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Davis MP. Novel therapies for nausea and vomiting in advanced illness and supportive cancer care. Palliat Care Soc Pract 2024; 18:26323524241257701. [PMID: 38855566 PMCID: PMC11159532 DOI: 10.1177/26323524241257701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
Nausea and vomiting are common experiences and are often dreaded more than pain. This review discusses blonanserin, mirtazapine, and isopropyl alcohol as antiemetics. Blonanserin, an atypical antipsychotic with a high affinity for dopamine D2 and D3 receptors and serotonin receptor 5-HT2A, has less of a risk of extrapyramidal adverse effects. Transdermal blonanserin, available in Korea, Japan, and China in a small number of trials, has improved nausea in patients not responding to standard antiemetics. Mirtazapine is a noradrenergic and specific serotonergic antidepressant that has been used for multiple symptoms besides depression. There is little evidence that mirtazapine improves anorexia or nausea in advanced cancer but is as effective as olanzapine in reducing chemotherapy-induced nausea and vomiting. Isopropyl alcohol aromatherapy has been successfully used in the emergency department for nausea and vomiting with an onset to benefit more rapidly than standard antiemetics. Isopropyl alcohol prep pads can be used for home-going antiemetic therapy and as a bridge to treating acute nausea until standard antiemetics take effect.
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Affiliation(s)
- Mellar P. Davis
- Geisinger Commonwealth School of Medicine, 100 North Academy Avenue, Danville, PA 17822, USA
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Arrieta O, Cárdenas-Fernández D, Rodriguez-Mayoral O, Gutierrez-Torres S, Castañares D, Flores-Estrada D, Reyes E, López D, Barragán P, Soberanis Pina P, Cardona AF, Turcott JG. Mirtazapine as Appetite Stimulant in Patients With Non-Small Cell Lung Cancer and Anorexia: A Randomized Clinical Trial. JAMA Oncol 2024; 10:305-314. [PMID: 38206631 PMCID: PMC10784994 DOI: 10.1001/jamaoncol.2023.5232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/17/2023] [Indexed: 01/12/2024]
Abstract
Importance Currently there is no standard therapy to improve cancer-related anorexia, hampering survival. Mirtazapine has been suggested as a feasible option in this context. Objectives To assess the effect of mirtazapine on appetite and energy consumption in patients with advanced non-small cell lung cancer (NSCLC). Design, Setting, and Participants This randomized, double-blind, placebo-controlled clinical trial including adults was performed in a tertiary cancer care center from August 2018 to May 2022 with a follow-up of 8 weeks. Overall, 134 patients were screened; 114 were assessed for eligibility and 28 were excluded. Interventions Patients were randomized in a 1:1 ratio to receive mirtazapine, 15 mg, or placebo for 2 weeks followed by a dose escalation to 30 mg until week 8 or placebo. Both groups received nutritional assessment and dietary advice. Main outcomes and measures Appetite was assessed by the Anorexia Cachexia Scale and energy intake. Dietary parameters were evaluated at baseline, 4 weeks, and 8 weeks, with a 24-hour dietary recall, and energy quantification based on the Mexican system of nutritional equivalents. Results A total of 86 patients met the inclusion criteria and were randomized to the placebo (n = 43) or the mirtazapine group (n = 43). The mean (SD) age was 63.5 (11.2) years, 41 were women (57.7%) and had adenocarcinoma, Eastern Cooperative Oncology Group performance status scale score of 1, stage IV NSCLC, and were receiving first-line treatment. Baseline characteristics were similar between groups. There was no difference in appetite scores in patients who received mirtazapine or placebo after 4 and 8 weeks. After 4 weeks, mirtazapine significantly increased energy intake (379.3 kcal; 95% CI, 1382.6-576.1; P < .001) including proteins (22.5 g; 95% CI, 11.5-33.4; P = .001), carbohydrates (43.4 g; 95% CI, 13.1-73.8; P = .006), and fats (13.2 g; 95% CI, 6.0-20.4; P = .006). Fats intake was significantly higher in patients in the mirtazapine group (14.5 g vs 0.7 g; P = .02) after 8 weeks. The mirtazapine group significantly decreased the proportion of patients with sarcopenia (82.8% vs 57.1%, P = .03) at 8 weeks. Patients on mirtazapine tolerated the treatment well, but reported a higher perception of nightmares at 2 weeks based on a 10 cm VAS score (0 [25th-75th percentile, 0-1] vs 0 [25th-75th percentile, 0-0] in the control group; P = .009) but this finding was nonsignificant after 4 and 8 weeks. Conclusion and Relevance In this randomized clinical trial of patients with advanced NSCLC, there was no difference in appetite scores in all patients who received mirtazapine or placebo, but the mirtazapine group had a significant increase in energy intake through the 4- and 8-week follow-up, mainly in fat intake, which is a better and crucial source of energy. The addition of mirtazapine in the treatment of patients with advanced NSCLC and anorexia may help these patients achieve their energy requirements and improve health-related quality of life, specifically emotional and cognitive functioning. Trial Registration ClinicalTrials.gov Identifier: NCT04748523.
