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Hirai R, Uesawa Y. Analysis of Opioid-Related Adverse Events in Japan Using FAERS Database. Pharmaceuticals (Basel) 2023; 16:1541. [PMID: 38004407 PMCID: PMC10675800 DOI: 10.3390/ph16111541] [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: 08/30/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Adverse events associated with opioid use in palliative care have been extensively studied. However, predicting the occurrence of adverse events based on the specific opioid used remains difficult. This study aimed to comprehensively analyze the adverse events related to µ-opioid receptor stimulation of opioids approved in Japan and investigate the tendencies of adverse event occurrence among different opioids. We utilized the FDA Adverse Event Reporting System database to extract reported adverse events for opioids approved in Japan. Cluster analysis was performed on reporting odds ratios (RORs) of adverse event names among opioids to visualize relationships between opioids and adverse events, facilitating a comparative study of their classifications. We calculated the RORs of adverse events for the target opioids. Cluster analysis based on these RORs resulted in five broad clusters based on the reported adverse events: i.e., strong opioids, weak opioids, loperamide, tapentadol, and remifentanil. This study provides a comprehensive classification of the association between μ-opioid-receptor-stimulating opioids and adverse events.
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Affiliation(s)
| | - Yoshihiro Uesawa
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Tokyo 204-8588, Japan
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2
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Nogéus M, Nilsson S, Björk M. Pediatric Nurses' Person-Centered Approach to Nausea Management in Children With Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:91-99. [PMID: 36718504 DOI: 10.1177/27527530221140056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: Nausea is a problematic side effect of childhood cancer treatment. However, it is not clear what interventions and assessments pediatric oncology nurses make when caring for a child with nausea. A person-centered approach can illuminate nausea management in pediatric care. The aim was to investigate how pediatric nurses retrieve the patient's narrative, establish partnership, and document nausea in hospitalized children with cancer. Methods: Individual interviews with nurses were conducted and analyzed using deductive content analysis with the framework of person-centered care. Results: The pediatric nurses described retrieving the patient's narrative regarding their nausea by listening to and observing the child. The pediatric nurses tried to establish a partnership with the child by allowing previous knowledge and the child's own preferences guide the interventions that focus on decreasing the child's nausea. The pediatric nurses also documented the effect of the given interventions and described the child's nausea using subjective words. When planning for the child's care it was rare for the nurses to have a documented care plan, but they did review documentation of previously administered interventions to plan for future care. Discussion: The results highlight the pediatric nurses' willingness to listen to the child, but also emphasize the need to further include the child and the parents in the partnership and documentation of nausea management. Collaboration with the child and the parents contributes to higher quality care and a partnership with trust.
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Affiliation(s)
| | - Stefan Nilsson
- 174416Institute of Health and Care Sciences, University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Björk
- CHILD Research Group, Department of Nursing, School of Health and Welfare, 4161Jönköping University, Jönköping, Sweden
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Graphical user interface design to improve understanding of the patient-reported outcome symptom response. PLoS One 2023; 18:e0278465. [PMID: 36693053 PMCID: PMC9873161 DOI: 10.1371/journal.pone.0278465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 10/18/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Symptom monitoring application (SMA) has clinical benefits to cancer patients but patients experience difficulties in using it. Few studies have identified which types of graphical user interface (GUI) are preferred by cancer patients for using the SMA. METHODS This is a cross-sectional study aimed to identify preferred GUI among cancer patients to use SMA. Total of 199 patients were asked to evaluate 8 types of GUIs combining text, icon, illustration, and colors using mixed-methods. Subgroup analyses were performed according to age and gender. RESULTS The mean age of the patients was 57 and 42.5% was male. The most preferred GUI was "Text + Icon + Color" (mean = 4.43), followed by "Text + Icon" (mean = 4.39). Older patients (≥ 60 years) preferred "Text + Icon" than younger patients (p for interaction < 0.01). Simple and intuitive text and icons were the most useful GUI for cancer patients to use the SMA. CONCLUSION Simple and intuitive text and icons were the most useful GUI for cancer patients to use the SMA. Researchers need to be careful when applying realistic face drawings to cancer symptom monitoring applications because they can recall negative images of cancer.
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Intranasal Delivery of Granisetron to the Brain via Nanostructured Cubosomes-Based In Situ Gel for Improved Management of Chemotherapy-Induced Emesis. Pharmaceutics 2022; 14:pharmaceutics14071374. [PMID: 35890270 PMCID: PMC9316995 DOI: 10.3390/pharmaceutics14071374] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 12/23/2022] Open
Abstract
This research aimed to boost granisetron (GS) delivery to the brain via the intranasal route to better manage chemotherapy-induced emesis. Glycerol monooleate (GMO), Poloxamer 407 (P 407) and Tween 80 (T 80) were used to formulate GS-loaded cubosomes (GS-CBS) utilizing a melt dispersion-emulsification technique. GS-CBS were characterized by testing particle diameter, surface charge and entrapment efficiency. The formulations were optimized using a Box–Behnken statistical design, and the optimum formula (including GMO with a concentration of 4.9%, P 407 with a concentration of 10%, and T 80 with a concentration of 1%) was investigated for morphology, release behavior, ex vivo permeation through the nasal mucosa, and physical stability. Moreover, the optimal formula was incorporated into a thermosensitive gel and subjected to histopathological and in vivo biodistribution experiments. It demonstrated sustained release characteristics, increased ex vivo permeability and improved physical stability. Moreover, the cubosomal in situ gel was safe and biocompatible when applied to the nasal mucosa. Furthermore, compared to a drug solution, the nose-to-brain pathway enhanced bioavailability and brain distribution. Finally, the cubosomal in situ gel may be a potential nanocarrier for GS delivery to the brain through nose-to-brain pathway.
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Zhu YJ, Wu XY, Wang W, Chang XS, Zhan DD, Diao DC, Xiao J, Li Y, Ma D, Hu M, Li JC, Wan J, Wu GN, Ke CF, Sun KY, Huang ZL, Cao TY, Zhai XH, Chen YD, Peng JJ, Mao JJ, Zhang HB. Acupuncture for Quality of Life in Gastric Cancer Patients Undergoing Adjuvant Chemotherapy. J Pain Symptom Manage 2022; 63:210-220. [PMID: 34563627 DOI: 10.1016/j.jpainsymman.2021.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 12/23/2022]
Abstract
CONTEXT Patients with gastric cancer experience health-related quality of life (HRQOL) decline during adjuvant chemotherapy following gastrectomy. OBJECTIVES This pilot study aimed to evaluate the preliminary effect and feasibility of electro-acupuncture (EA) for HRQOL and symptom burden in these patients. METHODS In this open-label, multicenter, parallel controlled trial, gastric cancer patients who planned to receive adjuvant chemotherapy were randomly assigned to receive high-dose EA (seven times each chemotherapy cycle for three cycles), low-dose EA (three times each chemotherapy cycle), or usual care only. The acupoints prescription consisted of bilateral ST36, PC6, SP4, and DU20, EX-HN3, and selected Back-shu points. Patients completed the Functional Assessment of Cancer Therapy-Gastric (FACT-Ga) weekly, and the Edmonton Symptom Assessment System (ESAS). The primary outcome was the difference among the groups on the gastric cancer subscale (GaCS) of the FACT-Ga. RESULTS Of the 66 randomized patients, 58 were analyzed according to intention-to-treat principle, and 45 were in the per-protocol set (PPS). The average scores in PPS of GaCS were 52.12±9.71, 51.85±12.36, and 45.37±8.61 in high-dose EA, low-dose EA, and control groups, respectively. EA was significantly associated with improved average GaCS scores when compared with control group (51.98±10.91 vs. 45.37±8.61, P = 0.039). EA treatment also produced ESAS relief at the end of intervention (14.36 ± 12.28 vs. 23.91 ± 15.52, P = 0.027). Participants in EA groups had fewer grade ≥3 leukopenia (0% vs. 15.79%, P = 0.031) and neutropenia (2.56% vs. 26.31%, P = 0.012). CONCLUSION EA showed promising effects in improving HRQOL, controlling symptom burden, and reducing toxicity during adjuvant chemotherapy in gastric cancer patients. Future adequately powered trials are feasible and needed to confirm the specific effect of EA.
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Affiliation(s)
- Yan-Juan Zhu
- Department of Oncology (Y.J.Z., X.S.C., D.D.Z., Y.D.C., H.B.Z.), Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome (Y.J.Z., H.B.Z.), Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research (Y.J.Z., H.B.Z.), Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Yu Wu
- Gastrointestinal Surgery (X.Y.W., G.N.W.), Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Wei Wang
- Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine (W.W., D.C.D., J.W.), the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xue-Song Chang
- Department of Oncology (Y.J.Z., X.S.C., D.D.Z., Y.D.C., H.B.Z.), Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dan-Dan Zhan
- Department of Oncology (Y.J.Z., X.S.C., D.D.Z., Y.D.C., H.B.Z.), Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De-Chang Diao
- Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine (W.W., D.C.D., J.W.), the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian Xiao
- Medical Oncology, the Sixth Affiliated Hospital (J.X., T.Y.C., X.H.Z.), Sun Yat-sen University, Guangzhou, China
| | - Yong Li
- Gastrointestinal Surgery (Y.L.), Guangdong Provincial People's Hospital, Guangzhou, China
| | - Dong Ma
- Gastrointestinal Oncology (D.M.), Guangdong Provincial People's Hospital, Guangzhou, China
| | - Ming Hu
- Gastrointestinal Surgery (M.H., C.F.K.), the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian-Chang Li
- Gastrointestinal Surgery (J.C.L., Z.L.H.), Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Jin Wan
- Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine (W.W., D.C.D., J.W.), the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guan-Nan Wu
- Gastrointestinal Surgery (X.Y.W., G.N.W.), Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Chuan-Feng Ke
- Gastrointestinal Surgery (M.H., C.F.K.), the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kai-Yu Sun
- Gastrointestinal Surgery (K.U.S., J.J.P.), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhi-Liang Huang
- Gastrointestinal Surgery (J.C.L., Z.L.H.), Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Tai-Yuan Cao
- Medical Oncology, the Sixth Affiliated Hospital (J.X., T.Y.C., X.H.Z.), Sun Yat-sen University, Guangzhou, China
| | - Xiao-Hui Zhai
- Medical Oncology, the Sixth Affiliated Hospital (J.X., T.Y.C., X.H.Z.), Sun Yat-sen University, Guangzhou, China
| | - Ya-Dong Chen
- Department of Oncology (Y.J.Z., X.S.C., D.D.Z., Y.D.C., H.B.Z.), Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian-Jun Peng
- Gastrointestinal Surgery (K.U.S., J.J.P.), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Jun J Mao
- Department of Medicine (J.J.M.), Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Hai-Bo Zhang
- Department of Oncology (Y.J.Z., X.S.C., D.D.Z., Y.D.C., H.B.Z.), Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome (Y.J.Z., H.B.Z.), Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research (Y.J.Z., H.B.Z.), Guangzhou University of Chinese Medicine, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine (H.B.Z.), the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou China.
