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Onishi H, Sato H, Uchida N, Yoshioka A, Sato I, Onizawa N, Ito H, Ishida M. Thiamine deficiency as a differential diagnosis for severe fatigue in terminally ill cancer patients. Palliat Support Care 2024:1-3. [PMID: 39360448 DOI: 10.1017/s1478951524001536] [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: 10/04/2024]
Abstract
OBJECTIVES Patients with advanced cancer present various symptoms as their disease progresses. Among these, fatigue is a frequent symptom in patients with advanced cancer and is associated with decreased quality of life (QOL). However, there are few reports regarding its association with thiamine deficiency (TD). METHODS We report a case in which we found TD in a patient with advanced lung cancer who presented with weight loss, significant fatigue, and appeared to have a worsening general condition, for whom symptoms were dramatically improved within a short period of time by intravenous administration of thiamine. RESULTS The patient was a 76-year-old woman who had been diagnosed with lung cancer and liver metastases 6 months earlier. Due to interstitial pneumonia, she was not a candidate for chemotherapy and so palliative care was started. At 8 months after initial diagnosis, the patient complained of fatigue during a medical examination, so a blood sample was taken. A week later, she visited the hospital with a cane. She felt extremely fatigued and was unable to stand, but results from the previous blood test revealed that a TD. The fatigue disappeared 15 minutes after intravenous administration of thiamine and she was able to return home without the cane. SIGNIFICANCE OF RESULTS Fatigue is a frequent symptom in advanced cancer patients, and TD may be the underlying cause. Inclusion of TD in the differential diagnosis may contribute to improving patient QOL.
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Affiliation(s)
- Hideki Onishi
- Departments of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroko Sato
- Department of Internal Medicine, Morigaoka Clinic, Kanagawa, Japan
| | - Nozomu Uchida
- Department of Palliative Medicine, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akira Yoshioka
- Department of Clinical Oncology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Izumi Sato
- Department of Clinical Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | | | - Hiroshi Ito
- Department of General Medicine, Ito Internal Medicine and Pediatric Clinic, Fukuoka, Japan
| | - Mayumi Ishida
- Departments of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
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Qazi SU, Hamid A, Ansari HUH, Khouri MG, Anker MS, Hall ME, Anker SD, Butler J, Khan MS. Trends in cancer and heart failure related mortality in adult US population: A CDC WONDER database analysis from 1999 to 2020. Am Heart J 2024; 278:170-180. [PMID: 39299631 DOI: 10.1016/j.ahj.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 08/17/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND With the advent of novel chemotherapy, survival of patients with cancer has improved. However, people with cancer have an increased risk of heart failure (HF). Conversely, HF-related mortality may undermine survival among people with cancer. We aim to analyze the trends of mortality in people with HF and cancer in the adult US population. METHODS We conducted an examination of death certificates sourced from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database, from the years 1999 to 2020. Mortality in adults with HF and cancer was assessed. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change were reported. RESULTS Between 1999 and 2020, 621,783 deaths occurred from HF in people with cancer. The AAMR declined from 16.4 in 1999 to 11.9 in 2017, after which an increase to 14.5 was observed in 2020. Men had consistently higher overall AAMR as compared to women (men = 18.1 vs women = 9.9). Similar AAMR was observed between non-Hispanic (NH) Blacks/African Americans (13.9) and NH Whites (13.3), with lower in American Indian/Alaska Native (9.6) and Hispanics (7.4). Asian/Pacific Islanders reported the lowest AAMR (5.7). The Midwestern region reported the highest AAMR (14.8). We observed the highest AAMR amongst the older population (61.4). CONCLUSION The mortality rates of people with HF and cancer are increasing in the adult U.S. POPULATION This underscores the need for increased screening, aggressive management, and subsequent surveillance of people at risk or with manifested HF in people with cancer.
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Affiliation(s)
- Shurjeel Uddin Qazi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Arsalan Hamid
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Michel G Khouri
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
| | - Markus S Anker
- Department of Cardiology CBF German Heart Center Charité, DZHK, BCRT, University Medicine Berlin FU and HU, Berlin, Germany
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitäts medizin Berlin, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Muhammad Shahzeb Khan
- Baylor Scott and White Research Institute, Dallas, Texas, USA; Division of Cardiology, Baylor Scott and White The Heart Hospital, Plano, TX, USA; Department of Medicine, Baylor College of Medicine, Temple, TX, USA.
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3
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Takahashi R, Nakazawa Y, Miyashita M, Morita T, Okumura Y, Kizawa Y, Kawagoe S, Yamamoto H, Takeuchi E, Yamazaki R, Ogawa A. Enhancing end-of-life care quality and achieving a good death for the elderly in Japan. Arch Gerontol Geriatr 2024; 124:105471. [PMID: 38728824 DOI: 10.1016/j.archger.2024.105471] [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: 02/27/2024] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND In the context of an aging populations, there is an escalating need for palliative care tailored to the needs of the elderly. This study aimed to assess differences in symptoms and good death among the elderly, along with the structures and processes involved in end-of life care, and to explore the impact of age on achieving a good death. METHODS We conducted a questionnaire survey for bereaved family members of patients with cancer, heart disease, stroke, pneumonia, and kidney failure in 2019 and 2020. The study population was categorized into the following age groups: ≤64, 65-74, 75-84, and ≥85. The outcomes included symptom intensity, achievement of a good death, and receipt of quality care. RESULTS In total, 62,576 bereaved family members agreed to participate in the survey (response rate; 54.0 %). The weighted percentages of 'severe' and 'very severe' symptoms decreased with age. These trends were observed across age groups, even among the elderly. The strongest effect of age on achieving a good death was found for 'feeling that life is complete' with reference to those aged ≤64 years: 65-74 years (odds ratio [OR]; 2.09, 95 % CI; 1.94 to 2.25), 75-84 years (OR; 4.86, 95 % CI; 4.52 to 5.22) and ≥85 years (OR; 12.8, 95 % CI; 11.9 to 13.8). CONCLUSION Age-specific differences were observed in quality of death, quality of care, and symptom intensity. It is important to provide individualized consideration for each age group rather than categorizing them broadly as the elderly when caring for them.
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Affiliation(s)
- Richi Takahashi
- Division of Quality Assurance Programs, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan; Division of Policy Evaluation, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Yoko Nakazawa
- Division of Quality Assurance Programs, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan; Division of Policy Evaluation, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Hamamatsu, Shizuoka, 433-8558, Japan; Research Association for Community Health, 3-24-2 Somejidai, Hamakita-ku, Hamamatsu, 434-0046, Japan
| | - Yasuyuki Okumura
- Initiative for Clinical Epidemiological Research, 1-2-5 Nakamachi, Machida,Tokyo, 194-0021, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shohei Kawagoe
- Aozora Clinic, 2-35 Midorigaoka, Matsudo, 271-0074, Japan
| | - Hiroshi Yamamoto
- Department of Respiratory Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Emi Takeuchi
- Division of Quality Assurance Programs, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Risa Yamazaki
- Department of Medical Psychology, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan
| | - Asao Ogawa
- Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577 Japan
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Fink M, Müller S, Warnecke E, Hense J, Schuler M, Teufel M, Comino MRS, Tewes M. Relevance of Patient-Reported Outcome Measures in Patients with Cancer: Detection of Underrated Psychological Distress of Palliative Care Patients in an Outpatient Setting. Palliat Med Rep 2024; 5:194-200. [PMID: 39050775 PMCID: PMC11265614 DOI: 10.1089/pmr.2023.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 07/27/2024] Open
Abstract
Background The overall level of physical and psychological symptom burden of advanced cancer patients (ACP) in an outpatient setting is notoriously difficult to assess. Therefore, more efficient and objective assessment is needed to accomplish this important task. Objectives The aim of this study was to compare the physical and psychological symptom burden rated by palliative care nurse (PCN) versus patient's self-rating. Design This retrospective German cohort study analyzed symptom burden using an electronic patient-reported outcome measure (ePROM). After referral to an outpatient specialized palliative care team, a PCN assessed the patient's symptoms both up to three months before initial presentation (IP) and at IP.Group differences were identified using analyses of variance (ANOVA). Further descriptive analysis of patient characteristics was used. Subjects The study enrolled 164 ACP who were referred to a specialized palliative care (SPC) team. Mean age was 62 (± 12.6) years. Gastrointestinal (n = 46; 28.0%), lung (n = 32; 19.5%), and breast cancer (n = 34; 20.7%) were the most common entities. Results Most frequent reasons for referral were pain (n = 55; 33.5%) and social care problems (n = 36; 22.0%). Patients reported significantly higher grades on depression (n = 144; Z = -2.8, p = 0.005), anxiety (n = 144; Z = -2.376, p = 0.018), and worsened general condition (n = 139; Z = -7.005, p < 0.001). Conclusion ACP in an outpatient setting were more frequently referred to SPC for pain management and assistance with social problems with regard to the cancer and its limitations. Psychological distress was underrated by the PCN in comparison with patient self-reporting through ePROM. This underlines the importance of self-reported outcome measurement.
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Affiliation(s)
- Madeleine Fink
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Psycho-Oncology, West German Cancer Center, National Center for Tumor Diseases (NCT), Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Sandy Müller
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Eva Warnecke
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jörg Hense
- Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Psycho-Oncology, West German Cancer Center, National Center for Tumor Diseases (NCT), Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Maria Rosa Salvador Comino
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Mitra Tewes
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Miyazaki K, Ikenaga M, Sato T, Ueshima K, Nawata S, Horimatsu T, Komori E, Kirishima T, Kawabata K, Kawamura T, Kasai H, Suzukamo Y, Matsuzaki K, Kuwabara Y, Nakayama T. A Randomized Controlled Trial of Betamethasone on Fatigue in Patients With Advanced Cancer. J Pain Symptom Manage 2024; 67:393-401.e1. [PMID: 38331232 DOI: 10.1016/j.jpainsymman.2024.01.037] [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: 07/15/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
CONTEXT Fatigue is one of the most uncomfortable physical symptoms seen in patients with advanced cancer. Previous studies have reported on the efficacy of corticosteroids from Western countries. OBJECTIVES To assess the effectiveness of 4mg betamethasone improving fatigue among Japanese patients with advanced cancer. METHODS A randomized, double-blind, placebo-controlled trial enrolled eligible patients with advanced cancer expected to survive 1-2 months, with an Eastern Cooperative Oncology Group Performance Status of 2-3, and experiencing fatigue according to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-15-palliative criteria. Participants received twice-daily oral administration of 2 mg betamethasone (4 mg/d) or placebo for seven days, with fatigue assessed using EORTC QLQ-C15-PAL subscale and numerical rating scale (NRS) score (at baseline and day seven). The trial was registered under the University Hospital Medical Information Network (UMIN)000011913. RESULTS Among the 267 screened patients, 81 were eligible, of which 70 were evaluable (betamethasone, 33; placebo, 37). The mean difference in the EORTC-QLQ-C15-PAL fatigue subscale was -8.2 (95% CIs: -22.3, 0.0; P = 0.178) and in a NRS for fatigue was -1.2 (95% CIs: -2.5, -0.01; P = 0.048), respectively. Emotional function, appetite loss, and global-health were slightly better in the betamethasone group than in the placebo group. CONCLUSION The impact of betamethasone 4 mg/d on alleviating fatigue in patients with advanced cancer in the last weeks of life did not reach statistical significance in the EORTC-QLQ-C15-PAL as the primary endpoint, however, it was significant in the NRS, the secondary endpoint.
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Affiliation(s)
- Kikuko Miyazaki
- Department of Health Informatics (K.M., T.N.), Kyoto University School of Public Health, Kyoto, Japan.
| | - Masayuki Ikenaga
- Department of Palliative Medicine (M.I.), Yodogawa Christian Hospital, Higashiosaka, Japan
| | - Tosiya Sato
- Department of Biostatistics (T.S.), Kyoto University School of Public Health, Kyoto, Japan
| | - Kenji Ueshima
- Institute for Advancement of Clinical and Translational Science (K.U., T.H., H.K., Y.K.), Kyoto University Hospital, Kyoto, Japan
| | - Shuichi Nawata
- Showa University School of Pharmacy (S.N.), Yokohama, Japan
| | - Takahiro Horimatsu
- Institute for Advancement of Clinical and Translational Science (K.U., T.H., H.K., Y.K.), Kyoto University Hospital, Kyoto, Japan
| | | | | | - Kunihiro Kawabata
- Palliative Care Center (K.K.), Tokai Central Hospital, Kagamihara, Japan
| | | | - Hiroi Kasai
- Institute for Advancement of Clinical and Translational Science (K.U., T.H., H.K., Y.K.), Kyoto University Hospital, Kyoto, Japan
| | - Yoshimi Suzukamo
- Department of Physical Medicine and Rehabilitation (Y.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Matsuzaki
- Department Public Health (K.M.), School of Medicine, Kitasato University, Sagamihara, Japan
| | - Yoshihiro Kuwabara
- Institute for Advancement of Clinical and Translational Science (K.U., T.H., H.K., Y.K.), Kyoto University Hospital, Kyoto, Japan; Cancer Control Center (Y.K.), Osaka International Cancer Institute, Osaka, Japan
| | - Takeo Nakayama
- Department of Health Informatics (K.M., T.N.), Kyoto University School of Public Health, Kyoto, Japan
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Borner T, De Jonghe BC, Hayes MR. The antiemetic actions of GIP receptor agonism. Am J Physiol Endocrinol Metab 2024; 326:E528-E536. [PMID: 38477667 PMCID: PMC11194054 DOI: 10.1152/ajpendo.00330.2023] [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: 10/04/2023] [Revised: 02/08/2024] [Accepted: 03/10/2024] [Indexed: 03/14/2024]
Abstract
Nausea and vomiting are primitive aspects of mammalian physiology and behavior that ensure survival. Unfortunately, both are ubiquitously present side effects of drug treatments for many chronic diseases with negative consequences on pharmacotherapy tolerance, quality of life, and prognosis. One of the most critical clinical examples is the profound emesis and nausea that occur in patients undergoing chemotherapy, which continue to be among the most distressing side effects, even with the use of modern antiemetic medications. Similarly, antiobesity/diabetes medications that target the glucagon-like peptide-1 system, despite their remarkable metabolic success, also cause nausea and vomiting in a significant number of patients. These side effects hinder the ability to administer higher dosages for optimal glycemic and weight management and represent the major reasons for treatment discontinuation. Our inability to effectively control these side effects highlights the need to anatomically, molecularly, and functionally characterize novel neural substrates that drive and inhibit nausea and emesis. Here, we discuss clinical and preclinical evidence that highlights the glucose-dependent insulinotropic peptide receptor system as a novel therapeutic central target for the management of nausea and emesis.
