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Kasiri N, Banegas M, Nodora J, Martinez ME, Strong D, Doran N, McDaniels-Davidson C, Parada Jr H. Cancer stage and consideration of cannabis use among adult cancer survivors in Southern California. J Natl Cancer Inst Monogr 2024; 2024:282-289. [PMID: 39108235 PMCID: PMC11303857 DOI: 10.1093/jncimonographs/lgad028] [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: 05/31/2023] [Revised: 07/20/2023] [Accepted: 08/24/2023] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The benefits of cannabis in symptom management among cancer survivors are widely acknowledged; however, patterns of cannabis use by cancer stage at diagnosis are unknown. METHODS Here, we examined the association between cancer stage at diagnosis and consideration of cannabis use since diagnosis. We analyzed cross-sectional survey data from 954 cancer survivors, weighted to be representative of a National Cancer Institute-Designated Comprehensive Cancer Center's patient population. We used survey-weighted multivariable logistic regression to examine the association between cancer stage at diagnosis (advanced [III/IV] versus non-advanced [I/II]) and consideration of cannabis use (yes versus no) since diagnosis. RESULTS Sixty percent of the population was diagnosed with non-advanced stages of cancer, and 42% had considered using cannabis since diagnosis. The odds of consideration of cannabis use were 63% higher (odds ratio = 1.63, 95% confidence interval = 1.06 to 2.49) among cancer survivors diagnosed at stages III/IV than among those diagnosed at stages I/II. CONCLUSION Cancer stage may be a predictor of consideration of cannabis use after diagnosis.
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Affiliation(s)
- Nasim Kasiri
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Matthew Banegas
- Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Jesse Nodora
- Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Maria Elena Martinez
- Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - David Strong
- Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Neal Doran
- Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
- Psychology Service, Jennifer Moreno VA Medical Center, San Diego, CA, USA
| | - Corinne McDaniels-Davidson
- Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Humberto Parada Jr
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
- Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, CA, USA
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Islam JY, Nguyen OT, Turner K, Martinez YC, Rodriguez OG, Rodriguez DI, Rajasekhara S, Chang YD, Gonzalez BD, Jim HSL, Egan KM. Concurrent substance use among cancer patients with and without a history of cannabis use since cancer diagnosis at an NCI-Designated Cancer Center in Florida. J Natl Cancer Inst Monogr 2024; 2024:224-233. [PMID: 39108241 PMCID: PMC11303859 DOI: 10.1093/jncimonographs/lgad036] [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] [Received: 07/17/2023] [Revised: 09/30/2023] [Accepted: 11/06/2023] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Although substance use may have adverse impacts on cancer outcomes, little is known regarding patterns of concurrent substance use with cannabis among cancer patients. Our objective was to examine predictors of concurrent substance use with cannabis among cancer patients since their cancer diagnosis and explore perceptions of cannabis among these patients. METHODS Patients treated at a National Cancer Institute-designated comprehensive cancer center were invited to participate in an electronic survey regarding medical cannabis from August to November 2021. Survey data were linked to internal data resources including electronic health records and patient intake forms to obtain history of substance use (defined as within at least 3 months of cancer diagnosis) of cigarettes, injection drugs, high levels of alcohol, or clinically unsupervised prescription drugs (total n = 1094). Concurrent substance users were defined as those with any reported substance use and cannabis use at the time of cancer diagnosis. We used descriptive statistics (χ2 or exact tests) to compare groups and estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) to identify predictors of substance use among users and nonusers of cannabis. RESULTS Approximately 45% (n = 489) of the sample reported cannabis use since their cancer diagnosis. Of patients who reported using cannabis, 20% self-reported concurrent polysubstance use, while 8% of cannabis nonusers reported substance use (P < .001). Among patients who use cannabis, those who reported 2 or more self-reported treatment-related symptoms (eg, pain, fatigue) were more likely to have self-reported concurrent substance use (AOR = 3.15, 95% CI = 1.07 to 9.27) compared with those without any symptoms. Among nonusers, those with lower educational background were more likely to have a history of concurrent substance use (AOR = 3.74, 95% CI = 1.57 to 8.92). Patients who use cannabis with concurrent substance use were more likely to report improved sleep (P = .04), increased appetite (P = .03), and treatment of additional medical conditions (P = .04) as perceived benefits of cannabis use. CONCLUSIONS High symptom burden may be associated with concurrent substance use with cannabis among cancer patients.
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Affiliation(s)
- Jessica Y Islam
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Oliver T Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kea Turner
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Yessica C Martinez
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Omar Garcia Rodriguez
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Sahana Rajasekhara
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Young D Chang
- Department of Supportive Care Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Heather S L Jim
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kathleen M Egan
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
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Mulvey MR, Paley CA, Schuberth A, King N, Page A, Neoh K. Neuropathic Pain in Cancer: What Are the Current Guidelines? Curr Treat Options Oncol 2024:10.1007/s11864-024-01248-7. [PMID: 39102168 DOI: 10.1007/s11864-024-01248-7] [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: 07/12/2024] [Indexed: 08/06/2024]
Abstract
OPINION STATEMENT Neuropathic cancer pain is experienced by 30-40% of patients with cancer. It significantly reduces quality of life and overall wellbeing for patients living with and beyond cancer. The underlying mechanisms of neuropathic pain in patients with cancer are complex and involve direct tumour involvement, nerve compression or infiltration, chemotherapy and/or radiotherapy-induced nerve damage, or post-surgical complications. It is crucial for healthcare professionals to assess and manage neuropathic cancer pain effectively. There is increasing recognition that standardisation of neuropathic pain assessment leads to tailored management and improved patient outcomes. Pain management strategies, including medication, interventional analgesia, physical and complementary therapy, can help alleviate neuropathic pain and improve the patient's comfort and quality of life.
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Affiliation(s)
- Matthew R Mulvey
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds Level, 10 Worsley Building, Clarendon Road, Leeds, LS2 9LN, UK.
| | - Carole A Paley
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds Level, 10 Worsley Building, Clarendon Road, Leeds, LS2 9LN, UK
| | - Anna Schuberth
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds Level, 10 Worsley Building, Clarendon Road, Leeds, LS2 9LN, UK
| | - Natalie King
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds Level, 10 Worsley Building, Clarendon Road, Leeds, LS2 9LN, UK
| | - Andy Page
- Academic Unit of Palliative Care, St Gemma's Hospice, Leeds, UK
| | - Karen Neoh
- Academic Unit of Palliative Care, St Gemma's Hospice, Leeds, UK
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Bulat E, Crowther JE, Chakravarthy V, Laufer I, Barzilai O, Gulati A. Management of Refractory Cancer Pain with Intrathecal Drug Delivery and Spinal Cord Stimulation. Palliat Med Rep 2024; 5:301-305. [PMID: 39144131 PMCID: PMC11319851 DOI: 10.1089/pmr.2023.0089] [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: 04/26/2024] [Indexed: 08/16/2024] Open
Abstract
Background Intrathecal pumps (ITPs) are indicated for refractory cancer pain and decrease systemic opioid requirements. While not yet indicated for cancer pain, spinal cord stimulators (SCSs) are used off-label for cancer pain, with increasing evidence of their efficacy. Materials and Methods A retrospective chart review was conducted of patients who underwent both ITP and at least SCS trial for cancer pain. Primary outcomes were pain numeric rating scale (NRS) and daily morphine equivalents (MEQs). Results Seventeen patients were identified. Both ITP and SCS were associated with significant decreases in pain ratings at the 3-month follow-up, but this decrease became nonsignificant subsequently. ITP, but not SCS, was associated with a significant decrease in MEQ. Conclusions ITP and SCS may both provide efficacy for cancer pain, but the opioid-sparing effects of SCS may be limited. ITP and SCS may potentially be complementary in their ability to provide relief from cancer-related pain.
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Affiliation(s)
- Evgeny Bulat
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jason E. Crowther
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vikram Chakravarthy
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ilya Laufer
- Department of Neurosurgery, New York University, New York, New York, USA
| | - Ori Barzilai
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Partain DK, Santivasi WL, Kamdar MM, Moeschler SM, Tilburt JC, Fischer KM, Strand JJ. Attitudes and Beliefs Regarding Pain Medicine: Results of a National Palliative Physician Survey. J Pain Symptom Manage 2024; 68:115-122. [PMID: 38677489 DOI: 10.1016/j.jpainsymman.2024.04.015] [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: 01/05/2024] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
CONTEXT Pain is a prevalent symptom in patients with serious illness and often requires interventional approaches for adequate treatment. Little is known about referral patterns and collaborative attitudes of palliative physicians regarding pain management specialists. OBJECTIVES To evaluate referral rates, co-management strategies, and beliefs of palliative physicians about the value of Pain Medicine specialists in patients with serious illness. METHODS A 30-question survey with demographic, referral/practice, and attitudes/belief questions was mailed to 1000 AAHPM physician members. Responses were characterized with descriptive statistics and further analyzed for associations between training experiences, practice environment, and educational activities with collaborative practice patterns and beliefs. RESULTS The response rate was 52.6%. Most survey respondents had initial board certification primarily in internal medicine (n = 286, 56%) or family medicine (n = 144, 28%). A minority of respondents had completed a formal ABMS Hospice and Palliative Medicine fellowship (n = 178, 34%). Respondents had been in practice for a median of nine years, (range 1-38 years) primarily in community hospitals (n = 249, 47%) or academic hospitals (n = 202, 38%). The variables best associated with collaborative practices and attitudes was practice in an academic hospital setting and participation in regular joint academic conferences with pain medicine clinicians. CONCLUSION This study shows that Palliative Care physicians have highly positive attitudes toward Pain Medicine specialists, but referrals remain low. Facilitating professional collaboration via joint educational/clinical sessions is one possible solution to drive ongoing interprofessional care in patients with complex pain.
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Affiliation(s)
- Daniel K Partain
- Division of Community Internal Medicine (D.K.P., J.J.S.), Geriatrics, and Palliative Care, Mayo Clinic, Rochester, Minnesota, USA.
| | - Wil L Santivasi
- Department of Medicine (W.L.S.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Mihir M Kamdar
- Section of Palliative Care and Geriatric Medicine (M.M.K.), Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Anesthesia Pain Medicine (M.M.K.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Susan M Moeschler
- Division of Pain Medicine (S.M.M.), Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jon C Tilburt
- Department of General Internal Medicine (J.C.T.), Mayo Clinic, Scottsdale, Arizona, USA
| | - Karen M Fischer
- Quantitative Health Services (K.M.F.), Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob J Strand
- Division of Community Internal Medicine (D.K.P., J.J.S.), Geriatrics, and Palliative Care, Mayo Clinic, Rochester, Minnesota, USA
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Costa MFFD, Bilobran MA, de Oliveira LC, Muniz AHR, Chelles PA, Sampaio SGDSM. Correlation Between Cancer Pain and Quality of Life in Patients With Advanced Cancer Admitted to a Palliative Care Unit. Am J Hosp Palliat Care 2024; 41:882-888. [PMID: 37559447 DOI: 10.1177/10499091231195318] [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] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Cancer pain is one of the most prevalent manageable symptoms in patients with advanced cancer, and it has a negative impact on quality of life (QoL). OBJECTIVE The aim of this study is to examine the correlation between cancer pain and QoL in patients with advanced cancer who are hospitalized in a palliative care unit. METHODS This study is a cross-sectional analysis of patients with advanced cancer who were hospitalized with cancer pain at a specialized palliative care unit between June 2021 and February 2022. Pain intensity and its impact on daily activities were assessed using the Brief Pain Inventory (BPI), while the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 PAL (QLQ-C15-PAL) was used to evaluate QoL. RESULTS A total of 104 patients with cancer pain were included, with a mean age of 53.6 years (±14.1). Most of the patients were female (65.38%), and the most common primary tumor site was in the gastrointestinal tract (22.11%). The most frequently reported site of cancer pain was the abdomen (32.69%). The mean duration of cancer pain was 52.3 days (±6.2). The domains of QoL most strongly correlated with cancer pain were weakness (coefficient = .52, P < .001), nausea (coefficient = .36, P < .001), and the physical domain (coefficient = -.30, P < .001). CONCLUSION Cancer pain is strongly correlated with a deterioration in QoL in patients with advanced cancer, and its management should be pursued as a strategy for optimizing QoL.
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Affiliation(s)
| | - Marcela Amitrano Bilobran
- Palliative Care Unit, National Cancer Institute, Rio de Janeiro, Brazil
- Prevent Senior, Palliative Care, Rio de Janeiro, Brazil
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Chai Q, Yang Z, Liu X, An D, Du J, Ma X, Rand K, Wu B, Luo N. Valuation of EQ-5D-5L health states from cancer patients' perspective: a feasibility study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:915-924. [PMID: 37837519 DOI: 10.1007/s10198-023-01635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/20/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES To assess the feasibility of estimating an EQ-5D-5L value set using a small study design in cancer patients and to compare the EQ-5D-5L values based on the preferences of cancer patients with those of the general public. METHODS Patients with clinically diagnosed cancers were recruited from two hospitals in Shanghai, China. In face-to-face interviews using the EQ-PVT survey, health states were valued by cancer patients using both cTTO and DCE methods. cTTO data was modelled alone or jointly with DCE data. Forty-eight models using different model specifications (cross-attribute level effect [CALE] and additive models), random/fixed effects model assumptions, data heteroscedasticity and censoring were estimated. The best performed model was identified in terms of monotonicity of estimated model coefficients and out-of-sample prediction accuracy. RESULTS Data collected from 221 cancer patients who participated in the study were included. The hybrid CALE model using both TTO and DCE data performed best in terms of prediction accuracy (Lin's concordance coefficient = 0.989; root mean squared error = 0.058) and suggested that pain/discomfort and anxiety/depression were the most undesirable health problems. Compared to values based on general Chinese public's health preferences, the values based on cancer patients' preferences were much higher and lower for health states characterized by extreme mobility problems and severe/extreme pain or discomfort, respectively. CONCLUSION This study demonstrated the feasibility of using a small design to develop EQ-5D-5L value sets based on cancer patients' health preferences. Since there were signs of differences between preferences of patients and general population, it may be valuable to develop patient-specific value sets and use them in clinical decision making and economic evaluations.
