Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A total of 61 patients with recurrent or persistent clinically measurable platin-resistant epithelial ovarian carcinoma were treated with 260 mg/m2 oral hexamethylmelamine daily for 14 days, repeated at 4-week intervals. Platin resistance was defined as progression or stable disease during cis- or carboplatin treatment (used alone or in combination with other drugs), or relapse within 6 months after the end of that therapy. Fifty patients were evaluable for response and 57 for toxicity. The objective response rate was 14% (3 complete and 4 partial responses). The response rate was higher in patients with relapse within 6 months than in patients with progression or stable disease on platin-based therapy. This observation underscores the importance of defining response and time to progression after first-line chemotherapy. The median duration of response was 8 months and the median survival in responding patients was 9+ months versus 5 months for patients with progression on hexamethylmelamine. Nausea and vomiting requiring antiemetic treatment occurred in 8 (14%) patients and reversible peripheral neuropathy in 3 patients. Two patients developed agitation, insomnia, and depression during hexamethylmelamine therapy. In conclusion, the 14% objective response rate and the occurrence of complete responses with oral hexamethylmelamine treatment in a group of ovarian cancer patients with true platin resistance are noteworthy.
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PMID:Hexamethylmelamine as second-line therapy in platin-resistant ovarian cancer. 147 37

Despite the importance of symptom control in the cancer population, few studies have systematically assessed the prevalence and characteristics of symptoms or the interactions between various symptom characteristics and other factors related to quality of life (QOL). As part of a validation study of a new symptom assessment instrument, inpatients and outpatients with prostate, colon, breast or ovarian cancer were evaluated using the Memorial Symptom Assessment Scale and other measures of psychological condition, performance status, symptom distress and overall quality of life. The mean age of the 243 evaluable patients was 55.5 years (range 23-86 years); over 60% were women and almost two-thirds had metastatic disease. The Karnofsky Performance Status (KPS) score was < or = 80 in 49.8% and 123 were inpatients at the time of assessment. Across tumour types, 40-80% experienced lack of energy, pain, feeling drowsy, dry mouth, insomnia, or symptoms indicative of psychological distress. Although symptom characteristics were variable, the proportion of patients who described a symptom as relatively intense or frequent always exceeded the proportion who reported it as highly distressing. The mean (+/- SD range) number of symptoms per patient was 11.5 +/- 6.0 (0-25); inpatients had more symptoms than outpatients (13.5 +/- 5.4 vs. 9.7 +/- 6.0, p < 0.002) and those with KPS < or = 80 had more symptoms than those with KPS > 80 (14.8 +/- 5.5 vs. 9.2 +/- 4.9, p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Symptom prevalence, characteristics and distress in a cancer population. 792 Apr 92

We assessed menstrual and reproductive factors in relation to ovarian cancer risk in a large, population-based, case-control study. 563 cases in Massachusetts and New Hampshire were ascertained from hospitals and statewide tumour registries; control women (n = 523) were selected through random digit dialing and matched to case women by age and telephone sampling unit. We used multivariate logistic regression to evaluate factors in relation to risk of ovarian cancer and the major tumour histologic subtypes. Ovarian cancer risk was reduced among parous women, relative to nulliparous women (OR = 0.4; 95% CI = 0.3-0.6). Among parous women, higher parity (P = 0.0006), increased age at first (P = 0.03) or last (P = 0.05) birth, and time since last birth (P = 0.04) were associated with reduced risk. Early pregnancy losses, abortions, and stillbirths were unrelated to risk, but preterm, term, and twin births were protective. Risk was lower among women who had breast-fed, relative to those who had not (OR = 0.7; 95% CI = 0.5-1.0), but the average duration of breast-feeding per child was unrelated to risk (P for trend = 0.21). Age at menarche and age at menopause were unrelated to risk overall, although increasing menarcheal age was protective among premenopausal women (P = 0.02). Menstrual cycle characteristics and symptoms were generally unrelated to risk, although cycle-related insomnia was associated with decreased risk (OR = 0.5; 95% CI = 0.3-0.8). We found no association between the type of sanitary product used during menstruation and ovarian cancer risk. In analyses by histologic subtype, reproductive and menstrual factors had most effect on risk of endometrioid/clear cell tumours, and least influential with regard to risk of mucinous tumours. Overall, our findings offer some support to current hypotheses of ovarian pathogenesis, and show aetiologic differences among the tumour subtypes.
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PMID:Menstrual and reproductive factors in relation to ovarian cancer risk. 1123 75

