1/13. nicotine dependence and withdrawal in an oncology setting: a risk factor for psychiatric comorbidity and treatment non-adherence.Highly nicotine dependent oncology patients are at high risk for psychiatric morbidity when they enter the medical care setting where smoking restrictions apply. nicotine withdrawal symptoms exacerbate cancer-related distress as well as common physical side effects of cancer treatment. This case report illustrates the management of a patient whose ongoing treatment for bladder cancer was jeopardized as a result of nicotine dependence and withdrawal. Several associated complications are described, the most serious of which were his acute anxiety and non-adherence to medical recommendations. A short-term management approach that included anxiolytics and nicotine replacement was effectively used to reduce this patient's excessive anxiety and thus facilitate compliance with stressful treatments. The severity of complications that can result from untreated nicotine dependence and withdrawal underscores the importance of assessing and monitoring smoking status in every patient. Greater staff awareness of the clinical practice guidelines regarding the diagnosis and treatment of nicotine dependence will likely result in improved patient care and compliance.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
2/13. Complete response, as determined by prostate-specific antigen level, to chlormadinone acetate withdrawal persisting longer than 2 years in patients with advanced prostate cancer: two case reports.Antiandrogen withdrawal syndrome (AWS) is a well-established phenomenon in prostate cancer. However, responses to AWS are usually of limited duration, and a complete response (CR) is extremely rare. We present two patients who exhibited a chemical CR for more than 2 years after the discontinuation of steroidal antiandrogen chlormadinone acetate use. Whether patients who respond to antiandrogen withdrawal include a group of patients with a better prognosis remains uncertain. However, considering that the usual survival period of patients with hormone-resistant prostate cancer is approximately 12 months, both of the patients reported here, who are present in excellent physical condition, exhibiting an improved quality of life, and attending their hospital as outpatients, obviously acquired a prolonged survival because of AWS.- - - - - - - - - - ranking = 2keywords = cancer (Clic here for more details about this article) |
3/13. tumor lysis syndrome associated with reduced immunosuppression in a lung transplant recipient.tumor lysis syndrome usually occurs after Initiation of chemotherapy or radiation therapy in cancer patients with a moderate to high tumor burden. To our knowledge, the occurrence of this syndrome after discontinuation or reduction of an immunosuppressive regimen has not been reported in the literature. We describe a patient who had undergone lung transplantation and who was receiving immunosuppression and experienced an episode of acute pancreatitis. During the course of the work-up, the patient was found to have a B-cell lymphoma (posttransplantation lymphoproliferative disease). His tacrolimus dosage was decreased, and azathioprine was discontinued. The patient subsequently developed tumor lysis syndrome. Other than the decrease in immunosuppression, we found no other factor that could have accounted for this syndrome.- - - - - - - - - - ranking = 0.33333333333333keywords = cancer (Clic here for more details about this article) |
4/13. Unusual opioid withdrawal syndrome. A case-report.In a patient with advanced cancer, neurosurgery relieved severe pain that had been uncontrolled by very high doses of opioids. On reduction of opioid dosage he had visual and auditory hallucinations and showed deterioration of consciousness progressing to coma. naloxone worsened his mental state whereas morphine restored it to normal. This syndrome may be related to opioid withdrawal at receptors other than the mu receptors that have been linked to analgesia and drug abuse.- - - - - - - - - - ranking = 0.33333333333333keywords = cancer (Clic here for more details about this article) |
5/13. Failure of epidural opioid to control cancer pain in a patient previously treated with massive doses of intravenous opioid.A patient with disseminated cancer pain failed to obtain pain relief despite the intravenous infusion of hydromorphone at a rate equivalent to over 7 g of morphine/day. Temporary pain relief occurred with an epidural injection of the local anesthetic lidocaine. Subsequently, the patient failed to obtain pain relief with a dose of epidural hydromorphone equivalent to approximately 3 g of morphine epidurally/day. At this time a syndrome of agitation, sweating, tachycardia and severe muscle cramps developed in the lower half of the body. After eliminating the possibility of spinal cord compression by diagnostic CT scanning, the patient was treated by reducing the dose of hydromorphone and adding local anesthetic, which provided pain relief but did not eliminate the severe muscle spasms and other symptoms. The addition of oral clonidine followed by clonidine dermal patch rapidly and completely eliminated the other symptoms, suggesting that the response was due to too rapid withdrawal of opioid. maintenance of pain relief required the simultaneous administration of epidural bupivacaine and hydromorphone. A low-dose infusion of epidural bupivacaine was continued for more than 3 weeks and during this entire period the patient showed no evidence of motor or sympathetic block.- - - - - - - - - - ranking = 1.6666666666667keywords = cancer (Clic here for more details about this article) |
