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Background: The possible link between psychological factors and length of cancer survival has generated a literature of contradictory findings. Associations usually have not been found when general psychological symptoms are assessed. Associations usually have been found for predictors related to expressive versus repressive emotional coping (e.g., depression, 'fighting spirit,' hostility, and type C personality); however, even these associations have been relatively small, when compared with those for medical factors. Yet few studies have adequately controlled for medical and treatment-related factors. Purpose: Within a Cancer and Leukemia Group B (CALGB) national clinical trial of four adjuvant therapy regimens for stage 11 breast cancer (CALGB 8082), this study prospectively examined the contribution of potential psychological predictors to length of disease-free and overall survival over a 15-year period. Methods: Subjects were 280 women with stage 11 breast cancer, out of a total of 899, who were randomly assigned to receive CMFVP (cyclophosphamide-methotrexate-fluorouracil-vincristine-prednisone) for two 6-week cycles or six 4-week cycles, then subsequently randomly assigned to receive or not to receive VATH (vinblastine-doxorubicin-thiotepa-fluoxymesterone). Subjects were recruited during the period between October 1980 and August 1984, inclusive, and followed until January 1996. Prior to chemotherapy, psychological symptoms were assessed using the Symptom Check List-90-Revised (SCL-90-R). SCL-90-R scores were trichotomized into categories representing high, medium, and low distress. Basic base-line sociodemographic data (including age, ethnicity, education, and marital status) and medical data (including lymph node status, estrogen receptor status, menopausal status, and performance status) were collected. Subjects with psychosocial data differed from those without psychosocial data solely in their higher percentage of classification in the mild limitation category of the Zubrod (Eastern Cooperative Oncology Group) performance status rating (subjects with psychosocial data: 14%; subjects without psychosocial data: 8%). Results: In stepwise Cox regression analyses that controlled for sociodemographic and medical variables, there was no significant predictive effect of the level of distress (as measured by the SCL-90-R trichotomized scores) on length of disease-free and overall survival of the study subjects. Risk ratios for low versus high distress were 1.01 (95% confidence interval [CI] = .62-1.66) for disease-free survival and 1.03 (95% CI = 0.58-1.82) for overall survival. Conclusions: This study failed to provide evidence that psychological factors contributed to length of disease-free or overall survival of women who received adjuvant chemotherapy (either CMFVP alone or CMFVP followed by VATH) for treatment of stage 11 breast cancer. Implications: In the context of far more potent medical factors, the contribution of psychological factors to disease-free and overall survival is likely to be relatively small. Future research should focus on specific theory-driven predictors rather than on general psychological symptoms. Moreover, it should be based on clinical studies using a controlled, prospective design, in which the effects of medical factors may be distinguished and psychological predictors are clear antecedents of survival outcomes.

Background. The prevalence characteristics, and impact of pain and other symptoms have not been studied systematically in women with ovarian cancer. Anecdotally, pain has been associated with the onset of the disease and is a common problem among those with advanced cancer; symptoms other than pain appear to be highly prevalent. Given the profound influence of pain and other symptoms on quality of life, the evaluation of these phenomena could provide data relevant to the cIinical management of these patients and advance quality. of life research in the area of symptom assessment. Methods. Questionnaires were completed by 111 inpatient; and 40 outpatients with ovarian cancer who were undergoing treatment at a cancer center. Measures include a a comprehensive pain questionnaire: the Rand Mental Health Inventory, Functional Living Index--Cancer; and the Memorial Symptom Assessment Scale. Results. The sample (N = 151) represented 74% of the eligible patients. The median age was 55 year's (range, 23-86), 82% had Stage Ill or IV disease at presentation, and 69% had active disease at the time of the survey. Pain, fatigue and psychologic distress were the most prevalent symptoms. Sixty-two percent (N = 94) described it pain syndrome that preceded the onset or recurrence of the disease. and 42% (N = 63) reported 'persistent or frequent pain' during the preceding 2 weeks. The latter pain had a median duration of 2 weeks (range, less than 1 to 75% weeks) and usually was in the abdominopelvic region (80%), frequent or almost constant (66%), and moderate to severe. Most patients reported moderate or greater pain-related interference with various aspects of function, particularly activity (68%), mood (62%), work (62%), and overall enjoyment of life (61%). Performance status, inpatient status. and unmarried status were significant predictors of pain presence or intensity, and both performance status and extent of tumor were significant predictors of pain interference with function. Conclusions. Among those with ovarian cancer, greater than 40% experienced pain that substantially undermined function in one half to two thirds of these patients. Impaired performance status is associated most strongly with pain. The onset or recurrence of disease often is heralded by a stereotype pain syndrome. Cancer 1994: 74:907-15, Key words: ovarian cancer, pain, cancer pain, palliative care, quality of life.

