Showing papers by "American Cancer Society published in 1990"

Cancer statistics, 1990

Abstract: The American Cancer Societys Department of Epidemiology and Statistics reports its 24th annual compilation of cancer incidence survival and mortality data for the United States and around the world. (EXCERPT)

Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study.

Abstract: We studied whether moderate alcohol drinkers have a lower total and coronary heart disease (CHD) mortality than nondrinkers. Among 276,802 U.S. men aged 40-59 enrolled in 1959 in an American Cancer Society prospective study, 42,756 deaths, 18,771 from CHD, occurred during the following 12 years (3% of the cohort was lost to follow-up). Using nondrinkers (55.3% of the cohort) as a reference category, age- and smoking-stratified relative risks (RR) of total mortality were 0.88 for occasional drinkers, 0.84 for those drinking 1 drink per day, 0.93, 1.02, 1.08, 1.22, and 1.38 for those drinking 2, 3, 4, 5, and 6 or more drinks per day, respectively. RRs of CHD mortality were 0.86, 0.79, 0.80, 0.83, 0.74, 0.85, and 0.92, respectively. Multivariate analysis failed to identify other confounders. No changes in RRs were introduced by excluding subjects with poor health or history of chronic disease at enrollment (32.8% of the cohort) or excluding subjects who died during the first 6 years of follow-up. These data indicate an apparent protective effect of moderate alcohol intake on CHD mortality that cannot be attributed to the inclusion of subjects with CHD or related diseases into the nondrinker category.

Malignant histiocytosis. A reassessment of cases previously reported in 1975 based on paraffin section immunophenotyping studies.

Abstract: Malignant histiocytosis (MH) is a term that has been used to describe a syndrome in which there is a systemic proliferation of cells that have the cytologic appearance of atypical histiocytes. Biopsy materials from 15 patients with malignant lymphoma diagnosed as malignant histiocytosis in a previous study reported in 1975 were analyzed by a panel of antibodies and reclassified using current nosologic concepts of malignant lymphoma. The antibodies used comprised reagents detecting a formalin-resistant epitope on B-cells (L26), T-cells (anti-CD3, anti-leu 22 [CD43], and UCHL1 [CD45RO]), monocyte/macrophage-derived cells (KP1 [CD68]), as well as antibodies that detect leukocyte common antigen (PD7 [CD45RB]), and a formalin-resistant epitope of Ki-1 (Ber-H2 [CD30]). The authors found that nine lymphomas had a profile consistent with T-lineage, including six in which Ki-1 (CD30) was coexpressed, and two were B-lineage. Three lymphomas showed no specific lineage characteristics although two were Ki-1 (CD30) positive, and none had expression of KP1 (CD68). The 12 lymph node biopsy specimens showed a variety of patterns of involvement, including sinusoidal, paracortical, and diffuse; the spleens showed predominantly red pulp involvement. A 15th case was believed most consistent with a virus-associated hemophagocytic syndrome. These findings support previous suggestions that the majority of cases diagnosed as MH represent T-lineage-associated hematolymphoid neoplasms, and that only a rare case will be of monocyte/macrophage origin. It is suggested that the term MH be subsumed under the rubric of large cell lymphoma and unless there are compelling immunohistochemical data to support a histiocytic origin, that the term MH be abandoned in favor of a more accurate descriptive term, such as sinusoidal large cell lymphoma.

Survival discriminants for differentiated thyroid cancer

Abstract: Since 1975, the American Cancer Society, Illinois Division, has published end results of major cancer sites drawn from patient data contributed voluntarily by hospital cancer registries throughout the state. The current study was undertaken, in part, to apprehend information regarding contested areas in the management of patients having differentiated (papillary/follicular) thyroid cancer. A total of 2,282 patients with either papillary or follicular carcinoma of the thyroid from 76 different Illinois hospitals and providing 10 years of follow-up information (life-table analysis) were retrospectively analyzed for demographic, disease, and treatment-related predictors of survival. Multivariate analysis using the Cox proportional hazards method was made for stage, age, race, sex, morphology, history of radiation exposure, presence of positive lymph nodes, initial surgical treatment, postoperative iodine 131 therapy, and replacement/ suppressive thyroid hormone treatment. Statistically significant (p≤0.05) predictors of favorable survival after thyroid cancer were low stage (I and II), young age (less than 50 years), white race, female sex, and the administration, postoperatively, of either thyroid hormone or radioactive iodine. Factors that had no influence on survival were lymph node status, choice of initial surgical treatment, and a history of prior irradiation. We suggest that where a prospective clinical trial is impracticable, a retrospective analysis of a large and detailed database, such as that available from cooperating hospital-based tumor registries, may yet provide useful insights to solutions of cancer management problems.

