Biomedical subjects

C D Runowicz

Publications and source records attributed to C D Runowicz.

78 records · Page 5Linked to original sources

PubMedDate not supplied

Compliance with Papanicolaou smear screening following tubal ligation in women with cervical cancer.

To evaluate patient compliance with Papanicolaou (Pap) smear screening after tubal ligation compared with other methods of birth control in patients who develop cervical cancer, a retrospective review of 262 women with cervical cancer diagnosed at age < or = 70 years was undertaken at the Albert Einstein College of Medicine from January 1987 to December 1995. Demographic data, stage of the disease, histologic type, history of smoking, history of sexually transmitted disease (STD), and birth control use were recorded. The Pap screening history was obtained from all the patients. Women who had a bilateral tubal ligation (BTL) were compared with those who did not have this form of birth control. The date and result of their last Pap test prior to their diagnosis of cervical cancer was noted. Two hundred fourteen women with cervical cancer were evaluable. The clinical stage, mean age, history of smoking, and history of STD were similar for both groups. Gravidity among the BTL group was higher than in the non-BTL group (p < 0.01). Forty-eight (22.4%) women had a previous BTL. Twenty-seven of these 48 patients (56.3%) did not have a Pap smear within 3 years prior to the diagnosis of cervical cancer. Of the 166 patients, 61 (36.7%) did not have a Pap test within 3 years (p < 0.05). Fourteen women (29.2%) in the tubal ligation group never returned for a Pap test following the BTL. An average of 6.2+/-5.9 years elapsed since the last Pap test in the BTL group, with 4.0+/-5.1 years in the nontubal ligation group (p < 0.05). There was a correlation between the number of years since BTL (14.2+/-7.7) to the number of years since the last Pap test (6.2+/-5.9) (p < 0.05). Women who have had a BTL should be considered high risk because of poor screening compliance. A Pap test every 3 years is not adequate in this high-risk population group. We advocate improved counseling regarding the importance of continued annual Pap screening for women who are considering tubal ligation.

Adult↗

PubMedDate not supplied

Can precolposcopy education increase knowledge and decrease anxiety?

OBJECTIVE: To investigate the impact of an educational intervention on knowledge and anxiety level of women scheduled for colposcopy after an abnormal Papanicolaou (Pap) test. DESIGN: Experimental, randomized controlled study. SETTING: An inner-city medical school. PARTICIPANTS: The final sample consisted of 58 women in the intervention group and 55 women in the control group. Exclusion criteria included any previous colposcopy. INTERVENTIONS: The women in the intervention group received in the mail, approximately 1 week before their appointment, a one-page handout about colposcopy. The control group received no mailed handout. After arriving for the visit, women were asked to participate in the study and then were interviewed. MAIN OUTCOME MEASURES: Knowledge of reason for visit and knowledge of colposcopy as measured by content analysis of interview; and anxiety as measured by the Spielberger State/Trait Anxiety Inventory. RESULTS: Women in the intervention group demonstrated significantly more knowledge about the reason for their visit and about colposcopy than did the other women. No significant difference in mean anxiety score was found between the groups. CONCLUSIONS: The intervention increased knowledge about colposcopy for this population. Because patient education is an essential nursing function, these results are encouraging. This intervention can be replicated by nurses in other settings. Further research is necessary to understand how nurses can best help women alleviate anxiety before colposcopy.

Adaptation, Psychological↗

PubMedDate not supplied

Advances in the screening and treatment of ovarian cancer.

Ovarian cancer is the leading cause of death from gynecologic malignancies. This article reviews the newer chemotherapeutic agents and treatment strategies available to the practicing clinician. Also discussed are the benefits and shortfalls of the various options for screening, such as ultrasound and tumor markers, as well as the data supporting oral contraceptives and the controversy surrounding prophylactic oophorectomy.

Antineoplastic Agents↗

PubMedDate not supplied

Hormone replacement therapy in cancer survivors: a con opinion.

