Hope and hoping in the talk of dying cancer patients.

Hope is the subject of increasing research and discussion within the healthcare literature. However, although deemed of vital import to patient welfare, there is little examination of how hope features within patients' speech. This qualitative study presents the discursive properties of hope as it emerged unprompted during semi-structured interviews with 28 patients in the final phase of terminal cancer recruited from the oncology clinic of the Royal Adelaide Hospital, Australia.

The multikinase inhibitor midostaurin (PKC412A) lacks activity in metastatic melanoma: a phase IIA clinical and biologic study.

Midostaurin (PKC412A), N-benzoyl-staurosporine, potently inhibits protein kinase C alpha (PKCalpha), VEGFR2, KIT, PDGFR and FLT3 tyrosine kinases. In mice, midostaurin slows growth and delays lung metastasis of melanoma cell lines. We aimed to test midostaurin's safety, efficacy and biologic activity in a Phase IIA clinical trial in patients with metastatic melanoma.

Scheduling cisplatin and radiotherapy in the treatment of squamous cell carcinomas of the head and neck: a modelling approach.

The aim of the present work was to implement the kinetics of cisplatin into a previously developed tumour growth model and to simulate the combined cisplatin-radiotherapy treatment with the emphasis on time sequencing and scheduling of drug and radiation. An investigation into whether the effect of cisplatin-radiation is determined by independent cell kill or by cisplatin-produced radiosensitization was also undertaken. It was shown that cisplatin administered before radiation conferred similar tumour control to the post-radiation sequencing of the drug.

End-of-life decision making is more than rational.

Most medical models of end-of-life decision making by patients assume a rational autonomous adult obtaining and deliberating over information to arrive at some conclusion. If the patient is deemed incapable of this, family members are often nominated as substitutes, with assumptions that the family are united and rational. These are problematic assumptions.

Phase II study of vinflunine in patients with metastatic renal cell carcinoma.

Purpose: An open-label, multicentre, non-comparative phase II trial to determine the response rate of intravenous vinflunine as first line chemotherapy in patients with metastatic renal cell carcinoma (RCC).

Patients And Methods: Patients with metastatic RCC were treated with vinflunine 350 mg/m2 (n = 11) or 320 mg/m2 (n = 22) administered intravenously every 21 days.

Results: Out of 33 patients included in this study, one partial response was observed in the group treated at 350 mg/m2 and none in the group receiving 320 mg/m2 resulting in a response rate in this population of 9.

Combined-modality therapy for primary central nervous system lymphoma: long-term data from a Phase II multicenter study (Trans-Tasman Radiation Oncology Group).

Purpose: To assess, in a multicenter setting, the long-term outcomes of a brief course of high-dose methotrexate followed by radiotherapy for patients with primary central nervous system lymphoma (PCNSL).

Methods And Materials: Forty-six patients were entered in a Phase II protocol consisting of methotrexate (1 g/m(2) on Days 1 and 8), followed by whole-brain irradiation (45-50.4 Gy).

Update on anti-emetics for chemotherapy-induced emesis.

The need to control chemotherapy-induced emesis has stimulated research into anti-emetics. Emesis is not only unpleasant, but negatively impacts on global quality of life. The development of two new classes of drugs has been responsible for the major advances in anti-emesis.

Evidence-based recommendations for the use of antiemetics in radiotherapy.

Background And Purpose: To report recommendations given in the Multinational Association of Supportive Care in Cancer (MASCC) International Consensus Conference regarding the use of antiemetics in radiotherapy.

Patients And Methods: A steering committee under MASCC auspice chose panel participants for the guidelines development process on prevention of chemotherapy- and radiotherapy-induced emesis (RIE). Pertinent information from published literature as of March 2004 was reviewed for the guideline process.

Treatment and survival from colorectal cancer: the experience of patients at South Australian teaching hospitals between 1980 and 2002.

Aims: To evaluate trends in colorectal cancer survival and treatment at South Australian teaching hospitals and degree of adherence to treatment guidelines which recommend adjuvant chemotherapy for Dukes' C colon cancers and combined chemotherapy and radiotherapy for high-risk rectal cancers.

Materials And Methods: Trends in disease specific survival and primary treatment were analysed, and comparisons drawn between diagnostic epochs, using cancer registry data from South Australian teaching hospitals. Statistical methods included univariate and multivariable disease specific survival analyses.

Phase II study of prolonged ambulatory infusion carboplatin and oral etoposide for patients progressing through hormonal therapy for prostate cancer.

Aim: To develop a well-tolerated outpatient chemotherapy regimen for hormone-insensitive prostate cancer.

Method: Forty patients received carboplatin 20 mg/m2 by continuous ambulatory infusion with oral etoposide 50 mg/day for 21 days repeated every 6 weeks.

Results: Four patients had a partial response and 16 patients had stable disease.

A phase I study of prolonged ambulatory infusion of Ifosfamide with oral mesna.

Background: Oral mesna allows investigation of ifosfamide as a prolonged ambulatory infusion for dose-intense out-patient use.

Methods: Cohorts of 3 patients received escalating doses of ifosfamide from 200 to 1,000 mg/m2/day as continuous ambulatory infusion with oral mesna at 30% of the ifosfamide dose every 6 h commencing 2 h prior to ifosfamide infusion as uroprotection on a 14-day schedule with cycles repeated every 28 days.

Results: Fifteen patients received a median of three cycles.

The Australian Cancer Anaemia Survey: a snapshot of anaemia in adult patients with cancer.

