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P Strang

Publications and source records attributed to P Strang.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Cancer-related pain requires targeted treatment. Analgesics are not the only therapeutic alternative].

Although analgetic treatment, based on modifications of the three-step approach recommended by the WHO, remains the cornerstone of cancer pain control, other treatment options are also needed to improve pain relief in severe cases. The article consists in a discussion of such treatment alternatives, a guiding principle being that, where causal treatment is possible, symptomatic effects are likely to be more manifest and more enduring than if treatment is confined to symptom management. The tumour biological basis of the analgesic or anti-inflammatory potential of steroids, palliative radiotherapy, bisphosphonates, and even such modalities as hormonal manipulation in metastatic prostate cancer, or chemotherapy are also discussed, as are calcitonin and stabilising orthopaedic measures.

Analgesics↗
PubMed1999

[Palliative medicine. A new research field with specific demands].

Palliative care is not merely a question of treating symptoms irrespective of cause, but is ideally based on proper analysis, treatment and evaluation. Education, quality assurance, clinical development and research are needed to improve palliative care. Education and research should be focussed on all four dimensions--the physical, the emotional, the social, and the existential. Research should be designed to address specific issues--for example, how anxiety and mood disturbances in (previously healthy) patients in palliative care differ from anxiety and depression in a psychiatric setting, in patients with a history of psychiatric problems. Efforts need to be made to link significant clinical problems and basic science. Not until we understand the underlying mechanisms (e.g., the involvement of cytokines in mediating cachexia), will it be possible to develop new treatment strategies for problematic symptoms.

Crisis Intervention↗
PubMed1999

Optimizing hospital-based home care for dying cancer patients: a population-based study.

In many reports the percentage of home deaths in cancer is based on selected populations. In this population-based study all cancer patients who died within 12 months within a specified area were studied (n = 108). This area is covered by hospital-based home care (HBHC) on a 24-h basis, which doctors available by day and at night. Forty people (37%) out of the total cancer population died in their own homes. Another 11% would theoretically have been ideal candidates for home care at the end of life. Thus, a home death rate of about 50% of the cancer patients is a realistic figure, and much higher than the usual 5-15% reported, provided that an effective HBHC is offered.

Adult↗
PubMed1999

Acupuncture for patients in hospital-based home care suffering from xerostomia.

A total of 20 patients (17 cancer patients) in late-stage palliative care reporting dryness of mouth and associated problems were treated for 5 weeks with 10 acupuncture treatments. Ten patients were also evaluated for speech problems (articulation) and dysphagia caused by xerostomia. Subjective assessments used Visual Analog Scales (VAS). Acupuncture had a dramatic effect on xerostomia and, subsequently, on dysphagia and articulation, with subjects showing definite improvement after 5 treatments. Release of neuropeptides that stimulate the salivary glands and increased blood flow are possible explanations for the effects.

Acupuncture Therapy↗
PubMed1998

Cancer pain--a provoker of emotional, social and existential distress.

Although methods for controlling most cases of severe cancer pain exist, probably about 50% of patients still suffer from unnecessary, poorly controlled pain. Cancer pain has a substantial negative effect on mood, resulting in anxiety, depressive feelings and even suicidal thoughts and cognitive functions are disturbed. As cancer pain often originates from skeletal metastases, movements and daily activities (ADL) functions are restricted. Cancer pain is associated by the public with progressive disease and dying and is therefore a trigger of existential fears, for both patients and the public. Pain treatment and education are therefore high-priority matters with effects far beyond the physical suffering.

Activities of Daily Living↗
PubMed1998

Differences of bone alkaline phosphatase isoforms in metastatic bone disease and discrepant effects of clodronate on different skeletal sites indicated by the location of pain.

