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Drewe J, Boonen G, Culmsee C. Treat more than heat-New therapeutic implications of Cimicifuga racemosa through AMPK-dependent metabolic effects. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 100:154060. [PMID: 35338990 DOI: 10.1016/j.phymed.2022.154060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/18/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cimicifuga racemosa extracts (CRE) have obtained a "well-established use status" in the treatment of postmenopausal (i.e., climacteric) complaints, which predominantly include vasomotor symptoms such as hot flushes and sweating, as well as nervousness, irritability, and metabolic changes. Although characteristic postmenopausal complaints are known for a very long time and the beneficial effects of CRE on climacteric symptoms are well accepted, both the pathophysiology of postmenopausal symptoms and the mechanism of action of CREs are not yet fully understood. In particular, current hypotheses suggest that changes in the α-adrenergic and serotonergic signaling pathways secondary to estrogen depletion are responsible for the development of hot flushes. PURPOSE Some of the symptoms associated with menopause cannot be explained by these hypotheses. Therefore, we attempted to extend our classic understanding of menopause by integrating of partly age-related metabolic impairments. METHODS A comprehensive literature survey was performed using the PubMed database for articles published through September 2021. The following search terms were used: (cimicifuga OR AMPK) AND (hot flush* OR hot flash* OR menopaus* OR osteoporos* OR cancer OR antioxida* OR cardiovasc*). No limits were set with respect to language, and the references cited in the articles retrieved were used to identify additional publications. RESULTS We found that menopause is a manifestation of the general aging process, with specific metabolic changes that aggravate menopausal symptoms, which are accelerated by estrogen depletion and associated neurotransmitter dysregulation. Cimicifuga extracts with their metabolic effects mitigate climacteric symptoms but may also modulate the aging process itself. Central to these effects are effects of CRE on the metabolic key regulator, the AMP-activated protein kinase (AMPK). CONCLUSIONS As an extension of this effect dimension, other off-label indications may appear attractive in the sense of repurposing of this herbal treatment.
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Affiliation(s)
- Jürgen Drewe
- Medical Department, Max Zeller Soehne AG, CH-8590 Romanshorn, Switzerland.
| | - Georg Boonen
- Medical Department, Max Zeller Soehne AG, CH-8590 Romanshorn, Switzerland
| | - Carsten Culmsee
- Institute of Pharmacology and Clinical Pharmacy, University of Marburg, D-35043 Marburg, Germany; Center for Mind, Brain and Behavior, D-35032 Marburg, Germany
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Guida M, Raffone A, Travaglino A, Neola D, Reppuccia S, Borgo M, Vitale C, Limone A, D'Alessandro P, Massaro G, Mollo A. Cimicifuga racemosa isopropanolic extract for menopausal symptoms: an observational prospective case-control study. Gynecol Endocrinol 2021; 37:1132-1137. [PMID: 34477029 DOI: 10.1080/09513590.2021.1974381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE We aimed to investigate the effectiveness of isopropanolic extract of Cimicifuga Racemosa (iCR) on reducing menopausal symptoms. MATERIALS AND METHODS A single-center observational prospective case-control study was performed to assess the improvement of menopausal symptoms in menopausal women undergone iCR administration (cases) or no treatment (controls). Menopausal symptoms were assessed through a modified version of the Menopause Rating Scale questionnaire (mMRS) at T0 (baseline), T1 (1-month follow-up), and T2 (3 months follow-up). Univariate comparisons between cases and controls were performed by using the unpaired T test for two-tailed P value with α = 0.05 significance level. RESULTS A total of 163 women (83 cases and 80 controls) were enrolled in the study. The difference in menopausal symptoms between cases and controls from T0 to T2, and from T0 to T1, was found significant for all analyses. In particular, the difference in all menopausal symptoms was 20.56 ± 0.90 points (95%CI: 18.77-22.33, p < .001) from T0 to T2, and 10.69 ± 0.6 (95%CI: 9.49-11.88, p < .001) from T0 to T1. CONCLUSION iCR may be effective in reducing menopausal symptoms, both after 1 month and after 3 months of treatment. The improvement was higher in vasomotor symptoms, sleep problems, and irritability.