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Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Daniela Cárdenas-Fernández
- Nutrition department of Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Oscar Rodriguez-Mayoral
- Palliative Care department, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | | | - Diana Castañares
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Diana Flores-Estrada
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Edgar Reyes
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Dennis López
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Pablo Barragán
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Pamela Soberanis Pina
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | | | - Jenny G. Turcott
- Nutrition department of Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
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Almeida OLS, Ferriolli E, Taveira RCC, Rosenburg MG, Campanari DD, da Cruz Alves NM, Pfrimer K, Rapatoni L, Peria FM, Lima NKC. Mirtazapine versus Megestrol in the Treatment of Anorexia-Cachexia Syndrome in Patients with Advanced Cancer: A Randomized, Double-Blind, Controlled Phase II Clinical Trial. Cancers (Basel) 2023; 15:3588. [PMID: 37509249 PMCID: PMC10377007 DOI: 10.3390/cancers15143588] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
This study compared mirtazapine with megestrol in the management of cancer-related anorexia-cachexia syndrome in patients with advanced cancer. A randomized, double-blind, controlled clinical trial involving patients with advanced cancer and anorexia-cachexia syndrome was performed. Participants received mirtazapine 30 mg/day or megestrol 320 mg/day for eight weeks. The primary endpoint was the effect of mirtazapine on weight gain and the secondary endpoints were its effect on appetite, muscle strength, physical performance, body composition, adverse events, and medication adherence. Linear regression model with mixed effects was applied and a significance level of 5% was adopted. Fifty-two patients were randomized. Mean age was 65.8 ± 8.4 years. There was weight gain in 52% of the participants in the megestrol group and in 38% in the mirtazapine group after four weeks (p = 0.040). Appetite improved in 92% of the participants in the megestrol group and in 56% in the mirtazapine group after eight weeks (p = 0.007). In the sub-analysis by sex, women showed improvement in appetite (p < 0.001) and weight gain (p < 0.005) in the mirtazapine group, which was not observed in men. Mirtazapine appears to be inferior to megestrol in weight and appetite improvement. However, there may be a difference in the therapeutic response between sexes.
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Affiliation(s)
- Olga Laura Sena Almeida
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
| | - Eduardo Ferriolli
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
| | - Roberta Cristina Cintra Taveira
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
| | - Meire Gallo Rosenburg
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
| | - Daniela Dalpubel Campanari
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
| | - Natália Maira da Cruz Alves
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
| | - Karina Pfrimer
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
| | - Liane Rapatoni
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
| | - Fernanda Maris Peria
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
| | - Nereida K C Lima
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
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Propensity score-matching analysis comparing safety outcomes of appetite-stimulating medications in oncology patients. Support Care Cancer 2022; 30:6299-6305. [PMID: 35471615 DOI: 10.1007/s00520-022-07081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/20/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE Anorexia and weight loss are common complications in the elderly, advanced cancer population. Appetite stimulants are commonly used therapies for oncology patients with weight loss, yet their safety comparison remains unknown. METHODS This was a two-center, retrospective, study conducted in New York City at Mount Sinai Beth Israel and New York University Langone from January 2016 to July 2019 in adult patients with histologic evidence of malignancy who were taking either megestrol acetate or mirtazapine as an appetite-stimulating medication. Endpoints included safety concerns of mortality, QTc prolongation, venous thromboembolism, fall, somnolence, xerostomia, and hallucinations. Effectiveness of weight gain or maintenance of weight was not assessed. A propensity score-matching analysis was performed using a logistic regression analysis to assess the two comparable groups. RESULTS The study included 350 patients (69.56 ± 13.31 years) with the most common malignancies being gastrointestinal, breast, and hematologic with metastasis present in over half the patients. Adverse events were commonly seen in the oncology population. After a propensity score-matched analysis, all safety outcomes associated with mirtazapine compared to megestrol acetate were similar; all-cause mortality (7%, n = 7 vs. 12%, n = 12, p = 0.23), QTc prolongation (31%, n = 31 vs. 31%, n = 31, p = 1.00), thromboembolism (11%, n = 11 vs. 11%, n = 11, p = 1.00), somnolence (29%, n = 30 vs. 22%, n = 23, p = 0.34), xerostomia (27%, n = 28 vs. 18%, n = 19, p = 0.24), and hallucinations (17%, n = 18 vs. 8%, n = 8, p = 0.06), respectfully. CONCLUSION There were no safety differences seen when evaluating both agents.