We compared clodronate with placebo administration in 42 primarily or secondarily hormone-refractory prostate cancer patients with skeletal metastases and persisting pain. Serum total alkaline phosphatase (ALP), bone ALP isoforms, osteocalcin, cross-linked carboxy-terminal telopeptide of type I collagen, and prostate-specific antigen were analyzed before and after 1 month of treatment. Six ALP isoforms were quantified by HPLC: one bone/intestinal, two bone (B1, B2), and three liver ALP isoforms. The most apparent difference compared with healthy males was observed for the bone ALP isoform B2. Patients and healthy males had a B2 activity corresponding to 75% and 35% of the total ALP activity, respectively (P <0.0001). We propose that the different bone ALP isoforms reflect different stages of osteoblast differentiation during the extracellular matrix maturation phase of osteogenesis. All bone markers except osteocalcin increased after 1 month of clodronate administration. These increases were associated with pain only in the upper part of the body. We suggest that the uptake of clodronate by the skeleton was not uniform during our treatment period.

Aged↗
PubMed1997

Existential consequences of unrelieved cancer pain.

Seventy-eight cancer patients who were being treated for pain-related problems underwent a semistructured interview concerning the influence of cancer and cancer pain on existential issues. Pain intensity was assessed with visual analogue scales in order to quantify the overall mean pain intensity as well as pain intensity during the best and worst periods. Patients with a higher overall mean pain score (i.e. insufficient pain control) or higher mean worst pain score expressed significantly more fear about the future (P < 0.01), worries about pain progression (P < 0.05) and general anxiety that hampered their daily living (P < 0.05). Younger patients expressed more fear of pain progression and of the future in general and they were much more concerned about the future of their families (P < 0.05). The fear of future pain problems was related to the duration of the pain (P < 0.01). In conclusion, partly unrelieved pain contributes to the 'total pain' experience, not only by causing immediate physical suffering, but also by increasing the anxiety level and the fear about the future and future problems. The study underlines that effective symptom control is a prerequisite for a good quality of life: pain control is a matter of the highest priority.

Adult↗
PubMed1996

A comparison of proliferation markers and their prognostic value for women with endometrial carcinoma. Ki-67, proliferating cell nuclear antigen, and flow cytometric S-phase fraction.

BACKGROUND: The understanding of proliferation is a central issue in oncology. Several methods exist for the assessment of the growth fraction and cell-cycle time, but comparative studies that give the clinician advice about the most reliable use of new markers are few. The aim of the current study was to perform methodologic, descriptive, comparative, and prognostic studies of Ki-67, proliferating cell nuclear antigen (PCNA), and flow cytometric S-phase fraction (SPF) in endometrial carcinoma. METHODS: The expression of Ki 67 (n = 175) and PCNA (n = 146) were studied immunohistochemically; and the SPF (n = 297) by flow cytometry. The median follow-up time was 78 months. RESULTS: Neither Ki-67 nor PCNA had any correlation to either the stage or the histopathologic subtype of the tumors, but they were covariant with the histopathologic grade (P < 0.05). There was an interrelationship between Ki-67 and PCNA (P < 0.001), and both were associated with the size of the SPF (P < 0.0001 and P < 0.05, respectively). Mean SPF was high in advanced stages and strongly associated with histopathologic subtype (P < 0.0001) and ploidy (P < 0.0001). Tumors with strong Ki-67 expression were more often aneuploid (P < 0.01). In initial analyses, Ki-67 and SPF were predictors of poor survival (P < 0.05 and P < 0.001, respectively), whereas PCNA was not. When SPF was added to a comprehensive multivariate model, Ki-67 provided no further prognostic information, whereas SPF remained a powerful predictor of survival. CONCLUSIONS: Ki-67 and, to a lesser extent, PCNA, give approximate estimates of the growth fraction, whereas SPF only reflects the proportion of cells in S-phase. However, SPF is by far the strongest predictor of survival.

Adult↗
PubMed1996

Mutant p53 protein as a predictor of survival in endometrial carcinoma.

The expression of mutated p53 protein was studied in paraffin-embedded, formalin-fixed tumour specimens from 183 women with endometrial carcinoma. Fifty-five per cent of the specimens were negative, whereas the staining intensity was weak, moderate or strong in 15, 2 and 28% of cases, respectively. Strong p53 expression (> 75% of the cells stained) was more common in uterine papillary serous cancers and clear cell cancers than in other tumour subtypes (P < 0.001), as well as in poorly differentiated tumours (P < 0.01) and in tumours with nuclear grade 3 (P < 0.0001). Strong p53 expression was also more frequently found in aneuploid tumours (P < 0.0001) and in tumours with a high S-phase fraction (P < 0.001). Strong p53 expression was highly predictive of poor survival in the univariate analysis (P = 0.006) and in the Cox multivariate analysis which included age, stage and grade. However, it lost most of its impact when the strongly prognostic nuclear grade and ploidy were added to the multivariate models.

