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PubMed2006

Long-term follow-up of pediatric cancer survivors: education, surveillance, and screening.

Cancer and its treatment predispose childhood cancer survivors to chronic or late occurring health problems that may not become clinically significant until many years after therapy. Frequently, long-term survivors of childhood cancer report late cancer-related effects that diminish quality of life and increase the risk of early mortality. Risk-based health care that involves a personalized plan for surveillance, screening, and prevention is recommended to reduce cancer-related morbidity in childhood cancer survivors. To implement optimal risk-based care, the survivor and health care provider must have accurate information about cancer diagnosis, treatment modalities, and potential cancer-related health risks to guide screening and risk-reducing interventions. However, previous studies evaluating health knowledge of childhood cancer survivors demonstrate noteworthy deficits and misperceptions about their cancer diagnosis, treatment, and cancer-related health risks. In addition, because of the relative rarity of childhood cancer, many health care providers lack familiarity with cancer-related health risks and risk-reduction methods relevant for this population. To correct these deficits, the Scottish Intercollegiate Guidelines Network (SIGN) and the Children's Oncology Group (COG) developed clinical practice guidelines to foster appropriate risk-based survivor care. Herein, we discuss the development, benefits, and limitations of the SIGN and COG guidelines and the foundation they provide for standardizing long-term follow-up care of the ever-growing vulnerable population of childhood cancer survivors.

Adolescent↗
PubMed1994

Perinatal factors increase breast cancer risk.

Emerging evidence suggests that breast cancer may originate during early life. In particular, offspring of mothers who during pregnancy exhibited behaviors that are associated with increased incidence of breast cancer, may be at risk. These behaviors include intake of high fat diet or alcohol, or stressful life style. We have found that neonatal exposure to handling that leads to improved ability to cope with stress, reduces 7,12-dimethylbenz(a)anthracene (DMBA)-induced mammary tumors in rats. Further, our results indicate that maternal exposure to high fat diet increases the incidence of DMBA-induced mammary tumors in female offspring. High fat diet also increases serum 17 beta-estradiol (E2) levels in pregnant animals. These results support the hypothesis that in utero concentrations of estrogens play a critical role in the vulnerability to develop breast cancer. The mechanism of estrogen action might be related to its effect on the induction of epithelial hyperplasia and altered breast differentiation. These events then increase the rate of genetic/epigenetic changes that increase the possibility of neoplastic transformation. Increased pregnancy estrogens may also lead to behavioral alterations in the offspring. This could explain the proposed association between certain behavioral patterns and increased tumorigenity. Our results in transgenic mice overexpressing transforming growth factor alpha (TGF alpha) are in accordance with this interpretation. The male TGF alpha mice exhibit elevated serum E2 levels, impaired ability to cope with stress, increased voluntary alcohol intake and high incidence of spontaneous hepatocellular tumors. These findings indicate that animal models offer a unique opportunity to investigate the role of timing of risk behaviors on breast cancer. They are also useful in the attempts to understand the mechanism of early estrogen action on mammary tumorigenesis.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed2005

Women's opinions about attending for breast cancer screening: stability of cognitive determinants during three rounds of screening.

OBJECTIVES: To examine the stability of beliefs and intentions towards repeat attendance at breast cancer screening, using the Theory of Planned Behaviour. The aims of the study were to examine whether and how cognitions changed in the course of the programme, and whether intentions that were assessed proximally were better predictors of behaviour than those assessed distally. DESIGN AND METHODS: A total of 2,657 women filled out a baseline questionnaire (T(1)), 2 months after being invited for an initial mammogram in the Dutch Breast Cancer Screening Programme. Actual attendance data in the second and third screening rounds were subsequently collected and follow-up questionnaires were sent to parts of the sample at four points in time: shortly before (T(2)) and after (T(3)) the second screening round, and shortly before (T(4)) and after (T(5)) the third screening round. RESULTS: Only minor changes in beliefs and intentions were found. In the assessments shortly before screening, women were somewhat less positive about attending than in the assessments shortly after screening. Throughout the course of the programme, women's opinions about attending remained positive. In fact, women became somewhat more convinced that they were vulnerable to getting breast cancer, and that participating in screening was beneficial to them. Actual attendance in subsequent rounds of screening was higher than expected. Proximal beliefs and intentions were only slightly more predictive of actual behaviour than distal beliefs. CONCLUSIONS: In organized breast cancer screening, beliefs and intentions remain positive and rather stable. Although our results should be interpreted with caution, due to little variation in behaviour, they suggest that the gap between intentions and behaviour could not be substantially reduced by proximal assessment of determinants.

