Angio-immunoblastic T-cell lymphoma in evolution: a case report.

Angio-immunoblastic T-cell lymphoma (AITL), a rare disease that constitutes 1% to 2% of non-Hodgkin's lymphomas, presents in middle-aged and elderly individuals. This report describes a patient with high-grade fever and lymphadenopathy. An extensive in-hospital work-up that included lymph node biopsy yielded negative results. The patient became asymptomatic for 4 wk, but then symptoms recurred with more pronounced lymphadenopathy. A computed tomography scan documented recurrent diffuse lymphadenopathy. Another lymph node biopsy revealed florid changes that strongly suggested AITL. Flow cytometry confirmed this diagnosis. The patient was treated with hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) and achieved complete remission after the first cycle. The patient developed sepsis during the second cycle and expired within 4 mo of diagnosis. The prognosis and natural course of AITL are poor when the classic chemotherapy protocol is administered. When infection has been ruled out, physicians should be wary of aggressive lymphomas that present with diffuse lymphadenopathy and fever.

A qualitative study of patient perspectives on colorectal cancer.

OBJECTIVES: The purpose of this study was to use qualitative methods to contribute to a complete patient perspective on the psychosocial impact of colorectal cancer. MATERIALS AND METHODS: A qualitative descriptive study was conducted in 20 patients attending a gastrointestinal follow-up clinic at the Toronto-Sunnybrook Regional Cancer Centre. The data documented included patient satisfaction and perceptions regarding to quality of care, information received, involvement in decision making, and long-term management of the illness. RESULTS: Overall, patients were satisfied with their treatment, including the quality and timeliness of the information they received, the quality of their healthcare, and the level of involvement in decision making. However, some patients were dissatisfied with information concerning long-term management of their illness. Patient care, including information and social support, was provided by cancer specialists, family physicians, family, and friends. Patients looked to cancer specialists as their primary source of information, but relied on family physicians to fill in gaps in understanding, to provide support, to manage overall care, and to act as a sounding board for ideas and treatment options. Social support was also provided by family and friends. All patients had a relatively positive outlook on their illness experience, although those with colostomies had some added difficulty. Despite the focus on positive change, many patients acknowledged difficulty coping with the side effects of treatment. CONCLUSIONS: These data indicate that patient information needs to be provided in the most common terms and the most straightforward language. Information also may need to be repeated and should include attention to long-term management of the illness. Health professionals should assume that patients may have difficulty in illness management and should encourage a discussion of patients' concerns.