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Said AM, Mansour YE, Soliman RR, Islam R, Fatahala SS. Design, synthesis, molecular modeling, in vitro and in vivo biological evaluation of potent anthranilamide derivatives as dual P-glycoprotein and CYP3A4 inhibitors. Eur J Med Chem 2024; 273:116492. [PMID: 38762918 DOI: 10.1016/j.ejmech.2024.116492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/21/2024]
Abstract
Paclitaxel (PTX) is considered the blockbuster chemotherapy treatment for cancer. Paclitaxel's (PTX) oral administration has proven to be extremely difficult, mostly because of its susceptibility to intestinal P-glycoprotein (P-gp) and cytochrome P450 (CYP3A4). The concurrent local inhibition of intestinal P-gp and CYP3A4 is a promising approach to improve the oral bioavailability of paclitaxel while avoiding potential unfavorable side effects of their systemic inhibition. Herein, we report the rational design and evaluation of novel dual potent inhibitors of P-gp and CYP3A4 using an anthranilamide derivative tariquidar as a starting point for their structural optimizations. Compound 14f, bearing N-imidazolylbenzyl side chain, was found to have potent and selective P-gp (EC50 = 28 nM) and CYP3A4 (IC50 = 223 nM) inhibitory activities with low absorption potential (Papp (A-to-B) <0.06). In vivo, inhibitor 14f improved the oral absorption of paclitaxel by 6 times in mice and by 30 times in rats as compared to vehicle, while 14f itself remained poorly absorbed. Compound 14f, possessing dual P-gp and CYP3A4 inhibitory activities, offered additional enhancement in paclitaxel oral absorption compared to tariquidar in mice. Evaluating the CYP effect of 14f on oral absorption of paclitaxel requires considering the variations in CYP expression between animal species. This study provides further medicinal chemistry advice on strategies for resolving concerns with the oral administration of chemotherapeutic agents.
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Affiliation(s)
- Ahmed M Said
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, BCC, Omaha, NE, 68198, USA; Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Helwan University, Ein-Helwan, Helwan, Cairo, 11795, Egypt; Department of Chemistry, University at Buffalo, The State University of New York, Buffalo, NY, 14260, USA.
| | - Yara E Mansour
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Helwan University, Ein-Helwan, Helwan, Cairo, 11795, Egypt
| | - Radwa R Soliman
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, 14260, USA
| | - Ridwan Islam
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, BCC, Omaha, NE, 68198, USA
| | - Samar S Fatahala
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Helwan University, Ein-Helwan, Helwan, Cairo, 11795, Egypt.
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Cobani E, Al Hallak MN, Shields AF, Maier J, Kelly TE, Naidoo N, Tobon M, Kim S, Beal EW. Gastric Cancer Survivorship: Multidisciplinary Management, Best Practices and Opportunities. J Gastrointest Cancer 2024; 55:519-533. [PMID: 38180678 DOI: 10.1007/s12029-023-01001-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE Gastric cancer is the 5th most common malignancy worldwide. As early detection increases and treatments for gastric cancer improve, the number of gastric cancer survivors grows. METHODS Here, we review the diagnosis and management of gastric cancer and discuss important considerations for gastric cancer survivorship including cancer surveillance, weight loss, malnutrition, fatigue, specific complications related to surgery and radiation, quality of life in gastric cancer survivorship, health behavior, and models of survivorship. RESULTS Multimodality therapy with chemotherapy and surgery can result in chronic toxicities in multiple organ systems. This emphasizes the need for a multidisciplinary survivorship care model including cancer surveillance, management of chronic toxicities, and optimization of modifiable risk factors with long-term involvement of appropriate providers. CONCLUSION Adequately caring for gastric cancer survivors requires a coordinated, multidisciplinary approach.
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Affiliation(s)
- Era Cobani
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Mohammed Najeeb Al Hallak
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R., Mailcode: HW04HO, 48201, Detroit, MI, USA
| | - Anthony F Shields
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R., Mailcode: HW04HO, 48201, Detroit, MI, USA
| | - Jordan Maier
- Department of Radiation Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Thomas E Kelly
- Department of Gastroenterology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Niren Naidoo
- Department of Supportive Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Miguel Tobon
- Department of Surgery, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Steve Kim
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R., Mailcode: HW04HO, 48201, Detroit, MI, USA
- Department of Surgery, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eliza W Beal
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R., Mailcode: HW04HO, 48201, Detroit, MI, USA.
- Department of Surgery, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
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3
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Kwon KK, Lacey J, Kerin-Ayres K, Heller G, Grant S. Acupuncture for the treatment of the pain-fatigue-sleep disturbance-numbness/tingling symptom cluster in breast cancer survivors: a feasibility trial. Support Care Cancer 2024; 32:332. [PMID: 38713422 PMCID: PMC11076364 DOI: 10.1007/s00520-024-08529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Breast cancer survivors following disease-modifying treatment frequently experience multiple-concurrent symptoms (Jansana et al. in Int J Cancer 149(10):1755 1767, 2021), negatively impacting their quality of life and increasing the risk of polypharmacy (Alwhaibi et al. in J Oncol Pharm Pract 26(5):1052 1059, 2020). This study evaluates the feasibility and acceptability of acupuncture for the management of the pain-fatigue-sleep disturbance-numbness/tingling symptom cluster in breast cancer survivors, and investigates relationships between the symptom cluster and Traditional Chinese Medicine (TCM) syndrome diagnosis. METHODS This was a single-arm, pre-test/post-test feasibility trial conducted at Chris O'Brien Lifehouse Hospital, Australia. Breast cancer survivors who completed treatment and experienced clinically significant levels of two or more symptoms (pain, fatigue, sleep disturbance, numbness/tingling) were eligible to participate in the individualized, pragmatic 6-week acupuncture intervention. The primary outcome was feasibility and acceptability. Effectiveness was explored using a symptom cluster mean score. RESULTS Twenty women enrolled in the study over an 11-week period and 90% completed the study. Most women agreed or completely agreed that acupuncture was feasible (85%), acceptable (90%), and appropriate (90%). Both mean and composite symptom cluster scores were significantly reduced (p < 0.001), as were individual symptom scores in fatigue (p < 0.001), sleep disturbance (p = 0.04), and numbness/tingling (p = 0.01). TCM syndromes most closely associated with this symptom cluster were Spleen qi deficiency and Heart fire. No adverse events were reported. CONCLUSION This study demonstrated that acupuncture was safe and feasible, justifying a powered randomized control trial. Preliminary findings suggest beneficial effects of acupuncture for the management of the pain-fatigue-sleep disturbance-numbness/tingling symptom cluster for women with breast cancer. TCM syndromes identified in this trial may be used to guide acupuncture treatment protocols. CLINICAL TRIAL REGISTRATION This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000590763) on 21 April 2022.
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Affiliation(s)
- Ki Kyung Kwon
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
- Chris O'Brien Lifehouse Hospital, Camperdown, NSW, Australia.
| | - Judith Lacey
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- Chris O'Brien Lifehouse Hospital, Camperdown, NSW, Australia
- University of Sydney, Camperdown, NSW, Australia
| | - Kim Kerin-Ayres
- Chris O'Brien Lifehouse Hospital, Camperdown, NSW, Australia
| | - Gillian Heller
- Chris O'Brien Lifehouse Hospital, Camperdown, NSW, Australia
- University of Sydney, Camperdown, NSW, Australia
| | - Suzanne Grant
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- Chris O'Brien Lifehouse Hospital, Camperdown, NSW, Australia
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Shetty ND, Dhande R, Parihar P, Bora N. Magnetic Resonance Imaging of Radiation-Induced Brachial Plexopathy. Cureus 2024; 16:e60067. [PMID: 38860104 PMCID: PMC11163868 DOI: 10.7759/cureus.60067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 05/09/2024] [Indexed: 06/12/2024] Open
Abstract
This report illustrates the case of a 37-year-old woman following chemoradiotherapy for invasive ductal carcinoma of the right breast. The patient underwent surgery and received a radiation dose of 50 gray to the chest wall and 45 gray to the regional lymph nodes in 25 total fractions. She developed motor and sensory weakness in the right upper limb eight years after treatment. Brachial plexus neuropathy in cancer patients may result from either trauma to the plexus during surgery, the spread of cancer, or radiation therapy, and distinguishing between them may be difficult. The case highlights the importance of recognizing the signs, symptoms, and possible differential diagnosis of radiation-induced brachial plexopathy in cancer patients post-radiation therapy. It emphasizes the role of magnetic resonance imaging in the careful assessment and diagnosis of such a case.
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Affiliation(s)
- Neha D Shetty
- Radiodiagnosis, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Rajasbala Dhande
- Radiodiagnosis, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikita Bora
- Radiology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Springer F, Maier A, Friedrich M, Raue JS, Finke G, Lordick F, Montgomery G, Esser P, Brock H, Mehnert-Theuerkauf A. Digital Therapeutic (Mika) Targeting Distress in Patients With Cancer: Results From a Nationwide Waitlist Randomized Controlled Trial. J Med Internet Res 2024; 26:e51949. [PMID: 38663007 PMCID: PMC11082740 DOI: 10.2196/51949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Distress is highly prevalent among patients with cancer, but supportive care needs often go unmet. Digital therapeutics hold the potential to overcome barriers in cancer care and improve health outcomes. OBJECTIVE This study conducted a randomized controlled trial to investigate the efficacy of Mika, an app-based digital therapeutic designed to reduce distress across the cancer trajectory. METHODS This nationwide waitlist randomized controlled trial in Germany enrolled patients with cancer across all tumor entities diagnosed within the last 5 years. Participants were randomized into the intervention (Mika plus usual care) and control (usual care alone) groups. The participants completed web-based assessments at baseline and at 2, 6, and 12 weeks. The primary outcome was the change in distress from baseline to week 12, as measured by the National Comprehensive Cancer Network Distress Thermometer. Secondary outcomes included depression, anxiety (Hospital Anxiety and Depression Scale), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), and quality of life (Clinical Global Impression-Improvement Scale). Intention-to-treat and per-protocol analyses were performed. Analyses of covariance were used to test for outcome changes over time between the groups, controlling for baseline. RESULTS A total of 218 patients (intervention: n=99 and control: n=119) were included in the intention-to-treat analysis. Compared with the control group, the intervention group reported greater reductions in distress (P=.03; ηp²=0.02), depression (P<.001; ηp²=0.07), anxiety (P=.03; ηp²=0.02), and fatigue (P=.04; ηp²=0.02). Per-protocol analyses revealed more pronounced treatment effects, with the exception of fatigue. No group difference was found for quality of life. CONCLUSIONS Mika effectively diminished distress in patients with cancer. As a digital therapeutic solution, Mika offers accessible, tailored psychosocial and self-management support to address the unmet needs in cancer care. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00026038; https://drks.de/search/en/trial/DRKS00026038.
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Affiliation(s)
- Franziska Springer
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, Leipzig, Germany
| | | | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, Leipzig, Germany
| | | | | | - Florian Lordick
- Department of Medicine II, University Medical Center Leipzig, Leipzig, Germany
- University Cancer Center Leipzig, Comprehensive Cancer Center Central Germany, Leipzig, Germany
| | - Guy Montgomery
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Peter Esser
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, Leipzig, Germany
| | - Hannah Brock
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, Leipzig, Germany
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Pérez C, Ochoa D, Sánchez N, Ballesteros AI, Santidrián S, López I, Mondéjar R, Carnaval T, Villoria J, Colomer R. Pain in Long-Term Cancer Survivors: Prevalence and Impact in a Cohort Composed Mostly of Breast Cancer Survivors. Cancers (Basel) 2024; 16:1581. [PMID: 38672663 PMCID: PMC11049399 DOI: 10.3390/cancers16081581] [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: 03/26/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Cancer survival is becoming more common which means that there is now a growing population of cancer survivors, in whom pain may be common. However, its prevalence has hardly been addressed systematically. We aimed to assess the prevalence and explore the pathophysiology and impact of pain on health outcomes in cancer survivors. We conducted a retrospective-prospective cohort study in cancer-free patients diagnosed with cancer at least five years before the study start date. We used multivariable regression to establish the association of patients' cancer characteristics with pain, and then the association of patients' pain features with health outcomes and related symptoms. Between March and July 2021, 278 long-term cancer survivors were evaluated. Almost half of them (130/278, 46.8%) had pain, of whom 58.9% had a probable neuropathic component, but only 18 (13.8%) were taking specific drugs for neuropathic pain. A history of surgery-related pain syndrome in breast cancer patients was more than twice as frequent in the pain cohort. Post-chemotherapy and post-radiotherapy pain syndromes were uncommon. Pain was associated with lower QoL, emotional functioning, professional performance, and disability scores. Pain is a frequent health determinant in cancer survivors. Referral to specialised pain services may be a reasonable move in some cases.