Adult↗
PubMed1998

[Nuclear accidents and iodine prophylaxis. Part 1: Risks due to irradiation of the thyroid gland].

In the frame of the emergency procedures in the case of an accident in a nuclear plant, this paper presents a survey of the information available on the risks related to the irradiation of the thyroid gland. Attention is focused on thyroid cancer resulting from an exposure to radioactive isotopes of iodine and especially and iodine-131. The consequences of the medical exposures as well as of the Hiroshima and Nagasaki irradiations are recalled first. Then the recently available informations on the effects on the populations exposed after the Tchernobyl accident are analysed more in details. Ten years after the accident, the most striking and the least questionable effects is a significant increase of the incidence of differentiated thyroid cancer in children, in the areas most exposed to the initial radioactive clouds. Young children are particularly vulnerable to this type of cancer which is of aggressive nature and shows a short latency period. These observations justify an iodine prophylaxis for the populations living in the vicinity of nuclear plants. Special attention should be paid to the protection of young children.

Adolescent↗
PubMed1988

Is the incidence of testis cancer related to trauma or temperature?

The position of the testes reduces their temperature but makes them vulnerable to trauma. Patients with testis cancer frequently report prior testicular trauma, but this trauma may have triggered diagnosis of the tumor rather than been aetiological. In this study, the frequencies of various prior traumatic and temperature exposures in 259 patients with testis cancer were compared with their frequencies in two sets of control patients who did not have testis cancer. Particular effort was made to prevent bias. Testis cancer was not significantly associated with any temperature or trauma exposure and the confidence limits of the findings excluded substantially raised risks. The evidence suggests that raised temperatures and traumas commonly encountered in everyday life are not important risk factors for testis cancer. The possible aetiological roles of extreme trauma sufficient to cause atrophy, and of the trauma and raised temperature which can occur in cryptorchidism, however, need investigation by other methods.

Adolescent↗
PubMed1987

Psychological evaluation and preparation of the patient and family.

The suspected and confirmed diagnosis of cancer places stress on the patient and the family. In addition to the feelings of helplessness, guilt, frustration, alienation, and vulnerability that a diagnosis of cancer provokes, the diagnosis of gynecologic cancer can exacerbate these feelings due to its relationship to the perceived physiologic core of femininity, sexuality, and motherhood. Evaluation of the patient's existing coping skills, perceived seriousness of the illness, anticipated loss of control over physical functioning, and available family support is an essential part of the treatment plan. Preparing the patient and family for diagnosis and treatment is enhanced by supportive intervention techniques such as provision of accurate information, exploration of the patient's fears and fantasies, restoration of degrees of control in the patient's life, and exposure to peer support groups.

Adaptation, Psychological↗
PubMed1988

Acute and chronic effects of diacetoxyscirpenol on cell replication in rat esophagus and stomach.

The effect of the mycotoxin diacetoxyscirpenol (DS) on the upper alimentary tract was studied on account of the association between the consumption of food contaminated by Fusaria and esophageal cancer. Previously it had been shown that a single high dose of DS induced basal cell replication in esophagus and in squamous and glandular stomach. To assess the significance of this effect in relation to the levels of exposure likely to be encountered by man and agricultural animals, it was essential to examine the dose response relationship. Also, the long-term effect of repeated intubations of DS, and of chronic feeding of DS at 10 ppm in the diet, was studied. Intubation of progressively lower doses of DS produced a decreasing effect on replication in esophagus and stomach, but at 0.06 mg/kg replication in squamous and glandular stomach was still more than in the control animals. Intubation repeated weekly for 6-8 weeks produced no detectable change in esophagus or stomach in the surviving animals which were killed at 9 months. When DS was fed in the diet, there was marked hyperplasia in the squamous stomach of two of the four animals which survived for 9 months. These results suggest that DS per se is not carcinogenic for esophagus or for stomach, and that exposure to occasional high doses does not cause persisting abnormalities in replication. However, repeated exposure to high doses would cause repeated periods of hyperplasia, and chronic exposure in some animals could result in continuing hyperplasia. Any increase in replication is likely to promote cancer by increasing the vulnerability of the gastric and esophageal mucosa to carcinogens.

