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Biomedical subjects

R J Winn

Publications and source records attributed to R J Winn.

66 records · Page 4Linked to original sources
PubMed1989

Chemoprevention of colon cancer.

Animal tumor experiments and epidemiologic studies suggest that several agents may be of potential value in blocking the development of colon adenomas and carcinoma. Recent laboratory investigations have demonstrated several intermediate markers that are altered in the colonic epithelium of high-risk individuals and that can be modulated by several possible chemopreventive agents. Calcium and ascorbic acid are two agents that have been investigated in preliminary studies. Although the results have not been striking, these studies have pointed up methodologic issues that must be addressed and will contribute greatly to the design of the next generation of trials. Given the advances in the elucidation of the carcinogenic processes in colon cancer, it is reasonable to hope that the next decade of research will discover chemoprevention strategies that will protect individuals from the development of the most common tumor in Western society.

Adenoma↗
PubMed1989

Clinical management of hereditary nonpolyposis colon cancer. High-risk clinics and registries.

Early age at onset, multiple primary colon cancers, and other clinical features enable recognition of discrete heritable nonpolyposis colon cancer syndromes, when a pattern involving several close relatives can be demonstrated in specific families. Similar clinical expression can be predicted in as-yet asymptomatic relatives and forms a basis for extraordinary early diagnostic measures, involving frequent endoscopic surveillance starting as early as age 20 to 30 years. When even an early cancer is found, radical measures may be indicated, including total colectomy. The invocation of unusual diagnostic and therapeutic measures is admittedly based on a lack of certainty as to genotypic status and natural history in individual cases; as such, the ongoing zealous search for epithelial and serum markers of risk and early neoplastic change is warranted. Because of the relative infrequency, complexity, and uncertainty surrounding high-risk families, referral to registries that deal on a daily basis with such problems is still indicated.

Adult↗
PubMed1985

Phase II trial of 4'-deoxydoxorubicin in patients with advanced breast cancer.

4'Deoxydoxorubicin (25 mg/m2 iv every 3 weeks) was evaluated in 20 patients with advanced breast cancer. The patients had good performance status and had not been heavily pretreated. Although all patients experienced leukopenia, no major therapeutic responses were observed. Nonhematologic toxicity was mild. Further evaluation of 4'-deoxydoxorubicin at this dose and schedule is not warranted in patients with advanced breast cancer.

Adult↗
PubMed1975

Program evaluation of Texas mental health and mental retardation centers.

The diversity of programs offered by the 24 mental health and mental retardation centers in Texas required that program evaluation take a management-by-objectives approach, with each center examined as a unique system with its own goals, techniques, and activities. The approach required the centers to develop statements of management objectives, which they did with varying degrees of success. The evaluations were carried out by site-visit teams. The authors describe the evaluation process, the difficulties encountered, and some of the beneficial effects.

Community Mental Health Services↗
PubMedDate not supplied

Phase II trial of 9-aminocamptothecin (NSC 603071) administered as a 120-hr continuous infusion weekly for three weeks in metastatic colorectal carcinoma.

9-Aminocamptothecin (9-AC) is a camptothecin derivative with broad antitumor activity in preclinical studies. Prior investigations suggested that prolonged maintenance of 9-AC lactone plasma concentrations above 10 nmol/l and frequent administration of the drug are important determinants of antitumor activity. Our phase II study, therefore, examined a 5-day continuous infusion of 9-AC weekly for 3 weeks in patients with advanced colorectal cancer. Eighteen patients previously untreated for metastatic disease received 480 microg/m2/day of 9-AC. No responses were observed in 17 evaluable patients. Severe toxicities included granulocytopenia, nausea, vomiting and diarrhea. The median absolute granulocyte count (AGC) nadir was 2,300/microl (range 0-9,000/microl) and occurred on day 10. Eight patients received an escalated dose of 600 microg/m2/day. The median AGC nadir at the escalated dose was 1,500/microl (range: 300-2,700/microl) and occurred on day 22. The median number of courses given was 2 (range: 1-8); and the median time to disease progression was 8 weeks (range: 1-40 weeks). 9-AC administered by this schedule lacked antitumor activity in patients with advanced colorectal carcinomas.

Antineoplastic Agents↗
PubMedDate not supplied

Cost considerations as potential barriers to cancer treatment.

