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Davis MP. Novel therapies for nausea and vomiting in advanced illness and supportive cancer care. Palliat Care Soc Pract 2024; 18:26323524241257701. [PMID: 38855566 PMCID: PMC11159532 DOI: 10.1177/26323524241257701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
Nausea and vomiting are common experiences and are often dreaded more than pain. This review discusses blonanserin, mirtazapine, and isopropyl alcohol as antiemetics. Blonanserin, an atypical antipsychotic with a high affinity for dopamine D2 and D3 receptors and serotonin receptor 5-HT2A, has less of a risk of extrapyramidal adverse effects. Transdermal blonanserin, available in Korea, Japan, and China in a small number of trials, has improved nausea in patients not responding to standard antiemetics. Mirtazapine is a noradrenergic and specific serotonergic antidepressant that has been used for multiple symptoms besides depression. There is little evidence that mirtazapine improves anorexia or nausea in advanced cancer but is as effective as olanzapine in reducing chemotherapy-induced nausea and vomiting. Isopropyl alcohol aromatherapy has been successfully used in the emergency department for nausea and vomiting with an onset to benefit more rapidly than standard antiemetics. Isopropyl alcohol prep pads can be used for home-going antiemetic therapy and as a bridge to treating acute nausea until standard antiemetics take effect.
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Affiliation(s)
- Mellar P. Davis
- Geisinger Commonwealth School of Medicine, 100 North Academy Avenue, Danville, PA 17822, USA
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2
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Pandey S, Bradley L, Del Fabbro E. Updates in Cancer Cachexia: Clinical Management and Pharmacologic Interventions. Cancers (Basel) 2024; 16:1696. [PMID: 38730648 PMCID: PMC11083841 DOI: 10.3390/cancers16091696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Despite a better understanding of the mechanisms causing cancer cachexia (CC) and development of promising pharmacologic and supportive care interventions, CC persists as an underdiagnosed and undertreated condition. CC contributes to fatigue, poor quality of life, functional impairment, increases treatment related toxicity, and reduces survival. The core elements of CC such as weight loss and poor appetite should be identified early. Currently, addressing contributing conditions (hypothyroidism, hypogonadism, and adrenal insufficiency), managing nutrition impact symptoms leading to decreased oral intake (nausea, constipation, dysgeusia, stomatitis, mucositis, pain, fatigue, depressed mood, or anxiety), and the addition of pharmacologic agents when appropriate (progesterone analog, corticosteroids, and olanzapine) is recommended. In Japan, the clinical practice has changed based on the availability of Anamorelin, a ghrelin receptor agonist that improved lean body mass, weight, and appetite-related quality of life (QoL) compared to a placebo, in phase III trials. Other promising therapeutic agents currently in trials include Espindolol, a non-selective β blocker and a monoclonal antibody to GDF-15. In the future, a single therapeutic agent or perhaps multiple medications targeting the various mechanisms of CC may prove to be an effective strategy. Ideally, these medications should be incorporated into a multimodal interdisciplinary approach that includes exercise and nutrition.
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Affiliation(s)
- Sudeep Pandey
- Department of Internal Medicine, Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.P.); (L.B.)
| | - Lauren Bradley
- Department of Internal Medicine, Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.P.); (L.B.)
| | - Egidio Del Fabbro
- Department of Medicine, Division of Palliative Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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Chen N, Ji S, Liu J, Wang L, Chen F, Zhu Y, Li J, Chen M, Chen L, Wang M, He R, Mei X, Zhang Z, Jin S, Zheng J, Jiang Y. Olanzapine for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a randomized controlled trial. Ther Adv Drug Saf 2024; 15:20420986241244593. [PMID: 38646425 PMCID: PMC11027591 DOI: 10.1177/20420986241244593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/13/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose This study was designed to investigate the prophylactic effect of oral olanzapine in postoperative nausea and vomiting after gynecologic laparoscopic surgery. Methods ASA I-II, aged 18-75 years, planned to undergo gynecologic laparoscopic surgery with general anesthesia in adult female patients. Using the randomized numbers table, the patients were placed in two groups. Oral olanzapine 5 mg or placebo was given 1 h before anesthesia. All patients received standard antiemetic prophylaxis with dexamethasone and granisetron. The primary outcome was nausea and/or vomiting in the 24 h after the postoperative. Results A total of 250 patients were randomized, and 241 were analyzed. The primary outcome occurred in 10 of 120 patients (8.3%) in the olanzapine group and 23 of 121 patients (19.2%) in the placebo group (p = 0.014). According to Kaplan-Meier analysis, the probabilities of nausea and/or vomiting in the 24 h after the postoperative in the olanzapine group were lower than in the placebo group (log-rank p = 0.014). In a multivariate Cox analysis, the variables of use of olanzapine [hazard ratio (HR): 0.35, 95% confidence interval (CI): 0.16-0.79; p = 0.012] and use of vasoactive drugs (HR: 2.48, 95% CI: 1.07-5.75; p = 0.034) were independently associated with nausea and/or vomiting in the 24 h after the postoperative. Conclusion Our data suggest that olanzapine relative to placebo decreased the risk of nausea and/or vomiting in the 24 h after gynecologic laparoscopic surgery. Trial registration The trial was registered prior to patient enrollment at The Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=166900, link to registry page, Principal investigator: Nanjin Chen, Date of registration: 25 April 2022).
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Affiliation(s)
- Nanjin Chen
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Shuman Ji
- Department of Anesthesiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Junfei Liu
- Department of Pathology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Liping Wang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Fenglin Chen
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Yanwu Zhu
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Jiao Li
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Minjuan Chen
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Lingyang Chen
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Mingcang Wang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Ruyi He
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Xiaopeng Mei
- Department of Anesthesiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhanqin Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shengwei Jin
- Department of Anaesthesia and Critical Care, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325088, China
| | - Jingming Zheng
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, No. 150, Ximen Street, Taizhou 317000, China
| | - Yongpo Jiang
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, No. 150, Ximen Street, Taizhou 317000, China
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Bianchini C, Bonomo P, Bossi P, Caccialanza R, Fabi A. Bridging gaps in cancer cachexia Care: Current insights and future perspectives. Cancer Treat Rev 2024; 125:102717. [PMID: 38518714 DOI: 10.1016/j.ctrv.2024.102717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
Cachexia is characterized by severe weight loss and skeletal muscle depletion, and is a threat to cancer patients by worsening their prognosis. International guidelines set indications for the screening and diagnosis of cancer cachexia and suggest interventions (nutritional support, physical exercise, and pharmacological treatments). Nevertheless, real-life experience not always aligns with such indications. We aimed to review the current state of the field and the main advancements, with a focus on real-life clinical practice from the perspectives of oncologists, nutrition professionals, and radiologists. Pragmatic solutions are proposed to improve the current management of the disease, emphasizing the importance of increasing awareness of clinical nutrition's benefits, fostering multidisciplinary collaboration, promoting early identification of at-risk patients, and leveraging available resources. Given the distinct needs of patients who are receiving oncologic anti-cancer treatments and those in the follow-up phase, the use of tailored approaches is encouraged. The pivotal role of healthcare professionals in managing patients in active treatment is highlighted, while patient and caregiver empowerment should be strengthened in the follow-up phase. Telemedicine and web-based applications represent valuable tools for continuous monitoring of patients, facilitating timely and personalized intervention through effective communication between patients and healthcare providers. These actions can potentially improve the outcomes, well-being, and survival of cancer patients with cachexia.
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Affiliation(s)
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Fabi
- Precision Medicine Unit in Senology, Fondazione Policlinico Universitario A. Gemelli IRCCS Rome, Italy
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Jenkins G. Review of Dopamine Antagonists for Nausea and Vomiting in Palliative Care Patients. J Pain Palliat Care Pharmacother 2024; 38:38-44. [PMID: 37843383 DOI: 10.1080/15360288.2023.2268065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
Symptoms of nausea and vomiting are common in palliative care and hospice patients. One of the many classes of medications used for the treatment of nausea and vomiting is dopamine receptor antagonists which are particularly helpful for treating nausea mediated by the chemoreceptor trigger zone (CTZ) and impaired gastrointestinal function. While dopamine antagonists can be very effective treatments for nausea they should be used with caution as they carry the risk of QTc prolongation, have a FDA black box warning for tardive dyskinesia (TD), and increased risk of precipitating psychosis and death in patients with dementia. This review will cover haloperidol, olanzapine, prochlorperazine, and metoclopramide for treatment of nausea and vomiting including evidence of efficacy, pharmacokinetics, and pharmacodynamics to improve safe and effective utilization in clinical practice. This includes medication receptor site affinities at histaminic, muscarinic, serotonergic, and alpha-adrenergic receptors which can help providers anticipate potential adverse effects and risk of extrapyramidal symptoms (EPS), TD, and QTc prolongation. This review also includes considerations for dose adjustments based on renal function, hepatic function, and age. Understanding the pharmacology of dopamine antagonists can help providers choose the best treatment for control of nausea and vomiting and subsequently improve patients' quality of life.
