Document LpR3ZLZL5dLMeXrwmbaDbL9pX

Correspondence 591 part of the observed discrepancy also may be due to differences in how ADL limitations were defined. Fratino et al. categorized individuals as functionally limited if they could not independently perform one or more of the following activities: bathing, dressing, going to the toilet, eating, continence, and getting in or out of bed. In our study, individuals were consid ered limited in an ADL if they responded that they had "a lot of difficulty" or were unable to do any of the following activities: bathing or showering, dressing, eating, walking, using the toilet, or getting into or out of bed or a chair. The potential impact of population selection and differences in definitions reinforces the value of con sistent methods for sampling and survey formulation. Our findings do appear to be consistent with those of Given et al. suggesting that at least 50% of individuals with cancer report limitations with s 1 ADLs.2 Popu lation and definitional differences may have had a smaller impact on the prevalence of IADL limitations. We are encouraged that research similar to ours is being conducted on the functional limitations of el derly cancer patients. Such research will focus atten tion on functional status as a vital outcome in the clinical management of cancer. We believe that the end result will be an improvement in cancer care. REFERENCES 1. Stafford RS, Cyr PL. The impact of cancer on the physical function of the elderly and their utilization of health care. Cancer 1997;80:1973-80. 2. Given CW, Given BA, Stommel M. The impact of age, treatment and symptoms on physical and mental health of cancer patients: a longitudinal perspective. Cancer 1994:74: 2128-38. Randall S. Stafford, M.D., Ph.D. Institute for Health Policy General Medicine Division Massachusetts General Hospital Harvard Medical School Boston, Massachusetts Philip Cyr, M.P.H. HCIA-Response, Inc. Waltham, Massachusetts Cancer among Spouses: Review of 195 Couples ease incidence may be explained by shared risk fac tors. This concept appears to have received little at tention in the literature previously. Malignant mesothelioma shows a strong associa tion with environmental asbestos exposure in at least 90% of cases.2 Significant domestic exposure to asbes tos has been documented in the wives of 1964 workers in an Italian cement factory.3 The data showed an increased incidence of pleural tumor deaths among the wives, although in only one case was a postmor tem performed to confirm malignant mesothelioma. No malignant mesotheliomas among spouses ap peared to occur in the series. Highlighting cancer occurrence among spouses is important in establishing a role for environmental factors. I have documented postmortems in the case of a married couple who both died of malignant mesothelioma of the pleura within 5 months of each other. The husband had sustained heavy occupa tional asbestos exposure for many years in his work at a dockyard lagging boilers with asbestos. An au topsy performed 6 months after the onset of dys pnea and weight loss showed extensive malignant mesothelioma of the pleura with asbestos bodies present in the lungs. His wife had died 5 months previously from a histologically proven malignant mesothelioma, diagnosed at autopsy, also associ ated with fibers in the lungs. The couple both had right-sided pleural tumors of epithelioid type. It appears that the wife's exposure had been indirect, possibly through contamination of the husband's hair and clothing with asbestos. Synchronous development of malignant me sothelioma in a married couple is exceptional and to my knowledge has not been documented previ ously. It serves to further emphasize the risk of developing asbestos-related disease away from the primary locus of exposure. Indeed, research in the U.S. has shown that domestic concentrations of air borne asbestos may be increased in the homes of asbestos workers.4 Oncologists should be aware of the potentially increased risk of cancer in a spouse and should be alert to the possibility of shared risk factors. When ever such cases are identified, an assessment of the risks to other household members should be under taken. REFERENCES A recent epidemiologic report1 highlights the pat tern of cancer development among a cohort of 1. Walach N, Novikov I, Milievskaya I, Goldzand G, Modan B. Cancer among spouses - review of 195 couples. Cancer spouses. The authors postulate that some of the dis 1998;82:180-5. 592 CANCER August 1,1998 / Volume 83 / Number 3 2. Hubbard R. The aetiology of mesothelioma: are risk factors other than asbestos exposure important? Thorax 1997; 52:496-7. 3. Magnani C, Terracini B, Ivaldi C, Botta M, Budel P, Mancini A, et al. A cohort study on mortality among wives of workers in the asbestos cement industry in Casale Monferrato, Italy. Br J Ind Med 1993;50:779-84. 4. Nicholson WJ, Rohl AN, Weisman I, Selikoff IJ. Environmen tal asbestos exposure in the United States. In: Wagner JC, editor. Biological effects of Mineral fibres. Scientific Pub. No. 30. Lyon: International Agency for Research on Cancer, 1980. Trevor W. Beer, M.B. Ch.B., M.R.C. Path Department of Pathology Royal Hospital Haslar Gosport, Hampshire United Kingdom