Shirley B. Lansky

A performance status scale for head and neck cancer patients

Effective assessment of treatment outcome and the development of successful rehabilitation for head and neck cancer patients demand an evaluation of the relevant parameters of functional status. This paper reports the development and testing of a new Performance Status Scale for Head and Neck Cancer Patients designed to assess the unique areas of dysfunction experienced by this population. The instrument is a simple, practical, clinician‐rated assessment tool consisting of three subscales: (1) Understandability of Speech, (2) Normalcy of Diet, and (3) Eating in Public. The scale was administered to a group of 181 head and neck patients and a comparison group of 30 breast cancer patients. Results indicate that the scale is reliable across raters and sensitive to functional differences across a broad spectrum of head and neck cancer.

The long‐term effects of cranial irradiation on the central nervous system

Cranial irradiation and chemotherapy may have significant long‐term deleterious effects on children with brain tumors. Intellectual deterioration, endocrinopathies, leukoencephalopathy, extraneural metastases, and oncogenesis may all complicate the treatment of central nervous system neoplasia. These long‐term effects of therapy have important implications, as some are amenable to treatment and others may be prevented by the careful monitoring of drug and radiation administration. Until recently, the survivals of children with brain tumors were limited, so that concerns over long‐term effects of therapy were unnecessary. As children with certain types of brain tumors now have a better prognosis, these long‐term and possibly remediable effects have important implications. This article emphasizes radiation effects on intellect, endocrine function, and oncogenesis. Recommendations for baseline and longitudinal evaluations of children with brain tumors are suggested. Cancer 56: 1841‐1846, 1985.

Absence of major depressive disorder in female cancer patients.

This investigation evaluated the prevalence of depression in female patients who had cancer in any of five predesignated sites. Five hundred five women aged 17 to 80 (190 with breast cancer, 143 with gynecologic malignancies, 111 with melanoma, 37 with bowel cancer, and 24 with lymphoma) were randomly screened. Assessment included the Hamilton rating scale for depression, the Zung self-rating depression scale, the Karnofsky performance scale, and a 10-cm visual pain analogue line. The results revealed a mean Hamilton of 10.2 (range, 0 to 41; SD, 7.5), a mean Zung score of 35.3 (range, 11 to 68; SD, 9.6), a Karnofsky median score of 80, and a median pain score of 0. Scores on the Zung scale were highly correlated with those of the Hamilton scale (r = .75). Based on cutoff scores accepted as indicating depression (Hamilton greater than or equal to 20 and Zung greater than or equal to 50), patients were depressed. The depressed subgroup was in significantly more pain, experienced greater physical disability, and was more likely to have had prior episodes of depression as compared to the non-depressed women. The two best predictors of current depression were performance status (Karnofsky) and history of depression. No relationship was found between depression and other demographic variables or disease parameters (diagnosis, time since diagnosis, stage or phase of illness, and current treatment). Our findings indicate that the prevalence of major depression in cancer patients is lower than many previous studies have indicated and falls within the range seen in the general population.

Psychosocial consequences of cure.

Survivors of childhood cancer, having overcome the biggest hurdle to a normal life span, must continue to be vigilant toward health care issues as well as toward certain psychological and social problems for which they are at a greater than normal risk. The long‐term survivors knowledge about his/her illness, its treatment, and the consequent need for health surveillance and maintenance practices must be continually updated. Equally important is the survivors preparation for coping with any long‐term consequences of disruption in family, academic, and social activities engendered by cancer treatment. Existing research has frequently focused on patients diagnosed in early childhood. Recent studies, however, suggest that the developmental disruptions may have special significance for the adolescent, who is already struggling with unique issues of separation, changes in peer relationships, emergent sexuality, and future academic and occupational goals. Previous investigations addressing the medical and psychiatric problems encountered by the long‐term survivor of adolescent cancer are presented with a focus on current psychological adjustment and degree of emancipation achieved. A recent pilot study, from three major medical centers, collected extensive interview data on a group of long‐term survivors and sibling controls. Preliminary analyses of these data are described, and areas for future research are suggested. Cancer 58:529‐533, 1986.