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Affiliation(s)
- Tito Borner
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, California, United States
| | - Bart C De Jonghe
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Matthew R Hayes
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Monsen RE, Lerdal A, Nordgarden H, Gay CL, Herlofson BB. A comparison of the prevalence of dry mouth and other symptoms using two different versions of the Edmonton Symptom Assessment System on an inpatient palliative care unit. BMC Palliat Care 2024; 23:75. [PMID: 38493155 PMCID: PMC10943902 DOI: 10.1186/s12904-024-01405-7] [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: 06/20/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Symptom assessment is key to effective symptom management and palliative care for patients with advanced cancer. Symptom prevalence and severity estimates vary widely, possibly dependent on the assessment tool used. Are symptoms specifically asked about or must the patients add them as additional symptoms? This study compared the prevalence and severity of patient-reported symptoms in two different versions of a multi-symptom assessment tool. In one version, three symptoms dry mouth, constipation, sleep problems were among those systematically assessed, while in the other, these symptoms had to be added as an "Other problem". METHODS This retrospective cross-sectional study included adult patients with advanced cancer at an inpatient palliative care unit. Data were collected from two versions of the Edmonton Symptom Assessment System (ESAS): modified (ESAS-m) listed 11 symptoms and revised (ESAS-r) listed 9 and allowed patients to add one "Other problem". Seven similar symptoms were listed in both versions. RESULTS In 2013, 184 patients completed ESAS-m, and in 2017, 156 completed ESAS-r. Prevalence and severity of symptoms listed in both versions did not differ. In ESAS-m, 83% reported dry mouth, 73% constipation, and 71% sleep problems, but on ESAS-r, these symptoms were reported by only 3%, 15% and < 1%, respectively. Although ESAS-r severity scores for these three symptoms were higher than on ESAS-m, differences did not reach statistical significance. CONCLUSION We identified significant differences in patient symptom reporting based on whether symptoms like dry mouth, obstipation and sleep problems were specifically assessed or had to be added by patients as an "Other problem".
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Affiliation(s)
- Ragnhild Elisabeth Monsen
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, Oslo, 0317, Norway.
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway.
| | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, Oslo, 0317, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Hilde Nordgarden
- National Resource Centre for Oral Health in Rare Disorders, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Caryl L Gay
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, USA
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Unit of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology - Head and Neck Surgery Division for Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
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8
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Romanovska V, Block A, Paul SM, Cooper BA, Hammer MJ, Conley YP, Levine JD, Kober KM, Miaskowski C. Exploration of the Relationships Between Stress and Distinct Pain and Sleep Disturbance Profiles in Patients Undergoing Chemotherapy. Cancer Nurs 2024; 47:E108-E122. [PMID: 36584234 PMCID: PMC10300234 DOI: 10.1097/ncc.0000000000001185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Unrelieved pain and sleep disturbance are common symptoms in oncology patients. Increased stress may be an underlying cause for both symptoms. OBJECTIVES The purposes of this study were to identify subgroups of outpatients with distinct pain and sleep disturbance profiles and to evaluate differences among these subgroups in demographic and clinical characteristics. Differences in global stress, cancer-specific stress, and cumulative life stress, as well as resilience and coping, were evaluated. METHODS Patients (N = 1343) completed self-report questionnaires for demographic and clinical characteristics and stress, resilience, and coping. Latent profile analysis was used to identify subgroups of patients with distinct pain and sleep disturbance profiles. Differences among the subgroups were determined using parametric and nonparametric tests. RESULTS Three distinct profiles were identified (ie, No Pain + Moderate Sleep Disturbance (SD) (27.6%), Moderate Pain + Moderate SD (38.6%), Severe Pain + High SD (33.8%)). Compared with the other 2 classes, Severe Pain + High SD class was younger, had fewer years of education, was more likely to be female, more likely to live alone, less likely to be employed, and had a higher level of comorbidity. This class had the highest stress scores and was more likely to report higher rates of adverse childhood experiences. CONCLUSION Over 70% of our sample reported clinically meaningful levels of both symptoms, and 33.8% reported relatively high rates of adverse childhood experiences. IMPLICATION FOR PRACTICE Clinicians need to perform routine assessments, particularly of adverse childhood experiences, and initiate appropriate referrals.
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Affiliation(s)
- Vita Romanovska
- Author Affiliations: School of Nursing (Mss Romanovska and Block, Drs Paul, Cooper, Kober, and Miaskowski) and School of Medicine (Drs Levine and Miaskowski), University of California, San Francisco; Dana Farber Cancer Institute (Dr Hammer), Boston, Massachusetts; and School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania
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Wang L, Wang X, Chen J, Liu Y, Wang G, Chen L, Ni W, Jia Y, Dai C, Shao W, Liu B. Low-intensity exercise training improves systolic function of heart during metastatic melanoma-induced cachexia in mice. Heliyon 2024; 10:e25562. [PMID: 38370171 PMCID: PMC10874746 DOI: 10.1016/j.heliyon.2024.e25562] [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: 08/06/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024] Open
Abstract
Cardiac dysfunction frequently emerges in the initial stages of cancer cachexia, posing a significant complication of the disease. Physical fitness is commonly recommended in these early stages of cancer cachexia due to its beneficial impacts on various aspects of the condition, including cardiac dysfunction. However, the direct functional impacts of exercise on the heart during cancer cachexia largely remain unexplored. In this study, we induced cancer cachexia in mice using a metastatic B16F10 melanoma model. Concurrently, these mice underwent a low-intensity exercise regimen to investigate its potential role in cardiac function during cachexia. Our findings indicate that exercise training can help prevent metastatic melanoma-induced muscle loss without significant alterations to body and fat weight. Moreover, exercise improved the melanoma-induced decline in left ventricular ejection fraction and fractional shortening, while also mitigating the increase in high-sensitive cardiac troponin T levels caused by metastatic melanoma in mice. Transcriptome analysis revealed that exercise significantly reversed the transcriptional alterations in the heart induced by melanoma, which were primarily enriched in pathways related to heart contraction. These results suggest that exercise can improve systolic heart function and directly influence the transcriptome of the heart during metastatic melanoma-induced cachexia.
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Affiliation(s)
- Lin Wang
- Xiamen Cardiovascular Hospital, School of Medicine, Xiamen University, Jinshan Road 2999, Xiamen, 361015, China
| | - Xuchao Wang
- Xiamen Cardiovascular Hospital, School of Medicine, Xiamen University, Jinshan Road 2999, Xiamen, 361015, China
| | - Jingyu Chen
- Xiamen Cardiovascular Hospital, School of Medicine, Xiamen University, Jinshan Road 2999, Xiamen, 361015, China
| | - Yang Liu
- Xiamen Cardiovascular Hospital, School of Medicine, Xiamen University, Jinshan Road 2999, Xiamen, 361015, China
- Liaoning University of Traditional Chinese Medicine, Chongshan East Road 79, Shenyang 110032, China
| | - Gang Wang
- Xiamen Cardiovascular Hospital, School of Medicine, Xiamen University, Jinshan Road 2999, Xiamen, 361015, China
| | - Linjian Chen
- Xiamen Cardiovascular Hospital, School of Medicine, Xiamen University, Jinshan Road 2999, Xiamen, 361015, China
| | - Wei Ni
- Xiamen Cardiovascular Hospital, School of Medicine, Xiamen University, Jinshan Road 2999, Xiamen, 361015, China
| | - Yijia Jia
- Zhoukou Central Hospital, Renmin Road 26, Zhoukou, 466000, China
| | - Cuilian Dai
- Xiamen Cardiovascular Hospital, School of Medicine, Xiamen University, Jinshan Road 2999, Xiamen, 361015, China
| | - Wei Shao
- Xiamen Cardiovascular Hospital, School of Medicine, Xiamen University, Jinshan Road 2999, Xiamen, 361015, China
| | - Binbin Liu
- Xiamen Cardiovascular Hospital, School of Medicine, Xiamen University, Jinshan Road 2999, Xiamen, 361015, China
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Osaghae I, Talluri R, Chido‐Amajuoyi OG, Tanco K, Shah DP, Pande M, Shete S. Awareness and interest in cannabis use for cancer management among cancer survivors. Cancer Med 2024; 13:e6902. [PMID: 38180296 PMCID: PMC10807618 DOI: 10.1002/cam4.6902] [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: 09/09/2023] [Revised: 11/16/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND We examined the awareness, interest, and information sources relating to cannabis use for cancer management (including management of cancer symptoms and treatment-related side effects) and determined factors associated with cancer survivors' awareness and interest in learning about cannabis use for cancer management. METHODS This was a cross-sectional study of adult cancer survivors (N = 1886) receiving treatment at a comprehensive cancer center. Weighted prevalence and multivariable logistic regression analyses were conducted. RESULTS Among cancer survivors, 88% were aware and 60% were interested in learning about cannabis use for cancer management. Common sources of information to learn about cannabis use for cancer management were cancer doctors/nurses (82%), other patients with cancer (27%), websites/blogs (26%), marijuana stores (20%), and family/friends (18%). The odds of being aware of cannabis use for cancer management was lower among male compared to female survivors (adjusted odds ratio [AOR]: 0.61; 95% confidence interval [CI]: 0.41-0.90), non-Hispanic Blacks compared to non-Hispanic Whites (AOR: 0.36; 95% CI: 0.21-0.62), and survivors who do not support the legalization of cannabis for medical use compared to those who do (AOR: 0.10; 95% CI: 0.04-0.23). On the other hand, the odds of being interested in cannabis use for cancer management was higher among non-Hispanic Blacks compared to non-Hispanic Whites (AOR: 1.65; 95% CI: 1.04-2.62), and among cancer survivors actively undergoing cancer treatment compared to patients on non-active treatment (AOR: 2.25; 95% CI: 1.74-2.91). CONCLUSION Awareness of cannabis use for cancer management is high within the cancer survivor population. Results indicated health care providers are leading information source and should receive continued medical education on cannabis-specific guidelines. Similarly, tailored educational interventions are needed to guide survivors on the benefits and risks of cannabis use for cancer management.
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Affiliation(s)
- Ikponmwosa Osaghae
- Department of EpidemiologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Division of Cancer Prevention and Population SciencesThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Rajesh Talluri
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Data ScienceUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | | | - Kimberson Tanco
- Department of Palliative, Rehabilitation and Integrative MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Dimpy P. Shah
- Mays Cancer Center, UT Health San Antonio MD Anderson Cancer CenterSan AntonioTexasUSA
| | - Mala Pande
- Department of Gastroenterology, Hepatology and NutritionThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Sanjay Shete
- Department of EpidemiologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Division of Cancer Prevention and Population SciencesThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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11
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Osaghae I, Chido-Amajuoyi OG, Khalifa BAA, Talluri R, Shete S. Cannabis Use among Cancer Survivors: Use Pattern, Product Type, and Timing of Use. Cancers (Basel) 2023; 15:5822. [PMID: 38136367 PMCID: PMC10741826 DOI: 10.3390/cancers15245822] [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: 11/22/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Despite growing interest in the use of cannabis for the treatment of cancer-related symptoms, there are limited studies that have assessed the use pattern, type, and mode of delivery of cannabis products used by cancer survivors. This study describes the current state of the use pattern, product type, and mode of delivery of cannabis used by cancer survivors. This was a cross-sectional study of cancer survivors from 41 U.S. states who received treatment at the largest NCI-designated comprehensive cancer center. The weighted prevalence of the use patterns, product types, and modes of delivery of cannabis used by cancer survivors was estimated. A total of 1886 cancer survivors were included in the study, with 915 (48% [95% CI: 45-51]) reporting ever using cannabis. Of survivors who had ever used cannabis, 36% (95% CI: 33-40) were current users. Among survivors who reported cannabis use after diagnosis, 40% used cannabis during and after cancer treatment, 35% used cannabis during treatment, and 25% used cannabis after completing their cancer treatment. Additionally, 48% of survivors reported an increase in cannabis use since cancer diagnosis. The commonest types of cannabis products used by cancer survivors were dry leaf cannabis (71%), cannabidiol (CBD) oil (46%), and cannabis candy (40%). Moreover, cancer survivors frequently used baked goods (32%), creams and gels (21%), and tinctures (18%). Furthermore, among ever users, the predominant mode of use was cannabis inhalation/smoking (69%) compared to eating/drinking (59%). More so, the common mode of inhalation/smoking of cannabis products were rolled cannabis cigarettes (79%), pipes (36%), water pipes (34%), vaporizers or vapes (14%), and e-cigarette devices (14%). A substantial number of cancer survivors use cannabis during cancer treatment, with increased use following cancer diagnosis. The forms and modes of delivery of cannabis varied among survivors, with most survivors inhaling or smoking cannabis. There is a need to educate healthcare providers (HCPs) and survivors on current evidence of cannabis use and strengthen cannabis regulatory frameworks to optimize benefits and minimize adverse events from cannabis use during cancer treatment.
