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Biomedical subjects

W B Forman

Publications and source records attributed to W B Forman.

At least 19 recordsLinked to original sources
PubMed1997

Life expectancy, comorbidity, and quality of life. A framework of reference for medical decisions.

The treatment of cancer in the elderly can benefit from increasingly sophisticated methods that measure a patient's quality of life. These measures are both general and cancer specific and herald a new and enlightened approach to patient care. The care of the older patient must be seen in light of what is known about life expectancy, the outcome of treatment, an awareness of comorbidity, and the importance of informed consent and respect for the values and preferences of the individual patient. This article reviews the growing literature on quality of life research in cancer patients.

Aged↗
PubMed1997

Symptomatic management of the older person with cancer.

The older person with cancer is often unable to participate in treatment regimens that a younger person might tolerate. We review the complex reasons why this may be so as well as provide to the reader a brief review of the major symptoms that can cause suffering and treatment regimens that can improve the patient's sense of well being. Palliative care provides the older person with advanced cancer the opportunity to live his or her life to the fullest during that period of life called dying.

Aged↗
PubMed1996

Opioid analgesic drugs in the elderly.

Much is known about opioid metabolism, which is critical in administering these agents to the elderly. Fear of addiction and tolerance are the major barriers to their use among patients as well as health-care professionals. Addressing these issues early in the initiation opioid therapy will help to alleviate these concerns. Once therapy with an opioid is initiated, the role of renal function is critical. Because many metabolites of the opioids are renally cleared and have activity either in analgesia or as undesired side effects, it is critical to be aware of the creatinine clearance (not just serum creatinine) in the elderly. The initiating doses of the opioids can be equal to that of younger patients, but the clinician should anticipate using a longer frequency of dosing interval or smaller doses during the course of therapy. Methadone, propoxyphene, and meperidine are not recommended for use in elderly people, because of the toxicity of their metabolites. Of all the unwanted effects of the opioids, the most difficult to deal with is that of constipation. Here, an aggressive approach using bowel stimulating laxatives is critical in order to prevent this problem. It is anticipated that a variety of newly formulated opioids will shortly be available for clinical use. Finally, as a better understanding of the neurophysiology of pain is gained, the clinician can anticipate having more analgesic opioids that target their receptors without agonist or antagonist effect on other opioid receptors. This will allow the clinician to better relieve pain with a minimum of unwanted side effects.

Aged↗
PubMed1994

The role of chemotherapy and adjuvant therapy in the management of colorectal cancer.

This review of the current literature related to the use of chemo- and adjuvant chemotherapy in colorectal carcinoma emphasizes the present dilemma in caring for people affected with this disorder. Adjuvant chemotherapy using combinations of 5-fluorouracil and levamisole clearly prolong survival, albeit, for only a small group of individuals. However, for the older person, this regimen may be associated with unacceptable toxicity and a physician's inability to deliver a dose-intensive course, as the authors currently understand it. Although quality of life is a clear concern of many older persons, little currently is available to evaluate this parameter during chemotherapy. It remains an important issue to address in the elderly person, because 35% of individuals found to have colorectal carcinoma are older than 65 years. Hopefully, better staging by incorporating molecular biologic techniques will assist in the effort to uncover the best regimens.

Aged↗
PubMed1994

Transdermal fentanyl disposition in elderly subjects.

The pharmacokinetic characteristics of a 20-cm2 fentanyl 24-hour transdermal patch were compared between 10 healthy elderly subjects 67-87 years and 6 young subjects 19-27 years. All 10 elderly subjects required patch removal prior to 24 h due to adverse effects versus none of the young subjects. The mean patch duration (PD) in elderly subjects was 11.7 +/- 4.9 h, yielding a mean area under the curve from 0 to 60 h (AUC0-60) of 20.4 +/- 10.3 ng h/ml versus a mean AUC0-60 of 21.0 +/- 10.4 ng h/ml in young subjects. Correcting AUC0-60 for PD (AUC0-60/PD) gave a mean value of 2.05 +/- 1.10 ng/ml for elderly subjects, which was significantly greater than the AUC0-60/PD of 0.88 +/- 0.44 ng/ml in young subjects (p = 0.034, Student's t test). The higher serum concentrations reflect increased absorption and/or decreased clearance in the elderly.

Administration, Cutaneous↗
PubMed1994

Pain management for the geriatric patient.

Pain is a common and complex problem in the geriatric population. Successful pain management in this patient population requires a comprehensive approach involving both pharmacologic and nonpharmacologic interventions.

Acetaminophen↗
PubMed1993

A novel morphine sulphate preparation: clinical trial of a controlled-release morphine suspension in cancer pain.