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Affiliation(s)
- Qingqing Chai
- Department of Pharmacy, Huangpu Branch, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Gui'an, China
| | - Xiaoyan Liu
- Department of Pharmacy, Huangpu Branch, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Di An
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiangyang Du
- Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiumei Ma
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kim Rand
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Bin Wu
- Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
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Morais MV, Lopes RA, Oliveira Júnior JO. Cordotomy for pain control and opioid reduction in cancer patients: A cancer center 11-year experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108571. [PMID: 39121636 DOI: 10.1016/j.ejso.2024.108571] [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: 05/07/2024] [Revised: 06/30/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Percutaneous lateral cervical cordotomy (PLCC) is a treatment option for predominantly nociceptive pain of oncological origin that is refractory to conservative methods, with unilateral distribution, particularly in the lower trunk or lower limbs of patients with a life expectancy of less than one year. OBJECTIVE The aim of this study was to assess the analgesic efficacy and opioid utilization alteration in patients undergoing PLCC. METHODS We retrospectively collected data from patients undergoing PLCC between 2011 and 2021 at the AC Camargo Cancer Center in São Paulo, Brazil. RESULTS Sixty-three patients and their respective surgical outcomes were analyzed. The mean preoperative pain intensity, as assessed by the mean numerical rating scale (NRS), was 8.4 (range: 4-10), while postoperatively, it decreased to 0.78 (range: 0-8). Lower postoperative NRS scores were observed for pain in the lower limbs and abdomen compared to the lower thorax. The mean preoperative oral morphine equivalent (OME) consumption was 231.0 mg (range: 30.0-1015.2). At 30 days postoperative, the mean consumption of OME was 120.2 mg (range: 0.0-705.0). Twelve months after surgery, the average consumption of OME was 98.3 mg (range: 0.0-396.0). CONCLUSION PLCC is a valuable therapeutic intervention for patients experiencing cancer pain that is unresponsive to conservative treatments. The anticipated analgesic outcomes are generally favorable, particularly in cases where the pain is localized unilaterally in the abdomen or lower body segments.
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Affiliation(s)
- Marcus V Morais
- Postgraduate Program in Health Sciences, Instituto de Assistência Mêdica ao Servidor Público Estadual (IAMSPE), São Paulo, Brazil.
| | | | - José O Oliveira Júnior
- Postgraduate Program in Health Sciences, Instituto de Assistência Mêdica ao Servidor Público Estadual (IAMSPE), São Paulo, Brazil; Pain Department, AC Camargo Cancer Center, São Paulo, Brazil; Neurosurgery Department, Hospital do Servidor Público Estadual, São Paulo, Brazil
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Huang L, Zhang L, Huang H, Cai R, Yu H, Li J, Li M, Yu T, Cheng S, Xiao J. Optimizing medication guidance support for patients with cancer pain: development and evaluation of a pharmaceutical care system for healthcare professionals. Support Care Cancer 2024; 32:533. [PMID: 39037493 DOI: 10.1007/s00520-024-08738-2] [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: 01/28/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Effective management of cancer pain critically depends on timely medication administration and adherence to precise medication guidelines. In the context of limited time and a busy healthcare environment, tailoring the optimal medication schedule for each patient with cancer pain presents a significant challenge for physicians and clinical pharmacists. METHODS To address this challenge, we conducted a comprehensive analysis of healthcare professionals' needs in guiding cancer pain medication. By developing core features based on key user needs and continuously updating them, we have created the Universal Medication Schedule System (UMSS). We invited 20 physicians and pharmacists specializing in oncology or cancer pain to trial the system and assessed UMSS usage through distributed questionnaires. RESULTS We identified five key needs of healthcare professionals in cancer pain medication guidance. Based on these needs, we (1) constructed a comprehensive drug information database, including basic information for 1135 drugs, 130,590 drug interaction data entries, and 1409 individual medication timing constraints, and (2) developed a web-based system that provides essential reference information such as drug interactions and dietary restrictions. It can create medication schedules and provide medication education tailored to the patient's daily routine. Participating evaluators unanimously agreed (100%) that the system aids in accurately assessing the risks of polypharmacy and quickly scheduling medication regimens. CONCLUSION UMSS, by offering personalized medication schedule support, assists healthcare professionals in better managing patients' medication treatment plans. However, further improvements are needed in the automation of database updates and maintenance, as well as in integrating it with electronic health records.
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Affiliation(s)
- Ling Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan, China
| | - Lu Zhang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan, China
| | - Hangxing Huang
- School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Ruwen Cai
- Dali University, Dali, Yunnan, China
| | - Huimin Yu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan, China
| | - Jingyang Li
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan, China
| | | | - Ting Yu
- Dali University, Dali, Yunnan, China
| | - Shuqiao Cheng
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan, China.
| | - Jian Xiao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan, China.
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10
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Simister SK, Bhale R, Cizik AM, Wise BL, Thorpe SW, Ferrell B, Randall RL, Fauer A. Supportive care interventions in metastatic bone disease: scoping review. BMJ Support Palliat Care 2024:spcare-2024-004965. [PMID: 39038991 DOI: 10.1136/spcare-2024-004965] [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: 05/08/2024] [Accepted: 05/21/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Patients with secondary metastatic involvement of the musculoskeletal system due to primary cancers are a rapidly growing population with significant risks for health-related end-of-life morbidities. In particular, bone metastases or metastatic bone disease (MBD) imparts significant adversity to remaining quality of life. No rigorous review of clinical trials on the use of supportive care interventions for MBD has been conducted. The objective of this review was to examine the characteristics of supportive care interventions for MBD and critically appraise study designs, key findings, and quality of evidence of the research. METHODS We searched for published clinical trials, systematic reviews and meta-analyses in PubMED, CINAHL and Google Scholar for articles published between September 2017 and September 2022. Some examples of Medical Subject Headings terms were: 'secondary neoplasm', 'metastatic bone disease', 'palliative care' and 'supportive care intervention'. Quality of published evidence was evaluated based on treatment types and study design. RESULTS After reviewing 572 publications, 13 articles were included in the final review and evaluation including seven clinical trials, two trial protocols and four systematic reviews. Feasible interventions included enhanced palliative care consultation, palliative radiotherapy and alternative medicines. Interventions addressed primary endpoints of fatigue (N=4, 31%), pain (N=3, 23%) or cancer-related symptoms (N=3, 23%) with patient-reported outcome instruments. No interventions reported on fracture complications or endpoints, specifically. The quality of most studies was moderate to strong. CONCLUSION Supportive care interventions for MBD are feasible and the impact is measurable via patient-reported outcome measures. While the evidence for interventions was moderate to strong, there are very few specific controlled trials for skeletal-related events and impacts of social determinants of health. Further clinical trials are needed to define supportive care interventions for MBD that demonstrate reduced risk of fracture and that mitigate the reduced quality of life when negative musculoskeletal outcomes arise.
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Affiliation(s)
- Samuel K Simister
- Department of Orthopaedics, University of California Davis, Sacramento, California, USA
| | - Rahul Bhale
- Department of Orthopaedics, University of California Davis, Sacramento, California, USA
| | - Amy M Cizik
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | - Barton L Wise
- Department of Orthopaedics, University of California Davis, Sacramento, California, USA
- Department or Internal Medicine, University of California Davis, Sacramento, California, USA
| | - Steven W Thorpe
- Department of Orthopaedics, University of California Davis, Sacramento, California, USA
| | - Betty Ferrell
- Nursing Research and Education, City of Hope, Duarte, California, USA
| | - R Lor Randall
- Department of Orthopaedics, University of California Davis, Sacramento, California, USA
| | - Alex Fauer
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, USA
- Comprehensive Cancer Center, University of California Davis, Sacramento, California, USA
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Alishahi Tabriz A, Turner K, Hemati H, Baugh C, Elston Lafata J. Assessing the Validity of the Centers for Medicare & Medicaid Services Measure in Identifying Potentially Preventable Emergency Department Visits by Patients With Cancer. JCO Oncol Pract 2024:OP2400160. [PMID: 39038257 DOI: 10.1200/op.24.00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/31/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE The Centers for Medicare & Medicaid Services (CMS) implemented chemotherapy measures (OP-35) to reduce potentially preventable emergency department visits (PPEDVs) and hospitalizations. This study evaluated the validity of the OP-35 measure in identifying PPEDVs among patients with cancer. METHODS This is a cross-sectional study, which used data from the 2012-2022 National Hospital Ambulatory Medical Care Survey. ED visits are assessed and compared on the basis of three measures: immediacy using Emergency Severity Index (ESI), disposition (discharge v hospitalization), and OP-35 criteria. RESULTS Between 2012 and 2022, a weighted sample of 46,723,524 ED visits were made by patients with cancer. Among reported ESI cases, 25.2% (8,346,443) was high urgency. In addition, 30.3% (14,135,496) of ED visits among patients with cancer led to hospitalizations. Using the OP-35 measure, it was found that 20.85% (9,743,977) was PPEDVs. A 21.9% (10,232,102) discrepancy between discharge diagnosis (CMS billing codes) and chief complaints was identified. Further analysis showed that 19.2% (1,872,556) of potentially preventable ED visits (CMS OP-35) were high urgency and 32.6% (3,181,280) resulted in hospitalization. CONCLUSION The CMS approach to identifying PPEDVs has limitations. First, it may overcount preventable visits by including high-urgency or hospitalization-requiring cases. Second, relying on final diagnoses for retrospective preventability judgment can be misleading as they may not reflect the initial reason for the visit. In addition, differentiating causes for ED visits in patients with cancer undergoing various treatments is challenging as the approach does not distinguish between chemotherapy-related complications and others. Identification inconsistencies arise because of varying coding practices and chosen preventable conditions, lacking consensus and alignment with specific hospital or patient needs. Finally, the model fails to consider crucial nonclinical factors like social support, economic barriers, and alternative care access, potentially unfairly penalizing hospitals serving underserved populations.
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Affiliation(s)
- Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Homa Hemati
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christopher Baugh
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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12
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Schmocker M, Engst R, Wirz M, Bana M. Factors influencing physical activity in individuals with head and neck cancer: a scoping review. BMJ Open 2024; 14:e083852. [PMID: 39019637 PMCID: PMC11331979 DOI: 10.1136/bmjopen-2023-083852] [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: 12/31/2023] [Accepted: 06/07/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES Higher physical activity (PA) levels are associated with better quality of life in people with head and neck cancer (HNC). Despite this positive association, most individuals with these cancer types have a sedentary or low-activity lifestyle. Limited knowledge exists regarding the factors that influence PA in this group. Therefore, we reviewed and mapped the available literature on factors that may influence PA in people with HNC. DESIGN We conducted a scoping review based on the framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline extension for scoping reviews. DATA SOURCES CINHAL, the Cochrane Library, EMBASE, PsycINFO, MEDLINE and Scopus were searched from inception to July 2023. ELIGIBILITY CRITERIA We included qualitative and quantitative studies that stated factors such as barriers, facilitators, beliefs, perceptions and views influencing PA in individuals with HNC. Furthermore, views and recommendations of healthcare professionals involved in the care of people affected by HNC and researchers in this domain were eligible for data extraction. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesised by one reviewer according to the predefined items including characteristics, barriers, facilitators, beliefs, perceptions and views of people being affected and views and recommendations of experts. Quantitative data were charted descriptively, and qualitative data were analysed and summarised using a basic content analysis approach. RESULTS Of the 1351 publications, we included 19 in our review. Publications mainly focused on barriers to PA, with some studies reporting facilitators and collecting data on patients' and healthcare professionals' views on PA. Most research teams made recommendations for promoting PA in people with HNC.Characteristics associated with activity levels included age, cancer type and stage, morbidity level and attitude towards being active. Prevalent barriers consisted of health-related factors, including fatigue, pain and nutritional issues, alongside personal and environmental impediments such as time constraints, lack of interest or motivation. Facilitating factors for PA included perceived or experienced mental and health-related benefits. Consensus among patients, healthcare professionals and researchers highlighted the necessity for enhanced information and education, emphasising individualised approaches to promote PA throughout the cancer continuum. CONCLUSIONS Numerous factors affect PA in individuals with HNC. Future research should concentrate on screening and addressing risk factors for sedentary behaviour and activity barriers and on optimal design and delivery of interventions to incorporate PA promotion into the care pathway.
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Affiliation(s)
- Martina Schmocker
- Institute for Therapies and Rehabilitation, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Ramona Engst
- Institute of Nursing Sciences, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Markus Wirz
- Institute of Physiotherapy, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Marika Bana
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
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13
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Begum NF, Ramadoss R, Yadalam PK, Ramani P, Ramalingam K. Phytochemical Targeting of Nerve Growth Factor by Thymoquinone and Cuscutin: A Molecular Dynamics Simulation Study. Cureus 2024; 16:e63727. [PMID: 39099944 PMCID: PMC11296693 DOI: 10.7759/cureus.63727] [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] [Accepted: 07/03/2024] [Indexed: 08/06/2024] Open
Abstract
Background Nerve growth factor (NGF) is a novel target of pain therapeutics for oral cancer, and it plays a main role in the nociception of chronic pain. Surgery, along with chemotherapy or radiotherapy, is the gold standard for treating patients, but the side effects are significant as well. Newer effective interventions with natural phytochemicals could improve patient compliance and enhance the quality of life among patients with oral cancer. A literature search revealed a positive correlation between NGF and oral cancer pain. Nigella sativa (N. sativa) and Cuscuta reflexa (C. reflexa) have proven anticancer effects, but their activity with NGF is unexplored. Aims and objectives We aimed to identify the potential phytochemicals in N. sativa and C. reflexa. We also checked the NGF-blocking activity of the phytochemicals. Molecular docking and molecular dynamic (MD) simulations evaluated the binding energy and stability between the NGF protein and selected phytochemical ligands. Materials and methods We obtained protein NGF structure from UniProt (ID: 4EDX, P01138, Beta-nerve growth factor), ligand (thymoquinone) structure using PubChem ID: 10281, and ligand (cuscutin) structure using PubChem ID: 66065. Maestro protein (Schrödinger Inc., Mannheim, Germany) was used for molecular docking. Desmond Simulation Package (Schrödinger Inc., Mannheim, Germany) was used to model MD for 100 nanoseconds (ns). We have assessed the interaction between the protein and ligands by root mean square deviation (RMSD) values. Results The interaction of thymoquinone and cuscutin with NGF was assessed. While interacting with thymoquinone, there was mild fluctuation from 0.6 Å to 2.5 Å up to 80 ns and ended up at 4.8 Å up to 100 ns. While interacting with cuscutin, mild fluctuation was seen from 0.8 Å to 4.8 Å till 90 ns and ended at 6.4 Å up to 100 ns. We found a stable interaction between our drug combination and the NGF receptor. Conclusion We have identified a stable interaction between thymoquinone, cuscutin, and NGF by our MD simulations. Hence, it could be used as an NGF inhibitor for pain relief and to control tumor progression. Further in vitro and in vivo evaluations of this novel drug combination with phytochemicals will help us understand their biological activities and potential clinical applications in oral cancer therapeutics.
