A sequential study of patients with cancer of the lung reveals that there is a marked alteration in delayed hypersensitivity as manifested by Dinitrochlorobenzene (DNCB) sensitization and purified protein derivative (PPD) reactions, when compared to age‐matched controls. Short survival times (diagnosis to death) are associated with negative DNCB tests. Skin reactivity does not necessarily change as patients approach death, however. Circulating lymphocytes decrease significantly in number during the months approaching death and these counts can be plotted into a smooth regression curve with time to death as the abscissa. Humoral antibody synthesis is not altered in these patients; the circulating levels of the various serum proteins and iramunoglobulins do not alter with time nor are they biologically different from control values.
A study of patterns of communications in families with a terminal cancer patient being treated at three urban institutions revealed that may first-order relatives (spouses, children, siblings) of patients did not have a communication link to the physician, especially if direct communication was not established at the time of diagnosis. Family members were frequently critical of the way information was communicated, yet relied upon the physician's interpretation of the patient's status to form their own opinion of the patient's future. Intra-familial communications regarding illness and dying were frequently discordance and guarded, leading to preceptions that the patient was withdrawing, and fostering a reliance upon the hospital for terminal care. More than half of the family members were uncomfortable visiting the patient in the hospital, experiencing feelings of helplessness, or sensing helplessness in the patients. Bearing the patient's pain was seen as particularly difficult.
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