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Xia W, Ou M, Chen Y, Chen F, Yan M, Xiao Z, Xu X. Experiences of patients with advanced cancer coping with chronic pain: a qualitative analysis. BMC Palliat Care 2024; 23:94. [PMID: 38600476 PMCID: PMC11005139 DOI: 10.1186/s12904-024-01418-2] [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: 11/22/2023] [Accepted: 03/22/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES To gain insight into the perceptions, and beliefs of patients with advanced cancer coping with chronic pain and to identify their attitudes and demands on pain management. METHODS From July to September 2022, 17 patients with advanced cancer living with chronic pain were recruited from a tertiary cancer hospital in Hunan Province, China. Qualitative and semi-structured interviews were conducted individually, with 30-45 minutes for each. The Colaizzi 7-step analysis method in phenomenological research was used for data analysis. RESULTS The experience of pain acceptance by advanced cancer patients with chronic pain was summarized into four themes: pain catastrophizing (unable to ignore the pain, try various methods to relieve the pain, exaggerating pain perception, and lack of knowledge about proper pain management), rumination (compulsive rumination and worrying rumination), avoidance coping (situational avoidance and repressive avoidance) and constructive action (setting clear value goal and taking reciprocal action). CONCLUSION Most patients with advanced cancer had low pain acceptance and negative attitudes. Feeling helpless in the face of pain and suffering alone were their norm. Long-term negative emotions could lead to gradual depression and loss of hope for treatment, resulting in pain catastrophizing and persistent rumination. Nevertheless, a few patients accepted pain with positive attitudes. Medical professionals should pay more attention to the psychological status of advanced cancer patients with chronic pain, and employ alternative therapies, for example, cognitive behavioral therapy. More efforts are needed to reduce patients' pain catastrophizing, and promote their pain acceptance by a better understanding of pain through health education.
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Affiliation(s)
- Wanting Xia
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Meijun Ou
- Head & Neck Plastic Surgery, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yongyi Chen
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Furong Chen
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Mengyao Yan
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Zhirui Xiao
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xianghua Xu
- Health Service Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
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Bahrami F, Rossi RM, De Nys K, Joerger M, Radenkovic MC, Defraeye T. Implementing physics-based digital patient twins to tailor the switch of oral morphine to transdermal fentanyl patches based on patient physiology. Eur J Pharm Sci 2024; 195:106727. [PMID: 38360153 DOI: 10.1016/j.ejps.2024.106727] [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: 07/12/2023] [Revised: 12/20/2023] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
Fentanyl transdermal patches are widely implemented for cancer-induced pain treatment due to the high potency of fentanyl and gradual drug release. However, transdermal fentanyl up-titration for opioid-naïve patients is difficult, which is why opioid treatment is often started with oral/iv morphine. Based on the daily dose of morphine, the initial dose of the fentanyl patch is decided upon. After reaching a stable level of pain, the switch is made from oral/iv morphine to transdermal fentanyl. There are standard calculation tools for transferring from oral/iv morphine to transdermal fentanyl, which is the same for all patients. By considering the variations in the physiology of the patients, a unique switching strategy cannot meet the needs of different patients. This study explores the outcome in terms of pain relief and minute ventilation during opioid therapy. For this, we used physics-based simulations on a virtually-generated population of patients, and we applied the same therapy to all patients. We could show that patients' physiology, such as gender, age, and weight, greatly impact the outcome of the therapy; as such, the correlation coefficient between pain intensity and age is 0.89, and the correlation coefficient between patient's weight and maximum plasma concentration of morphine and fentanyl is -0.98 and -0.97. Additionally, a different combination of the duration of overlap between morphine and fentanyl therapy with different doses of fentanyl was considered for the virtual patients to find the best opioid-switching strategy for each patient. We explored the impact of combining physiological features to determine the best-suited strategy for virtual patients. Our findings suggest that tailoring morphine and fentanyl therapy only based on a limited number of features is insufficient, and increasing the number of impactful physiological features positively influences the outcome of the therapy.
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Affiliation(s)
- Flora Bahrami
- Laboratory for Biomimetic Membranes and Textiles, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, St. Gallen CH-9014, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Mittelstrasse 43, Bern CH-3012, Switzerland
| | - René Michel Rossi
- Laboratory for Biomimetic Membranes and Textiles, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, St. Gallen CH-9014, Switzerland
| | - Katelijne De Nys
- Kantonsspital St. Gallen, Palliativzentrum, Rorschacherstrasse 95, St. Gallen CH-9000, Switzerland; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, ON2 Herestraat 49 - box 424, Leuven BE-3000, Belgium
| | - Markus Joerger
- Kantonsspital St. Gallen, Medizinische Onkologie und Hämatologie, Rorschacherstrasse 95, St. Gallen CH-9000, Switzerland
| | - Milena Cukic Radenkovic
- Laboratory for Biomimetic Membranes and Textiles, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, St. Gallen CH-9014, Switzerland
| | - Thijs Defraeye
- Laboratory for Biomimetic Membranes and Textiles, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, St. Gallen CH-9014, Switzerland.
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Samuels N, Ben-Arye E. Integrative Medicine for Cancer-Related Pain: A Narrative Review. Healthcare (Basel) 2024; 12:403. [PMID: 38338288 PMCID: PMC10855884 DOI: 10.3390/healthcare12030403] [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: 11/13/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Cancer-related pain (C-RP) is a prevalent and debilitating concern among patients with cancer, with conventional treatments limited in their ability to provide adequate relief, and by the adverse effects associated with their use. Complementary and integrative medicine (CIM) modalities have been shown to be potentially effective and safe for the treatment of pain and related symptoms, when used in conjunction with conventional medications and under medical supervision. An increasing number of oncology centers provide CIM within their conventional supportive and palliative care service, in an "Integrative Oncology" (IO) setting. A large body of clinical research, including systematic reviews and guidelines such as those published in 2022 by the Society for Integrative Oncology (SIO), in collaboration with the American Society for Clinical Oncology (ASCO), support the use of some CIM modalities for C-RP and related concerns. These include acupuncture for general and peri-operative/procedural pain, as well as aromatase inhibitor-associated arthralgia (AIA); reflexology or acupressure for pain during systemic therapy for cancer; hypnosis for procedural pain or pain due to diagnostic workup; and massage for pain experienced by patients during palliative and hospice care. Further research is needed, within both randomized control trials and pragmatic non-controlled studies which are more reflective of the real-life IO setting. This review summarizes the evidence supporting the use of CIM for C-RP; the analgesic mechanism of the modalities presented; and the challenges facing IO researchers, as well as the implementation of the 2022 SIO-ASCO guideline recommendations.
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Affiliation(s)
- Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103102, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa 3535152, Israel;
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
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Mercadante S. An overview of the current drug treatment strategies for moderate to severe, chronic malignant tumor-related pain. Expert Opin Pharmacother 2024; 25:171-179. [PMID: 37016731 DOI: 10.1080/14656566.2023.2200137] [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: 03/10/2022] [Accepted: 04/04/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION The pharmacological management of cancer pain is a complex issue that requires knowledge and experience in the use of analgesics. The aim of this expert review is to provide a panorama of the pharmacological strategies in cancer pain management. AREAS COVERED Opioid dose titration is a delicate process regarding the start of opioid treatment in different clinical conditions. How to improve the opioid response is a fundamental step, which includes different strategies when an initial treatment with opioids fails. The use of adjuvants is another relevant issue that should be considered in some specific circumstances to optimize the management of cancer pain management. Some clinical conditions, such as neuropathic pain and breakthrough pain, deserve a special attention. Relevant literature was selected to provide an overview of cancer pain management strategies. EXPERT OPINION Opioid therapy still remains the cornerstone of pharmacological management of cancer pain. Opioids should be used according to the level of tolerance, also personalizing the treatment (route, drug, and dosing). Adjuvant drugs may help in specific conditions, although their use should be balanced with the adverse effects. Breakthrough pain requires expertise in tailoring a treatment according to patient's profile and characteristics of episodes.
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Affiliation(s)
- Sebastiano Mercadante
- Main regional center of pain relief and supportive/palliative care, La Maddalena Cancer Center, Palermo, Italy
- Home palliative care program, Regional Home care program, SAMOT, Palermo, Italy
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Lantis K, Schnell P, Bland CR, Wilder J, Hock K, Vargo C, Glover NA, Hackney ME, Lustberg MB, Worthen-Chaudhari L. Biomechanical effect of neurologic dance training (NDT) for breast cancer survivors with chemotherapy-induced neuropathy: study protocol for a randomized controlled trial and preliminary baseline data. Trials 2023; 24:564. [PMID: 37658464 PMCID: PMC10472642 DOI: 10.1186/s13063-023-07554-z] [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: 05/27/2023] [Accepted: 07/28/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is among the most common forms of cancer experienced by women. Up to 80% of BC survivors treated with chemotherapy experience chemotherapy-induced neuropathy (CIN), which degrades motor control, sensory function, and quality of life. CIN symptoms include numbness, tingling, and/or burning sensations in the extremities; deficits in neuromotor control; and increased fall risk. Physical activity (PA) and music-based medicine (MBM) are promising avenues to address sensorimotor symptoms. Therefore, we propose that we can combine the effects of music- and PA-based medicine through neurologic dance training (NDT) through partnered Adapted Tango (NDT-Tango). We will assess the intervention effect of NDT-Tango v. home exercise (HEX) intervention on biomechanically-measured variables. We hypothesize that 8 weeks of NDT-Tango practice will improve the dynamics of posture and gait more than 8 weeks of HEX. METHODS In a single-center, prospective, two-arm randomized controlled clinical trial, participants are randomly assigned (1:1 ratio) to the NDT-Tango experimental or the HEX active control intervention group. Primary endpoints are change from baseline to after intervention in posture and gait. Outcomes are collected at baseline, midpoint, post, 1-month follow-up, and 6-month follow-up. Secondary and tertiary outcomes include clinical and biomechanical tests of function and questionnaires used to compliment primary outcome measures. Linear mixed models will be used to model changes in postural, biomechanical, and PROs. The primary estimand will be the contrast representing the difference in mean change in outcome measure from baseline to week 8 between treatment groups. DISCUSSION The scientific premise of this study is that NDT-Tango stands to achieve more gains than PA practice alone through combining PA with MBM and social engagement. Our findings may lead to a safe non-pharmacologic intervention that improves CIN-related deficits. TRIAL REGISTRATION This trial was first posted on 11/09/21 at ClinicalTrials.gov under the identifier NCT05114005.
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Affiliation(s)
- Kristen Lantis
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA.
| | - Patrick Schnell
- College of Public Health, Division of Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Courtney R Bland
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA
| | - Jacqueline Wilder
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA
| | - Karen Hock
- Comprehensive Cancer Center, The Ohio State University, 281 W Lane Ave, Columbus, OH, 43210, USA
| | - Craig Vargo
- Comprehensive Cancer Center, The Ohio State University, 281 W Lane Ave, Columbus, OH, 43210, USA
| | - Nelson A Glover
- George Mason University, 4400 University Dr, Fairfax, VA, 22030, USA
| | - Madeleine E Hackney
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, 2015 Uppergate Dr, Atlanta, GA, 30307, USA
| | | | - Lise Worthen-Chaudhari
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA
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Marshall VK, Chavez M, Efre A, Lake PW, Rigg KK, Lubrano B, Pabbathi S, Rajasekhara S, Tyson DM. Barriers to Adequate Pain Control and Opioid Use Among Cancer Survivors: Implications for Nursing Practice. Cancer Nurs 2023; 46:386-393. [PMID: 37607374 PMCID: PMC10232667 DOI: 10.1097/ncc.0000000000001126] [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] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cancer survivors can experience long-term negative effects from cancer and its treatment. Pain is one of the most common and distressing symptoms that cancer survivors experience. Opioids are often prescribed for pain; however, cancer survivors who have completed active treatment may have unique challenges with regard to pain management. OBJECTIVE The aim of this study was to explore barriers to pain management and perceptions of opioid use among cancer survivors. METHODS This research was an exploratory pilot study using in-depth qualitative interviews with adult cancer survivors who were recruited from community-based survivorship organizations. Data were analyzed using applied thematic analysis techniques. RESULTS Participants (n = 25) were mostly women (96%), diagnosed with breast cancer (88%) and stages I to III disease (84%), with a mean age of 56.2 years. Three themes on barriers to adequate pain control emerged: (1) taking just enough to take the edge off: self-medicating behaviors and nonadherence to prescribed regimen; (2) lack of insurance coverage and costly alternative pain treatment options; and (3) chronicity of cancer-related pain not adequately addressed and often mismanaged. CONCLUSIONS Discussions with cancer survivors unveiled personal accounts of unmanaged pain resulting from limited pain management/opioid education, fear of opioid addiction, negative perceptions/experiences with opioids, lack of insurance coverage for alternative pain therapies, and regulatory policies limiting access to opioids. IMPLICATIONS FOR PRACTICE There is a clear need for improved access to multimodal pain management options and nonopioid alternatives for cancer survivors. Oncology nurses should endeavor to support policies and procedures aimed at opioid education, training, and legislation.
