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High-Dose Vitamin C in Advanced-Stage Cancer Patients.

High-dose intravenously administered vitamin C (IVC) is widely used in cancer patients by complementary and alternative medicine practitioners. The most frequent indications for IVC therapy result from the belief in its effectiveness as a potent anti-cancer agent which additionally enhances chemosensitivity of cancer cells and reduces chemotherapy-related toxicities and fatigue intensity. In this narrative review, we decided to deal with this issue, trying to answer the question whether there is any scientific evidence supporting the rationale for application of high-dose IVC therapy in advanc

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… Cancer pain can be related to primary tumor, disease progression, and metastasis as well as to anti-cancer therapy and its complications. Despite increased attention on assessment and management of pain in the last decade, its prevalence and intensity still remain substantial. …

Supportive care during treatment for breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.

Breast cancer patients may have unmet supportive care needs during treatment, including symptom management of treatment-related toxicities, and educational, psychosocial, and spiritual needs. Delivery of supportive care is often a low priority in low- and middle-income settings, and is also dependent on resources available. This consensus statement describes twelve key recommendations for supportive care during treatment in low- and middle-income countries, identified by an expert international panel as part of the 5th Breast Health Global Initiative (BHGI) Global Summit for Supportive Care, w

The impact of hemoglobin levels on fatigue and quality of life in cancer patients.

BACKGROUND: Although fatigue is a commonly reported symptom in cancer patients its etiology is still poorly understood. The objective of the present study was to investigate the relationship between hemoglobin (Hb) levels and the subjective experience of fatigue and quality of life in cancer patients with mild or no anemia undergoing chemotherapy. PATIENTS AND METHODS: Sixty-eight cancer patients (25 colorectal, 26 lung and 17 ovarian cancer) presently undergoing chemotherapy participated in the study. Fatigue was measured with the Multidimesional Fatigue Inventory (MFI-20), quality of life w

Resentful, Resigned and Respectful: Opioid Analgesics, Pain and Control, a Qualitative Study.

Opioid analgesic prescribing has increased significantly with associated concerns about dependence and overdose. This study aimed to explore non-cancer patients' experiences and views of taking opioid analgesics to manage their pain. Twenty-two patients were purposively sampled from English GP practices and participated in semi-structured telephone interviews. Braun and Clarke's thematic analysis was used to generate emerging latent and semantic themes. Patients resented taking opioid analgesics due to tolerance and addiction fears but were resigned to experiencing chronic pain. Control emerge

Activation of µ-δ Opioid Receptor Heteromer Attenuates Chemotherapy-Induced Neuropathic Pain in Mice.

Chemotherapy-induced neuropathic pain (CINP) affects up to 80% of cancer patients treated with cytostatic drugs like paclitaxel (PTX), leading to significant chronic sensorimotor dysfunction. Current pharmacological treatments often cause CNS side effects such as sedation and addiction. Increasing evidence indicates that native µ- and δ-opioid receptors (ORs) can associate to form heteromers in discrete brain regions. However, the role of µ-δ heteromer in CINP remains unclear. Therefore, we investigated the analgesic activity of CYM51010, a µ-δ heteromer agonist in CINP and how µ-δ heteromer a

Peripheral Neuromodulation: Type 2 Complex Regional Pain Syndrome Secondary to an Excisional Biopsy.

Complex regional pain syndrome (CRPS) is a multifactorial and often refractory condition that involves hyperalgesia and allodynia of the extremities. Current treatments are mostly limited and short-lived; thus, different modalities of interventional pain control have come up to play a significant role in the management of CRPS. The aim of this article is to present a single case from a Multidisciplinary Pain Management Center, regarding a wireless peripheral nerve stimulation (WPNS) treatment for a type II CRPS. The European Organization for the Research and Treatment of Cancer Quality of Life

Oral Neuropathy Associated with Commonly used Chemotherapeutic Agents: A Narrative Review.

Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent complication of cytotoxic chemotherapeutic agents; its incidence largely varies, depending on type, dose, agent and preexisting risk factors. Oral-and-perioral-CIPN (OCIPN) is underreported. Neurotoxic agents can cause jaw pain or numbness. This review aims to present available data on OCIPN RECENT FINDINGS: A narrative literature review, following SANRA guidelines was conducted. PubMed and Cochrane databases were searched until September 2023. Articles referring to neuropathy or neuropathic pain due to head and neck cancer, head

Sleep disturbances and sleep disorders as risk factors for chronic postsurgical pain: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed at evaluating the role of sleep disturbances and sleep disorders in influencing presence and intensity of chronic postsurgical pain (CPSP). We included cohort studies which enrolled adults, assessed sleep disturbances or disorders before surgery, measured pain intensity, presence of pain, or opioid use at least three months after surgery. Eighteen studies were included in a narrative synthesis and 12 in a meta-analysis. Sleep disturbances and disorders were significantly related to CPSP, with a small effect size, r = 0.13 (95% CI 0.06-0.20). The c

Scheduled intravenous acetaminophen versus nonsteroidal anti-inflammatory drugs (NSAIDs) for better short-term outcomes after esophagectomy for esophageal cancer.

PURPOSE: To evaluate the effect of scheduled intravenous acetaminophen administration versus nonsteroidal anti-inflammatory drugs on postoperative pain and short-term outcomes after esophagectomy. METHODS: The subjects of this study were 150 consecutive patients who underwent esophagectomy for esophageal cancer. Seventy-seven patients received scheduled intravenous acetaminophen and the other 73 received NSAIDs enterally for postoperative pain management. We compared the postoperative pain and short-term outcomes between the groups. Inverse probability of treatment weighting (IPTW) based on p

Assessment and Management of Patients With Metastatic Spinal Cord Compression: A Multidisciplinary Review.

PURPOSE: Metastatic spinal cord compression (MSCC) can be a catastrophic manifestation of advanced cancer that causes immobilizing pain and significant neurologic impairment. Oncologists can protect their patients by having a high index of suspicion for MSCC when patients present with new or worsening back pain before motor, sensory, bowel, or bladder deficits develop. We provide an updated, evidence-based narrative review of the presentation, diagnosis, and treatment of MSCC. METHODS: This narrative review was conducted by searching MEDLINE and Cochrane Database of Systematic Reviews for rel

Celiac Plexus Block and Neurolysis in the Management of Chronic Upper Abdominal Pain.

Chronic upper abdominal pain occurs as a complication of various malignant and benign diseases including pancreatic cancer and chronic pancreatitis, and when present may contribute to lower quality of life and higher mortality. Though various pain management strategies are available as part of a multimodal approach, they are often incompletely effective and accompanied by side effects. Pain originating in upper abdominal viscera is transmitted through the celiac plexus, which is an autonomic plexus located in the retroperitoneum at the root of the celiac trunk. Direct intervention at the level

Higher doses of opioids in patients who need palliative sedation prior to death: cause or consequence?

BACKGROUND: Palliative sedation (PS) is necessary in a significant percentage of patients dying on an acute palliative care unit (PCU). Common indications are terminal restlessness, pain and dyspnoea. On our PCU, terminal restlessness was the main indication for PS but pain was the most prevalent symptom during admission. Because delirium is often drug induced in terminal cancer patients and opioids are amongst the most frequently implicated drugs, we hypothesised that the underlying pain problem and its treatment might have been related to the need for sedation. PATIENTS AND METHODS: To test

Treatment and prevention of pain due to vaso-occlusive crises in adults with sickle cell disease: an educational void.

Pain due to vaso-occlusive crisis is the major cause of hospital use in sickle cell disease. Although available guidelines provide recommendations for opioid administration in this setting, only 4 (21%) of 19 medical textbooks present treatment regimens that are consistent with them. Moreover, only 7 texts (37%) note that addiction is infrequent in this population, while 11 (92%) of 12 texts provide such reassurance for cancer-related pain (P < .005). Finally, hydroxyurea use to decrease the frequency of vaso-occlusive crises is completely defined only in 2 textbooks. Thus, most medical texts

Excellent prognosis of Japanese patients with chest pain and normal or nearly normal coronary arteries--2- to 13-year follow-up of 274 patients after coronary cineangiography.