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Affiliation(s)
- Grace Jenkins
- Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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Kimura T, Kanai A, Muraoka H, Takahashi Y, Ara M, Inada K. Asenapine versus olanzapine for the treatment of nausea and vomiting in patients with cancer: A retrospective study. Neuropsychopharmacol Rep 2024; 44:158-164. [PMID: 38239112 PMCID: PMC10932765 DOI: 10.1002/npr2.12412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/24/2023] [Accepted: 12/21/2023] [Indexed: 03/14/2024] Open
Abstract
AIM Patients with cancer often experience nausea and vomiting (N/V), but may have difficulty using olanzapine (OLZ), a common antiemetic. Asenapine (ASE) is a multi-acting receptor-targeted antipsychotic like OLZ, although there is little evidence that ASE serves as an antiemetic. The aim of this study was to evaluate the efficacy and tolerability of ASE compared to those of OLZ for the treatment of N/V in patients with cancer. METHODS This retrospective study involved patients who received 5 mg ASE, 5 mg OLZ, or 2.5 mg OLZ for 2 days. Daily worst N/V was rated on a scale of 0 (none) to 3 (very much). The primary endpoint was the proportion of patients who had a response, defined as any reduction in N/V score. A complete response (CR) was defined as a score reduction to 0. Secondary endpoints included the proportion of patients with CR and adverse events. RESULTS Between April 2017 and March 2023, 212 patients were enrolled to receive treatment: 5 mg ASE (n = 34), 5 mg OLZ (n = 102), or 2.5 mg OLZ (n = 76). No significant differences in response rates (52.9% vs. 58.8% vs. 52.6%, p = 0.671) or secondary endpoints were observed between the groups. Patients receiving ASE were more likely to experience oral hypoesthesia (p = 0.004). CONCLUSION This preliminary study suggests that ASE may be effective for N/V. Further studies are required to confirm these findings.
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Affiliation(s)
- Tomohiko Kimura
- Department of PsychiatryKitasato University School of MedicineSagamihara‐shiJapan
- Department of PsychiatryKitasato University Graduate School of Medical SciencesSagamihara‐shiJapan
| | - Akifumi Kanai
- Department of Research and Development Center for New Medical FrontiersKitasato University School of MedicineSagamihara‐shiJapan
| | - Hiroyuki Muraoka
- Department of PsychiatryKitasato University School of MedicineSagamihara‐shiJapan
| | - Yuichiro Takahashi
- Department of AnesthesiologyKitasato University School of MedicineSagamihara‐shiJapan
| | - Masatomo Ara
- Department of AnesthesiologyKitasato University School of MedicineSagamihara‐shiJapan
| | - Ken Inada
- Department of PsychiatryKitasato University School of MedicineSagamihara‐shiJapan
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Satomi E, Kobayashi T, Ishikawa A, Arakawa S, Ishiki H, Amano K, Sakiyama N, Ariyoshi K, Kihara K, Oyamada S, Mizushima A. Investigating the efficacy and safety of olanzapine prophylaxis for opioid-induced nausea and vomiting (JORTC-PAL20): a study protocol for an open-label, single-arm exploratory study. BMJ Open 2024; 14:e076575. [PMID: 38417963 PMCID: PMC10900404 DOI: 10.1136/bmjopen-2023-076575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 01/16/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION In opioid therapy for cancer pain, opioid-induced nausea and vomiting (OINV) occur in 20%-40% of patients during initial opioid treatment or increasing opioid doses. OINV result in failure to achieve pain relief due to poor opioid adherence. Therefore, antiemetics are used to prevent OINV, but their efficacy and safety in this context have not yet been fully elucidated. Olanzapine is a promising antiemetic for the prophylaxis of chemotherapy-induced nausea and vomiting. METHODS AND ANALYSIS This single-arm, single-centre exploratory study will evaluate the prophylactic antiemetic efficacy and safety of 5 mg olanzapine in patients with cancer pain who are withholding initial regular opioid therapy. Thirty-five patients will be enrolled. The primary endpoint is the proportion of patients achieving complete control (CC) of OINV during 5 days of opioid treatment. CC was defined as the absence of emetic episodes, no need for rescue medication to treat nausea, and minimal or no nausea (3 or less on an 11-point categorical scale). Secondary endpoints include the complete response, defined as no emetic episodes and no use of rescue medication during the overall assessment period, the time from opioid initiation to first emetic episode, the time from opioid initiation to first rescue antiemetic administration, and adverse events graded by Patient-Reported Outcome (PRO) Common Terminology Criteria for Adverse Events (CTCAE) version 1.0 and CTCAE version 5.0. ETHICS AND DISSEMINATION This study protocol was approved by National Cancer Center Hospital Certified Review Board. The results will be used as preliminary data to conduct a validation study. TRIAL REGISTRATION NUMBER Japan Registry of Clinical Trials (jRCT) jRCTs031220008.
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Affiliation(s)
- Eriko Satomi
- Palliative Medicine, National Cancer Center Japan, Tokyo, Japan
- Palliative Medicine, Juntendo University School of Medicine, Graduate School of Medicine, Tokyo, Japan
| | | | - Ayaka Ishikawa
- Palliative Medicine, National Cancer Center Japan, Tokyo, Japan
| | - Sayaka Arakawa
- Palliative Medicine, National Cancer Center Japan, Tokyo, Japan
| | - Hiroto Ishiki
- Palliative Medicine, National Cancer Center Japan, Tokyo, Japan
| | - Koji Amano
- Palliative Medicine, Osaka University, Oaska, Japan
| | | | - Keisuke Ariyoshi
- Data Center, Japanese Organisation for Research and Treatment of Cancer, Tokyo, Japan
| | - Kota Kihara
- Secretary, Japanese Organisation for Research and Treatment of Cancer, Tokyo, Japan
| | - Shunsuke Oyamada
- Biostatictics, Japanese Organisation for Research and Treatment of Cancer, Tokyo, Japan
| | - Akio Mizushima
- Palliative Medicine, Juntendo University School of Medicine, Graduate School of Medicine, Tokyo, Japan
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Poon IO, Ajewole V, Braun UK. A Review of Olanzapine in the Treatment of Cancer Anorexia-Cachexia Syndrome. PHARMACY 2024; 12:34. [PMID: 38392941 PMCID: PMC10893239 DOI: 10.3390/pharmacy12010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Cancer anorexia-cachexia syndrome (CAS) is a multifactorial condition that is highly prevalent in advanced cancer patients and associated with significant reduction in functional performance, reduction in quality of life, and increased mortality. Currently, no medications are approved for this indication. Recently, the American Society of Clinical Oncology (ASCO) released a rapid recommendation suggesting that low-dose olanzapine once daily may be used to treat cancer cachexia. Many questions still exist on how to use olanzapine for this indication in clinical practice. The objective of this review is to identify existing knowledge on the use of olanzapine for CAS. METHODS A comprehensive search was conducted to identify the primary literature that involved olanzapine for anorexia and cachexia in cancer patients between 2000 and 2023. RESULTS Seven articles were identified and are discussed here, including two randomized double-blinded placebo-controlled studies, one randomized comparative study, two prospective open-label studies, one retrospective chart review, and one case report. CONCLUSIONS Low dose olanzapine (2.5-5 mg once daily) may be useful in the treatment of CAS for increasing appetite, reducing nausea and vomiting, and promoting weight gain. Further large-scale multi-center randomized placebo-controlled studies will be needed to investigate the impact of olanzapine on weight change in CAS patients.
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Affiliation(s)
- Ivy O. Poon
- Department of Pharmacy Practice, Texas Southern University, Houston, TX 77004, USA; (I.O.P.); (V.A.)
| | - Veronica Ajewole
- Department of Pharmacy Practice, Texas Southern University, Houston, TX 77004, USA; (I.O.P.); (V.A.)
