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NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lowerlevel evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lowerlevel evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Please Note These guidelines are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment.

After preliminary observation had shown the hydrochloric acid secretion of the stomach of a 60-year-old woman with a gastric fistula to be at persistently high normal levels, observations of the gastric secretions through the fistulous opening were made while the patient was leceiving, simultaneously, although separately, intensive psychotherapy. Eight months after the psychotherapy was begun, the high normal level of the gastric hydrochloric acid dropped abrupdy and remained at a low level for 12 months. A possible explanation is suggested, the methodology is described, and the effects of various parameters, especially the physiologic observations, upon the psychotherapy are noted. The difficulty in accurately correlating the physiological and the psychological data, especially with regard to the time factor, appears to indicate limitations in the method of making physiologic observations at the same time the patient is receiving psychotherapy.

Pain can be a prominent finding in breast cancer patients. It may occur in the setting of the postmastectomy period, related to the disruption of normal neural pathways or the development of lymphedema. In advanced disease, the management of pain from nerve compression or bone metastases requires special approaches. In this panel discussion, the participating physicians will discuss these topics and provide an up-to-date approach to pain control in breast cancer patients.

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