PubMed Health⌕ Search

Biomedical subjects

L Deschênes

Publications and source records attributed to L Deschênes.

At least 37 records · Page 2Linked to original sources
PubMed1996

Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumors.

BACKGROUND: In 1982, the National Surgical Adjuvant Breast and Bowel Project initiated a randomized, double-blinded, placebo-controlled trial (B-14) to determine the effectiveness of adjuvant tamoxifen therapy in patients with primary operable breast cancer who had estrogen receptor-positive tumors and no axillary lymph node involvement. The findings indicated that tamoxifen therapy provided substantial benefit to patients with early stage disease. However, questions arose about how long the observed benefit would persist, about the duration of therapy necessary to maintain maximum benefit, and about the nature and severity of adverse effects from prolonged treatment. PURPOSE: We evaluated the outcome of patients in the B-14 trial through 10 years of follow-up. In addition, the effects of 5 years versus more than 5 years of tamoxifen therapy were compared. METHODS: In the trial, patients were initially assigned to receive either tamoxifen at 20 mg/day (n = 1404) or placebo (n = 1414). Tamoxifen-treated patients who remained disease free after 5 years of therapy were then reassigned to receive either another 5 years of tamoxifen (n = 322) or 5 years of placebo (n = 321). After the study began, another group of patients who met the same protocol eligibility requirements as the randomly assigned patients were registered to receive tamoxifen (n = 1211). Registered patients who were disease free after 5 years of treatment were also randomly assigned to another 5 years of tamoxifen (n = 261) or to 5 years of placebo (n = 249). To compare 5 years with more than 5 years of tamoxifen therapy, data relating to all patients reassigned to an additional 5 years of the drug were combined. Patients who were not reassigned to either tamoxifen or placebo continued to be followed in the study. Survival, disease-free survival, and distant disease-free survival (relating to failure at distant sites) were estimated by use of the Kaplan-Meier method; differences between the treatment groups were assessed by use of the logrank test. The relative risks of failure (with 95% confidence intervals [CIs]) were determined by use of the Cox proportional hazards model. Reported P values are two-sided. RESULTS: Through 10 years of follow-up, a significant advantage in disease-free survival (69% versus 57%, P < .0001; relative risk = 0.66; 95% CI = 0.58-0.74), distant disease-free survival (76% versus 67%, P < .0001; relative risk = 0.70; 95% CI = 0.61-0.81), and survival (80% versus 76%, P = .02; relative risk = 0.84; 95% CI = 0.71-0.99) was found for patients in the group first assigned to receive tamoxifen. The survival benefit extended to those 49 years of age or younger and to those 50 years of age or older. Tamoxifen therapy was associated with a 37% reduction in the incidence of contralateral (opposite) breast cancer (P = .007). Through 4 years after the reassignment of tamoxifen-treated patients to either continued-therapy or placebo groups, advantages in disease-free survival (92% versus 86%, P = .003) and distant disease-free survival (96% versus 90%, P = .01) were found for those who discontinued tamoxifen treatment. Survival was 96% for those who discontinued tamoxifen compared with 94% for those who continued tamoxifen treatment (P = .08). A higher incidence of thromboembolic events was seen in tamoxifen-treated patients (through 5 years, 1.7% versus 0.4%). Except for endometrial cancer, the incidence of second cancers was not increased with tamoxifen therapy. CONCLUSIONS AND IMPLICATIONS: The benefit from 5 years of tamoxifen therapy persists through 10 years of follow-up. No additional advantage is obtained from continuing tamoxifen therapy for more than 5 years.

Antineoplastic Agents, Hormonal↗
PubMed1996

Adding sodium dodecyl sulfate and Pseudomonas aeruginosa UG2 biosurfactants inhibits polycyclic aromatic hydrocarbon biodegradation in a weathered creosote-contaminated soil.

The effect of two anionic surfactants was assessed during biodegradation of 13 of the 16 USEPA priority polycyclic aromatic hydrocarbons (PAH) in a wood-preserving soil contaminated with creosote and pentacholorophenol for a period of at least 20 years. Sodium dodecyl sulfate (SDS) and biosurfactants from Pseudomonas aeruginosa UG2 were utilized at concentrations of 10, 100 and 500 micrograms/g soil. Because both surfactants are readily biodegradable, the microcosms received a fresh spike of surfactant every 2 weeks. Biodegradation of aged PAH residues was monitored by GC/MS for a period of 45 weeks. Results indicated that the biodegradation of the three-ring PAH was rapid and almost complete but was slowed by the addition of 100 micrograms/g and 500 micrograms/g chemical surfactant. Similarly, at the same concentrations, the two surfactants significantly decreased the biodegradation rate of the four-ring PAH. In this case, the inhibition was more pronounced with SDS. High-molecular-mass PAH (more than four rings) were not biodegraded under the test conditions. It was suggested that the preferential utilization of surfactants by PAH degraders was responsible for the inhibition observed in the biodegradation of the hydrocarbons. The high biodegradability and the inhibitory effect of these two surfactants would have a significant impact on the development of both above-ground and in situ site reclamation processes.

