R.M. Fox

On the receiving end—patient perception of the side-effects of cancer chemotherapy

We conducted a survey to identify and rank side-effects perceived by 99 patients receiving cancer chemotherapy. Non-physical side-effects constituted 54% of the 15 most severe symptoms, and included the thought of coming for treatment, the length of time taken by treatment and having to have a needle. Major physical side-effects were vomiting, nausea and hair loss. Differences in ranking of severity of side-effects were evident when patient groups were divided by sex, age, marital status and domestic situation, as well as by diagnosis, treatment and response. Evaluation of patient perception of the severity of side-effects is an aid to striking the cost benefit balance when deciding whether to use cancer chemotherapy.

On the receiving end—II. Linear analogue self-assessment (LASA) in evaluation of aspects of the quality of life of cancer patients receiving therapy

Linear analogue self-assessment (LASA) scales were used to measure general well-being and specific factors (mood, pain, nausea and vomiting, appetite, breathlessness, physical activity) in patients receiving therapy for malignant melanoma, small cell bronchogenic carcinoma (SCBC) or ovarian cancer. Among the patients with SCBC and melanoma, high correlations were observed between LASA scores for general well-being, mood and appetite. There was a significant relationship between performance status and LASA scores for general well-being, pain and appetite. Among patients with ovarian cancer, there was a significant association between performance status and LASA scores for general well-being, breathlessness and physical activity. Objective response category was related to change in LASA scores for pain. Changes in LASA scores during treatment reflected increased morbidity during radiotherapy in patients also receiving chemotherapy for SCBC. The LASA technique provides a convenient method for the assessment of quality of life in patients receiving cancer therapy, and potentially allows comparison of patient perception of treatment-related morbidities.

UNDIFFERENTIATED CARCINOMA IN YOUNG MEN: THE ATYPICAL TERATOMA SYNDROME

In 5 young men with apparent undifferentiated carcinoma involving lung, mediastinum, and lymph-nodes subsequent response to treatment, tumour-marker analysis, and histology review suggested a diagnosis of embryonal-cell carcinoma. It is suggested that atypical presentation of extragonadal germ-cell tumours may be common. Because such tumours respond to chemotherapy, accurate diagnosis is essential.

Extraskeletal Ewing's sarcoma: A clinical, morphological and ultrastructural analysis of five cases with a review of the literature

In 1969 it was recognised that tumors with light microscopic appearances indistinguishable from Ewings sarcoma of bone may arise in extraskeletal sites (extraskeletal Ewings sarcoma). Here, we review the available literature and report five new cases. All five received combined modality therapy with combination chemotherapy and radiotherapy to the primary site followed by surgical excision in two. All attained complete remission; after a median follow-up of 26 months, three remain disease-free but two have relapsed and died. Our experience, in accord with previous series, suggests that extraskeletal Ewings sarcoma compared with its bony counterpart tends to occur in older subjects, has a similar incidence in males and females, usually presents with a painless mass and readily responds to combined modality therapy. We detected no light or electron microscopic features to denote a histogenetic origin. However, we suspect extraskeletal Ewings sarcoma may occur more frequently than previously supposed.

THYMIDINE SENSITIVITY OF CULTURED LEUKÆMIC LYMPHOCYTES

Cultured leukaemic lymphocytes from patients with T, null, or pre-B acute lymphoblastic leukaemia are shown to be highly sensitive to growth inhibition by thymidine. Thymidine sensitivity was correlated with reduced activity of the catabolic enzyme thymidine phosphorylase and sustained elevation of the deoxythymidine triphosphate pool after exposure to thymidine. It is suggested that thymidine may have a role in the management of certain acute lymphoblastic leukaemias of lymphomas.

Causes of deaths in an oncology unit.

Abstract The medical records of 102 autopsies performed in Royal Prince Alfred Hospital on patients treated by a medical oncology unit between January 1977 and May 1979 were analysed. Organ failure was the recorded cause of death in 42% ; infection in 23% ; carcinomatosis in 18% ; haemorrhage in 15% ; and metabolic derangement in 2%. 27% of patients had autopsy evidence of severe coexistent non-neoplastic disease, predominantly widespread atheroma and coronary artery disease. The immediate cause of death was unrelated to cancer in 19% and treatment-related in 19% . In 13% , death accompanied a high intake of narcotic analgesia during the pre-terminal 24 hours. A terminal care policy was adopted for 56 (55%) patients during their last month and three-quarters of narcotic-related deaths occurred in this group. 55% of the patients received some form of aggressive anti-tumour therapy in their terminal month and 30% of these died of treatment-related causes. 25% of the patients underwent an invasive investigation during their terminal month. Correlation of death certificate, clinical and autopsy causes of death showed the death certificate to be wrong in 41% of cases, with 29% of these errors being of potentially epidemiological importance. Pre-mortem assessment of the cause of death was in error in 26% of patients.