Pamela N. Schultz

Anaplastic carcinoma of the thyroid: A clinicopathologic study of 121 cases

One hundred twenty‐one cases of anaplastic carcinoma of the thyroid treated at M. D. Anderson Cancer Center, Houston, were reviewed. Anaplastic carcinoma is a rapidly growing neoplasm with a dismal prognosis. The mean survival of our patients was 7.2 ± 10 months. A significant percentage of our patients (35%) had areas of well‐differentiated thyroid carcinoma elsewhere, supporting the hypothesis that anaplastic thyroid carcinoma arises from preexisting well‐differentiated thyroid carcinoma. Twenty‐four of 30 tumors analyzed (84%) stained for keratin, 28 (93.3%) stained for vimentin, and ten (33%) stained for epithelial membrane antigen. Younger patients lived longer than older patients, and patients whose disease was earlier‐stage at presentation responded better than patients with metastases at presentation. Radical surgery alone did not significantly increase survival duration over less radical surgery. The role of multimodality therapy needs further evaluation.

Estrogen receptor: A prognostic factor in breast cancer

Two‐hundred‐seventeen women with primary breast carcinoma had an estrogen receptor determination tested by both the dextran‐coated charcoal assay and sucrose density gradient. The results were correlated with the disease‐free interval, survival, response to hormone therapy or chemotherapy, and site of recurrent disease. The disease‐free interval (DFI) was significantly longer in premenopausal patients with estrogen receptor positive (ER+) determination compared with premenopausal patients with estrogen receptor negative (ER‐) determinations, irrespective of nodal involvement (P < 0.05). There was no difference between the postmenopausal patients.

Parathyroid carcinoma: A 22-year experience

Because parathyroid carcinoma is rare, clear consensus is not available regarding the optimal management of patients with this condition. Treatment strategies generally derive from clinical and anecdotal experiences. We report our experience with this entity.

Health profiles in 5836 long-term cancer survivors

Increasingly, prolonged survival follows the diagnosis of cancer. Cancer therapies result in complex and lasting health effects that create unique health‐care needs for the survivors but are poorly understood (especially in survivors of adult cancers). Cancer survivors were asked to respond to a mailed health survey and provide medical and social information pertaining to their cancer experience. Information about demographics and perceived disease‐related medical problems was analyzed. We analyzed the response of 5,836 survivors of adult cancers. Two‐thirds of the responses came from women, and the response rate was 51% in both sexes. The mean interval since cancer diagnosis was 18.0 ± 8.5 years. Younger survivors and men were more likely to report that cancer had affected their health. The health effect most commonly reported by survivors was arthritis/osteoporosis (26% of respondents). Survivors of Hodgkins disease prominently reported thyroid and lung problems (33.8% of responders with the diagnosis). Prior diagnosis of lymphoma was associated with frequent mention of memory loss (14.7%). The passage of time decreased some perceived effects (memory loss) but increased others (arthritis/osteoporosis, cataracts). Compared with the general population, the incidence of several age‐ and gender‐adjusted health conditions in cancer survivors is different. This group of cancer survivors reported generally good health but outlined multiple lasting medical problems. The health survey described represents 1 approach to the development of comprehensive information about the health needs of cancer survivors.

Differentiated thyroid cancer in children and adolescents: Clinical outcome and mortality after long‐term follow‐up

Children and adolescents with differentiated thyroid cancer (DTC) have a good prognosis and prolonged survival even when extensive regional disease or lung metastases are present at the diagnosis; very‐long‐term follow‐up is needed to appreciate what, if any, impact the disease may exert on the ultimate outcome.

Health profiles and quality of life of 518 survivors of thyroid cancer.

Available literature describes the long‐term outcome of thyroid cancer survivors with respect to thyroid cancer but not their overall medical and social well‐being.

Clinical use of molecular information in the management of multiple endocrine neoplasia type 2A

Abstract. One hundred and ninety‐seven members of 28 kindreds with multiple endocrine neoplasia type 2A (MEN 2A) were screened for RET proto‐oncogene exon 10 and 11 mutations. Seventy‐one known affected individuals had mutations of codons 609, 618, 620 or 634, whereas 53 unaffected individuals had no abnormalities. Nineteen out of 54 individuals of unknown status, mostly children, had RET mutations. Four of these children had thyroidectomy based on this analysis and were found to have C‐cell abnormalities. We identified one false negative mutation analysis because of a codon 691 polymorphism. We conclude that RET mutational analysis is a cost‐effective and accurate method for determination of gene carrier status in MEN 2A.

Cancer survivors. Work related issues.

New and more effective treatments for cancer have resulted in individuals living longer with a better quality of life. Many more survivors are employed in the workplace. Cancer is no longer only an issue for survivors and their families; it has become an issue for the employer and the workplace. This article describes survey results of 4,364 long term cancer survivors in which they were asked to respond to items describing their ability to work, job discrimination, and quality of life. Thirty-five percent of survivors were working at the time they completed the survey, and 8.5% considered themselves unable to work. This research has shown that age, gender, ethnic group, and cancer type affected the working status of the survivors. Of survivors continuing to work, 7.3% indicated they had experienced job discrimination. The results indicate most cancer survivors do not perceive employment related problems, and are readily assimilated into the work force. Job discrimination and the ability to work is a quality of life issue.

Severity of Violence Against Women by Intimate Partners and Associated Use of Alcohol and/or Illicit Drugs by the Perpetrator

One hundred eighty abused women presenting for protective orders or to file assault charges were interviewed. The Severity of Violence Against Women Scale measured threats of abuse and actual physical violence. A questionnaire measured stalking. Additionally, the women were asked if the perpetrator was drunk daily and/or used illicit drugs. Perpetrators were divided into four groups: no alcohol or drug use (33%); alcohol only (19%); drugs only (18%); and alcohol and drugs (30%). Using multivariate analysis and controlling for demographic variables, physical abuse was significantly (p = .005) higher for women with perpetrators who used drugs only (x = 60.4) compared with perpetrators who used alcohol only (x = 47.7). Stalking was significantly (p = .001) higher for perpetrators who used alcohol and drugs (x = 8.2) compared with perpetrators who did not use alcohol or drugs (x = 5.6). To enable abused women to promote their safety, an understanding of the association between substance use and specific types of intimate partner violence is required.

Internet message board use by patients with cancer and their families.

The Life After Cancer Care (LACC) Internet Web site and message board were created at a comprehensive cancer center to provide up-to-date information about different types of cancer, treatments, late effects, and research findings. The message board enables patients with cancer to exchange information on a more personal basis. During the 16-month period since the creation of the Web site, 972 people logged on to the message board and 284 people posted 619 messages. Most (64%) posted only one message. The posted messages were related most frequently to cancers of the breast, gastrointestinal system, lung, gynecologic system, head and neck, and colon. Sixty percent of the people posting messages were cancer survivors; the remaining 40% were family or friends of survivors. The most frequent query themes were concerns about treatment, support, and long-term side effects of treatment. Individuals with cancer were significantly more likely to post messages about long-term side effects of treatment than family and friends. Message boards are a useful tool for sharing information with others who have similar experiences. Message board entry data also provide valuable information that can be used to refine the boards. Message boards have not been used traditionally in healthcare research but hold considerable promise as an information resource for people affected by cancer.