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Im EO, Chee W, Paul S, Choi MY, Kim SY, Yeo S, Ulrich CM, Schapira MM, Nguyen GT, Meghani S, Mao JJ, Ma G, Inouye J, Deatrick JA, Shin D, Bao T. Five Dimensions of Needs for Help: The Efficacy of a Technology-Based Intervention Among Asian American Breast Cancer Survivors. J Cancer Educ 2024; 39:335-348. [PMID: 38594385 DOI: 10.1007/s13187-024-02415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 04/11/2024]
Abstract
Cancer survivors including Asian American breast cancer survivors have reported their high needs for help during their survivorship process. With the COVID-19 pandemic, the necessity of technology-based programs to address their needs for help without face-to-face interactions has been highlighted. The purpose of this randomized intervention study was to determine the efficacy of a technology-based program in reducing various types of needs for help among this specific population. This was a randomized clinical trial with repeated measures. A total of 199 participants were included in the data analysis. The recruitment settings included both online and offline communities/groups for Asian Americans. The needs for help were assessed using the Support Care Needs Survey-34 Short Form (SCNS) subscales measuring psychological, information, physical, support, and communication needs. Data analysis was conducted through an intent-to-treat approach. In the mixed effect models, psychological needs, information needs, physical needs, and communication needs decreased over time (P < .001). However, there were no significant group * time effects. Social support significantly mediated the effects of a technology-based intervention on psychological, information, and support needs at the pre-test and the post-1 month. This study supported significant decreases in the needs for help of Asian American breast cancer survivors by a technology-based intervention. Further studies are needed with other racial/ethnic groups of cancer survivors to confirm the efficacy of a technology-based intervention in reducing cancer survivors' needs for help during their survivorship process.
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Affiliation(s)
- Eun-Ok Im
- The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Wonshik Chee
- The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA
| | | | - Mi-Young Choi
- Emory University, Atlanta, USA
- Chungbuk National University, Cheongju, South Korea
| | - Seo Yun Kim
- Emory University, Atlanta, USA
- Department of Nursing, Gangneung-Wonju National University, Gangwon-do, South Korea
| | - SeonAe Yeo
- The University of North Carolina, Chapel Hill, Chapel Hill, USA
| | | | | | | | | | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Grace Ma
- Temple University, Philadelphia, USA
| | | | | | - David Shin
- The University of California, Los Angeles, Los Angeles, USA
| | - Ting Bao
- Integrative Breast Oncology, Dana-Farber Cancer Institute, Boston, USA
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Yang M, Li QS, Baser RE, Li X, Hou J, Mao JJ. Nocebo expectations rather than placebo expectations affect topical pain relief: A randomized clinical trial. Biomed Pharmacother 2024; 175:116728. [PMID: 38733772 DOI: 10.1016/j.biopha.2024.116728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024] Open
Abstract
Patients' expectations and beliefs regarding the potential benefits and harms of medical interventions may induce placebo and nocebo effects, and affect the response to pain therapies. In a randomized clinical trial, we examined the effect of placebo and nocebo expectations on pain relief and adverse events (AEs) in association with a topical treatment among 65 cancer survivors experiencing chronic musculoskeletal pain. Participants received either a 1% camphor-based topical pain patch or a placebo treatment for 14 days. We measured pain severity with the worst pain item of the Brief Pain Inventory (BPI) at baseline and 14 days and treatment expectations at baseline with validated expectation questionnaires. We found that high vs. low nocebo expectations decreased pain severity improvements by 2.5 points (95% confidence interval [CI] -3.8 to -1.2; p<0.001) on a 0-10 numeric rating scale of the BPI and pain response rate by 42.7% (95% CI 0.2-0.6; p<0.001) at day 14, irrespective of placebo expectation status or treatment arms. Patients with high vs. low nocebo expectations in the true arm reported 22.4% more unwanted AEs. High nocebo expectations were associated with increased AEs by 39.5% (odds ratio: 12.0, 95% CI 1.2, 145.5; p=0.029) and decreased pain response in the true arm vs. placebo. Our study demonstrated that nocebo expectations, rather than placebo expectations, elevate the risk of AEs and compromise the effect of topical pain interventions. The findings raise the possibility that nocebo expectations may worsen somatic symptoms through heightening central pain amplification and should be further investigated.
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Affiliation(s)
- Mingxiao Yang
- Department of Medical Oncology, Dana-Farber Cancer Institute, and Harvard Medical School, 450 Brookline Ave, Boston, MA 02115, USA
| | - Qing S Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, New York, NY 10065, USA
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1250 First Avenue, New York, NY 10065, USA
| | - Xiaotong Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, New York, NY 10065, USA
| | - Jason Hou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, New York, NY 10065, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, New York, NY 10065, USA.
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Daly B, Cracchiolo J, Holland J, Ebstein AM, Flynn J, Duck E, Moy M, Walters CB, Giacomazzo L, Huang J, Fahy R, Bernal C, Ackerman J, Salvaggio R, Begue A, Raj N, Kuperman G, Mao JJ, Panageas K. Digitally Enabled Transitional Care Management in Oncology. JCO Oncol Pract 2024; 20:657-665. [PMID: 38382002 DOI: 10.1200/op.23.00565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/20/2023] [Accepted: 01/03/2024] [Indexed: 02/23/2024] Open
Abstract
PURPOSE Improving care transitions for patients with cancer discharged from the hospital is considered an important component of quality care. Digital monitoring has the potential to better the delivery of transitional care through improved patient-provider communication and enhanced symptom management. However, remote patient monitoring (RPM) interventions have not been widely implemented for oncology patients after discharge, an innovative setting in which to apply this technology. METHODS We implemented a RPM intervention which identifies medical oncology patients at discharge, monitors their symptoms for 10 days, and intervenes as necessary to manage symptoms. We evaluated the feasibility (>50% patient engagement with symptom assessment), appropriateness (symptom alerts), and acceptability (net promoter score >0.7) of the intervention and the initial effect on acute care visits and return on investment. RESULTS During the study period, January 1, 2021, to December 31, 2022, we evaluated 2,257 medical oncology discharges representing 1,857 unique patients. We found that 65.9% of patients discharged (N = 1,489) completed at least one symptom assessment postdischarge and of them, 45.5% (n = 678) generated a severe symptom alert that we helped to manage. Patients expressed high satisfaction with the intervention with a net promoter score of 84%. In preliminary analysis of patients with GI malignancies (n = 449), we found a nonsignificant decrease in 30-day readmissions for the intervention cohort (n = 269) by 5.8% as compared with the control (n = 180; from 33.3% to 27.5%; P = .22). CONCLUSION Digital transitional care management was feasible and demonstrated that patients transitioning from the hospital to home have a substantial symptom burden. The intervention was associated with high patient satisfaction but will require further refinement and evaluation to increase its impact on 30-day readmission.
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Affiliation(s)
- Bobby Daly
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Jessica Flynn
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elaine Duck
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Morgan Moy
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Jennie Huang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Camila Bernal
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jill Ackerman
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Aaron Begue
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nitya Raj
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
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Verdini NP, Bryl KL, Baser RE, Lapen K, Mao JJ, Gillespie EF. Patient-Reported Outcomes as a Recruitment Strategy for Clinical Trial Enrollment. JAMA Oncol 2024:2817455. [PMID: 38602690 PMCID: PMC11009859 DOI: 10.1001/jamaoncol.2024.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/10/2023] [Indexed: 04/12/2024]
Abstract
Importance Clinical trials are critical for progress in oncology; however, only 5% of the adult cancer population participates. Harnessing data that are routinely collected (ie, electronic patient-reported outcomes [ePROs]) may serve as a method to promote trial enrollment. Objective To evaluate if an ePRO-prompted recruitment strategy is associated with increased clinical trial enrollment. Design, Setting, and Participants A randomized substudy was conducted from September 2022 to March 2023 at a multisite tertiary cancer center as part of an ongoing clinical trial that was testing a symptom-intervention for cancer-related fatigue. Patients with breast cancer who were undergoing radiotherapy who completed at least 1 ePRO questionnaire during the study period were included. Physician-level cluster randomization assigned fatigue-eligible patients to either receive a portal message invitation to a symptom-intervention trial or standard of care (SOC; physician-based referral). Exposure ePRO questionnaires distributed in routine practice were queried weekly and screened for moderate or greater fatigue, the principle inclusion criterion for the primary trial. To assess the association of the portal message source with response and enrollment, every other patient received a message from the primary radiation oncology team or the referral service. Main Outcomes and Measures Clinical trial response/referral and enrollment. Results A total of 1041 patients completed ePRO questionnaires, of whom 394 (38%; 53 Asian [13.6%], 43 Black [11.0%], 29 Hispanic [7.4%], and 262 White individuals [66.5%]; median [IQR] age, 55 [47-65] years) endorsed moderate or greater fatigue while receiving treatment. A total of 210 patients (53.3%) were assigned to receive a portal message and 184 (46.7%) patients, SOC. In the portal message group, 73 patients (35%) responded and 41 (20%) enrolled compared with 1 patient (0.5%) referred and 0 enrolled in the SOC group (P < .001). The response rate to portal messages favored the referral service vs the primary radiation oncology service (44% vs 26%; P = .01), but there was no significant difference in enrollments. Conclusions and Relevance The study results suggest that use of routine care ePROs was associated with greater enrollment in a symptom-intervention trial compared with physician-based referral. Messaging directly from the referral service may support enrollment and help reduce oncology physician-level barriers to trial enrollment for studies testing symptom interventions.
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Affiliation(s)
- Nicholas P. Verdini
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karolina L. Bryl
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jun J. Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F. Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiation Oncology, University of Washington, Seattle
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Raghunathan NJ, Brens J, Vemuri S, Li QS, Mao JJ, Korenstein D. Correction to: In the weeds: a retrospective study of patient interest in and experience with cannabis at a cancer center. Support Care Cancer 2024; 32:277. [PMID: 38589577 DOI: 10.1007/s00520-024-08477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
- Nirupa J Raghunathan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Jessica Brens
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Swetha Vemuri
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qing S Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah Korenstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Mao JJ, Molena D, Desai K, Baser RE, Seluzicki C, Rocco G, Jones D. Participation in Virtual Prehabilitation and Outcomes Following Thoracic Cancer Surgery. JAMA Netw Open 2024; 7:e244084. [PMID: 38546649 PMCID: PMC10979307 DOI: 10.1001/jamanetworkopen.2024.4084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/01/2024] [Indexed: 04/01/2024] Open
Abstract
This cohort study evaluates the association of a virtual synchronized prehabilitation program with perioperative outcomes among patients undergoing thoracic cancer surgery.
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Affiliation(s)
- Jun J. Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Krupali Desai
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christina Seluzicki
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Zhang YL, Mao JJ, Li QS, Weitzman M, Liou KT. Battlefield acupuncture for chronic musculoskeletal pain in cancer survivors: a novel care delivery model for oncology acupuncture. Front Pain Res (Lausanne) 2023; 4:1279420. [PMID: 38116187 PMCID: PMC10728598 DOI: 10.3389/fpain.2023.1279420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Battlefield Acupuncture (BFA), a standardized auricular acupuncture protocol, is widely used for pain in the military but is not well-studied in oncology. This study examined cancer survivors who received BFA for pain. Methods This is a secondary analysis of a randomized trial that compared the effectiveness of BFA and electroacupuncture vs. usual care for chronic musculoskeletal pain in cancer survivors. This study focused on participants randomized to BFA. Participants received 10 weekly treatments. Needles were placed until one of these stop conditions were satisfied: ten needles were administered; pain severity decreased to ≤1 out of 10; patient declined further needling, or vasovagal reaction was observed. Pain severity was assessed using Brief Pain Inventory. Responders were those with ≥30% pain severity reduction. We examined pain location, BFA stop reason, and pain reduction of participants during the first session. We also examined which factors predicted responder status after the first session (week 1) or the full treatment (week 12). Results Among 143 randomized to BFA, most common pain locations were lower back (30.8%) and knee/leg (18.2%). Of 138 who initiated treatment, 41 (30.0%) received ten needles; 81 (59.1%) achieved pain ≤1; 14 (10.2%) declined further needling; and 1 (0.7%) had vasovagal reaction. BFA reduced pain severity by 2.9 points (95% CI 2.6 to 3.2) after the first session (P < 0.001). After adjusting for baseline pain severity, responders at week 1 were 2.5 times more likely to be responders at week 12, compared to those who were non-responders at week 1 (AOR 2.5, 95% CI 1.02 to 6.11, P = 0.04). Among those who achieved pain ≤1, 74% were responders at week 12, a higher proportion compared to the proportion of responders among those who received ten needles (39.5%), those who declined further needling (50%), and those with vasovagal reaction (0.0%) (P = 0.001). Those with pain in proximal joints had a higher proportion of responders at week 12, compared to those with pain in distal joints (64.2% vs. 20%, P = 0.008). Conclusion Specific factors may predict the likelihood of achieving meaningful pain reduction from BFA. Understanding these predictors could inform precision pain management and acupuncture delivery models.