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Affiliation(s)
- N Fazulunnisa Begum
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Ramya Ramadoss
- Oral Pathology and Oral Biology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Pradeep Kumar Yadalam
- Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Pratibha Ramani
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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14
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Howren MB, Christensen AJ, Pagedar NA. Prevalence of pain in a sample of long-term survivors of head and neck cancer. Am J Otolaryngol 2024; 45:104300. [PMID: 38640810 PMCID: PMC11168893 DOI: 10.1016/j.amjoto.2024.104300] [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: 04/06/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE The experience of long-term pain in head and neck cancer (HNC) survivors is important but has received less attention in the HNC literature. The present study sought to examine the prevalence of pain from 2 to 5 years postdiagnosis and its association with HNC-specific health-related quality of life. MATERIALS & METHODS Prospective observational study at a single-institution tertiary care center. Pain was measured using a single item ranging from 0 to 10 with 0 representing no pain and 10 representing worst pain possible at 2 through 5 years postdiagnosis. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI). RESULTS Pain reports were consistent across time. At 2 years postdiagnosis (N = 581), 27.6 % experienced at least some pain with 14.3 % reporting moderate or severe pain. At 3 years postdiagnosis (N = 417), 21.4 % experienced at least some pain with 14.2 % indicating moderate or severe pain. At 4 years postdiagnosis (N = 334), 26.7 % experienced at least some pain with 15.9 % reporting moderate or severe pain. At 5 years postdiagnosis (N = 399), 30.5 % experienced at least some pain with 17.5 % indicating moderate or severe pain. In general, across all four HNCI domains, those in the moderate and severe pain categories largely failed to reach 70 which is indicative of high functioning on the HNCI. CONCLUSIONS Pain is a considerable issue in long-term HNC survivors up to 5 years postdiagnosis. More research is needed to understand correlates of pain after treatment, including opportunities for screening and intervention, to improve outcomes and optimize recovery in HNC.
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Affiliation(s)
- M Bryant Howren
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, United States of America; Department of Internal Medicine, The University of Iowa, Iowa City, IA, United States of America; Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America.
| | - Alan J Christensen
- Department of Psychology, East Carolina University, Greenville, NC, United States of America
| | - Nitin A Pagedar
- Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America; Department of Otolaryngology, Head and Neck Surgery, The University of Iowa, Iowa City, IA, United States of America
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15
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Kaye AD, Dufrene K, Cooley J, Walker M, Shah S, Hollander A, Shekoohi S, Robinson CL. Neuropsychiatric Effects Associated with Opioid-Based Management for Palliative Care Patients. Curr Pain Headache Rep 2024; 28:587-594. [PMID: 38564124 DOI: 10.1007/s11916-024-01248-0] [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] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW The abundance of opioids administered in the palliative care setting that was once considered a standard of care is at present necessitating that providers evaluate patients for unintentional and deleterious symptomology related to aberrant opioid use and addiction. Polypharmacy with opioids is dynamic in affecting patients neurologically, and increased amounts of prescriptions have had inimical effects, not only for the individual, but also for their families and healthcare providers. The purpose of this review is to widen the perspective of opioid consequences and bring awareness to the numerous neuropsychiatric effects associated with the most commonly prescribed opioids for patients receiving palliative care. RECENT FINDINGS Numerous clinical and research studies have found evidence in support for increased incidence of opioid usage and abuse as well as undesirable neurological outcomes. The most common and concerning effects of opioid usage in this setting are delirium and problematic drug-related behavioral changes such as deceitful behavior towards family and physicians, anger outbursts, overtaking of medications, and early prescription refill requests. Other neuropsychiatric effects detailed by recent studies include drug-seeking behavior, tolerance, dependence, addictive disorder, anxiety, substance use disorder, emotional distress, continuation of opioids to avoid opioid withdrawal syndrome, depression, and suicidal ideation. Opioid usage has detrimental and confounding effects that have been overlooked for many years by palliative care providers and patients receiving palliative care. It is necessary, even lifesaving, to be cognizant of potential neuropsychiatric effects that opioids can have on an individual, especially for those under palliative care. By having an increased understanding and awareness of potential opioid neuropsychiatric effects, patient quality of life can be improved, healthcare system costs can be decreased, and patient outcomes can be met and exceeded.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
- Department of Pharmacology, Louisiana State University Health Sciences Center at Shreveport, Toxicology, and Neurosciences, Shreveport, LA, 71103, USA
| | - Kylie Dufrene
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Jada Cooley
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Madeline Walker
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Shivam Shah
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Alex Hollander
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
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16
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Yan L, Kang P, Cao C, Jinhui B, Yong L. Prognostic value of systemic immune-inflammation index/albumin ratio for immunotherapy-treated patients receiving opioids. PLoS One 2024; 19:e0305119. [PMID: 38935663 PMCID: PMC11210763 DOI: 10.1371/journal.pone.0305119] [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: 02/29/2024] [Accepted: 05/23/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE This study evaluated the effect of the systemic immune-inflammation index/albumin ratio (SII/ALB) on the prognosis of immunotherapy-treated patients receiving opioids. METHODS A retrospective analysis was conducted of 185 immunotherapy-treated patients who received opioids at Xuzhou Central Hospital from 01/09/2021 to 01/09/2023. The results of related clinical data were collected during the week before the cancer patients received immunotherapy. The SII/ALB cut-off value was determined, and the relationship between the SII/ALB and clinical pathological parameters was analyzed using the chi-square test. The effect of the SII/ALB on progression-free survival (PFS) was examined using Kaplan-Meier curves and the Cox proportional hazard model. RESULT The SII/ALB cut-off value was 20.86, and patients were divided into low (SII/ALB ≤ 20.86) and high (SII/ALB > 20.86) SII/ALB groups. Adverse reactions (hazard ratio [HR] = 0.108; 95% confidence interval [CI]: 0.061-0.192, P < 0.001) and the SII/ALB (HR = 0.093; 95% CI: 0.057-0.151, P < 0.001) were independent prognostic factors for PFS. Compared with the high SII/ALB group, the low SII/ALB group had longer PFS after opioid treatment (12.2 vs. 5.2 months, P < 0.001). CONCLUSION The SII/ALB is a potentially important prognostic parameter in immunotherapy-treated patients receiving opioids.
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Affiliation(s)
- Lei Yan
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Pan Kang
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chengsong Cao
- Department of Oncology, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, Jiangsu, China
| | - Bu Jinhui
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Liu Yong
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Oncology, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, Jiangsu, China
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17
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Micha JP, Rettenmaier MA, Bohart RD, Goldstein BH. Medical marijuana in the treatment of cancer-associated symptoms. J Oncol Pharm Pract 2024:10781552241262963. [PMID: 38899936 DOI: 10.1177/10781552241262963] [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: 06/21/2024]
Abstract
OBJECTIVE Previous cancer studies have indicated that medical marijuana addresses a significant unmet need, namely chronic pain treatment and conferring oncology supportive care. However, the clinical research evaluating medical marijuana is preliminary and requires further consideration. DATA SOURCES We conducted a PubMed search primarily comprising retrospective and prospective studies, systematic reviews, and randomized clinical trials (RCTs) from approximately 2020-2023. The search included specific terms that incorporated medical marijuana, cancer treatment, cancer-related symptoms, pain management, and side effects. DATA SUMMARY A total of 40 studies were included in the review, many of which were either of acceptable or good quality. Select investigations indicated that medical marijuana was associated with decreased overall pain levels and improvements in nausea and vomiting. Alternatively, the results from RCTs have found that the benefits from a placebo were equivalent to medical marijuana in both the treatment of cancer-related pain and providing an opioid-sparing effect. CONCLUSIONS Despite the potential cancer-related benefits derived from medical marijuana, the study design and results for many of the investigations on which the evidence is based, were neither uniform nor conducted via RCTs; hence, the efficacy and appropriateness of medical marijuana in treating cancer-related conditions remain indeterminate.
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Affiliation(s)
- John P Micha
- Women's Cancer Research Foundation, Laguna Beach, CA, USA
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Gaertner J, Boehlke C, Kreye G, Fusi-Schmidhauser T, Mueller E, Roch C. Pharmacological treatment of cancer pain and opioid induced nausea and vomiting: online survey and comparison with current guidelines. Support Care Cancer 2024; 32:436. [PMID: 38879720 PMCID: PMC11180006 DOI: 10.1007/s00520-024-08628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/02/2024] [Indexed: 06/19/2024]
Abstract
PURPOSE We assumed that in Palliative Care, even in common clinical situations, the choice of drugs differs substantially between physicians. Therefore, we assessed the practice of pharmaceutical treatment choices of physicians for cancer pain and opioid-induced nausea and vomiting (OINV) and the rationale for their choices. METHODS An online survey was conducted with physicians covering the following domains: i) Cancer pain therapy: non-opioids in addition to opioids: choice of drug ii) prevention of OINV: choice of drug and mode of application. Current guidelines concerning cancer pain therapy and prevention of OINV were compared. RESULTS Two-hundred-forty European physicians responded to our survey. i) Use of non-opioids in addition to opioids for the treatment of cancer pain: Only 1.3% (n = 3) of respondents never used an additional non-opioid. Others mostly used: dipyrone/metamizole (49.2%, n = 118), paracetamol/acetaminophen (34.2%, n = 82), ibuprofen / other NSAIDs (11.3%, n = 27), specific Cox2-inhibitors (2.1%, n = 5), Aspirin (0.4%, n = 1), no answer (2.9%, n = 7). ii) Antiemetics to prevent OINV: The drugs of choice were metoclopramide (58.3%, n = 140), haloperidol (26.3%, n = 63), 5-HT3 antagonists (9.6%, n = 23), antihistamines (1.3%, n = 3) and other (2.9%, n = 7); no answer (1.7%, n = 4). Most respondents prescribed the substances on-demand (59.6%, n = 143) while others (36.3%, n = 87) provided them as around the clock medication. Over both domains, most physicians answered that their choices were not based on solid evidence from randomized controlled trials (RCTs). Guidelines were inconsistent regarding if and what non-opioid to use for cancer pain and recommend anti-dopaminergic drugs for prevention or treatment of OINV. CONCLUSIONS Physician's practice in palliative care for the treatment of cancer pain and OINV differed substantially. Respondents expressed the lack of high-quality evidence- based information from RCTs. We call for evidence from methodologically high-quality RCTs to be available to inform physicians about the benefits and harms of pharmacological treatments for common symptoms in palliative care.
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Affiliation(s)
- Jan Gaertner
- Palliative Care Center Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Christopher Boehlke
- Palliative Care Center Basel, Basel, Switzerland.
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
| | - Gudrun Kreye
- Division of Palliative Care, Department of Internal Medicine, Karl Landsteiner University of Health Sciences, Krems, Austria
- Karl Landsteiner University of Health Sciences, University Hospital, Krems, Austria
| | - Tanja Fusi-Schmidhauser
- Palliative and Supportive Care Clinic and Department of Internal Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Department of Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Evelyn Mueller
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Carmen Roch
- Interdisciplinary Center for Palliative Medicine, University Hospital Wuerzburg, Würzburg, Germany
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19
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Xia W, Ding J, Yan Y, Chen F, Yan M, Xu X. Effectiveness of Virtual Reality Technology in Symptom Management of Patients at the end of life: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2024:105086. [PMID: 38880120 DOI: 10.1016/j.jamda.2024.105086] [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: 01/23/2024] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVES The objective of this review was to explore the effectiveness of virtual reality (VR) technology in symptom management of patients at the end of life. DESIGN This is a systematic review and meta-analysis, which has been registered on PROSPERO (CRD42022344679). SETTING AND PARTICIPANTS Patients at the end of life. METHODS PubMed, Embase, Web of Science, the Cochrane Library, JBI, EBSCO, CNKI, Wanfang, and SinoMed were searched from inception to July 31, 2023. Search terms included "virtual reality" and "end-of-life." Articles were screened according to the inclusion and exclusion criteria. The random effects model was used to calculate the standardized mean difference (SMD), and the fixed effects model was used to calculate the mean difference (MD). The Cochrane Risk of Bias Tool 2.0 and JBI Evaluation tool were used to assess the risk of bias. The I2 statistic was used to measure heterogeneity between studies. Forest plots were used for analysis. RESULTS A total of 234 patients at the end of life from 3 randomized controlled trials and 6 quasi-experimental studies were included. Compared with pre-VR intervention, the pain [standardized mean difference (SMD) -0.89, 95% CI -1.29 to -0.48, P < .05], shortness of breath [mean difference (MD) -0.98, 95% CI -0.98-0.51, P < .05], depression (MD -0.62, 95% CI -0.85 to -0.40, P < .05), and anxiety (SMD -0.93, 95% CI -1.50 to 0.36, P < .05) of patients at the end of life was significantly improved after VR intervention. However, there were no significant differences observed in tiredness, drowsiness, nausea, and lack of appetite. CONCLUSIONS AND IMPLICATIONS VR technology can be effective in improving pain, shortness of breath, depression, and anxiety in patients at the end of life. For tiredness, drowsiness, nausea, and lack of appetite, further research is required.
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Affiliation(s)
- Wanting Xia
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha, Hunan, China; Xiangya Subcenter of JBI Evidence-Based Center, China
| | - JinFeng Ding
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China; Xiangya Subcenter of JBI Evidence-Based Center, China
| | - Yixia Yan
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, China
| | - Furong Chen
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, China
| | - Mengyao Yan
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha, Hunan, China; Xiangya Subcenter of JBI Evidence-Based Center, China
| | - Xianghua Xu
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, China.
