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Galiana-Melendez F, Huot JR. The Impact of Non-bone Metastatic Cancer on Musculoskeletal Health. Curr Osteoporos Rep 2024; 22:318-329. [PMID: 38649653 DOI: 10.1007/s11914-024-00872-4] [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] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the musculoskeletal consequences of cancer, including those that occur in the absence of bone metastases. RECENT FINDINGS Cancer patients frequently develop cachexia, a debilitating condition reflected by weight loss and skeletal muscle wasting. The negative effects that tumors exert on bone health represents a growing interest amongst cachexia researchers. Recent clinical and pre-clinical evidence demonstrates cancer-induced bone loss, even in the absence of skeletal metastases. Together with muscle wasting, losses in bone demonstrates the impact of cancer on the musculoskeletal system. Identifying therapeutic targets that comprehensively protect musculoskeletal health is essential to improve the quality of life in cancer patients and survivors. IL-6, RANKL, PTHrP, sclerostin, and TGF-β superfamily members represent potential targets to counteract cachexia. However, more research is needed to determine the efficacy of these targets in protecting both skeletal muscle and bone.
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Affiliation(s)
| | - Joshua R Huot
- Department of Anatomy, Cell Biology & Physiology, Indianapolis, IN, 46202, USA.
- Indiana Center for Musculoskeletal Health, Indianapolis, IN, USA.
- Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.
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Ru Q, Chen L, Xu G, Wu Y. Exosomes in the pathogenesis and treatment of cancer-related cachexia. J Transl Med 2024; 22:408. [PMID: 38689293 PMCID: PMC11062016 DOI: 10.1186/s12967-024-05201-y] [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: 01/18/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024] Open
Abstract
Cancer-related cachexia is a metabolic syndrome characterized by weight loss, adipose tissue decomposition, and progressive skeletal muscle atrophy. It is a major complication of many advanced cancers and seriously affects the quality of life and survival of cancer patients. However, the specific molecules that mediate cancer-related cachexia remain elusive, and the fundamental cellular and molecular mechanisms associated with muscle atrophy and lipidolysis in cancer patients still need to be investigated. Exosomes, a newly discovered class of small extracellular vesicles that facilitate intercellular communication, have a significant role in the onset and development of various cancers. Studies have shown that exosomes play a role in the onset and progression of cancer-related cachexia by transporting active molecules such as nucleic acids and proteins. This review aimed to provide an overview of exosome developments in cancer-induced skeletal muscle atrophy and adipose tissue degradation. More importantly, exosomes were shown to have potential as diagnostic markers or therapeutic strategies for cachexia and were prospected, providing novel strategies for the diagnosis and treatment of cancer-related cachexia.
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Affiliation(s)
- Qin Ru
- Institute of Intelligent Sport and Proactive Health,Department of Health and Physical Education, Jianghan University, Wuhan, 430056, China
| | - Lin Chen
- Institute of Intelligent Sport and Proactive Health,Department of Health and Physical Education, Jianghan University, Wuhan, 430056, China
| | - Guodong Xu
- Institute of Intelligent Sport and Proactive Health,Department of Health and Physical Education, Jianghan University, Wuhan, 430056, China
| | - Yuxiang Wu
- Institute of Intelligent Sport and Proactive Health,Department of Health and Physical Education, Jianghan University, Wuhan, 430056, China.
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Amano K, Hopkinson JB, Baracos VE, Mori N. Holistic multimodal care for patients with cancer cachexia and their family caregivers. Asia Pac J Oncol Nurs 2023; 10:100290. [PMID: 38197043 PMCID: PMC10772164 DOI: 10.1016/j.apjon.2023.100290] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/01/2023] [Indexed: 01/11/2024] Open
Abstract
Patients with cancer cachexia frequently suffer from physical symptoms and psychological symptoms of illness, which can lead to emotional distress in patients and family caregivers. Although there is no standard care to manage cancer cachexia despite its high prevalence and negative impact on quality of life in patients and family caregivers, there is accumulating evidence showing the importance of holistic multimodal care for cancer cachexia. However, there is no agreement on the essential components of holistic multimodal care. Therefore, the aims of this review are to give an overview of what is known about the holistic multimodal care and to suggest the composition of a multidisciplinary team to achieve holistic interventions. Holistic multimodal care for cancer cachexia is defined as an approach that addresses physical health through medical, pharmacological, nutritional, and rehabilitative interventions as well as psychological, emotional, and social well-being issues according to the needs of patients and family caregivers. Moreover, an ideal multidisciplinary team is proposed to achieve holistic interventions based on patient- and family-centered care. However, the development of educational programs on cancer cachexia for both clinicians and patients and family caregivers is needed. Furthermore, measurements to assess the benefits of holistic multimodal care also need to be established.