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Affiliation(s)
| | | | | | | | - Kevin T. Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Ulrich CM, Ratcliffe SJ, Hochheimer CJ, Zhou Q, Huang L, Gordon T, Knafl K, Richmond T, Schapira MM, Miller V, Mao JJ, Naylor M, Grady C. Informed Consent among Clinical Trial Participants with Different Cancer Diagnoses. AJOB Empir Bioeth 2023:1-13. [PMID: 37921867 DOI: 10.1080/23294515.2023.2262992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
IMPORTANCE Informed consent is essential to ethical, rigorous research and is important to recruitment and retention in cancer trials. OBJECTIVE To examine cancer clinical trial (CCT) participants' perceptions of informed consent processes and variations in perceptions by cancer type. DESIGN AND SETTING AND PARTICIPANTS Cross-sectional survey from mixed-methods study at National Cancer Institute-designated Northeast comprehensive cancer center. Open-ended and forced-choice items addressed: (1) enrollment and informed consent experiences and (2) decision-making processes, including risk-benefit assessment. Eligibility: CCT participant with gastro-intestinal or genitourinary, hematologic-lymphatic malignancies, lung cancer, and breast or gynecological cancer (N = 334). MAIN OUTCOME MEASURES Percentages satisfied with consent process and information provided; and assessing participation's perceptions of risks/benefits. Multivariable logistic or ordinal regression examined differences by cancer type. RESULTS Most patient-participants felt well informed by the consent process (more than 90% overall and by cancer type) and. most (87.4%) reported that the consent form provided all the information they wanted, although nearly half (44.8%) reported that they read the form somewhat carefully or less. More than half (57.9%) said that talking to research staff (i.e., the consent process) had a greater impact on participation decisions than reading the consent form (2.1%). A third (31.1%) were very sure of joining in research studies before the informed consent process (almost half of lung cancer patients did-47.1%). Most patients personally assessed the risks and benefits before consenting. However, trust in physicians played an important role in the decision to enroll in CCT. CONCLUSIONS AND RELEVANCE Cancer patients rely less on written features of the informed consent process than on information obtained from the research staff and their own physicians. Research should focus on information and communication strategies that support informed consent from referring physicians, researchers, and others to improve patient risk-benefit assessment and decision-making.
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Affiliation(s)
- Connie M Ulrich
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | - Qiuping Zhou
- George Washington University, Washington, District of Columbia, USA
| | - Liming Huang
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Thomas Gordon
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Kathleen Knafl
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Therese Richmond
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Marilyn M Schapira
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Victoria Miller
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mary Naylor
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Christine Grady
- National Institutes of Health, Clinical Center Department of Bioethics, Bethesda, Maryland, USA
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Epstein AS, Liou KT, Romero SAD, Baser RE, Wong G, Xiao H, Mo Z, Walker D, MacLeod J, Li Q, Barton-Burke M, Deng GE, Panageas KS, Farrar JT, Mao JJ. Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer: The IMPACT Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2342482. [PMID: 37962891 PMCID: PMC10646731 DOI: 10.1001/jamanetworkopen.2023.42482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/26/2023] [Indexed: 11/15/2023] Open
Abstract
Importance Pain is challenging for patients with advanced cancer. While recent guidelines recommend acupuncture and massage for cancer pain, their comparative effectiveness is unknown. Objective To compare the effects of acupuncture and massage on musculoskeletal pain among patients with advanced cancer. Design, Setting, and Participants A multicenter pragmatic randomized clinical trial was conducted at US cancer care centers consisting of a northeastern comprehensive cancer center and a southeastern cancer institute from September 19, 2019, through February 23, 2022. The principal investigator and study statisticians were blinded to treatment assignments. The duration of follow-up was 26 weeks. Intention-to-treat analyses were performed (linear mixed models). Participants included patients with advanced cancer with moderate to severe pain and clinician-estimated life expectancy of 6 months or more. Patient recruitment strategy was multipronged (eg, patient database queries, mailings, referrals, community outreach). Eligible patients had English or Spanish as their first language, were older than 18 years, and had a Karnofsky score greater than or equal to 60 (range, 0-100; higher scores indicating less functional impairment). Interventions Weekly acupuncture or massage for 10 weeks with monthly booster sessions up to 26 weeks. Main Outcomes and Measures The primary end point was the change in worst pain intensity score from baseline to 26 weeks. The secondary outcomes included fatigue, insomnia, and quality of life. The Brief Pain Inventory (range, 0-10; higher numbers indicate worse pain intensity or interference) was used to measure the primary outcome. The secondary outcomes included fatigue, insomnia, and quality of life. Results A total of 298 participants were enrolled (mean [SD] age, 58.7 [14.1] years, 200 [67.1%] were women, 33 [11.1%] Black, 220 [74.1%] White, 46 [15.4%] Hispanic, and 78.5% with solid tumors). The mean (SD) baseline worst pain score was 6.9 (1.5). During 26 weeks, acupuncture reduced the worst pain score, with a mean change of -2.53 (95% CI, -2.92 to -2.15) points, and massage reduced the Brief Pain Inventory worst pain score, with a mean change of -3.01 (95% CI, -3.38 to -2.63) points; the between-group difference was not significant (-0.48; 95% CI, -0.98 to 0.03; P = .07). Both treatments also improved fatigue, insomnia, and quality of life without significant between-group differences. Adverse events were mild and included bruising (6.5% of patients receiving acupuncture) and transient soreness (15.1% patients receiving massage). Conclusions and Relevance In this randomized clinical trial among patients with advanced cancer, both acupuncture and massage were associated with pain reduction and improved fatigue, insomnia, and quality of life over 26 weeks; however, there was no significant different between the treatments. More research is needed to evaluate how best to integrate these approaches into pain treatment to optimize symptom management for the growing population of people living with advanced cancer. Trial Registration ClinicalTrials.gov Identifier: NCT04095234.
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Affiliation(s)
- Andrew S. Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kevin T. Liou
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sally A. D. Romero
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Greta Wong
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Han Xiao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zunli Mo
- Cancer Patient Support Center, Baptist Health Miami Cancer Institute, Miami, Florida
| | - Desiree Walker
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jodi MacLeod
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Qing Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Margaret Barton-Burke
- Office of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gary E. Deng
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine S. Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John T. Farrar
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jun J. Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Bao T, Zhi WI, Baser RE, Li QS, Weitzman M, Gillespie EF, Robson M, Mao JJ. Electro-acupuncture versus battle field auricular acupuncture in breast cancer survivors with chronic musculoskeletal pain: subgroup analysis of a randomized clinical trial. Breast Cancer Res Treat 2023; 202:287-295. [PMID: 37612534 DOI: 10.1007/s10549-023-07072-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE Chronic musculoskeletal pain is common and debilitating among breast cancer survivors. The PEACE trial demonstrated that electro-acupuncture (EA) and battle field auricular acupuncture (BFAA) both reduced pain more than usual care (UC) in cancer survivors. However, the comparative effectiveness between EA and BFAA among breast cancer survivors is unknown. METHODS EA and BFAA received ten weekly treatments. UC was offered ten EA treatments after week 12. The primary endpoint was change in mean Brief Pain Inventory (BPI) pain severity from baseline to week 12. We analyzed the subset of 165 (46%) trial participants with a breast cancer primary diagnosis. We conducted constrained linear mixed model analyses, which constrained all arms to a common pre-randomization baseline mean. Model-based mean estimates at weeks 12 and 24 were compared between arms using model contrasts. RESULTS Among 165 breast cancer survivors, common pre-randomization mean pain severity was 5.35 [95% Confidence Interval (CI) 5.04, 5.66]. At week 12, BPI pain severity score was 2.69 (2.26. 3.13) in EA, 3.60 (3.17, 4.02) in BFAA, and 5.06 (4.47, 5.65) in UC. EA reduced pain severity significantly more than BFAA at weeks 12 [- 0.90 (- 1.45, - 0.36), p = 0.001] and 24 [- 0.82, (- 1.38, - 0.27), p = 0.004]. EA and BFAA significantly improved both Patient-Reported Outcomes Measurement Information System (PROMIS) - Global Health physical health and mental health component scores at week 12 compared to UC. Mild toxicities were reported. CONCLUSION EA was more effective than BFAA at reducing pain severity, but both similarly improved physical and mental health scores. Breast cancer survivors with chronic musculoskeletal pain may consider EA before BFAA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02979574. https://clinicaltrials.gov/ct2/show/NCT02979574.
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Affiliation(s)
- Ting Bao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Breast Medicine Service, Solid Tumor Division, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 E. 61st Street, 4th Floor, New York, NY, 10065, USA.
| | - W Iris Zhi
- Breast Medicine Service, Solid Tumor Division, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Q Susan Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew Weitzman
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erin F Gillespie
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Mark Robson
- Breast Medicine Service, Solid Tumor Division, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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11
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Im EO, Chee W, Paul S, Choi MY, Kim SY, Deatrick JA, Inouye J, Ma G, Meghani S, Nguyen GT, Schapira MM, Ulrich CM, Yeo S, Bao T, Shin D, Mao JJ. A randomized controlled trial testing a virtual program for Asian American women breast cancer survivors. Nat Commun 2023; 14:6475. [PMID: 37838727 PMCID: PMC10576740 DOI: 10.1038/s41467-023-42132-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/25/2023] [Indexed: 10/16/2023] Open
Abstract
A culturally tailored virtual program could meet the survivorship needs of Asian American women breast cancer survivors (AABC). This study aims to determine the efficacy of a culturally tailored virtual information and coaching/support program (TICAA) in improving AABC's survivorship experience. A randomized clinical trial (NCT02803593) was conducted from January 2017 to June 2020 among 199 AABC. The intervention group utilized TICAA and the American Cancer Society [ACS] website while the control group used only ACS website for 12 weeks. The outcomes were measured using the SCNS-34SF (needs; primary), the MSAS-SF (symptoms; secondary), and the FACT-B (quality of life; secondary). The data were analyzed using an intent-to-treat approach. The intervention group showed significant reductions in their needs from the baseline (T0) to post 4 weeks (T1) and to post 12 weeks (T2). Although the changes were not statistically significant, the intervention group had decreased symptoms from T0 to T2 while the control group had an increase in their symptoms. The intervention group had a significant increase in their quality of life from T0 to T2. A culturally tailored virtual program could therefore improve quality of life in AABC patients. Trial Registration: To Enhance Breast Cancer Survivorship of Asian Americans (TICAA), NCT02803593, https://clinicaltrials.gov/ct2/show/NCT02803593?titles=TICAA&draw=2&rank=1.