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Affiliation(s)
- Ikponmwosa Osaghae
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Banda A. A. Khalifa
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Rajesh Talluri
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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12
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Davies A, Cleary N, Hannon M, Webber K. Taste disturbance in patients with advanced cancer: who gets it? Support Care Cancer 2023; 32:17. [PMID: 38091093 DOI: 10.1007/s00520-023-08244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Andrew Davies
- Trinity College Dublin / University College Dublin / Our Ladies Hospice and Care Services, Dublin, Ireland.
- Academic Department of Palliative Medicine, Education & Research Centre, Our Lady's Hospice Dublin, Harold's Cross, Dublin, D6W RY72, Ireland.
| | - Niamh Cleary
- Academic Department of Palliative Medicine, Education & Research Centre, Our Lady's Hospice Dublin, Harold's Cross, Dublin, D6W RY72, Ireland
- Trinity College Dublin / Our Ladies Hospice and Care Services, Dublin, Ireland
| | - Marie Hannon
- Academic Department of Palliative Medicine, Education & Research Centre, Our Lady's Hospice Dublin, Harold's Cross, Dublin, D6W RY72, Ireland
- University College Dublin / Our Ladies Hospice and Care Services, Dublin, Ireland
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13
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van der Stap L, de Heij AH, van der Heide A, Reyners AK, van der Linden YM. Clinical decision support system to optimise symptom management in palliative medicine: focus group study. BMJ Support Palliat Care 2023; 13:e397-e407. [PMID: 34272271 DOI: 10.1136/bmjspcare-2021-002940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/27/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Suboptimal symptom control in patients with life-limiting illnesses is a major issue. A clinical decision support system (CDSS) that combines a patient-reported symptom assessment scale (SAS) and guideline-based individualised recommendations has the potential to improve symptom management. However, lacking end-user acceptance often prevents CDSS use in daily practice.We aimed to evaluate the acceptability and feasibility of a palliative care CDSS according to its targeted end-users. METHODS Six focus groups with different groups of stakeholders were conducted: (1) patient representatives; (2) community nurses; (3) hospital nurses; (4) general practitioners; (5) hospital physicians and (6) palliative care specialists. Audiotapes were transcribed verbatim and thematically analysed. RESULTS Fifty-one stakeholders (6-12 per focus group) participated. Six themes were discussed: effect, validity, continuity, practical usability, implementation and additional features. All participants expected a CDSS to improve symptom management, for example, by reminding clinicians of blind spots and prompting patient participation. They feared interference with professional autonomy of physicians, doubted the validity of using a patient-reported SAS as CDSS input and thought lacking care continuity would complicate CDSS use. Clinicians needed clear criteria for when to use the CDSS (eg, life-limiting illness, timing in illness trajectory). Participants preferred a patient-coordinated system but were simultaneously concerned patients may be unwilling or unable to fill out an SAS. CONCLUSIONS A palliative care CDSS was considered useful for improving symptom management. To develop a feasible system, barriers for successful implementation must be addressed including concerns about using a patient-reported SAS, lacking care continuity and unclear indications for use.
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Affiliation(s)
- Lotte van der Stap
- Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert H de Heij
- Center of Expertise for Palliative Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anna Kl Reyners
- Center of Expertise for Palliative Care/Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvette M van der Linden
- Center of Expertise in Palliative Care/Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
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14
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Parikh RB, Schriver E, Ferrell WJ, Wakim J, Williamson J, Khan N, Kopinsky M, Balachandran M, Gabriel PE, Schuchter LM, Patel MS, Shulman LN, Manz CR. Remote Patient-Reported Outcomes and Activity Monitoring to Improve Patient-Clinician Communication Regarding Symptoms and Functional Status: A Randomized Controlled Trial. JCO Oncol Pract 2023; 19:1143-1151. [PMID: 37816198 PMCID: PMC10732505 DOI: 10.1200/op.23.00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/08/2023] [Accepted: 08/29/2023] [Indexed: 10/12/2023] Open
Abstract
PURPOSE Routine collection of patient-generated health data (PGHD) may promote earlier recognition of symptomatic and functional decline. This trial assessed the impact of an intervention integrating remote PGHD collection with patient nudges on symptom and functional status understanding between patients with advanced cancer and their oncology team. METHODS This three-arm randomized controlled trial was conducted from November 19, 2020, to December 17, 2021, at a large tertiary oncology practice. We enrolled patients with stage IV GI and lung cancers undergoing chemotherapy. Over 6 months, patients in two intervention arms received PROStep-weekly text message-based symptom surveys and passive activity monitoring using a wearable accelerometer. PGHD were summarized in dashboards given to patients' oncology team before appointments. One intervention arm received an additional text-based active choice prompt to discuss worsening symptoms or functional status with their clinician. Control patients did not receive PROStep. The coprimary outcomes patient perceptions of oncology team symptom and functional understanding at 6 months were measured on a 1-5 Likert scale (5 = high understanding). RESULTS One hundred eight patients enrolled: 55% male, 81% White, and 77% had GI cancers. Patient-reported clinician understanding did not differ between control and intervention arms for symptoms (4.5 v 4.5; P = .87) or functional status (4.5 v 4.3; P = .31). In the intervention arms, combined patient adherence to weekly symptom reports and daily activity monitoring was 64% and 53%, respectively. Intervention patients in the PROStep versus PROStep + active choice arms reported low burden from wearing the accelerometer (mean burden [standard deviation], 2.7 [1.3] v 2.1 [1.3]; P = .15) and completing surveys (2.1 [1.2] v 1.9 [1.3]; P = .44). CONCLUSION Patients receiving PROStep reported high understanding of symptoms and functional status from their oncology team, although this did not differ from controls.
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Affiliation(s)
- Ravi B. Parikh
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Emily Schriver
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA
- Penn Medicine Predictive Healthcare, University of Pennsylvania Health System, Philadelphia, PA
| | - William J. Ferrell
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jonathan Wakim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joelle Williamson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Neda Khan
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Health Care Innovation, Penn Medicine, Philadelphia, PA
| | - Michael Kopinsky
- Center for Health Care Innovation, Penn Medicine, Philadelphia, PA
| | | | - Peter E. Gabriel
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lynn M. Schuchter
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | | | - Christopher R. Manz
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Harvard University, Boston, MA
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15
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Luo T, Elewonibi B, Williams D. A hospital-based therapeutic food pantry study for people living with cancer in New Orleans. Support Care Cancer 2023; 31:712. [PMID: 37982868 PMCID: PMC10661716 DOI: 10.1007/s00520-023-08171-x] [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: 03/17/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Food pantries have the potential to improve health outcomes and quality of life for individuals living with cancer. Gender has been linked to certain cancer symptoms and dietary patterns. Nevertheless, the extent of research on the utilization of food pantries among this population, particularly with regard to gender differences, remains limited. The objective of this study is to explore the demographic characteristics and gender differences in quality of life, as well as the impact of cancer on the lives of individuals who utilize food pantry services. METHODS Between February 26, 2019 and July 24, 2022, 400 people living with cancer were eligible to participate the University Medical Center New Orleans (UMC) food pantry. Participants were asked to provide demographic information and completed two health assessments related to the challenges in daily activities, nutrition, and mental health. RESULTS The study participants had a mean age of 54.1, and the majority of the participants were female. More than half of the participants did not have access to a vehicle or use public transportation to access grocery stores. People living with cancer reported several quality of life issues, with the most prevalent challenges being interference of cancer with work, lack of energy, difficulty affording food, pain, and sleep problems. Additionally, less than half of the patients reported consuming fruits and vegetables on a daily basis, and males were found to be less likely to consume them compared to females. DISCUSSION The current study sheds light on the characteristics and quality of life of individuals who utilize UMC food pantry services, as well as the impact of cancer on their lives. The findings reveal a gender disparity in fruit and vegetable consumption, with male individuals living with cancer reporting lower levels of consumption. IMPLICATIONS FOR RESEARCH AND PRACTICE Identifying and addressing food insecurity among people living with cancer are necessary. Meanwhile, partnerships with community organizations may be valuable in finding ways to assist cancer survivors in returning to work. Future studies could also focus on encouraging fruit and vegetable consumption, particularly among male individuals living with cancer.
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Affiliation(s)
- Ting Luo
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92122, USA.
| | - Bilikisu Elewonibi
- Epidemiology and Population Health, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, 70112, USA
| | - Donna Williams
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, 70112, USA.
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16
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Walsh M, Fagan N, Davies A. Xerostomia in patients with advanced cancer: a scoping review of clinical features and complications. BMC Palliat Care 2023; 22:178. [PMID: 37950188 PMCID: PMC10638744 DOI: 10.1186/s12904-023-01276-4] [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: 07/10/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The aim of this project was to review the literature on dry mouth / xerostomia in patients with advanced cancer, with the objectives being to determine its prevalence, clinical features, and complications. METHODS Standard methodology was used to conduct this scoping review. Detailed searches of the Medline, Embase, CINAHL, and PsycInfo databases were conducted to identify relevant studies: eligible studies had to include patients with advanced cancer, and to contain details of clinical features and/or complications of xerostomia. Commercial bibliographic / systematic review software was used to support the process. RESULTS Forty-three studies were discovered from the database and hand searches. The studies included 23 generic symptom studies, eight "symptom cluster" studies, nine oral symptom / problem studies, and three xerostomia-specific studies. In depth data is described on the clinical features and complications of xerostomia, and on the "symptom clusters" including xerostomia, in this cohort of patients. CONCLUSION This review discovered a relatively small number of focused studies (involving a similarly small number of patients). Nonetheless, it demonstrates that xerostomia is a very common problem in patients with advanced cancer and is often associated with significant morbidity (and impairment of quality of life).
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Affiliation(s)
- Maria Walsh
- Marymount University Hospital & Hospice, Curraheen, Ireland
| | - Norah Fagan
- Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Andrew Davies
- Trinity College Dublin, University College Dublin & Our Lady's Hospice Dublin, Dublin, Ireland.
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Epstein AS, Liou KT, Romero SAD, Baser RE, Wong G, Xiao H, Mo Z, Walker D, MacLeod J, Li Q, Barton-Burke M, Deng GE, Panageas KS, Farrar JT, Mao JJ. Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer: The IMPACT Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2342482. [PMID: 37962891 PMCID: PMC10646731 DOI: 10.1001/jamanetworkopen.2023.42482] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/26/2023] [Indexed: 11/15/2023] Open
Abstract
Importance Pain is challenging for patients with advanced cancer. While recent guidelines recommend acupuncture and massage for cancer pain, their comparative effectiveness is unknown. Objective To compare the effects of acupuncture and massage on musculoskeletal pain among patients with advanced cancer. Design, Setting, and Participants A multicenter pragmatic randomized clinical trial was conducted at US cancer care centers consisting of a northeastern comprehensive cancer center and a southeastern cancer institute from September 19, 2019, through February 23, 2022. The principal investigator and study statisticians were blinded to treatment assignments. The duration of follow-up was 26 weeks. Intention-to-treat analyses were performed (linear mixed models). Participants included patients with advanced cancer with moderate to severe pain and clinician-estimated life expectancy of 6 months or more. Patient recruitment strategy was multipronged (eg, patient database queries, mailings, referrals, community outreach). Eligible patients had English or Spanish as their first language, were older than 18 years, and had a Karnofsky score greater than or equal to 60 (range, 0-100; higher scores indicating less functional impairment). Interventions Weekly acupuncture or massage for 10 weeks with monthly booster sessions up to 26 weeks. Main Outcomes and Measures The primary end point was the change in worst pain intensity score from baseline to 26 weeks. The secondary outcomes included fatigue, insomnia, and quality of life. The Brief Pain Inventory (range, 0-10; higher numbers indicate worse pain intensity or interference) was used to measure the primary outcome. The secondary outcomes included fatigue, insomnia, and quality of life. Results A total of 298 participants were enrolled (mean [SD] age, 58.7 [14.1] years, 200 [67.1%] were women, 33 [11.1%] Black, 220 [74.1%] White, 46 [15.4%] Hispanic, and 78.5% with solid tumors). The mean (SD) baseline worst pain score was 6.9 (1.5). During 26 weeks, acupuncture reduced the worst pain score, with a mean change of -2.53 (95% CI, -2.92 to -2.15) points, and massage reduced the Brief Pain Inventory worst pain score, with a mean change of -3.01 (95% CI, -3.38 to -2.63) points; the between-group difference was not significant (-0.48; 95% CI, -0.98 to 0.03; P = .07). Both treatments also improved fatigue, insomnia, and quality of life without significant between-group differences. Adverse events were mild and included bruising (6.5% of patients receiving acupuncture) and transient soreness (15.1% patients receiving massage). Conclusions and Relevance In this randomized clinical trial among patients with advanced cancer, both acupuncture and massage were associated with pain reduction and improved fatigue, insomnia, and quality of life over 26 weeks; however, there was no significant different between the treatments. More research is needed to evaluate how best to integrate these approaches into pain treatment to optimize symptom management for the growing population of people living with advanced cancer. Trial Registration ClinicalTrials.gov Identifier: NCT04095234.
