The psychiatrist as advocate for post surgical "quality of life"

Measuring symptoms as a critical component of drug development and evaluation in hematological diseases

With the rapid development of new therapies for patients with hematological malignancies, there is an increasing need for patient report of symptom status during all phases of drug testing. The patient's perspective on new treatments reflects treatment tolerability as well as symptom benefit, and may assist patients and clinicians in choosing treatments. Inclusion of patient-reported outcomes, more common in solid-tumor than hematological trials, provides early information about symptoms to guide decisions about appropriate dosing and supportive care needs. We provide a historical overview of the use of patient-reported outcomes and symptom assessment in solid-tumor and hematological drug development, and offer recommendations about methodological issues in the monitoring of symptoms in the drug development process in hematological clinical trials.

Problems and coping behaviour of facial cancer patients

On the basis of an arrangement scheme by Cohen and Lazarus, an investigation has been made into the literature on problems patients experience after having undergone tumour surgery resulting in facial mutilation. Furthermore, the ways in which these patients cope with their problems have been looked at. The greatest problems arise at the interpersonal level, and in particular with intimate (sexual) relationships and with superficial, anonymous contacts. The face is found to be of essential importance in interpersonal relationships. During the first phase of the disease, when all attention is focused on the fact of having cancer, patients especially react with intrapsychic coping mechanisms. Later, after surgery, the problems are mainly concentrated on the inescapable necessity to live with a clearly visible mutilation. At this stage, in order to be able to talk about his experiences, to find recognition; and to adapt his self-image, the patient particularly turns to other people for support. It turned out that the ordering of Cohen and Lazarus' arrangement scheme gives a good outline of the difficulties patients encounter. In addition to this, several psychological theories and concepts offer good explanations for the facts as found.

The use of quality-of-life considerations in medical decision making

Quality-of-life considerations in physicians' decisions on life-sustaining therapy were explored using a patient management problem (PMP) depicting acute respiratory failure in an elderly man with chronic pulmonary disease; 205 internal medicine and family medicine physicians were interviewed. The physicians' perceptions of the patient's quality of life demonstrated marked variability. Physicians considered the patient's quality of life more often to support decisions to withhold therapy than to support decisions to use mechanical ventilation (p less than 0.01). Consideration of quality of life was associated significantly with several PMP components: interpretation of the patient's prior medical experience, management of supplementary case information, attitudes about medical responsibilities/patient rights, and estimates of the patient's survival time. The authors conclude that consideration of quality of life in making life-and-death treatment decisions may involve judgments about the value of life, and that responsible consideration requires guidelines grounded in ethical principles.

Tumors of the head and neck. A 4-year study of a multidisciplinary approach

A multidisciplinary conference composed of the essential medical, surgical, dental, and allied specialists involved in the region of the head and neck, with resources to call upon other contributors when necessary, was undertaken at a major teaching center in the Northeastern U.S.A. (Long Island Jewish Hillside Medical Center). Meeting on a bimonthly basis with referrals accepted from all sources, but non-publicized, a total of 343 patients were seen over a period of 50 months. The results indicate that optimum patient care can be achieved with a minimum loss of time for treatment initiation and substantial cost savings from these specialists meeting as a group.