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Affiliation(s)
- Concepción Pérez
- Pain Clinic, Hospital de La Princesa, 28006 Madrid, Spain; (D.O.); (N.S.); (S.S.); (I.L.)
| | - Dolores Ochoa
- Pain Clinic, Hospital de La Princesa, 28006 Madrid, Spain; (D.O.); (N.S.); (S.S.); (I.L.)
| | - Noelia Sánchez
- Pain Clinic, Hospital de La Princesa, 28006 Madrid, Spain; (D.O.); (N.S.); (S.S.); (I.L.)
| | - Ana Isabel Ballesteros
- Department of Clinical Oncology, Hospital de la Princesa, 28006 Madrid, Spain; (A.I.B.); (R.M.); (R.C.)
| | - Sheila Santidrián
- Pain Clinic, Hospital de La Princesa, 28006 Madrid, Spain; (D.O.); (N.S.); (S.S.); (I.L.)
| | - Isabel López
- Pain Clinic, Hospital de La Princesa, 28006 Madrid, Spain; (D.O.); (N.S.); (S.S.); (I.L.)
| | - Rebeca Mondéjar
- Department of Clinical Oncology, Hospital de la Princesa, 28006 Madrid, Spain; (A.I.B.); (R.M.); (R.C.)
| | - Thiago Carnaval
- Department of Design and Biometrics, Medicxact, S.L., 28430 Alpedrete, Spain; (T.C.); (J.V.)
| | - Jesús Villoria
- Department of Design and Biometrics, Medicxact, S.L., 28430 Alpedrete, Spain; (T.C.); (J.V.)
| | - Ramón Colomer
- Department of Clinical Oncology, Hospital de la Princesa, 28006 Madrid, Spain; (A.I.B.); (R.M.); (R.C.)
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Chen L, Li J, Xu S, Liu Z, Jiao Y, Zhou Z. Efficacy of acupuncture therapy on cancer-related insomnia: a systematic review and network meta-analysis. Front Neurol 2024; 15:1342383. [PMID: 38414556 PMCID: PMC10896907 DOI: 10.3389/fneur.2024.1342383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
Objectives Cancer-related insomnia (CRI) takes a toll on many cancer survivors, causing distressing symptoms and deteriorating the quality of life. Acupuncture therapy has been used for CRI already. However, it is still uncertain which acupuncture regime is best for CRI. The primary objective of this review is to conduct a comparative evaluation and ranking of the effectiveness of different acupuncture therapies for CRI. Methods Randomized controlled trials (RCTs) that were published up to July 31, 2023, from 8 databases (PubMed, Embase, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc) were integrated in this study. Trials that met the inclusion criteria were evaluated the risk of bias. Pittsburgh sleep quality index (PSQI) was used to assess the efficacy of different acupuncture therapies as the primary outcome. Then, STATA 15, R, and OpenBUGS were applied to perform the network meta-analysis. PRISMA statements were followed in this network meta-analysis. Results A total of 37 studies were included in this review, involving 16 interventions with 3,246 CRI participants. Auriculotherapy + moxibustion [surface under the cumulative ranking curve (SUCRA) 98.98%] and auriculotherapy (SUCRA 77.47%) came out top of the ranking, which were more effective than control, medicine, usual care and sham acupuncture. Conclusion Auriculotherapy + moxibustion and auriculotherapy + acupuncture emerged as the top two acupuncture regimes for CRI and future studies should pay more attention to CRI. Clinical trial registration https://clinicaltrials.gov/, identifier INPLASY202210095.
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Affiliation(s)
- Liying Chen
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Jiaqi Li
- Optics Valley Hospital District Medical Office, Hospital of Stomatology Wuhan University, Wuhan, China
| | - Shiting Xu
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Zhiyi Liu
- College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, China
| | - Yang Jiao
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Zhongyu Zhou
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
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Kelmendi N, Nilsson M, Taloyan M, Sundberg K, Langius-Eklöf A, Craftman ÅG. Preferences for Tailored Support - Patients' and Health Care Professionals' Experiences Regarding Symptoms and Self-Management Strategies During the First Year After Curatively Intended Prostate Cancer Treatment. Patient Prefer Adherence 2024; 18:275-288. [PMID: 38333642 PMCID: PMC10850763 DOI: 10.2147/ppa.s440689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/06/2024] [Indexed: 02/10/2024] Open
Abstract
Purpose There is an increase in the number of men undergoing screening for prostate cancer, and advancements in treatments, which implies current knowledge about symptoms and self-management. This study aims to explore experiences of symptom distress, and self-management strategies during the first year after curatively intended treatment for prostate cancer, as identified by patients and health care professionals. Methods A qualitative design was used, including data triangulation from individual interviews with patients (n =17) and one focus group interview with healthcare professionals (n =5). Thematic analysis was used. Results The two main themes were identified: living with the consequences of treatment and navigating a new situation. Living with the consequences of treatment illustrated how losing control of bodily functions such as bladder, bowel, and sexual functions interfered with daily life. A stigma around the disease was described, and a life living in an unfamiliar body challenged ideas of masculinity. The first months after treatment ended was a distressing period related to the abruption in frequent contact with healthcare providers, and concerns about the future. The second theme, navigating a new situation, illustrates that self-management strategies varied, due to individual factors as did the need for tailored information and support provided from healthcare professionals and family, which was highly valued. Information and support were described as complex topics and healthcare professionals emphasized the need for appropriate education for staff to provide proper support to men after ended treatment. Conclusion Lingering symptoms and concerns were evident during the first year after treatment. Self-management strategies varied, and timely and tailored information and support during the first year were considered highly valued, important, and preferred by patients. Our results indicate that support should be offered immediately after curatively intended treatment.
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Affiliation(s)
- Nazmije Kelmendi
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Marie Nilsson
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Marina Taloyan
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Kay Sundberg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Åsa G Craftman
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
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Vande Vyvere T, De Groote A, De Groef A, Haenen V, Tjalma W, Van Dyck P, Meeus M. Morphological and functional brain changes in chronic cancer-related pain: A systematic review. Anat Rec (Hoboken) 2024; 307:285-297. [PMID: 36342941 DOI: 10.1002/ar.25113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to perform a systematic review of the available literature on morphological and functional brain changes measured by modern neuroimaging techniques in patients suffering from chronic cancer-related pain. A systematic search was conducted in PubMed, Embase, and Web of Science using different keyword combinations. In addition, a hand search was performed on the reference lists and several databases to retrieve supplementary primary studies. Eligible articles were assessed for methodological quality and risk of bias and reviewed by two independent researchers. The search yielded only four studies, three of which used MRI and one PET-CT. None of the studies measured longitudinal morphological (i.e., gray or white matter) changes. All studies investigated functional brain changes and found differences in specific brain regions and networks between patients with chronic cancer-related pain and pain-free cancer patients or healthy volunteers. Some of these alterations were found in brain networks that also show changes in non-cancer populations with chronic pain (e.g., the default mode network and salience network). However, specific findings were inconsistent, and there was substantial variation in imaging methodology, analysis, sample size, and study quality. There is a striking lack of research on morphological brain changes in patients with chronic cancer-related pain. Moreover, only a few studies investigated functional brain changes. In the retrieved studies, there is some evidence that alterations occur in brain networks also involved in other chronic non-cancer pain syndromes. However, the low sample sizes of the studies, finding inconsistencies, and methodological heterogeneity do not allow for robust conclusions.
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Affiliation(s)
- Thijs Vande Vyvere
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
| | - Amber De Groote
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
| | - An De Groef
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Vincent Haenen
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Wiebren Tjalma
- Department of Gynecological Oncology, Antwerp University Hospital, Antwerp, Belgium
- Multidisciplinary Breast Clinic, Antwerp University Hospital, Antwerp, Belgium
| | - Pieter Van Dyck
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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10
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Meeus M. Pain after cancer: Time to move towards a mechanism-based approach! Anat Rec (Hoboken) 2024; 307:243-247. [PMID: 37638722 DOI: 10.1002/ar.25309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023]
Abstract
The high prevalence and the debilitating nature of pain following cancer urge the need for appropriate pain assessment and management in this population. Yet cancer pain remains under-recognized and under-treated. For effective pain management, correct identification of the presence of different underlying pain mechanisms is warranted, since pain management strategies differ considerably according to the predominant mechanisms. To raise awareness around possible underlying pain mechanisms in pain after cancer, the three major pain mechanisms are shortly explained and translated to this specific population. Next, in this Special Issue, we delve further into the existing evidence on the presence of these pain mechanisms in patients with pain after cancer, and on how they can be assessed or approached in patients with pain after cancer.
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Affiliation(s)
- Mira Meeus
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group (PiM), Wilrijk, Belgium
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11
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Harris SR. Brachial plexopathy after breast cancer: A persistent late effect of radiotherapy. PM R 2024; 16:85-91. [PMID: 37272709 DOI: 10.1002/pmrj.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/20/2023] [Accepted: 05/18/2023] [Indexed: 06/06/2023]
Abstract
Radiation-induced brachial plexopathy (RIBP) is an iatrogenic, progressively disabling, and often very late effect of adjuvant radiotherapy most commonly seen in breast cancer survivors but also in those treated for lymphoma, lung, and head and neck cancers. In late-onset RIBP following breast cancer, the nerve injury is chronic and irreversible, occurring more commonly when axillary and/or supraclavicular nodes have been irradiated, as well as the breast/chest wall. RIBP is manifested initially by paresthesia, hypoesthesia, dysesthesia, and later by weakness in the ipsilateral hand with those symptoms progressing distally to proximally up through the shoulder. Depressed/absent deep tendon reflexes in the upper extremity and muscle fasciculations occur also. Neither patients nor their health care providers tend to associate these unusual neurological symptoms with cancer treatments received ≥20 years prior, often failing to link these sensory-motor symptoms with radiotherapy decades before. Because long-term follow-up of these patients now typically falls to general practitioners, many cases may be missed or misdiagnosed because of the rarity of this disorder. Physiatrists and allied rehabilitation professionals must be aware of this progressively disabling, incurable condition to provide appropriate diagnoses and compensatory rehabilitation therapies. Additionally, professional oncology organizations should include RIBP in their long-term, survivorship guidelines for breast cancer. Researchers examining the iatrogenic late effects of radiotherapy should extend their follow-up periods well beyond the current 5-6 years to ascertain the true incidence of RIBP today. Rehabilitation providers must continue to advocate for awareness, diagnosis, and management of iatrogenic outcomes experienced by long-term cancer survivors.
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Affiliation(s)
- Susan R Harris
- Department of Physical Therapy - Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Pelizzola M, Tanderup K, Chopra S, Jürgenliemk-Schulz IM, Nout R, Kirchheiner K, Spampinato S. Co-occurrence of symptoms after radiochemotherapy in locally advanced cervix cancer patients: a cluster analysis. Acta Oncol 2023; 62:1479-1487. [PMID: 37906286 DOI: 10.1080/0284186x.2023.2271252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/06/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND State of the art combined radiochemotherapy and image-guided brachytherapy for locally advanced cervical cancer (LACC) has shown improved disease control and survival as well as a significant reduction of organ related morbidity. However, LACC cancer survivors are still experiencing a spectrum of symptoms. The aim of this study was to identify co-occurring symptoms in cervix cancer survivors by using patient-reported outcome and physician assessed morbidity. MATERIALS AND METHOD EMBRACE I is a multicenter prospective observational study with 1416 LACC patients (2008-2015). Information on physician-assessed morbidity and patient-reported outcome was assessed at baseline and at regular follow-ups up with the CTCAE v.3 and EORTC-C30/CX24, respectively. Patients with at least 2 years of follow-up were included and data from 3 months to 2 years was used in the analysis. Factor analysis was used on both EORTC and CTCAE data with symptoms and follow-ups as observations. The extracted factors represent clusters of symptoms. Subsequently, regression models were built to investigate associations between the symptom clusters and QOL. RESULTS The analysis included 742 patients. Despite the differences in the definition of physician-assessed and patient-reported symptoms, similar clusters are identified by the two assessment methods. Three main organ-related clusters are recognized for urinary, gastro-intestinal and vaginal morbidity. Furthermore, a general symptoms cluster where fatigue, pain, insomnia, neuropathy, and hot flashes have large weights is found. Lastly, a cluster with nausea, vomit and lack of appetite is also identified. The general, gastrointestinal and nausea clusters show significant associations with general QOL. CONCLUSIONS This analysis on both PRO and physician-assessed morbidity found a cluster associated with general symptoms and organ-related symptom clusters (urinary, gastrointestinal, vaginal). This shows that LACC survivors experience a variety of co-occurring symptoms. Our analysis also shows that the cluster of general symptoms is associated with a decrease in QOL.