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Affiliation(s)
- Eun-Ok Im
- The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Wonshik Chee
- The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA
| | - Sudeshna Paul
- Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Mi-Young Choi
- Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA
- Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, South Korea
| | - Seo Yun Kim
- Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Janet A Deatrick
- University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Jillian Inouye
- University of Hawaii, 2528 McCarthy Mall, Webster Hall 402, Honolulu, HI, 96822, USA
| | - Grace Ma
- Temple University, 1801 N Broad St, Philadelphia, PA, 19122, USA
| | - Salimah Meghani
- University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Giang T Nguyen
- Harvard University Health Services, 75 Mt. Auburn Street, Cambridge, MA, 02138, USA
| | - Marilyn M Schapira
- University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Connie M Ulrich
- University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - SeonAe Yeo
- University of North Carolina, Carrington Hall, S Columbia St, Chapel Hill, NC, 27599, USA
| | - Ting Bao
- Memorial Sloan Kettering Cancer Center, 321 East 61st Street, Room 456, New York, NY, 10065, USA
| | - David Shin
- University of California, Los Angeles, 855 Tiverton Dr, Los Angeles, CA, 90024, USA
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, 321 East 61st Street, Room 456, New York, NY, 10065, USA
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12
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Reiner AS, Applebaum AJ, Bossert D, Buthorn JJ, Sigler AM, Fournier D, Brewer K, Atkinson TM, Lynch KA, Gilliland J, Mao JJ, Panageas KS, Diamond EL. Dyadic communication in rare cancer: a registry-based study of patients with Erdheim-Chester disease and their caregivers. Blood Adv 2023; 7:5904-5910. [PMID: 37540824 PMCID: PMC10558707 DOI: 10.1182/bloodadvances.2023010827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023] Open
Affiliation(s)
- Anne S. Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Allison J. Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dana Bossert
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Justin J. Buthorn
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Allison M. Sigler
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Thomas M. Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kathleen A. Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jaime Gilliland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jun J. Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine S. Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eli L. Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
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13
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Li X, Mao JJ, Garland SN, Root J, Li SQ, Ahles T, Liou KT. Comparing sleep measures in cancer survivors: Self-reported sleep diary versus objective wearable sleep tracker. Res Sq 2023:rs.3.rs-3407984. [PMID: 37886444 PMCID: PMC10602054 DOI: 10.21203/rs.3.rs-3407984/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Purpose Cancer survivors are increasingly using wearable fitness trackers, but it's unclear if they match traditional self-reported sleep diaries. We aimed to compare sleep data from Fitbit and the Consensus Sleep Diary (CSD) in this group. Methods We analyzed data from two randomized clinical trials, using both CSD and Fitbit to collect sleep outcomes: total sleep time (TST), wake time after sleep onset (WASO), number of awakenings (NWAK), time in bed (TIB) and sleep efficiency (SE). Insomnia severity was measured by Insomnia Severity Index (ISI). We used the Wilcoxon Singed Ranks Test, Spearman's rank correlation coefficients, and the Mann-Whitney Test to compare sleep outcomes and assess their ability to distinguish insomnia severity levels between CSD and Fitbit data. Results Among 62 participants, compared to CSD, Fitbit recorded longer TST by an average of 14.6 (SD = 84.9) minutes, longer WASO by an average of 28.7 (SD = 40.5) minutes, more NWAK by an average of 16.7 (SD = 6.6) times per night, and higher SE by an average of 7.1% (SD = 14.4); but shorter TIB by an average of 24.4 (SD = 71.5) minutes. All the differences were statistically significant (all p < 0.05), except for TST (p = 0.38). Moderate correlations were found for TST (r = 0.41, p = 0.001) and TIB (r = 0.44, p < 0.001). Compared to no/mild insomnia group, participants with clinical insomnia reported more NWAK (p = 0.009) and lower SE (p = 0.029) as measured by CSD, but Fitbit outcomes didn't. Conclusions TST was the only similar outcome between Fitbit and CSD. Our study highlights the advantages, disadvantages, and clinical utilization of sleep trackers in oncology.
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Affiliation(s)
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center
| | | | | | | | - Tim Ahles
- Memorial Sloan Kettering Cancer Center
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14
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Verdini NP, Bryl KL, Bucknum AE, Baser RE, Lapen K, Khan AJ, Gomez DR, Braunstein LZ, Mao JJ, Gillespie EF. Harnessing Electronic Patient-Reported Outcomes (ePRO) in Routine Care to Promote Clinical Trial Enrollment: A Randomized Study. Int J Radiat Oncol Biol Phys 2023; 117:S115-S116. [PMID: 37784301 DOI: 10.1016/j.ijrobp.2023.06.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Only approximately 5% of adult cancer patients participate in clinical trials. While collection of patient-reported outcomes (PRO) is now routine in clinical trials, their role in actively improving care is evolving, particularly in radiation oncology. At our single multi-site institution, weekly electronic patient reported outcomes (ePRO) questionnaires regarding acute toxicity are routinely sent to all patients undergoing breast radiation We hypothesized that using ePROs to prompt recruitment to a clinical trial assessing a supportive intervention would increase enrollment. MATERIALS/METHODS An automated weekly query of ePRO survey responses was generated to identify patients with moderate or greater fatigue, the primary eligibility criterion for an ongoing randomized clinical trial testing an integrative medicine intervention. 23 radiation oncologists treating breast cancer were randomized to have their patients potentially eligible by ePRO receive a direct portal message about the trial, or to usual care (physician-based referral). Physician randomization was stratified by patient caseload and assigned in a 1:1 ratio. Secondarily, every other patient in the portal message group was assigned to receive the message either from their radiation oncologist or integrative medicine. Statistical analysis included two-sample, two-sided proportion tests. RESULTS From September 5, 2022, to December 19, 2022, among 776 patients completing ePROs during radiation treatment, 252 patients (32%) screened positive for fatigue. Of those who screened positive, 135 were randomized to the ePRO-prompted portal message group and 117 to the usual care group (physician-based referral). Among patients in the portal message group, 52 responded (39%) and 27 enrolled (20%), compared to 1 patient referred (0.8%) and 0 enrolled with physician-based referral alone (p < 0.001). In the portal message group, there were 21 responses (30%) and 12 enrollments (17%) among those messaged by their radiation oncologist, compared to 31 responses (48%) and 15 enrollments (23%) among those messaged by integrative medicine. When evaluating the source of the portal message, there was a significant difference in response rate favoring integrative medicine (p = 0.03), but no difference in enrollments (p = 0.39). CONCLUSION Utilization of ePROs to prompt recruitment to a trial testing a symptom intervention resulted in increased enrollment compared to standard physician-based referral, suggesting a promising new role for ePROs. Importantly, messaging from the supportive care service directly did not result in a difference in enrollments and may help reduce oncology physician-level barriers to studies testing supportive interventions. Future directions should investigate this method to reduce disparities in patients enrolling on clinical trials and facilitate access to symptom support services in routine cancer care.
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Affiliation(s)
- N P Verdini
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - K L Bryl
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A E Bucknum
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - R E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - K Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A J Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - D R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - L Z Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J J Mao
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - E F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiation Oncology, University of Washington, Seattle, WA
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15
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Yang M, Baser RE, Khanin R, Autuori I, Li QS, Panageas KS, Orlow I, Mao JJ. COMT Val158Met Affects the Analgesic Response to Acupuncture Among Cancer Survivors With Chronic Pain. J Pain 2023; 24:1721-1730. [PMID: 37187218 DOI: 10.1016/j.jpain.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/30/2023] [Accepted: 05/11/2023] [Indexed: 05/17/2023]
Abstract
Catechol-O-methyltransferase (COMT) is the major enzyme involved in the catabolism of dopamine, a neurotransmitter in the brain's reward system. The common COMT polymorphism Val158Met (rs4680 G>A) modulates pain response to opioids through a reward-motivated mechanism; however, its role in nonpharmacological pain medicine has not been clinically characterized. We genotyped 325 participants from a randomized controlled trial of cancer survivors with chronic musculoskeletal pain. We found that carrying methionine at position 158 (158Met) of COMT, encoded by the A allele, significantly increased the analgesic response to electroacupuncture (74% vs 50%; odds ratio [OR]: 2.79; 95% confidence interval [CI]: 1.31, 6.05; P < .01), but not to auricular acupuncture (68% vs 60%; OR: 1.43; 95% CI: .65, 3.12; P = .37) or usual care (24% vs 18%; OR: 1.46; 95% CI: .38, 7.24; P = .61) compared to Val/Val. These findings raise the possibility that COMT Val158Met might be an important predictor of analgesic response to electroacupuncture, providing novel insights into precision nonpharmacologic pain management tailored to individual genetic backgrounds. PERSPECTIVE: This work suggests the modulating effects of the polymorphism in COMT Val158Met on the response to acupuncture. Further research needs to validate these findings, increase the mechanistic understanding of acupuncture, and guide further development of acupuncture as a precision pain management strategy.
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Affiliation(s)
- Mingxiao Yang
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raya Khanin
- Bioinformatics Core Computational Biology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Isidora Autuori
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Qing S Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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16
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Salz T, Meza AM, Chino F, Mao JJ, Raghunathan NJ, Jinna S, Brens J, Furberg H, Korenstein D. Cannabis use among recently treated cancer patients: perceptions and experiences. Support Care Cancer 2023; 31:545. [PMID: 37650961 PMCID: PMC10585595 DOI: 10.1007/s00520-023-07994-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To characterize cannabis use among cancer patients, we aimed to describe 1) patterns of cannabis use across multiple cancer sites; 2) perceived goals, benefits, harms of cannabis; and 3) communication about cannabis. METHODS Patients with 9 different cancers treated at Memorial Sloan Kettering Cancer Center between March and August 2021 completed an online or phone survey eliciting cannabis use, attitudes, and communication about cannabis. Multivariable logistic regression estimated the association of cancer type and cannabis use, adjusting for sociodemographic characteristics and prior cannabis use. RESULTS Among 1258 respondents, 31% used cannabis after diagnosis, ranging from 25% for lung cancer to 59% for testicular cancer. Characteristics associated with cannabis use included younger age, lower education level, and cancer type. In multivariable analysis, compared to lung cancer patients, gastrointestinal cancer patients were more likely to use cannabis (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.25-5.43). Cannabis use in the year prior to diagnosis was strongly associated with cannabis use after diagnosis (OR 19.13, 95% CI 11.92-30.72). Among users, reasons for use included difficulty sleeping (48%); stress, anxiety, or depression (46%); and pain (42%). Among respondents who used cannabis to improve symptoms, 70-90% reported improvement; < 5% reported that any symptom worsened. Only 25% discussed cannabis with healthcare providers. CONCLUSIONS Almost a third of cancer patients use cannabis, largely for symptom management. Oncologists may not know about their patients' cannabis use. To improve decision making about cannabis use during cancer care, research is needed to determine benefits and harms of cannabis use.
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Affiliation(s)
- Talya Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
| | - Akriti Mishra Meza
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nirupa J Raghunathan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sankeerth Jinna
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Jessica Brens
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Helena Furberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Deborah Korenstein
- Department of Internal Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
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17
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Li X, Yang M, Zhang YL, Hou YN, Smith CM, Korenstein D, Mao JJ. Ginseng and Ginseng Herbal Formulas for Symptomatic Management of Fatigue: A Systematic Review and Meta-Analysis. J Integr Complement Med 2023; 29:468-482. [PMID: 36730693 PMCID: PMC10457628 DOI: 10.1089/jicm.2022.0532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Objectives: Ginseng has been widely used in fatigue management. However, its efficacy on fatigue remains unclear. This study aimed to assess the efficacy and safety of ginseng and ginseng herbal formulas for fatigue in randomized clinical trials (RCTs). Methods: The authors searched PubMed, Embase, Cochrane, Web of Science, and Allied and Complementary Medicine Database (AMED) databases from inception to July 6, 2022. Outcomes included fatigue severity, quality of life (QoL), and adverse events (AEs). Quality of evidence was assessed using the Cochrane Risk of Bias Tool. They pooled all included data and performed subgroup analysis by fatigue type, assessment instrument, and ginseng type. Results: The authors included 19 RCTs. Pooled analyses found no significant reduction in fatigue severity with ginseng versus controls (standardized mean difference [SMD]: -0.36, 95% confidence interval [CI]: -0.82 to 0.11, p = 0.13). In subgroup analysis, there was significant fatigue reduction with the ginseng herbal formula (SMD: -0.39, 95% CI: -0.66 to -0.13, p = 0.004) and chronic fatigue (CF) (SMD: -0.30, 95% CI: -0.56 to -0.03, p = 0.03) compared to controls. Ginseng produced significant reductions in general (i.e., non-disease-specific) fatigue compared to controls (SMD: -0.48, 95% CI: -0.71 to -0.25, p < 0.0001). Ginseng was associated with a trend toward QoL improvement (p = 0.05) and did not increase AEs compared with controls. Effect sizes were small. Conclusion: Ginseng herbal formulas improved fatigue severity compared to controls, especially among patients with CF, but with a small effect size. Rigorous RCTs as well as guidelines for standard ginseng usage are needed to further evaluate the effects of ginseng for fatigue and ensure proper use.