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Affiliation(s)
- Koji Amano
- Palliative and Supportive Care Center, Osaka University Hospital, Osaka, Japan
- Department of Psycho-Oncology and Palliative Medicine, Osaka International Cancer Institute, Osaka, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Jane B. Hopkinson
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Wales, UK
| | - Vickie E. Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Cross Cancer Institute, Alberta, Canada
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan
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Galvez T, Berkane I, Thézenas S, Eberlé MC, Flori N, Guillemard S, Ilonca AD, Santoro L, Kotzki PO, Senesse P, Deshayes E. Identification of 18F-FDG PET/CT Parameters Associated with Weight Loss in Patients with Esophageal Cancer. Nutrients 2023; 15:3042. [PMID: 37447367 DOI: 10.3390/nu15133042] [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: 05/08/2023] [Revised: 06/16/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
18F-FDG PET-CT is routinely performed as part of the initial staging of numerous cancers. Other than having descriptive, predictive and prognostic values for tumors, 18F-FDG PET-CT provides full-body data, which could inform on concurrent pathophysiological processes such as malnutrition. To test this hypothesis, we measured the 18F-FDG uptake in several organs and evaluated their association with weight loss in patients at diagnosis of esophageal cancer. Forty-eight patients were included in this retrospective monocentric study. 18F-FDG uptake quantification was performed in the brain, the liver, the spleen, bone marrow, muscle and the esophageal tumor itself and was compared between patients with different amounts of weight loss. We found that Total Lesion Glycolysis (TLG) and peak Standardized Uptake Values (SUVpeak) measured in the brain correlated with the amount of weight loss: TLG was, on average, higher in patients who had lost more than 5% of their usual weight, whereas brain SUVpeak were, on average, lower in patients who had lost more than 10% of their weight. Higher TLG and lower brain SUVpeak were associated with worse OS in the univariate analysis. This study reports a new and significant association between 18F-FDG uptake in the brain and initial weight loss in patients with esophageal cancer.
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Affiliation(s)
- Thierry Galvez
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
- Department of Endocrinology, Diabetes and Nutrition, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France
| | - Ikrame Berkane
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
| | - Simon Thézenas
- Biometry Unit, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
| | - Marie-Claude Eberlé
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
| | - Nicolas Flori
- Department of Clinical Nutrition and Gastroenterology, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, 34298 Montpellier, France
| | - Sophie Guillemard
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
| | - Alina Diana Ilonca
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
| | - Lore Santoro
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
| | - Pierre-Olivier Kotzki
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, 34298 Montpellier, France
| | - Pierre Senesse
- Department of Clinical Nutrition and Gastroenterology, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, 34298 Montpellier, France
| | - Emmanuel Deshayes
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, 34298 Montpellier, France
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Chang VT, Sandifer C, Zhong F. GI Symptoms in Pancreatic Cancer. Clin Colorectal Cancer 2023; 22:24-33. [PMID: 36623952 DOI: 10.1016/j.clcc.2022.12.002] [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: 08/30/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
This review will apply a multidisciplinary approach to GI symptoms with attention to symptom assessment (instruments and qualitative aspects), differential diagnosis, and recent findings relevant to management of symptoms and underlying diseases. We conclude that further development of supportive interventions for GI symptoms for both patient and caregivers has the potential to reduce distress from GI symptoms, and anticipate better symptom control with advances in scientific knowledge and improvement of the evidence base.
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Affiliation(s)
- Victor T Chang
- Section Hematology Oncology (111), VA New Jersey Health Care System, East Orange, NJ; Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ.