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Affiliation(s)
- Maurizio Guida
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Daniele Neola
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Sabrina Reppuccia
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maria Borgo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Clorinda Vitale
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Andrea Limone
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Pietro D'Alessandro
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giulia Massaro
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Mollo
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Baronissi, Italy
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Shen W, Chang SC. Antidepressant therapy in patients with cancer: A clinical review. TAIWANESE JOURNAL OF PSYCHIATRY 2019. [DOI: 10.4103/tpsy.tpsy_3_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hunter MS, Stefanopoulou E. Vasomotor symptoms in prostate cancer survivors undergoing androgen deprivation therapy. Climacteric 2015; 19:91-7. [PMID: 26673756 DOI: 10.3109/13697137.2015.1125460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Hot flushes and night sweats (HFNS) are common but under-researched in prostate cancer survivors undergoing androgen-deprivation therapy (ADT). We aimed to examine subjective reports and physiological measures of HFNS, and the influence of sociodemographic, clinical and psychological factors on HFNS in men undergoing ADT. METHODS Sixty-eight men undergoing ADT for prostate cancer attended an assessment interview, completed questionnaires (assessing HFNS frequency and problem-rating, mood, stress, optimism, somatosensory amplification, HFNS beliefs/behaviors) and wore an ambulatory sternal skin conductance (SSC) monitor for 48 h. RESULTS The sample had a mean age of 69.76 (standard deviation, SD = 8.04) years, were on average 27.24 (SD = 28.53) months since cancer diagnosis and had been on their current ADT regime for 16 months (range 2-74 months). The men reported frequent (weekly mean 51.04, SD = 33.21) and moderately problematic HFNS. Overall, 294 (20%) of the SSC-defined HFNS were concordant with prospective frequency (event marker), while 63% were under-reported and 17% were over-reported, under-reporting being more common than over-reporting. There were no significant predictors of HFNS frequency (subjective or physiological measures), but psychological variables (HFNS beliefs and behaviors (β = 0.56, p < 0.03), anxiety (β = 0.24, p < 0.01) and somatic amplification (β = 0.76, p < 0.04) were the main predictors of problematic HFNS, i.e. troublesome symptoms. CONCLUSIONS These results are consistent with those of studies of women during menopause and breast cancer survivors, i.e. subjective and physiological measures appear to identify different HFNS dimensions. Psychological variables (HFNS beliefs and behaviors, anxiety and somatic amplification) can be targeted, using cognitive behavior therapy, for symptom relief.
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Affiliation(s)
- M S Hunter
- a Department of Psychology , Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - E Stefanopoulou
- a Department of Psychology , Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
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Mebes I, Graf M, Kellner M, Keck C, Segerer SE. High Estradiol Levels During Postmenopause - Pitfalls in Laboratory Analysis. Geburtshilfe Frauenheilkd 2015; 75:941-944. [PMID: 26500371 DOI: 10.1055/s-0035-1557815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A 54-year-old woman was admitted with a result of high serum estradiol levels (> 4300 pg/ml) and typical postmenopausal symptoms. She had a history of an adnexectomy (normal histopathology) due to the elevated estradiol levels. After surgery, estradiol levels were as high as before. Analyzing the anti-mullerian hormone (AMH), inhibin B, DHEA-S and estrone, typical postmenopausal levels were found. Serum estradiol levels were controlled several times with rabbit-derived polyclonal as well as monoclonal antibodies to optimize the selectivity of the test system. Secondary, a radioimmunoassay was performed to exclude interferences of the detection system where lower, but still elevated estradiol levels (186 pg/ml) were found. Hypothesizing that our patient underwent a cross reaction with irregular antibodies, a control was done using sheep-derived antibodies, which proved a postmenopausal hormone level (estradiol level < 5 pg/ml). This result was confirmed using a fluorescence enzyme immunoassay (FEIA) revealing high levels of irregular antibodies (> 200 mg/l; reference < 30 mg/l). This case depicts the pitfalls of estradiol measurement detecting false elevated estradiol levels in a postmenopausal woman.