Background. Because of the dearth of information concerning the quality of life of patients with prostate cancer, a data base was established to examine the nature and extent of problems in patients' and spouses' adaptation and their interrelationships and to examine the effect of disease stage combined with treatment regimen on patients' quality of life. Methods. One hundred seventy-two patients and 83 spouses/partners completed quality of life questionnaires in a prostate cancer health education lecture series. The measures used were the European Organization for Research and Treatment of Cancer (EORTC) Prostate Cancer Quality of Life Questionnaire, the Intrusion subscale (IS) of the Impact of Event Scale; and Selby's QL Uniscale. Fifty-five percent of patients had received medical and/or surgical hormonal therapy, 28% had received a radical prostatectomy and/or radiation therapy only, and 18% had not been placed on any treatment. Results. Patients experiencing problems in adaptation were significantly more likely to have advanced stage disease; received surgical or medical hormonal therapy; and were reporting greater pain, fatigue, urinary problems, and deteriorating physical functioning. Spouses reported significantly greater psychological distress than did patients (EORTC Psychological Distress subscale, P < 0.001; IS, P < 0.001). Conclusions. A two-stage clinical evaluation is recommended, in which quality of life questionnaires would initially be used to identify patients and spouses experiencing problems in adaptation for further evaluation by a mental health professional for appropriate treatment. Cancer 1994; 73:2791-802.

Background and Methods. The quality of life in patients who elected to receive hormonal therapy for newly diagnosed asymptomatic metastatic prostate cancer was compared with a comparable group of patients who chose to defer immediate intervention. Results and Conclusions. The premise that active therapy, despite its side effects, would improve or maintain the psychosocial quality of life was not substantiated, and the no-therapy group had better physical and sexual functioning. Cancer 1993; 71:1143-50.

Background. Survivors of advanced Hodgkin disease, who were assigned randomly to treatment by mechlorethamine, vincristine, procarbazine, and prednisone (MOPP); doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD); or MOPP alternating with ABVD in a clinical trial of the Cancer and Leukemia Group B (protocol 8251), were compared in terms of their psychosocial adaptation and psychosexual function an average of 2.2 years after completion of treatment (range, 1-5 years). The study was undertaken to determine if there were differences among treatments in these functional areas as a consequence of differential long-term gonadal damage in the three regimens. Methods. Ninety-three disease-free survivors of advanced Hodgkin disease (56 men and 37 women) were studied (a minimum of 1 year after completion of treatment) by an interview conducted over the telephone. Standardized measures were used to assess their psychologic, sexual, family, and vocational functioning, including the following tests: the Psychosocial Adjustment to Illness Scale--Self Report, the Brief Symptom Inventory, the Profile of Mood States, and the Impact of Event Scale. Results. Contrary to expectation, no statistically significant differences in survivors' psychosocial adaptation or psychosexual function were found by treatment arm. Infertility (based on survivors' reports of medical test results and perceptions) and lower income 1 year before the diagnosis of cancer were significant predictors of poorer adjustment. Most survivors reported a range of problems that they attributed to having had cancer: 35%, proven or perceived infertility; 24%, sexual problems; 31%, health and life insurance problems; 26%, a negative socioeconomic effect; and 51%, conditioned nausea, associated with visual or olfactory reminders of chemotherapy. Conclusions. No significant long-term advantage in psychosocial adaptation or psychosexual function was found for survivors of Hodgkin disease treated by the less gonadally toxic ABVD regimen 1 to 5 years after completion of treatment. Cancer 1992; 70:2508-2516.

