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Suraj D, Zhang A, Appelbaum T, Ahmed N, Shih S, Gofman J, Kalenja K, Abrigo JN, Shaporova V, Mannan A, Jacobs RJ. Clinical Presentation and Management of Malignant Psoas Syndrome: A Scoping Review of Case Reports and Case Series. Cureus 2023; 15:e41522. [PMID: 37551242 PMCID: PMC10404467 DOI: 10.7759/cureus.41522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
Malignant psoas syndrome (MPS) is a rare and underreported clinical syndrome that significantly impacts the quality of life of cancer patients through metastatic infiltration of the iliopsoas muscle. Patients suffering from MPS often present with painful hip flexion, loss of mobility, and immense pain in their legs and back. The current literature describing the clinical presentation, management, and prognosis of MPS is limited primarily to case reports and outdated literature reviews. There remains a gap in the current knowledge of MPS and in the management of this complex cancer-related pain syndrome. Thus, this scoping review aimed to map current case reports and case series on MPS for clinical presentation, treatment modalities, and resulting prognoses of MPS in late-stage cancer patients. A systemized search using the databases Embase and PubMed (Medline) was conducted to access case reports and case series published between January 1990 and October 2022 that met the study's inclusion criteria: (1) adult patients with metastatic cancer; (2) MPS symptoms secondary to infiltration of iliopsoas; (3) clinical presentation, treatment modality, and prognosis; and (4) English-language text. Our search strategy yielded 1926 citations. After removing 629 duplicates, 1,283 reports were excluded due to failure to meet eligibility criteria (n=1,271) or inaccessibility (n=12). Using the JBI appraisal tools for case reports and case series, a total of 14 articles remained for the final review. With histories of either genitourinary, hepatic, gastric, or skin cancer, each case reported new onset intense pain in the legs, back, abdomen, or pelvis with associated symptoms such as flexion of the hip or gait disorder. A computerized tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan typically confirmed metastasis into the iliopsoas causing these symptoms, which suggested MPS. Each case utilized two to seven different pain management strategies to alleviate MPS symptoms. Many cases first used opioids for pain relief. Following a necessitated increase in morphine equivalent daily dose, a subsequent increase in the strength of analgesic, change in route of administration, and integration of combination drug therapy were generally added to the treatment regime. Many cases reported successful management of symptoms through utilizing methadone, radiation therapy, botulinum toxin injection, increased opioid dosage, or epidural catheter administration of opioids. A unified clinical definition of MPS may be required to inform physicians of this syndrome to help support clinical decisions regarding treatments for patients. The studies indicated that a clearer guideline for treatment protocol may be warranted as most cases reported utilizing various treatment medication dosages and procedures with vastly differing results.
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Affiliation(s)
- Delwin Suraj
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Angel Zhang
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Taylor Appelbaum
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Nahiyan Ahmed
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Susana Shih
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Joseph Gofman
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Klea Kalenja
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Juanito N Abrigo
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Valeriya Shaporova
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Arhum Mannan
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Robin J Jacobs
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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Roze des Ordons AL, Sinuff T, Stelfox HT, Kondejewski J, Sinclair S. Spiritual Distress Within Inpatient Settings-A Scoping Review of Patients' and Families' Experiences. J Pain Symptom Manage 2018; 56:122-145. [PMID: 29548894 DOI: 10.1016/j.jpainsymman.2018.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
CONTEXT Spiritual distress contributes to patients' and families' experiences of care. OBJECTIVES To map the literature on how seriously ill patients and their family members experience spiritual distress within inpatient settings. METHODS Our scoping review included four databases using search terms "existential" or "spiritual" combined with "angst," "anxiety," "distress," "stress," or "anguish." We included original research describing experiences of spiritual distress among adult patients or family members within inpatient settings and instrument validation studies. Each study was screened in duplicate for inclusion, and the data from included articles were extracted. Themes were identified, and data were synthesized. RESULTS Within the 37 articles meeting inclusion criteria, we identified six themes: conceptualizing spiritual distress (n = 2), diagnosis and prevalence (n = 7), assessment instrument development (n = 5), experiences (n = 12), associated variables (n = 12), and barriers and facilitators to clinical support (n = 5). The majority of studies focused on patients; two studies focused on family caregivers. The most common clinical settings were oncology (n = 19) and advanced disease (n = 19). Terminology to describe spiritual distress varied among studies. The prevalence of at least moderate spiritual distress in patients was 10%-63%. Spiritual distress was experienced in relation to self and others. Associated variables included demographic, physical, cognitive, and psychological factors. Barriers and facilitators were described. CONCLUSION Patients' and families' experiences of spiritual distress in the inpatient setting are multifaceted. Important gaps in the literature include a narrow spectrum of populations, limited consideration of family caregivers, and inconsistent terminology. Research addressing these gaps may improve conceptual clarity and help clinicians better identify spiritual distress.
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Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Tasnim Sinuff
- Interdepartmental Division of Critical Care, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jane Kondejewski
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Tayjasanant S, Bruera E, Hui D. How far along the disease trajectory? An examination of the time-related patient characteristics in the palliative oncology literature. Support Care Cancer 2016; 24:3997-4004. [PMID: 27129839 DOI: 10.1007/s00520-016-3225-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/17/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE Adequate reporting of time-related patient characteristics is needed for research findings to be properly interpreted, applied, and reproduced. Our objective was to characterize the time-related patient characteristics in palliative oncology studies and to examine the differences in time-related patient characteristics by various study characteristics. METHODS We extracted time-related patient characteristics including actual survival, performance status, cancer stage, disease trajectory, study setting, and eligibility criteria (life expectancy and performance status) from an established cohort of original palliative oncology articles published in 2004 and 2009. RESULTS Among 742 original articles, 409 (55 %) were case series. Only 247 (33 %) articles reported actual survival, 157 (21 %) reported actual performance status, 362 (49 %) cancer stage, and 392 (53 %) reported study setting. Based on all the available time-related characteristics, we were able to classify the studies into specific time-related categories in 378 (51 %) studies. Among these, only 47 (13 %) focused on patients in the last month of life. Compared to studies involving patients earlier in the disease trajectory, these studies were more likely to be case series (81 vs. 56 %, P = 0.005), retrospective (64 vs. 49 %, P = 0.03), and had a smaller sample size (median 20 vs. 61, P = 0.06). CONCLUSIONS A majority of studies did not adequately report time-related patient characteristics. We also identified a gap in both the quantity and quality of studies involving patients in the last month of life. Our study has implications for study reporting and future directions for palliative oncology research.