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Affiliation(s)
- Xiaotong Li
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yi Lily Zhang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yen-Nien Hou
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colleen M. Smith
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah Korenstein
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun J. Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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18
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Chang X, Zhu Y, Zhao W, Liu Y, He Y, Chen Y, Xu D, Mao JJ, Zhang HB. Electro-acupuncture for health-related quality of life and symptoms in patients with gastric cancer undergoing adjuvant chemotherapy (EAGER): a protocol for a multicenter randomized controlled trial. Health Qual Life Outcomes 2023; 21:70. [PMID: 37434165 PMCID: PMC10334569 DOI: 10.1186/s12955-023-02135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 05/19/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Patients with local gastric cancer experience a decline of Health-related quality of life (HRQOL) during adjuvant chemotherapy following gastrectomy. Our previous pilot study has indicated the potential of acupuncture to improve HRQOL and control cancer-related symptoms burden. This full-scale trial will focus on confirming the effect of acupuncture for patients with gastric cancer. METHODS A multicenter, open-label, three-arm randomized controlled trial with 249 patients will be conducted in China. Patients will be randomly assigned, in a ratio of 1:1:1, to receive high-dose acupuncture (HA, 7 times each chemo-cycle for 3 cycles), low-dose acupuncture (LA, 3 times each chemo-cycle for 3 cycles), or no acupuncture. The acupoints prescription consisted of bilateral ST36, PC6, SP4, DU20, EX-HN3, and selected Back-shu points. Patients-reported Functional Assessment of Cancer Therapy-Gastric (FACT-Ga) and modified Edmonton Symptom Assessment Scale (mESAS) during the therapy will be recorded. Area under curve (AUC, 21 days/cycle × 3 cycles) and average trajectory of FACT-Ga and mESAS will be calculated. The primary outcome will be the differences in AUC of the FACT-Ga Trial Outcome Index (TOI) between HA and LA versus control groups. Secondary outcomes include AUCs and average trajectory of other FACT-Ga subscales and mESAS scores. DISCUSSION This study aims to assess the effect of acupuncture and to compare the difference between LA and HA groups on HRQOL and symptom burden controlling in gastric cancer patients by an adequately powered trial. TRIAL REGISTRATION This study was approved by the Ethics Committee of the Guangdong Provincial Hospital of Traditional Chinese Medicine (approval number: BF2018-118) with registration at ClinicalTrials.gov (identifier: NCT04360577).
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Affiliation(s)
- Xuesong Chang
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yanjuan Zhu
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenjie Zhao
- The Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yihong Liu
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yihan He
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yadong Chen
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Danghan Xu
- Rehabilitation Center, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun J Mao
- Bendheim Integrative Medicine Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Hai-Bo Zhang
- Department of Oncology, Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China.
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China.
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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19
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Bryl K, Tortora S, Whitley J, Kim SD, Raghunathan NJ, Mao JJ, Chimonas S. Utilization, Delivery, and Outcomes of Dance/Movement Therapy for Pediatric Oncology Patients and their Caregivers: A Retrospective Chart Review. Curr Oncol 2023; 30:6497-6507. [PMID: 37504337 PMCID: PMC10378356 DOI: 10.3390/curroncol30070477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
Children with cancer and their caregivers face physical and psychosocial challenges during and after treatment. Dance/movement therapy (DMT) has been used to improve well-being, promote healthy coping, and mitigate the impact of illness, but limited knowledge exists regarding DMT utilization, delivery, and outcomes in pediatric oncology. This retrospective study aimed to identify reasons for referral to DMT, DMT visit characteristics, key DMT techniques and processes, and clinician-reported outcomes. We examined the electronic medical records of 100 randomly selected pediatric patients (resulting in 1160 visits) who received DMT services between 2011 and 2021. Sociodemographic, clinical, and visit characteristics, referral reasons, and clinician-reported outcomes were reported as frequency and proportions. Qualitative thematic analysis was used to identify key DMT techniques and processes. Among 100 patients (63% female, aged 0-27 years), 77.9% were referred for psychological distress and 19.6% for pain. Two distinct DMT approaches were used during visits: a traditional DMT approach (77%) and a multisensory DMT approach (23%). The most common visit length was 15-25 min (41.6%), followed by sessions of 30-45 min (22.5%) and ≤10 min (18.1%). A total of 61.9% of DMT visits were inpatient and 38.1% outpatient. Of all visits, 8.8% were new and 91.2% were follow-ups. Caregivers were engaged in treatment in 43.7% of visits, and 5.5% of visits focused entirely on the work with the caregiver. DMT intervention focused on self-expression, emotional self-regulation, coping strategies, socialization, and caregiver-child interaction. Clinician-reported outcomes included enhanced coping with hospital experience (58%), improved pain management (27%), improved self-regulation (21%), and increased physical activation (13.2%). The results suggest DMT as a supportive intervention for psychological distress and pain management in pediatric oncology patients and provide insights into DMT practices and outcomes to guide intervention development and future research.
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Affiliation(s)
- Karolina Bryl
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.B.)
| | - Suzi Tortora
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.B.)
- MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jennifer Whitley
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.B.)
- MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Soo-Dam Kim
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.B.)
| | - Nirupa J. Raghunathan
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.B.)
- Department of General Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jun J. Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.B.)
| | - Susan Chimonas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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20
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Yang M, Baser RE, Liou KT, Li SQ, Piulson L, Panageas KS, Mao JJ. Effect of acupuncture versus usual care on sleep quality in cancer survivors with chronic pain: Secondary analysis of a randomized clinical trial. Cancer 2023; 129:2084-2094. [PMID: 36989257 PMCID: PMC10330176 DOI: 10.1002/cncr.34766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/31/2023] [Accepted: 02/21/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Chronic pain negatively affects sleep; it is unclear whether pain relief from acupuncture contributes to sleep quality improvements in cancer survivors. This study aimed to evaluate the effect of acupuncture versus usual care on sleep quality among cancer survivors with comorbid sleep disturbance and chronic musculoskeletal pain. METHODS Sleep outcome data from the Personalized Electroacupuncture Versus Auricular Acupuncture Comparative Effectiveness (PEACE) randomized clinical trial were analyzed. Electroacupuncture or auricular acupuncture was compared with usual care for sleep quality improvement over 10 weeks of treatment among cancer survivors with clinically significant sleep disturbance and chronic musculoskeletal pain at baseline. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) global score. RESULTS Among 268 participants (mean [standard deviation (SD)] age, 61.4 [12.6] years; 191 women [71.3%]; mean [SD] baseline PSQI global score, 10.3 [3.3] points), electroacupuncture and auricular acupuncture resulted in greater reductions in the PSQI global score from baseline to 10 weeks in comparison with usual care: 1.42 points (95% confidence interval [CI], 0.45-2.38; p = .004) and 1.59 points (95% CI, 0.62-2.55; p = .001), respectively. The improvement in sleep quality for the acupuncture groups was sustained for 24 weeks from randomization. Furthermore, a greater proportion of patients in the electroacupuncture and auricular acupuncture groups had clinically meaningful improvement in sleep quality compared to the usual care group (41.0% and 42.9% vs. 21.4%; p = .044). CONCLUSIONS Among cancer survivors with comorbid sleep disturbance and chronic pain, electroacupuncture and auricular acupuncture produced a clinically relevant and persistent improvement in sleep quality. These findings suggest that acupuncture may be an evidence-based nonpharmacologic intervention to improve sleep health for cancer survivors with pain. PLAIN LANGUAGE SUMMARY This study analyzed the sleep quality data from a published randomized clinical trial that evaluated the effect of electroacupuncture or auricular acupuncture versus usual care on pain relief among people who survived cancer. This analysis included a prespecified subgroup of 268 participants with co-occurring sleep disturbance and chronic musculoskeletal pain at baseline and found that patients who used acupuncture for pain relief demonstrated greater improvements in sleep quality compared with patients who received usual care. Sleep quality improvement by acupuncture was sustained after the treatment ended.
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Affiliation(s)
- Mingxiao Yang
- Integrative Medicine Service, Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kevin T. Liou
- Integrative Medicine Service, Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Susan Q. Li
- Integrative Medicine Service, Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lauren Piulson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Katherine S. Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jun J. Mao
- Integrative Medicine Service, Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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21
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Mao JJ, Molena D, Desai K, Schobert K, Seluzicki C, Wilson D, Hardbattle R, Rocco G, Jones D. Implementing a virtual mind-body prehabilitation program for patients undergoing thoracic surgery: A quality improvement project. JTCVS Open 2023; 14:615-622. [PMID: 37425445 PMCID: PMC10328830 DOI: 10.1016/j.xjon.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/06/2023] [Accepted: 03/07/2023] [Indexed: 07/11/2023]
Abstract
Background Prehabilitation before thoracic surgery has been found to improve outcomes in patients with cancer; however, COVID-19 presented challenges to access on-site programs. We describe the development, implementation, and evaluation of a synchronous, virtual mind-body prehabilitation program developed in response to COVID-19. Methods Eligible participants were patients seen at a thoracic oncology surgical department of an academic cancer center, aged 18 years or older with a diagnosis of thoracic cancer and referred at least 1 week before surgery. The program offered 2 45-minute preoperative mind-body fitness classes each week delivered via Zoom (Zoom Video Communications, Inc). We collected data for referrals, enrollment, participation, and evaluated patient-reported satisfaction and experience. We conducted brief semistructured interviews about participants' experience. Results Among 278 patients referred, 260 were approached, and of those 197 (76%) patients agreed to participate. Among participants, 140 (71%) attended at least 1 class, with an average of 11 attendees per class. The majority of participants reported being extremely satisfied (97.8%), extremely likely to recommend the classes to others (91.2%), and indicated that classes were very much helpful in preparing for surgery (90.8%). Patients also reported that the classes helped reduce anxiety/stress (94.2%), fatigue (88.5%), pain (80.7%), and shortness of breath (86.5%). Qualitative data further suggest that the program made participants feel stronger, more connected to their peers, and better prepared for surgery. Conclusions This virtual mind-body prehabilitation program was well received with high satisfaction and benefits and is highly feasible to implement. This approach may help overcome some of the challenges to in-person participation.
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Affiliation(s)
- Jun J. Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Krupali Desai
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kelsey Schobert
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Seluzicki
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Donna Wilson
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Hardbattle
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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22
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Reiner AS, Bossert D, Buthorn JJ, Sigler AM, Gonen S, Fournier D, Brewer K, Corkran J, Goyal G, Allen CE, McClain KL, Atkinson TM, Lynch KA, Mao JJ, Panageas KS, Diamond EL. Patient-reported fatigue and pain in Erdheim-Chester disease: a registry-based, mixed methods study. Haematologica 2023; 108:1685-1690. [PMID: 36546452 PMCID: PMC10230438 DOI: 10.3324/haematol.2022.282287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Anne S Reiner
- Department of Epidemiology and Biostatistics; Memorial Sloan Kettering Cancer Center
| | - Dana Bossert
- Department of Neurology; Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Carl E Allen
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Kenneth L McClain
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Kathleen A Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Jun J Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics; Memorial Sloan Kettering Cancer Center
| | - Eli L Diamond
- Department of Neurology; Memorial Sloan Kettering Cancer Center.
