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Wang Y, Allsop MJ, Epstein JB, Howell D, Rapoport BL, Schofield P, Van Sebille Y, Thong MSY, Walraven I, Ryan Wolf J, van den Hurk CJG. Patient-reported symptom monitoring: using (big) data to improve supportive care at the macro-, meso-, and micro-levels. Support Care Cancer 2024; 32:182. [PMID: 38386101 DOI: 10.1007/s00520-024-08373-x] [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: 04/26/2023] [Accepted: 02/11/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE This paper aims to provide a comprehensive understanding of the need for continued development of symptom monitoring (SM) implementation, utilization, and data usage at the macro-, meso-, and micro-levels. METHODS Discussions from a patient-reported SM workshop at the MASCC/ISSO 2022 annual meeting were analyzed using a macro-meso-micro analytical framework of cancer care delivery. The workshop categories "initiation and implementation, barriers to adoption and utilization, and data usage" were integrated for each level. RESULTS At the macro-level, policy development could encourage data sharing and international collaboration, including the exchange of SM methods, supportive care models, and self-management modules. At the meso-level, institutions should adjust clinical workflow and service delivery and promote a thorough technical and clinical integration of SM. At the micro-level, SM should be individualized, with timely feedback for patients, and should foster trust and understanding of AI decision support tools amongst clinicians to improve supportive care. CONCLUSIONS The workshop reached a consensus among international experts on providing guidance on SM implementation, utilization, and (big) data usage pathways in cancer survivors across the cancer continuum and on macro-meso-micro levels.
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Affiliation(s)
- Yan Wang
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
- Mckinsey & Company, 1 PPG Pl # 2350, Pittsburgh, PA, 15222, USA
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, 6 Clarendon Way, Woodhouse, Leeds, LS2 9LH, UK
| | - Joel B Epstein
- City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
- Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Pavilion, 7th Floor, Los Angeles, CA, 90048, USA
| | - Doris Howell
- Princess Margaret Cancer Research Institute, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Bernardo L Rapoport
- The Medical Oncology Centre of Rosebank, 129 Oxford Road, Saxonwold, Johannesburg, 2196, South Africa
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Corner Doctor Savage Road and Bophelo Road, Pretoria, 0002, South Africa
| | - Penelope Schofield
- Department of Psychology, and Iverson Health Innovation Research Institute Swinburne University, John St, Hawthorn, VIC, 3122, Australia
- Health Services Research and Implementation Sciences, Peter MacCallum Cancer Centre, Melbourne, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia
| | - Ysabella Van Sebille
- University of South Australia, 61-68 North Terrace, Adelaide, SA, 5000, Australia
| | - Melissa S Y Thong
- Unit of Cancer Survivorship (C071), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Iris Walraven
- Department of Health Evidence, Radboud University Nijmegen Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Julie Ryan Wolf
- Department of Dermatology, Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY, 14642, USA
| | - Corina J G van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Rijnkade 5, 3511, LC, Utrecht, The Netherlands.
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Lopez CJ, Teggart K, Ahmed M, Borhani A, Kong J, Fazelzad R, Langelier DM, Campbell KL, Reiman T, Greenland J, Jones JM, Neil-Sztramko SE. Implementation of electronic prospective surveillance models in cancer care: a scoping review. Implement Sci 2023; 18:11. [PMID: 37101231 PMCID: PMC10134630 DOI: 10.1186/s13012-023-01265-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/19/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Electronic prospective surveillance models (ePSMs) for cancer rehabilitation include routine monitoring of the development of treatment toxicities and impairments via electronic patient-reported outcomes. Implementing ePSMs to address the knowledge-to-practice gap between the high incidence of impairments and low uptake of rehabilitation services is a top priority in cancer care. METHODS We conducted a scoping review to understand the state of the evidence concerning the implementation of ePSMs in oncology. Seven electronic databases were searched from inception to February 2021. All articles were screened and extracted by two independent reviewers. Data regarding the implementation strategies, outcomes, and determinants were extracted. The Expert Recommendations for Implementing Change taxonomy and the implementation outcomes taxonomy guided the synthesis of the implementation strategies and outcomes, respectively. The Consolidated Framework for Implementation Research guided the synthesis of determinants based on five domains (intervention characteristics, individual characteristics, inner setting, outer setting, and process). RESULTS Of the 5122 records identified, 46 interventions met inclusion criteria. The common implementation strategies employed were "conduct educational meetings," "distribute educational materials," "change record systems," and "intervene with patients to enhance uptake and adherence." Feasibility and acceptability were the prominent outcomes used to assess implementation. The complexity, relative advantage, design quality, and packaging were major implementation determinants at the intervention level. Knowledge was key at the individual level. At the inner setting level, major determinants were the implementation climate and readiness for implementation. At the outer setting level, meeting the needs of patients was the primary determinant. Engaging various stakeholders was key at the process level. CONCLUSIONS This review provides a comprehensive summary of what is known concerning the implementation of ePSMs. The results can inform future implementation and evaluation of ePSMs, including planning for key determinants, selecting implementation strategies, and considering outcomes alongside local contextual factors to guide the implementation process.
