Ernest I. Kohorn

Psychosocial benefits of a cancer support group

Many clinicians use group support to reduce the psychosocial difficulties of persons with cancer. This study compared the long‐term benefits of a thematic counseling model used both as a structure for group support and for counseling patients individually. The thematic model included eight counseling sessions focused on information about cancer and positive health strategies such as progressive relaxation, diet, and exercise. The psychosocial status of women newly diagnosed with gynecologic cancer was assessed before the counseling, immediately after counseling, and again 6 months later. The women who participated in thematic counseling were significantly less depressed and less anxious and had more knowledge of their illness, better relationships with care givers, fewer sexual difficulties, and more participation in leisure activities. Data confirmed the model to be equally helpful whether it was used as a structure for individual counseling or more cost‐effective group counseling. This model is easily adaptable to the needs of persons with other forms of cancer.

The Value of Urodynamic Testing in Stress Urinary Incontinence

Preoperative urodynamic testing for the identification of specific types of urinary incontinence was found useful to select an appropriate operative procedure. Failure of the operation to relieve stress incontinence was unusual in 346 patients followed for a minimum of 2 years. Of the total group of patients with stress incontinence 27 per cent also had detrusor instability identified urodynamically preoperatively. However, identification of the syndrome is of limited prognostic significance since the majority of these patients had no difficulty with the syndrome postoperatively and some other patients appeared to have the syndrome only postoperatively.

Pretreatment prognostic factors in carcinoma of the uterine cervix: a multivariable analysis of the effect of age, stage, histology and blood counts on survival.

From January, 1953 through December, 1977, 910 previously untreated patients with invasive carcinoma of the uterine cervix (Stages IB-IVB) were seen at Yale-New Haven Medical Center and affiliated hospitals. An extensive retrospective analysis was undertaken in an attempt to identify prognostically significant pretreatment factors. The patients studied were uniformly staged according to the current FIGO recommendations and the majority of patients had been treated under standardized protocols combining external beam radiation therapy and intracavitary radium. Pretreatment parameters, including prior medical illnesses, gross tumor characteristics, histology, and blood parameters were studied, employing stepwise Cox regression analyses to identify the possible effects of all factors and all two-way interactions among factors on survival, disease-free survival and freedom from local-regional failure, controlling for stage of disease. FIGO stage, patient age at diagnosis, pretreatment neutrophil count and hematocrit, uterine position, prior subtotal hysterectomy, histology, history of diabetes mellitus and number of pregnancies were all found to have prognostic significance. When other factors including stage of disease were controlled for, increased tumor size was associated with decrease disease-free survival and local-regional control rates.

Borderline ovarian tumors

Abstract Ninety-four patients with borderline ovarian tumors were retrospectively analyzed for clinical features, treatments, and survival characteristics. There were 46 patients with FIGO stage IA cancer, 7 with stage IB, 20 with stage IC, 4 with stage IIB, 5 with stage IIC, 5 with stage IIIA, 3 with stage IIIB, and 4 with stage IIIC tumors. Seventy patients had at least a total abdominal hysterectomy and bilateral salpingo-oophorectomy, 20 patients had conservative surgery including unilateral salping-oophorectomy or ovarian cystectomy, and 4 patients had bilateral salpingo-oophorectomy. Fifteen patients with stage I disease received adjuvant melphalan therapy and 2 received external beam radiation for concomitant gynecologic cancers; 7 with stage II tumors received adjuvant melphalan therapy and 1 received external beam radiation; and 5 with stage III tumors received melphalan therapy and 6 patients received cisplatin-based combination chemotherapy. Follow-up ranged from 1 to 117 months, with a median of 33.5 months. Eighty-seven patients were alive. Seven patients died, two of disease. The overall 5-year survival rate was 83.0%; those treated with adjuvant therapy had a 79.5% survival, whereas the others had 84.6% survival. Second-look surgery was performed in 10 patients; six results were negative after melphalan therapy, one was negative after cisplatin combination therapy, and one was negative after no adjuvant treatment. Two patients had positive second-look surgery, one with stage IIIC disease treated with a cisplatin combination and the other with stage IC disease treated with melphalan. This review did not demonstrate that patients with borderline ovarian tumors benefited from adjuvant therapy.

Assessing Sexual Function and Dyspareunia with the Female Sexual Function Index (FSFI) in Women with Vulvodynia

Using the Female Sexual Function Index (FSFI; Rosen et al., 2000), we assessed forty-two women with vulvodynia. Internal consistency was high (Cronbachs alphas = 0.90–0.97) for all scales. We compared scale scores to published healthy and patient sample data and found very large effect sizes (1.15–2.83), which indicated that women with vulvodynia reported significantly worse overall sexual function than women without sexual dysfunction and greater pain with sexual intercourse than women with female sexual arousal disorder. Results highlight difficulties experienced across all domains of sexual function, particularly with regard to dyspareunia, for women with vulvodynia. Findings also support the internal consistency and discriminant validity of the FSFI.