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Affiliation(s)
- Andrew S. Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kevin T. Liou
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sally A. D. Romero
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Greta Wong
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Han Xiao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zunli Mo
- Cancer Patient Support Center, Baptist Health Miami Cancer Institute, Miami, Florida
| | - Desiree Walker
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jodi MacLeod
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Qing Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Margaret Barton-Burke
- Office of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gary E. Deng
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine S. Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John T. Farrar
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jun J. Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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18
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Jung JY, Yun YH. Self-Management Strategy Clustering, Quality of Life, and Health Status in Cancer Patients Considering Cancer Stages. Int J Behav Med 2023; 30:769-776. [PMID: 36169885 DOI: 10.1007/s12529-022-10128-z] [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] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND In the cancer-care continuum, self-management can help cancer patients regardless of their treatment plan or cancer stage. However, research examining self-management strategy clusters considering cancer stages is lacking. Thus, we examined self-management strategy clusters considering cancer stages and the effects of self-management strategy clusters on quality of life (QoL) and overall health status. METHOD A total of 256 patients who completed both baseline and second surveys for a 6-month period ultimately participated in this prospective cohort study. To identify the interrelationship between self-management strategies measured by the Smart management strategies for health assessment tool (SAT), we conducted cluster analysis using a principal component analysis in varimax rotation and the k-mean clustering method. We also performed multivariate-adjusted analyses in QoL and overall health status comparisons by dividing the cancer stage into early (I, II) and advanced (III, IV). RESULTS All patients experienced two domains of self-management strategies concurrently. However, self-management strategy clusters differed by cancer stage, and the effect of self-management strategy clusters on quality of life and overall health status also differed. Self-management strategy clusters effectively improved the quality of life and overall health status of the entire cohort of patients, even in patients with advanced-stage cancer. CONCLUSION This study revealed that the pattern of using self-management strategies might differ by cancer stage. The strategy cluster positively affected QoL and overall health status in cancer patients. Identifying the self-management clusters of cancer patients with different cancer stages may have clinical implications for supporting their health management.
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Affiliation(s)
- Ju Youn Jung
- Department of Biomedical Science, Seoul National University College of Medicine and Hospital, Seoul, South Korea
| | - Young Ho Yun
- Department of Family Medicine, Seoul National University College of Medicine and Hospital, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.
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Hannon M, Shaw A, Connolly M, Davies A. Taste disturbance in patients with advanced cancer: a scoping review of clinical features and complications. Support Care Cancer 2023; 31:562. [PMID: 37672147 PMCID: PMC10482768 DOI: 10.1007/s00520-023-08012-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE The purpose of this scoping review is to appraise the published literature on taste disturbance in patients with advanced cancer, with the specific objectives being to determine its prevalence, clinical features and complications. METHODS This scoping review was conducted using the recommended methodological framework. A detailed search of databases (Medline, Embase, CINAHL and PsycInfo) was conducted to identify eligible studies: eligible studies needed to include patients with advanced cancer and needed to include details of clinical features and/or complications of taste disturbance. Standard bibliographic/systematic review software was used to store the records and manage the review process, respectively. RESULTS Twenty-five studies were identified from the database searches. The studies identified included eight physical and/or psychological symptom studies, six symptom cluster studies, five oral symptom studies and six taste and/or smell specific studies. Detailed data is presented on the clinical features and complications of taste disturbance and on the symptom clusters involving taste disturbance in this cohort of patients. CONCLUSION This scoping review identified a relatively small number of relevant studies involving a relatively small number of participants. Nevertheless, it confirms that taste disturbance is a common problem in patients with advanced cancer and is associated with significant morbidity because of the primary condition and the associated complications.
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Affiliation(s)
- Marie Hannon
- University College Dublin, Dublin, Ireland.
- Our Lady's Hospice & Care Services, Dublin, Ireland.
| | | | - Michael Connolly
- University College Dublin, Dublin, Ireland
- Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Andrew Davies
- University College Dublin, Dublin, Ireland
- Our Lady's Hospice & Care Services, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
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Borner T, Doebley SA, Furst CD, Pataro AM, Halas JG, Gao X, Choi GK, Ramadan SA, Chow A, De Jonghe BC. Screening study of anti-emetics to improve GDF15-induced malaise and anorexia: Implications for emesis control. Physiol Behav 2023; 267:114229. [PMID: 37164246 PMCID: PMC10883415 DOI: 10.1016/j.physbeh.2023.114229] [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: 03/17/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/12/2023]
Abstract
Considerable preclinical and clinical attention has focused on the food intake and body weight suppressive effects of growth differentiation factor 15 (GDF15) and its elevated blood levels as a consequence of disease states and disease treatment therapeutics. We have previously reported that exogenous administration of GDF15 induces anorexia through nausea and emesis in multiple species. Importantly, GDF15 signaling as a meditator of chemotherapy-induced anorexia and emesis has recently been demonstrated in both murine and nonhuman primate models. The mechanism, however, by which GDF15 induces malaise and the utility of existing therapeutic targets to counteract its effects remain largely unknown. Using a dose of GDF15 that mimics stimulated levels following chemotherapy administration and reliably induces malaise, we sought to screen anti-emetics that represent distinct pharmacotherapeutic classes hypothesized to reduce GDF15-induced effects in rats. Strikingly, our results showed that none of the tested compounds were effective at preventing GDF15-induced malaise. These results illustrate the complexity of GDF15 signaling mechanism and may have important implications for medical conditions characterized by elevated GDF15 levels and incomplete symptom control, such as chemotherapy-induced nausea and vomiting.
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Affiliation(s)
- Tito Borner
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, United States.
| | - Sarah A Doebley
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - C Daniel Furst
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Allison M Pataro
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Julia G Halas
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Xing Gao
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Grace K Choi
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Sarah A Ramadan
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Angela Chow
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Bart C De Jonghe
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, United States
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21
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Mochamat M, Przyborek M, Jaspers B, Cuhls H, Conrad R, Mücke M, Radbruch L. Development of Care Pathway for Assessment and Treatment of Fatigue in Palliative Care. Indian J Palliat Care 2023; 29:256-265. [PMID: 37700894 PMCID: PMC10493685 DOI: 10.25259/ijpc_194_2022] [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: 08/10/2022] [Accepted: 11/15/2022] [Indexed: 01/13/2023] Open
Abstract
Objectives Fatigue is a frequent and burdensome symptom in patients with advanced disease in palliative care. However, it is under-assessed and undertreated in clinical practice, even though many treatment options have been identified in systematic reviews. Care pathways with defined and standardised steps have been recommended for effective management in the clinical setting. This paper describes a care pathway for managing fatigue in palliative care patients. This study aims to develop a care pathway with detailed guidance for screening, assessment, diagnosis, and treatment of fatigue in palliative care patients. Material and methods A collaborative effort of multidisciplinary clinicians participated in constructing the care pathway. The care pathway was developed using the following steps: (a) Developing an intervention; (b) piloting and feasibility; (c) evaluating the intervention; (d) reporting; and (e) implementation. This paper covers the first step, which includes the evidence base identification, theory identification/development, and process/outcomes modeling. A literature search was conducted to understand the extent of the fatigue problem in the palliative care setting and identify existing guidelines and strategies for managing fatigue. Consistent recommendations emanating from the included papers were then contributed to a care pathway. Patient representatives and palliative care professionals provided feedback on the draft. Results The care pathway address the following care processes: (1) Screening for the presence of fatigue; (2) assessment to evaluate the severity of fatigue; (3) diagnostic procedure, including history, physical examination, and laboratory finding; (4) therapeutic management pathway for clinical decision-making; and (5) valuation of treatment effect, using questionnaires, diaries and physical activity monitoring with body-worn sensors. Conclusion The development of a care pathway will help to implement regular and structured assessment, diagnosis, and treatment of fatigue for healthcare professionals treating palliative care patients. Reviewing the pathway with a multidisciplinary expert group and field testing the pathway will be the next steps toward implementation.
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Affiliation(s)
- Mochamat Mochamat
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Diponegoro University Semarang, Indonesia, Germany
- Dr. Kariadi General Hospital, Semarang, Indonesia, Germany
| | - Marta Przyborek
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Birgit Jaspers
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Henning Cuhls
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Aachen, Germany
| | - Martin Mücke
- Department of Digitalization and General Practice, RWTH Aachen, Aachen, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
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Kroenke K, Lam V, Ruddy KJ, Pachman DR, Herrin J, Rahman PA, Griffin JM, Cheville AL. Prevalence, Severity, and Co-Occurrence of SPPADE Symptoms in 31,866 Patients With Cancer. J Pain Symptom Manage 2023; 65:367-377. [PMID: 36738867 PMCID: PMC10106386 DOI: 10.1016/j.jpainsymman.2023.01.020] [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: 11/23/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To examine the prevalence, severity, and co-occurrence of SPPADE symptoms as well as their association with cancer type and patient characteristics. BACKGROUND The SPPADE symptoms (sleep disturbance, pain, physical function impairment, anxiety, depression, and low energy /fatigue) are prevalent, co-occurring, and undertreated in oncology and other clinical populations. METHODS Baseline SPPADE symptom data were analyzed from the E2C2 study, a stepped wedge pragmatic, population-level, cluster randomized clinical trial designed to evaluate a guideline-informed symptom management model targeting the six SPPADE symptoms. Symptom prevalence and severity were measured with a 0-10 numeric rating (NRS) scale for each of the six symptoms. Prevalence of severe (NRS ≥ 7) and potential clinically relevant (NRS ≥ 5) symptoms as well as co-occurrence of clinical symptoms were determined. Distribution-based methods were used to estimate the minimally important difference (MID). Associations of cancer type and patient characteristics with a SPPADE composite score were analyzed. RESULTS A total of 31,886 patients were assessed for SPPADE symptoms prior to, during, or soon after an outpatient medical oncology encounter. The proportion of patients with a potential clinically relevant symptom ranged from 17.5% for depression to 33.4% for fatigue. Co-occurrence of symptoms was high, with the proportion of patients with three or more additional clinically relevant symptoms ranging from 45.2% for fatigue to 68.6% for depression. The summed SPPADE composite score demonstrated good internal reliability (Cronbach's alpha of 0.86), with preliminary MID estimates of 4.1-4.3. Symptom burden differed across several types of cancer but was generally similar across most sociodemographic characteristics. CONCLUSION The high prevalence and co-occurrence of SPPADE symptoms in patients with all types of cancer warrants clinical approaches that optimize detection and management.
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Affiliation(s)
- Kurt Kroenke
- Indiana University School of Medicine (K.K.), Indianapolis, Indiana, USA; Regenstrief Institute, Inc. (K.K.), Indianapolis, Indiana, USA.
| | - Veronica Lam
- Department of Physical Medicine and Rehabilitation (V.L., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn J Ruddy
- Division of Medical Oncology (K.J.R.), Mayo Clinic, Rochester, Minnesota, USA
| | - Deirdre R Pachman
- Division of Community Internal Medicine, Geriatrics, and Palliative Care (D.R.P.), Mayo Clinic, Rochester, Minnesota, USA
| | - Jeph Herrin
- Yale University School of Medicine (J.H.), New Haven, Connecticut, USA
| | - Parvez A Rahman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.R., J.M.G., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.R., J.M.G., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA; Division of Health Care Delivery Research (J.M.G.), Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation (V.L., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.R., J.M.G., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA
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23
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Iezzi R, Kovács G, Dimov V, Contegiacomo A, Posa A, Efthymiou E, Lancellotta V, Rodolfino E, Punzi E, Trajkovski ZB, Valentini V, Manfredi R, Filippiadis D. Multimodal locoregional procedures for cancer pain management: a literature review. Br J Radiol 2023; 96:20220236. [PMID: 36318237 PMCID: PMC9975366 DOI: 10.1259/bjr.20220236] [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: 02/26/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 11/27/2022] Open
Abstract
Pain is the most common and fearsome symptom in cancer patients, particularly in the advanced stage of disease. In cancer pain management, the first option is represented by analgesic drugs, whereas surgery is rarely used. Prior to considering surgical intervention, less invasive locoregional procedures are available from the wide pain management arsenal. In this review article, comprehensive information about the most commonly used locoregional options available for treating cancer pain focusing on interventional radiology (neurolysis, augmentation techniques, and embolization) and interventional radiotherapy were provided, also highlighting the potential ways to increase the effectiveness of treatments.
