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Biomedical subjects

L Deschênes

Publications and source records attributed to L Deschênes.

At least 19 recordsLinked to original sources
PubMed1992

Psychological distress after initial treatment of breast cancer. Assessment of potential risk factors.

BACKGROUND: Patient and disease characteristics are often mentioned by clinicians as possible risk factors for psychological distress among women with breast cancer. However, either these factors have not been evaluated or when they were evaluated, results were inconclusive. METHODS: Potential risk factors for psychological distress were assessed among 205 patients with newly diagnosed breast cancer by home interview 3 and 18 months after surgery. RESULTS: At 3 months, proportions of women with high distress reporting 0-1, 2-3, 4-5, and 6-15 stressful life events in the 5 years preceding diagnosis were 17%, 20%, 28%, and 37%, respectively (P = 0.006). High levels of psychological distress were present in 63.1% of women with a history of depression, compared with 14.3% of those with no such history (P = 0.0001). Associations of these factors with distress also were present 18 months after diagnosis. At 18 months only, distress was more frequent in women with regional disease (44%) than in those with localized disease (22%) (P = 0.006). Age, education, and marital status had little or no association with levels of psychological distress. CONCLUSIONS: Number of stressful life events before diagnosis and history of depression appear to be strong indicators of the risk of psychological distress and may be useful for identifying patients with breast cancer in need or more intense psychosocial support.

Adult↗
PubMed1991

Droloxifene, a new antiestrogen, in advanced breast cancer. A double-blind dose-finding study. The Droloxifene 002 International Study Group.

To determine the optimal daily dose of the new antiestrogen droloxifene for the treatment of breast cancer, a multinational, multicenter, randomized, double-blind, phase II trial was initiated. Postmenopausal women with progressive advanced breast cancer (distant metastatic cancer, inoperable recurrent or primary tumor) with positive or unknown hormone receptor status (estrogen or progesterone) were entered in the study. Droloxifene was administered in a double-blind randomized design with daily doses of either 20, 40, or 100 mg once daily as first-line systemic therapy. None of the patients had received previous systemic antitumor therapy with the exception of adjuvant chemotherapy terminated at least one year before the patient's recruitment. Response was determined according to Union Internationale Contre le Cancer/World Health Organization criteria. Only patients with at least one measurable lesion were entered into the trial. The highest quality of data was achieved in two ways: source verification in the hospitals through monitors and peer review with subgroups of investigators determining the tumor response of each patient at adjudication meetings (evaluating parameters obtained from physical examination and reviewing X-rays and computer tomography scans). To date, 254 patients have been enrolled. Results from all these groups, without breaking the randomization code, based on 131 patients whose data have been verified are as follows: 10 complete responses (CR), 37 partial responses (PR), 47 no change, 29 progressive disease, 8 patients too early to evaluate. Thus, the overall response rate (CR + PR) was 38%. Droloxifene was well tolerated.

Antineoplastic Agents↗
PubMed1991

[Integrated mother-baby nursing care].

The article describes how the obstetrical department at Notre-Dame Hospital in Montreal developed a new, integrated approach to maternal-infant care. The first part deals with the family-centred philosophy of the unit, which has had a profound influence on the nursing staff. It explains how the previous system of post-partum care was changed, what physical modifications had to be made in the obstetrical wing and the organizational changes required to make the new system work. The second part of the article deals with the results of all these changes, as perceived by the clients. A study was conducted, using an experimental and a control group. The former consisted of clients who had experienced the new integrated system of mother-infant care. Results showed them to be more satisfied with the care they received than the control group, who received care along the lines of the traditional model. Clients in both groups were equally satisfied with the physical changes in the obstetrical wing. In summary, the new approach seems to respond to the need expressed by many couples to have their baby in a family-style atmosphere.

Adult↗
PubMed1989

Body weight and prognostic indicators in breast cancer. Modifying effect of estrogen receptors.

The relations of body weight, height, and Quetelet index to axillary node involvement at diagnosis, estrogen receptor status, and histologic features of the primary tumor were examined in 656 patients with a newly diagnosed infiltrating breast carcinoma first treated in Québec City from July 1982 to December 1984. Node involvement increased with body weight and Quetelet index. This association was more regular and much stronger among patients with estrogen receptor-positive tumors than among those with estrogen receptor-negative breast cancers. Among patients with estrogen receptor-positive tumors, the percentage with involved nodes at diagnosis increased regularly from 32.9% among lean patients (Quetelet index less than 21 kg/m2) to 65.6% among obese women (Quetelet index greater than 27 kg/m2). This trend was seen even after adjustment for age and tumor size. In contrast, among patients with estrogen receptor-negative breast cancers, the association of weight and Quetelet index with node involvement were weak and irregular. The modifying effect of estrogen receptor status on the relation of obesity to node involvement was apparent in pre- and post-menopausal women. Body weight and Quetelet index were not related to estrogen receptor status or to any of the measured histologic features of breast tumors including nuclear grade, histologic grade, tubule formation, mitotic activity, and size of nucleus of cancer cells. These findings suggest that the observed deleterious effect of obesity on breast cancer prognosis is unlikely to be an artifact of delayed diagnosis in overweight patients. It may be due to hormonal changes associated with increases in body weight.

Axilla↗
PubMed1988

Dietary fat in relation to prognostic indicators in breast cancer.

