Julian W. Proctor

A Screening Tool to Enhance Clinical Trial Participation at a Community Center Involved in a Radiation Oncology Disparities Program

PURPOSE To investigate the effectiveness of a screening tool to enhance clinical trial participation at a community radiation oncology center involved in a National Cancer Institute-funded disparities program but lacking on-site clinical trials personnel. PATIENTS AND METHODS The screening form was pasted to the front of the charts and filled out for all new patients over the 9-month period of the study, during which time five external beam radiation therapy (EBRT) trials and a patient perception study were open for accrual. Patient consent was obtained by assorted personnel at several different sites. Patients potentially eligible for a trial were identified and approached by one of the clinic staff. Patients who were under- or uninsured, age > 80 years, members of an racial/ethnic minority, or recipients of medical assistance were identified as at risk for health care disparities and were offered patient navigator services. RESULTS Of 196 patients consulted during the study, 144 were treated with EBRT. Of the 24 patients eligible for EBRT trials, 23 were approached (one had an incomplete screening form), and 15 accepted. Of 77 patients eligible for a patient perception trial, 72 were approached (five had incomplete forms), and 45 accepted. The eligibility and acceptance rates for EBRT trials were similar for disparities and nondisparities patients. Screening was completed for 96 patients (67%). CONCLUSION When completed, the screening tool ensured clinical trial accrual. The major factor limiting overall accrual was a shortage of available trials.

A SIMPLE AND EFFECTIVE DAILY PAIN MANAGEMENT METHOD FOR PATIENTS RECEIVING RADIATION THERAPY FOR PAINFUL BONE METASTASES

PURPOSE The incidence of painful bone metastases increases with longer survival times. Although external beam radiation therapy (EBRT) is an effective palliative treatment, it often requires several days from the start of treatment to produce a measurable reduction in pain scores and a qualitative amelioration of patient pain levels. Meanwhile, the use of analgesics remains the best approach early on in the treatment course. We investigated the role of radiation therapists as key personnel for collecting daily pain scores to supplement assessments by physician and oncology nursing staff and manage pain more effectively during radiation treatment. METHODS AND MATERIALS Daily pain scores were obtained by the radiation therapists for 89 patients undertaking a total of 124 courses of EBRT for bone metastases and compared with pretreatment pain scores. The majority of patients (71%) were treated to 30 Gy (range, 20-37.5) in 10 fractions (range, 8-15 fractions). RESULTS One hundred nineteen treatment courses (96%) were completed. Pain scores declined rapidly to 37.5%, 50%, and 75% of the pretreatment levels by Days 2, 4, and 10, respectively. Pain was improved in 91% of patients with only 4% of worse pain at the end of treatment. Improved pain scores were maintained in 83% of patients at 1-month follow-up, but in 35% of them, the pain was worse than at the end of treatment. CONCLUSIONS Collection of daily pain scores by radiation therapists was associated with an effective reduction in pain scores early on during EBRT of painful osseous metastases.

Variations in the Level of Haematogenous Antitumour Immunity during Progressive Tumour Growth and Spontaneous Blood-Borne Metastatic Spread

Inbred DBA2 mice bearing the syngeneic 1699 mammary tumour in the hind limb were challenged intravenously with 125IUdR-labelled single 1699 cell suspensions, and the amount of radioactivity in the lungs compared 20--24 h later with that in the lungs of normal mice or in those of mice bearing the antigenically unrelated syngeneic SaD2 tumour. An immunologically specific decrease in radioactivity was evident at variable periods of time after tumour induction, depending on the number of cells used to induce the leg tumours, but fell below that in normal mice as the leg tumours progressed beyond a weight of approximately 1 g. As assessed by microscopic scanning of serial histological sections of the same lungs the incidence of spontaneous metastases rose to between 80 and 100% immediately the amount of cell loss from the lungs of the tumour-bearing mice reached that of the normal controls. This extremely rapid series of events does not allow a definitive conclusion as to whether immunity failed and led to metastatic spread or vice versa, but does underline the strong association of immunity with the blood-borne dissemination of tumour cells in this tumour system. Following excision of tumours, in no instance was immunity detected 14 days later, and in a single experiment did not reach detectable limits until 25 days after excision, at a time when the lung metastases were observed mostly to have regressed spontaneously.

Development of a bioassay for the antitumor activity of biological response modifiers of the reticuloendothelial stimulant class

SummaryFollowing intravenous administration of various doses of DiLuzio glucan, Wellcome C. parvum, or BCG, the increase in clearance of intravenous 125IUdR-radiolabeled B16 tumor cells from the lung correlated with a subsequent reduction in the outgrowth of pulmonary tumor nodules. The ranges of values for tumor cell clearance were very much narrower for most groups of animals than the ranges obtained for the number of pulmonary tumor nodules in similar groups, allowing 2–3 times the definition of data with the former method.

Mitogenic augmentation of T cells from immunodepressed cancer patients by a murine interleukin-1 (IL-1).

An interleukin-1 (IL-1) lymphocyte-activating factor, with an approximate molecular weight of 13,000-16,000 was isolated from the culture supernatants of a murine macrophage-like cell line, P388D1. Contrary to the general belief that murine mediator is incapable of stimulating human lymphocyte mitogenic responses, leukoagglutinin (LA)-induced mitogenesis of peripheral blood lymphocyte (PBL) were significantly affected by murine IL-1. On one hand, when PBL were obtained from either normal healthy individuals or from cancer patients who still possessed normal levels of general immunocompetence, their mitogenic responses were not augmented any further by the murine mediator. Instead, slight but significant suppression were noted in most cases. On the other hand, the LA-induced responses of PBL from 5 immunodepressed cancer patients were markedly augmented by murine IL-1.