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Affiliation(s)
- Victoria Kate Marshall
- Author Affiliations: Colleges of Nursing (Drs Marshall and Efre) and Public Health (Mss Chavez and Lake and Dr Tyson) and Department of Mental Health Law and Policy, College of Behavioral and Community Science (Dr Rigg), University of South Florida; and Moffitt Cancer Center (Drs Lubrano, Pabbathi, and Rajasekhara), Tampa, Florida
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Lantis KD, Schne P, Bland CR, Wilder J, Hock K, Glover NA, Hackney ME, Lustberg MB, Worthen-Chaudhari L. Biomechanical effect of neurologic dance training (NDT) for breast cancer survivors with chemotherapy-induced neuropathy: study protocol for a randomized controlled trail and preliminary baseline data. RESEARCH SQUARE 2023:rs.3.rs-2988661. [PMID: 37461666 PMCID: PMC10350217 DOI: 10.21203/rs.3.rs-2988661/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background Breast cancer (BC) is among the most common forms of cancer experienced by women. Up to 80% of BC survivors treated with chemotherapy experience chemotherapy-induced neuropathy (CIN), which degrades motor control, sensory function, and quality of life. CIN symptoms include numbness, tingling, and/or burning sensations in the extremities; deficits in neuromotor control; and increased fall risk. Physical activity (PA) and music-based medicine (MBM) are promising avenues to address sensorimotor symptoms. Therefore, we propose that we can combine the effects of music- and PA-based medicine through Neurologic Dance Training (NDT) through partnered Adapted Tango (NDT-Tango). We will assess the intervention effect of NDT-Tango v. home exercise (HEX) intervention on biomechanically-measured variables. We hypothesize that 8 weeks of NDT-Tango practice will improve the dynamics of posture and gait more than 8 weeks of HEX. Methods In a single-center, prospective, two-arm randomized controlled clinical trial, participants are randomly assigned (1:1 ratio) to the NDT-Tango experimental or the HEX active control intervention group. Primary endpoints are change from baseline to after intervention in posture and gait. Outcomes are collected at baseline, midpoint, post, 1mo follow up, and 6mo follow up. Secondary and tertiary outcomes include clinical and biomechanical tests of function and questionnaires used to compliment primary outcome measures. Linear mixed models will be used to model changes in postural, biomechanical, and PROs. The primary estimand will be the contrast representing the difference in mean change in outcome measure from baseline to week 8 between treatment groups. Discussion The scientific premise of this study is that NDT-Tango stands to achieve more gains than PA practice alone through combining PA with MBM and social engagement. Our findings may lead to a safe non-pharmacologic intervention that improves CIN-related deficits. Trial Registration This trial was first posted on 11/09/21 at ClinicalTrials.gov under the identifier NCT05114005.
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Affiliation(s)
- Kristen D Lantis
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio
| | - Patrick Schne
- College of Public Health, Division of Biostatistics, The Ohio State University, Columbus, Ohio
| | - Courtney R Bland
- College of Public Health, Division of Biostatistics, The Ohio State University, Columbus, Ohio
| | - Jacqueline Wilder
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio
| | - Karen Hock
- Comprehensive Cancer Center, The Ohio State University, Columbus OH
| | | | - Madeleine E Hackney
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA
| | | | - Lise Worthen-Chaudhari
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio
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Zhou S, Jin Q, Yao H, Ying J, Tian L, Jiang X, Yang Y, Jiang X, Gao W, Zhang W, Zhu Y, Cao W. Pain-Related Gene Solute Carrier Family 24 Member 3 Is a Prognostic Biomarker and Correlated with Immune Infiltrates in Cervical Squamous Cell Carcinoma and Endocervical Adenocarcinoma: A Study via Integrated Bioinformatics Analyses and Experimental Verification. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2023; 2023:4164232. [PMID: 36798148 PMCID: PMC9928512 DOI: 10.1155/2023/4164232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/13/2022] [Accepted: 11/24/2022] [Indexed: 02/10/2023]
Abstract
The aim of this study was to explore cervical carcinoma and screen a suitable gene as the biomarker used for prognosis evaluation as well as pain therapy. Low expression levels of solute carrier family 24 member 3 (SLC24A3) was involved in the appearance and development of numerous malignancies. Nevertheless, the prognostic value of SLC24A3 expression with cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC) patients remains uncertain. During the present study, SLC24A3 expression in CESC was retrieved from TCGA, GEO, and MSigDB databases. Based on TCGA and GEO profiles, we performed survival and difference analyses about SLC24A3 both in two GEO (GSE44001 and GSE63514) and TCGA-CESC cohorts (all p < 0.05), indicating that SLC24A3 was low expressed in tumors and associated with higher overall survival in CESC patients. Additionally, we programmed a series of analyses, including genomic profiling, enrichment analysis, immune infiltration analysis, and therapy-related analysis to identify the mechanism of the SLC24A3 in the process of cancer in CESC. Meanwhile, qRT-PCR was used to validate that the expression of SLC24A3 mRNA in Hela and SiHa cell lines was significantly lower than in PANC-1 and HUCEC cell lines. Our finding elucidated that the SLC24A3, a sodium-calcium regulator of cells, is an indispensable factor which can significantly influence the prognosis of patients with CESC and could provide novel clinical evidence to serve as a potential biological indicator for future diagnosis and pain therapy.
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Affiliation(s)
- Shuguang Zhou
- Department of Gynecology, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
- Department of Gynecology, Linquan Maternity and Child Healthcare Hospital, Fuyang, Anhui 236400, China
| | - Qinqin Jin
- Department of Gynecology, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
| | - Hui Yao
- Department of Gynecology, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
| | - Jie Ying
- Department of Gynecology, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
| | - Lu Tian
- Department of Gynecology, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
| | - Xiya Jiang
- Department of Gynecology, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
| | - Yinting Yang
- Department of Gynecology, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
| | - Xiaomin Jiang
- Department of Gynecology, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
| | - Wei Gao
- Department of Gynecology, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
| | - Weiyu Zhang
- Department of Gynecology, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
| | - Yuting Zhu
- Department of Gynecology, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
| | - Wujun Cao
- Department of Clinical Laboratory, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 230001, China
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Simões Corrêa Galendi J, Siefen AC, Moretti DM, Yeo SY, Grüll H, Bratke G, Morganti AG, Bazzocchi A, Gasperini C, De Felice F, Blanco Sequeiros R, Huhtala M, Nijholt IM, Boomsma MF, Bos C, Verkooijen HM, Müller D, Stock S. Factors Influencing the Adoption of Magnetic Resonance-Guided High-Intensity Focused Ultrasound for Painful Bone Metastases in Europe, A Group Concept Mapping Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1084. [PMID: 36673840 PMCID: PMC9858703 DOI: 10.3390/ijerph20021084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) is an innovative treatment for patients with painful bone metastases. The adoption of MR-HIFU will be influenced by several factors beyond its effectiveness. To identify contextual factors affecting the adoption of MR-HIFU, we conducted a group concept mapping (GCM) study in four European countries. The GCM was conducted in two phases. First, the participants brainstormed statements guided by the focus prompt "One factor that may influence the uptake of MR-HIFU in clinical practice is...". Second, the participants sorted statements into categories and rated the statements according to their importance and changeability. To generate a concept map, multidimensional scaling and cluster analysis were conducted, and average ratings for each (cluster of) factors were calculated. Forty-five participants contributed to phase I and/or II (56% overall participation rate). The resulting concept map comprises 49 factors, organized in 12 clusters: "competitive treatments", "physicians' attitudes", "alignment of resources", "logistics and workflow", "technical disadvantages", "radiotherapy as first-line therapy", "aggregating knowledge and improving awareness", "clinical effectiveness", "patients' preferences", "reimbursement", "cost-effectiveness" and "hospital costs". The factors identified echo those from the literature, but their relevance and interrelationship are case-specific. Besides evidence on clinical effectiveness, contextual factors from 10 other clusters should be addressed to support adoption of MR-HIFU.
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Affiliation(s)
- Julia Simões Corrêa Galendi
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
| | - Ann-Cathrine Siefen
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
| | - Debora M. Moretti
- Institute for Food and Resource Economics, Chair for Technology, Innovation Management and Entrepreneurship, University of Bonn, 53115 Bonn, Germany
| | - Sin Yuin Yeo
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
| | - Holger Grüll
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, University of Cologne, 50939 Cologne, Germany
| | - Grischa Bratke
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero, Universitaria of Bologna, 40138 Bologna, Italy
- Radiation Oncology, DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Chiara Gasperini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | | | - Mira Huhtala
- Department of Oncology, Turku University Hospital, University of Turku, 20521 Turku, Finland
| | - Ingrid M. Nijholt
- Department of Radiology, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Martijn F. Boomsma
- Department of Radiology, Isala Hospital, 8025 AB Zwolle, The Netherlands
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Clemens Bos
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Helena M. Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
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10
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Ying J, Xiao R, Xu L, Yan M. Transcutaneous Electrical Nerve Stimulation (TENS) for Opioid-Induced Constipation in Palliative Care: A Systematic Review and Network Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:5383821. [PMID: 37123082 PMCID: PMC10132909 DOI: 10.1155/2023/5383821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 05/02/2023]
Abstract
Background Opioid-induced constipation (OIC) has become increasingly prevalent with the rise of prescription opioid use, particularly in patients with advanced illnesses. Existing literature suggests that transcutaneous electrical nerve stimulation (TENS) could be applied to treat cancer pain and reduce OIC incidence. However, there need to be more systematic review studies on the effectiveness of TENS in treating OIC. Objective In order to fill the gap of TENS in treating OIC in current knowledge, we have conducted a systematic review and network meta-analysis. Methods The comprehensive computer retrieval PubMed, Embase, Cochrane, China National Knowledge Infrastructure (CNKI), Chinese Biomedical (CBM), and Wanfang Database were used to collect literature for relevant studies of TENS treatment of OIC, in accordance with the standard of literature filtering, data extraction, and quality evaluation. The data were meta-analysed using ReviewManager 5.3 software recommended by Cochrane. Results A total of 180 pieces of literature were yielded through original search. Based on the inclusion and exclusion criteria, a total of 9 articles were included in this study. Our analysis of seven studies has revealed that TENS (28.18%) significantly reduces the incidence rate of OIC compared to control (52.45%) (I 2 = 57%, P=0.03; OR = 0.66 (95% CI, 0.53 to 0.82), Z = 3.70, P < 0.01). The results of two studies indicated that TENS significantly improved the quality of life compared to the control group (i.e., treatment-as-usual only) (I 2 = 80%, P=0.03; OR = -1.91; 95% CI, -2.54 to -1.29, Z = 6.00, P < 0.01). Conclusion The administration of TENS therapy holds the potential to mitigate the occurrence of OIC and augment the quality of life for individuals suffering from cancer. Particularly, TENS therapy proves to be appropriate for propagation within community and domestic environments. Nevertheless, advanced clinical randomized controlled trials of superior quality are necessary to authenticate the comprehensive clinical efficiency and safety of this therapy. Further investigation is indispensable to comprehend its mechanism in greater detail and establish the optimum therapeutic strategy.
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Affiliation(s)
- Jianyue Ying
- Campus Hospital of Zhejiang University, Zhejiang University, Hangzhou, Zhejiang, China
| | - Renzhong Xiao
- Hunan Royal Pharmaceutical Technology Co. Ltd., Changsha, Hunan, China
| | - Lili Xu
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Mei Yan
- Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China
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11
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Satiamurthy R, Yaakob NS, Shah NM, Azmi N, Omar MS. Potential Roles of 5-HT 3 Receptor Antagonists in Reducing Chemotherapy-induced Peripheral Neuropathy (CIPN). Curr Mol Med 2023; 23:341-349. [PMID: 35549869 DOI: 10.2174/1566524022666220512122525] [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: 08/12/2021] [Revised: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 11/22/2022]
Abstract
5-HT3 receptor antagonists corresponding to ondansetron, granisetron, tropisetron, and palonosetron are clinically accustomed to treating nausea and emesis in chemotherapy patients. However, current and previous studies reveal novel potentials of those ligands in other diseases involving the nervous system, such as addiction, pruritus, and neurological disorders, such as anxiety, psychosis, nociception, and cognitive function. This review gathers existing studies to support the role of 5-HT3 receptors in CIPN modulation. It has been reported that chemotherapy drugs increase the 5-HT content that binds with the 5-HT3 receptor, which later induces pain. As also shown in pre-clinical and clinical studies that various neuropathic pains could be blocked by the 5-HT3 receptor antagonists, we proposed that 5-HT3 receptor antagonists via 5- HT3 receptors may also inhibit neuropathic pain induced by chemotherapy. Our review suggests that future studies focus more on the 5-HT3 receptor antagonists and their modulation in CIPN to reduce the gap in the current pharmacotherapy for cancer-related pain.
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Affiliation(s)
- Raajeswari Satiamurthy
- Centre for Drug and Herbal Development, Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nor Syafinaz Yaakob
- Centre for Drug and Herbal Development, Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norazrina Azmi
- Centre for Drug and Herbal Development, Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Marhanis Salihah Omar
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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12
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Slotman DJ, Bartels MMTJ, Ferrer CJ, Bos C, Bartels LW, Boomsma MF, Phernambucq ECJ, Nijholt IM, Morganti AG, Siepe G, Buwenge M, Grüll H, Bratke G, Yeo SY, Blanco Sequeiros R, Minn H, Huhtala M, Napoli A, De Felice F, Catalano C, Bazzocchi A, Gasperini C, Campanacci L, Simões Corrêa Galendi J, Müller D, Braat MNGJA, Moonen C, Verkooijen HM. Focused Ultrasound and RadioTHERapy for non-invasive palliative pain treatment in patients with bone metastasis: a study protocol for the three armed randomized controlled FURTHER trial. Trials 2022; 23:1061. [PMID: 36582001 PMCID: PMC9798627 DOI: 10.1186/s13063-022-06942-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/17/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cancer-induced bone pain (CIBP), caused by bone metastases, is a common complication of cancer and strongly impairs quality of life (QoL). External beam radiotherapy (EBRT) is the current standard of care for treatment of CIBP. However, approximately 45% of patients have no adequate pain response after EBRT. Magnetic resonance image-guided high-intensity focused ultrasound (MR-HIFU) may improve pain palliation in this patient population. The main objective of this trial was to compare MR-HIFU, EBRT, and MR-HIFU + EBRT for the palliative treatment of bone metastases. METHODS/DESIGN The FURTHER trial is an international multicenter, three-armed randomized controlled trial. A total of 216 patients with painful bone metastases will be randomized in a 1:1:1 ratio to receive EBRT only, MR-HIFU only, or combined treatment with EBRT followed by MR-HIFU. During a follow-up period of 6 months, patients will be contacted at eight time points to retrieve information about their level of pain, QoL, and the occurrence of (serious) adverse events. The primary outcome of the trial is pain response at 14 days after start of treatment. Secondary outcomes include pain response at 14 days after trial enrolment, pain scores (daily until the 21st day and at 4, 6, 12 and 24 weeks), toxicity, adverse events, QoL, and survival. Cost-effectiveness and cost-utility analysis will be conducted. DISCUSSION The FURTHER trial aims to evaluate the effectiveness and cost-effectiveness of MR-HIFU-alone or in combination with EBRT-compared to EBRT to relieve CIBP. The trial will be performed in six hospitals in four European countries, all of which are partners in the FURTHER consortium. TRIAL REGISTRATION The FURTHER trial is registered under the Netherlands Trials Register number NL71303.041.19 and ClinicalTrials.gov registration number NCT04307914. Date of trial registration is 13-01-2020.
