Patients with limited-stage small-cell carcinoma of the lung (SCCL) were randomly assigned to a f... more Patients with limited-stage small-cell carcinoma of the lung (SCCL) were randomly assigned to a four-drug chemotherapy program consisting of methotrexate, doxorubicin, cyclophosphamide, and CCNU (MACC) or to a regimen consisting of cyclophosphamide, CCNU, and vincristine alternated with Adriamycin (Adria Laboratories, Columbus, Ohio) and vincristine (CCV/AV). All patients received 4,500 cGy, in a split course, to the primary tumor, mediastinum, and supraclavicular lymph node drainage areas and 3,000 cGy to the whole brain. After four cycles of chemotherapy, patients were randomly assigned to chemotherapy plus methanol extractable residue of BCG (MER-BCG) or no MER-BCG. The complete response frequencies were similar for the two regimens (54% and 48%) as were the median survivals (12.0 and 11.5 months) and the two-year survival rates (15% and 17%). Immunotherapy with MER-BCG did not prolong the time to disease progression or improve survival. Women had a greater chance of achieving a complete remission independent of performance status. There was a complex interaction between sex and the chemotherapy regimens that may have important implications for the design and stratification of future trials in SCCL.
Aspergillomas developed in pulmonary cavities produced by blastomycosis in 2 patients within two ... more Aspergillomas developed in pulmonary cavities produced by blastomycosis in 2 patients within two years of apparently successful treatment of blastomycosis with intravenously administered amphotericin B. The patients have been followed up for 76 and 12 months, respectively. Aside from the appearance of minimal hemoptysis in both, the presence of aspergillomas was not deleterious to these patients.
Two hundred ninety patients with a recent diagnosis of multiple myeloma were studied psychologica... more Two hundred ninety patients with a recent diagnosis of multiple myeloma were studied psychologically at the time of initial treatment. Physician- and patient-completed psychosocial scales were correlated with physical variables used to measure tumor load and physical status. A logistic regression model was used to analyze objective response to treatment. Indirect measures of response to treatment were obtained, and factors influencing survival duration were studied using a Cox regression model. If physical variables were controlled, there were no significant correlations between psychologic scores on entry and response to treatment or survival duration. Thus, the notion that mood influences disease outcome once the disease process has begun in patients with multiple myeloma is not supported by this data set.
The current study assessed the psychologic and neuropsychologic functioning of patients with smal... more The current study assessed the psychologic and neuropsychologic functioning of patients with small-cell lung cancer who were randomized in a large clinical trial to receive intensive doxorubicin, cyclophosphamide, etoposide (ACE)/cisplatin, cyclophosphamide, etoposide (PCE) chemotherapy and radiation therapy (RT) to the primary tumor and prophylactic whole-brain irradiation with (regimen I) or without (regimen II) warfarin. Patients' emotional states and cognitive functioning were assessed using the Profile of Mood States (POMS) and Trail Making B Test (Trails B), respectively. Two hundred ninety-five patients completed the POMS and Trails B at pretreatment, 224 patients after the completion of the ACE course of chemotherapy (week 9), and 177 patients after the completion of the PCE chemotherapy and RT (week 17). No differences on the POMS or Trails B measures were found between the two treatment arms as predicted, given that the only difference between the two treatment arms was the presence or absence of warfarin. Analysis of the POMS revealed that, overall, mean scores remained stable over the course of treatment; however, women showed a trend toward higher mean scores, which indicated a higher level of distress, compared with men at the pretreatment assessment. Examination of cognitive functioning, measured by the Trails B, revealed improved performance from baseline to post-ACE chemotherapy, which is consistent with a practice effect, but a significant worsening of Trails B scores post-RT compared with the pre-RT assessments, which is consistent with impaired cognitive functioning because of treatment (P < .0001). Emotional state, measured by the POMS, did not differ between the groups or change significantly over time in this study of small-cell lung cancer patients treated with a combination of chemotherapy and RT plus or minus warfarin. However, the pattern of relatively stable POMS scores and poorer Trails B performance post-RT suggested that this combination of chemotherapy and RT had a negative impact on cognitive functioning.
