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Kish JA, Zhang Q, Langer CJ, Nguyen-Tân PF, Rosenthal DI, Weber RS, List MA, Wong SJ, Garden AS, Hu K, Trotti AM, Bonner JA, Jones CU, Yom SS, Thorstad W, Schultz CJ, Ridge JA, Shenouda G, Harris J, Le QT. The impact of age on outcome in phase III NRG Oncology/RTOG trials of radiotherapy (XRT) +/- systemic therapy in locally advanced head and neck cancer. J Geriatr Oncol 2021; 12:937-944. [PMID: 33814339 PMCID: PMC8829803 DOI: 10.1016/j.jgo.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/08/2021] [Accepted: 03/17/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To examine the role age plays in the treatment and prognosis of locally advanced head and neck cancer (LAHNC) treated definitively with radiation alone or combined modality therapy. METHODS A retrospective analysis was performed of three NRG/RTOG trials examining either radiation alone or combined radiation and systemic therapy for LAHNC. The effect of age (≥70 yrs.) on cause-specific survival (CSS), overall survival (OS), and toxicity was evaluated. RESULTS A total of 2688 patients were analyzed, of whom 309 patients (11.5%) were ≥ 70. For all studies combined, the hazard ratio (HR) for CSS for patients age ≥ 70 vs. those <70 was 1.33 (95%CI: 1.14-1.55, p < 0.001). For OS, the HR for patients age ≥ 70 vs. those <70 for all studies combined was 1.55 (95% CI 1.35-1.77, p < 0.001). After adjustment for all covariates, age ≥ 70 was associated with worse OS regardless of adjustment for smoking and p16 status. The survival difference was more pronounced in those receiving combined radiation and systemic therapy. Hematologic and renal toxicities were increased in combined modality trials in patients ≥70 years old. CONCLUSIONS Patients age ≥ 70 with LAHNC were underrepresented in these clinical trials. Their CSS and OS proved inferior to patients <70 years old.
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Affiliation(s)
- Julie A Kish
- H. Lee Moffitt Cancer Center & Research Institute, United States of America.
| | - Qiang Zhang
- NRG Oncology Statistics and Data Management Center, United States of America
| | | | | | - David I Rosenthal
- University of Texas-MD Anderson Cancer Center, United States of America
| | - Randal S Weber
- University of Texas-MD Anderson Cancer Center, United States of America
| | - Marcy A List
- University of Chicago Comprehensive Cancer Center, United States of America
| | - Stuart J Wong
- Medical College of Wisconsin, United States of America
| | - Adam S Garden
- University of Texas-MD Anderson Cancer Center, United States of America
| | - Kenneth Hu
- New York University Langone, United States of America
| | - Andy M Trotti
- H. Lee Moffitt Cancer Center & Research Institute, United States of America
| | - James A Bonner
- University of Alabama at Birmingham, United States of America
| | | | - Sue S Yom
- University of California San Francisco, United States of America
| | | | | | - John A Ridge
- Fox Chase Cancer Center, United States of America
| | | | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, United States of America
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Aschebrook-Kilfoy B, Kibriya MG, Chiu BCH, Huo D, List MA, Stepniak E, Sarwar G, Al Shams R, Gopalakrishnan R, Le Beau MM, Ahsan H. Variation in screening rates in a multi-ethnic population-based study in Chicago. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.1509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1509 Background: We initiated the Chicago Multiethnic Prevention and Surveillance Study (COMPASS) in 2013. Here, we present screening rates for key cancers with known disparities in risk/and or outcomes in Chicago, considering the effect health care access and race/ethnicity, and we compare the findings in COMPASS to rates reported by the CDC. Methods: COMPASS participant responses to a health interview were analyzed. The analysis of colorectal cancer screening (CRCS) was limited to persons 50-75, mammography screening (MS) was restricted to women ages 50-74, and cervical screening (CS) by pap smear testing was restricted to women ages 21-65. Frequency statistics and linear regression models were run to evaluate associations. Results: A total of 2,967 COMPASS participants were included in the analysis from 18 communities. We found ever CRCS rates in Chicago are lower than the national average (52.3% vs. 58.6%; p < .01) and that CRCS is lower in blacks (50.3%) and Hispanics (52.1%) compared to whites (65.8%), and that those with health insurance (HI) report a CRCS rate of 56.8% compared to 25.5% without insurance. Mammography within the last 2 years was 70.8% in COMPASS women compared to 72.4% nationally, with black women reporting higher rates of MS in the past 2 years (73.0%) compared to white women (65.4%) and Hispanic women (62.9%); and higher MS among women with HI (74.2%) compared to women without HI (47.2%). Pap screening within the last 5 years was 84.3% in COMPASS women compared to 83.0% nationally (last 3 years), with both black (85.3%) and Hispanic (83.2%) women reporting non-significantly higher CS compared to white women (80.9%) in COMPASS, and significantly higher CS among women with HI (86.2%) compared to women without HI (77.7%). Conclusions: Our results reinforce the fact that differences in cancer screening reflect the larger problem of access to care. We further found racial disparities in CRC screening in COMPASS to be consistent with disparities in incidence. However, our results do not support the notion that the disproportionate burden of breast and cervical cancer in black and Hispanic women in Chicago are primarily due to a lack of screening.
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Affiliation(s)
| | | | - Brian C-H Chiu
- Department of Health Studies, Division of Epidemiology, University of Chicago, Chicago, IL
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Marcy A List
- University of Chicago Comprehensive Cancer Center, Chicago, IL
| | | | - Golam Sarwar
- University of Chicago Research Bangladesh, Dhaka, Bangladesh
| | - Rabab Al Shams
- University of Chicago Research Bangladesh, Dhaka, Bangladesh
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Kish JA, Zhang Q, Langer CJ, Nguyen-Tan F, Rosenthal DI, Weber RS, List MA, Wong SJ, Garden AS, Cooper JS, Trotti A, Bonner JA, Jones CU, Yom SS, Michalski JM, Schultz CJ, Ridge JA, Shenouda G, Le QT. The effect of age on outcome in prospective, phase III NRG Oncology/RTOG trials of radiotherapy (XRT) +/- chemotherapy in locally advanced (LA) head and neck cancer (HNC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.6003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Corey J. Langer
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | - Felix Nguyen-Tan
- Centre Hospitalier de I'Universite de Montreal, Montreal, QC, Canada
| | | | - Randal S. Weber
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marcy A List
- University of Chicago Comprehensive Cancer Center, Chicago, IL
| | | | - Adam S. Garden
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - James A. Bonner
- University of Alabama at Birmingham, Comprehensive Cancer Center, Department of Radiation Oncology, Birmingham, AL
| | | | - Sue S Yom
- UC San Francisco Radiation Oncology, San Francisco, CA
| | | | | | | | | | - Quynh-Thu Le
- Stanford University Medical Center, Stanford, CA
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Paskett ED, Herndon JE, Day JM, Stark NN, Winer EP, Grubbs SS, Pavy MD, Shapiro CL, List MA, Hensley ML, Naughton MA, Kornblith AB, Habin KR, Fleming GF, Bittoni MA. Applying a conceptual model for examining health-related quality of life in long-term breast cancer survivors: CALGB study 79804. Psychooncology 2009; 17:1108-20. [PMID: 18314912 DOI: 10.1002/pon.1329] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The Survivor's Health and Reaction study used a quality-of-life model adapted for cancer survivors by Dow and colleagues to identify factors related to global health-related quality of life (HRQL) and to document the prevalence of problems and health-oriented behaviors in a follow-up study of breast cancer patients who participated in CALGB 8541. METHODS A total of 245 survivors (78% of those invited) who were 9.4-16.5 years post-diagnosis completed surveys that inquired about current HRQL, economic, spiritual, physical and psychosocial concerns, and health-oriented behaviors (e.g. smoking, exercise, and supplement use). A regression model was developed to examine factors related to global HRQL across all domains. RESULTS The regression model revealed that decreased energy levels (odds ratio (OR)=1.05, 95% confidence interval (CI): 1.03, 1.07), having heart disease (OR=5.01, 95% CI: 1.39, 18.1), having two or more co-morbidities (OR=2.39, 95% CI: 1.10, 5.19), and lower social support (OR=1.03, 95% CI: 1.02, 1.05) were associated with lower global HRQL. Factors related to psychological, spiritual, and economic domains were not predictive of global HRQL. Regarding lifestyle changes, some women reported engaging in health-oriented behaviors since their cancer diagnosis, such as improving eating habits (54%), increasing exercise (32%), and reducing/quitting smoking (20%). The most prevalent problems reported by women at follow-up were menopausal symptoms (64%), such as hot flashes and vaginal dryness, osteoporosis (25%), and lymphedema (23%). CONCLUSION Suggestions are provided to target interventions, such as provider-based strategies, in order to improve HRQL in long-term breast cancer survivors.
