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Robbins-Welty GA, Chammas D, Silverman EJ, Lowry MF, Hale E, Martinez C, Nakatani MM, Shalev D, Noufi P, Riordan PA, Brenner KO, Rosa WE, Jones CA. Top Ten Tips Palliative Care Clinicians Should Know About Diagnosing, Categorizing, and Addressing Fatigue. J Palliat Med 2024. [PMID: 39052494 DOI: 10.1089/jpm.2024.0232] [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: 07/27/2024] Open
Abstract
Fatigue is a multifactorial symptom that is commonly faced by patients with cancer, chronic disease, and other serious illnesses. Fatigue causes suffering across biopsychosocial domains and affects patients and their loved ones. In this article, a consortium of professionals across cancer care, physical therapy, exercise, pharmacy, psychiatry, and palliative medicine offers tips and insights on evaluating, categorizing, and addressing fatigue in the setting of serious illness. The comprehensive approach to managing fatigue underscores the importance of collaborative efforts characteristic of interdisciplinary palliative care. Prioritizing screening, diagnosing, and treating fatigue is crucial for enhancing patients' and families' overall quality of life.
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Affiliation(s)
- Gregg A Robbins-Welty
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Danielle Chammas
- Division of Palliative Medicine, Departments of Medicine and Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Ethan J Silverman
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Maria Felton Lowry
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Hale
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Corina Martinez
- Department of Physical Therapy, Duke University School of Physical Therapy, Durham, North Carolina, USA
| | - Morgan M Nakatani
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Paul Noufi
- Division of Palliative Medicine, Department of Medicine, MedStar Health, Georgetown University School of Medicine, Baltimore, Maryland, USA
| | - Paul A Riordan
- Department of Veterans Affairs, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Keri O Brenner
- Section of Palliative Care, Department of Medicine, School of Medicine, Stanford University, Palo Alto, California, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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2
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Durak A, Catikkas NM. Is caregiver sleep quality an important clinical issue? Sleep Biol Rhythms 2024; 22:403-410. [PMID: 38962792 PMCID: PMC11217237 DOI: 10.1007/s41105-024-00523-2] [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: 10/31/2023] [Accepted: 03/06/2024] [Indexed: 07/05/2024]
Abstract
Sleep quality is directly related to general health and quality of life. Caregivers' sleep disturbances affect not only their own health, but also the optimal care of their patients, with negative consequences such as neglect and medication errors. This study was conducted prospectively in the palliative care unit. The participants were divided into two groups: the caregivers and the control group. The caregiver groups were categorized into two subgroups: family and paid caregivers. The sleep quality of the caregivers was evaluated with the Pittsburgh Sleep Quality Index (PSQI). The demographics, body mass index, educational level, the presence of chronic diseases and medications, need for spiritual support, daytime sleepiness, duration of caregiving, nighttime awakening, and tea/coffee consumption were recorded. The study included 250 caregivers (female: 74.8%, mean age: 50.6 ± 12.1) and 103 control group members. Family caregivers significantly had an advanced age, lower educational level, more chronic diseases, and medications, need for spiritual support, and longer duration of caregiving compared to the paid caregivers (p = 0.018, < 0.001, 0.001, 0.005, < 0.001, and 0.003, respectively). The total PSQI scores of caregivers were significantly higher in the FDR, family group, females, those with need of spiritual support, and tea/coffee consumption close to bedtime (p = 0.002 < 0.004. 0.026. < 0.001, and 0.022, respectively). The fact that the sleep quality of family group caregivers is worse than that of paid caregivers may prevent healthy medical service delivery. The provision of care by paid professional caregivers will improve quality of care and quality of life.
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Affiliation(s)
- Ayfer Durak
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Sancaktepe, 34785 Istanbul, Turkey
| | - Nezahat Muge Catikkas
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Sancaktepe, 34785 Istanbul, Turkey
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3
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Troyer J, Tanco K. Review of the Use of Medicinal Cannabis Products in Palliative Care. Cancers (Basel) 2024; 16:1412. [PMID: 38611090 PMCID: PMC11011126 DOI: 10.3390/cancers16071412] [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: 03/04/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
In this review, we discuss the potential role of cannabis and cannabinoids in the management of cancer-related symptoms. There is limited evidence demonstrating the effectiveness of cannabis-based products in treating cancer-related pain and gastrointestinal symptoms such as nausea, vomiting, and loss of appetite. Regarding the role of cannabis-based products in the treatment of insomnia and mood disorders, most studies looked at these symptoms as secondary outcomes with mixed results. Cannabis-based products have adverse effects, ranging from neuropsychiatric to systemic effects to potential drug interactions.
