1
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Tekie Y, Nigatu YA, Mekonnen W, Berhe YW. Breakthrough pain among cancer patients at oncology units in Northern Ethiopia; a multi-center study. Front Oncol 2024; 13:1248921. [PMID: 38264754 PMCID: PMC10805268 DOI: 10.3389/fonc.2023.1248921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Background Breakthrough cancer pain (BTCP) is a transient exacerbation of pain that affects the length of hospitalization and quality of life of patients. The objective of this study was to determine the prevalence and factors associated with BTCP among cancer patients at oncology units in Northern Ethiopia in 2022. Methods A multi-center cross-sectional study was conducted from April to June 2022. After obtaining ethical approval, data were collected prospectively from 424 adult cancer patients admitted to oncology units. Breakthrough cancer pain was assessed by the numeric rating scale. Descriptive and binary logistic regression analyses were performed to determine the factors associated with BTCP. The strength of association was described in adjusted odds ratio (AOR) with 95% confidence intervals and variables with a P-value < 0.05 were considered to have a statistically significant association with BTCP. Result The prevalence of BTCP among cancer patients was 41.5%. The factors that were found to be associated with BTCP were colorectal cancer (AOR: 7.7, 95% CI: 1.8, 32.3), lung cancer (AOR: 6.9, 95% CI: 1.9, 26.0), metastasis (AOR: 9.3, 95% CI: 3.0, 29.1), mild background pain (AOR: 7.5, 95% CI: 2.5, 22.6), moderate background pain (AOR: 7.0, 95% CI: 2.2, 23.1), severe background pain (AOR: 7.1, 95% CI: 2.2, 22.8), no analgesics taken for background pain (AOR: 5.1, 95% CI: 2.8, 9.3) and uncontrolled background pain (AOR: 3.3, 95% CI: 1.8, 6.1). Conclusion The prevalence of BTCP was high. Colorectal cancer, lung cancer, the presence of metastasis, the presence of background pain, not taking analgesics for background pain, and uncontrolled background pain were significantly associated with BTCP.
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Affiliation(s)
- Yohanes Tekie
- Department of Anesthesia, Aksum University, Aksum, Ethiopia
| | | | - Wudie Mekonnen
- Department of Anesthesia, University of Gondar, Gondar, Ethiopia
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2
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Yan M, Tjong M, Chan WC, Darling G, Delibasic V, Davis LE, Doherty M, Hallet J, Kidane B, Mahar A, Mittmann N, Parmar A, Tan V, Tan H, Wright FC, Coburn NG, Louie AV. Dyspnea in patients with stage IV non-small cell lung cancer: a population-based analysis of disease burden and patterns of care. J Thorac Dis 2023; 15:494-506. [PMID: 36910044 PMCID: PMC9992624 DOI: 10.21037/jtd-22-919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/09/2022] [Indexed: 02/23/2023]
Abstract
Background Patients with metastatic non-small cell lung cancer (NSCLC) experience significant morbidity with dyspnea being a common symptom with a prevalence of 70%. The objective of this study was to determine factors associated with a moderate-to-severe dyspnea score based on the Edmonton Symptom Assessment System (ESAS), as well as resultant patterns of intervention and factors correlated to intervention receipt. Methods Using health services administrative data, we conducted a population-based study of all patients diagnosed with metastatic NSCLC treated from January 2007 to September 2018 in the province of Ontario. The primary outcomes of interest are the prevalence of moderate-to-severe dyspnea scores, and the receipt of dyspnea-directed intervention. Differences in baseline characteristic between moderate-to-severe dyspnea and low dyspnea score cohorts were assessed by comparative statistics. Predictors of intervention receipt for patients with moderate-to-severe dyspnea scores were estimated using multivariable modified Poisson regression. Results The initial study cohort included 13,159 patients diagnosed with metastatic NSCLC and of these, 9,434 (71.7%) reported a moderate-to-severe dyspnea score. Compared to patients who did not report moderate-to-severe dyspnea scores, those who reported a moderate-to-severe dyspnea score were more likely to complete a greater number of ESAS surveys, be male, have a higher Elixhauser comorbidity index (ECI) score, and receive subsequent systemic therapy after diagnosis. Most patients with a moderate-to-severe dyspnea score received intervention (96%), of which the most common were palliative care management (87%), thoracic radiotherapy (56%) and thoracentesis (37%). Multivariable regression identified older patients to be less likely to undergo pleurodesis. Thoracentesis was less common for patients living in rural and non-major urban areas, lower income areas, and earlier year of diagnosis. Receipt of thoracic radiotherapy was less common for older patients, females, those with ECI ≥4, patients living in major urban areas, and those with later year of diagnosis. Finally, palliative care referrals were less frequent for patients with ECI ≥4, age 60-69, residence outside of major urban areas, earlier year of diagnosis, and lower income areas. Conclusions Dyspnea is a prevalent symptom amongst patients with metastatic NSCLC. Subpopulations of patients with moderate-to-severe dyspnea scores were in which inequities may exist in access to care that require further attention and evaluation.
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Affiliation(s)
- Michael Yan
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Michael Tjong
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Wing C Chan
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Gail Darling
- Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Victoria Delibasic
- Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Laura E Davis
- Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Mark Doherty
- Department of Oncology, St. Vincent's Hospital Group, Dublin, Ireland.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Biniam Kidane
- Division of Thoracic Surgery, University of Manitoba, Winnipeg, Canada
| | - Alyson Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nicole Mittmann
- Canadian Agency for Drugs and Technology in Health, Ottawa, Canada
| | - Ambica Parmar
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vivian Tan
- Department of Radiation Oncology, University of Western Ontario, London, Canada
| | - Hendrick Tan
- Department of Radiation Oncology, Fiona Stanley Hospital, Perth, Australia
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Natalie G Coburn
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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3
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Yaghi M, Beydoun N, Mowery K, Abadir S, Bou Zerdan M, Jabbal IS, Rivera C, Liang H, Alley E, Saravia D, Arteta-Bulos R. Social disparities in pain management provision in stage IV lung cancer: A national registry analysis. Medicine (Baltimore) 2023; 102:e32888. [PMID: 36827013 DOI: 10.1097/md.0000000000032888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
A strong association exists between pain and lung cancer (LC). Focusing on the disparities in pain referral in LC patients, we are aiming to characterize the prevalence and patterns of referrals to pain management (PM) in Stage IV non-small-cell LC (NSLC) and small-cell LC (SCLC). We sampled the National Cancer Database for de novo stage IV LC (2004-2016). We analyzed trends of pain referral using the Cochran-Armitage test. Chi-squared statistics were used to identify the sociodemographic and clinico-pathologic determinants of referral to PM, and significant variables (P < .05) were included in one multivariable regression model predicting the likelihood of pain referral. A total N = 17,620 (3.1%) of NSLC and N = 4305 (2.9%) SCLC patients were referred to PM. A significant increase in referrals was observed between 2004 and 2016 (NSLC: 1.7%-4.1%, P < .001; SCLC: 1.6%-4.2%, P < .001). Patient and disease factors played a significant role in likelihood of referral in both groups. Demographic factors such as gender, age, and facility type played a role in the likelihood of pain referrals, highlighting the gap and need for multidisciplinary PM in patients with LC. Despite an increase in the proportion of referrals to PM issued for terminal stage LC, the overall proportion remains low. To ensure better of quality of life for patients, oncologists need to be made aware of existent disparities and implicit biases.
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Affiliation(s)
- Marita Yaghi
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Najla Beydoun
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Kelsey Mowery
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | | | - Maroun Bou Zerdan
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Iktej Singh Jabbal
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Carlos Rivera
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Hong Liang
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Evan Alley
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Diana Saravia
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Rafael Arteta-Bulos
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
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4
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Booth A, Manson S, Halhol S, Merinopoulou E, Raluy Callado M, Hareendran A, Knoll S. Using health-related social media to understand the experiences of adults with lung cancer in the era of immuno-oncology and targeted therapies: an observational study (Preprint). JMIR Cancer 2023. [PMID: 37436789 PMCID: PMC10372558 DOI: 10.2196/45707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The treatment of non-small cell lung cancer (NSCLC) has evolved dramatically with the approval of immuno-oncology (IO) and targeted therapies (TTs). Insights on the patient experience with these therapies and their impacts are lacking. Health-related social media has been increasingly used by patients to share their disease and treatment experiences, thus representing a valuable source of real-world data to understand the patient's voice and uncover potential unmet needs. OBJECTIVE This study aimed to describe the experiences of patients with NSCLC as reported in discussions posted on lung cancer-specific social media with respect to their disease symptoms and associated impacts. METHODS Publicly available posts (2010-2019) were extracted from selected lung cancer- or NSCLC-specific websites. Social media users (patients and caregivers posting on these websites) were stratified by metastatic- and adjuvant-eligible subgroups and treatment received using natural language processing (NLP) and machine learning methods. Automated identification of symptoms was conducted using NLP. Qualitative data analysis (QDA) was conducted on random samples of posts mentioning pain-related, fatigue-related, respiratory-related, or infection-related symptoms to capture the patient experience with these and associated impacts. RESULTS Overall, 1724 users (50,390 posts) and 574 users (4531 posts) were included in the metastatic group and adjuvant group, respectively. Among users in the metastatic group, pain, discomfort, and fatigue were the most commonly mentioned symptoms (49.7% and 39.6%, respectively), and in the QDA (258 posts from 134 users), the most frequent impacts related to physical impairments, sleep, and eating habits. Among users in the adjuvant group, pain, discomfort, and respiratory symptoms were the most commonly mentioned (44.8% and 23.9%, respectively), and impacts identified in the QDA (154 posts from 92 users) were mostly related to physical functioning. CONCLUSIONS Findings from this exploratory observational analysis of social media among patients and caregivers informed the lived experience of NSCLC in the era of novel therapies, shedding light on most reported symptoms and their impacts. These findings can be used to inform future research on NSCLC treatment development and patient management.