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Sedhom R, Gupta A, Wang L, Paller C, Bao T. Payer Coverage of Integrative Medicine Interventions for Symptom Control in Patients With Cancer. JCO Oncol Pract 2021; 17:587-590. [PMID: 34310190 DOI: 10.1200/op.21.00361] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Ramy Sedhom
- Penn Medicine, Division of Hematology and Oncology, Philadelphia, Pennsylvania
| | - Arjun Gupta
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lin Wang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.,Center for Drug Safety and Effectiveness, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Channing Paller
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ting Bao
- Integrative Medicine and Breast Medicine Services, Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY
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Popescu RA, Roila F, Arends J, Metro G, Lustberg M. Supportive Care: Low Cost, High Value. Am Soc Clin Oncol Educ Book 2021; 41:1-11. [PMID: 33830830 DOI: 10.1200/edbk_320041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Supportive care aims to prevent and manage adverse effects of cancer and its treatment across the entire disease continuum. Research and clinical experience in dedicated centers have demonstrated that early appropriate supportive care interventions improve symptoms, quality of life, and overall survival in a cost-effective manner. The challenge is to assess symptoms and needs with validated tools regularly and, ideally, between clinic appointments; electronic patient-reported outcome measures and dedicated easily accessible supportive care units can help. As management of certain problems improves, others come to the fore. Cancer-related fatigue and malnutrition are very frequent and need regular screening, assessment of treatable causes, and early intervention to improve. Pharmacologic agents and phytopharmaceuticals are of little use, but other interventions are valuable: physical exercise, counseling on fatigue, and cognitive behavioral therapy/mind-body interventions (e.g., for fatigue). Nutrition should be oral, rich in proteins, and accompanied by muscle training adapted to the patient's condition. Psychological and societal counseling is often useful; nausea or other problems such as gastrointestinal dysmotility or metabolic derangements must be tackled. Chemotherapy-induced peripheral neuropathy frequently worsens quality of life and has no established prevention strategy (notwithstanding current interest in cryotherapy and compression therapy) and thus requires careful assessment of patient predisposition to develop it with the consideration of feasible dose and treatment alternatives. When painful, duloxetine helps. Nonpharmacologic strategies, including acupuncture, physical exercise, cryotherapy/compression, and scrambler therapy, are promising but require large phase III trials to become the accepted standard. Personalization of chemotherapy, dependent on realistic goals, is key.
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Affiliation(s)
| | - Fausto Roila
- Medical Oncology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Jann Arends
- Department of Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Giulio Metro
- Medical Oncology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Maryam Lustberg
- Division of Medical Oncology, The Ohio State University, Columbus, OH
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8
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Seol KH, Bong SH, Kang DH, Kim JW. Factors Associated with the Quality of Life of Patients with Cancer Undergoing Radiotherapy. Psychiatry Investig 2021; 18:80-87. [PMID: 33460533 PMCID: PMC7897871 DOI: 10.30773/pi.2020.0286] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/01/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Approximately half of patients with cancer have comorbidities, such as adjustment disorder, major depressive disorder, and delirium. Radiotherapy can cause psychological problems, e.g., the fear of treatment and its side effects, anxiety, depression, and social isolation. Health-related quality of life (QoL) must be determined to evaluate the effectiveness of cancer treatment. We analyzed the clinical, psychological, and sociodemographic factors influencing the QoL of patients with cancer who were undergoing radiotherapy. METHODS Twenty-six patients undergoing radiotherapy (10 male, 16 female) were included. Sociodemographic and clinical data were collected prior to radiotherapy. Psychosocial factors were assessed by self-reported questionnaires before, immediately after, and 3 months after radiotherapy. A multivariate regression analysis identified factors affecting QoL at each time point. RESULTS Patients' diagnoses were breast, cervical, prostate, endometrial, rectal, hypopharyngeal, laryngeal, liver, gallbladder, esophageal, ovarian, lung, and skin cancers. Before radiotherapy, better resilience was significantly associated with a higher QoL score (R2=0.199, p=0.033). Immediately after radiotherapy, financial difficulty was significantly associated with a lower QoL score (R2=0.274, p=0.010). Three months after radiotherapy, the presence of chronic disease (R2=0.398, p=0.002) and the severity of nausea and vomiting were significantly associated with a lower QoL score (R2=0.278, p=0.014). CONCLUSION Resilience, financial difficulty, the presence of chronic diseases, and the severity of nausea and vomiting significantly influenced the QoL of patients with cancer who were undergoing radiotherapy. Factors affecting QoL varied at each time point. Thus, patients with cancer should undergo regular mental health assessments, including assessments of QoL. Multidimensional (physical, psychological, and social) approaches and individualized time-based interventions are needed to improve the QoL of cancer patients undergoing radiotherapy.
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Affiliation(s)
- Ki Ho Seol
- Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Su Hyun Bong
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Dae Hun Kang
- Department of Psychiatry, The Armed Forces Daejeon Hospital, Daejeon, Republic of Korea
| | - Jun Won Kim
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
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Aogi K, Takeuchi H, Saeki T, Aiba K, Tamura K, Iino K, Imamura CK, Okita K, Kagami Y, Tanaka R, Nakagawa K, Fujii H, Boku N, Wada M, Akechi T, Iihara H, Ohtani S, Okuyama A, Ozawa K, Kim YI, Sasaki H, Shima Y, Takeda M, Nagasaki E, Nishidate T, Higashi T, Hirata K. Optimizing antiemetic treatment for chemotherapy-induced nausea and vomiting in Japan: Update summary of the 2015 Japan Society of Clinical Oncology Clinical Practice Guidelines for Antiemesis. Int J Clin Oncol 2021; 26:1-17. [PMID: 33161452 PMCID: PMC7788035 DOI: 10.1007/s10147-020-01818-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/16/2020] [Indexed: 01/07/2023]
Abstract
Patients with cancer should appropriately receive antiemetic therapies against chemotherapy-induced nausea and vomiting (CINV). Antiemetic guidelines play an important role in managing CINV. Accordingly, the first Japanese antiemetic guideline published in 2010 by the Japan Society of Clinical Oncology (JSCO) has considerably aided Japanese medical staff in providing antiemetic therapies across chemotherapy clinics. With the yearly advancements in antiemetic therapies, the Japanese antiemetic guidelines require revisions according to published evidence regarding antiemetic management worldwide. A revised version of the first antiemetic guideline that considered several upcoming evidences had been published online in 2014 (version 1.2), in which several updated descriptions were included. The 2015 JSCO clinical practice guideline for antiemesis (version 2.0) (in Japanese) has addressed clinical antiemetic concerns and includes four major revisions regarding (1) changes in emetogenic risk categorization for anti-cancer agents, (2) olanzapine usage as an antiemetic drug, (3) the steroid-sparing method, and (4) adverse drug reactions of antiemetic agents. We herein present an English update summary for the 2015 JSCO clinical practice guideline for antiemesis (version 2.0).
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Affiliation(s)
- Kenjiro Aogi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Hideki Takeuchi
- Department of Breast Oncology, Saitama Medical University, Saitama, Japan
- Department of Breast Surgical Oncology, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, Yokohama, Japan
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshiaki Saeki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Keisuke Aiba
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
- Todachuo General Hospital, Saitama, Japan
| | - Kazuo Tamura
- General Medical Research Center, Fukuoka University Hospital, Fukuoka, Japan
| | - Keiko Iino
- Department of Adult Nursing, National College of Nursing, Tokyo, Japan
| | - Chiyo K Imamura
- Department of Clinical Pharmacokinetics and Pharmacodynamics, Keio University, Tokyo, Japan
- Advanced Cancer Translational Research Institute, Showa University, Tokyo, Japan
| | - Kenji Okita
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Postgraduate School of Medicine, Sapporo, Hokkaido, Japan
- JR Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Yoshikazu Kagami
- Division of Radiation Oncology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Ryuhei Tanaka
- Department of Pediatric Hematology and Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hirofumi Fujii
- Department of Clinical Oncology, Jichi Medical University, Tochigi, Japan
| | - Narikazu Boku
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Wada
- Department of Psycho-Oncology and Palliative Medicine, Osaka International Cancer Institute, Osaka, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | | | - Shoichiro Ohtani
- Department of Breast Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Ayako Okuyama
- Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Keiko Ozawa
- Department of Nursing, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yong-Il Kim
- Department of Medical Oncology, Seirei Hamamatsu General Hospital, Sizuoka, Japan
- Department of Medical Oncology, Yodogawa Christian Hospital, Osaka, Japan
| | - Hidenori Sasaki
- Division of Medical Oncology, Hematology and Infectious Disease, Department of Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Masayuki Takeda
- Department of Medical Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Eijiro Nagasaki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
- Todachuo General Hospital, Saitama, Japan
| | - Toshihiko Nishidate
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Postgraduate School of Medicine, Sapporo, Hokkaido, Japan
- JR Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Takahiro Higashi
- Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Kouichi Hirata
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Postgraduate School of Medicine, Sapporo, Hokkaido, Japan
- JR Sapporo Hospital, Sapporo, Hokkaido, Japan
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10
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Huang X, Xue J, Gao M, Qin Q, Ma T, Li X, Wang H. Medical Management of Inoperable Malignant Bowel Obstruction. Ann Pharmacother 2020; 55:1134-1145. [PMID: 33345552 DOI: 10.1177/1060028020979773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To review medical management of inoperable malignant bowel obstruction. DATA SOURCES A literature review using PubMed and MEDLINE databases searching malignant bowel obstruction, etiology, types, pathophysiology, medical, antisecretory, anti-inflammatory, antiemetic drugs, analgesics, promotion of emptying, prevention of infection, anticholinergics, somatostatin analogs, gastric antisecretory drugs, prokinetic agents, glucocorticoid, opioid analgesics, antibiotics, enema, and adverse effects. STUDY SELECTION AND DATA EXTRACTION Randomized or observational studies, cohorts, case reports, or reviews written in English between 1983 and November 2020 were evaluated. DATA SYNTHESIS Malignant bowel obstruction (MBO) commonly occurs in patients with advanced or recurrent malignancies and severely affects the quality of life and survival of patients. Its management remains complex and variable. Medical management is the cornerstone of MBO treatment, with the goal of reducing distressing symptoms and optimizing quality of life. Until now, there has been neither a standard clinical approach nor registered medications to treat patients with inoperable MBO. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review provides information on the etiology, type and pathophysiology, and medical treatment of MBO and related adverse reactions of the drugs commonly used, which can greatly assist clinicians in making clinical decisions when treating MBO. CONCLUSIONS Published research shows that medical management of MBO mainly consists of antisecretory, anti-inflammatory strategies, controlling vomiting and pain, promoting emptying, preventing infection, and combination therapy. Being knowledgeable about the most current treatment options, the related adverse effects, and the evidence supporting different practices is critical for clinicians to provide individualized medical therapy for MBO patients.