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Affiliation(s)
| | - Kimberson Tanco
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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Mussa MV, Allegra S, Armando T, Storto S, Ghezzo B, Soave G, Abbadessa G, Chiara F, Di Maio M, Dagnoni FM, De Francia S. Self-Completion Questionnaire on Sleep Evaluation in Patients Undergoing Oxaliplatin Therapy: An Observational Study. Cancers (Basel) 2024; 16:946. [PMID: 38473307 DOI: 10.3390/cancers16050946] [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: 12/29/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Sleep is a fundamental human need; sleep disruption, in fact, causes an increase in the activity of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, metabolic effects, changes in circadian rhythms, and pro-inflammatory responses. The scientific literature is finally starting to pay attention to the central role of sleep alterations in patients health. Oxaliplatin is extensively used for the treatment of gastrointestinal cancer and other malignancies, with an increased frequency of use in recent years. This study aims to understand the effects of sleep complaints on health and quality of life in cancer patients treated with oxaliplatin. A study has been conducted through the creation and distribution of questionnaires to patients to investigate their complaints about sleep quality. We observed significant differences between males and females in evaluating sleep hygiene scores, the Pittsburgh Sleep Quality Index, and previous difficulty sleeping. Moreover, in females, stress, worries, and anxiety seem to play a negative role in the sleep hygiene score. The obtained results could improve the interest of healthcare personnel and caregivers in sleep quality in patients undergoing chemotherapy.
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Affiliation(s)
- Maria Valentina Mussa
- Centro Oncoematologico Subalpino (COES), Molinette University Hospital of the City of Health and Science of Turin, 10126 Turin, Italy
| | - Sarah Allegra
- Laboratory of Clinical Pharmacology "Franco Ghezzo", Department of Clinical and Biological Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Tiziana Armando
- Centro Oncoematologico Subalpino (COES), Molinette University Hospital of the City of Health and Science of Turin, 10126 Turin, Italy
| | - Silvana Storto
- Centro Oncoematologico Subalpino (COES), Molinette University Hospital of the City of Health and Science of Turin, 10126 Turin, Italy
| | - Beatrice Ghezzo
- Specialization School in Ophthalmology, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy
| | - Giulia Soave
- Centro Oncoematologico Subalpino (COES), Molinette University Hospital of the City of Health and Science of Turin, 10126 Turin, Italy
| | - Giuliana Abbadessa
- Laboratory of Clinical Pharmacology "Franco Ghezzo", Department of Clinical and Biological Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Francesco Chiara
- Laboratory of Clinical Pharmacology "Franco Ghezzo", Department of Clinical and Biological Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Massimo Di Maio
- Centro Oncoematologico Subalpino (COES), Molinette University Hospital of the City of Health and Science of Turin, 10126 Turin, Italy
| | - Fiammetta Maria Dagnoni
- Centro Oncoematologico Subalpino (COES), Molinette University Hospital of the City of Health and Science of Turin, 10126 Turin, Italy
| | - Silvia De Francia
- Laboratory of Clinical Pharmacology "Franco Ghezzo", Department of Clinical and Biological Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy
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Grassi L, Zachariae R, Caruso R, Palagini L, Campos-Ródenas R, Riba MB, Lloyd-Williams M, Kissane D, Rodin G, McFarland D, Ripamonti CI, Santini D. Insomnia in adult patients with cancer: ESMO Clinical Practice Guideline. ESMO Open 2023; 8:102047. [PMID: 38158225 PMCID: PMC10774975 DOI: 10.1016/j.esmoop.2023.102047] [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: 05/12/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 01/03/2024] Open
Abstract
•Insomnia is common in patients with cancer, with a higher prevalence than observed in the general population. •Insomnia is often under-recognised and inadequately treated in patients with cancer. •Brief validated screening tools are available for the evaluation of insomnia in clinical practice. •First-line therapy should be based on international guidelines recommending cognitive behavioural therapy for insomnia.
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Affiliation(s)
- L Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - R Zachariae
- Unit for Psychooncology and Health Psychology (EPoS), Department of Oncology, Aarhus University Hospital, Aarhus; Danish Center for Breast Cancer Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
| | - R Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - L Palagini
- Sleep Clinic, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - R Campos-Ródenas
- Department of Psychiatry, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | - M B Riba
- Department of Psychiatry, University of Michigan, Ann Arbor; University of Michigan Rogel Cancer Center, University of Michigan, Ann Arbor, USA
| | - M Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool; Department of Supportive and Palliative Care, Liverpool John Moores University, Liverpool, UK
| | - D Kissane
- Department of Psychiatry, Monash University and Monash Medical Centre, Monash Health, Clayton, Australia
| | - G Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - D McFarland
- Department of Psychiatry, University of Rochester, Rochester; Wilmont Cancer Institute, University of Rochester Medical Center, Rochester, USA
| | - C I Ripamonti
- School of Speciality in Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - D Santini
- Medical Oncology A, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Çelik A, Usta Yeşilbalkan Ö. The Effect of the Bright White Light Application to Cancer Patients Receiving Palliative Care on Their Fatigue Level and Sleep Quality: A Randomized Control Trial. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:303-317. [PMID: 35532064 DOI: 10.1177/00302228221093462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
This study aimed to examine the effect of bright white light on the fatigue level and sleep quality of cancer patients receiving palliative care. The study sample consisted of 52 patients who met the inclusion criteria and were assigned to the study or control group by stratified randomization. The bright white light (10,000 lux) or dim red light (<50 lux) was applied for 30 minutes every morning for 14 days to the patients in the study and control group. In the study, bright white light significantly decreased the level of fatigue and the level of fatigue-related effect on daily life activities, improved sleep quality and increased total sleep time (p < 0.05). It was found that dim red light significantly decreased the level of fatigue and increased the sleep quality, but this change was lower than the study group (p < 0.05).
