Immediate versus delayed chemotherapy in patients with asymptomatic incurable metastatic cancer

Aim: To examine the evidence of benefit in initiating immediate chemotherapy in patients with newly diagnosed asymptomatic metastatic incurable cancer, compared with delaying chemotherapy until symptomatic progression. Methods: Through an extensive review of published reports, we examined the biological, clinical, psychological and ethical background of the issue and reported on the available clinical trial evidence in a variety of tumor types. Results: Only a limited number of clinical trials have directly examined the role of immediate versus delayed chemotherapy in patients with incurable asymptomatic metastatic cancer. Small studies in mesothelioma, colorectal cancer, breast cancer, myeloma, and low‐grade lymphoma suggest no survival benefit for the immediate initiation of chemotherapy. However, there was no evidence in other tumor types. Conclusion: The appropriate timing of chemotherapy initiation in an asymptomatic patient with metastatic cancer remains a substantial question in oncology. Many factors are likely to impact on the decision. However, little if any evidence demonstrates a clear advantage in the immediate initiation of chemotherapy in this setting.     

THE GRIEF EVALUATION MEASURE (GEM): AN INITIAL VALIDATION STUDY

ABSTRACT

This article describes the development of the Grief Evaluation Measure (GEM), a new instrument designed to screen for the development of a complicated mourning response in a bereaved adult. The GEM provides a quantitative and qualitative assessment of risk factors, including the mourner's loss and medical history, coping resources before and after the death, and circumstances surrounding the death. It is designed to provide an in-depth evaluation of the bereaved adult's subjective grief experience and associated symptoms. Reliability and validity studies were conducted with two samples of bereaved adults (n = 23 and n = 92, respectively) from various clinical and support settings. Data on the two central sections of the GEM that assess the mourner's grief response and the level of symptomatology are described. Results indicate that the GEM's internal consistency and test–retest reliability are high. The GEM demonstrates good concurrent validity for established measures of bereavement, trauma, and physical and psychiatric symptoms, and good predictive validity for mourner adjustment one year after initial assessment. Plans for future development and an invitation for other researchers to collaborate with research on the GEM are also discussed.     

DEVELOPMENT OF INCLUSION BODIES CONTAINING RIBOSE NUCLEIC ACID IN MYELOMA CELLS AFTER INJECTIONS OF STILBAMIDINE. DETERMINATION OF STILBAMIDINE IN MYELOMA TISSUE

The cytoplasm of myeloma cells is rich in ribose nucleic acid. The basophilicinclusion bodies which develop in myeloma cells under the influence of stilbamidinecontain ribose nucleic acid. The myeloma tissue of patients treated with stilbamidine contains appreciable amounts of stilbamidine.

There is reason to believe that the nucleoproteins of myeloma cells differ from thenucleoproteins of other cells. This could explain why stilbamidine reacts with thenucleoproteins of myeloma cells only, and not with the nucleoproteins of othercells.

     

His Bundle Ablation with the Laser Thermal Probe ("Hot Tip"): A Feasibility Study

Successful percutaneous ablation of the bundle of His requires accurate localization together with delivery of the minimum effective energy to avoid unwanted effects. The energy output from laser sources can be controlled very precisely but is not easily directed to the bundle of His using conventional fiber optics. The laser thermal probe ("hot tip") consists of an optical fiber and a terminal metal cap that is rapidly heated during energy delivery. When applied to cadaver hearts at energies of 100-150 joules (10 watts for 10-15 seconds) the 2.0-mm diameter peripheral artery probe was able to damage the bundle of His without extensive surrounding damage. The right ventricular free wall and interventricular septum were perforated during some applications at these energies leaving a tract with a diameter of less than 2.0 mm. The atrioventricular (AV) membranous septum, Foramen Ovale, right atrial appendage, and septal leaflet of the tricuspid valve were more resistant at these energy levels and perforations were always less than 1.0 mm in diameter. The probe was modified for use during electrophysiological studies and good quality unipolar electrograms were recorded from the metal cap confirming that the probe could be accurately positioned adjacent to the bundle of His. The laser thermal probe deserves further study as a "self directing" ablation tool.