In order to determine the efficacy of a novel controlled-release morphine suspension, we performed two prospective sequential open-label studies in patients with pain due to cancer. The studies were identical except for the duration of treatment (three days and 30 days respectively). Sixty-nine patients with a variety of advanced cancers and associated pain participated. Fifty-three patients completed the trials, 38 on the three-day trial and 15 on the 30-day trial. In both groups the amount of morphine required to obtain pain relief was initially established using controlled-release morphine tablets and immediate-release morphine for 'rescue' dosing. Patients were begun on equivalent doses of the study drug in place of the controlled-release tablets. No differences in pain score or the amount of 'rescue' morphine were noted following the switch to the controlled-release morphine suspension. Toxicity was as anticipated for the use of morphine in this situation and no adverse effects were observed during administration of the suspension. These data suggest that this new formulation of morphine is equipotent to conventional controlled-release morphine tablets and provides pain relief for a 12-hour dosing interval. This novel morphine formulation could be especially useful for paediatric patients and for those who have difficulty in swallowing.

Adult↗
PubMed1992

Influence of age, performance status, body weight, and tumor type in individuals with cancer on the disposition of warfarin and its enantiomers: Department of Veterans Affairs cooperative study number 75.

Plasma warfarin and its R,S enantiomer concentrations, one-stage prothrombin times, and mean daily warfarin doses were analyzed in 196 patients given warfarin. These individuals were part of a controlled clinical trial that examined the effect of warfarin as an adjuvant to "standard" treatment in a variety of malignancies. Neither the plasma warfarin concentration nor the daily warfarin dose required to produce a given degree of prothrombin-time prolongation was influenced by age or body weight in these subjects. When the data were analyzed by performance status, we noted several variations of interest. Individuals with different tumor types demonstrated disparities in warfarin disposition. Patients with colorectal cancer, for example, required lower mean daily warfarin doses to achieve a given degree of one-stage prothrombin time prolongation. Analysis of warfarin enantiomers (R,S) in a selected group of patients demonstrated a lower-than-normal ratio (2:1) for the colorectal cancer group (1.42:1) because of an apparent decrease in the plasma R component. In contrast, patients with head and neck cancer demonstrated a ratio of 2.85:1, and the R component was elevated. Warfarin disposition and the effect of warfarin on vitamin K-dependent clotting factor production were altered in the patients with cancer reported in this study. The mechanisms for these alterations are complex and not completely understood.

Aging↗
PubMed1991

Current approaches to chronic pain in older patients.

As the population ages, primary care physicians face an increasing number of individuals who suffer from the effects of chronic diseases, including the accompanying chronic pain. This article reviews the common causes of pain in the elderly and suggests a system for assessing its severity. Five different approaches to treating pain in this population are outlined, as are guidelines for managing the potential side effects of treatment.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1988

Effect of mopidamol on survival in carcinoma of the lung and colon: final report of Veterans Administration Cooperative Study No. 188.

Mopidamol (RA-233), a derivative of dipyridamole, is a phosphodiesterase inhibitor that has been shown previously to limit progression of malignancy in certain experimental animal models and in a pilot study in humans. RA-233 plus chemotherapy was compared with chemotherapy alone in a 5-year double-blind trial involving 719 patients with advanced carcinomas of the lung and of the colon. RA-233 treatment was associated with a statistically significant prolongation of survival in patients with non-small cell lung cancer (N-SCLC) limited to one hemithorax and with reduction in mean plasma fibrogen concentration. RA-233 was not toxic. The favorable effects on survival could not be explained by any factor other than the RA-233 treatment. In other tumor categories tested, no differences in survival were observed. These results suggest that RA-233 is useful in the treatment of N-SCLC of limited extent. They also suggest that therapeutic intervention aimed at modified intracellular pathways might constitute a novel investigative approach to the treatment of cancer.

Carcinoma↗
PubMed1988

Tumor conference: the role of continuing medical education.

Tumor conferences and/or boards are established institutions in most hospitals. They function as forums for discussing cancer care. In an attempt to increase attendance of physicians at our tumor conference, CME I credit was granted for a six-month period. Data for a similar period during the prior year were chosen for comparison. Physician attendance as determined on a weekly basis and adjusted for holidays, etc., for the control and study periods was similar (14/control, 13.8/study). We not only did not increase attendance, but of those physicians present, only 42% bothered to sign in for CME I. We concluded that offering CME I credit did not stimulate physician attendance at the tumor conference. This is consistent with recent studies which show that few physicians list "credit" as a motivator of learning.

Cancer Care Facilities↗
PubMed1987

Abnormalities of blood coagulation tests in patients with cancer.

