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This Week in JAMA
June 9, 2004

This Week in JAMA

JAMA. 2004;291(22):2673. doi:10.1001/jama.291.22.2673
Symptoms Reported in Ovarian Cancer

Many women with ovarian cancer report symptoms before diagnosis, but distinguishing symptoms that merit investigation is difficult. To address this problem, Goff and colleaguesArticle administered a symptom survey to women attending a primary care clinic and to women awaiting surgery for a pelvic mass. They compared the frequency, severity, and duration of symptoms reported by women with ovarian cancer and benign masses with those reported by women seeking primary care. Women with ovarian cancer reported more frequent and severe symptoms that had more recently manifested than what women in the primary control group reported. In an editorial, Daly and OzolsArticle emphasize the importance of good patient-physician communication and skilled clinical judgment to help facilitate early diagnosis of ovarian cancer.

Natural History of Early Prostate Cancer

Previous studies have estimated a 10- to 15-year progression-free and cause-specific survival for men with early, localized and untreated prostate cancer, but little is known about disease progression and mortality beyond this time frame. Johansson and colleaguesArticle report results from a population-based, cohort study of men with initially untreated, early stage prostate cancer who were followed up for a mean of 21 years. Although most cancers remained indolent through 15 years of follow-up, beyond 15 years, both disease progression and prostate cancer mortality increased approximately 3-fold compared with the earlier period. In an editorial, Neugut and GrannArticle discuss the implications of these findings for initial treatment decisions.

Participation in Cancer Clinical Trials

Adequate representation of racial and ethnic minorities, women, and elderly patients is necessary to assess whether cancer treatments are effective for all patients. To characterize the representation of these groups in nonsurgical cancer treatment trials, Murthy and colleagues conducted a population-based analysis of participants in colorectal, breast, prostate, and lung cancer trials sponsored by the National Cancer Institute Clinical Trial Cooperative Group in 2000 through 2002. They compared enrollment by race and ethnicity in the years 1996 through 1998 with that in the years 2000 through 2002. They found blacks and Hispanics were underrepresented in trials compared with whites and that enrollment was inversely related to age. From 1996 through 2002, trial enrollment increased nearly 50%, but the percentage of racial and ethnic minority enrollees decreased relative to whites.

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Predicting Mortality After Acute Coronary Events

Identification of patients at high risk of 6-month mortality following an acute coronary syndrome (ACS) could improve their posthospital care. Eagle and colleagues used data from more than 15 000 patients in the Global Registry of Acute Coronary Events to develop a decision tool to estimate the 6-month all-cause mortality risk in patients surviving an ACS. Their final model included 9 historical, admission, and treatment variables that predict 6-month postdischage mortality.

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Prognosis for Patients With Advanced Dementia

Reliable tools to predict life expectancy of patients with advanced dementia could help families and clinicians determine when palliative care would be appropriate. Mitchell and colleagues used data from newly admitted nursing home residents with advanced dementia—collected for the federally mandated Minimum Data Set (MDS)—to construct a scoring system that predicts the risk of 6-month mortality. They compared the performance of their model with existing criteria for hospice eligibility. Twelve variables from the MDS were included in the final model, which more accurately predicted 6-month mortality than hospice guidelines in current use.

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Medical News & Perspectives

Scientists are developing new techniques for producing laboratory-grown cartilage for the repair of damaged joints.

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Secondhand Smoke in Latin America

Airborne nicotine was detected in 94% of public places in an assessment in the capital cities of 7 countries.

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CLINICIAN'S CORNER

A systematic literature review reveals 3 useful signs predictive of dehydration in children.

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JAMA Patient Page

For your patients: Information about cancer clinical trials.

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