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Affiliation(s)
- Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210-1240, USA.
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Salama JK, Stenson KM, List MA, Mell LK, Maccracken E, Cohen EE, Blair E, Vokes EE, Haraf DJ. Characteristics associated with swallowing changes after concurrent chemotherapy and radiotherapy in patients with head and neck cancer. ACTA ACUST UNITED AC 2008; 134:1060-5. [PMID: 18936351 DOI: 10.1001/archotol.134.10.1060] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To define factors that acutely influenced swallowing function prior to and during concurrent chemotherapy and radiotherapy. DESIGN A summary score from 1 to 7 (the swallowing performance status scale [SPS]) of oral and pharyngeal impairment, aspiration, and diet, was assigned to each patient study by a single senior speech and swallow pathologist, with higher scores indicating worse swallowing. Generalized linear regression models were formulated to asses the effects of patient factors (performance status, smoking intensity, amount of alcohol ingestion, and age), tumor factors (primary site, T stage, and N stage), and treatment-related factors (radiation dose, use of intensity-modulated radiation therapy, response to induction chemotherapy, postchemoradiotherapy neck dissection, and preprotocol surgery) on the differences between SPS score before and after treatment. SETTING University hospital tertiary care referral center. PATIENTS The study included 95 patients treated under a multiple institution, phase 2 protocol who underwent a videofluorographic oropharyngeal motility (OPM) study to assess swallowing function prior to and within 1 to 2 months after the completion of concurrent chemotherapy and radiotherapy. MAIN OUTCOME MEASURES Factors associated with swallowing changes after chemoradiotherapy. RESULTS The mean pretreatment and posttreatment OPM scores were 3.09 and 3.77, respectively. Patients with T3 or T4 tumors (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.15-0.95; P = .04) and a performance status of 1 or 2 (OR, 0.37; 95% CI, 0.15-0.91; P = .03) were less likely to have worsening of swallowing after chemoradiotherapy. There was a trend for worse swallowing with increasing age (OR, 1.04; 95% CI, 0.99-1.09; P = .08). Only T stage (T3 or T4) was associated with improved swallowing after treatment (OR, 8.96; 95% CI, 1.9-41.5; P < .001). CONCLUSION In patients undergoing concurrent chemotherapy and radiotherapy, improved swallowing function over baseline is associated with advanced T stage.
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Affiliation(s)
- Joseph K Salama
- Department of Radiation and Cellular Oncology, 5758 S Maryland Ave, MC 9006, Chicago, IL 60637, USA.
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6
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Cohen EEW, Haraf DJ, List MA, Kocherginsky M, Mittal BB, Rosen F, Brockstein B, Williams R, Witt ME, Stenson KM, Kies MS, Vokes EE. High survival and organ function rates after primary chemoradiotherapy for intermediate-stage squamous cell carcinoma of the head and neck treated in a multicenter phase II trial. J Clin Oncol 2006; 24:3438-44. [PMID: 16849759 PMCID: PMC4430103 DOI: 10.1200/jco.2006.05.8529] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Patients with intermediate-stage squamous cell carcinoma of the head and neck traditionally have been treated with initial surgical resection followed by radiotherapy (RT) alone or chemoradiotherapy. A previous study in this patient population reported a 91% locoregional control rate and 65% overall survival (OS) rate at 5 years, with chemoradiotherapy used as primary treatment. This study was undertaken to assess whether shortening treatment duration with hyperfractionated RT would be feasible and improve locoregional control, organ preservation, and progression-free survival. METHODS Eligible patients with stage II or III disease received fluorouracil, hydroxyurea, and RT given twice daily on a week-on/week-off schedule. Quality-of-life scores were measured using three validated indexes. RESULTS All 53 patients enrolled are included in the analysis, with a median follow-up of 42 months (range, 5 to 98 months). Grade 3 or 4 in-field mucositis was observed in 77% and 9%, respectively. No patients required surgical salvage at the primary tumor site (pathological complete response rate, 100%). The 3-year progression-free and OS rates are 67% and 78%, respectively. The 3-year disease-specific mortality rate is 7%. At the time of analysis, 87% of surviving patients do not require enteral feeding support. Quality-of-life and performance assessment indicated that, although acute treatment toxicities were severe, most patients returned to pretreatment function by 12 months. CONCLUSION Concurrent chemoradiotherapy with hyperfractionated RT is feasible in this patient population and yields high local control and cure rates. Compared with our historical control using once-daily fractionation, hyperfractionation is accompanied by increased acute in-field toxicity.
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Affiliation(s)
- Ezra E W Cohen
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, 60637, USA.
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7
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Pfister DG, Laurie SA, Weinstein GS, Mendenhall WM, Adelstein DJ, Ang KK, Clayman GL, Fisher SG, Forastiere AA, Harrison LB, Lefebvre JL, Leupold N, List MA, O'Malley BO, Patel S, Posner MR, Schwartz MA, Wolf GT. American Society of Clinical Oncology Clinical Practice Guideline for the Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer. J Clin Oncol 2006; 24:3693-704. [PMID: 16832122 DOI: 10.1200/jco.2006.07.4559] [Citation(s) in RCA: 322] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To develop a clinical practice guideline for treatment of laryngeal cancer with the intent of preserving the larynx (either the organ itself or its function). This guideline is intended for use by oncologists in the care of patients outside of clinical trials. Methods A multidisciplinary Expert Panel determined the clinical management questions to be addressed and reviewed the literature available through November 2005, with emphasis given to randomized controlled trials of site-specific disease. Survival, rate of larynx preservation, and toxicities were the principal outcomes assessed. The guideline underwent internal review and approval by the Panel, as well as external review by additional experts, members of the American Society of Clinical Oncology (ASCO) Health Services Committee, and the ASCO Board of Directors. Results Evidence supports the use of larynx-preservation approaches for appropriately selected patients without a compromise in survival; however, no larynx-preservation approach offers a survival advantage compared with total laryngectomy and adjuvant therapy with rehabilitation as indicated. Recommendations All patients with T1 or T2 laryngeal cancer, with rare exception, should be treated initially with intent to preserve the larynx. For most patients with T3 or T4 disease without tumor invasion through cartilage into soft tissues, a larynx-preservation approach is an appropriate, standard treatment option, and concurrent chemoradiotherapy therapy is the most widely applicable approach. To ensure an optimum outcome, special expertise and a multidisciplinary team are necessary, and the team should fully discuss with the patient the advantages and disadvantages of larynx-preservation options compared with treatments that include total laryngectomy.