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Affiliation(s)
- Christian J Lopez
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Kylie Teggart
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mohammed Ahmed
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Anita Borhani
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Jeffrey Kong
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, Toronto, Canada
| | - David M Langelier
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Tony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, Canada
| | - Jonathan Greenland
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada
| | - Jennifer M Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sarah E Neil-Sztramko
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
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Kiderlen TR, Schnack A, de Wit M. Essential barriers and considerations for the implementation of electronic patient-reported outcome (ePRO) measures in oncological practice: contextualizing the results of a feasibility study with existing literature. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 31:1-18. [PMID: 36320803 PMCID: PMC9613453 DOI: 10.1007/s10389-022-01767-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/16/2022] [Indexed: 12/02/2022]
Abstract
Aim Monitoring electronic patient-reported outcomes (ePRO) can provide various benefits to cancer patients, such as enhanced quality of life, reduction of hospital admissions, and even prolonged survival. Furthermore, ePRO might offer significant benefits to patients under antineoplastic treatment in the context of the current COVID-19 pandemic. However, evidence on feasibility of ePRO in routine cancer care and barriers met in a real-life setting remains limited. Subject and methods We conducted a feasibility study among patients diagnosed with multiple myeloma currently under antineoplastic treatment. Patients filled out weekly ePRO questionnaires and were followed up for 6 months. In case of adverse events, an alert was sent to the clinic. We assessed uptake and adherence, as well as subjective perceptions of patients and clinic staff. A semi-structured literature review was conducted to contextualize results. Results Eleven patients were recruited and followed up for 6 months. Overall adherence was found at a high level and remained stable throughout the study period. Feedback from patients was positive; however, clinic staff expressed disappointment and frustration, criticising an increase of workload while not perceiving any benefit to the oncological treatment. Both findings were backed by evidence we found in literature. Conclusions Implementation of ePRO monitoring to routine cancer treatment seems to be feasible regarding patients' acceptance and compliance. However, integration of the tool into clinical workflow without increasing workload and deterring clinicians proves to be a major challenge. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01767-3.