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Affiliation(s)
- I Mebes
- Endokrinologikum Hamburg, Zentrum für Hormon- und Stoffwechselerkrankungen, Reproduktionsmedizin und Pränatale Medizin, Hamburg
| | - M Graf
- Endokrinologikum Hamburg, Zentrum für Hormon- und Stoffwechselerkrankungen, Reproduktionsmedizin und Pränatale Medizin, Hamburg
| | - M Kellner
- Endokrinologikum Hamburg, Zentrum für Hormon- und Stoffwechselerkrankungen, Reproduktionsmedizin und Pränatale Medizin, Hamburg
| | - C Keck
- Endokrinologikum Hamburg, Zentrum für Hormon- und Stoffwechselerkrankungen, Reproduktionsmedizin und Pränatale Medizin, Hamburg
| | - S E Segerer
- Endokrinologikum Hamburg, Zentrum für Hormon- und Stoffwechselerkrankungen, Reproduktionsmedizin und Pränatale Medizin, Hamburg
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Jayasena CN, Comninos AN, Stefanopoulou E, Buckley A, Narayanaswamy S, Izzi-Engbeaya C, Abbara A, Ratnasabapathy R, Mogford J, Ng N, Sarang Z, Ghatei MA, Bloom SR, Hunter MS, Dhillo WS. Neurokinin B administration induces hot flushes in women. Sci Rep 2015; 5:8466. [PMID: 25683060 PMCID: PMC4329553 DOI: 10.1038/srep08466] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/21/2015] [Indexed: 12/04/2022] Open
Abstract
Neurokinin B (NKB) is a hypothalamic neuropeptide binding preferentially to the neurokinin 3 receptor. Expression of the gene encoding NKB is elevated in postmenopausal women. Furthermore, rodent studies suggest that NKB signalling may mediate menopausal hot flushes. However, the effects of NKB administration on hot flushes have not been investigated in humans. To address this, we performed a randomised, double-blinded, placebo-controlled, 2-way cross-over study. Ten healthy women were admitted to a temperature and humidity-controlled research unit. Participants received 30 minute intravenous infusions of NKB and vehicle in random order. Symptoms, heart rate, blood pressure, sweating and skin temperature were compared between NKB and vehicle in a double-blinded manner. Eight of ten participants experienced flushing during NKB infusion with none experiencing flushing during vehicle infusion (P = 0.0007). Significant elevations in heart rate (P = 0.0106 vs. pre-symptoms), and skin temperature measured using skin probe (P = 0.0258 vs. pre-symptoms) and thermal imaging (P = 0.0491 vs. pre-symptoms) characteristic of menopausal flushing were observed during hot flush episodes. Our findings provide evidence that NKB administration can cause hot flushes in women. Further studies are required to determine if pharmacological blockade of NKB signalling could inhibit hot flushes during the menopause and during treatment for sex-steroid dependent cancers.
