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Biomedical subjects

M Klee

Publications and source records attributed to M Klee.

At least 19 recordsLinked to original sources
PubMed2001

Ovarian carcinoma: care and survival in a community-based population.

BACKGROUND: Previous studies of the management and costs of ovarian cancer have been based on data from oncology practices. Such studies may exclude patients who are not candidates for treatment and may not account for costs incurred during diagnosis or primary treatment. OBJECTIVE: The purpose of this study was to describe the epidemiology, management, and costs of care of ovarian cancer in a geographically defined population to better reflect the total spectrum of the disease and its care. METHODS: We conducted a retrospective review of the medical records of all residents of Olmsted County, Minnesota, who received a first diagnosis of epithelial ovarian carcinoma (including postmortem diagnoses) between 1985 and 1997. RESULTS: Of the 107 women with a new diagnosis of ovarian cacinoma, 42 (39%) had stage I or II tumors at the time of diagnosis. The mean age of the patients at the time of diagnosis was 64.7 years, and 20% were nulliparous. The diagnostic assessment for ovarian carcinoma was initiated by a family physician or internist in 50% of cases and by an obstetrician or gynecologist in 16% of cases. One hundred two patients (95%) underwent surgical treatment, and 80 (75%) received primary chemotherapy. The 5-year survival rate was 88% in those with stage I or II tumors and 17% in those with stage III or IV tumors. The mean charges for secondary care were higher than those for primary care ($36,110 vs $32,367; P < 0.05) in those receiving both types of therapy. Fifty percent of those dying of ovarian cancer received hospice care for a mean of 39.0 days before death. CONCLUSIONS: Most assessments leading to a diagnosis of ovarian carcinoma were initiated by primary care physicians. In this community-based population, early-stage and low-grade tumors were common (> or = 30%) and were associated with lower costs of care and higher 5-year survival rates. Total treatment costs for those requiring secondary therapy were approximately twice the costs for those requiring primary treatment only, with approximately 50% of costs associated with inpatient care.

Adult↗
PubMed2001

Health-related quality of life of patients with endometrial cancer who are disease-free following external irradiation.

Health-related quality of life (HQoL) is assessed through the patients' own evaluation of the impact that a disease and its treatment may have on some of the physical, psychological and social aspects of their lives. The purpose of this study is to describe the HQoL of patients with endometrial cancer who are free of disease after undergoing external irradiation. An HQoL questionnaire was designed and validated, and consisted of the EORTC QLQ-C30 and 80 additional questions. The patients provided self-reported assessments at the end of radiotherapy, and 1, 3, 6, 12, 18 and 24 months later. Forty-nine out of 66 potential subjects participated in the study, which was confined to the period during which the, women were disease free. Most patients experience physical side effects at the end of treatment and up to 6 months thereafter; 10% of the patients have chronic local symptoms and a large number of the patients think about their treatment even two years later. The patients' overall evaluation of their quality of life is lower than that of a matched population of healthy women.

Adult↗
PubMed2001

The Southeast Minnesota Fetal and Infant Mortality Reduction Project.

Using linked birth and death certificates, researchers collected information on the events surrounding and potentially contributing to all fetal and infant deaths in an 11-county southeast Minnesota area May 1, 1996, through May 31, 1998. Data were collected from medical record reviews and maternal interviews. Information was collated and presented to county review teams consisting of health, human services, and education personnel. These teams identified factors associated with potentially preventable deaths and gaps in services for women, infants, and families. A regional team then grouped and prioritized the factors.

Adolescent↗
PubMed2000

The patients' perspective on physical symptoms after radiotherapy for cervical cancer.

PURPOSE: The aim of this study was to describe the physical symptoms experienced by patients with advanced stages of cervical cancer during the first 2 years after radiotherapy. METHODS: A questionnaire about health-related quality of life was used. It consisted of the EORTC QLQ-C30 and additional specific questions. The patients were assessed at the end of treatment and 1, 3, 6, 12, 18, and 24 months later. The scores from the 118 patients were compared to those from 236 healthy controls. RESULTS: Most patients had acute physical symptoms at the end of treatment and up to 3 months later. Local symptoms such as frequent voiding and diarrhea may become chronic symptoms. CONCLUSION: Assessment of health-related quality of life includes information about milder side effects that is not usually included in physician scoring of morbidity. Information about possible side effects improves the patient's ability to cope with the symptoms should they occur.

Adaptation, Psychological↗
PubMed2000

Life after radiotherapy: the psychological and social effects experienced by women treated for advanced stages of cervical cancer.

