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Sulistio M, Gorelik A, Tee HJ, Wojnar R, Kissane D, Michael N. Methadone versus other opioids for refractory malignant bone pain: a pilot randomised controlled study. Support Care Cancer 2024; 32:495. [PMID: 38980427 PMCID: PMC11233296 DOI: 10.1007/s00520-024-08706-w] [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: 05/07/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Refractory cancer-induced bone pain (CIBP) affects a patient's functional capacity and quality of life, but there is limited evidence to guide opioid choice. We assessed the feasibility, tolerability and possible efficacy of methadone rotation (MR) compared to other opioid rotations (OOR) in this cohort. METHODS Adults with CIBP and worst pain intensity ≥ 4/10 and/or opioid toxicity graded ≥ 2 on the Common Terminology Criteria for Adverse Events were randomised 1:1 to methadone or another opioid rotation. Standardised assessment tools were used at pre-defined study time points up to 14 days. RESULTS Of 51 eligible participants, 38 (74.5%) consented, and 29 (76.3%, MR: 14, OOR: 15) completed the fourteen days follow-up post-opioid rotation. Both groups displayed significant reduction in average (MR: d = - 1.2, p = 0.003, OOR: d = - 0.8, p = 0.015) and worst pain (MR: d = - 0.9, p = 0.042, OOR: d = - 0.6, p = 0.048) and total pain interference score (MR: d = - 1.1, p = 0.042, OOR: d = - 0.7, p = 0.007). Oral morphine equivalent daily dose was reduced significantly in MR compared to the OOR group (d = - 0.8, p = 0.05). The incidence of opioid-related adverse events following MR was unchanged but lower in the OOR group (d = 0.9, 95% CI 0.1,1.7, p = 0.022). There were no within-group or between-group differences in satisfaction with analgesia at the end of the study. CONCLUSION This pilot study demonstrated that MR and OOR in patients with refractory CIBP are feasible, safe and acceptable to patients. Appropriately powered multi-centre randomised controlled studies are needed to confirm the efficacy of MR and OOR in this cohort. TRIAL REGISTRATION ACTRN12621000141842 registered 11 February 2021.
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Affiliation(s)
- Merlina Sulistio
- Cabrini Health, Melbourne, VIC, 3144, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- School of Medicine, University of Notre Dame Australia, Fremantle, Australia.
| | - Alexandra Gorelik
- Musculoskeletal Health and Wiser Healthcare Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Hoong Jiun Tee
- Cabrini Health, Melbourne, VIC, 3144, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Medicine, University of Notre Dame Australia, Fremantle, Australia
| | | | - David Kissane
- Cabrini Health, Melbourne, VIC, 3144, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Medicine, University of Notre Dame Australia, Fremantle, Australia
| | - Natasha Michael
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Medicine, University of Notre Dame Australia, Fremantle, Australia
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Rather AM, Rai S, Rattan V, Jolly SS, Malhotra S. Comparaison of Efficacy and Safety of Fentanyl Transdermal Patch with Oral Ketorolac for Pain Management in Dry Socket: A Randomized Clinical Trial. J Maxillofac Oral Surg 2024; 23:552-560. [PMID: 38911417 PMCID: PMC11190102 DOI: 10.1007/s12663-022-01713-6] [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: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this study was to compare the efficacy and safety of transdermal Fentanyl patch with oral Ketorolac for pain management in dry socket patients. Study design Sixty patients who were diagnosed with dry socket (VAS > 40 mm) were recruited in this prospective randomized controlled trial. Patients were divided into two groups. Group1 (n = 30) Transdermal Fentanyl patch (25mcg/hr) was given and in Group 2 (n = 30) Ketorolac 10 mg Oral tablet was prescribed for pain management. The primary endpoint was the mean pain scores within 72 h evaluated by visual analog scale (VAS). Secondary measures included the safety and tolerability, amount of rescue medication (analgesic and antiemetic) and effectiveness of treatment interventions by Brief Pain Inventory Questionnaire (BPI). Results The mean VAS pain scores were significantly less in group 1 (Fentanyl) as compared to group 2 (ketorolac) on all follow-up days. Significant difference was noted in the mean amount of rescue analgesic medication. It was 2.16 + 1.53 in group 1 and 8.50 + 3.98 in group 2. Side effects were seen in both the groups. Nausea (46%) and vomiting (43%) were reported in group 1 while headache (36.6%) and epigastric pain (53.3%) in group 2. Conclusions Thus, transdermal Fentanyl was better in pain control than Ketorolac with less need for rescue analgesic medication in dry socket.