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5
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Jokic V, Savic-Vujovic K, Spasic J, Bukumiric Z, Marinkovic M, Radosavljevic D, Cavic M. Evaluation of Clinical and Genetic Determinants of Treatment OutCome In EGFR Mutation Positive Advanced Lung Adenocarcinoma. Dose Response 2022; 20:15593258221117354. [PMID: 35958274 PMCID: PMC9358214 DOI: 10.1177/15593258221117354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/06/2022] [Accepted: 07/15/2022] [Indexed: 11/27/2022] Open
Abstract
Background The aim of this research was to evaluate clinical and low-cost genetic determinants of treatment outcome in EGFR mutation positive advanced lung adenocarcinoma patients. Material and Methods EGFR mutation testing and EGFR 181946C>T genotyping were performed in 101 advanced lung adenocarcinoma patients using qRT-PCR and PCR-RFLP, respectively. Progression-free survival was defined as the time from the start of TKI therapy to date of progression, and overall survival as the time from diagnosis to death from any cause. Pain level was evaluated using a Numerical Rating Scale and the Verbal Descriptor Scale. Statistical significance was considered for P < .05. Results Patients were treated with EGFR-TKIs for a period of 1–39months (median 9), with a median PFS of 12.0 months (10.4-13.6, CI 95%), and a median OS of 19.0 months (15.1-22.7, CI 95%). The presence of pain was significantly correlated with the existence of bone (P < .001) and adrenal glands metastases (P = .029). Genetic factors did not have a direct impact on pain management but had a significant effect on the response to TKIs leading to pain alleviation. Conclusions EGFR mutation subtype and the EGFR 181946 C>T SNP had a significant effect on the response to TKI inducing an indirect anti-dolorous effect.
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Affiliation(s)
- Vera Jokic
- Clinic for Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Katarina Savic-Vujovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Spasic
- Clinic for Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Zoran Bukumiric
- Department of Statistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mladen Marinkovic
- Clinic for Radiation Oncology and Diagnostics, Department of Radiation Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Davorin Radosavljevic
- Clinic for Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Milena Cavic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
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6
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Osowicka M, Janowiak P, Gorzewska A, Lichodziejewska-Niemierko M. Inhaled opioids for cancer pain relief: A narrative review. Medicine (Baltimore) 2022; 101:e28921. [PMID: 35758345 PMCID: PMC9276280 DOI: 10.1097/md.0000000000028921] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/07/2022] [Indexed: 11/26/2022] Open
Abstract
Despite the many new possibilities, cancer pain treatment is not always effective and often poses a challenge for practitioners. At the end-of-life care, both oral and subcutaneous drug delivery very often are not attainable. The increasing number of patients in terminal stage of chronic diseases forced us to look for the alternative ways of administration of pain treatment. In this context, the potentially rapid onset of action and ease of use make aerosolized drug delivery an attractive option in palliative care settings. The objective of this review was to identify literature on pain relief with inhaled opioids. The evidence suggests that nebulized opioids might be effective in the treatment of pain in various aetiologies; however, randomized controlled studies on nebulization therapy for cancer pain are lacking.
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Affiliation(s)
- Magdalena Osowicka
- Department of Palliative Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Janowiak
- Department of Pulmonology, Medical University of Gdańsk, Gdańsk, Poland
| | - Agnieszka Gorzewska
- Department of Palliative Medicine, Medical University of Gdańsk, Gdańsk, Poland
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7
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Peyravian N, Sun E, Dikici E, Deo S, Daunert S, Toborek M. Opioid Antagonist Nanodrugs Successfully Attenuate the Severity of Ischemic Stroke. Mol Pharm 2022; 19:2254-2267. [PMID: 35506882 PMCID: PMC9257743 DOI: 10.1021/acs.molpharmaceut.2c00079] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
![]()
The United States
is in the midst of an opioid epidemic that is
linked to a number of serious health issues, including an increase
in cerebrovascular events, namely, stroke. Chronic prescription opioid
use exacerbates the risk and severity of ischemic stroke, contributing
to stroke as the fifth overall cause of death in the United States
and costing the US health care system over $30 billion annually. Pathologically,
opioids challenge the integrity of the blood–brain barrier
(BBB), resulting in a dysregulation of tight junction (TJ) proteins
that are crucial in maintaining barrier homeostasis. Despite this,
treatment options for ischemic stroke are limited, and there are no
pharmacological options to attenuate TJ damage, including in incidents
that are linked to opioid use. Herein, we have generated carrier-free,
pure “nanodrugs” or nanoparticles of naloxone and naltrexone
with enhanced therapeutic properties compared to the original (parent)
drugs. The generated nanoformulations of both opioid antagonists exhibited
successful attenuation of morphine- or oxycodone-induced alterations
of TJ protein expression and reduced oxidative stress to a greater
extent than the parent drugs (non-nano). As a proof of concept, we
then proceeded to evaluate the therapeutic effectiveness of the generated
nanodrugs in an ischemic stroke model of mice exposed to morphine
or oxycodone. Our results demonstrate that the opioid antagonist nanoformulations
reduced stroke severity in mice. Overall, this research implements
advances in nanotechnology-based repurposing of FDA-approved therapeutics,
and the obtained results also suggest underlying pharmacological mechanisms
of opioid antagonists, further supporting these opioid antagonists
and their respective nanoformulations as potential therapeutic agents
for ischemic stroke.
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Affiliation(s)
- Nadia Peyravian
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, Florida 33136, United States.,Dr. JT Macdonald Foundation Biomedical Nanotechnology Institute of the University of Miami, Miami, Florida 33136, United States
| | - Enze Sun
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, Florida 33136, United States
| | - Emre Dikici
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, Florida 33136, United States.,Dr. JT Macdonald Foundation Biomedical Nanotechnology Institute of the University of Miami, Miami, Florida 33136, United States
| | - Sapna Deo
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, Florida 33136, United States.,Dr. JT Macdonald Foundation Biomedical Nanotechnology Institute of the University of Miami, Miami, Florida 33136, United States.,University of Miami Clinical and Translational Science Institute, Miami, Florida 33136, United States
| | - Sylvia Daunert
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, Florida 33136, United States.,Dr. JT Macdonald Foundation Biomedical Nanotechnology Institute of the University of Miami, Miami, Florida 33136, United States.,University of Miami Clinical and Translational Science Institute, Miami, Florida 33136, United States
| | - Michal Toborek
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, Florida 33136, United States.,Dr. JT Macdonald Foundation Biomedical Nanotechnology Institute of the University of Miami, Miami, Florida 33136, United States
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8
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On J, Park HA, Yoo S. Development of a prediction models for chemotherapy-induced adverse drug reactions: A retrospective observational study using electronic health records. Eur J Oncol Nurs 2021; 56:102066. [PMID: 34861529 DOI: 10.1016/j.ejon.2021.102066] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/28/2021] [Accepted: 11/07/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Chemotherapy-induced adverse drug reactions (ADRs) are common and diverse, and not only affect changes or interruptions to treatment schedules, but also negatively affect the patient's quality of life. This study aimed to predict eight chemotherapy-induced ADRs based on electronic health records (EHR) data using machine-learning algorithms. METHODS We used EHR data of 6812 chemotherapy cycles for 935 adult patients receiving four different chemotherapy regimens (FOLFOX, 5-fluorouracil + oxaliplatin + leucovorin; FOLFIRI, 5-fluorouracil + irinotecan + leucovorin; paclitaxel; and GP, gemcitabine + cisplatin) at a tertiary teaching hospital between January 2015 and June 2016. The predicted ADRs included nausea-vomiting, fatigue-anorexia, diarrhea, peripheral neuropathy, hypersensitivity, stomatitis, hand-foot syndrome, and constipation. Three machine learning algorithms were used to developed prediction models: logistic regression, decision tree, and artificial neural network. We compared the performance of the models with area of under the ROC (Receiver Operating Characteristic) curve (AUC) and accuracy. RESULTS The AUCs of the logistic regression, decision tree, and artificial neural network models were 0.62-0.83, 0.61-0.83, and 0.62-0.83, respectively, and the accuracies were 0.59-0.84, 0.55-0.88, and 0.57-0.88, respectively. Among the algorithms, the logistic regression models performed best and had the highest AUC for six ADRs (range 0.67-0.83). The nausea-vomiting prediction models performed best with an AUC of 0.83 for the three algorithms. CONCLUSIONS The prediction models for chemotherapy-induced ADRs were able to predict eight ADRs using EHR data. The logistic regression models were best suited to predict ADRs. The models developed in this study can be used to predict the risk of ADRs in patients receiving chemotherapy.
