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The article discusses the use of transcutaneous electrical nerve stimulation (TENS) and scrambler therapy for relief of chronic and neuropathic pain as of July 2023. Topics covered include the physiology and mechanisms of electroanalgesia, the devices in a TENS unit and their use in patients, the heterogenous results with TENS, and the distinctive Scrambler therapy and its differences with TENS. Also noted is the suggested analgesic benefit of scrambler therapy on patients with chronic pain.

The article presents the revelations of the Partial Oral Treatment of Endocarditis (POET) trial. It discusses the change in initial intravenous antibiotic treatment to two-drug oral antibiotic treatment on patients with infective endocarditis on the left side of the heart, heart problems caused by streptococcus.

The article reports on the projected increase in medical expenses of U.S. cancer patients to more than 173 billion U.S. dollars by year 2020. It examines the contribution of treatment duration and prices of anticancer drugs that limit the number of people with access to health benefits. It explores a challenge to oncologists to help reduce the cost of medical expenses through choice of drugs, type of support therapy and limitations of imaging procedures and hospitalizations.

The article discusses the short supply of several vital chemotherapy drugs in the U.S. It claims that majority of such drugs are generic that are used to treat childhood leukemia and curable cancers, including vincristine, methotrexate and cytarabine. Among the adverse impacts of the shortage are increased costs of cancer care and lesser incentives for oncologists in administering generics rather than brand-name drugs.

The article discusses the role of physicians in talking with patients about dying. It recommends self-deception as a valuable personal coping tool because it allows a person to aspire to significance and strive for new knowledge. It references a study which found that the majority of patients with metastatic lung cancer or colorectal cancer felt that their treatment course will cure them. The article encourages physicians to help patients deal with their terminal illness effectively.

The article presents three clinical, economic and political cases focused on data in patients with advanced cancer to show the value of earlier specialty palliative care. Data are used to propose initial priorities for clinicians and policymakers to achieve early integration of palliative care across all populations with serious illness. Improved public and professional awareness of the benefits of palliative care and coordinated action from health professionals and educators is stressed.

The article focuses on hussain and colleagues report the results of the PROfound trial which has assessed olaparib as compared with control therapy in the treatment of metastatic castration-resistant prostate cancer. Topics include the Kaplan-Meier curves for overall survival converge near the proportional-hazards assumption is not valid, and the validity of the adjusted overall survival curves in depends on model assumptions that cannot be tested.

Background: In women 70 years of age or older who have early breast cancer, it is unclear whether lumpectomy plus tamoxifen is as effective as lumpectomy followed by tamoxifen plus radiation therapy. Methods: Between July 1994 and February 1999, we randomly assigned 636 women who were 70 years of age or older and who had clinical stage I (T1N0M0 according to the tumor–node–metastasis classification), estrogen-receptor–positive breast carcinoma treated by lumpectomy to receive tamoxifen plus radiation therapy (317 women) or tamoxifen alone (319 women). Primary end points were the time to local or regional recurrence, the frequency of mastectomy for recurrence, breast-cancer–specific survival, the time to distant metastasis, and overall survival. Results: The only significant difference between the two groups was in the rate of local or regional recurrence at five years (1 percent in the group given tamoxifen plus irradiation and 4 percent in the group given tamoxifen alone, P<0.001). There were no significant differences between the two groups with regard to the rates of mastectomy for local recurrence, distant metastases, or five-year rates of overall survival (87 percent in the group given tamoxifen plus irradiation and 86 percent in the tamoxifen group, P=0.94). Assessment by physicians and patients of cosmetic results and adverse events uniformly rated tamoxifen plus irradiation inferior to tamoxifen alone. Conclusions: Lumpectomy plus adjuvant therapy with tamoxifen alone is a realistic choice for the treatment of women 70 years of age or older who have early, estrogen-receptor–positive breast cancer. N Engl J Med 2004;351:971-7. [ABSTRACT FROM AUTHOR]