Background. The long-term psychosocial adaptations of 273 survivors of advanced Hodgkin disease were assessed to determine the nature and extent of problems experienced and to identify those at high risk for maladaptation. Methods. Hodgkin disease survivors were identified who initially had been treated in clinical trials within the Cancer and Leukemia Group B from 1966 to 1986, were currently disease free, and had completed treatment for a minimum of 1 year. All survivors had advanced Hodgkin disease (with disease diagnosed at a mean age of 28 years). Survivors were at a mean age of 37 years at the time of interview (6.3 years after treatment completion), and 60% were male. Survivors were interviewed over the telephone 7-10 days after questionnaires were mailed to them concerning their psychological, social, vocational, and sexual functioning. Results. Psychological distress was found to be elevated by one standard deviation (SD) above that of healthy subjects on the Brief Symptom Inventory, and 22% met the criterion suggested for a psychiatric diagnosis. In addition, the following problems were reported by survivors to be a consequence of having had Hodgkin disease: denial of life (31%) and health (22%) insurance, sexual problems (37%), conditioned nausea in response to reminders of chemotherapy (39%), and a negative socio-economic effect (36%). Survivors found to be at high risk for maladaptation were: men earning less than $15,000 per year or who were currently unemployed; unmarried individuals; those with serious illnesses since treatment completion; and those who were less educated. Conclusions. These findings suggest that including a routine assessment of these factors would help to target survivors in need of additional evaluation and treatment. Cancer 1992; 70:2214-2224.

Background. Pregnancy outcome was reported by 139 survivors of advanced Hodgkin disease treated on nine protocols of Cancer and Leukemia Group B from 1966 to 1986. Methods. These patients provided data on 302 singleton pregnancies of a duration of at least 20 weeks that occurred before, during, or after treatment for Hodgkin disease (252, 26, and 24 pregnancies, respectively). Results. There were 4 perinatal deaths, as compared with 5.7 expected. Cancer subsequently developed in 2 offspring (expected, 1.2). However, 22 newborn infants had low a birth weight, exceeding the expected number of 13.7 (relative risk 1.6; 95% confidence interval, 1.0-2.4). The excess number of low weight births occurred primarily during the period of Hodgkin disease diagnosis and treatment but is based on small numbers. Conclusion. No increase in adverse outcome occurred in pregnancies that antedated the development of Hodgkin disease. Cancer 1992; 70:688-692.

The charts of 200 consecutive patients admitted for cancer treatment were reviewed for the prescription of psychotropic drugs. The prescription practices were then compared with studies of psychotropic drug prescriptions performed in 1977 and 1984. There was an overall 30 percent increase in the use of psychotropic drugs, but the ratios of drugs prescribed from different categories has remained relatively constant. In 1987, 43 percent of the prescriptions were for hypnotics; in 1977, hypnotics comprised 48 percent of psychotropics prescribed. In 1987, antipsychotics accounted for 28 percent of the prescriptions, anxiolytics about 27 percent, and antidepressants represented about three percent of prescriptions. Although the categories have remained relatively constant, the drugs prescribed within the categories have changed, reflecting the greater choice of agents presently available. The drugs were prescribed for anxiety, difficulty falling asleep, and for medical procedures such as chemotherapeutic infusion. Many of the prescriptions are to counteract the effects of chemotherapy. Antipsychotic drugs also have antiemetic effect (prevents or relieves nausea and vomiting), and their use among cancer patients reflects this fact. Antidepressant prescriptions were given least frequently, despite the fact that the prevalence of major depression among cancer patients has been estimated at six percent, and may be as high as 20 percent among hospitalized patients. This low rate of prescribing antidepressant drugs may reflect either a general unfamiliarity on the part of the oncologist, or a failure to perceive the seriousness of the psychiatric condition in an environment where life-threatening cancer is the primary target. (Consumer Summary produced by Reliance Medical Information, Inc.)