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20
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Carrillo-de-la-Peña MT, Fernandes C, Castro C, Medeiros R. Validity of central pain processing biomarkers for predicting the occurrence of oncological chronic pain: a study protocol. BMC Cancer 2024; 24:705. [PMID: 38849731 PMCID: PMC11161916 DOI: 10.1186/s12885-024-12455-8] [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: 05/03/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Despite recent improvements in cancer detection and survival rates, managing cancer-related pain remains a significant challenge. Compared to neuropathic and inflammatory pain conditions, cancer pain mechanisms are poorly understood, despite pain being one of the most feared symptoms by cancer patients and significantly impairing their quality of life, daily activities, and social interactions. The objective of this work was to select a panel of biomarkers of central pain processing and modulation and assess their ability to predict chronic pain in patients with cancer using predictive artificial intelligence (AI) algorithms. METHODS We will perform a prospective longitudinal cohort, multicentric study involving 450 patients with a recent cancer diagnosis. These patients will undergo an in-person assessment at three different time points: pretreatment, 6 months, and 12 months after the first visit. All patients will be assessed through demographic and clinical questionnaires and self-report measures, quantitative sensory testing (QST), and electroencephalography (EEG) evaluations. We will select the variables that best predict the future occurrence of pain using a comprehensive approach that includes clinical, psychosocial, and neurophysiological variables. DISCUSSION This study aimed to provide evidence regarding the links between poor pain modulation mechanisms at precancer treatment in patients who will later develop chronic pain and to clarify the role of treatment modality (modulated by age, sex and type of cancer) on pain. As a final output, we expect to develop a predictive tool based on AI that can contribute to the anticipation of the future occurrence of pain and help in therapeutic decision making.
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Affiliation(s)
- M T Carrillo-de-la-Peña
- Brain and Pain (BaP) Lab, Departamento de Psicoloxía Clínica y Psicobioloxía, Facultade de Psicoloxia, Universidade de Santiago de Compostela, Campus Vida, Santiago de Compostela, A Coruña, 15782, Spain
| | - C Fernandes
- Faculty of Human and Social Sciences, University Fernando Pessoa, Praça 9 de Abril, 349, Porto, 4249-004, Portugal
- Faculty of Psychology and Education Sciences, Laboratory of Neuropsychophysiology, University of Porto, Rua Alfredo Allen, Porto, 4200-135, Portugal
- Molecular Oncology and Viral Pathology Group, Research Center of IPO (CI-IPOP) & RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto. CCC), R. Dr. António Bernardino de Almeida 865, Porto, 4200-072, Portugal
| | - C Castro
- Molecular Oncology and Viral Pathology Group, Research Center of IPO (CI-IPOP) & RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto. CCC), R. Dr. António Bernardino de Almeida 865, Porto, 4200-072, Portugal.
- School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 400, Porto, 4200-072, Portugal.
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal.
| | - R Medeiros
- Molecular Oncology and Viral Pathology Group, Research Center of IPO (CI-IPOP) & RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto. CCC), R. Dr. António Bernardino de Almeida 865, Porto, 4200-072, Portugal
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
- Abel Salazar Institute of Biomedical Sciences (ICBAS), University of Porto, R. Jorge de Viterbo Ferreira 228, Porto, 4050-313, Portugal
- Virology Service, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Rua Dr. António Bernardino de Almeida, 865, 4200-072, Portugal
- Biomedical Research Center (CEBIMED), Faculty of Health Sciences of Fernando Pessoa University, Praça 9 de Abril, 349, Porto, 4249-004, Portugal
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21
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Barr J, Walz A, Restaino AC, Amit M, Barclay SM, Vichaya EG, Spanos WC, Dantzer R, Talbot S, Vermeer PD. Tumor-infiltrating nerves functionally alter brain circuits and modulate behavior in a male mouse model of head-and-neck cancer. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.10.18.562990. [PMID: 37905135 PMCID: PMC10614955 DOI: 10.1101/2023.10.18.562990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Cancer patients often experience changes in mental health, prompting an exploration into whether nerves infiltrating tumors contribute to these alterations by impacting brain functions. Using a male mouse model for head and neck cancer, we utilized neuronal tracing techniques and show that tumor-infiltrating nerves indeed connect to distinct brain areas via the ipsilateral trigeminal ganglion. The activation of this neuronal circuitry led to behavioral alterations represented by decreased nest-building, increased latency to eat a cookie, and reduced wheel running. Tumor-infiltrating nociceptor neurons exhibited heightened activity, as indicated by increased calcium mobilization. Correspondingly, the specific brain regions receiving these neural projections showed elevated cFos and delta FosB expression in tumor-bearing mice, alongside markedly intensified calcium responses compared to non-tumor-bearing counterparts. The genetic elimination of nociceptor neurons in tumor-bearing mice led to decreased brain Fos expression and mitigated the behavioral alterations induced by the presence of the tumor. While analgesic treatment successfully restored behaviors involving oral movements to normalcy in tumor-bearing mice, it did not have a similar therapeutic effect on voluntary wheel running. This discrepancy points towards an intricate relationship, where pain is not the exclusive driver of such behavioral shifts. Unraveling the interaction between the tumor, infiltrating nerves, and the brain is pivotal to developing targeted interventions to alleviate the mental health burdens associated with cancer.
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Shindo Y, Koide Y, Nagai N, Kitagawa T, Aoyama T, Shimizu H, Hashimoto S, Tachibana H, Kodaira T, Ishihara S, Naganawa S. Palliative radiotherapy for painful non-bone lesions in patients with advanced cancer: a single center retrospective study. Jpn J Radiol 2024; 42:656-661. [PMID: 38386259 PMCID: PMC11139690 DOI: 10.1007/s11604-024-01536-0] [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: 11/13/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE This retrospective study aimed to assess the efficacy and safety of palliative radiotherapy for painful non-bone lesions in patients with advanced cancer. MATERIALS AND METHODS We enrolled patients with painful non-bone lesions who underwent conventional palliative radiotherapy between September 2018 and September 2022. The treatment targets included primary tumor lesions, lymph node metastases, non-bone hematogenous metastases, and other lesions. The primary endpoint was the overall pain response rate in evaluable patients, determined based on the International Consensus Pain Response Endpoint criteria. The secondary endpoints included overall survival, pain recurrence, and adverse events. RESULTS Of the 420 screened patients, 142 received palliative radiotherapy for painful non-bone lesions, and 112 were evaluable. A pain response was achieved in 67 patients (60%) of the 112 evaluable patients within a median of 1.2 months. Among these patients, 25 exhibited complete response, 42 partial response, 18 indeterminate response, and 27 pain progression. The median survival time was 5.5 months, recorded at a median follow-up of 6.0 months, during which 67 patients died. Multivariate analysis identified poor performance status scores of 2-4, opioid use, and re-irradiation as independent factors associated with a reduced likelihood of achieving a pain response. Pain recurrence occurred in 18 patients over a median of 4.1 months. Seventeen patients had grade 1-2 adverse events, while none experienced grade 3 or higher toxicity. CONCLUSION Palliative radiotherapy can potentially be a safe and well-tolerated modality for managing painful non-bone lesions, with a low rate of adverse events.
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Affiliation(s)
- Yurika Shindo
- Department of Radiation Oncology, Aichi Cancer Center, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi, 464-0824, Japan
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi, 464-0824, Japan.
| | - Naoya Nagai
- Department of Radiation Oncology, Aichi Cancer Center, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi, 464-0824, Japan
| | - Tomoki Kitagawa
- Department of Radiation Oncology, Aichi Cancer Center, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi, 464-0824, Japan
| | - Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Center, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi, 464-0824, Japan
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi, 464-0824, Japan
| | - Shingo Hashimoto
- Department of Radiation Oncology, Aichi Cancer Center, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi, 464-0824, Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology, Aichi Cancer Center, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi, 464-0824, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi, 464-0824, Japan
| | - Shunichi Ishihara
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Peters M, Kutzko DJ, Stilos K. Continuous Ambulatory Delivery Device Use for Patients Managed by an Inpatient Palliative Care Team. Pain Manag Nurs 2024; 25:e236-e242. [PMID: 38616457 DOI: 10.1016/j.pmn.2024.02.014] [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: 11/22/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The use of Patient Controlled Analgesia (PCA) via a Continuous Ambulatory Delivery Device (CADD) is a common and effective means of pain and symptom management for hospitalized patients with a malignancy. Studies exploring the indications for starting such a device for hospitalized inpatients referred to inpatient palliative care teams are limited. AIM This retrospective chart review aims to explore indications, timing of initiation, and barriers to the use of a CADD. METHODS Over a six month period, during daily inpatient palliative care consult team rounds, patients who required a CADD were enrolled in this study. Sixty-one adult patients were identified who required a pump for symptom control. The team's database sheets were used to capture patient demographics. RESULTS The main reasons for initiating a Continuous Ambulatory Delivery Device in the above setting included: lack of efficacy of oral opioids and to increase patient autonomy of their pain management. Approximately 20% of patients required transfer to another unit that could accommodate the CADD. The median length of stay for these patients was 13 days, with a median length of half a day for a pump to be started. CONCLUSIONS This initial study provides the Palliative Care Consult Team with information on the indications for the use of a CADD. The lack of universal access to a CADD in various areas of our hospital due to differences in departmental protocols may compromise good symptom management and patient safety. These results strengthen the argument that the existing hospital policy requires revamping to improve CADD access. A CADD has been shown to provide hospitalized patients, with a malignancy, with timely access to effective symptom management, and in turn, reducing their length of stay in hospital. These findings will help inform this organization's CADD policy and support the need to broaden access to this device.
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Affiliation(s)
- Madison Peters
- Advanced Practice Nurse, Division of Palliative Care Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dr Justin Kutzko
- Palliative Care Physician, Division of Supportive and Palliative Care, Brampton Civic Hospital, William Osler Health System, Brampton, Ontario, Canada; Senior Lecturer, University of Queensland, Brisbane, Australia
| | - Kalli Stilos
- Advanced Practice Nurse, Division of Palliative Care Sunnybrook Health Sciences Centre, Adjunct Clinical Faculty for Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
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Li X, Baser RE, Bryl K, Amann L, Chimonas S, Mao JJ. How does pretreatment expectancy influence pain outcomes with electroacupuncture and battlefield acupuncture in cancer survivors?: Pretreatment expectancy and pain reduction by acupuncture. Integr Med Res 2024; 13:101040. [PMID: 38721341 PMCID: PMC11077026 DOI: 10.1016/j.imr.2024.101040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 07/15/2024] Open
Abstract
Background Outcome expectancy is an important component of non-specific effect that may play an important role in pain research and clinical care. We sought to evaluate whether pretreatment expectancy predicts pain reduction in cancer survivors receiving electroacupuncture (EA) or battlefield acupuncture (BFA). Methods We analyzed data from a randomized clinical trial that compared EA and BFA versus wait list control (WLC) for chronic musculoskeletal pain in cancer survivors. Expectancy was measured by the Acupuncture Expectancy Scale (AES) at baseline. Pain severity was assessed using the Brief Pain Inventory (BPI) at baseline and week 12. For each treatment arm, multivariable regression models were used to evaluate the association between pretreatment expectancy and week 12 pain severity, controlling for baseline pain severity, age, sex, race, and education. Results Among 360 participants enrolled, the mean age was 62.1 years (SD 12.7), with 251 (69.7 %) women and 88 (24.4 %) non-white survivors. Pretreatment expectancy was similar for all groups at baseline (EA: 13.9 ± 3.6; BFA: 13.2 ± 3.7, WLC:12.8 ± 3.3, p = 0.14). Greater pretreatment expectancy was not significantly associated with greater pain reduction in any group, after adjusting for co-variates (EA: Coef. = -0.05, 95 % CI = -0.14 - 0.04, p = 0.28; BFA: Coef. = -0.07, 95 % CI = -0.16 - 0.02, p = 0.15; WLC: Coef. = -0.09, 95 % CI = -0.25 - 0.06, p = 0.23). Conclusions Pretreatment expectancy did not predict pain reduction for either EA or BFA in cancer survivors. Our study contributes to the interpretation of analgesic effects of EA or BFA, beyond the notion of a mere 'placebo effect'.
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Affiliation(s)
- Xiaotong Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Karolina Bryl
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Lindsay Amann
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Susan Chimonas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jun J. Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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25
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Martini RS, Brown T, Singh V, Woodbury A. Integrative Approaches for Cancer Pain Management. Curr Oncol Rep 2024; 26:691-705. [PMID: 38683254 DOI: 10.1007/s11912-024-01536-3] [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: 04/09/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE OF REVIEW The goal of this review is to summarize updates to the broad array of complementary therapies available for cancer pain. This paper will serve as a reference for clinicians managing pain in cancer patients. RECENT FINDINGS Patients are embracing integrative therapies in growing numbers; clinicians must be prepared to incorporate these therapies into patients' existing treatment regimens. This requires knowledge regarding risks, benefits, and potential interactions with existing cancer therapies. Integrative cancer pain management strategies have shown promise, with several proven effective for the management of cancer pain. Energy therapies, including acupuncture, and biologicals and nutraceuticals including overall diet and vitamin D, have the highest level of evidence for efficacy. The remaining therapies discussed in this chapter may be beneficial for patients on a case-by-case basis; risks and benefits of each individual therapy as described in the text must be further assessed in future rigorous trials to further clarify the role of these complementary therapies in cancer pain management.
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Affiliation(s)
- Reema Sabeeha Martini
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA.
