Differences between black and white women with breast cancer in time from symptom recognition to medical consultation. Black/White Cancer Survival Study Group.

BACKGROUND: Studies in the United States have reported that Black women have higher fatality rates than White women following a diagnosis of breast cancer and are more likely to be diagnosed with late-stage cancers. PURPOSE: To evaluate reasons for these racial differences, we explored the difference between Black and White women in the length of time from symptom recognition to initial medical consultation. We also evaluated the extent to which other factors related to the length of this interval might contribute to any observed racial difference. METHODS: As part of a collaborative study of differences in the survival rates of Black patients and White patients with cancer, we interviewed a sample of 410 Black women and 325 White women from Atlanta, New Orleans, and San Francisco/Oakland who were newly diagnosed in 1985 or 1986 with invasive breast cancer. Retrospective data were collected on symptoms, dates of symptom recognition and initial medical consultation, and several other factors which may affect the interval between symptom recognition and medical consultation. Data were analyzed as if from a follow-up study, using product limit procedures and proportional hazards regression. RESULTS: At diagnosis, Black women with breast cancer were two times more likely to have stage IV breast cancer and one and one-half times more likely to have stage III breast cancer than White women with breast cancer and were only approximately one-half as likely to have stage I breast cancer. Similarly, Black women were almost twice as likely as White women to have tumors that were larger than 5 cm or tumors that had extensions to the chest wall or skin at presentation. However, the average rate at which Black women with breast cancer obtained an initial medical consultation lagged behind that for White women by only a slight but statistically significant difference (15%). The median time between symptom recognition and medical consultation was slightly longer for Black women (16 days) than for White women (14 days) (P = .06). Adjustment for other characteristics predictive of the length of this interval had little effect on racial differences. The racial differences tended to vary somewhat by age and metropolitan area, suggesting that the results may not apply equally to all demographic subgroups and regions in the United States. CONCLUSION: This small difference in the time from symptom recognition to medical consultation is unlikely to account for the large racial differences in survival rates and in stage of disease at the time of diagnosis.

A medical chart review for information about sexual functioning in cervical carcinoma.

Fifty medical charts from two departments of radiotherapy, one in France and the other in the United States, were reviewed to determine their utility in contributing to information about sexual functioning after treatment for cervical cancer. For both settings, useful information about the disease, its treatment and the post-treatment complications was readily available. Significant differences were found between the settings in the documentation of data about sexual function, vaginal dilator use and dilator compliance. The utility of medical records for the purpose of gathering information about sexual functioning after radiotherapy for cervical cancer was found to be significantly higher in one of the settings for several variables. Possible reasons for these findings are given along with medical charts for the promotion and study of sexual rehabilitation for patients with cervical carcinoma.

Dental preservation in patients irradiated for head and neck tumours: A 10-year experience with topical fluoride and a randomized trial between two fluoridation methods.

Since 1972, the dentures of 935 patients irradiated for head and neck carcinoma have been preserved after careful selection and according to well-defined criteria, using a prospective programme of daily applications of topical sodium fluoride gel. The results of 1-10 years follow-up are given. Four percent of the patients developed a diffuse dental decay and 1% a bone necrosis which can be related to the dental preservation. None of these complications occurred with careful patient selections nor when programme compliance was maintained. Post-irradiation dental extractions were performed in 29 cases with subsequent healing in all cases but one. The surgical technique of such extractions is described. In March 1980, a randomized protocol was activated to compare the use of the sodium fluoride gel to high content fluoride toothpaste (1350 ppm F-). Two hundred and twenty patients were entered. At 12-36 months follow-up, dental caries were observed in 3% of the patients receiving the fluoride gel as compared to 11% receiving the toothpaste (p = 0.1). However, none of the patients adhering to the programme instructions failed in either arm. Currently, it seems reasonable to state that preservation of teeth in irradiated patients should be the rule and not the exception, given good dental condition prior to treatment and patient cooperation. The 5 min daily application of fluoride gel is the most reliable method for prevention of post-irradiation dental caries. The twice daily use of high content fluoride toothpaste is a good alternative provided its limitations are well understood by the clinician and patient.

[Measurement of quality of life. Application to the screening of psychological distress in cancer patients]. / Mesure de la qualité de vie. Application au dépistage de la souffrance psychologique chez les patients cancéreux.

As cancer treatments are becoming more and more traumatic the quality of life of these patients must be taken into consideration. This study was set up in 1982 and aimed at screening patients suffering from major psychological distress using a quantitative assessment of the quality of life. A self-administered questionnaire (QLQ) and linear analogues (LA) were developed and validated. The patient's acceptance of these two measuring instruments was tested on a sample group of patients in the Oncology Department of Besançon University Hospital and gave a result of 94% which was higher than that of a psychological interview (64%). A comparison of the assessment of the quality of life by the patient, the psychologist and the physician is an important phase in this concept. Agreement by the doctor and the patient using the Karnofsky indices was moderate (62% of the cases using a simplified scale): patients tended to overstate the extremes. The overall scores and the different questionnaire items completed by the patient and the psychologist were correlated, but agreement varied according to each item. An attempt was made to establish a predictive value for the questionnaire and the linear analogues to identify patients suffering from major psychological distress and requiring psychosocial support by comparing the results of the tests with the assessment of the psychologist during an interview. A stepwise logistical regression selected a combination of three items which screened more than 80% of these patients. The linear analogues were not sufficiently discriminatory to be used. The overall results suggest that a quality of life measurement can be integrated into daily clinical practice.

Breast cancer and sexual functioning: a review of the literature and implications for future research.

A review of the literature from 1953-1981 about breast cancer and sexual functioning is presented with an emphasis on the reported research in this field. Based on the literature there is evidence to suggest that women with breast cancer are at risk for developing sexual difficulties as a result of their illness and its subsequent treatment. The existing research indicates that the study of breast cancer and sexual functioning is in its infancy. Most of the research is found to be lacking in an appreciation for the complexity of variables which may contribute to sexual difficulties in this population. An outline of such variables, which are drawn from patient, partner and health provider sources, is presented. Particular attention is given to the effect of treatment upon the patient's ability to maintain her previous level of sexual functioning. Implications for future research are given throughout the discussions of those variables and throughout critiques of the previous studies.

Patient acceptance and differential perceptions of quality of life measures in a French oncology setting.

A three-part study evaluated French cancer patients' acceptance of self-rated quality of life measures, the predictive value of these measures, and the agreement between patient and health provider ratings of patient quality of life. In part one, 93% of 137 patients indicated a willingness to complete the Qualite de la Vie-Questionnaire (QOL-Q) and Analogues Lineaires pour la Mesure de la Qualite de vie (LA), and 63.6% indicated a willingness to be interviewed by a psychologist. Willingness to complete the scales was related to hospitalization status and treatment modality. In parts two and three, 100 patients were asked to complete the QOL-Q, LA, the Karnofsky Index (KI) and a side-effects checklist, and to undergo a psychological interview. Following interview, a psychologist rated the patients using the QOL-Q, and classified patient level of emotional distress. Oncologists rated the patient using the KI and the side-effects checklist. The results indicate that the patients' ratings of their quality of life were higher than the psychologist's ratings, and that the QOL-Q has predictive value in identifying severe emotional distress. Low level of patient and physician agreement on the KI was partially explained by patient age and cancer site. A moderate level of agreement was found between patient and physician perceptions of side effects. The study suggests that the QOL-Q, not the LA, may be useful as a screening tool to identify patients with impaired quality of life, and that self-rated measures should be included in quality of life assessments.