Biomedical subjects

N Iscoe

Publications and source records attributed to N Iscoe.

10 recordsLinked to original sources

PubMed1995

Orchidectomy and hormonal therapy of prostate cancer.

The objective of this study is to document the use of hormonal therapies in treating prostate cancer in Ontario in the last decade. Drug utilization data were extracted from the Ontario Drug Benefit Program, while surgical orchidectomy rates were calculated from Hospital Medical Records Institute data. The provincial rate of orchidectomy showed a 55% relative increase from 1981 to 1991. There was a 6.4-fold variation in orchidectomy rates among counties in Ontario. As well, the expenditures on new hormonal therapies rose 38-fold between 1985 and 1990, and doubled between 1990 and 1992. There was no consistent relationship between use of orchidectomy and hormonal drug therapy at the county level. We conclude that both forms of hormonal therapy have increased in Ontario. The wide variation in surgical orchidectomy rates observed in Ontario suggests differences in practice styles and possible medical uncertainty. Guidelines for the hormonal therapy of prostate cancer may be a helpful step forward for practitioners and patients.

Journal Article↗

PubMed1993

A phase II study of methotrexate, vinblastine, doxorubicin and cisplatin plus recombinant human granulocyte-macrophage colony stimulating factors in patients with advanced transitional cell carcinoma.

The use of methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) to treat transitional cell carcinoma is associated with high rates of granulocytopenia. To test whether the addition of recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) would decrease the hematological toxicity of M-VAC 21 patients were treated with standard dose M-VAC (30 mg./m.2 methotrexate on days 1, 15 and 22, 3 mg./m.2 vinblastine on days 2, 15 and 22, 30 mg./m.2 doxorubicin on day 2 and 70 mg./m.2 cisplatin on day 2) plus 5 micrograms./kg. rhGM-CSF subcutaneously on days 4 to 13. On cycles 1 and 2 of therapy grade III or greater granulocytopenia (less than 1.0 x 10(9)/l.) was noted in 39% and 43% of the patients, respectively, and the majority were able to receive the day 15 and day 22 treatments as scheduled. This was an apparent improvement over our historical experience with M-VAC alone (p = 0.03). By cycle 3 of treatment this beneficial effect of rhGM-CSF was no longer apparent, with 80% of the patients experiencing grade III or greater granulocytopenia and thrombocytopenia also becoming apparent. Seven patients had to discontinue rhGM-CSF because of side effects. It is unlikely that clinically significant escalation of chemotherapy dosages can be achieved with M-VAC and rhGM-CSF.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1992

The evaluation of analgesic effects in cancer patients as exemplified by a double-blind, crossover study of immediate-release versus controlled-release morphine.

We compared the effects of controlled-release and immediate-release morphine preparations in adult patients with moderate-to-severe cancer pain and report methodologic approaches to pain evaluation. The study consisted of a two-phase randomized crossover trial preceded by a titration phase; all phases were conducted under double-blind conditions. To evaluate pain intensity, a visual analogue scale (VAS) and the Present Pain Intensity scale of the McGill Pain Questionnaire were used. Additional morphine solution for breakthrough pain was used as an outcome measure. Pain was evaluated nine times daily, which permitted correlation of pain scores with the pharmacokinetic patterns of the test drugs. Side effects were rated once daily, using a scale from 0 to 3. To assess the relative importance of side effects, a toxicity index was designed based on both the intensity and duration of each side effect. The overall VAS pain scores during treatment with controlled-release and immediate-release morphine were 1.3 (SD = 0.1) and 1.4 (SD = 0.2), respectively. Use of supplemental morphine solution for breakthrough pain expressed as the percentage of the daily dose of the test drug was 5.5% for the controlled-release drug and 10.9% for the immediate-release drug. Differences in pain scores, side effects, and supplemental morphine requirement between the two groups were not significant. We discuss methodologic issues in double-blind clinical trials of analgesics, in particular the validity of "Patient Preference" as an outcome measure and problems related to the titration phase.

Adult↗

PubMed1988

Continuous narcotic infusion with patient-controlled analgesia for chronic cancer pain in outpatients.