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Affiliation(s)
- Xiaoyan Huang
- Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China
| | - Jing Xue
- Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China
| | - Min Gao
- Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China
| | - Qiyuan Qin
- Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China
| | - Tenghui Ma
- Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China
| | - Xiaoyan Li
- Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China
| | - Hui Wang
- Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China
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Kawasumi K, Kujirai A, Matsui R, Kawano Y, Yamaguchi M, Aoyama T. Survey of serious adverse events and safety evaluation of oral anticancer drug treatment in Japan: A retrospective study. Mol Clin Oncol 2020; 14:12. [PMID: 33282287 DOI: 10.3892/mco.2020.2174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 09/22/2020] [Indexed: 11/05/2022] Open
Abstract
The present study assessed the safety of outpatient oral anticancer chemotherapeutic drugs by investigating the type and frequency of serious adverse effects (SAEs). Emergency hospitalization, unplanned consultations and telephone calls were investigated in 1,832 patients who received oral anticancer drug treatment at the National Cancer Center Hospital East between December 1, 2014 and November 30, 2015. Oral cytotoxic anticancer and molecular targeted drugs were administrated to 1,140 (62.2%) and 692 (37.8%) patients, respectively. A total of 52 (2.8%) SAEs were reported, with 32 (2.8%) occurring following cytotoxic anticancer drug administration and 20 (2.9%) occurring after molecular targeted drug treatment. The most common SAE was gastrointestinal toxicity. The median time to SAE occurrence was 32 days (range, 5-1,705 days). The rate of unplanned consultations and telephone calls were 5.5 and 37.9% among all patients, respectively, with skin reactions being the most common reason for unplanned consultations. SAEs often occurred early after treatment initiation. It was concluded that measures against gastrointestinal toxicity are particularly important were administering chemotherapeutic agents.
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Affiliation(s)
- Kenji Kawasumi
- Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan.,Faculty of Pharmaceutical Sciences, Tokyo University of Science, Noda, Chiba 278-8511, Japan
| | - Azusa Kujirai
- Faculty of Pharmaceutical Sciences, Tokyo University of Science, Noda, Chiba 278-8511, Japan
| | - Reiko Matsui
- Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan
| | - Yohei Kawano
- Faculty of Pharmaceutical Sciences, Tokyo University of Science, Noda, Chiba 278-8511, Japan
| | - Masakazu Yamaguchi
- Department of Pharmacy, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Takao Aoyama
- Faculty of Pharmaceutical Sciences, Tokyo University of Science, Noda, Chiba 278-8511, Japan
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12
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Salama AH, Elmotasem H, Salama AAA. Nanotechnology based blended chitosan-pectin hybrid for safe and efficient consolidative antiemetic and neuro-protective effect of meclizine hydrochloride in chemotherapy induced emesis. Int J Pharm 2020; 584:119411. [PMID: 32423876 DOI: 10.1016/j.ijpharm.2020.119411] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/23/2022]
Abstract
The aim of this study was to formulate an easily-administered, safe and effective dosage form loaded with meclizine for treatment of chemotherapy-induced nausea and vomiting (CINV) through the buccal route. CINV comprises bothersome side effects accompanying cytotoxic drugs administration in cancer patients. Meclizine was loaded in chitosan-pectin nanoparticles which were further incorporated within a buccal film. Different formulations were prepared based on a 21.31 full factorial study using Design Expert®8. The optimum formulation possessed favorable characters regarding its particle size (129 nm), entrapment efficiency (90%) and release profile. Moreover, its permeation efficiency through sheep buccal mucosa was assessed via Franz cell diffusion and confocal laser microscopy methods. Enhanced permeation was achieved compared with the free drug form. In-vivo performance was assessed using cyclophosphamide induced emesis. The proposed formulation exerted significant relief of the measured responses (reduced body weight and motor coordination, elevated emesis, anorexia, proinflammatory mediators and neurotransmitters that were also associated with scattered degenerated neurons and glial cells). The developed formulation ameliorated all behavioral, biochemical and histopathological changes induced by cyclophosphamide. The obtained data were promising suggesting that our bioadhesive formulation can offer an auspicious medication for treating distressing symptoms associated with chemotherapy for cancer patients.
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Affiliation(s)
- Alaa H Salama
- Pharmaceutical Technology Department, Pharmaceutical and Drug Industries Research Division, National Research Centre, Dokki, Cairo 12622, Egypt; Department of Pharmaceutics, Faculty of Pharmacy, Ahram Canadian University, 6(th) of October City, Cairo, Egypt.
| | - Heba Elmotasem
- Pharmaceutical Technology Department, Pharmaceutical and Drug Industries Research Division, National Research Centre, Dokki, Cairo 12622, Egypt
| | - Abeer A A Salama
- Pharmacology Department, Medical Research Division, National Research Centre, Dokki, Cairo 12622, Egypt
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13
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Bossi P, Airoldi M, Aloe Spiriti MA, Antonuzzo A, Bonciarelli G, Campagna A, Cassano A, Murialdo R, Musio D, Silvano G. A multidisciplinary expert opinion on CINV and RINV, unmet needs and practical real-life approaches. Expert Opin Drug Saf 2020; 19:187-204. [PMID: 32005072 DOI: 10.1080/14740338.2020.1724955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: A range of combination chemotherapy regimens are currently used in clinical practice. However, international antiemetic guidelines often only categorize the emetogenic potential of single agents rather than the emetogenicity of combination chemotherapy regimens. To manage the nausea and vomiting induced by antineoplastic combinations, guidelines suggest antiemetics that are appropriate for the component drug with the highest emetogenic potential. Furthermore, antiemetic guidelines generally do not consider the influence of other factors, including individual patient characteristics, on the emetic effects of cancer treatments. Similarly, the emetogenic potential of radiotherapy is stratified only according to the site of radiation, while other factors contributing to emetic risk are overlooked.Areas covered: An Expert Panel was convened to examine unresolved issues and summarize the current clinical research on managing nausea and vomiting associated with combination chemotherapy and radiotherapy.Expert opinion: The panel identified the incidence of nausea and vomiting induced by multi-drug combination therapies currently used to treat cancer at different anatomic sites and by radiotherapy in the presence of other risk factors. Based on these data and the clinical experience of panel members, several suggestions are made for a practical approach to prevent or manage nausea and vomiting due to chemotherapy regimens and radiation therapy.
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Affiliation(s)
- Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Mario Airoldi
- Oncology Departement, Città della Salute e della Scienza Hospital of Turin, Turin, Italy
| | - Maria Antonietta Aloe Spiriti
- Department of Clinical and Molecular Medicine, Azienda Universitaria Ospedaliera Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Antonuzzo
- Medical Oncology Unit 1 SSN, Pisa University Hospital, Pisa, Italy
| | | | - Alessia Campagna
- Department of Hematology, Azienda Universitaria Ospedaliera Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Alessandra Cassano
- Division of Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Roberto Murialdo
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Daniela Musio
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Silvano
- Radiation Oncology Unit, San Giuseppe Moscati Hospital, Taranto, Italy
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14
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Ramsey WA, Heidelberg RE, Gilbert AM, Heneghan MB, Badawy SM, Alberts NM. eHealth and mHealth interventions in pediatric cancer: A systematic review of interventions across the cancer continuum. Psychooncology 2019; 29:17-37. [DOI: 10.1002/pon.5280] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/09/2019] [Accepted: 10/28/2019] [Indexed: 12/22/2022]
Affiliation(s)
- William A. Ramsey
- Department of PsychologySt. Jude Children's Research Hospital Memphis Tennessee
- Department of Counseling Psychology, Education, and ResearchUniversity of Memphis Memphis Tennessee
| | | | - Alexandra M. Gilbert
- Department of PsychologySt. Jude Children's Research Hospital Memphis Tennessee
- Department of PsychologyUniversity of Mississippi Oxford Mississippi
| | - Mallorie B. Heneghan
- Department of PediatricsNorthwestern University Feinberg School of Medicine Chicago Illinois
- Division of Hematology, Oncology and Stem Cell TransplantAnn & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois
| | - Sherif M. Badawy
- Department of PediatricsNorthwestern University Feinberg School of Medicine Chicago Illinois
- Division of Hematology, Oncology and Stem Cell TransplantAnn & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois
| | - Nicole M. Alberts
- Department of PsychologySt. Jude Children's Research Hospital Memphis Tennessee
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15
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Zia FZ, Olaku O, Bao T, Berger A, Deng G, Fan AY, Garcia MK, Herman PM, Kaptchuk TJ, Ladas EJ, Langevin HM, Lao L, Lu W, Napadow V, Niemtzow RC, Vickers AJ, Shelley Wang X, Witt CM, Mao JJ. The National Cancer Institute's Conference on Acupuncture for Symptom Management in Oncology: State of the Science, Evidence, and Research Gaps. J Natl Cancer Inst Monogr 2018; 2017:4617820. [PMID: 29140486 DOI: 10.1093/jncimonographs/lgx005] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/07/2017] [Indexed: 12/20/2022] Open
Abstract
The Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, at the National Cancer Institute (NCI) held a symposium on "Acupuncture for Cancer Symptom Management" on June 16 and 17, 2016. Invited speakers included 19 scientists and scholars with expertise in acupuncture and cancer research from the United States, Europe, and China. The conference reviewed the NCI's grant funding on acupuncture, analyzed the needs of cancer patients, reviewed safety issues, and assessed both the current scientific evidence and research gaps of acupuncture in oncology care. Researchers and stakeholders presented and discussed basic mechanisms of acupuncture; clinical evidence for specific symptoms; and methodological challenges such as placebo effects, novel biostatistical methods, patient-reported outcomes, and comparative effectiveness research. This paper, resulting from the conference, summarizes both the current state of the science and clinical evidence of oncology acupuncture, identifies key scientific gaps, and makes recommendations for future research to increase understanding of both the mechanisms and effects of acupuncture for cancer symptom management.
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Affiliation(s)
- Farah Z Zia
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Oluwadamilola Olaku
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Ting Bao
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Ann Berger
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Gary Deng
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Arthur Yin Fan
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Mary K Garcia
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Patricia M Herman
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Ted J Kaptchuk
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Elena J Ladas
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Helene M Langevin
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Lixing Lao
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Weidong Lu
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Vitaly Napadow
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Richard C Niemtzow
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Andrew J Vickers
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Xin Shelley Wang
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Claudia M Witt
- Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Kelly Services, Incorporated, Rockville, MD, and Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD; Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Rockville, MD; McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA; Department of General Oncology/Integrative Medicine Program, MD Anderson Cancer Center, Houston, TX; Health Division, RAND Corporation, Santa Monica, CA; Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University, New York, NY; Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Chinese Medicine, University of Hong Kong, Hong Kong, China; Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston MA; United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, MD; Department of Symptom Research, MD Anderson Cancer Center, Houston, TX; Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
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16
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Abma E, De Spiegelaere W, Vanderperren K, Stock E, Van Brantegem L, Cornelis I, Daminet S, Ni Y, Vynck M, Verstraete G, Smets P, de Rooster H. A single dose of intravenous combretastatin A4-phosphate is reasonably well tolerated and significantly reduces tumour vascularization in canine spontaneous cancers. Vet Comp Oncol 2018; 16:467-477. [PMID: 29797763 DOI: 10.1111/vco.12402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 12/01/2022]
Abstract
Combretastatin A4-phosphate (CA4P) is an anti-tumour vascular targeting agent which selectively blocks tumour blood flow. Research on CA4P in rodent tumour models is extensive; however, knowledge of its effect on spontaneous cancer is scarce. This study was conducted in canine patients with spontaneous solid tumours. The goal was to assess the toxicity and efficacy of CA4P in various spontaneous tumour types. Eight dogs with spontaneous tumours were enrolled and treated with a single dose of 75 mg m-2 intravenous CA4P. The dogs were screened and monitored before and after injection. Pre- and post-treatment tumour blood flow was analysed in vivo by power Doppler ultrasound (PDUS) and contrast-enhanced ultrasound (CEUS). Vessel destruction and tumour necrosis were evaluated by histopathology. Clinically relevant toxicity was limited to one case of temporary tetraparesis; other adverse events were mild. Significant cardiovascular changes were mostly confined to changes in heart rate and cTnI levels. Macroscopic tumour size reduction was evident in 2 dogs. Based on PDUS and CEUS, CA4P induced a significant decrease in vascular index and tumour blood flow. Post-treatment, histopathology revealed a significant increase of necrotic tumoural tissue and a significant reduction in microvessel density in tumoural tissue. Anti-vascular and necrotizing effects of CA4P were documented in a variety of canine spontaneous cancers with only minimal side effects. This is the first study reporting the administration of CA4P to canine cancer patients with in vivo and ex vivo assessment, and a first step toward implementing CA4P in combination therapies in veterinary oncology patients. The use of CA4P in canine patients was approved and registered by the Belgian Federal Agency for Medicines and Health Products (FAMHP) (approval number 0002588, registration number 6518 ID 2F12).