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Affiliation(s)
- Ayşegül Çelik
- Faculty of Health Sciences, Department of Nursing, İzmir Bakırçay University, Izmir, Türkiye
| | - Öznur Usta Yeşilbalkan
- Nursing Faculty, Department of Internal Medicine Nursing, Ege University, Izmir, Türkiye
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Wong AK, Wang D, Marco D, Le B, Philip J. Prevalence, Severity, and Predictors of Insomnia in Advanced Colorectal Cancer. J Pain Symptom Manage 2023; 66:e335-e342. [PMID: 37295563 DOI: 10.1016/j.jpainsymman.2023.05.020] [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: 02/15/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
CONTEXT Insomnia is an under-recognized and undertreated symptom in palliative care and advanced cancer cohorts. Insomnia in an advanced colorectal cancer cohort is yet to be investigated despite colorectal cancer being the third commonest cancer worldwide and one with a high symptom burden. OBJECTIVES To examine the prevalence of insomnia and its associations in a large advanced colorectal cancer cohort. METHODS A consecutive cohort study of 18,302 patients with colorectal cancer seen by palliative care services across various settings (inpatient, outpatient, and ambulatory) was conducted from an Australia-wide database (2013-2019). The Symptom Assessment Score (SAS) was used to assess the severity of insomnia. Clinically significant insomnia was defined as SAS score ≥3/10, and used to compare associations with other symptoms and functional scores from validated questionnaires. RESULTS The prevalence of any insomnia was 50.5%, and clinically significant insomnia 35.6%, particularly affecting people who were younger (<45-years-old), more mobile (AKPS score ≥70), or physically capable (RUG-ADL score ≤5). Outpatients and patients living at home had higher prevalence of insomnia. Nausea, anorexia and psychological distress were the commonest concurrent symptoms in patients with clinically significant insomnia. CONCLUSIONS To our knowledge, this study was the first to investigate the prevalence and associations of insomnia in an advanced colorectal cancer cohort. Our findings demonstrate several groups at greater risk of suffering from insomnia (younger, greater physical capacity, living at home, and those with greater psychological distress). This may guide earlier recognition and management of insomnia to improve overall quality of life in this population.
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Affiliation(s)
- Aaron K Wong
- Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Eastern Hill Campus, (A.K.W., D.M., J.P.), University of Melbourne, Fitzroy, Victoria, Australia.
| | - Dorothy Wang
- Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - David Marco
- Department of Medicine, Eastern Hill Campus, (A.K.W., D.M., J.P.), University of Melbourne, Fitzroy, Victoria, Australia; Centre for Palliative Care, St Vincent's Hospital Melbourne (D.M.), Fitzroy, Victoria, Australia
| | - Brian Le
- Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jennifer Philip
- Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Eastern Hill Campus, (A.K.W., D.M., J.P.), University of Melbourne, Fitzroy, Victoria, Australia; Palliative Care Service (J.P.), St Vincent's Hospital, Fitzroy, Victoria, Australia
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8
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Nishigami T, Manfuku M, Lahousse A. Central Sensitization in Cancer Survivors and Its Clinical Implications: State of the Art. J Clin Med 2023; 12:4606. [PMID: 37510721 PMCID: PMC10380903 DOI: 10.3390/jcm12144606] [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: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Although the prevalence of cancer pain is 47% after treatment, cancer pain is often underestimated, and many patients are undertreated. The complexity of cancer pain contributes to the lack of its management. Recently, as the mechanism of cancer pain, it has become clear that central sensitization (CS) influences chronic pain conditions and the transition from acute to chronic pain. In this state-of-the-art review, we summarized the association of CS or central sensitivity syndrome with pain and the treatment for pain targeting CS in cancer survivors. The management of patients with CS should not only focus on tissue damage in either the affected body regions or within the central nervous system; rather, it should aim to target the underlying factors that sustain the CS process. Pain neuroscience education (PNE) is gaining popularity for managing chronic musculoskeletal pain and could be effective for pain and CS in breast cancer survivors. However, there is a study that did not demonstrate significant improvements after PNE, so further research is needed. Precision medicine involves the classification of patients into subgroups based on a multifaceted evaluation of disease and the implementation of treatment tailored to the characteristics of each patient, which may play a central role in the treatment of CS.