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Affiliation(s)
- Channa N Jayasena
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Alexander N Comninos
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Evgenia Stefanopoulou
- Department of Psychology, Institute of Psychiatry, King's College London, Guy's Hospital, London, UK
| | - Adam Buckley
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | | | - Chioma Izzi-Engbeaya
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Ali Abbara
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Risheka Ratnasabapathy
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Julianne Mogford
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Noel Ng
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Zubair Sarang
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Mohammad A Ghatei
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Stephen R Bloom
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Myra S Hunter
- Department of Psychology, Institute of Psychiatry, King's College London, Guy's Hospital, London, UK
| | - Waljit S Dhillo
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
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Drewe J, Bucher KA, Zahner C. A systematic review of non-hormonal treatments of vasomotor symptoms in climacteric and cancer patients. SPRINGERPLUS 2015; 4:65. [PMID: 25713759 PMCID: PMC4331402 DOI: 10.1186/s40064-015-0808-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/09/2015] [Indexed: 12/03/2022]
Abstract
The cardinal climacteric symptoms of hot flushes and night sweats affect 24-93% of all women during the physiological transition from reproductive to post-reproductive life. Though efficacious, hormonal therapy and partial oestrogenic compounds are linked to a significant increase in breast cancer. Non-hormonal treatments are thus greatly appreciated. This systematic review of published hormonal and non-hormonal treatments for climacteric, and breast and prostate cancer-associated hot flushes, examines clinical efficacy and therapy-related cancer risk modulation. A PubMed search included literature up to June 19, 2014 without limits for initial dates or language, with the search terms, (hot flush* OR hot flash*) AND (clinical trial* OR clinical stud*) AND (randomi* OR observational) NOT review). Retrieved references identified further papers. The focus was on hot flushes; other symptoms (night sweats, irritability, etc.) were not specifically screened. Included were some 610 clinical studies where a measured effect of the intervention, intensity and severity were documented, and where patients received treatment of pharmaceutical quality. Only 147 of these references described studies with alternative non-hormonal treatments in post-menopausal women and in breast and prostate cancer survivors; these results are presented in Additional file 1. The most effective hot flush treatment is oestrogenic hormones, or a combination of oestrogen and progestins, though benefits are partially outweighed by a significantly increased risk for breast cancer development. This review illustrates that certain non-hormonal treatments, including selective serotonin reuptake inhibitors, gabapentin/pregabalin, and Cimicifuga racemosa extracts, show a positive risk-benefit ratio. Key pointsSeveral non-hormonal alternatives to hormonal therapy have been established and registered for the treatment of vasomotor climacteric symptoms in peri- and post-menopausal women. There are indications that non-hormonal treatments are useful alternatives in patients with a history of breast and prostate cancer. However, confirmation by larger clinical trials is required.
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Affiliation(s)
- Juergen Drewe
- Max Zeller AG, Seeblickstr. 4, 8590 Romanshorn, Switzerland
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Multiple factors must be considered when selecting the best antidepressant to treat depression in patients with cancer. DRUGS & THERAPY PERSPECTIVES 2014. [DOI: 10.1007/s40267-013-0096-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Elkins GR, Kendrick C, Koep L. Hypnotic relaxation therapy for treatment of hot flashes following prostate cancer surgery: a case study. Int J Clin Exp Hypn 2014; 62:251-9. [PMID: 24837059 DOI: 10.1080/00207144.2014.901051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This case study reports on a 69-year-old African American male who presented with hot flashes following a diagnosis of prostate cancer and subsequent prostatectomy. Measures include both self-reported and physiologically measured hot flash frequency and sleep quality. The intervention involved 7 weekly sessions of hypnotic relaxation therapy directed toward alleviation of hot flashes. Posttreatment self-reported hot flashes decreased 94%; physiologically measured hot flashes decreased 100%; and sleep quality improved 87.5%. At week 12, both self-reported and physiologically measured hot flashes decreased 95% and sleep quality improved 37.5% over baseline, suggesting hypnotic relaxation therapy may be an effective intervention for men with hot flashes following treatment for prostate cancer.
