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Biomedical subjects

P F Engstrom

Publications and source records attributed to P F Engstrom.

At least 55 records · Page 3Linked to original sources
PubMed1991

Corporate-sponsored breast cancer screening at the work site: results of a statewide program.

Mobile screening mammography was offered to 3,627 employees of a large corporation in Pennsylvania and Delaware. The examination was available to women employees or employee spouses aged 35 years and older. Women were charged $30 for a standard two-view examination. They also received health education materials on mammography and breast self-examination. The remaining costs of the program were underwritten by the corporation. During this program, 3,627 mammographic studies were performed; 63 biopsies were recommended. Fifty-seven biopsies were performed, and nine cancers were diagnosed. Costs of this program are presented in detail. The authors conclude that mobile screening programs at the work site provide an inexpensive, convenient alternative to more traditional screening programs. The inherent advantages of this program are the low cost, the relative ease with which the examination can be performed, and the positive role that corporate medical personnel assume in encouraging individual and group participation.

Adult↗
PubMed1991

Cancer risk notification: psychosocial and ethical implications.

Basic and medical science investigations have identified a growing number of risk factors important in carcinogenesis. By communicating cancer risk information in medical practice, we have the potential to motivate high-risk individuals to adhere to cancer prevention and surveillance protocols. However, cancer screening and risk notification might have adverse psychologic and social consequences as well. In this review, we address the psychosocial and ethical implications of cancer risk notification. The literature on the psychosocial impact of cancer screening programs and programs for notifying workers exposed to occupational carcinogens is reviewed critically. In addition, we examine new concerns and responsibilities raised by the emerging field of cancer genetics. Suggestions for future research and for patient education are addressed.

Comprehension↗
PubMed1990

A phase II trial of tamoxifen in hepatocellular carcinoma.

Because prolonged estrogen therapy can initiate hepatic adenomas, and estrogen receptors (ER) are found in 33% of hepatocellular carcinomas, a Phase II study of antiestrogen therapy was initiated in patients with hepatocellular carcinoma. Tamoxifen (20 mg twice a day) was administered to 33 patients who had biopsy proven and measurable hepatocellular carcinoma and who had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1. No patient had a complete or partial antitumor response; eight patients had stable disease ranging from 5 to 13 months. The median survival time for all patients was 6 months from the initiation of tamoxifen therapy. Four patients have continuing long-term survival of 18+, 22+, and 39+ months.

Adult↗
PubMed1990

Factors associated with repeat adherence to breast cancer screening.

This study identified barriers and facilitators of repeat participation in mammography and breast physical examination among women ages 50 years and over. Telephone interviews were conducted with 910 women in this age group. Forty percent of respondents had never had a mammogram. Only 38% had had one in the past 12 months. Of women who had a prior mammogram, 43% had had only one. Only 60% of women had had a breast exam in the past 12 months. A physician recommendation was the single best predictor of adherence to mammography. However, only 60% of women reported that their physicians had ever recommended mammography. Several other barriers to mammography were revealed, including anxiety, embarrassment, and concerns about cost and radiation. Both a family history of breast cancer and heightened perceived vulnerability to breast cancer were associated positively with repeat mammography participation; anxiety about screening reduced the likelihood of this outcome. These findings suggest that physicians can play a powerful role in motivating women to participate in initial and subsequent breast cancer screening. Reassurance may reduce women's anxiety and embarrassment and increase utilization further.

Age Factors↗
PubMed1990

Adherence to colorectal cancer screening in an HMO population.

This study aimed to determine factors that influence fecal occult blood test performance in colorectal cancer screening. A random sample was selected of men and women ages 50 to 74 years of age who had been mailed a fecal occult blood testing kit in a screening program in fall 1986. One year after initial test mailing, sample group members (n = 504) were surveyed by telephone. Four months later, the survey sample received a second fecal occult blood test mailing. Multivariable analysis for subjects with validated past fecal occult blood test status (n = 322) revealed the past testing was positively associated with physician encouragement of screening, age, the belief that cancer is curable, perceived test efficacy, and strong intention to do testing. It also was discovered that persons who felt that they had little control over their health were more likely to have done past testing. Preliminary analysis of prospective adherence showed that the strongest statistically significant independent predictor was past test performance. Prospective adherence among past nontesters (n = 121) was associated with expressed commitment to do fecal occult blood testing and reported presence of colorectal cancer risk factors. Analysis of adherence among past testers (n = 201) revealed that belief in colorectal cancer curability and age were significant predictors. The findings reported here indicate that factors influencing adherence among past nontesters differ from those for past testers. Overall, these results suggest that to increase participation in colorectal cancer screening, physicians and other health professionals should (a) deliver educational messages that increase awareness of risk factors for colorectal cancer and curability of the disease, and (b) elicit from potential screenees a commitment to engage in recommended preventive behaviors. It may also be well to consider "tailoring" messages for past nontesters and past testers, respectively, by emphasizing colorectal cancer risk factors and highlighting curability.

Age Factors↗
PubMed1990

Effects of coping style and relaxation on cancer chemotherapy side effects and emotional responses.