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Affiliation(s)
- Derk J. Slotman
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands ,grid.452600.50000 0001 0547 5927Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Marcia M. T. J. Bartels
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cyril J. Ferrer
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Clemens Bos
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lambertus W. Bartels
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Martijn F. Boomsma
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands ,grid.452600.50000 0001 0547 5927Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Erik C. J. Phernambucq
- grid.452600.50000 0001 0547 5927Department of Radiation Oncology, Isala Hospital, Zwolle, The Netherlands
| | - Ingrid M. Nijholt
- grid.452600.50000 0001 0547 5927Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Alessio G. Morganti
- grid.6292.f0000 0004 1757 1758DIMES, Alma Mater Studiorum - Bologna University, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giambattista Siepe
- grid.6292.f0000 0004 1757 1758Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Milly Buwenge
- grid.6292.f0000 0004 1757 1758DIMES, Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Holger Grüll
- grid.6190.e0000 0000 8580 3777Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Grischa Bratke
- grid.6190.e0000 0000 8580 3777Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sin Yuin Yeo
- grid.6190.e0000 0000 8580 3777Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roberto Blanco Sequeiros
- grid.410552.70000 0004 0628 215XDepartment of Radiology, Turku University Hospital, Turku, Finland
| | - Heikki Minn
- grid.1374.10000 0001 2097 1371Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
| | - Mira Huhtala
- grid.1374.10000 0001 2097 1371Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
| | - Alessandro Napoli
- grid.7841.aDepartment of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesca De Felice
- grid.7841.aDepartment of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- grid.7841.aDepartment of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alberto Bazzocchi
- grid.419038.70000 0001 2154 6641Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Chiara Gasperini
- grid.419038.70000 0001 2154 6641Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Campanacci
- grid.419038.70000 0001 2154 66413Rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Julia Simões Corrêa Galendi
- grid.6190.e0000 0000 8580 3777Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Dirk Müller
- grid.6190.e0000 0000 8580 3777Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Manon N. G. J. A. Braat
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Chrit Moonen
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Helena M. Verkooijen
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2022; 40:3998-4024. [PMID: 36122322 DOI: 10.1200/jco.22.01357] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 227 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra Barton
- University of Michigan School of Nursing, Ann Arbor, MI
| | - Eran Ben-Arye
- Lin & Carmel Medical Centers, Clalit Health Services; Technion Faculty of Medicine, Haifa, Israel
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City, UT
| | | | | | - Richard T Lee
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ana Maria Lopez
- Thomas Jefferson. Sidney Kimmel Cancer Center, Philadelphia, PA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jodi MacLeod
- Patient Representative, Memorial Sloan Kettering Integrative Medicine Service, New York, NY
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, GA
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Wu X, Qin F, Zhang Q, Qiao J, Qi Y, Liu B. Immunotherapy improved cancer related pain management in patients with advanced Hepato-Pancreatic Biliary Cancers: A propensity score-matched (PSM) analysis. Front Oncol 2022; 12:914591. [PMID: 36212482 PMCID: PMC9533141 DOI: 10.3389/fonc.2022.914591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHepato-pancreato-biliary (HPB) cancer is a serious form of cancer. in many HPB cancers, including cholangiocarcinoma (also known as bile duct cancer), pancreatic cancer, hepatocellular carcinoma, gallbladder cancer and ampullary cancer, although several treatment options are developed during these decades, the prognosis is still poor.MethodsA total of 356 HPB cancers patients in advanced stage received different kinds of treatments including adjuvant chemotherapy, radiotherapy, targeted therapy and immunotherapy. Among these patients with advanced HPB cancers, 135 patients have received standard opioid treatment for pain controlling.ResultsWe performed a PSM analysis to minimize differences between groups. Before PSM, 135 patients received standard opioid treatment for pain controlling were enrolled in this study and divided into 4 groups, including chemotherapy, radiotherapy, targeted therapy and immunotherapy. Relevant clinical variables that were available at the time of initial diagnosis were used for 1:1 matching between the two groups. After PSM, the cohort consisted of 18 patients in each group. Prior to PSM, patients received targeted therapy and immunotherapy exhibited shorter median OSs than their counterparts for patients received chemotherapy and radiotherapy (p<0.001). there were so survival differences among all the four different treatments for these patients with HPB cancers (p>0.05). We found the OMED (mg) q/day and NRS scores decreased significantly when patients received immunotherapy treatment. Fewer adverse events were showed between immunotherapy group and other three treatment groups, which was consistent with our previous reports.ConclusionIn conclusion, we found that given the same survival benefit, immunotherapy reduced opioid consumption in HPB cancers patients and improved the pain management. Moreover, immunotherapy results in fewer other adverse effects.
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Affiliation(s)
- Xiufang Wu
- Department of Pain, Jinan People’s Hospital, Jinan, China
| | - Fei Qin
- Department of Pain, Jinan People’s Hospital, Jinan, China
| | - Qiangze Zhang
- Department of Pain, Jinan People’s Hospital, Jinan, China
| | - Jianling Qiao
- Department of Medical Oncology, Jinan Hospital of Integrated Traditional Chinese and Western Medicine, Jinan, China
| | - Yulian Qi
- Department of Medical Oncology, Jinan People’s Hospital, Jinan, China
| | - Bing Liu
- Department of Disease Control and Prevention, Rocket Force Characteristic Medical Center, Beijing, China
- *Correspondence: Bing Liu,
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15
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Kibret AA, Wolde HF, Molla MD, Aragie H, Getnet Adugna D, Tafesse E, Melese EB, Worku YB, Belay DG. Factors associated with adherence to guidelines in cancer pain management among adult patients evaluated at oncology unit, in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. FRONTIERS IN PAIN RESEARCH 2022; 3:884253. [PMID: 35978991 PMCID: PMC9377527 DOI: 10.3389/fpain.2022.884253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionCancer pain is one of the most important deleterious and distressing symptoms suffered by patients with cancer which disturb their quality of life, especially in the last part of their life. Alleviating pain is a primary goal of prognosis of cancer pain management and pain symptoms must be prevented, treated as a priority, and considered an independent part of cancer management. Despite the presence of guidelines for cancer pain management, many patients with cancer are still undertreated. Therefore, this study aimed to assess factors associated with adherence to guidelines in cancer pain management among adult patients evaluated at the oncology unit, in the University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia.MethodsAn institution-based cross-sectional study was conducted from January to March 2021. All patients who were in cancer treatment were our population of interest. A systematic random sampling technique was used to select a total of 384 participants. The dependent variable of the study was adherence to guidelines in cancer pain management. It was determined using the pain management index (PMI) which was calculated by subtracting the pain level from the analgesics level. A negative range was considered an indicator of poor adherence to guidelines in cancer pain management. Bivariable and multivariable binary logistic regression analyses were performed. Adjusted odds ratio (AOR) with a 95% CI was used as a measure of association. Variables having P < 0.05 from the multivariable analysis were considered to have a significant association with the outcome.ResultsThe prevalence of poor adherence to guidelines in cancer pain management among 384 adult patients in this study was 21.35% (95%CI: 17.53, 25.76). Patients who were not married [AOR = 2.2; 95%CI: 1.15, 4.19], who know their diagnosis before 4 months ago [AOR = 0.53; 95%CI: 0.26, 0.96], who have metastasis cancer [AOR = 3.76; 95%CI: 1.83, 7.72], and being stage III patients [AOR = 3.21; 95%CI: 1.64, 7.93] and stage IV patients [AOR = 1.63; 95%CI: 1.09, 5.81], respectively, had a significant association with poor adherence to guidelines in cancer pain management.ConclusionThe prevalence of poor adherence to guidelines in cancer pain management among adult patients with cancer in UoGCSH Northwest Ethiopia is relatively low as compared with other studies. Factors such as patients who were not married and who have metastasis cancer, and being patients with stage III and stage IV cancer had a significant positive association with poor adherence to guidelines in cancer pain management, on the other hand, patients who know their diagnosis 4 months ago had a positive association with having adherence to guidelines in cancer pain management. Patients with high stage and metastasis need care from pain specialists early on in the diagnosis of pain. The hospital should reassure the diagnosis of cancer for the patient before they started the treatment.
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Affiliation(s)
- Anteneh Ayelign Kibret
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Meseret Derbew Molla
- Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hailu Aragie
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dagnew Getnet Adugna
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ephrem Tafesse
- Department of Internal Medicine School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endalkachew Belayneh Melese
- Department of Internal Medicine School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yilkal Belete Worku
- Department of Internal Medicine School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- *Correspondence: Daniel Gashaneh Belay
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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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Heart Rate Variability as a Potential Indicator of Cancer Pain in a Mouse Model of Peritoneal Metastasis. SENSORS 2022; 22:s22062152. [PMID: 35336325 PMCID: PMC8955674 DOI: 10.3390/s22062152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 01/27/2023]
Abstract
Heart rate variability (HRV) is closely related to changes in the autonomic nervous system (ANS) associated with stress and pain. In this study, we investigated whether HRV could be used to assess cancer pain in mice with peritoneal metastases. At 12 days after cancer induction, positive indicators of pain such as physiological characteristics, appearance, posture, and activity were observed, and time- and frequency-domain HRV parameters such as mean R-R interval, square root of the mean squared differences of successive R-R intervals, and percentage of successive R-R interval differences greater than 5 ms, low frequency (LF), high frequency (HF), and ratio of LF and HF power, were found to be significantly decreased. These parameters returned to normal after analgesic administration. Our results indicate that overall ANS activity was decreased by cancer pain and that HRV could be a useful tool for assessing pain.
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Mercadante S, Adile C, Ferrera P, Giuliana F. When the game is hard, more complex weapons are needed. BMJ Support Palliat Care 2022:bmjspcare-2021-003518. [PMID: 35260432 DOI: 10.1136/bmjspcare-2021-003518] [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: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aim of this paper is to illustrate how to manage a very difficult pain condition. METHODS This is a clinical note of a complex approach using multiple analgesic regimens to effectively afford challenging pain situations. RESULTS A man underwent an opioid dose titration, followed by dose stabilisation for some months. Then he underwent two opioid substitutions, unsuccessfully. A spinal analgesia provided good analgesia for a prolonged period of time, necessitating variable interventions to counteract the evolving, challenging clinical situation. CONCLUSIONS The description of this case illustrates the need of a high level of experience and knowledge to elaborate complex strategies step by step every time the pain syndrome was worsening. Recommendations are unlikely in these extreme circumstances, and treatment should be based on continuous clinical counteraction to the evolving clinical conditions.
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Affiliation(s)
- Sebastiano Mercadante
- Pain relief and supportive care, La Maddalena, Palermo, Italy
- Palliative Care, La Maddalena Cancer Center, Palermo, Italy
| | - Claudio Adile
- Pain relief and supportive care, La Maddalena, Palermo, Italy
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19
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Dupoiron D. Cancer Pain Management-A European Perspective. Cancer Treat Res 2021; 182:39-55. [PMID: 34542875 DOI: 10.1007/978-3-030-81526-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cancer pain management is a major challenge in both Europe and the United States. Recent studies show that the incidence of cancer pain remains high and even increases at an advanced stage of the disease.
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Affiliation(s)
- Denis Dupoiron
- Anesthesia and Pain Department, Institut de Cancérologie de l'Ouest, Rue Boquel, 49055, Angers, France.
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20
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Chen C, Li SQ, Bao T, Zhang L, Seluzicki C, Mao JJ. A Systematic Review of CheeZheng Pain Relieving Plaster for Musculoskeletal Pain: Implications for Oncology Research and Practice. Integr Cancer Ther 2021; 19:1534735420918933. [PMID: 32880472 PMCID: PMC7485161 DOI: 10.1177/1534735420918933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Musculoskeletal pain is a common and debilitating condition for cancer patients. Existing therapies for these pain conditions have substantial limitations. To identify an integrative approach to pain management, we conducted a systematic review to evaluate the safety and efficacy of a Tibetan herbal-based topical agent, CheeZheng Pain Relieving Plaster (PRP), for the treatment of osteoarthritis (OA) pain. METHODS We extracted citations from PubMed and Chinese databases (CNKI, WanFang Data, and CQVIP). We included randomized clinical trials evaluating the effectiveness and safety of CheeZheng PRP compared to conventional OA pain treatments. RESULTS Twenty-two randomized clinical trials (n = 2556 participants) compared CheeZheng PRP against nonsteroidal anti-inflammatory drugs (11), glucosamine (2), intraarticular corticosteroid (2), hyaluronic acid injections (6), and acetaminophen (1). Ten studies found a statistically greater effectiveness (assessed by ≥30% reduction in symptom severity) of CheeZheng PRP in improving OA pain (measured by the Visual Analogue Scale), stiffness, and function compared to control. Ten studies reported that 4.8% of participants experienced application site skin irritation that resolved after discontinuing the plaster. Randomization was not sufficiently described in most studies, and no placebo-controlled trials were identified. CONCLUSIONS There is promising evidence for the safety and clinical effectiveness of CheeZheng PRP to treat OA; however, lack of placebo control and unclear descriptions of randomization increase the potential risk for bias. Future randomized, placebo-controlled trials are needed to establish the safety and efficacy of CheeZheng PRP for pain management in oncology settings.