- Pharmacy Department, Houston Methodist Hospital, Houston, TX 77004, USA
| | - Ursula K. Braun
- Rehabilitation & Extended Care Line, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Section of Geriatrics & Palliative Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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McNeill R, Prael G, Hunt J, Chang S, Wilcock A, Dunwoodie D, Lau C, Morgan N, Iupati S, Currow DC. Cyclizine pharmacovigilance in hospice/palliative care: net effects for nausea or vomiting. BMJ Support Palliat Care 2024; 13:e1191-e1197. [PMID: 36357164 DOI: 10.1136/spcare-2022-003795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/19/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To describe the contemporary real-world use of cyclizine for nausea or vomiting, and the associated benefits and harms. METHODS This was a prospective, consecutive case series of routine clinical use of cyclizine for nausea or vomiting in palliative care conducted across 19 sites in Australia, Aotearoa/New Zealand and the UK. Clinical outcomes were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events at baseline and 72 hours after initiation of cyclizine. Ad hoc safety reporting continued for 2 weeks. RESULTS Data were collected from 101 patients between May 2018 and December 2020. Cyclizine was mostly used in combination with another antiemetic. Overall, 79 patients benefited and 32 experienced harm (56 had benefit without harm; 9 had harm without benefit). The most common harms were constipation (13%), somnolence (9%) and confusion (7%), adding to the already high rates of these symptoms at baseline. For the four patients with serious harms (grade ≥3), these were exacerbations of existing symptoms. Nine patients stopped cyclizine at 72 hours and a further 20 patients within 2 weeks. The most common reasons for stopping were lack of benefit and symptom resolution; none stopped because of harms. CONCLUSIONS When used as described in a palliative care setting, cyclizine benefits about three-quarters of patients, with about one-third experiencing tolerable harms.
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Affiliation(s)
- Richard McNeill
- School of Medicine (Christchurch Campus), University of Otago, Christchurch, New Zealand
| | - Grace Prael
- Palliative Care Clinical Studies Collaborative (PaCCSC), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jane Hunt
- Palliative Care Clinical Studies Collaborative (PaCCSC), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sungwon Chang
- Palliative Care Clinical Studies Collaborative (PaCCSC), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Andrew Wilcock
- Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Faculty of Medicine and Health Sciences, Nottingham University, Nottingham, UK
| | - David Dunwoodie
- Palliative Care Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Corey Lau
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Nicola Morgan
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Salina Iupati
- Te Omanga Hospice, Wellington, New Zealand
- Department of Preventative and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - David C Currow
- Palliative Care Clinical Studies Collaborative (PaCCSC), University of Technology Sydney, Sydney, New South Wales, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Casadio C, Tassinari E, Carloni R, Rossi R, Tenti MV, Fabbri L, Maltoni M. Appropriateness of Mini-Invasive Approaches for Nausea and Vomiting Refractory to Medical Therapy in Palliative Care Setting: A Case Report. Case Rep Oncol 2024; 17:264-270. [PMID: 38362443 PMCID: PMC10869145 DOI: 10.1159/000536218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Nausea and vomiting are frequent multifactorial symptoms in oncological patients. These manifestations, mainly affecting the advanced disease stages, may lead to existential, psychological, and physical suffering, with a negative impact on the quality of life (QoL) of the individual and his family. The medical approach makes use of a wide range of drugs, with different antiemetic potency and various mechanisms of action, taking into account the etiology and the patient's response to the different therapeutic strategies. In recent years, in addition to pharmacological treatments, some endoscopic procedures have been integrated into clinical practice as promising palliative approaches. Case Presentation Herein, we describe and discuss a case of a 64-year-old female affected by advanced stage pancreatic adenocarcinoma, in which different techniques - both medical and endoscopic - have been used to approach a refractory symptomatology with a negative impact on the patient's QoL. In the context of a multidisciplinary approach in primary palliative care, a tailored intervention encompassing invasive methods for palliative purposes, may be considered adequate and appropriate when the prognostic expectation and the physical functionality indices allow it. Conclusion Minimally invasive palliative interventions should be offered to patients with advanced cancer when symptoms become refractory to standard medical therapies, as part of the holistic approach in modern treatments. Therefore, the integration of an early palliative approach into the patient's therapeutic path becomes essential for the management of all the individual's needs.
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Affiliation(s)
- Chiara Casadio
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elisa Tassinari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Carloni
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Romina Rossi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | | | - Laura Fabbri
- Palliative Care Unit, Azienda Unità Sanitaria Locale (AUSL) Romagna, Forli, Italy
| | - Marco Maltoni
- Palliative Care Unit, Azienda Unità Sanitaria Locale (AUSL) Romagna, Forli, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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11
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Bonar S, Schneider HL, Cook K, Samala RV, Poole MFF. Olanzapine for Non-Chemotherapy Related Nausea and Emesis in Patients with a Palliative Care Consult. J Pain Symptom Manage 2023; 66:e455-e459. [PMID: 37348739 DOI: 10.1016/j.jpainsymman.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
CONTEXT Current palliative care guidelines lack a specific treatment algorithm for nausea and emesis. Olanzapine is an atypical antipsychotic with antiemetic activity that's recommended in the guidelines for the treatment of chemotherapy induced nausea and vomiting, but outside of oncologic indications there is a lack of research. OBJECTIVES To describe the safety and efficacy of olanzapine for nausea and emesis in the palliative care domain, excluding patients actively undergoing chemotherapy or radiation. METHODS This retrospective chart review encompassed hospitalized adult patients from six hospitals across a large health system admitted from August 2020 through August 2021, with a palliative care consult, and being treated with olanzapine for nausea or emesis. Data was collected on antiemetic therapy affordability, the ability for patients to tolerate medications by mouth, and safety outcomes such as QTc prolongation and increased liver function tests. RESULTS A total of 78 patients were included in the study. Olanzapine decreased the number of doses required of antiemetic medications, the median doses of antiemetic medications pre-olanzapine was 1.6 (IQR 0.8-2.8) and post-olanzapine was 0.6 (IQR 0-2.4) (P = 0.0006). After olanzapine was initiated, appetite was improved (P < 0.001), cost of antiemetic therapy was reduced by 65 cents per day (P = 0.059) and olanzapine was prescribed at discharge in 69% of patients. QTc prolongation was observed in 19% of patients, and increased ALT and AST were observed in 4.3% and 0%, respectively. CONCLUSION This retrospective review demonstrated benefit to utilizing olanzapine for nausea and emesis in palliative care patients and should be considered to aid in symptom management.
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Affiliation(s)
- Sarah Bonar
- Department of Pharmacy (S.B.), Cleveland Clinic, Cleveland, Ohio, USA.
| | - Harold L Schneider
- Department of Pharmacy (H.L.S., M.F.F.P.), Cleveland Clinic Medina Hospital, Medina, Ohio, USA
| | - Katherine Cook
- Department of Palliative and Supportive Care (K.C.), Cleveland Clinic Medina Hospital, Medina, Ohio, USA
| | - Renato V Samala
- Department of Palliative and Supportive Care (R.V.S.), Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michelle F F Poole
- Department of Pharmacy (H.L.S., M.F.F.P.), Cleveland Clinic Medina Hospital, Medina, Ohio, USA
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12
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Nishie K, Nishie T, Sato S, Hanaoka M. Update on the treatment of cancer cachexia. Drug Discov Today 2023; 28:103689. [PMID: 37385369 DOI: 10.1016/j.drudis.2023.103689] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 06/09/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
Cancer cachexia is a complex multifaceted syndrome involving functional impairment and changes in body composition that cannot be reversed by nutritional support. Cancer cachexia is characterized by decreased skeletal muscle mass, increased lipolysis, and decreased food intake. Cancer cachexia decreases chemotherapy tolerance as well as quality of life. However, because no fully effective interventions are available, cancer cachexia remains an unmet need in cancer treatment. In recent years, several discoveries and treatments for cancer cachexia have been studied, and guidelines have been published. We believe that the development of effective strategies for the diagnosis and treatment of cancer cachexia will lead to breakthroughs in cancer treatment.
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Affiliation(s)
- Kenichi Nishie
- Department of Respiratory Medicine, Iida Municipal Hospital, 438 Yawatamachi Iida Nagano, 395-0814, Japan; The First Department of Internal Medicine, Shinshu University School of Medicine, Japan.
| | - Tomomi Nishie
- The Faculty of Pharmaceutical Sciences, Ritsumeikan University, Japan
| | - Seiichi Sato
- Department of Pharmaceutics, Iida Municipal Hospital, Japan
| | - Masayuki Hanaoka
- The First Department of Internal Medicine, Shinshu University School of Medicine, Japan
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13
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Roeland EJ, Bohlke K, Baracos VE, Smith TJ, Loprinzi CL. Cancer Cachexia: ASCO Guideline Rapid Recommendation Update. J Clin Oncol 2023; 41:4178-4179. [PMID: 37467399 DOI: 10.1200/jco.23.01280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023] Open
Abstract
ASCO Rapid Recommendations Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. See the Appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).