Objective: To evaluate the frequency and management of anaemia in Australian adults with solid and haematological malignancies.

Design: 6-month observational, prospective, multicentre study.

Participants: 694 patients recruited from outpatient oncology clinics in 24 hospitals in five Australian states between 9 April 2001 and 31 July 2001.

Achieving equal standards in medical student education: is a national exit examination the answer?

Although it is commonly assumed that the quality of medical school education in Australia is uniformly high, there is no national process for assessing its outcomes. There is substantial variability in the content of medical school curricula, and the process of curriculum change is becoming more challenging because of intense competition for time and space in the course. A national exit examination could provide a uniform standard of assessment for all medical school graduates in Australia, as well as foreign graduates applying to work in Australia.

Tumour resistance to cisplatin: a modelling approach.

Although chemotherapy has revolutionized the treatment of haematological tumours, in many common solid tumours the success has been limited. Some of the reasons for the limitations are: the timing of drug delivery, resistance to the drug, repopulation between cycles of chemotherapy and the lack of complete understanding of the pharmacokinetics and pharmacodynamics of a specific agent. Cisplatin is among the most effective cytotoxic agents used in head and neck cancer treatments.

Anticipatory nausea and vomiting.

Anticipatory nausea and vomiting (ANV) is not only a learned response but can occur without prior exposure to chemotherapy depending on patient emotional distress and expectations. The best method to avoid development or reinforcement of ANV is to avoid both vomiting and nausea from the first exposure to chemotherapy. If ANV develops, benzodiazepines have been documented to help in adult patients, and several psychological techniques are also of help, including systematic desensitization.

Radiotherapy-induced nausea and vomiting (RINV): antiemetic guidelines.

As many as 40-80% of patients undergoing radiotherapy (RT) will experience nausea and/or vomiting, depending on the site of irradiation. Fractionated RT may involve up to 40 fractions over a 6-8 weeks period, and prolonged symptoms of nausea and vomiting could affect quality of life. Furthermore, uncontrolled nausea and vomiting may result in patients delaying or refusing further radiotherapy.

Motivational interviewing as a smoking cessation intervention for patients with cancer: randomized controlled trial.

Background: Smoking cessation of patients with cancer can improve treatment efficacy and survival.

Objective: To determine whether a motivational interviewing intervention increased successful smoking cessation attempts of patients with cancer attending a South Australian public hospital, as compared with usual care.

Methods: A randomized controlled trial was used to study 137 patients with mixed cancer sites, including 74 intervention patients and 63 control patients.

Consensus proposals for the prevention of acute and delayed vomiting and nausea following high-emetic-risk chemotherapy.

This paper uses an evidence-based approach whenever possible to formulate recommendations, emphasizing the results of controlled trials concerning the best use of antiemetic agents. We address issues of dose, schedule, and route of administration of five selective 5-HT(3) antagonists. We conclude that for each of these five drugs, there is a plateau in therapeutic efficacy above which further dose escalation does not improve outcome.

Antiemetics in children receiving chemotherapy.

Only a few studies have been carried out in children on the prevention of chemotherapy-induced acute emesis. 5-HT3 antagonists have been shown to be more efficacious and less toxic than metoclopramide, phenothiazines and cannabinoids. The optimal dose and scheduling of the 5-HT3 antagonists has not been identified.

Modelling of post-irradiation accelerated repopulation in squamous cell carcinomas.

The mechanisms postulated to be responsible for the accelerated repopulation of squamous cell carcinomas during radiotherapy are the loss of asymmetry of stem cell division, acceleration of stem cell division, abortive division and/or recruitment of the non-cycling cell with proliferative capacity. Although accelerated repopulation was observed with recruitment and accelerated cell cycles, it was not sufficient to cause an observable change to the survival curve. However, modelling the loss of asymmetry in stem cell division has reshaped the curve with a 'growth' shoulder.

Relationships between patients' pre-treatment expectations of toxicities and post chemotherapy experiences.

A lack of adequate pharmacological explanations for side effect variation following chemotherapy suggests psychological factors may contribute to toxicity experience. This research aimed to determine if patients' expectations were associated with perceived toxicities for a wider range of chemotherapy toxicities than previously researched, including subjective and objective side effects. Eighty-seven chemotherapy-naive patients rated their expectations of 20 common side-effects before treatment, and then rated their experiences following their first chemotherapy dose.

Aprepitant in antiemetic combinations to prevent chemotherapy-induced nausea and vomiting.

Aprepitant is an oral neurokinin-1 receptor antagonist which acts centrally to block chemotherapy-induced emesis. Its main pathway of elimination is by the cytochrome p450 isozyme CYP3A4, which is the basis for drug interactions with dexamethasone and oral contraceptives. Aprepitant is well tolerated, and phase II trials in high-dose cisplatin-induced emesis showed that it is most effective when 125 mg orally is added to a 5-hydroxytryptamine-3 receptor antagonist and dexamethasone for acute emesis and then an 80 mg oral dose continued with dexamethasone on days 2 and 3 to prevent delayed emesis.

Optimism and survival in lung carcinoma patients.

Background: It is popular belief that the psychologic response to a diagnosis of cancer influences survival in patients with cancer; however, research has produced contradictory results. In this prospective study, the authors investigated the relation between pretreatment levels of optimism and survival in patients with nonsmall cell lung carcinoma (NSCLC).

Methods: Two hundred four patients who were participating in a randomized trial that compared accelerated and conventional radiotherapy with and without carboplatin chemotherapy were asked to complete two questionnaires assessing optimism.