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Affiliation(s)
- Marta Pelizzola
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Ina M Jürgenliemk-Schulz
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, CX, The Netherlands
| | - Remi Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Sofia Spampinato
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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13
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Zhang T, Wakefield CE, Ren Z, Chen W, Du X, Shi C, Lai L, Zhao C, Gao Y, Chen Z, Zhou Y, Wu T, Cai M. Effects of digital psychological interventions on physical symptoms in cancer patients: A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 84:47-59. [PMID: 37385139 DOI: 10.1016/j.genhosppsych.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/12/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE This meta-analysis was to assess the efficacy of digital psychological interventions to improve physical symptoms (i.e., fatigue, pain, disturbed sleep, and physical well-being) among cancer patients, as well as to evaluate the variables that possibly moderate intervention effects. METHODS Nine databases were searched for the literature up to February 2023. Two reviewers independently conducted a quality assessment. Effect sizes were reported as the standardized mean difference (Hedge's g) and estimated using a random-effects model. RESULTS The meta-analysis included 44 randomized clinical trials comprising 7200 adults with cancer. Digital psychological interventions were associated with significant improvements in short-term fatigue (g = -0.33; 95% CI, -0.58 to -0.07) and disturbed sleep (g = -0.36; 95% CI, -0.57 to -0.15), but with non-significant changes in pain (g = -0.23; 95% CI, -0.68 to 0.21) and physical well-being (g = 0.31; 95% CI, -0.18 to 0.80). Additionally, no alleviation in long-term physical symptoms was observed. In subgroup analysis, results suggest that the country significantly moderated the effectiveness of digital psychological interventions in alleviating fatigue. CONCLUSIONS Digital psychological interventions can be effective for improving short-term fatigue and disturbed sleep in patients with cancer. Clinicians could consider digital psychological interventions as a possible and efficient addition to better manage some of the physical symptoms during and after cancer treatment.
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Affiliation(s)
- Tao Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Claire Elizabeth Wakefield
- School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Sydney, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China.
| | - Wenke Chen
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Xiayu Du
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Congrong Shi
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Lizu Lai
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Chunxiao Zhao
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Yujun Gao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhuang Chen
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Yubu Zhou
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Tong Wu
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Manqi Cai
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
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14
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Wolff J, Stupin J, Olschewski J, Pirmorady Sehouli A, Maier A, Fofana M, Raue JS, Finke G, Sehouli J. Digital therapeutic to improve cancer-related well-being: a pilot randomized controlled trial. Int J Gynecol Cancer 2023:ijgc-2023-004304. [PMID: 37321673 DOI: 10.1136/ijgc-2023-004304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE This randomized waitlist controlled pilot study aimed to evaluate the feasibility and preliminary efficacy of Mika, an app-based digital therapeutic intervention hypothesized to improve management and the support of cancer patients. METHODS Patients with gynecological malignancies undergoing post-operative or routine outpatient chemotherapy were randomized (5:2) into intervention (Mika plus treatment-as-usual) and control (treatment-as-usual alone). Feasibility outcomes including dropout rate, reasons for dropout, and intervention adherence, as well as efficacy outcomes including depression, fatigue, and health literacy were assessed at baseline, 4, 8, and 12 weeks. Changes in efficacy outcomes from baseline to week 12 were evaluated in the intervention group only by means of Wilcoxon signed-rank tests. RESULTS Seventy participants (intervention group, n=50; control group, n=20) with gynecological cancer (ovarian, cervical, and endometrial) were randomized. The dropout rate increased from 15.7% (11/70) between baseline and week 4 to 37.1% (26/70) between weeks 8 and 12. Primary reasons for dropout were death (n=10) and health status deterioration (n=11). The initial high intervention adherence observed between baseline and week 4 (86% usage rate, average usage time: 120 min, average number of logins: 16.7) declined in weeks 8 to 12 (46% usage rate, average usage time: 41 min, average number of logins: 9). Participants in the intervention group showed significant intra-individual reductions in depressive symptoms by 42% (d=0.85) and fatigue symptoms by 23.1% (d=0.5) from baseline to 12 weeks. CONCLUSIONS This pilot study provides initial evidence of the feasibility and efficacy of Mika in improving the well-being of cancer patients. The high initial intervention adherence and significant reductions in depressive and fatigue symptoms suggest that Mika has the potential to improve the management and support of cancer patients. TRIAL REGISTRATION German Clinical Trials Register (DRKS) ID: DRKS00023791; retrospectively registered on February 24, 2022.
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Affiliation(s)
- Josefine Wolff
- Department of Gynecology with Center for Oncological Surgery, Charité Campus Virchow Clinic, Berlin University of Medicine, Berlin, Germany
| | - Jens Stupin
- Department of Gynecology with Center for Oncological Surgery, Charité Campus Virchow Clinic, Berlin University of Medicine, Berlin, Germany
| | - Jessica Olschewski
- Department of Gynecology with Center for Oncological Surgery, Charité Campus Virchow Clinic, Berlin University of Medicine, Berlin, Germany
| | - Adak Pirmorady Sehouli
- Department of Psychosomatic Medicine and Psychotherapy, Charité - Berlin University of Medicine, Berlin, Germany
| | | | | | | | | | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité Campus Virchow Clinic, Berlin University of Medicine, Berlin, Germany
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15
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Oliveira M, Reis-Pina P. [Chemotherapy-Induced Peripheral Neuropathic Pain and the Impact on the Quality of Life]. ACTA MEDICA PORT 2023; 36:440. [PMID: 37261915 DOI: 10.20344/amp.19883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Marta Oliveira
- Unidade de Saúde Familiar Cardilium. Agrupamento Centros de Saúde do Médio Tejo. Administração Regional de Saúde de Lisboa e Vale do Tejo. Torres Novas. Portugal
| | - Paulo Reis-Pina
- Casa de Saúde da Idanha. Sintra; Faculdade de Medicina da Universidade de Lisboa. Lisboa. Portugal
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16
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Billa O, Bonnetain F, Chamois J, Ligey A, Ganansia V, Renard S, Maillard S, Quivrin M, Vulquin N, Truntzer P, Noel G, Maingon P, Dabakuyo-Yonli TS. Predictive value of health-related quality of life on radiotherapy-related toxicities in patients with head and neck cancer. Support Care Cancer 2023; 31:268. [PMID: 37058164 DOI: 10.1007/s00520-023-07736-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE Little is known about whether baseline health-related quality of life (HRQoL) scores also could predict occurrence radiotherapy-related toxicities, which we aim to assess in this study. METHODS This study analyzed data from 200 patients enrolled in randomized study investigating the utility of HRQoL. HRQOL was assessed at baseline and during follow up using QLQ-C30 questionnaire and major toxicity was considered as adverse event ≥ 3 according to NCI-CTCAE classification. Cox regressions adjusting for clinical and sociodemographic data were used to assess prognostic significance of HRQOL scores. RESULTS In multivariable analyses adjusted on clinical and sociodemographic data, every 10-point improvement in physical (HR = 0.74), role (HR = 0.87) and social (HR = 0.88) functioning was associated with 24%, 13% and 12% lower hazard of occurrence of major toxicity respectively while every 10 point-increase in dyspnea (HR = and loss appetite was associated with 15% and 16% increased hazard of major toxicity. CONCLUSION Certain baseline HRQoL scores were found to be significantly associated with the occurrence of major toxicity.
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Affiliation(s)
- Oumar Billa
- Epidemiology and Quality of Life Unit, Georges-François Leclerc Cancer Centre-UNICANCER, 21000, Dijon, France.
- Lipids, Nutrition, Cancer Research Center, U1231 INSERM, 21000, Dijon, France.
- Epidemiology and Quality of Life Unit, Lipids, Nutrition, Cancer Research Center, U1231 INSERM, Georges-François Leclerc Cancer Centre-UNICANCER, 1 rue Professeur Marion BP 77980, 21079, Dijon Cedex, France.
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, Inserm UMR 1098, University Hospital of Besancon, Besancon, France
| | - Jérôme Chamois
- Centre Hospitalier Saint Gregoire, 35760, Saint-Grégoire, France
| | - Angeline Ligey
- Centre Hospitalier Fleriat, 01012, Bourg-en-Bresse, France
| | | | - Sophie Renard
- Institut de Cancérologie de Lorraine, 54519, Vandœuvre-lès-Nancy, France
| | | | - Magali Quivrin
- Radiotherapy Department, Georges-François Leclerc Cancer Centre-UNICANCER, 1 Rue Professeur Marion, 21000, Dijon, France
| | - Noémie Vulquin
- Radiotherapy Department, Georges-François Leclerc Cancer Centre-UNICANCER, 1 Rue Professeur Marion, 21000, Dijon, France
| | - Pierre Truntzer
- Paul Strauss Cancer Centre-Unicancer, 67000, Strasbourg, France
| | - Georges Noel
- Paul Strauss Cancer Centre-Unicancer, 67000, Strasbourg, France
- Institut de Cancerologie Strasbourg Europe, ICANS.eu, 67000, Strasbourg, France
| | - Philippe Maingon
- Radiotherapy Department, Georges-François Leclerc Cancer Centre-UNICANCER, 1 Rue Professeur Marion, 21000, Dijon, France
- Radiotherapy Unit, Hôpital de la Pitié-Salpêtrière-APHP, 75013, Paris, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Epidemiology and Quality of Life Unit, Georges-François Leclerc Cancer Centre-UNICANCER, 21000, Dijon, France
- Lipids, Nutrition, Cancer Research Center, U1231 INSERM, 21000, Dijon, France
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17
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Cuthbert C, Twomey R, Bansal M, Rana B, Dhruva T, Livingston V, Daun JT, Culos-Reed SN. The role of exercise for pain management in adults living with and beyond cancer: a systematic review and meta-analysis. Support Care Cancer 2023; 31:254. [PMID: 37039883 PMCID: PMC10088810 DOI: 10.1007/s00520-023-07716-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Pain is a common side effect of cancer or cancer treatment that negatively impacts biopsychosocial wellbeing and quality of life. Exercise is a potential intervention to manage pain that is safe and has multiple benefits. The objective was to determine the role of exercise in cancer pain management. METHODS We completed a systematic review and meta-analysis of exercise interventions in adults with any type or stage of cancer by searching Ovid MEDLINE®, Embase, APA PsycInfo, the Cochrane Central Register of Controlled Trials, CINAHL, and SPORTDiscus. We included experimental and quasi-experimental designs where pain was measured as an outcome. Data synthesis included narrative and tabular summary. A meta-analysis was performed on studies powered to detect the effect of exercise on pain. Study quality was evaluated using the Cochrane risk of bias tool and certainty of evidence was evaluated using the GRADE tool. RESULTS Seventy-six studies were included. Studies were predominantly conducted in breast cancer and exercise usually included a combination of aerobic and strength training. Ten studies were included in the meta-analysis demonstrating a significant effect for exercise in decreasing pain (estimated average standard mean difference (SMD) was g = - 0.73 (95% CI: - 1.16 to - 0.30)); however, the overall effect prediction interval was large. Overall risk of bias for most studies was rated as some concerns and the grading of evidence certainty was low. CONCLUSION There are limitations in the evidence for exercise to manage cancer-related pain. Further research is needed to understand the role of exercise in a multimodal pain management strategy.
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Affiliation(s)
- Colleen Cuthbert
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Rosie Twomey
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Mannat Bansal
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Benny Rana
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Tana Dhruva
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | | | - Julia T Daun
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - S Nicole Culos-Reed
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
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18
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Leach MJ, Barber G, Monacella S, Jamieson P, Trinh T, Vo N, Schmidt U, Byrne A, Ristevski E. Physical activity, obesity, and quality of life among rural Australian cancer survivors: a cross-sectional study. Support Care Cancer 2023; 31:222. [PMID: 36939924 PMCID: PMC10027785 DOI: 10.1007/s00520-023-07691-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/13/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE We aimed to describe physical activity (PA), obesity, and quality of life (QoL) among rural Australian cancer survivors, assess whether total and item-specific QoL are associated with sufficient PA and obesity, and assess whether PA and obesity interact with respect to QoL. METHODS In a cross-sectional study, convenience sampling was used to recruit adult cancer survivors via a chemotherapy day unit and allied health professionals at a rural hospital in Baw Baw Shire, Australia. Exclusion criteria were acute malnutrition and end-of-life care. PA and QoL were measured using Godin-Shephard and 7-item Functional Assessment of Cancer Therapy (FACT-G7) questionnaires, respectively. Factors associated with total and item-specific QoL were assessed via linear and logistic regression, respectively. RESULTS Among 103 rural cancer survivors, the median age was 66 years, 35% were sufficiently physically active, and 41% presented with obesity. Mean/median total QoL scores were 17 on the FACT-G7 scale (0-28; higher scores indicate better QoL). Sufficient PA was associated with better QoL ([Formula: see text]=2.29; 95% confidence interval [CI] = 0.26, 4.33) and more energy (odds ratio [OR] = 4.00, 95% CI = 1.48, 10.78) while obesity was associated with worse QoL ([Formula: see text]=-2.09; 95% CI = -4.17, -0.01) and more pain (OR = 3.88, 95% CI = 1.29, 11.68). The PA-obesity interaction was non-significant (p-value = 0.83). CONCLUSIONS This is the first known study conducted among rural survivors of any cancer to find sufficient PA and obesity are associated with better and worse QoL, respectively. PA, weight management, and QoL-including energy and pain-should be considered when targeting and tailoring supportive care interventions for rural cancer survivors.
