Dexamethasone for the prophylaxis of radiation-induced emesis: a National Cancer Institute of Canada Clinical Trials Group phase III study.

PURPOSE: To investigate the efficacy of dexamethasone as a prophylactic antiemetic for patients receiving fractionated radiotherapy to the upper abdomen in a randomized controlled trial. PATIENTS AND METHODS: One hundred fifty-four patients planned to receive fractionated radiotherapy to fields involving the upper abdomen (minimum total dose, 20 Gy; minimum number of fractions, five) were randomized to receive prophylactic dexamethasone (2 mg orally three times a day [tid], starting in the morning of first treatment and continuing until after their fifth treatment) or placebo. The primary end point of the study was the proportion of patients free from emesis during the study period. Secondary end points included a quality-of-life assessment using the core questionnaire of the European Organization for Research and Treatment of Cancer and side effects of dexamethasone therapy in this population of patients. RESULTS: Fifty-four (70%) out of 75 patients receiving dexamethasone had complete protection versus 37 (49%) out of 75 patients on placebo (P = .025). Most emetic episodes occurred during the initial phase of treatment. Although there was no difference in global quality of life between the two sets of patients, patients receiving dexamethasone had less nausea and vomiting and less loss of appetite but more insomnia. CONCLUSION: Dexamethasone 2 mg tid seems to be an effective prophylactic antiemetic in this situation. Side effects were acceptable, but there seemed to be no overall effect on global quality of life.

[Perception of symptom distress in lung cancer patients: I. Agreement between patients and their caregiving relatives]. / Wahrnehmung der Symptombelastung bei Lungenkrebspatienten: I. Ubereinstimmung zwischen Patienten und den sie hauptsächlich pflegenden Angehörigen.

This paper employs a comparative descriptive design to compare primary family caregivers' assessment of lung cancer patients' symptom distress with patients' own perceptions of symptom distress in the home setting. The second part describes the results of the qualitative component of this research. A convenience sample of 37 patient-family caregiver dyads completed the McCorkle and Young Symptom Distress Scale (SDS). Family caregivers' global scores were moderately correlated with patients' global scores (r = 0.71; P < 0.001). No significant differences in ratings were found for 10 of the 13 symptoms assessed. Therefore, when the patient is unable to provide a self-report of symptom distress, health-care professionals may seriously consider family caregivers' assessments of patients' symptom distress to be reasonable estimates for at least 10 of the 13 symptoms on the SDS.

Spontaneous emission control in quantum well laser diodes.

Spontaneous emission control has been achieved in GaAs/AlGaAs quantum well lasers by the use of Bragg reflectors to define a micro-cavity perpendicular to the quantum wells. The room temperature emission is inhibited whilst below 130K there is an enhancement. These changes to the spontaneous recombination process directly effect the threshold current producing a 25% reduction at room temperature. Theoretical modeling of the lasers is in agreement with the experimental results and highlights the effect of the micro-cavity in altering the overlap of the electro-magnetic field with the quantum well dipole oscillators.

Perceptions of symptom distress in lung cancer patients: I. Congruence between patients and primary family caregivers.

Part I of this two-part paper employs a comparative design to compare primary family caregivers' assessments of lung cancer patients' symptom distress with patients' own perceptions of symptom distress in the home setting. Part II describes the results of the qualitative component of this research. A convenience sample of 37 patient-family caregiver dyads completed the McCorkle and Young Symptom Distress Scale (SDS). Family caregivers' global scores were moderately correlated with patients' global scores (r = 0.71; P < 0.001). No significant differences in ratings were found for ten of the 13 symptoms assessed. Therefore, when the patient is unable to provide a self-report of symptom distress, health-care professionals may seriously consider family caregivers' assessments of patients' symptom distress to be reasonable estimates for at least ten of the 13 symptoms on the SDS.

The role of palliative radiotherapy for brain metastases.

Brain metastases (BRM) are common complications of malignancy, frequently associated with disability and death. Clinical trials have addressed a few of the issues arising from treatment options for BRM. Phase III trials have shown superior survival for patients with solitary resectable BRM (SRBRM) when palliative radiation treatment (RT) to the brain is preceded by resection compared to brain RT alone, but no trial has explored resection plus brain RT compared to resection alone. One Phase III trial in patients with solitary unresected BRM comparing lower to higher doses of RT has shown a small survival advantage with higher-dose radiotherapy. All other trials, however, comparing different radiation doses and fractionation schedules have failed to indicate improved outcomes from treatment more intense than 2000 cGy in 5 fractions over 1 week (in any subset of patients with unresected BRM). A panel of radiation oncologists and medical oncologists discussed a literature review and results of Phase III trials of therapy for BRM. The panel was instructed to identify from these trials any evidence for the efficacy, indications, toxicity and fractionation of palliative RT for BRM. The panel concluded that unresected BRM is a possible indication for brain RT. The panel concluded that the benefits and toxicities of brain RT for unresected BRM are not characterized adequately to allow a stronger recommendation. The panel concluded that there is no evidence for superiority for any dose or schedule of brain RT for BRM more protracted or intense than 2000 cGy in 5 fractions over one week. The panel recommended further study in order to characterize the benefits and toxicities of brain RT for unresectable BRM. The panel considered the potential value of conducting a Phase III trial comparing palliative care and strategies that included brain RT to the same strategies excluding brain RT; the panel did not, however, reach consensus on the feasibility of such a trial.

The establishment of a microcomputer-based diagnosis and operations index in the Department of Surgery of a district general hospital.

The development and running of a microcomputer-based index of diagnoses and operations in the surgical department of a district general hospital is described. Many major problems have occurred, leading to malfunction or failure of the system, but it appears that these difficulties have now been resolved. In one year 4360 records have been fully processed with 4775 diagnoses, and 3968 operation codes have been permanently recorded. A further 560 patient records have been entered and await admission. The day-to-day running of the computer has been achieved by established secretarial staff without increase in number. The advantages and disadvantages of this system are outlined.