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Affiliation(s)
- Til Ramón Kiderlen
- Department of Hematology, Oncology and Palliative Care, Vivantes Hospital Neukoelln, Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Alexandra Schnack
- Department of Hematology, Oncology and Palliative Care, Vivantes Hospital Neukoelln, Berlin, Germany
| | - Maike de Wit
- Department of Hematology, Oncology and Palliative Care, Vivantes Hospital Neukoelln, Berlin, Germany
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4
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van den Hurk CJG, Sonis ST, Epstein JB. A common infrastructure for real-world patient-reported symptoms: one size fits many. Support Care Cancer 2022; 30:7833-7834. [PMID: 35900594 DOI: 10.1007/s00520-022-07295-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Stephen T Sonis
- Divisions of Oral Medicine and Dentistry, Brigham and Women's Hospital and the Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joel B Epstein
- City of Hope Comprehensive Center, Duarte, CA, USA.,Cedars-Sinai Medical System, Los Angeles, CA, USA
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van den Hurk CJG, Mols F, Eicher M, Chan RJ, Becker A, Geleijnse G, Walraven I, Coolbrandt A, Lustberg M, Velikova G, Charalambous A, Koczwara B, Howell D, Basch EM, van de Poll-Franse LV. A Narrative Review on the Collection and Use of Electronic Patient-Reported Outcomes in Cancer Survivorship Care with Emphasis on Symptom Monitoring. Curr Oncol 2022; 29:4370-4385. [PMID: 35735458 PMCID: PMC9222072 DOI: 10.3390/curroncol29060349] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Electronic patient-reported outcome (ePRO) applications promise great added value for improving symptom management and health-related quality of life. The aim of this narrative review is to describe the collection and use of ePROs for cancer survivorship care, with an emphasis on ePRO-symptom monitoring. It offers many different perspectives from research settings, while current implementation in routine care is ongoing. ePRO collection optimizes survivorship care by providing insight into the patients' well-being and prioritizing their unmet needs during the whole trajectory from diagnosis to end-of-life. ePRO-symptom monitoring can contribute to timely health risk detection and subsequently allow earlier intervention. Detection is optimized by automatically generated alerts that vary from simple to complex and multilayered. Using ePRO-symptoms during in-hospital consultation enhances the patients' conversation with the health care provider before making informed decisions about treatments, other interventions, or self-management. ePRO(-symptoms) entail specific implementation issues and complementary ethics considerations. The latter is due to privacy concerns, digital divide, and scarcity of adequately representative data for particular groups of patients.
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Affiliation(s)
- Corina J. G. van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands; (F.M.); (G.G.); (L.V.v.d.P.-F.)
- Correspondence:
| | - Floortje Mols
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands; (F.M.); (G.G.); (L.V.v.d.P.-F.)
- CoRPS—Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Manuela Eicher
- Institute of Higher Education and Research in Health Care (IUFRS), Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, CH-1010 Lausanne, Switzerland;
- Department of Oncology, Lausanne University Hospital, CH-1011 Lausanne, Switzerland
| | - Raymond J. Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Annemarie Becker
- Amsterdam UMC, Department of Pulmonary Diseases, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Gijs Geleijnse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands; (F.M.); (G.G.); (L.V.v.d.P.-F.)
| | - Iris Walraven
- Radboudumc, Department for Health Evidence, 6525 GA Nijmegen, The Netherlands;
| | - Annemarie Coolbrandt
- Department of Oncology Nursing, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, 3000 Leuven, Belgium
| | - Maryam Lustberg
- Breast Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT 06520, USA;
- Breast Center at Smilow Cancer Hospital, New Haven, CT 06519, USA
| | - Galina Velikova
- Leeds Institute of Medical Research at St James’s, University of Leeds and Leeds Cancer Centre, St James’s University Hospital, Leeds LS9 7TF, UK;
| | - Andreas Charalambous
- Nursing Department, Cyprus University of Technology, Limassol 3036, Cyprus;
- Department of Nursing Science, University of Turku, 00074 CGI Turku, Finland
| | - Bogda Koczwara
- Flinders Medical Centre, Flinders University, Adelaide, SA 5042, Australia;
| | - Doris Howell
- Princess Margaret Cancer Research Institute, University of Toronto, Toronto, ON M5G 2M9, Canada;
| | - Ethan M. Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina Cancer Center, Chapel Hill, NC 27599, USA;
| | - Lonneke V. van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands; (F.M.); (G.G.); (L.V.v.d.P.-F.)
