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Objectives The current exploratory cross-sectional study was designed to examine and characterize survivorship issues among patients treated with radiation for head and neck cancer with regard to dental health, shoulder-neck dysfunction, and overall quality of life (QOL). Methods Patients (N = 58) being seen for follow-up at a radiation oncology clinic at least 1 year beyond the end of treatment completed three survey questionnaires regarding general QOL as well as dental health issues and shoulder-neck dysfunction. The questionnaires were scored and univariate analyses were performed using the variables of age, radiation dosage, definitive radiation + neck dissection versus definitive surgery + postoperative radiation, and chemotherapy. Results Median follow-up was 2.5 years. Of 58 patients, 35% reported having more problems with their general dental health as compared to before treatment and 38% reported having pain at night in the neck/shoulder after treatment. With regard to pretreatment counseling, 79% of patients reported being counseled about their dental health prior to treatment, while 31% reported being counseled about possible shoulder-neck dysfunction. Patients younger than 65, patients receiving higher doses of radiation, and patients undergoing definitive surgery + postoperative radiation reported more functional and symptomatic issues. Conclusion Patients treated with radiation for head and neck cancer face a number of survivorship issues, including problems with dental health and shoulder-neck dysfunction, and are not necessarily thoroughly counseled about these issues prior to treatment. Patients younger than 65, patients receiving higher doses of radiation, and patients undergoing definitive surgery + postoperative radiation may experience more survivorship issues. Level of evidence IV.

Purpose The purpose of this evaluation is to examine the relationship among nurses' pain management attitudes and pain management practices and to begin to explore the theoretical underpinnings that may influence this relationship. Description of study A convenience sample of 29 female registered nurses working in hospice or home health settings participated in an educational program 1 day per week for 6 weeks. All participants were asked to complete the Cancer Pain Knowledge Inventory and Survey of Expectations and Pain Assessment Questionnaire 5 weeks before, immediately before, immediately after, 6 months after, and 12 months after the program. Seventeen participants completed all questionnaires at the 6-month follow-up; 16 participants completed all questionnaires at the 1-year follow-up. Personal beliefs about pain were evaluated in relation to the dimensions and treatment of pain. Intentions and expectations to perform specific activities were evaluated in relation to in-depth assessments, equianalgesic conversions, demonstration of new ideas, and communication. Results Nurses' attitudes, beliefs, intentions, and expectations about pain and pain management influenced nurses' patient care and educational activities. Nurses who believed that patients should be pain free and nurses who focused on both the dimensions and treatment of pain implemented more pain management activities. In general, nurses who had high intentions and expectations performed more pain management activities. Clinical implications Although nurses reported change in attitude, and high expectancy for change, feelings of increased credibility, and increased motivation as advocates for new approaches to practice, nurses sometimes found it difficult to implement new practices because of constraints in time and collaborative efforts. To implement new knowledge and achieve individualized goals for change, nurses must be allowed adequate time to analyze the relationships between their beliefs about pain and the ways that they solve patients' pain problems. In addition, more support for multidisciplinary collaboration is needed.

To determine a dose-response relationship of ondansetron for the prevention of emesis induced by high-dose cisplatin and to study the efficacy of the extended dosing schedule of ondansetron during 20 hours after cisplatin administration, 36 patients with malignant neoplasms who had not previously received chemotherapy but who were currently receiving cisplatin were treated. These patients received a six-dose regimen of 0.01 mg/kg (low dose) or 0.18 mg/kg (high dose) of ondansetron. Seven (41%) patients in the high-dose group had no emesis and four (24%) patients had one or two episodes. One (5%) patient in the low-dose group had no emesis and four (21%) patients had one or two episodes. The difference in the number of emetic episodes was significant (P less than 0.02). Fifty percent of the high-dose patients reported no nausea or mild nausea, compared with 11% of the low-dose patients. Clinical adverse events included mild, transient headache and dizziness in the high-dose group and headache and diarrhea in the low-dose group, with no significant laboratory abnormalities. There is a parallel relationship between the ondansetron doses and the antiemetic efficacy. The response rate for the six-dose regimen of 0.18 mg/kg was not superior to that for the previously reported 0.18 mg/kg regimen given in a three-dose schedule in a similar clinical setting.

A study of predictive factors for locoregional recurrences after curative surgery for breast cancer was undertaken. Specifically, the authors wished to determine whether such recurrences correlated with either hormonal receptor status or a delay between the initial biopsy and the definitive surgery. A retrospective chart review was done on all women with breast cancer who had surgery for cure between 1970 and 1982. Factors analyzed included, among others, size of the tumor, clinical and pathologic status of the axilla, estrogen and progesterone receptors status, and delay between biopsy and definitive surgery. There were 404 patients studied. Pathologic axillary nodal status was the most important predictor of locoregional recurrence, with failures in 36 of 188 (19%) node-positive but only 9 of 216 (4%) node-negative patients (P = 0.0001). In node-positive patients, tumor size was a predictor of local recurrence, with failure in only 4 of 51 (8%) of tumors less than 2 cm, but in 14 of 44 (32%) of tumors greater than 6 cm (P = 0.004). Progesterone receptor (PR) status correlated with locoregional recurrence, but estrogen receptor status did not. In node-positive women, there were 4 of 14 PR-negative but 0 of 15 PR-positive local failures (P = 0.017); this result has not been previously reported. The presence of palpable axillary disease was also found to be a predictor of local recurrence. Finally, no increase in locoregional recurrence could be attributed to the delay between biopsy and definitive surgery. Two new predictors for locoregional recurrence in breast cancer, not previously emphasized, are PR and clinical axillary status. Should these findings be substantiated, patients at high risk for locoregional recurrence could then be more readily identified.

Thirty-nine cancer patients (Ca) and 37 age-and sex-matched healthy controls (Co) evaluated 11 commercially available enteral supplements using a modified wine-tasting scale. The cancer patients were 19 males with lung cancer and 20 females with breast cancer, and their controls consisted of 17 males and 20 females, respectively. Mean evaluation scores for the individual supplements revealed no significant differences (NS) between lung cancer patients and controls. Ensure Plus (strawberry) received the highest score from both groups (Ca 16.0 +/- 3.0 vs Co 17.1 +/- 2.6, N.S.) while Vital received the lowest (Ca 6.3 +/- 4.8 vs Co 4.9 +/- 4.2, NS). Similar results were obtained for breast cancer patients and their controls except that chocolate Sustacal was rated significantly higher by breast cancer patients than by controls (16.6 +/- 2.6 vs 13.3 +/- 4.3, p less than 0.01). Again, Ensure Plus (strawberry) received the highest score from both groups (Ca 17.0 +/- 3.5 vs Co 17.8 +/- 2.3, NS), while Vital was rated lowest by both groups (Ca 5.6 +/- 4.7 vs Co 4.3 +/- 5.0, NS). The modified wine-tasting scale provides a method for quantitating taste preference for various dietary supplements. We report here the numerical rating of 11 supplements by patients with lung cancer and patients with breast cancer as well as their age- and sex-matched controls.