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Torta RGV, Ieraci V. Pharmacological Management of Depression in Patients with Cancer: Practical Considerations. Drugs 2013; 73:1131-45. [DOI: 10.1007/s40265-013-0090-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Yousaf O, Stefanopoulou E, Grunfeld EA, Hunter MS. A randomised controlled trial of a cognitive behavioural intervention for men who have hot flushes following prostate cancer treatment (MANCAN): trial protocol. BMC Cancer 2012; 12:230. [PMID: 22687265 PMCID: PMC3419080 DOI: 10.1186/1471-2407-12-230] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 06/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This randomised controlled trial (RCT) aims to evaluate the effectiveness of a guided self-help cognitive behavioural intervention to alleviate problematic hot flushes (HF) and night sweats (NS) in men who are undergoing prostate cancer treatment. The trial and the self-help materials have been adapted from a previous RCT, which showed that a cognitive behavioural intervention reduced the self-reported problem-rating of hot flushes in women with menopausal symptoms, and in women undergoing breast cancer treatment. We hypothesize that guided self-help will be more effective than usual care in reducing HF/NS problem-rating at post treatment assessment. METHODS/DESIGN Seventy men who are undergoing treatment for prostate cancer and who have been experiencing more than ten HF/NS weekly for over a month are recruited into the trial from urology clinics in London. They are randomly allocated to either a four-week self-help cognitive behavioural therapy (CBT) treatment or to their usual care (control group). The treatment includes information and discussion about hot flushes and night sweats in the context of prostate cancer, monitoring and modifying precipitants, relaxation and paced respiration, stress management, cognitive therapy for unhelpful thoughts and beliefs, managing sleep and night sweats, and advice on maintaining these changes. Prior to randomisation, men attend a clinical interview, undergo 24-48-hour sternal skin conductance monitoring, and complete pre-treatment questionnaires (e.g., problem-rating and frequency of hot flushes and night sweats; quality of life; mood; hot flush beliefs and behaviours). Post-treatment measures (sternal skin conductance and the above questionnaires) are collected four-six weeks later, and again at a six-month follow-up. DISCUSSION MANCAN is the first randomised controlled trial of cognitive behavioural therapy for HF/NS for men that measures both self-reported and physiologically indexed symptoms. The results will inform future clinical practice by evaluating an evidence-based, non-medical treatment, which can be delivered by trained health professionals. TRIAL REGISTRATION UK Clinical Research Network UKCRN10904.
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Affiliation(s)
- Omar Yousaf
- Department of Psychology (at Guy's), Institute of Psychiatry, King's College London, 5 Floor Bermondsey Wing, Guy's Campus, London, SE1 9RT, UK
| | - Evgenia Stefanopoulou
- Department of Psychology (at Guy's), Institute of Psychiatry, King's College London, 5 Floor Bermondsey Wing, Guy's Campus, London, SE1 9RT, UK
| | | | - Myra S Hunter
- Department of Psychology (at Guy's), Institute of Psychiatry, King's College London, 5 Floor Bermondsey Wing, Guy's Campus, London, SE1 9RT, UK
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Andropause syndrome in men treated for metastatic prostate cancer: a qualitative study of the impact of symptoms. Cancer Nurs 2012; 35:63-9. [PMID: 21558849 DOI: 10.1097/ncc.0b013e318211fa92] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) has become the cornerstone of treatment for men with metastatic prostate cancer. However, treatments are associated with a number of adverse effects that collectively are referred to as andropause syndrome, or the male menopause. OBJECTIVE This study explored the experience and impact of andropause symptoms, particularly hot flashes, among men undergoing ADT for metastatic prostate cancer. METHODS Twenty-one men receiving ADT for metastatic prostate cancer underwent a qualitative interview focusing on the adverse effects of ADT and the impact of these symptoms on daily living and coping strategies. RESULTS The most frequently mentioned adverse effects were hot flashes and night sweats, gynecomastia, cognitive decline, and changes in sexual function. Hot flashes did impact on everyday functioning, and night sweats regularly disturbed sleep patterns and led to participants feeling tired and irritable. Participants reported a lack of control over their hot flashes and night sweats. There was reluctance among our sample to disclose the type of symptoms experienced to others. CONCLUSION The occurrence of andropause symptoms, including hot flashes and night sweats, was common among this sample. Participants reported a range of cognitive and behavioral responses to these symptoms. There was some reluctance about discussing a prostate cancer diagnosis or the occurrence of symptoms with others. IMPLICATIONS FOR PRACTICE The findings have implications for a range of individual and couple interventions to manage the impact of this constellation of symptoms.