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Affiliation(s)
- Michael J Leach
- School of Rural Health, Monash University, Warragul, Bendigo, VIC, Australia.
| | | | | | | | - Thi Trinh
- West Gippsland Healthcare Group, Warragul, VIC, Australia
| | - Ngan Vo
- West Gippsland Healthcare Group, Warragul, VIC, Australia
| | - Ulla Schmidt
- West Gippsland Healthcare Group, Warragul, VIC, Australia
| | - Anny Byrne
- West Gippsland Healthcare Group, Warragul, VIC, Australia
| | - Eli Ristevski
- School of Rural Health, Monash University, Warragul, VIC, Australia
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19
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Elsous A, Radwan M, Najjar S, Masad A, Abu Rayya M. Unmet needs and health-related quality of life of breast cancer survivors: survey from Gaza Strip, Palestine. Acta Oncol 2023; 62:194-209. [PMID: 36802358 DOI: 10.1080/0284186x.2023.2180326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Cancer, especially breast cancer, remains a public health problem because of its negative consequences, which require long-term programs to alleviate its devastating effects. This study aimed to examine unmet supportive care needs and health-related quality of life of females with breast cancer. METHODS A cross-sectional study with a mixed-method design was employed. A simple, randomly selected sample of 352 females attending Al-Rantisi and Al-Amal hospitals was included in this study. A validated Arabic version of the Supportive Care Needs Survey (34 items) and The European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C15-PAL) were used. Moreover, twenty-five semi-structured interviews were performed (13 females, eight husbands, and four healthcare workers). Quantitative data were analysed using descriptive and inferential analysis, whereas thematic analysis was used for qualitative data to highlight main themes. RESULTS The highest unmet need reported by females with breast cancer was psychological needs (63%), followed by health-related systems and information (62%) and physical and daily life (61%). Pain and fatigue were the most reported symptoms (65.8% and 62.5%, respectively), followed by emotional distress, physical function, and physical symptoms; 55.8%, 54.3%, and 51.5%, respectively. These unmet needs and health-related quality of life-related dimensions were highlighted and elicited by qualitative data analysis. Unmet needs are high among married females, on conservative treatments, young females (< 40 years old), and females in the first year of diagnosis. The presence of chronic diseases did not increase needs. However, health-related quality of life was affected. Six themes are subtracted: availability of anticancer therapy, affordability of healthcare, family and social support, psychological support, health education, and self-image & intimate relationship. CONCLUSION Many needs are unmet. Caring for females with breast cancer should be comprehensive to fill gaps, including psychological care, health information and education, physical care and support, and medical care.
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Affiliation(s)
- Aymen Elsous
- Faculty of Medical Sciences, Israa University -Gaza, Gaza strip, Palestine.,Department of Planning, Unit of Planning and Institutional Development Performance, Ministry of Health, Gaza strip, Palestine
| | - Mahmoud Radwan
- Department of Foreign Relations, General Directorate of International Cooperation, Ministry of Health, Gaza strip, Palestine
| | - Shahenaz Najjar
- Health Policy and Health Informatics, Arab American University of Palestine, Palestine.,Leuven Institute for Healthcare Policy, Pillar Quality and Safety, Department of Public Health and Primary Care, KU Leuven
| | - Atef Masad
- Department of Medical Laboratories, Faculty of Medical Sciences, Israa University -Gaza, Gaza strip, Palestine
| | - Mohammed Abu Rayya
- Public Health Consultant, Aid and Hope Program for Cancer Patients Care, Gaza strip, Palestine
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20
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Rugo HS, Umanzor GA, Barrios FJ, Vasallo RH, Chivalan MA, Bejarano S, Ramírez JR, Fein L, Kowalyszyn RD, Kramer ED, Wang H, Kwan MFR, Cutler DL. Open-Label, Randomized, Multicenter, Phase III Study Comparing Oral Paclitaxel Plus Encequidar Versus Intravenous Paclitaxel in Patients With Metastatic Breast Cancer. J Clin Oncol 2023; 41:65-74. [PMID: 35858154 PMCID: PMC9788977 DOI: 10.1200/jco.21.02953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Intravenous paclitaxel (IVpac) is complicated by neuropathy and requires premedication to prevent hypersensitivity-type reactions. Paclitaxel is poorly absorbed orally; encequidar (E), a novel P-glycoprotein pump inhibitor, allows oral absorption. METHODS A phase III open-label study comparing oral paclitaxel plus E (oPac + E) 205 mg/m2 paclitaxel plus 15 mg E methanesulfonate monohydrate 3 consecutive days per week versus IVpac 175 mg/m2 once every 3 weeks was performed. Women with metastatic breast cancer and adequate organ function, at least 1 year from last taxane, were randomly assigned 2:1 to oPac + E versus IVpac. The primary end point was confirmed radiographic response using RECIST 1.1, assessed by blinded independent central review. Secondary end points included progression-free survival (PFS) and overall survival (OS). RESULTS Four hundred two patients from Latin America were enrolled (265 oPac + E, 137 IVpac); demographics and prior therapies were balanced. The confirmed response (intent-to-treat) was 36% for oPac + E versus 23% for IVpac (P = .01). The PFS was 8.4 versus 7.4 months, respectively (hazard ratio, 0.768; 95.5% CI, 0.584 to 1.01; P = .046), and the OS was 22.7 versus 16.5 months, respectively (hazard ratio, 0.794; 95.5% CI, 0.607 to 1.037; P = .08). Grade 3-4 adverse reactions were 55% with oPac + E and 53% with IVpac. oPac + E had lower incidence and severity of neuropathy (2% v 15% > grade 2) and alopecia (49% v 62% all grades) than IVpac but more nausea, vomiting, diarrhea, and neutropenic complications, particularly in patients with elevated liver enzymes. On-study deaths (8% oPac + E v 9% IVpac) were treatment-related in 3% and 0%, respectively. CONCLUSION oPac + E increased the confirmed tumor response versus IVpac, with trends in PFS and OS. Neuropathy was less frequent and severe with oPac + E; neutropenic serious infections were increased. Elevated liver enzymes at baseline predispose oPac + E patients to early neutropenia and serious infections (funded by Athenex, Inc; ClinicalTrials.gov identifier: NCT02594371).
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Affiliation(s)
- Hope S. Rugo
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA,Hope S. Rugo, MD, UCSF Helen Diller Family Comprehensive Cancer Center, 70 Santa Clara Ave, San Francisco, CA 94127; e-mail:
| | | | | | | | | | | | - Julio R. Ramírez
- Sanatorio Centro Regional de Sub-Especialidades Médicas (CRESEM), Quetzaltenango, Guatemala
| | - Luis Fein
- Instituto de Oncología de Rosario, Rosario, Argentina
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21
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Hypnosis and relaxation interventions for chronic pain management in cancer survivors: a randomized controlled trial. Support Care Cancer 2023; 31:50. [DOI: 10.1007/s00520-022-07498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
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22
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Tay MRJ, Wong CJ, Aw HZ. Assessment of Health-Related Quality of Life and Distress in an Asian Community-Based Cancer Rehabilitation Program. Curr Oncol 2022; 29:7012-7020. [PMID: 36290828 PMCID: PMC9600369 DOI: 10.3390/curroncol29100551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 01/13/2023] Open
Abstract
Cancer survivors have reduced health-related quality of life (HRQOL) and high levels of distress during and after active treatment, due to physical, psychological, and social problems. Understanding the prevalence and associations of HRQOL and distress in a patient population in the community is important when designing rehabilitation programs. This was a cross-sectional observational study conducted at a community-based cancer rehabilitation center, with the aim of investigating the prevalence and associations of HRQOL and distress in cancer patients. There were 304 patients who were recruited. We found low levels of HRQOL and high levels of distress in patients, with a mean FACT-G7 total score of 11.68, and a mean distress thermometer score of 3.51. In the multivariate regression model, significant factors for low HRQOL were metastatic disease (p = 0.025) and Malay ethnicity (p < 0.001). Regression analyses also found that significant distress was associated with family health issues (p = 0.003), depression (p = 0.001), worry (p = 0.005), breathing (p = 0.007), getting around (p = 0.012) and indigestion (p = 0.039). A high prevalence of impaired HRQOL and distress was reported in cancer survivors even in a community rehabilitation setting. The physical and psychosocial well-being of cancer survivors should be monitored and managed as part of community-based cancer rehabilitation.
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Affiliation(s)
- Matthew Rong Jie Tay
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
- Singapore Cancer Society Rehabilitation Center, 52 Jurong Gateway Rd, Singapore 608550, Singapore
- Correspondence:
| | - Chin Jung Wong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
- Singapore Cancer Society Rehabilitation Center, 52 Jurong Gateway Rd, Singapore 608550, Singapore
| | - Hui Zhen Aw
- Singapore Cancer Society Rehabilitation Center, 52 Jurong Gateway Rd, Singapore 608550, Singapore
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23
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Liu C, Tang Y, Li H, Zhao G, Li B, Zhang B, Zhao Z, Shen C, Cai Z. Cognitive behavioural therapy for insomnia in people with cancer. Hippokratia 2022. [DOI: 10.1002/14651858.cd015176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Chunyu Liu
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
- Evidence-Based Pharmacy Center; West China Second University Hospital, Sichuan University; Chengdu China
- Department of Pharmacy; West China Second University Hospital, Sichuan University; Chengdu China
| | - Yiguo Tang
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy; West China Hospital of Sichuan University; Chengdu, Sichuan China
| | - Hancong Li
- West China School of Medicine, Sichuan University; Chengdu China
| | - Guozhen Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University; Beijing China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University; Beijing China
| | - Bo Zhang
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
| | - Zhou Zhao
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
| | - Chaoyong Shen
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
| | - Zhaolun Cai
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
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24
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Pérez-Hernández C, Cánovas ML, Carmona-Bayonas A, Escobar Y, Margarit C, Mulero Cervantes JF, Quintanar T, Serrano Alfonso A, Virizuela J. A Delphi Study on the Management of Neuropathic Cancer Pain in Spain: The DOLNEO Study. J Pain Res 2022; 15:2181-2196. [PMID: 35942117 PMCID: PMC9356710 DOI: 10.2147/jpr.s365351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The objectives of this project were to assess the current situation and management of cancer-related neuropathic pain (CRNP) in Spain and to provide specific recommendations for the assessment, diagnosis and treatment of CRNP using a Delphi methodology. Methods This was a qualitative study that followed a Delphi methodology using a questionnaire with 56 statements that were grouped into 5 areas related to CRNP: prevalence and impact, pathophysiology, assessment and diagnosis, specific syndromes, treatment, and multidisciplinary approach. Based on the responses, the scientific committee prepared an algorithm and a recommended pathway for the management of CRNP. Results Seventy-nine physicians attended the meeting and completed the questionnaire. Consensus was reached for all statements relating to the prevalence and impact of CRNP. However, the perceptions of specialists from palliative care of the frequency and impact of CRNP differed from those of other specialists. A high degree of consensus was reached for all statements concerning the assessment and diagnosis of CRNP. Regarding specific syndromes, the only statement with a lack of consensus was that on the frequency of NP in patients undergoing radiotherapy. There were some disagreements regarding the multidisciplinary approach and referral criteria for the management of NP. Conclusion Our results show a large degree of agreement on the assessment, diagnosis and treatment of cancer-related neuropathic pain among the specialists involved in its management. There were, however, some disagreements regarding the multidisciplinary approach and referral criteria for the management of neuropathic pain.
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Affiliation(s)
- Concepción Pérez-Hernández
- Pain Unit, Hospital Universitario de la Princesa, Madrid, Spain
- Correspondence: Concepción Pérez-Hernández, Pain Unit, Hospital Universitario de la Princesa, Calle de Diego de León 62, Madrid, 28006, Spain, Tel +34 915 20 22 00, Email
| | - María Luz Cánovas
- Anesthesia, Complexo Hospitalario Universitario de Ourense (SERGAS), Ourense, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - Yolanda Escobar
- Medical Oncology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - César Margarit
- Pain Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Teresa Quintanar
- Medical Oncology, Hospital General Universitario de Elche, Elche, Spain
| | - Ancor Serrano Alfonso
- Anesthesiology, Resuscitation and Pain Management, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Virizuela
- Medical Oncology, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Content features and its implementation in novel app-based psycho-oncological interventions for cancer survivors: a narrative review. Curr Opin Oncol 2022; 34:313-319. [PMID: 35837701 DOI: 10.1097/cco.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The interest in and availability of app-based psycho-oncological interventions for cancer survivors has grown rapidly. In this narrative review, we therefore aim to provide an overview of the psychological content features included in psycho-oncological apps and how the content is implemented in the apps. RECENT FINDINGS A total of 19 studies (six randomized controlled trials, six studies with prepost design, five study protocols and two app developments), all published in the last 18 months (July 2020 to December 2021), were analyzed in terms of the described app-based interventions and their psycho-oncological content. Apps for cancer survivors are conducted for a variety of different diagnoses and often target a specific patient population, for example patients with a specific therapy. The most frequent content features are psychoeducation, self-monitoring of symptoms, and some sort of exercise or relaxation program. Depending on the app's purpose, some offer specific content, such as decision aids, medication schedules or modules to improve coping strategies. Most apps combine informative and interactive elements. SUMMARY Psycho-oncological apps for cancer survivors target many relevant psychological problem areas and aim to improve patient empowerment. Available mHealth interventions can therefore be seen as a good complement for cancer care and also offer the possibility to improve patient involvement.