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Affiliation(s)
- Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima 723-0053, Japan
| | - Masahiro Manfuku
- Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Hiroshima 723-0053, Japan
- Department of Rehabilitation, Breast Care Sensyu Clinic, Osaka 596-0076, Japan
| | - Astrid Lahousse
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
- Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, 1090 Brussels, Belgium
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9
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Marcolin ML, Tarot A, Lombardo V, Pereira B, Lander AV, Guastella V. The effects of foot reflexology on symptoms of discomfort in palliative care: a feasibility study. BMC Complement Med Ther 2023; 23:66. [PMID: 36855141 PMCID: PMC9971681 DOI: 10.1186/s12906-023-03873-5] [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: 09/25/2022] [Accepted: 02/06/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND In palliative care, the relief of discomfort is sought by an overall approach, combining prescribed medication and additional therapies, such as foot reflexology (FR). The main objective of this study was to assess the feasibility of FR in a population of inpatients in a palliative care unit (PCU).The precariousness of the patients led us to perform a feasibility study and not a cohort study from the outset. Its secondary objective was to assess the impact of an FR session on some symptoms of discomfort (anxiety, pain, troubled sleep, and psychological distress). METHODS This is a feasibility study designed as a randomized controlled two-arm therapeutic trial. One arm tested FR, the other an active control, massage therapy (MT). The evaluators were blinded. RESULTS FR was feasible for 14 patients out of the 15 included in the FR group (95% CI [68%; 100%]). These patients were in the palliative care phase of cancer, motor neuron disease, or terminal organ failure. Concerning the symptoms of discomfort, ESAS sleep quality score was on average 3.9 (± 2.5) before a session in the FR group. It was improved to an average of 3 (± 2.3) on the day after the session (effect-size = 0.38 [0.03; 0.73]). CONCLUSION This study confirms the feasibility of an FR session for patients hospitalized in a PCU. It resulted in a slight improvement in sleep quality. For other discomfort symptoms such as anxiety, pain and distress, FR yielded a non-significant improvement. Significant results would have needed a larger cohort.
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Affiliation(s)
- Marie Lavarelo Marcolin
- grid.494717.80000000115480420Université de Clermont Auvergne, CHU Clermont-Ferrand, Palliative Care Center, 63001 Clermont-Ferrand, France
| | - Andréa Tarot
- grid.494717.80000000115480420Université de Clermont Auvergne, CHU Clermont-Ferrand, ACCePPT UCA, Palliative Care Center, 63001 Clermont-Ferrand, France
| | - Véronique Lombardo
- grid.494717.80000000115480420Université de Clermont Auvergne, CHU Clermont-Ferrand, Palliative Care Center, 63001 Clermont-Ferrand, France
| | - Bruno Pereira
- grid.494717.80000000115480420Université de Clermont Auvergne, CHU Clermont-Ferrand, Secteur Biométrie Et Médico-Économie, 63001 Clermont-Ferrand, France
| | - Axelle Van Lander
- grid.494717.80000000115480420Université de Clermont Auvergne, CHU Clermont-Ferrand, ACCePPT UCA, Palliative Care Center, 63001 Clermont-Ferrand, France
| | - Virginie Guastella
- Palliative Care Center, CHU Clermont-Ferrand, Clermont-Ferrand, France. .,Université de Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, 63001, Clermont-Ferrand, France.
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10
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Korabelnikova EA, Akavov AN, Baranov ML. [Insomnia in neurological patients with disabilities]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:12-20. [PMID: 36843454 DOI: 10.17116/jnevro202312302112] [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: 02/28/2023]
Abstract
Sleep is the most important factor reflecting the level of psychophysical well-being of a person and influencing him/her to the same extent. The greater susceptibility to sleep disturbances in patients with disabilities is associated with numerous factors. In the existing literature, there are few studies of insomnia in people with neurological disabilities. This article presents a current view on sleep disorders in disabled people and methods for their treatment.
