Leukemia and lymphoma patients linked by prior social contact. Evaluation using a case-control approach.

A case-control approach was used to evaluate whether patients with leukemia or lymphoma have a greater than expected tendency to have had prior close personal associations. Two census enumeration districts in different states with low population mobility were chosen, and each resident who had developed leukemia or lymphoma during a predetermined fixed interval was ascertained by review of tumor registry records. For each patient, a resident of the area was selected as a control matched for age, sex, race, and geographic location as of the time of diagnosis. Close personal associations between patients, controls, and both were determined by interviewing. In Area 1 the 8 patients had 11 social links (3 direct, 8 indirect) and the controls had 2 (both direct); P=0.0156, one-tailed significance test. In Area 2, the 21 patients had 21 close links (15 direct, 6 indirect) whereas the controls had 10 (direct 8, indirect 2; 0.25 greater than P greater than 0.20).

A reappraisal of staging and therapy for patients with cancer of the rectum. I. Development of two new systems of staging.

Existing systems of staging for patients with rectal cancer depend almost exclusively on anatomic evidence. Consequently, the stages cannot be determined in advance of therapeutic decisions and cannot be used for patients treated without surgery. Furthermore, the stages contain no provision for important prognostic distinctions, that cannot be discerned from anatomic data. After preparing a taxonomy for hiterto unclassified medical data, we developed and tested two new systems of staging in a cohort if 318 patients. The first system which can be applied before treatment, is divided into four composite stages that contain elements of symptomatic, chronometric, co-morbid, and para-morbid data, as well as information obtained from physical examination, sigmoidoscopy, and roentgenography. The second system, applicable to patients with resected tumors, is based on a combination of pre-therapeutic clinical information and post-surgical anatomic evidence. The two systems produce prognostic gradients that are clinically distinctive and statistically efficacious.

A reappraisal of staging and therapy for patients with cancer of the rectum. II. Patterns of presentation and outcome of treatment.

Two new biologically composite systems of staging were used to analyze the patterns of presentation, therapy, and outcome for 318 patients with rectal cancer. Selectional bias was evident in therapeutic decisions. The patients chosen for surgical exploration and possible resection came mainly from prognostically favorable stages and had higher survival rates than the "inoperable" patients wven when the tumor was not resected. In patients with tumors located 8 cm or higher above the anus, survival rates in each composite symptom-anatomic (S-A) stage were essentially similar with radical and simple resections. Radical surgery gave better survival rates than simple surgery for tumors at 5 to 7 cm and was an anatomic necessity to remove tumors at 0 to 4 cm. Regardless of the extensiveness of surgery, the S-A stages were directly related to rates of postoperative infection, postoperative death, subsequent quality of life, and deaths due either to cancer or to noncancer causes.

Leukaemia and lymphoma patients interlinked by prior social contact.

Patients with either leukemia or lymphoma were asked if they had close personal associations with other patients before the onset of disease. Iinitial interviews indicated that several patients could be interlinked into social clusters. Tumour-registry records were used to contact each patient (or a surviving relative) diagnosed during the years 1964-73 in three areas of West Virginia. Close personal associations, antedating the onset of disease in 1 or both individuals of each linkage pair, were detected in 14 of 23 (61%), 14 of 22 (68%), and 6 of 8 (75%) patients from these three areas during this ten-year period. In addition, among 28 randomly selected patients with Hodgkin's disease from various parts of the United States, 10 (36%) had direct or indirect close personal associations with 17 other patients with leukemia or lymphoma. Patients with leukemia or lymphoma frequently are interlinked by prior close personal associations to other patients with these diseases.