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Affiliation(s)
- Jeongah On
- College of Nursing, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
| | - Hyeoun-Ae Park
- College of Nursing, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul, Republic of Korea; Interdisciplinary Graduate Program of Medical Informatics, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
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9
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Tang W, Zhang WQ, Hu SQ, Shen WQ, Chen HL. Incidence and risk factors of suicide in patients with lung cancer: a scoping review. Support Care Cancer 2021; 30:2945-2957. [PMID: 34628516 DOI: 10.1007/s00520-021-06604-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore the high-risk period of the occupation of suicide after diagnosis; and clarify the risk factors of suicidal behaviors (suicidal ideation, suicide attempt, and suicidal death) behind the lung cancer patients during the cancer cure process. METHODS This scoping review was conducted through the whole month of April 2021. We extracted data of the suicide mortality after diagnosis and latent risk factors of suicidal behaviors among lung cancer patients where we used to study from the two online databases which are PubMed and Web of Science. Two online databases were searched and written in English without age restriction. To note that the standardized mortality ratio (SMR), person-years, and odds ratio (OR) associated with lung cancer were documented. RESULTS Out of 570 records, 23 studies mentioned suicidal behaviors and lung cancer met the included criteria. Eleven (n = 47.8%) of the selected publications reported changes in suicide mortality. None of them reported suicidal ideation or suicide attempt after diagnosis. The individuals with lung cancer have significantly higher rates of suicidal death (SMR, 2.04-13.4) during the first years after diagnosis and decrease over subsequent years (SMR, 0.66-3.17). The median time from cancer diagnosis to suicide death was around 7 months. Across all studies with the 22 studies that examined factors, we extracted the data of the suicidal ideation (n = 3), suicide attempt (n = 1), and suicidal death (n = 18) in individuals. For patients with suicidal ideation, there was a significantly higher incidence in males than in females. Among patients who attempted suicide, the incidence of mental illness is greater than the incidence of physical illness. Factors for suicidal death, including gender (male, 56.3-100%), prognosis tumors (poor, 25.8-66.3%), marital status (widowhood or unmarried, 19-75.7%), and age of patients (> 70 years, 24.5-47%) with lung cancer, play a vital role. Treatment of lung cancer is expected to affect a patient in his/her mental state. CONCLUSION Overall, our finding indicates that lung cancer patients have been presented with a higher incidence of suicide death in a specific period, especially the early years after diagnosis. Discovering risk factors for suicide helps prevent potential suicide. It is essential to screen lung cancer patients for suicidal ideation, especially those with high-risk factors. Future prospective studies are necessary to confirm these findings to support care.
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Affiliation(s)
- Wen Tang
- School of Medicine, Nantong University, Nantong, China
| | | | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, China
| | - Wang-Qin Shen
- School of Medicine, Nantong University, Nantong, China.
| | - Hong-Lin Chen
- School of Public Health, Nantong University, 9# Seyuan Road, Nantong, 226000, Jiangsu, China.
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10
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Abstract
Recent decades have demonstrated significant strides in cancer screening, diagnostics and therapeutics. As such there have been dramatic changes in survival following a diagnosis of cancer.
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Affiliation(s)
- Matthew R D Brown
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | | | - David J Magee
- The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.
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11
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Quiñones-Avila V, Ortiz-Ortiz KJ, Ríos-Motta R, Marín-Centeno H, Tortolero-Luna G. Use of palliative radiotherapy among patients with metastatic non-small-cell lung cancer in Puerto Rico. BMC Palliat Care 2021; 20:127. [PMID: 34389004 PMCID: PMC8364074 DOI: 10.1186/s12904-021-00819-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative radiotherapy (RT) represents an important treatment opportunity for improving the quality of life in metastatic non-small cell lung cancer (NSCLC) patients through the management of symptoms within the course of the illness. The aim of the study is to determine the proportion of patients who had palliative RT within 12 months of diagnosis and evaluate the factors associated with it. METHODS A retrospective cohort study was performed using secondary data analysis from 2009 to 2015 from the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database (PRCCR-HILD). A logistic regression model was used to examine factors associated with palliative RT. RESULTS Among the 929 patients identified with metastatic NSCLC, 33.80% received palliative RT within the first year after diagnosis. After adjusting for other covariates, receipt of chemotherapy (ORAdj = 3.90; 95% CI = 2.91-5.45; P < 0.001) and presence of symptoms (ORAdj = 1.41; 95% CI =1.00-1.98; P = 0.045) were associated with increased odds of palliative RT use. Although marginally significant, patients with private health insurance had increased odds of palliative RT use (ORAdj = 1.50; 95% CI = 0.98-2.29; P = 0.061) when compared to beneficiaries of Medicaid, after adjusting by other covariates. CONCLUSIONS The results of this study reveal concerning underuse of palliative RT among patients with metastatic NSCLC in Puerto Rico. Additional research is necessary to further understand the barriers to using palliative RT on the island.
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Affiliation(s)
- Valerie Quiñones-Avila
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 363027, San Juan, 00936-3027, Puerto Rico. .,Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico. .,Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.
| | - Ruth Ríos-Motta
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Heriberto Marín-Centeno
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.,Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
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12
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Gurney JK, Stanley J, Adler J, McLeod H, Atkinson J, Sarfati D. National Study of Pain Medicine Access Among Māori and Non-Māori Patients With Lung Cancer in New Zealand. JCO Glob Oncol 2021; 7:1276-1285. [PMID: 34383597 PMCID: PMC8389912 DOI: 10.1200/go.21.00141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Pain is among the most common and consequential symptoms of cancer, particularly in the context of lung cancer. Māori have extremely high rates of lung cancer, and there is evidence that Māori patients with lung cancer are less likely to receive curative treatment and more likely to receive palliative treatment and to wait longer for their treatment than non-Māori New Zealanders. The extent to which Māori patients with lung cancer are also less likely to have access to pain medicines as part of their supportive care remains unclear. METHODS Using national-level Cancer Registry and linked health records, we describe access to subsidized pain medicines among patients with lung cancer diagnosed over the decade spanning 2007-2016 and compare access between Māori and non-Māori patients. Descriptive and logistic regression methods were used to compare access between ethnic groups. RESULTS We observed that the majority of patients with lung cancer are accessing some form of pain medicine and there do not appear to be strong differences between Māori and non-Māori in terms of overall access or the type of pain medicine dispensed. However, Māori patients appeared more likely than non-Māori to first access pain medicines within 2 weeks before their death and commensurately less likely to access them more than 24 weeks before death. CONCLUSION Given the plausibility that there are differences in first access to pain medicines (particularly opioid medicines) among Māori approaching end of life, further investigation of the factors contributing to this disparity is required.