PURPOSE: The aim of this study was to describe the psychological and social reactions of women with advanced stages of cancer of the cervix during and after radiotherapy. METHODS: A questionnaire about health-related quality of life was used, which consisted of the EORTC QLQ-C30 and additional specific questions. One-hundred eighteen patients filled out the questionnaire at the end of treatment and 1, 3, 6, 12, 18, and 24 months later. The scores from the disease-free patients were compared to those from 236 healthy controls. RESULTS: Many patients experience psychological and social consequences at the end of treatment and 1 to 3 months later. Patients continue to think about their illness and treatment throughout the 24-month study period, but find it increasingly hard to share their worries with others. Their score on overall quality of life never reaches that of the controls. CONCLUSION: Disease-free patients treated for cancer of the cervix with radiotherapy have psychological reactions. The interpretation of the results should take into consideration that the patients change their personal frame of reference over the course of time. Professionals should be aware of patients' needs to talk about their disease long after treatment. Patients should be informed about the risk of psychological reactions. The more information about possible symptoms they receive the better their ability to cope with them should they arise.

Adaptation, Psychological↗
PubMed1999

Using data from studies of health-related quality of life to describe clinical issues examples from a longitudinal study of patients with advanced stages of cervical cancer.

The focus of the paper is to describe how to present data from studies on health-related quality of life (H-QoL) in a way that is simple and clinically relevant. Data from a longitudinal study of patients with advanced stages of cervix cancer are used. One hundred and eighteen patients filled out questionnaires (including EORTC QLQ-C30) 7 times over a period of 2 years. The following issues are considered: (1) The use of a panel for an initial overview of data. (2) The visual difference between using mean and median values. (3) Box-whisker plots to illustrate the variability of the data. (4) The effect of combining categorical data into fewer categories. (5) Individual patient profiles showing the wide variability among patients. (6) A table showing the change of scores over a one-year period. (7) "Prognostic plots" dividing the initial scores and the following scores. (8) Plotting changes over time. (9) Illustration of the impact of non-random dropout. (10) The effect of drop-out for the patients who fill out two sequential assessments. (11) The use of healthy controls to help answer the question "what is normal?".

Adult↗
PubMed1997

Quality of life of Danish women: population-based norms of the EORTC QLQ-C30.

The aim of this was to derive population-based norms for women completing the EORTC QLQ-C30 version 1 which is designed for use with patients who have cancer. The study was conducted using two different questionnaires: one designed for use in female patients with breast cancer, the other for those with gynaecological cancers, but both including the EORTC QLQ-C30. The women were drawn from the Danish Central Population Register without knowledge of their health status and divided at random between the two questionnaires. All procedures for collecting data were identical. The response rate for those receiving the gynaecological cancer (GS) questionnaire was 49% and it was 71% for the breast cancer (BS) questionnaire. Detailed comparison between the two samples revealed several EORTC QLQ-C30 items showing a clear difference in distribution of scores between them. Because of this and the possible bias due to the relative low age-related response rate in GS, only the results from the BS are used for constructing norms. The norms cover all 30 single items on the EORTC QLQ-C30 and the nine derived scales, for women in four 10-year age groups commencing at 30 years and for those aged 70-75. Clear trends in, for example, declining ability to undertake strenuous activity are illustrated and quantified. Levels of certain symptoms, such as pain, are surprisingly high although it is recognized that the population sampled will contain a proportion of women with active disease including cancer. We recommend the use of these norms both as an aid to the clinical assessment of an individual patient, and to assist in the interpretation of clinical trial and longitudinal quality of life data. As a secondary result, we note that a population-based sample will have a lower response rate to a questionnaire with more questions, especially if many of these extra questions are on sexual issues.

Adult↗
PubMed1994

Sexuality among gynecologic cancer patients--a cross-sectional study.

To establish the prevalence of sexual activity among gynecologic cancer patients and to estimate the extent of sexual problems, a cross-sectional study using questionnaires was used. All patients (pts) had gynecologic cancer treated with chemotherapy or radiation therapy and attended the gynecologic outpatient department at Rigshospitalet, Copenhagen from December 1, 1989 to January 31, 1990; 146/186 (78%) pts participated. The study describes the 107/146 (74%) pts who had a partner. Median ages for pts with endometrial, cervical, and ovarian cancers were 63, 55, and 52 years, respectively. The median time since diagnosis was 15 months (range, 0-311 months). Little or no desire for sexual relations was found among 74% of the patients and 42% of their partners, but 54% of the patients were sexually active, 79% of the patients < 55 years old, and 37% of the patients > 55 years old. Sexual activities were not related to diagnosis or stage of disease. Among the sexually active patients 40% experienced dyspareunia. Only 22% of all patients with a partner expressed dissatisfaction with their sexual life or lack thereof. Despite considerable decrease in sexual desire and frequent dyspareunia, many gynecologic cancer patients continue to be sexually active. Gynecologic cancer patients of all ages should be supplied with information on the possible sexual changes their disease may evoke, but they should also be reassured that many patients regain their sexual capacity and satisfaction.