Animals↗
PubMed2004

What influences university students' intentions to practice safe sun exposure behaviors?

PURPOSE: To apply Protection Motivation Theory to examine adolescents' intentions to perform safe sun exposure behaviors. METHODS: A total of 239 students (aged 18 to 22 years) from two British universities were recruited to the study. The majority of participants were white (68%), 29% were classified as Asian, and the remaining 3% were Afro-Caribbean. Participants completed a questionnaire comprising items examining the components of Protection Motivation Theory. Intention to perform safe sun exposure behaviors was examined by asking participants to indicate their agreement with five statements about future sun exposure behaviors. RESULTS: Hierarchical multiple regression analysis revealed that the threat appraisal components of Protection Motivation Theory were stronger predictors of intention to perform safe sun exposure behaviors (accounting for 15% of the variance) than the coping appraisal components (accounting for 3% of the variance). However, previous performance of similar behaviors emerged as the strongest overall predictor of intention to perform safe sun exposure behaviors (beta = -.514, p < .01), followed by perceived vulnerability to developing skin cancer (beta = .232, p < .01) and practicing skin and naevi self examination behaviors (beta = -.172, p < .01). CONCLUSIONS: The results suggest that a strategic sun protection education campaign is necessary with the aim of encouraging adaptive sun behaviors by emphasizing the risk of skin cancer associated with sunburn.

Adult↗
PubMed2001

Chromosome segregation and cancer: cutting through the mystery.

Mitosis is the most dramatic--and potentially dangerous--event in the cell cycle, as sister chromatids are irreversibly segregated to daughter cells. Defects in the checkpoints that normally maintain the fidelity of this process can lead to chromosomal instability (CIN) and cancer. However, CIN--a driving force of tumorigenesis--could be the cancer cell's ultimate vulnerability. An important goal is to identify novel anticancer compounds that directly target the mitotic errors at the heart of CIN.

Aneuploidy↗
PubMed2001

Breast cancer screening for older women with intellectual disability living in community group homes.

Breast cancer is one of the commonest cancers to affect women. Present health service guidelines call for screening and mammography for all women aged between 50 and 65 years in an effort to increase early detection and improve survival rates. Nulliparity is one of the associated risk factors for breast cancer. Women with intellectual disability (ID) are increasing in longevity and are frequently nulliparous, and therefore, they are at increased risk of developing breast cancer. The aim of the present study was to review the uptake and knowledge of women with ID living in the community of breast screening programmes. A postal survey of women aged > or = 50 years with ID living in community group homes was used to gather data. Only one-third of the women carried out regular breast examination and a similar proportion had received invitations to mammography. General practitioners and practice nurses were currently playing very minor roles in breast screening these women. Primary health care professionals may be missing opportunistic health promotion opportunities and the support services for women with ID living in the community could be provided with better training and resources to improve breast cancer screening in this vulnerable group.

Aged↗
PubMed1997

The psychosocial consequences of mammography.

Increasing numbers of mammograms being performed in the United States will be accompanied inevitably by an increasing number of false positives. According to reliable estimates from a survey of radiology facilities, U.S. women in their forties experience close to one million false positive mammograms every year. To determine the impact of false positive mammograms and the broader psychological impact of mammography, we conducted literature searches of Medline, CancerLit, and PsycInfo. We identified nine studies examining the impact of false positive mammograms. Most found short-term increases in such psychological measures as anxiety, distress, and intrusive thoughts. One study found substantial effects on these measures three months after an abnormal mammogram. Another study found an 18-month impact on anxiety. Few studies have used behavioral outcomes, but one reported overpractice of breast self-exam among women who had received false positive results. Another found no reduction in adherence to mammography among women who have had an abnormal test. The more general mammography literature suggests that many women are anxious about mammography before the exam; women with lower levels of education, African Americans, and women with a family history of breast cancer may be more vulnerable to distress. Unfortunately, this literature suffers major limitations, such as small sample sizes, inconsistent and sometimes inappropriate measures, variations in the time frames for measurement, few studies with women aged 40-49, and a paucity of U.S. research. More research is needed to characterize at-risk women and to test interventions designed to reduce the negative impact of abnormal mammograms. Improved communication is also needed throughout the entire mammography process.

Adaptation, Psychological↗
PubMed2005

Psychological functioning in African American women at an increased risk of hereditary breast and ovarian cancer.