Toward the development of a play performance scale for children (PPSC)

Performance scales (i.e., Karnofsky), as they measure quality of life, have been used effectively as an integral part of repeated assessment of adult cancer patients for the last several years. An equally concise measure of performance has not been developed for children. The task of developing a scale to assess performance in infants, toddlers, school‐age children, and adolescents is formidable, as the activity measured should be of equal merit at each age level. Although all childhood cancer patients could benefit from a simple‐to‐administer, rapid assessment, children with brain tumors have the greatest need for a repeated measure of performance. The goal, then, is to develop a simplified set of criteria that can be used for assessment of children with brain tumors during hospitalization, at the time of clinic visits, and/or at the time of diagnostic procedures when the patient is in a reasonable state of health. The assessment should be able to be performed by nonprofessional persons. Cancer 56: 1837‐1840, 1985.

School Phobia in Children With Malignant Neoplasms

With the advent of improved therapy, many of the childhood malignant diseases have become chronic. This group of patients and their families demonstrate many problems usually not associated with the primary disease, but which can become incapacitating. School phobia was selected as one such problem for this study. The 11 cases reported here demonstrate the insidious and subtle nature of the onset of the disease. With aggressive management, some long-standing cases of school phobia could be reversed, but not all. In a group subjected to a prophylactic regime at the onset of their malignant neoplasm, there have been no new cases of school phobia. It is important for pediatricians caring for these children to search actively for the signs of school phobia and intervene as soon as possible.

Central nervous system prophylaxis Studies showing impairment in verbal skills and academic achievement

School attendance and school achievement were the parameters studied to assess the pediatric cancer patients ability to learn and keep pace with their peers. Effects of CNS prophylaxis, as either intrathecal methotrexate (IT) alone or intrathecal methotrexate given in addition to cranial radiation (CRT), were studied in two groups. A third group of cancer patients who received no CNS prophylaxis, and two comparison groups, siblings and a matched sample of children, also participated in the study. Impairment in central nervous system function was measured by means of psychological testing, neurological examination, and computer-assisted tomography. Patients who received central nervous system prophylactic treatments at an early age had poorer performance on verbal IQ scores, with comprehension and arithmetic subscores being most affected. Patients who received both cranial radiotherapy plus intrathecal methotrexate showed a decrease in six out of seven categories of instruction when grades from the year prior to diagnosis were compared to those obtained 3 years after diagnosis. The combined groups of patients with leukemia had a lower grade point average and poorer school attendance than did the comparison groups.

Management of Stressful Periods in Childhood Cancer

There are four major periods of stress for a family having a child with cancer. They are diagnosis, remission, death, and long-term survival. Each of these periods has particular management problems requiring careful assessment and intervention. The author provides such management strategies in this article.

The high cost of cancer

Anxiety about managing the financial costs of cancer is equaled only by fear of the disease itself. In addition to the rising cost of medical care, nonmedical costs contribute a large share of the financial burden. A number of studies, which are reviewed in this article, document the significance of costs incurred in the areas of food, family care, clothing, transportation, lodging and other miscellaneous items, and, in addition, loss of wages. Four factors account for variability in financial cost: level of care, performance status of the patient, family size, and distance from the hospital. Concern is expressed about the high cost of cancer treatment and the question posed as to who should be responsible for payment.

MMPI indicators of stress and marital discord among parents of children with chronic illness

Abstract The present study explored the emotional adjustment and marital relationships of parents of children with chronic, life-threatening illness. The Minnesota Multiphasic Personality Inventory (MMPI) was completed by 42 fathers and 71 mothers of pediatric cancer patients and 26 fathers and 29 mothers of hemophilic children. Their MMPI profiles were examined for signs of emotional disturbance (i.e., number of T scores of 70 or higher on the clinical scales). Profiles of husband-and-wife pairs were analyzed for marital stress using the Arnold Sign Indicator (ASI). Results indicated that both groups of parents suffered more distress than a normal group but less than marriage counselees. Parents of cancer patients showed higher levels of stress than parents of hemophiliacs.