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Biomedical subjects

P Esper

Publications and source records attributed to P Esper.

9 recordsLinked to original sources
PubMed2000

Psychiatric side effects of interferon therapy: prevalence, proposed mechanisms, and future directions.

The increasing use of interferon (IFN) in treating a variety of disorders including, malignant melanoma and hepatitis C, has resulted in the identification and increasing concern about the psychiatric side effects that can result from treatment. These effects can occur either shortly after beginning IFN therapy or later as a result of continued treatment. Studies have reported the incidence of later side effects, which include symptoms of depression, anxiety, and occasional suicidal ideation, to be from 0% to 70%. Case studies have demonstrated that pharmacologic interventions are beneficial in reducing iatrogenic psychiatric symptoms while allowing patients to maintain IFN therapy. The present article provides an overview of the psychiatric effects of IFN therapy, the proposed mechanisms of these side effects, and case studies that provide mechanistic support. In addition, limitations of the current literature are provided with suggestions for treating physicians and a discussion of possible future research directions.

Humans↗
PubMed1999

Supportive care, pain management, and quality of life in advanced prostate cancer.

Despite achievements in the area of providing care for patients with advanced prostate cancer, ample work remains. Additional research is needed regarding the control of pain from bone metastases and the management of fatigue and urinary symptoms. Investigators have only begun to explore the area of quality of life research in patients with prostate cancer. Other issues not addressed in this article that are significant to the care of these patients include caregiver burden and end-of-life care. These areas significantly affect quality of life. The supportive care, pain management, and quality of life issues discussed herein present many challenges to health care providers. Close attention to what patients tell us about their care will make the challenge more attainable and the caregiving more satisfying.

Humans↗
PubMed1999

Phase II trial of oral estramustine, oral etoposide, and intravenous paclitaxel in hormone-refractory prostate cancer.

PURPOSE: To evaluate the combination of intravenous (IV) paclitaxel, oral estramustine, and oral etoposide in patients with advanced hormone-refractory prostate cancer. PATIENTS AND METHODS: Forty patients with carcinoma of the prostate that was progressing despite hormonal therapy and who had undergone antiandrogen withdrawal (if previously treated with an antiandrogen) were enrolled onto this phase II trial. Patients were treated with oral estramustine 280 mg tid and oral etoposide 100 mg/d for 7 days, with paclitaxel 135 mg/m(2) IV over 1 hour on day 2 of each 21-day treatment cycle. Patients received a maximum of six cycles of therapy. RESULTS: Thirty-seven patients were assessable for response. Twenty-two had measurable disease at baseline; response was not assessable in six of these patients. Overall response was 45% (10 of 22 patients; 95% confidence interval [CI], 24% to 68%), and response was 63% (10 of 16) in assessable patients. Twenty-six patients had a > or = 50% decrease from their baseline prostate-specific antigen levels during therapy, for a response rate of 65% (95% CI, 48% to 79%) by this criterion. Median duration of response was 3.2 months, with an estimated median survival of 12.8 months. Major toxicities of therapy were leukopenia (eight patients had > or = grade 4 leukopenia) and anemia. Hematologic toxicity seemed to be associated with liver metastases. Serial measurements in 24 patients using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) showed no significant change in quality of life (QOL) as a result of therapy. CONCLUSION: The combination of IV paclitaxel, oral estramustine, and oral etoposide is active in patients with advanced prostate cancer. The regimen is tolerable and does not have a significant impact on QOL as measured by the FACT-P in a limited sample of patients.

Adenocarcinoma↗
PubMed1997

Measuring quality of life in men with prostate cancer using the functional assessment of cancer therapy-prostate instrument.

OBJECTIVES: As the incidence of prostate cancer in the United States exceeds 330,000 in 1997, increasingly more men are faced with treatment choices for which there is no clear approach. At every stage of disease, these treatment choices may involve clinically equivalent modalities that differ in side effects and impact upon quality of life (QOL). Comprehensive, yet efficient, questionnaires are needed to measure QOL in patients with prostate cancer. METHODS: Developed as a disease-specific adjunct to the Functional Assessment of Cancer Therapy (FACT) measurement system, a 12-item prostate cancer subscale (PCS) was developed and tested in three independent samples: a subscale development sample (n = 43), validity sample 1 (n = 34), and validity sample 2 (n = 96). The 12 items ask about symptoms and problems specific to prostate cancer. These questions are added to the general (FACT-G) instrument, thereby comprising a 47-item questionnaire. RESULTS: Internal consistency of the PCS ranged from 0.65 to 0.69, with coefficients for FACT-G subscales and aggregated scores ranging from 0.61 to 0.90. Concurrent validity was confirmed by the ability to discriminate patients by disease stage, performance status, and baseline prostate-specific antigen (PSA) level. Sensitivity to change in performance status and PSA score over a 2-month period suggested that some subscales of the FACT-Prostate (P) (including the PCS) are sensitive to meaningful clinical change. CONCLUSIONS: Our findings support use of the FACT-P as a meaningful component of QOL evaluation in men undergoing therapy for prostate cancer.

Aged↗
PubMed1994

Phase II trial of recombinant interleukin-1 beta in patients with metastatic renal cell carcinoma.

