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Borner T, Doebley SA, Furst CD, Pataro AM, Halas JG, Gao X, Choi GK, Ramadan SA, Chow A, De Jonghe BC. Screening study of anti-emetics to improve GDF15-induced malaise and anorexia: Implications for emesis control. Physiol Behav 2023; 267:114229. [PMID: 37164246 PMCID: PMC10883415 DOI: 10.1016/j.physbeh.2023.114229] [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: 03/17/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/12/2023]
Abstract
Considerable preclinical and clinical attention has focused on the food intake and body weight suppressive effects of growth differentiation factor 15 (GDF15) and its elevated blood levels as a consequence of disease states and disease treatment therapeutics. We have previously reported that exogenous administration of GDF15 induces anorexia through nausea and emesis in multiple species. Importantly, GDF15 signaling as a meditator of chemotherapy-induced anorexia and emesis has recently been demonstrated in both murine and nonhuman primate models. The mechanism, however, by which GDF15 induces malaise and the utility of existing therapeutic targets to counteract its effects remain largely unknown. Using a dose of GDF15 that mimics stimulated levels following chemotherapy administration and reliably induces malaise, we sought to screen anti-emetics that represent distinct pharmacotherapeutic classes hypothesized to reduce GDF15-induced effects in rats. Strikingly, our results showed that none of the tested compounds were effective at preventing GDF15-induced malaise. These results illustrate the complexity of GDF15 signaling mechanism and may have important implications for medical conditions characterized by elevated GDF15 levels and incomplete symptom control, such as chemotherapy-induced nausea and vomiting.
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Affiliation(s)
- Tito Borner
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, United States.
| | - Sarah A Doebley
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - C Daniel Furst
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Allison M Pataro
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Julia G Halas
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Xing Gao
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Grace K Choi
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Sarah A Ramadan
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Angela Chow
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Bart C De Jonghe
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, United States
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Neeman Z, Abu Ata M, Touma E, Saliba W, Barnett-Griness O, Gralnek IM, Rock W, Bisharat N. Is fasting still necessary prior to contrast-enhanced computed tomography? A randomized clinical study. Eur Radiol 2020; 31:1451-1459. [PMID: 32901302 DOI: 10.1007/s00330-020-07255-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/30/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES There is very limited evidence to support the common practice of preparative fasting prior to contrast-enhanced computerized tomography (CT). This study examined the effect of withholding fasting orders, prior to contrast-enhanced CT, on the incidence of aspiration pneumonitis and adverse gastrointestinal symptoms. METHODS This randomized controlled trial enrolled hospitalized patients referred for non-emergency, contrast-enhanced CT scan to either at least 4 h of fasting or to an unrestricted consumption of liquids and solids up to the time of CT. The primary outcome was incidence of aspiration pneumonitis and the secondary outcomes were rates of adverse gastrointestinal symptoms (nausea and/or vomiting). RESULTS After excluding participants with incomplete follow-up, a total of 1080 participants were assigned to the fasting group and 1011 were assigned to the non-fasting group. Aspiration pneumonitis was not identified in either group. The mean time of fasting in the fasting group was 8.4 ± 1.6 h. Rates of nausea and vomiting were not statistically different between the fasting group compared with the non-fasting group, 6.6% vs. 7.6% (p = 0.37) and 2.6% vs. 3.0% (p = 0.58), respectively. A subgroup analysis of patients who were required to drink oral contrast agent (n = 1257) showed that rates of nausea and vomiting were not statistically different between the fasting and non-fasting groups, 6.8% vs. 8.0% (p = 0.42) and 2.6% vs. 3.6% (p = 0.3), respectively. CONCLUSIONS Withholding fasting orders prior to contrast-enhanced CT was not associated with a greater risk of aspiration pneumonitis or a significant increase in rates of adverse gastrointestinal symptoms. TRIAL REGISTRATION ClinicalTrials.gov : NCT03533348 KEY POINTS: • Is fasting necessary prior to contrast-enhanced computed tomography (CT)? • In this randomized clinical study including 2091 participants referred to non-emergency contrast-enhanced CT scan, withholding preparative fasting was not associated with a greater risk of aspiration pneumonitis or clinically significant increase in rates of adverse gastrointestinal symptoms. • Eating and drinking prior to contrast-enhanced CT can be allowed and are not associated with an increased risk of aspiration pneumonitis.
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Affiliation(s)
- Ziv Neeman
- Department of Radiology, Emek Medical Center, Afula, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Mayasa Abu Ata
- Department of Medicine D, Emek Medical Center, 18341, Afula, Israel
| | - Elia Touma
- Department of Medicine D, Emek Medical Center, 18341, Afula, Israel
| | - Walid Saliba
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Ofra Barnett-Griness
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Ian M Gralnek
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
| | - Wasim Rock
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Medicine A, Emek Medical Center, Afula, Israel
| | - Naiel Bisharat
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
- Department of Medicine D, Emek Medical Center, 18341, Afula, Israel.