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Affiliation(s)
| | - György Kovács
- Università Cattolica del Sacro Cuore, Gemelli-INTERACTS, Rome, Italy
| | - Vladimir Dimov
- Acibadem Sistina Hospital Skopje, Skopje, North Macedonia
| | - Andrea Contegiacomo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Posa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy
| | - Elena Rodolfino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Sandford A, Haywood A, Rickett K, Good P, Khan S, Foster K, Hardy JR. Corticosteroids for the management of cancer-related fatigue in adults with advanced cancer. Cochrane Database Syst Rev 2023; 1:CD013782. [PMID: 36688471 PMCID: PMC9869433 DOI: 10.1002/14651858.cd013782.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Fatigue is the most commonly reported symptom in people with advanced cancer. Cancer-related fatigue (CRF) is pervasive and debilitating, and can greatly impact quality of life (QoL). CRF has a highly variable clinical presentation, likely due to a complex interaction of multiple factors. Corticosteroids are commonly used to improve CRF, but the benefits are unclear and there are significant adverse effects associated with long-term use. With the increasing survival of people with metastatic cancer, the long-term effects of medications are becoming increasingly relevant. Since the impact of CRF can be immensely debilitating and can negatively affect QoL, its treatment warrants further review. OBJECTIVES To determine the benefits and harms of corticosteroids compared with placebo or an active comparator in adults with advanced cancer and CRF. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Science Citation Index (ISI Web of Science), LILACS, and two clinical trial registries from inception to 18 July 2022. SELECTION CRITERIA: We included randomised controlled trials in adults aged ≥18 years. We included participants with advanced cancer who were suffering from CRF. We included trials that randomised participants to corticosteroids at any dose, by any route, administered for the relief of CRF; compared to placebo or an active comparator, including supportive care or non-pharmacological treatments. DATA COLLECTION AND ANALYSIS Three review authors independently assessed titles identified by the search strategy; two review authors assessed risk of bias; and two extracted data. We extracted the primary outcome of participant-reported fatigue relief using validated scales and secondary outcomes of adverse events, serious adverse events and QoL. We calculated the risk ratio with 95% confidence intervals (CIs) between groups for dichotomous outcomes. We measured arithmetic mean and standard deviation, and reported the mean difference (MD) with 95% CI between groups for continuous outcomes. We used standardised mean difference (SMD) with 95% CIs when an outcome was measured with different instruments measuring the same construct. We used a random-effects model to meta-analyse the outcome data. We rated the certainty of the evidence using GRADE and created two summary of findings tables. MAIN RESULTS: We included four studies with 297 enroled participants; data were available for only 239 participants. Three studies compared corticosteroid (equivalent ≤ 8 mg dexamethasone) to placebo. One study compared corticosteroid (dexamethasone 4 mg) to an active comparator (modafinil 100 mg). There were insufficient data to evaluate subgroups, such as dose and duration of treatment. One study had a high risk of performance and detection bias due to lack of blinding, and one study had a high risk of attrition bias. Otherwise, we assessed risks of bias as low or unclear. Comparison 1: corticosteroids compared with placebo Participant-reported fatigue relief The was no clear difference between corticosteroids and placebo (SMD -0.46, 95% CI -1.07 to 0.14; 3 RCTs, 165 participants, very low-certainty evidence) for relief of fatigue at one week of the intervention. We downgraded the certainty of the evidence three times for study limitations due to unclear risk of bias, imprecision, and inconsistency. Adverse events There was no clear difference in the occurrence of adverse events between groups, but the evidence is very uncertain (3 RCTs, 165 participants; very low-certainty evidence). Serious adverse events There was no clear difference in the occurrence of serious adverse events between groups, but the evidence is very uncertain (2 RCTs, 118 participants; very low-certainty evidence). Quality of lIfe One study reported QoL at one week using the Edmonton Symptom Assessment System (ESAS) well-being, and found no clear difference in QoL between groups (MD -0.58, 95% CI -1.93 to 0.77). Another study measured QoL using the Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs (QoL-ACD), and found no clear difference between groups. There was no clear difference between groups for either study, but the evidence is very uncertain (2 RCTs, 118 participants; very low-certainty evidence). Comparison 2: corticosteroids compared with active comparator (modafinil) Participant-reported fatigue relief There was improvement in fatigue from baseline to two weeks in both groups (modafinil MD 10.15, 95% CI 7.43 to 12.87; dexamethasone MD 9.21, 95% CI 6.73 to 11.69), however no clear difference between the two groups (MD -0.94, 95% CI -4.49 to 2.61; 1 RCT, 73 participants, very low-certainty evidence). We downgraded the certainty of the evidence three times for very serious study limitations and imprecision. Adverse events There was no clear difference in the occurrence of adverse events between groups, but the evidence is very uncertain (1 RCT, 73 participants; very low-certainty evidence). Serious adverse events There were no serious adverse events reported in either group (1 RCT, 73 participants; very low-certainty evidence). Quality of lIfe One study measured QoL at two weeks, using the ESAS-well-being. There was marked improvement in QoL from baseline in both groups (modafinil MD -2.43, 95% CI -2.88 to -1.98; dexamethasone MD -2.16, 95% CI -2.68 to -1.64), however no clear difference between the two groups (MD 0.27, 95% CI -0.39 to 0.93; 1 RCT, 73 participants, very low-certainty evidence). AUTHORS' CONCLUSIONS There is insufficient evidence to support or refute the use of systemic corticosteroids in adults with cancer and CRF. We included four small studies that provided very low-certainty of evidence for the efficacy of corticosteroids in the management of CRF. Further high-quality randomised controlled trials with larger sample sizes are required to determine the effectiveness of corticosteroids in this setting.
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Affiliation(s)
- Amy Sandford
- Department of Palliative and Supportive Care, Mater Health Services, Brisbane, Australia
| | - Alison Haywood
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
- Mater Research Institute - The University of Queensland, Brisbane, Australia
| | - Kirsty Rickett
- The University of Queensland Library, UQ/Mater McAuley Library, Brisbane, Australia
| | - Phillip Good
- Mater Research Institute - The University of Queensland, Brisbane, Australia
- Department of Palliative Care, St Vincent's Private Hospital, Brisbane, Australia
| | - Sohil Khan
- Mater Research Institute - The University of Queensland, Brisbane, Australia
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Karyn Foster
- Department of Palliative and Supportive Care, Mater Health Services, Brisbane, Australia
- Mater Research Institute - The University of Queensland, Brisbane, Australia
| | - Janet R Hardy
- Department of Palliative and Supportive Care, Mater Health Services, Brisbane, Australia
- Mater Research Institute - The University of Queensland, Brisbane, Australia
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25
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Llamas-Ramos I, Alvarado-Omenat JJ, Rodrigo-Reguilón M, Llamas-Ramos R. Quality of Life and Side Effects Management in Cancer Treatment-A Cross Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1708. [PMID: 36767073 PMCID: PMC9914572 DOI: 10.3390/ijerph20031708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
Cancer disease is a world problem which is increasing in its prevalence. Oncology patients have a multitude of symptoms derived from the treatments and from the disease itself that affect their quality of life to a greater or lesser extent. The aim of this study has been to discover the physical and psychological symptoms related to chemotherapy treatment in Spanish cancer patients in order to improve their quality of life. Symptoms from the previous week were taken into account and the Memorial Symptom Assessment Scale was used to measure the frequency, severity and associated distress of 32 symptoms. A total of 246 chemotherapy patients at the University Day Hospital in Salamanca completed the scale once while receiving chemotherapy treatment. A 95% confidence interval was considered. The most prevalent symptoms were a lack of energy (76.4%), anxiety (66.7%) and a dry mouth (60.6%). Lung cancer was the most prevalent cancer in men (26%) and breast cancer was the most prevalent cancer in women (72%). There is no consensus on which is the most prevalent symptom in this population and more studies will need to be carried out to determine the best treatment protocols. Symptom's prevalence knowledge could improve the patients' care to prevent or avoid complications and to improve the cancer patients' quality of life.
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Affiliation(s)
- Inés Llamas-Ramos
- Faculty of Nursing and Physiotherapy, Universidad de Salamanca, C/Donantes de Sangre s/n, 37007 Salamanca, Spain
- University Hospital of Salamanca, Paseo de San Vicente, 182, 37007 Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
| | | | | | - Rocío Llamas-Ramos
- Faculty of Nursing and Physiotherapy, Universidad de Salamanca, C/Donantes de Sangre s/n, 37007 Salamanca, Spain
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26
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Van Tap N, Bang HT, Huong DT, Chi PC, Anh LTN. Malnutrition in hospitalized cancer patients: A single-center, cross-sectional study in Southern Vietnam. SAGE Open Med 2023; 11:20503121231171491. [PMID: 37152843 PMCID: PMC10161330 DOI: 10.1177/20503121231171491] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/06/2023] [Indexed: 05/09/2023] Open
Abstract
Objectives Malnutrition in cancer patients reduces response to chemotherapy, increases the hospitalization costs, hospital infections, and deaths. The aim of this study was to determine the prevalence, level of malnutrition, and its related factors in cancer patients at a local hospital in Southern Vietnam. Methods A descriptive cross-sectional study was performed on all 118 cancer patients who were undergoing inpatient treatment at Long An General Hospital, Vietnam from May to September 2020. Data were collected from patients by face-to-face interviewing using a subjective global assessment (SGA) and from medical records. Malnutrition is divided into three groups: SGA-A (normal), SGA-B (mild/moderate/suspected malnutrition), SGA-C (severe malnutrition). Multivariable logistic regression is used to identify factors related to malnutrition with statistical significance p < 0.05. Results Out of 118 participants, 72 (61.0%) were males and 84 (71.2%) aged ⩾60 years. The prevalence of malnutrition in cancer patients was 84.7% (100/118), in which 33% (39/118) were severe (SGA-C) and 51.7% (61/118) were mild-moderate (SGA-B). Pancreatic and lung cancers are the most malnourished. The results of multivariate logistic regression analysis showed that the factors related to malnutrition in cancer patients were gastrointestinal symptoms lasting 2 weeks (odds ratio: 6.10, 95% confidence interval: 1.12-33.35), patients with decreased motor function (odds ratio: 13.73, 95% confidence interval: 2.56-73.86), blood albumin <35 g/l (odds ratio: 6.42, 95% confidence interval: 1.54-26.82), and blood lymphocyte ⩽ 1700 cells/mm3 (odds ratio: 5.36, 95% confidence interval: 1.31-21.97). Conclusions There was a high proportion of malnutrition in cancer patients. Therefore, it is necessary to strengthen nutrition counseling and intervention for these patients, especially those that have prolonged gastrointestinal symptoms, reduced motor function, and low blood albumin or low blood lymphocytes.
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Affiliation(s)
- Nguyen Van Tap
- Faculty of Medical Management, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Ho Tat Bang
- University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Pham Cong Chi
- Tan Hung District Medical Center, Tan Hung, Tan An, Long An, Vietnam
| | - Le Thi Ngoc Anh
- Institute of Public Health, Ho Chi Minh City, Vietnam
- Le Thi Ngoc Anh, Department of Health Planning, Institute of Public Health, 159 Hung Phu street, Ward 8, District 8, Ho Chi Minh City 73008, Vietnam.
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27
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Müller S, Fink M, Hense J, Comino MRS, Schuler M, Teufel M, Tewes M. Palliative care outpatients in a German comprehensive cancer center-identifying indicators for early and late referral. BMC Palliat Care 2022; 21:221. [PMID: 36503625 PMCID: PMC9743520 DOI: 10.1186/s12904-022-01114-z] [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: 05/27/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Despite that early integration of palliative care is recommended in advanced cancer patients, referrals to outpatient specialised palliative care (SPC) frequently occur late. Well-defined referral criteria are still missing. We analysed indicators associated with early (ER) and late referral (LR) to SPC of an high volume outpatient unit of a comprehensive cancer center. METHODS Characteristics, laboratory parameters and symptom burden of 281 patients at first SPC referral were analysed. Timing of referral was categorized as early, intermediate and late (> 12, 3-12 and < 3 months before death). Ordinal logistic regression analysis was used to identify factors related to referral timing. Kruskal-Wallis test was used to determine symptom severity and laboratory parameter in each referral category. RESULTS LRs (50.7%) had worse scores of weakness, loss of appetite, drowsiness, assistance of daily living (all p < 0.001) and organisation of care (p < 0.01) in contrast to ERs. The mean symptom sum score was significantly higher in LRs than ERs (13.03 vs. 16.08; p < 0.01). Parameters indicative of poor prognosis, such as elevated LDH, CRP and neutrophil-to-lymphocyte ratio (NLR) (p < 0.01) as well as the presence of ascites (p < 0.05), were significantly higher (all p < 0.001) in LRs. In univariable analyses, psychological distress (p < 0.05) and female gender (p < 0.05) were independently associated with an ER. CONCLUSION A symptom sum score and parameters of poor prognosis like NLR or LDH might be useful to integrate into palliative care screening tools.
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Affiliation(s)
- S. Müller
- grid.410718.b0000 0001 0262 7331Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
| | - M. Fink
- grid.5718.b0000 0001 2187 5445Clinic of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147 Essen, Germany
| | - J. Hense
- grid.410718.b0000 0001 0262 7331Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
| | - M. R. Salvador Comino
- grid.410718.b0000 0001 0262 7331Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
| | - M. Schuler
- grid.410718.b0000 0001 0262 7331Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany ,grid.410718.b0000 0001 0262 7331German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
| | - M. Teufel
- grid.5718.b0000 0001 2187 5445Clinic of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147 Essen, Germany
| | - M. Tewes
- grid.410718.b0000 0001 0262 7331Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
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Kenny C, Regan J, Balding L, Higgins S, O'Leary N, Kelleher F, McDermott R, Armstrong J, Mihai A, Tiernan E, Westrup J, Thirion P, Walsh D. Dysphagia in Solid Tumors Outside the Head, Neck or Upper GI Tract: Clinical Characteristics. J Pain Symptom Manage 2022; 64:546-554. [PMID: 36058400 DOI: 10.1016/j.jpainsymman.2022.08.019] [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: 07/11/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT Dysphagia is common in cancer, but underlying pathophysiology and manifestations within patients are unknown. OBJECTIVES To examine dysphagia characteristics in those with solid malignancies outside the head, neck and upper gastrointestinal tract. METHODS Seventy-three individuals with dysphagia (46 male, 27 female, aged 37-91) were recruited from a parent trial conducted in two acute hospitals and one hospice. Cranial nerve function, Oral Health Assessment Tool (OHAT), Mann Assessment of Swallowing Ability (MASA) and Functional Oral Intake Scale (FOIS) evaluated swallow profile. RESULTS Only 9/73 (12%) had documented dysphagia prior to study enrollment. MASA risk ratings found n=61/73 (84%) with dysphagia risk and n=22/73 (30%) with aspiration risk. Food texture modification was required for n=34/73 (47%), fluid texture modification for n=1/73 (1%). Compensatory strategies for food were needed by n=13/73 (18%) and for fluids by n=24/73 (33%). Cranial nerve deficits were present in n=43/73 (59%). Oral health problems were common, with xerostomia in two-thirds. Worse dysphagia on MASA was associated with disease progression, affecting hospice, and palliative care the most. Worse performance status was indicative of poorer MASA raw score (P<0.001, OR 2.2, 95% CI 1.5-3.4), greater risk of aspiration (P=0.005, OR 2.1, 95% CI 1.3-3.6) and lower FOIS (P=0.004, OR 2.0, 95% CI 1.2-3.2). CONCLUSION Dysphagia management in those with cancer requires robust assessment to uncover clinically important needs like food texture modification and safe swallowing advice. Better assessment tools should be developed for this purpose. Oral health problems should be routinely screened in this population since they exacerbate dysphagia.