Mammographic screening of women with increased risk of breast cancer

Abstract: Five hundred one women from Dallas County, Texas who participated in the American Cancer Society 1987 Texas Breast Screening Project were selected because of a self-reported family history of breast cancer (cases). They were matched with 501 randomly selected women from the same county with no family history (controls). Although there was a statistically significant trend with age for an increasing proportion of women to report having undergone mammography, there was no significant difference when comparing mammographic histories of cases with controls after controlling for age (31.5% versus 35.1%, P = 0.33). Significantly more cases (79%) perceived their risk for breast cancer to be moderate or greater compared with controls (54%, P less than 0.0001), but mammographic histories were not different when controlling for perceived risk. Both cases and controls cited lack of physician referral and cost as their reasons for not having undergone mammography. Women at increased risk for breast cancer (because of their family history) are not undergoing regular mammographic screening despite their self-awareness of the increase in their risk.

Current issues in cancer rehabilitation

Abstract: Many patients with cancer enjoy long-term survival and are cured; others may live for extended periods while receiving specific treatment for cancer. This has been accomplished with increasingly complex and multimodal therapy, along with heightened toxicity and longer treatment. Cancer has become a chronic disease for many patients. Contemporary cancer rehabilitation provides a coordinated approach that addresses the physical, psychosocial, vocational, and economic concerns of the patient. Key components of a cancer rehabilitation program should include initial needs assessment with periodic reassessments, direct provision of specific interventions, and referrals to appropriate community resources. Almost all patients with cancer can benefit from a rehabilitation assessment and intervention. Important rehabilitation issues include the physical toxicity of treatment, psychosocial concerns, sexual dysfunction, diet and nutritional concerns, pain management, and vocational and economic problems. Patient groups with unique rehabilitation problems include patients with head and neck cancer or breast cancer, and patients who have undergone osteotomies or amputations. Long-term cancer survivors also have special rehabilitation needs that relate to the delayed effects of treatment on normal tissues, gonadal dysfunction, second neoplasms, employment discrimination, and difficulties obtaining health and life insurance coverage. Rehabilitation assessment and intervention should be incorporated into the routine health care of patients with cancer.

Survival of the older patient compared with the younger patient with hodgkin's disease. Influence of histologic type, staging, and treatment

Abstract: Age as an independent risk factor for survival of Hodgkin's disease (HD) was investigated using data for the 6345 patients in the American College of Surgeons, Patterns of Care Study. Patients were divided into those 15 to 34 years of age, and those older than 50 years. Older patients had higher rates of advanced stage and B symptoms (e.g., Stage IVB, 19.7% compared with 7.7%) and significantly higher rates of poor prognosis histologic types, odds ratio (OR) = 3.7. The older population with clinical stage (CS) I and II disease was also less likely to have received any of the selected staging procedures, bone marrow biopsy, lymphogram, or laparotomy (OR = 4.48). The two populations were equivalently understaged when CS was compared with pathologic stage (PS). In each category the older patients were more likely to have received no therapy; for PS I and II disease the OR for older patients compared with the younger patient was 2.14. When stratified by PS, B symptom status, histologic type, and treatment the older patients continued to show poorer 5-year survival by the life-table method. The authors' hypothesis--that older patients equivalently staged and treated would have no significant difference in long-term survival--was not substantiated by the data. However, in the analyses in which corrections for the known risk factors were made, the difference in survival was not as great as that in the crude, unstratified data. This study, as well as other recent studies utilizing smaller numbers of patients, finds age an independent predictor of poorer survival in HD patients.