Gestagens and endometrial carcinoma

Abstract The current state of knowledge of the clinical and cellular effects of progestational agents in endometrial carcinoma is reviewed. High dose gestagens have an overall response rate of 32%, with most response in well-differentiated tumors. Nevertheless, 15% of poorly differentiated tumors do respond. Tumor differentiation rather than patient age is the discriminating factor in response. The effect of the hormone is a direct one on the cell but the precise mechanism of action at the cellular level awaits elucidation. Data are presented for a more rational approach to hormone administration.

HIGH LEVEL EXPRESSION OF FMS PROTO-ONCOGENE mRNA IS OBSERVED IN CLINICALLY AGGRESSIVE HUMAN ENDOMETRIAL ADENOCARCINOMAS

Six micron paraffin sections of paraformaldehyde-fixed endometrial currettings of 21 benign and neoplastic endometrial specimens were assayed for tumor cell-specific oncogene expression by in situ hybridization with probes for six oncogenes, beta-actin, and the E. coli plasmid pBR322. In the benign hyperplasias and invasive adenocarcinomas, multiple oncogenes, including erbB, fms, c-myc, and Ki-ras were expressed at significant levels. For the adenocarcinomas, statistical analysis demonstrated that high levels of expression of fms-complementary mRNA correlated strongly with clinicopathologic features (high FIGO histologic grade, high FIGO clinical stage, deep myometrial penetration) predictive of aggressive clinical behavior and poor outcome. The authors discuss the role which M-CSF receptor (the fms gene product) and locally-produced M-CSF may play in the development of the observed aggressively-malignant phenotypes. They also propose that pre-hysterectomy assay of fms gene expression in endometrial currettings in FIGO Stage I patients might be clinically useful to help identify preoperatively those patients with deep myometrial penetration or other locoregional spread.

Ovarian germ cell malignancies: The Yale University experience

Abstract Eighty-one patients with ovarian germ cell malignancies (immature teratoma 29, dysgerminoma 26, endodermal sinus tumors 15, mixed germ cell tumor 8, other 3) seen or consulted on at Yale University over a 15 year period are presented. Initial therapy was successful in 70 of 81 (86.4%) patients and 75 (92.6%) are currently alive and disease free. Early stage dysgerminomas may be safely treated with surgery whereas advanced disease is exquisitely sensitive to vincristine, actinomycin D, and cyclophosphamide (VAC) therapy. Early stage immature teratoma is uniformly successfully treated with short-term VAC whereas advanced disease requires longer treatment. Early stage endodermal sinus tumor (EST) and mixed germ cell tumors may be effectively treated with VAC or platinum-based therapy but advanced disease should be treated with paltinum-based regimens. Serial alpha fetoprotein assays should determine duration of therapy in tumors containing EST elements. Conservative surgery to preserve reproductive function is appropriate for all patients with early stage ovarian germ cell malignancies and selected patients with advanced disease.

Colony-stimulating factor-1 in primary ascites of ovarian cancer is a significant predictor of survival

OBJECTIVE Our purpose was to determine whether the concentration of colony-stimulating factor in ascites of ovarian carcinoma is a prognostic factor for survival. STUDY DESIGN Forty-four ascites samples from patients undergoing primary surgery for ovarian carcinoma were measured for colony-stimulating factor-1 by radioimmunoassay. Retrospective analysis of clinical data allowed comparison of accepted prognostic factors to ascites colony-stimulating factor-1 concentration for impact on survival by means of life-table analysis (Kaplan-Meier) by the Wilcoxon test and the Cox regression methods. RESULTS In patients with advanced disease (International Federation of Gynecology and Obstetrics stages III and IV, n = 37) ascites colony-stimulating factor-1 concentration levels below a critical cutoff of 8.59 ng/ml were associated with longer overall survival (p < 0.05) and were a better predictor of survival than any other prognostic factor except zero residual disease after cytoreduction. International Federation of Gynecology and Obstetrics stage, tumor histologic type, malignant cells in fluid, grade of tumor, age, and performance status at presentation were not predictive of outcome. CONCLUSION Colony-stimulating factor-1 in ascites may be an independent indicator of prognosis in patients with epithelial ovarian cancer.

Adenocarcinoma of the endometrium

Abstract Analysis of 265 patients with adenocarcinoma of the endometrium treated at the Yale-New Haven Medical Center showed that older patients and those with an undifferentiated tumor had a less favorable prognosis. To permit comparison between the groups who received preoperative radiotherapy with one that received operation only, it was found necessary to adjust for differences in the incidences of the histologic grades among these two groups. This had a significant influence upon the interpretation of the survival rates in the patient with a histologically well-differentiated tumor. No relationship could be determined between survival and the size of the uterus in these patients nor between the radiation response (RR), sensitization response (SR), and the response of the tumor to radiotherapy. It is the feeling of the authors that histologic grade may prove the best subdivision for evaluation of results of tumor confined to the uterus.