- CoRPS—Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
- Department of Psychosocial Research, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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6
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van Deursen L, Versluis A, van der Vaart R, Standaar L, Struijs J, Chavannes N, Aardoom JJ. eHealth Interventions for Dutch Cancer Care: Systematic Review Using the Triple Aim Lens. JMIR Cancer 2022; 8:e37093. [PMID: 35699991 PMCID: PMC9240931 DOI: 10.2196/37093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Globally, the burden of cancer on population health is growing. Recent trends such as increasing survival rates have resulted in a need to adapt cancer care to ensure a good care experience and manageable expenditures. eHealth is a promising way to increase the quality of cancer care and support patients and survivors. OBJECTIVE The aim of this systematic review was 2-fold. First, we aimed to provide an overview of eHealth interventions and their characteristics for Dutch patients with and survivors of cancer. Second, we aimed to provide an overview of the empirical evidence regarding the impact of eHealth interventions in cancer care on population health, quality of care, and per capita costs (the Triple Aim domains). METHODS The electronic databases Web of Science, PubMed, Cochrane, and Ovid PsycINFO were searched using 3 key search themes: eHealth interventions, cancer care, and the Netherlands. The identified interventions were classified according to predetermined criteria describing the intervention characteristics (eg, type, function, and target population). Their impact was subsequently examined using the Triple Aim framework. RESULTS A total of 38 interventions were identified. Most of these were web portals or web applications functioning to inform and self-manage, and target psychosocial factors or problems. Few interventions have been tailored to age, disease severity, or gender. The results of this study indicate that eHealth interventions could positively affect sleep quality, fatigue, and physical activity of patients with and survivors of cancer. Inconclusive results were found regarding daily functioning and quality of life, psychological complaints, and psychological adjustment to the disease. CONCLUSIONS eHealth can improve outcomes in the Triple Aim domains, particularly in the population health and quality of care domains. Cancer-related pain and common symptoms of active treatment were not targeted in the included interventions and should receive more attention. Further research is needed to fully understand the impact of eHealth interventions in cancer care on participation, accessibility, and costs. The latter can be examined in economic evaluations by comparing eHealth interventions with care as usual.
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Affiliation(s)
- Liza van Deursen
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Anke Versluis
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Rosalie van der Vaart
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Lucille Standaar
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Department of Quality and Organization of Care, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Jeroen Struijs
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Health Campus The Hague, Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, Netherlands
| | - Niels Chavannes
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Jiska J Aardoom
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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7
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Kosse LJ, Weits G, Vonkeman HE, Tas SW, Hoentjen F, Van Doorn MB, Spuls PI, D'Haens GR, Nurmohamed MT, van Puijenbroek EP, Van Den Bemt BJ, Jessurun NT. Patients' perspectives on a drug safety monitoring system for immune-mediated inflammatory diseases based on patient-reported outcomes. Expert Opin Drug Saf 2021; 20:1565-1572. [PMID: 34348543 DOI: 10.1080/14740338.2021.1963436] [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: 10/20/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) on adverse drug reactions (ADRs) are increasingly used in cohort event monitoring (CEM) to obtain a better understanding of patients' real-world experience with drugs. Despite the leading role for patients, little is known about their perspectives on CEM systems. RESEARCH DESIGN AND METHODS In a cross-sectional open survey following the rationale of the Technology Acceptance Model, we aimed to obtain insight in patients' perspectives on the perceived usefulness, ease of use and attitude toward using a PRO-based drug safety monitoring system for ADRs attributed to biologics. RESULTS Patients considered structural reporting of ADRs in web-based questionnaires as useful and not burdensome. It was preferred to link the questionnaire frequency to regular hospital consultations or the biologic administration schedule. Various respondents were interested in sharing questionnaires with their medical specialist (49.0%) or pharmacist (34.2%), and suggested to minimize the questionnaire frequency in case of an unaltered situation or absence of ADRs. CONCLUSIONS Patients' perspectives should be considered in the setup of PRO-based CEM studies, as this contributes to data quality and patient centeredness. Since incorporation of patients' perspectives in CEM studies is indispensable, a delicate balance should be found between user-friendliness and study aims.
