Opinions vary, but some recommend hitting certain cancers 'harder and earlier'

Article Abstract:

The use of very toxic doses of chemotherapeutic drugs to treat certain kinds of cancer was discussed at the 33rd American Cancer Society Science Writers' Seminar in Phoenix, Arizona. The topic has been controversial because the side effects of chemotherapeutic agents can be life-threatening, causing serious infections and excess bleeding due to effects on the bone marrow. But modern methods of bolstering patients' immune systems and combatting the nausea and vomiting that often accompany chemotherapy may reduce the risks of high-dose chemotherapy. Richard J. O'Reilly, who chaired the session of the meeting in which the issue was discussed, believes that oncologists' reluctance to see their patients hospitalized because of the side effects of treatment may have held back progress against cancer. Dr. O'Reilly draws the analogy between cancer and bacterial infection: if hit hard, and early, the disease is more likely to succumb. While intensive drug regimens carry significant risks, more patients are cured by them. Higher doses of chemotherapy can cause permanent damage to the bone marrow, but this can be prevented by removing and freezing some marrow from the patient before treatment starts, and then returning it later. The marrow itself may contain malignant cells, however; techniques are described whereby these cells are purged from the marrow prior to reinfusion into the patient. This approach has been used for patients with breast cancer, neuroblastoma (a tumor of nerve cell origin), and multiple myeloma (a malignancy of the bone marrow cells). Acute lymphoblastic leukemia (another bone-marrow malignancy) has not responded as well to this method of treatment; possible reasons for this are briefly described. It is predicted that bone marrow transplantation will expand as a technology to offer hope to an increasing number of cancer patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer, Dosage and administration, Chemotherapy

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Cocaine use in pregnancy: physicians urged to look for problem where they least expect it

Article Abstract:

Physicians who believe that drug-addicted pregnant women are poor, urban, or of minority ethnic groups, are, quite simply, wrong, according to research recently reported. Ira J. Chasnoff studied women who received prenatal care in clinics and private obstetrical offices in Pinellas County, Florida, and found that urine tests were positive for 16.3 percent of the women who visited public clinics, and for 13.1 percent of the women treated in private offices. Approximately the same percentage of white (15.4) and black (14.4) women used drugs, with differences in the type of drug used most: white women more often chose marijuana, and black women, cocaine. Myths about the power of cocaine to hasten labor may encourage the drug's use. The myth is unfounded, according to a recent study. Women may also try to get a 'thrill' out of delivery, by taking drugs when labor begins. The practice can lead to disastrous, even fatal, consequences for the infants. Obstetricians need to inquire about patients' drug histories as a routine part of care. Using large amounts of cocaine near the end of pregnancy can cause infarction (tissue death due to reduced blood supply) of the brain, heart, or other organs. Some mothers who have used cocaine in this manner then go on to sue their physicians for the use of forceps during delivery. Because of cocaine, infant mortality in Washington, D.C., increased 40 percent during 1989. Although detection of cocaine users early in pregnancy can significantly reduce the rate of prematurity and growth retardation among their infants, such women presently often remain unidentified. Physicians do not usually inquire about pregnant women's life-styles, or their drug or cigarette use. Moreover, even if identified, such women often cannot find a drug treatment program that will accept them. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Physician and patient, Physician-patient relations, Statistics, Pregnant women, Drug use, Cocaine, Drug abuse in pregnancy

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