The Mental Adjustment to Cancer Scale--a psychometric analysis and the concept of coping.

A psychometric analysis of the Mental Adjustment to Cancer (MAC) scale was performed in a heterogeneous Swedish sample of cancer patients (n = 868). The homogeneity of the original subscales proved to be satisfactory (alpha coefficients 0.61-0.81). The sample was randomly split into two subgroups, and a factor analysis was carried out in one of them using the LISREL 8.20 procedure. This yielded four factors called 'Hopeless', 'Positive', 'Anxious' and 'Avoidant' including 28 of the 40 original items (alpha coefficients 0.58-0.81). The novel factor structure was cross-validated and confirmed in the second subgroup. In contrast to the original scale (one item), 'Avoidance', was indexed by three items. The distinction between mental adjustment and coping is discussed. It is concluded that both versions of the MAC scale are measures of mental adjustment including emotional reactions as well as coping.

Phase II study of high dose toremifene in advanced breast cancer progressing during tamoxifene treatment.

Thirty-five (34 evaluable) consecutive postmenopausal women with estrogen receptor positive (greater than or equal to 10 fmol/mg) or unknown advanced breast cancer were treated with high dose toremifene in a phase II study. All patients had progressed during prior adjuvant or palliativ antiestrogen treatment. The dose of toremifene was 240 mg per day. No complete or partial responders were registered. Nine patients (26%) were considered to have stable disease (NC). The time to progression for these patients was 5-27+ months with a mean time of twelve months and median time of eight months. Two patients are still on treatment after twelve and 24 months respectively. There seems to be a relationship with receptor value; however, there are two few patients for a safe statistical analysis. The side effects were insignificant. The conclusion is that the efficiency of toremifene as second line hormonal treatment is restricted, although it may be one additional choice.

Weekly-dose doxorubicin (WDA) in advanced breast cancer.

Doxorubicin in a weekly fixed dose of 20 mg as i.v. bolus (WDA) was given to 48 patients with mostly pretreated progressing breast cancer. The response rate (CR + PR) was 9/48 (19%), and a further 16 (33%) of the patients achieved stable disease. Myelosuppression was mild and without clinical significance. Other side effects, particularly nausea, vomiting and hair loss were also relatively mild. Cardiac toxicity, however, was seen in six patients. Five of these six patients were previously treated with mitoxantrone or combination chemotherapy containing doxorubicin. Median response duration was 10+ months for responders and 11+ months in patients who had stable disease. It is concluded that weekly-dose doxorubicin has a favourable profile with a low frequency of side effects and that this treatment is an alternative to other cancer chemotherapy in breast cancer, especially when not only CR and PR but even stabilization of disease is considered of benefit to the patient.