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23
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Bryl K, Chimonas S, Li X, Li SQ, Mao JJ. The relationship between anxiety and vaginal-related sexual health in postmenopausal breast cancer survivors on aromatase inhibitors therapies: a cross sectional study. Breast Cancer Res Treat 2023:10.1007/s10549-023-06981-5. [PMID: 37226019 DOI: 10.1007/s10549-023-06981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Sexual health problems and anxiety are disruptive symptoms in breast cancer survivors; however, little is known about these symptoms in postmenopausal breast cancer survivors on aromatase inhibitors therapies. This study aimed to determine the relationship between anxiety and vaginal-related sexual health problems in this population. METHODS We analyzed cross-sectional data from a cohort study of postmenopausal women breast cancer survivors receiving aromatase inhibitors. Vaginal-related sexual health problems were assessed with the Breast Cancer Prevention Trial Symptom Checklist. Anxiety was assessed with the anxiety subscale of the Hospital Anxiety and Depression Scale. We used multivariable logistic regression to evaluate relationship between anxiety and vaginal-related sexual health adjusted for clinical and sociodemographic variables. RESULTS Among 974 patients, 305 (31.3%) reported anxiety and 403 (41.4%) had vaginal-related sexual health problems. Compared to those without anxiety, patients with borderline and clinically abnormal anxiety reported higher rates of vaginal-related sexual health problems (36.8% vs. 49% and 55.7% respectively, p < 0.001). In multivariate analyses adjusted for clinical and sociodemographic factors, abnormal anxiety was associated with a higher rate of vaginal-related sexual health problems, with adjusted odds ratios of 1.69 (95% CI 1.06-2.70, p = 0.03). Vaginal-related sexual health problems were more frequent among patients who were under 65 years of age, received Taxane-based chemotherapy, reported depression, and were married/living with a partner (p < 0.05). CONCLUSION Among postmenopausal breast cancer survivors on aromatase inhibitors therapies, anxiety was significantly associated with vaginal-related sexual health problems. As treatments for sexual health problems are limited, results suggest that psychosocial interventions for anxiety could potentially be adapted to simultaneously address sexual health needs.
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Affiliation(s)
- Karolina Bryl
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan Chimonas
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiaotong Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan Q Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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24
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Li X, Liou KT, Chimonas S, Bryl K, Wong G, Spiguel E, Li SQ, Garland SN, Bao T, Mao JJ. Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia. Integr Med Res 2023; 12:100922. [PMID: 36843902 PMCID: PMC9944506 DOI: 10.1016/j.imr.2023.100922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Background Fatigue is a troublesome symptom in cancer survivors that often results from disrupted sleep. We sought to assess whether two insomnia-focused non-pharmacological interventions are also effective for improving fatigue. Methods We analyzed data from a randomized clinical trial comparing cognitive behavioral therapy for insomnia (CBT-I) versus acupuncture for insomnia among cancer survivors. Participants were 109 patients who reported insomnia and moderate or worse fatigue. Interventions were delivered over eight weeks. Fatigue was evaluated at baseline, week 8, and week 20 using the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). We used both mediation analysis and t-tests to explore the extent to which fatigue reduction was attributable to insomnia response. Results Compared to baseline, both CBT-I and acupuncture produced significant reductions in total MFSI-SF scores at week 8 (-17.1 points; 95% confidence interval [CI]: -21.1 to -13.1, and -13.2 points; 95% CI: -17.2 to -9.2, respectively, all p<0.001) and week 20 (-14.6 points; 95% CI: -18.6 to -10.6, and -14.2 points; 95% CI: -18.1 to -10.3. respectively, all p<0.001), with no significant between-group differences. MFSI-SF total scores at week 8 were significantly associated with sleep improvements in both CBT-I and acupuncture groups (p<0.001 and p=0.011, respectively). Insomnia responders demonstrated significantly greater improvements in mean MFSI-SF total scores compared with non-responders in the CBT-I group (p=0.016) but not in the acupuncture group. Conclusion CBT-I and acupuncture produced similar, clinically meaningful, and durable fatigue reductions in cancer survivors with insomnia, primarily through improvements in sleep. Acupuncture may also reduce fatigue through additional pathways.
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Affiliation(s)
- Xiaotong Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Kevin T. Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Susan Chimonas
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, United States,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Karolina Bryl
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Greta Wong
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Eugenie Spiguel
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States,Department of Advanced Practice Providers, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Susan Q. Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Sheila N. Garland
- Department of Psychology and Oncology, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Ting Bao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jun J. Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States,Corresponding author at: Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, 4th Floor, New York, NY 10065, United States.
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25
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Mao JJ, Witt CM. Acupuncture as an Evidence-Based Treatment for Cancer Pain Management: The Joint Society for Integrative Oncology-American Society for Clinical Oncology Guideline. J Integr Complement Med 2023; 29:209-211. [PMID: 36847338 DOI: 10.1089/jicm.2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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26
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Liou KT, McConnell KM, Currier MB, Baser RE, MacLeod J, Walker D, Casaw C, Wong G, Piulson L, Popkin K, Lopez AM, Panageas K, Bradt J, Mao JJ. Virtual Music Therapy versus Virtual Cognitive Behavioral Therapy for Anxiety in Cancer Survivors: Rationale and Protocol for a Comparative Effectiveness Trial (Preprint). JMIR Res Protoc 2023; 12:e46281. [PMID: 37103999 PMCID: PMC10176150 DOI: 10.2196/46281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Cancer survivors represent one of the fastest growing populations in the United States. Unfortunately, nearly 1 in 3 survivors experience anxiety symptoms as a long-term consequence of cancer and its treatment. Characterized by restlessness, muscle tension, and worry, anxiety worsens the quality of life; impairs daily functioning; and is associated with poor sleep, depressed mood, and fatigue. Although pharmacological treatment options are available, polypharmacy has become a growing concern for cancer survivors. Music therapy (MT) and cognitive behavioral therapy (CBT) are evidence-based, nonpharmacological treatments that have demonstrated effectiveness in treating anxiety symptoms in cancer populations and can be adapted for remote delivery to increase access to mental health treatments. However, the comparative effectiveness of these 2 interventions delivered via telehealth is unknown. OBJECTIVE The aims of the Music Therapy Versus Cognitive Behavioral Therapy for Cancer-related Anxiety (MELODY) study are to determine the comparative effectiveness of telehealth-based MT versus telehealth-based CBT for anxiety and comorbid symptoms in cancer survivors and to identify patient-level factors associated with greater anxiety symptom reduction for MT and CBT. METHODS The MELODY study is a 2-arm, parallel-group randomized clinical trial that aims to compare the effectiveness of MT versus CBT for anxiety and comorbid symptoms. The trial will enroll 300 English- or Spanish-speaking survivors of any cancer type or stage who have experienced anxiety symptoms for at least 1 month. Participants will receive 7 weekly sessions of MT or CBT delivered remotely via Zoom (Zoom Video Communications, Inc) over 7 weeks. Validated instruments to assess anxiety (primary outcome), comorbid symptoms (fatigue, depression, insomnia, pain, and cognitive dysfunction), and health-related quality of life will be administered at baseline and at weeks 4, 8 (end of treatment), 16, and 26. Semistructured interviews will be conducted at week 8 with a subsample of 60 participants (30 per treatment arm) to understand individual experiences with the treatment sessions and their impact. RESULTS The first study participant was enrolled in February 2022. As of January 2023, 151 participants have been enrolled. The trial is expected to be completed by September 2024. CONCLUSIONS This study is the first and largest randomized clinical trial to compare the short- and long-term effectiveness of remotely delivered MT and CBT for anxiety in cancer survivors. Limitations include the lack of usual care or placebo control groups and the lack of formal diagnostic assessments for psychiatric disorders among trial participants. The study findings will help guide treatment decisions for 2 evidence-based, scalable, and accessible interventions to promote mental well-being during cancer survivorship. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46281.
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Affiliation(s)
- Kevin T Liou
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | | | - Raymond E Baser
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jodi MacLeod
- Society for Integrative Oncology, Washington, DC, United States
| | | | - Camila Casaw
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Greta Wong
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Lauren Piulson
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Karen Popkin
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ana Maria Lopez
- Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Joke Bradt
- Drexel University, Philadelphia, PA, United States
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
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27
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Hung TK, Latte-Naor S, Li Y, Kuperman GJ, Seluzicki C, Pendleton E, Pfister DG, Mao JJ. Assessment of Oncology Patient Engagement and Interest in Virtual Mind-Body Programming: Moving Toward Personalization of Virtual Care. JCO Oncol Pract 2023; 19:e185-e196. [PMID: 36399698 PMCID: PMC9970275 DOI: 10.1200/op.22.00424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/25/2022] [Accepted: 10/07/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Accelerated by the COVID-19 pandemic, the virtual platform has become a prominent medium to deliver mind-body therapies, but the extent to which patients engage in virtual mind-body programming remains unclear. This study aims to assess oncology patient engagement in a virtual mind-body program. METHODS We surveyed oncology patients enrolled in a live-streamed (synchronous) virtual mind-body program in May 2021. Patients self-reported engagement by weekly attendance. We applied multivariate regression to identify associations of engagement with sociodemographic and clinical factors. As an exploratory analysis, we used machine learning to partition engagement subgroups to determine preferential interest in prerecorded (asynchronous) mind-body therapy videos. RESULTS Among 148 patients surveyed (response rate: 21.4%), majority were female (94.5%), White (83.1%), age 65 years or older (64.9%), retired (64.2%), and in survivorship (61.8%). Patient engagement ranged from 1 to 13 classes/week (mean [standard deviation]: 4.23 [2.56]) and was higher for female (β, .82; 95% CI, 0.01 to 1.62), non-White (β, .63; 95% CI, 0.13 to 1.13), and retired patients (β, .50; 95% CI, 0.12 to 0.88). The partition model identified three engagement subgroups: employed (low engagers), retired White (intermediate engagers), and retired non-White (high engagers). Particularly, low engagers had preferential interest in meditation videos (odds ratio, 2.85; 95% CI, 1.24 to 6.54), and both low and high engagers had preferential interest in Tai Chi videos (odds ratio, 2.26; 95% CI, 1.06 to 4.82). CONCLUSION In this cross-sectional study among oncology patients, engagement in virtual mind-body programming was higher for female, non-White, and retired patients. Our findings suggest the need for both synchronous and asynchronous mind-body programming to meet the diverse needs of oncology patients.
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Affiliation(s)
| | | | - Yuelin Li
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Eva Pendleton
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jun J. Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
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28
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Yang M, Wang H, Zhang YL, Zhang F, Li X, Kim SD, Chen Y, Chen J, Chimonas S, Korenstein D, Mao JJ. The Herbal Medicine Suanzaoren ( Ziziphi Spinosae Semen) for Sleep Quality Improvements: A Systematic Review and Meta-analysis. Integr Cancer Ther 2023; 22:15347354231162080. [PMID: 37014010 PMCID: PMC10084578 DOI: 10.1177/15347354231162080] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Sleep disturbances are common and bothersome among cancer and noncancer populations. Suanzaoren (Ziziphi Spinosae Semen) is commonly used to improve sleep, yet its efficacy and safety are unclear. METHODS We systematically searched PubMed, Cochrane Library, and EMBASE from inception through October 5, 2021, to identify randomized trials of Suanzaoren. We included randomized trials comparing Suanzaoren to placebo, medications, cognitive behavioral therapy (CBT), or usual care for improving sleep outcomes in cancer and noncancer patients with insomnia or sleep disturbance. We performed a risk of bias analysis following Cochrane guidelines. Depending on heterogeneity, we pooled studies with similar comparators using fixed- and random-effects models. RESULTS We included participants with insomnia disorder (N = 785) or sleep disturbance (N = 120) from 9 trials. Compared with placebo, Suanzaoren led to significant subjective sleep quality improvements in participants with insomnia and patients with sleep disturbance combined (standard mean difference -0.58, 95% CI -1.04, -0.11; P < .01); Compared with benzodiazepines or CBT, Suanzaoren was associated with a significant decrease in insomnia severity (mean difference -2.68 points, 95% CI -5.50, -0.22; P = .03) at 4 weeks in the general population and cancer patients. The long-term effects of Suanzaoren were mixed among trials. Suanzaoren did not increase the incidence of major adverse events. The placebo-controlled studies had a low risk of bias. CONCLUSION Suanzaoren is associated with short-term patient-reported sleep quality improvements among individuals with insomnia or sleep disturbance. Due to the small sample size and variable study quality, the clinical benefits and harms of Suanzaoren, particularly in the long term, should be further assessed in a sufficiently powered randomized trial. REGISTRATION PROSPERO CRD42021281943.