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Milano MT, Vokes EE, Kao J, Jackson W, List MA, Stenson KM, Witt ME, Dekker A, MacCracken E, Garofalo MC, Chmura SJ, Weichselbaum RR, Haraf DJ. Intensity-modulated radiation therapy in advanced head and neck patients treated with intensive chemoradiotherapy: preliminary experience and future directions. Int J Oncol 2006; 28:1141-51. [PMID: 16596230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
We review our recent experience with intensity-modulated radiation therapy (IMRT) and conventional three-dimensional radiation therapy (C3DRT) in advanced head and neck cancer. Sixty-nine patients with Stage IV head and neck cancer (and stage III base of tongue and hypopharynx) enrolled in a Phase II study of definitive chemoradiation; 20 received all or part of their radiation with IMRT. Image-guided set-up, using video subtraction techniques, was used in all patients. Six weekly doses of induction carboplatin (AUC=2) and paclitaxel (135 mg/m2) were followed by alternating weekly chemoradiation to 75 Gy with 1.5 Gy BID fractions, concurrent with paclitaxel (100 mg/m2/week), 5-fluorouracil (600 mg/m2/d) and hydroxyurea (500 mg PO BID). Two consecutive cohorts enrolled, differing in radiation scheme: 75 Gy to gross disease in both, 60 or 54 Gy to first echelon lymphatics and 45 or 39 Gy to second echelon lymphatics. With a median follow-up of 47 months, 3-year overall survival is 68.5% and 3-year locoregional control is 94.0%, with no significant differences between those treated with C3DRT versus IMRT, nor between the two radiation dosing schemes. Actuarial overall survival without tracheostomy or laryngectomy, or without a gastrostomy tube was also similar. Acute mucositis, dermatitis and pain were similar with C3DRT and IMRT. Preliminary data suggests IMRT is well tolerated, and does not compromise locoregional control, indicating that IMRT adequately covers the clinical volume at risk. Building on the present clinical experience, future directions include more directed efforts at reducing toxicity, with better planning software and planning techniques.
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Affiliation(s)
- Michael T Milano
- Department of Cellular and Radiation Oncology, University of Chicago, Chicago, IL 60637, USA.
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9
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Cohen EEW, Kane MA, List MA, Brockstein BE, Mehrotra B, Huo D, Mauer AM, Pierce C, Dekker A, Vokes EE. Phase II trial of gefitinib 250 mg daily in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck. Clin Cancer Res 2005; 11:8418-24. [PMID: 16322304 DOI: 10.1158/1078-0432.ccr-05-1247] [Citation(s) in RCA: 189] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE An objective response rate of 11% was reported in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN) treated with 500 mg daily gefitinib although the recommended dose in lung cancer is 250 mg. This study evaluated the efficacy and toxicity of 250 mg daily gefitinib in patients with recurrent and/or metastatic SCCHN. EXPERIMENTAL DESIGN Phase II trial with objective response rate as the primary end point. Measurements of quality of life and levels of serum vascular endothelial growth factor and transforming growth factor-alpha were assessed before and during therapy. RESULTS In 70 patients, 1 (1.4%) partial response was observed. Median progression-free survival and overall survival were 1.8 and 5.5 months, respectively. Quality of life scores improved transiently during the first weeks of therapy before returning to baseline. Median vascular endothelial growth factor and transforming growth factor-alpha levels were above the normal range but were not predictive of outcome. Four patients experienced grade 3 drug-related adverse events. Rash of any grade was observed in 64% of subjects. Correlation between disease control (partial response + stable disease), progression-free survival, and overall survival and grade of cutaneous toxicity was observed (P = 0.001, 0.001, and 0.008 respectively). CONCLUSIONS Gefitinib monotherapy at 250 mg in recurrent and/or metastatic SCCHN seems to have less activity than was previously observed for 500 mg daily. A dose-response relationship may exist for this agent in SCCHN and grade of cutaneous toxicity attributable to gefitinib is a clinical predictor of better outcome.
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Affiliation(s)
- Ezra E W Cohen
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, IL 60637, USA.
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Lilenbaum RC, Herndon JE, List MA, Desch C, Watson DM, Miller AA, Graziano SL, Perry MC, Saville W, Chahinian P, Weeks JC, Holland JC, Green MR. Single-agent versus combination chemotherapy in advanced non-small-cell lung cancer: the cancer and leukemia group B (study 9730). J Clin Oncol 2005; 23:190-6. [PMID: 15625373 DOI: 10.1200/jco.2005.07.172] [Citation(s) in RCA: 345] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE We compared the efficacy of combination chemotherapy versus single-agent therapy in patients with advanced non-small-cell lung cancer. PATIENTS AND METHODS A total of 561 eligible patients were randomly assigned to receive paclitaxel alone or in combination with carboplatin. RESULTS The response rate was 17% in the paclitaxel arm and 30% in the carboplatin-paclitaxel arm (P < .0001). Median failure-free survival was 2.5 months in the paclitaxel arm and 4.6 months in the carboplatin-paclitaxel arm (P = .0002). Median survival times were 6.7 months (95% CI, 5.8 to 7.8) and 8.8 months (95% CI, 8.0 to 9.9), and 1-year survival rates were 32% (95% CI, 27% to 38%), and 37% (95% CI, 32% to 43%), respectively. The overall survival distributions were not statistically different: hazard ratio = 0.91 (95% CI, 0.77 to 1.17; P = .25). Hematological toxicity and nausea were more frequent in the combination arm, but febrile neutropenia and toxic deaths were equally low in both arms. There was no significant survival difference in elderly patients. Performance status 2 patients treated with combination chemotherapy had a better survival rate than those treated with single-agent therapy (P = .019). CONCLUSION Combination chemotherapy improves response rate and failure-free survival compared with single-agent therapy, but there was no statistically significant difference in the primary end point of overall survival. The results in elderly patients were similar to younger patients. Performance status 2 patients had a superior outcome when treated with combination chemotherapy.
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Affiliation(s)
- Rogerio C Lilenbaum
- The Mount Sinai Comprehensive Cancer Center, 4306 Alton Rd, Miami Beach, FL, USA.
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11
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Abstract
For advanced head and neck cancer (HNC) patients, aggressive radiation and chemoradiation treatments offer new therapy options. The aims of these regimens are increased survival and organ preservation, with the goals of preserving organ function, minimizing late effects, and improving quality of life (QOL). At the same time, the toxicities of these regimens are acknowledged as is the potential for long-term dysfunction. Thus, particularly now, with the increasing use of aggressive chemoradiation therapy (CRT) regimens, documentation of the QOL and functional outcomes of these treatments is critical. The implications for speech and swallowing are widely recognized and the broader effects of these impairments on overall QOL have received some attention. This article presents data on the performance, functional, and QOL results of radiation therapy (RT) and various CRT regimens in HNC.
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Affiliation(s)
- Marcy A List
- University of Chicago Cancer Research Center, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637-1470, USA.
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12
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List MA, Rutherford JL, Stracks J, Pauloski BR, Logemann JA, Lundy D, Sullivan P, Goodwin W, Kies M, Vokes EE. Prioritizing treatment outcomes: head and neck cancer patients versus nonpatients. Head Neck 2004; 26:163-70. [PMID: 14762885 DOI: 10.1002/hed.10367] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Treatment decisions in head and neck cancer (HNC) might involve consideration of uncertain tradeoffs of one late effect against another or increasing toxicity or residual impairment for increased chance of survival. Understanding how patients prioritize potential outcomes, as well as whether these preferences are similar to those of nonpatients, is important to informed decision making and treatment planning. METHODS Two hundred forty-seven newly diagnosed HNC patients from nine institutions and 131 nonpatients rank ordered a set of 12 potential treatment outcomes (eg, cure; being able to swallow; normal voice) from highest (1) to lowest (12). RESULTS Patients and nonpatients were similar with respect to the three items most frequently ranked in the top three, that is, "being cured of cancer," "living as long as possible," and "having no pain" in that order. In contrast, patients more frequently ranked "cure" (90% vs 80%) and less frequently ranked "no pain" (34% vs 52%) in the top three. CONCLUSIONS Survival seems to be of paramount importance to both patient and nonpatient groups, overshadowing associated toxicities and potential dysfunction. At the same time, patients might be more willing than nonpatients to undergo aggressive treatments and endure acute distress in the interest of potential long-term gains (ie, cure or longer survival).