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Affiliation(s)
- Jason K Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jonathan Adler
- Capital and Coast District Health Board, Wellington, New Zealand
| | - Heather McLeod
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - June Atkinson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- Te Aho o Te Kahu-Cancer Control Agency, Wellington, New Zealand
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13
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Kuang R, Xiong G, Lv W, Zhao Y, Yu M, Jiang J. Efficacy and safety of acupuncture combined with analgesics on lung cancer pain: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26225. [PMID: 34115008 PMCID: PMC8202641 DOI: 10.1097/md.0000000000026225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 05/18/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lung cancer (LC) is the malignant tumor with the highest incidence in the world, and treatment methods include surgery, radiotherapy, chemotherapy, and immunotherapy. Cancer pain is a common symptom in patients with LC, and the clinical treatment is to relieve it with analgesics. Acupuncture can relieve cancer pain. This study aims to systematically study the efficacy and safety of acupuncture combined with analgesics on cancer pain in patients with LC. METHODS From the beginning to April 2021, search Medline, Embase, Cochrane Central Controlled Trials Register (Central), China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biomedical Literature Database (CBM), and Chinese Science Journal Database (VIP database). Search the international clinical trial registration platform and the Chinese clinical trial registration platform to find ongoing or unpublished trials. The main outcome indicator is the total effective rate of analgesia, and the secondary outcome indicator is pain intensity score and adverse reactions. The RevMan 5.4 software will be used for statistical analysis. RESULTS This study will provide the latest evidence for acupuncture combined with analgesics to relieve LC pain. CONCLUSION The conclusion of this study is to evaluate the effectiveness and safety of acupuncture combined with analgesics in alleviating LC pain. INPLASY REGISTRATION NUMBER INPLASY202150051.
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Affiliation(s)
| | - Guojiang Xiong
- The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China
| | - Wei Lv
- The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China
| | - Yun Zhao
- The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China
| | - Min Yu
- Jiangxi University of Chinese Medicine
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14
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Tang H, Chen L, Wang Y, Zhang Y, Yang N, Yang N. The efficacy of music therapy to relieve pain, anxiety, and promote sleep quality, in patients with small cell lung cancer receiving platinum-based chemotherapy. Support Care Cancer 2021; 29:7299-7306. [PMID: 34041615 DOI: 10.1007/s00520-021-06152-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Chemotherapy induces a range of physical and psychological symptoms, including pain, sleep disorders, fatigue, and anxiety. We aimed to assess the efficacy of six-step music therapy in relieving pain and anxiety and improving sleep quality in lung cancer patients receiving platinum-based chemotherapy. METHODS Between March 2013 and October 2015, we enrolled a total of 100 patients who were diagnosed with small cell lung cancer and scheduled for platinum-based chemotherapy. Patients were randomly assigned to two groups: the music therapy group (received six-step music therapy, n=50) and the control group (not received six-step music therapy, n=50). The anxiety, pain, and sleep quality of all patients were assessed using the self-rating anxiety scale (SAS), the visual analogue scale (VAS), and the Pittsburgh Sleep Quality Index (PSQI), respectively. RESULTS There were no significant differences in the demographic characteristics and music background between the two groups. The SAS and VAS scores in the two groups were not statistically different before chemotherapy. However, patients in the music therapy group showed significantly lower SAS and VAS scores compared with the control group at both 1 day and 5 days after chemotherapy. (SAS score at 1-day post-therapy, 49.48±2.14 vs 61.46±8.8, P=0.011; SAS score at 5-day post-therapy, 39.73±1.79 vs 62.02±8.83, P=0.005; VAS score at 1-day post-therapy, 2.14±0.78 vs 4.74±1.01, P=0.005; VAS score at 5-day post-therapy, 2.06±0.79 vs 4.74±1.08, P=0.004). In addition, the total PSQI score of patients who received music therapy was also significantly higher than that of the control group after therapy (total PSQI score at 1-day post-therapy, 8.50±1.69 vs 17.81±3.01, P=0.006; total PSQI score at 5-day post-chemotherapy, 9.84±3.02 vs 18.66±2.91, P=0.012). CONCLUSION The music therapy was an effective approach in alleviating pain and anxiety and promoting sleep quality in lung cancer patients receiving platinum-based chemotherapy. TRIAL REGISTRATION Chinese Clinical Trial Registry (registration number: ChiCTR-TRC-13003993).
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Affiliation(s)
- Haoke Tang
- Music Therapist of Department of Nursing, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong Province, People's Republic of China
| | - Liping Chen
- Department of Nursing, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong Province, People's Republic of China
| | - Yichun Wang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong Province, People's Republic of China
| | - Yongchang Zhang
- Department of Lung Cancer and Gastroenterology, Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
| | - Nong Yang
- Department of Lung Cancer and Gastroenterology, Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
| | - Ning Yang
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, No.63, Duobao Road, Liwan District, Guangzhou, 510150, Guangdong Province, People's Republic of China.
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15
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Kumar PS, Saphire ML, Grogan M, Benedict J, Janse S, Agne JL, Bertino EM, Presley CJ. Substance Abuse Risk and Medication Monitoring in Patients with Advanced Lung Cancer Receiving Palliative Care. J Pain Palliat Care Pharmacother 2021; 35:91-99. [PMID: 34010103 DOI: 10.1080/15360288.2021.1920545] [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: 01/31/2023]
Abstract
Oncology and Palliative Medicine lack guidance on routine opioid risk screening and compliance monitoring. This study explored relationships among risk screening and aberrant medication related behaviors in patients with advanced lung cancer receiving embedded palliative care. This was a single center, prospective study and data was collected from December 2018 to March 2020. At the initial palliative visit, patients provided a baseline urine drug screen (UDS) test and completed the Screener and Opioid Assessment for Patients with Pain - Revised (SOAPP-R) self-assessment. Clinical pharmacists provided comprehensive review and interpretation of UDS results. Among 39 patients, 12 (30.8%) scored positive for risk of aberrant medication behaviors on the SOAPP-R. Only 34 of 39 patients provided a baseline UDS test and were included in further analysis. Prior to pharmacist review, 11/11 (100%) baseline UDS results in the positive-risk group and 13/23 (56.5%) in the negative-risk group appeared unexpected (p = 0.01). After pharmacist review, aberrant baseline UDS results were confirmed for 5/11 (45.5%) positive-risk and 4/23 (17.4%) negative-risk patients (p = 0.11). Overall, the SOAPP-R alone may be inadequate in this population and clinical pharmacists play an important role in comprehensive UDS result interpretation. Future studies are needed to validate this risk-screening tool in palliative cancer populations.
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Affiliation(s)
- Pooja S Kumar
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Maureen L Saphire
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Madison Grogan
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Jason Benedict
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Sarah Janse
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Julia L Agne
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Erin M Bertino
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Carolyn J Presley
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
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16
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Lee MK. Relationships of Symptom Groups and Functioning Domains in Patients with Advanced-Stage Non-Small Cell Lung Cancer Undergoing Treatment: A Cross-Sectional Study. Healthcare (Basel) 2020; 9:28. [PMID: 33396797 PMCID: PMC7823599 DOI: 10.3390/healthcare9010028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to describe the symptoms experienced by patients with non-small cell lung cancer (NSCLC), examine whether different symptom groups significantly affected different functioning domains in these patients, and determine the effect of the "lack of energy" and "pain" symptom groups on the different functioning domains of health-related quality of life (HRQOL). From a single tertiary institution, this cross-sectional study enrolled 135 consecutive NSCLC patients who were mostly undergoing chemotherapy and were in the advanced stage (National University Hospital, Daegu, South Korea). Clinical and self-reported demographic information and data on different functioning domains (from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30)), symptom experience (from the EORTC QLQ-LC13), and the Symptom Distress Scale (SDS) were examined. The four most common symptoms were fatigue (69%), pain (47%), dyspnea (38%), and lack of appetite (36%). The "pain" symptom group was negatively associated with physical, emotional, cognitive, and role functioning. The "lack of energy" symptom group was negatively associated with physical, role, emotional, social, and cognitive functioning. The "lack of energy" symptom group explained the most variance for physical and role functioning, and the "pain" symptom group explained the most variance for emotional functioning. Impaired concentration explained the most variance for cognitive functioning.
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Affiliation(s)
- Myung Kyung Lee
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu 41944, Korea
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17
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Miles VN, Patel RK, Smith AG, McCall RP, Wu J, Lei W. The Effect of Heat Shock Protein 90 Inhibitor on Pain in Cancer Patients: A Systematic Review and Meta-Analysis. Medicina (B Aires) 2020; 57:medicina57010005. [PMID: 33374669 PMCID: PMC7822414 DOI: 10.3390/medicina57010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 11/21/2022] Open
Abstract
Background and objectives: Heat shock protein 90 (Hsp90) is a molecular chaperone that plays an essential role in tumor growth. Numerous Hsp90 inhibitors have been discovered and tested in preclinical and clinical trials. Recently, several preclinical studies have demonstrated that Hsp90 inhibitors could modulate pain sensitization. However, no studies have evaluated the impact of Hsp90 inhibitors on pain in the patients. This study aims to summarize the pain events reported in clinical trials assessing Hsp90 inhibitors and to determine the effect of Hsp90 inhibitors on pain in patients. Materials and Methods: We searched PubMed, EBSCOhost, and clinicaltrials.gov for Hsp90 inhibitor clinical trials. The pain-related adverse events were summarized. Meta-analysis was performed using the data reported in randomized controlled trials. Results: We identified 90 clinical trials that reported pain as an adverse effect, including 5 randomized controlled trials. The most common types of pain reported in all trials included headache, abdominal pain, and back pain. The meta-analysis showed that Hsp90 inhibitors increased the risk of abdominal pain significantly and appeared to increase the risk for back pain. Conclusions: In conclusion, Hsp90 inhibitor treatment could potentially increase the risk of pain. However, the meta-analysis demonstrated only moderate evidence for the connection between Hsp90 inhibitor and pain.
