Attitude of cancer patients toward diagnosis disclosure and their preference for clinical decision-making: a national survey.

OBJECTIVES: There is still contradictory evidence on disclosure preferences regarding cancer diagnosis. The aim of this study was to evaluate the preference of cancer patients for knowing the truth about their disease, as well as the factors that might have an impact on these preferences. METHOD: This study was conducted in 11 cancer centers in Iran. A questionnaire was used to collect data, and all patients above 15 years of age who were willing to participate were included in the study. The patients were asked if they were aware of the malignant nature of their disease, and if they came to know about their disease at the time of initial diagnosis, or later. The patients were then asked about the way they looked upon their disease. In the final part of the questionnaire, the participants were asked the level of involvement they prefer to have in making treatment decisions. RESULTS: In total, 1226 patients were enrolled in this study, only 565 (46.7%) of whom were aware of their disease at the time of diagnosis, and 878 (72.7%) at the time of interview, while 980 (85.2%) were willing to receive information about their disease. Patients' awareness was significantly associated with age under 50 years, female gender, having breast, skin or head and neck cancer, and having medical care in Shiraz or Hamadan while it was not associated with the stage or accompanying illness. CONCLUSION: While the majority of Iranian cancer patients prefer to be aware of the nature of their disease and have an active role in treatment decision making, they do not receive this information.

Primary bone lymphoma: a clinicopathological retrospective study of 28 patients in a single institution.

BACKGROUND: Primary bone lymphoma (PBL) is a rare disease and distinct clinicopathological entity. The optimal treatment strategy is still unclear. Because of rarity of PBL, we report our institute experience in PBL clinicopathological feature and treatment results. METHODS: 28 patients diagnosed with PBL were referred to Omid Hospital, cancer research center (CRC), between March 2001 and February 2009. Immunophenotype studies on 16 out of 28 pathological blocks were performed. We analyzed disease free survival (DFS) and overall survival (OS) rates. RESULTS: 14 patients with PBL were analyzed retrospectively. 17 patients (60.7%) were male and 11 (39.3%) were female with a median age of 41 years (range: 11-79). Long bones were the most primarily site of involvement (71%). 26 (93%) patients had diffuse large B cell lymphoma and 2 (7%) had small lymphoblastic lymphoma. One (3%) patient received radiation alone, 18 (66%) cases received combined modality (chemotherapy + radiotherapy) and 8 (30%) received only chemotherapy during their treatment period. The median follow up was 18 months (range: 1-82). Mean DFS was 51 months (range: 37-66). Overall survival (OS) was 54 months (range: 40-68). OS was significantly better in the chemoradiotherapy group compared with other two groups (64 versus 27 months, respectively, p=0.014). DFS was also significantly better in combined modality arm compared with other two groups (64 versus 21 months, respectively, p=0.003). CONCLUSIONS: In spite of small number of patients reported in this study, combined modality treatment (chemotherapy and radiotherapy) was shown to be useful as an effective treatment strategy in PBL.