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Mary A Weiser

Publications and source records attributed to Mary A Weiser.

3 recordsLinked to original sources
PubMed2004

The "duty to warn" a patient's family members about hereditary disease risks.

Genetic tests for adult-onset disorders, including common forms of cancer, are now commercially available, and tests for genetic polymorphisms that predict drug effects or toxicity after treatment are under development. For each of these circumstances, testing of 1 individual may imply an increased risk to his/her relative. The obligation, if any, to warn family members of the identification of a genetic mutation has generated concerns regarding the conflict between the physician's ethical obligations to respect the privacy of genetic information vs the potential liabilities resulting from the physician's failure to notify at-risk relatives. A duty to warn relatives about risks due to some infectious agents has been assumed by state and local health agencies, and the duty to breach confidentiality to warn of imminent harm has been the subject of case law. In general, the special nature of genetic tests has been viewed as a barrier to physicians' breaching the confidentiality of personal genetic information. However, the failure to warn family members about hereditary disease risks has already resulted in 3 lawsuits against physicians in the United States. While the findings of case law and the state and federal statutes that bear on the issue of "duty to warn" of inherited health risk are still being defined, we believe that health care professionals have a responsibility to encourage but not to coerce the sharing of genetic information in families, while respecting the boundaries imposed by the law and by the ethical practice of medicine.

Duty to Warn↗
PubMed2002

Comparison of two different schedules of granulocyte-colony-stimulating factor during treatment for acute lymphocytic leukemia with a hyper-CVAD (cyclophosphamide, doxorubicin, vincristine, and dexamethasone) regimen.

BACKGROUND: Although the safety and efficacy of granulocyte-colony-stimulating factor (G-CSF) (filgrastim) in the treatment of hematologic malignancies has been well established, to the authors' knowledge the optimal timing of filgrastim administration during remission induction chemotherapy and consolidation chemotherapy has not been determined. The purpose of the current study was to determine whether a delay in the administration of filgrastim from Day 5 to Day 10 during chemotherapy with a hyper-CVAD (cyclophosphamide, doxorubicin, vincristine, and dexamethasone) regimen resulted in a longer time to neutrophil or platelet count recovery or increased the incidence of infection. METHODS: One hundred ninety-nine patients who achieved complete disease remission after a single course of induction chemotherapy were considered for evaluation. Induction chemotherapy was with hyper-CVAD (fractionated cyclophosphamide, 300 mg/m2, twice daily for Days 1-3; doxorubicin, 50 g/m2, on Day 4; vincristine, 2 mg, on Days 4 and 11; and dexamethasone, 40 mg, on Days 1-4 and Days 11-14), which also was given in odd-numbered consolidation Courses 3, 5, and 7. Even-numbered courses (Courses 2, 4, 6, and 8) were comprised of methotrexate, 200 mg/m2, over 2 hours followed by 800 mg/m2 over 24 hours on Day 1; cytarabine, 3 g/m2, every 12 hours for 4 doses over 2 days (Days 2 and 3); and intravenous methylprednisolone, 50 mg, twice daily on Days 1-3 (MTX/ara-C regimen). Two sequential treatment groups were assessable based on timing of the filgrastim administration; 151 patients received filgrastim starting on Day 5 (D5) of induction chemotherapy and 48 patients received filgrastim starting on Day 10 (D10). RESULTS: Time to neutrophil recovery was shorter for the D5 group than for the D10 group during induction chemotherapy (18 days vs. 19 days; P = 0.04) and hyper-CVAD Courses 3 and 5 (12 days vs. 15 days during Course 3, P < 0.001; and 13 days vs. 16 days during Course 5, P = 0.002). There was no apparent significant difference between the two groups with regard to time to neutrophil recovery during the MTX/ara-C courses or the last hyper-CVAD course. Delay in the administration of filgrastim did not appear to result in an increase in time to platelet count recovery or in the incidence of infection; however, there was an increased incidence of mucositis during induction chemotherapy. CONCLUSIONS: For a hyper-CVAD and MTX/ara-C regimen, the results of the current study have shown that the administration of filgrastim can be delayed until Day 10 without increasing the risk of treatment-related morbidity during consolidation chemotherapy. During induction chemotherapy, delay in the administration of filgrastim may result in a slight increase in the time to neutrophil count recovery and risk of mucositis, but there is no apparent associated increase in the risk of infection.

Adolescent↗