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Affiliation(s)
- Leanne J Kosse
- Netherlands Pharmacovigilance Centre Lareb, 's-hertogenbosch, The Netherlands
| | - Gerda Weits
- Netherlands Pharmacovigilance Centre Lareb, 's-hertogenbosch, The Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Sander W Tas
- Department of Rheumatology & Clinical Immunology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Infection & Immunity Institute and Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology, Radboudumc, Nijmegen, The Netherlands
| | | | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael T Nurmohamed
- Department of Rheumatology, Reade and Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, The Netherlands
| | - Eugène P van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 's-hertogenbosch, The Netherlands.,University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology & Pharmacoeconomics, Groningen, The Netherlands
| | - Bart Jf Van Den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboudumc, Nijmegen, The Netherlands
| | - Naomi T Jessurun
- Netherlands Pharmacovigilance Centre Lareb, 's-hertogenbosch, The Netherlands
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8
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de Carvalho FMDA, Schneider JK, de Jesus CVF, de Andrade LN, Amaral RG, David JM, Krause LC, Severino P, Soares CMF, Caramão Bastos E, Padilha FF, Gomes SVF, Capasso R, Santini A, Souto EB, de Albuquerque-Júnior RLC. Brazilian Red Propolis: Extracts Production, Physicochemical Characterization, and Cytotoxicity Profile for Antitumor Activity. Biomolecules 2020; 10:biom10050726. [PMID: 32384801 PMCID: PMC7277404 DOI: 10.3390/biom10050726] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022] Open
Abstract
Brazilian red propolis has been proposed as a new source of compounds with cytotoxic activity. Red propolis is a resinous material of vegetal origin, synthesized from the bees of the Appis mellifera family, with recognized biological properties. To obtain actives of low polarity and high cytotoxic profile from red propolis, in this work, we proposed a new solvent accelerated extraction method. A complete 23 factorial design was carried out to evaluate the influence of the independent variables or factors (e.g., temperature, number of cycles, and extraction time) on the dependent variable or response (i.e., yield of production). The extracts were analyzed by gas chromatography coupled with mass spectrometry for the identification of chemical compounds. Gas chromatography analysis revealed the presence of hydrocarbons, alcohols, ketones, ethers, and terpenes, such as lupeol, lupenone, and lupeol acetate, in most of the obtained extracts. To evaluate the cytotoxicity profile of the obtained bioactives, the 3-(4,5-dimethyl-2-thiazole)-2,5-diphenyl-2-H-tetrazolium bromide colorimetric assay was performed in different tumor cell lines (HCT116 and PC3). The results show that the extract obtained from 70 °C and one cycle of extraction of 10 min exhibited the highest cytotoxic activity against the tested cell lines. The highest yield, however, did not indicate the highest cytotoxic activity, but the optimal extraction conditions were indeed dependent on the temperature (i.e., 70 °C).
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Affiliation(s)
- Felipe Mendes de Andrade de Carvalho
- Tiradentes University (UNIT), Av. Murilo Dantas, 300, Aracaju 49010-390, Brazil; (F.M.d.A.d.C.); (J.K.S.); (C.V.F.d.J.); (L.C.K.); (P.S.); (C.M.F.S.); (E.C.B.); (F.F.P.); (S.V.F.G.)
- Institute of Technology and Research (ITP), Av. Murilo Dantas, 300, Aracaju 49032-490, Brazil
| | - Jaderson Kleveston Schneider
- Tiradentes University (UNIT), Av. Murilo Dantas, 300, Aracaju 49010-390, Brazil; (F.M.d.A.d.C.); (J.K.S.); (C.V.F.d.J.); (L.C.K.); (P.S.); (C.M.F.S.); (E.C.B.); (F.F.P.); (S.V.F.G.)
- Institute of Technology and Research (ITP), Av. Murilo Dantas, 300, Aracaju 49032-490, Brazil
| | - Carla Viviane Freitas de Jesus
- Tiradentes University (UNIT), Av. Murilo Dantas, 300, Aracaju 49010-390, Brazil; (F.M.d.A.d.C.); (J.K.S.); (C.V.F.d.J.); (L.C.K.); (P.S.); (C.M.F.S.); (E.C.B.); (F.F.P.); (S.V.F.G.)
- Institute of Technology and Research (ITP), Av. Murilo Dantas, 300, Aracaju 49032-490, Brazil
| | - Luciana Nalone de Andrade
- Federal University of Sergipe (UFS), Avenida Marechal Rondon, São Cristovão 49100-000, Brazil; (L.N.d.A.); (R.G.A.)
| | - Ricardo Guimarães Amaral
- Federal University of Sergipe (UFS), Avenida Marechal Rondon, São Cristovão 49100-000, Brazil; (L.N.d.A.); (R.G.A.)
| | | | - Laíza Canielas Krause
- Tiradentes University (UNIT), Av. Murilo Dantas, 300, Aracaju 49010-390, Brazil; (F.M.d.A.d.C.); (J.K.S.); (C.V.F.d.J.); (L.C.K.); (P.S.); (C.M.F.S.); (E.C.B.); (F.F.P.); (S.V.F.G.)
