Samario Chaitchik

Doctor‐patient communication in a cancer ward

This study explored doctor-patient interaction by focusing on a specific type of encounter in an oncology ward, designed to enable discussion of the case by the doctors and informing the patient. In line with the cognitive orientation theory of Kreitler and Kreitler, the encounters effects were examined in regard to three aspects--disease, treatment, and general state--on four levels: the information the patients have, their feelings, the information they desire, and the information they consider desirable. The patients were 52 men and women with different cancer diagnoses. Comparable questionnaires were administered to the patients before and after the meeting, and to the doctors only after it. The patients responded before and after also to Spielbergers scales of state anxiety and state anger. The results showed that patients claimed they had gained hardly any new information concerning the disease and their overall state. There were no decreases in the desired and desirable information. Their feelings were affected negatively to a slight extent, especially concerning treatment. In a quarter of the subjects, anxiety decreased and was replaced by anger. In regard to all levels and aspects there was a large gap between the evaluations of doctors and patients. The major conclusions were that patients and doctors differ in the meaning they assign to information, and that patients are conflicted in regard to asking for the personally relevant information they want.

Life satisfaction and health in cancer patients, orthopedic patients and healthy individuals

Life satisfaction (LS) is one of a set of constructs defining quality of life. Previous studies showed that LS was sometimes related to health and sometimes not. The study was designed to examine the relation of LS as a general construct to satisfaction in specific domains. We assumed that there is a tendency to maintain an acceptable level of LS even under stressful and threatening conditions, that it is related to optimism and that the likelihood of attaining satisfaction in a particular domain affected the selection of domains on which LS is based. We expected that in cancer patients LS would be related to more domains but not to health. The study was done with 55 head-and-neck cancer patients, of all stages and grades of tumor; 51 orthopedic patients, victims of accidents with good recovery chances; and 55 healthy individuals. The healthy individuals and orthopedic patients were matched (in terms of group values) to the cancer patients in age, gender and education. Single-item measures of LS and optimism, and a questionnaire with 49 multiple-choice items assessing adjustment in 13 domains were administered to all subjects. The results showed that in cancer patients LS was related to most domains but not to health and not to optimism, whereas in the other groups it was related to few domains including health, and also to optimism. The findings support the tendency to maintain LS with the materials available to the individual, and show that health is related to LS only if its maintenance or attainment are realistic goals. Thus, both bottom-up and top-down theories of LS are supported.

Neurotoxicity of interferon-alpha.

Interferon (IFN) related neurotoxicity includes somnolence and confusion, fatigue, lethargy, psychiatric symptoms, conceptual disorganization, neurological deficits, cortical blindness, coma and, rarely, death. The neurologic syndromes seem to be more common in elderly patients, following intramuscular or intravenous administration, at higher doses of frequent injections of IFN-alpha and in primary renal cell carcinoma. The duration of the treatment was not strongly related to neurotoxicity. Computed tomography findings were non-specific and included atrophy or periventricular lucencies. Electroencephalograph studies demonstrated a generalized increase in slow wave activity which returned to normal after cessation of treatment. Behavioral and mental changes in patients treated with IFN are warning signs, and indicate the need to withdraw treatment.

Scalp cooling in the prevention of alopecia in patients receiving depilating chemotherapy

To assess any difference in the incidence of alopecia during treatment and of skull metastases during follow-up among breast cancer patients undergoing scalp cooling during chemotherapy and those treated at ambient temperatures. A series of 35 breast cancer patients receiving adjuvant chemotherapy were consecutively assigned either to a scalp cooling regimen (19 patients) or to an ambient temperature regimen (16 patients). Hypothermia was administered with electrically cooled caps (SCS 11: Amit Technology, Jerusalem) for 30 min before, during, and for 1 h after treatment. A significant difference (P=0.014) was detected in the incidence of alopoecia: 48% (9 patients) of those who had undergone cooling suffered alopoecia, while 81% (13 patients) of the group who had not undergone cooling lost scalp hair. Patient comfort levels were high. Follow-up (median time 14 months) has disclosed no scalp metastases. The implementation of routine scalp hypothermia as part of adjuvant chemotherapy treatment, especially in cancers without tendencies to bone metastases, should be seriously considered.

Anti-tyrosinase antibodies in malignant melanoma.