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Affiliation(s)
- Eric J Roeland
- Oregon Health and Science University, Knight Cancer Institute, Portland, OR
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
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14
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Joseph A, Vemula B, Smith TJ. Symptom Management in the Older Adult: 2023 Update. Clin Geriatr Med 2023; 39:449-463. [PMID: 37385696 DOI: 10.1016/j.cger.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
In the older adult with a serious illness, the goal of palliative medicine and symptom management is to optimize quality of life. Frailty has become an overarching finding in many older adults with serious illness. Symptom management options need to be considered in the lens of increasing frailty along an illness trajectory. Here, the authors emphasize literature updates and best practices for the most common symptoms experienced by the older adult with a serious illness.
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Affiliation(s)
- Augustin Joseph
- Department of Medicine, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Blalock 359, Baltimore, MD 21287, USA.
| | - Balakrishna Vemula
- Department of Medicine, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Blalock 359, Baltimore, MD 21287, USA; Department of Emergency Medicine, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Blalock 359, Baltimore, MD 21287, USA
| | - Thomas J Smith
- Department of Medicine, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Blalock 359, Baltimore, MD 21287, USA; Department of Oncology, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Blalock 359, Baltimore, MD 21287, USA
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15
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Mutwalli H, Keeler JL, Bektas S, Dhopatkar N, Treasure J, Himmerich H. Eating cognitions, emotions and behaviour under treatment with second generation antipsychotics: A systematic review and meta-analysis. J Psychiatr Res 2023; 160:137-162. [PMID: 36804110 PMCID: PMC10682412 DOI: 10.1016/j.jpsychires.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
Weight gain and metabolic disturbances are frequent in people treated with second generation antipsychotics (SGA). We aimed to investigate the effect of SGAs on eating behaviors, cognitions and emotions, as a possible contributor to this adverse effect. A systematic review and a meta-analysis were conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Original articles measuring outcomes relating to eating cognitions, behaviours and emotions, during treatment with SGAs were included in this review. A total of 92 papers with 11,274 participants were included from three scientific databases (PubMed, Web of Science and PsycInfo). Results were synthesized descriptively except for the continuous data where meta-analyses were performed and for the binary data where odds ratios were calculated. Hunger was increased in participants treated with SGAs with an odds ratio for appetite increase of 1.51 (95% CI [1.04, 1.97]; z = 6.40; p < 0.001). Compared to controls, our results showed that craving for fat and carbohydrates are the highest among other craving subscales. There was a small increase in dietary disinhibition (SMD = 0.40) and restrained eating (SMD = 0.43) in participants treated with SGAs compared to controls and substantial heterogeneity across studies reporting these eating traits. There were few studies examining other eating-related outcomes such as food addiction, satiety, fullness, caloric intake and dietary quality and habits. Understanding the mechanisms associated with appetite and eating-related psychopathology changes in patients treated with antipsychotics is needed to reliably inform the development of effective preventative strategies.
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Affiliation(s)
- Hiba Mutwalli
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Clinical Nutrition, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Johanna Louise Keeler
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sevgi Bektas
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychology, Hacettepe University, Ankara, Turkey
| | - Namrata Dhopatkar
- Eating Disorders Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust (SLaM), London, UK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Eating Disorders Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust (SLaM), London, UK
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Eating Disorders Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust (SLaM), London, UK
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16
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Chang VT, Sandifer C, Zhong F. GI Symptoms in Pancreatic Cancer. Clin Colorectal Cancer 2023; 22:24-33. [PMID: 36623952 DOI: 10.1016/j.clcc.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
This review will apply a multidisciplinary approach to GI symptoms with attention to symptom assessment (instruments and qualitative aspects), differential diagnosis, and recent findings relevant to management of symptoms and underlying diseases. We conclude that further development of supportive interventions for GI symptoms for both patient and caregivers has the potential to reduce distress from GI symptoms, and anticipate better symptom control with advances in scientific knowledge and improvement of the evidence base.
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Affiliation(s)
- Victor T Chang
- Section Hematology Oncology (111), VA New Jersey Health Care System, East Orange, NJ; Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ.
| | | | - Fengming Zhong
- Section Hematology Oncology (111), VA New Jersey Health Care System, East Orange, NJ; Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ
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17
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Pinucci I, Maraone A, Tarsitani L, Pasquini M. Insomnia among Cancer Patients in the Real World: Optimising Treatments and Tailored Therapies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3785. [PMID: 36900794 PMCID: PMC10001409 DOI: 10.3390/ijerph20053785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Insomnia is commonly reported by cancer patients. Its multifaceted pathophysiology makes this symptom a complex challenge for the clinician, who should bear in mind the manifold world of causes and consequences of sleep disturbances in these patients and the importance of accurate treatment that should consider the frequent co-prescription of multiple medications. With our work, we aim to provide a tool to better master the treatment of this symptom in cancer patients, considering the gap between clinical and pharmacodynamic knowledge about the efficacy of different molecules and evidence-based prescribing. METHODS A narrative review of the studies investigating the pharmacological treatment of insomnia in cancer patients was conducted. Three hundred and seventy-six randomised controlled trials (RCTs), systematic reviews and meta-analyses were identified through PubMed. Only publications that investigated the efficacy of the pharmacological treatment of insomnia symptoms in cancer patient were considered. RESULTS Among the 376 publications that were individuated, fifteen studies were eligible for inclusion in the review and were described. Pharmacological treatments were outlined, with a broad look at specific clinical situations. CONCLUSIONS The management of insomnia in cancer patients should be personalised, as is already the case for the treatment of pain, taking into account both the pathophysiology and the other medical treatments prescribed to these patients.
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18
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Development of an EORTC Item Bank for Computer-Adaptive Testing of Nausea and Vomiting. Semin Oncol Nurs 2022; 38:151341. [PMID: 36280540 DOI: 10.1016/j.soncn.2022.151341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Nausea and vomiting (NV) remain common cancer symptoms and frequent side effects of anticancer therapies despite available antiemetics. They can lead to treatment disruption and discontinuation. NV is an important patient reported outcome in oncology. This study aimed to build an item bank for computer-adaptive testing (CAT) based on NV questions in the European Organisation for Research for Treatment of Cancer, Quality of Life for Cancer Patients (EORTC QLQ-C30) questionnaire and complete the first three phases of development as described in the EORTC Quality of Life Group guidelines. DATA SOURCES The development followed a standard procedure. The three phases include conceptualization and literature search (phase 1); item classification, selection, formulation and rating, and expert evaluations (phase 2); and patient pretesting (phase 3). The literature search resulted in a preliminary list of 115 items. Following classification, formulation, and rating, 21 candidate items adhered to the QLQ-C30 format. Evaluation by experts (n = 11) from five countries and patients (n = 31) pretesting in Denmark, Poland, and the UK lead to a final list of 20 items. CONCLUSION The selection, development, and refining of NV items have been described. The nature of this testing ensures an initial CAT item bank that after field testing (phase 4) and psychometric analysis is expected to provide a precise and efficient NV measurement while still being comparable to the original QLQ-C30 scale. IMPLICATIONS FOR NURSING PRACTICE Access to reliable tools that facilitate NV comprehensive assessment is an important issue for nurses caring for patients with cancer. This CAT item bank is meant to support clinical decisions when all phases of testing are completed.
