A randomized controlled trial of a brief psychoeducational support group for partners of early stage breast cancer patients.

Partners of breast cancer patients are relied upon for support at a time when their own coping abilities are taxed by the challenge of cancer, yet few studies have investigated psychosocial interventions that include or target the patient's 'significant other'. Of the 118 consecutive patients approached, 36 patients and their partners participated in a randomized controlled trial of a brief psychoeducational group program for partners only. Psychometric instruments (including the Profile of Mood States (POMS), the Index of Marital Satisfaction (IMS) and DUKE-UNC Functional Social Support Scale (FSSS)) were administered pre-test, post-test and at 3 months follow-up. The Mental Adjustment to Cancer Scale (MAC) was also completed by patients. Three months after the intervention, partners had less mood disturbance than did controls. Patients whose partners received the intervention reported less mood disturbance, greater confidant support (CS) and greater marital satisfaction.

Prognosis of common cancers.

Four cancers in each sex account for nearly 60% of all cases. Lung cancer therapy is stymied by a lack of effective agents, but can be prevented by a smoking cessation program. Breast cancer is far too prevalent, but has the best response rate to drugs and the best palliation of any of these tumours. Prostate cancer, once androgen deprivation has failed, is untreatable. Colorectal cancer therapy after years of inactivity is now exciting, while pancreas cancer remains almost untreatable. All Canadian patients should be encouraged to participate in clinical trials when appropriate.

Failure of methylprednisolone acetate to prolong the antinauseant effect of intravenous methylprednisolone sodium succinate in patients receiving chemotherapy.

The efficacy of intramuscular methylprednisolone acetate in maintaining the antinauseant effect of intravenous methylprednisolone sodium succinate was assessed in a prospectively-randomized, double-blind, crossover-design trial. Of 150 patients entered, 127 were evaluable. There was no statistically significant difference between methylprednisolone acetate and saline placebo, although patient preferences slightly favoured the methylprednisolone acetate for nausea, vomiting, and overall effectiveness.

Multiple daily fractionated radiation therapy and misonidazole in the management of malignant astrocytoma. A preliminary report.

Various attempts have been made to improve the effectiveness of radiation in the treatment of cerebral malignant astrocytomas. A trend favoring multiple daily fractionated (MDF) radiation therapy over conventional single daily fractionated (CF) radiation therapy was identified in our previous study. In order to assess the effect of MDF with and without misonidazole, a province-wide prospective randomized trial was initiated in January 1981. By March 1984, 124 patients with histologically verified grade III and IV astrocytomas were randomized to CF (5800 cGy/6 weeks/30 fractions), MDF (6141 cGy/4.5 weeks/69 fractions at 89 cGy every 3-4 hours, three times a day) and MDF in combination with misonidazole (1.25 g/m2 three times weekly for the first 3 weeks). Thirty-eight patients were randomized to CF, 43 patients to MDF, and 43 patients to MDF and misonidazole. At the preliminary assessment in July 1984, the median survival time was 27 weeks for the CF group, 39 weeks for the MDF group and 49 weeks for MDF and misonidazole group. The 1-year actuarial survival rate from surgery was 20% for CF group, 41% for MDF group, and 45% for MDF and misonidazole group. There is a statistically significant difference (P less than 0.001) between the CF and MDF group. However, the addition of misonidazole does not significantly alter survival.

Misonidazole combined with hyperfractionation in the management of malignant glioma.

