PubMed Health⌕ Search

Biomedical subjects

M A Zevon

Publications and source records attributed to M A Zevon.

At least 19 recordsLinked to original sources
PubMed2000

Second malignant neoplasms after treatment for Hodgkin's disease in childhood or adolescence.

PURPOSE: To determine the frequency of and risk factors for second malignant neoplasms (SMNs) after treatment for Hodgkin's disease diagnosed in children and adolescents. PATIENTS AND METHODS: One hundred eighty-two consecutive, previously untreated patients with Hodgkin's disease who were younger than 20 years of age at diagnosis and who were referred to Roswell Park Cancer Institute (Buffalo, NY) for treatment between January 1, 1960, and December 31, 1989, were studied. Sex-specific standardized incidence ratios (SIRs) were calculated. Kaplan-Meier survival estimates and Cox regression analyses were performed to determine the relationship of several demographic and treatment variables to SMN incidence. RESULTS: Twenty-eight patients developed an SMN at a mean of 14.93 +/- 8.09 years (range, 2.65 to 29.88 years) after diagnosis of Hodgkin's disease. The cumulative percentage of patients who developed an SMN was 26.27 +/- 6.75% at 30 years after diagnosis. The SIR was 9.39 (95% confidence interval [CI], 4.05 to 18.49) for male patients and 10.16 (95% CI, 5.56 to 17.05) for female patients. The most frequent SMNs were thyroid cancer, breast cancer, nonmelanoma skin cancer, non-Hodgkin's lymphoma, and acute leukemia. Multivariate analysis of sex, treatment with any alkylating agent, treatment with doxorubicin, splenectomy, and relapse (as a time-dependent covariate) with time to SMN onset gave nonsignificant results. CONCLUSION: Successfully treated children and adolescents with Hodgkin's disease have a substantial risk for the occurrence of subsequent neoplasms. The most frequent SMNs (skin, thyroid, and breast) are readily detected by physical examination and available screening procedures.

Adolescent↗
PubMed1999

Psychosocial factors and the development of breast cancer: a meta-analysis.

A meta-analysis examined the relationship between psychosocial factors and the development of breast cancer. Average effect sizes (Hedges's g) were calculated from 46 studies for 8 major construct categories: anxiety/depression, childhood family environment, conflict-avoidant personality, denial/repression coping, anger expression, extraversion-introversion, stressful life events, and separation/loss. Significant effect sizes were found for denial/repression coping (g = .38), separation/loss experiences (g = .29), and stressful life events (g = .25). Although conflict-avoidant personality style was also significant (g = .19), the effect size was less robust, and a moderate number of future studies with null results would reduce the significance. Results overall support only a modest association between specific psychosocial factors and breast cancer and are contrary to the conventional wisdom that personality and stress influence the development of breast cancer.

Adaptation, Psychological↗
PubMed1999

Cancer and cardiac mortality among 15-year survivors of cancer diagnosed during childhood or adolescence.

PURPOSE: To evaluate the impact of cardiac disease and second malignant neoplasms on late mortality rate and to identify risk factors for late mortality among 15-year survivors of cancer diagnosed during childhood or adolescence. PATIENTS AND METHODS: Gender-specific all-cause and cause-specific (cardiac disease, cancer) standardized mortality ratios were calculated. Kaplan-Meier survival estimates and Cox regression analyses were performed to determine the relationship of several demographic and treatment variables to survival. RESULTS: Patients who survived for 15 years after diagnosis had excess subsequent all-cause, cancer (second malignant neoplasms only), and cardiac mortality rates. No decrease in the late mortality rate by treatment era (1960 to 1970, 1971 to 1984) was identified. Risk factors for males included disease recurrence during the first 15 years after diagnosis, treatment with doxorubicin, and the diagnosis of Hodgkin's disease. Those for females included treatment with radiation therapy, treatment with an alkylating agent, and disease recurrence during the first 15 years after diagnosis. Cox regression analysis demonstrated that only an initial duration of remission of less than 15 years (P <.01) and treatment with doxorubicin (P =.08) were significantly associated with shorter survival time for males. No variable was significantly associated with shorter survival time for females in Cox regression analysis. CONCLUSION: Fifteen-year survivors of childhood cancer have excess mortality. More effective treatments must be developed to reduce this excess risk. Fifteen-year relapse-free survivors did not have excess mortality. This group will require continued observation to determine whether excess mortality will become apparent as more events occur.

Adolescent↗
PubMed1998

Adaptation to metastatic cancer pain, regional/local cancer pain and non-cancer pain: role of psychological and behavioral factors.

