Chemotherapy side effects, patient distress, and patient-practitioner communication were evaluated in an inception sample of 238 patients with breast cancer or malignant lymphoma. Participants were interviewed at five points during their first six cycles of therapy, and a subsample kept brief daily symptom diaries. Nausea, hair loss, and tiredness were each experienced by more than 80% of patients. By cycle 6, 46% of patients had thoughts about quitting therapy, but only a few had told medical staff. Patients' ratings of the objective difficulty of treatment increased over time, varied by treatment regimen, and were predicted by the experience of side effects, with the number of different side effects serving as the best predictor. In contrast, emotional distress was less sensitive to the directly assessable characteristics of treatment. Communication between patient and practitioner was found to be inadequate in a number of respects (i.e., patients did not fully anticipate the toxicities of treatment and did not report their concerns to medical staff). Communication may be impeded by inaccuracies in a patient's recall of treatment difficulties and by a patient's inability or unwillingness to attend to all presented information. More frequent opportunities for patient-practitioner discussion are necessary.

The relationship between worry about cancer and judged cancer risk was examined among 54 expatients who had been cured of breast cancer and 81 women with no history of cancer. Worry required both a perception of substantial risk and the presence of concrete perceptual cues. Worry promoters include visits to a physician and concrete, noncancerlike symptoms (e.g., fever, pain). Supporting analyses indicate that the symptom effects are not due to self-report biases or attributions of symptoms to cancer but are the result of a reminder process whereby vulnerability beliefs are aroused by somatic cues. Judged cancer risk was unrelated to affective cues, suggesting that across-time variation in worry about cancer reflects the onset and offset of symptom episodes rather than a shift in risk appraisals. Expatients were more worried overall than nonpatient controls. The results have implications for controlling disease worry and initiating preventive behaviors.

This paper examines the sources of public opposition to a high‐level nuclear waste repository among samples of 1001 residents of Nevada and a national sample of 1201 residents. Two models of choice are contrasted: A benefit‐cost model and a risk‐perception model of individual choice. The data suggest that the willingness of Nevada residents to accept a repository at Yucca Mountain depends upon subjective risk factors, especially the perceived seriousness of risk to future generations. Perceived risk depends in part on level of trust placed in the Department of Energy to manage a repository safely. Opposition to a local repository did not decrease significantly if compensation in the form of annual rebates, either ($1000, $3000, or $5000 per year for 20 years) were offered to residents. The public needs to be convinced before compensation is considered, that the repository will possess minimal risks to themselves as well as to future generations, and that the site currently targeted is suitable. One way to do this is through adoption of mitigation and control procedures such as strict federal standards and local control over the operation of the repository. The federal government should also consider returning to the fair procedure for selection between candidate sites specified in the initial Nuclear Waste Policy Act of 1982.

We reviewed age-specific national mortality data for the years 1981 through 1985 to evaluate changes in the location of death among the nation's elderly after implementation of Medicare's prospective payment system (PPS). Although it was unchanged in 1981 and 1982, the percentage of deaths occurring in the nation's nursing homes increased from 18.9 percent in 1982 to 21.5 percent in 1985. The increases in nursing home deaths were greatest between 1983 and 1984, when 33 states showed larger-than-expected increases when compared with a base period before implementation of PPS. These changes were accompanied by a decline in the percentage of deaths that occurred in hospitals. These changes in the location of death were most pronounced in the Midwest, South, and West; they were very small in the Northeast and in states not affected by the PPS. Furthermore, the states with high population enrollments in health maintenance organizations and with large declines in the mean hospital length of stay in 1984 showed the greatest shifts in the location of death. We conclude that Medicare's PPS resulted in the increased transfer of terminally ill patients from hospitals to nursing homes. Further study is required to determine whether such transfer is medically appropriate.