Biomedical subjects

Chris Robertson

Publications and source records attributed to Chris Robertson.

22 records · Page 2Linked to original sources

PubMed2002

Timing of patient satisfaction assessment: effect on questionnaire acceptability, completeness of data, reliability and variability of scores.

The present study compared the performance of a multidimensional patient satisfaction questionnaire according to the timing of questionnaire administration. Comparisons were made in terms of: (a) the completeness and representativeness of the data set (number of missing questionnaires, number missing item responses, respondents' representativeness to the target population); (b) the questionnaire acceptability to respondents (time and difficulty to complete); (c) the questionnaire reliability; and (d) variability of scores. One hundred and ten consecutive breast cancer patients hospitalised for surgery were randomised between being sent the comprehensive assessment of satisfaction with care (CASC) at 2 weeks (T(2W)) or at 3 months (T(3M)) after hospital discharge. The time to complete the CASC was shorter at T(3M) than at T(2W) and the mean percentage of item omission was lower at T(3M) (1.68) than at T(2W) (3.82). However, the response rate was much higher at T(2W) (87%) than at T(3M) (66%), making item omission non-significant. At both times of questionnaire administration samples were equally biased towards patients having undergone a less invasive surgery. Moreover, the multi-item scales of the CASC demonstrated adequate internal consistency coefficients, except the general satisfaction scale at T(3M), and fairly symmetrical distribution of scores. Response rate should be considered in priority. This criteria favoured an administration of the CASC shortly after discharge. Besides in a cancer patient population care experience and perception may vary in a 6 weeks time lapse. The timing of assessment needs to be clearly specified in cancer patients satisfaction survey.

Female↗

PubMed2002

Phase II trial of vinorelbine, cisplatin and continuous infusion of 5-fluorouracil followed by hyperfractionated radiotherapy in locally advanced head and neck cancer.

OBJECTIVE: We undertook a prospective phase II study to assess the feasibility and activity of a new induction chemotherapy regimen followed by hyperfractionated irradiation in locally advanced squamous cell head and neck cancer. METHODS: 25 patients with locally advanced head and neck cancer were treated with 4 cycles of vinorelbine (20 mg i.v. day 1, 3), cisplatin (60 mg/m(2) i.v. day 1) and 5-fluorouracil (200 mg/m(2) continuous i.v. infusion day 1-21) (ViFuP regimen) followed by bifractionated radiotherapy (bidRT) up to 74.4 Gy in 62 fractions of 1.2 Gy twice daily. RESULTS: Chemotherapy was well tolerated, 6 patients developed grade 3 and one patient grade 4 neutropenia. Response to chemotherapy was observed in 19 patients (76%) including three complete responses and 16 partial responses. Planned bidRT was completed in 25 patients and all but one received planned bidRT dose without interruptions. Radiotherapy was well tolerated, mucositis was the most common side effect (grade 3-12 patients, grade 4-1 patient). At evaluation after the completion of bidRT, 13 patients had complete response (52%), 7 partial response (28%), 2 stable disease and 3 tumor progression. At the median follow-up of 18.2 months, 11 patients were alive and free of disease, and 14 patients had died (12 of tumor). Late xerostomy was observed in all but one 3-month survivors. Late mandibular necrosis was seen in 1 patient. CONCLUSIONS: bidRT preceded by ViFuP seems a feasible and active combination in locally advanced head and neck cancer. Good patient compliance did not compromise the delivery of planned dose of bidRT. However, short median duration of response (14.6 months) and moderate median overall survival (18.7 months) indicate the need for more intensive therapeutic strategies. On the basis of these results, modifications of our treatment schedule (shortening the overall treatment time by reduction of chemotherapy cycles and the use of chemotherapy concomitantly with irradiation) are planned for the future study.

Adolescent↗

PubMed2000

Hormonal Therapy and Chemoprevention.

Hormone replacement therapy (HRT) can increase the quality as well as the length of life, but a prolonged use can also increase the risk of breast cancer. The combination of HRT and a selective estrogen receptor modulator (SERM) such as tamoxifen may retain the benefits while reducing the risks of either agent. A post hoc analysis of the Italian Tamoxifen Prevention Study showed a borderline significant reduction of breast cancer among women who were on HRT continuously and tamoxifen as compared with continuous HRT users who received placebo. Recent studies suggest that the standard dose of tamoxifen may be reduced to one-quarter (i.e., 10 mg every other day) without loss of its beneficial biological effects. Since the endometrial effect of tamoxifen seems to be both dose and time dependent, a dose reduction could substantially reduce the risk of endometrial cancer while retaining its preventive efficacy. On the other hand, the addition of HRT containing progestins could also minimize the risk of endometrial cancer associated with tamoxifen. Moreover, estrogen should reduce the incidence of vasomotor and urogenital symptoms, which are a major reason for tamoxifen withdrawal in prevention studies. Notably, in the National Surgical Adjuvant Breast Project (NSABP) P-1 trial, women ages 50 or younger had no increased incidence of adverse events, including endometrial cancer and venous thromboembolic events. One possible explanation for the lack of toxicity in premenopause is the presence of adequate circulating estrogen levels which prevent tamoxifen to act as an estrogen agonist at these target tissues. Moreover, data from the current Italian tamoxifen prevention trial indicate that the compliance was substantially higher for de novo and current HRT users as compared to women who never received HRT during the study. The combination of HRT and tamoxifen at low doses could thus reduce the risks and side effects while retaining the benefits of either agent.

Journal Article↗

PubMedDate not supplied

Analysis of irradiated lung and heart volumes using virtual simulation in postoperative treatment of stage I breast carcinoma.

AIMS AND BACKGROUND: The aim of the study was to assess the usefulness of virtual simulation in postoperative radiotherapy treatment planning of early-stage breast cancer and to evaluate its potential to reduce the volume of critical structures exposed compared to treatment plans produced by a conventional 2D system. METHODS AND STUDY DESIGN: Eighteen patients undergoing breast radiotherapy following conservative surgery for small breast carcinomas were studied. Scans from spiral CT equipment (with the patient in the treatment position) were transferred to a virtual simulator. From the screen images the operator contoured breast, lung and heart. Calculations were made of the extent to which the heart and lung were included in the irradiation fields (50% isodose line of tangential fields). RESULTS: Manual contouring was time-consuming, but when virtual simulation was used, the mean volume of the lung included in the radiation fields was significantly reduced compared to the 2D treatment plan (4.5% vs 5.4%, P = 0.034); in addition, a slight reduction was observed for the heart (0.5% to 1.2%), but this was not statistically significant. CONCLUSIONS: With a 3D system we obtained optimal target coverage and a reduction of the dose to critical structures (statistically significant only for the lung). From a clinical point of view, this 0.9% reduction in the mean irradiated lung volume is probably not significant, as the percentage irradiated with a 2D system is considerably below the recommended value. Furthermore, our analysis was performed in a relatively small group of patients; for a reliable estimate larger series would be required. Consequently, the 3D system should not be considered in routine treatment after breast conserving surgery for early stage carcinomas; for the time being it should be reserved for selected cases.

Adult↗