Psychological distress among male patients and male spouses: what do oncologists need to know?

BACKGROUND: The aim of the current study was to strengthen the knowledge of oncologists concerning psychological distress and social support among married and unmarried male cancer patients and healthy male spouses of female cancer patients. PATIENTS AND METHODS: Three groups of men were recruited from three major cancer centers in Israel: 185 married colon and rectal cancer patients, 54 single (unmarried) colon and rectal cancer patients, and 153 male spouses of female cancer patients. Participants were evaluated on four standardized instruments measuring psychological distress, coping, and social support. RESULTS: About 42.6% of the participants reported on a clinical level of psychological distress, with the highest rates (61.1%) among the single (unmarried) patients. Distress was negatively correlated to Karnofsky score and coping variables among all study groups. Distress was significantly and negatively correlated to social support variables among the spouses and married patients but not among the single patient groups. CONCLUSIONS: Social support received by male cancer patients from friends and family may be mediated by spouse support. As a result, single male patients are at higher risk for psychological distress. Male spouses were also found to have high rates of distress. These two groups need special attention by oncologists.

Relationship of urinary polyamines to tumor activity and tumor volume in patients.

Serially obtained urinary polyamine levels were determined for 192 patients during a specified time period. The number of patient urine samples totaled 938. The patients had tumors of either the breast, stomach, prostate, or female genital tract, or metastatic carcinomas of unknown origin. Tumor activity and tumor volume, along with other clinical information, were also recorded during the time period. Possible associations between tumor activity and tumor volume on one hand, and polyamine levels on the other hand, were explored via different statistical analyses. For each tumor type, statistically significant group differences were found in polyamine levels between patients with nonactive tumors and patients with active large tumors. Predictive values of polyamine assays for change in disease activity and stability in disease nonactivity for tumors of the breast, female genital tract, and prostate were also computed. For breast tumors, these predictive values do not support the clinical utility of the use of polyamine levels to monitor disease states. For tumors of the female genital tract and prostate, these predictive values yield an indeterminant conclusion.

Further evidence for the use of polyamines as biochemical markers for malignant tumors.

One hundred ninety patients with a variety of tumor presented within a specified time period and fit a specified protocol. Multiple serial urinary putrescine, spermidine, and spermine levels were obtained in these patients, and their disease activity over time, defined as either active or nonactive, was determined by clinical examination, the results of laboratory tests, and radiological criteria. Twenty-four-hr urine collections were used for analysis of polyamine levels. A linear mixed-effects model and the method of maximum likelihood estimation were used for statistical analysis. Statistically significant differences were found in polyamine levels between patients with active or nonactive disease for tumors of the breast, stomach, prostate, female genital tract, and a variety of metastatic carcinomas of unknown origin. There were 105 patients with these tumors; 319 polyamine determinations were obtained from this subset of patients. Our results suggest that serial determination of polyamine levels in urine may have clinical utility for monitoring the disease states for these tumors.

The palliative efficacy of a single high dose of radiation in treatment of symptomatic osseous metastases.

Radiation therapy is effective for palliation of painful metastatic osseous lesions. Various fractionation doses have been previously described. The present study was initiated to evaluate the efficacy of a high single dose of radiation on pain relief, with the goal of reducing the number of radiation sessions to a minimum. Treatment consisted of a high single dose of radiation ranging between 6 to 10 Gy administered to painful osseous metastases. Prior to radiation therapy response to conservative analgesic therapy was minimal in most cases. Response to radiation therapy thereafter was 71.3% lasting up to 6 and 12 months in 37.3% and 20.9% of cases respectively.

Randomized study comparing chemotherapy with and without estrogen priming in advanced breast-cancer.

A randomized trial was performed to determine if combination chemotherapy (CT) with estrogen (E) priming (E+ study arm) was superior to CT alone (E- study arm) in patients with advanced breast cancer. CT for both arms included adriamycin + vincristine (AV) starting on day 7 alternating with cytoxan + methotrexate + fluorouracil (CMF) starting on day 28, the entire cycle repeated every 6 weeks. Estrogen priming consisting of 2 mg estradiol + 1 mg estriol (E+ arm) was given orally twice daily beginning on day 1 and continuously through CT until disease progression or unacceptable toxicity. Performance status (KPS) for all patients (n=19, E+ arm; n=22, E- arm) ranged between 70-100%. Mean age (53 y, E+ arm; 56 y, E- arm), menopausal and estrogen receptor status and treatment duration (approximately 38 weeks) were similar for both groups. Estrogen priming did not alter or enhance CT toxicity. Objective responses (CR,PR) were noted in 79% on the E+ arm (CR=11%, PR=68%) and in 73% on the E- arm (CR=9%, PR=64%). Thus, estrogen priming in this cohort of patients with advanced breast cancer did not appear to add to the toxicity or palliative benefit of CT.