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Hunter CN, Abdel-Aal HH, Elsherief WA, Farag DE, Riad NM, Alsirafy SA. Mirtazapine in Cancer-Associated Anorexia and Cachexia: A Double-Blind Placebo-Controlled Randomized Trial. J Pain Symptom Manage 2021; 62:1207-1215. [PMID: 34051293 DOI: 10.1016/j.jpainsymman.2021.05.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 01/03/2023]
Abstract
CONTEXT Few pharmacological interventions are available for cancer-associated anorexia and cachexia. Mirtazapine has been suggested for use in cancer-associated anorexia and cachexia. OBJECTIVES This study was conducted to assess the efficacy and tolerability of mirtazapine in cancer-associated anorexia and cachexia. METHODS A double-blind placebo-controlled randomized trial. The study included 120 incurable solid tumour patients with anorexia (appetite loss ≥4 on 0 - 10 scale, 10 = maximum appetite loss), cachexia (>5% body weight loss over 6 months or >2% plus body mass index <20) and depression score ≤3 on 0-6 scale (6 = extreme feelings of depression). Patients were 1:1 randomized to receive mirtazapine 15mg daily at night for 8 weeks or placebo. The primary endpoint was change in appetite from baseline to day 28. Other outcomes included changes in quality-of-life, fatigue, depressive symptoms, body weight, lean body mass, handgrip strength, inflammatory markers, adverse events and survival. RESULTS 48 (80%) patients in the mirtazapine arm and 52 (87%) in the placebo were assessable for the 1ry endpoint. Appetite score increased significantly with mirtazapine as well as with placebo (P < 0.0001 each). The increase in appetite score did not differ significantly between the two arms in the per-protocol and intention-to-treat analysis (P = 0.472 and 0.462, respectively). Mirtazapine was associated with significantly less increase in depressive symptoms and higher prevalence of somnolence. The change in other outcomes did not differ significantly between mirtazapine and placebo. CONCLUSION Mirtazapine 15mg at night for 28 days is no better than placebo in improving the appetite of incurable solid tumor patients with cancer-associated anorexia and cachexia.
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Affiliation(s)
- Catherine N Hunter
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hesham H Abdel-Aal
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Wessam A Elsherief
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Dina E Farag
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Nermine M Riad
- Clinical and Chemical Pathology Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Samy A Alsirafy
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
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Mogavero MP, DelRosso LM, Fanfulla F, Bruni O, Ferri R. Sleep disorders and cancer: State of the art and future perspectives. Sleep Med Rev 2020; 56:101409. [PMID: 33333427 DOI: 10.1016/j.smrv.2020.101409] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 12/29/2022]
Abstract
A bidirectional connection between sleep and cancer exists; however, the specific associations between individual sleep disorders and particular tumors are not very clear. An accurate assessment of sleep disorders in cancer patients is necessary to improve patient health, survival, response to therapy, quality of life, reduction of comorbidities/complications. Indeed, recent scientific evidence shows that knowledge and management of sleep disorders offer interesting therapeutic perspectives for the treatment of cancer. In light of this need, the objective of this review is to assess the evidence highlighted in the research of the last ten years on the correlation between each specific category of sleep disorder according to the International Classification of Sleep Disorders 3rd Ed. and several types of tumor based on their anatomical location (head-neck, including the brain and thyroid; lung; breast; ovary; endometrium; testes; prostate; bladder; kidney; gastrointestinal tract, subdivided into: stomach, liver, colon, pancreas; skin; bone tumors; hematological malignancies: leukemia, lymphoma, multiple myeloma, polycythemia), in order to evaluate what is currently known about: 1) sleep disorders as cancer risk factor; 2) tumors associated with the onset of sleep disorders; 3) targeted therapies of sleep disorders in cancer patients and new oncological perspectives following the evaluation of sleep.