Adult↗
PubMed1996

Carcinoma of the endometrium: do the nuclear grade and DNA ploidy provide more prognostic information than do the FIGO and WHO classifications?

The aim of this study was to compare the World Health Organization (WHO), the International Federation of Gynecology (FIGO), and nuclear grading systems and to evaluate their reproducibility, as well as their prognostic impact, in relation to clinical variables and DNA ploidy. The study comprised 266 women with endometrial carcinoma in clinical stages I-IV. Low-risk patients, i.e., patients with grade 1-2 tumors in clinical stage I, were generally not included. In univariate Cox analyses, WHO, FIGO, and especially nuclear grading (p < 0.001), as well as age, stage, and ploidy, were prognostic regarding survival. In the multivariate Cox analyses, WHO and FIGO grades yielded little further independent information beyond nuclear grade. When DNA ploidy was added to the analyses, nuclear grade lost most of its impact because aneuploidy was a powerful factor (p < 0.001) that covaried with nuclear grade. The WHO, FIGO, and nuclear grading systems were found to be subjective, with correlation coefficients of approximately 0.60 between different pathologists. Age, stage, and aneuploidy were the most important predictors of outcome in the multivariate analyses. Nuclear grade was a strong prognostic factor in the univariate analyses and a more important indicator than the commonly used histopathological grading systems.

Adult↗
PubMed1996

Analgesic effect of bisphosphonates on bone pain in breast cancer patients: a review article.

Bisphosphonates exert their analgesic effect by several mechanisms. The long-term effects are probably due to osteoclast inhibition. The acute pain-relieving effect, which occurs within days or a week, is likely to be associated with the reduction of various potentially pain-producing substances. As regards pamidronate, several open, controlled studies have shown a significant effect on bone pain in 30-70% of breast cancer patients. The effects have been dose-dependent: a mean dose of 15 mg i.v./week is obviously suboptimal, whereas higher doses yield markedly better effects. The dose response is most evident at doses between 15 and 30 mg/week. Furthermore, the total dose per infusion is of interest: 30 mg every 2 weeks is an ineffective treatment, whereas 60 mg every 4 weeks is more effective. Thus, both the dose per week and the total dose per infusion are of importance in order to achieve optimal treatment. Patients with rapid progression of their disease require higher doses than patients with slow progression. Parenteral therapy is more effective than oral treatment. Both oral and parenteral clodronate exert a significant, positive effect on total skeletal morbidity and thus probably also on bone pain. Unfortunately, pain measurements have not been performed and evidence for pain reduction is indirect. Specific pain studies and studies of quality of life, with few exceptions, are, however, still lacking.

Analgesia↗
PubMed1995

Pain, nausea and anxiety during intra-uterine brachytherapy of cervical carcinomas.

The aim of this quality-assurance study was to assess how patients with cancer of the uterine cervix experience different aspects of care during brachytherapy treatment. Twenty patients scheduled for intrauterine brachytherapy using an afterloading technique and 20 controls with other gynaecological malignancies, undergoing a gynaecological palpation under anaesthesia, were given a questionnaire to complete. The questionnaire consisted of ten items related to information received, pain, sleep, nausea and food intake. Each item was constructed as a statement to be answered on a five-point Likert-like scale, with alternatives ranging from very positive to very negative. Among the results, 17 of the 20 brachytheraphy patients reported that they experienced great anxiety before admission. The corresponding figure for the control group was 9/20 (P < 0.01). As regards pain, 13/20 and 0/20, respectively, suffered from moderate or severe pain (P = 0.0000), despite standard analgesic medication. Twelve of the brachytherapy patients praised the ordinary hospital liquid foods, whereas 8/20 would clearly have preferred alternative menus. In the control group 18/20 approved of the food and 2/20 did not (P < 0.05). The results clearly underline the importance of quality-assurance studies that focus on the side-effects of treatment. This study has resulted in a new care programme with intensified prophylactic treatment of pain and nausea and a novel form of "picking food", i.e. pieces of vegetables, meat and chips that are easy to eat in a supine position.