Leukocyte alkaline phosphatase in cancer patient.

Leukocyte alkaline phosphatase (LAP) activity in peripheral blood was determined in 113 patients with non-metastatic malignancies, 36 patients with metastatic spread, and 22 individuals who served as controls. The LAP score of the non-metastatic cancer patients was significantly higher (p less than 0.001) than the controls, and the score of the metastatic group was further increased significantly as compared to both control (p less than 0.001) and non-metastatic groups (p less than 0.001). The results of this survey suggest that the level of LAP score in peripheral blood might be used to differentiate between non-metastatic and metastatic disease and might serve as an aid in prognosis of the patients.

Effect of very high single dose of cisplatinum and of radiation on the brain of the rabbit.

The importance of chemotherapy and radiotherapy for treating brain tumors, is well established. In a previous study, a rabbit's brain was treated with doses of up to 12 mg kg-1 of cisplatinum and 4000 cGy, without any morphological or pathological changes. The purpose of this study is to establish the effect of very high single doses of cisplatinum and radiation on the rabbit's brain, applied in 12, 16 and 18 mg kg-1, and 5000, 7500 and 8000 cGy, respectively. The general clinical and neurological condition of the rabbits was unaffected, but areas of alopecia and scalp ulcers appeared. Although these are very high doses of chemotherapy and radiotherapy, the histopathological and morphological examination of the rabbit's brain remained normal.

Brain effect of intracarotid administration of cisplatinum.

The antitumoral effect of Cisplatinum is well known, including its effect on brain tumors. With the purpose of establishing the effect of intraarterial cis-dichlorodiammine platinum (CDDP) on the brain, Cisplatinum was injected in rabbits that were sacrificed at different intervals. The general clinical and neurological condition of the rabbits was unaffected, and histopathological examination of the rabbit's brain was normal.

Effect of high simple dose of cisplatinum and of radiation on the brain of rabbit.

In former studies of intracarotid and intravenous administration of cisplatinum, separate and combined with brain irradiation, we found no cerebral damage. In this study, gradually increasing high doses (above the therapeutic ones) of cisplatinum were administered intravenously to one series of rabbits and increasing high amounts of irradiation (above the therapeutic amounts) were given to another series. Although the rabbits that received highest doses of irradiation developed areas of alopecia and skin ulcers on the head, the general clinical and histopathologic examination of the rabbits' brains in both series was normal. The purpose of this study was to establish the effects of high doses of intravenous cisplatinum and irradiation on the rabbits brains.

Effect of the combination of cisplatinum and radiation in the rabbit's brain.

The effect of cisplatinum as a potential radiosensitizer in brain tumors is controversial. We examined the effect of the combination of cisplatinum with radiation compared to radiation alone in rabbits' brain. All rabbits were irradiated and cisplatinum was injected intravenously into part of them. Therapeutic doses of cisplatinum and irradiation were given. The rabbits were euthanised at different intervals according to protocol. The general clinical and neurological condition of the rabbits was unaffected, and histopathological examination of the rabbit's brain was normal. The purpose of this study was to establish the effect of cisplatinum followed by cranial irradiation in therapeutic doses to the normal rabbit's brain.

Cancer in married couples: higher or lower distress?

This study focuses on the question of what occurs when both spouses become seriously ill. Our hypothesis was that psychological distress in married couples involving two ill partners is far higher than when only one partner is ill. The study group comprised 20 married couples, in which both spouses were diagnosed with cancer. Two comparison groups were also studied: 20 married couples with the husband diagnosed with cancer, and 20 couples with the wife diagnosed with cancer. All patients in the three groups completed four self-report scales: the Brief Symptom Inventory (BSI); the Perceived Family Support (PFS); the Impact of Events Scale (IES); and the Mental Adjustment to Cancer (MAC). The healthy spouses completed only the first three scales. Our findings supported the null hypothesis--that is, that the psychological distress in married couples with both partners diagnosed with cancer was not significantly different than when only one partner had cancer. Our findings also showed that neither sociodemographic background, medical condition, nor family support affect patient distress. Gender differences were found with Intrusiveness contributing to the distress of male, but not female, patients. This study confirms and augments earlier work, and shows that partners of cancer patients report a high degree of distress, with this level of distress not being much different from that of the patients.

Leukocyte alkaline phosphatase and serum alkaline phosphatase in patients with metastatic breast and colon cancer.