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Affiliation(s)
- Ciarán Kenny
- Department of Clinical Speech and Language Studies (C.K., J.R.), Trinity College Dublin, Ireland; Academic Department of Palliative Medicine (C.K., D.W.), Our Lady's Hospice & Care Services, Ireland; School of Medicine (C.K., D.W.), Trinity College Dublin, Ireland.
| | - Julie Regan
- Department of Clinical Speech and Language Studies (C.K., J.R.), Trinity College Dublin, Ireland
| | - Lucy Balding
- Department of Palliative Medicine (L.B., S.H., N.O.), Our Lady's Hospice & Care Services, Ireland
| | - Stephen Higgins
- Department of Palliative Medicine (L.B., S.H., N.O.), Our Lady's Hospice & Care Services, Ireland
| | - Norma O'Leary
- Department of Palliative Medicine (L.B., S.H., N.O.), Our Lady's Hospice & Care Services, Ireland
| | | | - Ray McDermott
- Tallaght University Hospital (F.K., R.M.), Ireland; Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | - John Armstrong
- Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | - Alina Mihai
- Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | - Eoin Tiernan
- Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | | | - Pierre Thirion
- Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | - Declan Walsh
- Academic Department of Palliative Medicine (C.K., D.W.), Our Lady's Hospice & Care Services, Ireland; School of Medicine (C.K., D.W.), Trinity College Dublin, Ireland; Department of Supportive Oncology (D.W.), Levine Cancer Institute, Atrium Health, North Carolina, USA
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He M, Slee EA, Sun M, Hu C, Chang WT, Xu G, Lu X, Wang M. Defect in Ser312 phosphorylation of Tp53 dysregulates lipid metabolism for fatty accumulation and fatty liver susceptibility: Revealed by lipidomics. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1211:123491. [DOI: 10.1016/j.jchromb.2022.123491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 08/20/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
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Parikh RB, Basen-Enquist KM, Bradley C, Estrin D, Levy M, Lichtenfeld JL, Malin B, McGraw D, Meropol NJ, Oyer RA, Sheldon LK, Shulman LN. Digital Health Applications in Oncology: An Opportunity to Seize. J Natl Cancer Inst 2022; 114:1338-1339. [PMID: 35640986 PMCID: PMC9384132 DOI: 10.1093/jnci/djac108] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/13/2022] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
Digital health advances have transformed many clinical areas including psychiatric and cardiovascular care. However, digital health innovation is relatively nascent in cancer care, which represents the fastest growing area of health-care spending. Opportunities for digital health innovation in oncology include patient-facing technologies that improve patient experience, safety, and patient-clinician interactions; clinician-facing technologies that improve their ability to diagnose pathology and predict adverse events; and quality of care and research infrastructure to improve clinical workflows, documentation, decision support, and clinical trial monitoring. The COVID-19 pandemic and associated shifts of care to the home and community dramatically accelerated the integration of digital health technologies into virtually every aspect of oncology care. However, the pandemic has also exposed potential flaws in the digital health ecosystem, namely in clinical integration strategies; data access, quality, and security; and regulatory oversight and reimbursement for digital health technologies. Stemming from the proceedings of a 2020 workshop convened by the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine, this article summarizes the current state of digital health technologies in medical practice and strategies to improve clinical utility and integration. These recommendations, with calls to action for clinicians, health systems, technology innovators, and policy makers, will facilitate efficient yet safe integration of digital health technologies into cancer care.
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Affiliation(s)
- Ravi B Parikh
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - Karen M Basen-Enquist
- Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center, Texas Medical Center, Houston, TX, USA
| | - Cathy Bradley
- Department of Health Systems, Management & Policy, University of Colorado Cancer Center, Aurora, CO, USA
| | - Deborah Estrin
- Cornell Ann S. Bowers College of Computing and Information Science, Cornell University, New York, NY, USA
| | - Mia Levy
- Division of Hematology, Oncology and Cell Therapy, Rush University, Chicago, IL, USA
| | | | - Bradley Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Lisa Kennedy Sheldon
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA
| | - Lawrence N Shulman
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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31
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O'Donoghue A. Early satiety in cancer. BMJ Support Palliat Care 2022; 13:175-177. [PMID: 36180200 DOI: 10.1136/spcare-2022-003956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/21/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Aidan O'Donoghue
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland .,Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
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Romero SAD, Emard N, Baser RE, Panageas K, MacLeod J, Walker D, Barton-Burke M, Liou K, Deng G, Farrar J, Xiao H, Mao JJ, Epstein A. Acupuncture versus massage for pain in patients living with advanced cancer: a protocol for the IMPACT randomised clinical trial. BMJ Open 2022; 12:e058281. [PMID: 36581960 PMCID: PMC9438082 DOI: 10.1136/bmjopen-2021-058281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/06/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Pain, comorbid fatigue and sleep disturbances are common and distressing symptoms for patients with advanced cancer, negatively impacting their quality of life. Clinical guidelines recommend non-pharmacological interventions, including acupuncture and massage, for pain management in adult patients with cancer in adjunct to conventional care. However, high-quality evidence about the comparative effectiveness and long-term durability of these therapies for symptom management is limited. METHODS AND ANALYSIS We describe the design of a two-arm, parallel group, multicentre randomised controlled trial that investigates the use of acupuncture versus massage for musculoskeletal pain among 300 patients with diverse types of advanced cancer. The primary aim is to evaluate the long-term effectiveness (26 weeks from randomisation) of acupuncture vs massage for pain (primary outcome) and comorbid symptoms (fatigue, sleep disturbance and quality of life). The secondary aim is to identify patient-level demographic characteristics (eg, sex, race, age), clinical factors (eg, insomnia, pain severity) and psychological attributes that are associated with a greater reduction in pain for either acupuncture or massage. Patients will receive weekly acupuncture or massage treatments for 10 weeks, followed by monthly booster sessions up to 26 weeks. The primary endpoint will be the change in worst pain intensity score from baseline to 26 weeks. We will collect validated patient-reported outcomes at multiple time points over 26 weeks. ETHICS AND DISSEMINATION The Institutional Review Board at Memorial Sloan Kettering Cancer Center in New York approved this protocol. Results will be disseminated via peer-reviewed scientific journals and conference presentations. Our findings will help patients and healthcare providers make informed decisions about incorporating non-pharmacological treatments to manage pain for patients with advanced cancer. TRIAL REGISTRATION NUMBER NCT04095234.
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Affiliation(s)
- Sally A D Romero
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, CA, USA
| | - Nicholas Emard
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine Panageas
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jodi MacLeod
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Desiree Walker
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Margaret Barton-Burke
- Office of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gary Deng
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Farrar
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Han Xiao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Jung EH, Lee SW, Kim YJ, Kang B, Suh KJ, Lee JH, Jeon E, Kim D, Hur SS, Lee JY, Kim JW, Kim SH, Kim JW, Lee JO, Lee KW, Kim JH, Bang SM, Lee JS, Bruera E. Clinical Outcomes of Operating an Acute Palliative Care Unit at a Comprehensive Cancer Center. JCO Oncol Pract 2022; 18:e1661-e1671. [DOI: 10.1200/op.22.00163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Acute palliative care units (APCUs) are inpatient services in tertiary hospitals that provide intensive symptom management and assist in hospital discharge for transitions to hospice care. We aimed to analyze the clinical outcomes of operating an APCU at a comprehensive cancer center. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 1,440 consecutive patients admitted to the APCU and analyzed demographic and clinical information, discharge outcomes, symptom assessments using the Edmonton Symptom Assessment System, spiritual distress, and financial distress. RESULTS: The median age of patients was 67.0 (range, 23-97) years, and 41% were female. The most common primary cancer types were lung (21.9%), hepatopancreatobiliary (14.1%), and colorectal cancers (12.9%). The median length of stay was 8.0 days (range, 1-60 days), and 31.0% of patients died in the APCU. Death in the APCU showed a significant decrease over time, and overall inpatient death in oncology wards did not increase after APCU opening. In total, 44.7% of patients were discharged to government-certified hospice centers. The proportion of patients discharged to certified hospice centers increased from 32.2% in 2015 to 62.4% in 2018. Among 715 patients with a follow-up evaluation 1 week after admission, Edmonton Symptom Assessment System symptom scores, spiritual distress, and financial distress showed statistically significant improvements compared with the baseline symptom scores ( P < .001). This improvement was limited to patients who did not die in the APCU. CONCLUSION: Patients with advanced cancer admitted to the APCU may experience significant improvements in distressing symptoms. The majority of patients requiring transition to hospice were successfully transferred to certified hospice centers. The percentage discharged alive improved over time.
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Affiliation(s)
- Eun Hee Jung
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Si Won Lee
- Palliative Care Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Beodeul Kang
- Division of Medical Oncology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Koung Jin Suh
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ju Hyun Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Esther Jeon
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dahee Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sung Soun Hur
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Yun Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji-Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Ok Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun-Wook Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jee Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Soo-Mee Bang
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong Seok Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Hansen MB, Adsersen M, Rojas-Concha L, Petersen MA, Ross L, Groenvold M. Nausea at the start of specialized palliative care and change in nausea after the first weeks of palliative care were associated with cancer site, gender, and type of palliative care service-a nationwide study. Support Care Cancer 2022; 30:9471-9482. [PMID: 35960379 DOI: 10.1007/s00520-022-07310-0] [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: 04/21/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Nausea is a common and distressful symptom among patients in palliative care, but little is known about possible socio-demographic and clinical patient characteristics associated with nausea at the start of palliative care and change after initiation of palliative care. The aim of this study was to investigate whether patient characteristics were associated with nausea at the start of palliative care and with change in nausea during the first weeks of palliative care, respectively. METHODS Data was obtained from the nationwide Danish Palliative Care Database. The study included adult cancer patients who were admitted to palliative care and died between June 2016 and December 2020 and reported nausea level at the start of palliative care and possibly 1-4 weeks later. The associations between patient characteristics and nausea at the start of palliative care and change in nausea during palliative care, respectively, were studied using multiple regression analyses. RESULTS Nausea level was reported at the start of palliative care by 23,751 patients of whom 8037 also reported 1-4 weeks later. Higher nausea levels were found for women, patients with stomach or ovarian cancer, and inpatients at the start of palliative care. In multivariate analyses, cancer site was the variable most strongly associated with nausea change; the smallest nausea reductions were seen for myelomatosis and no reduction was seen for stomach cancer. CONCLUSION This study identified subgroups with the highest initial nausea level and those with the least nausea reduction after 1-4 weeks of palliative care. These latter findings should be considered in the initial treatment plan.
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Affiliation(s)
- Maiken Bang Hansen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, NV, DK-2400, Copenhagen, Denmark.
| | - Mathilde Adsersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, NV, DK-2400, Copenhagen, Denmark
| | - Leslye Rojas-Concha
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, NV, DK-2400, Copenhagen, Denmark
| | - Morten Aagaard Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, NV, DK-2400, Copenhagen, Denmark
| | - Lone Ross
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, NV, DK-2400, Copenhagen, Denmark
| | - Mogens Groenvold
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, NV, DK-2400, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, DK-1353, Copenhagen, Denmark
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Wallström S, Sutherland JM, Kopec JA, Anis AH, Sawatzky R. Distinguishing symptom patterns in adults newly diagnosed with cancer: a latent class analysis. J Pain Symptom Manage 2022; 64:146-155. [PMID: 35460831 DOI: 10.1016/j.jpainsymman.2022.04.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Socio-demographic differences, including place of residence, socio-economic status, ethnicity, and gender, have been associated with various inequities in cancer care outcomes. OBJECTIVES The aims were to distinguish subgroups of patients with different symptom patterns at the time of the initial oncology visit and determine which clinical and socio-demographic variables are associated the different symptom patterns. METHOD Responses to the Edmonton Symptom Assessment Scale- revised and clinical and socio-demographic variables were obtained via the Ontario Cancer Registry and linked health data files. Latent class analyses were conducted to identify and compare the subgroups. RESULTS The cohort (n = 216,110) with a mean age of 64.5 years consisted of 54.1% women. The analyses identified six latent classes (proportions ranging from 0.09 to 0.31) with distinct symptom patterns, including: 1) many severe symptoms, 2) many less severe symptoms, 3) predominantly mild symptoms, 4) severe psychosocial symptoms, 5) severe somatic symptoms, 6) few symptoms. The subgroups were associated not only with clinical differences (diagnoses and functional status), but also with various socio-demographic (age, sex) and community characteristics (neighborhood income, proportion of foreign born, rurality). CONCLUSION The results indicated that there were substantial differences in symptom patterns at the time of the initial oncology visit, which were associated with both clinical diagnoses and socio-demographic differences. These results point to the importance of taking the social situation of patients into account, and not just diagnosis, to better understand differences in symptom patterns of people living with cancer.
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Affiliation(s)
- Sara Wallström
- Institute of Health and Care Sciences (S.W., R.S.), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Center for Person-Centered Care (GPCC) (S.W.), University of Gothenburg, Gothenburg, Sweden; Forensic Psychiatric Clinic (S.W.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jason M Sutherland
- Center for Health Services and Policy Research (J.M.S.), School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health (J.M.S., J.A.K., A.H.A.), University of British Columbia, Vancouver, BC, Canada; Center for Health Evaluation and Outcome Sciences (J.M.S., R.S.), Vancouver, BC, Canada
| | - Jacek A Kopec
- Arthritis Research Canada (J.A.K.), Vancouver, BC, Canada; School of Population and Public Health (J.M.S., J.A.K., A.H.A.), University of British Columbia, Vancouver, BC, Canada
| | - Aslam H Anis
- School of Population and Public Health (J.M.S., J.A.K., A.H.A.), University of British Columbia, Vancouver, BC, Canada; Center for Health Evaluation and Outcome Sciences (J.M.S., R.S.), Vancouver, BC, Canada
| | - Richard Sawatzky
- Institute of Health and Care Sciences (S.W., R.S.), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Center for Health Evaluation and Outcome Sciences (J.M.S., R.S.), Vancouver, BC, Canada; School of Nursing (R.S.), Trinity Western University, Langley, BC, Canada.