The present study compared the adaptation of cancer pain patients and chronic non-cancer pain patients. Differences between samples of cancer pain patients with and without metastatic disease were also examined. Cancer pain patients reported comparable levels of pain severity to non-cancer chronic pain patients; however, pain due to cancer was associated with higher levels of perceived disability (t(250) = 2.97, P < 0.004) and lower degree of activity (t(286) = 2.45, P < 0.04). The patients with cancer pain, particularly those with metastatic disease, reported significantly higher levels of support and solicitous behaviors from significant others, compared to non-cancer chronic pain patients. The majority of the cancer patients, both with (81%) and without (84%) metastatic disease as well as non-cancer chronic pain patients (85%), could be classified into one of three psychosocial subgroups that had been previously identified with non-cancer chronic pain patients: 'dysfunctional' (high levels of pain, perceived interference, affective distress and low levels of perceived control and activity), 'interpersonally distressed' (high levels of affective distress, negative responses from significant others and low levels of perceived support) and 'adaptive copers' (low levels of interference and affective distress, high levels of perceived control and activity). The distribution of the profiles was significantly different across groups (chi2(4) = 12.79, P < 0.02). However, within each profile. the response patterns were highly comparable across groups. Thus, contrary to the suggestions of some authors, cancer pain and non-cancer chronic pain patients share many features in common. Furthermore, the heterogeneity of psychosocial adaptation to pain within each patient group suggests the importance of psychological assessment in determining the pain management plan.

Adaptation, Psychological↗
PubMed1998

The relationship between depression and pain language in cancer and chronic non-cancer pain patients.

The present study investigated the relationship between depression and pain description among cancer and chronic non-cancer pain patients in a large outpatient sample. Participants consisted of 312 patients (158 men and 154 women) attending a pain management clinic at a comprehensive cancer institute. Sixty-one percent of the patients (190/312) were experiencing pain related to cancer and 39% (122/312) were experiencing chronic nonmalignant pain. Multivariate analyses of covariance were used to assess differences in the sensory and affective indices of the McGill Pain Questionnaire (MPQ) associated with depression and type of pain. Current pain intensity was the covariate. The results indicated that the MPQ affective and sensory intensity scales did not significantly differ among patients with cancer and chronic non-cancer pain. There were also no significant differences in the percentage of affective and sensory pain descriptors chosen by these patients. However, depression significantly influenced MPQ pain description. Depressed patients with pain scored higher on the affective pain intensity dimension of the MPQ than non-depressed patients with pain (P < 0.001). Depressed patients also chose more affective pain descriptors than non-depressed patients (P < 0.001). Chi-square analyses revealed that depressed and non-depressed pain patients made significantly different choices on four of the five MPQ affective adjective lists. There were no differences in the sensory pain index or the percentage of sensory pain descriptors based on depression. These findings are discussed in terms of their clinical implications and their relationship to the existing literature.

Adolescent↗
PubMed1998

The structure of work-related stress and coping among oncology nurses in high-stress medical settings: a transactional analysis.

A transactional approach was used to examine stress and coping among 59 oncology nurses. Nine work stress clusters were identified: Physician-Related Stress, Organizational Factors, Observing Suffering, Ethical Concerns, Death and Dying, Carryover Stress, Negative Self-Thoughts, Inadequate Resources, and Coworker Stress, with the first 3 rated as most frequent and most intense. Ten coping clusters were also identified: Coworker Support, Positive Reappraisal, Developing a Growth Perspective, Positive Involvement in Treatment, Affective Regulation, Balancing Work Stress, Negative Coping, Apathy, Withdrawal, and Catharsis, with the first 3 rated as most frequently used and most effective. The relationships among the clusters, as well as the theoretical and clinical implications of these results, were discussed.

Adaptation, Psychological↗
PubMed1997

Birth defects and childhood cancer in offspring of survivors of childhood cancer.