STUDY OBJECTIVE: To determine the feasibility and safety of outpatient continuous narcotic infusions with additional bolus capabilities (patient-controlled analgesia) in patients with cancer pain. DESIGN: A single arm (non-randomized) series. SETTING: Outpatient with contact by telephone and through outpatient clinic. PATIENTS: Consecutive series of 18 patients with poorly controlled cancer pain or significant side effects from regular administration of various narcotics. INTERVENTIONS: Patients taught and supervised to use portable pump capable of delivering a continuous narcotic infusion with bolus capabilities. MEASUREMENTS AND MAIN RESULTS: All patients had improvement in pain control as judged by the use of a linear analogue scale. Side effects and safety profile were highly acceptable. Narcotics used and maximum doses were meperidine, 50 mg/h; morphine, 80 mg/hr; and hydromorphone, 60 mg/hr. Infusion duration ranged from 7 to 225 days (mean, 54 days). CONCLUSIONS: Continuous narcotic infusions using a programmable portable pump with bolus capabilities is a safe and reliable method of delivering narcotics to outpatients.

Adult↗

PubMed1987

Re-evaluating the cost of outpatient cancer chemotherapy.

Chemotherapy for common malignant tumours has historically been considered relatively expensive. An examination of costs at the Toronto-Bayview Regional Cancer Centre and Sunnybrook Medical Centre, Toronto, suggests that this perception is not accurate. The cost of chemotherapeutic agents administered on an outpatient basis over 4 to 6 months in established drug protocols ranged from $260 to $5374 (mean $2224). The total cost of outpatient administration was estimated to be $152.53 per dose, compared with $185.39 for inpatient administration of the same protocol, a difference of 22%. The difference was predominantly due to a higher allocated per-diem charge at the medical centre. The results indicate that outpatient administration reduces the overall cost of chemotherapy.

Ambulatory Care↗

PubMed1987

Predictive value of staging investigations in patients with clinical stage I malignant melanoma.

We reviewed the charts of 393 consecutive patients referred to the Toronto-Bayview Regional Cancer Centre and the Ontario Cancer Institute between January 1, 1978, and December 31, 1982, with clinical stage I malignant melanoma to determine the predictive value of routine staging investigations. The investigations reviewed included physical examination, liver function tests, radionuclide liver-spleen and bone scans, chest x-ray, whole-lung tomograms, CT chest scans, CT brain scans, and bipedal lymphangiograms. The clinical stage of nine patients was changed, eight as a result of physical examination and one as a result of lymphangiogram. No other investigations detected metastatic melanoma at referral. We recommend that staging investigations for patients referred with clinical stage I malignant melanoma be restricted to a complete physical examination and a baseline chest x-ray for all patients.

Humans↗

PubMed1985

A phase II study of spirogermanium in patients with metastatic malignant melanoma. An NCI Canada Clinical Trials Group Study.

The National Cancer Institute of Canada Clinical Trials Group conducted a phase II study of spirogermanium given daily for 5 days every 3 weeks to previously untreated patients with malignant melanoma. In 21 evaluable patients one complete response was seen (response rate 5%). Disease progression occurred in the other 20 patients. Toxicity was primarily neurologic and mild or moderate in most patients, though there was one treatment related death. In this schedule spirogermanium has extremely limited activity against malignant melanoma and will not contribute significantly to the systemic therapy of this disease.

Adult↗

PubMed1985

Venous access ports.

Explore the source record for details and available documents.

Catheters, Indwelling↗

PubMed1985

Lomustine, vincristine, and procarbazine in the treatment of metastatic malignant melanoma.

Sixty-five previously untreated patients with metastatic malignant melanoma were treated with lomustine, vincristine, and procarbazine. Sixty-four patients were evaluable for response, with a response rate of 13%. Only one complete response was observed, in a patient with nodal disease only. Three partial responses were observed in patients with disease confined to soft tissue, and four partial responses were observed in patients with pulmonary metastases. Median survival for all patients was 22 weeks. We conclude that this regimen offers no improvement compared to other drug combinations.

Adult↗

PubMedDate not supplied

Predicting psychological distress in patients with cancer: conceptual basis and reliability evaluation of a self-report questionnaire.

UNLABELLED: BACKGROUND/MATERIALS AND METHODS: A battery of instruments intended to predict the likelihood of future psychosocial distress in patients with cancer was developed and tested. The battery consists of newly-developed items for constructs relating to social support and to past coping experiences. Embedded within the past coping items are items on future illness-dependent expectations. The battery also incorporates previously developed instruments for recent stressful life events (Sarason) and the presence of anxiety or depression (SCL-90-R). The reliability of the entire instrument was determined in 2 similar groups of patients with cancer. RESULTS: The illness-dependent expectations items were stable and internally consistent. The past coping and social support items possessed stability, but did not possess sufficient internal consistency for either to be used as a scale. The recent stressful life event scores were not stable in either patient group over the two week retest interval. For the SCL-90-R, internal consistencies and stability coefficients are acceptable for all symptom dimensions with the exception of the stability coefficient for hostility.

Adaptation, Psychological↗