No abstract

Treating cancer in patients with concurrent severe mental illness is complex and challenging for patients, families, and health care providers. Two such illnesses include schizophrenia and bipolar disorder. In this review, cases of women with breast cancer and severe mental illness from Philadelphia, PA illustrate the obstacles these women face in maintaining adequate cancer care. Barriers to receiving cancer treatment include understanding their disease, continuing medications and appointments, and experiencing complications of their psychiatric disorders. Learning from these cases is critical for health care providers and allows for innovation in treating and educating this difficult population. Increasing patient visit time, using social support services, and psychiatrist and psychiatrist-liaisons are necessary to improve care. In addition, family or caregivers should be included in discussions when possible. These techniques will assist in educating patients, improve insight into their disease and treatment, and allow them to benefit from cancer therapy.

Adjuvant endocrine therapy (AET) has substantially improved the mortality rate among breast cancer survivors. Despite the proven efficacy, the non-adherence rate to therapy is still high. This study is aimed to examine women's challenges related to AET adherence and management. Semi-structured interviews were conducted with six Caucasian and six African American breast cancer survivors who were prescribed for AET. The transcripts of audio-taped interviews were qualitatively analyzed. Key themes were: 1) positive beliefs in AET, 2) uncertainty about long-term adherence, 3) experiences with side effects, 4) forgetting and remembering, 5) other concerns and information needs, 6) potential intervention format, and 7) culturally-coping among African American women. The findings provided insight into women's experiences and beliefs and how these behaviors might influence AET adherence. Although most women in this study took AET as prescribed, many experienced a range of side effects and emotional distress, often without seeking support or help. New models of programs to promote adherence, support symptom management, and ultimately improve survival are critically needed. Developing culturally sensitive interventions for African American women is desirable.

Malignant chondroid syringomas are extremely rare adnexal tumors of the skin, so far reported only in six cases, all females. The present case occurred in a male. There were multiple nodules in the left lower limb of long duration. The malignant nature of the tumor was evident from repeated recurrences after excision of the nodules. The excised nodules showed cellular pleomorphism and mitoses. Lack of response to radiotherapy and chemotherapy led to mid-thigh amputation.