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Affiliation(s)
- Abid Majeed Rather
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sachin Rai
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidya Rattan
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satnam Singh Jolly
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Samir Malhotra
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Austin PD, Lee W, Costa DSJ, Ritchie A, Lovell MR. Efficacy of aerobic and resistance exercises on cancer pain: A meta-analysis of randomised controlled trials. Heliyon 2024; 10:e29193. [PMID: 38623224 PMCID: PMC11016720 DOI: 10.1016/j.heliyon.2024.e29193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/19/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
Purpose To evaluate effects of aerobic and resistance exercises for cancer-related pain in adults with and surviving cancer. Secondary objectives were to a) evaluate the effect of exercise on fatigue, psychological function, physical function, b) assess fidelity to exercise. Design A systematic search of MEDLINE, EMBASE, AMED, CINAHL and Cochrane Central Register of Controlled Trials was conducted to identify randomised controlled trials (RCTs) comparing aerobic and/or resistance exercise to control groups. The primary endpoint were changes in cancer-related pain intensity from baseline to post intervention. Meta-regression analysis evaluated predictors for heterogeneity between study findings. Tolerability was defined as reporting of exercise-induced adverse events while fidelity evaluated by reported intervention dropout. Results Twenty-three RCTs including 1954 patients (age 58 ± 8.5 years; 78 % women); 1087 (56 %) and 867 (44 %) allocated to aerobic/resistance exercise therapy and control group, respectively. Exercise therapy was associated with small to moderate decreases in cancer-related pain compared to controls (SMD = 0.38, 95 % CI: 0.17, 0.58). Although there was significant heterogeneity between individual and pooled study effects (Q = 205.25, p < 0.0001), there was no publication bias. Meta-regression including supervision, age, duration and exercise type as moderators showed no significant differences in reported outcomes. Analysis of secondary outcomes revealed a moderate effect for improvements in physical function, fatigue and psychological symptoms. Conclusions Aerobic and resistance exercises are tolerable and effective adjunct therapies to reduce cancer-related pain while also improving physical function, fatigue and mood. Future RCTs of dose, frequency, compliance and exercise type in specific cancer settings are required.
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Affiliation(s)
- Philip D. Austin
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
| | - Wei Lee
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel SJ. Costa
- Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, Northern Sydney Local Health District, Sydney, NSW, Australia
- School of Psychology, University of Sydney, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Alison Ritchie
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
| | - Melanie R. Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
- Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
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4
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O'Regan A, Fish LJ, Makarushka C, Somers T, Fitzgerald Jones K, Merlin JS, Dinan M, Oeffinger K, Check D. Managing Chronic Pain in Cancer Survivorship: Communication Challenges and Opportunities as Described by Cancer Survivors. Am J Hosp Palliat Care 2024; 41:78-86. [PMID: 36927121 DOI: 10.1177/10499091231164634] [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: 03/18/2023] Open
Abstract
OBJECTIVES Many cancer survivors experience chronic pain after completing curative-intent treatment. Based on available data, chronic pain may be undertreated in this context; however, little is known about cancer survivors' experiences with clinical management of chronic pain. The purpose of this study was to better understand cancer survivors' pain management experiences after curative-intent treatment. METHODS We conducted 13 semi-structured interviews with a convenience sample of cancer survivors who had completed treatment for stage I-III breast, head/neck, lung or colorectal cancer. We used a thematic approach to qualitative data analysis. RESULTS Participants described that chronic pain often goes unrecognized by their providers, potentially due to limitations in how pain is assessed clinically and the tendency of both cancer survivors and providers to minimize or invalidate the pain experience. To improve communication, participants suggested that providers ask more open-ended questions about their pain, help them to establish functional goals, and provide patients with options for pain management. SIGNIFICANCE OF RESULTS This study demonstrates the importance of provider-initiated communication around pain management for cancer survivors to make them feel more supported in their care. Communication and shared decision-making interventions may improve cancer survivor-provider communication around chronic pain management, addressing an important gap in survivorship care.
