The fears of men in a prostate cancer support group: A pilot study

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Background: Little is published on prostate cancer patients’ fears and the effectiveness of interventional strategies. Methods: A 20-item questionnaire addressing various potential fears was administered to 30 men in a local prostate cancer support group: 15 had undergone curative therapy and were NED, and 15 had recurrent disease on androgen suppression. Level of fear for each question was rated from 1 to 5. At a later date, a different questionnaire was administered to 10 men with recurrent disease, addressing the predominant fear previously identified—uncontrolled symptoms at the end of life—with 10 specific questions on this subject. This was followed by the intervention: a 90 minute group discussion, led by an MD boarded in Medical Oncology and Hospice and Palliative Medicine. To assess impact, the 10 item questionnaire on end of life symptoms was readministered immediately after the discussion, and again 2 months later. Results: a) Patients with recurrent disease expressed a greater degree of fear than those free of recurrence; b) A major fear of the future is of uncontrollable symptoms at end of life, and was more of a concern than death itself; c) Of the 7 (of 10 total) items that were most significant to the patients (mean score 2.9 or higher, scale 1–5), a mean drop of 0.7 was seen in the level of fear following the intervention; d) This was inconsistently sustained 2 months later, with some concerns lessened but others not. Conclusions: In this small pilot study of men with prostate cancer, there appeared to be some measurable impact on the level of fear following the group discussion, though inconsistently sustained; questionnaires such as this are feasible to administer and appear to encourage productive discussion of difficult issues in the support group setting.

No significant financial relationships to disclose.

A phase I trial of doxorubicin, paclitaxel, and valspodar (PSC 833), a modulator of multidrug resistance

PURPOSE

P-glycoprotein is an efflux pump for many drugs including doxorubicin and paclitaxel. This study evaluated the coadministration of these drugs with the P-glycoprotein inhibitor valspodar (PSC 833) with the aim of determining: (a) maximum tolerated doses (MTDs) of doxorubicin followed by paclitaxel (DP); (b) the MTD of DP combined with PSC 833 (DPV), without and with filgrastim (G-CSF); and (c) the pharmacokinetic interactions of PSC 833 with doxorubicin and paclitaxel.

EXPERIMENTAL DESIGN

For the first cycle, patients received doxorubicin as a 15-min infusion followed by paclitaxel as a 1-h infusion. For the second cycle, patients received reduced doses of DP with PSC 833 at 5 mg/kg p.o., four times a day for 12 doses.

RESULTS

Thirty-three patients with various refractory malignancies were enrolled and assessable. The MTD of DP without PSC 833 was 35 mg/m(2) doxorubicin and 150 mg/m(2) paclitaxel. The MTD of DPV without G-CSF was 12.5 mg/m(2) doxorubicin and 70 mg/m(2) paclitaxel. The dose-limiting toxicity for both DP and DPV was neutropenia without thrombocytopenia. With G-CSF, the MTD for DPV was 20 mg/m(2) doxorubicin and 90 mg/m(2) paclitaxel. No grade 4 nonhematological toxicities were observed. Five partial and two minor tumor remissions were observed. Paired pharmacokinetics with and without PSC 833 revealed substantial drug interactions with both doxorubicin and paclitaxel.

CONCLUSIONS

PSC 833 can be administered safely with doxorubicin and paclitaxel. The pharmacokinetic profiles of these drugs are significantly affected by PSC 833, requiring approximately 60% dose reductions for equivalent degrees of myelosuppression.

Hematolymphoid malignancies diagnosed at the time of radical prostatectomy

PURPOSE

The clinical impact of hematolymphoid malignancies discovered during radical prostatectomy has not been previously defined to our knowledge.

MATERIALS AND METHODS

From October 1988 to September 1995, 1,092 patients underwent radical retropubic prostatectomy.

RESULTS

Of 1,092 radical prostatectomy specimens, 13 (1.2%) were found to have hematologic malignancies involving the prostate and/or lymph nodes sampled during concomitant pelvic lymph node dissection. The malignancies detected included Hodgkin's disease (3) and hairy cell leukemia (1), which required further therapy. However, 9 of the 13 patients (62%) demonstrated either chronic lymphocytic leukemia (3) or low grade, small lymphocytic lymphoma (6), which requires symptomatic treatment only. The transrectal ultrasound guided prostate biopsies revealed suspicious lymphocytic infiltrate in addition to prostatic adenocarcinoma in 2 of the 13 patients (15%).

CONCLUSIONS

The majority of hematologic malignancies discovered at radical prostatectomy do not require further treatment and should not delay treatment of prostatic adenocarcinoma.

Non-Hodgkin's lymphoma of the paranasal sinuses: clinical and pathological features, and response to combined-modality therapy

PURPOSE

Lymphomas of the paranasal sinuses may have poorer prognoses compared with other extranodal lymphomas of the head and neck, and are not well defined as a particular clinicopathologic entity. The outcome of combined-modality therapy and central nervous system (CNS) prophylaxis has not been fully determined.

PATIENTS AND METHODS

We retrospectively reviewed our experience with 16 consecutive, carefully defined patients, all treated with both chemotherapy and radiotherapy.

RESULTS

There were 11 men and five women, mean age 52. All presented with local symptoms; 13 had stage I or II disease. Thirteen had diffuse large cell lymphoma, two diffuse mixed, and one small noncleaved. Phenotyping revealed 10 B-cell, four T-cell, and two T or natural killer (NK). Most received CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy; the order of chemotherapy and radiotherapy varied. Twelve received CNS prophylaxis. Of 12 complete responses, six relapsed, all at distant sites, and two died during initial therapy. Five-year survival was 29%, and median survival 18 months. Four of 10 B-lineage patients were relapse-free at 4 years; all six T- or T/NK-lineage patients relapsed or were dead within 6 months. Tumors of T or NK lineage often expressed CD56 and showed evidence of Epstein-Barr viral infection; otherwise, pathological features were not predictive of lineage or outcome. Neither age nor lactate dehydrogenase predicted prognosis. No complete responder recurred in the CNS as site of first relapse.

CONCLUSION

Despite localized stage at presentation, sinus lymphoma is an aggressive disease, characterized by distant relapse and early mortality. Combined-modality therapy with CNS prophylaxis improves outcome compared with radiotherapy alone; however, prognosis remains poor. Patients with T-lineage disease appear to have a particularly bad outcome. Autologous bone marrow transplantation should be evaluated as first-line therapy for those at high risk of relapse.

Unmet analgesic needs in cancer patients

This study was designed to characterize unmet analgesic needs in a group of cancer patients. One hundred one inpatients were surveyed to document pain prevalence and intensity, satisfaction with pain control and factors associated with unmet analgesic needs during the week prior to admission. Forty-four percent had unmet analgesic needs, defined as pain of moderate or greater than moderate intensity. These patients had a significantly greater prevalence of bone and axillary node involvement, higher than pain intensity, and less satisfaction with pain control. Fifty-nine percent were satisfied with pain control. Dissatisfaction was associated with higher usual pain intensity, less satisfaction with physician information about pain etiology, less frequent attribution of pain to disease, sharp pain, constant and intermittent pain, patient perceptions of less physician concern about pain, patient and physician belief that the patient is receiving insufficient analgesic, and patient wanting more control over analgesic regimen. Patients may benefit from improved treatment of specific syndromes and by attention to communication.