Peripheral blood leukocyte alkaline phosphatase (LAP) scores and serum alkaline phosphatase (SAP) levels in 70 patients with metastatic breast and colorectal cancer (metastases to the liver, lung, bone and abdomen) and in 18 healthy controls were measured. The mean LAP score in the metastatic cancer patients was significantly higher than in the control group (244 vs. 61) and there was no overlap between the 95% confidence level intervals of the two groups. The mean (SAP) level in the metastatic patients was also higher than in the controls (249 u/l vs. 162 u/l) but the 95% confidence level interval of the controls was inside the 95% interval of the metastatic patients meaning that considerable percentage of the metastatic patients will have a SAP level within the normal range. We conclude that of the two markers, the LAP is the better one for detection of metastatic tumors.

CEA levels in active and non-active malignant tumors.

A total of 895 CEA estimations were carried out on serum samples from 283 patients with different primary tumor sites. All assays were performed during the period of follow up or treatment of the patients. Concomitantly with CEA estimation, activity of disease was recorded, based on objective laboratory and clinical parameters. The results obtained proved a high accuracy rate for normal CEA values in non-active disease as well as elevated CEA values in active disease. It is concluded that the correlation between CEA level and activity of disease in various neoplasms in an important aid in clinical decision making during the course of disease, provided false positive or negative results are taken into consideration.

Leukocyte alkaline phosphatase and carcinoembryonic antigen in breast cancer patients. Influence of the treatment on the markers.

Leukocyte alkaline phosphatase (LAP) scores and carcinoembryonic antigen (CEA) levels were analyzed in 53 patients suffering from breast cancer. All patients underwent mastectomy and received adjuvant treatment, and all lived more than 5 years after diagnosis without metastatic disease. Thirty-three patients received adjuvant radiotherapy, and 20 patients received adjuvant chemotherapy. The median LAP score before radiotherapy was 117 +/- 48; two months after the beginning of radiotherapy this value was 175 +/- 71, being significantly higher than the original value (p less than 0.001), and one year after the beginning of radiotherapy it was 105 +/- 63, which approximated the normal scores. The median LAP score before chemotherapy was 138 +/- 69; two months after the beginning of chemotherapy it was 194 +/- 63, i.e. significantly higher than before chemotherapy (p less than 0.002), and one year after the beginning of chemotherapy it was 150 +/- 56. Median CEA levels before radiotherapy were 6.4 +/- 5.1 ng/ml; two months after the beginning of radiotherapy this value was 6.0 +/- 5.0 ng/ml; and one year later 7.4 +/- 6.2 ng/ml. Median CEA levels before chemotherapy were 8.1 +/- 12.0 ng/ml; two months after the beginning of chemotherapy 12.6 +/- 13.0 ng/ml (p less than 0.05) in comparison with the values before chemotherapy; and one year after the beginning of chemotherapy it was 8.6 +/- 5.4 ng/ml. We concluded that the LAP scores were influenced by adjuvant radio- or chemotherapy, and the CEA levels were influenced by chemotherapy.

Leukocyte alkaline phosphatase, CA15-3, CA125, and CEA in cancer patients.

Peripheral blood leukocyte alkaline phosphatase (LAP) scores and CA15-3, CA125, and CEA levels in plasma were measured in 57 patients with metastatic breast, ovarian, and colorectal cancer, respectively, and in 79 patients with the same types of nonmetastatic cancer. The mean LAP scores of the metastatic cancer patients (261, 272 and 275 for breast, ovary and colon, respectively) were significantly higher than those of the nonmetastatic cancer group (70, 68 and 57, respectively). There was no overlap between the 95% confidence intervals of the two groups (i.e., metastatic versus nonmetastatic), and no patient known to be metastatic had a LAP score within the normal range. The mean levels of other markers in the metastatic patients (CA15-3, 63.4 mu/ml; CA125, 104.8 mu/ml; and CEA, 51.8 ng/ml for metastatic breast, ovarian, and colon cancer, respectively) were also higher than in the nonmetastatic patients (CA15-3, 24 mu/ml; CA125, 25.3 mu/ml; and CEA, 5.8 ng/ml for nonmetastatic breast, ovarian, and colon cancer, respectively). However, the 95% confidence intervals of the nonmetastatic and the metastatic patients overlapped so that there were false-negatives and/or false-positives when the other markers were used. We therefore conclude that the addition of the LAP score to conventional cancer markers could be helpful for the diagnosis of recurrence and follow-up of cancer patients and suggest that our results be confirmed by further studies on a larger series of patients.

Meningiomas after radiotherapy for tinea capitis--still no history.

