A phase II Hoosier Oncology Group study of vinorelbine and estramustine phosphate in hormone-refractory prostate cancer.

BACKGROUND: The purpose was to evaluate the combined anti-microtubular regimen of vinorelbine and estramustine phosphate (EMP) in hormone refractory prostate cancer. PATIENTS AND METHODS: Weekly vinorelbine 20 mg/m2 (or 15 mg/m2 if a history of prior pelvic radiotherapy) was combined with EMP at 280 mg orally tds for 3 days (the day before, the day of and the day after vinorelbine infusion). After 8 weeks of therapy the combination was given every other week. RESULTS: From February 1998 to February 1999, 23 men were enrolled with a median age of 69 years (range 50-83 years). The median prostate-specific antigen (PSA) at entry was 160 ng/ml (range 0-802 ng/ml). A median of 13 weeks of therapy was administered and the median follow-up was 14.8 months. Eleven patients (48%) had lower extremity edema requiring diuretic therapy, two (9%) had grade 2 granulocytopenia and four patients [17%; 95% confidence interval (CI) 5% to 39%] had a thromboembolic episode. There was no treatment-related mortality. Fifteen of 21 patients (71%; 95% CI 49% to 89%) had at least a 50% decrease in the PSA for at least 2 months with a median time to serologic progression of 3.5 months (range 0.75-10.5 months). One of eight patients (12.5%; 95% CI 0% to 53%) with measurable disease had a confirmed partial response. The estimated median survival was 15.1 months and the actual one year overall survival was 71% (95% CI 51% to 88%). CONCLUSIONS: Weekly vinorelbine with short course oral EMP is an active regimen as evaluated by rate of PSA response, time to progression and median survival. However, the toxicities of EMP, even when given as a short course, are still problematic.

An attempt to employ the Zung Self-Rating Depression Scale as a "lab test" to trigger follow-up in ambulatory oncology clinics: criterion validity and detection.

We examined issues of criterion validity and detection of depression employing the Zung Self-Rating Depression Scale (ZSDS) as a "lab test" to trigger follow-up interviews of ambulatory oncology patients by oncology staff and the possibility of subsequent algorithm-based antidepressant treatment. Sixty oncology patients were screened with the ZSDS and then interviewed using the Mini-International Neuropsychiatric Interview (MINI). We examined the sensitivity and specificity of various cutoffs on the ZSDS and a briefer version, the Brief Zung Self-Rating Depression Scale (BZSDS) as they predicted results of the MINI, which was used as the criterion. Mean age of patients was 58.3 years (SD = 11.9). Thirty-two were female (53.3%) and 28 were male (46.7%). The correlation of the ZSDS (r = -0.66, P <.0001) and BZSDS (r = -0.57, P <.0001) with the MINI overall suggested acceptable levels of criterion validity. Additionally, we examined various cutoff scores on the ZSDS and BZSDS to explore the false negative and false positive rates that are associated with each. For example, using the mild cutoff on the Zung (score > 48) to determine depression or adjustment disorder, 14 false negatives and 2 false positives were found. When the more stringent moderate cutoff (score > 56) was used, 25 false negatives and 0 false positives were found. Oncology staff can utilize such data to make decisions about where to set cut-offs that trigger follow-up based on the amount of error that is allowable in their attempts to identify depressive symptoms in their patients. We discuss that such decisions might be based on many factors including the resources available in a particular site for follow-up or the comfort of particular oncologists and nurses managing and prescribing psychotropic medications, or in providing supportive counseling.

Oncology staff recognition of depressive symptoms on videotaped interviews of depressed cancer patients: implications for designing a training program.

We examined oncologists' and nurses' ability to recognize depressive symptoms in two cancer patients who were interviewed on videotape. The study was conducted in a rural community, hospital-based outreach network. Staff were given a one-hour in-service on the use of the Mini International Neuropsychiatric Interview (MINI)-a brief diagnostic interview-to provide a differential diagnosis (no psychiatric diagnosis, major depressive disorder, or adjustment disorder with depressed mood). Next, the staff viewed a videotape of an investigator (S.P.) utilizing the MINI to interview two depressed breast cancer patients. Staff subsequently rated depressive symptoms on the MINI and made a diagnosis. Findings indicated a high concordance among staff regarding symptom ratings on a straightforward example of major depressive disorder. Concordance on diagnosis, severity level, and specific symptoms declined slightly on a more difficult case involving primarily cognitive symptoms and a diagnosis of adjustment disorder. Following brief didactic training on depressive disorders, oncologists and nurses were able to identify depressive symptoms in cancer patients on videotape. Learning to use a semistructured interview can increase oncologists' awareness of depressive symptoms and may be a good training model.

Back pain: the primrose path--a case report.

In the evaluation of patients older than 50 with severe back pain and chronic simple anemia, the diagnosis of multiple myeloma must be considered. Due to the age group affected, degenerative changes on spinal films may be misdiagnosed as osteoporosis, and anemia may be attributed to iron deficiency. These errors can be avoided in more than 99% of the cases of multiple myeloma by ordering a serum protein electrophoresis (SPE). Abnormal SPE patterns include monoclonal gammopathy and hypogammaglobulinemia. In the detection of multiple myeloma, magnetic resonance imaging has been found superior to plain radiograph, computed tomography and bone scan.

Comparison of electron paramagnetic resonance and atomic absorption serum copper measurements in human normal control and cancer patients.

Serum copper levels of 132 controls and 122 cancer patients (including Hodgkin's disease, lung cancer, breast cancer, leukemia, untreated patients, and patients in progression) were measured using both atomic absorption (AA) and electron paramagnetic resonance (EPR) techniques. The data pairs were compared using linear regression analysis, EPR versus AA, and all the data (controls and cancers) fit a single regression line with a squared correlation coefficient (r2) of 0.80. Comparison of the subpopulations revealed possible small differences, but none great enough to be of diagnostic value for individual patients. Thus, in a number of cases of practical interest, EPR-determined serum copper levels were essentially redundant with respect to AA measurements. Previous reports recommending the use and possible superiority of EPR for serum copper determinations appear not to have compared the EPR and AA techniques adequately or correctly. EPR serum copper measurements may yet provide unique data in these diseases, but a more detailed analysis of the spectral parameters will be required. EPR-determined serum transferrin levels are also reported.

Clinical Oncology Program: a community cancer control model.

The majority of cancer patients are diagnosed and treated in their local communities, making it imperative to upgrade cancer management at the community level. The Clinical Oncology Program has demonstrated that sophisticated cancer control programs are possible in a community setting. Moreover, if "quality of survival" data collection is included in such programs, valuable information emerges that can further improve cancer management in the community.

Health effects: pregnancy use of diethylstilbestrol.

PIP: The use of DES (diethylstilbestrol) to prevent pregnancy complications and miscarriages has shown effects in women who took DES and their offspring. A University of Chicago follow-up study indicated that women who had used DES had more breast and gynecological cancers than a control group, although the results were statistically insignificant. DES daughters have a higher occurrence of a rare malignant vaginal cancer, clear cell adenocarcinoma, and DES-exposed males showed a history of cryptorchidism, hypoplastic testes, epididymal cysts, and low sperm counts. A DES Task Force formed by the Office of the Assistant Secretary for Health in 1978 recommends that all persons exposed to DES be informed of health risks and that DES daughters be carefully monitored by using Pap smears, iodine staining, and colposcopy when necessary. In addition, the Task Force recommends that DES women not use estrogens, that postmenopausal replacement estrogens be prescribed prudently, that DES not be given to suppress lactation, and that women given DES for postcoital contraception be informed of the possible health risks.^ieng