OBJECTIVE: To determine the effect of chemotherapy for cancer during childhood and adolescence on subsequent pregnancy outcome and the occurrence of cancer in the offspring. DESIGN: We reviewed the history of 405 former patients with pediatric cancer. A self-administered questionnaire was completed by members of a cohort of consecutively treated patients who were aged 18 years or older at the most recent follow-up visit and who were at least 5 years beyond the initial diagnosis of their cancer. SETTING: Department of Pediatrics of a National Cancer Institute-designated comprehensive cancer center. RESULTS: One hundred forty-eight patients reported 280 pregnancies. Ninety-one of the patients who reported 1 or more liveborn or stillborn infants following the completion of treatment had received 1 or more chemotherapeutic agents as part of their treatment of cancer. The frequency of congenital anomalies was 3.3% among the liveborn offspring of the treated women and 3.3% among the liveborn offspring of the spouses or female companions of the treated men. No cases of childhood cancer have been diagnosed among the offspring. CONCLUSIONS: The present data suggest that prior treatment with mutagenic chemotherapeutic agents, in the dosage ranges examined, does not increase the frequency of congenital anomalies in the offspring of former pediatric and adolescent patients with cancer. Although no cases of childhood cancer have been observed thus far among the offspring, additional follow-up is necessary to adequately assess their risk of childhood cancer.

Abnormalities, Drug-Induced↗
PubMed1995

In situ breast carcinoma after treatment during adolescence for thyroid cancer with radioiodine.

We reviewed the courses of patients treated during childhood or adolescence for thyroid cancer to estimate the frequency of, and to identify possible risk factors for, the occurrence of second malignant tumors in this population. We identified all patients treated for thyroid cancer in a cohort of 1,406 pediatric cancer patients who were diagnosed prior to 20 years of age during the period January 1, 1960 through December 31, 1988 and who were treated at Roswell Park Cancer Institute. Twelve patients were treated for thyroid cancer, of whom nine were women. In situ breast carcinoma was diagnosed 25 and 26 years after diagnosis of thyroid cancer in two of four women treated with radioiodine. No new cancers were diagnosed in the five women treated with thyroidectomy only. Two of four women treated for thyroid cancer during adolescence with radioiodine, which is concentrated in the breast as well as other organs, developed in situ breast carcinoma. Review of a large cohort of adolescent female thyroid cancer patients treated with radioiodine is necessary to provide an accurate estimate of their risk of developing breast cancer. These patients must remain under medical surveillance throughout their lifetimes to facilitate prompt diagnosis of and early intervention for new conditions, such as the occurrence of breast cancer.

Adolescent↗
PubMed1994

Use and effectiveness of transdermal nicotine in primary care settings.

OBJECTIVE: To assess the use and effectiveness of transdermal nicotine patches by smokers receiving care in primary care settings. DESIGN: Telephone survey of a convenience sample of patients. SETTING: Primary care settings in western New York. SUBJECTS: Two hundred eighty-four adult members of an independent practice association health maintenance organization who received a prescription for transdermal nicotine between January 1, 1992, and June 30, 1992. MAIN OUTCOMES: Patient reports regarding advice received from physicians about the use of the nicotine patch, cessation methods used in addition to the patch, usual daily use of the patch, side effects experienced while wearing the patch, and smoking behavior while using the patch and after discontinuing therapy. RESULTS: Most patients reported getting proper advice from their physician about how to use the nicotine patch and possible side effects. The majority of those who used the patch said they used it every day for 24 hours. Side effects associated with using the patch were common but did not cause many subjects to discontinue therapy. Half of the patients who had completed patch therapy were not smoking, including 43% of patients who had not been using the patch for 4 months or longer. CONCLUSION: Transdermal nicotine patches appear to be an effective cessation aid for smokers receiving care outside specialized smoking cessation programs. Proper pretreatment screening to identify patients who are motivated to stop smoking is critical to the success of nicotine patch therapy.

Administration, Cutaneous↗
PubMed1994

Second malignant tumors following treatment during childhood and adolescence for cancer.

Many pediatric and adolescent cancer patients are treated with carcinogenic chemotherapeutic agents and radiation therapy to achieve permanent control of their malignancy. These modalities may induce a new cancer in the successfully treated patient. To identify disease and treatment factors which increased the risk of occurrence of a second malignant tumor following modern treatment for cancer during childhood or adolescence, we reviewed the courses of 1,406 previously untreated patients who were less than 20 years of age at diagnosis and were treated at Roswell Park Cancer Institute between January 1, 1960 and December 31, 1989. Eighteen patients developed a second malignant tumor, including two meningiomas, 2.65-25.65 years after diagnosis of the first cancer. The actuarial risk of a second malignant tumor was 5.6% at 25 years after diagnosis. Using Cox proportional hazards modelling, we identified prior therapy with BCNU (P = 0.0055) and doxorubicin (P = 0.0254) as the only factors that were significantly associated with the risk of a second malignant tumor. Three second malignant tumors of the central nervous system occurred following treatment with a nitrosourea. Successfully treated patients must be carefully followed to identify treatment related malignant tumors at an early stage.