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Affiliation(s)
- Supakarn Tayjasanant
- Department of Palliative Care and Rehabilitation Medicine Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
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Kwon JH, Tanco K, Park JC, Wong A, Seo L, Liu D, Chisholm G, Williams J, Hui D, Bruera E. Frequency, Predictors, and Medical Record Documentation of Chemical Coping Among Advanced Cancer Patients. Oncologist 2015; 20:692-7. [PMID: 25933929 DOI: 10.1634/theoncologist.2015-0012] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/05/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In this prospective study, we determined the frequency of opioid-related chemical coping among advanced cancer patients, as diagnosed by palliative medicine specialists. We also determined predictors for chemical coping and the concordance between the physician's diagnosis and documentation in the medical records. PATIENTS AND METHODS Palliative medicine specialists evaluated and diagnosed consecutive patients seen for chemical coping. The proportion of patients identified as chemically coping was compared with the proportion documented in the medical records. Demographic data; cancer diagnosis; history of smoking; substance abuse; psychiatric disease; morphine equivalent daily dosage; Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) questionnaire scores; and Edmonton Symptom Assessment System scores were also collected. RESULTS A total of 432 patients were evaluated. Overall, 76 patients (18%; 95% confidence interval [CI]: 14%-21%) were diagnosed as chemically coping. Documentation of chemical coping in the medical records was reported for only 15 patients (4%; 95% CI: 2%-6%). CAGE positivity (odds ratio [OR]: 2.89), younger age (OR: 0.97 per year), better performance status (OR: 0.68 per point), pain (OR: 1.20 per point), and well-being (OR: 1.28 per point) were found to be significant predictors of chemical coping by protocol definition. After recursive partitioning, 21 of 50 patients (42%) who were CAGE positive and had an Eastern Cooperative Oncology Group performance status ≤2 were diagnosed as chemically coping. CONCLUSION Approximately 18% of palliative care patients seen were diagnosed as chemically coping by palliative medicine specialists. The frequency of documentation in the medical records was significantly lower. Better and safer ways for physicians to assess and report chemical coping are needed. IMPLICATIONS FOR PRACTICE Cancer pain is a multidimensional symptom for which opioids are the mainstay of treatment. However, opioids can have a double effect resulting in drug-seeking behaviors. Chemical coping occurs when a patient uses opioids in a nonprescribed way to cope with various stressful events. This can lead to misuse of opioids and complications including neurotoxicities, respiratory depression, and death. Proper diagnosis and documentation is needed to ensure proper management of pain and to avoid unnecessary harm. The findings of this study suggest that ∼18% of advanced cancer patients seen by a palliative care service were diagnosed as chemical coping, but only 4% were documented in the medical records.
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Affiliation(s)
- Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea; Departments of Palliative Care and Rehabilitation Medicine, Biostatistics, and Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Palliative Care, Mercy Medical Group, Dignity Health Medical Foundation, Sacramento, California, USA
| | - Kimberson Tanco
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea; Departments of Palliative Care and Rehabilitation Medicine, Biostatistics, and Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Palliative Care, Mercy Medical Group, Dignity Health Medical Foundation, Sacramento, California, USA
| | - Ji Chan Park
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea; Departments of Palliative Care and Rehabilitation Medicine, Biostatistics, and Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Palliative Care, Mercy Medical Group, Dignity Health Medical Foundation, Sacramento, California, USA
| | - Angelique Wong
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea; Departments of Palliative Care and Rehabilitation Medicine, Biostatistics, and Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Palliative Care, Mercy Medical Group, Dignity Health Medical Foundation, Sacramento, California, USA
| | - Lisa Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea; Departments of Palliative Care and Rehabilitation Medicine, Biostatistics, and Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Palliative Care, Mercy Medical Group, Dignity Health Medical Foundation, Sacramento, California, USA
| | - Diane Liu
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea; Departments of Palliative Care and Rehabilitation Medicine, Biostatistics, and Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Palliative Care, Mercy Medical Group, Dignity Health Medical Foundation, Sacramento, California, USA
| | - Gary Chisholm
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea; Departments of Palliative Care and Rehabilitation Medicine, Biostatistics, and Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Palliative Care, Mercy Medical Group, Dignity Health Medical Foundation, Sacramento, California, USA
| | - Janet Williams
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea; Departments of Palliative Care and Rehabilitation Medicine, Biostatistics, and Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Palliative Care, Mercy Medical Group, Dignity Health Medical Foundation, Sacramento, California, USA
| | - David Hui
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea; Departments of Palliative Care and Rehabilitation Medicine, Biostatistics, and Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Palliative Care, Mercy Medical Group, Dignity Health Medical Foundation, Sacramento, California, USA
| | - Eduardo Bruera
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea; Departments of Palliative Care and Rehabilitation Medicine, Biostatistics, and Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Palliative Care, Mercy Medical Group, Dignity Health Medical Foundation, Sacramento, California, USA
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