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Wan Q, Luo S, Wang X, Tian Q, Xi H, Zheng S, Fang Q, Chen H, Wu W, Pan R. Association of Acupuncture and Auricular Acupressure With the Improvement of Sleep Disturbances in Cancer Survivors: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:856093. [PMID: 35664757 PMCID: PMC9159913 DOI: 10.3389/fonc.2022.856093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Studies on the efficacy of acupuncture and auricular acupressure on sleep disturbances in cancer patients have been growing, but there is no specific and comprehensive systematic review and meta-analysis. This review aims to evaluate the efficacy and safety of acupuncture and auricular acupressure on sleep disturbances in cancer survivors based on existing randomized clinical trials (RCTs). Methods Four English-language and four Chinese-language biomedical databases were searched for RCTs published from database inception to July 30, 2021. RCTs comparing acupuncture and auricular acupressure with sham control, drug therapy, behavior therapy, or usual care for managing cancer were included. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias (ROB) tool. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated for the effect sizes. Results Thirteen RCTs with 961 patients were included. The risk of performance bias or reporting bias for most of the included trials was high or unclear. Evidence was not found for short-term effects on sleep scales compared to sham control (MD, 1.98; 95% CI, 0.33-3.64; p = 0.02; I2 = 36%), wait list control (MD, 0.40; 95% CI, -0.87-1.68; p = 0.54; I2 = 49%), drug therapy (MD, 1.18; 95% CI, -3.09-5.46; p = 0.59; I2 = 98%). For long-term effect, two sham-controlled RCTs showed no significance of acupuncture on insomnia scale scores (MD, 1.71; 95% CI, -2.38-5.81; p = 0.41; I2 = 89%). Subgroup analyses suggested no evidence that auricular acupressure (MD, 3.14; 95% CI=1.52, 4.76; p = 0.0001; I2 = 0%) or acupuncture (MD, 0.54; 95% CI=-1.27, 2.34; p = 0.56; I2 = 0%) was associated with the reduction in insomnia scale scores. Conclusions This systematic review and meta-analysis found no evidence about acupuncture or auricular acupressure in the improvement of sleep disturbances in cancer survivors in terms of short- or long-term effect. Adverse events were minor. The finding was inconsistent with previous research and suggested that more well-designed and large-scale randomized controlled trials are needed to identify the efficacy of acupuncture and auricular acupressure for sleep disturbances in cancer survivors. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, CRD42020171612.
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Affiliation(s)
- Qingyun Wan
- Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shuting Luo
- Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaoqiu Wang
- Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Qianmo Tian
- Department of Acupuncture and Rehabilitation, Nanjing Traditional Chinese Medicine Hospital, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hanqing Xi
- Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shiyu Zheng
- Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Qinqin Fang
- Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hao Chen
- The Second Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenzhong Wu
- Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Rui Pan
- Department of Oncology, Jiangsu Cancer Hospital, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
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27
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O'Malley DM, Davis SN, Amare R, Sanabria B, Sullivan B, Devine KA, Ferrante JM, Findley PA, Miller SM, Hudson SV. User-Centered Development and Patient Acceptability Testing of a Health-Coaching Intervention to Enhance Cancer Survivorship Follow-up in Primary Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:788-797. [PMID: 33025453 PMCID: PMC8024404 DOI: 10.1007/s13187-020-01883-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 05/07/2023]
Abstract
We describe an iterative three-phase approach used to develop a cancer survivorship health-coaching intervention to guide self-management and follow-up care for post-treatment breast, colorectal, and prostate cancer survivors. Informed by theory (e.g., Cognitive-Social Health Information Processing Model (C-SHIP)), relevant literature, and clinical guidelines, we engaged in a user-centered design process. In phase I, we conducted depth interviews with survivors of breast (n = 34), prostate (n = 4), and colorectal (n = 6) cancers to develop a health coaching prototype. In phase II, we utilized user-testing interviews (n = 9) to test and refine the health coaching prototype. For both phases, we used a template analysis independently coding each interview. In phase I, majority (n = 34, 81%) of survivors were positive about the utility of health coaching. Among these survivors (n = 34), the top areas of identified need were emotional support (44%), general health information (35.3%), changes in diet and exercise (29.3%), accountability and motivation (23.5%), and information about treatment effects (17.7%). The prototype was developed and user-tested and refined in phase III to address the following concerns: (1) the amount of time for calls, (2) density of reading materials, (3) clarity about health coaches' role, (4) customization. Collectively, this resulted in the development of the Extended Cancer Educational for Long-Term Cancer Survivors health-coaching (EXCELSHC) program, which represents the first cancer survivorship follow-up program to support follow-up care designed-for-dissemination in primary care settings. EXCELSHC is being tested in a clinical efficacy trial. Future research will focus on program refinement and testing for effectiveness in primary care.
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Affiliation(s)
- Denalee M O'Malley
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.
- Rutgers Biomedical and Health Sciences, New Brunswick, USA.
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA.
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.
| | - Stacy N Davis
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Biomedical and Health Sciences, New Brunswick, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
- Rutgers, School of Public Health, Department of Health Behavior, Society, and Policy, New Brunswick, USA
| | - Rahwana Amare
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Biomedical and Health Sciences, New Brunswick, USA
| | - Bianca Sanabria
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Biomedical and Health Sciences, New Brunswick, USA
| | - Brittany Sullivan
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Biomedical and Health Sciences, New Brunswick, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Katie A Devine
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Jeanne M Ferrante
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Biomedical and Health Sciences, New Brunswick, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Patricia A Findley
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
- Rutgers School of Social Work, New Brunswick, USA
| | | | - Shawna V Hudson
- Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
- Rutgers Biomedical and Health Sciences, New Brunswick, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
- Rutgers, School of Public Health, Department of Health Behavior, Society, and Policy, New Brunswick, USA
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28
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Li H, Liu H. The influence of Chinese herbal medicines on cancer-related pressure ulcer wound, fatigue, constipation, and anorexia: A meta-analysis. Int Wound J 2022; 20:28-37. [PMID: 35582926 PMCID: PMC9797920 DOI: 10.1111/iwj.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/13/2022] [Accepted: 04/21/2022] [Indexed: 01/07/2023] Open
Abstract
We performed a meta-analysis to evaluate the influence of Chinese herbal medicines on cancer-related pressure ulcer wounds, fatigue, constipation, and anorexia. A systematic literature search up to March 2022 was done and 25 studies included 1777 subjects with cancer-related symptoms at the start of the study; 953 of them were provided with Chinese herbal medicines and 824 were control. They were reporting relationships about the influence of Chinese herbal medicines on cancer-related pressure ulcer wounds, fatigue, constipation, and anorexia. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the influence of Chinese herbal medicines on cancer-related pressure ulcer wounds, fatigue, constipation, and anorexia using the dichotomous method with a random or fixed-effect model. Chinese herbal medicines had significantly higher effectiveness in treating pressure ulcer wound (OR, 5.94; 95% CI, 3.94-8.95, P < .001), fatigue (OR, 2.81; 95% CI, 1.78-4.41, P < .001), and effectiveness on treating constipation (OR, 2.59; 95% CI, 1.57-4.25, P < .001) compared to control in subjects with cancer-related symptoms. However, Chinese herbal medicines had no significant effect on treating anorexia (OR, 1.69; 95% CI, 0.61-4.66, P = .31) compared to control in subjects with cancer-related symptoms. Chinese herbal medicines had significantly higher effectiveness in treating pressure ulcer wound, treating pressure ulcer wound, fatigue, and constipation compared to control in subjects with cancer-related symptoms. However, Chinese herbal medicines had no significant effect on the effectiveness of treating anorexia compared to control in subjects with cancer-related symptoms. Further studies are required to validate these findings.
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Affiliation(s)
- Han Li
- Internal Medicine of Traditional Chinese Medicine, Senior Department of Traditional Chinese MedicineThe Sixth Medical Center of PLA General HospitalBeijingChina
| | - Huan Liu
- Gynecology of Integrated Traditional Chinese and Western MedicineBeijing Xicheng Guangwai HospitalBeijingChina
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Yang M, Baser RE, Li SQ, Hou YN, Chong K, Zhang YL, Hoque I, Bao T, Mao JJ. Tibetan Herbal Pain-Relieving Plaster for Chronic Musculoskeletal Pain Among Cancer Survivors: Study Protocol of a Randomized, Double-Blind, Placebo-Controlled Trial. Front Pharmacol 2022; 13:878371. [PMID: 35600872 PMCID: PMC9114465 DOI: 10.3389/fphar.2022.878371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic pain is common and debilitating in cancer survivors. Tibetan herbal pain-relieving plaster is used as an external analgesic to treat musculoskeletal pain in China; however, its safety and efficacy have not been evaluated via clinical trials in cancer survivors. We designed this Phase II randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov Identifier: NCT04916249) to assess the efficacy and safety of the pain-relieving plaster for temporary pain relief among cancer survivors with chronic musculoskeletal pain. Under ethical approval from the Institutional Review Board at the Memorial Sloan Kettering Cancer Center, we will enroll eligible cancer survivors who have a clinical diagnosis of moderate to severe chronic musculoskeletal pain in this study. We use a central randomization system to allocate the eligible participants to either the treatment or the control group in a 1:1 ratio, with stratification by baseline opioid use. We will instruct the participants to apply the herbal patch (Tibetree Pain-Relieving Plaster, Tibet Cheezheng Tibetan Medicine Co. Ltd., Tibet, China) or placebo patch daily at the focal area with worst pain for 14 consecutive days. Study physician, participant, outcome assessor, and biostatistician are blinded to the group allocation. The primary outcome is pain severity measured by the Brief Pain Inventory on Days 2–7. Secondary outcomes include changes in insomnia, anxiety, depression, fatigue, pressure pain threshold, pain medication use, and global impression of change. We will also monitor the adverse events throughout the study period. Statistical analysis will follow the intention-to-treat principle and linear mixed modeling will be used. With rigorous design and implementation, this randomized, placebo-controlled trial will provide the initial evidence on the efficacy and safety of the pain-relieving plaster for pain relief among cancer survivors with chronic musculoskeletal pain.
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Affiliation(s)
- Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, NY, United States
| | - Susan Q. Li
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yen-Nien Hou
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Kamyar Chong
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yi Lily Zhang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Irfan Hoque
- Investigational Drug Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ting Bao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Jun J. Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
- *Correspondence: Jun J. Mao,
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30
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Ke Y, Tan CJ, Yeo HLA, Chan A. Adherence to Cancer Survivorship Care Guidelines and Health Care Utilization Patterns Among Nonmetastatic Breast Cancer Survivors in Singapore. JCO Glob Oncol 2022; 8:e2100246. [PMID: 35377727 PMCID: PMC9005251 DOI: 10.1200/go.21.00246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Currently, limited information is available on care provided to breast cancer survivors in Singapore. This study aims to assess the quality of post-treatment cancer survivorship care among breast cancer survivors on the basis of compliance with international guidelines up to 5 years post-primary treatment. We evaluated the adherence to international breast cancer survivorship care guidelines in Singapore.![]()
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Affiliation(s)
- Yu Ke
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Chia Jie Tan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Hui Ling Angie Yeo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National Cancer Centre Singapore, Singapore.,Department of Clinical Pharmacy Practice, University of California Irvine, Irvine, CA
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31
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Chen RW, Wang Q, Hu T, Xie YX, Chang HY, Cheng J. Validation and Application of the Chinese Version of the M. D. Anderson Symptom Inventory in Breast Cancer Patients. Curr Med Sci 2022; 42:426-433. [PMID: 35314928 DOI: 10.1007/s11596-022-2544-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/09/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To validate and use the Chinese Version of the M. D. Anderson Symptom Inventory (MDASI-C) to assess the symptom burden of breast cancer patients in China. METHODS A total of 342 breast cancer patients in China participated in this study. Their symptoms were investigated with the MDASI-C from November 2020 to February 2021, and the reliability and validity of this tool were evaluated, respectively. Cluster analysis and correlation analysis were also performed. RESULTS The Cronbach's alpha coefficient values of the symptom and interference items were 0.827 and 0.880, respectively. Construct validity revealed a four-factor structure. The Kaiser-Meyer-Olkin value was 0.760. The Karnofsky Performance Status, treatment phase, and cancer stage of the patients were grouped, and the differences of scores within the groups were significant. In addition, the employment status, education level, and age of the patients were significantly correlated with the symptoms. The correlation analysis of the education level of the patients showed that most of the symptoms and interference items were reduced as the education level was increased. The top three symptoms were disturbed sleep (3.10±2.52), difficulty remembering (2.54±2.30), and fatigue (2.24±2.13). The clinical and biochemical indicators such as body mass index and neutral granulocyte lymphocyte ratio had effects on many symptoms. As the patients' BMI increased, the patients' pain, disturbed sleep, and difficulty remembering were aggravated, and numbness was alleviated. CONCLUSION The MDASI-C is a reliable and effective assessment tool to evaluate patients with breast cancer in China. The symptoms are related to many clinical and biochemical indicators.
