Psychosocial characteristics of individuals with non-stage IV melanoma.

PURPOSE: Melanoma is the fastest growing solid tumor among men and women and accounts for 79% of skin cancer-related deaths. Research has identified that distress is frequently associated with a diagnosis of cancer and may slow treatment-seeking and recovery, increasing morbidity and even mortality through faster disease course. Given that the 5-year survival rates for individuals with melanoma are determined primarily by the depth and extent of spread, distress that interferes with seeking treatment has the potential to be life-threatening. PATIENTS AND METHODS: The current study was designed to identify levels of distress present in individuals seeking treatment at a large, Midwestern, multidisciplinary melanoma clinic. It also focused on determining the quality of life, level of anxiety, and coping strategies used by individuals with melanoma before treatment. Given that the course of treatment and outcome for patients with stage IV disease is vastly different from that of patients with stages I to III disease, they were excluded from the study. RESULTS: Results indicated that most individuals who are presenting to a melanoma clinic do not report a clinically significant level of distress. However, there is some variability in this, with 29% of patients reporting moderate to high levels of distress. Moreover, analyses suggest that distressed individuals are more likely to use maladaptive coping strategies, such as escape-avoidance coping, and to have poorer quality of life. CONCLUSION: Although most individuals do not present with significant levels of distress, a significant minority are distressed and rely more heavily on coping strategies that do not benefit them. Such individuals would likely benefit most from psychological intervention.

A randomized comparison of tamoxifen with surgical oophorectomy in premenopausal patients with advanced breast cancer.

We randomized 122 premenopausal women to receive tamoxifen or to undergo a surgical oophorectomy. Of 54 evaluable women treated with tamoxifen, 24% had an objective response, as compared with 21% of 53 women having an oophorectomy. The median duration of response for tamoxifen (20 months) was longer than that for surgical oophorectomy (7 months), but this did not achieve statistical significance (P = .056). Overall median survival was 15 months for 58 patients receiving tamoxifen and 25 months for 53 patients undergoing oophorectomy (P = .18). Toxicity was greater in those undergoing oophorectomy, though both treatments were well tolerated. In those premenopausal women for whom hormonal therapy is indicated, tamoxifen is a suitable alternative to surgical oophorectomy.

The predictive value of T-lymphocyte counts in breast cancer patients treated by endocrine manipulation.

Endocrine manipulation has a valuable role in the management of advanced breast cancer. However, it is only effective in some cases and at least 12 weeks is required before efficacy can be ascertained. In an attempt to achieve earlier assessment of response, changes in lymphocyte counts have been studied in patients receiving endocrine therapy. Absolute lymphocytes were not significantly changed by 6 weeks in any patients but there was a significant increase (P less than 0.05) in absolute T counts by 6 weeks in patients who achieved partial remission when compared with those whose disease continued to progress. Percentage T counts increased significantly from pretreatment values (P less than 0.002) in patients in whom disease progression was stopped by endocrine manipulation and this rise was maintained during clinical benefit. Fall in percentage T counts to pretreatment values predated objective evidence of recurrence by as much as 2 months. There was no increase in percentage T counts in patients in whom disease progression continued despite treatment, indicating that the rise in percentage T counts is a secondary phenomenon to tumour response. T-lymphocyte counts may permit earlier evaluation of the patient during treatment, allowing earlier selection of alternative treatment modalities.

Adrenalectomy for advanced breast cancer: a reappraisal.

The introduction of strict criteria of treatment response for advanced breast cancer facilitates comparison of treatment modalities. Recent studies of pharmacological measures are usually recorded according to UICC criteria but this has not been the case with regard to adrenalectomy. An analysis of 41 patients undergoing adrenalectomy for advanced breast cancer was undertaken to assess response according to UICC criteria. There were no complete objective responses but 12.2% had Partial Remission and 12.2% Static Disease, the remainder showing disease progression. These figures are lower than in most reported series which have used less clearly defined criteria of response. The Partial Response and No Change groups were similar in terms of symptomatic improvement and survival but superior to the treatment failure group. Adrenalectomy was associated with significant morbidity (46.7%) and operative mortality (6.7%). Only 1 patient of 11 previously treated with tamoxifen had a subsequent response to adrenalectomy. The low response rate when assessed on UICC criteria and high morbidity when compared with alternative treatment suggest that adrenalectomy will be less widely used in the future.