| | | | - Fengming Zhong
- Section Hematology Oncology (111), VA New Jersey Health Care System, East Orange, NJ; Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ
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Factors Affecting the Assessment of Cancer Cachexia by Nurses Caring for Patients with Advanced Cancer Undergoing Chemotherapy: A Cross-Sectional Survey. Asia Pac J Oncol Nurs 2022; 9:100075. [PMID: 35669286 PMCID: PMC9163426 DOI: 10.1016/j.apjon.2022.100075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to identify the awareness, knowledge, and assessment of cancer cachexia among nurses who cared for patients with advanced cancer undergoing chemotherapy. In addition, we identified the factors that affected their assessments. Methods A cross-sectional survey was conducted among nurses who cared for patients with advanced cancer undergoing chemotherapy at designated cancer care hospitals and regional cancer care cooperation hospitals between June and September 2020. We applied Bandura's triadic reciprocal causation as the research framework. The questionnaire consisted of questions on awareness, knowledge, and assessment of cancer cachexia. Single and multiple regression analyses were conducted on the relationship between each variable and the number of assessment items. Results Questionnaires were sent to 1026 nurses, 403 of whom responded (response rate: 39.3%). Among these, 299 responses were valid, being a 74.1% valid response rate. The average age was 39.74 ± 9.65 years and the mean work experience as a nurse was 16.50 ± 9.14 years. In respect of the awareness of cancer cachexia, 93.3% of the participants answered “assessment of cancer cachexia was needed,” and 75.2% answered “a nurse's role includes assessing for cancer cachexia.” Only 15.4% responded positively regarding “confidence in the assessment of cancer cachexia.” Regarding knowledge of cancer cachexia, the percentage of correct answers to questions about the definition of cachexia and diagnostic criteria ranged from 45.5% to 53.8%. With regard to cancer cachexia assessments, the participants assessed “weight loss or rate of weight loss (56.9%),” “symptoms affecting nutritional status (54.2%),” and “anorexia (46.2%).” Factors affecting the assessment of cancer cachexia were higher knowledge scores on cancer cachexia (P = 0.039), routine assessment of cancer cachexia (P < 0.001), experiences of participating in in-hospital training on cancer cachexia (P = 0.027), and collaborating with physical/occupational therapists in the nutritional management of patients (P = 0.025). Conclusions Nurses held the view that their role required them to assess for cancer cachexia, but they did not feel confident in doing so. In addition, they lacked knowledge of reversible “cancer cachexia;” hence, the assessments were not routinely completed. Education on these topics and the development and standardization of tools to assess or collaborate with other professions are required.
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Martin P. Cancer Cachexia Syndrome: Reflecting on 20 years of providing cancer cachexia care as the leader of an interdisciplinary team in an Australian Cancer Centre. Asia Pac J Oncol Nurs 2022; 9:100070. [PMID: 35637652 PMCID: PMC9142557 DOI: 10.1016/j.apjon.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022] Open
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Socratous G, Cloconi C, Tsatsou I, Charalambous A. Nurses' Knowledge in Relation to the Anorexia-Cachexia Syndrome in Cancer Patients: A Cross-National Comparison in Two European Countries. SAGE Open Nurs 2021; 7:23779608211035208. [PMID: 34632056 PMCID: PMC8493427 DOI: 10.1177/23779608211035208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/05/2021] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION The Anorexia-Cachexia Syndrome (ACS) is a severe complication of cancer and is considered to be a significant cause of morbidity and mortality affecting up to two-thirds of cancer patients and one that needs specialized nursing care. Studies showed that the ACS has been relatively under-researched and under-resourced whist the nurses' knowledge has not been systematically explored. OBJECTIVE Τo explores nurses' knowledge, understanding, and management of ACS in clinical practice in two European countries. METHODS Descriptive-comparative study with 197 cancer nurses recruited during two National Conferences in Greece and Cyprus. Data were retrieved with the "Investigation of anorexia-cachexia syndrome in Practice" questionnaire. RESULTS In terms of nurses' perceptions on ACS, the prevailing characteristic reported in both countries was anorexia (p = .65) followed by weight loss (p = .04). 189 nurses (95.9%, p = .176) do not currently use a tool to assess patients' nutritional status as part of their standard clinical practice. Statistically significant differences were found in relation to the routine assessment of nutritional-related symptoms including early satiety (Cyprus 64% vs. Greece 37%, p = .001), hiccough (66% vs. 36%, p < .001), alteration of the taste/odor sensation (77% vs. 45%, p < .001), problems in the oral cavity (84% vs. 68%, p = .032) and daily activities (85% vs. 69%, p = .032). The priority level for the ACS management differed significantly in the two countries (p = .006), with higher priority being reported in Cyprus. CONCLUSION The study showed that more education is needed for cancer nurses to better understand the ACS which can facilitate the better management of the syndrome in clinical practice.
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Affiliation(s)
| | | | - Ioanna Tsatsou
- Oncology-Hematology Department, Hellenic Airforce General
Hospital, Athens, Greece
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Lacroix C, Georges G, Thézenas S, Flori N, Francioni L, Janiszewski C, Courraud J, Lecornu H, de Forges H, Senesse P. [The role of the specialist nurse in parenteral nutrition : An observational study of complications with home parenteral nutrition in adult cancer patients]. Rech Soins Infirm 2020; 140:107-116. [PMID: 32524798 DOI: 10.3917/rsi.140.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background : In France, home parenteral nutrition (HPN) is managed by two parallel healthcare systems : in approved specialist centers (HPN > 12 weeks), and outside of these approved specialist centers (HPN<12 weeks).