The relation of diet, especially fat intake, to recognized prognostic indicators for breast cancer was investigated in 666 women with a newly diagnosed infiltrating breast carcinoma. Diet during the year preceding diagnosis was assessed by interview using a food frequency questionnaire covering the intake of 114 food items. Prognostic indicators included axillary node involvement at diagnosis, estrogen receptor status, and selected histologic features of the primary tumor such as nuclear grade, histologic grade, tubule formation, mitotic activity, and nuclear size of tumor cells. After adjustment for total energy intake, age, body weight, and tumor size at diagnosis, an increase in saturated fat intake was related to an increased frequency of node involvement at diagnosis among postmenopausal patients. In contrast, an elevation in polyunsaturated fat intake was related to a reduction of the percentage of patients with positive nodes at diagnosis. This relation was observed among both premenopausal and postmenopausal patients. Dietary fat was not related to the estrogen receptor status of tumors. No association was found between dietary habits and histologic features of the primary tumor. These data suggest that dietary fat may have an effect on the growth or spread of breast cancer during the preclinical phase of the disease and that this effect may vary according to the type of fat considered.

Aged↗
PubMed1985

Beware of breast fibroadenomas in middle-aged women.

On first examination of 8512 Quebec area women from 40 to 59 years of age who participated in the National Study of Breast Cancer Screening, the prevalence of fibroadenoma was 8.3 per 1000. In two women, a carcinoma was discovered within their fibroadenoma--intraductal carcinoma in one and an infiltrating ductal carcinoma in the other. Clinical and histopathologic findings are described and the prognosis and treatment discussed. The peak age of women at the time of diagnosis of a fibroadenoma is in their twenties while for those with a fibroadenoma containing a carcinoma, it is in the forties. For patients under 25 years, excision can be postponed for a few months since spontaneous regression may occur and the risk of breast cancer is small at that age. For older women, treatment should not be delayed.

Adenofibroma↗
PubMed1984

[The patient's weight and height and the stage of breast cancer at the time of diagnosis].

The aim of this study was to evaluate the relation of body weight and height to the stage of breast cancer at the time of diagnosis. Information on weight, height and stage was abstracted from the medical records of 466 women with newly diagnosed breast cancer treated at the Hôpital du Saint-Sacrement in Quebec City from Jan. 1, 1975 to Mar. 31, 1981. The percentage of patients with regional disease or distant metastases was found to increase from 35.5% among women weighing less than 55 kg to 51.2% among those 65 kg or more. Palpation (including breast self-examination) may be less valuable or breast cancer biologically more aggressive in obese women.

Body Height↗
PubMed1978

Survival in colorectal cancer.

The authors studied the hospital records of 258 patients with colorectal cancer diagnosed between 1965 and 1974 at l'Hôpital du Saint-Sacrement, Quebec and computed expected and relative survival rates to adjust for deaths from other causes. Life-table methods based on full intervals only were used to analyse survival. The patients (138 men and 120 women) ranged in age from 24 to 96 years (mean, 64.9 +/- 12.7 years). The 5-year relative survival rate expressed as a percentage was 48.6 +/- 4.7 for the total group and 64.1 +/- 5.6 for patients in stages A, B and C of Dukes' classification. The overall operative mortality rate of 2.7% compared favourably with that reported elsewhere. Among patients with cancer of the sigmoid colon or rectum (the most readily detectable), the diagnosis was made at stage A in one out of nine and at stage D in approximately one out of four. Despite the introduction of universal medical insurance in Quebec in 1970, there has been no significant trend towards earlier diagnosis.

Adult↗
PubMed1978

Fine needle aspiration biopsy in the management of palpable breast lesions.

During a 34-month period 2050 fine needle aspiration biopsies of solid or cystic palpable breast lesions were performed. Of the 1182 patients with solid lesions, 384 underwent 405 surgical procedures. Carcinoma was the histologic diagnosis of 118 lesions. Of these, aspiration cytology had identified 92 (78%) as malignant; in 13 (11%) a malignant condition was suspected; 9 (7.6%) had been falsely assessed as benign. Cytology reports were accurate in 237 (83%) of the 287 histologically confirmed benign lesions. There were no false-positive reports. The 243 patients with cystic lesions underwent 572 aspirations for diagnosis and as treatment. Four lesions were excised and found to be benign. Needle aspiration biopsy is a most valuable tool. It is safe, simple, quick, repeatable and easily accepted by patients. Its positive predictive value is excellent (100% in our series). Cytology reports negative for malignant change should be disregarded if cancer is suspected clinically.

Adult↗
PubMed1976

Survival in breast cancer: study of 283 patients.

Records of 283 women with breast cancer diagnosed from 1965 through 1973 at l'Hôpital du Saint-Sacrement were studied for survival at 3 and 5 years. These were all patients who had not previously received cancer-directed treatment. Life-table methods based on full intervals only were used to analyze survival. Adjustment for deaths from other causes was provided by computing the expected and relative survival rates. The 5-year relative survival rates (%) were 60.2+/-4.1 for the total group of 283 patients, 87.9+/-4.5 for the 142 with localized disease and 44.9+/-59 for the 118 with regional spread. Of the patients with disease that was either localized or regional, 84% underwent total mastectomy. The age of patients at entry did not differ from that of cases reported to the Quebec Tumour Registry. The significant increase over time in the proportion of patients with localized disease would be expected to reduce the Quebec death rate from breast cancer in future if the better survival of these patients is not simply a function of earlier diagnosis.

Adult↗