Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Aug 2007
ReviewOpioids for chronic pain: molecular and genomic basis of actions and adverse effects.
Opioid analgesics are being increasingly used for pain control in both cancer and noncancer patients. Despite thousands of years of their use, the biological basis of their action and adverse effects are only now being understood. It is important to understand these agents better so that the potentially large sections of the population who may eventually be eligible to receive therapeutic opioids are treated rationally and safely. ⋯ Understanding the biological basis of how opioids work and produce adverse effects should help us to make better choices of which drugs to use for specific populations. Identifying individual genetic differences in opioid receptors and drug metabolism pathways may also pave the way to more targeted and safer medication in the future.
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Curr Opin Support Palliat Care · Apr 2007
ReviewBereavement in families with relatives dying of cancer.
The aim of this review is to examine the new conceptualization on bereavement and, more specifically, on grief and bereavement in family members of patients who have died of cancer ⋯ It is important to understand the suffering endured by family members of patients dying of cancer and the consequences of bereavement. A careful and systematic exploration of the risk factors for pathological bereavement is important for optimal psychosocial care of family members in palliative medicine programs and community medicine.
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Curr Opin Support Palliat Care · Apr 2007
ReviewRadiation damage to the gastrointestinal tract: mechanisms, diagnosis, and management.
To summarize current knowledge about gastrointestinal radiation toxicity, with emphasis on mechanisms and clinical diagnosis and management. ⋯ The risk of injury to the intestine is dose limiting during abdominal and pelvic radiation therapy. Delayed bowel toxicity is difficult to manage and adversely impacts the quality of life of cancer survivors. More than 200,000 patients per year receive abdominal or pelvic radiation therapy, and the estimated number of cancer survivors with postradiation intestinal dysfunction is 1.5-2 million. Worthwhile progress towards reducing toxicity of radiation therapy has been made by dose-sculpting treatment techniques. Approaches derived from an improved understanding of the pathophysiology of bowel injury, however, will result in further advances. This article discusses the mechanisms of radiation-induced bowel toxicity and reviews current principles in diagnosis and management.
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Curr Opin Support Palliat Care · Apr 2007
ReviewCognitive adverse effects of chemotherapy in breast cancer patients.
This article reviews the most recent literature on chemotherapy-associated cognitive changes in women with breast cancer. ⋯ Significant advances have been made in the study of chemotherapy-related cognitive dysfunction over the past 10 years. The investigation of additional factors that may contribute to cognitive outcome, such as the effects of treatments other than chemotherapy and genetic susceptibility, is likely to further advance the field.