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Affiliation(s)
- Maria Paola Mogavero
- Sleep Medicine Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Pavia 27100, Italy
| | - Lourdes M DelRosso
- Pulmonary and Sleep Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Francesco Fanfulla
- Sleep Medicine Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Pavia 27100, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome 00185, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Research Institute, IRCCS, Troina 94018, Italy.
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Economos G, Lovell N, Johnston A, Higginson IJ. What is the evidence for mirtazapine in treating cancer-related symptomatology? A systematic review. Support Care Cancer 2020; 28:1597-1606. [PMID: 31858251 PMCID: PMC7036072 DOI: 10.1007/s00520-019-05229-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/05/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Cancer patients often experience multiple distressing symptoms which are challenging to manage. It would therefore be helpful to find a treatment that alleviates more than one symptom, to avoid polypharmacy: mirtazapine has been used in several studies for this purpose. The objective of this study was to assess the effectiveness and safety of mirtazapine in alleviating one or more frequently encountered cancer-related symptoms. METHODS Systematic review of clinical trials in English or French. Eight databases were searched. Included studies assessed the effectiveness of mirtazapine in alleviating one or more frequently encountered cancer-related symptoms. Comparator and validated assessment tools were required. Studies were independently appraised by two investigators before data synthesis. RESULTS The search yielded 1898 references, from which we identified 12 relevant articles evaluating highly heterogeneous outcomes. These were two randomised-controlled (RCTs), three non-randomised controlled, and seven non-randomised non-controlled trials. In total, 392 participants were included and 185 were in RCTs. No study assessed the effectiveness of mirtazapine in alleviating symptoms at the same time, but some considered more than one symptom. Overall, the data was of poor quality, limited by small sample size and bias. However, mirtazapine showed effectiveness in treating depression, anxiety, sleep disorders, emesis and neuropathic pain. Across all studies, mirtazapine is safe to use, with drowsiness and dizziness the most common side-effects. CONCLUSION Study design and small sample sizes limit the ability to interpret results. Trials to assess the impact of mirtazapine or other medicines in alleviating multiple symptoms would be valuable.
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Affiliation(s)
- Guillaume Economos
- Cicely Saunders Institut, Departement Palliative Care Policy and Rehabilitation, King’s College London, 10 Cutcombe Rd, Brixton, London, SE5 9PJ UK
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Palliative Care, 165 chemin du Grand Revoyet, 69310 Pierre-Bénite, France
| | - Natasha Lovell
- Cicely Saunders Institut, Departement Palliative Care Policy and Rehabilitation, King’s College London, 10 Cutcombe Rd, Brixton, London, SE5 9PJ UK
| | - Anna Johnston
- Cicely Saunders Institut, Departement Palliative Care Policy and Rehabilitation, King’s College London, 10 Cutcombe Rd, Brixton, London, SE5 9PJ UK
| | - Irene J. Higginson
- Cicely Saunders Institut, Departement Palliative Care Policy and Rehabilitation, King’s College London, 10 Cutcombe Rd, Brixton, London, SE5 9PJ UK
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Ständer S, Zeidler C, Augustin M, Bayer G, Kremer AE, Legat FJ, Maisel P, Mettang T, Metz M, Nast A, Niemeier V, Raap U, Schneider G, Ständer HF, Staubach P, Streit M, Weisshaar E. S2k Guidelines for the diagnosis and treatment of chronic pruritus - update - short version. J Dtsch Dermatol Ges 2018; 15:860-872. [PMID: 28763584 DOI: 10.1111/ddg.13304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Associated with a host of different diseases, pruritus is a cardinal symptom that poses an interdisciplinary diagnostic and therapeutic challenge. Over time, that symptom may progress independently of the initial cause, thus losing its function as a warning sign and turning into a clinically relevant disease of its own. In Germany, approximately 13.5 % of the general population are affected by chronic pruritus, with an incidence of 7 %. All forms of chronic pruritus require targeted treatment consisting of (a) diagnosis and management of the underlying disease, (b) dermatological treatment of primary or secondary (for example, dry skin, scratch lesions) symptoms, (c) symptomatic antipruritic treatment, and (d) psychological/psychotherapeutic treatment in case of an underlying or associated psychological or psychosomatic condition. Medical care of patients with chronic pruritus should therefore include an interdisciplinary approach, in particular with respect to diagnosis and therapy of the underlying disease as well as in terms of the management of treatment and adverse events. The objective of the present interdisciplinary guidelines is to define and standardize diagnostic and therapeutic procedures in patients with chronic pruritus. This is a short version of the current S2 guidelines on chronic pruritus. The long version may be found at www.awmf.org.