The correlation between gross appearance of the appendix at appendicectomy and histological examination.

A retrospective review of patients with a preoperative diagnosis of appendicitis or thought to have appendicitis at laparotomy showed a discrepancy between the surgeons' opinion of the macroscopic appearance of the appendix and the pathologist's opinion (which was assumed to be the most accurate) in 14.5% of cases. All cases were false positive diagnoses. Using the surgeons' descriptions of the appendix at appendicectomy, a sub-group can be identified with an 80% error rate. In this group, the terms used to describe the appendix were 'mild, early, slight or moderate inflammation'. This error rate is often ignored in studies on appendicitis. We recommend that only the terms 'normal' 'inflamed' or 'gangrenous or perforated' should be used to describe the appendix. If there is any doubt, it should be classed as normal. These recommendations will improve diagnostic accuracy at operation.

The effect of tamoxifen on plasma growth hormone and prolactin in postmenopausal women with advanced breast cancer.

The effect of tamoxifen on serum levels of basal prolactin and basal and stimulated growth hormone was assessed in 10 women with advanced breast cancer prior to and after 1 and 8 weeks of treatment. Tamoxifen had no effect on basal levels of either hormone or on insulin-stimulated growth hormone. Two of 4 patients undergoing arginine provocation testing had a partial response to tamoxifen and both exhibited marked diminution of growth hormone stimulation which was not seen in the non-responders.

Cancer-specific worry interference in women attending a breast and ovarian cancer risk evaluation program: impact on emotional distress and health functioning.

Intrusive thoughts about cancer, often identified as 'cancer-specific worries' or 'cancer-specific distress', have been postulated to be associated with dysfunction in women at increased risk of developing breast or ovarian cancer. The current study discusses the development and validation of a measure designed to assess women's perceptions of the interference such worries create in their daily functioning. Analyses revealed that approximately two-thirds of a high-risk breast cancer clinic sample perceived worries about breast cancer as interfering with their functioning across a variety of life domains. Multiple regression analyses indicated that worry interference scores predicted Profile of Mood States (POMS) Anxiety and Confusion, and Short Form-36 (SF-36) Role-Emotional and Mental Health scores after the effects of other variables such as frequency of worry about breast cancer, and having a family history of cancer had been considered. Women who perceived their worries as interfering with their functioning reported higher levels of anxiety and confusion, and diminished mental health and role functioning. The results add to the expanding area of anxiety/distress in at-risk populations by providing (1) a direct measure of the perceived interference associated with breast cancer-specific thoughts, (2) a validation of the measure via its associations with standard measures of emotional distress and health functioning, and (3) evidence of the measure's incremental predictive value in explaining distress and quality of life, after consideration of background variables, such as having a family history of cancer.

E-rosette inhibition and tumour recurrence in early breast cancer.

The relationship of serum blocking activity and susceptibility to tumour recurrence using E-rosette inhibition by normal allogenic lymphocytes was evaluated before and after operation in 20 patients with early breast cancer. Preoperative serum inhibition levels did not predict recurrent tumour. The mean postoperative inhibition in patient with recurrence was significantly greater than in those without recurrence. Postoperative testing only in a group of 124 patients showed that the development of local tumour recurrence was preceded by significantly greater inhibition of E-rosetting than occurred in patients without recurrence. The application of a threshold level of serum inhibition of 15 per cent distinguishes patients who are unlikely to develop tumour recurrence over a 4-year follow-up period. Serial measurements of serum inhibition at 6-monthly intervals over 2 years did not add to the predictive value of this test.