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Smoot BJ, Mastick J, Shepherd J, Paul SM, Kober KM, Cooper BA, Conley YP, Dixit N, Hammer MJ, Fu MR, Abrams G, Miaskowski C. Use of Dual-Energy X-Ray Absorptiometry to Assess Soft Tissue Composition in Breast Cancer Survivors With and Without Lymphedema. Lymphat Res Biol 2022; 20:391-397. [PMID: 34793255 PMCID: PMC9422781 DOI: 10.1089/lrb.2021.0030] [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] [Indexed: 11/12/2022] Open
Abstract
Background: In patients with lymphedema (LE), in addition to hand dominance, between-group comparisons of interlimb soft tissue differences need to account for differences in whole-body adiposity, measured directly by dual energy X-ray absorptiometry (DXA) or indirectly by body mass index. No study has evaluated the effects of hand dominance and whole-body adiposity on limb composition in patients with LE. This study's purpose was to compare soft tissue composition of affected and unaffected limbs of women with breast cancer, who did and did not have LE, controlling for dominance and percent body fat. Methods and Results: Whole-body DXA scans were acquired and included measures of percent body fat, upper limb total mass, upper limb fat mass, and upper limb fat-free mass. Participants were classified into one of three groups: women without LE; women with only subjective LE; and women with objective signs of LE at the time of assessment. Differences among the LE groups were evaluated using analysis of variance (ANOVA) and Chi-square analyses. Analysis of covariance (ANCOVA) was used to control for percent body fat and for the affected limb dominance. Compared to women without LE, women with objective signs of LE have greater total limb mass, fat mass, and fat-free mass in their affected limbs, independent of affected side dominance and percent body fat. In addition, the interlimb differences in total mass, fat mass, and fat-free mass were greater for the women with objective signs of LE, compared to the other two groups. Conclusions: DXA is useful in identifying soft tissue changes in patients with LE. Given that limb circumferences measure only changes in limb volume and that bioimpedance provides estimates of extracellular fluid, DXA has the advantage of being able to estimate the volumes of specific tissues in the limb.
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Affiliation(s)
- Betty J. Smoot
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - John Shepherd
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Steven M. Paul
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Kord M. Kober
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Bruce A. Cooper
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Niharika Dixit
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Mei R. Fu
- School of Nursing, Boston College, Boston, Massachusetts, USA
| | - Gary Abrams
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- School of Medicine, University of California San Francisco, San Francisco, California, USA
- School of Nursing, University of California San Francisco, San Francisco, California, USA
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Park M, Kwon SY, Yun H, Lyu CJ, Han JW, Hahn SM, Jung M, Rha SY, Beom SH, Lee CK, Jang H. Care Needs of Adolescents and Young Adults with Cancer Undergoing Active Treatment in South Korea: A Mixed Methods Study. J Adolesc Young Adult Oncol 2022. [PMID: 35904961 DOI: 10.1089/jayao.2022.0030] [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] Open
Abstract
Purpose: Adolescents and young adults (AYAs) with cancer have special care needs that are different from those of children and older adults with cancer. This study assessed the perspective and experience of AYAs with cancer in South Korea to identify their care needs. Methods: This study used a convergent mixed-methods design. From July 2020 to November 2021, AYAs with cancer (N = 77; 15-39 years of age) participated in a quantitative cross-sectional study, using a tool developed by our study team. In May 2021, a qualitative focus group was conducted with 10 AYAs with cancer. Integrated analyses were conducted concurrently by reporting the quantitative and qualitative findings together. Results: Quantitative findings revealed that the highest care need domains were communication and information, whereas the highest care priority item was the management of pain and symptoms occurring during the treatment. Qualitative findings revealed 12 themes across 5 domains. Comparing and merging of the quantitative and qualitative data resulted in eight confirmed themes and four expanded findings, including knowing people who overcame similar illnesses, fear of death, dedicated space, and a program for AYAs with cancer. Conclusion: When developing and implementing programs and health care services, especially in countries with no established program or cancer specialty unit for AYAs with cancer, it is important to consider the special care needs and priorities of AYAs with cancer. This mixed methods study provided empirical evidence to help understand and prioritize the needs of AYAs with cancer undergoing active treatment in South Korea.
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Affiliation(s)
- Mina Park
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Department of Nursing, Yonsei University Graduate School, Seoul, South Korea
| | - Seung Yeon Kwon
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Palliative Care Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Hyeseon Yun
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Chuhl Joo Lyu
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung Woo Han
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Min Hahn
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Minkyu Jung
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea.,Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Hoon Beom
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Choong-Kun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyeju Jang
- Provider Partners Health Plan, Linthicum Heights, Maryland, USA
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Chen L, Zhao M, Tan L, Zhang Y. Effects of Five-Step Nutritional Interventions Conducted by a Multidisciplinary Care Team on Gastroenteric Cancer Patients Undergoing Chemotherapy: A Randomized Clinical Trial. Nutr Cancer 2022; 75:197-206. [PMID: 35903847 DOI: 10.1080/01635581.2022.2104329] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The present study aims to report a five-step nutritional intervention conducted by a multidisciplinary care team as well as to investigate its effects on the nutritional status and quality of life of gastroenteric cancer patients undergoing chemotherapy. A total of 176 patients with newly diagnosed gastroenteric cancer were enrolled in the observational study. The nutritional status of the patients was assessed using Patient-Generated Subjective Global Assessment (PG-SGA) and Nutritional Risk Screening-2002 (NRS-2002), and anthropometry and biological tests were performed. Patients were randomly divided into intervention group (n = 40) and control group (n = 38). Patients in the intervention group received five-step nutrition intervention, while the control group received routine nutrition management. In the newly diagnosed patients with gastroenteric cancer, 50% presented mild to moderate malnutrition, 29.5% presented severe malnutrition, while only 20.5% of patients were in good nutritional status. Nutritional interventions reduced the progression of malnutrition after 10 weeks. Anthropometric parameters increased as well as function and symptoms improved; therefore, controlled the decline in quality of life. To sum up, five-step nutritional interventions conducted by a multidisciplinary care team improved the nutritional status of patients with gastroenteric cancer undergoing chemotherapy, and showed positive impacts on quality of life.
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Affiliation(s)
- Lijia Chen
- Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Minyan Zhao
- Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Liping Tan
- Department of Nursing, the Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Yusong Zhang
- Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, PR China
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Haddad G, Hueniken K, Xu MC, Bratman S, de Almeida J, Goldstein D, Huang SH, Hansen A, Hope A, Spreafico A, Xu W, Liu G. Association of post-treatment longitudinal symptom severity clusters with subsequent survival in oropharyngeal cancer. Head Neck 2022; 44:2181-2196. [PMID: 35801270 DOI: 10.1002/hed.27139] [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: 07/18/2021] [Revised: 05/16/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with cancer often experience multiple symptoms concurrently. We identified patient clusters based on longitudinal symptom severity trajectories in oropharyngeal cancer (OPC) and evaluated the potential clinical utility of this approach. METHODS A retrospective OPC patient cluster analysis using 6 months of symptom severity data from radiotherapy initiation. The clinico-demographic characteristics and overall survival of patients were compared between clusters. RESULTS We identified four clusters of patients differing in longitudinal symptom severity. Cluster A (n = 168) included patients with the mildest longitudinal symptoms, cluster B (n = 59) and cluster C (n = 63) were intermediate, and cluster D (n = 30) included patients with the worst symptoms. The clusters differed in their HPV status, ECOG performance status, smoking history, drinking history, treatment modality, and 5-year survival. These clusters separated symptom severity trajectories more distinctly than individual clinico-demographic characteristics. CONCLUSIONS Early symptom severity trajectory clustering revealed distinct patient clusters that were prognostic of overall survival.
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Affiliation(s)
- Ghazal Haddad
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Hueniken
- Department of Biostatistics, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Maria Christine Xu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Scott Bratman
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - John de Almeida
- Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David Goldstein
- Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Aaron Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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40
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Sex differences exist in the perceived relief of cancer symptoms with medical cannabis: results from the Quebec Cannabis Registry. Support Care Cancer 2022; 30:7863-7871. [PMID: 35723729 DOI: 10.1007/s00520-022-07193-1] [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] [Received: 07/13/2021] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study explored whether symptom relief differs by sex in patients with cancer receiving medical cannabis (MC) therapy. METHODS This is an analysis of data collected from patients with cancer enrolled in the Quebec Cannabis Registry. MC was initiated for the therapeutic management of cancer symptoms. Patients completed the revised Edmonton Symptom Assessment System (ESAS-r) questionnaire at baseline and 3-month follow-up. We examined the interaction between sex and time on each ESAS-r symptom and the interaction between time and tetrahydrocannabinol:cannabidiol (THC:CBD) ratios for each sex on total symptom burden. RESULTS The analysis included 358 patients (M: 171). There were no sex differences in baseline ESAS-r scores. Three months of MC therapy led to significant improvements in pain (M: - 1.4 ± 0.3, p < 0.001; F: - 1.1 ± 0.3, p < 0.01), tiredness (M: - 1.7 ± 0.4, p < 0.001; F: - 1.2 ± 0.4, p < 0.05), anxiety (M: - 1.1 ± 0.4, p < 0.05; F: - 1.2 ± 0.4, p < 0.001), and well-being (M: - 1.2 ± 0.4, p < 0.05; F: - 1.4 ± 0.4, p < 0.01) in both sexes. Only F perceived improved drowsiness (- 1.1 ± 0.4, p < 0.05), nausea (- 0.9 ± 0.3, p < 0.05), lack of appetite (- 1.7 ± 0.4, p < 0.001), and shortness of breath (- 0.9 ± 0.3, p < 0.05). From baseline to 3-month follow-up, THC-dominant MC significantly reduced pain (- 1.52 ± 0.52, p < 0.05) in M, whereas in F it diminished nausea (- 2.52 ± 0.70, p < 0.01) and improved well-being (- 2.41 ± 0.79, p < 0.05). THC:CBD-balanced products significantly reduced pain (- 1.48 ± 0.49, p < 0.05), tiredness (- 1.82 ± 0.62, p < 0.05), anxiety (- 1.83 ± 0.54, p < 0.05), and improved well-being (- 2.01 ± 0.56, p < 0.01) in M. CBD-dominant products did not offer significant symptom relief in either sex. CONCLUSION The perceived relief of cancer symptoms from MC differs between sexes. More randomized controlled trials are needed to confirm our findings.
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Hiccups in patients with cancer: a multi-site, single-institution study of etiology, severity, complications, interventions, and outcomes. BMC Cancer 2022; 22:659. [PMID: 35705907 PMCID: PMC9202213 DOI: 10.1186/s12885-022-09760-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background To our knowledge, previous studies have not investigated hiccups in patients with cancer with detailed patient-level data with the goal of capturing a broad spectrum of hiccup symptomatology. Methods This multi-site, single institution study examined consecutive medical records to better understand hiccups in patients with cancer. Results A total of 320 patients are the focus of this report. The median age of patients when hiccups were first reported in the medical record was 63 years (range: 21, 97 years) with 284 (89%) men and 36 (11%) women. The most common diagnose was gastrointestinal cancer. Hiccups most frequently occurred daily, as seen in 194 patients (62%), and the most common duration was less than 1 week, as seen in 146 patients (47%). However, nine patients had had daily hiccups for greater than 6 weeks, and 5 had symptoms for years. Cited etiology was non-chemotherapy medications in 36 (11%) and cancer chemotherapy in 19 (6%). Complications occurred in approximately a third and included insomnia in 51 patients (16%); hospitalization or emergency department visit in 34 (11%); and musculoskeletal pain in 23 (7%). Baclofen was the single most prescribed agent for hiccup palliation, but 100 patients received more than one medication. Medical procedures, which included acupuncture, paracentesis, or phrenic nerve block, were performed in 5 patients. In 234 patients (73%), the medical record documented hiccup cessation. Conclusions Hiccups appear to be highly problematic in a small subset of patients with cancer with no well-defined palliative approaches.
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Hadler RA, Goldshore M, Rosa WE, Nelson J. "What do I need to know about you?": the Patient Dignity Question, age, and proximity to death among patients with cancer. Support Care Cancer 2022; 30:5175-5186. [PMID: 35246729 PMCID: PMC8896848 DOI: 10.1007/s00520-022-06938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/24/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The Patient Dignity Question (PDQ), "What do I need to know about you as a person to give you the best care possible?" is a validated instrument designed to assess patient priorities and stressors. Administration of the PDQ has been demonstrated to improve patient-provider relationships. The PDQ has been evaluated in multiple settings, but never as a standard component of palliative care consultation. The primary objectives of this study were to determine the feasibility of PDQ screening in palliative care consultation and to characterize responses. The secondary objective was to determine patient and disease factors associated with PDQ response among patients diagnosed with cancer. METHODS PDQ responses were collected from 2015 to 2017, and patient survival data collected through 2018. A codebook was developed to categorize responses using literature review and template analysis; coding was performed until thematic saturation was achieved. We descriptively analyzed thematic distribution among responders and performed multivariable multinomial regression to determine the association between patient characteristics and PDQ response. RESULTS Response to the PDQ was documented in 2053/5002 consultations (41.1%); 1877 patient responses were included in final analysis. A total of 544 (29.5%) patients referenced illness-related concerns, 879 (46.8%) shared personal insights, and 283 (15.1%) cited interpersonal relationships. Younger patients frequently reported illness-related concerns; older respondents (age > 65) often responded with insights into their identity. Patients' responses evaluated less than 1 year before death were more likely to focus upon identity and interpersonal relationships than illness-related concerns. CONCLUSION The PDQ can be used as a means of eliciting values among patients with cancer. Variations in response pattern suggest that approaches to distress may be tailored to age and proximity to death.