AIMS AND BACKGROUND: To review the clinical, radiological and histological findings of 19 patients with radiation-induced intracranial meningiomas treated at our neurosurgical department between 1981 and 1996. METHOD: The records of 18 patients with intracranial meningiomas who underwent low-dose radiation for tinea capitis in childhood, and of one patient irradiated for pituitary adenoma, were analyzed in respect of the previously reported features of postradiation meningiomas. RESULTS: The mean age of the patients with low-dose radiation-induced meningiomas was 58 years and the mean shortest onset latency was 48 years. The male to female ratio was 1.1:1. Forty-seven percent of patients presented with mental changes and/or focal neurological signs, 21% with signs of increased intracranial pressure and 26% with seizures. Calvarial location of the meningiomas was found in 54% of patients and in one patient the tumor arose from the skull base. Multiple tumors were present in 15% of patients and 29% of the meningiomas displayed malignant features on histological examination. A significantly lower meningioma recurrence rate was found in our series compared to the recurrence rate in the reported series of postradiation meningiomas. Five patients had a history of a second neoplasm other than meningioma. CONCLUSION: Our series of low-dose radiation-induced meningiomas represents one of the largest of its kind in the English literature. The patients did not differ substantially in sex ratio, tumor localization, multiplicity and histological features from the previously reported postradiation meningioma patients, except for the significantly lower tumor recurrence rate. It would seem that over the next years we will be further witnessing the deleterious effects of low-dose radiation administered in childhood.

Leukocyte alkaline phosphatase and carcinoembryonic antigen in metastatic colorectal cancer patients.

Peripheral blood leukocyte alkaline phosphatase scores and plasma carcinoembryonic antigen levels in 26 patients with metastatic colorectal cancer were compared to those in 30 healthy controls. Patients had metastases to the liver and abdomen. The mean leukocyte alkaline phosphatase score in the metastatic colorectal cancer patients was significantly higher than in the control group (246 +/- 65 vs, 52 +/- 26, p less than 0.001); and the mean carcinoembryonic antigen level in the patients was also significantly higher than in the controls (110 +/- 100 vs, 4.9 +/- 3 ng/ml, p less than 0.001). One hundred percent of the metastatic cancer patients had elevated LAP scores and 73% of these patients had elevated CEA levels. There was a difference between the mean CEA levels in the patients with liver metastases and those with abdominal metastases (162 +/- 135 vs, 39 +/- 53 ng/ml, p less than 0.04). The results suggest that although both markers were elevated in metastatic colorectal cancer, the LAP score seems to be more useful in detecting metastatic disease, since we found 11% false negatives with the CEA level and 0% false negatives with the LAP score.

Clinical determinants of long-term survival in patients with glioblastoma multiforme.

Repeated reports of more than ten years postoperative survival in patients with glioblastoma multiforme (GM) have appeared in the literature over the last decades. Authors have tried to identify the clinical, therapeutic and histological features determining long-term survival. We present two patients in whom, after radical removal of the tumor followed by conventional radiation, there has been no recurrence for at least ten years. The young age of the patients and the radical surgical approach were in accordance with previous reports of long-term survival. Nevertheless, one tumor originated from the thalamus, a location considered to be of unfavorable prognosis. We therefore further discuss the value of clinical signs as determinants in the prognosis of GM.

Skilled nursing facilities as a setting for comprehensive care of older people with advanced cancer: a model of care in the post oncologic stage.

METHODS: We surveyed the elderly cancer patients admitted to the Skilled Nursing Wards of Shmuel Harofe Hospital, Geriatric Medical Center, during a 5-year period. RESULTS: The 304 elderly patients admitted with advanced cancer represented 16% of the skilled nursing patients admitted during this period. Their average time of survival was 4.2 months, ranging from 9.1 for breast cancer to 1.8 months for gastric cancer. Ninety-five percent were severely dysfunctional, and all had a high rate of medical complications. CONCLUSIONS: Our study reveals the benefits of a skilled nursing system that provides comprehensive care, flexibility, and continuity of care at a difficult and demanding stage of this illness. This model functions at reasonable cost, and we recommend it for the care of elderly patients with advanced cancer in the post oncologic stage.

[Cancer in husband and wife--a report of 105 couples].

The occurrence of cancer in both members of 105 couples related only by marriage, is reported from a regional hospital, 68 couples had tumors of the same histopathologic type. 6 had tumors of the same organ, with similar histology. The tumors were of the brain (astrocytoma), urinary bladder (transitional cell carcinoma) lung (adenocarcinoma), retroperitoneum (sarcoma), stomach (adenocarcinoma) and colon (adenocarcinoma). The significance of our observations is unclear, and they are most probably coincidences. Analysis of more data could help to explain these observations, because factors such as environment, nutrition and contamination affect both members of a married couple for extended periods of time.