- Emory University Laney Graduate School, Atlanta, GA, USA.
| | | | - Vinita Singh
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Anna Woodbury
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
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26
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Rosenberg JE, Mamtani R, Sonpavde GP, Loriot Y, Duran I, Lee JL, Matsubara N, Vulsteke C, Castellano D, Sridhar SS, Pappot H, Gurney H, Bedke J, van der Heijden MS, Galli L, Keam B, Masumori N, Meran J, O'Donnell PH, Park SH, Grande E, Sengeløv L, Uemura H, Skaltsa K, Campbell M, Matsangou M, Wu C, Hepp Z, McKay C, Powles T, Petrylak DP. Health-related Quality of Life in Patients with Previously Treated Advanced Urothelial Carcinoma from EV-301: A Phase 3 Trial of Enfortumab Vedotin Versus Chemotherapy. Eur Urol 2024; 85:574-585. [PMID: 38418343 DOI: 10.1016/j.eururo.2024.01.007] [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: 10/31/2022] [Revised: 11/30/2023] [Accepted: 01/09/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND AND OBJECTIVE In comparison to chemotherapy, enfortumab vedotin (EV) prolonged overall survival in patients with previously treated advanced urothelial carcinoma in EV-301. The objective of the present study was to assess patient experiences of EV versus chemotherapy using patient-reported outcome (PRO) analysis of health-related quality of life (HRQoL). METHODS For patients in the phase 3 EV-301 trial randomized to EV or chemotherapy we assessed responses to the validated European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) at baseline, weekly for the first 12 wk, and then every 12 wk until discontinuation. We analyzed the QLQ-C30 change from baseline to week 12, the confirmed improvement rate, and the time to improvement or deterioration. KEY FINDINGS AND LIMITATIONS Baseline PRO compliance rates were 91% for the EV arm (n = 301) and 89% for the chemotherapy arm (n = 307); the corresponding average rates from baseline to week 12 were 70% and 67%. Patients receiving EV versus chemotherapy had reduced pain (difference in change from baseline to week 12: -5.7, 95% confidence interval [CI] -10.8 to -0.7; p = 0.027) and worsening appetite loss (7.3, 95% CI 0.90-13.69; p = 0.026). Larger proportions of patients in the EV arm reported HRQoL improvement from baseline than in the chemotherapy arm; the odds of a confirmed improvement across ten QLQ-C30 function/symptom scales were 1.67 to 2.76 times higher for EV than for chemotherapy. Patients in the EV arm had a shorter time to first confirmed improvement in global health status (GHS)/QoL, fatigue, pain, and physical, role, emotional, and social functioning (all p < 0.05). EV delayed the time to first confirmed deterioration in GHS/QoL (p = 0.027), but worsening appetite loss occurred earlier (p = 0.009) in comparison to chemotherapy. CONCLUSIONS AND CLINICAL IMPLICATIONS HRQoL with EV was maintained, and deterioration in HRQoL was delayed with EV in comparison to chemotherapy. Better results with EV were reported for some scales, with the greatest difference observed for pain. These findings reinforce the EV safety and efficacy outcomes and benefits observed in EV-301. PATIENT SUMMARY Patients with previously treated advanced cancer of the urinary tract receiving the drug enfortumab vedotin maintained their HRQoL in comparison to patients treated with chemotherapy. The EV-301 trial is registered on ClinicalTrials.gov as NCT03474107 and on EudraCT as 2017-003344-21.
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Affiliation(s)
| | - Ronac Mamtani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Guru P Sonpavde
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Yohann Loriot
- Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Ignacio Duran
- Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Jae-Lyun Lee
- Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Christof Vulsteke
- Center for Oncological Research, University of Antwerp, Integrated Cancer Center Ghent, Ghent, Belgium
| | | | | | | | | | - Jens Bedke
- Faculty of Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | - Luca Galli
- Azienda Ospedaliero-Universitaria Pisana Spedali Riuniti S. Chiara, Pisa, Italy
| | - Bhumsuk Keam
- Seoul National University Hospital, Seoul, South Korea
| | | | - Johannes Meran
- Internal Medicine 2, Krankenhaus der Barmherzigen Brüder Wien, Vienna, Austria
| | | | - Se Hoon Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | | | | | - Hiroji Uemura
- Yokohama City University Medical Center, Yokohama, Japan
| | | | | | | | | | | | | | - Thomas Powles
- Barts Cancer Centre, Queen Mary University of London, London, UK
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Zhang H, Yang Y, Cao Y, Guan J. Effects of chronic stress on cancer development and the therapeutic prospects of adrenergic signaling regulation. Biomed Pharmacother 2024; 175:116609. [PMID: 38678960 DOI: 10.1016/j.biopha.2024.116609] [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: 01/19/2024] [Revised: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024] Open
Abstract
Long-term chronic stress is an important factor in the poor prognosis of cancer patients. Chronic stress reduces the tissue infiltration of immune cells in the tumor microenvironment (TME) by continuously activating the adrenergic signaling, inhibits antitumor immune response and tumor cell apoptosis while also inducing epithelial-mesenchymal transition (EMT) and tumor angiogenesis, promoting tumor invasion and metastasis. This review first summarizes how adrenergic signaling activates intracellular signaling by binding different adrenergic receptor (AR) heterodimers. Then, we focused on reviewing adrenergic signaling to regulate multiple functions of immune cells, including cell differentiation, migration, and cytokine secretion. In addition, the article discusses the mechanisms by which adrenergic signaling exerts pro-tumorigenic effects by acting directly on the tumor itself. It also highlights the use of adrenergic receptor modulators in cancer therapy, with particular emphasis on their potential role in immunotherapy. Finally, the article reviews the beneficial effects of stress intervention measures on cancer treatment. We think that enhancing the body's antitumor response by adjusting adrenergic signaling can enhance the efficacy of cancer treatment.
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Affiliation(s)
- Hao Zhang
- Department of Oncology, The Eighth Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing 100091, China; Department of Oncology, The Fifth Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing 100071, China.
| | - Yuwei Yang
- College of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing Key Laboratory of OTIR, Beijing, 100091, China.
| | - Yan Cao
- College of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing Key Laboratory of OTIR, Beijing, 100091, China.
| | - Jingzhi Guan
- Department of Oncology, The Fifth Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing 100071, China.
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Nicolson GL, Ferreira de Mattos G. Membrane Lipid Replacement for reconstituting mitochondrial function and moderating cancer-related fatigue, pain and other symptoms while counteracting the adverse effects of cancer cytotoxic therapy. Clin Exp Metastasis 2024; 41:199-217. [PMID: 38879842 DOI: 10.1007/s10585-024-10290-6] [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: 10/07/2023] [Accepted: 04/25/2024] [Indexed: 06/30/2024]
Abstract
Cancer-related fatigue, pain, gastrointestinal and other symptoms are among the most familiar complaints in practically every type and stage of cancer, especially metastatic cancers. Such symptoms are also related to cancer oxidative stress and the damage instigated by cancer cytotoxic therapies to cellular membranes, especially mitochondrial membranes. Cancer cytotoxic therapies (chemotherapy and radiotherapy) often cause adverse symptoms and induce patients to terminate their anti-neoplastic regimens. Cancer-related fatigue, pain and other symptoms and the adverse effects of cancer cytotoxic therapies can be safely moderated with oral Membrane Lipid Replacement (MLR) glycerolphospholipids and mitochondrial cofactors, such as coenzyme Q10. MLR provides essential membrane lipids and precursors to maintain mitochondrial and other cellular membrane functions and reduces fatigue, pain, gastrointestinal, inflammation and other symptoms. In addition, patients with a variety of chronic symptoms benefit from MLR supplements, and MLR also has the ability to enhance the bioavailability of nutrients and slowly remove toxic, hydrophobic molecules from cells and tissues.
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Affiliation(s)
- Garth L Nicolson
- Department of Molecular Pathology, The Institute for Molecular Medicine, Huntington Beach, CA, 92647, USA.
- Department of Molecular Pathology, The Institute for Molecular Medicine, P.O. Box 9355, S. Laguna Beach, CA, 92652, USA.
| | - Gonzalo Ferreira de Mattos
- Laboratory of Ion Channels, Biological Membranes and Cell Signaling, Department of Biophysics, Facultad de Medicina, Universidad de La República, Montevideo, Uruguay
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Adhikari B, Shrestha N, Bhatt VR. A real-world study of the quality of Outpatient Pain Management in patients with Cancer. J Cancer Surviv 2024:10.1007/s11764-024-01621-3. [PMID: 38795285 DOI: 10.1007/s11764-024-01621-3] [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: 03/06/2024] [Accepted: 05/21/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE Up to 40% patients with cancer reporting pain may not receive optimal analgesia indicating inadequate treatment of pain. We examined the patterns of outpatient pain management in patients with cancer who reported pain. METHODS We used the National Ambulatory Medical Care Survey data for outpatient visits from 2006 to 2018 for patients with any cancer and reporting pain. The primary outcome was prescription of pain medications among these patients. We performed multinomial logistic regression to identify factors associated with analgesic prescriptions among patients with cancer who reported pain. RESULTS We captured an estimated total of 412 million outpatient visits of which 22 million visits dealt with patients with cancer reporting pain. An estimated total of 13.8 million (61.33%) patient visits had pain reported but were not prescribed any pain medications. 5.5 million (24.44%) patient visits had non-opioid analgesic prescription while opioid analgesics were prescribed during 3.2 million (14.22%) visits. Patients who were black, aged 45-64 years, residing in rural geographical areas, visiting medical subspecialty practices, and having cancers of the respiratory and digestive systems had higher odds of receiving opioid prescription. CONCLUSIONS As one of the largest pain management studies among patients with cancer in the outpatient setting, covering 412 million patient visits, our study shows that a significant proportion of patients with cancer who reported pain did not receive a prescription for analgesics suggesting a possibility of undertreatment of pain. IMPLICATIONS FOR CANCER SURVIVORS Undertreatment of pain continues to remain a major unmet need in patients with cancer.
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Affiliation(s)
- Biplov Adhikari
- Medstar Health Internal Medicine Residency Program, 201 E University Pkwy, Baltimore, MD, USA.
| | - Nistha Shrestha
- Department of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Vijaya Raj Bhatt
- Division of Hematology-Oncology, The Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
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30
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Ito T, Tomizawa E, Yano Y, Akiyama D, Konishi H, Takei K, Ikeda M, Takahashi N, Shaku F. Transitional Changes of Anxiety, Pain and Other Symptoms in Cancer Patients Admitted to a Palliative Care Unit, Evaluated Using the Support Team Assessment Schedule - Japanese Version. Am J Hosp Palliat Care 2024:10499091241254522. [PMID: 38748849 DOI: 10.1177/10499091241254522] [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: 05/30/2024] Open
Abstract
Objective: Association between physical symptoms and psychosocial difficulties of cancer patients has been reported widely. Nevertheless, the effects of pain and other symptom control on anxiety in such patients have not been investigated well. We investigated the association of improvement of pain and other symptoms with patient anxiety, and assessed factors associated with improvement of such symptoms. Methods: Data of patients with advanced cancer admitted to a palliative care unit during August 2018 - June 2022 were analyzed retrospectively. Severity of pain, other symptoms, and anxiety was assessed by the Support Team Assessment Schedule Japanese version (STAS-J) administered at admission and after 2 weeks. Patients' physical data, their Palliative Prognostic Index (PPI) at admission, and their overall survival were collected and recorded. Results: Data of 701 patients were analyzed. Improvement of pain or other symptoms after 2 weeks was not associated with the PPI total score or actual survival (P = .105 and .999). Patients with higher anxiety on admission experienced improvement of pain or other symptoms more frequently (P = .005). Worsening of anxiety was observed less in patients who experienced improvement in pain or other symptoms after 2 weeks (P = .027). Conclusion: Pain or other symptoms of patients with advanced cancer was improved irrespective of the general condition indicated with actual survival and prognosis-predictive factors. These findings suggest the importance of pain and other symptoms' improvement and its important roles in the management of patient psychosocial problems such as anxiety.
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Affiliation(s)
- Tetsuya Ito
- Department of Palliative Medicine and Advanced Clinical Oncology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
- Department of Palliative Care, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Emi Tomizawa
- Department of Palliative Care, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Yuki Yano
- Department of Palliative Care, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Dai Akiyama
- Department of Palliative Care, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Haruko Konishi
- Department of Palliative Care, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Kiyozumi Takei
- Department of Palliative Care, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Masahiro Ikeda
- Department of Palliative Medicine and Advanced Clinical Oncology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
- Department of Palliative Medicine, Cancer Institute Hospital, Koto-ku, Tokyo, Japan
| | - Naoko Takahashi
- Department of Palliative Care, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Fumio Shaku
- Department of Psychosomatic Internal Medicine, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
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Rodrigues Aguiar MDF, Guterres MM, Benarrosh EM, Verri WA, Calixto-Campos C, Dias QM. The Nociceptive and Inflammatory Responses Induced by the Ehrlich Solid Tumor Are Changed in Mice Healed of Plasmodium berghei Strain ANKA Infection after Chloroquine Treatment. J Parasitol Res 2024; 2024:3771926. [PMID: 38774541 PMCID: PMC11108701 DOI: 10.1155/2024/3771926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 05/24/2024] Open
Abstract
Comorbidities that involve infectious and noninfectious diseases, such as malaria and cancer, have been described. Cancer and malaria induce changes in the nociceptive and inflammatory responses through similar pathophysiological mechanisms. However, it is unclear whether malaria and antimalarial treatment can change the inflammatory and nociceptive responses induced by solid cancer. Therefore, the present study experimentally evaluated the effect of infection by Plasmodium berghei strain ANKA and chloroquine treatment on the nociceptive and inflammatory responses induced by the solid Ehrlich tumor in male BALB/c mice. On the 1st experimental day, mice were infected with Plasmodium berghei and injected with tumor cells in the left hind paw. From the 7th to the 9th experimental day, mice were treated daily with chloroquine. The parasitemia was evaluated on the 7th and 10th days after infection. On the 11th experimental day, mice were evaluated on the von Frey filament test, the hot plate test, and the paw volume test. At the end of the experimental tests on the 11th day, the peripheral blood of all mice was collected for dosing of IL-1β and TNF-α. The blood parasitemia significantly increased from the 7th to the 10th day. The chloroquine treatment significantly decreased the parasitemia on the 10th day. The presence of the tumor did not significantly change the parasitemia on the 7th and 10th days in mice treated and nontreated with chloroquine. On the 11th day, the mechanical and thermal nociceptive responses significantly increased in mice with tumors. The treatment with antimalarial significantly reduced the mechanical nociceptive response induced by tumors. The hyperalgesia induced by tumors did not change with malaria. The mechanical and thermal hyperalgesia induced by the tumor was significantly reduced in mice treated and healed from malaria. On the 11th day, the volume of the paw injected by the tumor was significantly increased. The mice treated with chloroquine, infected with malaria, or healed of malaria showed reduced paw edema induced by the tumor. Mice with tumors did not show a change in IL-β and TNF-α serum levels. Mice with tumors showed a significant increase in serum levels of IL-1β but not TNF-α when treated with chloroquine, infected with malaria, or healed of malaria. In conclusion, the results show that malaria infection and chloroquine treatment can influence, in synergic form, the nociceptive and inflammatory responses induced by the solid tumor. Moreover, the mechanical antinociception, the thermal hyperalgesia, and the antiedema effect observed in mice treated with chloroquine and healed from malaria can be related to the increase in the serum level of IL-1β.