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Affiliation(s)
- E Abma
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Medical Research Building, University Hospital Ghent, Ghent, Belgium
| | - W De Spiegelaere
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - K Vanderperren
- Department of Medical Imaging and Orthopedics of Small Animals, Faculty of Veterinary Medicine, University of Ghent, Ghent, Belgium
| | - E Stock
- Department of Medical Imaging and Orthopedics of Small Animals, Faculty of Veterinary Medicine, University of Ghent, Ghent, Belgium
| | - L Van Brantegem
- Department of Pathology, Bacteriology and Poultry Diseases, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - I Cornelis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - S Daminet
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Y Ni
- Theragnostic Lab, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - M Vynck
- Department of Data Analysis and Mathematical Modeling, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - G Verstraete
- Laboratory of Pharmaceutical Technology, Ghent University, Ghent, Belgium
| | - P Smets
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - H de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Medical Research Building, University Hospital Ghent, Ghent, Belgium
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17
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Abstract
Emerging evidence indicates self-compassion can be beneficial for medical populations and for medical adherence; yet, research to date has not fully examined the reasons for this association. This study examined the association of dispositional self-compassion to adherence across five medical samples and tested the extent to which perceived stress accounted for this association. Five medical samples (total N = 709), including fibromyalgia, chronic fatigue syndrome, and cancer patients, recruited from various sources, completed online surveys. Self-compassion was positively associated with adherence in all five samples. A meta-analysis of the associations revealed a small average effect size (average r = .22, [0.15, 0.29]) of self-compassion and adherence and non-significant heterogeneity among the effects (Q (4) = 3.15, p = .532). A meta-analysis of the kappa2 values from the indirect effects of self-compassion on adherence revealed that, on average, 11% of the variance in medical adherence that was explained by self-compassion could be attributed to lower perceived stress. Overall, findings demonstrate that dispositional self-compassion is associated with better medical adherence among people with fibromyalgia, chronic fatigue syndrome, and cancer, due in part to lower stress. This research contributes to a growing evidence base indicating the value of self-compassion for health-related behaviours in a variety of medical populations.
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Affiliation(s)
- Fuschia M. Sirois
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT UK
| | - Jameson K. Hirsch
- Department of Psychology, East Tennessee State University, Johnson City, TN USA
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18
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Brugnatelli S, Gattoni E, Grasso D, Rossetti F, Perrone T, Danova M. Single-dose palonosetron and dexamethasone in preventing nausea and vomiting induced by moderately emetogenic chemotherapy in breast and colorectal cancer patients. TUMORI JOURNAL 2018; 97:362-6. [DOI: 10.1177/030089161109700318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Palonosetron, a unique second-generation 5-HT3 receptor antagonist, has been demonstrated to control emesis related to chemotherapy-induced nausea and vomiting (CINV). The aim of this study was to evaluate the efficacy and tolerability of palonosetron followed by a single dose of dexamethasone in patients with breast cancer (BC) or colorectal cancer (CRC) receiving moderate emetogenic chemotherapy (MEC). Methods and study design Chemotherapy-naive BC and CRC patients were given MEC as adjuvant or first-line treatment. Palonosetron (0.25 mg IV) and dexamethasone (8 mg IV) were administered before chemotherapy on day 1. The primary endpoint was complete response (CR; no vomiting and no use of rescue medication) during the overall study period (days 1–5). The antiemetic response was evaluated during the acute (day 1) and delayed (days 2–5) phases. Results Sixty-eight patients were enrolled (median age 61 years, 56 females; BC = 40, CRC = 28). CR was observed in 46 of 68 patients (67.6%), while CR during the acute and delayed phases was 75.0% in each cancer group. The antiemetic regimen was well tolerated. Conclusions A single administration of palonosetron and dexamethasone on day 1 in BC and CRC patients adequately controls CINV during the entire period of emetic risk.
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Affiliation(s)
| | | | | | | | - Tania Perrone
- Medical Advisor, Scientific Department Italfamaco Sp A, Cinisello Balsamo, Italy
| | - Marco Danova
- Medical Oncology, Fondazione Policlinico San Matteo, Pavia
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19
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Ahmad A, Khushtar M, Kumar R, Badruddeen, Riyaz A, Khan MI, Rahman A. Augmented Reversal of Cisplatin-Induced Delayed Gastric Emptying by Amla (Emblica Officinalis) Fruit Extract in Sprague-Dawley Rats. J Diet Suppl 2017; 15:684-691. [PMID: 29115898 DOI: 10.1080/19390211.2017.1385562] [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: 10/18/2022]
Abstract
Despite the availability of effective antiemetics, control of acute and delayed chemotherapy-induced nausea and vomiting (CINV) is often suboptimal and there is need of an inexpensive and safer alternative. Thus, this study was designed to evaluate the effect of Emblica officinalis Gaertn (Euphorbiaceae) fruit extract (EEEO) on cisplatin-induced delayed gastric emptying in Sprague-Dawley rats so that Emblica officinalis can be clarified for its application in CINV as a potential candidate. Groups I, II, III, IV, and V rats were pretreated orally with 1% carboxymethyl cellulose (CMC, 1 mL/kg), 1% CMC (1 mL/kg), EEEO (250 mg/kg), EEEO (500 mg/kg), and ondansetron (3 mg/kg), respectively, for 5 consecutive days. Then, Group I rats received 0.1 mL of normal saline and Groups II-V rats received 10 mg/kg body weight of cisplatin intraperitoneally. Immediately after that, a test meal (1.5 mL/rat) was administered to each group, and after 30 minutes, rats were euthanized to evaluate the percentage of gastric emptying. EEEO at the specified doses reversed the cisplatin-induced delayed gastric emptying. EEEO (500 mg/kg body weight) pretreatment for 5 days before cisplatin challenge in Group IV rats significantly (p < .05) increased gastric emptying to 74.25% ± 7.19%. Reversal of cisplatin-induced delay in gastric emptying by EEEO (500 mg/kg body weight) in Group IV was significantly (p < .05) comparable to that of the ondansetron treated Group V. EEEO possesses the property to reverse the cisplatin-induced delayed gastric emptying and can be used as an antiemetic for the prevention of CINV.
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Affiliation(s)
- Asad Ahmad
- a Bioactive Research Laboratory, Faculty of Pharmacy , Integral University , Lucknow , Uttar Pradesh , India
| | - Mohammad Khushtar
- a Bioactive Research Laboratory, Faculty of Pharmacy , Integral University , Lucknow , Uttar Pradesh , India
| | - Ranjan Kumar
- a Bioactive Research Laboratory, Faculty of Pharmacy , Integral University , Lucknow , Uttar Pradesh , India
| | - Badruddeen
- a Bioactive Research Laboratory, Faculty of Pharmacy , Integral University , Lucknow , Uttar Pradesh , India
| | - Ambreena Riyaz
- a Bioactive Research Laboratory, Faculty of Pharmacy , Integral University , Lucknow , Uttar Pradesh , India
| | - Mohammad Irfan Khan
- a Bioactive Research Laboratory, Faculty of Pharmacy , Integral University , Lucknow , Uttar Pradesh , India
| | - Azizur Rahman
- a Bioactive Research Laboratory, Faculty of Pharmacy , Integral University , Lucknow , Uttar Pradesh , India
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20
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Chen B, Guo Y, Zhao X, Gao LL, Li B, Zhao TY, Zhang QW, Zou JX, Li MY, Guo YM, Guo Y, Pan XF. Efficacy differences of electroacupuncture with single acupoint or matching acupoints for chemotherapy-induced nausea and vomiting: study protocol for a randomized controlled trial. Trials 2017; 18:477. [PMID: 29029639 PMCID: PMC5640953 DOI: 10.1186/s13063-017-2186-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 09/13/2017] [Indexed: 11/25/2022] Open
Abstract
Background Previous studies have shown that acupuncture is beneficial for the alleviation of chemotherapy-induced nausea and vomiting. However, there is a lack of clinical evidence concerning the effects of acupoint-matching on chemotherapy-induced nausea and vomiting. Methods/design This is a parallel randomized controlled trial to evaluate the occurrence of nausea and vomiting after chemotherapy (the incidence of nausea and vomiting, frequency, VAS score, RINVR rating) as the main outcome for cancer. Quality of life, anxiety and depression scores are the secondary outcomes. Quality of life, anxiety and depression scores are the secondary phase. Use of remedy drugs, routine blood examination, and blood biochemical tests are the safety evaluation. We also compare the different effects of ST36 (single acupoint), CV12 (single acupoint), and ST36-CV12 matching groups. Discussion The results of this trial are expected to explore the effects of matching different acupoints and to offer biologic plausibility for the use of acupuncture in the treatment of chemotherapy-induced nausea and vomiting (CINV). Trial registration This trial is registered with clinicaltrials.gov NCT02195921, The date of registration was 17 July 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2186-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bo Chen
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Yang Guo
- The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Xue Zhao
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Li-Li Gao
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Bo Li
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Tian-Yi Zhao
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Qi-Wen Zhang
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Jin-Xing Zou
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Ming-Yue Li
- Clinical Practice Teaching Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Yong-Ming Guo
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Yi Guo
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China.
| | - Xing-Fan Pan
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China.
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21
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Vazin A, Eslami D, Sahebi E. Evaluating the antiemetic administration consistency to prevent chemotherapy-induced nausea and vomiting with the standard guidelines: a prospective observational study. Ther Clin Risk Manag 2017; 13:1151-1157. [PMID: 28919769 PMCID: PMC5592905 DOI: 10.2147/tcrm.s133820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nausea and vomiting (NV) are the most prevalent adverse effects of chemotherapy (CT). This study was conducted to evaluate adherence of the health care team to standard guidelines for antiemetics usage to prevent acute chemotherapy-induced nausea and vomiting (CINV) in a large CT center. A prospective study was performed during an 11-month period on patients receiving CT. A form was designed to collect patients’ demographic information and their chemotherapeutic and antiemetic regimen data. The Likert scale was used to measure the effectiveness of the antiemetics in patients. In this study, the effect of patient-related risk factors on the incidence rate of CINV was examined. Based on the results, CINV events were reported by 74.4% of patients. The antiemetic regimen of 71.2% of the patients complied with the guidelines. The complete response, complete protection, and complete control end points did not differ significantly between patients undergoing guidelines-consistent prophylaxis or guidelines-inconsistent prophylaxis. The females clearly showed a higher incidence rate of CINV (P=0.001) during the first course of CT (P=0.006). A history of motion sickness did not affect the incidence of NV. The maximum compliance error occurred for the use of aprepitant, as 16.16% of the patients who were receiving aprepitant did not comply with its instructions. The results of this study highlight how CINV was controlled in this center, which was significantly lower than that of the global standard. Perhaps, factors such as noncompliance to antiemetic regimens with standard guidelines and the failure to adhere to the administration instructions of the antiemetics were involved in the incomplete control of CINV.
