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Biomedical subjects

S Greer

Publications and source records attributed to S Greer.

At least 37 records · Page 2Linked to original sources
PubMed1992

Adjuvant psychological therapy for patients with cancer: a prospective randomised trial.

OBJECTIVE: To determine the effect of adjuvant psychological therapy on the quality of life of patients with cancer. DESIGN: Prospective randomised controlled trial comparing the quality of life of patients receiving psychological therapy with that of patients receiving no therapy, measured before therapy, at eight weeks, and at four months of follow up. SETTING: CRC Psychological Medicine Group of Royal Marsden Hospital. PATIENTS: 174 patients aged 18-74 attending hospital with a confirmed diagnosis of malignant disease, a life expectancy of at least 12 months, or scores on various measures of psychological morbidity above previously defined cut off points. INTERVENTION: Adjuvant psychological therapy, a brief, problem focused, cognitive-behavioural treatment programme specifically designed for the needs of individual cancer patients. MAIN OUTCOME MEASURES: Hospital anxiety and depression scale, mental adjustment to cancer scale, Rotterdam symptom checklist, psychosocial adjustment to illness scale. RESULTS: 156 (90%) patients completed the eight week trial; follow up data at four months were obtained for 137 patients (79%). At eight weeks, patients receiving therapy had significantly higher scores than control patients on fighting spirit and significantly lower scores on helplessness, anxious preoccupation, and fatalism; anxiety; psychological symptoms; and on orientation towards health care. These differences indicated improvement in each case. At four months, patients receiving therapy had significantly lower scores than controls on anxiety; psychological symptoms; and psychological distress. Clinically, the proportion of severely anxious patients dropped from 46% at baseline to 20% at eight weeks and 20% at four months in the therapy group and from 48% to 41% and to 43% respectively among controls. The proportion of patients with depression was 40% at baseline, 13% at eight weeks, and 18% at four months in the therapy group and 30%, 29%, and 23% respectively in controls. CONCLUSIONS: Adjuvant psychological therapy produces significant improvement in various measures of psychological distress among cancer patients. The effect of therapy observed at eight weeks persists in some but not all measures at four month follow up.

Adolescent↗
PubMed1992

5-chlorodeoxycytidine, a radiosensitizer effective against RIF-1 and Lewis lung carcinoma, is also effective against a DMBA-induced mammary adenocarcinoma and the EMT-6 tumor in BALB/c mice.

5-Chlorodeoxycytidine (CldC), coadministered with modulators of pyrimidine metabolism, is an effective radiosensitizer of murine tumors. Past studies that utilized RIF-1 tumors in C3H mice and Lewis lung carcinoma (LLC) in BDF1 mice have been extended with an emphasis on using multiple cycles of drug administration followed by irradiation of LLC and the use of two additional tumor models. Four of seven cures of BDF1 mice bearing LLC were obtained with three doses of 20 Gy irradiation, in which the first and third dose were preceded by a "Standard Protocol" that includes N-(phosphonacetyl)-L-aspartic acid (PALA), 5-fluorodeoxycytidine (FdC), tetrahydrouridine, and the radiosensitizer, 5-chlorodeoxycytidine. No cures were obtained in groups of mice receiving radiation alone or drugs alone, and there were no "no takes" in untreated control groups (six mice/group). Extensive tumor inhibition, exceeding that obtained with drugs or radiation alone, was obtained with two cycles of drugs and radiation combined when a dimethybenzanthracene-induced mammary adenocarcinoma was used in BALB/c mice. With the EMT-6 tumor in BALB/c mice, doses of 10 and 20 Gy were administered 9 and 16 days after tumor implantation, each preceded with the Standard Protocol; this resulted in a tumor growth delay of 24 days. No tumor growth delay occurred with drugs or radiation alone. The omission of PALA, FdC or CldC from the Standard Protocol resulted in loss of tumor control, which was obtained with the complete protocol. The fact that 5-chlorodeoxycytidine is an effective radiosensitizer in four rodent tumor systems is compelling evidence that it has potential as a radiosensitizer of human tumors, especially in view of its tumor selectivity and its resistance to catabolism when used with modulators of its metabolism, and in view of the high levels of the key enzymes in human tumors, which can convert 5-chlorodeoxycytidine to 5-chlorodeoxyuridine triphosphate, the proximate radiosensitizer.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1992

The management of denial in cancer patients.

Faced with a diagnosis of cancer, many patients react initially with a kind of numbed disbelief that is a form of denial. In the majority of cases, this reaction is subsequently replaced by other coping responses. Some patients, however, continue to use denial. Clinically, it is useful to categorize denial as follows: (1) complete denial, (2) denial of implications of a diagnosis of cancer, (3) denial of affect. Denial, particularly if complete, can have adverse effects in terms of delay in seeking treatment and noncompliance with treatment. But there are also certain advantages. Denial is associated with reduction in psychological distress, and there is preliminary evidence suggesting that it may be associated with prolonged duration of survival in women with nonmetastatic breast cancer. Although there are no hard and fast guidelines for the psychological management of patients who use denial, four possible management scenarios are provided.

Breast Neoplasms↗
PubMed1991

Psychological response to cancer and survival.

The hypothesis is advanced that the psychological stance which patients adopt in response to cancer can, in some cases, influence the course of their disease. This hypothesis is examined in the light of the author's 15-year follow-up study of women with early breast cancer and of other pertinent studies. The available evidence supports the hypothesis in respect of certain early-stage non-metastatic cancers.

Adaptation, Psychological↗
PubMed1991

Relationships between emotional control, adjustment to cancer and depression and anxiety in breast cancer patients.

