Determinants of cancer patients' utilization of hospital care within two years after diagnosis.

This study aimed to identify factors at diagnosis that are related to cancer patients' utilization of hospital care during the first 2 years after diagnosis, and thereby improve identification of patients with an increased need for close follow-up. Data from a prospective intervention study of psychosocial support and from a computerized patient administration system were used. A total of 393 newly diagnosed patients were included. Hierarchical regression analyses were performed to determine whether the addition of information regarding age, comorbidity, functional status, symptoms, and socioeconomic variables improved the prediction of utilization of specialist inpatient care beyond that afforded by cancer-related factors. In addition to cancer diagnosis and treatment, comorbidity, physical function, and pain determined use of inpatient care. Patients living in rural areas and those with a low income utilized hospital care more often. The results suggest that thorough assessment can identify patients at diagnosis with an increased need for follow-up, e.g. intensified home care services.

The role of preoperative and postoperative radiotherapy in rectal cancer.

Radiotherapy has an important role to play when used in addition to surgery in primary and recurrent rectal cancer. In primary resectable rectal cancer, a large number of randomized trials have shown that preoperative radiotherapy can slightly improve survival and can decrease local recurrence rates by more than half. Postoperative radiotherapy may also decrease the risk of local failure although with less efficacy. A preoperative schedule of 5 Gy/day for 5 out of 7 days is a convenient and low-toxic treatment, provided it is not given with 2 beams to large volumes, and it appears to be at least as effective as postoperative radiochemotherapy, generally meaning 6 months of therapy with 5 weeks of radiation. The schedule of 5 Gy/day for 5 days also reduces local recurrences with total mesorectal excision. It is unlikely that preoperative radiochemotherapy will substantially increase the chances of a sphincter-preserving procedure in a low-lying rectal cancer and that the long-term function will be adequate even if this is believed by many. In primary nonresectable or locally recurrent rectal cancer, preoperative radiotherapy may downsize or downstage the tumor so that it can be resected. Scientific support that radiochemotherapy is more efficient than radiotherapy alone in this situation is weak.

A randomized study of nutritional support in patients with colorectal and gastric cancer.

Involuntary weight loss is often seen among patients with gastrointestinal (GI) cancer. Weight loss may influence quality of life (QoL) and is a predictor of survival. The present study is an attempt to improve body weight development in GI cancer patients by individual support (IS), including nutritional measures. Patients were randomized in a 2 x 2 design between 1) IS, including nutritional support, 2) group rehabilitation (GR), 3) IS + GR (ISGR), or 4) standard care (SC). Data concerning dietary intake (24-h recalls), body weight, and QoL (EORTC-QLQ C-30) were collected over 2 yr for 67 patients with colorectal or gastric cancer, randomized to IS or ISGR. Data on weight and QoL were collected for 70 patients with the same diagnoses randomized to GR or SC. Despite a tendency to greater weight loss at inclusion, the IS + ISGR group managed to gain weight significantly more rapidly and to a greater extent than the GR + SC group. The differences became statistically significant at 12 and 24 mo (P < 0.05). Patients with weight loss at baseline increased their energy intake and weight more than those without weight loss. No differences were seen in QoL ratings between randomization groups, but there was a positive correlation between weight development and QoL and a negative correlation between fatigue and weight development. There was a numerical difference, not statistically significant (P = 0.3), indicating a shorter time of survival in patients in the GR + SC group. IS, including nutritional support, leads to more rapid weight gain than SC in patients with newly diagnosed GI cancer.

Assessment of drug activity and proliferation ex vivo for prediction of outcome in aggressive non-Hodgkin's lymphomas.

The activity of cytotoxic drugs and tumour cell proliferation rate were assessed ex vivo using the fluorometric microculture cytotoxicity assay (FMCA) and stainings for Ki67 and mitosis in 40 patients with aggressive non-Hodgkin's lymphomas (NHL). The findings were correlated to clinical response and survival. Twenty-three patients had a complete remission and 10 a partial remission. A drug sensitivity index based on the cell survival for three major drugs in NHL treatment was derived empirically and proliferation was expressed as low-, intermediate- or high. In 5 out of 8 drugs tested, cell survival ex vivo was higher in clinical non-responders than that in responders. Using the median drug sensitivity index as a cut-off, the sensitivity and specificity for tumour response were 58% and 100%, respectively, and was similar for the proliferation index. Both indices combined increased the sensitivity to 73% at retained specificity. Intermediate/high proliferation was significantly associated with impaired survival, whereas the drug sensitivity index was not predictive of survival. Thus, ex vivo assessments of drug sensitivity and proliferation seem to provide prognostic information in aggressive NHL.