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Biomedical subjects

L J Fallowfield

Publications and source records attributed to L J Fallowfield.

At least 37 records · Page 2Linked to original sources
PubMed1993

A daily diary for quality of life measurement in advanced breast cancer trials.

The Qualitator is a daily diary card to measure Quality of Life, developed for use in chemotherapy trials for patients with advanced breast cancer. In a trial at King's College Hospital, 29 patients completed the Qualitator and their scores were compared with scores in the Linear Analogue Self-Assessment and Nottingham Health Profile taken four-weekly. In a separate study at Guy's Hospital, 31 patients completed the diary. The Qualitator offers accurate prognostic data regarding subsequent UICC response and survival and is simple to use.

Adult↗
PubMed1993

Combination or mild single agent chemotherapy for advanced breast cancer? CMF vs epirubicin measuring quality of life.

Forty patients with advanced breast cancer, randomised to receive CMF or weekly low dose Epirubicin, were evaluated by UICC criteria of response and WHO toxicity criteria, in addition to three QoL instruments: the 'Qualitator' daily diary card, 4 weekly Nottingham Health Profile (NHP) and Linear Analogue Self-Assessment (LASA). Response rates were 58% for CMF and 29% for epirubicin (chi 2 = 3.51, 1 d.f., P > 0.05). Median time to treatment failure was 24 weeks for CMF, 7 weeks for epirubicin (P < 0.05) but survival was similar in both groups. Survival was better for responders than for non-responders (medians 87 and 30 weeks, P = 0.02). CMF caused more objective alopecia (P < 0.001), nausea and vomiting (P < 0.001) and haematological toxicity (P < 0.02). However, QoL measures only recorded a significant difference in energy and pain, influenced primarily by the non-responders in each treatment group but with no difference in overall global scores. Scores for responders, irrespective of treatment, were better to start with (LASA P = 0.001); at 12 weeks, scores had improved (Qualitator P < 0.05; NHP P < 0.05). Scores in non-responders showed no change. In this small study aggressive chemotherapy gave better response and similar survival without impairing Quality of life overall. Detailed QoL measurement should be integral to all cancer chemotherapy trials.

Adult↗
PubMed1993

Quality of life measurement in breast cancer.

Appropriate assessment of quality of life parameters should be a mandatory requirement when determining the outcome of different treatments for breast cancer. Such measures provide useful, sometimes counterintuitive information concerning treatment costs and benefits and can help guide the clinician with management decisions. It is important to choose well-validated measures of quality of life to enable comparison between studies assessing the impact of different therapeutic modalities and psychosocial interventions.

Anxiety Disorders↗
PubMed1992

Behavioural interventions and psychological aspects of care during chemotherapy.

Numerous studies have reported the deleterious impact that the side effects of cytotoxic chemotherapy can exert on the quality of life in patients with cancer. Nausea and vomiting consistently feature as the most distressing aspects of cancer therapy. Uncontrolled emesis can cause patients to abandon treatment and the poor public image of chemotherapy may lead others to refuse treatment altogether. Anticipatory nausea and vomiting can also develop in patients and this may persist for many years after successful completion of treatment. There are several behavioural interventions that are effective in ameliorating or preventing these unpleasant side effects. Consequently, psychological support should be provided as an integral part of good patient management, alongside appropriate antiemetic and anxiolytic drugs. As we can identify the characteristics of those patients more at risk from severe emesis and the development of anticipatory problems, there are good arguments for the most effective drug therapy (rather than the cheapest) being given to them prophylactically, together with relaxation techniques.

Antineoplastic Agents↗
PubMed1991

Psychosocial and sexual impact of diagnosis and treatment of breast cancer.

Psychosocial and sexual disturbances are common sequelae to a diagnosis of breast cancer and its treatment. The intuitively plausible hope that the advent of breast conserving techniques would prevent the psychological distress experienced following mastectomy has not been realised. Studies comparing psychosocial outcome of mastectomy with lumpectomy and radiotherapy reveal some advantage to women treated with breast conserving procedures in terms of body image, but very little difference in terms of psychiatric morbidity or sexual dysfunction. Whatever the primary therapy, women must still confront the fact that they have had cancer, a life-threatening disease which may recur. In this chapter the research comparing psychological outcome between mastectomy and lumpectomy is critically reviewed and the implications that these data have for clinical practice are discussed.

Adaptation, Psychological↗
PubMed1990

Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial.