This study was designed to determine (a) the relationship of coping style to cancer chemotherapy side effects and (b) whether coping style moderated the impact of a relaxation intervention on anxiety, depression, and nausea associated with chemotherapy. Forty-eight cancer patients were assigned randomly to receive either progressive muscle relaxation training before chemotherapy (experimental group) or standard care (control group). Spearman correlations indicated that a "blunting" or distraction-oriented coping style was associated with less anticipatory anxiety, less depression, and less nausea during and after chemotherapy. Spearman correlations also indicated that a "monitoring" or information-gathering coping style was associated with more anticipatory anxiety, and more nausea before and during chemotherapy. Although there was a significant effect of the relaxation intervention on posttreatment nausea, there were no other between-group differences. The results did suggest, however, that relaxation was effective in reducing anticipatory anxiety among "blunters," but not "monitors," perhaps because relaxation is a distraction strategy and therefore is consistent with a blunting coping style. The effects of coping and relaxation on pretreatment anxiety may have important implications, because anxiety is a key factor in classic conditioning models of anticipatory nausea and vomiting.

Adaptation, Psychological↗
PubMed1989

Why women resist screening mammography: patient-related barriers.

Mammography utilization remains below the level needed to achieve the National Cancer Institute's year-2000 goals for reducing breast cancer mortality by 50%. Previous research has identified both patient and physician barriers. The authors interviewed 600 randomly selected women who were offered a free mammographic examination. Interviews were conducted by professional interviewers using a brief, structured questionnaire. Data were analyzed with chi 2 Wilcoxon and Kruskal-Wallis rank-sum statistics and discriminant analysis. Noncompliant subjects reported more barriers than compliant subjects. The former were more likely to believe that mammography is unnecessary in the absence of symptoms and that it is inconvenient. In both the bivariate and multivariate analyses, the woman's belief that her doctor believes in regular mammography was an important predictor of compliance.

Adult↗
PubMed1988

Combined radiation and chemotherapy as primary management of adenocarcinoma of the esophagus and gastroesophageal junction.

Between January 1981 and December 1986, 20 patients with adenocarcinoma of the esophagus and gastroesophageal junction were entered into a prospective study involving combined radiation therapy and chemotherapy (5-fluorouracil [5-FU] and mitomycin) as primary management. Nine patients with Stage I or II disease received definitive treatment consisting of 6000 cGy in 6 to 7 weeks and 5-FU (1000 mg/m2/24 hours) as a continuous intravenous (IV) infusion for 96 hours starting on days 2 and 29. Mitomycin (10 mg/m2) was administered as a bolus injection on day 2. Ten patients with extraesophageal and disseminated disease (Stages III and IV) and one patient with an unresectable anastomotic recurrence were considered palliative. Generally the palliative regimen did not differ from the definitive except for the radiation dose which in seven of the 11 patients was less than 6000 cGy (4000-5600 cGy). The range of follow-up was 6 to 74 months and no patient was lost to follow-up. Seven of the eight evaluable definitively treated patients were complete responders. The median relapse-free survival was 10 months and the median survival was 15 months in this group. In the palliative group, six of nine evaluable patients had relief of dysphagia until death or last follow-up with a median duration of 8 months. Our results indicate that combined modality treatment with infusional 5-FU, mitomycin, and radiation is an effective and well-tolerated treatment for adenocarcinoma of the esophagus and gastroesophageal junction. This treatment regimen offers palliation and some chance for cure to those patients who are inoperable, unresectable, or who refuse surgery.

Adenocarcinoma↗
PubMed1988

ECOG phase II trials of MGBG, chlorozotocin, COM multidrug therapy in advanced measurable colorectal cancer.

The Eastern Cooperative Oncology Group (ECOG) entered 326 patients with advanced measurable colorectal cancer into four phase II drug or drug combination trials. Previously treated and chemotherapy-naive patients were eligible. Chlorozotocin was administered to 83 patients (51 previously treated), methyl-glyoxal-bis-guanylhydrozone (MGBG) to 90 patients (58 previously treated), and two regimens of the three-drug combination of cyclophosphamide, vincristine, and methotrexate (COM) to 153 patients (120 previously treated). The multidrug regimen had been developed specifically for previously treated patients. In this trial, chemotherapy-naive patients were no more likely to respond than were members of the previously-treated group. Even among previously untreated patients, response rates did not exceed 10% in any of these phase II programs. They are not recommended for further trials in patients with colorectal cancers.

Adenocarcinoma↗
PubMed1988

Some reasons for compliance and noncompliance in a health maintenance organization breast cancer screening program.

Impressive reductions in breast cancer mortality have been demonstrated through regular screening programs using mammograms and clinical breast examinations. Nevertheless, only a small proportion of American women obtain annual mammograms. The US HEALTHCHECK breast cancer screening program offered free breast cancer screening to age-eligible members of a Health Maintenance Organization. Subscribers were mailed packets of materials and asked to return a Breast Risk Assessment Form to determine their eligibility to receive a free mammogram. This study was conducted to assess why women did or did not return a Breast Risk Assessment Form. Brief telephone interviews were conducted with a random sample of compliers and noncompliers (n = 502). Women who complied by returning the Risk Assessment Form said more frequently that they were unlikely to get breast cancer, were older, and more likely to have read the materials and to have rated them positively than women who did not return the Risk Assessment Form.

Adult↗