PURPOSE: An analytical cross-sectional survey was conducted to determine the prevalence of barriers to cancer treatment in Texas as perceived by diagnosed cancer patients. Results reported here address the role of insurance coverage, indirect costs (transportation, lodging, and work days lost), and direct costs of care as barriers to treatment for white, black, and Hispanic cancer patients. Specific objectives of the analyses undertaken here are to examine 1) racial/ethnic differences in insurance coverage; 2) barriers relating to insurance coverage experienced by cancer patients; and 3) role of treatment-related costs as barriers to cancer treatment. DESCRIPTION OF STUDY: A mail questionnaire was developed to assess the perceived barriers to cancer treatment in Texas for adult cancer patients, 17 years and older, who had been diagnosed with breast, colon, cervical, prostate, or lymphoma during the period of 1989 to 1993. The sampling frame for this study was obtained from a network of cancer treatment facilities throughout the state of Texas within the University of Texas M.D. Anderson Cancer Center Texas Community Oncology Network. A total of 593 cancer patients returned their surveys, yielding a 65.2% response rate. Weighting adjustments were then made to correct for differential sampling and response rates by racial groupings and type of cancer. All of the analyses used adjusted weights. RESULTS: The findings document the financial considerations (insurance, direct and indirect costs) as they relate to barriers to cancer treatment. Specific insurance premium-related barriers with regard to maintaining and affording coverage were more prevalent for blacks. Hispanics were less likely to have insurance coverage; however, more blacks reported being denied insurance coverage when they changed jobs compared with whites and Hispanics. Minorities, particularly Hispanics, were more likely to have experienced cost-related barriers associated with medications, diagnostic tests, and hospitalizations. In addition, Hispanics experienced significant out-of-pocket costs in paying for cancer treatment. CLINICAL IMPLICATIONS: This research shows the need for staff at cancer treatment facilities to be aware that there are nonclinical, financial factors that are important considerations in the treatment of cancer patients. Assessment of cancer patients during the diagnostic and treatment stages, possibly through case management, will provide information on potential barriers to treatment for individual patients. Hospital programs that reimburse out-of-pocket costs, transportation costs to obtain services, and lodging accommodations may be available. Additional services may be offered through cancer advocacy groups, such as the American Cancer Society and the National Coalition for Cancer Survivors, to assist patients with managing costs and overcoming barriers to care.

Adolescent↗
PubMedDate not supplied

Reduction in oral mucosa micronuclei frequency following alpha-tocopherol treatment of oral leukoplakia.

Micronuclei frequency, a marker of genotoxicity, was studied within a trial of alpha-tocopherol for chemoprevention of oral leukoplakia. Oral swabs were obtained from two sites, the leukoplakia lesion and normal-appearing mucosa, at baseline and following 24 weeks of therapy with 400 international units of alpha-tocopherol twice daily. These specimens were analyzed for micronuclei frequency. The major risk factors for oral carcinogenesis in the group studied were cigarette smoking and alcohol consumption. alpha-tocopherol therapy produced a significant reduction in micronuclei frequencies in specimens from both the visible lesions (P < 0.01) and the normal-appearing mucosa (P < 0.01). The micronuclei frequencies, both at baseline and following therapy, were greater in specimens taken from the lesion than in those from the normal-appearing mucosa. Although these results indicate that alpha-tocopherol has a beneficial effect in oral carcinogenesis, there was no significant clinical or histological response associated with the change in micronuclei frequency. Micronuclei frequency has not yet been validated as a biomarker for cancer incidence, and consequently, its utility as an intermediate end point for chemoprevention trials is not known. Determining clinical significance of micronuclei frequency patterns in oral carcinogenesis and chemoprevention will require further study.

Adult↗
PubMedDate not supplied

Terminally ill cancer patients. Their most important concerns.