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Affiliation(s)
- Mingxiao Yang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hui Wang
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Yi Lily Zhang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Furong Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaotong Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Soo-Dam Kim
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Daejeon University, Dong-gu, Daejeon, Republic of Korea
| | - Yalan Chen
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiyao Chen
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Susan Chimonas
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Mao JJ, Greenlee H, Bao T, Ismaila N, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline Summary and Q&A. JCO Oncol Pract 2023; 19:45-48. [PMID: 36260826 DOI: 10.1200/op.22.00622] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY
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Desai K, Applebaum AJ, Latte-Naor S, Pendleton EM, Cheyney S, Li QS, Bao T, Chimonas S, Mao JJ. Interest in and Barriers to Practicing Yoga among Family Caregivers of People with Cancer. Int J Yoga 2023; 16:5-11. [PMID: 37583540 PMCID: PMC10424271 DOI: 10.4103/ijoy.ijoy_203_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 08/17/2023] Open
Abstract
Background Family caregivers of people with cancer report high levels of psychological distress. Yoga, with well-documented mental health benefits, could be a useful intervention to address distress in this population. However, little is known about yoga practices among cancer caregivers. The present study evaluates their interest in and barriers to yoga practice. Methods We conducted a cross-sectional survey study of family caregivers of cancer patients at five suburban satellite locations of an academic cancer center. Survey items and statistical analyses focused on yoga usage as well as interest in and barriers to yoga practice. Results Among 539 participants, most were females (64.8%), white (84.2%), and caring for a spouse or partner (54.7%). Interest in practicing yoga among study participants was 42.3%. Increased interest was independently associated with being females (odds ratio [OR] = 3.30, 95% confidence interval [CI] = 1.98-5.51, P < 0.001) and employed (part-time: OR = 2.58, 95% CI = 1.1-6.18, P = 0.03; full-time: OR = 1.77, 95% CI = 1.1-2.01, P = 0.02). Few participants (6.3%) were currently practicing yoga, although 31% had done so in the past. Sixty-one percent of those who had practiced before their loved one's diagnosis stopped practicing yoga afterward. Commonly cited barriers to yoga practice included time constraints (37.3%) and psychological obstacles (33.6%). About a quarter of those who had never practiced yoga lacked awareness of yoga's benefits (26.6%). Conclusion Despite the low use of yoga, interest in practicing was moderately high, especially among women and employed caregivers. As caregivers face numerous barriers to yoga practice, strategies are needed to overcome these barriers and help them access yoga's health benefits.
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Affiliation(s)
- Krupali Desai
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Allison J. Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Shelly Latte-Naor
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Eva M. Pendleton
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Sarah Cheyney
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Qing S. Li
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Ting Bao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Susan Chimonas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Jun J. Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, NY, USA
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Li X, Bao T, Garland SN, Li SQ, Yu J, Li Y, Mao JJ. Does expectancy affect insomnia treatment response in cancer survivors receiving acupuncture and cognitive behavioral therapy? J Cancer Surviv 2022; 17:826-835. [DOI: 10.1007/s11764-022-01272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/07/2022] [Indexed: 12/05/2022]
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Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2022; 40:3998-4024. [PMID: 36122322 DOI: 10.1200/jco.22.01357] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 227 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra Barton
- University of Michigan School of Nursing, Ann Arbor, MI
| | - Eran Ben-Arye
- Lin & Carmel Medical Centers, Clalit Health Services; Technion Faculty of Medicine, Haifa, Israel
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City, UT
| | | | | | - Richard T Lee
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ana Maria Lopez
- Thomas Jefferson. Sidney Kimmel Cancer Center, Philadelphia, PA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jodi MacLeod
- Patient Representative, Memorial Sloan Kettering Integrative Medicine Service, New York, NY
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, GA
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Lichtl A, Casaw C, Edwards J, Popkin K, Yu J, Li QS, Cadwell M, Mao JJ, Liou KT. Music Therapy for Pain in Black and White Cancer Patients: A Retrospective Study. J Pain Symptom Manage 2022; 64:478-485. [PMID: 35870654 PMCID: PMC9588734 DOI: 10.1016/j.jpainsymman.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Racial pain disparities present challenges to cancer symptom management. Music therapy has demonstrated benefits for pain and is a promising treatment option for diverse populations due to music's multicultural presence. However, Black cancer patients are under-represented in music therapy trials. OBJECTIVES This study compared pain severity, treatment approaches, and responses to music therapy between Black and white cancer patients. The findings will be used to generate hypotheses for future music therapy research to address racial disparities in pain management. METHODS We conducted a retrospective program evaluation of Black and white patients who received music therapy at an NCI-Designated Comprehensive Cancer Center. We used the Edmonton Symptom Assessment Scale (ESAS) to assess pain. We abstracted opioid use, music therapy referral reasons, and treatment approaches from the electronic health record. RESULTS Among 358 patients, 18% were Black, 42% reported moderate-to-severe pain, and 47% received opioids. Black patients reported higher baseline pain than white patients, but similar proportions of Black and white patients received opioids. Greater proportions of Black patients received music therapy referrals for pain (73% vs. 56%, P = 0.04) and engaged in active techniques (92% vs. 82%, P = 0.04). Black and white patients reported clinically meaningful pain reduction of similar magnitude after music therapy. Black patients discussed spirituality more commonly during music therapy, whereas white patients focused on family bonds. CONCLUSION Black and white patients reported clinically meaningful pain reduction through varying music therapy approaches. Our findings may help inform cultural adaptations of music therapy to address racial pain disparities in oncology.
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Affiliation(s)
- Alexandria Lichtl
- New York University Grossman School of Medicine (A.L.), New York, NY, USA
| | - Camila Casaw
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jasmine Edwards
- Steinhardt School of Culture, Education, and Human Development (J.E.), New York University, New York, NY, USA
| | - Karen Popkin
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer Yu
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qing S Li
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Malik Cadwell
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin T Liou
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Ulrich CM, Ratcliffe SJ, Zhou Q, Huang L, Hochheimer C, Gordon T, Knafl K, Miller V, Naylor MD, Schapira MM, Richmond TS, Grady C, Mao JJ. Association of Perceived Benefit or Burden of Research Participation With Participants' Withdrawal From Cancer Clinical Trials. JAMA Netw Open 2022; 5:e2244412. [PMID: 36449287 PMCID: PMC9713607 DOI: 10.1001/jamanetworkopen.2022.44412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Attrition in cancer clinical trials (CCTs) can lead to systematic bias, underpowered analyses, and a loss of scientific knowledge to improve treatments. Little attention has focused on retention, especially the role of perceived benefits and burdens, after participants have experienced the trial. OBJECTIVES To examine the association between patients' perceived benefits and burdens of research participation and CCT retention. DESIGN, SETTING, AND PARTICIPANTS This survey study was conducted at a National Cancer Institute-designated comprehensive cancer center in the Northeast region of the US. The sample included adult patients with a cancer diagnosis participating in cancer therapeutic trials. Data were collected from September 2015 to June 2019. Analysis of study data was ongoing since November 2019 through October 2022. EXPOSURES Self-reported validated survey instrument with a list of 22 benefits and 23 burdens of research participation that can be rated by patients with a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). MAIN OUTCOMES AND MEASURES A primary outcome was actual withdrawal from the CCT, and a composite outcome was composite withdrawal that included both actual withdrawal and thoughts of withdrawing. Bivariate and multivariable logistic regressions were used. RESULTS Among the 334 participants in the sample, the mean (SD) age was 61.9 (11.5) years and 174 women (52.1%) were included. Top-cited benefits included both aspirational and action-oriented goals, including helping others (94.2%), contributing to society (90.3%), being treated respectfully (86.2%), and hoping for a cure (86.0%). Worry over receiving a placebo (61.3%), rearranging one's life (41.9%), and experiencing bothersome adverse effects (41.6%) were notable burdens. An increased burden score was associated with a higher probability of actual withdrawal (adjusted odds ratio [OR], 1.86; 95% CI, 1.1-3.17; P = .02) or composite withdrawal (adjusted OR, 3.44; 95% CI, 2.09-5.67; P < .001). An increased benefit score was associated with lower composite withdrawal (adjusted OR, 0.40; 95% CI, 0.24-0.66; P < .001). For participants who reported the benefits as being equal to or greater than the burdens, 13.4% withdrew. For those who perceived the benefits as being less than the burdens, 33.3% withdrew (adjusted OR, 3.38; 95% CI, 1.13-10.14; P = .03). The risk of withdrawal was even higher for the composite outcome (adjusted OR, 7.70; 95% CI, 2.76-21.48; P < .001). CONCLUSIONS AND RELEVANCE This survey study found that patients perceived important benefits from CCT participation, and this perception was associated with trial retention, even among those who also perceived substantial burdens. A broader dialogue among stakeholders can inform an ethical and patient-centric focus on benefits throughout the course of a CCT to increase retention.
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Affiliation(s)
- Connie M. Ulrich
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia
| | | | - Qiuping Zhou
- Department of Policy, Population and Systems Community, The George Washington University, Washington, DC
| | - Liming Huang
- Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia
| | - Camille Hochheimer
- Center for Innovative Design and Analysis, Colorado School of Public Health, Aurora
| | - Thomas Gordon
- Department of Psychology, University of Massachusetts Lowell, Lowell
| | - Kathleen Knafl
- University of North Carolina at Chapel Hill, Chapel Hill
| | - Victoria Miller
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mary D. Naylor
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia
| | - Marilyn M. Schapira
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Therese S. Richmond
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia
| | - Christine Grady
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland
| | - Jun J. Mao
- Integrative Medicine, Bendheim Integrative Medicine Center, Memorial Sloan Kettering, New York, New York
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Hidalgo L, Saldías-Fuentes C, Carrasco K, Halpern AC, Mao JJ, Navarrete-Dechent C. Complementary and alternative therapies in skin cancer a literature review of biologically active compounds. Dermatol Ther 2022; 35:e15842. [PMID: 36124923 PMCID: PMC10481428 DOI: 10.1111/dth.15842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/28/2022] [Accepted: 09/18/2022] [Indexed: 11/25/2022]
Abstract
Complementary and alternative medicine or therapies (CAM) are frequently used by skin cancers patients. Patient's self-administration of CAM in melanoma can reach up to 40%-50%. CAMs such as botanical agents, phytochemicals, herbal formulas ("black salve") and cannabinoids, among others, have been described in skin cancer patients. The objective of this review article was to acknowledge the different CAM for skin cancers through the current evidence, focusing on biologically active CAM rather than mind-body approaches. We searched MEDLINE database for articles published through July 2022, regardless of study design. Of all CAMs, phytochemicals have the best in vitro evidence-supporting efficacy against skin cancer including melanoma; however, to date, none have proved efficacy on human patients. Of the phytochemicals, Curcumin is the most widely studied. Several findings support Curcumin efficacy in vitro through various molecular pathways, although most studies are in the preliminary phase. In addition, the use of alternative therapies is not exempt of risks physicians should be aware of their adverse effects, interactions with standard treatments, and possible complications arising from CAM usage. There is emerging evidence for CAM use in skin cancer, but no human clinical trials support the effectiveness of any CAM in the treatment of skin cancer to date. Nevertheless, patients worldwide frequently use CAM, and physicians should educate themselves on currently available CAMs.
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Affiliation(s)
- Leonel Hidalgo
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Karina Carrasco
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Hospital Nutrition Unit, Fundación Arturo López Pérez, Santiago, Chile
| | - Allan C. Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jun J. Mao
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Raghunathan NJ, Brens J, Vemuri S, Li QS, Mao JJ, Korenstein D. In the weeds: a retrospective study of patient interest in and experience with cannabis at a cancer center. Support Care Cancer 2022; 30:7491-7497. [PMID: 35665859 PMCID: PMC9165925 DOI: 10.1007/s00520-022-07170-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/19/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Cannabis products, including the cannabinoids CBD and THC, are rising in popularity and increasingly used for medical purposes. While there is some evidence that cannabinoids improve cancer-associated symptoms, understanding regarding appropriate use remains incomplete. PURPOSE To describe patient experiences with medical cannabis with focus on use contexts and patients' reported benefits and harms. METHODS A standardized intake form was implemented in a dedicated medical cannabis clinic at an NCI-designated cancer center; data from this form was abstracted for all initial visits from October 2019 to October 2020. We report descriptive statistics, chi-square analysis, and multivariate logistic regression. RESULTS Among 163 unique new patients, cannabis therapy was commonly sought for sleep, pain, anxiety, and appetite. Twenty-nine percent expressed interest for cancer treatment; 40% and 46% reported past use of CBD and THC, respectively, for medical purposes. Among past CBD users, the most commonly reported benefits were less pain (21%) or anxiety (17%) and improvement in sleep (15%); 92% reported no side effects. Among those with past THC use, reported benefits included improvement in appetite (40%), sleep (32%), nausea (28%), and pain (17%); side effects included feeling "high." Seeking cannabis for anti-neoplastic effects was associated with receipt of active cancer treatment in both univariate and multivariate analysis. CONCLUSION Cancer patients seek medical cannabis to address a wide variety of concerns despite insufficient evidence of benefits and harms. As more states move to legalize medical and recreational cannabis, cancer care providers must remain aware of emerging data and develop knowledge and skills to counsel their patients about its use.