- Institute of Technology and Research (ITP), Av. Murilo Dantas, 300, Aracaju 49032-490, Brazil
| | - Patrícia Severino
- Tiradentes University (UNIT), Av. Murilo Dantas, 300, Aracaju 49010-390, Brazil; (F.M.d.A.d.C.); (J.K.S.); (C.V.F.d.J.); (L.C.K.); (P.S.); (C.M.F.S.); (E.C.B.); (F.F.P.); (S.V.F.G.)
- Institute of Technology and Research (ITP), Av. Murilo Dantas, 300, Aracaju 49032-490, Brazil
- Tiradentes Institute, 150 Mt Vernon St, Dorchester, MA 02125, USA
| | - Cleide Mara Faria Soares
- Tiradentes University (UNIT), Av. Murilo Dantas, 300, Aracaju 49010-390, Brazil; (F.M.d.A.d.C.); (J.K.S.); (C.V.F.d.J.); (L.C.K.); (P.S.); (C.M.F.S.); (E.C.B.); (F.F.P.); (S.V.F.G.)
- Institute of Technology and Research (ITP), Av. Murilo Dantas, 300, Aracaju 49032-490, Brazil
| | - Elina Caramão Bastos
- Tiradentes University (UNIT), Av. Murilo Dantas, 300, Aracaju 49010-390, Brazil; (F.M.d.A.d.C.); (J.K.S.); (C.V.F.d.J.); (L.C.K.); (P.S.); (C.M.F.S.); (E.C.B.); (F.F.P.); (S.V.F.G.)
- Institute of Technology and Research (ITP), Av. Murilo Dantas, 300, Aracaju 49032-490, Brazil
| | - Francine Ferreira Padilha
- Tiradentes University (UNIT), Av. Murilo Dantas, 300, Aracaju 49010-390, Brazil; (F.M.d.A.d.C.); (J.K.S.); (C.V.F.d.J.); (L.C.K.); (P.S.); (C.M.F.S.); (E.C.B.); (F.F.P.); (S.V.F.G.)
- Institute of Technology and Research (ITP), Av. Murilo Dantas, 300, Aracaju 49032-490, Brazil
| | - Silvana Vieira Flores Gomes
- Tiradentes University (UNIT), Av. Murilo Dantas, 300, Aracaju 49010-390, Brazil; (F.M.d.A.d.C.); (J.K.S.); (C.V.F.d.J.); (L.C.K.); (P.S.); (C.M.F.S.); (E.C.B.); (F.F.P.); (S.V.F.G.)
- Institute of Technology and Research (ITP), Av. Murilo Dantas, 300, Aracaju 49032-490, Brazil
| | - Raffaele Capasso
- Department of Agricultural Sciences, University of Napoli Federico II, Via Università 100, 80055 Portici, Italy;
| | - Antonello Santini
- Department of Pharmacy, University of Napoli Federico II, Via D. Montesano 49, 80131 Napoli, Italy;
| | - Eliana Barbosa Souto
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
- CEB-Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- Correspondence: (E.B.S.); (R.L.C.d.A.-J.)
| | - Ricardo Luiz Cavalcanti de Albuquerque-Júnior
- Tiradentes University (UNIT), Av. Murilo Dantas, 300, Aracaju 49010-390, Brazil; (F.M.d.A.d.C.); (J.K.S.); (C.V.F.d.J.); (L.C.K.); (P.S.); (C.M.F.S.); (E.C.B.); (F.F.P.); (S.V.F.G.)
- Institute of Technology and Research (ITP), Av. Murilo Dantas, 300, Aracaju 49032-490, Brazil
- Correspondence: (E.B.S.); (R.L.C.d.A.-J.)
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