Rhonda K. Dailey

Patient Perspective on Watchful Waiting/Active Surveillance for Localized Prostate Cancer

Objective: To describe prostate cancer treatment decision making, focusing on knowledge and attitudes toward observation, known as watchful waiting (WW) or active surveillance (AS), and reasons for not choosing WW/AS. Methods: Semistructured in-person interviews were conducted with 21 men (14 black; 7 white) with recently diagnosed localized prostate cancer. Results: All cancers were detected by prostate-specific antigen screening; 14 men had low-risk disease. Nineteen chose surgery or radiation treatment. The majority wanted to “get rid of” or “cure” the cancer by undergoing aggressive therapy, even with awareness of the potential for significant side effects. Most men seemed unaware of the uncertainty/controversies that aggressive treatment may not cure their cancer or improve their survival. Limited knowledge about WW/AS was common, and few remembered WW/AS being presented as a viable option. Rather, many men perceived it as “doing nothing.” Some men, who initially were inclined toward WW/AS, yielded to pressure from family, physicians, or both to choose aggressive treatment. Lack of physician support was a significant barrier to WW/AS. Conclusions: The observational strategy (WW/AS) was not viewed as a reasonable approach, even for those with low-risk cancer. The desire for aggressive therapy may reflect the complex psychology associated with receiving a diagnosis of cancer and the limited supportive counseling received. Further efforts to better understand and educate patients and physicians may help men make informed and appropriate treatment decisions to maximize quality of life without compromising survival.

Analysis of Citations to Biomedical Articles Affected by Scientific Misconduct

We describe the ongoing citations to biomedical articles affected by scientific misconduct, and characterize the papers that cite these affected articles. The citations to 102 articles named in official findings of scientific misconduct during the period of 1993 and 2001 were identified through the Institute for Scientific Information Web of Science database. Using a stratified random sampling strategy, we performed a content analysis of 603 of the 5,393 citing papers to identify indications of awareness that the cited articles affected by scientific misconduct had validity issues, and to examine how the citing papers referred to the affected articles. Fewer than 5% of citing papers indicated any awareness that the cited article was retracted or named in a finding of misconduct. We also tested the hypothesis that affected articles would have fewer citations than a comparison sample; this was not supported. Most articles affected by misconduct were published in basic science journals, and we found little cause for concern that such articles may have affected clinical equipoise or clinical care.

Herbal product use and menopause symptom relief in primary care patients: a MetroNet study.

OBJECTIVES The four study objectives were to determine (1) the prevalence of use of four herbal product types promoted to reduce menopause symptoms (phytoestrogens, St. Johns wort, Ginkgo biloba, and ginseng) among primary care patients approaching or in menopause, (2) the extent to which women who use these types of herbal products report menopause-related symptoms compared with herbal product nonusers, (3) the frequency of reported symptom reduction after use, and (4) if use was disclosed to their physicians. METHODS A cross-section of ethnically diverse women 40-55 years of age (35.5% African American, 60.2% Caucasian) who were recruited from eight primary care centers in Michigan to complete a self-report survey. The questionnaire included demographic items, health history, recent use of four herbal product types purported to relieve menopause symptoms and perception of symptom improvement, and interest in additional herbal product information. RESULTS Of 397 women, 24.9% reported taking, in the previous 6 months, at least one of the four study herbs. Herbal product use did not vary by patient demographics or health characteristics. Herbal product users reported more menopause symptoms than nonusers, and 68% of the users said that the herbs improved their symptoms; 56.4% said that their physician was aware of their herbal product use. CONCLUSIONS Primary care patients experiencing common menopausal symptoms are likely to use herbal products that are purported to provide menopause symptom relief, and many believe that these products improve their menopausal symptoms. Healthcare providers should be aware of patients positive attitude, use patterns, and lack of disclosure of use of herbal medicines. Inquiry of herbal product use is another way for physicians to learn about patient self-medication of bothersome symptoms.

Predictors, Barriers, and Facilitators of Lipid-Lowering Medication Use Among African Americans in a Primary Care Clinic

INTRODUCTION Hypercholesterolemic African Americans are less likely than white Americans to be taking lipid-lowering medications, yet they suffer disproportionately from coronary heart disease (CHD). METHODS Through medical record abstraction and focus groups with patients and physicians, we sought a better understanding of the predictors, barriers, and facilitators to lipid-lowering medication use in a Detroit primary care clinic. Stepwise regression analysis included 634 African American patients with abnormal cholesterol values (n = 575) or currently prescribed a lipid-lowering medication (n = 59). Focus group transcripts were analyzed with a framework approach. RESULTS Overall 174 (30.3%) of hypercholesterolemic African Americans were prescribed a lipid-lowering medication. Patients with hypertension or CHD were significantly more likely to have a lipid-lowering medication prescription than those without, adjusted prevalence ratio 2.56 (95% CI, 1.76-3.74) for hypertension and 1.70 (95% CI, 1.45-2.00) for CHD. Focus groups revealed 2 barriers to lipid-lowering medication use named by both physicians (n = 12) and patients (n = 23): cost and forgetting to take medication, often because of lack of symptoms. CONCLUSIONS Physicians and patients suggested better education by physicians and at the community level to improve lipid-lowering medication use. Simple and direct patient-physician discussions emphasizing long-term benefits are recommended.

90 NATURAL HISTORY OF MENOPAUSAL SYMPTOMS IN PRIMARY CARE PATIENTS

Background The association between changes in menopausal status and vasomotor, psychological and somatic symptoms reporting over the course of the menopause transition is not well understood. Objectives 1) Determine the prevalence and the natural history of menopause symptoms among primary care patients approaching or at menopause; and 2) examine the relationships between self-reported symptoms, sociodemographic variables and menopausal status. Study Design Cross-sectional self-report survey of 342 women aged 40 to 55 years (31.6% African American) were recruited from eight family practice centers in 2000-2001. Results Among 251 women without surgical menopause, 133 (53.0%) were pre-menopausal; 72 (28.7%) were peri-menopausal and 46 (18.3%) were post-menopausal. Vasomotor symptoms were less common in pre-menopause compared to peri- and post- menopause (p<0.01), even though as many as 28.6% of the women with regular menstruation reported hot flashes and 18.8% had night sweats. Post-menopausal women reported more psychological symptoms, including loss of sexual interest, nervousness, and irritability (but not depression). Somatic symptoms, including memory loss, fast heartbeat, difficulty sleeping, and arm or leg numbness, were also associated with menopausal status. African-American women reported painful sex more often than whites (p<0.01). Education, practice location, and hormone therapy were not associated with any reported symptoms. Conclusions Symptoms are not uncommon among pre-menopausal women and become more prevalent as the transition to menopause occurs. The prevalence of vasomotor symptoms in pre-menopausal women may be an under-recognized aspect of the natural history of the menopause transition.