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Affiliation(s)
- Marcy A List
- University of Chicago Cancer Research Center, 5841 S Maryland Ave (MC 1140), Chicago, Illinois 60637, USA.
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13
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Abstract
For advanced head and neck cancer (HNC) patients, the effects of disease and the side effects of aggressive treatments have the potential to severely affect function and quality of life. More recent treatment strategies offer patients many options and have increased rates of locoregional control. However, they have not eliminated either acute treatment side effects or the spectrum of negative late sequelae, such as eating and speech dysfunction, residual pain, and troublesome dryness of the mouth. Understanding this broad spectrum of side effects and how patients experience them as well as the functional and quality of life implications is important to treatment evaluation and patient decision making. The heterogeneity of HNC patients (in terms of tumor site), the diversity of surgical techniques and chemoradiotherapy regimens, together with individual patient differences in response to these variables, make it particularly difficult to describe precise outcomes attached to various treatment options. However, in the context of this caveat, there are increasing data documenting the impact of various treatment modalities on physical, functional, and QOL outcomes. This article presents some of these data with a focus on the performance and functional results of radiation therapy, surgery, or concomitant chemoradiation therapy.
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Affiliation(s)
- Marcy A List
- University of Chicago Cancer Research Center, Chicago, IL 60637, USA
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14
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Haraf DJ, Rosen FR, Stenson K, Argiris A, Mittal BB, Witt ME, Brockstein BE, List MA, Portugal L, Pelzer H, Weichselbaum RR, Vokes EE. Induction chemotherapy followed by concomitant TFHX chemoradiotherapy with reduced dose radiation in advanced head and neck cancer. Clin Cancer Res 2003; 9:5936-43. [PMID: 14676118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
PURPOSE Induction chemotherapy with carboplatin and paclitaxel followed by concomitant TFHX (paclitaxel, infusional 5-fluorouracil, hydroxyurea, and twice-daily radiation therapy administered every other week) has resulted in 70% 3-year survival in stage IV patients. Locoregional and distant control rates were 94 and 93%, respectively. In an attempt to decrease toxicity without compromising local control, a second cohort of patients was treated with a lower dose of radiation to sites of potential microscopic disease. EXPERIMENTAL DESIGN Sixty-four patients were entered on study. Patients received six weekly doses of carboplatin (area under the curve 2) and paclitaxel (135 mg/m2) followed by five cycles of TFHX. The radiation dose to gross disease was 75 Gy as in the previous trial. The radiation dose to high-risk microscopic disease was reduced from 60 to 54 Gy, and the dose to low-risk microscopic disease was reduced from 45 to 39 Gy. RESULTS Ninety-seven percent of patients had stage IV disease. The response rate to induction chemotherapy was 82% with a complete response rate of 42%. At the completion of therapy the clinical complete response rate rose to 100% with a median follow-up of 29 months. The actuarial 2 and 3-year survival was 77 and 70%, respectively. Five patients developed progressive disease for an overall 3-year progression-free survival of 90%. Two patients failed in locoregional sites alone, resulting in a 3-year locoregional control of 97%. The 3-year systemic control was 95%. Four patients were completely feeding tube dependent at the time of analysis. Only 1 of these patients had normal swallowing function before treatment. CONCLUSIONS In this second trial, induction chemotherapy with carboplatin and paclitaxel followed by TFHX chemoradiotherapy results in high survival and progression-free survival. The reduction in radiation dose did not compromise survival or disease control compared with our prior study using higher radiation doses. Data continues to support definitive evaluation of this approach.
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Affiliation(s)
- Daniel J Haraf
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois 60637-1470, USA.
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Lamont EB, Hayreh D, Pickett KE, Dignam JJ, List MA, Stenson KM, Haraf DJ, Brockstein BE, Sellergren SA, Vokes EE. Is patient travel distance associated with survival on phase II clinical trials in oncology? J Natl Cancer Inst 2003; 95:1370-5. [PMID: 13130112 DOI: 10.1093/jnci/djg035] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Prior research has suggested that patients who travel out of their neighborhood for elective care from specialized medical centers may have better outcomes than local patients with the same illnesses who are treated at the same centers. We hypothesized that this phenomenon, often called "referral bias" or "distance bias," may also be evident in curative-intent cancer trials at specialized cancer centers. METHODS We evaluated associations between overall survival and progression-free survival and the distance from the patient residence to the treating institution for 110 patients treated on one of four phase II curative-intent chemoradiotherapy protocols for locoregionally advanced squamous cell cancer of the head and neck conducted at the University of Chicago over 7 years. RESULTS Using Cox regression that adjusted for standard patient-level disease and demographic factors and neighborhood-level economic factors, we found a positive association between the distance patients traveled from their residence to the treatment center and survival. Patients who lived more than 15 miles from the treating institution had only one-third the hazard of death of those living closer (hazard ratio [HR] = 0.32, 95% confidence interval [CI] = 0.12 to 0.84). Moreover, with every 10 miles that a patient traveled for care, the hazard of death decreased by 3.2% (HR = 0.97, 95% CI = 0.94 to 0.99). Similar results were obtained for progression-free survival. CONCLUSION Results of phase II curative-intent clinical trials in oncology that are conducted at specialized cancer centers may be confounded by patient travel distance, which captures prognostic significance beyond cancer stage, performance status, and wealth. More work is needed to determine what unmeasured factors travel distance is mediating.
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Affiliation(s)
- Elizabeth B Lamont
- Department of Medicine and Cancer Research Center, The University of Chicago, Chicago, IL, USA.
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Affiliation(s)
- Marcy A List
- University of Chicago Cancer Research Center, Chicago, IL 60637, USA
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Rosen FR, Haraf DJ, Kies MS, Stenson K, Portugal L, List MA, Brockstein BE, Mittal BB, Rademaker AW, Witt ME, Pelzer H, Weichselbaum RR, Vokes EE. Multicenter randomized Phase II study of paclitaxel (1-hour infusion), fluorouracil, hydroxyurea, and concomitant twice daily radiation with or without erythropoietin for advanced head and neck cancer. Clin Cancer Res 2003; 9:1689-97. [PMID: 12738722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
PURPOSE To expand on our experience with the combination of paclitaxel, fluorouracil, hydroxyurea, and twice daily irradiation (T-FHX) and to assess the impact of weekly administration of erythropoietin (r-HuEpo) on transfusion requirements, we conducted a Phase II multi-institutional trial with a simplified 1-h paclitaxel infusion schedule and randomized patients to receive weekly doses of r-HuEpo. PATIENTS AND METHODS A total of 90 patients with locally advanced head and neck cancers (stage IV, 96%; N(2)/N(3), 66%) were treated on a regimen of 1-h infusion of paclitaxel (100 mg/m(2)/day, day 1), 120-h infusion of 5-fluorouracil (600 mg/m(2)/day, days 0-5); hydroxyurea 500 mg p.o. every 12 h for 11 doses; and radiation 150cGy bid, days 1-5 of each 14-day cycle repeated for five cycles over 10 weeks (7200-7500 cGy). Before initiating therapy, patients were randomized to receive r-HuEpo 40,000 IU s.c. once weekly. RESULTS At median follow-up of 40 months, 3-year progression-free survival is 62%, locoregional control is 84%, and systemic control is 79%. Overall survival is 59%. Anemia, leucopenia, dermatitis, and mucositis were the most frequent grade 3 or 4 toxicities. Patients randomized to erythropoietin experienced less grade 2/3 anemia (52 versus 77%; P = 0.02), but transfusion requirements were not significantly different. CONCLUSIONS T-FHX is an active and tolerable regimen inducing local tumor control and promising survival with organ preservation in high-risk patients. One h infusion of paclitaxel simplified the regimen without compromising efficacy. Addition of erythropoietin does not reduce the need for transfusion with this nonplatinum-containing regimen. T-FHX should be advanced to a randomized trial and compared with a cisplatin-based concomitant regimen.