6/13. tamoxifen withdrawal response. Report of a case.A postmenopausal patient with breast cancer with a left infrahilar lung mass was treated with tamoxifen. She became asymptomatic, but after having stable disease for eight months, she developed progressive increase in the size of the mass necessitating tamoxifen withdrawal. Complete resolution of the mass occurred following withdrawal of tamoxifen. Withdrawal responses, though known to occur with additive hormonal treatment, especially complete regression of metastatic disease as seen in our patient, is not widely recognized. Thus, when clinically possible, patients should be observed off treatment for up to six weeks, before initiating a new therapeutic modality.- - - - - - - - - - ranking = 0.33333333333333keywords = cancer (Clic here for more details about this article) |
7/13. Steroid-withdrawal radiation pneumonitis in cancer patients.Two cancer patients developed steroid-withdrawal radiation pneumonitis. This complication is a recognized risk in the treatment of patients with Hodgkin's disease and other malignant lymphomas, but is under-recognized in patients receiving treatment for carcinoma.- - - - - - - - - - ranking = 1.6666666666667keywords = cancer (Clic here for more details about this article) |
8/13. Antiandrogen withdrawal syndrome in prostate cancer after treatment with steroidal antiandrogen chlormadinone acetate.OBJECTIVES. A case report is presented of 2 patients whose levels of serum prostate-specific antigen (PSA) improved after the withdrawal of a steroidal antiandrogen. methods. Two cases with prostate cancer had been treated with surgical castration and the steroidal antiandrogen chlormadinone acetate (CMA), and, on disease progression, the administration of CMA was terminated. RESULTS. Following withdrawal of CMA, a fall in PSA levels and remarkable clinical improvement were observed in both cases. One patient revealed a decrease and the other an increase in serum prostate acid phosphatase after the discontinuation of CMA. serum levels of testosterone, prolactin, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione were not significantly elevated after CMA withdrawal. CONCLUSIONS. Withdrawal of the steroidal antiandrogen CMA resulted in a decline in PSA levels and clinical improvement in prostate cancer patients with disease progression. Changes in testosterone, prolactin, or adrenal androgens were not a cause of the antiandrogen withdrawal syndrome.- - - - - - - - - - ranking = 2keywords = cancer (Clic here for more details about this article) |
9/13. Dramatic prostate specific antigen decrease in response to discontinuation of megestrol acetate in advanced prostate cancer: expansion of the antiandrogen withdrawal syndrome.We report a dramatic decrease in prostate specific antigen in response to the discontinuation of megestrol acetate in a patient with progressive metastatic prostate cancer. Our case demonstrates that withdrawal responses may occur with steroidal and nonsteroidal antiandrogens.- - - - - - - - - - ranking = 1.6666666666667keywords = cancer (Clic here for more details about this article) |
10/13. Prostate specific antigen decline after antiandrogen withdrawal: the flutamide withdrawal syndrome.Post-therapy changes in prostate specific antigen (PSA) have been proposed as a surrogate end point for response in clinical trials of patients with hormone refractory prostatic cancer. While the specific criteria for response are evolving, there are concerns that changes in serum levels of PSA may be the result of changes in PSA expression or secretion independent of effects on cell growth and proliferation. We report 3 representative cases receiving complete androgen blockade with either gonadotropin-releasing hormone or orchiectomy plus the antiandrogen flutamide, which demonstrated sustained declines in serum PSA levels after discontinuation of the antiandrogen. Similar results have been observed in 6 additional patients. Whether this represents an agonist effect of the antiandrogen is unknown. The results suggest that a trial of flutamide withdrawal is justified in an asymptomatic patient with an increasing PSA before treatment with more toxic therapies. It also shows the importance of documenting sequential elevations in the marker before enrolling a patient in a clinical trial, and that changes in PSA must be interpreted cautiously in clinical trials when an antiandrogen is discontinued.- - - - - - - - - - ranking = 0.33333333333333keywords = cancer (Clic here for more details about this article) |
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