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64 Miscellaneous A randomized clinical trial of home nursing care for lung cancer patier& McCorkle R, Benoliel JQ. Donaldson G, Georgiadou F, Moinpour C, Goode11 B. (lniversity of Pennsylvania School of Nursing, Philadel- phia, PA. 19104. Cancer 1989;64:1375-82. A randomized clinical trial was conducted to assess the effects of home nursing care for patients with progressive lung cancer. One hundred sixty-six patients were assigned to either an oncology home care group (OHC) that received care from oncology home care nurses, a standard home care group (SHC) that received care from regular home care nurses, or an office care group (OC) that received whatever care they needed except for home care. Patients were entered into the study 2 months after diagnosis and followed for 6 months. Patients were interviewed at 6-week intervals across five occasions. At the end of the study, there were no differences in pain, mood disturbance, and con- cerns among the three groups. There were significant differences in symptom distress,enforced social dependency, and health perceptions. The two home nursing care groups had less distress and greater independence 6 weeks longer than the office care group. In addition, the two home nursing care groups steadily reported worse health percep- tions over time. Thus, it was remarkable that the office care group, which indicated more symptom distress and social dependency with time, also indicated perceptions of improved health with time. These results suggest that home nursing care assists patients with forestalling distress from symptoms and maintaining their independence longer in comparison to no home nursing care. Home care may also include assisting patients in acknowledging the reality of their situation. Atypical carcinoid tumor of the lung: A case report and discussion of the literature ArishitaCI,Ostrow LB, Kl~ncAL.Depar~menrofSurgery,DavidGrani USAF Medical Center, TravisAir Force Base. CA 94535-3500 Mil Med 1989;154:421-4. Carcinoid tumors comprise 1% to 2% of all tumors of the lung. Although carcinoid tumors are generally felt to be of low grade malignancy, an atypical variant exists that exhibits more virulent behavior and a less favorable prognosis. The treatment of carcinoid tumors is complete surgical removal and a more aggressive approach is required in the treatment of atypical carcinoids. A case is presented with a review of the literature. Cost-effectiveness of cancer chemotherapy: An economic evalu- ation of a randomized trial in small-cell lung cancer Goodwin PJ, Feld R, Evans WK. Pater J. Department of Medicine, Women’s College Hospital,Toronto, Ont.MSS IB6. J Clin Oncol 1988; 6: 153147. An economic evaluation of a randomized trial of cyclophosphamide, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and vincristine alone or alternating with etoposide (VP-16) and cisplatin in extensive small-cell lung cancer (SCLC) was undertaken. A survival benefit of 1.6 months in favor of alternating chemotherapy was associ- ated with an additional cost of $450 (1984 Canadian dollars) per patient. This translated to a cost of $3,370 per year of life gained. Sensitivity analyses demonstrated that the cost-effectiveness (CEA) of alternating chemotherapy was greatest when treatment was given on an outpatient basis. The results of the evaluation were sensitive to hospitalization rates, but even the most unfavorable analyses revealed the CEA of alternating chemotherapy to be comparable to that of treatments of common nonmalignant diseases. It is concluded that the CEA of alternating chemotherapy for SCLC was favorable whencompared with accepted treatments for nonmalignant diseases. The survival benefit seen with alternating chemotherapy was felt to be clinically significant and alternating chemotherapy is recommended as routine therapy for extensive SCLC. Clinical and pathological study of lung cancer in Japanese National Railways’ workers Ot.sukaT.FukudaS. MurotaY. DepartmentofThoracicSurgery. Tokyo General Hospital, East Japan Railway Company, Tokyo. J Transport Med 1989;43:1-12. The record of 175 cases of lung cancer seen in Japanese National Railways’ workers during a period of 27 years was reviewed from the viewpoint of clinical and pathological appearance. There were 174 men and 1 woman averaging 49.2 years in age (range 25 to 57). The rate of lung cancerdetection byregularmedicalcheckupwas49.1%andperipheral lung cancer constituted 72.0% of all cases. Cytological examinations were performed and the positive rate of malignant cell was 79.4%. By histological type, adenocarcinoma was as much as 56.0%, while epider- moid carcinoma was 20.6%. small cell carcinoma 14.3% and large cell carcinoma 5.7%. In the cases detected by regular medical check up, stage I was only 36.0% and advanced cases of stages BIa, 1IIband IV was 51.1%. Therewasnocaseofearlycancerofthepulmonary hilus. IngeneraLthe size of early peripheral lung cancer is said to be less than 2.0 cm in diameter. However, 35.0% of the peripheral lung cancer casts less than 2.0 cm in diameter showed lymph node metastasis of Nl and N2. In surgical treatment, 56.6% ofall cases underwentresection. Incurability, curative operation was 43.4%, relative curative operation 33.3%. relative non-curative operation 9% and absolute non-curative operation 14.1%. The five year survival rate for all cases was 25.9%, in the cases detected by regular check up 31.8%, in the resected cases 56.6%, in curative operation 67.6% and in stage I of the resected cases 69.8%. For the improvement of treated results, greater effort must be made to detect lung cancer in the early stage and a vigorous therapeutic approach taken with theconviction that acombination ofopcration, madiation,chemo- therapy and immunotherapy will offer the best possible cure.