Biodegradation, Environmental↗
PubMed1996

Randomized trial of a psychologic distress screening program after breast cancer: effects on quality of life.

PURPOSE: Although psychosocial intervention can reduce psychosocial distress following breast cancer, many women who are experiencing problems are not identified and offered additional help. This trial assessed effects on quality of life of psychologic distress screening among newly diagnosed, nonmetastatic breast cancer patients. PATIENTS AND METHODS: From 1990 to 1992, all eligible patients in one regional breast cancer center were identified and offered study participation. Women in both control and experimental groups received brief psychosocial intervention from a social worker at initial treatment. The experimental group also had monthly telephone screening of distress levels using a brief, validated instrument, with additional psychosocial intervention offered only to those with high distress at screening. RESULTS: Among 282 eligible patients, 89% were randomized and completed the study. Participants' psychologic distress levels decreased over the study period (P = .0001). However, no between-group differences were observed. Mean distress scores among control and experimental women at 0-, 3-, and 12-month interviews were 20.7 and 20.4, 15.5 and 15.0, and 14.6 and 13.5, respectively. No between-group differences were observed with respect to physical health, functional status, social and leisure activities, return to work, or marital satisfaction. CONCLUSION: Our results indicate that, among patients who receive a minimal psychosocial intervention as part of their initial cancer care, a distress screening program does not improve quality of life. Minimal psychosocial intervention at initial treatment may be effective in reducing distress, thus making it difficult to obtain additional benefit from a screening program.

Breast Neoplasms↗
PubMed1995

Social support and survival among women with breast cancer.

BACKGROUND: Two recently reported randomized trials, one among patients with advanced breast cancer and the other among patients with early stage melanoma, suggested that social support may affect survival favorably. This study assesses relationships of social support indicators with 7-year survival among women diagnosed with localized or regional stage breast cancer. METHODS: All newly diagnosed patients with surgically treated localized or regional disease in seven Quebec City hospitals in 1984 were considered for this analysis. Among 235 eligible patients, 224 (95%) participated in a home interview 3 months after surgery. This interview provided information on the use of confidants in the 3 months after surgery. Data on disease and treatment characteristics were abstracted from patients' medical records. RESULTS: Compared with women who used no confidant in the 3 months after surgery, the hazard ratio for the 7-year period was 0.61 (95% confidence interval [CI], 0.33-1.12) among those who had used at least one confidant, 0.54 (95% CI, 0.28-1.06) in women who used two or more types of confidant, and 0.51 (95% CI, 0.22-1.18) among those whose confidants included either physician or nurse. These results were adjusted for age, presence of invaded axillary lymph nodes, adjuvant radiotherapy, and adjuvant systemic therapy (hormone or chemotherapy). CONCLUSION: These results support the view that social support may be associated with longer survival among women with localized or regional stage breast cancer.

Breast Neoplasms↗
PubMed1993

Arm problems and psychological distress after surgery for breast cancer.

The frequency of problems in the arm affected by surgery for breast cancer and the association of these problems with psychological distress were assessed among 223 women with newly diagnosed breast cancer 3 months after operation and again 15 months later among 201 of these same women. At 3 months after operation, 182 (82%) of the 223 patients reported at least one arm problem. Specific problems reported were swelling (24%), weakness (26%), some limitation in range of movement (32%), stiffness (40%), pain (55%) and numbness (58%), and these percentages had changed little 15 months later. Regardless of the type of mastectomy, women who underwent axillary dissection had more arm problems. Compared with women reporting no arm problems, the adjusted odds ratios of having psychological distress at 3 months for women reporting one to two, three to four and five to six arm problems were 1.2, 2.3 and 3.1 respectively (chi 2 for trend = 9.5, p = 0.002). Arm problems are frequent after operation for breast cancer, and these problems appear to increase the likelihood of psychological distress. Women should be informed that arm problems are expected but non-threatening sequelae of initial surgical treatment for breast cancer.

Arm↗
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↗