Genetic counseling for individuals at high risk for developing breast and ovarian cancer (oncogenetic counseling) involves evaluation of cancer risk, psychological assessment, and genetic testing for germline mutations in BRCA1/BRCA2 genes. The long-term psychosocial impact of oncogenetic counseling on consultees and the retention of oncogenetic information are uncertain. We retrospectively interviewed 155 women who underwent oncogenetic counseling in a single medical center in Israel in 1996 (N = 50) and 1998 (N = 105). There were 29 (18.7%) BRCA1/BRCA2 mutation carriers and 126 non-carriers; 58 (37.4%) had a past or present history of cancer, and 97 (62.6%) were first-degree relatives within breast/ovarian cancer families. A questionnaire evaluating self-reported distress and anxiety symptoms before and after counseling, as well as the retention of relevant information (e.g., individual and offspring cancer risk, early detection schemes), one and three years after the initial consultation was administered. Overall, oncogenetic counseling had a minimal effect on anxiety-related symptoms. Mutation carriers reported anxiety-associated symptoms, such as sleeplessness and "bad mood", more frequently than non-carriers following oncogenetic counseling. As expected, 61.8% of carriers and only 30% of non-carriers accurately remembered the personal and offspring cancer risk and preventive and early detection schemes. We conclude that although there seemed to be slight worsening of anxiety-related symptoms following oncogenetic counseling in BRCA1/BRCA2 mutation carriers, these symptoms were minimal and did not affect everyday life activities. In addition, there is an ongoing need to emphasize oncogenetic information to high-risk individuals.
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PMID:Genetic counseling in hereditary breast/ovarian cancer in Israel: psychosocial impact and retention of genetic information. 1221 Mar 41

Despite the high objective response rate of advanced ovarian cancer to combination platinum/taxane-based chemotherapy, the majority of patients ultimately experience disease progression. Thus, there is a need to find new management strategies that can improve upon the results of existing therapies. We are currently conducting a phase II trial to explore the toxicity and potential efficacy of a three-drug program, which adds irinotecan (CPT-11, Camptosar) at 100 mg/m2 to carboplatin (Paraplatin) at an area under the concentration-time curve of 5 and paclitaxel at 150 mg/m2 over 3 hours. Treatment was initially given on an every-3-week schedule, but was subsequently changed to an every-4-week schedule due to excessive bone marrow toxicity. The study remains in progress, with 26 patients currently evaluable for toxicity, which has included grade 4 neutropenia (42% incidence), grade 4 thrombocytopenia (12%), and grade 3 emesis (12%), with one patient each experiencing grade 3 diarrhea, hepatic dysfunction, and insomnia. Data regarding response rates are immature. Our preliminary analysis reveals that the combination of carboplatin/paclitaxel/irinotecan can be administered to women with advanced ovarian cancer with significant, but overall acceptable, toxicity. Randomized trials will be required to define a possible role for this three-drug combination chemotherapy regimen in the standard management of advanced ovarian cancer.
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PMID:Toxicity associated with carboplatin/paclitaxel/Irinotecan use in advanced ovarian cancer: preliminary analysis. 1280 Jun 4