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Affiliation(s)
- E A Korabelnikova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A N Akavov
- Dagestan State Medical University, Makhachkala, Russia
| | - M L Baranov
- Main Military Clinical Hospital of the National Guard Forces, Moscow, Russia
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11
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Calvo-Schimmel A, Kober KM, Paul SM, Cooper BA, Harris C, Shin J, Hammer MJ, Conley YP, Dokiparthi V, Olshen A, Levine JD, Miaskowski C. Sleep disturbance is associated with perturbations in immune-inflammatory pathways in oncology outpatients undergoing chemotherapy. Sleep Med 2023; 101:305-315. [PMID: 36470166 PMCID: PMC11200329 DOI: 10.1016/j.sleep.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep disturbance is a common problem in patients receiving chemotherapy. Purpose was to evaluate for perturbations in immune-inflammatory pathways between oncology patients with low versus very high levels of sleep disturbance. PATIENTS/METHODS Sleep disturbance was evaluated using the General Sleep Disturbance Scale six times over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct sleep disturbance profiles. Pathway impact analyses were performed in two independent samples using gene expression data obtained from RNA sequencing (n = 198) and microarray (n = 162) technologies. Fisher's combined probability test was used to identify significantly perturbed pathways between Low versus Very High sleep disturbance classes. RESULTS In the RNA sequencing and microarray samples, 59.1% and 51.9% of patients were in the Very High sleep disturbance class, respectively. Thirteen perturbed pathways were related to immune-inflammatory mechanisms (i.e., endocytosis, phagosome, antigen processing and presentation, natural killer cell mediated cytotoxicity, cytokine-cytokine receptor interaction, apoptosis, neutrophil extracellular trap formation, nucleotide-binding and oligomerization domain-like receptor signaling, Th17 cell differentiation, intestinal immune network for immunoglobulin A production, T-cell receptor signaling, complement and coagulation cascades, and tumor necrosis factor signaling). CONCLUSIONS First study to identify perturbations in immune-inflammatory pathways associated with very high levels of sleep disturbance in oncology outpatients. Findings suggest that complex immune-inflammatory interactions underlie sleep disturbance.
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Affiliation(s)
- Alejandra Calvo-Schimmel
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | - Kord M Kober
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | - Steven M Paul
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | - Bruce A Cooper
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | - Carolyn Harris
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | - Joosun Shin
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Vasuda Dokiparthi
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | - Adam Olshen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Jon D Levine
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
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12
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Jakobsen G, Sjue K, Paulsen Ø, Kaasa S, Hjermstad MJ, Klepstad P. Zopiclone versus placebo for short-term treatment of insomnia in patients with advanced cancer-a double-blind, randomized placebo-controlled clinical multicenter phase IV trial. Support Care Cancer 2023; 31:60. [PMID: 36534165 PMCID: PMC9763131 DOI: 10.1007/s00520-022-07537-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Insomnia is frequent in patients with advanced cancer, and a variety of pharmacological agents is used to treat this condition. Still, few clinical trials have investigated the effectiveness of pharmacological sleep therapies in this patient group. We aimed to study the short-term effectiveness of zopiclone on sleep quality in patients with advanced cancer who report insomnia. METHODS A randomized, double-blind, placebo-controlled, parallel-group, multicenter, phase IV clinical trial in adult patients with metastatic malignant disease and insomnia. Patients were treated with zopiclone or placebo for six subsequent nights. Primary end point was patient-reported sleep quality during the final study night (NRS 0-10). Secondary end points were patient-reported sleep onset latency (SOL) and total sleep time (TST). RESULTS Forty-one patients were randomized, with 18 being analyzed in the zopiclone group and 21 in the placebo group. Median age was 66, median Karnofsky performance score was 80, and 56% were male. Mean sleep quality at end of study was 2.9 (CI 2.3 to 3.8) in the zopiclone group and 4.5 (CI 3.6 to 5.4) in the placebo group (p = 0.021). At end of study, SOL was significantly different between the treatment groups: zopiclone 29 min (CI 13 to 51) and placebo 62 min (CI 40 to 87) (p = 0.045). TST was not significantly different across groups: zopiclone 449 min (403 to 496) and placebo 411 min (CI 380 to 440) (p = 0.167). CONCLUSION Zopiclone improved short-term patient-reported sleep quality in this cohort of patients with advanced cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02807922.
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Affiliation(s)
- Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), and Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Karin Sjue
- Department of Oncology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ørnulf Paulsen
- Institute of Clinical Medicine, European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, Oslo, Norway, University of Oslo, Oslo, Norway, and Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marianne Jensen Hjermstad
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway, and European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, Oslo, Norway, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Klepstad
- Department of Anaesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, and Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
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Akui C, Kimura T, Hirose M. Associations between insomnia and central sensitization in cancer survivors undergoing opioid therapy for chronic cancer pain: A STROBE-compliant prospective cohort study. Medicine (Baltimore) 2022; 101:e30845. [PMID: 36197271 PMCID: PMC9509184 DOI: 10.1097/md.0000000000030845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Several risk factors for insomnia in cancer patients have been recognized, including chronic pain and treatment with opioid. Although associations between insomnia and central sensitization were previously reported in patients with chronic non-cancer pain, those have not been elucidated among cancer survivors undergoing opioid therapy for chronic cancer pain. To investigate the associations between insomnia and central sensitization among cancer survivors undergoing opioid therapy for chronic cancer pain, consecutive patients undergoing chemotherapy with chronic cancer pain under opioid therapy on an outpatient basis were enrolled from September 2019 to August 2020 and answered questions from the Athens Insomnia Scale (AIS) for assessing insomnia. Pain characteristics, including pain intensity, neuropathic pain, central sensitization assessed using the central sensitization inventory (CSI), opioid use disorder, and pain-related psychological symptoms were also examined. Uni- and multivariate regression analyses were performed to elucidate correlations between the AIS score and these pain characteristics. Of 44 enrolled patients, 20 patients completed to answer all questions. Insomnia was identified in 9 patients (45%). Although AIS scores showed no significant associations with pain intensity, neuropathic pain, opioid use disorder, or psychological symptoms, multivariate regression analysis revealed that CSI scores showed a positive relationship with AIS scores (P = .004). Discrimination was assessed using linear regression analysis which confirmed a significant association between the AIS and CSI scores (P = .002). Insomnia appears to be associated with central sensitization in cancer survivors with chronic cancer pain under opioid therapy.