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Affiliation(s)
- Sonja Ständer
- Center for Chronic Pruritus (KCP) and Department of Dermatology, University Medical Center, Münster, Germany
| | - Claudia Zeidler
- Center for Chronic Pruritus (KCP) and Department of Dermatology, University Medical Center, Münster, Germany
| | - Matthias Augustin
- Institute for Health Care Research in Dermatology and Nursing (IVDP), Competence Center for Nursing Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gudrun Bayer
- Institute of General Medicine, Charité - University Medical Center, Berlin, Germany
| | - Andreas E Kremer
- Department of Medicine I, Gastroenterology, Pulmonology, and Endocrinology, University of Erlangen-Nuremberg, Germany
| | - Franz J Legat
- Department of Dermatology, Venereology, Graz Medical University, Graz, Austria
| | - Peter Maisel
- Center for General Medicine, Medical Faculty, University of Münster, Germany
| | - Thomas Mettang
- Department of Nephrology, DKD Helios Klinik, Wiesbaden, Germany
| | - Martin Metz
- Allergy Center Charité, Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center, Berlin, Germany
| | - Alexander Nast
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center, Berlin, Germany
| | - Volker Niemeier
- Department of Dermatology, Venereology, and Allergology, University Medical Center Giessen and Marburg (Giessen site) and Practice for Dermatology, Psychotherapy, and Psychoanalysis, Giessen, Germany
| | - Ulrike Raap
- Department of Dermatology, Allergology Faculty of Medicine and Health Science, University of Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Gudrun Schneider
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Cener, Münster, Germany
| | - Hartmut F Ständer
- Dermatology Bad Bentheim, Dermatology Practice at Paulinenkrankenhaus Bad Bentheim and Department of Dermatology Medical Center Dortmund gGmbH, Dortmund, Germany
| | - Petra Staubach
- Clinical Research Center, Department of Dermatology, University Medical Center, Mainz, Germany
| | - Markus Streit
- Department of Dermatology, Aarau Canton Hospital, Aarau, Switzerland
| | - Elke Weisshaar
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Medical Center, Heidelberg, Germany
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Practical approaches to managing cancer patients with weight loss. Curr Opin Support Palliat Care 2017; 11:272-277. [DOI: 10.1097/spc.0000000000000300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Ständer S, Zeidler C, Augustin M, Bayer G, Kremer AE, Legat FJ, Maisel P, Mettang T, Metz M, Nast A, Niemeier V, Raap U, Schneider G, Ständer HF, Staubach P, Streit M, Weisshaar E. S2k-Leitlinie zur Diagnostik und Therapie des chronischen Pruritus - Update - Kurzversion. J Dtsch Dermatol Ges 2017; 15:860-873. [DOI: 10.1111/ddg.13304_g] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sonja Ständer
- Kompetenzzentrum Chronischer Pruritus (KCP) und Klinik für Hautkrankheiten; Universitätsklinikum Münster; Münster Deutschland
| | - Claudia Zeidler
- Kompetenzzentrum Chronischer Pruritus (KCP) und Klinik für Hautkrankheiten; Universitätsklinikum Münster; Münster Deutschland
| | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVPD), Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm); Universitätsklinikum Hamburg-Eppendorf; Hamburg Deutschland
| | - Gudrun Bayer
- Institut für Allgemeinmedizin der Charité - Universitätsmedizin Berlin; Berlin Deutschland
| | - Andreas E. Kremer
- Medizinische Klinik 1, Gastroenterologie, Pneumologie und Endokrinologie; Friedrich-Alexander-Universität Erlangen; Erlangen Deutschland
| | - Franz J. Legat
- Universitätsklinik für Dermatologie und Venerologie; Medizinische Universität Graz; Graz Österreich
| | - Peter Maisel
- Centrum für Allgemeinmedizin, Medizinische Fakultät; Westfälische Wilhelms-Universität Münster; Münster Deutschland
| | - Thomas Mettang
- Fachbereich Nephrologie; DKD Helios Klinik; Wiesbaden Deutschland
| | - Martin Metz
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie; Charité - Universitätsmedizin Berlin; Berlin Deutschland
| | - Alexander Nast
- Division of Evidence based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie; Charité - Universitätsmedizin Berlin; Berlin Deutschland
| | - Volker Niemeier
- Klinik für Dermatologie, Venerologie und Allergologie UKGM; Standort Gießen und Praxis für Dermatologie, Psychotherapie und Psychoanalyse; Gießen Deutschland
| | - Ulrike Raap
- Universitätsklinik für Dermatologie und Allergologie; Klinikum Oldenburg AöR, Oldenburg; Deutschland
| | - Gudrun Schneider
- Klinik für Psychosomatik und Psychotherapie; Universitätsklinikum Münster; Deutschland
| | - Hartmut F. Ständer