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Affiliation(s)
| | | | | | | | | | - Wei Lei
- Correspondence: ; Tel.: +1-864-938-3836
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18
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Pathak AK, Husain N, Kant S, Bala L. Relevance of genetic polymorphisms in tobacco-related detoxifying enzymes in non-small cell lung carcinoma susceptibility. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kumar J, Alam MM, Johnson KC. Nonpharmacological Interventions for Pain Management in Lung Cancer Patients: A Systematic Review. Indian J Palliat Care 2020; 26:444-456. [PMID: 33623305 PMCID: PMC7888434 DOI: 10.4103/ijpc.ijpc_24_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/25/2020] [Indexed: 11/18/2022] Open
Abstract
Background: The presence of lung cancer is almost always associated with pain, a symptom that causes severe distress in patients. Although many pharmacological methods are available to manage pain in this oncologic population, the medications often cause undesirable sideeffects and inadequate relief. Nonpharmacological interventions can be used as adjuvants to pharmacological interventions in reducing pain and increasing quality of life. Objectives: The purpose of this review is to compare the efficacy of nonpharmacological interventions in reducing pain in lung cancer patients. Materials and Methods: This is a systematic review study guided by the Preferred Reporting Items of Systematic reviews and Meta-Analysis Protocol. Interventions identified in the present systematic review have been categorized as physical treatment, technologybased, cognitive behavioral, coping, and coaching. Results: Results indicate that the nonpharmacological interventions such as physical treatment interventions, selfmanagement and coaching interventions, cognitive behavioral interventions, and technologybased interventions or coping skills interventions had limited and shortterm effects on alleviating pain among the patients. However, previous studies have provided limited evidence regarding nonpharmacologic therapy due to the lack of a comparison group, small sample sizes, and lack of longterm followup periods to determine whether sustained effects are feasible. Conclusion: Healthcare professionals should consider additional research on the added advantage of utilizing the nonpharmacological interventions as an adjunct option while managing pain in lung cancer patients.
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Affiliation(s)
- Jayaprakash Kumar
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Mohammad Masudul Alam
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
| | - Karen Chandler Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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Moreno E, Cavic M, Krivokuca A, Canela EI. The Interplay between Cancer Biology and the Endocannabinoid System-Significance for Cancer Risk, Prognosis and Response to Treatment. Cancers (Basel) 2020; 12:cancers12113275. [PMID: 33167409 PMCID: PMC7694406 DOI: 10.3390/cancers12113275] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022] Open
Abstract
The various components of the endocannabinoid system (ECS), such as the cannabinoid receptors (CBRs), cannabinoid ligands, and the signalling network behind it, are implicated in several tumour-related states, both as favourable and unfavourable factors. This review analyses the ECS's complex involvement in the susceptibility to cancer, prognosis, and response to treatment, focusing on its relationship with cancer biology in selected solid cancers (breast, gastrointestinal, gynaecological, prostate cancer, thoracic, thyroid, CNS tumours, and melanoma). Changes in the expression and activation of CBRs, as well as their ability to form distinct functional heteromers affect the cell's tumourigenic potential and their signalling properties, leading to pharmacologically different outcomes. Thus, the same ECS component can exert both protective and pathogenic effects in different tumour subtypes, which are often pathologically driven by different biological factors. The use of endogenous and exogenous cannabinoids as anti-cancer agents, and the range of effects they might induce (cell death, regulation of angiogenesis, and invasion or anticancer immunity), depend in great deal on the tumour type and the specific ECS component that they target. Although an attractive target, the use of ECS components in anti-cancer treatment is still interlinked with many legal and ethical issues that need to be considered.
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Affiliation(s)
- Estefanía Moreno
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain
- Institute of Biomedicine of the University of Barcelona (IBUB), 08028 Barcelona, Spain
- Correspondence: (E.M.); (E.I.C.)
| | - Milena Cavic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia; (M.C.); (A.K.)
| | - Ana Krivokuca
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia; (M.C.); (A.K.)
| | - Enric I. Canela
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain
- Institute of Biomedicine of the University of Barcelona (IBUB), 08028 Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
- Correspondence: (E.M.); (E.I.C.)
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Liu W, Chen Y, Xu W, Wang W, Tang L, Xia R, Zhu Q. Fentanyl stimulates tumor angiogenesis via activating multiple pro-angiogenic signaling pathways. Biochem Biophys Res Commun 2020; 532:225-230. [PMID: 32861420 DOI: 10.1016/j.bbrc.2020.08.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/13/2020] [Indexed: 02/02/2023]
Abstract
Angiogenesis plays a vital role in tumor progression and metastasis. To better understand the role of anesthesia in tumor biology, we previously reported that bupivacaine displayed the inhibitory effects in endothelial cells. In this work, we demonstrated that fentanyl, an opioid medication commonly used in cancer patients, stimulated tumor angiogenesis. We found that fentanyl at nanomolar concentrations significantly stimulated capillary network formation of human lung tumor-associated endothelial cell (HLT-EC) in a similar manner as vascular endothelial growth factor (VEGF), and furthermore that the stimulatory effect of fentanyl was mainly involved in early stage of HLT-EC vascular structure assembly. Particularly, fentanyl significantly increased HLT-EC growth and migration. Fentanyl also protected HLT-EC from apoptosis induced by growth factor withdrawal. In contrast, the same concentrations of fentanyl did not affect human lung cancer cell growth and survival. Fentanyl stimulated migration of some but not all tested human lung cancer cells. Mechanism analysis suggested that fentanyl activates multiple pro-angiogenic signaling pathways, including VEGFR2/FAK/PI3K/Akt and small GTPases. Our work systematically demonstrates that fentanyl stimulates tumor angiogenesis via activating multiple pro-angiogenic signaling pathways. Our findings highlight the potential adverse effect of fentanyl in cancer patients.
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Affiliation(s)
- Weiwei Liu
- Department of Anesthesiology, The First Affiliated Hospital of Yangtze University, The First People's Hospital of Jingzhou, Jingzhou, Hubei Province, China
| | - Yi Chen
- Department of Anesthesiology, The First Affiliated Hospital of Yangtze University, The First People's Hospital of Jingzhou, Jingzhou, Hubei Province, China
| | - Wei Xu
- Department of Anesthesiology, The First Affiliated Hospital of Yangtze University, The First People's Hospital of Jingzhou, Jingzhou, Hubei Province, China
| | - Wei Wang
- Department of Anesthesiology, The First Affiliated Hospital of Yangtze University, The First People's Hospital of Jingzhou, Jingzhou, Hubei Province, China
| | - Li Tang
- Department of Anesthesiology, The First Affiliated Hospital of Yangtze University, The First People's Hospital of Jingzhou, Jingzhou, Hubei Province, China
| | - Rui Xia
- Department of Anesthesiology, The First Affiliated Hospital of Yangtze University, The First People's Hospital of Jingzhou, Jingzhou, Hubei Province, China.
| | - Qiong Zhu
- Department of Anesthesiology, The First Affiliated Hospital of Yangtze University, The First People's Hospital of Jingzhou, Jingzhou, Hubei Province, China.
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Modified technique for thermal radiofrequency ablation of Thoracic dorsal root ganglia under combined fluoroscopy and CT guidance: a randomized clinical trial. BMC Anesthesiol 2019; 19:234. [PMID: 31852438 PMCID: PMC6921431 DOI: 10.1186/s12871-019-0906-4] [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: 05/17/2019] [Accepted: 12/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study is comparing thermal radiofrequency ablation (TRFA) of the thoracic dorsal root ganglia (TDRG) guided by Xper CT and fluoroscopy with the standard fluoroscopy. Methods This randomized clinical trial included 78 patients suffering from chronic refractory pain due to chest malignancies randomly allocated into one of two groups according to guidance of TRFA of TDRG. In CT guided group (n = 40) TRFA was done under integrated Xper CT-scan and fluoroscopy guidance, while it was done under fluoroscopy guidance only in standard group (n = 38). The primary outcome was pain intensity measured by visual analog scale (VAS) score, functional improvement and consumption of analgesics. The secondary outcome measures were patient global impression of changes (PGIC) and adverse effects. Results VAS scores decreased in the two groups compared to baseline values (p < 0.001) and were lower in CT guided group up to 12 weeks. Pregabalin and oxycodone consumption was higher in the standard group at 1, 4 and 12 weeks (p < 0.001). Functional improvement showed near significant difference between the two groups (P = 0.06 at week 1, 0.07 at week 4 respectively) while the difference was statistically significant at week 12 (P = 0.04). PGIC showed near significant difference only at week 1 (P = 0.07) while the per-patient adverse events were lower in CT guided group (p = 0.027). Conclusions Integrated modality guidance with Xper CT-scan and fluoroscopy together with suprapedicular inferior transforaminal approach may improve efficacy and safety of TRFA of TDRG for the treatment of intractable chest pain in cancer patients. Trial registration The study was retrospectively registered at clinicaltrials.gov on 04/22/2018 (Registration No.: NCT03533413).