Multiple daily fractionated radiation therapy (MDF) may be more effective than conventionally fractionated radiation therapy (CF) in the treatment of malignant glioma. The hypoxic cell sensitizer misonidazole (MISO) could be more effective when employed with small fractions of radiation every 4 hours to take advantage of the long half-life of the drug. To evaluate MDF and MDF in combination with MISO, a randomized prospective trial was initiated. Between January 1981, and December 1982, patients with histologically verified astrocytoma with anaplastic foci or glioblastoma multiforme were randomized to CF (5800 cGy, 30 fractions, 6 weeks), MDF (6141 cGy, 69 fractions, 4 1/2 weeks, at 89 cGy every 4 hours 3 times daily) and MDF in combination with MISO (1.25 gm/M2 three times weekly for the first 3 weeks). In January 1983, the CF arm was dropped and a high dose MDF arm added (7120 cGy, 80 fractions, 5 1/2 weeks, at 89 cGy per fraction every 4 hours 3 times daily). CCNU chemotherapy was given at the time of tumor progression. One hundred and twenty-eight patients were evaluated (38 CF, 42 MDF, 37 MDF plus MISO, and 11 high dose MDF). Median survival was 29 weeks for CF, 45 weeks for MDF and 50 weeks for MDF plus MISO. Survival was significantly improved for patients treated with MDF compared to patients treated with CF (p less than .002). The addition of MISO to MDF did not result in further improvement in survival. Acute toxicity was acceptable. No clinically apparent delayed toxicity was observed.

Superfractionation radiation therapy in the treatment of malignant astrocytoma.

Superfractionation (SF) radiation therapy is the administration of three fractions per day. We have assessed the effect of SF in a prospective randomized clinical study of malignant astrocytomas from July 1978 to December 1980. Thirty-five patients were randomized to SF (4000 rad in 45 fractions in 3 weeks whole brain and 1000 rad in five fractions in one week local boost). Thirty-four patients were randomized to conventional fractions (3400 rad in 17 fractions whole brain in 3.5 weeks and 1600 rad in eight fractions in 1.5 weeks local boost). Both treatment arms received chemotherapy with CCNU. The 1- and 2-year actuarial survival rate is 54% and 21% for SF group and 32% and 10% for CF group. The other advantages of SF include shorter mean duration of steroid administration and improved performance status following radiation therapy.

Treatment of primary breast cancer with chemotherapy and tamoxifen.

We studied the possibility that the addition of tamoxifen to L-phenylalanine mustard combined with 5-fluorouracil enhances the benefit from the latter two drugs that has been observed in women with primary breast cancer and positive axillary nodes. Recurrence of disease was reduced at two years in patients given the three-drug regimen whose tumor estrogen-receptor levels were greater than or equal to 10 fmol. Among patients greater than or equal to 50 years old treatment failure was significantly reduced (P less than 0.001): by 51 per cent in those with one to three positive nodes and by 64 per cent in those with four or more. Higher receptor levels were associated with a greater probability of disease-free survival. Patients less than or equal to 49 years old were less responsive: those with one to three positive nodes received no benefit from tamoxifen at any receptor level, whereas those with four or more appeared to have reduced treatment failure associated with higher receptor levels. This adjuvant chemotherapy is not indicated in patients less than or equal to 49 years old whose tumor receptor levels are below 10 fmol; there is a suggestion of benefit in patients greater than or equal to 50 years old whose levels are low.

Care in the terminal stage of carcinoma of the pancreas.

Palliative care of the patient with terminal cancer of the pancreas concerns itself with pain, anorexia, nausea and vomiting, bowel and bladder disturbances, sleep aberrations, jaundice, hydration, nutritional state, neuropsychiatric disorders and attitude of patient and family towards the disease and its implications. Each of these facets has a bearing on the quality of life remaining. The administration of pain medication should consider the role of anxiety in the intensification of pain and an anxiolytic or sedative agent can be added if necessary. Specific kinds of pain should be dealt with in specific ways. Gastrointestinal conditions such as constipation, nausea and obstruction should be eliminated. Anorexia may cause debilitation and may also rob the patient of purpose and emotional pleasure.

Study of serum beta-2 microglobulin levels in breast cancer patients.

Serum beta-2 microglobulin levels were measured in normal individuals and in breast cancer patients. It was observed that there was a significant rise in levels especially in advanced stages of the disease. It was concluded that patients with a beta-2 microglobulin/creatinine ratio of greater than 3.8 were likely to have metastatic breast cancer.