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Holmes FA, Liticker JD. Pharmacogenomics of tamoxifen in a nutshell-and who broke the nutcracker? J Oncol Pract 2011; 1:155-9. [PMID: 20871698 DOI: 10.1200/jop.2005.1.4.155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Novel, potent anti-androgens of therapeutic potential: recent advances and promising developments. Future Med Chem 2011; 2:667-80. [PMID: 21426013 DOI: 10.4155/fmc.10.14] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The beneficial effect of androgen ablation has been well established in prostate cancer therapy. Despite the initial response, patients typically relapse with a more aggressive form described as castration-resistant prostate cancer (CRCP), driven by continued androgen receptor (AR) signaling. This review details the current state of anti-androgen therapy, mainly for CRPC, with major emphasis on the most potent and promising compounds under development. Anti-androgen failure has been linked to elevated AR expression, increased expression of coactivator proteins, AR mutations, ligand-independent AR activation and persistent intraprostatic androgens. MDV3100, BMS-641988 and VN/124-1 were developed to overcome these mechanisms. In CRCP, prostate cancer cells still rely on intracellular androgens and, to a greater extent, on active AR for growth and survival. Therefore, potent anti-androgens that efficiently disrupt the functions (signaling) of AR are envisioned to be effective drugs for all types of prostate cancers.
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Thomas KS, Bower J, Hoyt MA, Sepah S. Disrupted sleep in breast and prostate cancer patients undergoing radiation therapy: the role of coping processes. Psychooncology 2010; 19:767-76. [PMID: 19885853 DOI: 10.1002/pon.1639] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Sleep problems are a common complaint in cancer patients that have been understudied. METHODS This study examined changes in sleep in 33 breast cancer (BC) patients and 23 prostate cancer (PC) patients during radiation therapy and over a 6-month followup. Coping processes were examined as predictors of sleep. Self-reported sleep was assessed at eight time-points before, during, and after treatment using the Medical Outcomes Study-Sleep Scale. The COPE Scale was used to assess coping processes before treatment onset. RESULTS Mixed effects linear modeling analyses revealed that both BC and PC patients reported the most sleep problems prior to and during the early weeks of treatment. Coping strategies predicted sleep trajectories in both groups. In particular, approach coping predicted better sleep in PC patients, whereas avoidance coping predicted worst sleep in both PC and BC patients (p's<0.05). CONCLUSION These findings highlight the importance of evaluating sleep in patients as they undergo treatment for cancer. Additionally, they suggest that interventions aimed at increasing the use of approach-oriented coping strategies may improve sleep and quality of life in these patients.
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Affiliation(s)
- Kamala S Thomas
- Department of Psychology, Pitzer College, Claremont, CA 91711, USA.
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Jelinsky SA, Choe SE, Crabtree JS, Cotreau MM, Wilson E, Saraf K, Dorner AJ, Brown EL, Peano BJ, Zhang X, Winneker RC, Harris HA. Molecular analysis of the vaginal response to estrogens in the ovariectomized rat and postmenopausal woman. BMC Med Genomics 2008; 1:27. [PMID: 18578861 PMCID: PMC2453134 DOI: 10.1186/1755-8794-1-27] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 06/25/2008] [Indexed: 11/21/2022] Open
Abstract
Background Vaginal atrophy (VA) is the thinning of the vaginal epithelial lining, typically the result of lowered estrogen levels during menopause. Some of the consequences of VA include increased susceptibility to bacterial infection, pain during sexual intercourse, and vaginal burning or itching. Although estrogen treatment is highly effective, alternative therapies are also desired for women who are not candidates for post-menopausal hormone therapy (HT). The ovariectomized (OVX) rat is widely accepted as an appropriate animal model for many estrogen-dependent responses in humans; however, since reproductive biology can vary significantly between mammalian systems, this study examined how well the OVX rat recapitulates human biology. Methods We analyzed 19 vaginal biopsies from human subjects pre and post 3-month 17β-estradiol treated by expression profiling. Data were compared to transcriptional profiling generated from vaginal samples obtained from ovariectomized rats treated with 17β-estradiol for 6 hrs, 3 days or 5 days. The level of differential expression between pre- vs. post- estrogen treatment was calculated for each of the human and OVX rat datasets. Probe sets corresponding to orthologous rat and human genes were mapped to each other using NCBI Homologene. Results A positive correlation was observed between the rat and human responses to estrogen. Genes belonging to several biological pathways and GO categories were similarly differentially expressed in rat and human. A large number of the coordinately regulated biological processes are already known to be involved in human VA, such as inflammation, epithelial development, and EGF pathway activation. Conclusion At the transcriptional level, there is evidence of significant overlap of the effects of estrogen treatment between the OVX rat and human VA samples.