Despite attention to psychological issues during genetic counselling and testing for hereditary breast and ovarian cancer risk, limited information is available on cancer-specific distress among African American women being targeted for participation in counselling and testing. Therefore, the purpose of this study is to examine cancer-specific distress in African American women at an increased risk of hereditary breast and ovarian cancer and to identify factors having significant associations with distress in this population. Respondents were 141 African American women identified for participation in genetic counselling and testing for BRCA1/2 mutations. Overall, respondents reported moderate levels of cancer-specific distress. Younger age (coefficient=6.0, p=0.001), being unemployed (coefficient=-5.0, p=0.01), and having a personal history of cancer (coefficient=5.0, p=0.02) had significant associations with intrusion. Younger age was also associated significantly with greater avoidance (r=6.0, p=0.02). These results suggest that African American women aged 50 and younger, those who are unemployed and women with a personal history of breast or ovarian cancer may be the most vulnerable to experiencing elevated levels of distress during genetic counselling and testing. Greater attention to psychological issues, including concerns about cancer and cancer risks, may be needed during genetic counselling and testing for BRCA1/2 mutations with these women.

Adult↗
PubMed2002

Cancer survivorship research among ethnic minority and medically underserved groups.

PURPOSE/OBJECTIVES: To review the current state of knowledge about the impact of cancer on ethnoculturally diverse and medically underserved survivors. DATA SOURCES: MEDLINE, CancerLit, and Psychlit searches from 1966-present were conducted to locate articles about survivorship outcomes among minority and underserved populations. DATA SYNTHESIS: 65 articles were identified and grouped into one of four content areas: physiologic; psychosocial; health services, patterns of care, and quality of care; and health-promoting behaviors and lifestyles. CONCLUSIONS: Despite limited information, researchers found a consistent theme: the need to recognize and address the socioeconomic and cultural variables that affect adaptation to and survival from cancer among diverse groups of survivors. IMPLICATIONS FOR NURSING: The researchers found specific variations in risk for, response to, and recovery from cancer that provide direction for changes in nursing practice that may reduce the burden of cancer in these often vulnerable populations.

Adult↗
PubMed2005

Informed consent for medical treatment and research: a review.

The practice of informed consent has historical roots in various disciplines, including medicine, moral philosophy, and the law. It is closely tied to philosophical notions of respect for persons and respect for individual autonomy. Consent to treatment is rooted in case law. Consent to research, in contrast, has its basis in ethical codes, statutes, and administrative regulations, with the courts playing a lesser role. In this article, we define the elements of informed consent in the treatment setting, outline its ethical and legal foundations, and explore some of its limitations. We contend that informed consent plays a critical role in clinical medicine but that other models of decision making deserve consideration under particular circumstances. We also delineate the current federal regulatory schemes guiding human subject research in the U.S., highlight how consent to research differs from consent to treatment, and explore the difficulties that arise in research involving cancer patients and certain vulnerable populations.

Humans↗
PubMed2026

A germline KDM3C polymorphism impairs DNA repair and sensitizes to chemoradiotherapy.

Chemoradiotherapy (CRT) is the standard-of-care therapy for many solid malignancies, yet predictive biomarkers of treatment response remain limited. We identified a germline single nucleotide polymorphism (SNP) in an intrinsically disordered region of the lysine demethylase KDM3C/JMJD1C (p.S464T) that is associated with CRT outcomes in locally advanced rectal cancers (LARC) and head and neck squamous cell carcinoma (LA-HNSCC). In silico modeling with AlphaFold predicted S464T substitution influenced interaction between phosphorylated KDM3C and RNF8 FHA domain. In cellular models, conversion of S464 to T464 increased sensitivity to DNA-damaging agents. S464T substitution impaired damage-induced MDC1-RAP80 signaling and downstream RAP80-BRCA1 colocalization. SNP carrying cells impaired DNA repair causing genotoxic stress that is associated with increased cGAS-cGAMP innate immune signaling and increased apoptosis. Population analyses with the SNP highlighted an increase incidence of UV-induced skin and other cancers, linking inherited variation in the chromatin regulatory gene KDM3C to genome instability, cancer risk, and therapeutic vulnerability.

Journal Article↗
PubMed2001

Depression and anxiety in oncology: the psychiatrist's perspective.