PURPOSE: When the goal of treatment is palliative, the most important outcome is improving patient quality of life. The authors describe the major concerns of terminally ill cancer patients with a prognosis of 6 months of less. OVERVIEW: In phase I of this three-part study, 74 terminally ill patients were interviewed to identify their major concerns. In phase II, interviews with 120 terminally ill cancer patients showed that their most important concerns encompass existential, spiritual, familial, physical, and emotional issues. Phase III will determine the validity and reliability of a quality-of-life scale based on these patients' most important concerns. The information presented here summarizes the results of interviews from phases I and II. CLINICAL IMPLICATIONS: Patients were receptive to being interviewed and remarked on the relevance and importance of these issues to their own experience. Several patients commented that although their disease was assessed and reassessed throughout their care, the existential, spiritual, familial, and emotional aspects of their illness rarely were a focus of their care. Healthcare professionals can create an atmosphere in which these patients feel comfortable exploring the quality-of-life issues that are most important to them. The systematic assessment of patient concerns about quality of life may complement disease assessment and facilitate referrals to appropriate members of the healthcare team. The wide range of concerns reported suggests that a team approach, including physicians, nurses, social workers, psychiatrists, psychologists, and chaplains, is the most effective way to meet the needs of terminally ill patients.

Attitude to Health↗
PubMedDate not supplied

The role of informal and formal social support networks for patients with cancer.

PURPOSE: In this study, the authors examined the role of informal and formal social support networks in mitigating barriers to cancer treatment among whites, blacks, and Hispanics, based on a representative sample of cancer patients in Texas. DESCRIPTION OF STUDY: The sample frame for this study was obtained from the University of Texas M. D. Anderson Cancer Center's Texas Community Oncology Network, a consortium of cancer treatment facilities in Texas. Of the 910 patients who were contacted, 593 (65%) responded to the survey. RESULTS: The results show the value of social support networks in assisting cancer patients with continuing treatment. An important finding indicated that health professionals do not provide information regarding social support groups to patients with cancer at the time of diagnosis. Fewer than half of the respondents were asked whether they would be interested in joining a formal social support group. Individuals of all racial/ethnic groups reported that the formal support groups provided emotional assistance. Minorities were more apt to report that the formal support groups helped with continuing treatment. In addition, informal social support networks, such as extended families and civic clubs, were seen as more helpful for blacks and Hispanics as compared with whites. CLINICAL IMPLICATIONS: The need for formal and informal networks is indicated by the results of this study, which show that networks, such as relationships with family, friends, and relatives, play an important role in assisting patients in coping with their cancer. These networks are part of the patient's total treatment experience and must be acknowledged by healthcare professionals. A large number of patients are not asked to join social support groups, suggesting a need for training healthcare professionals to provide information regarding the potential benefits of support groups for cancer patients.

Adolescent↗
PubMedDate not supplied

Transportation as a barrier to cancer treatment.

PURPOSE: Patients with cancer must overcome many psychological, social, and economic barriers to obtain needed treatment. Because of the need for repeated visits for cancer treatment on either an outpatient or an inpatient basis, one of the major issues that patients with cancer must confront is that of arranging for transportation to care. METHODS: This study compares the distance and mode of transportation to radiotherapy and chemotherapy and perceptions of transportation as a barrier to care among white, black, and Hispanic cancer patients receiving treatment from a consortium of cancer treatment facilities in Texas. A mail questionnaire was developed to assess the perceived barriers to cancer treatment for patients who had been diagnosed clinically with breast, colon, cervical, or prostate cancer, or lymphoma between 1989 and 1993. A total of 910 surveys were mailed to prospective participants. Of the surveys mailed, 593 were returned, yielding a 65.2% response rate. By race, the respondents included whites (42%), blacks (40%), Hispanics (15%), and Asian-Pacific Islanders (3%). Two respondents were 17 years of age; the remaining respondents were 18 years or older. RESULTS: This study shows that some patients may forgo needed treatment because of problems with transportation. This was perceived as an issue more for minority patients than for white patients. Black and Hispanic patients consistently reported that barriers such as distance, access to an automobile, and availability of someone to drive them to the treatment center were potential major problems. The distance to the facilities was farther for whites than for blacks and Hispanics. Patients generally had to travel farther for chemotherapy than for radiotherapy. CLINICAL IMPLICATIONS: Patients, particularly minorities, may opt to forgo needed care in the absence of available and affordable means of transportation to treatment facilities. These findings demonstrate the need for healthcare providers to be aware of the transportation problems that patients with cancer experience in obtaining treatment. Healthcare providers must work with patients, their families, and volunteer agencies in the community to facilitate transportation to cancer treatment services.

Adolescent↗