WITHDRAWN: Interventions for fatigue and weight loss in adults with advanced progressive illness

Continuity of Care plus Whole Process Psychological Intervention for Lung Cancer Patients undergoing Chemotherapy

Objective

To explore the efficiency of continuity of care plus whole process psychological intervention for lung cancer patients undergoing chemotherapy.

Methods

A total of 130 patients who have lung cancer undergoing chemotherapy admitted to our hospital from 2019 to 2021 were recruited and assigned via different intervention methods (1 : 1) to receive either continuity of care plus whole process psychological intervention (observation group) or routine nursing (control group). Outcome measures included psychological state, treatment compliance, quality of life, and nursing satisfaction.

Results

Continuity of care plus whole process psychological intervention was associated with significantly lower Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores versus routine care. The patients given combined nursing showed higher self-esteem scores versus those given routine care. Continuity of care plus whole process psychological intervention also resulted in significantly lower cancer-related fatigue scores and higher treatment compliance versus routine care. Patients given continuity of care plus whole process psychological intervention had a better quality of life and higher nursing satisfaction versus those given routine care (P < 0.05).

Conclusions

Continuity of care plus whole process psychological intervention can effectively mitigate the negative emotions of lung cancer patients, alleviate cancer-related fatigue, improve treatment compliance, and boost the life quality of patients.

Exercise for cancer cachexia in adults

BACKGROUND

Cancer cachexia is a multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass, with or without a loss of fat mass, leading to progressive functional impairment. Physical exercise may attenuate cancer cachexia and its impact on patient function. This is the first update of an original Cochrane Review published in Issue 11, 2014, which found no studies to include.

OBJECTIVES

To determine the effectiveness, acceptability and safety of exercise, compared with usual care, no treatment or active control, for cancer cachexia in adults.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, and eight other databases to March 2020. We searched for ongoing studies in trial registries, checked reference lists and contacted experts to seek relevant studies.

SELECTION CRITERIA

We sought randomised controlled trials in adults with cancer cachexia, that compared a programme of exercise alone or in combination with another intervention, with usual care, no treatment or an active control group.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed titles and abstracts for relevance and extracted data on study design, participants, interventions and outcomes from potentially relevant articles. We used standard methodological procedures expected by Cochrane. Our primary outcome was lean body mass and secondary outcomes were adherence to exercise programme, adverse events, muscle strength and endurance, exercise capacity, fatigue and health-related quality of life. We assessed the certainty of evidence using GRADE and included two Summary of findings tables.

MAIN RESULTS

We included four new studies in this update which overall randomised 178 adults with a mean age of 58 (standard deviation (SD) 8.2) years. Study sample size ranged from 20 to 60 participants and in three studies the proportion of men ranged from 52% to 82% (the fourth study was only available in abstract form). Three studies were from Europe: one in the UK and Norway; one in Belgium and one in Germany. The remaining study was in Canada. The types of primary cancer were head and neck (two studies), lung and pancreas (one study), and mixed (one study). We found two comparisons: exercise alone (strength-based exercise) compared to usual care (one study; 20 participants); and exercise (strength-based exercise/endurance exercise) as a component of a multimodal intervention (pharmacological, nutritional or educational (or a combination) interventions) compared with usual care (three studies, 158 participants). Studies had unclear and high risk of bias for most domains. Exercise plus usual care compared with usual care We found one study (20 participants). There was no clear evidence of a difference for lean body mass (8 weeks: MD 6.40 kg, 95% CI -2.30 to 15.10; very low-certainty evidence). For our secondary outcomes, all participants adhered to the exercise programme and no participant reported any adverse event during the study. There were no data for muscle strength and endurance, or maximal and submaximal exercise capacity. There was no clear evidence of a difference for either fatigue (4 to 20 scale, lower score was better) (8 weeks: MD -0.10, 95% CI -4.00 to 3.80; very low-certainty evidence) or health-related quality of life (0 to 104 scale, higher score was better) (8 weeks: MD 4.90, 95% CI -15.10 to 24.90; very low-certainty evidence). Multimodal intervention (exercise plus other interventions) plus usual care compared with usual care We found three studies but outcome data were only available for two studies. There was no clear evidence of a difference for lean body mass (6 weeks: MD 7.89 kg, 95% CI -9.57 to 25.35; 1 study, 44 participants; very low-certainty evidence; 12 weeks: MD -2.00, 95% CI -8.00 to 4.00; one study, 60 participants; very low-certainty evidence). For our secondary outcomes, there were no data reported on adherence to the exercise programme, endurance, or maximal exercise capacity. In one study (44 participants) there was no clear evidence of a difference for adverse events (patient episode report) (6 weeks: risk ratio (RR) 1.18, 95% CI 0.67 to 2.07; very low-certainty evidence). Another study assessed adverse events but reported no data and the third study did not assess this outcome. There was no clear evidence of a difference in muscle strength (6 weeks: MD 3.80 kg, 95% CI -2.87 to 10.47; 1 study, 44 participants; very low-certainty evidence; 12 weeks MD -5.00 kg, 95% CI -14.00 to 4.00; 1 study, 60 participants; very low-certainty evidence), submaximal exercise capacity (6 weeks: MD -16.10 m walked, 95% CI -76.53 to 44.33; 1 study, 44 participants; very low-certainty evidence; 12 weeks: MD -62.60 m walked, 95% CI -145.87 to 20.67; 1 study, 60 participants; very low-certainty evidence), fatigue (0 to 10 scale, lower score better) (6 weeks: MD 0.12, 95% CI -1.00 to 1.24; 1 study, 44 participants; very low-certainty evidence) or health-related quality of life (0 to 104 scale, higher score better) (12 weeks: MD -2.20, 95% CI -13.99 to 9.59; 1 study, 60 participants; very low-certainty evidence).