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Affiliation(s)
- Maria de Fatima Rodrigues Aguiar
- Laboratory of Neuro and Immunopharmacology (NIMFAR)-Oswaldo Cruz Foundation, Fiocruz Rondônia, Rua da Beira, 7671, BR 364, Km 3.5, Bairro Lagoa, Porto Velho, Rondônia, Brazil
- Postgraduate Program in Experimental Biology (PGBIOEXP), Federal University of Rondônia, Campus-BR 364, Km 9.5, Porto Velho, Rondônia, Brazil
| | - Meiriane Mendes Guterres
- Laboratory of Neuro and Immunopharmacology (NIMFAR)-Oswaldo Cruz Foundation, Fiocruz Rondônia, Rua da Beira, 7671, BR 364, Km 3.5, Bairro Lagoa, Porto Velho, Rondônia, Brazil
| | - Eduarda Magalhães Benarrosh
- Laboratory of Neuro and Immunopharmacology (NIMFAR)-Oswaldo Cruz Foundation, Fiocruz Rondônia, Rua da Beira, 7671, BR 364, Km 3.5, Bairro Lagoa, Porto Velho, Rondônia, Brazil
| | - Waldiceu Aparecido Verri
- Department of Pathology, Laboratory of Pain, Inflammation, Neuropathy and Cancer, Center of Biological Sciences, State University of Londrina, Londrina, Paraná, Brazil
| | - Cássia Calixto-Campos
- Department of Pathology, Laboratory of Pain, Inflammation, Neuropathy and Cancer, Center of Biological Sciences, State University of Londrina, Londrina, Paraná, Brazil
| | - Quintino Moura Dias
- Laboratory of Neuro and Immunopharmacology (NIMFAR)-Oswaldo Cruz Foundation, Fiocruz Rondônia, Rua da Beira, 7671, BR 364, Km 3.5, Bairro Lagoa, Porto Velho, Rondônia, Brazil
- Postgraduate Program in Experimental Biology (PGBIOEXP), Federal University of Rondônia, Campus-BR 364, Km 9.5, Porto Velho, Rondônia, Brazil
- National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- São Lucas University Center - São Lucas PVH, Porto Velho, Rondônia, Brazil
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Hasegawa-Moriyama M, Morioka Y, Hiroi S, Naya N, Suzuki Y, Koretaka Y, Hara E, Abe H, Uchida K, Sumitani M. High prevalence of severe pain is associated with low opioid availability in patients with advanced cancer: Combined database study and nationwide questionnaire survey in Japan. Neuropsychopharmacol Rep 2024. [PMID: 38735866 DOI: 10.1002/npr2.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/14/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
OBJECTIVES Opioid availability for the palliative care of patients with advanced cancer is increasing globally. However, opioid availability remains extremely low in Japan. We investigated whether pain is appropriately controlled by low-dose opioid prescriptions in patients with advanced cancer in Japan. METHODS A web-based nationwide survey for caregivers from 2000 community comprehensive support care centers was performed in Japan to assess details about pain in the 30 days before patients died of end-stage cancer. Separately, the data for opioid prescription doses and medical services in the 90 days before the death of patients with cancer were extracted from a health insurance claim database. RESULTS Responses from 1034 responders were retrieved and 665 patients were included. In total, 254 patients (38.2%) complained of severe-to-intolerable cancer-related pain. The median cumulative prescription dose of opioids in the 90 days before patient death was 311.0 mg by oral morphine equivalent doses. Multiple regression analyses across prefectures revealed that the proportion of patients with severe-to-intolerable cancer-related pain was negatively associated with the cumulative opioid consumption expressed as morphine-equivalent doses within 90 days before death. CONCLUSIONS The very low availability of opioids for patients with end-stage cancer could result in high rate of severe-to-intolerable cancer-related pain patients. There were several limitations in this study, and the interpretations of the findings should be carefully. However, the increase in the absolute dose of opioids could improve the palliative care framework to the pain control levels of the global standard.
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Affiliation(s)
- Maiko Hasegawa-Moriyama
- Department of Pain and Palliative Medical Sciences, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Shinzo Hiroi
- Medical Affairs Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Noriyuki Naya
- Medical Affairs Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Yura Suzuki
- Data Science Department, Shionogi & Co., Ltd., Osaka, Japan
| | | | - Erina Hara
- Department of Anesthesiology and Pain Relief, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroaki Abe
- Department of Pain and Palliative Medicines, The University of Tokyo Hospital, Tokyo, Japan
| | - Kanji Uchida
- Department of Anesthesiology and Pain Relief, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicines, The University of Tokyo Hospital, Tokyo, Japan
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Winston GM, Zimering JH, Newman CW, Reiner AS, Manalil N, Kharas N, Gulati A, Rakesh N, Laufer I, Bilsky MH, Barzilai O. Safety and Efficacy of Surgical Implantation of Intrathecal Drug Delivery Pumps in Patients With Cancer With Refractory Pain. Neurosurgery 2024:00006123-990000000-01156. [PMID: 38700319 DOI: 10.1227/neu.0000000000002978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/12/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Pain management in patients with cancer is a critical issue in oncology palliative care as clinicians aim to enhance quality of life and mitigate suffering. Most patients with cancer experience cancer-related pain, and 30%-40% of patients experience intractable pain despite maximal medical therapy. Intrathecal pain pumps (ITPs) have emerged as an option for achieving pain control in patients with cancer. Owing to the potential benefits of ITPs, we sought to study the long-term outcomes of this form of pain management at a cancer center. METHODS We retrospectively reviewed medical records of all adult patients with cancer who underwent ITP placement at a tertiary comprehensive cancer center between 2013 and 2021. Baseline characteristics, preoperative and postoperative pain control, and postoperative complication rate data were collected. RESULTS A total of 193 patients were included. We found that the average Numerical Rating Scale (NRS) score decreased significantly by 4.08 points (SD = 2.13, P < .01), from an average NRS of 7.38 (SD = 1.64) to an average NRS of 3.27 (SD = 1.66). Of 185 patients with preoperative and follow-up NRS pain scores, all but 9 experienced a decrease in NRS (95.1%). The median overall survival from time of pump placement was 3.62 months (95% CI: 2.73-4.54). A total of 42 adverse events in 33 patients were reported during the study period. The 1-year cumulative incidence of any complication was 15.6% (95% CI: 10.9%-21.1%) and for severe complication was 5.7% (95% CI: 3.0%-9.7%). Eleven patients required reoperation during the study period, with a 1-year cumulative incidence of 4.2% (95% CI: 2.0%-7.7%). CONCLUSION Our study demonstrates that ITP implantation for the treatment of cancer-related pain is a safe and effective method of pain palliation with a low complication rate. Future prospective studies are required to determine the optimal timing of ITP implantation.
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Affiliation(s)
- Graham M Winston
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA
| | - Jeffrey H Zimering
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA
- Current affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York , New York , USA
| | - Christopher W Newman
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York , New York , USA
| | - Noel Manalil
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA
| | - Natasha Kharas
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York , New York , USA
| | - Neal Rakesh
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York , New York , USA
| | - Ilya Laufer
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA
- Current affiliation: Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Mark H Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA
| | - Ori Barzilai
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA
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Bäckryd E. Should cancer pain still be considered a separate category alongside acute pain and chronic non-cancer pain? Reflections on ICD-11. FRONTIERS IN PAIN RESEARCH 2024; 5:1397413. [PMID: 38756912 PMCID: PMC11096455 DOI: 10.3389/fpain.2024.1397413] [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: 03/07/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Traditionally, cancer pain has often been viewed as an independent third major category in pain medicine alongside acute pain and chronic non-cancer pain. However, the new chronic pain category MG30 in the eleventh version of International Classification of Diseases (ICD-11) includes cancer-related pain as one of its seven subgroups. In light of this, the aim of the paper is to investigate whether the traditional trichotomy should be replaced by a dichotomy between acute pain and chronic pain, cancer-related pain being part of both groups depending on the duration of pain. Methods The rationale for viewing cancer pain as a separate category is reviewed. Results Cancer being a deadly disease, cancer pain has a life-and-death and existential dimension that is different from non-cancer pain. It seems sensible to believe that this is an additional dimension to the suffering caused by cancer pain, and that clinicians should therefore take this existential dimension into consideration when assessing pain. Conclusion Without challenging the place of chronic cancer-related pain under the MG30 heading, it is concluded that while using ICD-11 in the future, pain clinicians should continue being mindful of the fact that the reality of death shapes the experience of cancer pain. The traditional trichotomy is therefore still valid and mirrors the fact that human beings are vulnerable (acute pain), temporal (chronic pain) and mortal (cancer pain).
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Affiliation(s)
- Emmanuel Bäckryd
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Faria M, Teixeira M, Pinto MJ, Sargento P. Efficacy of acupuncture on cancer pain: A systematic review and meta-analysis. JOURNAL OF INTEGRATIVE MEDICINE 2024; 22:235-244. [PMID: 38493063 DOI: 10.1016/j.joim.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/29/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Pain associated with cancer is one of the greatest causes of reduced quality of life in patients. Acupuncture is one of the treatments used to address this issue, with the great advantage of having little or no side effects, especially when compared with pharmacological pain-killers. OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the current evidence regarding the efficacy of acupuncture for cancer pain. SEARCH STRATEGY Six electronic databases (PubMed, EBSCO, Cochrane Library, Scielo, b-On and Scopus) were searched for relevant articles about pain relief in cancer patients from their beginning until 2022 using MeSH terms such as "acupuncture," "electroacupuncture," "ear acupuncture," "acupuncture analgesia," ''oncological pain," and "cancer pain." INCLUSION CRITERIA Studies included were randomized controlled trials (RCTs) where acupuncture was compared with no treatment, placebo acupuncture or usual care. DATA EXTRACTION AND ANALYSIS Three independent reviewers participated in data extraction and evaluation of risk of bias, and a meta-analysis was conducted. The primary outcome was pain intensity, measured with the visual analog scale, numeric rating scale, or brief pain inventory. Secondary outcomes also assessed were quality of life, functionality, xerostomia, pain interference, and analgesic consumption. Results were expressed as standardized mean difference (SMD) with 95% confidence interval (CI). RESULTS Sixteen RCTs with a total of 1124 participants were included in the meta-analysis, with the majority of the studies presenting a low or unclear risk of bias. Acupuncture was more effective in reducing pain than no treatment (SMD = -0.90, 95 % CI [-1.68, -0.12]), sham acupuncture (SMD = -1.10, 95 % CI [-1.59, -0.61]) or usual care (SMD = -1.16, 95 % CI [-1.38, -0.93]). CONCLUSION The results of this study suggest that acupuncture may be an effective intervention to reduce pain associated with cancer. Despite some limitations due to the low quality and small sample size of some included studies, as well as the different types and stages of cancer, acupuncture might provide an effective and safe treatment to reduce cancer pain. Please cite this article as: Faria M, Teixeira M, Pinto MJ, Sargento P. Efficacy of acupuncture on cancer pain: A systematic review and meta-analysis. J Integr Med. 2024; 22(3): 235-244.
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Affiliation(s)
- Miguel Faria
- Núcleo de Investigação em Ciências e Tecnologias da Saúde, Instituto Politécnico da Lusofonia, 1950-396 Lisboa, Portugal; Clínica São João de Deus, 1700-048 Lisboa, Portugal.
| | - Mónica Teixeira
- Núcleo de Investigação em Ciências e Tecnologias da Saúde, Instituto Politécnico da Lusofonia, 1950-396 Lisboa, Portugal; REQUIMTE/LAQV (Rede de Química e Tecnologia/Laboratório Associado para a Química Verde), Instituto Superior de Engenharia, Instituto Politécnico do Porto, 4051-401 Porto, Portugal
| | | | - Paulo Sargento
- Núcleo de Investigação em Ciências e Tecnologias da Saúde, Instituto Politécnico da Lusofonia, 1950-396 Lisboa, Portugal; Centro de Estudos Avançados em Direito "Francisco Suarez", 1749-024 Lisboa, Portugal
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Aguiar-Rosas S, Plancarte-Sanchez R, Hernandez-Porras BC, García-Andreu J, Lezcano-Velazquez BO, Reyes-Torres I, Alarcón-Barrios S. Pain management in cervical cancer. Front Oncol 2024; 14:1371779. [PMID: 38725634 PMCID: PMC11079655 DOI: 10.3389/fonc.2024.1371779] [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: 01/17/2024] [Accepted: 04/01/2024] [Indexed: 05/12/2024] Open
Abstract
Cervical cancer (CC) occupies the second place in incidence and mortality among women in México. Despite this, Cervical Cancer continues to have a late diagnosis which leads to a high rate of complications. Pain represents the most feared and disabling symptom, being present in up to 86% of patients with advanced disease. The approach to managing pain in this population has not been studied and described to a full extent. In addition, there is a pressing need to provide concise recommendations to promote adequate pain control. We performed a review of the literature in CC and had experts in the field of pain management evaluate the evidence found. We then issued relevant recommendations on pharmacology and interventional pain management. Thus, the approach to pain management must be comprehensive and individualized, considering the timely and appropriate use of pharmacologic treatment as well as interventional procedures.
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Affiliation(s)
- Sebastián Aguiar-Rosas
- Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
- Independent Researcher, Mexico City, Mexico
| | - Ricardo Plancarte-Sanchez
- Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
- Independent Researcher, Mexico City, Mexico
| | | | - Jorge García-Andreu
- Star Medica Hospital, Queretaro, Mexico
- Independent Researcher, Queretaro, Mexico
| | | | | | - Silvia Alarcón-Barrios
- Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
- Independent Researcher, Mexico City, Mexico
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Dong MP, Dharmaraj N, Kaminagakura E, Xue J, Leach DG, Hartgerink JD, Zhang M, Hanks HJ, Ye Y, Aouizerat BE, Vining K, Thomas CM, Dovat S, Young S, Viet CT. Stimulator of Interferon Genes Pathway Activation through the Controlled Release of STINGel Mediates Analgesia and Anti-Cancer Effects in Oral Squamous Cell Carcinoma. Biomedicines 2024; 12:920. [PMID: 38672274 PMCID: PMC11047833 DOI: 10.3390/biomedicines12040920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Oral squamous cell carcinoma (OSCC) presents significant treatment challenges due to its poor survival and intense pain at the primary cancer site. Cancer pain is debilitating, contributes to diminished quality of life, and causes opioid tolerance. The stimulator of interferon genes (STING) agonism has been investigated as an anti-cancer strategy. We have developed STINGel, an extended-release formulation that prolongs the availability of STING agonists, which has demonstrated an enhanced anti-tumor effect in OSCC compared to STING agonist injection. This study investigates the impact of intra-tumoral STINGel on OSCC-induced pain using two separate OSCC models and nociceptive behavioral assays. Intra-tumoral STINGel significantly reduced mechanical allodynia in the orofacial cancer model and alleviated thermal and mechanical hyperalgesia in the hind paw model. To determine the cellular signaling cascade contributing to the antinociceptive effect, we performed an in-depth analysis of immune cell populations via single-cell RNA-seq. We demonstrated an increase in M1-like macrophages and N1-like neutrophils after STINGel treatment. The identified regulatory pathways controlled immune response activation, myeloid cell differentiation, and cytoplasmic translation. Functional pathway analysis demonstrated the suppression of translation at neuron synapses and the negative regulation of neuron projection development in M2-like macrophages after STINGel treatment. Importantly, STINGel treatment upregulated TGF-β pathway signaling between various cell populations and peripheral nervous system (PNS) macrophages and enhanced TGF-β signaling within the PNS itself. Overall, this study sheds light on the mechanisms underlying STINGel-mediated antinociception and anti-tumorigenic impact.