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Singer EA, Golijanin DJ, Miyamoto H, Messing EM. Androgen deprivation therapy for prostate cancer. Expert Opin Pharmacother 2008; 9:211-28. [PMID: 18201145 DOI: 10.1517/14656566.9.2.211] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Androgen deprivation continues to play a crucial role in the treatment of advanced and metastatic prostate cancer. In the 65 years since its use was first described, urologists and medical oncologists have developed new and innovative ways to manipulate the hypothalamic-pituitary-gonadal axis with the goal of alleviating symptoms and prolonging the life of men with prostate cancer. Despite the successes that androgen deprivation therapy has brought, each method and regimen possesses unique benefits and burdens, of which the clinician and patient must be cognizant. This review discusses the first-line androgen deprivation methods and regimens presently in use with special attention paid to their side effects and the management of them, as well as the question of when to initiate androgen deprivation therapy.
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Affiliation(s)
- Eric A Singer
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, USA
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Abstract
As survival from breast cancer increases, there is a corresponding rise in the number of women living with the long-term consequences of its treatment. Distressing menopausal hot flushes occur in many of these women. This article reports on interviews conducted with 8 women, exploring the experience of hot flushes after breast cancer. Women's accounts of hot flushes varied from being a mild sensation to an intensely unpleasant sensation affecting the whole body and accompanied by drenching perspiration. Flushes affected all aspects of the women's lives, including sleeping, clothing, social situations, intimate relationships, and ability to work. Emotionally, women talked about being out of control. Having cancer and menopause simultaneously made it more difficult for the women to cope, and cancer treatment could cause flushing. The women used many strategies to help relieve their difficulties. Some resorted to hormone replacement therapy, whereas others turned to herbal medications and other alternative interventions such as acupuncture. Most women adopted behavioral strategies to try to regain control. Ultimately, they found that control was gained by attitude of mind. Cognitive behavioral techniques may enhance the sense of control and contribute to coping during hot flushes.
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Affiliation(s)
- D R Fenlon
- University of Southampton, Highfield, Southampton, UK.
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Walji R, Boon H, Guns E, Oneschuk D, Younus J. Black cohosh (Cimicifuga racemosa [L.] Nutt.): safety and efficacy for cancer patients. Support Care Cancer 2007; 15:913-21. [PMID: 17602247 DOI: 10.1007/s00520-007-0286-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 06/07/2007] [Indexed: 11/28/2022]
Abstract
GOALS OF WORK Black cohosh is commonly used to treat hot flashes and other symptoms associated with menopause. It is thought to have multiple mechanisms of action, including potential phytoestrogenic properties. This has caused some concern about its use by patients with hormone-sensitive cancer. This paper will present the results of a systematic review of the safety and efficacy of black cohosh (Cimicifuga racemosa [L.] Nutt.) in patients with cancer. MATERIALS AND METHODS A critical assessment of clinical (n = 5) and preclinical (n = 21) studies of black cohosh and cancer (breast and prostate) to treat hot flashes and other related symptoms is presented. In addition, clinical studies, case reports, animal studies, and in vitro assessments of the safety of black cohosh for patients with hormonally sensitive cancers is summarized and interpreted. MAIN RESULTS In general, the research assessing efficacy of black cohosh for the treatment of hot flashes in women with breast cancer is inconclusive. There is laboratory evidence of antiproliferative properties but no confirmation from clinical studies for a protective role in cancer prevention. Black cohosh seems to have a relatively good safety profile. Concerns about liver toxicity are inconclusive. With relevance to cancer patients, black cohosh also seems not to exhibit phytoestrogenic activity and is in fact possibly an inhibitor of tumor growth. CONCLUSIONS The use of black cohosh appears to be safe in breast cancer patients without risk for liver disease, although further research is needed in this and other populations.