Clinical and pathological study of lung cancer in Japanese National Railways' workers

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64

Miscellaneous

A randomized clinical trial of home nursing care for lung cancer patier& McCorkle R, Benoliel JQ. Donaldson G, Georgiadou F, Moinpour C, Goode11 B. (lniversity of Pennsylvania School of Nursing, Philadel- phia, PA. 19104. Cancer 1989;64:1375-82.

A randomized clinical trial was conducted to assess the effects of home nursing care for patients with progressive lung cancer. One hundred sixty-six patients were assigned to either an oncology home care group (OHC) that received care from oncology home care nurses, a standard home care group (SHC) that received care from regular home care nurses, or an office care group (OC) that received whatever care they needed except for home care. Patients were entered into the study 2 months after diagnosis and followed for 6 months. Patients were interviewed at 6-week intervals across five occasions. At the end of the study, there were no differences in pain, mood disturbance, and con- cerns among the three groups. There were significant differences in symptom distress,enforced social dependency, and health perceptions. The two home nursing care groups had less distress and greater independence 6 weeks longer than the office care group. In addition, the two home nursing care groups steadily reported worse health percep- tions over time. Thus, it was remarkable that the office care group, which indicated more symptom distress and social dependency with time, also indicated perceptions of improved health with time. These results suggest that home nursing care assists patients with forestalling distress from symptoms and maintaining their independence longer in comparison to no home nursing care. Home care may also include assisting patients in acknowledging the reality of their situation.

Atypical carcinoid tumor of the lung: A case report and discussion of the literature ArishitaCI,Ostrow LB, Kl~ncAL.Depar~menrofSurgery,DavidGrani USAF Medical Center, Travis Air Force Base. CA 94535-3500 Mil Med 1989;154:421-4.

Carcinoid tumors comprise 1% to 2% of all tumors of the lung. Although carcinoid tumors are generally felt to be of low grade malignancy, an atypical variant exists that exhibits more virulent behavior and a less favorable prognosis. The treatment of carcinoid tumors is complete surgical removal and a more aggressive approach is required in the treatment of atypical carcinoids. A case is presented with a review of the literature.

Cost-effectiveness of cancer chemotherapy: An economic evalu- ation of a randomized trial in small-cell lung cancer Goodwin PJ, Feld R, Evans WK. Pater J. Department of Medicine, Women’s College Hospital, Toronto, Ont. MSS IB6. J Clin Oncol 1988; 6: 153147.

An economic evaluation of a randomized trial of cyclophosphamide, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and vincristine alone or alternating with etoposide (VP-16) and cisplatin in extensive small-cell lung cancer (SCLC) was undertaken. A survival benefit of 1.6 months in favor of alternating chemotherapy was associ- ated with an additional cost of $450 (1984 Canadian dollars) per patient. This translated to a cost of $3,370 per year of life gained. Sensitivity analyses demonstrated that the cost-effectiveness (CEA) of alternating chemotherapy was greatest when treatment was given on an outpatient basis. The results of the evaluation were sensitive to hospitalization rates, but even the most unfavorable analyses revealed the CEA of alternating chemotherapy to be comparable to that of treatments of common nonmalignant diseases. It is concluded that the CEA of alternating chemotherapy for SCLC was favorable whencompared with accepted treatments for nonmalignant diseases. The survival benefit seen with alternating chemotherapy was felt to be clinically significant and alternating chemotherapy is recommended as routine therapy for extensive SCLC.

Clinical and pathological study of lung cancer in Japanese National Railways’ workers Ot.sukaT.FukudaS. MurotaY. DepartmentofThoracicSurgery. Tokyo General Hospital, East Japan Railway Company, Tokyo. J Transport Med 1989;43:1-12.

The record of 175 cases of lung cancer seen in Japanese National Railways’ workers during a period of 27 years was reviewed from the viewpoint of clinical and pathological appearance. There were 174 men and 1 woman averaging 49.2 years in age (range 25 to 57). The rate of lung cancerdetection byregularmedicalcheckupwas49.1%andperipheral lung cancer constituted 72.0% of all cases. Cytological examinations were performed and the positive rate of malignant cell was 79.4%. By histological type, adenocarcinoma was as much as 56.0%, while epider- moid carcinoma was 20.6%. small cell carcinoma 14.3% and large cell carcinoma 5.7%. In the cases detected by regular medical check up, stage I was only 36.0% and advanced cases of stages BIa, 1IIb and IV was 51.1%. Therewasnocaseofearlycancerofthepulmonary hilus. IngeneraLthe size of early peripheral lung cancer is said to be less than 2.0 cm in diameter. However, 35.0% of the peripheral lung cancer casts less than 2.0 cm in diameter showed lymph node metastasis of Nl and N2. In surgical treatment, 56.6% ofall cases underwentresection. Incurability, curative operation was 43.4%, relative curative operation 33.3%. relative non-curative operation 9% and absolute non-curative operation 14.1%. The five year survival rate for all cases was 25.9%, in the cases detected by regular check up 31.8%, in the resected cases 56.6%, in curative operation 67.6% and in stage I of the resected cases 69.8%. For the improvement of treated results, greater effort must be made to detect lung cancer in the early stage and a vigorous therapeutic approach taken with theconviction that acombination ofopcration, madiation,chemo- therapy and immunotherapy will offer the best possible cure.