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Affiliation(s)
- R. A. Hadler
- Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242 USA
| | - M. Goldshore
- Department of Surgery, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - W. E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Fl, New York, NY 10022 USA
| | - J. Nelson
- Division of Supportive Care, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
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Parikh RB, Ferrell W, Wakim J, Williamson J, Khan N, Kopinsky M, Balachandran M, Gabriel PE, Zhang Y, Schuchter LM, Shulman LN, Chen J, Patel MS, Manz CR. Patient and clinician nudges to improve symptom management in advanced cancer using patient-generated health data: study protocol for the PROStep randomised controlled trial. BMJ Open 2022; 12:e054675. [PMID: 35551088 PMCID: PMC9109034 DOI: 10.1136/bmjopen-2021-054675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Patients with advanced cancers often face significant symptoms from their cancer and adverse effects from cancer-associated therapy. Patient-generated health data (PGHD) are routinely collected information about symptoms and activity levels that patients either directly report or passively record using devices such as wearable accelerometers. The objective of this study was to test the impact of an intervention integrating remote collection of PGHD with clinician and patient nudges to inform communication between patients with advanced cancer and their oncology team regarding symptom burden and functional status. METHODS AND ANALYSIS This single-centre prospective randomised controlled trial randomises patients with metastatic gastrointestinal or lung cancers into one of three arms: (A) usual care, (B) an intervention that integrates PGHD (including weekly text-based symptom surveys and passively recorded step counts) into a dashboard delivered to oncology clinicians at each visit and (C) the same intervention as arm B but with an additional text-based active choice intervention to patients to encourage discussing their symptoms with their oncology team. The study will enrol approximately 125 participants. The coprimary outcomes are patient perceptions of their oncology team's understanding of their symptoms and their functional status. Secondary outcomes are intervention utility and adherence. ETHICS AND DISSEMINATION This study has been approved by the institutional review board at the University of Pennsylvania. Study results will be disseminated using methods that describe the results in ways that key stakeholders can best understand and implement. TRIAL REGISTRATION NUMBERS NCT04616768 and 843 616.
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Affiliation(s)
- Ravi B Parikh
- Abramson Cancer Center, Philadelphia, Pennsylvania, USA
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - William Ferrell
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jonathan Wakim
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joelle Williamson
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Neda Khan
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Michael Kopinsky
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Mohan Balachandran
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | | | - Yichen Zhang
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | - Jinbo Chen
- Abramson Cancer Center, Philadelphia, Pennsylvania, USA
| | - Mitesh S Patel
- Departments of Medical Ethics and Health Policy and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher R Manz
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medical Oncology, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
OPINION STATEMENT Cannabinoids have been purported as having a wide range of therapeutic uses although currently, there is minimal evidence to support these claims. Patients with advanced cancer experience many distressing symptoms, with some turning to medicinal cannabis to help alleviate these. Focus has fallen on cannabidiol (CBD) as a potential treatment for a variety of symptoms in advanced cancer due to the lack of psychoactive side effects and the potential molecular mechanisms of action associated with this cannabinoid. Many cannabinoid products are easily available in the community, and more countries are legalizing or allowing over the counter products. Studies show that CBD is generally well tolerated, but there are many potential drug interactions that have not been well studied. Few studies have specifically looked at the role of CBD in treating cancer symptoms, with most focusing on combination cannabinoid products. There are currently many unknowns associated with CBD, including which symptoms it might be best for, appropriate dosing, and route of administration. This is especially important in advanced cancer where patients often have significant organ dysfunction and frailty that could impact on the pharmacology of CBD. A small pilot study has shown promise for a role of CBD in the psychological symptoms associated with advanced cancer. Further research is currently underway to further clarify the role of CBD in this setting and to understand how best it might help our patients. Currently we advocate that CBD be used in supervised clinical trials, so that efficacy and adverse effects can be closely monitored.
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Hiratsuka Y, Suh SY, Won SH, Kim SH, Yoon SJ, Koh SJ, Kwon JH, Park J, Ahn HY, Cheng SY, Chen PJ, Yamaguchi T, Morita T, Tsuneto S, Mori M, Inoue A. Prevalence and severity of symptoms and signs in patients with advanced cancer in the last days of life: the East Asian collaborative cross-cultural study to elucidate the dying process (EASED). Support Care Cancer 2022; 30:5499-5508. [PMID: 35304634 DOI: 10.1007/s00520-022-06969-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/10/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Few large-scale studies have focused on the prevalence of symptoms and signs during the last days of patients diagnosed with advanced cancer. Identifying the patterns of specific symptoms according to cancer type is helpful to provide end-of-life care for patients with advanced cancer. We investigated the prevalence and severity of symptoms and signs associated with impending death in patients with advanced cancer. METHODS In this secondary analysis of an international multicenter cohort study conducted in three East Asian countries, we compared the severity of symptoms and signs among dying patients in the last 3 days of life according to the type of primary cancer using one-way analysis of variance (ANOVA). Post hoc analysis was conducted for multiple comparisons of each symptom according to the type of primary cancer. RESULTS We analyzed 2131 patients from Japan, Korea, and Taiwan. The prevalence of most symptoms and signs were relatively stable from 1 week after admission to the last 3 days of life. According to cancer type, edema of the lower extremities was the most common symptom and fatigue/ ascites were the most severe symptoms in digestive tract cancer. For lung cancer, respiratory secretion was the most prevalent and dyspnea/respiratory secretion were the most severe symptoms. CONCLUSION We demonstrated the prevalence and severity of symptoms and signs associated with the impending death of patients with advanced cancer in East Asia. Our study can enable clinicians to recognize the specific symptoms and signs at the very end of life.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea.
- Department of Medicine, Dongguk University Medical School, Pildong 1-30, Jung-gu, Seoul, South Korea.
| | - Seon-Hye Won
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Su-Jin Koh
- Department Hematology and Oncology, Ulsan University Hospital Ulsan University College of Medicine, Ulsan, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jeanno Park
- Department of Internal Medicine, Bobath Hospital, Seongnam, South Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Fan R, Yang S, Bu X, Chen Y, Wang Y, Shen B, Qiu C, Li X. Symptomatic Features and Factors Associated With Do-Not-Resuscitate Consent in Advanced Cancer Patients Admitted to Palliative Care Ward. Am J Hosp Palliat Care 2022; 39:1312-1324. [PMID: 35041534 DOI: 10.1177/10499091211068824] [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: 11/15/2022] Open
Abstract
This study aimed to conduct a retrospective cross-sectional study to investigate the prevalence of symptoms and symptom clusters on sociodemographic and disease characteristics, as well as factors associated with Do-Not-Resuscitate (DNR) consent. Advanced cancer patients were enrolled between 2018 and 2020 with available data. Demographic and clinical data were obtained for analysis from Hospital Information System (HIS) in China. Symptom clusters were extracted by hierarchical cluster analysis. Chi-square test and multiple logistic regression were conducted to investigate the prevalence characteristics of symptoms and influencing factors of DNR consent, respectively. 798 advanced cancer patients were enrolled. The most prevalent symptoms were pain (93%), anorexia (36.5%), and sleep disorders (34.2%). High heart rate was associated with poor performance status and more symptoms. Three clusters were extracted: fatigue-related, respiratory-circulatory system, and digestive system symptom clusters. The incidence of symptoms was statistically significant in age, gender, education level, residence, BMI, performance status, distress score, ADL, and primary pain level. The DNR signature rate was 15.5%. Female, distant metastasis, in-ward rescue, and appearance of dyspnea were independent influencing factors of DNR signature.Chinese hospitalized cancer patients had more symptoms burden that were influenced by various demographic characteristics, especially pain and fatigue-related symptoms. Concerning the trajectory of vital signs is important among advanced cancer patients. The DNR signature rate was lower and our finding indicating an urgency to accurately assess the prognosis and give more palliative care education to enhance DNR rates and early signing in Chinese context.
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Affiliation(s)
- Rongrong Fan
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Siyu Yang
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Xiaofan Bu
- 12570Xiangya Nursing School of Central South University, Changsha, China
| | - Yongyi Chen
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Ying Wang
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Boyong Shen
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Cuiling Qiu
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Xuying Li
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
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Wulff-Burchfield E. Supportive and Palliative Care for Genitourinary Malignancies. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_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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Sousa MS, Davis W, Blanchard M, Razmovski-Naumovski V, Agar M, Daveson B, Hsm D, Currow DC. Appetite-Related Distress Is Burdensome in the Last Sixty Days of Life of People Receiving Palliative Care: A National Longitudinal Consecutive Cohort Study. J Palliat Med 2021; 25:636-642. [PMID: 34978898 DOI: 10.1089/jpm.2021.0462] [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] Open
Abstract
Background: People with life-limiting illnesses experience a range of distressing symptoms. Appetite-related symptoms are common, but studies have found varied prevalence and the distress caused has had limited quantification. Objectives: To examine the clinicodemographic factors and trajectory of appetite-related distress in the last 60 days of life. Design/Setting/Subjects: Consecutive cohort of 109,385 patients (359,038 data points) using specialist palliative care services in the Australian Palliative Care Outcomes Collaboration (PCOC). Measurements: Patient-reported appetite-related distress using the PCOC Symptom Assessment Scale. Results: Diagnoses included cancer (75%), end-stage organ failure (11%), neurodegenerative disease (4%), dementia (3%), and other noncancer (7%). Fifty-eight percent reported some degree of appetite-related distress at least once in the last 60 days of life. Daily mean distress scores did not vary greatly by diagnosis and the distributions of symptom severity were not linked with performance status. There was a sharp decline in mean distress for all diagnostic groups around 7-10 days before death. Moderate to severe distress was associated with nausea-, bowel-, pain-, and breathing-related distress, controlling for key baseline factors. Conclusion: Appetite-related distress is prevalent and burdensome in the 60 days before death and is strongly associated with distress from other cardinal symptoms.
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Affiliation(s)
- Mariana S Sousa
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Walter Davis
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Megan Blanchard
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Valentina Razmovski-Naumovski
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Meera Agar
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | | | - Dip Hsm
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - David C Currow
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.,Wolfson Palliative Care Research Centre, University of Hull, Hull, England
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Mori M, Kawaguchi T, Imai K, Yokomichi N, Yamaguchi T, Suzuki K, Matsunuma R, Watanabe H, Maeda I, Matsumoto Y, Matsuda Y, Morita T. Visualizing How to Use Parenteral Opioids for Terminal Cancer Dyspnea: A Pilot, Multicenter, Prospective, Observational Study. J Pain Symptom Manage 2021; 62:936-948. [PMID: 33992759 DOI: 10.1016/j.jpainsymman.2021.05.001] [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: 01/24/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT How physicians use opioids for dyspnea in imminently dying cancer patients (terminal dyspnea) varies markedly, which could hamper quality care. OBJECTIVES To examine the adherence to an algorithm-based treatment for terminal dyspnea, and explore its outcomes over 24 hours. METHODS This was a pre-planned subgroup analysis of a multicenter prospective observational study. Inclusion criteria were: advanced cancer patients admitted to palliative care units, ECOG performance status = 3-4, and a dyspnea intensity ≥2 on the Integrated Palliative care Outcome Scale (IPOS). We developed an algorithm to visualize how palliative care physicians would use parenteral opioids. Participating physicians (palliative care specialists) initiated parenteral opioids, choosing whether to use the algorithm based on their preference. We measured the adherence rate to the algorithm over 24 hours (predefined goal = 70%), and compared dyspnea IPOS scores and adverse events between patients with and without algorithm-based treatment. RESULTS Of 164 patients (median survival = 5 days), 71 (43%) received algorithm-based treatment, and 70 (99%; 95% confidence interval = 92%-100%) adhered to it over 24 hours. In a complete case analysis, mean dyspnea IPOS scores significantly decreased from 2.9 (standard error = 0.1) to 1.5 (0.1) in the algorithm group (n = 54; P < 0.001), and 2.9 (0.1) to 1.6 (0.1) in the non-algorithm group (n = 72; P < 0.001). There was no significant between-group difference in changes in dyspnea IPOS scores (P = 0.65). Adverse events were rare (n = 5). CONCLUSION The algorithm-based treatment was feasible, and might be as effective and safe as the usual care by palliative care specialists. Its implementation may help physicians provide quality care for terminal dyspnea.
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Affiliation(s)
- Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Naosuke Yokomichi
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Medical Center, Kobe, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-chuo Hospital, Osaka, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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50
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Oelschlägel L, Dihle A, Christensen VL, Heggdal K, Moen A, Österlind J, Steindal SA. Implementing welfare technology in palliative homecare for patients with cancer: a qualitative study of health-care professionals' experiences. BMC Palliat Care 2021; 20:146. [PMID: 34535125 PMCID: PMC8448170 DOI: 10.1186/s12904-021-00844-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/09/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Introducing welfare technology in home-based palliative care has been suggested to be beneficial for improving access to health care at home and enhancing patients' feelings of security and safety. However, little is known about the experiences of municipal health-care professionals using welfare technology in palliative home care. The aim of this study was to explore municipal health-care professionals' experiences regarding the significant challenges, facilitators, and assessments associated with implementing a technological solution named "remote home care" in palliative home care for patients with cancer. METHODS A qualitative, descriptive, exploratory design was used. Data were collected through focus-group interviews and individual semi-structured interviews with interdisciplinary health-care professionals who had experience using remote home care in clinical encounters with cancer patients who were in the palliative phase and living at home. Data were analyzed using qualitative content analysis. RESULTS Three themes were identified: 1) shifting from objective measures to assessing priorities for patients, 2) lack of experience and personal distress regarding cancer inhibits professional care, and 3) prominent organizational challenges undermine the premise of remote home care. CONCLUSION The results showed that shifting from a disease-focused to a person-centered approach enables health-care professionals to assess patients' personal priorities. However, health-care professionals' uncertainty and lack of knowledge and experience, along with organizational issues concerning information-sharing, represent great challenges that have the potential to inhibit professional care. The availability of networks through which difficult issues can be discussed was highlighted as being a fundamental resource for facilitating the provision of care.
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Affiliation(s)
- Lina Oelschlägel
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456, Oslo, Norway.
- Department of Nursing, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Alfhild Dihle
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Vivi L Christensen
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456, Oslo, Norway
- University of South-Eastern Norway, Drammen, Norway
| | - Kristin Heggdal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456, Oslo, Norway
| | - Anne Moen
- Department of Nursing, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jane Österlind
- Department of Healthcare Sciences/Palliative Research Center, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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