Depression and anxiety are frequently undiagnosed and untreated in cancer patients, resulting in a significant negative impact on quality of life and disease outcome. Furthermore, although effective therapies for depression and anxiety are available, there have been few clinical trials of pharmacotherapy in cancer patients. This article explores how the diagnosis of depression and anxiety can be improved in cancer patients and reviews current treatment options in the oncology setting. The Hospital Anxiety and Depression Scale, a simple, patient-administered questionnaire, is effective in screening for psychiatric symptoms at an early stage of cancer treatment, particularly if vulnerable individuals can be identified and targeted. Selective serotonin reuptake inhibitors are currently first-choice therapy for depression, and many of the drugs in the class are effective in anxiety disorders. Further studies of these agents in the oncology setting are warranted.

Adolescent↗
PubMed1995

Disruption of p53 function sensitizes breast cancer MCF-7 cells to cisplatin and pentoxifylline.

The possibility that appropriately designed chemotherapy could act selectively against p53-defective tumor cells was explored in MCF-7 human breast cancer cells. These cells were chosen because they have normal p53 function but are representative of a tumor cell type that does not readily undergo p53-dependent apoptosis. Two sublines (MCF-7/E6 and MCF-7/mu-p53) were established in which p53 function was disrupted by transfection with either the human papillomavirus type-16 E6 gene or a dominant-negative mutant p53 gene. p53 function in MCF-7/E6 and MCF-7/mu-p53 cells was defective relative to control cells in that there were no increases in p53 or p21Waf1/Cip1 protein levels and no G1 arrest following exposure to ionizing radiation. Survival assays showed that p53 disruption sensitized MCF-7 cells to cisplatin (CDDP) but not to several other DNA-damaging agents. CDDP sensitization was not limited to MCF-7 cells since p53 disruption in human colon carcinoma RKO cells also enhanced sensitivity to CDDP. Contrary to the other DNA-damaging agents tested, CDDP-induced DNA lesions are repaired extensively by nucleotide excision, and in agreement with a defect in this process, MCF-7/E6 and MCF-7/mu-p53 cells exhibited a reduced ability to repair a CDDP-damaged chloramphenicol acetyltransferase-reporter plasmid transfected into the cells. Therefore, we attributed the increased CDDP sensitivity of MCF-7 cells with disrupted p53 to defects in G1 checkpoint control, nucleotide excision repair, or both. The G2 checkpoint inhibitor pentoxifylline exhibited synergism with CDDP in killing MCF-7/E6 cells but did not affect sensitivity of the control cells. Moreover, pentoxifylline inhibited G2 checkpoint function to a greater extent in MCF-7/E6 than in the parental cells. These results suggested that, in the absence of p53 function, cancer cells are more vulnerable to G2 checkpoint abrogators. Our results show that a combination of CDDP and pentoxifylline is capable of synergistic and preferential killing of p53-defective tumor cells that do not readily undergo apoptosis.

Apoptosis↗
PubMed2004

Nurse experiences as cancer survivors: part I-personal.

PURPOSE/OBJECTIVES: To uncover dimensions of nurses' personal experiences of cancer survivorship. DESIGN: Interpretive, phenomenologic. SETTING: Metropolitan area in the northeastern United States. SAMPLE: 25 RNs diagnosed with cancer. Average age was 50 years, and 20 participants were less than five years from initial diagnosis. METHODS: Interviews. Analysis using methodology of Newman (1994, 1999) and Van Manen (1990). MAIN RESEARCH VARIABLES: Nurses' personal experiences of cancer survivorship. FINDINGS: Themes of the nurses' personal experiences of survivorship included the shock of becoming a patient and multifaceted dimensions of the treatment experience, including time, coordinating their own care, the struggle to maintain normalcy, uncertainty, nonclinical self-care strategies, and encounters with caring and uncaring providers. Participants identified the need for supportive relationships both in personal and professional arenas throughout the survivorship process. The cancer experience became an opportunity for change in priorities. CONCLUSIONS: Although nurse cancer survivors experience similar personal vulnerabilities to those of non-nurses, their vulnerabilities often are affected by their knowledge of the healthcare process and content of care with which they are most familiar. They also are affected by what they know is at stake. This particular insider vulnerability is not cited often in research literature and, therefore, is not recognized as a particular type of need that should be addressed in cancer survivorship. IMPLICATIONS FOR NURSING: Nurse patients need providers to be sensitive to their information and support needs, which may vary because of their professional experiences and personal resources. Findings suggest that nurse patients may need supportive approaches that target their unique vulnerabilities.

Attitude of Health Personnel↗