Objective : To prospectively evaluate infectious and vascular complications in adult cancer patients undergoing HPN administered via a central venous line, outside of approved specialist HPN centers.
Methods : Our observational prospective study included adult patients with cancer, hospitalized for 48 hours or more, and under HPN. They had a WHO performance status of ≤ 2 and had had a nutritional consultation before discharge.
Results : 25 patients were included in the study, with a median age of 63 years [19–74]. Weight loss of ≥ 5% was reported in 79% of patients. The Ingesta score was < 7 in 96% of cases. 87% of patients presented chill or body temperature variation episodes, with a median of 2 episodes [1–6] per patient. The median delay between end of hospitalization and the first chill episode was 11 days [1–85]. A vascular complication (obstruction without thrombosis) was reported in one patient.
Discussion : This high number of infectious episodes requires improvement of patient care when it comes to strictly adhering to the recommendations. Getting the approved specialist HPN centers to work together and share care protocols could be the first important step.
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Ninot G, Flori N, Huteau ME, Stoebner-Delbarre A, Senesse P. Activités physiques et cancers : des bénéfices prouvés pendant et après les traitements. Bull Cancer 2020; 107:474-489. [DOI: 10.1016/j.bulcan.2019.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 09/18/2019] [Accepted: 11/29/2019] [Indexed: 01/15/2023]
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Mistiaen P, Van den Heede K. Nutrition Support Teams: A Systematic Review. JPEN J Parenter Enteral Nutr 2020; 44:1004-1020. [PMID: 32181928 DOI: 10.1002/jpen.1811] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The concept of a nutrition support team (NST) was first introduced at the end of the 20th century in the US and Europe. Expected benefits include reduced (inappropriate) prescription of (par)enteral nutrition; however, to the authors' knowledge, no recent review has assessed the effectiveness of NSTs. Therefore, this systematic review evaluated the effectiveness of NSTs with respect to the prevalence of adult patients receiving (par)enteral nutrition. METHODS Five literature databases were searched and completed by citing searches. Studies on NSTs that were published between 2000 and 2018 in Western countries, applied a comparative design, and contained at least outcome data on the prevalence of (par)enteral nutrition were included. Analyses were mainly descriptive because of high heterogeneity that prevented meta-analyses. RESULTS The 27 included studies mainly originated from the UK and US. Only 1 of the included studies was a randomized trial; the other studies had a pre-post design (n = 17) or compared groups in a nonrandomized way. All but 2 studies were performed in acute care hospitals, and 5 studies focused only on intensive care patients. There was conflicting evidence of whether NSTs lead to reduction or increase in patients starting parenteral nutrition (PN); however, weak evidence suggested that NSTs might lead to an increase in the ratio of enteral nutrition to PN use and might decrease inappropriate PN use. CONCLUSION Although almost all studies concluded in favor of NSTs, the evidence base is weak and insufficient because of a lack of well-designed studies and successful outcomes.
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Impact of Cachexia and Opioid Analgesic Cotreatment on Pregabalin Pharmacokinetics and Central Nervous System Symptoms in Cancer Patients. Ther Drug Monit 2019; 41:591-597. [PMID: 30986807 DOI: 10.1097/ftd.0000000000000634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with cancer receiving pregabalin potentially have a high incidence of central nervous system (CNS) symptoms. The purpose of this study was to explore clinical factors influencing the incidence of CNS symptoms, including plasma pregabalin exposure, cancer cachexia, and opioid analgesic cotreatment. METHODS Sixty-eight patients with cancer receiving twice-daily pregabalin were enrolled. Plasma concentrations of pregabalin, clinical laboratory data, opioid analgesic cotreatment, and the Glasgow Prognostic Score, which is an inflammation-based cachexia score, were considered as clinical factors. The incidence of CNS symptoms was collected from the patients' medical records. The predose plasma concentrations of pregabalin at steady state were determined by ultra-high-performance liquid chromatography. RESULTS The steady-state trough plasma pregabalin concentrations showed a large variability with an interquartile range of 0.43-1.2 mg/L per mg/kg and were negatively correlated with an estimated glomerular filtration rate (eGFR). C-reactive protein (standardized partial regression coefficient, β = 0.31) and opioid analgesic cotreatment (β = 0.24) were also identified in addition to eGFR (β = -0.60) in the multiple regression analysis. The incidence of CNS symptoms was significantly increased with opioid analgesic cotreatment and a higher Glasgow Prognostic Score but not with the absolute value of plasma pregabalin concentrations, eGFR, or other clinical laboratory data. CONCLUSIONS In patients with cancer, steady-state trough plasma pregabalin concentrations were altered with renal function, systemic inflammation, and opioid analgesic cotreatment. However, a higher incidence of CNS symptoms observed in patients with cancer on pregabalin was more related to cachexia and opioid analgesic cotreatment than to altered pregabalin concentrations.
