzymes was found to be delayed 10 to 15 min as compared to wild-type T4 infection. The kinetics of early enzyme formation was very similar to that obtained after DNA-negative mutant infection. The transcription of gene 1 (one of the genes coded for early enzymes) ceased at 9 to 12 min after infection whether the gene 55 product was active or not, as determined by the time dependence of fluorouracil rescuability of DNA synthesis in cells infected with a gene 1 amber mutant. The synthesis of the major part of the early RNA species, determined by pulse-labeling with uracil-5-(3)H, was furthermore found to be regulated independently of gene 55. An explanation for the extended early enzyme synthesis in DNA-negative and gene 55 mutant infection is offered: translation of early messengers is restricted after about 12 min in wild-type infection, whereas in cells infected with DNA-negative or gene 55 mutants, i.e., the absence of late protein synthesis, early messengers direct the formation of early enzymes for a longer time.

Suicides and suicide attempts in cancer patients.

Suicides and suicide attempts in cancer patients were analysed by following all patients treated for cancer in Stockholm County from 1975 to 1985. Among 59,845 patients we identified 144 suicides and 196 suicide attempts during the follow-up, which represents a more than two-fold excess mortality from suicide and a moderately increased rate of suicide attempts. Although the absolute number of deaths from suicide in cancer patients is low, the increased risk highlights the problems of coping with severe illness and the need for psychological and social support in cancer care.

Regulation of early mRNA synthesis in bacteriophage T4-infected bacteria: dependence on bacteriophage-specific protein synthesis.

The mechanism of the transcriptional turn-off was studied for those species of mRNA in T4 infection which specify early phage proteins. Total synthesis of these early RNA species was determined by short-time labeling with uracil-5-(3)H after the infection of Escherichia coli B with DNA-negative, conditional lethal mutants, which produce no late mRNA under nonpermissive conditions. With both amber and temperature-sensitive mutants a decrease in incorporation into early RNA by more than 90% was observed within 15 min after infection. Analysis by thin-layer chromatography showed uracil-5-(3)H to enter nucleotide pools throughout the infection cycle. The observed decrease in early RNA synthesis was dependent on protein synthesis, since it could be prevented by chloramphenicol. By varying the time of chloramphenicol addition, the effect of this regulatory protein(s) was found to appear at 3 to 4 min and reached its full extent at 10 to 15 min after infection. The turn-off of transcription of a defined early gene was studied by 5-fluorouracil (FU) rescue of an early, DNA-negative, amber mutant (gene 1, deoxynucleotide kinase) at different times after infection. DNA synthesis could be rescued by FU addition early after infection, but not after 12 min. 5-fluorouracil was efficiently taken up into the nucleotide pools also at late times, as shown by thin-layer chromatography. After incubation in the presence of chloramphenicol from 3 min after infection, DNA synthesis could be rescued as late as 45 min after infection. Thus, when protein synthesis was blocked during the early period of infection, the shut-off of transcription of the studied early gene was prevented.

Transforming the exhausting to energizing process of being a good parent in the face of cancer.

The aim in this study was to gain a deeper understanding of the interaction between women who have been treated for breast cancer and their children. The focus was on how they deal with being a mother at the same time attending to their own needs. The main strategies of the grounded theory method were used to conceptualize the interactive process involved. Nine women, with children aged 4 to 23, living at home at the time of diagnosis, were interviewed. By the process of constant comparative analysis, the main theme that seemed to capture how the lives of these women had changed was transforming the exhausting-to-energizing process in being a good parent in the face of cancer. This theme is related to Meleis's concept of health-illness transition. The findings here indicate the need for family counseling, with special attention paid to the single parent with cancer.

Multiple chronic health problems are negatively associated with health related quality of life (HRQoL) irrespective of age.

PURPOSE: To examine HRQoL measured by EORTC QLQ-C30 with respect to an increasing number of self-reported chronic health problems in the general Swedish population and to study the association between HRQoL, chronic health problems and age, gender, income, marital status and employment status. METHOD: A postal survey among a large random sample of 4000 adults aged 18-79 years. The study material contained EORTC QLQ-C30 core questionnaire supplemented by a sociodemographic questionnaire including questions about 13 chronic health problems of which four categories, 'No', 'Few', 'Some' or 'A lot of chronic health problems were constructed. RESULTS: Multiple chronic health problems were significantly associated with reduced HRQoL. The increased number of chronic health problems was also associated with age. When the number of chronic health problems was accounted for, the influence of age diminished. Low income and unemployment were associated with greater decline in HRQoL with respect to increasing number of problems among the respondents in working age. CONCLUSION: The impact of increased number of chronic health problems had varying consequences in different age groups. Moreover, sociodemographic and economic factors showed to interact differently with chronic health problems and HRQoL in various age groups. It appears from our results that an assessment and a careful consideration of these factors will be valuable in order to facilitate the interpretation of the effects of cancer and treatment on long-term HRQoL of cancer patients.