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Biomedical subjects

C R Smart

Publications and source records attributed to C R Smart.

At least 37 records · Page 2Linked to original sources
PubMed1990

Bladder cancer survival statistics.

Bladder cancer is the most common urinary system malignancy and the fourth most frequently occurring cancer among men. Although it occurs in both sexes, the disease is 2.5 times more likely to develop in men, probably because of life-style factors such as smoking and occupational exposures. The estimated 47,000 new cases and 10,200 bladder cancer deaths in 1989 constitute almost 5% of all new cancer cases and approximately 2.2% of all cancer deaths. More than half of new cases occur in persons 70 and older. The incidence rate for whites is approximately 37% greater than the rate for blacks. (However, only 50% of blacks have localized disease at diagnosis as compared with 72% for whites.) The 51% increase in incidence over 35 years has been greatly tempered through earlier detection and improved treatment resulting in improved survival and a 33% reduction in mortality. Overall survival has improved by more than 45% during the past 35 years, within each stage as well as overall. The relative 5-year survival rates for whites v blacks are overall, 81% v 58%; for localized disease, 88% v 74%; for regional disease, 44% v 30%; for distant disease, 9% v 8%; and for unknown stage, 61% v 35%.

Black or African American↗
PubMed1990

Screening and early cancer detection.

NCI is the primary research institution that has funded most of the research to establish evidence of benefit from mass cancer screening. A study of prostate, lung, and colorectal cancer is presently being planned. These trials are large, expensive, and require 10 to 15 years or longer to complete. RCST trials are only feasible in the three or four most common sites. While developing better evidence, NCI suggests the Working Guidelines for the Early Detection of Cancer in seven sites where direct and/or indirect evidence suggests benefit. The potential for early cancer detection to contribute to a decrease in cancer mortality is great. However, unless early detection is applied by the public and by physicians, it is useless. It is hoped that this chapter has been helpful to physicians and oncologists in judging these matters and applying the benefits to patients.

Adult↗
PubMed1990

National survey of the pattern of care for carcinoma of the lung.

A national survey of the patterns of care for carcinoma of the lung sponsored by the Commission on Cancer of the American College of Surgeons has documented continuing changes in epidemiology, treatment, and outcome. The project consisted of a long-term study of 15,219 patients whose diagnosis was made in 1981 and a short-term study of 19,074 patients whose diagnosis was made in 1986. The male/female incidence ratios have continued to decrease and the decrease has moved into the older age groups. Although the percentage of adenocarcinoma is increasing at the expense of squamous carcinoma, the latter is still the most prevalent histologic type. The accuracy of percutaneous needle biopsy and transbronchial biopsy of lung nodules reported from this group of 941 hospitals was high and equal to that reported by single institutions. The percentage of patients having a resection did not increase from 1981 to 1986, but for smaller lesions a move was apparent toward more lung-sparing resections. Little change has occurred in the use of adjuvant radiotherapy, particularly in stage III disease, where approximately 50% of the patients received postoperative irradiation. An improvement in the overall 5-year survival when compared with Surveillance, Epidemiology, and End Results data was noted. Whether this is a true improvement in survival or is the result of selection because of an unrecognized change in the pattern of care for patients with a carcinoma of the lung is unknown.

Adult↗
PubMed1990

Results of a national survey of characteristics of hospital tumor conferences.

A descriptive survey of hospital tumor conferences, which are also referred to as tumor boards, was conducted by the National Cancer Institute in collaboration with the American College of Surgeons and Roswell Park Memorial Institute. The survey was done to assess the involvement of the tumor conference in the care of the patient with cancer and to lay the groundwork for additional studies of the conference. The data from the descriptive survey are based on questionnaires sent to 1,700 hospitals in the United States. The questionnaires requested information about frequency, attendance, composition, role of the chairman, agenda and other variables that relate to the format and purpose of the conference. From the results, we conclude that tumor conferences are an accepted and established institution for the multidisciplinary care of patients with cancer. They are a major source of consultation and education for physicians and for other professionals involved in oncology. Tumor conferences are conducted in a wide spectrum of hospitals and related institutions that vary in size and function.

Clinical Protocols↗
PubMed1989

Stage-shift cancer screening model.

A stage-shift cancer screening model is developed in the context of a randomized controlled trial (RCT) of cancer screening. In the model, detection by screening causes the time of diagnosis of the cancer to be advanced so that either the stage at diagnosis is shifted from one stage to the next lower one or the stage of diagnosis is unchanged but the cancer is diagnosed earlier in the stage. These are called external and internal stage shifts, respectively. At each stage the extent of the external and internal shifts and any associated mortality benefits are estimated. Further, the model allows the interrelationships of these benefits within and between stages to be delineated. This then allows us to better understand the results of the RCT. Data from a completed breast cancer screening RCT are used to illustrate the application of the model and its value in improving our understanding of the trial's results.

Adult↗
PubMed1989

[Treatment of morbid obesity by gastric bypass. Apropos of 1158 cases treated surgically].

After defining pathological obesity and describing the technical methods used for gastric bypass, a series of 1158 surgical cases is analysed. Discussion, supported by a review of the literature, involved post-operative mortality and morbidity, mid-term results and patient selection criteria. In the light of the results obtained, it would no longer appear justified to offer this type of surgical procedure.

Adolescent↗
PubMed1988

Analysis of breast cancer mortality and stage distribution by age for the Health Insurance Plan clinical trial.