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Affiliation(s)
- Nirupa J Raghunathan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Jessica Brens
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Swetha Vemuri
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qing S Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah Korenstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Romero SAD, Emard N, Baser RE, Panageas K, MacLeod J, Walker D, Barton-Burke M, Liou K, Deng G, Farrar J, Xiao H, Mao JJ, Epstein A. Acupuncture versus massage for pain in patients living with advanced cancer: a protocol for the IMPACT randomised clinical trial. BMJ Open 2022; 12:e058281. [PMID: 36581960 PMCID: PMC9438082 DOI: 10.1136/bmjopen-2021-058281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Pain, comorbid fatigue and sleep disturbances are common and distressing symptoms for patients with advanced cancer, negatively impacting their quality of life. Clinical guidelines recommend non-pharmacological interventions, including acupuncture and massage, for pain management in adult patients with cancer in adjunct to conventional care. However, high-quality evidence about the comparative effectiveness and long-term durability of these therapies for symptom management is limited. METHODS AND ANALYSIS We describe the design of a two-arm, parallel group, multicentre randomised controlled trial that investigates the use of acupuncture versus massage for musculoskeletal pain among 300 patients with diverse types of advanced cancer. The primary aim is to evaluate the long-term effectiveness (26 weeks from randomisation) of acupuncture vs massage for pain (primary outcome) and comorbid symptoms (fatigue, sleep disturbance and quality of life). The secondary aim is to identify patient-level demographic characteristics (eg, sex, race, age), clinical factors (eg, insomnia, pain severity) and psychological attributes that are associated with a greater reduction in pain for either acupuncture or massage. Patients will receive weekly acupuncture or massage treatments for 10 weeks, followed by monthly booster sessions up to 26 weeks. The primary endpoint will be the change in worst pain intensity score from baseline to 26 weeks. We will collect validated patient-reported outcomes at multiple time points over 26 weeks. ETHICS AND DISSEMINATION The Institutional Review Board at Memorial Sloan Kettering Cancer Center in New York approved this protocol. Results will be disseminated via peer-reviewed scientific journals and conference presentations. Our findings will help patients and healthcare providers make informed decisions about incorporating non-pharmacological treatments to manage pain for patients with advanced cancer. TRIAL REGISTRATION NUMBER NCT04095234.
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Affiliation(s)
- Sally A D Romero
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, CA, USA
| | - Nicholas Emard
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine Panageas
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jodi MacLeod
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Desiree Walker
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Margaret Barton-Burke
- Office of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gary Deng
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Farrar
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Han Xiao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Wang H, Hou YN, Yang M, Feng Y, Zhang YL, Smith CM, Hou W, Mao JJ, Deng G. Herbal Formula Shenling Baizhu San for Chronic Diarrhea in Adults: A Systematic Review and Meta-analysis. Integr Cancer Ther 2022; 21:15347354221081214. [PMID: 35635135 PMCID: PMC9158428 DOI: 10.1177/15347354221081214] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Shenling Baizhu San (SBS), a well-known Chinese medicine herbal formula, has been widely used for treating chronic diarrhea for thousands of years. However, the efficacy and safety of SBS in treating chronic diarrhea have not been fully assessed. Objective: This study evaluates the efficacy and safety of the herbal formula SBS in symptomatic relief of chronic diarrhea. Methods: English and Chinese language databases (PubMed, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Data, and SinoMed electronic databases) were searched through April 2020 for relevant randomized controlled trials (RCTs). The outcomes in these RCTs included stool frequency, stool consistency, patient-reported satisfaction of chronic diarrhea treatment, quality of life and adverse events. Paired reviewers independently extracted data and conducted qualitative and quantitative analyses. The Cochrane revised risk of bias RoB-2 tool was applied to assess the risk of bias for each trial whereas the RevMan 5.3 software was used for outcomes data synthesis and meta-analysis. Mean difference (MD) and the 95% confidence interval (CI) were used to measure continuous data. The dichotomous data were analyzed via the relative risk (RR) with 95% CIs. Results: Fourteen RCTs including 1158 participants (54% males) with chronic diarrhea were included. Shenling Baizhu San combined with or without conventional medicine (CM) was associated with greater patient-reported satisfaction than CM alone. There was no increased risk of adverse events (AEs) during treatment. Conclusion: Treatment with SBS was associated with significant improvement in patient-reported satisfaction, irrespective of conventional medicine use. Rigorous and powered RCTs with objective outcome measures are needed to confirm the effects of SBS in specific gastrointestinal disease populations with chronic diarrhea symptoms. Systematic review registration number (PROSPERO): CRD42020178073
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Affiliation(s)
- Hui Wang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yen-Nien Hou
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mingxiao Yang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ye Feng
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Yi Lily Zhang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Wei Hou
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jun J. Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gary Deng
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Yang M, Baser RE, Li SQ, Hou YN, Chong K, Zhang YL, Hoque I, Bao T, Mao JJ. Tibetan Herbal Pain-Relieving Plaster for Chronic Musculoskeletal Pain Among Cancer Survivors: Study Protocol of a Randomized, Double-Blind, Placebo-Controlled Trial. Front Pharmacol 2022; 13:878371. [PMID: 35600872 PMCID: PMC9114465 DOI: 10.3389/fphar.2022.878371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic pain is common and debilitating in cancer survivors. Tibetan herbal pain-relieving plaster is used as an external analgesic to treat musculoskeletal pain in China; however, its safety and efficacy have not been evaluated via clinical trials in cancer survivors. We designed this Phase II randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov Identifier: NCT04916249) to assess the efficacy and safety of the pain-relieving plaster for temporary pain relief among cancer survivors with chronic musculoskeletal pain. Under ethical approval from the Institutional Review Board at the Memorial Sloan Kettering Cancer Center, we will enroll eligible cancer survivors who have a clinical diagnosis of moderate to severe chronic musculoskeletal pain in this study. We use a central randomization system to allocate the eligible participants to either the treatment or the control group in a 1:1 ratio, with stratification by baseline opioid use. We will instruct the participants to apply the herbal patch (Tibetree Pain-Relieving Plaster, Tibet Cheezheng Tibetan Medicine Co. Ltd., Tibet, China) or placebo patch daily at the focal area with worst pain for 14 consecutive days. Study physician, participant, outcome assessor, and biostatistician are blinded to the group allocation. The primary outcome is pain severity measured by the Brief Pain Inventory on Days 2–7. Secondary outcomes include changes in insomnia, anxiety, depression, fatigue, pressure pain threshold, pain medication use, and global impression of change. We will also monitor the adverse events throughout the study period. Statistical analysis will follow the intention-to-treat principle and linear mixed modeling will be used. With rigorous design and implementation, this randomized, placebo-controlled trial will provide the initial evidence on the efficacy and safety of the pain-relieving plaster for pain relief among cancer survivors with chronic musculoskeletal pain.
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Affiliation(s)
- Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, NY, United States
| | - Susan Q. Li
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yen-Nien Hou
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Kamyar Chong
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yi Lily Zhang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Irfan Hoque
- Investigational Drug Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ting Bao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Jun J. Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
- *Correspondence: Jun J. Mao,
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Zhang YQ, Jiao RM, Witt CM, Lao L, Liu JP, Thabane L, Sherman KJ, Cummings M, Richards DP, Kim EKA, Kim TH, Lee MS, Wechsler ME, Brinkhaus B, Mao JJ, Smith CA, Gang WJ, Liu BY, Liu ZS, Liu Y, Zheng H, Wu JN, Carrasco-Labra A, Bhandari M, Devereaux PJ, Jing XH, Guyatt G. How to design high quality acupuncture trials-a consensus informed by evidence. BMJ 2022; 376:e067476. [PMID: 35354583 PMCID: PMC8965655 DOI: 10.1136/bmj-2021-067476] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
An international panel including patients, clinicians, researchers, acupuncture and surgery trialists, statisticians, and experts in clinical epidemiology and methodology have developed new guidance for randomised controlled trials in acupuncture. It addresses the most prevalent and critical concerns of current acupuncture trials and will help funding agencies, trial registers, and journal editors to evaluate the relevance, importance, and quality of submitted trial proposals and completed trials
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Affiliation(s)
- Yu-Qing Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- CEBIM (Center for Evidence-Based Integrative Medicine)-Clarity Collaboration, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo, China
| | - Rui-Min Jiao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- China Center for Evidence-Based Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lixing Lao
- Virginia University of Integrative Medicine, Fairfax, VA, USA
| | - Jian-Ping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Lehana Thabane
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Karen J Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle WA, USA
- Department of Epidemiology, University of Washington, Seattle WA, USA
| | | | - Dawn P Richards
- Patient and Public Engagement, Clinical Trials Ontario, Toronto, ON, Canada
| | - Eun-Kyung Anna Kim
- Department of Western Medicine, Virginia University of Integrative Medicine, Fairfax, VA, USA
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Seoul, Republic of Korea
- Korean Medicine Hospital, Seoul, Republic of Korea
- Kyung Hee University, Seoul, Republic of Korea
| | - Myeong Soo Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medicine, University of Science and Technology, Daejeon, Republic of Korea
| | | | - Benno Brinkhaus
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jun J Mao
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, New York, NY USA
| | - Caroline A Smith
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Wei-Juan Gang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- China Center for Evidence-Based Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bao-Yan Liu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhi-Shun Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hui Zheng
- School of Acupuncture-Moxibustion and Tuina/The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Jia-Ni Wu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Alonso Carrasco-Labra
- Center for Integrative Global Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mohit Bhandari
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Philip J Devereaux
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Xiang-Hong Jing
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- China Center for Evidence-Based Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Mao JJ, Pillai GG, Andrade CJ, Ligibel JA, Basu P, Cohen L, Khan IA, Mustian KM, Puthiyedath R, Dhiman KS, Lao L, Ghelman R, Cáceres Guido P, Lopez G, Gallego-Perez DF, Salicrup LA. Integrative oncology: Addressing the global challenges of cancer prevention and treatment. CA Cancer J Clin 2022; 72:144-164. [PMID: 34751943 DOI: 10.3322/caac.21706] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022] Open
Abstract
The increase in cancer incidence and mortality is challenging current cancer care delivery globally, disproportionally affecting low- and middle-income countries (LMICs) when it comes to receiving evidence-based cancer prevention, treatment, and palliative and survivorship care. Patients in LMICs often rely on traditional, complementary, and integrative medicine (TCIM) that is more familiar, less costly, and widely available. However, spheres of influence and tensions between conventional medicine and TCIM can further disrupt efforts in evidence-based cancer care. Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge health care gaps in delivering evidence-informed, patient-centered care. This growing field uses lifestyle modifications, mind and body therapies (eg, acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer. On the basis of this review of the global challenges of cancer control and the current status of integrative oncology, the authors recommend: 1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy life styles; 2) developing and testing TCIM interventions to address cancer symptoms or treatment-related adverse effects (eg, pain, insomnia, fatigue); and 3) disseminating and implementing evidence-based TCIM interventions as part of comprehensive palliative and survivorship care so patients from all cultures can live with or beyond cancer with respect, dignity, and vitality. With conventional medicine and TCIM united under a cohesive framework, integrative oncology may provide citizens of the world with access to safe, effective, evidence-informed, and culturally sensitive cancer care.