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Affiliation(s)
- Connie Chen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan Q Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lily Zhang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Saraswati W, Wardani R, Suhatno S, Hartono P, Imandiri A. The Effect of Electroacupuncture Therapy on Pain, Plasma β-Endorphin, and Quality of Life of Stage III Cervical Cancer Patients: A Randomized Control Trial. J Acupunct Meridian Stud 2021; 14:4-12. [DOI: 10.51507/j.jams.2021.14.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/18/2020] [Accepted: 12/28/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Wita Saraswati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ratih Wardani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Suhatno Suhatno
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Pudjo Hartono
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ario Imandiri
- Department of Traditional Healer, Faculty of Vocations, Universitas Airlangga, Surabaya, Indonesia
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22
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Huang L, Zhao Y, Xiang M. Knowledge Mapping of Acupuncture for Cancer Pain: A Scientometric Analysis (2000-2019). J Pain Res 2021; 14:343-358. [PMID: 33574698 PMCID: PMC7872910 DOI: 10.2147/jpr.s292657] [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: 11/21/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022] Open
Abstract
Objective This study aimed to demonstrate the state of the present situation and trends concerning the global use of acupuncture for cancer pain in the past 20 years. Methods Searched the Web of Science database from 2000 to 2019 related to acupuncture for cancer pain, and then used CiteSpace to conduct scientometric analysis to acquire the knowledge mapping. Results Yearly output has increased year by year, and the growth rate has become faster after 2012. According to the cluster analysis of institutions, authors, cited references, and keywords, 4, 4, 15, and 14 categories were obtained, respectively. The most productive countries, institutions, and authors are the USA, Mem Sloan Kettering Cancer Center, and Mao JJ, whose frequencies are 196, 24, and 17, respectively. However, the most important of them are Australia, Univ. Maryland, and Bao T, owing to their highest centrality, they are 0.90, 0.21, and 0.09 separately. Moreover, cited references that contributed to the most co-citations are Crew KD (2010), however, the most key cited reference is Roscoe JA (2003). Keywords such as acupuncture, pain, breast cancer, palliative care, and quality of life are the most frequently used. But auricular acupuncture is the crucial keyword. In the cluster analysis of institutions, authors, cited references, and keywords, the more convincing research categories are multiple myeloma, placebo effect, neck malignancies, and early breast cancer, with S values of 0.990, 0.991, 0.990, and 0.923, respectively. Therefore, they can be regarded as research hotspots in this field. Conclusion Based on the scientometric analysis in the past 20 years, the knowledge mapping of the country, institution, author, cited reference, and the keyword is gained, which has an important guiding significance for quickly and accurately positioning the trend in this field.
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Affiliation(s)
- Li Huang
- Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yanqing Zhao
- Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Minhong Xiang
- Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
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23
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Bartels MMTJ, Verpalen IM, Ferrer CJ, Slotman DJ, Phernambucq ECJ, Verhoeff JJC, Eppinga WSC, Braat MNGJA, van den Hoed RD, van 't Veer-Ten Kate M, de Boer E, Naber HR, Nijholt IM, Bartels LW, Bos C, Moonen CTW, Boomsma MF, Verkooijen HM. Combining radiotherapy and focused ultrasound for pain palliation of cancer induced bone pain; a stage I/IIa study according to the IDEAL framework. Clin Transl Radiat Oncol 2021; 27:57-63. [PMID: 33532631 PMCID: PMC7822778 DOI: 10.1016/j.ctro.2021.01.005] [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: 11/12/2020] [Revised: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 11/18/2022] Open
Abstract
Combined treatment of EBRT and MR-HIFU is feasible and well tolerated by patients. Clinical outcomes of combined treatment of EBRT and MR-HIFU are promising. Superiority of combined treatment over standard EBRT needs to be evaluated in a comparative study.
Background Cancer induced bone pain (CIBP) strongly interferes with patient’s quality of life. Currently, the standard of care includes external beam radiotherapy (EBRT), resulting in pain relief in approximately 60% of patients. Magnetic Resonance guided High Intensity Focused Ultrasound (MR-HIFU) is a promising treatment modality for CIBP. Methods A single arm, R-IDEAL stage I/IIa study was conducted. Patients presenting at the department of radiation oncology with symptomatic bone metastases in the appendicular skeleton, as well as in the sacrum and sternum were eligible for inclusion. All participants underwent EBRT, followed by MR-HIFU within 4 days. Safety and feasibility were assessed, and pain scores were monitored for 4 weeks after completing the combined treatment. Results Six patients were enrolled. Median age was 67 years, median lesion diameter was 56,5 mm. In all patients it was logistically possible to plan and perform the MR-HIFU treatment within 4 days after EBRT. All patients tolerated the combined procedure well. Pain response was reported by 5 out of 6 patients at 7 days after completion of the combined treatment, and stabilized on 60% at 4 weeks follow up. No treatment related serious adverse events occurred. Conclusion This is the first study to combine EBRT with MR-HIFU. Our results show that combined EBRT and MR-HIFU in first-line treatment of CIBP is safe and feasible, and is well tolerated by patients. Superiority over standard EBRT, in terms of (time to) pain relief and quality of life need to be evaluated in comparative (randomized) study.
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Affiliation(s)
- Marcia M T J Bartels
- University Medical Center Utrecht, Department of Radiation Oncology, Division of Imaging and Oncology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,University Medical Center Utrecht, Department of Radiology, Division of Imaging and Oncology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Inez M Verpalen
- Isala Hospital, Department of Radiology, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Cyril J Ferrer
- University Medical Center Utrecht, Image Sciences Institute, Division of Imaging and Oncology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Derk J Slotman
- Isala Hospital, Department of Radiology, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Erik C J Phernambucq
- Isala Hospital, Department of Radiation Oncology, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Joost J C Verhoeff
- University Medical Center Utrecht, Department of Radiation Oncology, Division of Imaging and Oncology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Wietse S C Eppinga
- University Medical Center Utrecht, Department of Radiation Oncology, Division of Imaging and Oncology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Manon N G J A Braat
- University Medical Center Utrecht, Department of Radiology, Division of Imaging and Oncology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rolf D van den Hoed
- Isala Hospital, Department of Radiology, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | | | - Erwin de Boer
- Isala Hospital, Department of Radiology, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Harry R Naber
- Isala Hospital, Department of Radiology, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Ingrid M Nijholt
- Isala Hospital, Department of Radiology, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Lambertus W Bartels
- University Medical Center Utrecht, Image Sciences Institute, Division of Imaging and Oncology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Clemens Bos
- University Medical Center Utrecht, Image Sciences Institute, Division of Imaging and Oncology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Chrit T W Moonen
- University Medical Center Utrecht, Image Sciences Institute, Division of Imaging and Oncology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Martijn F Boomsma
- Isala Hospital, Department of Radiology, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Helena M Verkooijen
- University Medical Center Utrecht, Department of Radiation Oncology, Division of Imaging and Oncology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,University Medical Center Utrecht, Department of Radiology, Division of Imaging and Oncology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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24
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Tyson DM, Chavez MN, Lake P, Gutierrez A, Sherry P, Rigg KK, Marshall VK, Henderson H, di Ciccone BL, Rajasekhara S, Pabbathi S. Perceptions of prescription opioid medication within the context of cancer survivorship and the opioid epidemic. J Cancer Surviv 2021; 15:585-596. [PMID: 33405057 DOI: 10.1007/s11764-020-00952-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/06/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Prescription opioid medication can be of great benefit for cancer patients and survivors who suffer from cancer-related pain throughout their cancer care trajectory. However, the current opioid epidemic has influenced how such medications are perceived. The purpose of this study was to explore the perceptions of opioid use and misuse in cancer survivorship within the context of the opioid epidemic. METHODS pt?>A qualitative study using a semi-structured interview was conducted with a purposive sample of health care professionals (n = 24), community-level stakeholders (n = 6), and cancer survivors (n = 25) using applied thematic analysis techniques. RESULTS Crosscutting themes include (1) fear of addiction and living with poorly managed pain, (2) the importance of good patient/provider communication and the need for education around the use/handling/disposal of prescription opioid medication, (3) preference for nonopioid alternatives for pain management, (4) cancer survivors perceived to be low risk for developing opioid use disorder (include inconsistent screening), and (5) impact of policies aimed at curbing the opioid epidemic on cancer survivors. CONCLUSION This study illustrates the intersecting and sometimes conflicting assumptions surrounding the use of opioids analgesics in the management of cancer pain among survivors embedded within the national discourse of the opioid epidemic. IMPLICATIONS FOR CANCER SURVIVORS A system of integrated cancer care using psychosocial screening, opioid risk mitigation tools, opioid treatment agreements, and specialist expertise that cancer care providers can rely on to monitor POM use in conjunction with patient-centered communication to empower patients informed decision making in managing their cancer pain could address this critical gap in survivorship care.
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Affiliation(s)
- Dinorah Martinez Tyson
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612-3805, USA.
| | - Melody N Chavez
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612-3805, USA
| | - Paige Lake
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612-3805, USA
| | - Ana Gutierrez
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612-3805, USA
| | - Peggie Sherry
- Faces of Courage, 10006 Cross Creek Blvd #519, Tampa, FL, 33647-2595, USA
| | - Khary K Rigg
- Department of Mental Health Law and Policy, University of South Florida, 13301 Bruce B. Downs Blvd, Tampa, FL, 33612-3805, USA
| | - Victoria K Marshall
- College of Nursing, University of South Florida, 12912 USF Health Dr., Tampa, FL, 33612, USA
| | - Heather Henderson
- Department of Anthropology, University of South Florida, 4202 E. Fowler Ave. SOC 107, Tampa, FL, 33620, USA
| | | | | | - Smitha Pabbathi
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
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25
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Glasser M, Chen J, Alzarah M, Wallace M. Non-opioid Analgesics and Emerging Therapies. Cancer Treat Res 2021; 182:125-142. [PMID: 34542880 DOI: 10.1007/978-3-030-81526-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pain is a common and debilitating symptom of cancer. Cancer-related pain can occur at any point along the continuum from diagnosis to treatment to survivorship1. A systematic review published in 2016 estimated the prevalence of cancer pain to be 55% in those undergoing antineoplastic treatment, 66.4% in advanced cancer, and 39.3% in the post-treatment population. Thirty-eight percent of cancer patients in this pooled analysis experienced moderate to severe pain2.
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Affiliation(s)
- Marga Glasser
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, 9300 Campus Point Dr, MC 7651, San Diego, USA
| | - Jeffrey Chen
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, 9300 Campus Point Dr, MC 7651, San Diego, USA.
| | - Mohammed Alzarah
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, 9300 Campus Point Dr, MC 7651, San Diego, USA
| | - Mark Wallace
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, 9300 Campus Point Dr, MC 7651, San Diego, USA
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26
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Mirshahidi S, Shields TG, de Necochea-Campion R, Yuan X, Janjua A, Williams NL, Mirshahidi HR, Reeves ME, Duerksen-Hughes P, Zuckerman LM. Bupivacaine and Lidocaine Induce Apoptosis in Osteosarcoma Tumor Cells. Clin Orthop Relat Res 2021; 479:180-194. [PMID: 33009230 PMCID: PMC7899706 DOI: 10.1097/corr.0000000000001510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteosarcoma is the most common type of bone cancer in adolescents. There have been no significant improvements in outcomes since chemotherapy was first introduced. Bupivacaine and lidocaine have been shown to be toxic to certain malignancies. This study evaluates the effect of these medications on two osteosarcoma cell lines. QUESTIONS/PURPOSES (1) Does incubation of osteosarcoma cells with bupivacaine or lidocaine result in cell death? (2) Does this result from an apoptotic mechanism? (3) Is a specific apoptotic pathway implicated? METHODS Two cell lines were chosen to account for the inherent heterogeneity of osteosarcoma. UMR-108 is a transplantable cell line that has been used in multiple studies as a primary tumor. MNNG/HOS has a high metastatic rate in vivo. Both cell lines were exposed bupivacaine (0.27, 0.54, 1.08, 2.16, 4.33 and 8.66 mM) and lidocaine (0.66, 1.33, 5.33, 10.66, 21.32 and 42.64 mM) for 24 hours, 48 hours, and 72 hours. These concentrations were determined by preliminary experiments that found the median effective dose was 1.4 mM for bupivacaine and 7.0 mM for lidocaine in both cell lines. Microculture tetrazolium and colony formation assay determined whether cell death occurred. Apoptosis induction was evaluated by phase-contrast micrographs, flow cytometry, DNA fragmentation and reactive oxygen species (ROS). The underlying pathways were analyzed by protein electrophoresis and Western blot. All testing was performed in triplicate and compared with pH-adjusted controls. Quantitative results were analyzed without blinding. RESULTS Both medications caused cell death in a dose- and time-dependent manner. Exposure to bupivacaine for 24 hours reduced viability of UMR-108 cells by 6 ± 0.75% (95% CI 2.9 to 9.11; p = 0.01) at 1.08 mM and 89.67 ± 1.5% (95% CI 82.2 to 95.5; p < 0.001) at 2.16 mM. Under the same conditions, MNNG/HOS viability was decreased in a similar fashion. After 24 hours, the viability of UMR-108 and MNNG/HOS cells exposed to 5.33 mM of lidocaine decreased by 25.33 ± 8.3% (95% CI 2.1 to 48.49; p = 0.03) and 39.33 ± 3.19% (95% CI 30.46 to 48.21; p < 0.001), respectively, and by 90.67 ± 0.66% (95% CI 88.82 to 92.52; p < 0.001) and 81.6 ± 0.47% (95% CI 79.69 to 82.31; p < 0.001) at 10.66 mM, respectively. After 72 hours, the viability of both cell lines was further reduced. Cell death was consistent with apoptosis based on cell morphology, total number of apoptotic cells and DNA fragmentation. The percentage increase of apoptotic UMR-108 and MNNG/HOS cells confirmed by Annexin-V positivity compared with controls was 21.3 ± 2.82 (95% CI 16.25 to 26.48; p < 0.001) and 21.23 ± 3.23% (95% CI 12.2 to 30.2; p = 0.003) for bupivacaine at 1.08 mM and 25.15 ± 4.38 (95% CI 12.9 to 37.3; p = 0.004) and 9.11 ± 1.74 (95% CI 4.35 to 13.87; p = 0.006) for lidocaine at 5.33 mM. The intrinsic apoptotic pathway was involved as the expression of Bcl-2 and survivin were down-regulated, and Bax, cleaved caspase-3 and cleaved poly (ADP-ribose) polymerase-1 were increased. ROS production increased in the UMR-108 cells but was decreased in the MNNG/HOS cells. CONCLUSION These findings provide a basis for evaluating these medications in the in vivo setting. Studies should be performed in small animals to determine if clinically relevant doses have a similar effect in vivo. In humans, biopsies could be performed with standard doses of these medications to see if there is a difference in biopsy tract contamination on definitive resection. CLINICAL RELEVANCE Bupivacaine and lidocaine could potentially be used for their ability to induce and enhance apoptosis in local osteosarcoma treatment. Outcome data when these medications are used routinely during osteosarcoma treatment can be evaluated compared with controls. Further small animal studies should be performed to determine if injection into the tumor, isolated limb perfusion, or other modalities of treatment are viable.