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19
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Childs DS, Helfinstine DA, Sangaralingham L, Orme JJ, O'Sullivan CC, Loprinzi CL, Ruddy KJ. Slow Uptake of an Effective Therapy: Patterns of Olanzapine Prescribing for Those Receiving Highly Emetogenic Chemotherapy. JCO Oncol Pract 2022; 18:e1953-e1960. [PMID: 36315918 DOI: 10.1200/op.22.00389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE For the past 5 years, most major antiemesis guidelines have included olanzapine-containing regimens among the recommended options for prophylaxis with highly emetogenic chemotherapy (HEC). We analyzed the uptake of olanzapine in clinical practice and the changing composition of multidrug antiemetic regimens. METHODS A retrospective analysis was performed using an OptumLabs deidentified database of medical and pharmacy claims, which was filtered for patients starting HEC in the interval of 2006 to Q2 of 2021. Descriptive statistics were used to analyze patient characteristics and year-by-year antiemetic prescribing patterns, coinciding with cycles 1 and 2 of chemotherapy. RESULTS A total of 63,154 distinct patients were included. The median age was 58 years (range, 18-88). Breast (45.2%) and hematologic (20.8%) cancers were the most common diagnoses. In 2016, olanzapine was prescribed to 1.4% of patients with cycle 1 of HEC. Prescriptions increased modestly each year, and by 2021, 13.9% of patients received olanzapine with their first cycle of chemotherapy. An additional 5.7% of patients received olanzapine for breakthrough symptoms or enhanced prophylaxis during cycle 2. In 2021, more than three-quarters of patients were prescribed antiemetics in a guideline-concordant manner, with an olanzapine-containing quadruplet (12.2%), an NK1-receptor antagonist triplet (64.5%), or an olanzapine triplet (suppressed for small sample size). CONCLUSION Despite inclusion in major antiemesis guidelines, there has been relatively slow uptake of olanzapine for prophylaxis with HEC. This finding highlights the challenges of disseminating information and keeping prescribing systems updated with the newest evidence in supportive oncology.
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Affiliation(s)
| | - David A Helfinstine
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.,OptumLabs, Eden Prairie, MN
| | - Lindsey Sangaralingham
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.,OptumLabs, Eden Prairie, MN
| | - Jacob J Orme
- Department of Oncology, Mayo Clinic, Rochester, MN
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20
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Nakagawa N, Suzuki M. Efficacy of Olanzapine for Symptom Relief in Cancer Patients. J Pain Palliat Care Pharmacother 2022; 36:216-222. [PMID: 36250742 DOI: 10.1080/15360288.2022.2126059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Olanzapine is an atypical antipsychotic and is widely used for prophylaxis of chemotherapy-induced nausea and vomiting in cancer patients. Previous studies have suggested its potential efficacy for the relief of various symptoms in cancer patients, especially gastrointestinal and psychiatric symptoms. We retrospectively reviewed the prescription of olanzapine to cancer patients at our hospital. Between 2008 and 2020, olanzapine was prescribed to 41 patients for relief of symptoms associated with cancer other than prophylaxis of chemotherapy-induced nausea and vomiting. Of those patients, symptom relief was seen in 53.7%. Notably, olanzapine was effective in 13 of 14 patients with chemotherapy-induced nausea and vomiting refractory to guideline-recommended prophylaxis. Of 16 patients in whom this symptom was not relieved by olanzapine, 13 (81.3%) continued taking olanzapine even after it was judged ineffective. No treatment-related adverse events were seen in this study. Our observation implies good efficacy of olanzapine for refractory chemotherapy-induced nausea and vomiting and a tendency to continue olanzapine even in those for whom it was ineffective.
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Affiliation(s)
- Natsuki Nakagawa
- Department of Respiratory Medicine, Kanto Central Hospital, Tokyo, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Kanto Central Hospital, Tokyo, Japan
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21
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Amano K, Hopkinson J, Baracos V. Psychological symptoms of illness and emotional distress in advanced cancer cachexia. Curr Opin Clin Nutr Metab Care 2022; 25:167-172. [PMID: 34966115 DOI: 10.1097/mco.0000000000000815] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Cachexia induces both physical and psychological symptoms of illness in patients with advanced cancer and may generate emotional distress in patients and families. However, physical symptoms of cachexia received the most emphasis. The aims of this review are to elucidate a link between systemic inflammation underlying cachexia and psychological symptoms and emotional distress, and to advance care strategy for management of psychological symptoms and emotional distress in patients and families. RECENT FINDINGS The main themes in the literature covered by this review are psychological symptoms in patients and emotional distress in patients and families. Studies of the underlying biology of cachexia identify the role of the central nervous system to amplify tumor-induced systemic inflammation. The brain mediates a cluster of symptoms, such as sleep disruption, anxiety, cognitive impairment, and reduction in motivated behavior (notably anorexia). These are distressing to patients as well as to families. SUMMARY There is growing recognition that holistic multimodal interventions are needed to alleviate psychological symptoms and emotional distress and to improve quality of life in patients with cancer cachexia and families. This is an approach that addresses not only physical health but also psychological, emotional, and social well being issues.
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Affiliation(s)
- Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute city, Aichi, Japan
| | - Jane Hopkinson
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Vickie Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
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22
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Sharma V, Sharma S, Hutson J, Martin A. A potential role for olanzapine in the treatment of hyperemesis gravidarum. J Matern Fetal Neonatal Med 2022; 35:9532-9535. [PMID: 35240910 DOI: 10.1080/14767058.2022.2046730] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hyperemesis gravidarum is a rare but potentially serious complication of pregnancy. Some women with severe symptoms and possibly psychiatric comorbidities remain symptomatic despite the use of currently available treatments. Due to its favorable safety profile, antiemetic efficacy in other conditions, and 5-HT3 antagonism, olanzapine may be a potentially useful addition to the armamentarium for management of hyperemesis gravidarum resistant to standard- of-care treatment.
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Affiliation(s)
- Verinder Sharma
- Department of Psychiatry, The University of Western Ontario, London, ON, Canada.,Department of Obstetrics & Gynecology, The University of Western Ontario, London, ON, Canada.,Parkwood Institute Mental Health, St. Joseph's Health Care, London, ON, Canada
| | - Sapna Sharma
- Department of Obstetrics and Gynecology, McMaster University, Ontario, ON, Canada
| | - Janine Hutson
- Department of Obstetrics & Gynecology, The University of Western Ontario, London, ON, Canada
| | - Alex Martin
- PGY 1 Family Medicine, University of Calgary, Calgary, Alberta, Canada
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23
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Khorasanchi A, Nemani S, Pandey S, Del Fabbro E. Managing Nutrition Impact Symptoms in Cancer Cachexia: A Case Series and Mini Review. Front Nutr 2022; 9:831934. [PMID: 35308290 PMCID: PMC8928189 DOI: 10.3389/fnut.2022.831934] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/07/2022] [Indexed: 12/31/2022] Open
Abstract
Malnutrition is common in cancer patients and can occur throughout a patient’s disease course. The contributors to the clinical syndrome of cancer cachexia are often multifactorial, and produced by the cancer and associated pro-inflammatory response. Since cancer cachexia is a multifactorial syndrome, a multimodal therapeutic approach is ideal. A key component of therapy is identifying and managing symptom barriers to adequate oral intake, known as nutritional impact symptoms (NIS). NIS are associated with reduced intake and weight loss in patients with advanced cancer, and aggregate NIS are a predictor of survival in patients with Head and Neck Cancer and in patients undergoing surgery for esophageal cancer. Currently, there are no guidelines regarding the specific management of NIS in oncology patients. Experience from specialist centers suggest relatively simple assessments and inexpensive interventions are available for the diagnosis and treatment of NIS. We present three patient cases from a cachexia clinic, where NIS management decreased symptom burden and improved clinical outcomes such as weight and physical performance.
