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Biomedical subjects

M E Stefanek

Publications and source records attributed to M E Stefanek.

At least 19 recordsLinked to original sources
PubMed1999

Sleep alterations in cancer patients.

This multi-institutional sleep study involved two phases aimed at investigating sleep alterations in patients with any stage of breast and lung cancer. The first phase of this study used an 82-item, 20-minute telephone survey to elicit information regarding the impact of sleep disturbances on a convenience sample of 150 patients. Of these patients, 44% reported a sleep problem during the month before the interview. Significant relations included these: report of sleep problems prediagnosis over the past month (x = 5.82; p = 0.02), duration of sleep medication use and frequency of sleep problem (r = 0.58; p = 0.05), age and severity of sleep problems (r = 0.38; p = 0.05), and frequency and severity of the sleep problem over the past month (r = 0.21; p < 0.10). Communication with health care providers occurred in 16.6% of patients reporting a sleep disturbance. The second phase of this study explored the type, frequency, and severity of sleep problems and perceptions of causation, support, and methods of coping with the sleep problem. A qualitative approach to the problem was used in this phase. A one-time telephone interview of 42 patients, derived from a convenience sample, revealed a 45% prevalence of sleep problems a month before the interview. A qualitative analysis of the responses suggested that sleep problems are related to experiences of other symptoms and perceptions of cancer and treatment. Content analysis of the responses identified the following categories: figuring out the reason, seeking help, seeking support and relation to the overall cancer experience.

Baltimore↗
PubMed1995

Predictors of and satisfaction with bilateral prophylactic mastectomy.

BACKGROUND: Women with a first-degree relative with breast cancer are at increased risk of developing this disease. The optimal medical management of these women is unclear, with options including close breast cancer screening, bilateral prophylactic mastectomy, or participation in chemoprevention trials. Among women who undergo prophylactic bilateral mastectomy, very little is known about satisfaction with this surgery. Also, we know very little about variables related to prophylactic mastectomy decision making. METHODS: Participants were women at increased risk of breast cancer due to family history. These women were categorized by self-report as not interested in prophylactic mastectomy (n = 58), interested but deciding against surgery (n = 92), or subsequently having a bilateral prophylactic mastectomy (n = 14). Information on screening practices, risk perception, level of depression, and cancer-related worry was collected. Women completing prophylactic mastectomy reported on their satisfaction with the surgery and breast reconstruction. RESULTS: Women selecting surgery reported more breast cancer worry. The group expressing no interest in surgery reported fewer biopsies and lower risk estimates. Women completing surgery were satisfied with their decision, although satisfaction with reconstruction was mixed. CONCLUSION: Factors influencing surgical decision making may include breast-cancer-related worry, biopsy history, and subjective breast cancer risk.

Adult↗
PubMed1995

Psychosocial issues in breast cancer.

Over the past year, increasing research attention has been devoted to the issue of women at increased risk of developing breast cancer. These articles focus on a range of issues from recruiting high-risk women into breast cancer trials to recommendations for assessment and counseling women with a family history of breast cancer. In addition, continuing research attention has focused on quality of life, symptom management, and articles related to physician-patient communication. This review summarizes and critiques publications in these areas, and it includes articles reviewing the status of research in psychosocial oncology.

Breast Neoplasms↗
PubMed1995

The practice of prophylactic mastectomy: a survey of Maryland surgeons.

OBJECTIVES: Bilateral prophylactic mastectomy is a drastic breast cancer preventive option for which indications are not standardized and efficacy has not been proven. To estimate the magnitude of this controversial practice, surgeons were surveyed on their recommendations about and performance of prophylactic mastectomy. METHODS: A cross-sectional survey was sent to general surgeons (n = 522), plastic surgeons (n = 80), and gynecologists (n = 801) licensed to practice in Maryland in 1992. Proportions responding were 41.9%, 66.3%, and 54.9%, respectively. In addition, there were 30 respondents who identified "other" as their specialty. The respondents were asked about the role of bilateral prophylactic mastectomy and the number of times they had recommended and performed it in a year. RESULTS: Seven hundred forty-two surgeons responded (51.8%). More plastic surgeons (84.6%) than general surgeons (47.0%) and gynecologists (38.3%) agreed that bilateral prophylactic mastectomy has a role in the care of high-risk women. Eighty-one percent of plastic surgeons had recommended the procedure, compared with 38.8% of general surgeons and 17.7% of gynecologists. CONCLUSIONS: Indications and practice patterns reveal heterogeneity of medical opinion and practice of prophylactic mastectomy. This study raises the need for better evaluation of the efficacy and appropriateness of prophylactic mastectomy.

