Susan Leigh

Surviving Adult Cancers. Part 2: Psychosocial Implications

PURPOSE To address the psychosocial implications of surviving adult cancers by a comprehensive review of the literature. DATA IDENTIFICATION An English-language literature search using MEDLINE (1970 to 1988). Index Medicus (1970 to 1988), and bibliographic reviews of textbooks and review articles. STUDY SELECTION Of 103 originally identified articles, 58 that specifically addressed the stated purpose were selected. DATA EXTRACTION Four authors reviewed and critiqued the literature extrapolating the major themes on this topic. RESULTS OF DATA SYNTHESIS There is little information on the many psychosocial variables that affect an adults long-term cancer survival trajectory. Collation of data identified the following significant psychosocial themes: fear of recurrence and death, relationships with the health care team, adjustment to physical compromise, alterations in customary social support, isolationism, psychosocial reorientation, and employment and insurance problems. CONCLUSIONS The continuation of a rehabilitation effort begun around the initial diagnosis of cancer would be instrumental in providing post-therapy evaluation and guidance needed by adult long-term survivors of cancer. Education, research, and support interventions need to be mobilized for this population of adults with a history of cancer.

Surviving adult cancers. Part 1: Physiologic effects.

PURPOSE To provide an overview of the physiologic long-term and late effects of adult cancers and cancer treatments by a review of the medical and nursing literature. DATA IDENTIFICATION Primarily from an English-language literature search using MEDLINE (1980 to 1988) and Index Medicus (1980 to 1988). STUDY SELECTION After a consensus review by four observers, 285 articles were selected that addressed the stated purpose. DATA EXTRACTION Four observers assessed the literature using predetermined criteria for eliciting information about long-term and late effects. RESULTS AND DATA SYNTHESIS: Much has been written about the acute phases of cancer and cancer treatments. In comparison, relatively few data are available that define physiologic long-term: and late effects of cancer treatments in adult survivors. Review of the existing data showed that these sequelae may affect virtually any body system months or years after treatment ends. In addition, few prospective studies dealing with physiologic survivorship issues have been done. CONCLUSIONS Health care providers need to be aware of long-term or late complications that may affect the increasing number of adult cancer survivors. Attention to treatment regimens in the acute cancer phase and careful follow-up once the disease is eradicated may help to prevent or manage these complications. More prospective research should be done in this area.

Multiagent chemotherapy in relapsing ovarian cancer.

Abstract A multiagent regimen (vinblastine, bleomycin, hexamethylmelamine, and cis -platinum) partly designed on the basis of data from a human tumor stem cell assay was used to treat 36 patients with relapsing epithelial ovarian cancer. All patients included in this study had previously received alkylating agent therapy, and 78% (2836) had also received Adriamycin. Thirty-five patients were clinically evaluable for response; eight achieved complete clinical remission, and nine achieved partial remission, for an overall response rate of 49%. The median duration of response was 10 months, and three of the complete responders are in remission at 10+, 17+, and 22+ months. Mild to moderate peripheral neuropathy was the major side effect, occurring in 11% (435) of patients. Myelotoxicity was well tolerated. We conclude that this four-drug regimen is effective in the treatment of relapsing ovarian cancer patients and should be considered for study as a front-line combination chemotherapy for previously untreated patients.

Isolated regional limb hyperthermic perfusion as treatment for melanoma.

ABSTRACT Conventional melanoma therapies of wide excision with or without regional node dissection may have little or no effect on preventing a type of spread called in-transit metastases. Reduced melanoma recurrence and increased survival rates have been documented following use of regional limb hyperthermic perfusion (R.L.H.P.) with Melphalan. Both primary melanoma and in-transit melanoma metastases can be treated with this procedure. Since R.L.H.P. is an investigational procedure, the protocol must be carefully followed so patient safety is ensured and the treatment regimen is evaluable. Patients under going R.L.H.P. require intensive preoperative preparation, major surgery, and extensive postoperative follow-up. This procedure is not without risk and can be frightening for the patient. In order to provide optimal informational and emotional patient support, medical oncology research nurses at the University of Arizona have become actively involved in the preoperative, intraoperative, and postoperative phases of R.L.H.P. Their involvement facilitates proper adherence to the investigational protocol and promotes continuity of patient care. This paper will provide historical and technical information regarding R.L.H.P and will discuss the role of the research nurse in all phases of treatment.

Multiagent chemotherapy in relapsing ovarian cancer

A multiagent regimen (vinblastine, bleomycin, hexamethylmelamine, and cis-platinum) partly designed on the basis of data from a human tumor stem cell assay was used to treat 36 patients with relapsing epithelial ovarian cancer. All patients included in this study had previously received alkylating agent therapy, and 78% (28/36) had also received Adriamycin. Thirty-five patients were clinically evaluable for response; eight achieved complete clinical remission, and nine achieved partial remission, for an overall response rate of 49%. The median duration of response was 10 months, and three of the complete responders are in remission at 10+, 17+, and 22+ months. Mild to moderate peripheral neuropathy was the major side effect, occurring in 11% (4/35) of patients. Myelotoxicity was well tolerated. We conclude that this four-drug regimen is effective in the treatment of relapsing ovarian cancer patients and should be considered for study as a front-line combination chemotherapy for previously untreated patients.