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Peyravian N, Dikici E, Deo S, Toborek M, Daunert S. Opioid antagonists as potential therapeutics for ischemic stroke. Prog Neurobiol 2019; 182:101679. [PMID: 31398359 PMCID: PMC6814577 DOI: 10.1016/j.pneurobio.2019.101679] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/01/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023]
Abstract
Chronic use of prescription opioids exacerbates risk and severity of ischemic stroke. Annually, 6 million people die from stroke worldwide and there are no neuroprotective or neurorestorative agents to improve stroke outcomes and promote recovery. Prescribed opioids such as morphine have been shown to alter tight junction protein expression, resulting in the disruption of the blood brain barrier (BBB), ultimately leading to stroke pathogenesis. Consequently, protection of the BBB has been proposed as a therapeutic strategy for ischemic stroke. This perspective addresses the deficiency in stroke pharmacological options and examines a novel application and repurposing of FDA-approved opioid antagonists as a prospective neuroprotective therapeutic strategy to minimize BBB damage, reduce stroke severity, and promote neural recovery. Future directions discuss potential drug design and delivery methods to enhance these novel therapeutic targets.
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Affiliation(s)
- Nadia Peyravian
- Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, USA; Dr. JT Macdonald Foundation Biomedical Nanotechnology Institute of the University of Miami, USA
| | - Emre Dikici
- Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, USA; Dr. JT Macdonald Foundation Biomedical Nanotechnology Institute of the University of Miami, USA
| | - Sapna Deo
- Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, USA; Dr. JT Macdonald Foundation Biomedical Nanotechnology Institute of the University of Miami, USA
| | - Michal Toborek
- Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, USA; Dr. JT Macdonald Foundation Biomedical Nanotechnology Institute of the University of Miami, USA.
| | - Sylvia Daunert
- Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, USA; Dr. JT Macdonald Foundation Biomedical Nanotechnology Institute of the University of Miami, USA; University of Miami Clinical and Translational Science Institute, USA.
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Saunders J, Ashton M, Hall C, Laird B, MacLeod N. Pain management in patients with malignant mesothelioma: challenges and solutions. LUNG CANCER-TARGETS AND THERAPY 2019; 10:37-46. [PMID: 31037036 PMCID: PMC6450333 DOI: 10.2147/lctt.s192558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive cancer with a considerable symptom burden and poor prognosis. Focus on maintaining patients’ quality of life and pain control is therefore paramount. Pain management in MPM is complex due to its multifactorial etiology resulting from direct tumor infiltration of the surrounding soft tissue, bone, and encasement of the intercostal nerves. A variety of treatment modalities, including pharmacological and non-pharmacological options, are often required to achieve adequate pain control in this challenging disease. This review article examines the current challenges and solutions available for pain management in MPM.
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Affiliation(s)
- J Saunders
- Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, UK,
| | - M Ashton
- Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, UK, .,Institute of Cancer Sciences, University of Glasgow, UK
| | - C Hall
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XR, UK.,St Columba's Hospice, Edinburgh EH5 3RW, UK
| | - B Laird
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XR, UK.,St Columba's Hospice, Edinburgh EH5 3RW, UK
| | - N MacLeod
- Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, UK,
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Strategies of Coping with Pain: Differences Associated with the Histological Type of Lung Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1222:43-53. [DOI: 10.1007/5584_2019_429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Brown M, Farquhar-Smith P. Pain in cancer survivors; filling in the gaps. Br J Anaesth 2017; 119:723-736. [DOI: 10.1093/bja/aex202] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Curtin M, Piggott RP, Murphy EP, Munigangaiah S, Baker JF, McCabe JP, Devitt A. Spinal Metastatic Disease: A Review of the Role of the Multidisciplinary Team. Orthop Surg 2017; 9:145-151. [PMID: 28544780 DOI: 10.1111/os.12334] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/02/2017] [Indexed: 12/16/2022] Open
Abstract
Historically, a simple approach centered on palliation was applicable to the majority of patients with metastatic spinal disease. With advances in diagnosis and treatment, a more complicated algorithm has devolved requiring a multidisciplinary approach with institutional commitment and support. We performed a database review including pertinent articles exploring the multidisciplinary management of spinal metastatic disease. The wide variation in clinical presentation and tumor response to treatment necessitates a multidisciplinary approach that integrates the diagnosis and treatment of the cancer, symptom management, and rehabilitation for optimal care of patients with spinal metastases. Advances in the field of radiology have led to earlier and more focused diagnosis of spinal metastasis and acts to guide therapy. Advances in surgical techniques, neurophysiologic monitoring, and anesthetic expertise have allowed surgeons to perform more extensive procedures leading to improved outcomes and reduced morbidity. Radiation oncology input that is essential as external beam radiation therapy can provide significant pain relief. Non-operative measures may include bisphosphonate infusions, management of complications (e.g. hypercalcemia of malignancy), monoclonal antibody infusions, and chemotherapy if indicated in the treatment of the primary malignancy. Input from psychology services is necessary to address the biopsychosocial ramifications of spinal metastasis. Allied health professionals in the form of physiotherapists, social workers, and dieticians also contribute in maximizing patients' quality of life and well-being.
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Affiliation(s)
- Mark Curtin
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Robert P Piggott
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Evelyn P Murphy
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Sudarshan Munigangaiah
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Joseph F Baker
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - John P McCabe
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Aiden Devitt
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
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Karbownik A, Szałek E, Sobańska K, Grabowski T, Wolc A, Grześkowiak E. Pharmacokinetic drug-drug interaction between erlotinib and paracetamol: A potential risk for clinical practice. Eur J Pharm Sci 2017; 102:55-62. [PMID: 28232141 DOI: 10.1016/j.ejps.2017.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/27/2017] [Accepted: 02/18/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Erlotinib is a tyrosine kinase inhibitor available for the treatment of non-small cell lung cancer. Paracetamol is an analgesic agent, commonly used in cancer patients. Because these drugs are often co-administered, there is an increasing issue of interaction between them. OBJECTIVE The aim of the study was to investigate the effect of paracetamol on the pharmacokinetic parameters of erlotinib, as well as the influence of erlotinib on the pharmacokinetics of paracetamol. METHODS The rabbits were divided into three groups: the rabbits receiving erlotinib (IER), the group receiving paracetamol (IIPR), and the rabbits receiving erlotinib+paracetamol (IIIER+PR). A single dose of erlotinib was administered orally (25mg) and was administered intravenously (35mg/kg). Plasma concentrations of erlotinib, its metabolite (OSI420), paracetamol and its metabolites - glucuronide and sulphate were measured with the validated method. RESULTS During paracetamol co-administration we observed increased erlotinib maximum concentration (Cmax) and area under the plasma concentration-time curve from time zero to infinity (AUC0-∞) by 87.7% and 31.1%, respectively. In turn, erlotinib lead to decreased paracetamol AUC0-∞ by 35.5% and Cmax by 18.9%. The mean values of paracetamol glucuronide/paracetamol ratios for Cmax were 32.2% higher, whereas paracetamol sulphate/paracetamol ratios for Cmax and AUC0-∞ were 37.1% and 57.1% lower in the IIPR group, when compared to the IIIER+PR group. CONCLUSIONS Paracetamol had significant effect on the enhanced plasma exposure of erlotinib. Additionally, erlotinib contributed to the lower concentrations of paracetamol. Decreased glucuronidation and increased sulphation of paracetamol after co-administration of erlotinib were also observed.