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Affiliation(s)
- Fred R Rosen
- Department of Medicine, Section of Hematology/Oncology, University of Illinois at Chicago, 60637, USA
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Vokes EE, Stenson K, Rosen FR, Kies MS, Rademaker AW, Witt ME, Brockstein BE, List MA, Fung BB, Portugal L, Mittal BB, Pelzer H, Weichselbaum RR, Haraf DJ. Weekly carboplatin and paclitaxel followed by concomitant paclitaxel, fluorouracil, and hydroxyurea chemoradiotherapy: curative and organ-preserving therapy for advanced head and neck cancer. J Clin Oncol 2003; 21:320-6. [PMID: 12525525 DOI: 10.1200/jco.2003.06.006] [Citation(s) in RCA: 186] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The paclitaxel, fluorouracil, and hydroxyurea regimen of paclitaxel, infusional fluorouracil, hydroxyurea, and twice-daily radiation therapy (TFHX) administered every other week has resulted in 3-year survival rates of 60% of stage IV patients. Locoregional and distant failure rates were 13% and 23%, respectively. To reduce distant failure rates, we added a brief course of induction chemotherapy to TFHX. PATIENTS AND METHODS Sixty-nine patients received six weekly doses of carboplatin (AUC2) and paclitaxel (135 mg/m2) followed by five cycles of TFHX. RESULTS Ninety-six percent had stage IV disease. Response to induction chemotherapy was partial response 52% and complete response (CR) 35%. Symptomatically, there was a significant reduction in mouth and throat pain. The most common grade 3 or 4 toxicity was neutropenia (36%). Best response following completion of TFHX was CR in 83%. Toxicities of TFHX consisted of grade 3 or 4 mucositis (74% and 2%) and dermatitis (47% and 14%). At a median follow-up of 28 months, locoregional or systemic disease progression were each noted in five patients. The overall 3-year progression-free survival was 80% (95% confidence interval [CI], 71% to 90%), and the 2- and 3-year overall survival rates were 77% (95% CI, 66% to 87%) and 70% (95% CI, 59% to 82%), respectively. At 12 months, five patients were completely feeding-tube dependent. CONCLUSION Administration of carboplatin and paclitaxel before TFHX chemoradiotherapy results in high response activity and may decrease distant failure rates. Overall survival, progression, and organ preservation/functional outcome data support definitive evaluation of this approach.
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Affiliation(s)
- Everett E Vokes
- Department of Medicine, Section of Hematology/Oncology, University of Chicago. IL 60637-1470, USA.
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Villano JL, List MA, Vokes EE. The Importance of Quality-of-Life Measurements in Oncology. Clin Lung Cancer 2002; 4:110. [PMID: 14653867 DOI: 10.1016/s1525-7304(11)70546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- J Lee Villano
- University of Chicago, Section of Hematology/Oncology, Chicago, IL, USA
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List MA, Lee Rutherford J, Stracks J, Haraf D, Kies MS, Vokes EE. An exploration of the pretreatment coping strategies of patients with carcinoma of the head and neck. Cancer 2002; 95:98-104. [PMID: 12115322 DOI: 10.1002/cncr.10653] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with head and neck carcinoma (HNC) often face exhaustive and debilitating treatment as well as physical and functional residual effects, such as disfigurement, compromised speech, dry mouth, and difficulties swallowing. Understanding how patients cope with these challenges is important in comprehensive care of patients with HNC. METHODS Seventy-nine patients with HNC were assessed for quality of life (QOL) and coping strategy. Measures included the Functional Assessment of Cancer Therapy-Head and Neck, the Performance Status Scale for Head and Neck Cancer Patients, and the Ways of Coping-Cancer Version. Coping strategies were summarized and related to patient demographics and QOL. RESULTS The results suggested that patients with HNC used a wide range of coping strategies, with social support seeking behaviors representing the greatest proportion of total coping effort (25%). The use of avoidant coping strategies (both cognitive and behavioral escape) was associated with poorer overall QOL. CONCLUSIONS Although further examination of these issues in larger groups of patients with HNC is warranted, the current findings suggest the adaptability of this group of patients and the potential benefit of social support-based assistance or intervention.
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Affiliation(s)
- Marcy A List
- Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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Mittal BB, Kepka A, Mahadevan A, Kies M, Pelzer H, List MA, Rademaker A, Logemann J. Tissue/dose compensation to reduce toxicity from combined radiation and chemotherapy for advanced head and neck cancers. Int J Cancer 2002; 96 Suppl:61-70. [PMID: 11992387 DOI: 10.1002/ijc.10360] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study was undertaken to quantify the reduction in normal tissue complications resulting from the aggressive management of advanced head and neck cancers (AHNCs) utilizing tissue/dose compensation (TDC). Thirty-nine patients with AHNC were treated on an intensive chemotherapy + radiation regimen. Eighteen of 39 patients were treated using TDC; the remaining 21 patients were radiated without TDC (NTDC). Acute and chronic toxicities, swallowing, speech function, and quality of life were assessed. The TDC group had a smaller radiation dose gradient across the entire treatment volume. Unscheduled treatment breaks were required in 11% of TDC patients as compared with 43% of the NTDC group (P = 0.04). The TDC group had fewer Grade 3 or 4 acute and chronic toxicities and lower SOMA scores. At 3 months posttreatment, patients in the TDC group had better oral intake, lower pharyngeal residue, and better oropharyngeal swallowing efficiency and were able to swallow more bolus types. Patients in the TDC group also had better articulation. Use of TDC resulted in reduced treatment-related interruptions, decreased acute and chronic toxicities, and better speech and swallowing functions. Techniques to improve radiation dose conformality around the target tissues while decreasing the radiation dose to the normal tissues should be an integral part of aggressive combined modality therapy.
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Affiliation(s)
- B B Mittal
- Department of Radiology, Section of Radiation Oncology, Northwestern University, Chicago, Illinois 60611, USA.
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Siston AK, List MA, Daugherty CK, Banik DM, Menke C, Cornetta K, Larson RA. Psychosocial adjustment of patients and caregivers prior to allogeneic bone marrow transplantation. Bone Marrow Transplant 2001; 27:1181-8. [PMID: 11551029 DOI: 10.1038/sj.bmt.1703059] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are many studies that examine the psychosocial adjustment of survivors of bone marrow transplantation (BMT). On the other hand, there are relatively few studies that examine the psychosocial adjustment of patients prior to BMT, and even fewer that focus on the psychosocial adjustment of the patient's caregiver. The purpose of the present study was to assess performance status and psychosocial adjustment to illness, mood and stress response of patients and caregivers prior to admission for allogeneic BMT. Forty patients and their 39 caregivers were assessed using standardized measures. One-fourth of the patients reported clinical levels of psychosocial maladjustment on the Psychosocial Adjustment to Illness Scale and had greater adjustment problems than BMT survivors. Approximately one-third (35%) and one-quarter (23%) of the patients reported significant symptoms of intrusive and avoidance stress responses, respectively on the Impact of Events Scale. Caregivers reported more impairments in family relationships than patients, but overall reported similar distress to that of patients. Information about the pre-BMT process appears to be critical to understanding the psychosocial impact that BMT can have on patients and their caregivers.