The possible relationship between psychological responses among breast cancer patients and disease outcome continues to be an area of controversy and debate. Two parallel findings are reported separately in the literature: first, that emotional control is more common among women with breast cancer than in women with benign breast disease or in healthy controls and second, that a helpless attitude towards the disease is related to a poor prognosis. These previously unrelated psychological responses are examined here in a group of women (N = 359) with early stage breast cancer, who were seen one to three months after diagnosis. The relationships between emotional control, adjustment to cancer and psychological morbidity were examined. Prevalence levels of 16 and 6% were observed for anxiety and depression respectively, which are lower than reported more generally in the literature. The results indicated a highly significant association between scores for the tendency to control emotional reactions and a fatalistic attitude toward cancer. A significant association was observed between anger control and a helpless attitude. Psychological morbidity was also linked to type of adjustment to cancer. The data are interpreted in terms of a process model of psychological responses which suggests that emotional control (an important component of the Type C behaviour pattern) fatalism, helplessness and psychological morbidity are linked.

Adaptation, Psychological↗
PubMed1991

Evaluation of adjuvant psychological therapy for clinically referred cancer patients.

Adjuvant psychological therapy (APT) is a newly developed cognitive behavioural treatment which has been designed specifically to improve the quality of life of cancer patients by alleviating emotional distress and inducing a fighting spirit. We report a phase I/II study which evaluates APT in routine clinical practice. A consecutive series of 44 outpatients with various cancers referred for psychiatric consultation and receiving APT at the Royal Marsden Hospital was studied. Standardised self-report questionnaires were used to measure anxiety, depression and four principal categories of mental adjustment to cancer, namely, fighting spirit, helplessness, anxious preoccupation and fatalism. Statistical comparisons between pre-therapy scores and scores after an average of five APT sessions revealed significant improvement in anxiety, depression, fighting spirit, anxious preoccupation and helplessness. Fatalism scores showed the same trend, but the changes were smaller. Patients with advanced disease showed as much improvement as those with local or locoregional disease. Present results indicate improvement in both psychiatric symptoms and mental adjustment to cancer associated with APT. Whether this association is causal remains to be determined by randomised controlled trials. Such a trial is in progress.

Adolescent↗
PubMed1991

The factor structure and factor stability of the hospital anxiety and depression scale in patients with cancer.

An exploratory factor analysis of the HAD was carried out in 568 cancer patients. Two distinct, but correlated, factors emerged which corresponded to the questionnaire's anxiety and depression subscales. The factor structure proved stable when subsamples of the total sample were investigated. The internal consistency of the two subscales was also high. These results provide support for the use of the separate subscales of the HAD in studies of emotional disturbance in cancer patients.

Adolescent↗
PubMed1990

Improved carrier detection of haemophilia A using novel RFLPs at the DXS115 (767) locus.

Two novel restriction fragment length polymorphisms (RFLPs) around the DXS115 (767) locus, detectable with the restriction enzymes MspI, are described. Since DXS115 is closely linked to the factor VIII gene (F8C), the MspI RFLP was employed in haemophilia A carrier detection. The utility of these RFLPs lies in the increased applicability and accuracy of diagnoses carried out in cases where available intragenic markers are uninformative.

Deoxyribonuclease HpaII↗
PubMed1990

Locus of control and adjustment to cancer.

The English form of the Cancer Locus of Control Scale was administered to an heterogeneous sample of 68 cancer patients. A principal components analysis confirmed the three subscales described in the original Dutch form, however, with five items excluded. Correlations with other measures indicated that high internal control over the course of the illness was associated with a tendency to adopt an attitude toward cancer of 'fighting spirit' whereas high internal control over the cause of the illness was associated with an 'anxious preoccupation' about cancer. No specific relationship was found between scale scores and either depression and anxiety or the tendency to be emotionally controlled. It was concluded that the scale provides a valid measure of perceptions of control of cancer patients and is a useful method of assessing these important psychological responses.

Adaptation, Psychological↗
PubMed1990

Some consequences of market forces in US hospitals: lessons for the new look NHS.

"We write", say Ann Greer and Scott Greer, "with the thought that an idea should not travel unencumbered by the experience of its implementation". They survey the arguments for a market in health care, describe the impact of competitive health policies in the USA and conclude that none of the expected benefits of the market have materialised.

Economic Competition↗
PubMed1989

Patients' adjustment to cancer: the Mental Adjustment to Cancer (MAC) scale vs clinical ratings.

Broad categories of adjustment to cancer were originally identified clinically. Subsequently, a self-rating questionnaire--the MAC (Mental Adjustment to Cancer) scale--was developed to measure these categories of adjustment. We report here a validation study of the MAC scale. Fifty-four consecutively referred patients with various cancers were given the MAC scale. The patients' adjustment to cancer was also rated clinically by two psychiatrists who had no knowledge of the MAC scale scores. Statistical comparisons between these scores and the clinical ratings are reported. The level of agreement obtained was 79%--Kappa 0.72.

Adult↗
PubMed1989

The Denver Developmental Screening Test: how good is its predictive validity?

Five studies assessing the predictive validity of the Denver Developmental Screening Test (DDST) were evaluated and the results were pooled. Only one study demonstrated good compliance with the authors' methodological standards, but the results were similar to the over-all pooled results. The pooled data indicated that for children over three years of age: (1) the DDST is specific (94 per cent of the children with a good outcome were categorized as normal); (2) the DDST is not sensitive (it did not identify 80 per cent of the children who later had a poor outcome); and (3) a child with a poor outcome was 14 times more likely to have an abnormal or questionable DDST result than a normal one. These data suggest that a child with an abnormal DDST is likely to have a poor school outcome and that many children with school-related problems who might benefit from early intervention are not identified by the DDST.

Age Factors↗