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Affiliation(s)
- Saied Mirshahidi
- S. Mirshahidi, R. de Necochea-Campion, A. Janjua, Biospecimen Laboratory, Loma Linda University Cancer Center, Department of Medicine and Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- T. G. Shields, N. L. Williams, Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
- X. Yuan, Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
- H. R. Mirshahidi Department of Medical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- M. E. Reeves Department of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- P. Duerksen-Hughes, Department of Biochemistry, Loma Linda University Medical Center, Loma Linda, CA, USA
- L. M. Zuckerman, Department of Surgery, Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Troy G Shields
- S. Mirshahidi, R. de Necochea-Campion, A. Janjua, Biospecimen Laboratory, Loma Linda University Cancer Center, Department of Medicine and Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- T. G. Shields, N. L. Williams, Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
- X. Yuan, Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
- H. R. Mirshahidi Department of Medical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- M. E. Reeves Department of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- P. Duerksen-Hughes, Department of Biochemistry, Loma Linda University Medical Center, Loma Linda, CA, USA
- L. M. Zuckerman, Department of Surgery, Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Rosalia de Necochea-Campion
- S. Mirshahidi, R. de Necochea-Campion, A. Janjua, Biospecimen Laboratory, Loma Linda University Cancer Center, Department of Medicine and Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- T. G. Shields, N. L. Williams, Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
- X. Yuan, Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
- H. R. Mirshahidi Department of Medical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- M. E. Reeves Department of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- P. Duerksen-Hughes, Department of Biochemistry, Loma Linda University Medical Center, Loma Linda, CA, USA
- L. M. Zuckerman, Department of Surgery, Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Xiangpeng Yuan
- S. Mirshahidi, R. de Necochea-Campion, A. Janjua, Biospecimen Laboratory, Loma Linda University Cancer Center, Department of Medicine and Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- T. G. Shields, N. L. Williams, Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
- X. Yuan, Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
- H. R. Mirshahidi Department of Medical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- M. E. Reeves Department of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- P. Duerksen-Hughes, Department of Biochemistry, Loma Linda University Medical Center, Loma Linda, CA, USA
- L. M. Zuckerman, Department of Surgery, Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Ata Janjua
- S. Mirshahidi, R. de Necochea-Campion, A. Janjua, Biospecimen Laboratory, Loma Linda University Cancer Center, Department of Medicine and Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- T. G. Shields, N. L. Williams, Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
- X. Yuan, Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
- H. R. Mirshahidi Department of Medical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- M. E. Reeves Department of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- P. Duerksen-Hughes, Department of Biochemistry, Loma Linda University Medical Center, Loma Linda, CA, USA
- L. M. Zuckerman, Department of Surgery, Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Nadine L Williams
- S. Mirshahidi, R. de Necochea-Campion, A. Janjua, Biospecimen Laboratory, Loma Linda University Cancer Center, Department of Medicine and Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- T. G. Shields, N. L. Williams, Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
- X. Yuan, Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
- H. R. Mirshahidi Department of Medical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- M. E. Reeves Department of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- P. Duerksen-Hughes, Department of Biochemistry, Loma Linda University Medical Center, Loma Linda, CA, USA
- L. M. Zuckerman, Department of Surgery, Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Hamid R Mirshahidi
- S. Mirshahidi, R. de Necochea-Campion, A. Janjua, Biospecimen Laboratory, Loma Linda University Cancer Center, Department of Medicine and Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- T. G. Shields, N. L. Williams, Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
- X. Yuan, Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
- H. R. Mirshahidi Department of Medical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- M. E. Reeves Department of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- P. Duerksen-Hughes, Department of Biochemistry, Loma Linda University Medical Center, Loma Linda, CA, USA
- L. M. Zuckerman, Department of Surgery, Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Mark E Reeves
- S. Mirshahidi, R. de Necochea-Campion, A. Janjua, Biospecimen Laboratory, Loma Linda University Cancer Center, Department of Medicine and Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- T. G. Shields, N. L. Williams, Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
- X. Yuan, Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
- H. R. Mirshahidi Department of Medical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- M. E. Reeves Department of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- P. Duerksen-Hughes, Department of Biochemistry, Loma Linda University Medical Center, Loma Linda, CA, USA
- L. M. Zuckerman, Department of Surgery, Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Penelope Duerksen-Hughes
- S. Mirshahidi, R. de Necochea-Campion, A. Janjua, Biospecimen Laboratory, Loma Linda University Cancer Center, Department of Medicine and Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- T. G. Shields, N. L. Williams, Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
- X. Yuan, Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
- H. R. Mirshahidi Department of Medical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- M. E. Reeves Department of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- P. Duerksen-Hughes, Department of Biochemistry, Loma Linda University Medical Center, Loma Linda, CA, USA
- L. M. Zuckerman, Department of Surgery, Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Lee M Zuckerman
- S. Mirshahidi, R. de Necochea-Campion, A. Janjua, Biospecimen Laboratory, Loma Linda University Cancer Center, Department of Medicine and Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- T. G. Shields, N. L. Williams, Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
- X. Yuan, Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
- H. R. Mirshahidi Department of Medical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- M. E. Reeves Department of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
- P. Duerksen-Hughes, Department of Biochemistry, Loma Linda University Medical Center, Loma Linda, CA, USA
- L. M. Zuckerman, Department of Surgery, Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA
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Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer. J Clin Med 2020; 9:jcm9113642. [PMID: 33198355 PMCID: PMC7696544 DOI: 10.3390/jcm9113642] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
Patients with cancer are at increased risk of cardiovascular disease, with a reported prevalence of acute coronary syndrome (ACS) ranging from 3% to 17%. The increased risk of ACS in these patients seems to be due to the complex interaction of shared cardiovascular risk factors, cancer type and stage, and chemotherapeutic and radiotherapy regimens. The management of ACS in patients with cancer is a clinical challenge, particularly due to cancer’s unique pathophysiology, which makes it difficult to balance thrombotic and bleeding risks in this specific patient population. In addition, patients with cancer have largely been excluded from ACS trials. Hence, an evidence-based treatment for ACS in this group of patients is unknown and only a limited proportion of them is treated with antiplatelets or invasive revascularization, despite initial reports suggesting their beneficial prognostic effects in cancer patients. Finally, cancer patients experiencing ACS are also at higher risk of in-hospital and long-term mortality as compared to non-cancer patients. In this review, we will provide an overview on the available evidence of the relationship between ACS and cancer, in terms of clinical manifestations, possible underlying mechanisms, and therapeutic and prognostic implications.
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Zielińska A, Włodarczyk M, Makaro A, Sałaga M, Fichna J. Management of pain in colorectal cancer patients. Crit Rev Oncol Hematol 2020; 157:103122. [PMID: 33171427 DOI: 10.1016/j.critrevonc.2020.103122] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/04/2020] [Accepted: 10/02/2020] [Indexed: 12/26/2022] Open
Abstract
In this review we focus on the pathophysiology of CRC-related pain and discuss currently applied pain management. Pain is a symptom reported by over 70 % of colorectal cancer (CRC) patients. It remains a feared and debilitating consequence of both cancer and cancer-related treatment. There are many options for pain management in CRC, consisting of intravenous, oral or topical medications. In order to address the full spectrum of pain, proper treatment should address the nociceptive, neuropathic and/or psychogenic pain component. Currently available methods do not bring pain relief to satisfying number of patients and, if used improperly, can cause a number of complications. Therefore, future treatments should focus primarily on alleviating pain, but also on reducing possible side effects. In this article we cover recent and promising pharmacological and non- pharmacological developments emerging in the field of CRC treatment.
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Affiliation(s)
- Anna Zielińska
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Poland
| | - Marcin Włodarczyk
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Poland; Department of General and Colorectal Surgery, Faculty of Medicine, Medical University of Lodz, Poland
| | - Adam Makaro
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Poland
| | - Maciej Sałaga
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Poland
| | - Jakub Fichna
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Poland.
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Saraswati W, Rosyiadi MR, Imandiri A. Electroacupuncture Versus Analgesics for Patients with Stage IIIB Cervical Cancer Post Cisplatin Chemotherapy. Med Acupunct 2020; 32:293-299. [PMID: 33101574 DOI: 10.1089/acu.2020.1425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: The prevalence of pain at advanced cervical cancer stages is increasing. Existing World Health Organization recommendations for management comprises a 3-step ladder of analgesic therapy but this still cannot address this pain optimally. An alternative therapy used to reduce pain, acupuncture, is almost without side-effects, is safe, and is easy to implement. This study compared electroacupuncture (EA) versus paracetamol 500 mg +10-mg codeine therapy for patients with stage-IIIB cervical cancer post cisplatin chemotherapy. Materials and Methods: Participants were divided into 2 groups (treatment and control groups). A quasiexperimental study was conducted using a nonequivalent control group pretest-post-test design. Participants in the treatment group were given EA for 30 minutes 10 times over 3 weeks, while participants in the control group were given paracetamol 3 × 500 mg and codeine 3 × 10 mg orally every day for 3 weeks. Statistical analysis used paired t-tests, a Wilcoxon test, an independent t-test, or a Mann-Whitney-U test with P < 0.05. Results: Pretest and post-test pain-scale levels were 5.39 ± 0.62 and 4.57 ± 0.88, respectively (P < 0.001). Average endorphin-β levels at pretest and post-test were 571.80 ± 281.13 and 491.14 ± 272.14, respectively (P = 0.818). Median values of quality of life at pretest and post-test were 681.75 (range: 503.80-915.20) and 635.25 (range: 538.20-781.20; P = 0.383), respectively. Conclusions: Pain-control therapy using drugs or EA produces similar results. However, EA, subjectively, produces improved pain-scale results better than pharmaceuticals.
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Affiliation(s)
- Wita Saraswati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Mochammad Rizalul Rosyiadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ario Imandiri
- Department of Traditional Healer, Faculty of Vocations, Universitas Airlangga, Surabaya, Indonesia.,The Traditional Poly Herbal Medicine, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
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Oh HJ, Hong SY, Jeong YM, Choi KS, Lee E, Lee E, Kim YJ, Bang SM. Drug use evaluation of opioid analgesics in pain management among patients with hematopoietic stem cell transplantation. Blood Res 2020; 55:151-158. [PMID: 32883891 PMCID: PMC7536558 DOI: 10.5045/br.2020.2020056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/15/2020] [Accepted: 08/07/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) patients usually experience mucositis, musculoskeletal pain associated with high-dose chemotherapy, radiation, post-HSCT infection, or graft-versus-host disease. Pain management is important for the patients' quality of life. We evaluated appropriate opioid analgesic use in HSCT patients to propose effective pain management strategies. METHODS A retrospective analysis was conducted using electronic medical records of adult patients with HSCT treated with opioids for moderate to severe pain at Seoul National University Bundang Hospital. The numeric rating scale (NRS) was used in pain management. NRS scores of 4‒10 correspond to moderate to severe pain. Appropriate opioid analgesic use was evaluated following published cancer pain management guidelines. RESULTS In total, 119 cases were evaluated, including 369 episodes of moderate to severe pain. Mucositis-related, musculoskeletal, and headache pain occurred in 62.6%, 25.8%, and 6.0% of episodes, respectively. Frequently used opioids were intravenous tramadol (84.9%), fentanyl patch (73.9%), and intravenous morphine sulfate (68.9%). Intravenous and topical administrations were used for mucosal pain. In total, 95.0% of patients received appropriate short-acting opioids for initial pain management, 80.5% received appropriate doses of short-acting opioids, appropriate opioids dose adjustment was done after first assessment in 95.5% of patients, and 85.6% were converted to appropriate long-acting opioids. CONCLUSION Short-acting opioid analgesic use for initial pain management and dose adjustment after assessment were appropriate. However, initial and conversion dosages recommended by guidelines may be difficult to implement considering the severity of HSCT patients. Pain management guidelines specific for HSCT patients should be developed in the future.
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Affiliation(s)
- Hyun Jin Oh
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So Yeon Hong
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Mi Jeong
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Suk Choi
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunsook Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Euni Lee
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soo-Mee Bang
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Abstract
Pain management for cancer patients should include pharmacologic and nonpharmacologic interventions. Integrative medicine therapies, such as mind-body practice, acupuncture, massage therapy, and music therapy, have been studied for their roles in pain management. Data from randomized controlled trials support the effect of hypnosis, acupuncture, and music therapy in reduction of pain. Mindfulness meditation, yoga, qigong, and massage therapy, although may not reduce pain per se, can relieve anxiety and mood changes, which are commonly associated with pain. In clinical practice, one should also consider burdens and risks to patients, patient preference, and the presence or absence of better alternatives when making decisions on whether an integrative medicine therapy is of clinical value.