Routine blood coagulation tests were performed on 431 consecutive patients enrolled in a study of the role of anticoagulation in cancer treatment (VA Cooperative Study #75). Two hundred sixteen control patients were treated with standard therapy, and 215 patients were treated with standard therapy plus sodium warfarin. At the time of entry into the study, the most common abnormalities were elevated fibrinogen levels, platelet counts, and fibrinopeptide A levels. Serial studies demonstrated a steady increase in platelet count and fibrinogen levels before death. Anticoagulation lowered FPA levels but had no significant effect on fibrinogen levels, platelet counts, or euglobulin clot lysis times. An unexpected finding was a dramatic increase in fibrin split product levels after institution of anticoagulation (means +/- SEM = 42.6 +/- 116.4 vs. 2.9 +/- 7.0 mg/L in control subjects; P less than 0.02). This study supports the presence of subclinical activation of blood coagulation in most patients with cancer. Moreover, the preferential activation of fibrinolysis in anticoagulated patients suggests a role for a vitamin K-dependent factor(s) in the regulation of fibrinolysis in patients with cancer.

Blood Coagulation Tests↗
PubMed1986

Consolidation and maintenance therapy in multiple myeloma: randomized comparison of a new approach to therapy after initial response to treatment.

A randomized, controlled trial was initiated in 1977 to evaluate the impact of three alternative approaches to consolidation and maintenance therapy after initial maximal response for multiple myeloma. All patients were treated initially with BCNU, cyclophosphamide, and prednisone (BCP) until a designated level of response was achieved. Responders were randomly assigned to either melphalan and prednisone (MP); prednisone, Adriamycin (Adria Laboratories, Columbus, Ohio), azathioprine, and vincristine (PAIV), or no therapy until relapse, then treatment with BCP. Initial response rates were comparable with previous trials. A small number of incremental responses were observed with both MP and PAIV. Survival was the same for all three maintenance approaches and the same as that observed in our previous continuous BCP or MP therapy. Additional or consolidation/maintenance therapy of the type administered here appears to offer little advantage once an initial response has been achieved.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Bleeding complications from warfarin anticoagulation in patients with malignancy.

Bleeding complications from warfarin anticoagulants were analyzed in 431 patients with carcinoma of the lung, colon, prostate and head and neck who were admitted to a randomized, controlled therapeutic trial of this agent. A total of 215 patients were randomized to the warfarin-treated group and 216 to the control groups. The mean prothrombin time was significantly prolonged (p = 0.0001) for warfarin-treated patients. The duration of warfarin administration was 64.9% of the total followup period providing 101 patient-years of experience with warfarin in cancer. Both the overall incidence of bleeding episodes (58% of warfarin-treated versus 30% of control) and the incidence of major bleeding episodes (42% versus 14%, respectively) were significantly increased in the warfarin-treated group (p = less than 0.001). The incidence of major bleeding was 1.86 per patient-year on warfarin. The most common sites of bleeding (in descending order) were the gastointestinal tract, the urinary tract, the nasal passages and skin. Hemorrhage occurred in association with the terminal event in 10 warfarin-treated and 12 control patients. Warfarin anticoagulation may have contributed to terminal bleeding in 3 (1.4%) patients. There was no difference in mean hemoglobin or hematocrit values for patients with versus patients without bleeding episodes.

Clinical Trials as Topic↗
PubMed1984

Esophageal carcinoma. A six-year review of the Cleveland Veterans Administration Hospital experience.

The records of 51 patients with esophageal carcinoma were reviewed. Twenty-two patients underwent attempted curative resection with a mean survival of 7.7 months. Twenty patients underwent primary radiotherapy (mean survival, 4.3 months). Nine patients received palliative therapy alone (mean survival, 2.8 months). Surgical mortality was 27%, but symptomatic palliation was complete in 59% of the surgical patients. Only 5% of the radiotherapy group, and 11% of the palliative group were completely palliated. There is only one long-term survivor (21 + months). Lesions in the middle third of the esophagus, and the presence of clinical evidence of metastatic disease were predictive of a shorter survival. Patients with metastatic disease at presentation had a mean survival of only 2.5 months from diagnosis. It is concluded that surgery should be considered a palliative, not curative procedure, and that it should be attempted only in those patients without clinical evidence of metastatic disease.

Adenocarcinoma↗
PubMed1984

Effect of warfarin anticoagulation on survival in carcinoma of the lung, colon, head and neck, and prostate. Final report of VA Cooperative Study #75.

VA Cooperative Study #75 was established to test in a controlled, randomized trial the hypothesis that warfarin anticoagulation would favorably affect the course of certain types of malignancy. No differences in survival were observed between warfarin-treated and control groups for advanced non-small cell lung, colorectal, head and neck and prostate cancers. However, warfarin therapy was associated with a significant prolongation in the time to first evidence of disease progression (P = 0.016) and a significant improvement in survival (P = 0.018) for patients with small cell carcinoma of the lung, including the subgroup of patients with disseminated disease at the time of randomization (P = 0.013). A trend toward improved survival with warfarin treatment was observed for the few patients admitted to this study with non-small cell lung cancer who had minimal disease at randomization. These results suggest that warfarin, as a single anticoagulant agent, may favorably modify the course of some, but not all, types of human malignancy, among which is small cell carcinoma of the lung. Further trials of warfarin may be indicated in patients with limited disease who have cell types that failed to respond when advanced disease was present.

Adenocarcinoma↗