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Affiliation(s)
- Amy O'Regan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Laura J Fish
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke School of Medicine Durham, NC, USA
| | - Christina Makarushka
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Tamara Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Katie Fitzgerald Jones
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michaela Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT, USA
| | - Kevin Oeffinger
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Devon Check
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
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Cohen SA, Veleber S, Siman J, Guthrie KA, McMillen K, Heit M, Wadhera S, Daniels J, Hansen K, Jacoby M, Taromina K, Chin S, Romeo M, Langley BO, Coveler AL, Hannan LM, King G, Purcell T, Safyan RA, Shankaran V, Zhen DB, Chiorean EG, Greenlee H. Use of acupuncture with acupressure in addition to standard-of-care cryotherapy to decrease chemotherapy-associated neuropathy in patients with gastrointestinal malignancies receiving oxaliplatin-based chemotherapy: Study protocol for a randomized, controlled pilot and feasibility study. Contemp Clin Trials 2023; 131:107273. [PMID: 37380021 PMCID: PMC10527487 DOI: 10.1016/j.cct.2023.107273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/30/2023] [Accepted: 06/25/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Oxaliplatin is a key chemotherapeutic agent in the treatment of local and metastatic gastrointestinal (GI) malignancies. Dose density and treatment adherence can be limited by chemotherapy-induced peripheral neuropathy (CIPN). Early research suggests CIPN incidence and severity may be mitigated by acupuncture, but rigorous data in GI oncology patients is limited. Here, we describe the protocol of a randomized, waitlist-controlled pilot study testing the use of preemptive of acupuncture plus acupressure to decrease CIPN and chemotherapy-related toxicities. METHODS Patients with a GI malignancy (n = 56) with planned 5-fluorouracil (5-FU) and oxaliplatin IV (FOLFOX, FOLFIRINOX) every 2 weeks are being recruited. Additional concurrent anti-neoplastic agents may be used. Enrolled patients are randomized 1:1 to a 3-month intervention of Arm A: acupuncture with acupressure and standard-of-care treatment, or Arm B: standard-of-care alone. In Arm A, on days 1 and 3 of each chemotherapy cycle a standardized acupuncture protocol is administered and patients are taught self-acupressure to perform daily between chemotherapy treatments. Patients in both arms are given standard-of-care oral and peripheral (hands/feet) ice chip cryotherapy during oxaliplatin administration. CIPN and other symptoms are assessed at baseline, 6 weeks, and 3 months from registration. The primary endpoint is CIPN severity at 3 months (EORTC-CIPN 20). Additional endpoints evaluate CIPN incidence (CTCAE, Neuropen, tuning fork); incidence of pain, fatigue, nausea, oral dysesthesia, and anxiety; and feasibility (recruitment, retention, adherence, acceptability). If warranted, trial results will inform the design of a multi-center trial to expand testing of the intervention to a larger patient cohort.
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Affiliation(s)
- Stacey A Cohen
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA.