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Stine C, Coleman DL, Flohrschutz AT, Thompson AL, Mishra S, Blagg BS, Largent-Milnes TM, Lei W, Streicher JM. Heat shock protein 90 inhibitors block the antinociceptive effects of opioids in mouse chemotherapy-induced neuropathy and cancer bone pain models. Pain 2020; 161:1798-1807. [PMID: 32701840 PMCID: PMC8607824 DOI: 10.1097/j.pain.0000000000001886] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Heat shock protein 90 (Hsp90) is a ubiquitous signal transduction regulator, and Hsp90 inhibitors are in clinical development as cancer therapeutics. However, there have been very few studies on the impact of Hsp90 inhibitors on pain or analgesia, a serious concern for cancer patients. We previously found that Hsp90 inhibitors injected into the brain block opioid-induced antinociception in tail flick, paw incision, and HIV neuropathy pain. This study extended from that initial work to test the cancer-related clinical impact of Hsp90 inhibitors on opioid antinociception in cancer-induced bone pain in female BALB/c mice and chemotherapy-induced peripheral neuropathy in male and female CD-1 mice. Mice were treated with Hsp90 inhibitors (17-AAG, KU-32) by the intracerebroventricular, intrathecal, or intraperitoneal routes, and after 24 hours, pain behaviors were evaluated after analgesic drug treatment. Heat shock protein 90 inhibition in the brain or systemically completely blocked morphine and oxymorphone antinociception in chemotherapy-induced peripheral neuropathy; this effect was partly mediated by decreased ERK and JNK MAPK activation and by increased protein translation, was not altered by chronic treatment, and Hsp90 inhibition had no effect on gabapentin antinociception. We also found that the Hsp90 isoform Hsp90α and the cochaperone Cdc37 were responsible for the observed changes in opioid antinociception. By contrast, Hsp90 inhibition in the spinal cord or systemically partially reduced opioid antinociception in cancer-induced bone pain. These results demonstrate that Hsp90 inhibitors block opioid antinociception in cancer-related pain, suggesting that Hsp90 inhibitors for cancer therapy could decrease opioid treatment efficacy.
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Affiliation(s)
- Carrie Stine
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724 USA
| | - Deziree L. Coleman
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724 USA
| | - Austin T. Flohrschutz
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724 USA
| | - Austen L. Thompson
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724 USA
| | - Sanket Mishra
- Department of Chemistry and Biochemistry, College of Science, University of Notre Dame, Notre Dame, IN 46556 USA
| | - Brian S. Blagg
- Department of Chemistry and Biochemistry, College of Science, University of Notre Dame, Notre Dame, IN 46556 USA
| | - Tally M. Largent-Milnes
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724 USA
| | - Wei Lei
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724 USA
- Department of Pharmaceutical and Administrative Sciences, School of Pharmacy, Presbyterian College, Clinton, SC 29325 USA
| | - John M. Streicher
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724 USA
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Xia R, Zeng H, Liu Q, Liu S, Zhang Z, Liu Y, Guo G, Song G, Zhu Y, Wu X, Song B, Liao X, Chen Y, Wei W, Chen G, Chen W, Zhuang G. Health-related quality of life and health utility score of patients with gastric cancer: A multi-centre cross-sectional survey in China. Eur J Cancer Care (Engl) 2020; 29:e13283. [PMID: 32602238 DOI: 10.1111/ecc.13283] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/05/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the health-related quality of life (HRQoL) and health state utility scores of gastric cancer patients in daily life at different clinical stages after treatment, and to explore influencing factors associated with HRQoL. METHODS Gastric cancer patients discharged from hospitals and healthy controls identified by screening were recruited. The three-level EQ-5D was employed to assess HRQoL and was scored using two Chinese-specific tariffs published in 2014 and 2018. RESULTS A total of 1,399 patients and 2,179 healthy controls were recruited. The likelihood of reporting problems in the five dimensions for patients was 4.0-23.8 times higher than controls. Based on the 2014/2018 tariff, the mean EQ-5D utility score was 0.321/0.163 lower than controls, and the mean utility scores of each patient subgroup were 0.077/0.039 (high-grade intraepithelial neoplasia/carcinoma in situ), 0.254/0.121 (Stage I), 0.249/0.123 (Stage II), 0.353/0.182 (Stage III) and 0.591/0.309 (Stage IV) lower than controls (all statistically significant). Age, occupation, duration of illness, other chronic disease status and therapeutic regimen had a significant impact upon different aspects of HRQoL in patients. CONCLUSIONS Gastric cancer significantly impaired patients' HRQoL in daily life after treatment. More advanced cancer stages were associated with larger decrements on health state utility.
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Affiliation(s)
- Ruyi Xia
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hongmei Zeng
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qian Liu
- Xi'an Center for Disease Control and Prevention, Xi'an, China
| | | | - Zhiyi Zhang
- Wuwei Cancer Hospital of Gansu Province, Wuwei, China
| | - Yuqin Liu
- Gansu Provincial Cancer Hospital, Lanzhou, China
| | | | - Guohui Song
- Cixian Institute for Cancer Prevention and Control, Cixian Cancer Hospital, Handan, China
| | - Yigong Zhu
- Luoshan Center for Disease Control and Prevention, Xinyang, China
| | - Xianghong Wu
- Center for Disease Control and Prevention of Sheyang County, Yancheng, China
| | - Bingbing Song
- Tumor Prevention and Treatment Institute, Harbin Medical University, Harbin, China
| | | | - Yanfang Chen
- Yueyang Lou District Center for Disease Prevention and Control, Yueyang, China
| | - Wenqiang Wei
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Vic., Australia
| | - Wanqing Chen
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
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Zuckerman LM, Frames WL, Mirshahidi HR, Williams NL, Shields TG, Otoukesh S, Mirshahidi S. Antiproliferative effect of bupivacaine on patient-derived sarcoma cells. Mol Clin Oncol 2020; 13:7. [PMID: 32754321 PMCID: PMC7393627 DOI: 10.3892/mco.2020.2077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/26/2020] [Indexed: 12/15/2022] Open
Abstract
Sarcomas are rare tumors with limited treatment options. Although chemotherapy is standard for certain subtypes, overall survival has not improved in several decades. Bupivacaine has been shown to induce apoptosis and prevent cell growth in multiple different types of malignancies but has not been studied in sarcoma. The current study evaluated the effects of bupivacaine on multiple patient-derived sarcoma cells and a commercial sarcoma cell line. Multiple patient-derived sarcoma cell subtypes and a commercial synovial cell sarcoma cell line were exposed to bupivacaine for different durations and at different concentrations. The patient-derived cells included a high-grade conventional osteosarcoma, a high-grade undifferentiated pleomorphic sarcoma of bone, and a high-grade synovial sarcoma. Flow cytometry and an MTT assay were used to evaluate whether a treatment effect was observed. Treatment of all the subtypes of sarcomas in this study with bupivacaine demonstrated a time- and dose-dependent increase in apoptosis and decrease in cell viability. A cell viability assay demonstrated that the IC50 was between 0.04 and 0.05% and that the treatment effect occurred at clinically relevant doses in vitro. Bupivacaine was toxic to both the patient-derived cells and the commercial cell line at doses commonly used in the clinical setting. These findings provide a foundation for further in vivo studies to evaluate whether these effects will translate to the clinical setting. Although further research is necessary, bupivacaine shows promise as not only an adjunct for pain management but as a treatment modality for sarcoma.
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Affiliation(s)
- Lee M Zuckerman
- Department of Surgery, Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - William L Frames
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Hamid R Mirshahidi
- Division of Hematology and Oncology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Nadine L Williams
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Troy G Shields
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Salman Otoukesh
- Division of Hematology and Oncology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Saied Mirshahidi
- Loma Linda Cancer Center Biospecimen Laboratory, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
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35
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Janah A, Bouhnik AD, Touzani R, Bendiane MK, Peretti-Watel P. Underprescription of Step III Opioids in French Cancer Survivors With Chronic Pain: A Call for Integrated Early Palliative Care in Oncology. J Pain Symptom Manage 2020; 59:836-847. [PMID: 31707070 DOI: 10.1016/j.jpainsymman.2019.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Chronic pain (CP) is a major concern in cancer survivors. Often under-reported by patients, it is both underassessed and undertreated by care providers. OBJECTIVES To assess CP prevalence and related treatment in cancer survivors five years after diagnosis and to identify factors associated with prescribing opioids among survivors with CP, focusing on access to palliative care (PC). METHODS In 2015-2016, we interviewed 4174 French patients diagnosed with cancer five years previously. Combining patient-reported and clinical-reported outcomes together with medicoadministrative data, we studied factors associated with Step II and Step III opioid prescriptions in cancer survivors with CP. We performed multinomial logistic regression adjusting for various covariates, including self-reported health status variables and inpatient PC. RESULTS Five years after cancer diagnosis, 63.5% of the respondents reported current CP (i.e., pain lasting three months or more). Of these, 64.6% and 14.4% were prescribed at least one Step II or Step III opioid, respectively. Only 1.9% had had inpatient PC since diagnosis. After adjustment for age, gender, clinical and self-reported variables, we found that the latter were more likely to receive Step III opioids (adjusted relative risk ratio 5.33; 95% CI 1.15, 24.58). CONCLUSION This study showed a high prevalence of CP five years after cancer diagnosis. Step III opioids were underprescribed but positively associated with inpatient PC. PC access in France remains limited, especially among cancer survivors. Integrating PC in oncology is essential to provide the best cancer-related symptoms management.
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Affiliation(s)
- Asmaa Janah
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, France
| | - Anne-Déborah Bouhnik
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, France
| | - Rajae Touzani
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, France; Institut Paoli Calmettes, SESSTIM, Marseille, France
| | - Marc-Karim Bendiane
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, France.
| | - Patrick Peretti-Watel
- IRD, AP-HM, SSA, VITROME, Aix Marseille University, Marseille, France; IHU-Méditerranée Infection, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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36
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Barke A, Koechlin H, Korwisi B, Locher C. Emotional distress: Specifying a neglected part of chronic pain. Eur J Pain 2020; 24:477-480. [PMID: 31876333 DOI: 10.1002/ejp.1525] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/11/2019] [Accepted: 12/16/2019] [Indexed: 11/07/2022]
Abstract
We argue that in all randomized controlled trials that investigate treatments for chronic pain emotional distress should be reported. In a majority of cases, pain intensity and pain-related disability are measured, yet-despite guidelines to the contrary-pain-related distress is not included. We suggest that the new extension code for chronic pain as incorporated in the ICD-11 will be well suited to fill this gap at minute additional effort for the participants.
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Affiliation(s)
- Antonia Barke
- Biological and Clinical Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Helen Koechlin
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Beatrice Korwisi
- Division of Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,School of Psychology, University of Plymouth, Plymouth, UK
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Al-Shahri MZ, Abdullah A, Alansari A, Sroor M. Opioid Prescribing Patterns Before and After an Inpatient Palliative Care Consultation. Am J Hosp Palliat Care 2019; 37:738-742. [PMID: 31876160 DOI: 10.1177/1049909119897260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND To the best of our knowledge, the change in opioid prescription patterns upon referral to a palliative care team (PCT) was not previously investigated in the Middle East. OBJECTIVE This study aimed to explore the change in the pattern of opioid prescription and the pain scores before and after referring inpatients to a PCT. METHODS We conducted a retrospective review of patients' records including all inpatients ≥15 years newly referred to the PCT over a period of 21 months at King Faisal Specialist Hospital and Research Center, Riyadh. RESULTS Of 631 patients, 52.3% were females, the median age was 54 years, and 96.7% had cancer. The proportion of patients on opioids before referral (83.4%) increased to 93.3% in the postreferral period, P < .0001. Patients receiving opioids on a regular basis increased from 31.9% before referral to 49.9% after referral to the PCT, P < .0001. Morphine was the most commonly prescribed opioid on a regular basis pre- and postreferral. Upon referral, the administration of opioids through the subcutaneous route increased from 3.7% to 10.9%, P < .0001. On average, pain scores were reduced by 1 point on a 0 to 10 numeric scale within 48 hours of seeing a patient by the PCT, P < .0001. CONCLUSION Patients referred to a PCT are likely to get their opioid prescription optimized and pain scores improved shortly after the PCT involvement. Patients with cancer-related pain requiring opioids should be referred to a PCT as early as possible.
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Affiliation(s)
| | | | - Ameena Alansari
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Sroor
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Hachem GE, Rocha FO, Pepersack T, Jounblat Y, Drowart A, Lago LD. Advances in pain management for older patients with cancer. Ecancermedicalscience 2019; 13:980. [PMID: 32010204 PMCID: PMC6974363 DOI: 10.3332/ecancer.2019.980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Indexed: 12/19/2022] Open
Abstract
The population of older patients is growing with a rising prevalence of cancer diagnoses and cancer-related pain syndromes. Older patients are also vulnerable to misleading pain evaluations and under treatment with opioids. Barriers to the effective and safe management of analgesics include pain assessments and the complex management of the best analgesic choice and dose-titration while achieving the fewest side effects. In this review, we will provide an overview of the challenges present in assessment and treatment choices, along with practical tips for routine clinical practice.