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Affiliation(s)
- Chiaki Akui
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University (Formerly Hyogo College of Medicine), School of Medicine, Nishinomiya, Hyogo, Japan
- Department of Pharmacy, Hyogo Medical University Hospital, Hyogo, Japan
| | - Takeshi Kimura
- Department of Pharmacy, Hyogo Medical University Hospital, Hyogo, Japan
| | - Munetaka Hirose
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University (Formerly Hyogo College of Medicine), School of Medicine, Nishinomiya, Hyogo, Japan
- *Correspondence: Munetaka Hirose, Department of Anesthesiology and Pain Medicine, Hyogo Medical University (Formerly Hyogo College of Medicine), School of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan (e-mail: )
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An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research. Cancers (Basel) 2022; 14:cancers14163933. [PMID: 36010925 PMCID: PMC9406296 DOI: 10.3390/cancers14163933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary This review focuses on sleep in patients with advanced cancer. Cancer patients experience multiple symptoms and they receive concomitant medications. These are all factors that may affect sleep. In this paper, we present recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that may contribute to insomnia. Sleep is an essential aspect of health-related quality of life; therefore, it is important for health care providers to focus on sleep to improve patient care. Abstract Patients with advanced cancer experience multiple symptoms, with fluctuating intensity and severity during the disease. They use several medications, including opioids, which may affect sleep. Sleep disturbance is common in cancer patients, decreases the tolerability of other symptoms, and impairs quality of life. Despite its high prevalence and negative impact, poor sleep quality often remains unrecognized and undertreated. Given that sleep is an essential aspect of health-related quality of life, it is important to extend both the knowledge base and awareness among health care providers in this field to improve patient care. In this narrative review, we provide recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that contribute to insomnia. We also present direct implications for health care providers working in palliative care and for future research.
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Akada K, Koyama N, Miura Y, Aoshima K. Nationwide database analysis of insomnia, depression, and sleeping pill prescriptions in hepatocellular carcinoma patients. Curr Med Res Opin 2022; 38:1333-1339. [PMID: 35608320 DOI: 10.1080/03007995.2022.2081451] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To clarify the status of insomnia and depression and the prescription of sleeping pills in hepatocellular carcinoma (HCC) patients before and after HCC diagnosis and treatment. METHODS Patients' data from a Japanese health insurance claims database were analyzed retrospectively to determine the incidence of insomnia and depression and their association with sleeping pill prescriptions during the 6 months before and after HCC diagnosis and treatment. RESULTS A total of 9,109 HCC patients (median age at diagnosis = 71.5 years, 68.1% male) were analyzed. The incidences of insomnia and depression increased significantly after HCC diagnosis. Insomnia was reported in 15.0% of patients before diagnosis, and it increased to 27.6% after diagnosis. Similarly, depression was reported in 6.3% and 11.3% before and after diagnosis, respectively. The incidences of insomnia and depression before diagnosis were higher in patients with concomitant liver diseases including hepatitis, cirrhosis, and hepatic encephalopathy. However, the rate of sleeping pill prescription was significantly lower in patients with concomitant liver diseases after diagnosis. The incidence of fracture was higher in insomnia or depression patients than others and in patients treated with sleeping pills than without before and after diagnosis. CONCLUSIONS HCC patients had increased risks of insomnia and depression after diagnosis. The high risk of fracture in HCC patients with insomnia and depression and treated with sleeping pills suggests that it is difficult to optimize the management of HCC patients, especially those with concomitant liver diseases.