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Affiliation(s)
- Rishma Walji
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, Canada
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Gillatt D. Antiandrogen treatments in locally advanced prostate cancer: are they all the same? J Cancer Res Clin Oncol 2006; 132 Suppl 1:S17-26. [PMID: 16845534 DOI: 10.1007/s00432-006-0133-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The objectives are to review the published literature and to evaluate the weight of evidence for clinical effectiveness, safety, and tolerability of the currently available antiandrogens in the treatment of locally advanced prostate cancer. This article covers efficacy as monotherapy relative to castration and as adjuvant to radiotherapy and radical prostatectomy as well as adverse-effect and quality-of-life data. METHODS The current literature from online databases between 1986 and the present, relating to antiandrogen treatments in men with locally advanced disease given either as monotherapy or as adjuvant to radical radiotherapy or prostatectomy, was reviewed. Antiandrogens researched included the non-steroidal antiandrogens, bicalutamide ('Casodex'), flutamide, and nilutamide, and the steroidal antiandrogen cyproterone acetate (CPA). RESULTS The most comprehensively investigated and reported antiandrogen is bicalutamide, which has shown survival outcomes similar to those observed with castration in patients with locally advanced prostate cancer. In contrast, only limited clinical data are available for the other non-steroidal antiandrogens (flutamide and nilutamide) and the steroidal antiandrogen CPA in patients with locally advanced disease. In terms of safety and tolerability, CPA is associated with loss of libido and erectile dysfunction. CPA is also associated with cardiovascular risk and there have been occasional reports of fatal fulminant hepatitis and hepatocellular carcinoma. Gynecomastia is quite rare with CPA, which is in contrast to the non-steroidal antiandrogens. There are no direct comparisons between the three non-steroidal antiandrogens in terms of quality of life, but available evidence suggests that bicalutamide has a more favorable safety and tolerability profile than nilutamide and flutamide. Unlike CPA, non-steroidal antiandrogens appear to be better tolerated than castration, allowing patients to maintain sexual activity, physical ability, and bone mineral density, but these agents have a higher incidence of gynecomastia and breast pain (mild to moderate in > 90% of cases). Gynecomastia and breast pain, however, can be effectively managed. CONCLUSIONS The available evidence indicates that the different antiandrogens should not be regarded as equivalents in clinical practice and so the choice of treatment for patients with prostate cancer should be made on an individual basis. It is, therefore, important for clinicians to discuss the efficacy and tolerability profiles of all available treatment options with their patients to enable them to choose a treatment program that best fits with their lifestyle.
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Affiliation(s)
- David Gillatt
- Urology Department, Southmead Hospital, Bristol, BS10 5NB, UK.
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Porzio G, Aielli F, Verna L, Porto C, Aloisi P, Cannita K, Ricevuto E, Marchetti P, Ficorella C. Gabapentin in the treatment of severe sweating experienced by advanced cancer patients. Support Care Cancer 2006; 14:389-91. [PMID: 16402235 DOI: 10.1007/s00520-005-0014-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 12/15/2005] [Indexed: 10/25/2022]
Abstract
Nine patients with advanced cancer suffering from idiopathic severe sweating were treated with gabapentin (600-1,800 mg/day). All patients responded to the treatment; five patients experienced transient drowsiness. Gabapentin seems to be a safe and effective treatment for idiopathic sweating in advanced cancer patients. Further studies are warranted to confirm or refute these results.
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Affiliation(s)
- Giampiero Porzio
- Supportive Care Task Force, Medical Oncology Department, University of L'Aquila, L'Aquila, Italy.
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