Quality of life in breast cancer survivors: implications for developing support services.

PURPOSE/OBJECTIVES: Quality of life (QOL) is becoming more important in regard to breast cancer as treatment advances extend the period of survivorship. The purpose of this article is to share the results of a cancer center's attempt to evaluate the QOL needs of breast cancer survivors in order to provide improved supportive-care services. DESIGN: Descriptive mailed survey. SETTING: A medical center in southern California. SAMPLE: A random sample of breast cancer survivors (N = 298). METHODS: Breast cancer survivors completed a mailed survey that included major outcome variables of QOL and pain. Subjects were stratified by three age groups: younger than 40 years, 40-60 years, and older than 60 years. MAIN RESEARCH VARIABLES: QOL subscales (physical, psychological, social, and spiritual well-being) and overall QOL score and pain as assessed by the Brief Pain Inventory. FINDINGS: Results indicated continued physical demands of breast cancer, including fatigue and pain, as well as psychological burdens related to fear of breast cancer recurrence and anxiety. The social well-being domain indicated some unique aspects of QOL when applied to breast cancer survivorship such as the fear of breast cancer in female relatives. The spiritual well-being domain illustrated the unique QOL aspects of life-threatening illness such as living with uncertainty and maintaining hope. Breast cancer survivors also reported positive aspects and life changes after successfully facing breast cancer. CONCLUSIONS: Breast cancer survivors experience many demands of illness across the physical, psychological, social, and spiritual domains. IMPLICATIONS FOR NURSING PRACTICE: The study's findings can be useful in directing cancer centers' efforts to provide comprehensive care for breast cancer survivors. Nurses play a critical role in leading these efforts for supportive-care services intended to improve the QOL of breast cancer survivors.

Response of leiomyosarcoma to cryosurgery: clinicopathological and ultrastructural study.

Two elderly patients with primary leiomyosarcoma (LMS) of the scalp were treated cryosurgically. Complete involution of both tumours with full epithelialization of the affected sites was achieved. Pretreatment biopsies and sequential biopsies obtained after treatment allowed observation of microscopical changes taking place during tumour involution. Gradual shrinkage of both LMS, closely monitored under the operating microscope, started immediately after the initial freezing. Light and electron microscopic observation of the shrinking LMS revealed a rapid disappearance of the tumoral architecture. Early accumulation of eosinophils and erythrocytes was followed by migration of lymphocytes and plasma cells. Capillary neoformation, fibroblasts and newly formed connective tissue fibres became apparent during the later stages of healing. Two years after treatment, both patients showed no signs of recurrence. These results suggest cryosurgery--performed in an extended protracted fashion--can be a valuable therapeutic choice in the management of LMS, particularly when surgical excision is not feasible.

Folic acid and vitamin B12 in vitiligo: a nutritional approach.

When compared with the normal population, patients with vitiligo often showed diminished blood levels of folic acid. In a group of fifteen patients with vitiligo, folic acid levels were below normal in the serum of eleven patients, in the whole blood of five patients, and in the erythrocytes of six patients. Vitamin B12 serum levels were below normal in five of the fifteen patients. Ascorbic acid plasma levels were also lowered in four of the patients. In eight patients prolonged oral administration of folic acid with simultaneous parenteral treatment with vitamin B12 and oral ascorbic acid was followed by definite repigmentation without side effects.

Studies of the accuracy of measurements of serum high density lipoprotein cholesterol levels.

Titration of serum lipoproteins with three different precipitants--heparin-MnCl2 92 mmol.L-1, dextran sulfate-MgSO4, and phosphotungstate-MgCl2--revealed gross errors in the high density lipoprotein cholesterol (HDL-C) levels measured in some hyperlipidemic sera. Dilution studies of eight normal sera with the phosphotungstate method revealed that the most reliable estimate of the HDL-C level was the level measured in the least diluted aliquot that yielded a good precipitate. With a heparin-MnCl2 kit, serial dilution of a lipemic serum demonstrated a requirement for a blank correction. Establishing an accurate estimate of the HDL-C level sometimes requires knowledge of the titration curve of the lipoprotein precipitant being used, a blank correction, and data obtained from dilution studies (or studies with increased precipitant levels) on the serum in question.