Post-primary Treatment Research Articles

The Role of Case Management in Retaining Clients in Substance Abuse Treatment: An Exploratory Analysis

The positive relationship between time spent in substance-abuse treatment and improved outcomes has led to a significant interest in interventions that encourage substance abusers to remain in treatment. Case management has been tested for its role in both encouraging continued participation and directly affecting desired outcomes. This article reports findings from an ongoing longitudinal study that randomly assigned over 600 substance abusers entering treatment to one of two groups, either: (1) usual primary and aftercare drug treatment services or (2) usual services and an enhancement of strengths-based case management. A cluster analytic technique was used to identify patterns of participation in post-primary treatment, i.e., aftercare and case management, among those substance abusers in the enhanced group. Three distinct clusters emerge that suggest a prominent role for this model of case management as either an adjunct or an alternative to conventional treatment.

A phase II study of cisplatin and continuous infusion of vindesine in metastatic head and neck squamous cell cancer

The chemotherapeutic treatment of recurrent and/or metastatic squamous cell carcinoma (SCC) of the head and neck (H & N) has a very dismal prognosis, with survival usually not exceeding 1 year. Reported objective response rates vary between 3% and 70%. This difference appears largely attributable to the heterogeneity of the patient populations included in most published Phase II studies in H & N cancer. They usually include together initially metastatic, recurrent, and post primary treatment metastatic disease patients. These patients respond differently to chemotherapy. Because of this situation, we decided to study a more homogeneous patient population consisting of metastatic patients only. Cisplatin (CDDP) and vindesine (VDS) are active agents in H & N SCC. As VDS has a cycle-specific activity, the therapeutic index may be increased if it is administered in a continuous infusion (CI) schedule. Thirty-three patients with metastatic H & N (69% biopsy proven) were treated with a combination regimen including CDDP (100 mg/m2) day 1 and VDS 0.6 to 1 mg/m2 for 96 hours of CI. Thirty-one patients were evaluable for response: five had a complete response (CR; 16%) and 11 had a partial response (PR; 36%) with an overall rate response of 52% (95% confidence limit: 33% to 70%). Median duration of CR was 6.4 months (3 to 19 months) and 4.4 months for PR (3 to 6 months). A decrease in the leukocytes was the main toxicity encountered with this regimen. This combination regimen containing CDDP and CI VDS was well tolerated and active in H & N SCC. The incorporation of an active vinca-alkaloid in neoadjuvant regimens should be considered.

Follow-up of the Cancer Patient

Contemporary treatment by an oncologist is presumed to have preceded the starting point of this text. The editors have allowed no indulgence in speculative measures; for example, adjuvant chemotherapy is considered at points where it is of demonstrable value or noted as a question for research protocol. At several points, particularly in the follow-up of successfully treated neoplasms, greater concern for nonneoplastic or second primary neoplastic disease should be demonstrated. The toxic effects of therapy should also be in diagnostic differentials. The one flawed chapter was that on breast cancer, where a unimodal surgical approach mentioned neither a combined modality treatment option with radiation therapy, nor any role for postprimary treatment, adjuvant chemotherapy. Diligent editing has eliminated redundancy in the brief chapters, all four to six pages devoted to each tumor type. The editorial belief that the nononcologist can provide excellent and cost-effective follow-up seems fulfilled in all solid-tumor areas.