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Affiliation(s)
- Ren-Wang Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qiong Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ting Hu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yu-Xiu Xie
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hai-Yan Chang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing Cheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Zhang X, Ma L, Feng L. Web-based self-management intervention for patients with cancer: A meta-analysis and systematic review. J Nurs Scholarsh 2022; 54:598-606. [PMID: 35294089 DOI: 10.1111/jnu.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/04/2021] [Accepted: 02/16/2022] [Indexed: 01/02/2023]
Abstract
AIM This study is conducted to synthesize the effects of web-based self-management intervention on patients with cancer. EVALUATION We searched Web of Science, PubMed, Embase and Cochrane library databases for related randomized controlled trials from inception through 2021. Reference lists of included studies were also searched for additional qualified studies. For quantitative data synthesis, standardized mean differences were used to eliminate the influence caused by different scales. Narrative synthesis was also performed. KEY ISSUES Nine in 1149 studies were included for narrative and quantitative analysis. The pooled data suggested that patients in the intervention group had better quality of life (standardized mean difference = 1.091, 95% confidence interval: 0.155-2.028) and lower depression (standardized mean difference = -1.634, 95% confidence interval: -2.980 to -0.287) than those in the control group. The result of narrative synthesis is that patients receiving intervention had lower cancer or symptom distress and higher self-efficacy than those in the control group. CONCLUSION Web-based self-management intervention improved lives of cancer survivors.
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Affiliation(s)
- Xiaoping Zhang
- Operating Theatre, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lina Ma
- Regis Aged Care, The Gap, Brisbane, Queensland, Australia
| | - Li Feng
- Operating Theatre, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Jerbi SHM, Alanazi SNS, Alanazi WAS, Mutlaq AYH, Alotaibi FSM, Alenezi MAH. The Role of Physiotherapy in the Management of Lymphoma Patients: Systematic Review. PHARMACOPHORE 2022. [DOI: 10.51847/dauh9lwbfl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Sohl SJ, Tooze JA, Johnson EN, Ridner SH, Rothman RL, Lima CR, Ansley KC, Wheeler A, Nicklas B, Avis NE, Wagner LI. A Randomized Controlled Pilot Study of Yoga Skills Training Versus an Attention Control Delivered During Chemotherapy Administration. J Pain Symptom Manage 2022; 63:23-32. [PMID: 34343620 PMCID: PMC8766874 DOI: 10.1016/j.jpainsymman.2021.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 01/03/2023]
Abstract
CONTEXT It is important to address fatigue and co-occurring symptoms during chemotherapy to preserve quality of life in patients with gastrointestinal (GI) cancer. OBJECTIVE To conduct a randomized controlled pilot study of a Yoga Skills Training (YST) intervention compared to an attention control (AC) among adults diagnosed with GI cancer. METHODS YST consisted of four 30-minute sessions delivered individually during chemotherapy plus home practice. AC provided empathic attention plus home diaries. Patient-reported (PROMIS T-score) assessments of fatigue, depressive symptoms, sleep disturbances, and psychological stress (Perceived Stress Scale) were collected at chemotherapy visits: baseline, Week 8, Week 10 and Week 14, and analyzed using a mixed effects model. Inflammatory cytokines were assessed at baseline and Week 10. RESULTS Forty-four of 77 adults approached agreed to participate (57%; YST n = 23; AC n = 21). Participants' mean age was 58 years and 48% were men. Participants randomized to YST reported a larger decline in fatigue (-2.4 difference, d = 0.30) and depressive symptoms (-2.5 difference, d = 0.30) than AC participants from baseline to Week 10 and sleep disturbances at Week 8 (-3.9 difference, d = 0.50). Differences in magnitude of change in symptoms were consistent with or exceeded a minimally important difference. Psychological stress decreased more in the AC at Week 10 (d = 0.30). Reductions in inflammatory cytokines (IL-6, sTNF R1) were larger in the YST group than AC. CONCLUSION YST showed promise for improving fatigue, depressive symptoms, sleep disturbances, and inflammation. YST is also feasible and reaches patients underrepresented in yoga research (i.e., GI cancer, men), thus warranting further examination.
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Affiliation(s)
- Stephanie J Sohl
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA.
| | - Janet A Tooze
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
| | - Emily Nance Johnson
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
| | - Sheila H Ridner
- Vanderbilt University School of Nursing (S.H.R.), Nashville, Tennessee, USA
| | - Russell L Rothman
- Vanderbilt University School of Medicine (R.L.R.), Nashville, Tennessee, USA
| | - Caio Rocha Lima
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
| | - Katherine C Ansley
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
| | - Amy Wheeler
- California State University (A.W.), San Bernardino, California, USA
| | - Barbara Nicklas
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
| | - Nancy E Avis
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
| | - Lynne I Wagner
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
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Lifestyle and Pain following Cancer: State-of-the-Art and Future Directions. J Clin Med 2021; 11:jcm11010195. [PMID: 35011937 PMCID: PMC8745758 DOI: 10.3390/jcm11010195] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023] Open
Abstract
This review discusses chronic pain, multiple modifiable lifestyle factors, such as stress, insomnia, diet, obesity, smoking, alcohol consumption and physical activity, and the relationship between these lifestyle factors and pain after cancer. Chronic pain is known to be a common consequence of cancer treatments, which considerably impacts cancer survivors' quality of life when it remains untreated. Improvements in lifestyle behaviour are known to reduce mortality, comorbid conditions (i.e., cardiovascular diseases, other cancer, and recurrence) and cancer-related side-effects (i.e., fatigue and psychological issues). An inadequate stress response plays an important role in dysregulating the body's autonomic, endocrine, and immune responses, creating a problematic back loop with pain. Next, given the high vulnerability of cancer survivors to insomnia, addressing and treating those sleep problems should be another target in pain management due to its capacity to increase hyperalgesia. Furthermore, adherence to a healthy diet holds great anti-inflammatory potential for relieving pain after cancer. Additionally, a healthy diet might go hand in hand with weight reduction in the case of obesity. Consuming alcohol and smoking have an acute analgesic effect in the short-term, with evidence lacking in the long-term. However, this acute effect is outweighed by other harms on cancer survivors' general health. Last, informing patients about the benefits of an active lifestyle and reducing a sedentary lifestyle after cancer treatment must be emphasised when considering the proven benefits of physical activity in this population. A multimodal approach addressing all relevant lifestyle factors together seems appropriate for managing comorbid conditions, side-effects, and chronic pain after cancer. Further research is needed to evaluate whether modifiable lifestyle factors have a beneficial influence on chronic pain among cancer survivors.
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Yang M, Liou KT, Garland SN, Bao T, Hung TKW, Li SQ, Li Y, Mao JJ. Acupuncture versus cognitive behavioral therapy for pain among cancer survivors with insomnia: an exploratory analysis of a randomized clinical trial. NPJ Breast Cancer 2021; 7:148. [PMID: 34848737 PMCID: PMC8633385 DOI: 10.1038/s41523-021-00355-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023] Open
Abstract
Pain and insomnia often co-occur and impair the quality of life in cancer survivors. This study evaluated the effect of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on pain severity among cancer survivors with comorbid pain and insomnia. Using data from the CHOICE trial that compared acupuncture versus CBT-I for insomnia among cancer survivors, we analyzed the effect of interventions on pain outcomes in 70 patients with moderate to severe baseline pain. Interventions were delivered over eight weeks. We assessed average pain severity (primary outcome) and pain interference at baseline, week 8, and week 20. We further defined insomnia and pain responders as patients who achieved clinically meaningful improvement in insomnia and pain outcomes, respectively, at week 8. We found that compared with baseline, the between-group difference (-1.0, 95% CI -1.8 to -0.2) was statistically significant favoring acupuncture for reduced pain severity at week 8 (-1.4, 95% CI -2.0 to -0.8) relative to CBT-I (-0.4, 95% CI-1.0 to 0.2). Responder analysis showed that 1) with acupuncture, insomnia responders reported significantly greater pain reduction from baseline to week 4, compared with insomnia non-responders (-1.5, 95% CI -2.7 to -0.3); 2) with CBT-I, pain responders reported significantly greater insomnia reduction at week 8, compared with pain non-responders (-4.7, 95% CI -8.7 to -1.0). These findings suggest that among cancer survivors with comorbid pain and insomnia, acupuncture led to rapid pain reductions, which contributed to a decrease in insomnia, whereas CBT-I had a delayed effect on pain, possibly achieved by insomnia improvement.
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Affiliation(s)
- Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Kevin T Liou
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Sheila N Garland
- Department of Psychology and Discipline of Oncology, Memorial University, 232 Elizabeth Avenue, St. John's, NL A1B 3×9, Canada
| | - Ting Bao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Tony K W Hung
- Department of Medicine, Division of Solid Tumor Oncology, Head & Neck Oncology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Susan Q Li
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Jun J Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA.
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Creff G, Jegoux F, Bendiane MK, Babin E, Licaj I. Social and sexual health of thyroid cancer survivors 2 and 5 years after diagnosis: the VICAN survey. Support Care Cancer 2021; 30:2777-2785. [PMID: 34837541 DOI: 10.1007/s00520-021-06715-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 11/19/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Thyroid cancer (TC) incidence is increasing. With its good prognosis and the young population concerned, the number of survivors is rising. However, their quality of life appears worse than expected. This study aims to assess the social and sexual health (SSH) of TC survivors and associated factors after a 2- and 5-year follow-up. METHODS This study belongs to the National VICAN Survey implemented in France among TC patients diagnosed between January and June 2010. Data were collected via phone interviews, medical surveys, and from medico-administrative register in 2012 and 2015. We used multivariable logistic regressions to qualify TC impact on SSH. RESULTS Across 146 patients, 121 were women, 50.7% were less than 42 years old, 77.5% were diagnosed at an early-stage, and 97.6% underwent thyroidectomy. At 2 years, 60.0% experienced social life discomfort because of cancer, 40.6% reported a decreased sexual desire, 37.4% fewer intercourse, 31.9% felt dissatisfied with this frequency, 30% reported difficulties achieving orgasm, and 15.2% considered that cancer had a negative influence for procreation. No significant difference was observed at 5 years. SSH was never discussed with medical professionals for 96.7% patients, as it was not proposed as a topic of concern (79.1%). In multivariable analysis, depression, embarrassment regarding their physical appearance since treatment, and reduced gestures of affection remained associated with decreased sexual desire. CONCLUSION This study highlights that TC is associated with an alteration of SSH which remains even at 5 years post-diagnosis. SSH should be discussed during diagnosis and considered during follow-up.
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Affiliation(s)
- Gwenaelle Creff
- Department of Otolaryngology Head and Neck Surgery, Rennes University Hospital, 35000, Rennes, France.
| | - Franck Jegoux
- Department of Otolaryngology Head and Neck Surgery, Rennes University Hospital, 35000, Rennes, France
| | | | - Emmanuel Babin
- Head and Neck Department, University Hospital Centre Caen, Caen, France
- Cancer & Cognition Platform, Ligue Contre Le Cancer, Caen, France
| | - Idlir Licaj
- Cancer & Cognition Platform, Ligue Contre Le Cancer, Caen, France
- Clinical Research Department, Centre François Baclesse, Caen, France
- Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
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Li J, Zhu C, Liu C, Su Y, Peng X, Hu X. Effectiveness of eHealth interventions for cancer-related pain, fatigue, and sleep disorders in cancer survivors: A systematic review and meta-analysis of randomized controlled trials. J Nurs Scholarsh 2021; 54:184-190. [PMID: 34791779 DOI: 10.1111/jnu.12729] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To systematically evaluate the effects of Electronic health (eHealth) interventions on fatigue, pain, and sleep disorders in cancer survivors. DESIGN A systematic review and meta-analysis was conducted. METHODS Relevant studies were searched from five databases (MEDLINE, Embase, the Cochrane Central Register of Controlled trials, CINAHL, and PsycINFO). The comprehensive literature search was done in December 2020. Only randomized controlled trials (RCTs) that examined the effects of eHealth interventions among cancer survivors were included. FINDINGS Twenty-five RCTs were included. The meta-analysis showed that eHealth interventions had a positive impact on pain interference (SMD = -0.37, 95% CI: -0.54 to -0.20, p = 0.0001) and sleep disorders (SMD = -0.43, 95% CI: -0.77 to -0.08, p = 0.02) but not on pain severity or fatigue in cancer survivors. The sensitivity and subgroup analyses indicated that the pooled results were robust and reliable. CONCLUSION eHealth interventions are effective in improving pain interference and sleep disorders in cancer survivors. Additional high-quality RCTs are needed to test the effectiveness of eHealth interventions on fatigue, pain, and sleep disorders in cancer survivors. CLINICAL RELEVANCE This systematic review and meta-analysis provides evidence to offer effective and sustainable eHealth care for symptom management among cancer survivors.