Association between smoking and leukemia in two American Cancer Society prospective studies.

Abstract: The association between smoking and leukemia in men and women was analyzed from the data of two prospective studies. Myeloid leukemia was positively associated with smoking in men in both studies (standardized mortality ratios [SMR], 2.44 and 1.32; P less than 0.05), but not with smoking in women. Lymphatic leukemia showed no elevation in risk in men and women in both studies. Animal studies suggest a real biologic difference in leukemogenic effect between the sexes, but further analyses are needed to characterize the smoking effect of leukemia in women.

Sixteen-week dose-intense chemotherapy in the adjuvant treatment of breast cancer.

Abstract: Fifty-three women with breast cancer were treated with a new 16-week dose-intense, chemotherapy regimen. Patients with operable breast cancer with 10 or more histologically positive axillary nodes were treated with this five-drug regimen that incorporated the concepts of weekly chemotherapy, sequential administration of antimetabolites, and continuous infusion of fluorouracil (5-FU). The chemotherapy regimen consisted of eight cycles (each of 2 wk duration) of 100 mg of cyclophosphamide/m2 orally on days 1-7, 40 mg of doxorubicin/m2 intravenous (IV) on day 1, 100 mg of methotrexate/m2 IV on day 1 with 10 mg of leucovorin rescue/m2 every 6 hours for six oral doses on day 2, 1 mg of vincristine IV on day 1, and 600 mg of 5-FU/m2 IV at hour 20 over 2 hours. A continuous infusion of 300 mg of 5-FU/m2 per day was given IV on days 8-9 of each 2-week cycle. The doses and schedule of drug administration were designed to minimize dosage reduction and treatment delay. At a median follow-up of 17 months, there have been eight relapses in the 53 patients. The actuarial 3-year disease-free survival is 80% (95% confidence interval, 62% to 90%). The major side effects were attributable to myelosuppression. Absolute neutrophil counts less than 250/microL were noted in 12 (23%) patients; seven patients (13%) required hospitalization for management of neutropenic fever. No treatment-related deaths occurred. Ninety-four percent of the planned doses were administered, and only 5% of the courses were delayed because of toxic reactions. The encouraging therapeutic data, manageable side effects, and our ability to deliver over 90% of the planned doses provide the rationale for a phase III comparison of this new dose-intense regimen and standard chemotherapy in patients with operable disease and positive axillary nodes.

Large-cell lymphomas: clinical and prognostic features.

Abstract: We reviewed the clinical and pathologic features in 186 patients with large-cell lymphomas seen at Vanderbilt University Hospital between 1970 and 1986. Ninety-two cases (49%) were large noncleaved-cell lymphoma (LNCCL), 61 cases (33%) were large-cleaved-cell lymphoma (LCCL), 17 cases (9%) were peripheral T-cell lymphoma (PTCL), and 16 cases (9%) were immunoblastic sarcoma of B cells (IBS-B). These subsets of large-cell lymphoma did not differ with respect to median age, distribution by stage, or incidence of bone marrow involvement. Significant differences between groups were noted with regard to male:female ratio, incidence of symptoms, incidence of extranodal disease, and pattern of adenopathy. However, when LCCL was excluded from the analysis, none of these differences were significant. By univariate analysis, age, stage, marrow involvement, extranodal disease, B symptoms, elevated serum lactic dehydrogenase (LDH), and diffuse pattern were unfavorable prognostic features in large-cell lymphoma. Howeve...

Mortality at ages 75 and older in the Cancer Prevention Study (CPS I).