The Health Insurance Plan (HIP) of Greater New York conducted a clinical trial to determine if screening for breast cancer with mammography and clinical examination would decrease breast cancer mortality. The extent of disease at diagnosis among breast cancers detected by screening and the effect of screening on breast cancer mortality have been evaluated in the cohort of all HIP women diagnosed with breast cancer within 6 years of entry into the trial and followed at least 18 years after trial entry. Six years was the earliest time at which the number of cases diagnosed in the control group was equal to the number of cases diagnosed in the study group. In the cohorts of women 40-49 and 50-64 years of age at entry, shifts were significant to lower stages for screen-detected cases. As a result, the study group women in each age cohort had significantly lower breast cancer mortality than control group women when statistical analyses were restricted to data from cases only. In the 40-49 age-at-entry cohort, the reduced breast cancer mortality in the study group appears to result from lower mortality in stage I cases as well as from earlier case detection, and this may explain differences between the two age-at-entry cohorts in the length of follow-up time required to demonstrate a mortality reduction due to screening.

Adult↗
PubMed1987

Quality of life.

The term quality of life (QL) is a global characterization usually consisting of the following factors: physical function, symptoms from disease and/or treatment, occupational and social interactions, and psychological parameters, including mood with some overall assessment of well-being, such as happiness or satisfaction. For the purposes of individual patient management, the physician often assesses many of these in the process of making decisions about cancer care. The aggregate assessment of QL in groups of patients is more difficult. The increasing subjectivity and difficulty in measurement as medical observers move from the physical (objective parameters) to the psychosocial (subjective parameters) has hindered our ability to study QL. The changing status of the patient from initial symptomatic disease, to the incapacitation related to the treatment and/or the ongoing course of the disease often leading to death makes the measurement of QL a moving target. One must be very specific as to the malignancy, the status of disease, the treatments with their side effects and sequela, and the time of measurement in this dynamic spectrum, if the data is to be comparable and to permit generalizations. For the purposes of clinical trials the emphasis remains with the physical factors: function and symptom control. Even these factors are difficult to assess consistently, making the aggregation of such data from similarly treated groups of patients sometimes suspect. The ability to determine the impact of disease and treatment on these factors in a reliable manner could make possible, with aggregated data from many patients, more objective assessment of the advantages and disadvantages of a particular therapy. Late sequelae of treatment may also be important. When cure or prolonged survival are not likely or possible then the ability to determine the probable effects, physical and psychosocial, of a specific treatment on an individual patient is valuable. Treatment then can be guided to some extent by QL considerations.

Humans↗
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↗
PubMed1985

Cancer data systems.

Explore the source record for details and available documents.

Abstracting and Indexing↗
PubMed1984

The 1982 national survey of carcinoma of the breast in the United States by the American College of Surgeons.

The 1982 survey documented changes in the management of carcinoma of the breast in this country. If one compares the current survey results with the results of the 1978 survey, an inescapable conclusion is that there is a changing understanding of carcinoma of the breast and a willingness to apply new knowledge to clinical practice. These results also show the potential of the hospital Tumor Registry when records are systematically aggregated and data from different points compared. Future applications of this survey procedure and further analyses of these data may be used to document progress in the control of cancer. While useful for these purposes, it should be noted that these data are not intended, nor suited, for assessing the superiority of given treatments. They may not reflect the outcome that would result from a clinical trial. Comparisons made herein often involve patients who differed in many respects other than that on which the comparison was focused. However, within these constraints, the data may be useful for clinicians and scientists interested in the dynamic state of the treatment of carcinoma of the breast in large numbers of hospitals in the United States.

Adult↗
PubMed1984

Management of cutaneous melanoma in the United States.

Melanoma is an especially important malignant disease for surgeons to know about, since it can be cured with surgical treatment if diagnosed at an early stage. In the American College of Surgeons Melanoma Survey of 4,545 melanoma patients diagnosed during 1980, the typical melanoma was relatively thin (less than 1.5 millimeters), not ulcerated (except in 9 per cent) and did not invade into the reticular dermis or beyond (level IV or V). The melanomas were most commonly located on the trunk in men and on the lower extremities in women. Eighty-eight per cent of the patients had no clinical evidence of metastases to regional nodes or to distant sites at the time of initial diagnosis. Only a small proportion (1 per cent) of patients in the survey were black and in most of these patients, their melanoma were located on the feet or hands. The treatment of melanoma was surgical in 92.5 per cent of the patients, with the majority of patients undergoing a wide excision of the melanoma as the initial form of treatment. Only one-fifth of the patients underwent elective regional node dissection for suspected micrometastases, and most of these patients had a tumor thickness exceeding 1.5 millimeters or a lesion invading to the reticular dermis (level III, IV or V). While the Breslow Microstaging Method is now recognized as the most important parameter that predicts the clinical course of the patient, this parameter was reported in only 45 per cent of the patients in the survey. The natural history of melanoma is changing, since the disease is increasing in frequency and becoming more curable. Surgical treatment should be tailored to the biologic aggressiveness of each individual patient's melanoma. This can be estimated by integrating such prognostic factors as the melanoma thickness, the presence or absence of ulceration, the level of invasion, the anatomic site and the gender of the patient.

Adult↗
PubMed1982

Patterns of breast cancer detection in the United States.

The American College of Surgeons Commission on Cancer Short-term Survey of Breast Cancer in 12,315 patients showed that 73% of malignant tumors are found by patients, 23% by physicians, and 4% by mammography. It also indicated that younger women are more likely to discover tumors than older women, and that mammography is more likely to detect small tumors with negative axillary nodes. The effectiveness of mammography is most evident in women 50 to 74 years of age, although in women 45 to 49 years, the frequency of tumors detected by mammography nearly equals that for other groups. In black women, mammography may not be currently fully utilized. Analysis of the survey data would indicate that patients appear to demonstrate adequate skill in detecting tumors, as compared to physicians. A delay in diagnosis of longer than 3 months is associated with larger tumors and increased likelihood of axillary metastasis.

Adenocarcinoma↗