Stage, estrogen receptor status, treatment and survival of 29 men with breast cancer attending the Breast Clinic of the Johannesburg Hospital between 1976 and 1985 are reviewed. Most patients had locoregionally advanced disease at presentation. Estrogen receptors (ER) were detected in significant concentration in 15/23 (65%). Local control was achieved in the majority, 19/26 (73%), by either surgery or radiation therapy alone or by combined modality treatment. Fifteen of 23 patients tested (65%) were ER-positive (greater than 10 fmol/mg protein). For patients with metastatic disease hormone receptor status was predictive of response to hormonal manipulation. Tamoxifen was the most acceptable and frequently used form of hormone therapy with 7/12 patients responding. Combination chemotherapy gave a response rate comparable to that seen in women with breast cancer.
Overview and summary Introduction: What is palliative care and what are its essential elements? Definition: Palliative care is:• Care that places the relief of suffering at its core, affirms life and does not hasten nor postpone death, but regards dying as a normal process, according to World Health Organization (WHO). • Care that is individualised: the person or patient is its core focus. The recipient is someone who has been diagnosed with a chronic, life-threatening illness that is no longer responsive to curative treatment, for example, cancer, irreversible end-stage end-organ failure, HIV infection and related disorders unresponsive to available treatment, et cetera. ß 'End-of-life' care is an aspect of palliative care that specifically refers to the care of persons estimated to have a life expectancy of ≤ 12 months, according to the National Council for Palliative Care, United Kingdom. • Care that is directed towards the control of distressing symptoms including the relief of pain: ß 'Total Pain' -this concept refers to pain that cannot be adequately controlled without addressing its contributory factors, namely, physical, emotional, social and spiritual factors. ß The opioid-use crisisinappropriate opioid use is a major contributor to the opioid addiction crisis currently reported from high-and middle-income countries. Under-use of and insufficient access to opioids however characterises opioid use in Africa and other low-income countries. Palliative care offers appropriate access to opioids without the risk of addiction and within the context of a professionally competent team. (Knaul et al.). 42 • Care that is provided by a team. The team is multidisciplinary and comprises nurses, doctors, paramedical persons, for example, physiotherapists, counsellors and accredited members of the religious community. The patient and their personal support network (e.g. family, partner and friends) are advisors to the team and receive support from the team. The team has a leader who takes responsibility for the totality of care, plans specific therapy, prescribes medication, completes medico-legal forms, et cetera. This is usually a medical doctor. ß Team care is intended to integrate the medical, practical, psychological and spiritual aspects of care in a system that promotes as active a lifestyle as possible until death. Team care provides support for the patient's family or partner, et cetera, during the illness and through the time of bereavement.
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