One hundred and seven patients with advanced pancreatic cancer and 1 1 1 patients with advanced g... more One hundred and seven patients with advanced pancreatic cancer and 1 1 1 patients with advanced gastric cancer, stratified for key medical and sociodemographic variables, were assessed with the Profile of Mood States before beginning combination chemotherapy in a national cancer clinical trials group. The pancreatic cancer patients had significantly higher self-ratings of depression, tension-anxiety, fatigue, confusion-bewilderment, and total mood disturbance; no difference was found in vigor or anger-hostility. These data support prior observations that patients with advanced pancreatic cancer experience significantly greater general psychological disturbance than patients with another type of advanced abdominal neoplasm. (Am J Psychiatry 143:982-986, 1986)
Survival data from eight Cancer and Leukemia Group B (CALGB) protocols were examined for patients... more Survival data from eight Cancer and Leukemia Group B (CALGB) protocols were examined for patients with lung cancer (N = 961), multiple myeloma (N = 577), gastric cancer (N = 231), pancreatic cancer (N = 174), breast cancer (N = 87), and Hodgkin's disease (N = 58). After accounting for differences in survival rate attributable to type of cancer, initial performance status, age, and 14 other protocol-specific prognostic indicators, the additional predictive value of socioeconomic status (SES) was evaluated. Race (white v non-white) was not a significant predictor of survival time, but income and education were. People with lower annual incomes (below $5,000 per year in the years 1977 to 1981) and those with lower educational level (grade school only) showed survival times significantly shorter than those with higher income or education, respectively. These survival differences were associated with, but could not be fully explained by, severity of disease at initial presentation. S...
1,000 medical and surgical inpatients referred for psychiatric conSULTATION SHOWED CONCURRENT PHY... more 1,000 medical and surgical inpatients referred for psychiatric conSULTATION SHOWED CONCURRENT PHYSICAL AND PSYCHIATRIC DISORDER IN 68.2% of cases. This is in accordance with epidemiological findings that these two types of morbidity have a positive association and coexist in 20-50% of patients. Depression was the commonest psychiatric disorder in all classes of organic disease and accounted for 53% of all psychiatric diagnoses. Organic brain syndromes, acute and chronic constituted 18% of referrals. Almost twice as many women as men were referred despite their nearly equal distribution in hospital population. One-third of the females had no positive medical diagnosis compared to one-fifth of the men. Alcoholism was a major problem in 8.9% of referrals. 7.8% of patients were referred following suicidal attempt. Of the 50 patients with cancer. 66% had depression. Too few medical patients with psychiatric complications are referred and adequately treated. Greater emphasis on teaching p...
Page 1. Sporotrichosis in Children Report of an Epidemic Bernhoff A. Dahl, MD; Peter M. Silberfar... more Page 1. Sporotrichosis in Children Report of an Epidemic Bernhoff A. Dahl, MD; Peter M. Silberfarb, MD; George A. Sarosi, MD; Robert J. Weeks; and Fred E. Tosh, MD Nine cases of lymphocutaneous sporotrichosis in children occurred in Kansas in the fall of 1969. ...
PURPOSE AND METHODS We studied the sleep architecture and psychologic state of 32 patients with b... more PURPOSE AND METHODS We studied the sleep architecture and psychologic state of 32 patients with breast or lung cancer compared with 32 age- and sex-matched, normal-sleeping volunteers and 32 otherwise healthy insomniacs. RESULTS Research findings indicate that lung cancer patients slept as poorly as did insomniacs, but underreported their sleep difficulties. Breast cancer patients slept similarly to normal-sleeping volunteers. No psychiatric disorders were detected in the cancer patients, and there were no significant differences in mood between lung and breast cancer patients. CONCLUSION Lung cancer patients appear to be unique in underestimating an objectively verified sleep difficulty. The adaptive mechanism of denial in these patients is discussed.
Consecutive admissions (58) to an acute psychiatric service were studied for the presence of thou... more Consecutive admissions (58) to an acute psychiatric service were studied for the presence of thought disturbance and soft neurologic signs. Forty-three percent of the patients studied showed neurologic impairment and 63 % evidence of thought disturbance. Sixty percent of those diagnosed schizophrenic showed neurologic impairment versus 29 % of the nonschizophrenics. Fifty-nine percent with thought disorder had neurologic impairment while 21 % without thought disorder had neurologic impairment. It is hypothesized that schizophrenia be viewed as a dysfunction of the central nervous system and that the presence of thought disorder in schizophrenic patients may be a reflection of this neurologic dysfunction, thus the relation of thought disorder and neurologic impairment may transcend diagnostic categories.
