Adjuvant radiation therapy for breast cancer in patients with schizophrenia.

BACKGROUND: Schizophrenia affects approximately 1% of subjects in all populations studied thus far. We sought to evaluate how patients with schizophrenia who are later diagnosed with breast cancer fare when adjuvant radiation therapy (ART) is clinically indicated. METHODS: We searched patient treatment file, the national inpatient computer database of the Department of Veterans Affairs, to identify patients with schizophrenia who subsequently developed breast cancer. RESULTS: Forty patients had schizophrenia, who later developed breast cancer and were candidates for ART, according to well-established guidelines. Of the 40 patients who were considered candidates for ART, we found data about the decision to offer ART in 35; only 22 (63%) were offered ART and 5 of those 22 (23%) refused it. CONCLUSIONS: Patients with schizophrenia and breast cancer often do not understand the nature of their illnesses well. They often do not comply with recommended standard therapies such as ART. Treatment strategies that rely on ART are likely to be met with noncompliance. Breast-preserving treatment plans may be impractical. Initial radical surgery without ART may be preferable.

Breast cancer in patients with schizophrenia.

BACKGROUND: Schizophrenia has a powerful impact on the outcomes of treatment for physical disorders. This study sought to estimate how the presence of schizophrenia disrupts the course of diagnosis and initial treatment of breast cancer. METHODS: We searched the Patient Treatment File, a comprehensive computer-based system for inpatient data in the Department of Veterans Affairs (DVA) medical system, to identify patients with codes for schizophrenia or schizoaffective disorder who later developed breast cancer. These data were augmented with chart-based clinical data. RESULTS: There were 56 evaluable patients from 34 DVA facilities; 37 (66%) were female. Delay in diagnosis was common. The mean size of the primary tumor was 4 cm in those for whom these data were recorded. Delay in diagnosis was common and many never received the indicated surgery. Distant metastases were present on diagnosis in 12 (21%) and developed after diagnosis in 14 (25%) others, including 7 who inappropriately delayed or refused indicated surgery and 4 who inappropriately delayed or refused indicated neoadjuvant chemotherapy. Twelve verbally abused or physically attacked caregivers. CONCLUSIONS: Patients with schizophrenia who later develop breast cancer often deny they have cancer. They often have high-stage disease at diagnosis and often delay or refuse therapy. Breast-conserving multimodality therapy is often not feasible.

Adjuvant chemotherapy for breast cancer in patients with schizophrenia.

The outcomes of treatment of physical illnesses are strongly affected by the presence of schizophrenia. We aimed to quantify the clinical course of schizophrenic breast cancer patients who were eligible for adjuvant chemotherapy to determine whether patients with this mental illness receive appropriate treatment for this physical illness. We searched the national Department of Veterans Affairs (DVA) computer database using computer codes for schizophrenia to identify patients who later developed breast cancer and were treated in DVA medical centers. Computer-based data were supplemented with chart-based clinical indicators. There were 55 subjects who appeared to be appropriate candidates for adjuvant systemic therapy. A number of these candidates were not offered postoperative endocrine or cytotoxic chemotherapy, while others refused treatment or were non-compliant. Behaviors typical of schizophrenic subjects, including hostility to caregivers, often disrupt their care. Schizophrenic patients often have advanced-stage cancer at diagnosis, often delay diagnosis and are frequently hostile towards healthcare workers. Many of these patients refuse therapy and/or are non-compliant.

Geometry of the semicircular canals of the chinchilla (Chinchilla laniger).

The orientations of the semicircular canals determines the response of the canals to head rotations and, in turn, the brain's ability to interpret those motions. The geometry of chinchillas' semicircular canals has never been reported. Volumetric representations of three chinchilla skulls were generated using a microCT scanner. The centroids of each semicircular canal lumen were identified as they passed through the image slices and were regressed to a plane. Unit vectors normal to the plane representing canal orientations were used to calculate angles between canal pairs. Pitch and roll maneuvers required to bring any canal into the horizontal plane for physiologic investigation were calculated. The semicircular canals of the chinchilla were found to be relatively planar. The horizontal canal was found to be oriented 55.0 degrees anteriorly upward. Pairs of ipsilateral chinchilla canals were not orthogonal and contralateral synergistic pairs were not parallel. Despite this arrangement, the canal plane unit normal vectors were organized to respond with approximately equal overall sensitivity to rotations in any direction. The non-orthogonal chinchilla labyrinth may provide an opportunity to determine whether the frame of reference used by the central vestibular and oculomotor system is based on directions of afferent maximum sensitivity or prime directions.