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Affiliation(s)
- A K Siston
- Department of Psychiatry and Behavioral Sciences, Northwestern University Medical School, the Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60612, USA
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Mantz CA, Vokes EE, Stenson K, Kies MS, Mittal B, Witt ME, List MA, Weichselbaum RR, Haraf DJ. Induction chemotherapy followed by concomitant chemoradiotherapy in the treatment of locoregionally advanced oropharyngeal cancer. Cancer J 2001; 7:140-8. [PMID: 11324767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
PURPOSE Locoregionally advanced oropharyngeal cancer has been conventionally treated with either surgery and adjuvant radiotherapy or radiotherapy alone, and clinical and functional outcomes have been poor. Chemoradiotherapy has been demonstrated to improve functional outcome and disease control over conventional treatment in recent randomized head and neck trials. Herein, we report overall survival, progression-free survival, and patterns of failure in locoregionally advanced oropharyngeal cancer treated with induction chemotherapy with or without conservative surgery followed by concomitant chemoradiation. MATERIALS AND METHODS Three cycles of induction chemotherapy consisting of cisplatin, 5-fluorouracil, leucovorin, and interferon alpha-2b (PFL-IFN) were followed by conservative, organ-sparing surgery for residual disease. All patients then proceeded to concomitant chemoradiation consisting of seven or eight cycles of 5-fluorouracil, hydroxyurea, and a total radiotherapy dose of roughly 7,000 cGy. RESULTS Sixty-one patients with predominantly stage IV disease were treated. Clinical complete response was observed in 65% of patients after induction therapy. The median follow-up was 68.0 months for survivors and 39.0 months for all patients. At 5 years, overall survival is 51%, progression-free survival is 64%, locoregional control is 70%, and distant control is 89%. Locoregional recurrence accounted for 80% of all initial failures. Only five radical surgeries (none were total glossectomy) were performed for initial disease control. Treatment-related toxicity accounted for four deaths. CONCLUSION PFL-IFN given with 5-fluorouracil, hydroxyurea, and radiotherapy produces a high rate of cures with organ preservation in a disease group that has traditionally fared poorly. Local and distant disease control and survival rates exceed those observed with more standard treatment approaches involving surgery and radiotherapy. Further investigation into chemoradiotherapy as a curative modality for this disease is warranted.
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Affiliation(s)
- C A Mantz
- Department of Cellular and Radiation Oncology, University of Chicago, Illinois 60637, USA
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Mantz CA, Vokes EE, Kies MS, Mittal B, Witt ME, List MA, Weichselbaum RR, Haraf DJ. Sequential induction chemotherapy and concomitant chemoradiotherapy in the management of locoregionally advanced laryngeal cancer. Ann Oncol 2001; 12:343-7. [PMID: 11332146 DOI: 10.1023/a:1011188726802] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To determine overall survival, progression-free survival, rate of voice preservation, and patterns of failure in locoregionally advanced laryngeal cancer treated with induction chemotherapy with or without surgery followed by concomitant chemoradiation. BACKGROUND Locoregionally advanced laryngeal cancer has been conventionally treated with either surgery and adjuvant radiotherapy or radiotherapy alone, and clinical and functional outcomes have been poor. Chemoradiotherapy has been demonstrated to improve functional outcome and disease control over conventional treatment in recent randomized head and neck trials. PATIENTS AND METHODS Advanced head and neck cancer patients were enrolled onto two consecutive phase II studies. Induction treatment consisted of three cycles of cisplatin, 5-fluorouracil (5-FU), leucovorin, and interferon-alpha 2b (PFL-IFN) followed by surgery for residual disease. Surgical intent was to spare the larynx when possible. All patients then proceeded to concomitant chemoradiation consisting of seven or eight cycles of 5-FU, hydroxyurea, and a planned total radiotherapy dose of 7000 cGy (FHX). RESULTS A subset of thirty-two laryngeal cancer patients with predominantly stage IV disease comprises the study group for this report. Clinical CR was observed in 59% of patients following induction therapy. The median follow-up was 63.0 months for surviving patients and 44.5 months for all patients. At five years, overall survival is 47%, progression-free survival is 78%, and locoregional control is 78%. No distant failures were observed. Voice preservation with disease control was 75% at five years. Only two total laryngectomies were performed during the course of treatment and follow-up. Treatment-related toxicity accounted for two deaths. CONCLUSIONS The addition of concomitant chemoradiotherapy to induction chemotherapy for locoregionally advanced laryngeal cancer appears to increase locoregional control and survival rates. PFL-IFN-FHX resulted in high rates of disease cure and voice preservation in a group of patients that has traditionally fared poorly in both clinical and functional outcome.
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Affiliation(s)
- C A Mantz
- Department of Cellular and Radiation Oncology, University of Chicago, Illinois, USA
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Abstract
This paper reviews quality-of-life (QOL) assessment in head and neck cancer with a focus on research and methodologic developments of the past year. Issues of QOL measurement, as well as the challenges to data synthesis in light of the heterogeneity of head and neck cancer and its treatment, are discussed briefly. Methodologic advances include increased use of validated measures, longitudinal study design, and attention to patients' attitudes. Although the majority of studies assessed multiple QOL domains, including both physical/functional and emotional/social, more focused areas of investigation included pain, organ preservation, and depression. Examinations of the relation among domains suggested that impaired function does not necessarily lead to poor QOL and that the best predictor of 12-month global QOL is pretreatment global QOL. Future challenges include the need for large multi-institutional studies, consensus about instrument selection, addressing the problem of missing data, and how to apply group OOL to individual patient decisions.
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Affiliation(s)
- M A List
- Department of Medicine, University of Chicago, Illinois 60637, USA.
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List MA, Stracks J, Colangelo L, Butler P, Ganzenko N, Lundy D, Sullivan P, Haraf D, Kies M, Goodwin W, Vokes EE. How Do head and neck cancer patients prioritize treatment outcomes before initiating treatment? J Clin Oncol 2000; 18:877-84. [PMID: 10673531 DOI: 10.1200/jco.2000.18.4.877] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine, pretreatment, how head and neck cancer (HNC) patients prioritize potential treatment effects in relationship to each other and to survival and to ascertain whether patients' preferences are related to demographic or disease characteristics, performance status, or quality of life (QOL). PATIENTS AND METHODS One hundred thirty-one patients were assessed pretreatment using standardized measures of QOL (Functional Assessment of Cancer Therapy-Head and Neck) and performance (Performance Status Scale for Head and Neck Cancer). Patients were also asked to rank a series of 12 potential HNC treatment effects. RESULTS Being cured was ranked top priority by 75% of patients; another 18% ranked it second or third. Living as long as possible and having no pain were placed in the top three by 56% and 35% of patients, respectively. Items that were ranked in the top three by 10% to 24% of patients included those related to energy, swallowing, voice, and appearance. Items related to chewing, being understood, tasting, and dry mouth were placed in the top three by less than 10% of patients. Excluding the top three rankings, there was considerable variability in ratings. Rankings were generally unrelated to patient or disease characteristics, with the exception that cure and living were of slightly lower priority and pain of higher priority to older patients compared with younger patients. CONCLUSION The data suggest that, at least pretreatment, survival is of primary importance to patients, supporting the development of aggressive treatment strategies. In addition, results highlight individual variability and warn against making assumptions about patients' attitudes vis-à-vis potential outcomes. Whether patients' priorities will change as they experience late effects is currently under investigation.