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Affiliation(s)
- Georges El Hachem
- Department of Hematology and Medical Oncology, Saint George Hospital University Medical Center, University of Balamand, PO Box 166378, Ashrafieh, Beirut 1100 2807, Lebanon
- Georges El Hachem and Francisco Oliveira Rocha contributed equally to writing this article
| | - Francisco Oliveira Rocha
- Medical Oncology Department, Institut Jules Bordet, L’Université Libre de Bruxelles (U.L.B), Brussels, Belgium
- Georges El Hachem and Francisco Oliveira Rocha contributed equally to writing this article
| | - Thierry Pepersack
- Medical Oncology Department, Institut Jules Bordet, L’Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Youssef Jounblat
- Department of Hematology and Medical Oncology, Lebanese University, PO Box 6573/14, Badaro, Museum, Beirut, Lebanon
| | - Annie Drowart
- Medical Oncology Department, Institut Jules Bordet, L’Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Lissandra Dal Lago
- Medical Oncology Department, Institut Jules Bordet, L’Université Libre de Bruxelles (U.L.B), Brussels, Belgium
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Sun Y, Zhang H, Xu HR, Liu JZ, Pan J, Zhai HZ, Lu CY, Zhao X, Chen YQ, Zhou LL, Yu J, Han J. Analgesia of percutaneous thermal ablation plus cementoplasty for cancer bone metastases. J Bone Oncol 2019; 19:100266. [PMID: 31788416 PMCID: PMC6880023 DOI: 10.1016/j.jbo.2019.100266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 01/06/2023] Open
Abstract
Background The purpose of this study was to review recent research related to the analgesic effect of ablation therapy combined with cementoplasty, as well as to identify the duration of analgesic effect and risk for cement leaks. Methods A systematic literature search using PubMed, Web of Science, and annual meeting proceedings of the oncology society and other organizations were conducted. Results Twelve retrospective studies met the inclusion criteria. Four of the studies included in the review assessed the changes immediately after treatment. Five studies were subjected to analyses of analgesic effect of combined percutaneous thermal ablation and Cementoplasty at 24 weeks after treatment. Incidences of leakage of bone cement during surgery were detected in 4 out of 12 studies. The change of mean pain scores at 1 days, at 1 week, and at 4 weeks, 12 weeks, and 24 weeks after treatment were -3.90 (95% CI: -4.80 to -3.00), -4.55 (95% CI:-5.46 to -3.64), -4.78 (95% CI: -5.70 to -3.86), -5.16 (95% CI: -6.39 to -3.92), and -5.91 (95% CI: -6.63 to -5.19). The relative risk of cement leakage was 0.10 (95% CI: -6.63 to -5.19). Conclusions Our systematic review suggested that thermal ablation combined with cementoplasty could be a safe and effective intervention for the management of bone metastases-induced pain.
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Affiliation(s)
- Yuandong Sun
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, 250117, PR China
| | - Hao Zhang
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, PR China
| | - Hui-Rong Xu
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, PR China
| | - Jing-Zhou Liu
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, PR China
| | - Jia Pan
- Mudan District Central Hospital
| | - Hui-Zhuan Zhai
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, 250117, PR China
| | - Chang-Yan Lu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, 250117, PR China
| | - Xia Zhao
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, 250117, PR China
| | - Ye-Qiang Chen
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, 250117, PR China
| | - Lin-Lin Zhou
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, 250117, PR China
| | - Jinming Yu
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, PR China
| | - Jianjun Han
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, PR China
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Thinh DHQ, Sriraj W, Mansor M, Tan KH, Irawan C, Kurnianda J, Nguyen YP, Ong-Cornel A, Hadjiat Y, Moon H, Javier FO. Analgesic Prescription Patterns and Pain Outcomes in Southeast Asia: Findings From the Analgesic Treatment of Cancer Pain in Southeast Asia Study. J Glob Oncol 2019; 4:1-10. [PMID: 30241271 PMCID: PMC6223410 DOI: 10.1200/jgo.17.00055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To identify patterns of analgesic prescription and to explore patient-reported pain intensity, sleep disturbance, and quality of life among cancer patients with pain in Southeast Asia (SEA). Methods This cross-sectional observational study included 465 adult outpatients prescribed analgesics for cancer pain for 1 month or longer at 22 sites in Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam. Data on analgesic prescription and cancer characteristics were extracted from medical records. Pain intensity, sleep disturbance, and quality of life measures were recorded via questionnaires. Results Most patients (84.4%) had stage III or IV cancer. A total of 419 patients (90.7%) were prescribed opioids; of these, 42.2% received only weak opioids, whereas 57.8% received at least one strong opioid. The mean worst pain intensity during the past 24 hours was 4.76 (standard deviation [SD], 2.47) on a scale of 0 (no pain) to 10 (worst possible pain); the mean current pain intensity was 4.10 (SD, 2.61). More than half of patients (54.8%) reported sleep disturbance caused by pain in the past 7 days. The majority of patients reported problems with pain/discomfort (82.3%), usual activities (65.8%), mobility (58.2%), and anxiety/depression (56.3%). The median daily dose prescribed in oral morphine equivalents was 30 mg for both morphine and tramadol. Conclusion Despite unrelieved pain, sleep disturbance, and issues with quality of life, a notable proportion of patients were prescribed only weak opioids, and opioid doses prescribed were generally low. Efforts focused on encouragement of prescriptions with analgesic strength and/or doses proportional to the pain management needs of patients are vital to improve the status of cancer pain management in the region.
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Affiliation(s)
- Dang Huy Quoc Thinh
- Dang Huy Quoc Thinh, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City; Yen Phi Nguyen, Vietnam National Cancer Hospital, Hanoi, Vietnam; Wimonrat Sriraj, Srinagarind Hospital, Khon Kaen, Thailand; Marzida Mansor, University of Malaya, Kuala Lumpur, Malaysia; Kian Hian Tan, Singapore General Hospital; Yacine Hadjiat and Hanlim Moon, APAC LATAM MEA, Mundipharma, Singapore; Cosphiadi Irawan, Cipto Mangunkusumo General Hospital, Universitas of Indonesia, Jakarta Pusat; Johan Kurnianda, Dr Sardjito General Hospital, Yogyakarta, Indonesia; Annielyn Ong-Cornel, Veterans' Memorial Medical Centre; and Francis O. Javier, St Luke's Medical Center, Quezon City, Philippines
| | - Wimonrat Sriraj
- Dang Huy Quoc Thinh, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City; Yen Phi Nguyen, Vietnam National Cancer Hospital, Hanoi, Vietnam; Wimonrat Sriraj, Srinagarind Hospital, Khon Kaen, Thailand; Marzida Mansor, University of Malaya, Kuala Lumpur, Malaysia; Kian Hian Tan, Singapore General Hospital; Yacine Hadjiat and Hanlim Moon, APAC LATAM MEA, Mundipharma, Singapore; Cosphiadi Irawan, Cipto Mangunkusumo General Hospital, Universitas of Indonesia, Jakarta Pusat; Johan Kurnianda, Dr Sardjito General Hospital, Yogyakarta, Indonesia; Annielyn Ong-Cornel, Veterans' Memorial Medical Centre; and Francis O. Javier, St Luke's Medical Center, Quezon City, Philippines
| | - Marzida Mansor
- Dang Huy Quoc Thinh, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City; Yen Phi Nguyen, Vietnam National Cancer Hospital, Hanoi, Vietnam; Wimonrat Sriraj, Srinagarind Hospital, Khon Kaen, Thailand; Marzida Mansor, University of Malaya, Kuala Lumpur, Malaysia; Kian Hian Tan, Singapore General Hospital; Yacine Hadjiat and Hanlim Moon, APAC LATAM MEA, Mundipharma, Singapore; Cosphiadi Irawan, Cipto Mangunkusumo General Hospital, Universitas of Indonesia, Jakarta Pusat; Johan Kurnianda, Dr Sardjito General Hospital, Yogyakarta, Indonesia; Annielyn Ong-Cornel, Veterans' Memorial Medical Centre; and Francis O. Javier, St Luke's Medical Center, Quezon City, Philippines
| | - Kian Hian Tan
- Dang Huy Quoc Thinh, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City; Yen Phi Nguyen, Vietnam National Cancer Hospital, Hanoi, Vietnam; Wimonrat Sriraj, Srinagarind Hospital, Khon Kaen, Thailand; Marzida Mansor, University of Malaya, Kuala Lumpur, Malaysia; Kian Hian Tan, Singapore General Hospital; Yacine Hadjiat and Hanlim Moon, APAC LATAM MEA, Mundipharma, Singapore; Cosphiadi Irawan, Cipto Mangunkusumo General Hospital, Universitas of Indonesia, Jakarta Pusat; Johan Kurnianda, Dr Sardjito General Hospital, Yogyakarta, Indonesia; Annielyn Ong-Cornel, Veterans' Memorial Medical Centre; and Francis O. Javier, St Luke's Medical Center, Quezon City, Philippines
| | - Cosphiadi Irawan
- Dang Huy Quoc Thinh, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City; Yen Phi Nguyen, Vietnam National Cancer Hospital, Hanoi, Vietnam; Wimonrat Sriraj, Srinagarind Hospital, Khon Kaen, Thailand; Marzida Mansor, University of Malaya, Kuala Lumpur, Malaysia; Kian Hian Tan, Singapore General Hospital; Yacine Hadjiat and Hanlim Moon, APAC LATAM MEA, Mundipharma, Singapore; Cosphiadi Irawan, Cipto Mangunkusumo General Hospital, Universitas of Indonesia, Jakarta Pusat; Johan Kurnianda, Dr Sardjito General Hospital, Yogyakarta, Indonesia; Annielyn Ong-Cornel, Veterans' Memorial Medical Centre; and Francis O. Javier, St Luke's Medical Center, Quezon City, Philippines
| | - Johan Kurnianda
- Dang Huy Quoc Thinh, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City; Yen Phi Nguyen, Vietnam National Cancer Hospital, Hanoi, Vietnam; Wimonrat Sriraj, Srinagarind Hospital, Khon Kaen, Thailand; Marzida Mansor, University of Malaya, Kuala Lumpur, Malaysia; Kian Hian Tan, Singapore General Hospital; Yacine Hadjiat and Hanlim Moon, APAC LATAM MEA, Mundipharma, Singapore; Cosphiadi Irawan, Cipto Mangunkusumo General Hospital, Universitas of Indonesia, Jakarta Pusat; Johan Kurnianda, Dr Sardjito General Hospital, Yogyakarta, Indonesia; Annielyn Ong-Cornel, Veterans' Memorial Medical Centre; and Francis O. Javier, St Luke's Medical Center, Quezon City, Philippines
| | - Yen Phi Nguyen
- Dang Huy Quoc Thinh, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City; Yen Phi Nguyen, Vietnam National Cancer Hospital, Hanoi, Vietnam; Wimonrat Sriraj, Srinagarind Hospital, Khon Kaen, Thailand; Marzida Mansor, University of Malaya, Kuala Lumpur, Malaysia; Kian Hian Tan, Singapore General Hospital; Yacine Hadjiat and Hanlim Moon, APAC LATAM MEA, Mundipharma, Singapore; Cosphiadi Irawan, Cipto Mangunkusumo General Hospital, Universitas of Indonesia, Jakarta Pusat; Johan Kurnianda, Dr Sardjito General Hospital, Yogyakarta, Indonesia; Annielyn Ong-Cornel, Veterans' Memorial Medical Centre; and Francis O. Javier, St Luke's Medical Center, Quezon City, Philippines
| | - Annielyn Ong-Cornel
- Dang Huy Quoc Thinh, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City; Yen Phi Nguyen, Vietnam National Cancer Hospital, Hanoi, Vietnam; Wimonrat Sriraj, Srinagarind Hospital, Khon Kaen, Thailand; Marzida Mansor, University of Malaya, Kuala Lumpur, Malaysia; Kian Hian Tan, Singapore General Hospital; Yacine Hadjiat and Hanlim Moon, APAC LATAM MEA, Mundipharma, Singapore; Cosphiadi Irawan, Cipto Mangunkusumo General Hospital, Universitas of Indonesia, Jakarta Pusat; Johan Kurnianda, Dr Sardjito General Hospital, Yogyakarta, Indonesia; Annielyn Ong-Cornel, Veterans' Memorial Medical Centre; and Francis O. Javier, St Luke's Medical Center, Quezon City, Philippines
| | - Yacine Hadjiat
- Dang Huy Quoc Thinh, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City; Yen Phi Nguyen, Vietnam National Cancer Hospital, Hanoi, Vietnam; Wimonrat Sriraj, Srinagarind Hospital, Khon Kaen, Thailand; Marzida Mansor, University of Malaya, Kuala Lumpur, Malaysia; Kian Hian Tan, Singapore General Hospital; Yacine Hadjiat and Hanlim Moon, APAC LATAM MEA, Mundipharma, Singapore; Cosphiadi Irawan, Cipto Mangunkusumo General Hospital, Universitas of Indonesia, Jakarta Pusat; Johan Kurnianda, Dr Sardjito General Hospital, Yogyakarta, Indonesia; Annielyn Ong-Cornel, Veterans' Memorial Medical Centre; and Francis O. Javier, St Luke's Medical Center, Quezon City, Philippines
| | - Hanlim Moon
- Dang Huy Quoc Thinh, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City; Yen Phi Nguyen, Vietnam National Cancer Hospital, Hanoi, Vietnam; Wimonrat Sriraj, Srinagarind Hospital, Khon Kaen, Thailand; Marzida Mansor, University of Malaya, Kuala Lumpur, Malaysia; Kian Hian Tan, Singapore General Hospital; Yacine Hadjiat and Hanlim Moon, APAC LATAM MEA, Mundipharma, Singapore; Cosphiadi Irawan, Cipto Mangunkusumo General Hospital, Universitas of Indonesia, Jakarta Pusat; Johan Kurnianda, Dr Sardjito General Hospital, Yogyakarta, Indonesia; Annielyn Ong-Cornel, Veterans' Memorial Medical Centre; and Francis O. Javier, St Luke's Medical Center, Quezon City, Philippines
| | - Francis O Javier
- Dang Huy Quoc Thinh, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City; Yen Phi Nguyen, Vietnam National Cancer Hospital, Hanoi, Vietnam; Wimonrat Sriraj, Srinagarind Hospital, Khon Kaen, Thailand; Marzida Mansor, University of Malaya, Kuala Lumpur, Malaysia; Kian Hian Tan, Singapore General Hospital; Yacine Hadjiat and Hanlim Moon, APAC LATAM MEA, Mundipharma, Singapore; Cosphiadi Irawan, Cipto Mangunkusumo General Hospital, Universitas of Indonesia, Jakarta Pusat; Johan Kurnianda, Dr Sardjito General Hospital, Yogyakarta, Indonesia; Annielyn Ong-Cornel, Veterans' Memorial Medical Centre; and Francis O. Javier, St Luke's Medical Center, Quezon City, Philippines
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Pino CA. PAIN MANAGEMENT IN CANCER. Cancer 2019. [DOI: 10.1002/9781119645214.ch26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Epstein JB, Miaskowski C. Oral Pain in the Cancer Patient. J Natl Cancer Inst Monogr 2019; 2019:5551353. [DOI: 10.1093/jncimonographs/lgz003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/07/2019] [Accepted: 04/01/2019] [Indexed: 01/02/2023] Open
Abstract
Abstract
Oral pain due to cancer and associated treatments is common. The prevalence and severity of oral cancer is high. Painful oral mucositis develops in head and neck cancer patients following surgery and associated radiation therapy and/or chemotherapy. In addition, oral pain, including pain from mucositis, occurs in patients receiving chemotherapy for cancers of the hematopoietic system and cancers at other anatomic sites. Despite pain management practices that include high-dose opioid analgesics, patients rarely obtain relief from either head and neck cancer pain or mucositis pain. Because oral pain in cancer patients is likely due to both nociceptive and neuropathic mechanisms, effective management of pain requires treatments for both processes. As knowledge of the pathophysiology of oral pain in cancer patients increases, new approaches for the prevention and management are anticipated. This article focuses on the emerging evidence that supports the molecular mechanisms and the unique oral micro-neuroanatomy that in combination produce the severe oral pain experienced by cancer patients. In addition, this article summarizes the current state of clinical management of oral mucositis pain.
