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Tamoxifen remains an important adjuvant therapy to reduce the rate of breast cancer recurrence among patients with oestrogen-receptor-positive tumours. Cytochrome P-450 2D6 metabolizes tamoxifen to metabolites that more readily bind the oestrogen receptor. This enzyme also metabolizes selective serotonin reuptake inhibitors (SSRI), so these widely used drugs - when taken concurrently - may reduce tamoxifen's prevention of breast cancer recurrence. We studied citalopram use in 184 cases of breast cancer recurrence and 184 matched controls without recurrence after equivalent follow-up. Cases and controls were nested in a population of female residents of Northern Denmark with stages I-III oestrogen-receptor-positive breast cancer 1985-2001 and who took tamoxifen for 1, 2, or most often for 5 years. We ascertained prescription histories by linking participants' central personal registry numbers to prescription databases from the National Health Service. Seventeen cases (9%) and 21 controls (11%) received at least one prescription for the SSRI citalopram while taking tamoxifen (adjusted conditional odds ratio=0.85, 95% confidence interval=0.42, 1.7). We also observed no reduction of tamoxifen effectiveness among regular citalopram users (>or=30% overlap with tamoxifen use). These results suggest that concurrent use of citalopram does not reduce tamoxifen's prevention of breast cancer recurrence. [ABSTRACT FROM AUTHOR]

Objective: To explore perceptions of the impact of erectile dysfunction on men who had undergone definitive treatment for early nonmetastatic prostate cancer.Design: Seven focus groups of men with early prostate cancer. The groups were semistructured to explore men's experiences and quality-of-life concerns associated with prostate cancer and its treatment.Setting: A staff model health maintenance organization, and a Veterans Affairs medical center.Patients: Forty-eight men who had been treated for early prostate cancer 12 to 24 months previously.Results: Men confirmed the substantial effect of sexual dysfunction on the quality of their lives. Four domains of quality of life related to men's sexuality were identified: 1) the qualities of sexual intimacy; 2) everyday interactions with women; 3) sexual imagining and fantasy life; and 4) men's perceptions of their masculinity. Erectile problems were found to affect men in both their intimate and nonintimate lives, including how they saw themselves as sexual beings.Conclusions: Erectile dysfunction, the most common side effect of treatment for early prostate cancer, has far-reaching effects upon men's lives. Assessment of quality of life related to sexual dysfunction should address these broad impacts of erectile function on men's lives. Physicians should consider these effects when advising men regarding treatment options. Physicians caring for patients who have undergone treatment should address these psychosocial issues when counseling men with erectile dysfunction. [ABSTRACT FROM AUTHOR]

Much has been written about the complexities of the doctor-patient relationship and the myriad ways that both parties communicate. When patients become more frail, this relationship must expand to include their family caregivers. This addition of a third person complicates the situation in more than an additive fashion. It requires more time and energy on the part of physicians that are not without costs. Balancing both patient and caregiver needs in a time-driven and increasingly competitive world is not easy. Physicians not only need better preparation to meet the challenges of caring for frail older patients, but they also need changes in reimbursement policies so that they can afford to spend the time needed to manage the complexities inherent in the doctor-patient-family caregiver relationship. Although there is uncertainty about timing of these changes, there is no uncertainty about the complexity of the doctor-patient-family caregiver relationship. To make its management easier, the following rules are worth remembering: 1. Carefully assess problems in all domains of patient function and develop plans for managing and monitoring these problems. 2. Recognize that the effects of patient disabilities cycle between patient and caregiver. 3. Pay attention to the needs and concerns of patients and of their caregivers. 4. Provide caregivers with as much information as possible and educate them about "when to worry." 5. Assure caregivers that you are available to answer questions and help them with handling problems that arise in the care of their elders. [ABSTRACT FROM AUTHOR]