Logically, the choice of any ultimate optimum therapy requires, as well as comparison of the survival outcomes, a comparison of both subjective and objective toxicities in terms of incidence, degree of severity, and duration. Frequently such detail is not collected in large studies. Both cisplatin and paclitaxel are effective but neurotoxic drugs for ovarian cancer. The optimum choice is further complicated in that carboplatin is a possible alternative for cisplatin, being less neurotoxic but having greater hematologic toxicity. Similarly, 3-h and 24-h infusion schedules of paclitaxel have different incidences in opposite directions of hematologic and neurologic toxicities. One hundred fifty two eligible Canadian patients entered in a European-Canadian study that compared paclitaxel-cisplatin (PT, 79) patients with cyclophosphamide-cisplatin (PC, 73 patients) had both subjective and objective neurotoxicity data collected from treatment initiation to disease progression. Incidence, degree, and duration (compared in an analogous way to remission durations) of neurotoxicity were compared in the two arms to quantify the additional paclitaxel toxicity. No significant differences were found for motor toxicity, motor impairment, hearing impairment, or insomnia. For sensory changes during treatment, toxicity (all grades, 91% vs. 49%; grade 3 or higher, 29% vs. 3%) incidence, subjective impairment (a little or more, 89% vs. 40%; lots, 54% vs. 11%) incidence, and toxicity duration (all grades only), and impairment durations (both degrees) were all worse for PT. During follow-up, only the incidence of all-grade sensory toxicity was worse and this was not reflected by any other parameters. We conclude that paclitaxel adds considerably, but only temporarily, to the sensoy neurotoxicity of cisplatin.
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PMID:A comparison of the incidence, duration, and degree of the neurologic toxicities of cisplatin-paclitaxel (PT) and cisplatin-cyclophosphamide (PC). 1291 18

The estimated prevalence of insomnia in cancer patients varies between 20% and 50%, which is substantially higher than the general population. To date, little is known about the risk factors for insomnia in patients with cancer. This study examines the prevalence and predictors of insomnia in a population-based sample of women with ovarian cancer. Participants were 772 women participating in the Australian Ovarian Cancer Study - Quality of Life Study. Insomnia was assessed using the Insomnia Severity Index (ISI). Demographic, disease and treatment variables, and psychosocial variables, including anxiety and depression, support care needs and social support and coping, were investigated as potential predictors of insomnia. Twenty-seven percent of women reported sub-clinical symptoms of insomnia (ISI score 8-14) and 17% reported clinically significant insomnia (ISI score 15-28). Three variables were significant predictors of clinically significant insomnia: young age (<50 years: Odds Ratio (OR)=2.36; Confidence Interval (CI) 1.06-5.26; 50-59 years: OR=2.73; CI 1.33-5.64) relative to 70+ years; higher unmet needs in the physical/daily living domain (OR=1.02; CI 1.01-1.03) and elevated anxiety (sub-clinical anxiety (Hospital Anxiety and Depression Scale (HADS) score 8-10): OR=1.83; CI 1.04-3.24; clinical anxiety (HADS score 11-21): OR=2.03; CI 1.08-3.85). In contrast to predictors of primary insomnia, women with cancer aged <60 years were more likely to report clinical levels of insomnia than women of 70+ years. Consistent with primary insomnia, elevated anxiety predicted insomnia in women with ovarian cancer. Given that both anxiety and insomnia are relatively common, and the relationship may potentially be bi-directional, the efficacy of interventions targeting insomnia and anxiety, rather than insomnia alone, is worthy of consideration.
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PMID:Prevalence and predictors of insomnia in women with invasive ovarian cancer: anxiety a major factor. 1954 Jul 48

This study investigated the association between positive genetic diagnosis for BRCA1/2 mutations and sleep quality in Ashkenazi asymptomatic women. Seventy-three women, including 17 asymptomatic BRCA1/2 carriers and 20 non-carriers from the oncogenetic clinic, and 36 community controls, participated in a cross-sectional design. Women completed sociodemographic, clinical, general psychological distress, cancer-related worry (CRW), fatigue and sleep questionnaires in their homes, and wore actigraphs for 5-7 nights. Impaired global subjective sleep quality was demonstrated in BRCA1/2 carriers compared to non-carriers and controls [mean Pittsburgh sleep quality index (PSQI) total scores 7.29 +/- 4.34; 3.94 +/- 2.49; 4.21 +/- 2.80, respectively, P = 0.021] and poor sleep quality (PSQI total score >5) was significantly higher in carriers (53%) compared to non-carriers (20%) and controls (28%, P = 0.03). Based on actigraphic measures, sleep latency tended to be longer in carriers compared to counterparts, albeit not significantly. Increased sleep disturbance was related significantly to increased fatigue in the entire sample and in the control group; to psychological distress in the entire sample and in non-carriers; and to CRW in the entire sample. In carriers, sleep disturbance was related strongly but non-significantly to fatigue, psychological distress and CRW. Fatigue and carrier status were significant predictors of sleep quality, accounting for 15.7% of the variance. In conclusion, asymptomatic BRCA1/2 carriers experience poor sleep quality compared to non-carriers and controls. Our study design is unique in that it offers insight regarding the nature of being an asymptomatic carrier, and affords the opportunity to examine factors that may contribute to the development of insomnia in women at risk for breast-ovarian cancer.
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PMID:Sleep disturbances in asymptomatic BRCA1/2 mutation carriers: women at high risk for breast-ovarian cancer. 2033 6