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Affiliation(s)
- M A List
- Departments of Medicine and Radiation and Cellular Oncology, and the Cancer Research Center, University of Chicago, Chicago, IL 60637, USA.
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List MA, Sinner M, Chodak GW. Improving knowledge about prostate cancer: the development of an educational program for African-Americans. Prostate Cancer Prostatic Dis 1999; 2:186-190. [PMID: 12496776 DOI: 10.1038/sj.pcan.4500313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/1998] [Revised: 06/17/1999] [Accepted: 06/28/1999] [Indexed: 11/09/2022]
Abstract
This study aimed to develop and test a prostate cancer educational program, as well as an electronic keypad survey procedure, among African-Americans. A 1 h seminar and 12-item knowledge questionnaire were reviewed by both professional and lay consultants and then tested among African-American men and women recruited from the city of Chicago. Eight free presentations were delivered to a total of 63 attendees. Mean percent correct rose from 20% pre-program to 57% post-program (P<0.001) and there was an increase on all individual questions. This feasibility study demonstrated: (a) there is a general lack of information about prostate cancer among African-Americans; (b) know-ledge can be significantly increased by means of an hour-long seminar; and (c) electronic keypads provide an easy, acceptable means of collecting data. Finally, the study underscored the need for the development of active and creative recruitment strategies to increase attendance. Such efforts are currently underway.
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Affiliation(s)
- M A List
- Department of Medicine, The University of Chicago Cancer Research Center, Chicago, IL
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List MA, Siston A, Haraf D, Schumm P, Kies M, Stenson K, Vokes EE. Quality of life and performance in advanced head and neck cancer patients on concomitant chemoradiotherapy: a prospective examination. J Clin Oncol 1999; 17:1020-8. [PMID: 10071297 DOI: 10.1200/jco.1999.17.3.1020] [Citation(s) in RCA: 185] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To prospectively evaluate performance and quality of life (QOL) in advanced-stage head and neck cancer (HNC) patients on a curative-intent, concomitant-chemoradiotherapy (CT/XRT) (twice-daily radiation, fluorouracil, hydroxyurea, and cisplatin) regimen aimed at improving locoregional control, survival, and QOL. PATIENTS AND METHODS Sixty-four patients were assessed before, during, and at 3-month intervals after treatment. Standardized measures of QOL (Functional Assessment of Cancer Therapy-Head and Neck), performance (Performance Status Scale for Head and Neck Cancer Patients and Karnofsky Performance Status Rating Scale), and patient-reported symptoms (McMaster University Head and Neck Radiotherapy Questionnaire) were administered. RESULTS Acute treatment toxicities were severe, with declines in virtually all QOL and functional domains. Marked improvement was seen by 12 months; general functional and physical measures returned to baseline levels of good to excellent. Although up to a third of the patients continued to report problems with swallowing, hoarseness, and mouth pain, these difficulties were present in similar magnitudes before treatment. The following symptoms were more frequent at 12 months: dry mouth (58% v 17%), difficulties tasting (32% v 8%), and soft food diet (82% v 42%). Twelve-month diet was not related to pretreatment functioning, disease, treatment, or patient characteristics. Twelve-month QOL was best predicted by pretreatment QOL, with very little relationship to residual side effects or functional impairments. Small numbers of patients in four of the five disease sites precluded examination of outcome by site. CONCLUSION These data support the feasibility of intense CT/XRT as primary treatment for advanced HNC. Results confirm acute toxicity but indicate that many of the treatment-related performance and QOL declines resolve by 12 months. The persistent inability to eat a full range of foods warrants further attention and monitoring.
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Affiliation(s)
- M A List
- Department of Medicine, Chicago Cancer Research Center, University of Chicago, IL 60637, USA.
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List MA, Maskay MH, Blumberg KG, Banik DM. You're never too old: a cancer education and risk reduction program for the elderly. J Cancer Educ 1999; 14:104-108. [PMID: 10397487 DOI: 10.1080/08858199909528590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Although age is the most significant risk factor for cancer, older adults are less likely to be informed about and to follow through with screening procedures. METHODS The University of Chicago Cancer Research Center, working in collaboration with health educators and city elderly organizations, developed a carefully scripted, hour-long presentation on cancer awareness and screening, designed specifically for older adults. The program was designed to be delivered in the community by trained graduate students. Pre-post-program surveys were used to evaluate the program's effectiveness in increasing cancer awareness. RESULTS The presentation was delivered 40 times at Chicago nutrition sites, regional senior centers, retirement homes, and community clinics, reaching close to 1,000 individuals. Responses to revised surveys showed improvements of an average of 22 (ranging from one to 41) percentage points per question. CONCLUSIONS This program gives older adults the basic knowledge and tools they need to take more active roles in their health care, follow healthier lifestyles, and reduce cancer risk.
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Affiliation(s)
- M A List
- University of Chicago Cancer Research Center and the Department of Medicine, University of Chicago, Illinois 60637-9848, USA
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List MA, Mumby P, Haraf D, Siston A, Mick R, MacCracken E, Vokes E. Performance and quality of life outcome in patients completing concomitant chemoradiotherapy protocols for head and neck cancer. Qual Life Res 1997; 6:274-84. [PMID: 9226985 DOI: 10.1023/a:1026419023481] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study evaluated post-treatment performance and quality of life (QOL) outcome in head and neck cancer (HNC) patients treated with organ preservation, intensive chemoradiotherapy (FHX). Participants were 47 Stage II-IV HNC patients with no evidence of disease at least one year post-completion of organ preservation, concomitant FHX treatment. Patients were assessed via a semi-structured in-person interview, standardized measures of QOL (FACT-H&N, CES-D), performance (PSS-HN) and patients' perception of residual side effects. Disease, treatment and toxicity data were retrieved from medical charts and protocol records. The most salient performance impairment was inability to eat a normal solid food diet, with 50% of patients able to eat soft foods or take liquids only. This specific functional deficit was not related to global QOL, nor to specific quality of life dimensions. Dry mouth, the most frequent and severe residual effect, was not associated with outcome diet, depression or QOL. Residual pain, seen in only 15% of patients, appeared to influence both functional and QOL parameters as well as being a marker for other troublesome symptoms. Twenty-three per cent of patients were depressed; depression was associated with past problems related to alcohol abuse. Decreased QOL and increased depressive symptomatology were related to total number and severity of residual effects. The data highlight the importance of systematic study of QOL dimensions and caution against making assumptions about patients' experience of particular disease and treatment sequelae.
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Affiliation(s)
- M A List
- Department of Medicine, University of Chicago Cancer Research Center, IL 60637, USA.
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List MA, D'Antonio LL, Cella DF, Siston A, Mumby P, Haraf D, Vokes E. The Performance Status Scale for Head and Neck Cancer Patients and the Functional Assessment of Cancer Therapy-Head and Neck Scale. A study of utility and validity. Cancer 1996; 77:2294-301. [PMID: 8635098 DOI: 10.1002/(sici)1097-0142(19960601)77:11<2294::aid-cncr17>3.0.co;2-s] [Citation(s) in RCA: 463] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The goal of this investigation was to examine the relationship between, and application of, two disease specific quality of life (QL) measures currently being employed for head and neck cancer patients: the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT-H&N) and the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN). METHODS The FACT-H&N and PSS-HN were administered to 151 head and neck cancer patients with a range of disease sites, treatment status (on vs. off treatment), and treatment modalities (surgery, radiation, and chemotherapy). RESULTS FACT-H&N subscale and total scores and PSS-HN subscale scores proved sensitive to patients groups (showed significant and clinically meaningful differences) on the basis of treatment status (on vs. off treatment) and global performance status (Karnofsky scores). The pattern of correlations between FACT-H&N and PSS-HN subscales supported the scales' construct (convergent vs. divergent) validity. The strongest and most significant associations were observed between PSS-HN Normalcy of Diet and Eating in Public, and the head and neck subscale (HNS) of FACT-H&N, both of which were designed to measure the unique problems of head and neck cancer patients. More modest associations were observed between subscales measuring physical and functional areas of performance, social functioning, and emotional well-being. CONCLUSIONS The FACT-HNS was found to be reliable and valid when applied to head and neck cancer patients. It clearly adds information to that collected by the parent (core) instrument. The PSS-HN also provides unique information, independent of that provided by the Karnofsky or the FACT-H&N. This study supported the multidimensional nature of QL for head and neck cancer patients, and thus the importance of assessing disease specific concerns in addition to general health status when assessing functional and QL outcome.