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Affiliation(s)
- Adam Khorasanchi
- Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, United States
| | - Srinidhi Nemani
- Virginia Commonwealth University, Richmond, VA, United States
| | - Sudeep Pandey
- Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, United States
| | - Egidio Del Fabbro
- Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, United States
- *Correspondence: Egidio Del Fabbro,
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24
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Kawai T, Momo K, Ota K. Olanzapine Improves Cachexia in a Breast Cancer Patient under Home Hospice Care. J Palliat Med 2022; 25:4-5. [PMID: 34978910 DOI: 10.1089/jpm.2021.0517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tomoko Kawai
- ak-Holdings Co., Ltd., Kaminagaya Pharmacy, Yokohama-shi, Kanagawa-ken, Japan.,Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Kenji Momo
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Kazue Ota
- Heiikukai Medical Corporation, Chuo-ku, Tokyo, Japan
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25
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Xiao BY, Su T, Huang YJ, Lin GH, Liu ZB, Tang YX, Wang BC. A pooled analysis of adding olanzapine to guideline-recommended antiemetic therapy for breast cancer patients treated with an anthracycline and cyclophosphamide in prospective and retrospective studies. Support Care Cancer 2021; 30:2445-2453. [PMID: 34775535 DOI: 10.1007/s00520-021-06689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE As an antipsychotic agent that targets multiple neurotransmitter receptors, olanzapine has been added to antiemetic therapies. For better understanding the application of olanzapine in antiemetic strategies for breast cancer patients who suffered anthracycline plus cyclophosphamide-induced nausea and vomiting, we comprehensively reviewed the antiemetic researches related to olanzapine and pooled-analyzed the results to confirm the efficacy and safety of olanzapine in breast cancer. METHODS PubMed, Web of Science, EMBASE, and Cochrane CENTRAL databases were searched from inception through Sep 15, 2021. Both prospective and retrospective studies were eligible. The primary outcomes were complete response (defined as no vomiting and no use of rescue medications) and no nausea rate, and the secondary outcome was treatment-related adverse events. RESULTS Four studies with 466 breast cancer patients were identified in the pooled analysis. In the acute period (0-24 h), the olanzapine group had significantly higher rates of complete response (71.3% vs 48.1%, odds ratio [OR]: 2.66, 95% confidence interval [CI] 1.39-5.11, p = 0.003) and no nausea (70.0% vs 43.0%, OR: 3.55, 95% CI 1.76-7.18, p = 0.04) than the placebo group, while in the delayed period, the olanzapine group was also superior to the placebo group in terms of the complete response (82.5% vs 63.3%, OR: 3.81, 95% CI 1.58-9.15, p = 0.003) and no nausea (66.3% vs 51.9%, OR: 2.08, 95% CI 1.03-4.21, p = 0.04) rates. During the overall period in prospective studies, the proportions of complete response (50.0% vs 34.2%, OR: 1.93, p = 0.04) and no nausea (51.3% vs 25.3%, OR: 3.40, p = 0.0006) in the olanzapine group were higher than those in the placebo group. CONCLUSION Highly emetogenic chemotherapy breast patients could benefit from olanzapine-contained antiemetic therapy. Furthermore, since the cost is low, olanzapine is worth further clinical application and promotion.
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Affiliation(s)
- Bo-Ya Xiao
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, 200433, China.,Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, China
| | - Tong Su
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, 200433, China
| | - Yu-Jia Huang
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, 200433, China
| | - Guo-He Lin
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Zhao-Bo Liu
- The Third People's Hospital of Ji'an, Ji'an, 343099, China.
| | - Yun-Xiang Tang
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University (Second Military Medical University), Shanghai, 200433, China.
| | - Bi-Cheng Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
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26
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Martin L, Muscaritoli M, Bourdel-Marchasson I, Kubrak C, Laird B, Gagnon B, Chasen M, Gioulbasanis I, Wallengren O, Voss AC, Goldwasser F, Jagoe RT, Deans C, Bozzetti F, Strasser F, Thoresen L, Kazemi S, Baracos V, Senesse P. Diagnostic criteria for cancer cachexia: reduced food intake and inflammation predict weight loss and survival in an international, multi-cohort analysis. J Cachexia Sarcopenia Muscle 2021; 12:1189-1202. [PMID: 34448539 PMCID: PMC8517347 DOI: 10.1002/jcsm.12756] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cancer-associated weight loss (WL) associates with increased mortality. International consensus suggests that WL is driven by a variable combination of reduced food intake and/or altered metabolism, the latter often represented by the inflammatory biomarker C-reactive protein (CRP). We aggregated data from Canadian and European research studies to evaluate the associations of reduced food intake and CRP with cancer-associated WL (primary endpoint) and overall survival (OS, secondary endpoint). METHODS The data set included a total of 12,253 patients at risk for cancer-associated WL. Patient-reported WL history (% in 6 months) and food intake (normal, moderately, or severely reduced) were measured in all patients; CRP (mg/L) and OS were measured in N = 4960 and N = 9952 patients, respectively. All measures were from a baseline assessment. Clinical variables potentially associated with WL and overall survival (OS) including age, sex, cancer diagnosis, disease stage, and performance status were evaluated using multinomial logistic regression MLR and Cox proportional hazards models, respectively. RESULTS Patients had a mean weight change of -7.3% (±7.1), which was categorized as: ±2.4% (stable weight; 30.4%), 2.5-5.9% (19.7%), 6.0-10.0% (23.2%), 11.0-14.9% (12.0%), ≥15.0% (14.6%). Normal food intake, moderately, and severely reduced food intake occurred in 37.9%, 42.8%, and 19.4%, respectively. In MLR, severe WL (≥15%) (vs. stable weight) was more likely (P < 0.0001) if food intake was moderately [OR 6.28, 95% confidence interval (CI 5.28-7.47)] or severely reduced [OR 18.98 (95% CI 15.30-23.56)]. In subset analysis, adjusted for food intake, CRP was independently associated (P < 0.0001) with ≥15% WL [CRP 10-100 mg/L: OR 2.00, (95% CI 1.58-2.53)] and [CRP > 100 mg/L: OR 2.30 (95% CI 1.62-3.26)]. Diagnosis, stage, and performance status, but not age or sex, were significantly associated with WL. Median OS was 9.9 months (95% CI 9.5-10.3), with median follow-up of 39.7 months (95% CI 38.8-40.6). Moderately and severely reduced food intake and CRP independently predicted OS (P < 0.0001). CONCLUSIONS Modelling WL as the dependent variable is an approach that can help to identify clinical features and biomarkers associated with WL. Here, we identify criterion values for food intake impairment and CRP that may improve the diagnosis and classification of cancer-associated cachexia.
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Affiliation(s)
- Lisa Martin
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Catherine Kubrak
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Barry Laird
- University of Edinburgh, European Palliative Care Research Center, Edinburgh, UK
| | - Bruno Gagnon
- Department of Family Medicine and Emergency Medicine, Université Laval, Laval, Quebec, Canada
| | - Martin Chasen
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ioannis Gioulbasanis
- Department of Medical Oncology, Αnimus-Κyanous Stavros General Clinic - Larissa, Thessaly, Greece
| | - Ola Wallengren
- Clinical Nutrition Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anne C Voss
- Global Research and Development (retired), Abbott Nutrition, Columbus, Ohio, USA
| | - Francois Goldwasser
- Medical Oncology, Cochin Hospital, APHP 5, University of Paris, Paris, France
| | - R Thomas Jagoe
- McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec, Canada
| | - Chris Deans
- Clinical and Surgical Sciences, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, UK
| | | | - Florian Strasser
- Oncological Palliative Medicine, Division of Oncology, Department of Internal Medicine and Palliative Care Center, Cantonal Hospital, St. Gallen, Switzerland
| | - Lene Thoresen
- Oncology Clinic, St. Olavs University Hospital, Trondheim, Norway
| | - Sean Kazemi
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Vickie Baracos
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Pierre Senesse
- Clinical Nutrition and Gastroenterology Unit, Institut de recherche en Cancérologie de Montpellier (IRCM) Inserm U1194, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
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Davis M, Hui D, Davies A, Ripamonti C, Capela A, DeFeo G, Del Fabbro E, Bruera E. MASCC antiemetics in advanced cancer updated guideline. Support Care Cancer 2021; 29:8097-8107. [PMID: 34398289 DOI: 10.1007/s00520-021-06437-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nausea and vomiting are a common clinical symptom in the advanced cancer patient. Pharmacologic management is important. Evidence for drug choices and guidelines are needed to help clinicians manage nausea and vomiting in this population METHODS: Evidence from a systematic review published in 2010, initial MASCC guidelines developed from a systematic review of literature to 2015, and a new systematic review of randomized trials published between 2015 and February 2, 2021, was combined to establish a new guideline. RESULTS A search of the literature between 2015 and February 2, 2021, revealed 257 abstracts of which there was one systematic review and 4 randomized trials which were used to modify the guideline. The new guideline is as follows: First Line: Metoclopramide (II) multiple small RCTs including a placebo-controlled trial, haloperidol (II) multiple non-placebo-controlled RCTs, high consensus. Second line: Methotrimeprazine (II) 1 well-powered non-placebo-controlled RCT, olanzapine (II) 1 placebo-controlled pilot RCT, high consensus. Third line: Tropisetron (II) large unblinded lower quality non-placebo-controlled RCT, levosulpiride (II) 1 blinded non-placebo-controlled pilot RCT, high consensus. DISCUSSION Haloperidol, metoclopramide, methotrimeprazine, olanzapine tropisetron, and levosulpiride have been antiemetics used in randomized trials with antiemetic activity demonstrated. There are only three placebo-controlled randomized trials we could find in our literature review. Placebo responses varied significantly between two randomized trials. More randomized placebo-controlled trials with either metoclopramide or haloperidol rescue are needed to clarify antiemetic choices in advanced cancer. CONCLUSION First-line antiemetics for nausea and vomiting in advanced cancer are metoclopramide and haloperidol, and second-line medications are methotrimeprazine and olanzapine.