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Affiliation(s)
- Juejin Li
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chuanmei Zhu
- Outpatient Department, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chunhua Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yonglin Su
- Department of Rehabilitation/Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xiaolin Hu
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, PR China
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Yoon JH, Kim EH, Park SB, Lee JY, Yoon SW. Traditional Herbal Medicine for Insomnia in Patients With Cancer: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:753140. [PMID: 34776971 PMCID: PMC8581246 DOI: 10.3389/fphar.2021.753140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Insomnia is one of the most prevalent cancer-related symptoms and has a severe impact on the quality of life. This study aimed to evaluate the efficacy and safety of traditional herbal medicine (THM) for improving sleep quality in patients with cancer. Methods: Randomized controlled trials (RCTs) evaluating orally administered THM in a cancer population with insomnia were searched using nine electronic databases up to November 30, 2020. The outcome measurements were sleep quality measured by validated questionnaire such as the Pittsburgh Sleep Quality Index (PSQI), total effective rate, and adverse effects. The included studies were appraised using the Cochrane risk of bias tool and meta-analyzed. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Results: Fourteen RCTs were included in the systematic review, and 10 RCTs were analyzed quantitatively. Compared to hypnotics, THM showed a significant improvement in sleep quality by reducing the PSQI score [mean difference (MD) -2.25, 95% confidence interval (CI) -3.46 to -1.05, I 2 = 84%] and increasing the total effective rate [risk ratio (RR) 1.26, 95% CI 1.07 to 1.48, I 2 = 70%] with low quality of evidence. Compared to placebo, THM also reduced the PSQI score significantly (MD -2.56, 95% CI -3.81 to -1.31, I 2 = 91%) with moderate quality of evidence. The most frequently used herbs were Ziziphus jujuba Mill. No serious adverse events were observed. Conclusion: This review suggests that THM may be an effective therapeutic option for insomnia in patients with cancer. However, considering the limited methodological qualities and inconsistent results of the included trials, further rigorous RCTs are required. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero], PROSPERO 2021 [CRD42021265070].
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Affiliation(s)
- Jee-Hyun Yoon
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Eun Hye Kim
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Su Bin Park
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jee Young Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - Seong Woo Yoon
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
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Onorato A, Napolitano A, Spoto S, Incorvaia L, Russo A, Santini D, Tonini G, Vincenzi B. S-Adenosylmethionine Supplementation May Reduce Cancer-Related Fatigue: A Prospective Evaluation Using the FACIT-F Questionnaire in Colon Cancer Patients Undergoing Oxaliplatin-Based Chemotherapy Regimens. Chemotherapy 2021; 66:161-168. [PMID: 34644703 DOI: 10.1159/000517376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fatigue is a common distressing symptom for patients living with chronic or acute diseases, including liver disorders and cancer (Cancer-Related Fatigue, CRF). Its etiology is multifactorial, and some hypotheses regarding the pathogenesis are summarized, with possible shared mechanisms both in cancer and in chronic liver diseases. A deal of work has investigated the role of a multifunctional molecule in improving symptoms and outcomes in different liver dysfunctions and associated symptoms, including chronic fatigue: S-adenosylmethionine (SAM; AdoMet). The aim of this work is actually to consider its role also in oncologic settings. PATIENTS AND METHODS Between January 2006 and December 2009, at the University Campus Bio-Medico of Rome, 145 patients affected by colorectal cancer in adjuvant (n = 91) or metastatic (n = 54; n = 40 with liver metastases) setting and treated with oxaliplatin-based regimen (FOLFOX for adjuvant and bevacizumab + XELOX for metastatic ones), 76 of which with the supplementation of S-adenosylmethionine (AdoMet; 400 mg b.i.d.) (57% of adjuvant patients and 44% of metastatic ones) and 69 without AdoMet supplementation, were evaluated for fatigue prevalence using the Functional Assessment of Chronic Illnesses Therapy-Fatigue (FACIT-F) questionnaire, at 3 and 6 months after the beginning of oncologic treatment. Notably, the number of patients with liver metastases was well balanced between the group of patients treated with AdoMet and those who were not. RESULTS Among patients receiving oxaliplatin-based chemotherapy, both in adjuvant and in metastatic settings, after just 3 months from the beginning of chemotherapy, mean scores from questionnaire domains like FACIT-F subscale (7.9 vs. 3.1, p = 0.006), FACIT physical (6.25 vs. 3.32, p = 0.020), FACIT emotional (4.65 vs. 2.19, p = 0.045), and FACIT-F total score (16.5 vs. 8.27, p = 0.021) were higher in those receiving supplementation of AdoMet, resulting in reduced fatigue; a significant difference was maintained even after 6 months of treatment. DISCUSSION AND CONCLUSIONS Mechanisms and strategies for managing CRF are not fully understood. This work aimed at investigating the possible role of S-adenosylmethionine supplementation in improving fatigue scores in a specific setting of cancer patients, using a FACIT-F questionnaire, a well-validated quality of life instrument widely used for the assessment of CRF in clinical trials.
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Affiliation(s)
- Angelo Onorato
- Medical Oncology Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Andrea Napolitano
- Medical Oncology Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Silvia Spoto
- Internal Medicine Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Lorena Incorvaia
- Medical Oncology Unit, Università degli Studi di Palermo, Palermo, Italy
| | - Antonio Russo
- Medical Oncology Unit, Università degli Studi di Palermo, Palermo, Italy
| | - Daniele Santini
- Medical Oncology Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe Tonini
- Medical Oncology Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Bruno Vincenzi
- Medical Oncology Unit, Università Campus Bio-Medico di Roma, Rome, Italy
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Vo JB, Gillman A, Mitchell K, Nolan TS. Health Disparities: Impact of Health Disparities and Treatment Decision-Making Biases on Cancer Adverse Effects Among Black Cancer Survivors. Clin J Oncol Nurs 2021; 25:17-24. [PMID: 34533532 DOI: 10.1188/21.cjon.s1.17-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Health disparities affect cancer incidence, treatment decisions, and adverse effects. Oncology providers may hold biases in the decision-making process, which can perpetuate health disparities. OBJECTIVES The purpose of this article is to describe health disparities across treatment decisions and adverse effects, describe decision-making biases, and provide suggestions for nurses to mitigate adverse outcomes. METHODS A scoping review of the literature was conducted. FINDINGS Factors affecting health disparities stem, in part, from structural racism and decision-making biases, such as implicit bias, which occurs when individuals have unconscious negative thoughts or feelings toward a particular group. Other decision-making biases, seemingly unrelated to race, include default bias, delay discounting bias, and availability bias. Nurses and nurse navigators can mitigate health disparities by providing culturally appropriate care, assessing health literacy, providing education regarding adverse effects, serving as patient advocates, empowering patients, evaluating personal level of disease knowledge, and monitoring and managing cancer treatment adverse effects.
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Affiliation(s)
| | | | | | - Timiya S Nolan
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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Lee M, Wang Q, Wanchoo R, Eswarappa M, Deshpande P, Sise ME. Chronic Kidney Disease in Cancer Survivors. Adv Chronic Kidney Dis 2021; 28:469-476.e1. [PMID: 35190113 DOI: 10.1053/j.ackd.2021.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022]
Abstract
As breakthroughs in cancer care are leading to improved long-term outcomes in a subset of advanced cancers, there is a growing population of long-term cancer survivors that are at risk of long-term complications. In this review, we summarize what is known about chronic kidney disease in cancer survivors, focusing on the following high-risk groups: survivors of childhood cancers, stem cell transplant recipients, patients with renal cell carcinoma, patients exposed to cisplatin and other nephrotoxic chemotherapies, and patients receiving immunotherapy for cancer. As new anticancer therapies are developed, more research is needed to understand the long-term risks of kidney function decline and to devise methods to prevent chronic kidney disease.
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Creff G, Jegoux F, Bendiane MK, Babin E, Licaj I. Returning to work by thyroid cancer survivors 5 years after diagnosis: the VICAN survey. J Cancer Surviv 2021; 16:801-811. [PMID: 34382180 DOI: 10.1007/s11764-021-01074-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/09/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Return to work (RTW) following cancer diagnosis is a challenge for both the patient and society. As thyroid cancer (TC) incidence is increasing, this study aims to assess difficulties in returning to work and income changes in TC survivors 5 years post-diagnosis. METHODS This study belongs to the national VICAN survey conducted in France among TC patients diagnosed between January and June 2010. Data were collected through phone interviews, medical surveys and from the national medico-administrative register in 2012 and 2015. We used multivariate logistic regressions to investigate TC impact on employment and income changes. RESULTS Of 146 patients, 121(82.9%) were women; the mean age was 42 years (SD = 8.34), 119 (81.3%) were diagnosed at an early stage, and 142(97.6%) underwent thyroidectomy. At 5 years post-diagnosis, 116 (79.7%) of the TC survivors were professionally active, 22 (15.4%) were unemployed and 8 (4.90%) were receiving disability. Among the patients employed at the time of diagnosis (n = 122), 15 (12.3%) had not returned to work 5 years post-diagnosis. Between 2 and 5 years post-diagnosis, there was no significant improvement in rates of RTW. At 5 years post-diagnosis, 90 (61.6%) reported an income decline. All TC survivors who have not returned to work were women and declared higher fatigue. Moreover, in multivariate analyses, not returning to work was associated with weight gain (OR = 8.41 (1.21; 58.23)) and working arrangements (6.90 (1.18-38.48)), while income decline was associated with comorbidities (OR = 2.28 (1.07; 4.86)) and to be engaged in manual work (OR = 2.28 (1.07; 4.88)). CONCLUSION This study highlights that, despite a good prognostic, up to 12.3% of TC survivors had not returned to work and 61.6% reported an income decline, 5 years post-diagnosis. Weight gain, fatigue, to be a woman and working-type arrangement were associated with higher probability of not returning to work. IMPLICATIONS FOR CANCER SURVIVORS TC affects a young working population. Our study identified potentially vulnerable TC survivors and important modifiable factors which may help TC survivors to be professionally active and, therefore, increase their overall quality of life.
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Affiliation(s)
- G Creff
- Department of Otolaryngology-Head and Neck Surgery, Rennes University Hospital, Rennes, France.
| | - F Jegoux
- Department of Otolaryngology-Head and Neck Surgery, Rennes University Hospital, Rennes, France
| | | | - E Babin
- Head and Neck Department, University Hospital Centre Caen, Caen, France.,Cancer & Cognition Platform, Ligue Contre le Cancer, Caen, France
| | - I Licaj
- Cancer & Cognition Platform, Ligue Contre le Cancer, Caen, France.,Clinical Research Department, Centre François Baclesse, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
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Persistent neuropathy among early-stage breast cancer survivors in a population-based cohort. Br J Cancer 2021; 125:445-457. [PMID: 34017086 PMCID: PMC8329002 DOI: 10.1038/s41416-021-01429-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/18/2021] [Accepted: 04/28/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The prevalence of persistent peripheral neuropathy (PN) in early-stage breast cancer (ESBC) survivors is largely unknown. We explored the occurrence and risk factors of PN among long-term ESBC survivors treated with taxane chemotherapy. METHODS A population-based cohort of 884 recurrence-free ESBC survivors diagnosed 2010-2015 in the South East Health Care region, Sweden and 1768 control women without prior cancer received a postal questionnaire that included the European Organisation for Research and Treatment of Cancer chemotherapy-induced peripheral neuropathy (CIPN20) items. Prevalence, relative risks (RRs) (Poisson regression) and risk factors (binomial regression) were calculated. Adjustments were made for confounding factors (e.g. age, body mass index, comorbidities). RESULTS The response rate was 79% for survivors and 59% for controls. The median time post taxane was 3.6 years (1.5-7.3 years). The adjusted RR was highest (RR 1.8) for "tingling/numbness of toes/feet". Individual sensory symptoms occurred in 8.9-48.4% and motor symptoms in 7.2-61.3% of survivors; the most prevalent symptoms were "difficulty opening jar" and "cramps in feet". Paclitaxel, older age, overweight, diabetes mellitus, vibrating hand tools, autoimmune disease and smoking were independent risk factors. CONCLUSIONS PN was more common among ESBC survivors than control women and many symptoms persisted over time. Risk factors should be considered when treatment decisions are made.