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Affiliation(s)
- Keishi Akada
- hhc Data Creation Center, Eisai Co. Ltd, Tokyo, Japan
| | - Noriyuki Koyama
- Government Relations Strategy Department, Eisai Co. Ltd, Tokyo, Japan
| | - Yuji Miura
- hhc Data Creation Center, Eisai Co. Ltd, Tokyo, Japan
| | - Ken Aoshima
- hhc Data Creation Center, Eisai Co. Ltd, Tokyo, Japan
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Currow DC, Davis W, Connolly A, Krishnan A, Wong A, Webster A, Barnes-Harris MM, Daveson B, Ekström M. Sleeping-related distress in a palliative care population: A national, prospective, consecutive cohort. Palliat Med 2021; 35:1663-1670. [PMID: 33726609 DOI: 10.1177/0269216321998558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Sleep, a multi-dimensional experience, is essential for optimal physical and mental wellbeing. Poor sleep is associated with worse wellbeing but data are scarce from multi-site studies on sleeping-related distress in palliative care populations. AIM To evaluate patient-reported distress related to sleep and explore key demographic and symptom distress related to pain, breathing or fatigue. DESIGN Australian national, consecutive cohort study with prospectively collected point-of-care data using symptoms from the Symptom Assessment Scale (SAS). SETTING/PARTICIPANTS People (n = 118,117; 475,298 phases of care) who died while being seen by specialist palliative care services (n = 152) 2013-2019. Settings: inpatient (direct care, consultative); community (outpatient clinics, home, residential aged care). RESULTS Moderate/severe levels of sleeping-related distress were reported in 11.9% of assessments, more frequently by males (12.7% vs 10.9% females); people aged <50 years (16.2% vs 11.5%); and people with cancer (12.3% vs 10.0% for other diagnoses). Sleeping-related distress peaked with mid-range Australia-modified Karnofsky Performance Status scores (40-60).Strong associations existed between pain-, breathing- and fatigue-related distress in people who identified moderate/severe sleeping-related distress, adjusted for age, sex and functional status. Those reporting moderate/severe sleeping-related distress were also more likely to experience severe pain-related distress (adjusted odds ratios [OR] 6.6; 95% confidence interval (CI) 6.3, 6.9); breathing-related distress (OR 6.2; 95% CI 5.8, 6.6); and fatigue-related distress (OR 10.4; 95% CI 9.99-10.8). CONCLUSIONS This large, representative study of palliative care patients shows high prevalence of sleeping-related distress, with strong associations shown to distress from other symptoms including pain, breathlessness and fatigue.
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Affiliation(s)
- David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Walter Davis
- Walt Centre for Applied Statistics in Health, Australian Health Services Research Institute, NSW, Australia
| | - Alanna Connolly
- Palliative Care Outcomes Collaboration (PCOC), Australian Health Services Research Institute (AHSRI), University of Wollongong, NSW, Australia Alana
| | - Anu Krishnan
- Palliative Care, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Aaron Wong
- Department of Palliative Care, Austin Health, Heidelberg, VIC, Australia
- Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Andrew Webster
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Matilda Mm Barnes-Harris
- York Teaching Hospital NHS Foundation Trust, York, UK
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Barb Daveson
- Palliative Care Outcomes Collaboration (PCOC), Australian Health Services Research Institute (AHSRI), University of Wollongong, NSW, Australia Alana
| | - Magnus Ekström
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
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Guiteras AF, Abelló HV, Domingo JP, Danés CF, Ripoll AR, Berger R. Palliative Oncological Patients with Insomnia: Concerns of the Patients and Their Relatives' Perception. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168509. [PMID: 34444258 PMCID: PMC8392089 DOI: 10.3390/ijerph18168509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022]
Abstract
Insomnia is one of the most frequent symptoms and usually generates significant stress in 60% of patients with advanced cancer. Worries from the patients' and relatives' perspective are crucial to improve the patients' quality of life but have received limited attention. The aims were to identify the concerns of patients with insomnia in the terminal illness stage in a palliative care unit and the relatives' perception, and to compare both. Here, 63 patients and 53 relatives answered a questionnaire about worries in the personal, spiritual, family-related and economic area, as well as a quality-of-life uniscale. The results showed that the relatives' most frequent concern was "Having lived life to the fullest" (100%), and the most intense was "The possible suffering during the process" (9.2/10). The patients' most expressed concern was: "Having unfinished business" (100%), and the most intense was "Suffering during the process" (9.3/10). Quality of life showed an average value of 6.95 out of 10. Relatives only coincided significantly in: "Not knowing what happens after death" (r = 0.600; p = 0.000). These results bring visibility to concerns during the final stage of oncological palliative patients with insomnia from the patients' and relatives' perspective. Knowing both is useful for professionals to foster the well-being for a short, yet very important, period for patients, relatives and the caregiving team.