Adult↗
PubMed1993

Performance status assessment in cancer patients. An inter-observer variability study.

The ECOG Scale of Performance Status (PS) is widely used to quantify the functional status of cancer patients, and is an important factor determining prognosis in a number of malignant conditions. The PS describes the status of symptoms and functions with respect to ambulatory status and need for care. PS 0 means normal activity, PS 1 means some symptoms, but still near fully ambulatory, PS 2 means less than 50%, and PS 3 means more than 50% of daytime in bed, while PS 4 means completely bedridden. An inter-observer variability study of PS assessment has been carried out to evaluate the non-chance agreement among three oncologists rating 100 consecutive cancer patients. Total unanimity was observed in 40 cases, unanimity between two observers in 53 cases, and total disagreement in seven cases. Kappa statistics reveal the ability of the observers compared to change alone and were used to evaluate non-chance agreement. Overall Kappa was 0.44, (95% confidence limits 0.38-0.51). The Kappa for PS 0 was 0.55 (0.44-0.67), while those for PS 1, 2, 3 and four were 0.48 (0.37-0.60), 0.31 (0.19-0.42), 0.43 (0.32-0.55), and 0.33 (0.33-0.45), respectively. If one observer allocated patients to PS 0-2, then another randomly selected observed placed the patients in the same category with a probability of 0.92. For patients with PS 3-4 the probability that the same category would be chosen was 0.82. Overall, the non-chance agreement between observers was only moderate, when all ECOG Performance Status groups were considered. However, agreement with regard to allocation of patients to PS 0-2 versus 3-4 was high. This is of interest because this cut-off is often used in clinical studies.

Activities of Daily Living↗
PubMed1991

Oral administration of idarubicin as first line cytostatic therapy in patients with metastasized breast cancer and favourable prognosis. A trial of the phase II study group of the Association for Medical Oncology of the German Cancer Society.

Idarubicin is a new anthracycline derivative with therapeutic efficacy in metastatic breast cancer. In a phase II trial we treated 23 patients with advanced breast carcinoma and favourable prognostic factors. Oral dose of idarubicin was 15 mg/m2 day 1-3 repeated every 3 weeks. All patients were pretreated with hormones. Idarubicin was administered as first line chemotherapy. 20 patients were evaluable for response: 3 patients achieved partial remission, 12 patients stable disease; tumour progression occurred in 5 patients. 3 patients were not evaluable for response because only 1 treatment cycle was administered. Main toxicites were leukopenia (median WHO-grade: 2,r:0-4), nausea and vomiting (median: 1,r:0-4) and alopezia (median: 1,r:0-3). 1 patient died in septic shock: Immediately after the administration of one idarubicine cycle, she was extensively irradiated because of bone metastasis. The fatal course of the disease in this patient does not depend only on the idarubicin therapy, but also on the extensive bone infiltration and on intensive radiation therapy. Idarubicin proved to be an effective drug in metastatic breast cancer with low systemic toxicity and the advantage of oral administration. The drug is an enrichment of therapeutic armament, especially in patients with soft tissue and bone metastasis.

Administration, Oral↗
PubMed1990

Tumor necrosis factor in advanced colorectal cancer: a phase II study. A trial of the phase I/II study group of the Association for Medical Oncology of the German Cancer Society.

In a phase II study, the efficacy and toxicity of human recombinant tumor necrosis factor (rh TNF-alpha) were evaluated in patients with advanced colorectal carcinoma. Rh TNF-alpha was given as short term infusion at a dose of 3 x 10(5) U/m2 on three successive days. Treatment was repeated after a two week interval. The response was evaluated after four treatment cycles. In 15 patients entering the study, we found one partial response, one stable disease, 9 progressive diseases, and four patients who were not evaluable for tumor remission. There were numerous side effects of the treatment, mainly fever, chills, loss of appetite, leukopenia, and hepatotoxicity. In this regimen, rh TNF-alpha does not suggest a therapeutic advantage for treatment of advanced colorectal carcinoma.

Adenocarcinoma↗
PubMed1989

Palliative irradiation of bone metastases.

Painful bone metastases is a common feature in patients with advanced cancer. The application of radiotherapy is often used as palliative treatment. A review of available data from the literature reveals that irrespective of the primary diagnosis palliation is achieved in 70-100% of cases. The biological basis of pain and the effects of radiotherapy is discussed. Treatment schedules for patients with single-bone lesions are reviewed. It is concluded that single-shot treatment in doses ranging from 5 to 8 Gy is as effective as multi-fractionated treatment. In addition, the possible role of radiotherapy in relation to patients with multiple lesions, and the use of combined surgery and radiotherapy in patients with impending and manifest fractures are discussed. It is concluded that the literature does not allow a definitive conclusion concerning an optimal use of radiotherapy.

Bone Neoplasms↗