Abstract: In the fall of 1959 the American Cancer Society began a comprehensive epidemiologic investigation of more than one million men and women drawn mainly from the middle-class population. The study reported here presents a portion of the investigation relating to the mortality among 49,469 subjects who attained age 75 years and older during the course of the study. Both men and women who at entry into this study (1960) were judged to be in good health registered distinctly lower mortality than those judged to be in poor health. Men and women with some college education had significantly lower death rates than those with lesser schooling. Men and women who reported a good family history of longevity showed consistently lower death rates in each five-year age group than those with average or poor family history of longevity. Persons with an average family history of longevity generally had lower death rates than those with a poor family history of longevity. Analysis of mortality by cause indicated that at ages 75 and older nearly half the deaths were attributed to all forms of heart disease. Coronary heart disease accounted for about 35 percent of all deaths, with the proportion decreasing with age. Deaths from stroke rose from 15 to about 20 percent with increase in age. Deaths from all sites of cancer declined with advancing age in both sexes, from about 16 percent of all deaths at ages 75 to 79 to about six percent at ages 90 to 99. Among men, cancer of the prostate accounted for 3.5 percent of deaths at ages 75 to 84, decreasing to about one half this proportion in the early-90s age group. Colorectal cancer decreased from about three percent of total deaths at ages 75 to 84 to about 1.5 percent in the early 90s. Lung cancer and stomach cancer remained at the same level at these ages.

Lung cancer and smoking trends in the United States over the past 25 years.

Abstract: Lung cancer is the leading cause of cancer incidence and death in the United States. The American Cancer Society estimated that there will be 157,000 new cases of lung cancer diagnosed in 1990 and 142,000 deaths.' Death rates in men have shown a remarkableincreasein the last 5Oyears paralleling arise in cigarette smoking20 years earlier. Age-adjustedlungcancerdeathratesinmenin theunited Statesgrew from 11 per 100,000 population in 1940 to 73 per 100,000 in 1982. Since then the rate has leveled off. In 1986, it was 74. The lung cancer rate in women started to rise in the early 1960s from 6 per 100,000 to 25 per 100,000 in 1986 adjusted to the total U.S. population in 1970. Lung cancer rates in young men age 35-44 started to decline in the 1970s and in men age 45-54 in the early 1980s. There has been a leveling off of mortality rates in men aged 5544. It is only in the oldest age groups that a steady increase in rates has been observed through 1986 (FIG. 1). These trends indicate that there should be a decrease in the overall lung cancer mortality rate in men by the early 1 9 9 0 ~ . ~ Among women the age-specific rates continue to increase, except for age group 35-44, where adecrease has beenseenstartingintheearly 1980s,andalevelingofratesin agegroup 45-54 (FIG. 2). In addition to a decrease in mortality trends, the incidence of lung cancer has also declined. Studies of lung cancer incidence by the SEER Program of the National Cancer Institute reveal that the annual percent increasein men between 1975 and 1979 was l.6%, but between 1982 and 1986, there was an annual percent decrease in incidence rate of 0.8% .3 The rate in whites decreased by 0.9% annually during this period but increased by 0.8% in blacks. Among women the annual rate of increase diminishedfrom6.3% inthe 1975-1979period to2.8% in 1982-1985. In black women however, there was no change in the annual rate of increase in the two periods, 8.4% and 8.57'0, respectively. Cigarette consumption per capita in persons age 18 and older measures total cigarette consumption divided by the estimated population and includes nonsmokers and exsmokers as well as smokers in the denominator. The index rose steadily from 1,085 in 1925 to 3,886 in 1952. Following publication of the smoking-health reports in the early 1950s, the index dropped 9% to 3,546 in 1954. It then continued to rise until

Comprehensive assessment of AIDS patients using the behavioural systems model for nursing practice instrument.

Abstract: The major changes resulting from the AIDS diagnosis and illness were measured, described and classified in the Behavioural Systems Model's eight subsystems--achievement, affiliative, aggressiveness/protectiveness, dependence, ingestive, eliminative, restorative and sexual. Thirty male AIDS patients with Kaposi's Sarcoma were drawn as a convenience sample from a major medical centre's outpatient clinic. The subjects self-rated their perceived changes in the above eight major areas, using a 140-item instrument (DBSM) consisting of 24 categories of changes distributed in the above eight areas. Patients reported changes in all categories and described them in terms of direction, quality and relative importance. Ordinal ranks of changes existed among the eight major subsystems' frequency and importance of change scores, as shown by ANOVA and Tukey's studentized t-tests of rank.