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Affiliation(s)
- Minh Phuong Dong
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Loma Linda University, Loma Linda, CA 92350, USA; (M.P.D.); (M.Z.); (H.-J.H.)
| | - Neeraja Dharmaraj
- Katz Department of Oral Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA; (N.D.); (J.X.); (S.Y.)
| | - Estela Kaminagakura
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São Paulo 12245-00, Brazil;
| | - Jianfei Xue
- Katz Department of Oral Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA; (N.D.); (J.X.); (S.Y.)
| | - David G. Leach
- Department of Chemistry, Rice University, Houston, TX 77005, USA; (D.G.L.); (J.D.H.)
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
| | - Jeffrey D. Hartgerink
- Department of Chemistry, Rice University, Houston, TX 77005, USA; (D.G.L.); (J.D.H.)
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
| | - Michael Zhang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Loma Linda University, Loma Linda, CA 92350, USA; (M.P.D.); (M.Z.); (H.-J.H.)
| | - Hana-Joy Hanks
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Loma Linda University, Loma Linda, CA 92350, USA; (M.P.D.); (M.Z.); (H.-J.H.)
| | - Yi Ye
- Translational Research Center, Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY 10010, USA;
- NYU Pain Research Center, Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA;
| | - Bradley E. Aouizerat
- NYU Pain Research Center, Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA;
| | - Kyle Vining
- Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Department of Materials Science and Engineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Carissa M. Thomas
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Sinisa Dovat
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA;
| | - Simon Young
- Katz Department of Oral Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA; (N.D.); (J.X.); (S.Y.)
| | - Chi T. Viet
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Loma Linda University, Loma Linda, CA 92350, USA; (M.P.D.); (M.Z.); (H.-J.H.)
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Xiao X, Sun J, Zhang D, Li L, Zhou H, Li Y, Li Q, He Z, Fu Y, Duan Q, Zheng G, Tang Z, Chu Q, Chen Y. Patient-Controlled Subcutaneous Analgesia with Hydromorphone versus Oral Oxycontin for Opioid Titration of Cancer Pain: A Prospective Multicenter Randomized Trial. J Pain Res 2024; 17:1441-1451. [PMID: 38628430 PMCID: PMC11020333 DOI: 10.2147/jpr.s451698] [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: 12/11/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Background Studies have shown that oral oxycontin tablets can be used for opioid titration. The European Society for Medical Oncology (ESMO) guidelines for adult cancer pain recommend opioid titration through the parenteral route, usually the intravenous or subcutaneous route. Patient-controlled subcutaneous analgesia (PCSA) with hydromorphone needs further evaluation for opioid titration. This prospective multicenter study was designed to compare the efficacy and safety of hydromorphone PCSA with oral oxycontin tablets for opioid titration of cancer pain. Patients and Methods Eligible patients with cancer pain were randomly assigned in a 1:1 ratio to the PCSA group or the oxycontin group for dose titration. Different titration methods were given in both groups depending on whether the patient had an opioid tolerance. The primary endpoint of this study was time to successful titration (TST). Results A total of 256 patients completed this study. The PCSA group had a significantly lower TST compared with the oxycontin group (median [95% confidence interval (CI)], 5.5[95% CI:2.5-11.5] hours vs.16.0 [95% CI:11.5-22.5] hours; p<0.001). The frequency (median; interquartile) of breakthrough pain (Btp) over 24 hours was significantly lower in the PCSA group (2.5;2.0-3.5) than in the oxycontin group.(3.0; 2.5-4.5) (p=0.04). The pain was evaluated by numeric rating scale (NRS) score at 12 hours after the start of titration. The pain score (median; interquartile) was significantly lower in the PCSA versus the oxycontin group (2.5;1.5-3.0) vs 4.5;3.0-6.0) (p=0.02). The equivalent dose of oral morphine (EDOM) for a successful titration was similar in both groups (p=0.29), but there was a significant improvement in quality of life (QoL) in both groups (p=0.03). No between-group difference in the incidence of opioid-related adverse effects was observed (p=0.32). Conclusion Compared with oral oxycontin tablet, the use of PCSA with hydromorphone achieved a shorter titration duration for patients with cancer pain (p<0.001), without significantly increasing adverse events (p=0.32).
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Affiliation(s)
- Xiaoguang Xiao
- Department of Oncology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Jianhai Sun
- Department of Oncology, Hubei Zhongshan Hospital, Wuhan, Hubei, People’s Republic of China
| | - Dongsheng Zhang
- Department of Oncology, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei, People’s Republic of China
| | - Linjun Li
- Department of Oncology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei, People’s Republic of China
| | - Haibo Zhou
- Department of Oncology, Yichang Central People’s Hospital, Yichang, Hubei, People’s Republic of China
| | - Yongjun Li
- Department of Oncology, Yichang Second People’s Hospital, Yichang, Hubei, People’s Republic of China
| | - Quan Li
- Department of Oncology, Xiangyang Central Hospital, Xiangyang, Hubei, People’s Republic of China
| | - Zhongshi He
- Department of Oncology, Xiangyang No 1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei, People’s Republic of China
| | - Yang Fu
- Department of Oncology, Xiangyang Hospital of Traditional Chinese Medicine, Xiangyang, Hubei, People’s Republic of China
| | - Qiwen Duan
- Department of Oncology, Taihe Hospital, Shiyan, Hubei, People’s Republic of China
| | - Guping Zheng
- Department of Oncology, Xiaogan Central Hospital, Xiaogan, Hubei, People’s Republic of China
| | - Ze Tang
- Department of Oncology, Huangshi Central Hospital, Huangshi, Hubei, People’s Republic of China
| | - Qian Chu
- Department of Oncology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Yuan Chen
- Department of Oncology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
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Lane H, Saunders R, Crookes K, Ang SGM, Bulsara C, Bulsara MK, Ewens B, Gallagher O, Gullick K, Haydon S, Hughes J, Nguyen KH, Seaman K, Etherton-Beer C. Prevalence of frailty and pain in hospitalised cancer patients: implications for older adult care. Intern Med J 2024; 54:671-674. [PMID: 38450876 DOI: 10.1111/imj.16351] [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: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 03/08/2024]
Abstract
A hospital-wide point prevalence study investigated frailty and pain in patients with a cancer-related admission. Modifiable factors associated with frailty in people with cancer were determined through logistic regression. Forty-eight patients (19%) with cancer-related admissions were 2.65 times more likely to be frail and 2.12 more likely to have moderate pain. Frailty and pain were highly prevalent among cancer-related admissions, reinforcing the need for frailty screening and importance of pain assessment for patients with cancer.
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Affiliation(s)
- Heather Lane
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Kate Crookes
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Seng G M Ang
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Beverley Ewens
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Olivia Gallagher
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Karen Gullick
- Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Sue Haydon
- Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Jeff Hughes
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- PainChek Ltd, Sydney, New South Wales, Australia
| | - Kim-Huong Nguyen
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Kennedy OJ, Glassee N, Kicinski M, Blank CU, Long GV, Atkinson VG, Dalle S, Haydon AM, Meshcheryakov A, Khattak A, Carlino MS, Sandhu S, Larkin J, Puig S, Ascierto PA, Rutkowski P, Schadendorf D, Boers-Sonderen M, Giacomo AMD, van den Eertwegh AJM, Grob JJ, Gutzmer R, Jamal R, van Akkooi ACJ, Gandini S, Buhrer E, Suciu S, Robert C, Eggermont AMM, Mandala M, Lorigan P, Valpione S. Prognostic and predictive value of non-steroidal anti-inflammatory drugs in the EORTC 1325/KEYNOTE-054 phase III trial of pembrolizumab versus placebo in resected high-risk stage III melanoma. Eur J Cancer 2024; 201:113585. [PMID: 38402687 DOI: 10.1016/j.ejca.2024.113585] [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: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Pain is common in patients with cancer. The World Health Organisation recommends paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) for mild pain and combined with other agents for moderate/severe pain. This study estimated associations of NSAIDs with recurrence-free survival (RFS), distant metastasis-free survival (DMFS) and the incidence of immune-related adverse events (irAEs) in high-risk patients with resected melanoma in the EORTC 1325/KEYNOTE-054 phase III clinical trial. PATIENTS AND METHODS Patients with AJCC7 stage IIIA, IIIB or IIIC resected melanoma were randomized to receive 200 mg of adjuvant pembrolizumab (N = 514) or placebo (N = 505) 3-weekly for one year or until recurrence. As previously reported, pembrolizumab prolonged RFS and DMFS. NSAID use was defined as administration between 7 days pre-randomization and starting treatment. Multivariable Cox and Fine and Gray models were used to estimate hazard ratios (HRs) for associations of NSAIDs with RFS, DMFS and irAEs. RESULTS Of 1019 patients randomized, 59 and 44 patients in the pembrolizumab and placebo arms, respectively, used NSAIDs. NSAIDs were not associated with RFS (HR 0.91, 95% CI 0.58-1.43) or DMFS in the pembrolizumab (HR 1.03, 95% CI 0.65-1.66) or placebo arms (for RFS, HR 0.76, 95% CI 0.48-1.20; for DMFS, HR 0.80, 95% CI 0.49-1.31). NSAIDs were associated with the incidence of irAEs in the placebo arm (HR 3.06, 95% CI 1.45-6.45) but not in the pembrolizumab arm (HR 0.94, 95% CI 0.58-1.53). CONCLUSION NSAIDs were not associated with efficacy outcomes nor the risk of irAEs in patients with resected high-risk stage III melanoma receiving adjuvant pembrolizumab.
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Affiliation(s)
- Oliver John Kennedy
- University of Manchester, Manchester, United Kingdom; Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Christian U Blank
- Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Georgina V Long
- Melanoma Institute Australia, the University of Sydney, and Mater and Royal North Shore Hospitals, Sydney, NSW, Australia
| | | | | | | | | | - Adnan Khattak
- Fiona Stanley Hospital & Edith Cowan University, Perth, WA, Australia
| | - Matteo S Carlino
- Westmead and Blacktown Hospitals, Melanoma Institute Australia and the University of Sydney, Sydney, NSW, Australia
| | | | | | - Susana Puig
- Hospital Clinic de Barcelona, Universitat de Barcelona, IDIBAPS, Spain & Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Piotr Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Dirk Schadendorf
- University Hospital Essen, Essen, German Cancer Consortium, Partner Site Essen & University Alliance Ruhr Research Center One Health, Essen, Germany
| | | | | | | | | | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Rahima Jamal
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de recherche du CHUM, Montreal, QC, Canada
| | | | - Sara Gandini
- IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Caroline Robert
- Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - Alexander M M Eggermont
- Princess Máxima Center and University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Center Munich, Technical University Munich & Ludwig Maximiliaan University, Munich, Germany
| | - Mario Mandala
- University of Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Paul Lorigan
- Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Sara Valpione
- Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, United Kingdom; Cancer Research UK National Biomarker Centre, Manchester, UK.
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Morioka N, Nakamura Y, Hisaoka-Nakashima K, Nakata Y. High mobility group box-1: A therapeutic target for analgesia and associated symptoms in chronic pain. Biochem Pharmacol 2024; 222:116058. [PMID: 38367818 DOI: 10.1016/j.bcp.2024.116058] [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: 11/24/2023] [Revised: 01/16/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
The number of patients with chronic pain continues to increase against the background of an ageing society and a high incidence of various epidemics and disasters. One factor contributing to this situation is the absence of truly effective analgesics. Chronic pain is a persistent stress for the organism and can trigger a variety of neuropsychiatric symptoms. Hence, the search for useful analgesic targets is currently being intensified worldwide, and it is anticipated that the key to success may be molecules involved in emotional as well as sensory systems. High mobility group box-1 (HMGB1) has attracted attention as a therapeutic target for a variety of diseases. It is a very unique molecule having a dual role as a nuclear protein while also functioning as an inflammatory agent outside the cell. In recent years, numerous studies have shown that HMGB1 acts as a pain inducer in primary sensory nerves and the spinal dorsal horn. In addition, HMGB1 can function in the brain, and is involved in the symptoms of depression, anxiety and cognitive dysfunction that accompany chronic pain. In this review, we will summarize recent research and discuss the potential of HMGB1 as a useful drug target for chronic pain.
