Robert L. Woods

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.

A randomized study: Small cell anaplastic lung cancer treated by combination chemotherapy and adjuvant radiotherapy

Chemotherapy and primary site radiation therapy were compared to chemotherapy alone in a randomized study of 125 patients with small cell cancer of the lung. The sites of initial relapse, as well as disease free and overall survival were analyzed. Radiotherapy to the primary site reduced the rate of local relapse, but median survival was not prolonged in patients with either limited or extensive disease, when the radiation therapy-chemotherapy group was compared to the group that received chemotherapy alone.

Allopurinol modulation of fluorouracil toxicity

SummaryConsiderable interest has developed in the modulation of fluorouracil activity by nucleosides. The toxicity of fluorouracil in mice is known to be reduced by concurrent administration of allopurinol, presumably because biochemical pathways activating fluorouracil in normal tissues are blocked.We have given allopurinol (300 mg t.d.s. PO) concurrently with continuous infusions of fluorouracil (2.0–2.25 g/m2/day x 5) to 34 patients with colorectal cancer and 11 patients with various adenocarcinomas. There were 41 patients assessable for toxicity. Stomatitis was the predominant dose-limiting toxicity (22% grade 1, 19% grade 2, and 27% grade 3 toxicity). Neutropenia (<1,000/μl) occurred in 17% patients. Among 26 colorectal cancer patients assessable for response there was a 15.4% response rate.We conclude that allopurinol modulates fluorouracil toxicity in man, allowing a two-fold increase in dose. However, at least in colorectal cancer no greater frequency of tumour response is seen than with lower doses of fluorouracil given by standard schedules of administration without allopurinol.

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.