Effective oncology communication depends on both patients' and clinicians' capacity to recognize and convey emotional information. Alexithymia has predominantly been studied as an individual trait. This Letter proposes dual alexithymia — an emergent interactional state arising when emotional awareness is constrained on both sides of the clinical encounter — and argues that it may disrupt the compensatory scaffolding available in single-sided dyads, producing a communication breakdown that neither party readily registers. The construct is distinguished from burnout, empathy deficits and other competing explanations, situated against existing dyadic alexithymia research, and translated into falsifiable predictions, a concise measurement strategy, and a hypothesized structural role for a third detecting node such as oncology nursing.
Abiraterone is a first-line therapy for metastatic castrate-resistant prostate cancer. In vitro, abiraterone metabolites inhibit OATP1B1, the primary hepatic uptake transporter for several substrates, including statins. We describe the case of a 70-year-old man taking rosuvastatin who commenced treatment with abiraterone for metastatic castrate-resistant prostate cancer. Two months later, he presented to hospital with nonspecific symptoms including fatigue and diffuse myalgias with laboratory evidence of rhabdomyolysis and associated acute kidney injury. Plasma rosuvastatin concentrations were more than 40-fold higher than expected for the dose. Subsequent pharmacogenetic testing showed the patient was heterozygous for SLCO1B1*15, a variant of the SLCO1B1 gene encoding OATP1B1, which results in moderately reduced OATP1B1 transport activity. Considering the high frequency of statin prescribing, clinicians should be aware of the possible drug-drug interactions between statins and abiraterone and the associated risk of rhabdomyolysis, which is also affected by genetic differences.
