Use of Botulinum Toxin for Effective Management of First Bite Syndrome Secondary to Malignancy: A Case Report.

First bite syndrome may impact patients who have undergone treatment for head and neck malignancies as well as those who have had surgery in the parapharyngeal space. As the name suggests, upon salivating and/or taking the initial bites of a meal, severe, intense pain may result. Generally, as the patient continues to consume the meal, the symptoms will lessen but may still lead to decreased quality of life. While pharmacological options traditionally include anticonvulsants or tricyclic antidepressants, botulinum toxin injections are an effective alternative to pharmacotherapy. We report the case of a patient with squamous cell carcinoma of the head and neck who experienced first bite syndrome secondary to malignancy with noticeable response to botulinum toxin injections to the right masseter and temporalis muscles. Furthermore, we present this case, as it highlights a rare syndrome with various treatment options, including botulinum toxin, the latter without a predetermined treatment dose.

Two Patients Experience Same-Day Analgesic Effect of Methadone on Trigeminal Neuralgia Secondary to Malignancy: A Case Report.

Trigeminal neuralgia (TN) secondary to malignancy leads to significant distress and subsequently impacts a patient's quality of life. Use of methadone as a first-line opioid analgesic in this subset of oncology patients is uncommon and is rarely initiated after traditional first-line therapies have failed. We report two patients with TN secondary to tumor burden who experienced significant analgesia within 24 hours of methadone initiation.

Application of Topical Lidocaine for Pain Relief in the Setting of Targeted Therapy-Induced Onycholysis: A Case Report.

Selective pan fibroblast growth factor receptor (FGFR) inhibitors have been linked to severe onycholysis, the uncomfortable separation of the nail plate from the nail bed. Recommendations to assist with FGFR inhibitor onycholysis vary based on the severity. We hypothesized that the application of topical lidocaine to mimic a digital nerve block would be beneficial in addition to traditional supportive care interventions and subsequently report its immediate and continued efficacy for targeted therapy-induced onycholysis.

Rate of cannabis use in older adults with cancer.

OBJECTIVES: Older adults with cancer are increasingly inquiring about and using cannabis. Despite this, few studies have examined cannabis use in patients with cancer aged 65 years and older as a separate group and identified characteristics associated with use. The current study sought to determine the rate of cannabis use in older adult patients with cancer and to identify demographic and clinical correlates of use. METHODS: We conducted a retrospective review of patients with cancer referred for specialised symptom management between January 2014 and May 2017 who underwent routine urine drug testing for tetrahydrocannabinol as part of their initial clinic visit. RESULTS: Approximately 8% (n=24) of patients with cancer aged 65 years and older tested positive for tetrahydrocannabinol compared with 30% (n=51) of young adults and 21% (n=154) of adults. At the univariate level, more cannabis users had lower performance status than non-users (p=0.02, Fisher's exact test). There were no other demographic and clinical characteristics significantly associated with cannabis use in older adults. CONCLUSIONS: Older adult patients made up nearly 25% (n=301) of the total sample and had a rate of cannabis use of 8%. As one of the first studies to assess cannabis use via objective testing rather than self-report, this study adds significantly to the emerging literature on cannabis use in people aged 65 years and older. Findings suggest the rate of use in older adults living with cancer is higher than that among older adults in the general population.

Pruritic Manifestation of Peripheral T Cell Lymphoma Effectively Managed with Mirtazapine: A Case Report.

Chronic pruritus associated with underlying malignancy can greatly hinder a patient's quality of life. The severity is variable and patients frequently fail traditional first line therapies. We report a patient with diffuse, chronic pruritus secondary to peripheral T Cell Lymphoma (PTCL) who had same day response to mirtazapine after a litany of other agents were unsuccessful.