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Wallner LP, Abrahamse P, Gargaro JG, Radhakrishnan A, Mullins MA, An LC, Griggs JJ, Schott AF, Ayanian JZ, Sales AE, Katz S, Hawley ST. Improving the delivery of team-based survivorship care after primary breast cancer treatment through a multi-level intervention: a pilot randomized controlled trial. Breast Cancer Res Treat 2021; 189:81-92. [PMID: 34235608 PMCID: PMC8375358 DOI: 10.1007/s10549-021-06257-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We developed and tested a multi-level intervention, ConnectedCancerCare (CCC), which includes a tailored website and appointment reminder system for women with early-stage breast cancer and a provider summary letter sent to their medical oncologist and primary care provider to improve the delivery of team-based survivorship care. METHODS We conducted a pilot randomized controlled trial to establish the feasibility and acceptability of CCC. Women diagnosed with stages 0-II breast cancer within one year of completing primary treatment were randomized to CCC (intervention) or a static online survivorship care plan (control). Participants completed baseline and 3-month follow-up surveys online. Post-trial interviews with 5 PCPs, 6 oncology providers, and 8 intervention patients were conducted. RESULTS Of the 160 eligible women invited to participate, 66 completed the baseline survey and were randomized (41%) and 54 completed a follow-up survey (83%). Participants in the intervention arm found the CCC content to be acceptable, with 82% reporting it was easy to use and 86% reporting they would recommend it to other patients. Women randomized to CCC (vs. control) more often reported scheduling a PCP follow-up visit (64% vs. 42%), communicating with their PCP about provider roles (67% vs. 18%), and higher mean team-based cancer care knowledge scores (3.7 vs. 3.4). CONCLUSION Deploying CCC in medical oncology practices was feasible, and the intervention content was acceptable. CCC shows promise for improving patient knowledge and patient-provider communication about provider roles in team-based cancer care and encouraging patients to engage with their PCP early in the survivorship period.
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Affiliation(s)
- Lauren P Wallner
- Division of General Medicine, Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 409E, Ann Arbor, MI, 48109-2800, USA.
- Department of Epidemiology, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 409E, Ann Arbor, MI, 48109-2800, USA.
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Paul Abrahamse
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Joan G Gargaro
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Archana Radhakrishnan
- Division of General Medicine, Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 409E, Ann Arbor, MI, 48109-2800, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Megan A Mullins
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Lawrence C An
- Division of General Medicine, Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 409E, Ann Arbor, MI, 48109-2800, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer J Griggs
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Anne F Schott
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - John Z Ayanian
- Division of General Medicine, Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 409E, Ann Arbor, MI, 48109-2800, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Anne E Sales
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Steven Katz
- Division of General Medicine, Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 409E, Ann Arbor, MI, 48109-2800, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Sarah T Hawley
- Division of General Medicine, Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 409E, Ann Arbor, MI, 48109-2800, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
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Stegmann ME, Geerse OP, van Zuylen L, Nekhlyudov L, Brandenbarg D. Improving Care for Patients Living with Prolonged Incurable Cancer. Cancers (Basel) 2021; 13:2555. [PMID: 34070954 PMCID: PMC8196984 DOI: 10.3390/cancers13112555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/17/2022] Open
Abstract
The number of patients that can no longer be cured but may expect to live with their cancer diagnosis for a substantial period is increasing. These patients with 'prolonged incurable cancer' are often overlooked in research and clinical practice. Patients encounter problems that are traditionally seen from a palliative or survivorship perspective but this may be insufficient to cover the wide range of physical and psychosocial problems that patients with prolonged incurable cancer may encounter. Elements from both fields should, therefore, be delivered concordantly to further optimize care pathways for these patients. Furthermore, to ensure future high-quality care for this important patient population, enhanced clinical awareness, as well as further research, are urgently needed.
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Affiliation(s)
- Mariken E. Stegmann
- Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9700 CC Groningen, The Netherlands; (M.E.S.); (D.B.)
| | - Olaf P. Geerse
- Academic Medical Center, Department of Pulmonary Medicine, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Lia van Zuylen
- Amsterdam University Medical Center, Department of Medical Oncology, 1105 AZ Amsterdam, The Netherlands;
| | - Larissa Nekhlyudov
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Daan Brandenbarg
- Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9700 CC Groningen, The Netherlands; (M.E.S.); (D.B.)
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Abstract
BACKGROUND Childhood trauma has been linked to neuropathic pain in noncancer populations, but its relationship with cancer treatment-related neuropathic pain is unknown. OBJECTIVE This secondary data analysis of a prospective, longitudinal, observational study aimed to explore the relationship of childhood trauma experience with pain severity, pain interference, and neuropathic symptom severity (NSS) 12 months after surgery in women receiving treatment for stage 0 to III breast cancer. METHODS Women (N = 44) recruited from a comprehensive cancer center self-reported childhood trauma experience, pain severity, pain interference, NSS, co-occurring symptoms, and pain beliefs via questionnaires. Descriptive statistics were used to describe childhood trauma experience. Linear regression was used to model childhood trauma and other predictors on pain variables 12 months after surgery. RESULTS Childhood trauma predicted pain severity and pain interference 12 months after surgery (P < .05), as did baseline pain severities and helplessness-pain catastrophizing. Age predicted only NSS. Together, the best models predicted 31.6% to 40.9% of the variance in pain severities at 12 months (P < .001). CONCLUSIONS Childhood trauma exposure was a significant predictor of pain 12 months after breast cancer surgery and adjuvant treatment. Younger and helplessness-pain catastrophizing women are also at risk. Research is needed to identify preventive neuropathic pain interventions for high-risk women. IMPLICATIONS FOR PRACTICE Women receiving breast cancer treatment should proactively be assessed for childhood trauma history, possibly by using discreet previsit questionnaires. Childhood trauma survivors may be at high risk for poor pain outcomes and may benefit from tailored pain interventions.
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Agalave NM, Mody PH, Szabo-Pardi TA, Jeong HS, Burton MD. Neuroimmune Consequences of eIF4E Phosphorylation on Chemotherapy-Induced Peripheral Neuropathy. Front Immunol 2021; 12:642420. [PMID: 33912169 PMCID: PMC8071873 DOI: 10.3389/fimmu.2021.642420] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/18/2021] [Indexed: 12/17/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a major dose-limiting side effect that occurs in up to 63% of patients and has no known effective treatment. A majority of studies do not effectively assess sex differences in the onset and persistence of CIPN. Here we investigated the onset of CIPN, a point of therapeutic intervention where we may limit, or even prevent the development of CIPN. We hypothesized that cap-dependent translation mechanisms are important in early CIPN development and the bi-directional crosstalk between immune cells and nociceptors plays a complementary role to CIPN establishment and sex differences observed. In this study, we used wild type and eIF4E-mutant mice of both sexes to investigate the role of cap-dependent translation and the contribution of immune cells and nociceptors in the periphery and glia in the spinal cord during paclitaxel-induced peripheral neuropathy. We found that systemically administered paclitaxel induces pain-like behaviors in both sexes, increases helper T-lymphocytes, downregulates cytotoxic T-lymphocytes, and increases mitochondrial dysfunction in dorsal root ganglia neurons; all of which is eIF4E-dependent in both sexes. We identified a robust paclitaxel-induced, eIF4E-dependent increase in spinal astrocyte immunoreactivity in males, but not females. Taken together, our data reveals that cap-dependent translation may be a key pathway that presents relevant therapeutic targets during the early phase of CIPN. By targeting the eIF4E complex, we may reduce or reverse the negative effects associated with chemotherapeutic treatments.
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Affiliation(s)
- Nilesh M Agalave
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, School of Behavioral and Brain Sciences, Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX, United States
| | - Prapti H Mody
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, School of Behavioral and Brain Sciences, Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX, United States
| | - Thomas A Szabo-Pardi
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, School of Behavioral and Brain Sciences, Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX, United States
| | - Han S Jeong
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, School of Behavioral and Brain Sciences, Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX, United States
| | - Michael D Burton
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, School of Behavioral and Brain Sciences, Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX, United States
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Heinemann M, Hoffmann C, Hardes J, Guder W, Streitbürger A, Götte M, Welz TL, Jürgens H, Ranft A, Vieth V, Weckesser M, Schäfers M, Stegger L, Dirksen U. Pain in survivors of Ewing sarcoma: Prevalence, associated factors and prediction of recurrence. Pediatr Blood Cancer 2021; 68:e28801. [PMID: 33179838 DOI: 10.1002/pbc.28801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND While the prognosis of patients with Ewing sarcoma (EwS) is improving, little is known about the frequency of pain and its risk factors in survivors of EwS. This study aims to analyse the prevalence and risk factors of pain and its predictive value for recurrence. PATIENTS AND METHODS In patients with remission after treatment of EwS, frequency and characteristics of pain within the first 5 years of follow up were assessed retrospectively. RESULTS Of 80 patients, 37 (46%) presented with at least one episode of pain. Chronic pain (>3 months) was observed in 10 patients (13%). Experience of at least one episode of pain was associated with prior combined local treatment (surgery and radiation compared to surgery alone; odds ratio [OR] 5.83, 95% confidence interval [CI] 1.43-34.9, P = .007). A total of 59 episodes of pain were observed, including 47 acute and 12 chronic episodes. Lower limb pain accounted for 46% (27/59) of all episodes of pain, and was associated with primary tumour of the pelvis or lower extremity (OR 4.29, 95% CI 1.18-18.21, P = .025), which represented 64% (51/80) of all EwS. The positive predictive value of pain for recurrence was only 12%. CONCLUSION Pain is a common problem in survivors of EwS, which mostly affects the lower extremity, and should be regularly assessed. Interventions to reduce pain may be particularly important in patients with combined local treatment with surgery and radiation, who seem to be at considerably increased risk for pain. Patients presenting with pain should be examined for recurrence.
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Affiliation(s)
- Melina Heinemann
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany.,Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Christiane Hoffmann
- Orthopaedic Hospital Volmarstein, Wetter, Germany.,Department of Orthopaedics and Tumour Orthopaedics, University Hospital Münster, Münster, Germany
| | - Jendrik Hardes
- Department of Orthopaedics and Tumour Orthopaedics, University Hospital Münster, Münster, Germany.,Department of Oncologic Musculoskeletal Surgery, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Wiebke Guder
- Department of Orthopaedics and Tumour Orthopaedics, University Hospital Münster, Münster, Germany.,Department of Oncologic Musculoskeletal Surgery, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Arne Streitbürger
- Department of Orthopaedics and Tumour Orthopaedics, University Hospital Münster, Münster, Germany.,Department of Oncologic Musculoskeletal Surgery, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Miriam Götte
- Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany.,Paediatrics III, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Theresa Luisa Welz
- Paediatrics III, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Heribert Jürgens
- Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Andreas Ranft
- Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany.,Paediatrics III, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Volker Vieth
- Department of Radiology, University Hospital Münster, Münster, Germany.,Department of Clinical Radiology, Klinikum Ibbenbüren, Ibbenburen, Germany
| | - Matthias Weckesser
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Uta Dirksen
- Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany.,Paediatrics III, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany.,DKTK, German Cancer Research Centre, Essen, Germany
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50
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Blair CK, Harding EM, Adsul P, Moran S, Guest D, Clough K, Sussman AL, Duff D, Cook LS, Rodman J, Dayao Z, Brown-Glaberman U, King TV, Pankratz VS, Servin E, Davis S, Demark-Wahnefried W. Southwest Harvest for Health: Adapting a mentored vegetable gardening intervention for cancer survivors in the southwest. Contemp Clin Trials Commun 2021; 21:100741. [PMID: 33659763 PMCID: PMC7896154 DOI: 10.1016/j.conctc.2021.100741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/26/2020] [Accepted: 02/04/2021] [Indexed: 01/22/2023] Open
Abstract
Few diet and physical activity evidence-based interventions have been routinely used in community settings to achieve population health outcomes. Adapting interventions to fit the implementation context is important to achieve the desired results. Harvest for Health is a home-based vegetable gardening intervention that pairs cancer survivors with certified Master Gardeners from the Cooperative Extension Service with the ultimate goal of increasing vegetable consumption and physical activity, and improving physical functioning and health-related quality-of-life. Harvest for Health has potential for widespread dissemination since Master Gardener Programs exist throughout the United States. However, state- and population-specific adaptations may be needed to improve intervention adoption by other Master Gardener Programs. Our primary objective was to adapt this evidence-informed intervention that was initially incepted in Alabama, for the drastically different climate and growing conditions of New Mexico using a recommended adaptation framework. Our secondary objective was to develop a study protocol to support a pilot test of the adapted intervention, Southwest Harvest for Health. The adaptation phase is a critical first step towards widespread dissemination, implementation, and scale-out of an evidence-based intervention. This paper describes the adaptation process and outcomes, and the resulting protocol for the ongoing pilot study that is currently following 30 cancer survivors and their paired Extension Master Gardener mentors.
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Affiliation(s)
- Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | | | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Sara Moran
- Extension Plant Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Dolores Guest
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Kathy Clough
- Albuquerque Area Extension Master Gardener Program, NMSU Cooperative Extension Service, Albuquerque, NM, USA
| | - Andrew L. Sussman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Dorothy Duff
- Albuquerque Area Extension Master Gardener Program, NMSU Cooperative Extension Service, Albuquerque, NM, USA
| | - Linda S. Cook
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Zoneddy Dayao
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Ursa Brown-Glaberman
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Towela V. King
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - V. Shane Pankratz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Eduardo Servin
- Extension Plant Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Sally Davis
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Prevention Research Center, Albuquerque, NM, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
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