Aged↗
PubMed1994

p53 expression in epithelial ovarian neoplasms: relationship to clinical and pathological parameters, Ki-67 expression and flow cytometry.

Epithelial ovarian tumors of varying malignancy as well as normal ovaries were examined for their expression of p53 with the monoclonal antibody PAb1801. Immunohistochemical detection of p53 protein is possible when the gene has been mutated, but not when the normal gene product alone is present. Our results indicate that this tumor suppressor gene may be involved in tumorigenesis, as its expression was detected in both borderline and malignant tumors while normal ovaries and benign ovarian tumors were unstained with the p53 antibody. The presence of p53 was also related to dissemination of disease, residual tumor bulk, and poor differentiation as well as the presence of the proliferation variable Ki-67, another negative prognostic variable. No significant relation could be detected to S-phase fraction or DNA ploidy. Furthermore, the presence of p53 in malignant epithelial ovarian tumors was related to significantly decreased patient survival, with only 36% alive compared to 70% in the p53-negative group (P = 0.002). In the subgroup of patients with residual tumor burden after surgery, those with p53-positive tumors had a significantly (P = 0.05) decreased survival compared to those with p53-negative neoplasms, which further supports an independent role in ovarian cancer malignancy.

Biomarkers, Tumor↗
PubMed1993

The influence of progesterone and androgens on the growth of endometrial carcinoma.

BACKGROUND: The prognosis for endometrial cancer is correlated to the proliferative activity, expressed as the fraction of cells in the synthesis phase (S-phase fraction [SPF]). Progesterone has an antiproliferative effect on the normal endometrium. Its effect in endometrial adenocarcinoma has not been investigated in such detail. METHODS: The SPF in tumor tissue and serum levels of progesterone, androstenedione, and testosterone were measured in 78 postmenopausal women with the diagnosis of endometrial adenocarcinoma. RESULTS: No correlations were found between the SPF and androstenedione or testosterone level. No linear correlation between the progesterone concentration and the SPF was revealed when all the patients were analyzed. The material was then divided into subgroups according to the tumor grade and ploidy level. A stepwise analysis based on the progesterone concentration showed that, in well-differentiated and moderately differentiated tumors, the growth rate, expressed as the SPF, fell when progesterone reached a serum level above 0.8 nM. CONCLUSIONS: Endogenous progesterone plays a role in the control of the tumor's proliferation activity and, consequently, might be significant in the prognosis.

Adenocarcinoma↗
PubMed1993

Caring for severely ill cancer patients. A comparison of working conditions in hospital-based home care and in hospital.

The goal of the study was to compare working conditions in a hospital with the conditions in a specialized hospital-based home care (HBHC) unit, which aims to replace hospital care for patients in need of institutional car. Staff (doctors included) in a HBHC unit (n = 35) and on three hospital wards (n = 113) participated in the study. All staff members worked regularly with severely ill cancer patients. Question about stress, job satisfaction and working conditions were asked in a self-administered questionnaire. Both groups showed a limited degree of continuous stress and a high degree of job satisfaction. Thus, the overall perception was than the working conditions were good. When significant differences were found, the responses of the HBHC staff were more positive. This included items such as more freedom to make their own decisions (P < 0.001), better co-operation between day and night shifts (P < 0.001), a more reasonable work load (P = 0.0001), fewer problems in communication with patients (P < 0.001), and fewer problems with tension (P < 0.05) and with sleeping (P < 0.05). The findings may be due to several factors: the HBHC staff were older, more often married, had more children, had worked longer in health care and were thus more experienced. Complementary explanations may be continuous education within the HBHC and an organization stimulating the staff's own initiative, but also capable of supporting when necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Burnout, Professional↗