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Affiliation(s)
- Antoni Font Guiteras
- Department de Psicologia Bàsica, Evolutiva i de la Educació, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (A.F.G.); (H.V.A.)
| | - Helena Villar Abelló
- Department de Psicologia Bàsica, Evolutiva i de la Educació, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (A.F.G.); (H.V.A.)
| | - José Planas Domingo
- Palliative Care Unit, Geriatric Department, Centre Fòrum, Hospital del Mar, 08003 Barcelona, Spain; (J.P.D.); (C.F.D.); (A.R.R.)
| | - Cristina Farriols Danés
- Palliative Care Unit, Geriatric Department, Centre Fòrum, Hospital del Mar, 08003 Barcelona, Spain; (J.P.D.); (C.F.D.); (A.R.R.)
| | - Ada Ruiz Ripoll
- Palliative Care Unit, Geriatric Department, Centre Fòrum, Hospital del Mar, 08003 Barcelona, Spain; (J.P.D.); (C.F.D.); (A.R.R.)
| | - Rita Berger
- Departamento de Psicología Social y Cuantitativa, Universitat de Barcelona, 08035 Barcelona, Spain
- Correspondence:
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A deep learning algorithm for sleep stage scoring in mice based on a multimodal network with fine-tuning technique. Neurosci Res 2021; 173:99-105. [PMID: 34280429 DOI: 10.1016/j.neures.2021.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Sleep stage scoring is important to determine sleep structure in preclinical and clinical research. The aim of this study was to develop an automatic sleep stage classification system for mice with a new deep neural network algorithm. For the purpose of base feature extraction, wake-sleep and rapid eye movement (REM) and non- rapid eye movement (NREM) models were developed by extracting defining features from mouse-derived electromyogram (EMG) and electroencephalogram (EEG) signals, respectively. The wake-sleep model and REM-NREM sleep model were integrated into three different algorithms including a rule-based integration approach, an ensemble stacking approach, and a multimodal with fine-tuning approach. The deep learning algorithm assessing sleep stages in animal experiments by the multimodal with fine-tuning approach showed high potential for increasing accuracy in sleep stage scoring in mice and promoting sleep research.
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Larson KL, Jewell GD, Maldonado MF, Braxton ME, Johnson LA. Call the Rezadora: Aiding Latino Families at the End of Life. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:147-155. [PMID: 34219506 DOI: 10.1177/15404153211028992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The rezadora, a lay spiritual leader, provides support to Latino families as they provide end-of-life (EOL) care for loved ones. The purpose of this study was to learn about the work of the rezadora in Guatemala as a resource for Latinos with serious illness in the United States. METHODS An ethnographic exploratory case study was conducted during summer 2018 in rural Guatemala. We interviewed three rezadoras who resided in two villages. The study yielded two cases, the single case and the paired case, which allowed for a holistic view of how the rezadora serves the community. RESULTS Content and thematic analysis led to two themes: Essence of being called and Power of prayerful song. Essence of being called was represented by the prominence of the rezadora and their perpetual faith work. Power of prayerful song was characterized through the mission, customs, and the presence of the rezadora. A good death was aided by the rezadora in this context. CONCLUSIONS As the Latino population ages in place, the need for palliative and EOL care services will increase. Lay spiritual leaders could enhance the palliative care teams in these communities and improve the quality of life for Latinos with serious illness.
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Affiliation(s)
- Kim L Larson
- College of Nursing, East Carolina University, Greenville, NC, USA
| | | | | | | | - Lee Ann Johnson
- School of Nursing, University of Virginia, Charlottesville, VA, USA
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Koebisu M, Koyama N, Nishida M, Muramoto K. [Preclinical and clinical efficacy of orexin receptor antagonist Lemborexant (Dayvigo ®) on insomnia patients]. Nihon Yakurigaku Zasshi 2021; 156:114-119. [PMID: 33642529 DOI: 10.1254/fpj.20093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Orexin receptor antagonists have been approved for insomnia, and the insomnia pharmacotherapy is being greatly progressed. Orexin is a neuropeptide produced in the lateral hypothalamic area, and its physiological role has been suggested to be a key mediator controlling the sleep-wake state. Orexin receptor antagonists are thought to induce physiological sleep by acting specifically on the sleep-wake cycle. Lemborexant is a dual antagonist acting on both two orexin receptors, the orexin 1 (OX1R) and 2 receptor (OX2R), with stronger inhibitory effects on OX2R. Since it binds to and dissociates from orexin receptors rapidly, the pharmacokinetics of its blood concentration may have an impact on its pharmacological action. In rats, lemborexant exhibited a sleep-inducing effect without altering sleep architecture. In the phase III studies in patients with insomnia, lemborexant significantly improved difficulties in falling asleep and maintaining sleep. While somnolence occurred as treatment-related adverse events in a dose-dependent manner, lemborexant was generally well-tolerated. Also, the effects on body sway and driving skills 8-9 hours after administration did not differ from those in the placebo group, suggesting little next morning residual effects. Subgroup analysis has shown that efficacy and safety of lemborexant were similar in patients with insomnia with comorbidities, suggesting lemborexant may also be useful for those patients. Based on the above results and others, lemborexant has been approved for the indication of insomnia in January 2020 in Japan. Lemborexant will give a new treatment option for patients with insomnia.
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