| | - Susan Veleber
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, USA
| | - Jonathan Siman
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, USA
| | | | - Kerry McMillen
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA
| | - Madilyn Heit
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA
| | - Sonia Wadhera
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA
| | - Jonathan Daniels
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA
| | - Kjell Hansen
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA
| | - Madeline Jacoby
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA
| | - Katherine Taromina
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, USA
| | - Samantha Chin
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, USA
| | - Melissa Romeo
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, USA
| | - Blake O Langley
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, USA; Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA 98195, USA
| | - Andrew L Coveler
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA
| | - Lindsay M Hannan
- Division of Medical Oncology, University of Washington School of Medicine, USA
| | - Gentry King
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA
| | - Tom Purcell
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA
| | - Rachael A Safyan
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA
| | - Veena Shankaran
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA
| | - David B Zhen
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA
| | - E Gabriela Chiorean
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA
| | - Heather Greenlee
- Clinical Research Division, Fred Hutchinson Cancer Center, 825 Eastlake Ave E, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington School of Medicine, USA; Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, USA
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Hernández SH, Guía VGJ, Núñez JM, Ciuró AH, Otero AN, Mohedo ED, Valenza MC. Widespread distribution and altered pain processing in head and neck cancer survivors at long-term after treatment. Support Care Cancer 2023; 31:394. [PMID: 37314529 DOI: 10.1007/s00520-023-07846-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Radiotherapy (RT) treatment in head and neck cancer (HNC) patients may induce long-term sequels as pain, which nowadays is not fully understand. Therefore, there is a need of characterization of pain features in HNC to enhance after oncology treatment management. Head and neck cancer survivors develop chronic pain after radiotherapy treatment. The purpose of the current study is to evaluate the presence of pain, pain distribution, and pain processing by means of patient reported outcomes and quantitative sensory testing. METHODS Pain pressure threshold (PPT), temporal summation (TS), Brief Pain Inventory (BPI), Widespread Pain Index (WPI), The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and EuroQol5D5L were assessed in 20 head and neck cancer survivors (sHNC) and 20 health-related sex and age-matched controls. RESULTS The sHNC present lower PPT values in both the affected and non-affected side than did the healthy controls, especially in the widespread pain in the body, an altered TS in both affected and non-affected side and lower scores in quality of life and arm dysfunction. CONCLUSIONS Following radiotherapy treatment after 1 year, sHNC present widespread pain, hypersensitivity in the radiated area, altered pain processing, upper limb affection, and a QoL diminution. These data provide evidence that a peripheral and central sensitization is happening in sHNC. Future efforts should focus on preventing pain after oncologic treatment. The comprehension about pain and its features in sHNC enhance health professional understanding and allows to tailor an optimal patient-targeted pain treatment.
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Affiliation(s)
- Sofía Hernández Hernández
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Vanessa Gabriela Jerviz Guía
- Oncological Radiotherapy Service of the Hospital PTS, Clínico San Cecilio University Hospital, 180061, Granada, Spain
| | - Javier Martín Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Alejandro Heredia Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Alba Navas Otero
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Esther Díaz Mohedo
- Department of Physiotherapy, Faculty of Health Sciences, Ampliación de Campus de Teatinos, University of Malaga, 29071, Málaga, Spain
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain.
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Sanò MV, Martorana F, Lavenia G, Rossello R, Prestifilippo A, Sava S, Ricciardi GR, Vigneri P. Ribociclib efficacy in special populations and analysis of patient reported outcomes in the MONALEESA trials. Expert Rev Anticancer Ther 2022; 22:343-351. [PMID: 35303782 DOI: 10.1080/14737140.2022.2052277] [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: 11/12/2022]
Abstract
INTRODUCTION Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors abemaciclib, palbociclib and ribociclib radically modified the treatment of hormone receptor-positive/human epidermal growth factor 2-negative advanced breast cancer. Ribociclib efficacy was proved in the phase III MONALEESA-2, -3 and -7 trials. In the first-line setting, ribociclib plus endocrine therapy determined statistically significant improvements in progression-free (PFS) and overall survival (OS) in pre-menopausal (MONALEESA-7) and post-menopausal (MONALEESA-2) women. Likewise, ribociclib and fulvestrant induced a significant PFS and OS benefit in post-menopausal women previously treated with endocrine therapy (MONALEESA-3). Additionally, ribociclib did not affect patient health-related quality of life in all the MONALEESA trials. AREAS COVERED We reviewed the results of the available randomized phase III trials testing ribociclib and endocrine therapy in advanced breast cancer, focusing on different patient subgroups and then on health-related quality of life. EXPERT OPINION The benefit of ribociclib was consistent across patient subgroups and is maintained in populations with unfavorable features, such as those with endocrine resistance or visceral metastases. Furthermore, the addition of ribociclib to endocrine therapy delays quality of life deterioration and improves pain scores. These results represent a pivotal improvement for the treatment of advanced breast cancer patients receiving CDK4/6 inhibitors.