- Dermatologie Bad Bentheim; Praxis für Dermatologie im Paulinenkrankenhaus Bad Bentheim und Hautklinik Klinikum Dortmund gGmbH; Dortmund Deutschland
| | - Petra Staubach
- Clinical Research Center; Hautklinik und Poliklinik der Universitätsmedizin, Johannes Gutenberg-Universität KöR; Mainz Deutschland
| | - Markus Streit
- Klinik für Dermatologie, KSA am Bahnhof, Kantonsspital Aarau; Aarau Schweiz
| | - Elke Weisshaar
- Klinische Sozialmedizin; Berufs und Umweltdermatologie, Universitätsklinikum Heidelberg; Heidelberg Deutschland
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Khoo SY, Quinlan N. Mirtazapine: A Drug with Many Palliative Uses #314. J Palliat Med 2016; 19:1116-1117. [PMID: 27258192 DOI: 10.1089/jpm.2016.0222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aoun SM, Nekolaichuk C. Improving the evidence base in palliative care to inform practice and policy: thinking outside the box. J Pain Symptom Manage 2014; 48:1222-35. [PMID: 24727305 DOI: 10.1016/j.jpainsymman.2014.01.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/23/2014] [Accepted: 02/07/2014] [Indexed: 02/01/2023]
Abstract
The adoption of evidence-based hierarchies and research methods from other disciplines may not completely translate to complex palliative care settings. The heterogeneity of the palliative care population, complexity of clinical presentations, and fluctuating health states present significant research challenges. The aim of this narrative review was to explore the debate about the use of current evidence-based approaches for conducting research, such as randomized controlled trials and other study designs, in palliative care, and more specifically to (1) describe key myths about palliative care research; (2) highlight substantive challenges of conducting palliative care research, using case illustrations; and (3) propose specific strategies to address some of these challenges. Myths about research in palliative care revolve around evidence hierarchies, sample heterogeneity, random assignment, participant burden, and measurement issues. Challenges arise because of the complex physical, psychological, existential, and spiritual problems faced by patients, families, and service providers. These challenges can be organized according to six general domains: patient, system/organization, context/setting, study design, research team, and ethics. A number of approaches for dealing with challenges in conducting research fall into five separate domains: study design, sampling, conceptual, statistical, and measures and outcomes. Although randomized controlled trials have their place whenever possible, alternative designs may offer more feasible research protocols that can be successfully implemented in palliative care. Therefore, this article highlights "outside the box" approaches that would benefit both clinicians and researchers in the palliative care field. Ultimately, the selection of research designs is dependent on a clearly articulated research question, which drives the research process.
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Affiliation(s)
- Samar M Aoun
- School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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Abstract
There is an interdependent relationship between insomnia and fatigue in the medical literature, but both remain distinct entities. Insomnia entails problematic sleep initiation, maintenance, or restoration with an accompanying decrease in perceived daytime function. Lethargy is a symptom that has a wide differential diagnosis that heavily overlaps with cancer-related fatigue; however, insomnia may contribute to worsened fatigue and lethargy in cancer patients. Insomnia is a major risk factor for mood disturbances such as depression, which may also contribute to lethargy in this at-risk population. The pathophysiology of fatigue and insomnia is discussed in this review, including their differential diagnoses as well as the emerging understanding of the roles of neurotransmitters, branched-chain amino acids, and inflammatory cytokines. Treatment approaches for insomnia and fatigue are also discussed and reviewed, including the role of hypnotics, psychotropics, hormonal agents, and alternative therapies.
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Multiple factors must be considered when selecting the best antidepressant to treat depression in patients with cancer. DRUGS & THERAPY PERSPECTIVES 2014. [DOI: 10.1007/s40267-013-0096-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Torta RGV, Ieraci V. Pharmacological Management of Depression in Patients with Cancer: Practical Considerations. Drugs 2013; 73:1131-45. [DOI: 10.1007/s40265-013-0090-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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