Adolescent↗
PubMed1994

Factors that influence the further survival of patients who survive for five years after the diagnosis of cancer in childhood or adolescence.

To evaluate the further survival, and to identify disease and treatment factors which influence the further survival, of five-year survivors of cancer diagnosed during childhood or adolescence, we reviewed the courses of 591 previously untreated patients who were less than 20 years of age at diagnosis and survived for five years after diagnosis. Fifty-three of 143 patients who experienced disease recurrence during the first five years after diagnosis died during the period of observation, compared to 18 of 448 patients who did not experience disease recurrence during the first five years after diagnosis. The sex-specific standardized mortality ratios for the group of patients who never relapsed or relapsed more than five years after diagnosis were not significantly different from those of the New York State population. Cox proportional hazards modelling of the subgroup of patients who relapsed during the first five years after diagnosis demonstrated that disease which was treated surgically, a diagnosis of Hodgkin's disease or acute lymphoblastic leukemia, and older age at diagnosis were significantly associated with further survival in this group, whereas similar modelling of the patients who did not experience disease recurrence during the first five years after diagnosis failed to identify any variables which were associated with continued survival. The results of this study suggest that childhood and adolescent cancer patients who survive for five years without disease recurrence have a survival rate similar to that of the general population. Continued follow-up of this cohort is required to determine if the present findings can still be demonstrated as the majority of the cohort ages beyond 35 years of age.

Actuarial Analysis↗
PubMed1993

Cancer stereotypes: a multidimensional scaling analysis.

The body of empirical research investigating the structure of stereotypes held by the physically healthy population toward individuals with medically related problems is remarkably small. This is particularly true for stereotypes related to cancer. This study adopted a multidimensional scaling (MDS) strategy in order to identify medically related stereotype dimensions for cancer and other illnesses. Sixty-eight subjects judged the similarity of cancer and eleven other medical conditions and rated each on 7-point attribute scales. A two-dimensional solution of respondents' similarity judgments was found and four distinct clusters of related conditions were perceived: (1) cancer and other illnesses with controllable risk factors, (2) conditions affecting motor function, (3) psychological/functional disorders and (4) communication/sensory functional disorders. Regression of mean attribute ratings onto the MDS disability coordinates labeled the two dimensions Normality and Physical Health. Implications of these dimensions for planning effective programs to change stereotypes and improve attitudes toward individuals with cancer and other medical conditions are discussed.

Adolescent↗
PubMed1991

Congenital anomalies in children of patients who received chemotherapy for cancer in childhood and adolescence.

BACKGROUND: Many patients who have been treated successfully for childhood cancer with regimens that contain one or more mutagenic chemotherapeutic agents are concerned that their own treatment during childhood or adolescence may adversely affect their children. METHODS: To determine the effect of chemotherapy for cancer during childhood and adolescence on the outcome of subsequent pregnancies, we reviewed the records of 306 men and women who had been treated for pediatric cancer and who responded to our questionnaire. One hundred of the 306 patients reported 202 pregnancies. Among the patients who had received chemotherapy as part of their treatment for cancer, 60 patients or wives of patients had had one or more pregnancies of 20 or more weeks' gestation. The 60 former patients had a total of 100 live-born and 2 stillborn children. RESULTS: The frequency of congenital anomalies was 8.1 percent (5 of 62) among the live-born children of the women and 7.9 percent (3 of 38) among the live-born children of the men. Structural congenital cardiac defects were identified in 10.0 percent (2 of 20) of the children of women who had been treated with dactinomycin, as compared with 0.6 percent (144 of 24,153) among the children in a multicenter survey of fetal anomalies (P = 0.0126). We found no relation between the number of mutagens received or the cumulative dose of any agent received and the frequency of congenital anomalies in the children. CONCLUSIONS: These data suggest that treatment of children and adolescents with mutagenic chemotherapeutic agents, in the dose ranges we examined, does not increase the frequency of congenital anomalies in the children subsequently born to the former patients. However, the possible adverse effect of dactinomycin on the children of such patients requires further study.

Abnormalities, Drug-Induced↗
PubMed1991

Achievement of life goals by adult survivors of modern treatment for childhood cancer.

