Quality of life of long-term survivors of breast cancer and lymphoma treated with standard-dose chemotherapy or local therapy.

Purpose: This study compared the quality of life (QOL) of long-term survivors of breast cancer and lymphoma who had been treated with standard-dose systemic chemotherapy or local therapy only.

Patients And Methods: Long-term survivors (mean, 10.0 +/- 5.

Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma.

Purpose: The primary purpose of this study was to compare the neuropsychologic functioning of long-term survivors of breast cancer and lymphoma who had been treated with standard-dose systemic chemotherapy or local therapy only.

Patients And Methods: Long-term survivors (5 years postdiagnosis, not presently receiving cancer treatment, and disease-free) of breast cancer or lymphoma who had been treated with systemic chemotherapy (breast cancer: n = 35, age, 59.1 +/- 10.

Massage therapy for patients undergoing autologous bone marrow transplantation.

The purpose of the current study was to examine the impact of massage therapy on psychological, physical, and psychophysiological measures in patients undergoing autologous bone marrow transplantation (BMT). Patients scheduled to undergo BMT were randomly assigned to receive either (a) massage therapy, consisting of 20-minute sessions of shoulder, neck, head, and facial massage, or (b) standard treatment. Overall effects of massage therapy on anxiety, depression, and mood were assessed pretreatment, midtreatment, and prior to discharge using the State-Trait Anxiety Inventory, Beck Depression Inventory, and Brief Profile of Mood States, respectively.

Knowledge and attitudes of health-care providers toward cancer pain management: a comparison of physicians, nurses, and pharmacists in the state of New Hampshire.

The knowledge and attitudes toward cancer pain management of physicians, nurses, and pharmacists in the state of New Hampshire were examined through the use of a statewide survey. Many of the providers who completed the survey, and thus indicated that they treated patients with cancer pain on a regular basis, were not pain or oncology specialists. Most of these providers were quite well informed about the fundamentals of cancer pain management.

Psychologic and neuropsychologic functioning of patients with limited small-cell lung cancer treated with chemotherapy and radiation therapy with or without warfarin: a study by the Cancer and Leukemia Group B.

Purpose: The current study assessed the psychologic and neuropsychologic functioning of patients with small-cell lung cancer who were randomized in a large clinical trial to receive intensive doxorubicin, cyclophosphamide, etoposide (ACE)/cisplatin, cyclophosphamide, etoposide (PCE) chemotherapy and radiation therapy (RT) to the primary tumor and prophylactic whole-brain irradiation with (regimen I) or without (regimen II) warfarin.

Patients And Methods: Patients' emotional states and cognitive functioning were assessed using the Profile of Mood States (POMS) and Trail Making B Test (Trails B), respectively. Two hundred ninety-five patients completed the POMS and Trails B at pretreatment, 224 patients after the completion of the ACE course of chemotherapy (week 9), and 177 patients after the completion of the PCE chemotherapy and RT (week 17).

Quality of life in patients with limited small-cell carcinoma of the lung receiving chemotherapy with or without radiation therapy, for cancer and leukemia group B.

Quality of life was assessed in 57 patients with limited small-cell carcinoma of the lung utilizing psychological scales that measured mood, functional status, and cognitive impairment. These patients received chemotherapy with or without radiotherapy to the primary tumor. All patients received prophylactic cranial radiation.

Assessment of sleep in patients with lung cancer and breast cancer.

Purpose And Methods: We studied the sleep architecture and psychologic state of 32 patients with breast or lung cancer compared with 32 age- and sex-matched, normal-sleeping volunteers and 32 otherwise healthy insomniacs.

Results: Research findings indicate that lung cancer patients slept as poorly as did insomniacs, but underreported their sleep difficulties. Breast cancer patients slept similarly to normal-sleeping volunteers.

Psycho-oncology: psychological well-being as one component of quality of life.

This review deals with the issues of quality of life and psychological well-being in cancer patients, with particular reference to the role of psychiatry in the oncology setting. The prevalence of psychiatric diagnoses as a measure of psychological well-being, the prediction of psychological well-being, the interactions between physical and psychological factors, and the impact of psychosomatic intervention on quality of life in cancer patients, are discussed.

Mood and clinical status in patients with multiple myeloma.

Two hundred ninety patients with a recent diagnosis of multiple myeloma were studied psychologically at the time of initial treatment. Physician- and patient-completed psychosocial scales were correlated with physical variables used to measure tumor load and physical status. A logistic regression model was used to analyze objective response to treatment.

Management of sleep problems in cancer patients.

Sleep disturbances are common in cancer patients, but there are few specific data on their prevalence. Among other things, sleep problems may be a symptom of the cancer itself, part of a stress reaction to having cancer, a sequela to some other cancer symptom such as pain, or a side effect of cancer treatment. Insomnia is the more common sleep problem, although hypersomnia also occurs.

Socioeconomic status and cancer survival.

Survival data from eight Cancer and Leukemia Group B (CALGB) protocols were examined for patients with lung cancer (N = 961), multiple myeloma (N = 577), gastric cancer (N = 231), pancreatic cancer (N = 174), breast cancer (N = 87), and Hodgkin's disease (N = 58). After accounting for differences in survival rate attributable to type of cancer, initial performance status, age, and 14 other protocol-specific prognostic indicators, the additional predictive value of socioeconomic status (SES) was evaluated. Race (white v non-white) was not a significant predictor of survival time, but income and education were.

Physiologic and psychobehavioral research in oncology.