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Al Qadire M, Alkhalaileh M. Jordanian oncology nurses' knowledge of managing chemotherapy-induced nausea and vomiting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2018; 27:S4-S12. [PMID: 29791227 DOI: 10.12968/bjon.2018.27.10.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND health practitioners, especially oncology nurses, play an important role in assessing and managing chemotherapy-induced nausea and vomiting (CINV). Oncology nurses need adequate knowledge and skills to optimally assess and manage CINV in oncology settings. AIM the study intended to assess Jordanian oncology nurses' knowledge of assessing and managing CINV. METHODS a cross-sectional design was used to survey 229 oncology nurses working in oncology units in three hospitals. FINDINGS most participants were female (62.9%). The age rage was 21-55 years, with a mean age of 29.9 years (SD=6.2). The mean overall knowledge score was low at 4.7 (SD=3.5) (95% CI=4.40-5.01). Poor knowledge of CINV assessment and management were noted. CONCLUSION oncology nurses' knowledge about the assessment and management of CINV is inadequate, and improvements in knowledge are needed. An educational intervention is recommended, which needs to be tested to ensure that it is both effective and feasible to provide.
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Affiliation(s)
- Mohammad Al Qadire
- Associate Professor, Vice Dean, Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
| | - Murad Alkhalaileh
- Associate Professor, Department of Nursing, Tabuk University, Tabuk Saudi Arabia
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Alhadeff AL, Holland RA, Zheng H, Rinaman L, Grill HJ, De Jonghe BC. Excitatory Hindbrain-Forebrain Communication Is Required for Cisplatin-Induced Anorexia and Weight Loss. J Neurosci 2017; 37:362-370. [PMID: 28077715 PMCID: PMC5242394 DOI: 10.1523/jneurosci.2714-16.2016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/04/2016] [Accepted: 11/19/2016] [Indexed: 11/21/2022] Open
Abstract
Cisplatin chemotherapy is commonly used to treat cancer despite severe energy balance side effects. In rats, cisplatin activates nucleus tractus solitarius (NTS) projections to the lateral parabrachial nucleus (lPBN) and calcitonin-gene related peptide (CGRP) projections from the lPBN to the central nucleus of the amygdala (CeA). We demonstrated previously that CeA glutamate receptor signaling mediates cisplatin-induced anorexia and body weight loss. Here, we used neuroanatomical tracing, immunofluorescence, and confocal imaging to demonstrate that virtually all NTS→lPBN and lPBN→CeA CGRP projections coexpress vesicular glutamate transporter 2 (VGLUT2), providing evidence that excitatory projections mediate cisplatin-induced energy balance dysregulation. To test whether lPBN→CeA projection neurons are required for cisplatin-induced anorexia and weight loss, we inhibited these neurons chemogenetically using a retrograde Cre-recombinase-expressing canine adenovirus-2 in combination with Cre-dependent inhibitory Designer Receptors Exclusive Activated by Designer Drugs (DREADDs) before cisplatin treatment. Inhibition of lPBN→CeA neurons attenuated cisplatin-induced anorexia and body weight loss significantly. Using a similar approach, we additionally demonstrated that inhibition of NTS→lPBN neurons attenuated cisplatin-induced anorexia and body weight loss significantly. Together, our data support the view that excitatory hindbrain-forebrain projections are necessary for cisplatin's untoward effects on energy intake, elucidating a key neuroanatomical circuit driving pathological anorexia and weight loss that accompanies chemotherapy treatment. SIGNIFICANCE STATEMENT Chemotherapy treatments are commonly used to treat cancers despite accompanying anorexia and weight loss that may limit treatment adherence and reduce patient quality of life. Strikingly, we lack a neural understanding of, and effective treatments for, chemotherapy-induced anorexia and weight loss. The current data characterize the excitatory nature of neural projections activated by cisplatin in rats and reveal the necessity of specific hindbrain-forebrain projections for cisplatin-induced anorexia and weight loss. Together, these findings help to characterize the neural mechanisms mediating cisplatin-induced anorexia, advancing opportunities to develop better-tolerated chemotherapies and adjuvant therapies to prevent anorexia and concurrent nutritional deficiencies during cancer treatment.