OBJECTIVES: To assess outside a clinical trial the psychological outcome of different treatment policies in women with early breast cancer who underwent either mastectomy or breast conservation surgery depending on the surgeon's opinion or the patient's choice. To determine whether the extent of psychiatric morbidity reported in women who underwent breast conservation surgery was associated with their participation in a randomised clinical trial. DESIGN: Prospective, multicentre study capitalising on individual and motivational differences among patients and the different management policies among surgeons for treating patients with early breast cancer. SETTING: 12 District general hospitals, three London teaching hospitals, and four private hospitals. PATIENTS: 269 Women under 75 with a probable diagnosis of stage I or II breast cancer who were referred to 22 different surgeons. INTERVENTIONS: Surgery and radiotherapy or adjuvant chemotherapy, or both, depending on the individual surgeon's stated preferences for managing early breast cancer. MAIN OUTCOME MEASURES: Anxiety and depression as assessed by standard methods two weeks, three months, and 12 months after surgery. RESULTS: Of the 269 women, 31 were treated by surgeons who favoured mastectomy, 120 by surgeons who favoured breast conservation, and 118 by surgeons who offered a choice of treatment. Sixty two of the women treated by surgeons who offered a choice were eligible to choose their surgery, and 43 of these chose breast conserving surgery. The incidences of anxiety, depression, and sexual dysfunction were high in all treatment groups. There were no significant differences in the incidences of anxiety and depression between women who underwent mastectomy and those who underwent lumpectomy. A significant effect of surgeon type on the incidence of depression was observed, with patients treated by surgeons who offered a choice showing less depression than those treated by other surgeons (p = 0.06). There was no significant difference in psychiatric morbidity between women treated by surgeons who offered a choice who were eligible to choose their treatment and those in the same group who were not able to choose. Most of the women (159/244) gave fear of cancer as their primary fear rather than fear of losing a breast. The overall incidences of psychiatric morbidity in women who underwent mastectomy and those who underwent lumpectomy were similar to those found in the Cancer Research Campaign breast conservation study. At 12 months 28% of women who underwent mastectomy in the present study were anxious compared with 26% in the earlier study, and 27% of women in the present study who underwent lumpectomy were anxious compared with 31% in the earlier study. In both the present and earlier study 21% of women who underwent mastectomy were depressed, and 19% of women who underwent lumpectomy in the present study were depressed compared with 27% in the earlier study.) CONCLUSIONS: There is still no evidence that women with early breast cancer who undergo breast conservation surgery have less psychiatric morbidity after treatment than those who undergo mastectomy. Women who surrender autonomy for decision making by agreeing to participate in randomised clinical trials do not experience any different psychological, sexual, or social problems from those women who are treated for breast cancer outside a clinical trial.

Adult↗
PubMed1990

What are the psychological factors influencing attendance, non-attendance and re-attendance at a breast screening centre?

We describe some preliminary findings from a pilot study using three recently developed questionnaires which assessed items such as the health beliefs, knowledge about cancer and attitudes to breast cancer screening in 242 women invited to attend for mammographic screening in South East London. We suggest that these questionnaires should be used in all regional centres both to monitor psychological variables and to identify local problems within the service which may be influencing the up-take of invitations to come for screening.

Attitude to Health↗
PubMed1990

Measurement of quality of life in advanced breast cancer.

Before the twentieth century the treatment of advanced breast cancer comprised either willful neglect or futile mastectomy. Recent years have seen the introduction of therapies capable of shrinking disease volume although the concept of a cure still remains remote. Many of these treatments are unpleasant and the burden they force the patient to bear may not be compensated by the reduction in tumour size. Decisions on the value of initiating or continuing such treatment have been taken by the clinician largely since no suitable instruments have been available to measure individual 'quality of life'. Several means have now evolved and in advanced breast cancer, where the treatment may profoundly affect the patient's sense of wellbeing, effort is being made to find out how much.

Breast Neoplasms↗
PubMed1990

The design of advanced breast cancer trials. New approaches.

The treatment of advanced breast cancer is always palliative. Only a modest prolongation of life is achieved even in the best series, and the traditional criteria of assessment of response take no account of factors other than tumour bulk. Restrictive entry criteria have resulted from the inability to quantify any other measurement of response, and so the power of such chemotherapy trials has been unnecessarily curtailed. We report on the progress being made in this department to develop a self-assessment diary to record quality of life in these patients and to mount a pragmatic trial of two different regimens in advanced breast cancer using this measure.

Breast Neoplasms↗
PubMed1990

Psychosocial adjustment after treatment for early breast cancer.

Psychosocial and sexual disturbances are common sequelae to a diagnosis of breast cancer and its treatment. The hope that the development of breast-conserving techniques would protect women from the psychological distress experienced after mastectomy has not been realized. Studies comparing the psychosocial outcome of mastectomy with lumpectomy and radiotherapy reveal an advantage of the breast-conservation groups in terms of body image, but little difference in terms of psychiatric morbidity. Whatever the primary therapy, women still have to confront the fact that they have had cancer, a life-threatening disease which may recur. It is therefore most important that, irrespective of the treatment offered, we improve our understanding of the premorbid personality characteristics and sociodemographic factors that may predispose certain women to failure of adjustment following a diagnosis of breast cancer.

Adaptation, Psychological↗
PubMed1989

Treatment outcomes and quality of life.

Physicians through the ages have practiced their trade with more or less regard to the effects of their treatment on their patients' sense of well-being, if not as much as on the disease itself. Until recently, however, little attempt has been made to measure the effect of disease upon quality of life and how this quality is or is not improved by the treatment. Several means have now evolved and in areas of medicine where the treatment may profoundly affect the patient's sense of well-being, effort is being made to gauge these consequences.

Evaluation Studies as Topic↗