AUTHORS' CONCLUSIONS

The previous review identified no studies. For this update, our conclusions have changed with the inclusion of four studies. However, we are uncertain of the effectiveness, acceptability and safety of exercise for adults with cancer cachexia. Further high-quality randomised controlled trials are still required to test exercise alone or as part of a multimodal intervention to improve people's well-being throughout all phases of cancer care. We assessed the certainty of the body of evidence as very low, downgraded due to serious study limitations, imprecision and indirectness. We have very little confidence in the results and the true effect is likely to be substantially different from these. The findings of at least three more studies (one awaiting classification and two ongoing) are expected in the next review update.

Effectiveness of non-pharmacological interventions to decrease fatigue in people living with HIV/AIDS: a protocol of systematic review and meta-analysis

INTRODUCTION

Fatigue is a common symptom among people living with HIV (PLWH). It has a substantial adverse impact on functional status and the ability to conduct activities of daily living. Identifying effective strategies to prevent or reduce fatigue is significant to promote the quality of life of this vulnerable population. The purpose of this review is to synthesise the non-pharmacological evidence and assess the effects of interventions on reducing HIV-related fatigue among PLWH.

METHODS AND ANALYSIS

We will comprehensively search literature available up to 30 June 2020, in the following databases: PubMed, Embase, CINAHL, Cochrane Library, Web of Science and PsycINFO. The reference list of selected studies and relevant published reviews will also be screened to retrieve potential articles. Two reviewers will identify the eligible articles, extract data and identify the biases in the selected studies. Any disagreements will be referred to a third reviewer. We will qualitatively synthesise the evidence and pool data with meta-analysis according to the heterogeneity of different studies.

ETHICS AND DISSEMINATION

This systematic review will not raise any ethical issues since it is a secondary data collection and analysis. The results will inform effective strategies to reduce fatigue among PLWH. The final report will be published in a peer-reviewed journal and academic conferences.

PROSPERO REGISTRATION NUMBER

CRD42020153715.

Flammer syndrome in multiple sclerosis: diagnostics, prediction, and personalization of treatments

Background

Flammer syndrome (FS) occurs from well-described signs and symptoms. The syndrome itself is not a disease, but it may be a directive marker for advancing therapeutic approaches by predictive and preventive measures as well as for personalization of treatments. The syndrome is related to many diseases, but FS has been rarely studied in multiple sclerosis (MS). The study aimed to determine whether FS signs and symptoms occur more often in people with MS than in healthy controls, and in order to personalize the treatment, we investigated the possible effect of current therapies on FS signs and symptoms.

Methods

Two hundred twenty-two MS patients and 203 healthy controls answered the questionnaire consisting of 15 signs and symptoms of FS.

Results

MS patients had significantly more complaints in 9 items of FS signs and symptoms (cold hands or/and feet, the reduced feeling of thirst, dizziness, drug side effects, other headaches (tension-type, medication overuse), weight loss, feeling cold, long sleep-onset time, and skin blotches) compared to healthy controls. Six items (low blood pressure, tinnitus, increased odor sensitivity, low pain threshold, and perfectionism) were similar between the two groups. The treatment agents currently used did not have any effect on the signs and symptoms of FS.

Conclusion

This study showed that FS might be associated with MS. Injectable or oral agents are not related to the signs and symptoms of FS. Further studies are needed to validate this association.

Relevance of the article for predictive preventive and personalized medicine

FS is common among MS patients. Being aware of this incidence that might impair the life quality of MS patients is useful to predict the comorbidity and develop preventive strategies and applying personalized treatment options and procedures.

Beneficial Effects of the Calcium Channel Blocker CTK 01512-2 in a Mouse Model of Multiple Sclerosis

Voltage-gated calcium channels (VGCCs) play a critical role in neuroinflammatory diseases, such as multiple sclerosis (MS). CTK 01512-2 is a recombinant version of the peptide Phα1β derived from the spider Phoneutria nigriventer, which inhibits N-type VGCC/TRPA1-mediated calcium influx. We investigated the effects of this molecule in the mouse model of experimental autoimmune encephalomyelitis (EAE). The effects of CTK 01512-2 were compared to those displayed by ziconotide-a selective N-type VGCC blocker clinically used for chronic pain-and fingolimod-a drug employed for MS treatment. The intrathecal (i.t.) treatment with CTK 01512-2 displayed beneficial effects, by preventing nociception, body weight loss, splenomegaly, MS-like clinical and neurological scores, impaired motor coordination, and memory deficits, with an efficacy comparable to that observed for ziconotide and fingolimod. This molecule displayed a favorable profile on EAE-induced neuroinflammatory changes, including inflammatory infiltrate, demyelination, pro-inflammatory cytokine production, glial activation, and glucose metabolism in the brain and spinal cord. The recovery of spatial memory, besides a reduction of serum leptin levels, allied to central and peripheral elevation of the anti-inflammatory cytokine IL-10, was solely modulated by CTK 01512-2, dosed intrathecally. The intravenous (i.v.) administration of CTK 01512-2 also reduced the EAE-elicited MS-like symptoms, similarly to that seen in animals that received fingolimod orally. Ziconotide lacked any significant effect when dosed by i.v. route. Our results indicate that CTK 01512-2 greatly improved the neuroinflammatory responses in a mouse model of MS, with a higher efficacy when compared to ziconotide, pointing out this molecule as a promising adjuvant for MS management.