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Affiliation(s)
- Agnieszka Karbownik
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Św. Marii Magdaleny 14, PL 61-861 Poznań, Poland
| | - Edyta Szałek
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Św. Marii Magdaleny 14, PL 61-861 Poznań, Poland
| | - Katarzyna Sobańska
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Św. Marii Magdaleny 14, PL 61-861 Poznań, Poland.
| | | | - Anna Wolc
- Department of Animal Science, Iowa State University, 239E Kildee Hall, Ames, IA 50011, USA; Hy-Line International, 2583 240th Street, Dallas Center, IA 50063, USA
| | - Edmund Grześkowiak
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Św. Marii Magdaleny 14, PL 61-861 Poznań, Poland
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Hochberg U, Elgueta MF, Perez J. Interventional Analgesic Management of Lung Cancer Pain. Front Oncol 2017; 7:17. [PMID: 28261561 PMCID: PMC5306685 DOI: 10.3389/fonc.2017.00017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/25/2017] [Indexed: 12/31/2022] Open
Abstract
Lung cancer is one of the four most prevalent cancers worldwide. Comprehensive patient care includes not only adherence to clinical guidelines to control and when possible cure the disease but also appropriate symptom control. Pain is one of the most prevalent symptoms in patients diagnosed with lung cancer; it can arise from local invasion of chest structures or metastatic disease invading bones, nerves, or other anatomical structures potentially painful. Pain can also be a consequence of therapeutic approaches like surgery, chemotherapy, or radiotherapy. Conventional medical management of cancer pain includes prescription of opioids and coadjuvants at doses sufficient to control the symptoms without causing severe drug effects. When an adequate pharmacological medical management fails to provide satisfactory analgesia or when it causes limiting side effects, interventional cancer pain techniques may be considered. Interventional pain management is devoted to the use of invasive techniques such as joint injections, nerve blocks and/or neurolysis, neuromodulation, and cement augmentation techniques to provide diagnosis and treatment of pain syndromes resistant to conventional medical management. Advantages of interventional approaches include better analgesic outcomes without experiencing drug-related side effects and potential for opioid reduction thus avoiding central side effects. This review will describe various pain syndromes frequently described in lung cancer patients and those interventional techniques potentially indicated for those cases.
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Affiliation(s)
- Uri Hochberg
- Cancer Pain Program, McGill University Health Centre , Montreal, QC , Canada
| | | | - Jordi Perez
- Cancer Pain Program, McGill University Health Centre, Montreal, QC, Canada; Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, QC, Canada
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Bülbül Y, Ozlu T, Arinc S, Ozyurek B, Gunbatar H, Senturk A, Bahadir A, Ozcelik M, Yilmaz U, Akbay M, Saglam L, Kilic T, Kirkil G, Ozcelik N, Tatar D, Baris S, Yavsan D, Sen H, Berk S, Acat M, Cakmak G, Yumuk P, Intepe Y, Toru U, Ayik S, Basyigit I, Ozkurt S, Mutlu L, Yasar Z, Esme H, Erol M, Oruc O, Erdoğan Y, Asker S, Ulas A, Erol S, Kerget B, Erbaycu A, Teke T, Beşiroğlu M, Can H, Dalli A, Talay F. Assessment of Palliative Care in Lung Cancer in Turkey. Med Princ Pract 2017; 26:50-56. [PMID: 27780164 PMCID: PMC5588338 DOI: 10.1159/000452801] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 10/24/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. SUBJECTS AND METHODS This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. RESULTS The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. CONCLUSION In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.
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Affiliation(s)
- Y. Bülbül
- Department of Chest Diseases, School of Medicine, Karadeniz Technical University, Trabzon, Izmir, Turkey
| | - T. Ozlu
- Department of Chest Diseases, School of Medicine, Karadeniz Technical University, Trabzon, Izmir, Turkey
| | - S. Arinc
- Department of Chest Diseases, School of Medicine, Sureyyapasa, Istanbul, Turkey
| | - B.A. Ozyurek
- Department of Chest Diseases, School of Medicine, Ataturk, Ankara, Turkey
| | - H. Gunbatar
- Department of Chest Diseases, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - A. Senturk
- Department of Chest Diseases, School of Medicine, Ataturk, Ankara
| | - A. Bahadir
- Department of Chest Diseases, School of Medicine, Yedikule, Istanbul, Turkey
| | - M. Ozcelik
- Department of Chest Diseases, School of Medicine, Kartal, Istanbul
| | - U. Yilmaz
- Department of Chest Diseases, School of Medicine, Dr. Suat Seren, Izmir, Education and Research Hospitals of, Izmir, Turkey
- *Prof. Yilmaz Bülbül, Department of Chest Diseases, School of Medicine, Karadeniz Technical University, Farabi Cd. No: 66, TR–61080 Trabzon (Turkey), E-Mail
| | - M.O. Akbay
- Department of Chest Diseases, School of Medicine, Sureyyapasa, Istanbul, Turkey
| | - L. Saglam
- Department of Chest Diseases, School of Medicine, Ataturk University, Erzurum, Turkey
| | - T. Kilic
- Department of Chest Diseases, School of Medicine, Inonu University, Malatya, Turkey
| | - G. Kirkil
- Department of Chest Diseases, School of Medicine, Firat University, Elazıg, Turkey
| | - N. Ozcelik
- Department of Chest Diseases, School of Medicine, Karadeniz Technical University, Trabzon, Izmir, Turkey
| | - D. Tatar
- Department of Chest Diseases, School of Medicine, Dr. Suat Seren, Izmir, Education and Research Hospitals of, Izmir, Turkey
| | - S.A. Baris
- Department of Chest Diseases, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - D.M. Yavsan
- Department of Chest Diseases, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - H.S. Sen
- Department of Chest Diseases, School of Medicine, Dicle University, Diyarbakir, Turkey
| | - S. Berk
- Department of Chest Diseases, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - M. Acat
- Department of Chest Diseases, School of Medicine, Karabük University, Karabük, Turkey
| | - G. Cakmak
- Department of Chest Diseases, School of Medicine, Haseki, Istanbul
| | - P.F. Yumuk
- Department of Chest Diseases, School of Medicine, Department of Medical Oncology School of Medicine, Marmara University, Istanbul, Izmir, Turkey
| | - Y.S. Intepe
- Department of Chest Diseases, School of Medicine, Bozok University, Yozgat, Turkey
| | - U. Toru
- Department of Chest Diseases, School of Medicine, Dumlupinar University, Kutahya, Turkey
| | - S.O. Ayik
- Department of Chest Diseases, School of Medicine, Katip Celebi University, Izmir, Turkey
| | - I. Basyigit
- Department of Chest Diseases, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - S. Ozkurt
- Department of Chest Diseases, School of Medicine, Pamukkale University, Denizli, Turkey
| | - L.C. Mutlu
- Department of Chest Diseases, School of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Z.A. Yasar
- Department of Chest Diseases, School of Medicine, Abant Izzet Baysal University, Bolu, Pulmonary Diseases and Thoracic Surgery Education and Research Hospitals of, Izmir, Turkey
| | - H. Esme
- Department of Chest Diseases, School of Medicine, Konya, Konya
| | - M.M. Erol
- Department of Chest Diseases, School of Medicine, Department of Thoracic Surgery School of Medicine, Uludag University, Bursa, Turkey
| | - O. Oruc
- Department of Chest Diseases, School of Medicine, Sureyyapasa, Istanbul, Turkey
| | - Y. Erdoğan
- Department of Chest Diseases, School of Medicine, Ataturk, Ankara, Turkey
| | - S. Asker
- Department of Chest Diseases, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - A. Ulas
- Department of Chest Diseases, School of Medicine, Ataturk, Ankara
| | - S. Erol
- Department of Chest Diseases, School of Medicine, Dr. Suat Seren, Izmir, Education and Research Hospitals of, Izmir, Turkey
| | - B. Kerget
- Department of Chest Diseases, School of Medicine, Ataturk University, Erzurum, Turkey
| | - A.E. Erbaycu
- Department of Chest Diseases, School of Medicine, Dr. Suat Seren, Izmir, Education and Research Hospitals of, Izmir, Turkey
| | - T. Teke
- Department of Chest Diseases, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - M. Beşiroğlu
- Department of Chest Diseases, School of Medicine, Department of Medical Oncology School of Medicine, Marmara University, Istanbul, Izmir, Turkey
| | - H. Can
- Department of Chest Diseases, School of Medicine, Department of Family Medicine School of Medicine, Katip Celebi University, Izmir, Turkey
| | - A. Dalli
- Department of Chest Diseases, School of Medicine, Katip Celebi University, Izmir, Turkey
| | - F. Talay
- Department of Chest Diseases, School of Medicine, Abant Izzet Baysal University, Bolu, Pulmonary Diseases and Thoracic Surgery Education and Research Hospitals of, Izmir, Turkey
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MacLeod N, Kelly C, Stobo J, McMahon L, Taggart D, Fallon M, Laird BJ. Pain in Malignant Pleural Mesothelioma: A Prospective Characterization Study. PAIN MEDICINE (MALDEN, MASS.) 2016; 17:2119-2126. [PMID: 27117437 DOI: 10.1093/pm/pnw061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Malignant pleural mesothelioma (MPM) is associated with severe pain. The underlying neurobiology of this is complex. The primary aim of this study was to characterize pain in MPM. METHODS This study was undertaken as part of a trial examining radiotherapy for the treatment of pain in MPM (ISRCTN 10644347). Patients had MPM with associated pain for which radiotherapy was planned and a worst pain score ≥ 4/10. The following assessments were undertaken: clinical neuropathic pain assessment, Brief Pain Inventory (BPI), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), Short form of the McGill Pain Questionnaire (SF-MPQ), and Quantitative Sensory Testing (QST). The relationship of these characteristics and response to radiotherapy was assessed. Unless stated, medians and interquartile range (IQR) are used. RESULTS Thirty-seven patients were recruited. Average pain and worst pain was 4 (4-6) and 8 (6-8), respectively. Higher average pain and higher worst pain scores were associated with higher interference scores on the BPI, P < 0.001 and P < 0.0005. Twenty patients (54%) had a clinical diagnosis of neuropathic pain, and of these, only six patients (40%) screened positively for neuropathic pain using the LANSS. Patients with a high LANSS also had higher BPI and SF-MPQs. The presence of neuropathic pain (clinically or by LANSS) did not predict response to radiotherapy, P < 0.05. The SF-MPQ scores were higher in those with abnormal cool sensation on QST (P = 0.016). CONCLUSION Pain in mesothelioma varies among patients and may have neuropathic components. An adequate pain assessment is necessary to guide the clinician in the appropriate choice of analgesics.
