Three sequential chemotherapy doublets for the treatment of newly diagnosed advanced müllerian malignancies: the modified triple doublet regimen.

OBJECTIVE: Previously, we reported the use of three sequential doublets (Triple Doublets) in the treatment of women with newly diagnosed and advanced stage müllerian malignancies. The surgically defined negative second look operation (SLO) rate to Triple Doublets was 38%. Modifications were made to this treatment regimen that were predicted to reduce toxicity and possibly increase efficacy. METHODS: Open label two-cohort study. Patients with a new diagnosis of Stages II-IV müllerian malignancy were eligible. After cytoreductive surgery, patients were treated with three sequential doublets including 3 cycles of carboplatin and gemcitabine, and 3 cycles of carboplatin and paclitaxel, and 3 cycles of doxorubicin and topotecan. After therapy, all women were clinically staged and evaluated at SLO if clinical staging was negative for residual disease. Primary endpoints were toxicity and negative SLO rate with rates of 60% and 40% defined a priori in optimally cytoreduced (cohort 1) and suboptimally cytoreduced or Stage IV (cohort 2), respectively. RESULTS: Eighty-five eligible patients were enrolled with a median age of 52 years. Forty-seven and thirty-eight women were in cohorts 1 and 2, respectively. 723 cycles of chemotherapy were delivered with no toxic deaths. Grades 3 and 4 toxicities included neutropenia in 75% of patients and thrombocytopenia in 65% of patients during at least one cycle of therapy. Fever and neutropenia were seen in 3.5% of patients. All Grades 3 and 4 non-hematologic toxicities were seen at a frequency of <10%. Seventy women underwent SLO with a negative SLO rate of 53% with an additional 9% having microscopically positive procedures. Negative SLO rate was 74% in cohort 1 and 36% in cohort 2. CONCLUSIONS: Treatment with the modified triple doublet regimen is tolerable with an encouraging pathologic CR rate.

Patterns of coping with cancer.

We identified five patterns of coping in a sample of 603 cancer patients: "seeking or using social support," "focusing on the positive," "distancing," "cognitive escape-avoidance," and "behavioral escape-avoidance." Relationships of these coping patterns to sociodemographic characteristics, medical factors, stress appraisals, psychotherapeutic experience, and emotional distress were tested using correlational and regression techniques. Type of cancer, time since diagnosis, and whether a person was currently in treatment had few or no relationships to coping. The specific cancer-related problem (e.g., pain, fear of future) was also not associated with how individuals coped. Perceptions of its stressfulness, however, were related to significantly more coping through social support and more of both forms of escape-avoidance. Coping through social support, focusing on the positive, and distancing was associated with less emotional distress, whereas using cognitive and behavioral escape-avoidance was associated with more emotional distress. Implications of the results for understanding coping processes and intervention with cancer patients are discussed.

Group therapies for rheumatoid arthritis. A controlled study of two approaches.

An important unanswered question about rheumatoid arthritis (RA) is how the patient's psychological or emotional state relates to disease activity and functional status. No controlled studies of psychotherapeutic interventions in RA have been reported. To test the hypothesis that a psychosocial intervention would lead to improvement in functional status or disease activity, 57 RA patients were randomly assigned to 1 of 3 groups, which received: 1) conventional group psychotherapy; 2) group assertion/relaxation training; or 3) no treatment (control group). Patient and physician questionnaires collected at baseline, immediately after the interventions, and 12 months after baseline provided outcome data on functional status, social and psychological adaptation, psychological symptoms, and disease activity. There were few outcome measures for which either treatment resulted in significantly higher scores than were seen in controls, though more improvement did occur among patients who received conventional group psychotherapy.

Nutritional therapy in advanced cancer. Setting realistic goals.

Cancer cachexia is a complex syndrome resulting from metabolic disturbances, mechanical obstacles, and behavioral alterations. Assessments of the potential benefits of nutritional support for an individual patient must reflect the cancer stage and prognosis, the patient's expressed wishes, and the impact of treatment on the family unit. Enteral or parenteral alimentation may preserve body mass during aggressive, potentially curative therapy of early cancer. Palliation may be provided for the more advanced patient whose major problem is not being able to eat. In terminal illness, feeding may no longer be therapeutic--it may briefly prolong life with considerable morbidity and expense. At each stage, decisions should be based on realistic assessments of possible gains and losses to the patient's life and overall well-being.

Vulnerability to schizophrenia. Prediction of adult schizophrenia using childhood information.

Forty years ago, Glueck and Glueck studied a group of Boston Inner city children to discover factors relating to delinquency. Detailed information was obtained on 1,000 boys aged 10 to 17 years, 500 "delinquents" and 500 "nondelinquent controls." In follow-up studies of this group, we have found that 24 have a diagnosis of adult schizophrenia. We matched these 24 with 48, who had a nonschizophrenic outcome, on the basis of IQ, ethnicity, age at interview, and original Glueck grouping (delinquent or control). The 72 childhood records were then examined on a blind basis by Independent raters looking for predetermined "indicators of vulnerability to schizophrenia." The total indicator scores were able to differentiate schizophrenic outcome from nonschizophrenic outcome at highly significant levels. A number of the individual indicators were likewise able to predict outcome. Prediction was improved when subjects with the lowest IQs (less than 85) were excluded from consideration.

A preliminary study of the personality of the nightmare sufferer: relationship to schizophrenia and creativity?

Through psychiatric interviews and psychological tests the authors studied 38 adults who reported experiencing at least one nightmare per week. Nearly all of the subjects had a lifelong history of frequent nightmares. Four of the subjects met DSM-III criteria for schizophrenia, 9 met the criteria for borderline personality, and 6 met the criteria for schizotypal personality. The others had no specific diagnosis, and none of the subjects had a diagnosis of typical neurosis. Many had mentally ill relatives. Most had artistic interests and talents. These nightmare sufferers may be seen as unusually vulnerable, with a potential for mental illness--especially schizophrenia--as well as a potential for artistic achievement.