Annals of oncology : official journal of the European Society for Medical Oncology
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Morphine and other opioids are the mainstay of cancer pain management, yet considerable fears surrounding them present barriers to pain control. Research in groups already using opioids has examined their concerns, but there is little evidence about how patients react when first offered opioids. We explored the factors influencing the decision to accept or reject morphine when first offered to patients with cancer. ⋯ Among cancer patients the idea that opioids represent a comfort measure for the dying and not legitimate analgesics may represent a greater barrier to their uptake than concerns about tolerance or addiction.
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There are now a number of highly effective options for the treatment of hormone-receptor-positive breast cancer. Although tamoxifen was the standard hormonal treatment for many years, we now have another option for postmenopausal women: the third-generation aromatase inhibitors (AIs) anastrozole, exemestane and letrozole. A number of trials have investigated the use of third-generation AIs compared with tamoxifen throughout the continuum of treatment settings for postmenopausal women with breast cancer. ⋯ Ongoing studies will further define the role of sequential adjuvant treatment. Appropriate duration of treatment is another important area of investigation. This review will cover hormonal therapy for postmenopausal women with breast cancer and will not address the treatment of premenopausal women.
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Little information is available about the diagnosis and management of acute methotrexate (MTX)-induced encephalopathy. ⋯ Acute MTX toxicity often manifests as fluctuating neurologic symptoms with alternating hemispheric involvement. Restricted diffusion on DWI is a reliable early sign of acute MTX encephalopathy and resolves as clinical status improves, despite the persistence of subtle abnormalities on MRI.