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Affiliation(s)
- Afsaneh Vazin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Davood Eslami
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ebrahim Sahebi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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22
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Digges M, Hussein A, Wilcock A, Crawford GB, Boland JW, Agar MR, Sinnarajah A, Currow DC, Johnson MJ. Pharmacovigilance in Hospice/Palliative Care: Net Effect of Haloperidol for Nausea or Vomiting. J Palliat Med 2017; 21:37-43. [PMID: 28772094 DOI: 10.1089/jpm.2017.0159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Haloperidol is widely prescribed as an antiemetic in patients receiving palliative care, but there is limited evidence to support and refine its use. OBJECTIVE To explore the immediate and short-term net clinical effects of haloperidol when treating nausea and/or vomiting in palliative care patients. DESIGN A prospective, multicenter, consecutive case series. SETTING/SUBJECTS Twenty-two sites, five countries: consultative, ambulatory, and inpatient services. MEASUREMENTS When haloperidol was started in routine care as an antiemetic, data were collected at three time points: baseline; 48 hours (benefits); day seven (harms). Clinical effects were assessed using the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE). RESULTS Data were collected (May 2014-March 2016) from 150 patients: 61% male; 86% with cancer; mean age 72 (standard deviation 11) years and median Australian-modified Karnofsky Performance Scale 50 (range 10-90). At baseline, nausea was moderate (88; 62%) or severe (11; 8%); 145 patients reported vomiting, with a baseline NCI CTCAE vomiting score of 1.0. The median (range) dose of haloperidol was 1.5 mg/24 hours (0.5-5 mg/24 hours) given orally or parenterally. Five patients (3%) died before further data collection. At 48 hours, 114 patients (79%) had complete resolution of their nausea and vomiting, with greater benefit seen in the resolution of nausea than vomiting. At day seven, 37 (26%) patients had a total of 62 mild/moderate harms including constipation 25 (40%); dry mouth 13 (21%); and somnolence 12 (19%). CONCLUSIONS Haloperidol as an antiemetic provided rapid net clinical benefit with low-grade, short-term harms.
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Affiliation(s)
- Madeline Digges
- 1 Discipline of Palliative Care, School of Medicine, Flinders University , Adelaide, South Australia, Australia
| | - Akram Hussein
- 1 Discipline of Palliative Care, School of Medicine, Flinders University , Adelaide, South Australia, Australia
| | - Andrew Wilcock
- 2 Hayward House Specialist Palliative Care Unit, School of Clinical Oncology, University of Nottingham , Nottingham, England
| | - Gregory B Crawford
- 3 Northern Adelaide Palliative Service , Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- 4 Discipline of Medicine, University of Adelaide , Adelaide, South Australia, Australia
| | - Jason W Boland
- 5 Wolfson Palliative Care Research Centre, Hull York Medical School , University of Hull, Hull, England
| | - Meera R Agar
- 6 IMPACCT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney , Sydney, New South Wales, Australia
| | - Aynharan Sinnarajah
- 7 Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary , Calgary, Alberta, Canada
- 8 Palliative/End of Life Care, Alberta Health Services , Calgary, Alberta, Canada
| | - David C Currow
- 3 Northern Adelaide Palliative Service , Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- 6 IMPACCT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney , Sydney, New South Wales, Australia
- 9 Southern Adelaide Palliative Services , Adelaide, South Australia, Australia
| | - Miriam J Johnson
- 5 Wolfson Palliative Care Research Centre, Hull York Medical School , University of Hull, Hull, England
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Abma E, Smets P, Daminet S, Cornelis I, De Clercq K, Ni Y, Vlerick L, de Rooster H. A dose-escalation study of combretastatin A4-phosphate in healthy dogs. Vet Comp Oncol 2017. [PMID: 28620942 DOI: 10.1111/vco.12327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Combretastatin A4-Phosphate (CA4P) is a vascular disrupting agent revealing promising results in cancer treatments for humans. The aim of this study was to investigate the safety and adverse events of CA4P in healthy dogs as a prerequisite to application of CA4P in dogs with cancer. Ten healthy dogs were included. The effects of escalating doses of CA4P on physical, haematological and biochemical parameters, systolic arterial blood pressure, electrocardiogram, echocardiographic variables and general wellbeing were characterised. Three different doses were tested: 50, 75 and 100 mg m-2 . At all 3 CA4P doses, nausea, abdominal discomfort as well as diarrhoea were observed for several hours following administration. Likewise, a low-grade neutropenia was observed in all dogs. Doses of 75 and 100 mg m-2 additionally induced vomiting and elevation of serum cardiac troponine I levels. At 100 mg m-2 , low-grade hypertension and high-grade neurotoxicity were also observed. In healthy dogs, doses up to 75 mg m-2 seem to be well tolerated. The severity of the neurotoxicity observed at 100 mg m-2 , although transient, does not invite to use this dose in canine oncology patients.
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Affiliation(s)
- E Abma
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - P Smets
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - S Daminet
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - I Cornelis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - K De Clercq
- Laboratory of Pharmaceutical Technology, Ghent University, Ghent, Belgium
| | - Y Ni
- Department of Radiology, KU Leuven, Leuven, Belgium
| | - L Vlerick
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - H de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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24
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Acupuncture with different acupoint combinations for chemotherapy-induced nausea and vomiting: study protocol for a randomized controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:441. [PMID: 27821107 PMCID: PMC5100267 DOI: 10.1186/s12906-016-1425-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/20/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Acupuncture is beneficial for controlling chemotherapy-induced nausea and vomiting (CINV). However, the effect of different acupoint combinations on controlling CINV remains unknown. This study aims to compare the effects of distal-proximal point association and local distribution point association on controlling CINV. METHODS/DESIGN The study is a single-center, randomized controlled trial. A total of 240 participants will be randomly divided into four groups. The control group will receive standard antiemetic only, whereas three acupuncture groups will receive four electro-acupuncture treatments once a day with the standard antiemetic. Acupuncture group I and II will receive distal-proximal point association ("Neiguan (PC6) and Zhongwan (CV12)", and "Zusanli (ST36) and CV12", respectively); Acupuncture group III will receive local distribution point association ("Shangwan (CV13) and CV12"). The primary outcome measures are the frequency and distress of nausea and vomiting. The secondary outcome measures are the grade of constipation and diarrhea, electrogastrogram, quality of life, etc. Assessment is scheduled from the day before chemotherapy to the fifth day of chemotherapy. Follow-ups are performed from the sixth day to the twenty-first day of chemotherapy. DISCUSSION Results of this trial will help in evaluating the efficacy and safety of electro-acupuncture with different acupoint combinations in the management of CINV. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02478047 .
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25
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Singer AE, Goebel JR, Kim YS, Dy SM, Ahluwalia SC, Clifford M, Dzeng E, O'Hanlon CE, Motala A, Walling AM, Goldberg J, Meeker D, Ochotorena C, Shanman R, Cui M, Lorenz KA. Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review. J Palliat Med 2016; 19:995-1008. [PMID: 27533892 PMCID: PMC5011630 DOI: 10.1089/jpm.2015.0367] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes. OBJECTIVE To inform how payers and providers should identify patients with "advanced illness" and the specific interventions they should implement, we reviewed the evidence to identify (1) individuals appropriate for palliative care and (2) elements of health service interventions (personnel involved, use of multidisciplinary teams, and settings of care) effective in achieving better outcomes for patients, caregivers, and the healthcare system. EVIDENCE REVIEW Systematic searches of MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews databases (1/1/2001-1/8/2015). RESULTS Randomized controlled trials (124) met inclusion criteria. The majority of studies in cancer (49%, 38 of 77 studies) demonstrated statistically significant patient or caregiver outcomes (e.g., p < 0.05), as did those in congestive heart failure (CHF) (62%, 13 of 21), chronic obstructive pulmonary disease (COPD; 58%, 11 of 19), and dementia (60%, 15 of 25). Most prognostic criteria used clinicians' judgment (73%, 22 of 30). Most interventions included a nurse (70%, 69 of 98), and many were nurse-only (39%, 27 of 69). Social workers were well represented, and home-based approaches were common (56%, 70 of 124). Home interventions with visits were more effective than those without (64%, 28 of 44; vs. 46%, 12 of 26). Interventions improved communication and care planning (70%, 12 of 18), psychosocial health (36%, 12 of 33, for depressive symptoms; 41%, 9 of 22, for anxiety), and patient (40%, 8 of 20) and caregiver experiences (63%, 5 of 8). Many interventions reduced hospital use (65%, 11 of 17), but most other economic outcomes, including costs, were poorly characterized. Palliative care teams did not reliably lower healthcare costs (20%, 2 of 10). CONCLUSIONS Palliative care improves cancer, CHF, COPD, and dementia outcomes. Effective models include nurses, social workers, and home-based components, and a focus on communication, psychosocial support, and the patient or caregiver experience. High-quality research on intervention costs and cost outcomes in palliative care is limited.
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Affiliation(s)
- Adam E. Singer
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
- RAND Corporation, Santa Monica, California
| | - Joy R. Goebel
- School of Nursing, California State University, Long Beach, Long Beach, California
| | - Yan S. Kim
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sydney M. Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Elizabeth Dzeng
- Division of Hospital Medicine, University of California at San Francisco, San Francisco, California
| | - Claire E. O'Hanlon
- RAND Corporation, Santa Monica, California
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California
| | | | - Anne M. Walling
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
- RAND Corporation, Santa Monica, California
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jaime Goldberg
- Supportive Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniella Meeker
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | | | | | - Mike Cui
- RAND Corporation, Pittsburgh, Pennsylvania
| | - Karl A. Lorenz
- RAND Corporation, Santa Monica, California
- Stanford University School of Medicine, Stanford, California
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26
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Kang G, Kim KR, Shim HJ, Hwang JE, Bae WK, Chung IJ, Kim HN, Lee J, Choi K, Shin HY, Kim JK, Jeong SW, Cho SH. Effect of the allelic variants of ABCB1, CYP2D6 and HTR3B on response of ramosetron to prevent chemotherapy-induced nausea and vomiting in Korean cancer patients. Asia Pac J Clin Oncol 2016; 13:53-60. [PMID: 27488933 DOI: 10.1111/ajco.12575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/28/2016] [Accepted: 05/10/2016] [Indexed: 11/28/2022]
Abstract
AIM Despite appropriate use of antiemetics including 5-hydroxytryptamine type 3 (5-HT3 ) receptor antagonists, chemotherapy-induced nausea and vomiting (CINV) is still an unsolved problem in patients with anticancer drugs. We examined whether the variants of ABCB1, CYP2D6 and HTR3B affect efficacy of ramosetron, a selective 5-HT3 receptor antagonist in a dose escalation clinical trial. METHODS We conducted a clinical trial on patients who underwent FOLFOX combination chemotherapy. The participants were randomized into three groups of ramosetron: 0.3 mg (standard dose), 0.45 mg and 0.6 mg. Rhodes index of nausea, vomiting and retching were measured at 1, 6 h, day 1, day 2 and day 7 after the administration of ramosetron as a clinical parameter of CINV and polymorphism was analyzed from genomic DNA. RESULTS There was a dose-dependent decrease in the nausea and vomiting scores at day 1 and day 2, not statistically significant. The Rhodes index of nausea, vomiting and retching score at day 1 in participants with HTR3B-100_-102delAAG deletion variants was significantly higher than wild type participants, regardless of dosages. However, the polymorphisms including ABCB1, CYP2D6 and other HTR3B genes did not affect response to ramosetron after chemotherapy. CONCLUSION These results suggest that the -AAG deletion variant of the 5-HT3B receptor gene may contribute to variability in response to antiemetic therapy for CINV regardless of dose escalation. These results suggest that carrying a -100_-102delAAG variant of 5-HT3 gene should be supported by alternate or additive antiemetics in addition to 5-HT3 antagonists to control acute emesis.