Although the prognosis of patients with chest pain and normal coronary arteries is reportedly good in the Western literature, it is unclear in Japan. The purpose of this study was to examine the natural history of 274 consecutive patients with chest pain and normal or nearly normal coronary arteries, and to determine whether the possibility of minor coronary artery disease has clinical implications as a prodromal factor of other heart diseases. Six of the patients died during the mean observation period of 6 years (74.5 +/- 35.4 months): 2 cancer, 3 cerebro-vascular accident, and 1 renal failu

[Phantom breast syndrome].

Phantom breast syndrome following mastectomy has been reported by other authors. However, the temporal course, character and extent of this phenomena have not been elucidated. In a prospective study we have investigated the incidence, clinical picture and temporal course of phantom breast syndrome. One hundred and twenty women who started postoperative control or treatment at the Oncology Department over a one-year period were interviewed by a standard questionnaire three weeks after the operation. One year later 110 patients and six years later 68 patients were interviewed again. The incidenc

The responsiveness of bone metastases to radiotherapy: the effect of site, histology and radiation dose on pain relief.

281 patients with a total of 463 symptomatic osseous metastases treated for palliation between 1975 and 1985 have been retrospectively analysed. The most frequent primary sites were breast (50.1%) prostate (16.6%) and lung (11%), accounting for more than three fourths of all metastatic areas. Other primaries were represented by bladder, kidney, colorectal, uterus (corpus and cervix) melanoma and thyroid tumors, and by cancer from unknown origin. Palliation was evaluated only on a subjective pain score. Complete response meant complete pain relief, and partial response meant more than 50% and l

[Main traps in proctology].

Main traps in proctology. Traps are numerous in proctology. Avoiding the clinical examination is the most common. Hemorrhoids are often challenged, while the abscess and the anal fissure are very common. Screening for colorectal cancer is essential in case of rectal bleeding, and the anus should be examined in search of cancer of the anal canal. The clinical examination must be comfortable for the physician and for the patient: it is now done usually lying on the left side, knees up to the breast. Treatments are easy to be prescribed in consultation. It is often necessary to regulate transit a

[Thymic sarcomatoid carcinoma; report of a case].

The case was a 35-year-old male patient. Upon visiting a local doctor with complaints of cough and pain in the left chest, he was diagnosed as having an anterior mediastinal tumor. A large tumor of 15 cm in size was found by computed tomography( CT) scanning at the anterior mediastinum extending to the left thoracic cavity. Surgical resection was considered to be feasible, and the tumor was removed combined with the left brachiocephalic vein. Partial resection of the pericardium and the left upper lobe was also necessary. The diagnosis was a sarcoma-like thymic cancer by pathology. Although ad

[New development in bisphosphonate treatment. Treatment with bisphosphonates for cancer-induced bone disease].

Bone metastases and multiple myeloma cause debilitating clinical symptoms including intractable bone pain, disabling multiple fractures and hypercalcemia. Adjuvant endocrine therapies with aromatase inhibitors or androgen deprivation further accelerate bone loss and increase in fracture risk (cancer treatment-induced bone loss) . Bisphosphonates appear to be a current mainstay for the treatment and prevention of the skeletal-related morbidity in cancers. However, osteonecrosis of the jaw emerges as a major concern associated with long-term bisphosphonate use. It is important to clarify the cli

Abdominal cancer, nausea, and vomiting.

Nausea and vomiting in abdominal cancer is perhaps one of the most difficult symptom complexes to manage, especially when complicated by bowel obstruction. There are many mechanisms of nausea in advanced abdominal cancer with a number of therapeutic interventions that can significantly enhance symptom control and overall quality of life. As with pain, the ideal approach should include a mechanistic analysis of the causes of nausea beginning with a thorough history, followed by a directed physical examination, and selected laboratory studies. The symptom history, in conjunction with a physical