Prospective new developments in laboratory research and clinical trials in prostatic cancer

Abstract: Laboratory research continues to develop new methods supporting clinicians in the management of prostatic cancer. Routine measurements of serum prostate-specific antigen (PSA) levels improve diagnosis, provide insight into tumor burden, and sharpen prognostication. New organ-specific antigenic targets are identified for monoclonal antibody-directed diagnostic and radiotherapeutic reagents. Such new immunospecific conjugates are already under evaluation in clinical trials. Cell culture techniques carry the promise of noninvasive early detection and prognostic evaluation of prostatic malignancy in preclinical stages. Molecular mechanisms responsible for androgen regulation of proliferation and malignancy of prostatic cancer are becoming open for scientific inquiry.

Phase I studies of recombinant interferon-gamma.

Abstract: A phase I study of the effects of intravenous administration of interferon-gamma on 31 patients was performed. The effects of dose, schedule, and chronic administration were studied. In the first phase of the study, a dose range of 0.01-500 MU/m2 (0.0002-25 mg/m2) was tested and we found the maximum tolerated dose to be 400 MU/m2; the dose-limiting toxicity with this preparation was hypotension. In the second phase, three different schedules of administration were tested. There were no significant differences in toxicity between a 20 min, a 4 h, or a 24 h infusion of 60 MU/m2 (3 mg/m2). In the third phase, patients received chronic administration of either 1 or 30 MU/m2. Patients given 30 MU/m2 twice a week for 4 weeks showed more symptoms--fever, nausea, and orthostasis--than those treated with 1 MU/m2. No significant changes were seen in natural killer cell activity, antibody-dependent complement cytotoxicity, or monocyte cytotoxicity at any dose. Maximal stimulation of 2',5'-oligodenylate synthetase occurred at low doses (12 MU/m2). Depressed bone marrow colony formation for CFU-GM, BFU-E, and CFU-GEMM in vivo was noted. No objective antitumor responses were noted. This preparation of recombinant interferon-gamma can be given in doses as high as 400 MU/m2. Chronic administration would appear to be limited to 30 MU/m2. However, lower doses may give maximal biologic responses. These studies provide further information on the biologic effects of a wide dose range and a variety of schedules of recombinant interferon-gamma.

Certification for oncology nurses: Maturing of a discipline

Abstract: —Certification for oncology nurses shares many similarities with board certification in medicine. Within the specialty of oncology nursing, certification provides one measure of excellence ...

Transfer of technology. Cancer education.

Abstract: Advances in research are transmitted to practicing physicians through a variety of continuing medical education approaches. Physicians are sophisticated managers of their learning and use group and self-instruction methods. Local hospitals and professional societies along with reading are major sources of continuing education. Cancer education to transmit the latest advances draws on all methods of continuing medical education. A study of practicing physicians' interests and preferences in cancer education provides guidance about tailoring continuing medical education to physician needs. The use of personal computers may be important in bringing information directly to the physician in the practice setting. The challenge is to provide educational opportunities in a variety of ways to meet the diverse needs of the practicing medical community.

A Public Health Evaluation of a Population-Based Colorectal Cancer Education and Screening Program

Abstract: A total of 561 residents of San Diego participated in an evaluation study of the effectiveness of the San Diego County Colorectal Cancer Education and Screening Program. The study design was a separate sample pre-test/post-test administration of a telephone questionnaire. The education project focused on clarifying misconceptions and informing the public of early detection measures for colorectal cancer. A significant difference existed at the P < .05 level between the pre-test and post-test groups for seven of 15 items on the questionnaire. Evaluation of the San Diego program indicated that it was more successful in providing the public information about early detection of colorectal cancer (fecal occult blood test, digital rectal exam, and proctosigmoidoscopic examination) than in clarifying misconceptions about the disease. Despite such a program, however, reduction in morbidity and mortality may not occur if public education to clarify misconceptions about colorectal cancer is not reinforced ...

Quality assurance in the care of the patient with cancer

Abstract: Efforts today have been broadened to reduce the risk of cancer by changing life styles, to detect cancer at its earliest possible and most highly curable stage, to provide prompt and adequate treatment, and to restore the patient to as nearly a normal way of life as possible after cancer therapy