Biopsy of sentinel nodes can predict the presence or absence of axillary-node metastases in patients with breast cancer. However, the procedure can be technically challenging, and the success rate varies according to the surgeon and the characteristics of the patient.

At diagnosis, 59 breast cancer patients reported on their overall optimism about life; 1 day presurgery, 10 days postsurgery, and at 3-, 6-, and 12-month follow-ups, they reported their recent coping responses and distress levels. Optimism related inversely to distress at each point, even controlling for prior distress. Acceptance, positive reframing, and use of religion were the most common coping reactions; denial and behavioral disengagement were the least common reactions. Acceptance and the use of humor prospectively predicted lower distress; denial and disengagement predicted more distress. Path analyses suggested that several coping reactions played mediating roles in the effect of optimism on distress. Discussion centers on the role of various coping reactions in the process of adjustment, the mechanisms by which dispositional optimism versus pessimism appears to operate, third variable issues, and applied implications.

A good deal of research now indicates that the personality dimension of optimism-pessimism plays an important role in a wide range of behavioral and psychological outcomes when people confront adversity (reviewed in Scheier & Carver, 1992). What is less clear is the mechanism (or mechanisms) by which the beneficial effects of optimism take place. One possibility is that optimists do better than pessimists because they cope more effectively.' There is an abundance of evidence that they at least cope differently. Optimists and pessimists differ from one another in reports of their general coping tendencies (Carver, Scheier, & Weintraub, 1989) and in the coping responses they bring to mind when considering hypothetical situations (Scheier, Weintraub, & Carver, 1986), recalling a stressful situation from the recent past (Scheier et al., 1986), dealing with infertility problems (Litt, Tennen, Affleck, & Klock, 1992), managing a life transition (Aspinwall & Taylor, 1992), coping with a serious disease (Friedman et al., 1992), and dealing with worries about specific health threats (Stanton & Snider, 1993;Taylor et al., 1992).Far less information is available, however, concerning the hypothesis that these differences in coping serve as the vehicle by which optimists experience better eventual outcomes. Three studies in the literature are relevant to the question. One of them (Scheier et al., 1989) examined men undergoing coronary artery bypass surgery. These subjects did not complete a full measure of coping but indicated their use of several cognitive-attentional strategies before and after the surgery. Although optimism was related to several of these strategies, there was scant evidence that the strategies mediated the beneficial effect of optimism on subsequent outcomes. The second study (Aspinwall & Taylor, 1992) assessed optimism and coping in a group of students entering college and assessed well-being 3 months later. In this case, the beneficial effects of optimism appeared to operate at least in part through differences in both active coping and avoidance coping.Both of these studies have an important limitation, however. Neither included an initial measure of the variables that served as the later outcome measure. Thus,

BACKGROUND.Differences in cancer survival based on race, ethnicity, and socioeconomic status (SES) are a major issue. To identify points of intervention and improve survival, the authors sought to determine the impact of race, ethnicity, and socioeconomic status for patients with cancers of the head and neck (HN).METHODS.HN cancer patients diagnosed between 1998 and 2002 were examined using a linked Florida Cancer Data System and Florida Agency for Health Care Administration data set.RESULTS.A total of 20,915 patients with HN cancers were identified, predominantly in the oral cavity and larynx. Overall, 72% of patients were male, 89.7% were white, 8.4% were African American (AA), and 10.6% were Hispanic. The median survival time (MST) was 37 months. MST varied significantly by race (white, 40 months vs AA, 21 months; P < .001), sex (men, 36 months vs women, 41 months; P = .001), and area poverty level (lowest, 27 months vs highest, 34 months; P < .0001). Only 32% of AA patients underwent surgery in comparison with 45% of white patients (P < .001). On multivariate analysis, independent predictors of poorer outcomes were race, poverty, age, sex, tumor site, stage, grade, treatment modality, and a history of smoking and alcohol consumption.CONCLUSIONS.Carcinomas of the HN have an overall high mortality with a disproportionate impact on AA patients and the poor. Dramatic disparities by race and SES are not explained completely by demographics, comorbid conditions, or undertreatment. Earlier diagnosis and greater access to surgery and adjuvant therapies in these patients would likely yield significant improvement in outcomes. Cancer 2008. © 2008 American Cancer Society.

: STS patients treated at HVC have significantly better survival and functional outcomes. Patients with either large (>10 cm), high-grade or truncal/retroperitoneal tumors should be treated exclusively at a high-volume center.

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Background. Recent studies indicate that breast cancer patients do not usually experience the devastating psychological consequences once viewed as inevitable. However, some adjust to the disease more poorly than others. This study examined the personality trait of optimism versus pessimism as a predictor of adjustment over the first year, postsurgery. Methods. Seventy women with early stage breast cancer reported on their general optimism‐pessimism at diagnosis. One day before surgery, and at 3‐month, 6‐month, and 12‐month follow‐ups, they reported their subjective well‐being (mood scales and a measure of satisfaction with life). At follow‐ups, they also rated their sex lives, indicated how much physical discomfort was interfering with their daily activities, and reported on thought intrusion. Results. Pessimism displayed poorer adjustment at each time point by all measures except interference from pain. Even controlling for previous well‐being, pessimism predicted poorer subsequent well‐being, suggesting that pessimism represents a vulnerability to a negative change in adjustment. In contrast, effects of pessimism on quality of sex life and thought intrusion were not incremental over time. Additional analyses indicated that effects of the optimism‐pessimism measure were captured relatively well by a single item from the scale. Conclusions. A sense of pessimism about one's life enhances a woman's risk for adverse psychological reactions to the diagnosis of, and treatment for, breast cancer. This finding suggests the potential desirability of assessing this quality informally in patients, to serve as a warning sign regarding the patient's well‐being during the period surrounding and following surgery. Cancer 1994; 73:1213–20.

LS and SLNB can be performed with technical success in the head and neck region. Complications are minimal. More accurate staging and mapping of lymphatic drainage may improve the quality of standard lymphadenectomy. The potential for minimally invasive surgery based on this technology exists, but there is a small risk of missing positive disease. Whether the failure rate is greater than that of standard lymphadenectomy without gamma probe guidance is not known. New studies need to focus on refinements of technique and validation of accuracy as well as biologic correlates for the prediction of metastases.