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Affiliation(s)
- Gaeun Kang
- Division of Clinical Pharmacology, Chonnam National University Hospital, Gwangju, Korea
| | - Ka-Rham Kim
- Department of Hematology-Oncolgy, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun-Jeong Shim
- Department of Hematology-Oncolgy, Chonnam National University Medical School, Gwangju, Korea
| | - Jun-Eul Hwang
- Department of Hematology-Oncolgy, Chonnam National University Medical School, Gwangju, Korea
| | - Woo-Kyun Bae
- Department of Hematology-Oncolgy, Chonnam National University Medical School, Gwangju, Korea
| | - Ik-Joo Chung
- Department of Hematology-Oncolgy, Chonnam National University Medical School, Gwangju, Korea
| | - Hee-Nam Kim
- Department of Preventive Medicine, Chonnam National University, Gwangju, Korea
| | - Jongtae Lee
- PIPET (Pharmacometrics Institute for Practical Education and Training), Seoul, Korea
| | - Kyungmee Choi
- PIPET (Pharmacometrics Institute for Practical Education and Training), Seoul, Korea.,Division of Mathematics, College of Science and Technology, Hongik University at Sejong, Jochiwon, Chungnam, Korea
| | - Hee-Young Shin
- Division of Clinical Pharmacology, Chonnam National University Hospital, Gwangju, Korea.,Department of Biomedical Science, Chonnam National University Medical School, Gwangju, Korea
| | - Jong-Keun Kim
- Division of Clinical Pharmacology, Chonnam National University Hospital, Gwangju, Korea.,Department of Pharmacology, Chonnam National University Medical School, Gwangju, Korea
| | - Seong-Wook Jeong
- Division of Clinical Pharmacology, Chonnam National University Hospital, Gwangju, Korea.,Department of Anethesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Hee Cho
- Department of Hematology-Oncolgy, Chonnam National University Medical School, Gwangju, Korea
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27
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Gu L, Li J. The assessment and management of chemotherapy-induced nausea and vomiting among cancer patients in a chemotherapy ward. ACTA ACUST UNITED AC 2016; 14:235-46. [DOI: 10.11124/jbisrir-2016-2626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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28
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Murray-Brown F, Dorman S. Haloperidol for the treatment of nausea and vomiting in palliative care patients. Cochrane Database Syst Rev 2015; 2015:CD006271. [PMID: 26524474 PMCID: PMC6481565 DOI: 10.1002/14651858.cd006271.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nausea and vomiting are common symptoms in patients with terminal, incurable illnesses. Both nausea and vomiting can be distressing. Haloperidol is commonly prescribed to relieve these symptoms. This is an updated version of the original Cochrane review published in Issue 2, 2009, of Haloperidol for the treatment of nausea and vomiting in palliative care patients. OBJECTIVES To evaluate the efficacy and adverse events associated with the use of haloperidol for the treatment of nausea and vomiting in palliative care patients. SEARCH METHODS For this updated review, we performed updated searches of CENTRAL, EMBASE and MEDLINE in November 2013 and in November 2014. We searched controlled trials registers in March 2015 to identify any ongoing or unpublished trials. We imposed no language restrictions. For the original review, we performed database searching in August 2007, including CENTRAL, MEDLINE, EMBASE, CINAHL and AMED, using relevant search terms and synonyms. Handsearching complemented the electronic searches (using reference lists of included studies, relevant chapters and review articles) for the original review. SELECTION CRITERIA We considered randomised controlled trials (RCTs) of haloperidol for the treatment of nausea or vomiting, or both, in any setting, for inclusion. The studies had to be conducted with adults receiving palliative care or suffering from an incurable progressive medical condition. We excluded studies where nausea or vomiting, or both, were thought to be secondary to pregnancy or surgery. DATA COLLECTION AND ANALYSIS We imported records from each of the electronic databases into a bibliographic package and merged them into a core database where we inspected titles, keywords and abstracts for relevance. If it was not possible to accept or reject an abstract with certainty, we obtained the full text of the article for further evaluation. The two review authors independently assessed studies in accordance with the inclusion criteria. There were no differences in opinion between the authors with regard to the assessment of studies. MAIN RESULTS We considered 27 studies from the 2007 search. In this update we considered a further 38 studies from the 2013 search, and two in the 2014 search. We identified one RCT of moderate quality with low risk of bias overall which met the inclusion criteria for this update, comparing ABH (Ativan®, Benadryl®, Haldol®) gel, applied to the wrist, with placebo for the relief of nausea in 22 participants. ABH gel includes haloperidol as well as diphenhydramine and lorazepam. The gel was not significantly better than placebo in this small study; however haloperidol is reported not to be absorbed significantly when applied topically, therefore the trial does not address the issue of whether haloperidol is effective or well-tolerated when administered by other routes (e.g. by mouth, subcutaneously or intravenously). We identified one ongoing trial of haloperidol for the management of nausea and vomiting in patients with cancer, with initial results published in a conference abstract suggesting that haloperidol is effective for 65% of patients. The trial had not been fully published at the time of our review. A further trial has opened, comparing oral haloperidol with oral methotrimeprazine (levomepromazine) for patients with cancer and nausea unrelated to their treatment, which we aim to include in the next review update. AUTHORS' CONCLUSIONS Since the last version of this review, we found one new study for inclusion but the conclusion remains unchanged. There is incomplete evidence from published RCTs to determine the effectiveness of haloperidol for nausea and vomiting in palliative care. Other than the trial of ABH gel vs placebo, we did not identify any fully published RCTs exploring the effectiveness of haloperidol for nausea and vomiting in palliative care patients for this update, but two trials are underway.
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Affiliation(s)
- Fay Murray-Brown
- Speciality Training Programme in Palliative Medicine, Peninsula Deanery, Devon, UK
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29
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A novel prospective descriptive analysis of nausea and vomiting among patients receiving gastrointestinal radiation therapy. Support Care Cancer 2015; 24:1545-61. [DOI: 10.1007/s00520-015-2942-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
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30
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Zaidan M, Soufi L, Hafeez M, Abdelwahid M, Rasul KI. Assessing prescribing patterns for the prevention of chemotherapy-induced nausea and vomiting in the national center for cancer care and research. Saudi Pharm J 2015; 23:381-7. [PMID: 27134539 PMCID: PMC4834678 DOI: 10.1016/j.jsps.2015.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/01/2015] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Chemotherapy is the mainstay of cancer treatment; however, chemotherapy treatment may cause nausea and vomiting, which could cause 25-50% of patients to consider delaying or refusing further cancer treatment. Chemotherapy-induced nausea and vomiting (CINV), can be prevented in 70-80% of patients with evidence-based anti-emetic regimen. The purpose of this study is to assess prescribing patterns with regard to prevention of CINV, in the national center for cancer care and research (NCCCR), and develop and implement a standardized evidence-based guideline for the management of CINV. METHODS 25 anti-emetic prescriptions were audited to assess their conformity with either of the published guidelines; Multinational Association of Supportive Care in Cancer (MASCC), American Society of Clinical Oncology (ASCO), or the National Comprehensive Cancer Network (NCCN), to establish baseline data. A multidisciplinary team of clinical pharmacists and oncologists developed and implemented a guideline for the prevention of CINV. The guideline was promoted using a variety of strategies; education, pocket cards, academic detailing and pharmacist intervention. Physician anti-emetic orders were audited by pharmacists, to assess their conformity with NCCCR anti-emetic guidelines. A data collection form was developed to capture relevant information including; patient demographics, type and emetogenic level of chemotherapy, and the conformity of anti-emetic order with NCCCR guidelines. SPSS statistical software was used to analyze the data. RESULTS The conformity of anti-emetic physician order with NCCCR anti-emetic guidelines increased from 0% baseline in June 2008 to an average of 60.006% (n = 331) by December 2010 and consistently increased reaching 94.3827% (n = 792) by December 2013, (p value 0.0002). CONCLUSION The introduction of anti-emetic guidelines succeeded in standardizing CINV management, toward an evidence-based approach.
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Affiliation(s)
- Manal Zaidan
- Pharmacy Department, National Center for Cancer Care and Research (NCCCR), Doha, Qatar
| | - Lana Soufi
- Pharmacy Department, National Center for Cancer Care and Research (NCCCR), Doha, Qatar
| | - M. Hafeez
- Pharmacy Department, National Center for Cancer Care and Research (NCCCR), Doha, Qatar
| | - M. Abdelwahid
- Pharmacy Department, National Center for Cancer Care and Research (NCCCR), Doha, Qatar
| | - Kakil I. Rasul
- Department of Medical Oncology, National Center for Cancer Care and Research (NCCCR), Doha, Qatar
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31
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Chen B, Hu SX, Liu BH, Zhao TY, Li B, Liu Y, Li MY, Pan XF, Guo YM, Chen ZL, Guo Y. Efficacy and safety of electroacupuncture with different acupoints for chemotherapy-induced nausea and vomiting: study protocol for a randomized controlled trial. Trials 2015; 16:212. [PMID: 25963295 PMCID: PMC4445984 DOI: 10.1186/s13063-015-0734-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 04/27/2015] [Indexed: 11/23/2022] Open
Abstract
Background Many patients experience nausea and vomiting during chemotherapy treatment. Evidence demonstrates that electroacupuncture is beneficial for controlling chemotherapy-induced nausea and vomiting (CINV). However, the acupoint or matching acupoint with the best efficacy for controlling CINV still remains unidentified. Methods/Design This study consists of a randomized controlled trial (RCT) with four parallel arms: a control group and three electroacupuncture groups (one with Neiguan (PC6), one with Zhongwan (CV12), and one with both PC6 and CV12). The control group received standard antiemetic only, while the other three groups received electroacupuncture stimulation with different acupoints besides the standard antiemetic. The intervention is done once daily from the first day (day 1) to the fourth day (day 4) during chemotherapy treatment. The primary outcome measures include frequency of nausea, vomiting and retching. The secondary outcome measures are the grade of constipation and diarrhea, electrogastrogram, assessment of quality of life, assessment of anxiety and depression, and other adverse effects during the chemotherapy. Assessments are scheduled from one day pre-chemotherapy (day 0) to the fifth day of chemotherapy (day 5). Follow-ups are done from day 6 to day 21. Discussion The aim of this study is to evaluate the efficacy and safety of electro-acupuncture with different acupoints in the management of CINV. Trial registration The register number of randomized controlled trial is NCT02195908. The date of registration was 21 July 2014.