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Affiliation(s)
| | | | - Huiyuan Zheng
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania 15260
| | - Linda Rinaman
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania 15260
| | - Harvey J Grill
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, and
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Vidall C, Sharma S, Amlani B. Patient-practitioner perception gap in treatment-induced nausea and vomiting. ACTA ACUST UNITED AC 2017; 25:S4-S11. [PMID: 27615540 DOI: 10.12968/bjon.2016.25.s4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This UK cohort analysis of a European survey evaluated the differences between health professionals and cancer patients regarding the perceived incidence, impact and drug management of chemotherapy/radiotherapy-induced nausea/vomiting (CINV/RINV). The UK healthcare system is unique in that it has dedicated oncology clinical nurse specialists. The analysis found that more patients experienced nausea following their most recent treatment cycle than vomiting. Health professionals overestimated the incidence of CINV/RINV but underestimated its impact on patients' daily lives, particularly in cases of mild and moderate nausea/vomiting. The level of antiemetic cover initiated and degree of symptom control was often suboptimal. Patients under-reported symptoms, primarily because they considered nausea/vomiting an inevitable side effect of treatment. Altogether, 42% of patients reported full adherence to their antiemetic regimen. Leading factors for non-adherence included not having a 'preventive mindset', low symptom severity and a reluctance to increase pill burden. In conclusion, there is a perceptual gap between health professionals and patients around experiences of CINV/RINV. Advances in management depend on enhancing health professional-patient communication, and reporting and understanding nausea as a distinct issue.
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Affiliation(s)
- Cheryl Vidall
- Head of Nursing and Governance, Alcura UK, Alton, Hampshire
| | | | - Bharat Amlani
- Medical Director International and Partnerships, Norgine, Uxbridge
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Zong X, Zhang J, Ji X, Gao J, Ji J. Patterns of antiemetic prophylaxis for chemotherapy-induced nausea and vomiting in China. Chin J Cancer Res 2016; 28:168-79. [PMID: 27199514 DOI: 10.21147/j.issn.1000-9604.2016.02.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapy-induced nausea and vomiting (CINV) at a national level in China or to assess how treatment regimens adhere to current guidelines. METHODS We searched the China Health Insurance Research Association (CHIRA) Database to identify patients with cancer who were ≥18 years old and received either moderately or highly emetogenic chemotherapy (MEC and HEC, respectively) between 2008 and 2012. Patients' characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics. RESULTS Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC (59.4% vs. 81.3%; P<0.001). The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group (P≤0.012); however, a higher proportion received a mixed regimen containing corticosteroids (P≤0.007). Although more than half of the patients in the HEC group took three antiemetics to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group (both P<0.001). Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic. CONCLUSIONS These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.
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Affiliation(s)
- Xianglong Zong
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 China Health Insurance Research Association, Beijing 100013, China ; 3 MSD China Holding Co., Ltd., Shanghai 200040, China
| | - Jie Zhang
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 China Health Insurance Research Association, Beijing 100013, China ; 3 MSD China Holding Co., Ltd., Shanghai 200040, China
| | - Xin Ji
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 China Health Insurance Research Association, Beijing 100013, China ; 3 MSD China Holding Co., Ltd., Shanghai 200040, China
| | - Jie Gao
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 China Health Insurance Research Association, Beijing 100013, China ; 3 MSD China Holding Co., Ltd., Shanghai 200040, China
| | - Jiafu Ji
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 China Health Insurance Research Association, Beijing 100013, China ; 3 MSD China Holding Co., Ltd., Shanghai 200040, China
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Underhill M, Chicko L, Berry D. A Nurse-Led Evidence-Based Practice Project to Monitor and Improve the Management of Chemotherapy-Induced Nausea and Vomiting. Clin J Oncol Nurs 2015; 19:38-40. [DOI: 10.1188/15.cjon.38-40] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affronti ML, Bubalo J. Palonosetron in the management of chemotherapy-induced nausea and vomiting in patients receiving multiple-day chemotherapy. Cancer Manag Res 2014; 6:329-37. [PMID: 25228819 PMCID: PMC4161526 DOI: 10.2147/cmar.s68102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Prevention of chemotherapy-induced nausea and vomiting (CINV) is a key component of treatment for patients with cancer. Guidelines are available to assist prescribers in the management of CINV associated with single-day chemotherapy regimens. However, currently there are no clear guidelines for management of CINV in patients receiving multiple-day chemotherapy regimens. Serotonin (5-HT3) receptor antagonists are a mainstay in preventing CINV, and palonosetron, given its longer half-life and duration of action relative to other 5-HT3 receptor antagonists, may be a useful option for managing CINV in multiple-day chemotherapy. Here we provide an overview of CINV and CINV treatment options, with a focus on palonosetron. We describe existing challenges in managing CINV, and discuss two patients receiving multiple-day chemotherapy, in whom CINV was managed successfully with palonosetron.
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Affiliation(s)
| | - Joseph Bubalo
- Oregon Health and Science University Hospital and Clinics, Portland, OR, USA
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