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Thirty-one adults with Wilms tumor were reported to the National Wilms Tumor Study from 1968 to 1979. Treatment and survival data for these patients were analyzed and compared to similar information derived from children enrolled in the first National Wilms Tumor Study. The ages of the 31 adults ranged from 17 to 63 years (mean 29 years). All but 3 patients had surgical resection or excision of tumor, 7 did not receive postoperative irradiation and all but 1 had chemotherapy. Actinomycin D and vincristine were the drugs used most commonly, 26 of the 31 patients receiving both agents. Advanced disease at diagnosis (6 stage III and 9 stage IV versus 9 stage I and 5 stage II--in 2 cases stage was not known) was found more often than in children in whom stages III and IV disease made up 27 per cent of the first National Wilms Tumor Study population. The 3-year actuarial survival rate for the 31 adults was 24 per cent: 48 per cent for stages I and II disease and 11 per cent for Stage IV disease. Comparable data for children in the first National Wilms Tumor Study, adjusted for stage, were 74, 87 and 53 per cent, respectively. It is concluded that adults with Wilms tumor treated as were these have a worse prognosis than children managed according to the first National Wilms Tumor Study regimen. However, those adults in this series who were treated aggressively, that is surgical excision, postoperative irradiation and multi-agent chemotherapy, appeared to have fared better than adults treated in the pre-chemotherapy era. It is concluded that aggressive therapy should be given to all adults with Wilms tumor irrespective of stage.

The purpose of this study was to identify predictors of survival time in first recurrent breast cancer patients, including psychologic as well as biologic factors. Beginning in 1979, 36 women being treated at the National Institutes of Health for histologically proven recurrent disease were enrolled in this prospective study. At the time of data analysis, 24 had died from their malignancy. Through the use of a Cox proportional hazards model, four factors significantly entered the equation predicting survival time in the sample: Patients with a longer disease-free interval, who expressed more joy at baseline testing, who were predicted to live longer by their physicians, and who had fewer metastatic sites tended to live longer with recurrent disease than others in the sample (X2 = 22.9, p less than 0.0001). Findings from recent clinical and animal studies suggest that regulatory systems within the organism are linked and potentially influence one another. This study has demonstrated that factors at a number of levels--behavioral, as well as biologic--need to be considered in accounting for disease outcome variance.

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