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Affiliation(s)
- Joel B Epstein
- Department of Surgery, City of Hope, Duarte, CA
- Department of Surgery, Cedars-Sinai Health System, Los Angeles, CA
- Seattle Cancer Care Alliance, Seattle, WA
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA
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Utne I, Småstuen MC, Nyblin U. Pain Knowledge and Attitudes Among Nurses in Cancer Care in Norway. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:677-684. [PMID: 29603056 DOI: 10.1007/s13187-018-1355-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The purpose of this study was to survey knowledge on, and attitudes to, pain and pain management among a cohort of Norwegian Nurses in cancer care, and to explore whether there is any association between various demographic variables and knowledge level. This is a web-based survey and nurses were recruited from the Forum for Cancer Nursing. Nurses completed the questionnaire "Nurses' Knowledge and Attitudes Survey Regarding Pain (NKAS)". Univariate and multivariate linear regression analysis were used to evaluate the association between knowledge and attitudes and demographic variables. Nurses from all over Norway answered. The majority were women and most had education above bachelor level. Mean NKAS total score was 31 points (75%). Significant associations were found between NKAS total score and pain management course (p = 0.01) and workplace (p = 0.04). Nurses in cancer care in Norway have relatively good pain knowledge. The potential for improvement is the greatest with regard to pharmacology and nurses' attitudes to how patients express pain. Our findings suggest that an extensive pain management course with patient histories may result in more theoretical knowledge being applied to the patients. In a time with large migration among nurses, our findings indicate that pain management courses should be aware of cultural differences in the educational training.
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Affiliation(s)
- Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, PO Box 4, St. Olavs Plass, NO-0130, Oslo, Norway.
| | - Milada Cvancarova Småstuen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, PO Box 4, St. Olavs Plass, NO-0130, Oslo, Norway
| | - Ulla Nyblin
- Department of Surgery, Vestre Viken Hospital Trust, PO 800, NO-3004, Drammen, Norway
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Sanft T, Denlinger CS, Armenian S, Baker KS, Broderick G, Demark-Wahnefried W, Friedman DL, Goldman M, Hudson M, Khakpour N, Koura D, Lally RM, Langbaum TS, McDonough AL, Melisko M, Mooney K, Moore HCF, Moslehi JJ, O'Connor T, Overholser L, Paskett ED, Peterson L, Pirl W, Rodriguez MA, Ruddy KJ, Smith S, Syrjala KL, Tevaarwerk A, Urba SG, Zee P, McMillian NR, Freedman-Cass DA. NCCN Guidelines Insights: Survivorship, Version 2.2019. J Natl Compr Canc Netw 2019; 17:784-794. [PMID: 31319383 PMCID: PMC7094216 DOI: 10.6004/jnccn.2019.0034] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for consequences of cancer and cancer treatment to aid healthcare professionals who work with survivors of adult-onset cancer. Guidance is also provided to help promote physical activity, weight management, and proper immunizations in survivors and to facilitate care coordination to ensure that all needs are addressed. These NCCN Insights summarize some of the topics discussed by the NCCN Survivorship Panel during the 2019 update of the guidelines, including the survivorship population addressed, ways to improve care coordination, and pain management.
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Affiliation(s)
- Tara Sanft
- Yale Cancer Center/Smilow Cancer Hospital
| | | | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | - Mindy Goldman
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Melissa Hudson
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | | | - Kathi Mooney
- Huntsman Cancer Institute at the University of Utah
| | - Halle C F Moore
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Lindsay Peterson
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Phyllis Zee
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University; and
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Johnson LA, Bell CJ, Ridner S, Murphy B. Health-Care Professionals Perceived Barriers to Effective Cancer Pain Management in the Home Hospice Setting: Is Dying at Home Really Best? OMEGA-JOURNAL OF DEATH AND DYING 2019; 83:587-600. [PMID: 31237818 DOI: 10.1177/0030222819857871] [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: 11/16/2022]
Abstract
Hospice health-care professionals (HCP) evaluate and manage cancer pain in patient homes. This study explores HCP's perceptions of barriers that affect pain management for home hospice cancer patients. A convenience sample of 20 experienced hospice HCP were recruited from a regional hospice agency. Data were collected through two focus groups using semistructured interviews and analyzed using a constant comparative approach to generate themes. An unexpected finding revealed patient's religious and cultural beliefs about suffering and family caregiver's beliefs that patients deserve to suffer due to past actions are barriers to pain management in home hospice. Hospice HCP can identify patients at risk for suffering at the end of life. Interventions targeting spiritual suffering and needs are needed. Home hospice HCP have an ethical obligation to address undue suffering through family's withholding of necessary pain medications and should consider alternative placement when home is not suitable for a peaceful death.
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Affiliation(s)
- Lee A Johnson
- College of Nursing, East Carolina University, Greenville, NC, USA
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The Patient with Difficult Cancer Pain. Cancers (Basel) 2019; 11:cancers11040565. [PMID: 31010249 PMCID: PMC6521083 DOI: 10.3390/cancers11040565] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/17/2022] Open
Abstract
Most patients with cancer pain can be managed with relatively simple methods using oral analgesics at relatively low doses, even for prolonged periods of time. However, in some clinical conditions pain may be more difficult to manage. Various factors can interfere with a desirable and favorable analgesic response. Data from several studies assessing factors of negative pain prognosis have indicated that neuropathic pain, incident pain, psychological distress, opioid addiction, and baseline pain intensity were associated with more difficult pain control. In this narrative review, the main factors that make the therapeutic response to opioids difficult are examined.
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Yao FD, Yang JQ, Huang YC, Luo MP, Yang WJ, Zhang B, Liu XJ. Antinociceptive effects of Ginsenoside Rb1 in a rat model of cancer-induced bone pain. Exp Ther Med 2019; 17:3859-3866. [PMID: 30988771 PMCID: PMC6447891 DOI: 10.3892/etm.2019.7404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/28/2018] [Indexed: 12/12/2022] Open
Abstract
Ginsenoside Rb1 (GRb1) is a major ingredient of ginseng, a traditional medicine that has been used for thousands of years. Previous studies have reported that GRb1 had anti-inflammatory, antioxidant and neuroprotective effects. The current study aimed to evaluate the antinociceptive effects of GRb1 in a rat model of cancer-induced bone pain (CIBP) established by intratibial injection of Walker 256 cells. Intraperitoneal injection (i.p.) of GRb1 (5 and 10 mg/kg, but not 1 mg/kg) partially and transiently reversed the mechanical allodynia and thermal hyperalgesia in CIBP rats at 14 days following surgery when the pain behavior is established. Furthermore, repeated administration of GRb1 demonstrated persistent analgesic effect. Additionally, the protein expression and immunoreactivity of iba1, which is the maker of microglia, was significantly suppressed in CIBP rats treated with GRb1 (i.p., 10 mg/kg) from day 12 for three consecutive days compared with CIBP rats treated with a vehicle. Furthermore, upregulation of spinal interleukin (IL)-1β, IL-6 and tumor necrosis factor-α were also significantly inhibited by the treatment of GRb1 (i.p., 10 mg/kg) from day 12 for three consecutive days. Together, these results indicated that GRb1 may attenuate CIBP via inhibiting the activation of microglia and glial-derived proinflammatory cytokines.
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Affiliation(s)
- Fu-Dong Yao
- Department of Spine Surgery, Baoji Central Hospital, Baoji, Shaanxi 721008, P.R. China
| | - Jun-Qi Yang
- Department of Orthopaedics, Baoji Central Hospital, Baoji, Shaanxi 721008, P.R. China
| | - Yuan-Chi Huang
- Department of Orthopaedics, Baoji Central Hospital, Baoji, Shaanxi 721008, P.R. China
| | - Ming-Peng Luo
- Department of Orthopaedics, Baoji Central Hospital, Baoji, Shaanxi 721008, P.R. China
| | - Wen-Jie Yang
- Department of Rehabilitation and Pain, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi 712000, P.R. China
| | - Bo Zhang
- Department of Orthopaedics, The Third Hospital of Xi'an City, Xi'an, Shaanxi 710018, P.R. China
| | - Xia-Jun Liu
- Department of Orthopaedics, Baoji Central Hospital, Baoji, Shaanxi 721008, P.R. China
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Stearns LJ, Narang S, Albright RE, Hammond K, Xia Y, Richter HB, Paramanandam GK, Haagenson KK, Doth AH. Assessment of Health Care Utilization and Cost of Targeted Drug Delivery and Conventional Medical Management vs Conventional Medical Management Alone for Patients With Cancer-Related Pain. JAMA Netw Open 2019; 2:e191549. [PMID: 30951156 PMCID: PMC6450326 DOI: 10.1001/jamanetworkopen.2019.1549] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Targeted drug delivery (TDD) has potential for cost savings compared with conventional medical management (CMM). Despite positive clinical and economic evidence, TDD remains underused to treat cancer pain. OBJECTIVE To assess the cost of TDD and CMM in treating cancer-related pain. DESIGN, SETTING, AND PARTICIPANTS This retrospective economic evaluation using propensity score-matched analysis was conducted using MarketScan commercial claims data on beneficiaries receiving TDD and CMM or CMM only for cancer pain from January 1, 2009, to September 30, 2015. Participants were matched on age, sex, cancer type, comorbidity score, and pre-enrollment characteristics. Data analysis was performed from June 1 to September 30, 2017. MAIN OUTCOMES AND MEASURES Total 2-, 6-, and 12-month costs, number of health care encounters, length of hospital stay, additional components of cost, and health care utilization. RESULTS A total of 376 TDD and CMM patients (mean [SD] age, 51.88 [9.98] years; 216 [57.5%] female) and 4839 CMM only patients (mean [SD] age, 51.52 [11.16] years; 3005 [62.1%] female) were identified for study inclusion. After matching, 536 patients were included in the study: 268 patients in the TDD and CMM group and 268 in the CMM only group. Compared with CMM only, TDD and CMM was associated with mean total cost savings of $15 142 (95% CI, $3690 to $26 594; P = .01) at 2 months and $63 498 (95% CI, $4620 to $122 376; P = .03) at 12 months; cost savings at 6 months were not statistically different ($19 577; 95% CI, -$12 831 to $51 984; P = .24). The TDD and CMM group had fewer inpatient visits (2-month mean difference [MD], 1.0; 95% CI, 0.8-1.2; P < .001; 6-month MD, 1.3; 95% CI, 0.8-1.7; P < .001; 12-month MD, 2.3; 95% CI, 1.2-3.4; P < .001) and shorter hospital stays (2-month MD, 6.8 days; 95% CI, 5.0-8.7 days; P < .001; 6-month MD, 6.8 days; 95% CI, 3.1-10.5 days; P < .001; 12-month MD, 10.6 days; 95% CI, 2.9-18.3 days; P = .007). Use of CMM only was associated with greater opioid use at 12 months (MD, 3.2; 95% CI, 0.4-6.0; P = .03). CONCLUSIONS AND RELEVANCE Compared with CMM alone, TDD and CMM together were associated with significantly lower cost and health care utilization. The findings suggest that TDD is a cost-saving therapy that should be considered in patients with cancer for whom oral opioids are inadequate or produce intolerable adverse effects and should be expanded as health care systems transition to value-based models.
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Affiliation(s)
| | - Sanjeet Narang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts
| | | | | | - Ying Xia
- Health Economics and Outcomes Research, Medtronic, Minneapolis, Minnesota
| | | | | | | | - Alissa H. Doth
- Health Economics and Outcomes Research, Medtronic, Minneapolis, Minnesota
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Saifan AR, Bashayreh IH, Al-Ghabeesh SH, Batiha AM, Alrimawi I, Al-Saraireh M, Al-Momani MM. Exploring factors among healthcare professionals that inhibit effective pain management in cancer patients. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2019. [DOI: 10.15452/cejnm.2019.10.0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Bioerodable Ketamine-Loaded Microparticles Fabricated Using Dissolvable Hydrogel Template Technology. J Pharm Sci 2019; 108:1220-1226. [DOI: 10.1016/j.xphs.2018.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 11/23/2022]
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