A major thrust in research in psychosocial oncology is the study of the interaction of psychologic and physiologic variables. This discussion reviews the current status and future directions of such research. Areas addressed include pain, nausea and vomiting with chemotherapy, sexuality, effects of cancer on psychologic and neuropsychologic function, impact of psychologic factors on cancer and its treatment, and psychoneuroimmunology.

Psychiatric treatment of the patient during cancer therapy.

In summary, the physician should view abnormal behavior in the cancer patient as an early and important diagnostic sign that an underlying medical problem (such as hypercalcemia) may be present. Depression and insomnia yield to intervention with antidepressants and hypnotics in cancer patients as readily as in noncancer patients. Finally, attentive listening is in and of itself anxiety-relieving and can go a long way toward reducing the emotional distress of people with cancer.

The relationship of psychological distress, extent of disease, and performance status in patients with lung cancer.

This study examined the association between two primary covariates, extent of disease (ED) and performance status rating (PSR), and the outcome of psychological distress in patients with small cell carcinoma of the lung. Patients were studied at the time of entry onto one of three Cancer and Leukemia Group B (CALGB) protocols: 7781 (N = 165) and 8083 (N = 139) for limited disease; and 7782 (N = 151) for extensive disease. Besides ED (limited versus extensive), a four-point rating of PSR was obtained.

Accelerated radiotherapy followed by chemotherapy for locally recurrent small-cell carcinoma of the lung. A phase II study of Cancer and Leukemia Group B.

Recurrent or persistent small-cell carcinoma of the lung (SCCL) after chemotherapy (CT) alone has shown a poor response to conventional salvage radiotherapy (RT). Accelerated RT is judged more effective than conventional RT for rapidly growing tumors such as SCCL. The objectives of this study were: to determine the tolerability of accelerated RT; and to test the ability of accelerated RT plus CT to achieve local tumor control (LTC) of SCCL recurrent after CT.

A brief POMS measure of distress for cancer patients.

The authors describe an 11-item short form of the Profile of Mood States' 58-item Total Mood Disturbance Score (TMDS). The Brief TMDS was derived from a sample of 619 adults with mixed cancer diagnoses, and replicated on a second sample of 295 lung cancer patients. Internal consistency of the Brief TMDS and the correlations of the Brief TMDS with the full TMDS were highly satisfactory for both samples.

Psychiatric aspects of cancer in the aged.

The greatest risk factor for cancer is ageing, yet little is known about the epidemiology and treatment of psychiatric disorders in the aged cancer population. This is particularly true for the group over 75 years of age. Four important areas of psychiatric treatment relevant to the aged cancer patient are: illness behaviour, cognitive disorders, depression and psychosocial adaptation.

Comparative psychological disturbance in patients with pancreatic and gastric cancer.

One hundred and seven patients with advanced pancreatic cancer and 111 patients with advanced gastric cancer, stratified for key medical and sociodemographic variables, were assessed with the Profile of Mood States before beginning combination chemotherapy in a national cancer clinical trials group. The pancreatic cancer patients had significantly higher self-ratings of depression, tension-anxiety, fatigue, confusion-bewilderment, and total mood disturbance; no difference was found in vigor or anger-hostility. These data support prior observations that patients with advanced pancreatic cancer experience significantly greater general psychological disturbance than patients with another type of advanced abdominal neoplasm.

Combined modality therapy with radiotherapy, chemotherapy, and immunotherapy in limited small-cell carcinoma of the lung: a Phase III cancer and Leukemia Group B Study.

Patients with limited-stage small-cell carcinoma of the lung (SCCL) were randomly assigned to a four-drug chemotherapy program consisting of methotrexate, doxorubicin, cyclophosphamide, and CCNU (MACC) or to a regimen consisting of cyclophosphamide, CCNU, and vincristine alternated with Adriamycin (Adria Laboratories, Columbus, Ohio) and vincristine (CCV/AV). All patients received 4,500 cGy, in a split course, to the primary tumor, mediastinum, and supraclavicular lymph node drainage areas and 3,000 cGy to the whole brain. After four cycles of chemotherapy, patients were randomly assigned to chemotherapy plus methanol extractable residue of BCG (MER-BCG) or no MER-BCG.

Insomnia in cancer patients.

This is a preliminary report of the sleep architecture in patients receiving radiation for unresectable lung cancer. One group of nine patients said they were good sleepers and a second group of five said they were poor sleepers. All fourteen patients slept for three consecutive nights in a sleep laboratory.

Psychiatric problems in breast cancer.

The author discusses the prevalence of psychiatric problems in cancer, and highlights five emotional problems common to all cancer patients: the emotionally charged nature of the word cancer, the patient's perceived lack of control, the uncertainty about outcome, the discordant treatment mode, and the debilitating nature of cancer treatments. The author then divides the problems faced by breast cancer patients into three categories needing clinical intervention: (1) the psychosocial, (2) the somatic, and (3) the psychiatric. Diagnosis and treatment of the two psychiatric problems of depression and delirium is emphasized.

Psychiatric complications of multiple myeloma.

Multiple myeloma is an uncommon cancer, but of eight patients with multiple myeloma admitted to a general hospital over 5 months, five had psychiatric illness, and four of the five had delirium. Consulting psychiatrists should be aware of the common occurrence of impaired cognition in patients with multiple myeloma.

Chemotherapy and cognitive defects in cancer patients.

The cognitive functions are defined and discussed. Factors that place cancer patients at high risk for disorders of cognition are presented along with the problem of semantic confusion in this area. The cognitive impairment found in cancer patients receiving chemotherapy is reviewed, as is the importance of the mental status examination and the treatment of delirium in cancer patients.