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Affiliation(s)
| | - David Hui
- Department of Palliative, Rehabilitation and Integrative Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew Davies
- Trinity College Dublin, University College Dublin, and Our Lady's Hospice Dublin, Dublin, Ireland
| | - Carla Ripamonti
- Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Onco-Haematology, Milan, Italy
| | - Andreia Capela
- Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO) and Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Giulia DeFeo
- Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Onco-Haematology, Milan, Italy
| | - Egidio Del Fabbro
- Palliative Care Endowed Chair Division of Hematology, Oncology & Palliative Care Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Akid I, Nesbit S, Nanavati J, Bienvenu OJ, Smith TJ. Prevention of Steroid-Induced Neuropsychiatric Complications With Neuroleptic Drugs: A Review. Am J Hosp Palliat Care 2021; 39:472-476. [PMID: 34387114 DOI: 10.1177/10499091211034771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Corticosteroids are used for a multitude of indications in palliative patients. In this narrative review, we aim to review literature on the treatment and prevention of neuropsychiatric complications of steroids. For prevention, only lamotrigine had a positive effect in a small number of studies. For treatment, olanzapine appears to be nearly universally effective at low doses, but randomized trial evidence is lacking. Further randomized clinical trials are necessary to elucidate data-driven guidelines for prevention and treatment of corticosteroid-induced neuropsychiatric symptoms. Until further data are available, it is reasonable to consider low dose olanzapine for any patient taking 40 mg of prednisone or its equivalent, especially those with a history of depression or neuropsychiatric symptoms.
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Affiliation(s)
- Ivy Akid
- Johns Hopkins Palliative Care Program, the Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Suzanne Nesbit
- Johns Hopkins Palliative Care Program, the Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Julie Nanavati
- Johns Hopkins Palliative Care Program, the Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Oscar Joseph Bienvenu
- Johns Hopkins Palliative Care Program, the Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Thomas J Smith
- Johns Hopkins Palliative Care Program, the Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Harry J. Duffey Family Patient and Family Services Program of the Sidney Kimmel Comprehensive Cancer Program, 588543Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Hui D, Puac V, Shelal Z, Liu D, Maddi R, Kaseb A, Javle M, Overman M, Yennurajalingam S, Gallagher C, Bruera E. Fixed-Dose Netupitant and Palonosetron for Chronic Nausea in Cancer Patients: A Double-Blind, Placebo Run-in Pilot Randomized Clinical Trial. J Pain Symptom Manage 2021; 62:223-232.e1. [PMID: 33388382 DOI: 10.1016/j.jpainsymman.2020.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022]
Abstract
CONTEXT No clinical trials have examined the effect of netupitant/palonosetron (NEPA) on chronic nausea in patients with cancer. OBJECTIVES In this pilot randomized trial, we assessed the efficacy of NEPA and placebo on chronic nausea. METHODS This double-blind, parallel, randomized trial enrolled patients with cancer and chronic nausea for at least 1 month, intensity ≥4/10 and not on moderately or highly emetogenic systemic therapies. Patients started with a placebo run-in period from days 1 to 5; those without a placebo response proceeded to the double-blinded phase between days 6 to 15 (NEPA: placebo 2:1 ratio). The primary outcome was within-group change in average nausea over the 24 hours on a 0-10 numeric rating scale between day 5 and 15. RESULTS Among the 53 enrolled patients, 46 proceeded to placebo run-in and 33 had blinded treatment (22 NEPA and 11 placebo). We observed a statistically significant within-group improvement in nausea numeric rating scale between day 5 and 15 in the NEPA group (mean change, -2.0; 95% CI, -3.1 to -0.8) and the placebo group (mean change, -2.3; 95% CI, -3.9 to -0.7). A complete response was achieved in 8 (38%) patients in the NEPA group and 2 (20%) in the placebo group by day 15. No grade 3-4 toxicities were attributed to NEPA. There were no statistically significant between-group differences for the primary/secondary outcomes. CONCLUSIONS NEPA and placebo were associated with similar magnitude of within-group improvement in chronic nausea without significant between-group differences (Clinicaltrials.gov NCT03040726).
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA.
| | - Veronica Puac
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Zeena Shelal
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane Liu
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Rama Maddi
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Overman
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sriram Yennurajalingam
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Colleen Gallagher
- Department of Bioethics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
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Arends J, Strasser F, Gonella S, Solheim TS, Madeddu C, Ravasco P, Buonaccorso L, de van der Schueren MAE, Baldwin C, Chasen M, Ripamonti CI. Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines ☆. ESMO Open 2021; 6:100092. [PMID: 34144781 PMCID: PMC8233663 DOI: 10.1016/j.esmoop.2021.100092] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/09/2021] [Accepted: 02/24/2021] [Indexed: 12/15/2022] Open
Abstract
•This ESMO Clinical Practice Guideline provides key recommendations for managing cancer-related cachexia. •It covers screening, assessment and multimodal management of cancer cachexia. •All recommendations were compiled by a multidisciplinary group of experts. •Recommendations are based on available scientific data and the author's expert opinion.
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Affiliation(s)
- J Arends
- Department of Medicine I, Medical Center - University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - F Strasser
- Integrated Cancer Rehabilitation and Cancer Fatigue Clinic, Klinik Gais/Kliniken Valens; Clinic Medical Oncology and Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - S Gonella
- Direction of Health Professions, Azienda Ospedaliero Universitaria Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy; Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - T S Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Cancer Clinic, Trondheim University Hospital, Trondheim, Norway
| | - C Madeddu
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - P Ravasco
- Immuno-Hemotherapy and Oncology, University Hospital of Santa Maria, CHULN, Lisbon, Portugal; Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisbon, Portugal; University of Lisbon, Portugal
| | - L Buonaccorso
- Psycho-Oncology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - M A E de van der Schueren
- Department of Nutrition, Dietetics and Life Style, School of Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - C Baldwin
- Department of Nutritional Sciences, King's College London, London, UK
| | - M Chasen
- Department of Medicine, University of Toronto, Toronto, Canada; Department of Family Medicine, McMaster University, Hamilton, Canada; William Osler Health Services, Brampton, Canada
| | - C I Ripamonti
- Oncology-Supportive Care in Cancer Unit, Department of Onco-Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Milan, Italy
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Maeda I, Satomi E, Kiuchi D, Nishijima K, Matsuda Y, Tokoro A, Tagami K, Matsumoto Y, Naito A, Morita T, Iwase S, Otani H, Odagiri T, Watanabe H, Mori M, Matsuda Y, Nagaoka H, Mayuzumi M, Kanai Y, Sakamoto N, Ariyoshi K. Patient-perceived symptomatic benefits of olanzapine treatment for nausea and vomiting in patients with advanced cancer who received palliative care through consultation teams: a multicenter prospective observational study. Support Care Cancer 2021; 29:5831-5838. [PMID: 33742244 DOI: 10.1007/s00520-021-06067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine the safety, effectiveness, and patient-perceived benefit of treatment with olanzapine for nausea and vomiting (N/V) in patients with advanced cancer. METHODS We conducted a multicenter prospective observational study in a tertiary care setting (Trial registration number: UMIN000020493, date of registration: 2016/1/12). We measured the following: average nausea in the last 24 h using a Numeric Rating Scale (NRS: range 0-10) at baseline and day 2, patient-perceived treatment benefit (based on a 5-point verbal scale), and adverse events (AEs; using the Common Terminology Criteria for Adverse Events version 4). RESULTS The 85 participants (45% men) had a mean age of 58.7±15.8 years. Major causes of N/V were opioids (44%) and chemotherapy (34%). All patients received a daily dose of olanzapine of 5 mg or less as first-line treatment (N=35) or second- or later-line treatment (N=50). Nausea NRS decreased from 6.1±2.2 to 1.8±2.0 (differences: -4.3, 95% CI -3.7 to -4.9, p<0.001). The proportion of patients who did not experience vomiting episodes in the last 24 h increased from 40-89%. Mean decrease in nausea NRS by patient-perceived treatment benefit were as follows: -0.8 for "none" (n=4, 5%); -2.8 for "slight" (n=17, 20%); -3.3 for "moderate" (n=14, 16%); -4.7 for "lots" (n=25, 29%); and -6.1 for "complete" (n=25, 29%; p-for-trend<0.001). The most prevalent AE was somnolence (n=15, 18%). CONCLUSION Short-term and relatively low-dose olanzapine treatment was effective for multifactorial N/V. Confirmatory studies with longer observation periods are needed to clarify the duration of the effect and adverse events.