In patients with hormonally sensitive tumors, estrogen replacement therapy carries a theoretical risk of stimulating recurrent disease as well as contributing to an increased risk of other hormonally related cancers. In women with hormone-related cancers, it is unknown if their inherently increased risk for other related cancers can be further increased by the administration of hormones. In genetically susceptible animal models, hormones have been shown to promote growth of hormonally sensitive cancers. The uncertainty and potential risk of hormone replacement therapy demonstrates the need for randomized, prospective trials to provide women with a reasonable basis for therapeutic alternatives. The most prudent approach with this population is to consider alternative treatments until the ongoing, randomized clinical trials have been evaluated with adequate longterm follow-up. Until such time, nonhormonal alternatives to manage symptomatic patients should be employed. It is incumbent on physicians to educate themselves and become adept in their use. Diet and exercise will have to be an essential component of the counseling provided to patients following cancer therapy.

Breast Neoplasms↗

PubMedDate not supplied

Preliminary phase II clinical and pharmacokinetic study of 9-cis retinoic acid in advanced cervical cancer. New York Gynecologic Oncology Group.

PURPOSE: 9-cis retinoic acid (ALRT 1057; 9cRA) is a promising new retinoid that binds to all known retinoic acid receptors (RAR and RXR), potentially providing it with a broader spectrum of biologic activity than either 13-cis retinoic acid or all-trans retinoic acid. It has been shown to be at least as active as all-trans retinoic acid as a differentiation-inducing and antiproliferative agent in both in vivo and in vitro tumor model systems. METHODS: The New York Gynecologic Oncology Group undertook a prospective, multi-institutional phase II clinical and pharmacokinetic trial of 9cRA in patients with advanced or recurrent squamous cell or adenosquamous cell carcinoma of the uterine cervix. Patients received daily oral doses of 140 mg/m2 of 9cRA. 9cRA and its metabolites were determined by reversed-phase HPLC in plasma samples drawn at 0.5 to 8 hours. RESULTS: Sixteen patients with advanced or recurrent carcinoma of the cervix were enrolled. Therapy was well tolerated with no unexpected toxicities. There were no complete or partial responses observed, indicating that a response rate of 20% or greater to this agent could be ruled out with 95% confidence. Pharmacokinetic parameters for 9cRA on day 1 were in agreement with previous studies. The area under the plasma versus time curves for 9cRA declined by 69% between days 1 and 8 with daily 9cRA dosing and remained at this low level in those patients evaluated on day 28. 4-oxo-9-cis retinoic acid (4-oxo-9cRA) was identified as a major plasma metabolite of 9cRA. Plasma levels of 4-oxo-9-cRA were initially 71% of those of 9cRA, but in contrast to 9cRA, there was no decline in plasma levels on days 8 and 28. The ratio of the area under the curve for the 4-oxo metabolite relative to that of the parent compound increased from less than 1 on day 1 to approximately 2.4 on days 8 and 28. Thus, despite early induction of its own metabolism, levels of total retinoid metabolites persisted at pharmacologic levels at day 28. CONCLUSIONS: 9cRA with this dose and schedule was inactive in women with advanced carcinoma of the cervix. Despite a decline in plasma levels of 9cRA over time, levels of the 4-oxo metabolite tended to persist. While the 4-oxo metabolite is less potent than the parent compound, these data nevertheless suggest that the lack of clinical activity in this patient population may not be attributable exclusively to suboptimal pharmacokinetic parameters.

Adult↗

PubMedDate not supplied

"I hope I don't have cancer": colposcopy and minority women.

PURPOSE: To determine what women scheduled for colposcopy knew about the procedure and to understand their concerns about the test and its implications. DESIGN: Descriptive, exploratory, qualitative. SAMPLE AND SETTING: All women scheduled for colposcopy in a three-month period (n = 29) in an inner-city academic center in the northeast United States. The sample consisted of African American (66%), Hispanic (31%), and white (3%) women ranging in age from 17-59 years (x = 39 years). METHODS: Women were interviewed on the telephone or in person and were asked seven open-ended questions about why they were referred and what they expected would happen at the appointment. Interviews were content analyzed. FINDINGS: Four themes common to the women's responses emerged from the interview data: fear about their health, apprehension about the colposcopy, uncertainty about the meaning of the Pap test, and pervasive lack of knowledge. CONCLUSIONS: These results suggest that women in this study scheduled for colposcopy had little factual information about the test or its implications, were anxious about the appointment, and wanted more complete information. IMPLICATIONS FOR NURSING PRACTICE: Nurses cannot assume that women understand the reasons for their referral for colposcopy or the implications of the test. These study results imply that lengthened appointment time might be required to provide appropriate education and help alleviate women's anxiety. Future nursing research should examine the effect of anticipatory counselling and education for this group of women.

Adolescent↗