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Affiliation(s)
- M A List
- University of Chicago Cancer Research Center, Illinois 60637, USA
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Abstract
BACKGROUND Although quality of life (QL) and performance status are important outcomes in head and neck (HN) cancer, there is little systematic inclusion of these parameters in treatment trials. METHODS Rate and recovery of function were evaluated over a 6-month period in 21 laryngeal cancer patients, 7 in each of 3 treatment groups: total laryngectomy (group 1), hemilaryngectomy (group 2), and radiotherapy only (group 3). Assessment included Performance Status Scale for Head and Neck Cancer Patients (PSS-HN: Diet, Speech, and Eating in Public subscales) and the FACT-HN, a multidimensional QL measure. RESULTS Groups differed in patterns of performance recovery over time in expected directions. Group 1 recovered most slowly, without achieving normal functioning by 6 months; most of group 2 returned to normal functioning by 3 months; group 3 showed little overall dysfunction. There was no difference in overall QL between groups or over time. Performance status was significantly correlated with the FACT head and neck subscale and somewhat with the Physical subscale. In contrast, ability to eat and/or speak was not associated with overall QL nor with any other specific QL dimension (eg, emotional or social well-being). CONCLUSIONS Results support the sensitivity and applicability of two site-specific performance/QL measures: PSS-HN and FACT-HN. Findings also emphasize the need to employ multidimensional tools to adequately evaluate the nonmedical outcomes in head and neck patients.
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Affiliation(s)
- M A List
- University of Chicago Cancer Research Center, IL 60637, USA
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Abstract
Effective assessment of treatment outcome and the development of successful rehabilitation for head and neck cancer patients demand an evaluation of the relevant parameters of functional status. This paper reports the development and testing of a new Performance Status Scale for Head and Neck Cancer Patients designed to assess the unique areas of dysfunction experienced by this population. The instrument is a simple, practical, clinician-rated assessment tool consisting of three subscales: (1) Understandability of Speech, (2) Normalcy of Diet, and (3) Eating in Public. The scale was administered to a group of 181 head and neck patients and a comparison group of 30 breast cancer patients. Results indicate that the scale is reliable across raters and sensitive to functional differences across a broad spectrum of head and neck cancer.
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Affiliation(s)
- M A List
- Illinois Cancer Council, Chicago 60603
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Abstract
The performance status of the child with cancer is an important outcome consideration in pediatric oncology research and practice. However, no single measure for children has been available. This is a report of the development and standardization of such a scale. The play-performance scale for children is a parent-rated instrument which records usual play activity as the index of performance. Performance status ratings were obtained on three groups of children: patients (n = 98), patients' siblings (n = 29), and an independent sample of hospital employees' children (n = 40). Children with all types and stages of childhood malignant neoplasms were represented. Test results established the parent as a competent, reliable rater and demonstrated the validity of the scale. Interrater reliability was examined using correlational statistics and percentage agreement. Agreement between parents was good, and there were no systematic rater biases. In addition, parents' ratings significantly discriminated differences in levels of functioning (mean score, patients 75.4 versus siblings 97.4). Correlational and analysis of variance (ANOVA) procedures demonstrated that the play-performance scale was significantly related to the global performance measures of experienced clinicians and was sensitive to change. Inpatients received a mean score of 42.3, outpatients 90.7, and normals 98.2. These findings indicate that the scale is both feasible and effective. It is concise, can be administered repeatedly even to extremely ill patients, and uses parents as observer reporters. The play-performance scale for children provides quantifiable, reproducible, and meaningful data, which is necessary for effective monitoring and management of the child with cancer.
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Abstract
Survivors of childhood cancer, having overcome the biggest hurdle to a normal life span, must continue to be vigilant toward health care issues as well as toward certain psychological and social problems for which they are at a greater than normal risk. The long-term survivor's knowledge about his/her illness, its treatment, and the consequent need for health surveillance and maintenance practices must be continually updated. Equally important is the survivor's preparation for coping with any long-term consequences of disruption in family, academic, and social activities engendered by cancer treatment. Existing research has frequently focused on patients diagnosed in early childhood. Recent studies, however, suggest that the developmental disruptions may have special significance for the adolescent, who is already struggling with unique issues of separation, changes in peer relationships, emergent sexuality, and future academic and occupational goals. Previous investigations addressing the medical and psychiatric problems encountered by the long-term survivor of adolescent cancer are presented with a focus on current psychological adjustment and degree of emancipation achieved. A recent pilot study, from three major medical centers, collected extensive interview data on a group of long-term survivors and sibling controls. Preliminary analyses of these data are described, and areas for future research are suggested.
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Lansky SB, List MA, Herrmann CA, Ets-Hokin EG, DasGupta TK, Wilbanks GD, Hendrickson FR. Absence of major depressive disorder in female cancer patients. J Clin Oncol 1985; 3:1553-60. [PMID: 4056846 DOI: 10.1200/jco.1985.3.11.1553] [Citation(s) in RCA: 119] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This investigation evaluated the prevalence of depression in female patients who had cancer in any of five predesignated sites. Five hundred five women aged 17 to 80 (190 with breast cancer, 143 with gynecologic malignancies, 111 with melanoma, 37 with bowel cancer, and 24 with lymphoma) were randomly screened. Assessment included the Hamilton rating scale for depression, the Zung self-rating depression scale, the Karnofsky performance scale, and a 10-cm visual pain analogue line. The results revealed a mean Hamilton of 10.2 (range, 0 to 41; SD, 7.5), a mean Zung score of 35.3 (range, 11 to 68; SD, 9.6), a Karnofsky median score of 80, and a median pain score of 0. Scores on the Zung scale were highly correlated with those of the Hamilton scale (r = .75). Based on cutoff scores accepted as indicating depression (Hamilton greater than or equal to 20 and Zung greater than or equal to 50), patients were depressed. The depressed subgroup was in significantly more pain, experienced greater physical disability, and was more likely to have had prior episodes of depression as compared to the non-depressed women. The two best predictors of current depression were performance status (Karnofsky) and history of depression. No relationship was found between depression and other demographic variables or disease parameters (diagnosis, time since diagnosis, stage or phase of illness, and current treatment). Our findings indicate that the prevalence of major depression in cancer patients is lower than many previous studies have indicated and falls within the range seen in the general population.
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Abstract
Performance scales (i.e., Karnofsky), as they measure quality of life, have been used effectively as an integral part of repeated assessment of adult cancer patients for the last several years. An equally concise measure of performance has not been developed for children. The task of developing a scale to assess performance in infants, toddlers, school-age children, and adolescents is formidable, as the activity measured should be of equal merit at each age level. Although all childhood cancer patients could benefit from a simple-to-administer, rapid assessment, children with brain tumors have the greatest need for a repeated measure of performance. The goal, then, is to develop a simplified set of criteria that can be used for assessment of children with brain tumors during hospitalization, at the time of clinic visits, and/or at the time of diagnostic procedures when the patient is in a reasonable state of health. The assessment should be able to performed by nonprofessional persons.
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