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Affiliation(s)
- Bo Chen
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Shu-xiang Hu
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Bao-hu Liu
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Tian-yi Zhao
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Bo Li
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Yan Liu
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Ming-yue Li
- Clinical Practice Teaching Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Xing-fang Pan
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Yong-ming Guo
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Ze-lin Chen
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Yi Guo
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
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32
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Poon M, Dennis K, DeAngelis C, Chung H, Stinson J, Zhang L, Bedard G, Wong E, Popovic M, Lao N, Pulenzas N, Wong S, Cheon P, Chow E. Symptom clusters of gastrointestinal cancer patients undergoing radiotherapy using the Functional Living Index-Emesis (FLIE) quality-of-life tool. Support Care Cancer 2015; 23:2589-98. [PMID: 25620759 DOI: 10.1007/s00520-015-2617-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The Functional Living Index-Emesis (FLIE) instrument is a validated nausea and vomiting specific quality of life (QOL) tool originally created as a 3-day test of the impact of chemotherapy-induced nausea and vomiting on cancer patients' daily life. The primary objective of the present study was to retrospectively explore the use of the FLIE from data obtained in a previously published study of patients with gastrointestinal radiation-induced nausea and vomiting (RINV) and compare the extracted symptom clusters on a weekly basis for the entirety of gastrointestinal cancer patients' radiotherapy treatments. METHODS QOL was assessed on a weekly basis using the 18-item FLIE questionnaire for patients' radiotherapy treatments. A principal component analysis with varimax rotation was performed at each visit. The internal consistency and reliability of the derived clusters was assessed with Cronbach's alpha. Robust relationship and correlation among symptoms was displayed with biplot graphics. RESULTS A total of 460 FLIE assessments were completed for the 86 gastrointestinal patients who underwent radiotherapy. Two components were consistently identified except for week 5 where only one component was identified. Component 1 contained the items "Q10-Q18" which included all vomiting items. Component 2 included all nausea items from "Q1 to Q9". All the variables were well accounted for by two components for most weeks of treatment with excellent internal consistency. Biplots indicate that the two symptom clusters were evident at each week, with the exception of the first week of treatment. Strong correlations were seen between the effect of nausea on patients' ability to make meals, patients' ability to do tasks within the home, and patients' willingness to spend time with family and friends. CONCLUSION The high internal consistency at all timepoints indicates that the FLIE QOL instrument is useful for the RINV population.
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Affiliation(s)
- Michael Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5
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Kwak SH, Cho YM, Noh GM, Om AS. Cancer Preventive Potential of Kimchi Lactic Acid Bacteria (Weissella cibaria, Lactobacillus plantarum). J Cancer Prev 2014; 19:253-8. [PMID: 25574459 PMCID: PMC4285955 DOI: 10.15430/jcp.2014.19.4.253] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 12/08/2014] [Accepted: 12/08/2014] [Indexed: 12/24/2022] Open
Abstract
The number of death due to cancer has been increasing in Korea. Chemotherapy is known to cause side effects because it damages not only cancerous cells but healthy cells. Recently, attention has focused on food-derived chemopreventive and anti-tumor agents or formulations with fewer side effects. Kimchi, most popular and widely consumed in Korea, contains high levels of lactic acid bacteria and has been shown to possess chemopreventive effects. This review focuses on Weissella cibaria and Lactobacillus plantarum, the representatives of kimchi lactic acid bacteria, in terms of their abilities to prevent cancer. Further studies are needed to understand the mechanisms by which lactic acid bacteria in kimchi prevent carcinogenic processes and improve immune functions.
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Affiliation(s)
- Shin-Hye Kwak
- Laboratory of Food Safety and Toxicology, Department of Food Science and Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
| | - Young-Mi Cho
- Laboratory of Food Safety and Toxicology, Department of Food Science and Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
| | - Geon-Min Noh
- Functional Food and Nutrition Division, Department of Agrofood Resources, National Academy of Agricultural Science, Wanju, Korea
| | - Ae-Son Om
- Laboratory of Food Safety and Toxicology, Department of Food Science and Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
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Zoto T, Kilickap S, Yasar U, Celik I, Bozkurt A, Babaoglu MO. Improved Anti-Emetic Efficacy of 5-HT3Receptor Antagonists in Cancer Patients with Genetic Polymorphisms of ABCB1 (MDR1) Drug Transporter. Basic Clin Pharmacol Toxicol 2014; 116:354-60. [DOI: 10.1111/bcpt.12334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Teuta Zoto
- Department of Pharmacology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Saadettin Kilickap
- Division of Medical Oncology; Department of Internal Medicine; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Umit Yasar
- Department of Pharmacology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Ismail Celik
- Division of Medical Oncology; Department of Internal Medicine; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Atilla Bozkurt
- Department of Pharmacology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Melih Onder Babaoglu
- Department of Pharmacology; Faculty of Medicine; Hacettepe University; Ankara Turkey
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Cheng ZD, Wang SZ, Li CR, Zhang ZX, Andre K, Ha JM, Chen YG. Effects of acupuncture on the tissue distribution of Paclitaxel in lung carcinoma mice. Chin J Integr Med 2014. [PMID: 24928377 DOI: 10.1007/s11655-014-1819-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study whether acupuncture affects the tissue distribution of Paclitaxel in mouse lung carcinoma. METHODS Totally 90 mice were divided into Paclitaxel group, Paclitaxel + Feishu (BL13) group, and Paclitaxel + Lingtai (DU10) group. Each group was consisted of 30 mice. After Paclitaxel injection, the mice received electro-acupuncture at Feishu or Lingtai acupoints once a day for 8 days. The effect of acupuncture on the tissue distribution of Paclitaxel was evaluated using high-performance liquid chromatography at 1, 2, and 3 h, respectively. The lung, liver, spleen, and kidney were examined for the concentration of Paclitaxel seperately. RESULTS Paclitaxel was widely distributed in various organs, particularly in the lung, liver, and kidney. Acupuncture at Lingtai or Feishu acupoints resulted in an obvious decrease of Paclitaxel distribution in kidney and delayed Paclitaxel distribution in liver. Meanwhile, it increased the time of metabolism. Acupuncture at Feishu acupoint facilitated the delivery of Paclitaxel to lung more effectively than did acupuncture at Lingtai acupoint. CONCLUSIONS Applying acupuncture at particular acupoints can influence tissue distribution of Paclitaxel. Tissue distribution change might be one of the mechanisms of acupuncture treatment during chemotherapy.
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Affiliation(s)
- Ze-Dong Cheng
- College of Acupuncture and Moxibustion, Liaoning University of Traditional Chinese Medicine, Shenyang, 110847, China,
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Poon M, Dennis K, DeAngelis C, Chung H, Stinson J, Zhang L, Bedard G, Popovic M, Lao N, Pulenzas N, Wong S, Chow E. A prospective study of gastrointestinal radiation therapy-induced nausea and vomiting. Support Care Cancer 2014; 22:1493-507. [DOI: 10.1007/s00520-013-2104-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
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Cramarossa G, Zeng L, Zhang L, Tseng LM, Hou MF, Fairchild A, Vassiliou V, Jesus-Garcia R, Alm El-Din MA, Kumar A, Forges F, Chie WC, Sahgal A, Lam H, Pulenzas N, Chow E. Predictive factors of overall quality of life in advanced cancer patients using EORTC QLQ-C30. Expert Rev Pharmacoecon Outcomes Res 2013; 14:139-46. [PMID: 24325545 DOI: 10.1586/14737167.2014.864560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To identify which domains/symptoms from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were predictive of overall quality of life (QoL) in advanced cancer patients. METHODS Four hundred and forty seven patients with brain metastases or bone metastases from seven countries were enrolled with regression analysis to determine the predictive value of the QLQ-C30 functional/symptom scores for patient reported overall QoL (question 30), overall health (question 29) and the global health status domain (questions 29 and 30). RESULTS Worse role functioning, social functioning, fatigue and financial problems were the most significant predictive factors for worse QoL. In the bone metastases subgroup (n = 400), role functioning, fatigue and financial problems were the most significant predictors. In patients with brain metastases (n = 47), none of the EORTC domains significantly predicted worse QOL. CONCLUSION Deterioration of certain QLQ-C30 functional/symptom scores significantly contributes to worse QoL, overall health and global health status.
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Affiliation(s)
- Gemma Cramarossa
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada
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Voigt M, Fröhlich CW, Hüttel C, Kranke P, Mennen J, Boessneck O, Lenz C, Erbes T, Ernst J, Kerger H. Prophylaxis of intra- and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia. Med Sci Monit 2013; 19:993-1000. [PMID: 24226381 PMCID: PMC3852368 DOI: 10.12659/msm.889597] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background This paper describes a randomized prospective study conducted in 308 patients undergoing caesarean section in spinal anaesthesia at a single hospital between 2010 and 2012 to find a suitable anti-emetic strategy for these patients. Material/Methods Spinal anesthesia was performed in left prone position, at L3/L4 with hyperbaric 0.5% Bupivacaine according to a cc/cm body height ratio. There were no opioids given peri-operatively. The patients received either no prophylaxis (Group I) or tropisetron and metoclopramide (Group II) or dimenhydrinate and dexamethasone (Group III), or tropisetron as a single medication (Group IV). The primary outcome was nausea and/or vomiting (NV) in the intraoperative, early (0–2 h) or late (2–24 h) postoperative period. Multivariate statistical analysis was conducted with a regression analysis and a backward elimination of factors without significant correlation. Results All prophylactic agents significantly reduced NV incidence intraoperatively. Relative risk reduction for NV by prophylaxis was most effective (59.5%) in Group II (tropisetron and metoclopramide). In Group III (dimenhydrinate and dexamethasone), NV risk was reduced by 29.9% and by 28.7% in Group IV (tropisetron mono-therapy). The incidence of NV in the early (0–2 h) and the late (2–24 h) postoperative period was low all over (7.8%), but the relative risk reduction of NV in the early postoperative period was 54.1% (Group IV), 45.1% (Group III), and 34.8% (Group II), respectively. In the late postoperative period, there was no significant difference between the 4 groups. Conclusions We recommend a prophylactic medication with tropisetron 2 mg and metoclopramide 20 mg for patients during caesarean section. These agents are safe, reasonably priced, and highly efficient in preventing nausea and vomiting.