Interleukin-1 (IL-1) plays a central role in the immune system, partly by stimulating the production of interleukin-2 (IL-2) and other cytokines by lymphocytes. In preclinical studies, recombinant interleukin-1 (rIL-1 beta) has shown antitumor activity. We conducted a phase II trial to evaluate the efficacy of rIL-1 in metastatic renal cell carcinoma (RCC). rIL-1 beta was given at a dose of 50 ng/kg i.v. daily for 5 days on a 28-day schedule. Nineteen patients were registered; 16 completed two cycles and were evaluable for response. There were no complete or partial responses to treatment. Toxicity was generally mild and typically involved grades I and II fever, rigors, hypotension, and weight gain. Severe neurologic toxicity was seen in two patients, grade IV seizures were seen in one, and grade III somnolence was seen in another. Analysis of soluble IL-2 receptor (sIL-2r) levels revealed an increase from a mean pretreatment level of 4,567 pg/ml to a mean of 6,124 pg/ml posttreatment (p < 0.001). The mean pretreatment IL-6 level was 51 pg/ml, increased to 84 pg/ml posttreatment (p < 0.05). Patients with bulky disease had higher sIL-2r levels, and patients with tumor fevers had higher IL-6 and sIL-2r levels than patients without fever did. A neutrophilic leukocytosis and a mild thrombocytosis were observed in response to rIL-1 beta administration. We conclude that rIL-1 beta in this dose and schedule is inactive in metastatic RCC.

Adult↗
PubMedDate not supplied

Electroretinographic findings in subjects after administration of fenretinide.

We measured the electroretinogram to determine whether ocular toxicity exists in men taking oral feretinide, 100 mg daily, for prevention of adenocarcinoma of the prostate. Male subjects at an increased risk for prostate cancer were recruited as volunteers. Fenretinide treatment took place over 1 year with a regimen of 100 mg/day for 25 days with 3 day hiatus intervals. Baseline testing included the electroretinogram Ishihara plates, and the Farnsworth-Munsell D-15 test. Subsequent electroretinographic testing was conducted at 4, 8, 12 and 18 months. Thirteen of 14 subjects maintained normal age-matched electroretinographic responses 6 months after fenretinide treatment. Of these 13 subjects, six showed slight decreases, within 1 standard deviation of the normal mean. Two subjects showed a slight gradual decline of rod-mediated a-wave amplitudes, while b-wave amplitudes were steady. One subject, who had glaucoma, unilaterally fell below normal. After treatment ended, all of the 13 subjects had electroretinographic responses at their respective baseline levels. The subject whose responses fell and remained below 1 standard deviation showed an overall decline in responses and, on follow-up, was diagnosed as having branch retinal vein occlusion, which most likely is the main contributor to the decrease in electroretinographic responses. Our results indicate that men taking 100 mg of oral fenretinide per day for 1 year, with a 3 day hiatus each month, do not show toxicity -induced retinal dysfunction, as measured by the electroretinogram.

Adaptation, Ocular↗
PubMedDate not supplied

A new concept in cancer care: the supportive care program.

This article describes the findings of a pilot program designed to enter advanced prostate cancer patients into the hospice benefit while they are still being actively treated, but in situations where treatment is known to be primarily palliative in nature. The supportive care program (SCP) combines the medical model's goal to prolong life with the goal of hospice to palliate symptoms and improve quality of life (QOL). The concept of a SCP was developed to create a team approach where advanced prostate cancer patients who are starting investigational chemotherapy are concurrently enrolled into a hospice program. The objectives were to identify whether SCP improved QOL and continuity of care while remaining cost-effective. Data were collected on patient quality of life, performance status, use of health care resources, and costs for the 36 enrolled patients. A comparison was made to a matched set of 23 control patients. Our findings indicate that the SCP contributes to continuity of care while being cost-effective.

Aged↗
PubMedDate not supplied

Quality-of-life evaluation in patients receiving treatment for advanced prostate cancer.

PURPOSE/OBJECTIVES: To evaluate the quality-of-life (QOL) experience in patients who are receiving treatment for advanced prostate cancer and the relationship between response to that treatment and QOL. DESIGN: Descriptive comparative study, repeated measures. SETTING: Medical oncology clinic in a comprehensive cancer center. SAMPLE: 33 patients receiving treatment for advanced prostate cancer. METHODS: Patient self-administered questionnaires and chart review. MAIN RESEARCH VARIABLES: Response to therapy and QOL. FINDINGS: No significant differences were seen in patients at the baseline evaluation. Patients who demonstrated response to therapy based on declining prostate specific antigen levels, however, demonstrated a significant increase in their QOL scores compared to those patients who were not responding to treatment. CONCLUSIONS: Although significant differences in survival at this stage of prostate cancer in patients who receive therapeutic treatment versus those who do not have yet to be demonstrated, there appears to be a benefit in QOL for those patients who respond to therapy. IMPLICATIONS FOR NURSING PRACTICE: These data support the use of QOL measurements in patients undergoing treatment for advanced prostate cancer. This information can be used in discussions with patients who are facing treatment decisions and who are concerned about the impact of treatment on their overall QOL. The data also stimulate questions for future research on QOL in this population, such as the difference in QOL in those patients who choose therapeutic treatment versus those who do not.

Aged↗