Martin Feuerman

The Memorial Symptom Assessment Scale Short Form (MSAS-SF)

The Memorial Symptom Assessment Scale Short Form (MSAS‐SF), an abbreviated version of the Memorial Symptom Assessment Scale, measures each of 32 symptoms with respect to distress or frequency alone. A physical symptom subscale (PHYS), psychologic symptom subscale (PSYCH), and global distress index (GDI) can be derived from the Short Form. We validated the MSAS‐SF in a population of cancer patients.

Survival of patients who had salvage castration after failure on bicalutamide monotherapy for stage (D2) prostate cancer

Abstract Patients with hormone-naive stage D2 prostate cancer often benefit from castration, This treatment, however, frequently produces many unacceptable physical and psychological side effects, especially in younger and sexually active patients. Bicalutamide is an oral antiandrogen with excellent tolerance and preservation of sexual function. Three institutions participated in phase II and III trials of bicalutamide monotherapy (50 mg daily) as primary therapy in hormone-naive patients with stage D2 prostate cancer. Upon bicalutamide failure, all patients underwent castreation and were followed until death. Fifty-four patients received bicalutamide 50 mg orally once a day. One patient (2%) had complete response, 9 patients (17%) had partial response, and 27 patients (50%) had stable disease. Seventeen patients (31%) had progressive disease. The median time to bicalutamide failure was 47.4 weeks, 70.5 weeks for the responders vs. 25.4 weeks for the nonresponders (p < 0.001). The median survival time after the sequential use of bicalutamide and castration was 119.2 weeks for all 54 patients, 162.0 weeks for the responders, and 73.5 weeks for nonresponders (p < 0.0001). The median survival time after initiation of castration was 71.1 weeks for all 54 patients, 91.4 weeks for bicalutainide responders, and 42.1 weeks for nonresponders (p < 0.01). In hormone-naive patients with stage D? prostate cancer, sequential treatment with bicalutamide monotherapy followed by castration upon failure may produce survival time within the range reported for initial treatment with castration. Thus, considering the favorable quality of life profile of bicalutamide, further studies are needed to define the role of sequential hormonal therapy in younger sexually active patients.

Limitations in testing for attitudes toward cancer

A Cancer Attitude And Knowledge Questionnaire was administered to two groups of incoming first year medical students and to one of these groups at the end of their second year. The same questionnaire, except for the questions dealing with cognitive knowledge, was also used to assess the attitudes of practicing oncologists. There was a wide variation in the responses to the attitudinal items in all groups. In view of many inconsistencies in the results, a rigorous analysis of the instrument was carried out. The subscales derived from the Cancer Attitude Survey were found to lack adequate reliability. The only part of the attitudinal test found to be reliable and discriminatory was the semantic differential developed by the authors. It is, therefore, concluded that the currently used techniques are inadequate, and there is a need for a new multidimensional approach to the assessment of attitudes toward cancer.

Cancer incidence and mortality in Newark, N. J. 1970–1974: A national comparison

New Jersey has acquired the invidious label “Cancer Alley U.S.A.” based upon a national cancer mortality analysis. However, a cancer incidence survey conducted in Newark, the largest metropolitan industrial city in New Jersey, showed that age‐adjusted Newark rates for all sites were comparable to the Third National Cancer Survey (TNCS) and Surveillance, Epidemiology and End Results (SEER) populations, except for black males who had statistically lower rates compared with the SEER population only. However, Newark did have statistically higher incidence of the following: (a) esophagus cancer among white men, black men, and black women; and (b) cervix, uterus, ovary, and bladder cancers among black women. Age‐adjusted Newark cancer mortality for all sites was not statistically different from the SEER experience, except for an excessive cancer mortality among white men for stomach and esophagus; white women for stomach, colon‐rectum, and uterus; black men for esophagus and colon‐rectum; black women for colon‐rectum, cervix, uterus, and ovary. An analysis of Newark mortality/incidence ratios suggests that the excessive cancer burden for the majority of sites studied resulted from poor end results of therapy, probably due to either late diagnosis, poor compliance, and/or suboptimal therapy. The Newark data cast doubt on the validity of the use of mortality data only in referring pejoratively to New Jersey as “Cancer Alley U.S.A.” Cancer 47:1047–1053, 1981.

Treatment benefit functions for a drug abuse rehabilitation treatment system

While generally justifying the large amount of money invested in the treatment effort, evaluation studies of treatment centers for drug addiction do not offer a rational method of allocating scarce resources among the various available treatment programs. The problem is further confounded by different costs associated with the different programs and also because clients rarely complete the prescribed treatment. We developed functional relationships between treatment outcomes and time in treatment that allow the inclusion of probable length of stay of patients and cost per week for a particular treatment program in the evaluation considerations. The model evolved from a drug addiction treatment system operating in Newark, New Jersey consisting of six different treatment centres. Treatment outcome measures are derived from a psychosocial questionnaire which was administered to patients at appropriate time intervals. The questionnaire probed into the important facets of human behavior as related to the use or non-use of drugs for non-medical reasons. Gompertz curves reflecting treatment benefit are computed for each treatment center by least square fit of the collected data to appropriate differential equations and used together with cost of treatment and treatment retention rates to compute expected net benefit for each treatment center. These enable the researcher to find the treatment centers with the best treatment outcome or alternately with the best expected cost benefit ratio for any patient type.

Standard deviation of a temperature coefficient

This paper considers the problem of finding the standard deviation of a temperature coefficient utilized in cell physiology, which is actually a ratio of two random variables raised to a power. An approximate formula and a simple derivation are provided, and a numerical example (utilizing data given to the author) is presented. The formula is a simple generalization of the special case of the well‐known formula for the variance of a ratio.

Determining Differences in Rates Corresponding to a Given Significance Level.

The well‐known Chi‐square test can be used to determine whether the difference in two rates is statistically significant, and if so, at what level of significance. This paper discusses the related question of how large a difference in rates must be (when one rate is held constant) in order to show statistical significance at a given level of significance. An illustrative example, adapted from data appearing in the biostatistical literature, is provided.