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Affiliation(s)
- Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Osaka, Japan.
| | - Eriko Satomi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Daisuke Kiuchi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Kaoru Nishijima
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Akihiro Tokoro
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Akemi Naito
- Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Irima, Saitama, Japan
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Ehret C, Jatoi A. Should Loss of Appetite Be Palliated in Patients with Advanced Cancer? Curr Treat Options Oncol 2021; 22:31. [PMID: 33641020 PMCID: PMC7914034 DOI: 10.1007/s11864-021-00829-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 02/04/2023]
Abstract
Loss of appetite is common among patients with advanced cancer. However, it remains controversial how, when, and if to palliate this symptom. Here, we provide an update on recent as well as past literature to address the question of whether loss of appetite should be palliated in patients with advanced cancer. In our opinion—and as discussed here—we believe that this symptom should be palliated, although perhaps not always with pharmacologic interventions.
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Affiliation(s)
| | - Aminah Jatoi
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Allahgholipour SZ, Farzipour S, Ghasemi A, Asgarian-Omran H, Hosseinimehr SJ. The Radiosensitizing Effect of Olanzapine as an Antipsychotic Medication in Glioblastoma Cell. Curr Radiopharm 2021; 15:50-55. [PMID: 33494694 DOI: 10.2174/1874471014666210120100448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Radiotherapy is used as one of the most effective regimens for cancer treatment, while radioresistance is a major drawback in cancer treatment. OBJECTIVES The aim of this study was to evaluate the sensitizing effect of olanzapine (OLA) with X-ray on glioblastoma (U-87 MG) cells death. METHODS The synergistic killing effect of OLA with ionizing radiation (IR) on glioma was evaluated by colony formation assay. The generations of reactive oxygen species (ROS) and protein carbonyl (PC) as oxidized protein were determined in OLA and irradiated cells. RESULTS The results of this study showed that OLA reduced the number of colonies in irradiated glioma cells. OLA elevated ROS and PC levels in irradiated cells. The synergistic killing effect of OLA with IR in U-87 MG cell was observed at concentrations 1 µM and 20 µM of OLA. The maximum radiosensitizing effect of OLA was observed at concentration of 20 µM. CONCLUSION The present study demonstrates that OLA has radiosensitizing effect on cell death induced by IR in glioma cells.
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Affiliation(s)
- Seyedeh Zahra Allahgholipour
- Department of Radiopharmacy, Faculty of Pharmacy, Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari. Iran
| | - Soghra Farzipour
- Department of Radiopharmacy, Faculty of Pharmacy, Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari. Iran
| | - Arash Ghasemi
- Department of Radiology and Radiation Oncology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari. Iran
| | - Hossein Asgarian-Omran
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari. Iran
| | - Seyed Jalal Hosseinimehr
- Department of Radiopharmacy, Faculty of Pharmacy, Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari. Iran
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The Management of Nausea and Vomiting Not Related to Anticancer Therapy in Patients with Cancer. Curr Treat Options Oncol 2021; 22:17. [PMID: 33443705 DOI: 10.1007/s11864-020-00813-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/11/2022]
Abstract
OPINION STATEMENT In cancer patients, the management of nausea and vomiting that is not directly related to treatment is challenging. Much current practice is based on expert opinion and anecdote. Fortunately, over recent years, a number of quality trials have been undertaken to strengthen the evidence base that guides the care of our patients with these distressing symptoms. Much is still unknown however. In this article, we present the latest literature that addresses some of the outstanding issues.
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Olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting: a systematic review, meta-analysis, cumulative meta-analysis and fragility assessment of the literature. Support Care Cancer 2021; 29:3439-3459. [PMID: 33442782 PMCID: PMC7805431 DOI: 10.1007/s00520-020-05935-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/03/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The aim of this study is to rigorously review the efficacy and safety of olanzapine in defined hematology oncology settings including (1) the setting of highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) settings (2) at 5 mg and 10 mg doses, and (3) for response rates for use in the acute, delayed, and overall settings post-MEC and HEC. METHODS Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched through April 23, 2020. The primary efficacy endpoints were the rate of complete response, in the acute (0-24 h post-chemotherapy), delayed (24-120 h post-chemotherapy), and overall (0-120 h post-chemotherapy) phases. The secondary efficacy endpoints were the rates of no nausea and no emesis, for each phase. Safety endpoints were the rate of no serious adverse events (i.e., no grade 3 or 4 toxicities), as assessed by Common Terminology Criteria for Adverse Events (CTCAE) criteria. The Mantel-Haenszel, random-effects analysis model was used to compute risk ratios and accompanying 95% confidence intervals for each endpoint. For endpoints that statistically favored one arm, absolute risk differences were computed to assess whether there is a 10% or greater difference, used as the threshold for clinical significance by MASCC/ESMO. Fragility indices were also calculated for each statistically significant endpoint, to quantitatively assess the robustness of the summary estimate. A cumulative meta-analysis was conducted for each efficacy meta-analysis with more than 5 studies, also using the Mantel-Haenszel random-effects analysis model. RESULTS Three studies reported on olanzapine for the rescue of breakthrough chemotherapy-induced nausea and vomiting (CINV); 22 studies reported on olanzapine in the prophylactic setting. For studies reporting on HEC patients, olanzapine-containing regimens were statistically and clinically superior in seven of nine efficacy endpoints in the prophylaxis setting. When olanzapine is administered at a 10-mg dose, it is statistically and clinically superior to control patients in eight of nine endpoints among adults. Olanzapine may be effective in the MEC setting and when administered at 5-mg doses, but the paucity of data leads to notable uncertainty. CONCLUSION Further RCTs are needed in the setting of MEC patients and administration of olanzapine at a lower 5-mg dose, which may be given to reduce the sedative effect of olanzapine at 10 mg.
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Abstract
OPINION STATEMENT Olanzapine has become a major drug in the management of chemotherapy-induced nausea and vomiting as a prophylactic agent. In addition, a recent randomized trial has demonstrated its benefits in treating nausea and vomiting associated with advanced cancer. The added benefit to olanzapine is that it also stimulates appetite. As a result, since it treats multiple symptoms associated with advanced cancer, it is likely to become the antiemetic of choice in palliative care at least in the USA. The added benefit of treating insomnia and the avoidance of benzodiazepines should place olanzapine in at the top of the list of drugs to use for patients who do complain of insomnia. There is no good evidence that it potentiates the respiratory depression of opioids unlike benzodiazepines. The evidence is weak that olanzapine in as an adjuvant analgesic. Hopefully, future trials will explore this in greater depth. The benefits of adding olanzapine to potent opioids are that it may reduce craving, drug cues, and opioid misuse. Other symptoms like anxiety and depression may be addressed by the addition of olanzapine to standard antidepressants.
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Affiliation(s)
- Mellar P Davis
- Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
| | - Gareth J Sanger
- Blizard Institute and National Bowel Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England
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Taherifard E. The Importance of a Cause-Based Protocol to Approach Cancer-Related Nausea and Vomiting. JAMA Oncol 2020; 6:1811-1812. [DOI: 10.1001/jamaoncol.2020.3703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Erfan Taherifard
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
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Loprinzi CL, Le-Rademacher JG, Navari RM. The Importance of a Cause-Based Protocol to Approach Cancer-Related Nausea and Vomiting—Reply. JAMA Oncol 2020; 6:1812-1813. [DOI: 10.1001/jamaoncol.2020.3706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
OPINION STATEMENT Nausea and vomiting is a common clinical issue in the advanced cancer patient. The etiology may be related to treatment (chemotherapy, radiation, surgery) or non-treatment clinical issues related to the advanced cancer. A very detailed initial assessment of nausea/vomiting is indicated including frequency, duration, intensity, associated activities, and the presence of anorexia or cachexia and is necessary in order to determine a specific etiology which may allow a potentially specific successful intervention. Various international antiemetic guidelines have been developed for the successful prevention of chemotherapy- and radiotherapy-induced nausea and emesis but the treatment of post-chemotherapy nausea/vomiting and of radiation-induced nausea/vomiting has been less successful. Chronic nausea/vomiting in the advanced cancer patient unrelated to treatment remains a significant clinical problem with few successful treatments and interventions. NCCN and ASCO palliative care guidelines provide various treatment suggestions but these are based on empiric evidence with very few clinical trials available to provide demonstrated effective treatments. Recent randomized clinical trials have demonstrated that olanzapine may be an effective agent for the prevention and treatment of chemotherapy-induced nausea and emesis as well as treatment of chronic nausea and vomiting unrelated to treatment.
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