The objective of our study was to compare prospectively the QoL in long-term ovarian cancer survivors with short-term survivors and to explore discriminating variables between short-term and long-term survival. Thirty-three patients were included, 22 died within 5 years post diagnosis and 11 survived beyond 10 years. QoL data were collected pre-treatment (baseline), 1-year post diagnoses and for long-term survivors 10 years post-treatment using the EORTC QLQ-C30. At baseline, there was no difference in terms of FIGO stage, residual tumor and adjuvant chemotherapy. Significantly, more short-term survivors (96%) had intra operative ascites as compared to long-term survivors (55%) (p = 0.01). Before treatment, short-term survivors had clinically significantly lower QoL scores on the physical functioning (mean 75.45) and role functioning scale (mean 68.94) compared to long-term survivors (mean 68.94 and 84.85, respectively). They also reported higher levels of symptoms. One year post-diagnosis, QoL scores were comparable in most domains. Long-term survivors had a significantly better global QoL but more insomnia. Emotional functioning and global QoL/health status improved significantly from baseline to 1-year post-diagnosis and remained relatively stable at the 10-year follow-up. The presence of intra operative ascites and a supporting social network were identified as significant variables that discriminated between short-term and long-term survival. Compared to a reference sample, long-term survivors showed similar QoL scores but more dyspnoea. Although ovarian cancer patients do not belong to the most prevalent survivor populations, we found that long-term survivors have QoL scores similar to females without a history of cancer.
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PMID:Prospective assessment of quality of life in long-term ovarian cancer survivors. 2082 13

Treatment of gynecological cancer has significant impact on a woman's quality of life because it commonly includes removal of the uterus and ovaries, both being the core of a woman's femininity, whilst irradiation and chemotherapy, be they as primary therapy or when indicated as postoperative adjuvant therapy, will lead to ablation of ovarian function if the ovaries had not been removed. This will lead to an acute onset of menopausal symptoms, which may be more debilitating than those occurring as a result of natural aging, and of which hot flushes, night sweats, insomnia, mood swings, vaginal dryness, decreased libido, malaise and a general feeling of apathy are the most common. About 25% of gynecological cancers will occur in pre- and perimenopausal women, a large percentage of whom will become menopausal as a result of their treatment. There are also the gynecological cancer survivors who are not rendered menopausal as a result of the treatment strategy but who will become menopausal because of natural aging. Concern among the medical attendants of these women is whether use of estrogen therapy or estrogen and progestogens for their menopausal symptoms will reactivate tumor deposits and therefore increase the rate of recurrence and, as a result, decrease overall survival among these women. Yet the data that are available do not support this concern. There are eight retrospective studies and only one randomized study that have analyzed outcome in endometrial cancer survivors who used hormone therapy after their surgery, whilst, among ovarian cancer survivors, there are four retrospective studies and one randomized study. The studies do suffer from small numbers and, although the studies pertaining to endometrial cancer analyze mostly women with early-stage disease, a number of the studies in both the endometrial and ovarian cancer survivors do have a sizeable follow-up. These studies seem to support that estrogen therapy after the treatment for gynecological cancer does not impact negatively on outcome in endometrial and ovarian cancer survivors and that estrogen therapy can be considered as a plausible therapeutic option in survivors who are debilitated by their menopausal symptoms. It is prudent not to offer estrogen therapy to survivors of endometrial stromal sarcoma and women with granulosa cell tumors of the ovaries. Vulval, vaginal and cervical cancers are not considered hormone-dependent and therefore estrogen therapy can be given.
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PMID:Estrogen therapy in gynecological cancer survivors. 2395 24


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