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Affiliation(s)
- Norimitsu Morioka
- Department of Pharmacology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan.
| | - Yoki Nakamura
- Department of Pharmacology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Kazue Hisaoka-Nakashima
- Department of Pharmacology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Yoshihiro Nakata
- Department of Pharmacology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
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Guo G, Li J, Zheng Y, Liu ZX, Lin H. Breast-conserving surgery is associated with a lower incidence of suicide among females with breast cancer in the United States: a population-based retrospective cohort study. Int J Surg 2024; 110:1392-1401. [PMID: 38215250 PMCID: PMC10942248 DOI: 10.1097/js9.0000000000001060] [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: 09/29/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND With comparable overall survival and local recurrence rates with mastectomy, breast-conserving surgery (BCS) has become the cornerstone of therapy for breast cancer; however, the difference in the incidence of suicide between BCS and mastectomy among breast cancer survivors remains unclear. This study evaluated the mortality risk from suicide among breast cancer survivors and compared suicide risk between BCS and mastectomy using a population-based cohort. MATERIALS AND METHODS Female patients newly diagnosed with first primary breast cancer, recorded in the Surveillance, Epidemiology and End Results database, were included. Standardized mortality ratio (SMR) and cumulative mortality rate from suicide among those who underwent BCS and mastectomy were compared. RESULTS A total of 1 190 991 patients with newly diagnosed first primary breast cancer were included in the study, of whom 56.5% underwent BCS and 36.1% underwent mastectomy. During the follow-up period, 667 suicides were recorded. Patients who underwent mastectomy exhibited significantly higher suicide mortality than the general population [mortality rate, 8.16 per 100 000 person-years; SMR 1.18 (95% CI 1.05-1.33)], while there was no significant difference in suicide rate between patients who underwent BCS and the general population [SMR 0.92 (95% CI 0.83-1.02)]. Multivariate Cox analysis revealed that BCS, compared with mastectomy, was associated with a significantly decreased risk of suicide among females with breast cancer [hazard ratio 0.80 (95% CI 0.68-0.95); P = 0.009]. CONCLUSION BCS was associated with a significantly lower incidence of suicide among females with breast cancer. BCS offers a compelling option for improving the quality of life and self-esteem of patients with cancer and provides a novel perspective on cancer management.
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Affiliation(s)
- Guiping Guo
- Department of Breast Surgery, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University
| | - Junteng Li
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Yongqiang Zheng
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Ze-Xian Liu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Huan Lin
- Department of Breast Surgery, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University
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Presto P, Sehar U, Kopel J, Reddy PH. Mechanisms of pain in aging and age-related conditions: Focus on caregivers. Ageing Res Rev 2024; 95:102249. [PMID: 38417712 DOI: 10.1016/j.arr.2024.102249] [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: 09/28/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
Pain is a complex, subjective experience that can significantly impact quality of life, particularly in aging individuals, by adversely affecting physical and emotional well-being. Whereas acute pain usually serves a protective function, chronic pain is a persistent pathological condition that contributes to functional deficits, cognitive decline, and emotional disturbances in the elderly. Despite substantial progress that has been made in characterizing age-related changes in pain, complete mechanistic details of pain processing mechanisms in the aging patient remain unknown. Pain is particularly under-recognized and under-managed in the elderly, especially among patients with Alzheimer's disease (AD), Alzheimer's disease-related dementias (ADRD), and other age-related conditions. Furthermore, difficulties in assessing pain in patients with AD/ADRD and other age-related conditions may contribute to the familial caregiver burden. The purpose of this article is to discuss the mechanisms and risk factors for chronic pain development and persistence, with a particular focus on age-related changes. Our article also highlights the importance of caregivers working with aging chronic pain patients, and emphasizes the urgent need for increased legislative awareness and improved pain management in these populations to substantially alleviate caregiver burden.
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Affiliation(s)
- Peyton Presto
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Inyang KE, Evans CM, Heussner M, Petroff M, Reimers M, Vermeer PD, Tykocki N, Folger JK, Laumet G. HPV+ head and neck cancer-derived small extracellular vesicles communicate with TRPV1+ neurons to mediate cancer pain. Pain 2024; 165:608-620. [PMID: 37678566 PMCID: PMC10915104 DOI: 10.1097/j.pain.0000000000003045] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/15/2023] [Indexed: 09/09/2023]
Abstract
ABSTRACT Severe pain is often experienced by patients with head and neck cancer and is associated with a poor prognosis. Despite its frequency and severity, current treatments fail to adequately control cancer-associated pain because of our lack of mechanistic understanding. Although recent works have shed some light of the biology underlying pain in HPV-negative oral cancers, the mechanisms mediating pain in HPV+ cancers remain unknown. Cancer-derived small extracellular vesicles (cancer-sEVs) are well positioned to function as mediators of communication between cancer cells and neurons. Inhibition of cancer-sEV release attenuated pain in tumor-bearing mice. Injection of purified cancer-sEVs is sufficient to induce pain hypersensitivity in naive mice that is prevented by QX-314 treatment and in Trpv1-/- mice. Cancer-sEVs triggered calcium influx in nociceptors, and inhibition or ablation of nociceptors protects against cancer pain. Interrogation of published sequencing data of human sensory neurons exposed to human cancer-sEVs suggested a stimulation of protein translation in neurons. Induction of translation by cancer-sEVs was validated in our mouse model, and its inhibition alleviated cancer pain in mice. In summary, our work reveals that HPV+ head and neck squamous cell carcinoma-derived sEVs alter TRPV1+ neurons by promoting nascent translation to mediate cancer pain and identified several promising therapeutic targets to interfere with this pathway.
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Affiliation(s)
| | - Christine M. Evans
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Matthew Heussner
- Department of Physiology, Michigan State University, East Lansing, MI, USA
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI
| | - Margaret Petroff
- Department of Pathology Michigan State University College of Veterinary Medicine, East Lansing, MI
| | - Mark Reimers
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Paola D. Vermeer
- Cancer Biology and Immunotherapies Group, Sanford Research, Sioux Falls, South Dakota
| | - Nathan Tykocki
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI
| | - Joseph K. Folger
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Geoffroy Laumet
- Department of Physiology, Michigan State University, East Lansing, MI, USA
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Adley NC, Brasky TM, Conroy SR, Newton AM, Plascak JJ, Strassels SA, Hays JL, Krok-Schoen JL. Associations of Cancer Patients' Demographic and Clinical Characteristics With Cannabis-Related Interest and Behaviors. J Palliat Med 2024; 27:394-399. [PMID: 38157334 DOI: 10.1089/jpm.2023.0490] [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] [Indexed: 01/03/2024] Open
Abstract
Background: Cannabis interest and use is increasing in the United States, yet research on its use among cancer patients is limited. Methods: Individuals with cancer completed an anonymous cross-sectional questionnaire. Multivariable logistic regressions estimated odds ratios (OR) between patients' demographic and clinical characteristics with cannabis-related interest, current use, and provider recommendation. Results: Participants (n = 943) were, on average, 61.7 years old. Older patients were less likely to use cannabis products (OR = 0.42, confidence interval [95% CI]: 0.26-0.69) and less likely to be interested in cannabis (OR = 0.60, 95% CI: 0.44-0.84) than younger patients. Those with higher education were less likely to be using cannabis (OR = 0.41, 95% CI: 0.25-0.67) and less likely to have received a provider recommendation of cannabis use than the least educated (OR = 0.38, 95% CI: 0.19-0.76). Cancer spread and type were significant correlates of provider recommendation of cannabis use. Conclusions: Additional research is warranted to better understand cancer patients' motivations for cannabis use and interest.
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Affiliation(s)
- Neema C Adley
- Department of Neuroscience, The Ohio State University College of Arts and Sciences, Columbus, Ohio, USA
| | - Theodore M Brasky
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sara R Conroy
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Alison M Newton
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jesse J Plascak
- Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - John L Hays
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jessica L Krok-Schoen
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Slaghmuylder Y, Maingi L, Pype P, Lauwerier E. The use of written guides to empower breast cancer survivors in their management of chronic pain: A realist evaluation. PATIENT EDUCATION AND COUNSELING 2024; 120:108129. [PMID: 38181590 DOI: 10.1016/j.pec.2023.108129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/30/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Many breast cancer survivors experience long-term complaints following treatment, such as pain, which are often not addressed in a sufficient way. To empower survivors in talking about their pain and related complaints and in searching for appropriate support when needed, we developed two written guides. With this study, we aimed to pilot test the guides and gain insight into the implementation process and influencing mechanisms through the perspective of a realist evaluation. METHODS Nine survivors were interviewed at two time points (i.e., post-intervention and at three-month follow-up). The data were thematically analysed and categorized into a context-implementation-mechanisms-outcomes hypothesis. RESULTS The guides empowered the participants to discuss pain with medical specialists and initiate support-seeking behaviour through underlying mechanisms such as awareness, acknowledgment, hope, reduced isolation, and motivation. Nonetheless, mechanisms and outcomes differed according to a survivor's unique context. CONCLUSION Written guides can offer a feasible way to empower survivors in their management of chronic pain. However, a one-size-fits-all approach is not desirable and other strategies might be necessary. PRACTICE IMPLICATIONS It is pivotal to engage survivors as well as professionals in adopting new interventions. As such, the role of nurses in introducing and endorsing the guides should be further explored.
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Affiliation(s)
- Yaël Slaghmuylder
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Lydiah Maingi
- Department of Psychology, Kenyatta University, Nairobi, Kenya; Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Emelien Lauwerier
- Department of Psychology, Open University of the Netherlands, Heerlen, the Netherlands.
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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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48
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Peters M, Butson G, Mizrahi D, Denehy L, Lynch BM, Swain CTV. Physical activity and pain in people with cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:145. [PMID: 38321248 PMCID: PMC10847204 DOI: 10.1007/s00520-024-08343-3] [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: 07/20/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Physical activity can provide analgesic benefit but its effect on cancer-related pain is unclear. This review synthesised and appraised the evidence for the effect of physical activity on pain in people living with or beyond cancer. METHODS A systematic search of Ovid Medline and Embase was performed to identify randomised controlled trials (RCTs), randomised cross-over studies (RXTs), and prospective observational studies that examined physical activity and pain outcomes in adults living with or beyond cancer. Meta-analyses were performed to generate effect estimates. Risk of bias was assessed, and the GRADE system was used to assess evidence quality. RESULTS One hundred twenty-one studies (n = 13,806), including 102 RCTs, 6 RXTs, and 13 observational studies, met the criteria for inclusion. Meta-analyses of RCTs identified a decrease in pain intensity (n = 3734; standardised mean difference (SMD) - 0.30; 95% confidence interval (CI) - 0.45, - 0.15) and bodily pain (n = 1170; SMD 0.28; 95% CI 0.01, 0.56) but not pain interference (n = 207; SMD - 0.13, 95% CI - 0.42, 0.15) following physical activity interventions. Individual studies also identified a reduction in pain sensitivity but not analgesic use, although meta-analysis was not possible for these outcomes. High heterogeneity between studies, low certainty in some effect estimates, and possible publication bias meant that evidence quality was graded as very low to low. CONCLUSION Physical activity may decrease pain in people living with and beyond cancer; however, high heterogeneity limits the ability to generalise this finding to all people with cancer or to specific types of cancer-related pain.
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Affiliation(s)
- Mitchell Peters
- Cancer Science Unit, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Grace Butson
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - David Mizrahi
- The Daffodil Centre, The University of Sydney, a Joint Venture With Cancer Council NSW, Sydney, NSW, Australia
| | - Linda Denehy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry St, Melbourne, VIC, 3010, Australia
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Christopher T V Swain
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry St, Melbourne, VIC, 3010, Australia.
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.
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Akbaş M, Dağıstan G. Effectiveness of CT-guided percutaneous cordotomy in intractable cancer pain: Experience in 14 patients. Pain Pract 2024; 24:296-302. [PMID: 37846871 DOI: 10.1111/papr.13307] [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] [Indexed: 10/18/2023]
Abstract
BACKGROUND Severe and treatment-resistant pain is a major issue for patients with cancer. Cordotomy is an effective approach for addressing severe cancer-related pain. It is based on blocking the transmission of pain by damaging the lateral spinothalamic tract. METHODS Computed tomography guided cordotomy was performed on 14 patients who did not respond to medical and interventional pain management methods. RESULTS Fourteen patients with cancer pain underwent CT-guided percutaneous cordotomy. Pain relief was reported in 86% of the patients. The visual analog scale values before and after cordotomy were compared and a significant difference was found (p = 0.0001). The improvement in the Karnofsky Performance Scale score of the patients was found to be statistically significant (p = 0.0001). CONCLUSION We believe that CT-guided cordotomy, performed by experienced hands in a team of experienced individuals and applied to the right patients, is an effective treatment. However, it is crucial to exercise extreme caution regarding potential side effects and serious complications during the cordotomy procedure.
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Affiliation(s)
- Mert Akbaş
- Division of Algology, Anesthesiology and Reanimation Department, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Gözde Dağıstan
- Division of Algology, Anesthesiology and Reanimation Department, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Sorrieul J, Robert J, Blanchet A, Gouju J, Bienfait F, Hamon SJ, Dupoiron D, Devys C. Physicochemical Stability Study of the Morphine-Bupivacaine-Ziconotide Association. Neuromodulation 2024:S1094-7159(23)01008-5. [PMID: 38300172 DOI: 10.1016/j.neurom.2023.11.009] [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: 09/19/2023] [Revised: 11/15/2023] [Accepted: 11/30/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the physicochemical stability of morphine-bupivacaine-ziconotide mixtures used in intrathecal analgesia in polypropylene syringes and intrathecal pumps. MATERIALS AND METHODS The stability study method was conceived according to International Council for Harmonisation guidelines. For propylene syringes, six different mixtures of morphine-bupivacaine and ziconotide were assessed over seven days. Two storage temperatures were tested (5 °C ± 3 °C and 25 °C ± 2 °C). For implantable pumps, nine different mixtures were assessed over 60 days and stored at 37 °C. Assays were performed using ultrahigh-pressure liquid chromatography. Turbidity and pH also were measured throughout the study. RESULTS Results confirmed excellent physicochemical stability for morphine and bupivacaine in the study for all conditions investigated (pumps at 37 °C, polypropylene syringes at 5 °C ± 3 °C and 25 °C ± 2 °C). Concerning ziconotide, after seven days, our study showed that every 95% confidence interval calculated had lower bounds >90% for all mixtures stored in polypropylene syringes. In implantable pumps, a decrease of the concentration was observed in all the mixtures studied. Moreover, the appearance of a degradation product confirmed the ziconotide degradation. CONCLUSION All results are in favor with a physicochemical stable preparation for six mixture profiles when stored in polypropylene syringes at 5 °C ± 3 °C and 25 °C ± 2 °C. For mixtures stored in implantable pumps, the efficacy should decrease over time owing to the degradation of ziconotide. A trade-off between high morphine concentration and increased refill interval will need to be found by clinicians.
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Affiliation(s)
- Jeremy Sorrieul
- Pharmacy, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France.
| | - Julien Robert
- Pharmacy, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Auriane Blanchet
- Pharmacy, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Julien Gouju
- Pharmacy, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Florent Bienfait
- Anesthesia and Pain Department, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Sabrina Jubier Hamon
- Anesthesia and Pain Department, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Denis Dupoiron
- Anesthesia and Pain Department, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Catherine Devys
- Pharmacy, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
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