RESUMEN
PURPOSE: To determine the significance of plasma c-erbB-2 levels to assess the extent of disease spread and to predict the response to chemotherapy in node-positive breast cancer patients. METHODS: We determined plasma levels of c-erbB-2 in 79 stages II and III breast cancer patients who received cyclophosphamide, methotrexate, and flourouracil (CMF)/cyclophosphamide, methotrexate, fluorouracil, vincristine, and prednisone (CMFVP) chemotherapy. All patients had a minimum follow-up of greater than 60 months or until disease recurrence. Plasma samples were obtained before and after chemotherapy. Plasma c-erbB-2 levels were quantified by enzyme-linked immunoassay. c-erbB-2 levels were analyzed in relation to the patients' axillary lymph node status, menopausal status, disease status, disease-free survival (DFS), and steroid receptor status of tumor. RESULTS: Plasma c-erbB-2 levels varied widely in breast cancer patients. In general, when all patients were included in the analyses, plasma c-erbB-2 levels before chemotherapy correlated significantly with the number of positive axillary lymph nodes and with postchemotherapy c-erbB-2 levels. No association was observed between pre- or postchemotherapy c-erbB-2 levels and other variables (patients' age at diagnosis, receptor status of the tumor, or disease status). The prognostic significance of different factors (ie, nodal status [one to three v > three positive nodes], menopausal status [pre- v postmenopausal women], estrogen receptor [ER] status [ER+ v ER-], and pre- and postchemotherapy c-erbB-2 levels) in predicting DFS was determined in all study patients. Among the variables examined, nodal status was the strongest predictor of DFS in these patients. The second most significant prognostic marker was postchemotherapy c-erbB-2 level. Prechemotherapy c-erbB-2 levels showed prognostic significance for DFS in a subset of breast cancer patients (ie, patients with > three positive nodes). Patients with greater than three positive lymph nodes and those with greater than 100 fmol/mL of plasma c-erbB-2 levels before therapy had significantly shorter DFS than did those patients with 100 fmol/mL or less c-erbB-2 levels. CONCLUSION: In breast cancer patients, determination of c-erbB-2 levels before therapy is an important biomarker to assess the extent of disease spread in the lymph nodes. Postchemotherapy c-erbB-2 levels are also a prognostic indicator for DFS in patients who receive chemotherapy. Finally, in a subgroup of patients with greater than three positive nodes, prechemotherapy c-erbB-2 levels are a prognostic marker for response of patients to standard chemotherapy.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/sangre , Neoplasias de la Mama/sangre , Neoplasias de la Mama/tratamiento farmacológico , Receptor ErbB-2/sangre , Adulto , Anciano , Análisis de Varianza , Western Blotting , Neoplasias de la Mama/patología , Ciclofosfamida/administración & dosificación , Supervivencia sin Enfermedad , Femenino , Fluorouracilo/administración & dosificación , Humanos , Metástasis Linfática , Metotrexato/administración & dosificación , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prednisona/administración & dosificación , Pronóstico , Receptor ErbB-2/efectos de los fármacos , Resultado del Tratamiento , Vincristina/administración & dosificaciónRESUMEN
PURPOSE/OBJECTIVES: To describe the mechanisms and nursing care associated with heparin-induced thrombocytopenia and thrombosis (HITT). DATA SOURCES: Published books and journal articles as well as clinical experience. DATA SYNTHESIS: HITT is an immune reaction that occurs in 1%-10% of individuals receiving heparin therapy. Characterized by a sudden drop in platelets, it can result in life-threatening hemorrhage and thrombus-related events. CONCLUSIONS: Heparin commonly is used in many oncology treatment settings. Awareness of this potentially serious complication and knowledge of its treatment is critical to safe administration. IMPLICATIONS FOR NURSING PRACTICE: Astute assessment skills are the key to diagnosis and treatment of HITT.
Asunto(s)
Heparina/efectos adversos , Planificación de Atención al Paciente , Trombocitopenia/inducido químicamente , Trombosis/inducido químicamente , Adulto , Anticoagulantes/uso terapéutico , Femenino , Humanos , Trombocitopenia/sangre , Trombocitopenia/inmunología , Trombocitopenia/terapia , Trombosis/sangre , Trombosis/inmunología , Trombosis/terapiaRESUMEN
We used a needs assessment questionnaire to survey a primarily adult oncology population and their significant others, to gauge their interest in a cancer screening program. The purpose of the study was to determine the feasibility of developing a cancer prevention and detection program for this group of individuals. Although there was overwhelming interest in participating in the program, the subjects held varied opinions about the program's benefits. Differences correlated with personal and familial history of cancer and, in some categories, were quite significant. Additional questionnaire information related to patients' preference in the design of a cancer screening program. The majority preferred the screening examination to be performed by both nurses and physicians. In selecting what should be included in examinations, those surveyed chose testicular cancer and prostate cancer the least number of times. Results of this questionnaire can be used to demonstrate the need for nurses to take an active role in the screening process, especially in patient education.