Nancy W. Fawzy

A structured psychoeducational intervention for cancer patients.

This manual is an attempt to standardize a strutured short-term psychoeducational intervention for breast cancer patients. It is intended to be used as an integral part of a comprehensive treatment program that combines standard medical care with psychological care. The manual is divided into two parts. The first section is for health care personnel who will be implementing the intervention. An brief overview of the psychological issues and impact of cancer is provided. Previous interventions for cancer patients are historically reviewed (...). The second part of the manual is intented for direct patient use

Advantages of Concurrent Biochemotherapy Modified by Decrescendo Interleukin-2, Granulocyte Colony-Stimulating Factor, and Tamoxifen for Patients With Metastatic Melanoma

PURPOSE Concurrent biochemotherapy results in high response rates but also significant toxicity in patients with metastatic melanoma. We attempted to improve its efficacy and decrease its toxicity by using decrescendo dosing of interleukin-2 (IL-2), posttreatment granulocyte colony-stimulating factor (G-CSF), and low-dose tamoxifen. PATIENTS AND METHODS Forty-five patients with poor prognosis metastatic melanoma were treated at a community hospital inpatient oncology unit affiliated with the John Wayne Cancer Institute (Santa Monica, CA) between July 1995 and September 1997. A 5-day modified concurrent biochemotherapy regimen of dacarbazine, vinblastine, cisplatin, decrescendo IL-2, interferon alfa-2b, and tamoxifen was repeated at 21-day intervals. G-CSF was administered beginning on day 6 for 7 to 10 days. RESULTS The overall response rate was 57% (95% confidence interval, 42% to 72%), the complete response rate was 23%, and the partial response rate was 34%. Complete remissions were achieved in an additional 11% of patients by surgical resection of residual disease after biochemotherapy. The median time to progression was 6.3 months and the median duration of survival was 11.4 months. At a maximum follow-up of 36 months (range, 10 to 36 months), 32% of patients are alive and 14% remain free of disease. Decrescendo IL-2 dosing and administration of G-CSF seemed to reduce toxicity, length of hospital stay, and readmission rates. No patient required intensive care unit monitoring, and there were no treatment-related deaths. CONCLUSION The data from this study indicate that the modified concurrent biochemotherapy regimen reduces the toxicity of concurrent biochemotherapy with no apparent decrease in response rate in patients with poor prognosis metastatic melanoma.

Group therapy in the cancer setting

The importance of psychiatric interventions designed to assist cancer patients in dealing with diagnosis and treatment has increased dramatically as survival rates have improved along with advances in medical care [1–3]. According to Holland [4], the goals of these interventions are to decrease feelings of alienation, isolation, helplessness, and being neglected; to reduce anxiety about the treatments; and to assist in clarifying misperception and misinformation. Such interventions, designed to help individuals to feel less helpless and hopeless have the additional benefit of encouraging more responsibility to get well and compliance with medical regimens. Today’s patients, aware of the benefits of these psychosocial therapeutic interventions, often specifically request such services. One intervention category that has received major attention is that of group therapy. The purpose of this article is to review those group therapy studies that have been designed specifically for cancer populations. It will describe these interventions addressing the type of patient population, research design, treatments, and outcomes. Outcome measures include changes in coping, affective state, quality of life (QOL), knowledge regarding disease and treatment, compliance, changes in physical status, and recurrence and survival. The value of group versus individual interventions will be discussed and a model of group intervention will be explored.