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How much does reduced food intake contribute to cancer-associated weight loss? Curr Opin Support Palliat Care 2018; 12:410-419. [DOI: 10.1097/spc.0000000000000379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guerdoux-Ninot E, Flori N, Janiszewski C, Vaillé A, de Forges H, Raynard B, Baracos VE, Thezenas S, Senesse P. Assessing dietary intake in accordance with guidelines: Useful correlations with an ingesta-Verbal/Visual Analogue Scale in medical oncology patients. Clin Nutr 2018; 38:1927-1935. [PMID: 30355527 DOI: 10.1016/j.clnu.2018.06.974] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/16/2018] [Accepted: 06/19/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Energy intake and food ingesta are central in nutritional screening and assessment. Cancer patients are at nutritional risk of losing weight, and clinicians need quick and easy tools to identify patients for nutritional support. This study aimed to evaluate the feasibility and the accuracy of a Visual/Verbal Analogue Scale of food ingesta (ingesta-VVAS) to assess energy food intake and nutritional risk in medical oncology patients. METHODS Dieticians administered prospectively the ingesta-VVAS in 1762 medical oncology patients. The external validity of the ingesta-VVAS was determined against daily energy intake based on a 24-h dietary recall. Patients had to estimate how they currently ate on a scale from 0 "nothing at all" to 10 "as usual". Area Under the Receiver-Operating Characteristics (ROC) curve served as determine the optimal cut-off and provide the discriminative power of the tool to detect patients who ingested less or more than 25 kcal kg-1 day-1. RESULTS The feasibility of the ingesta-VVAS was 97.7%. The scores were significantly correlated with energy intake (ρ = .67, p < .05), whatever the specific situation (i.e. malnutrition or not). With a cut-off of ≤7, the ingesta-VVAS exhibited a good power discrimination (AUC = .804) to detect patients who ingested less or more than 25 kcal kg-1 day-1, with a sensitivity of 80.8%, a positive predictive value of 83.6%, a specificity of 67.5%, and a negative predictive value of 63.3%. Patients with a score ≤7 on the ingesta-VVAS score were at 12-fold higher probability of nutritional risk [OR 12.3; 95% CI (8.7-17.4); p < .001]. Sensitivity to detect patients with a significant weight loss was 71%, and a positive predictive value of 75.9%. CONCLUSIONS This easy-to-use ingesta-VVAS is well-correlated with energy intake and may be useful in clinical practice. An ingesta-VVAS score is ≤ 7 could be used to detect patients with nutritional risk of weight loss in medical oncology.
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Affiliation(s)
- Estelle Guerdoux-Ninot
- Department of Supportive Care, Cancer Institute of Montpellier (ICM), Montpellier, University of Montpellier, France; Department of Clinical Nutrition and Gastroenterology, Cancer Institute of Montpellier (ICM), University of Montpellier, France.
| | - Nicolas Flori
- Department of Clinical Nutrition and Gastroenterology, Cancer Institute of Montpellier (ICM), University of Montpellier, France
| | - Chloé Janiszewski
- Department of Clinical Nutrition and Gastroenterology, Cancer Institute of Montpellier (ICM), University of Montpellier, France
| | - Arnaud Vaillé
- Department of Clinical Nutrition and Gastroenterology, Cancer Institute of Montpellier (ICM), University of Montpellier, France
| | - Hélène de Forges
- Clinical Research Department, Cancer Institute of Montpellier (ICM), University of Montpellier, France
| | - Bruno Raynard
- Department of Supportive Care, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Simon Thezenas
- Department of Biostatistics, Cancer Institute of Montpellier (ICM), University of Montpellier, France
| | - Pierre Senesse
- Department of Supportive Care, Cancer Institute of Montpellier (ICM), Montpellier, University of Montpellier, France; Department of Clinical Nutrition and Gastroenterology, Cancer Institute of Montpellier (ICM), University of Montpellier, France
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