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Shaw C, Power J. Nutritional Support for the Cancer Patient. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Suppression of lithium chloride-induced conditioned gaping (a model of nausea-induced behaviour) in rats (using the taste reactivity test) with metoclopramide is enhanced by cannabidiolic acid. Pharmacol Biochem Behav 2013; 111:84-9. [PMID: 24012649 DOI: 10.1016/j.pbb.2013.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/19/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
Abstract
We aimed to determine the potential of various doses of metoclopramide (MCP, a dopamine antagonist) to reduce lithium chloride (LiCl)-induced conditioned gaping (a nausea-induced behaviour) in rats, using the taste reactivity test. We then evaluated whether an ineffective low dose of cannabidiolic acid (CBDA, 0.1 μg/kg, Rock and Parker, 2013), the potent acidic precursor of cannabidiol (CBD, a non-psychoactive component of cannabis) could enhance the anti-nausea effects of an ineffective low dose of MCP. MCP (3.0 mg/kg) reduced conditioned gaping responses. Coadministration of ineffective doses of MCP (0.3 mg/kg) and CBDA (0.1 μg/kg) enhanced the suppression of conditioned gaping, over that of either drug alone, without interfering with conditioned taste avoidance. MCP dose-dependently reduced nausea-induced conditioned gaping in rats. As well, the suppression of conditioned gaping was enhanced when ineffective doses of MCP and CBDA were coadministered. These data suggest that CBDA could be a powerful adjunct treatment to anti-emetic regimens for chemotherapy-induced nausea.
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Nozawa K, Shimizu C, Kakimoto M, Mizota Y, Yamamoto S, Takahashi Y, Ito A, Izumi H, Fujiwara Y. Quantitative assessment of appearance changes and related distress in cancer patients. Psychooncology 2013; 22:2140-7. [DOI: 10.1002/pon.3268] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 10/30/2012] [Accepted: 01/28/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Keiko Nozawa
- Yamano College of Aesthetics; Tokyo Japan
- Cancer Information and Support Center; National Cancer Center Hospital; Tokyo Japan
| | - Chikako Shimizu
- Breast and Medical Oncology Division; National Cancer Center Hospital; Tokyo Japan
| | - Minako Kakimoto
- Breast and Medical Oncology Division; National Cancer Center Hospital; Tokyo Japan
| | - Yuri Mizota
- Center for Cancer Control and Information; National Cancer Center; Tokyo Japan
| | - Seiichiro Yamamoto
- Center for Cancer Control and Information; National Cancer Center; Tokyo Japan
| | - Yumiko Takahashi
- Department of Nursing; National Cancer Center Hospital; Tokyo Japan
| | - Atsuko Ito
- Department of Nursing; National Cancer Center Hospital; Tokyo Japan
| | - Hideko Izumi
- Department of Nursing; National Cancer Center Hospital; Tokyo Japan
| | - Yasuhiro Fujiwara
- Breast and Medical Oncology Division; National Cancer Center Hospital; Tokyo Japan
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Pattern of prophylaxis administration for chemotherapy-induced nausea and vomiting: an analysis of city-based health insurance data. Int J Clin Oncol 2012; 18:971-6. [PMID: 23011102 DOI: 10.1007/s10147-012-0477-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/02/2012] [Indexed: 10/27/2022]
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Dobos G, Wilhelm M. [Model projects in integrated oncology]. ACTA ACUST UNITED AC 2012; 35 Suppl 5:21-5. [PMID: 22965290 DOI: 10.1159/000340027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Gustav Dobos
- Klinik Innere Medizin V, Naturheilkunde und Integrative Medizin, Kliniken Essen-Mitte, Germany
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Griffiths P, Richardson A, Blackwell R. Outcomes sensitive to nursing service quality in ambulatory cancer chemotherapy: Systematic scoping review. Eur J Oncol Nurs 2012; 16:238-46. [DOI: 10.1016/j.ejon.2011.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/31/2011] [Accepted: 06/12/2011] [Indexed: 11/29/2022]
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Genç A, Can G, Aydiner A. The efficiency of the acupressure in prevention of the chemotherapy-induced nausea and vomiting. Support Care Cancer 2012; 21:253-61. [DOI: 10.1007/s00520-012-1519-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/28/2012] [Indexed: 11/27/2022]
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Hata A, Katakami N, Fujita S, Horai A, Takatori K, Ose T, Kitajima N. Medroxyprogesterone acetate for refractory emesis in cisplatin-treated patients. J Palliat Med 2012; 15:1158-60. [PMID: 22650802 DOI: 10.1089/jpm.2011.0527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is one of the most distressing side effects in systemic chemotherapies. Recently, several effective agents have been developed to prevent CINV, and CINV can be prevented in 70%-80% of patients receiving chemotherapies. Conversely, 20%-30% of patients still suffer from CINV despite recommended optimal antiemetic preventions. Refractory emesis is defined as emesis occuring despite the use of antiemetic prophylaxis during the previous cycle of chemotherapy. Salvage treatments for refractory emesis are necessary, but there are few effective treatments at present. We consider medroxyprogesterone acetate to be a potentially promising agent for refractory emesis. We encountered three cases in which medroxyprogesterone acetate was extremely effective for refractory emesis induced by cisplatin-containing chemotherapy.
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Affiliation(s)
- Akito Hata
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Chuo-ku, Kobe, Japan.
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Letarte N. L’éducation thérapeutique d’un patient souffrant de nausées et vomissements induits par la chimiothérapie. ACTUALITES PHARMACEUTIQUES 2012. [DOI: 10.1016/s0515-3700(12)71351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rangwala F, Zafar SY, Abernethy AP. Gastrointestinal symptoms in cancer patients with advanced disease: new methodologies, insights, and a proposed approach. Curr Opin Support Palliat Care 2012; 6:69-76. [PMID: 22228030 DOI: 10.1097/spc.0b013e32834f689d] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This review summarizes recent developments in the management of gastrointestinal symptoms experienced by cancer patients and provides a framework for education, assessment and monitoring, and treatment. RECENT FINDINGS Although many viable treatment options exist, gastrointestinal symptoms - particularly nausea and vomiting, constipation, and diarrhea - continue to challenge both patients and clinicians. Current clinical guidelines now recommend that patients treated with moderate emetic risk chemotherapy regimens be preferentially treated with the 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, palonosetron, in combination with dexamethasone. A large randomized trial has also recently validated that single-dose fosaprepitant is equivalent to the standard 3-day, aprepitant regimen. New medications, such as skin patch delivery of granisetron for nausea or methylnaltrexone for constipation, show promise in both the management of symptoms and as preventive agents. The integration of complementary and alternative therapies, such as relaxation techniques, ginger, and electroacupuncture may also assist with symptom relief. Accurate assessment is essential, but often problematic, especially as the patient's experience of gastrointestinal distress is often disproportionate with objective measures. New methodologies that harness technology to collect patient-reported outcomes may improve the accuracy of assessment, provide a better picture of the patient's experience of gastrointestinal symptoms, and deliver a means to simultaneously monitor symptoms, educate patients, and collect longitudinal data. SUMMARY Palliative management of gastrointestinal symptoms in advanced cancer patients requires a multipronged approach that entails effective assessment, judicious use of latest evidence-based approaches, and monitoring that incorporates both clinical measures and patient-reported outcomes. When combined with refinements in the overall clinical approach to symptom management, standardized instruments that streamline data collection and enable data warehousing will support better symptom management.
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Affiliation(s)
- Fatima Rangwala
- Division of Medical Oncology, Department of Medicine, Duke University Medical Centre, Durham, North Carolina, USA
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Henry DH, Langer CJ, McKenzie RS, Piech CT, Senbetta M, Schulman KL, Stepanski EJ. Hematologic outcomes and blood utilization in cancer patients with chemotherapy-induced anemia (CIA) pre- and post-national coverage determination (NCD): results from a multicenter chart review. Support Care Cancer 2011; 20:2089-96. [PMID: 22160485 DOI: 10.1007/s00520-011-1318-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 11/01/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE In July 2007, the Centers for Medicare and Medicaid Services (CMS) limited coverage of erythropoiesis-stimulating agents (ESAs) in cancer patients with chemotherapy-induced anemia (CIA) through a National Coverage Determination (NCD). The primary objective of this study was to compare transfusion rates in patients with CIA with lung, breast, or colorectal cancer before and after the NCD. METHODS Adult Medicare patients with CIA treated at 49 community oncology clinics were selected from two time periods based on clinics' NCD implementation date. Chart data were abstracted for 12 weeks post-CIA episode start, defined as hemoglobin (Hb) level <11 g/dL while receiving chemotherapy or within 60 days of the last chemotherapy dose. Multivariate analyses were used to calculate the odds of transfusion and to assess the units of blood transfused, controlling for differences in demographics, clinical history, and chemotherapy. RESULTS Eight hundred pre-NCD and 994 post-NCD patients from 49 sites were selected. Of the patients, 56% used ESAs post-NCD vs. 88% pre-NCD (p < 0.0001). The duration of ESA use decreased in the post-NCD (32.1 days) vs. pre-NCD (48.4 days, p < 0.0001) group. The post-NCD group reported significantly lower Hb levels, higher odds of receiving a transfusion (odds ratio: 1.41, 95% CI 1.05-1.89, p = 0.0238) and increased blood utilization of 53% (units transfused: OR 1.53, 95% CI 1.15-2.04, p = 0.0034). CONCLUSIONS Decreased frequency and duration of ESA administration were reported in the post-NCD vs. pre-NCD period. Findings were accompanied by a modest but statistically significant increase in transfusions and a decrease in Hb values.
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Affiliation(s)
- David H Henry
- Joan Karnell Cancer Center, Pennsylvania Hospital, Philadelphia, PA 19106, USA.
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Fatigue after treatment in breast cancer survivors: prevalence, determinants and impact on health-related quality of life. Support Care Cancer 2011; 20:1901-9. [PMID: 21994001 DOI: 10.1007/s00520-011-1293-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 09/27/2011] [Indexed: 11/12/2022]
Abstract
PURPOSE Fatigue is a phenomenon that may persist for years after completion of adjuvant therapy, and is one of the most frequent symptoms associated with breast cancer survivors. The purposes of this study were to investigate the occurrence of fatigue in disease-free breast cancer survivors after treatment, to identify variables associated with fatigue, and to evaluate the impact of fatigue on health-related quality of life. METHODS A cross-sectional study was conducted on 202 consecutive women diagnosed with in-situ to Stage III breast cancer attending in outpatient facilities of two large hospitals, one year or more after diagnosis. They completed the Piper Fatigue Scale-Revised and the European Organization for Research and Treatment of Cancer QLQ-C30. Multiple logistic regression models were used to identify predictive factors associated with fatigue. EORTC QLQC-30 scores for fatigued survivors were compared to non-fatigued survivors. RESULTS The prevalence of fatigue reported by the breast cancer survivors was 37.6%. Multiple logistic regression analysis revealed that predictive factors for fatigue included younger age (odds ratio [OR]=2.23, 95% confidence interval [CI]=1.11-4.45, p = 0.024); presence of pain (OR = 3.87, 95% CI = 1.88-7.98, p = 0.000); dyspnea (OR = 3.72, 95% CI = 1.46-9.50, p = 0.006); insomnia (OR = 2.40, 95% CI = 1.19-4.86, p = 0.015); and nausea and vomiting (OR = 12.25, 95% CI = 1.18-126.75, p = 0.036). Fatigued women had poorer health-related quality of life than non-fatigued women in all domains. CONCLUSION Our results suggest that many disease-free breast cancer survivors after treatment experienced fatigue that compromises their health-related quality of life.
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