Quality-of-life evaluation in patients receiving treatment for advanced prostate cancer.

PURPOSE/OBJECTIVES: To evaluate the quality-of-life (QOL) experience in patients who are receiving treatment for advanced prostate cancer and the relationship between response to that treatment and QOL. DESIGN: Descriptive comparative study, repeated measures. SETTING: Medical oncology clinic in a comprehensive cancer center. SAMPLE: 33 patients receiving treatment for advanced prostate cancer. METHODS: Patient self-administered questionnaires and chart review. MAIN RESEARCH VARIABLES: Response to therapy and QOL. FINDINGS: No significant differences were seen in patients at the baseline evaluation. Patients who demonstrated response to therapy based on declining prostate specific antigen levels, however, demonstrated a significant increase in their QOL scores compared to those patients who were not responding to treatment. CONCLUSIONS: Although significant differences in survival at this stage of prostate cancer in patients who receive therapeutic treatment versus those who do not have yet to be demonstrated, there appears to be a benefit in QOL for those patients who respond to therapy. IMPLICATIONS FOR NURSING PRACTICE: These data support the use of QOL measurements in patients undergoing treatment for advanced prostate cancer. This information can be used in discussions with patients who are facing treatment decisions and who are concerned about the impact of treatment on their overall QOL. The data also stimulate questions for future research on QOL in this population, such as the difference in QOL in those patients who choose therapeutic treatment versus those who do not.

A new concept in cancer care: the supportive care program.

This article describes the findings of a pilot program designed to enter advanced prostate cancer patients into the hospice benefit while they are still being actively treated, but in situations where treatment is known to be primarily palliative in nature. The supportive care program (SCP) combines the medical model's goal to prolong life with the goal of hospice to palliate symptoms and improve quality of life (QOL). The concept of a SCP was developed to create a team approach where advanced prostate cancer patients who are starting investigational chemotherapy are concurrently enrolled into a hospice program. The objectives were to identify whether SCP improved QOL and continuity of care while remaining cost-effective. Data were collected on patient quality of life, performance status, use of health care resources, and costs for the 36 enrolled patients. A comparison was made to a matched set of 23 control patients. Our findings indicate that the SCP contributes to continuity of care while being cost-effective.

Increased interleukin-1 receptor antagonist in idiopathic pulmonary fibrosis. A compartmental analysis.

Idiopathic pulmonary fibrosis (IPF) is a poorly understood interstitial disease that usually proves refractory to therapy and results in irreversible tissue scarring and pulmonary dysfunction. Previous investigations have suggested a number of possible mediators of inflammation and fibrosis that typify IPF. We report increases in lung interleukin-1 receptor antagonist protein (IRAP) content in patients with IPF, as compared with normal control subjects. Importantly, this increase in IRAP was not accompanied by concomitant increases in interleukin-1 beta (IL-1 beta), resulting in a local environment that may be profibrotic. Tissue homogenates and bronchoalveolar lavage fluid from patients with IPF both demonstrate elevated IRAP content compared with that in normal subjects. Immunohistochemical staining and in situ hybridization localize IRAP to hyperplastic type II pneumocytes, macrophages, and local stromal cells. Finally, in vitro studies utilizing fibroblasts isolated from patients with IPF demonstrated no difference in constitutive IRAP production compared with that in normal subjects, but they revealed an exaggerated response to stimulation with transforming growth factor-beta (TGF-beta). These findings suggest that the fibrotic tissue changes of IPF and possibly other chronic interstitial lung diseases may result in part from the local effects of IRAP, and they also demonstrate that pulmonary nonimmune cells may influence local tissue changes through the elaboration of IRAP.

Dispersed repeats and structural reorganization in subclover chloroplast DNA.

The plastid genome from subclover, Trifolium subterraneum, is unusual in a variety of respects, compared with other land-plant chloroplast DNAs. Gene mapping of subclover chloroplast DNA reveals major structural reorganization of the genome. Ten clusters of genes are rearranged in both order and orientation. Eight large inversions are sufficient to explain this reorganization; however, the actual evolutionary changes may have been more complex. For example, a fine-scale analysis of a set of ribosomal protein genes reveals the occurrence of insertions, deletions, and transpositions. Associated with this unusually unstable genome are two structural features potentially involved in the rearrangements. A dispersed family of repeats, with each element about 1 kb in length, is present in at least six copies. A survey of a wide taxonomic range of species indicates that these elements are unique to the chloroplast DNAs of subclover and two closely related species. Several of the repeated elements are associated with genomic rearrangements, and one repeat is inserted within a normally highly conserved series of genes. This set of dispersed repeats may be the first family of transposable elements found in any organelle genome. In addition, the subclover genome is much larger than those in other closely related legumes, even when one takes into account the presence of the repeated elements. Some of the extra DNA has no sequence similarity to other chloroplast genomes and may represent insertion of DNA from another genome. These unusual features are not found in the structurally stable chloroplast genomes of other vascular plants and may, therefore, be implicated in the rapid and major reorganization of the chloroplast DNA in subclover.