Patients with limited-stage small-cell carcinoma of the lung (SCCL) were randomly assigned to a f... more Patients with limited-stage small-cell carcinoma of the lung (SCCL) were randomly assigned to a four-drug chemotherapy program consisting of methotrexate, doxorubicin, cyclophosphamide, and CCNU (MACC) or to a regimen consisting of cyclophosphamide, CCNU, and vincristine alternated with Adriamycin (Adria Laboratories, Columbus, Ohio) and vincristine (CCV/AV). All patients received 4,500 cGy, in a split course, to the primary tumor, mediastinum, and supraclavicular lymph node drainage areas and 3,000 cGy to the whole brain. After four cycles of chemotherapy, patients were randomly assigned to chemotherapy plus methanol extractable residue of BCG (MER-BCG) or no MER-BCG. The complete response frequencies were similar for the two regimens (54% and 48%) as were the median survivals (12.0 and 11.5 months) and the two-year survival rates (15% and 17%). Immunotherapy with MER-BCG did not prolong the time to disease progression or improve survival. Women had a greater chance of achieving a complete remission independent of performance status. There was a complex interaction between sex and the chemotherapy regimens that may have important implications for the design and stratification of future trials in SCCL.
Aspergillomas developed in pulmonary cavities produced by blastomycosis in 2 patients within two ... more Aspergillomas developed in pulmonary cavities produced by blastomycosis in 2 patients within two years of apparently successful treatment of blastomycosis with intravenously administered amphotericin B. The patients have been followed up for 76 and 12 months, respectively. Aside from the appearance of minimal hemoptysis in both, the presence of aspergillomas was not deleterious to these patients.
Two hundred ninety patients with a recent diagnosis of multiple myeloma were studied psychologica... more Two hundred ninety patients with a recent diagnosis of multiple myeloma were studied psychologically at the time of initial treatment. Physician- and patient-completed psychosocial scales were correlated with physical variables used to measure tumor load and physical status. A logistic regression model was used to analyze objective response to treatment. Indirect measures of response to treatment were obtained, and factors influencing survival duration were studied using a Cox regression model. If physical variables were controlled, there were no significant correlations between psychologic scores on entry and response to treatment or survival duration. Thus, the notion that mood influences disease outcome once the disease process has begun in patients with multiple myeloma is not supported by this data set.
The current study assessed the psychologic and neuropsychologic functioning of patients with smal... more The current study assessed the psychologic and neuropsychologic functioning of patients with small-cell lung cancer who were randomized in a large clinical trial to receive intensive doxorubicin, cyclophosphamide, etoposide (ACE)/cisplatin, cyclophosphamide, etoposide (PCE) chemotherapy and radiation therapy (RT) to the primary tumor and prophylactic whole-brain irradiation with (regimen I) or without (regimen II) warfarin. Patients' emotional states and cognitive functioning were assessed using the Profile of Mood States (POMS) and Trail Making B Test (Trails B), respectively. Two hundred ninety-five patients completed the POMS and Trails B at pretreatment, 224 patients after the completion of the ACE course of chemotherapy (week 9), and 177 patients after the completion of the PCE chemotherapy and RT (week 17). No differences on the POMS or Trails B measures were found between the two treatment arms as predicted, given that the only difference between the two treatment arms was the presence or absence of warfarin. Analysis of the POMS revealed that, overall, mean scores remained stable over the course of treatment; however, women showed a trend toward higher mean scores, which indicated a higher level of distress, compared with men at the pretreatment assessment. Examination of cognitive functioning, measured by the Trails B, revealed improved performance from baseline to post-ACE chemotherapy, which is consistent with a practice effect, but a significant worsening of Trails B scores post-RT compared with the pre-RT assessments, which is consistent with impaired cognitive functioning because of treatment (P < .0001). Emotional state, measured by the POMS, did not differ between the groups or change significantly over time in this study of small-cell lung cancer patients treated with a combination of chemotherapy and RT plus or minus warfarin. However, the pattern of relatively stable POMS scores and poorer Trails B performance post-RT suggested that this combination of chemotherapy and RT had a negative impact on cognitive functioning.