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Affiliation(s)
- Maria V Sanò
- Medical Oncology, Humanitas, Centro Catanese di Oncologia, Contrada Cubba, SP54, 11 - 95045, Misterbianco, Catania, Italy
| | - Federica Martorana
- Department of Clinical and Experimental Medicine, University of Catania, Piazza Università, 2 - 95131, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico "G. Rodolico - San Marco", Via Santa Sofia, 78 - 95123 Catania, Italy
| | - Giuseppe Lavenia
- Oncology Unit, Azienda Ospedaliera "Garibaldi-Nesima", Via Palermo, 636 - 95122 Catania, Italy
| | - Rosalba Rossello
- Oncology Unit; Ospedale San Vincenzo, Contrada Sirina - 98039 Taormina, Messina, Italy
| | - Angela Prestifilippo
- Department of Medical Oncology, Istituto Oncologico del Mediterraneo, Via Penninazzo, 7 - 95029 Viagrande, Catania, Italy
| | - Serena Sava
- Department of Medical Oncology, Istituto Oncologico del Mediterraneo, Via Penninazzo, 7 - 95029 Viagrande, Catania, Italy
| | | | - Paolo Vigneri
- Department of Clinical and Experimental Medicine, University of Catania, Piazza Università, 2 - 95131, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico "G. Rodolico - San Marco", Via Santa Sofia, 78 - 95123 Catania, Italy.,Oncology Unit, A.O.U. Policlinico "G. Rodolico - San Marco", Via Santa Sofia 78 - 95123 Catania, Italy
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Faravel K, Huteau ME, Jarlier M, de Forges H, Meignant L, Senesse P, Norton J, Jacot W, Stoebner A. Importance of Patient Education for At-home Yoga Practice in Women With Hormonal Therapy-induced Pain During Adjuvant Breast Cancer Treatment: A Feasibility Study. Integr Cancer Ther 2021; 20:15347354211063791. [PMID: 34939444 PMCID: PMC8725037 DOI: 10.1177/15347354211063791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Osteo-articular pain (OAP) is experienced by approximately 50% of women under
hormonal therapy (HT) for breast cancer (BC), which increases the risk for
therapy discontinuation. This study was aimed to assess benefits of yoga
practice combined with patient education (PE) for at-home practice by
evaluating feasibility among BC patients under HT and measuring OAP,
flexibility and satisfaction. Methods Feasibility was evaluated by patient adherence as accomplishment of at least
4 out of 6 supervised yoga-PE sessions along with 70% or more at-home yoga
sessions. Intervention (12 weeks) included two 6-weeks periods: P1
comprising one 90-minutes supervised yoga-PE session/week and 15-minutes
daily at-home yoga and P2, daily autonomous at-home yoga sessions.
Evaluations (at inclusion and by the end of each period) consisted in
assessment of OAP on Visual Analog Scale (VAS), forward flexibility (cm) and
patient satisfaction on Likert (0-10 points) scale. Results Between September 2018 and May 2019 we included 24 patients of median
53 years (range 36-72). Feasibility was validated by 83% successful
adherence rate. Pain was significantly reduced from median VAS of 6 [range
4-10] to 4 [range 0-7] at the end of both P1 and P2
(p < 0.01), albeit with no difference between P1 and P2.
Forward flexibility improved by a median gain of 8 cm (end of P2) and median
satisfaction score of 10/10 [range 8-10]. Conclusion Combined physiotherapy-yoga-PE intervention is a feasible strategy to
increase at-home yoga practice with potential benefit on pain, flexibility,
and satisfaction, thus prompting further evaluations in larger randomized
multicenter trials. ClinicalTrials.gov NCT04001751
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Affiliation(s)
- Kerstin Faravel
- Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
| | - Marie-Eve Huteau
- Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
| | - Marta Jarlier
- Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
| | - Hélène de Forges
- Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
| | - Laetitia Meignant
- Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
| | - Pierre Senesse
- Cancer Institute of Montpellier, University of Montpellier, Montpellier, France.,University of Montpellier, INSERM UA11, U1194, U1298, Montpellier, France
| | - Joanna Norton
- University of Montpellier, INSERM UA11, U1194, U1298, Montpellier, France
| | - William Jacot
- Cancer Institute of Montpellier, University of Montpellier, Montpellier, France.,University of Montpellier, INSERM UA11, U1194, U1298, Montpellier, France
| | - Anne Stoebner
- Cancer Institute of Montpellier, University of Montpellier, Montpellier, France.,University of Montpellier, INSERM UA11, U1194, U1298, Montpellier, France
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A Practical Approach to Assessment and Management of Patients at Risk for Non-medical Opioid Use: a Focus on the Patient with Cancer-Related Pain. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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