In the article in the February 10th issue on the topic of prophylactic cranial irradiation (PCI) in non-small cell lung cancer (RTOG 0214), one of my statements was quoted in error. It should have read, “People did NOT have memory problems such as being unable to recognize family or friends,” but rather the memory deficits were subtle. [Editor's Note: We apologize for and regret that mistake.]
Differences in recall were evaluated in this study using the Hopkins Verbal Learning Test-Revised (HVLT-R), a memory test administered by reading words aloud, then asking the individual to verbally repeat the list of words (immediately and after a delay) and to identify the words from the list from a verbal presentation (including both the target words and the distractors). However, the study demonstrated no significant differences between patients on the control or PCI arms in the Activities of Daily Life Scale (ADLS), the Mini-Mental Status Exam (MMSE) or Quality of Life (using the EORTC instrument).
Interestingly, the differences in recall between the control and PCI arms at one year (while significant) where much less prominent than at three or six months post-treatment, suggesting that some recovery in memory occurs over time. Strategies being explored to address this important issue include testing agents to “protect” neurocognitive function (e.g., RTOG 0614: Phase III study of memantine in patients receiving brain radiation) and developing conformal PCI techniques that may spare memory function: (e.g., hippocampal avoidance to protect neuronal progenitor cells in this region).
Clearly, more research is needed in this area to further enhance the therapeutic ratio of PCI.
BENJAMIN MOVSAS, MD
Herndon Chair in Oncology Research Chairman, Department of Radiation Oncology Henry Ford Health System Detroit
LETTER: Wendy Harpham's “View from the Other Side of the Stethoscope” (1/25/10 issue)
I enjoyed Wendy Harpham's “Passing the Baton” column in the January 25th issue. The biggest point I took away from it was the “putting the blame where it belongs” portion and the discussion we often have about or with the patient. As a new NP myself, I feel this is very important to keep in mind when speaking with and caring for patients and it makes me take a step back when I have discussions with patients and families. I do try and put myself in the patient's place but seeing this in print is self actualizing. I will be sharing this with my nurse and doctor colleagues!
TRACEY JURGENSMEIER, ARNP, MSN, OCN
Katzmann Breast Center Mercy Medical Center Clive, Iowa
LETTER: Simone's OncOpinion: ‘The Gullible Decade’ (1/25/10 issue)
I enjoyed Joe Simone's “The Gullible Decade” column in the January 25th issue. What society is missing today is the lack of tempering that newsprint essayists of days past offered the public as a kind of “moral consciousness.” Today we have “e-conscioussness,” in the form of blogs, Twitter, and the like. There are often no great lessons to be garnered from these attempts at ethical “sound bites.”
Joe Simone's attempts at offering his opinions on medical-moral issues are to be lauded and imitated. The challenging crossroads we have encountered recently in health care need more discourse by thought leaders who can escape the rigidity of their research that envelopes free thought and exchange of philosophical ideas that are the basis of our being.
ANTHONY PROVENZANO, MD