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Affiliation(s)
- Nicholas MacLeod
- *Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Jon Stobo
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Lynn McMahon
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Marie Fallon
- *Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - Barry J Laird
- *Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
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Abstract
Lung cancer is the leading cause of death due to malignancy. Although lung cancer mortality has been decreasing in recent years, it remains substantially higher than other causes of cancer death. Median survival for patients with locally advanced non-small cell lung cancer, defined as lung cancer involving regional lymph nodes, is estimated to be approximately 10 to 17 months, and median survival for patients with metastatic disease is only 6 to 9 months. In addition, patients with advanced lung cancer often experience debilitating symptoms and poor quality of life. Pain, dyspnea, and fatigue are most frequently reported and affect at least 65% of patients with advanced lung cancer. Given this burden of symptoms and high mortality, patients and their families facing a diagnosis of advanced lung cancer are in need of support. Palliative care, with its focus on addressing the emotional, physical, and spiritual sources of suffering utilizing the expertise of an interdisciplinary team, can provide this comprehensive support. This review describes the role of supportive and palliative care integrated into the treatment of patients with a diagnosis of advanced lung cancer with sections focused on the evaluation and treatment of pain and dyspnea, approaches to challenging communication tasks, and the support of caregivers who care for patients with advanced lung cancer.
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Chandrasekar D, Tribett E, Ramchandran K. Integrated Palliative Care and Oncologic Care in Non-Small-Cell Lung Cancer. Curr Treat Options Oncol 2016; 17:23. [PMID: 27032645 PMCID: PMC4819778 DOI: 10.1007/s11864-016-0397-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OPINION STATEMENT Palliative care integrated into standard medical oncologic care will transform the way we approach and practice oncologic care. Integration of appropriate components of palliative care into oncologic treatment using a pathway-based approach will be described in this review. Care pathways build on disease status (early, locally advanced, advanced) as well as patient and family needs. This allows for an individualized approach to care and is the best means for proactive screening, assessment, and intervention, to ensure that all palliative care needs are met throughout the continuum of care. Components of palliative care that will be discussed include assessment of physical symptoms, psychosocial distress, and spiritual distress. Specific components of these should be integrated based on disease trajectory, as well as clinical assessment. Palliative care should also include family and caregiver education, training, and support, from diagnosis through survivorship and end of life. Effective integration of palliative care interventions have the potential to impact quality of life and longevity for patients, as well as improve caregiver outcomes.
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Affiliation(s)
- Divya Chandrasekar
- />Hospice and Palliative Medicine, Stanford University School of Medicine, 2502 Galahad Court, San Jose, CA 95122 USA
| | - Erika Tribett
- />General Medical Disciplines, Stanford University School of Medicine, Medical School Office Building, 1265 Welch Road, MC 5475, Stanford, CA 94305 USA
| | - Kavitha Ramchandran
- />Outpatient Palliative Medicine, Stanford Cancer Institute, Medical School Office Building, 1265 Welch Road MC 5475, Stanford, CA 94305 USA
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Hu M, Zhi X, Zhang J. Radiofrequency ablation (RFA) for palliative treatment of painful non-small cell lung cancer (NSCLC) rib metastasis: Experience in 12 patients. Thorac Cancer 2015; 6:761-4. [PMID: 26557915 PMCID: PMC4632929 DOI: 10.1111/1759-7714.12258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 02/25/2015] [Indexed: 11/30/2022] Open
Abstract
Background Painful rib metastasis is common in non-small cell lung cancer (NSCLC). Pain is often partially or totally refractory to analgesic medications or the side effects of medication are unacceptable. We report the safety and efficacy of a new method: radiofrequency ablation (RFA) in treating painful NSCLC rib metastasis. Methods RFA procedures were completed in 12 patients with painful rib metastasis. Patient age ranged from 66–83 years (mean 74.8 years, standard deviation (SD) = 5.3). There were four cases of squamous-carcinoma, seven adenocarcinomas, and one case of large cell carcinoma. Pain caused by neoplasm size, pain levels pre-procedure and post-procedure (as assessed using the visual analog scale, VAS), time length, and target temperature of RFA treatments were documented. Results RFA procedures were performed with 100% technical success. The mean pre-procedure and post-procedure pain, as measured by the VAS, was 7.9 (SD = 0.90) and 3.4 (SD = 0.99), respectively. No symptomatic complications occurred. Non-symptomatic complications included one case of pneumothorax and one case of hemoptysis. Conclusion RFA appears to be a safe, practical, and effective method for the palliative treatment of painful NSCLC chest wall metastasis.
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Affiliation(s)
- Mu Hu
- Thoracic Surgery Department, Xuanwu Hospital Capital Medical University Beijing, China
| | - Xiuyi Zhi
- Thoracic Surgery Department, Xuanwu Hospital Capital Medical University Beijing, China
| | - Jian Zhang
- Thoracic Surgery Department, Xuanwu Hospital Capital Medical University Beijing, China
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Tang J, Salama R, Gadgeel SM, Sarkar FH, Ahmad A. Erlotinib resistance in lung cancer: current progress and future perspectives. Front Pharmacol 2013; 4:15. [PMID: 23407898 PMCID: PMC3570789 DOI: 10.3389/fphar.2013.00015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 01/25/2013] [Indexed: 12/26/2022] Open
Abstract
Lung cancer is the most common cancer in the world. Despite modern advancements in surgeries, chemotherapies, and radiotherapies over the past few years, lung cancer still remains a very difficult disease to treat. This has left the death rate from lung cancer victims largely unchanged throughout the past few decades. A key cause for the high mortality rate is the drug resistance that builds up for patients being currently treated with the chemotherapeutic agents. Although certain chemotherapeutic agents may initially effectively treat lung cancer patients, there is a high probability that there will be a reoccurrence of the cancer after the patient develops resistance to the drug. Erlotinib, the epidermal growth factor receptor (EGFR)-targeting tyrosine kinase inhibitor, has been approved for localized as well as metastatic non-small cell lung cancer where it seems to be more effective in patients with EGFR mutations. Resistance to erlotinib is a common observation in clinics and this review details our current knowledge on the subject. We discuss the causes of such resistance as well as innovative research to overcome it. Evidently, new chemotherapy strategies are desperately needed in order to better treat lung cancer patients. Current research is investigating alternative treatment plans to enhance the chemotherapy that is already offered. Better insight into the molecular mechanisms behind combination therapy pathways and even single molecular pathways may help improve the efficacy of the current treatment options.
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Affiliation(s)
- Joy Tang
- Department of Pathology, Karmanos Cancer Institute, Wayne State University School of MedicineDetroit, MI, USA
| | - Rasha Salama
- Department of Pathology, Karmanos Cancer Institute, Wayne State University School of MedicineDetroit, MI, USA
| | - Shirish M. Gadgeel
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of MedicineDetroit, MI, USA
| | - Fazlul H. Sarkar
- Department of Pathology, Karmanos Cancer Institute, Wayne State University School of MedicineDetroit, MI, USA
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of MedicineDetroit, MI, USA
| | - Aamir Ahmad
- Department of Pathology, Karmanos Cancer Institute, Wayne State University School of MedicineDetroit, MI, USA
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