Breast Neoplasms↗
PubMed1995

Bilateral prophylactic mastectomy: issues and concerns.

At present, the care of women at increased risk of developing breast cancer poses a clinical dilemma and remains an area of controversy. A number of investigators have addressed the pros and cons of prophylactic mastectomy versus close follow-up, utilizing annual mammography, semiannual or even more frequent physical examinations of the breast, and proficient monthly breast self-examinations. Recent efforts to isolate a gene (BRCA1) on chromosome 17q12-21 raise additional concerns about the management of women testing positive for BRCA1 mutations. These women are estimated to have an 85% lifetime risk of developing breast cancer. Testing for BRCA1 mutation carriers may soon be available for population screening. This article describes preliminary studies investigating health care provider and patient perceptions of bilateral prophylactic mastectomy. In addition, a number of research questions remain regarding the efficacy and utilization of bilateral prophylactic mastectomy as a treatment option for women at increased risk of developing breast cancer. These women include those testing positive for BRCA1 mutations. In addition, women with a strong family history opting against testing for BRCA1 mutations may express interest in surgery.

Attitude of Health Personnel↗
PubMed1994

Quality of life and other psychosocial issues in breast cancer.

Over the past year, quality of life among patients with breast cancer has continued to be a noteworthy area of research. Several articles related to provider-patient communication are also included in this review. Reports on the psychologic distress and cancer screening practices of spouses and other relatives of patients with breast cancer are noted. This review summarizes and critiques publications in these three areas.

Breast Neoplasms↗
PubMed1993

Psychosocial aspects of breast cancer.

Over the past year, several research areas have been noteworthy. This article discusses decision making related to breast cancer treatment, the effects of treatment on measures of psychological distress, and studies related to quality-of-life among breast cancer patients. In addition, an area of continued interest involves breast cancer survival as a function of psychological distress or psychological intervention. This article summarizes and critiques publications in these areas.

Breast Neoplasms↗
PubMed1992

Psychosocial aspects of breast cancer.

Over the past year, several research areas have been noteworthy. This article discusses several reports on psychiatric morbidity and psychological factors of breast cancer, quality-of-life issues related to breast cancer treatment, and psychological factors in breast cancer screening. An area of increasing interest includes studies examining the psychological status and breast cancer screening practices of women at increased risk of developing breast cancer, primarily as a function of family history.

Adaptation, Psychological↗
PubMed1991

First degree relatives of breast cancer patients: screening practices and provision of risk information.

Little is known about breast cancer screening knowledge and behaviors among women with a family history of breast cancer. Data gathered from 125 first-degree relatives of breast cancer patients indicated that only 63.3% of women over age 35 "ever" had a mammogram, 53% of women 40 or older reported a mammogram in the last year, and only 36.8% of all participants reported monthly breast self-exam (BSE). Self-reported BSE competence was generally poor. One hundred five (105) (84%) reported a clinical breast exam over the previous year. Only 71 (56.8%) of the women indicated that they had been asked about their family history of breast cancer by their physician, and minimal information about risk related to family history was provided. Worry about developing breast cancer was positively related to mammography use and BSE competence. Confidence in performing BSE and learning BSE from a physician/nurse were both positively related to competence. Women who believed they had control over finding breast cancer in its early stages reported more frequent BSE. Poor compliance of women with a family history of breast cancer in the practice of BSE and utilization of mammography, and lack of risk information provided by physicians mandate a search for effective intervention.

Adult↗
PubMed1990

Counseling women at high risk for breast cancer.

