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Biomedical subjects

R W Frelick

Publications and source records attributed to R W Frelick.

At least 37 records · Page 2Linked to original sources
PubMed1987

Effects of patient management guidelines on physician practice patterns: the Community Hospital Oncology Program experience.

The Community Hospital Oncology Program (CHOP), funded under contracts by the National Cancer Institute (NCI) from 1981 to 1984, was designed to be a model for delivery of the most up-to-date cancer care in the community setting. Site specific patient management guidelines (PMGs) were developed by physicians who saw a majority of cancer patients in each community and represent a consensus of the most current information on pretreatment evaluation and management for each cancer site. There was the potential for PMGs to have a strong effect on physician practice patterns. A patterns of care study (POC) was conducted in the 17 CHOPs to determine the influence of guidelines on practice patterns. The practice elements examined in this report are clinical staging for breast and small-cell lung cancer, medical oncology consultation for breast cancer patients with positive lymph nodes, and radiation therapy consultation for rectal and small-cell lung cancer. These elements were in all CHOP guidelines. Except for physicians most active in the CHOP, the data provide no evidence of diffusion of guideline principles to the majority of practicing physicians. Although all guidelines contained discussion of the importance of staging before definitive treatment for breast cancer, only 33% of the 1,922 charts examined had a stage recorded. In small-cell lung cancer, 67% of the 388 charts examined had stage recorded. The years in practice of the primary physician had an inverse relationship to practice patterns as defined by the guidelines. Physician specialty was also a determinant of practice patterns for small-cell lung cancer. However, participation in guideline development and their dissemination did not significantly influence the patterns of care elements examined in this study.

Breast Neoplasms↗
PubMed1987

Selection factors in clinical trials: results from the Community Clinical Oncology Program Physician's Patient Log.

Between August 1984 and November 1985, data concerning 44,156 newly diagnosed cancer patients were entered in the Community Clinical Oncology Program Physician's Patient Log. Forty percent (17,773 patients) had a National Cancer Institute-approved protocol available for site and stage of disease. Fifty-six percent of patients with a protocol available were clinically eligible and 19% were entered on protocol. Thus, one-third of clinically eligible patients were entered in the study. Age was a major factor influencing eligibility and entry on study. Eighty percent of patients less than 25 years of age with a protocol available were clinically eligible for clinical trials participation, and 58% were placed on protocol. Patients greater than or equal to 65 years of age with a protocol available were less likely to be clinically eligible (48%) or placed on study (14%). A physician's preference for an alternate treatment and patient refusal for protocol treatment were also important reasons that clinically eligible patients were not registered on protocol. Selection for clinical trials participation affects the characteristics of patients under study and may have an impact on the ability to generalize the results of clinical trials.

Adult↗
PubMed1980

Malignant pheochromocytoma (paraganglioma) of the organ of Zuckerkandl: a study of two cases.

Ten percent of pheochromocytomas are found in extra-adrenal locations and are called paragangliomas. In recent years we have had the opportunity to study two patients with malignant paragangliomas of the organ of Zuckerlandl. Only 13 cases of such neoplasms have been reported previously. Our cases are of interest because of their features of recurrence, distant metastases, response to adjuvant therapy, and long survival.

Autonomic Nervous System↗
PubMed1979

Combination chemotherapy for soft-tissue sarcomas: a phase III study.

A total of 144 patients with advanced sarcomas were entered into a randomized prospective protocol with four treatment arms utilizing different combinations of chemotherapeutic agents. Of these, 120 patients (83%) were judged acceptable. Treatment 1: actinomycin-D (Act-D), 0.01 mg/kg IV, days 1--5; phenylalanine mustard (L-PAM), 4 mg PO, days 1--10 every six weeks. Treatment 2: Act-D, 0.01 mg/kg IV, days 1--5; L-PAM, 4 mg PO, days 1--10; vincristine, 1 mg IV, days 1, 8, 15, 22, 29, 36, repeat every six weeks. Treatment 3: Act-D, 0.01 mg/kg IV, days 1--5; L-PAM, 4 mg PO, DAYS 1--10; NSC-1026, 200 mg/kg IV, days 1--6. Treatment 4: Adriamycin, 0.4 mg/kg IV, days 1, 2, 3, 8, 9, 10, then 2XWK starting day 15 (max. 1,200 mg). There was a provision that upon progression of the disease in the first three treatment regimens, patients would be crossed over to Treatment 4. Responses were as follows: 1 - Partial Response (PR) 1/25; No Change (NC) 9/25 (36%). gF2 - NC 17/26 (65%). 3 - NC 13/25 (52%). 4 - Complete Response (CR) 1/41; PR 6/41; (15%); NC 27/41 (66%). Clearly Treatment 4 was the best arm, with a 17% response rate and an initial progression rate of 17%. The only other response was a partial in 1. The difference is statistically significant (H = 17.247, P = 0.0006). If the responders to Adriamycin were analyzed without crossovers, the response rate would be 22% (6/27). (H = 14.079, P = 0.003). Median times to progression were 12.5, 8.7 weeks for 1 and 2, and 5 weeks for 3 and 4. There was no significant difference in the median survival times among the four treatment arms. It appears that Adriamycin as a single drug is superior to the drug combinations and would probably be even more effective used in combination with known active agents.

Antineoplastic Agents↗