Abstract Anti-tyrosinase antibodies were measured by enzyme-linked immunosorbent assay in sera of patients with malignant melanoma with either metastatic disease or no evidence of disease, in patients with melanoma and associated hypopigmentation (MAH), in patients with vitiligo and in healthy volunteers. The mean relative absorbance (Arel) was calculated by dividing the absorbance of each sample by the mean value for the control group. Using this method, the Arel of the control group was 1.000(SE 0.083). Arel of patients with metastatic disease (1.516; SE 0.225) was significantly higher (P = 0.03) than the value for the controls, but insignificantly higher than that for patients with no evidence of disease (1.216; SE 0.148). Patients with no evidence of disease, in whom the primary lesion originated in the lower limb, had a significantly higher (P = 0.01) Arel than the healthy volunteers. Patients with metastatic disease showed higher Arel if their primary lesions were confined to the area of the head and neck or to the lower limb. Patients with vitiligo had higher Arel values for their anti-tyrosinase antibody than any of the other groups. However, those with melanoma and MAH (vitiligo-like) had the same Arel of anti-tyrosinase antibodies as the controls or the patients with metastatic melanoma. This observation reflected the possible absorption of anti-tyrosinase antibodies to melanoma antigens, and pointed to the participation of anti-tyrosinase antibodies in the destruction of normal melanocytes in patients with melanoma, as part of the immune reaction towards this disease.

Interferon-related mental deterioration and behavioral changes in patients with renal cell carcinoma

Five out of 38 patients (13%) with metastatic renal cell carcinoma had mental deterioration 3 weeks to 13 months after the start of treatment with recombinant interferon alpha-C. Metastatic spread to the brain, paraneoplastic effect of the tumor on the central nervous system and other causes of dementia were excluded. Computed tomography of the brain in these patients was normal and the width of the cerebral sulci and ventricles did not correlate with the severity of dementia. Specific patterns of atrophy were not seen. General deterioration, assessed by the change in Karnofsky performance status, was associated with dementia. The dementia may have been caused by a neurotoxic effect of interferon.

Small cell carcinoma of the gallbladder: clinical course and response to chemotherapy.

Small cell carcinoma of the gall bladder is a rare tumor. The neoplasm is highly lethal, metastasizes early, and may cause death shortly after diagnosis. An oat cell carcinoma of the gallbladder metastatic to the liver and adjacent lymph nodes is described in a 60-year-old male. Partial cholecystectomy was performed followed by aggressive chemotherapy with etoposide and cisplatinum. An 80 % reduction in the size of the unexcised tumor was noted over a period of 6 months. The partial response and the relatively long survival of the patient suggest the use of the above protocol for these rare cases.

A viral antigen as a marker for the prognosis of human breast cancer

An antigen present in human breast tumor cells, and which is immunologically related to the envelope protein (gp52) of murine mammary tumor virus, was used as a marker for the detection of breast cancer in an Israeli population. The results show that the antigen was detectable in 128 of 204 breast carcinomas tested (62.7%). The immunological reaction was not detected in normal breast tissue, benign breast tumors, ductal hyperplasia or in primary malignancies in other organs. A significantly higher percentage of cases with demonstrable antigen was found in Israeli women born in North Africa (78%) as compared to women of European origin (60.6%). The frequency of detection of the antigen was higher in stage IV (80%) as compared to stage I (15%), suggesting that the gp52 cross-reacting antigen is a marker for the severity of the disease. Moreover, a retrospective study of 97 cases of stage II breast cancer shows that if the antigen is detected at the time of mastectomy, one can usually predict an unfavorable prognosis. Survival data analysis indicates that patients without detectable antigen survived significantly longer than those with a detectable antigen.

The psychological profile of women attending breast-screening tests.

Though the benefits of early detection of breast cancer are generally known, only few women attend breast-screening examinations. The study was designed to gain insight into the problem by exploring the psychological profile of clinic attenders. In order to find out whether there is such a profile, 210 self-referred women were compared with 210 nonattending women, from the same working and social environments, matched in age, education and occupational level. All subjects were administered 10 tests in 7 domains. The tests were administered as part of a health survey. The results showed that clinic attenders scored higher on negative emotions and total emotions and lower on positive emotions; higher on repression; lower on daydreams; lower on range of self-concept, references to others and negative self-references but higher on positive self-references; scored higher on self-references describing oneself in a functional and in a passive way and scored lower on those describing oneself in terms of ones attitudes, body and appearance; scored lower on neuroticism; scored lower on different somatic complaints and health orientation but higher in alexithymia. No differences were found in authoritarianism, locus of control and self-complexity. Conclusions are that there is a psychological profile of clinic attenders, that it is focused on dysphoric emotions, psychological disease promotion and defensiveness and that it includes characteristics of the construct that is sometimes called the cancer-prone personality.

Computerized tomography in ovarian cancer

Sixteen women suffering from ovarian cancer were staged by clinical and pathological means and concomitantly scanned by computed tomographic means. Computed tomography (CT) was found accurate in nine patients. The staging of the disease was upgraded in three patients following the CT examination. CT examination in four patients was equivocal or failed to detect the true extent of the disease. It was not possible to accurately assess the true nature of the pelvic mass on CT following a partial debulking pelvic procedure, as the remnant pelvic bed tissue could be misinterpreted as recurrent cancer. Small peritoneal cancer seedings were not detected on CT. CT scanning despite certain limitations is a valuable noninvasive adjunct in the assessment of carcinoma of the ovary and its response to treatment.