To assess the impact of the diagnosis and modern treatment of childhood cancer on achievement of adult goals, the authors evaluated employment, health and life insurance coverage, marriage, divorce, and reproduction in 227 former pediatric cancer patients. Each area was evaluated in relation to a common set of disease and demographic factors that included age at follow-up, age at diagnosis, gender, marital status, history of disease recurrence, and diagnosis. Patients were younger than 20 years of age at diagnosis, and their diagnoses were made between January 1, 1960, and December 31, 1984. The median age at diagnosis was 11.4 years, and the median age at follow-up was 26.6 years. The percentage of unemployed male respondents did not differ from population norms. The percentage of unemployed female respondents, however, was slightly higher than that of the United States population. Approximately 11% of the survivors reported some form of employment-related discrimination, a level significantly lower than that of prior reports. Company-offered health insurance was provided to 92.4% of full-time and 90.0% of part-time employed respondents. Life insurance was purchased by 60% of full-time employed men and 55% of women. These percentages were lower than those reported for the United States population. Twenty-four percent of those with life insurance had difficulty obtaining it. Fifty-eight percent of the subjects were married or lived as married. The percentages of married men and women were significantly lower than United States norms. Twenty percent of those who were married or lived as married have divorced or separated or no longer live as married. Women aged 20 to 24 years were less likely to marry, and women aged 35 to 44 years had a significantly higher frequency of divorce than similarly aged United States women. In general, the history of childhood cancer did not influence the decision to marry or live as married but was occasionally (20%) important in the decision to dissolve a marital relationship. Many former patients indicated that their diagnosis and treatment for childhood cancer influenced their decision to have children. The current study suggests that most former pediatric cancer patients achieve adult life goals. Additional research is necessary to define those populations at greatest risk of failure to achieve these goals.

Adolescent↗
PubMed1990

Spouse adjustment to cancer surgery: distress and coping responses.

Although often acknowledged, the impact of the surgical treatment of cancer on the spouse of the adult cancer patient is a largely unexplored area. The present study examined distress, coping, and appraisal among spouses (N = 36) and patients (N = 43) assessed prior to and following surgery. The results indicated that at both the presurgical and postsurgical period, spouses were exhibiting significantly greater distress than patients. Surprisingly, spouses' levels of distress remained fairly constant across the presurgery to postsurgery period, while the patients' distress decreased. Escape and avoidance behaviors were found to be maladaptive for spouses coping with their partners' surgical treatment. Appraisal was also found to be a critical factor in understanding individual reactions to the stress of cancer surgery. Spouses of cancer patients undergoing surgical treatment appear to be an underacknowledged population at risk.

Adaptation, Psychological↗
PubMed1990

Models of helping and coping, responsibility attributions, and well-being in community elderly and their helpers.

The analysis of Brickman et al. (1982), which separates attribution of a problem's cause and solution, was tested in 4 studies. Young and elderly adults' (n = 210) well-being was related only to taking responsibility for solutions. The elderly compared with the young adults assumed less responsibility for problem cause and solution. They also preferred helping and coping models that assume low self-responsibility for solutions (e.g., medical model). This result was replicated with Meals on Wheels clients (n = 51). An intragenerational helping pattern was found in Study 3. Lay helpers (n = 63) helped mainly same-age recipients. Elderly and middle-aged helpers compared with young adults preferred using a medical model. Overall, a cohort bias in model preference was suggested. In Study 4, problem type and recipient age moderated attributions and model choice of young and middle-aged Ss (n = 92). Relevance to the control literature and ethical and clinical implications of a medical-model bias are discussed.

Adaptation, Psychological↗
PubMed1990

Adjustment and vocational satisfaction of patients treated during childhood or adolescence for acute lymphoblastic leukemia.

This investigation evaluated the psychosocial consequences of the diagnosis and treatment of acute lymphoblastic leukemia (ALL) on the long-term adjustment of a sample of 46 patients less than 20 years of age at diagnosis (mean age: 7.46 years). Subjects were followed up for an average of 15.4 years after diagnosis and were a mean of 22.87 years old at assessment. A sample of Hodgkin's disease and non-Hodgkin's lymphoma survivors served as a comparison group. Patients completed standardized measures of well-being, stress reaction, vocational satisfaction, and a questionnaire assessing defensiveness regarding their history of cancer treatment, experienced job discrimination, and social involvement. Overall, the subjects appeared to be well-adjusted; female subjects, however, exhibited an increased tendency to experience anxiety in stressful situations. Vocational discrimination did not appear to be a significant problem for this group of survivors, and subjects exhibited levels of vocational satisfaction that did not differ from population norms. Greater defensiveness regarding a history of cancer treatment was associated with lower levels of well-being and heightened stress reaction. Survivors who received CNS prophylaxis that included cranial irradiation had lower well-being scores than did those survivors receiving only intrathecal methotrexate.

Adaptation, Psychological↗