One hundred and seven patients with advanced pancreatic cancer and 1 1 1 patients with advanced g... more One hundred and seven patients with advanced pancreatic cancer and 1 1 1 patients with advanced gastric cancer, stratified for key medical and sociodemographic variables, were assessed with the Profile of Mood States before beginning combination chemotherapy in a national cancer clinical trials group. The pancreatic cancer patients had significantly higher self-ratings of depression, tension-anxiety, fatigue, confusion-bewilderment, and total mood disturbance; no difference was found in vigor or anger-hostility. These data support prior observations that patients with advanced pancreatic cancer experience significantly greater general psychological disturbance than patients with another type of advanced abdominal neoplasm. (Am J Psychiatry 143:982-986, 1986)
Survival data from eight Cancer and Leukemia Group B (CALGB) protocols were examined for patients... more Survival data from eight Cancer and Leukemia Group B (CALGB) protocols were examined for patients with lung cancer (N = 961), multiple myeloma (N = 577), gastric cancer (N = 231), pancreatic cancer (N = 174), breast cancer (N = 87), and Hodgkin's disease (N = 58). After accounting for differences in survival rate attributable to type of cancer, initial performance status, age, and 14 other protocol-specific prognostic indicators, the additional predictive value of socioeconomic status (SES) was evaluated. Race (white v non-white) was not a significant predictor of survival time, but income and education were. People with lower annual incomes (below $5,000 per year in the years 1977 to 1981) and those with lower educational level (grade school only) showed survival times significantly shorter than those with higher income or education, respectively. These survival differences were associated with, but could not be fully explained by, severity of disease at initial presentation. S...
1,000 medical and surgical inpatients referred for psychiatric conSULTATION SHOWED CONCURRENT PHY... more 1,000 medical and surgical inpatients referred for psychiatric conSULTATION SHOWED CONCURRENT PHYSICAL AND PSYCHIATRIC DISORDER IN 68.2% of cases. This is in accordance with epidemiological findings that these two types of morbidity have a positive association and coexist in 20-50% of patients. Depression was the commonest psychiatric disorder in all classes of organic disease and accounted for 53% of all psychiatric diagnoses. Organic brain syndromes, acute and chronic constituted 18% of referrals. Almost twice as many women as men were referred despite their nearly equal distribution in hospital population. One-third of the females had no positive medical diagnosis compared to one-fifth of the men. Alcoholism was a major problem in 8.9% of referrals. 7.8% of patients were referred following suicidal attempt. Of the 50 patients with cancer. 66% had depression. Too few medical patients with psychiatric complications are referred and adequately treated. Greater emphasis on teaching p...
Page 1. Sporotrichosis in Children Report of an Epidemic Bernhoff A. Dahl, MD; Peter M. Silberfar... more Page 1. Sporotrichosis in Children Report of an Epidemic Bernhoff A. Dahl, MD; Peter M. Silberfarb, MD; George A. Sarosi, MD; Robert J. Weeks; and Fred E. Tosh, MD Nine cases of lymphocutaneous sporotrichosis in children occurred in Kansas in the fall of 1969. ...
PURPOSE AND METHODS We studied the sleep architecture and psychologic state of 32 patients with b... more PURPOSE AND METHODS We studied the sleep architecture and psychologic state of 32 patients with breast or lung cancer compared with 32 age- and sex-matched, normal-sleeping volunteers and 32 otherwise healthy insomniacs. RESULTS Research findings indicate that lung cancer patients slept as poorly as did insomniacs, but underreported their sleep difficulties. Breast cancer patients slept similarly to normal-sleeping volunteers. No psychiatric disorders were detected in the cancer patients, and there were no significant differences in mood between lung and breast cancer patients. CONCLUSION Lung cancer patients appear to be unique in underestimating an objectively verified sleep difficulty. The adaptive mechanism of denial in these patients is discussed.
Consecutive admissions (58) to an acute psychiatric service were studied for the presence of thou... more Consecutive admissions (58) to an acute psychiatric service were studied for the presence of thought disturbance and soft neurologic signs. Forty-three percent of the patients studied showed neurologic impairment and 63 % evidence of thought disturbance. Sixty percent of those diagnosed schizophrenic showed neurologic impairment versus 29 % of the nonschizophrenics. Fifty-nine percent with thought disorder had neurologic impairment while 21 % without thought disorder had neurologic impairment. It is hypothesized that schizophrenia be viewed as a dysfunction of the central nervous system and that the presence of thought disorder in schizophrenic patients may be a reflection of this neurologic dysfunction, thus the relation of thought disorder and neurologic impairment may transcend diagnostic categories.
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