Cancer risk analysis is a relatively new clinical service that has developed as more precise information has become available regarding specific risk factors. Both epidemiological and genetic factors contribute substantially to the identification of women at higher risk for developing breast cancer. The definition of what constitutes risk, an understanding of which factors influence risk, and the ability to present risk information clearly are critical features. In addition to providing information about risk and assessing each woman's perception of risk, the emotional issues must be addressed. The focus of intervention should center upon the benefits of early detection, assessment of breast self-examination skills, individualized breast cancer screening recommendations, such as mammography and physical exams, and recommendations for life style changes for possible prevention.

Breast Neoplasms↗
PubMed1989

Illness-related worry among cancer patients: prevalence, severity, and content.

The present study assessed the prevalence, severity, and other parameters of illness-related worry among 83 cancer patients receiving active treatment for their illness. Participants completed questionnaires assessing a variety of worry dimensions. In addition, a family member of each patient completed a brief questionnaire regarding their perception of the patient's illness-related worry. Nurse ratings of patients' clinic-related behaviors were obtained. Fifty-one percent (n = 43) of patients reported worry to be at least "somewhat of a problem." Fifteen percent (n = 12) reported it to be a significant to severe problem. Significant correlations included patients self-rating of worry and: nurse rating of clinic behavior, total score on a Worry Content Scale, ability to stop worrying once started, and impact of worry on mood and functioning. Rating by the significant other of how much of a problem worry was for the patient and whether the patient was a worrier preillness was also significantly correlated. There were no significant differences between "worriers" and "nonworriers" on demographic or disease variables. A logistic regression model using the categories of "worries" or "nonworriers" as a dependent variable found that women and patients reporting poor social support were more likely to report a problem with worry. However, a large amount of the variance remained unexplained.

Adult↗
PubMed1988

Anticipatory nausea and vomiting: does it remain a significant clinical problem?

A study performed 5 years ago in our clinic revealed a prevalence rate of 31% for anticipatory symptoms. This finding is consistent with other investigations. It was hypothesized that more effective management of postchemotherapy nausea and vomiting and briefer chemotherapy regimens since the previous study would decrease the prevalence of anticipatory symptoms. The study reported in this article assessed the prevalence of anticipatory symptoms in 121 patients receiving parenteral chemotherapy over a 7-week period. The overall prevalence rate of 33% for anticipatory symptoms was not significantly different from the previous study or other investigations. Length of postchemotherapy nausea was significantly related to the report of anticipatory symptoms. However, the severity of symptoms reported in the investigation was mild. The prevalence in patients on adjuvant therapy for breast cancer was also significantly reduced from the previous investigation. It is concluded that although anticipatory symptoms commonly occur they are only rarely clinically significant.

Adult↗
PubMed1987

Clonidine for anticipatory nausea and vomiting: a pilot study examining dose-toxicity relationships and potential for further study.

In preparation for studies of noradrenergic activity in anticipatory nausea and vomiting, we performed an open-dose study of clonidine to examine dose-toxicity relationships and indications of antiemetic activity. Nine patients, three each at 0.1, 0.2, and 0.4 mg/day, received clonidine twice a day for 5 days before chemotherapy. Unwanted effects, principally blood pressure reduction, dry mouth, and sedation, accumulated between 4 and 5 micrograms/kg/day. Four of eight evaluable patients had no anticipatory symptoms on clonidine. It is concluded that clonidine, at a dose of 4 micrograms/kg/day, might safely probe the role of noradrenergic activity in anticipatory nausea and vomiting.

Adult↗
PubMed1986

Expectancy effects on relaxation instructions: physiological and self-report indices.

Two sessions of relaxation instructions were administered under high and low expectancy conditions. Fifty-four college students scoring high on a self-report measure of anxiety served as subjects. Live and taped abbreviated progressive muscle relaxation instructions and a self-relaxation condition were equally effective in reducing within-session self-report and physiological indices of anxiety. High expectancy instructions led to greater reductions in heart rate than did low expectancy instructions. Factors controlling anxiety reduction during relaxation therapies are discussed.

Anxiety↗