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Affiliation(s)
- Jun J Mao
- Bendheim Integrative Medicine Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Geetha Gopalakrishna Pillai
- Traditional, Complementary and Integrative Medicine Unit, Service Delivery and Safety Department, World Health Organization, Geneva, Switzerland
| | | | - Jennifer A Ligibel
- Leonard P. Zakim Center for Integrative Therapies and Healthy Living, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Partha Basu
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Lorenzo Cohen
- Integrative Medicine Program, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ikhlas A Khan
- National Center for Natural Products Research, University of Mississippi, Jackson, Mississippi
| | - Karen M Mustian
- Wilmot Cancer Institute, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | | | | | - Lixing Lao
- Virginia University of Integrative Medicine, Fairfax, Virginia
| | - Ricardo Ghelman
- Brazilian Academic Consortium for Integrative Health, University of São Paulo, São Paulo, Brazil
| | - Paulo Cáceres Guido
- Pharmacokinetics and Research in Clinical Pharmacology and Integrative Medicine Group, Garrahan Pediatric Hospital, Buenos Aires, Argentina
- Traditional, Complementary, and Integrative Medicine Network of the Americas, São Paulo, Brazil
| | - Gabriel Lopez
- Integrative Medicine Program, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel F Gallego-Perez
- Traditional, Complementary, and Integrative Medicine Network of the Americas, São Paulo, Brazil
- Boston University School of Public Health, Boston, Massachusetts
| | - Luis Alejandro Salicrup
- Center for Global Health and Office of Cancer Complementary and Alternative Medicine, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Daly B, Nicholas K, Flynn J, Silva N, Panageas K, Mao JJ, Gazit L, Gorenshteyn D, Sokolowski S, Newman T, Perry C, Wagner I, Zervoudakis A, Salvaggio R, Holland J, Chiu YO, Kuperman GJ, Simon BA, Reidy-Lagunes DL, Perchick W. Analysis of a Remote Monitoring Program for Symptoms Among Adults With Cancer Receiving Antineoplastic Therapy. JAMA Netw Open 2022; 5:e221078. [PMID: 35244701 PMCID: PMC8897754 DOI: 10.1001/jamanetworkopen.2022.1078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Electronic patient-reported outcomes (ePROs) may have the potential to improve cancer care delivery by enhancing patient quality of life, reducing acute care visits, and extending overall survival. However, the optimal cadence of ePRO assessments is unknown. OBJECTIVE To determine patient response preferences and the clinical value associated with a daily cadence for ePROs for patients receiving antineoplastic treatment. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study of adult patients undergoing antineoplastic treatment assessed a remote monitoring program using ePROs that was developed to manage cancer therapy-related symptoms. ePRO data submitted between October 16, 2018 to February 29, 2020, from a single regional site within the Memorial Sloan Kettering Cancer Center network were included. Data were analyzed from April 2020 to January 2022. EXPOSURE While undergoing active treatment, patients received a daily ePRO assessment that, based on patient responses, generated yellow (moderate) or red (severe) symptom alerts that were sent to clinicians. MAIN OUTCOMES AND MEASURES The main outcomes assessed included patient response rate, symptom alert frequency, and an analysis of the clinical value of daily ePROs. RESULTS A total of 217 patients (median [range] age, 66 [31-92] years; 103 [47.5%] women and 114 [52.5%] men) initiating antineoplastic therapy at high risk for symptoms were monitored for a median (range) of 91 (2-369) days. Most patients had thoracic (59 patients [27.2%]), head and neck (48 patients [22.1%]), or gastrointestinal (43 patients [19.8%]) malignant neoplasms. Of 14 603 unique symptom assessments completed, 7349 (50.3%) generated red or yellow symptom alerts. Symptoms commonly generating alerts included pain (665 assessments [23.0%]) and functional status (465 assessments [16.1%]). Most assessments (8438 assessments [57.8%]) were completed at home during regular clinic hours (ie, 9 am-5 pm), with higher response rates on weekdays (58.4%; 95% CI, 57.5%-59.5%) than on weekend days (51.3%; 95% CI, 49.5%-53.1%). Importantly, 284 of 630 unique red alerts (45.1%) surfaced without a prior yellow alert for the same symptom within the prior 7 days; symptom severity fluctuated over the course of a week, and symptom assessments generating a red alert were followed by an acute care visit within 7 days 8.7% of the time compared with 2.9% for assessments without a red alert. CONCLUSIONS AND RELEVANCE These findings suggest that daily ePRO assessments were associated with increased insight into symptom management in patients undergoing antineoplastic treatment and symptom alerts were associated with risk of acute care.
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Affiliation(s)
- Bobby Daly
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kevin Nicholas
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica Flynn
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nicholas Silva
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Jun J. Mao
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lior Gazit
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Claire Perry
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Isaac Wagner
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Rori Salvaggio
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessie Holland
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yeneat O. Chiu
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Brett A. Simon
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Wendy Perchick
- Memorial Sloan Kettering Cancer Center, New York, New York
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Zhi WI, Mao JJ, Baser RE, Li SQ, Blinder VS, Norton L, Seidman AD, Robson ME, Bao T. Abstract P4-08-01: Effectiveness of electroacupuncture versus auricular acupuncture in breast cancer survivors with chronic musculoskeletal pain: The PEACE randomized clinical trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-08-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Chronic musculoskeletal pain is common and debilitating among breast cancer survivors. Recently, the Personalized Electroacupuncture (EA) versus Auricular Acupuncture (AA) Comparative Effectiveness (PEACE) trial demonstrated that both acupuncture methods improved pain control better than usual care (UC) in cancer survivors. However, the comparative effectiveness between EA and AA among breast cancer survivors, specifically, for chronic musculoskeletal pain is unknown. Here, we report the results of breast cancer survivors enrolled in the PEACE trial. Methods: PEACE is a three-arm, parallel, single center randomized trial investigating the effectiveness of EA and AA versus UC for chronic musculoskeletal pain in 360 cancer survivors. Patients in both EA and AA received ten weekly treatments. Patients in UC could receive ten EA treatments after week 12. The primary endpoint was the change in mean Brief Pain Inventory (BPI) pain intensity from baseline to week 12; change from baseline to week 24 was a secondary endpoint. We analyzed the subset of trial participants with a primary diagnosis of breast cancer (46%). We conducted constrained linear mixed model analyses, which constrained all arms to have a common pre-randomization baseline mean. Model-based mean estimates at weeks 12 and 24 were compared between arms using model contrasts. Results: Among the 165 breast cancer survivors, mean (SD) age was 60.3 (11.0) years, 35.8% were non-white, and mean time since cancer diagnosis was 5.4 (6.5) years. Patients had been experiencing pain for 5.6 (7.3) years, with baseline mean pain severity of 5.35 (95% CI: 5.04, 5.66). 86.7% had a prior history of surgery, 43.0% chemotherapy, 64.8% radiotherapy, and 50.3% endocrine therapy. The common locations of pain were lower back (24.2%), knee/leg (23.6%), and shoulder/arm/elbow (13.9%). 107 (66.9%) patients were taking pain medication. At week 12, the BPI pain severity score was 2.69 (2.26. 3.13) in EA, 3.60 (3.17, 4.02) in AA, and 5.06 (4.47, 5.65) in UC. The change in mean BPI intensity score from baseline was -2.65 (-3.06, -2.25), -1.75 (-2.15, -1.35), and -0.29 (-0.86, 0.28) in EA, AA, and UC, respectively (Table 1). At week 24, the mean BPI pain severity was 2.84 (95% Confidence Interval [CI]: 2.40, 3.28) in EA and 3.67 (95% CI: 3.23, 4.10) in AA. EA reduced pain severity significantly more than AA at both week 12, (-0.90 [-1.45, -0.36], p =0.001) and week 24 (-0.82, [-1.38, -0.27], p=0.004). Minimal toxicities were reported. Conclusions: While both EA and AA were associated with clinically meaningful and persistent reduction of pain among breast cancer survivors, EA was more effective than AA at reducing pain severity. Breast cancer survivors with chronic musculoskeletal pain may consider EA.
Table 1.Changes in BPI Pain Intensity from BaselineBPI Pain IntensityUCEAAAEA vs AAChange from baselineChange from baselineDifference from UCChange from baselineDifference from UCDifference between EA and AAWeek 12Mean (95% CI)-0.29 (-0.86, 0.28)-2.65* (-3.06, -2.25)-2.37*(-3.05, -1.68)-1.75* (-2.15, -1.35)-1.46* (-2.14, -0.78)-0.90* (-1.45, -0.36)*p≤0.001
Citation Format: Wanqing Iris Zhi, Jun J Mao, Raymond E Baser, Susan Q Li, Vicotria S Blinder, Larry Norton, Andrew D Seidman, Mark E Robson, Ting Bao. Effectiveness of electroacupuncture versus auricular acupuncture in breast cancer survivors with chronic musculoskeletal pain: The PEACE randomized clinical trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-08-01.
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Affiliation(s)
- Wanqing Iris Zhi
- Memorial Sloan Ketter Cancer Center, Breast Medicine Service, New York, NY
| | - Jun J Mao
- Memorial Sloan Ketter Cancer Center, Integrative Medicine Service, New York, NY
| | - Raymond E Baser
- Memorial Sloan Ketter Cancer Center, Epidemiology & Biostatistics, New York, NY
| | - Susan Q Li
- Memorial Sloan Ketter Cancer Center, Integrative Medicine Service, New York, NY
| | - Vicotria S Blinder
- Memorial Sloan Ketter Cancer Center, Breast Medicine Service, New York, NY
| | - Larry Norton
- Memorial Sloan Ketter Cancer Center, Breast Medicine Service, New York, NY
| | - Andrew D Seidman
- Memorial Sloan Ketter Cancer Center, Breast Medicine Service, New York, NY
| | - Mark E Robson
- Memorial Sloan Ketter Cancer Center, Breast Medicine Service, New York, NY
| | - Ting Bao
- Memorial Sloan Ketter Cancer Center, Integrative Medicine Service, New York, NY
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Naughton MJ, Zahrieh D, Gnant M, Zdenkowski N, Lemieux J, Mao JJ, Bjelic-Radisic V, Shinn E, Balic M, Thomssen C, Neisel J, Ruiz-Echarri M, Loibl S, Isaacs C, Cameron D, Carrasco FMH, Goetz M, Wette V, Werutsky G, Rugo H, Vetter M, Tseng LM, Miller K, Fitzal F, Gil JMG, Park H, Linderholm B, Bajetta E, Dayao Z, Prat A, Ehrhardt K, Metzger O, Arahmani A, Law E, Partridge A, Carey L, Zoroufy A, Dueck A, Hlauschek D, DeMichele A, Mayer E. Abstract P4-10-01: Quality of life and symptom severity in the PALLAS randomized trial of palbociclib with adjuvant endocrine therapy in early breast cancer (AFT-05). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-10-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Quality of life (QOL) in breast cancer patients (pts) can be greatly impacted by initial treatment and ongoing therapy, particularly if side effects and symptoms are not well tolerated. The PALLAS trial investigated whether the addition of 2 years of palbociclib (palbo) to adjuvant endocrine therapy (ET) improved invasive disease-free survival (iDFS) over adjuvant ET alone. We report on the main patient-reported outcome (PRO) quality of life (QOL) and symptom severity results of this trial by treatment arm. Methods: PALLAS is an ongoing multicenter, open label phase 3 trial that enrolled hormone receptor positive, HER2-negative, stage II-III breast cancer patients at 406 cancer centers across 21 countries. Patients were randomly assigned (1:1) to either 2 years of palbo (125mg/day, 3 weeks on 1 week off) plus ongoing provider or patient-choice adjuvant ET (palbo+ET) versus ongoing ET alone. The primary study endpoint was iDFS. Treatment with palbo in all pts stopped at the time of the second interim analysis (5/2020) due to futility; all pts then moved to follow up. The PRO analyses were triggered for completion after awareness of the pre-specified 469 iDFS cases in November 2020. Eight PRO endpoints were measured serially (i.e., day 1 of each monthly cycle for the first 3 months, then every 3 months for the first 2 years, and once at year 3). The endpoints were the EORTC QLQ-C30 global health status/QOL score, the Brief Fatigue Inventory score, the modified Brief Pain Inventory severity and pain interference scores, the EORTC QLQ-BR23 alopecia score, and the Breast Cancer Prevention Trial hot flash symptoms, vaginal problems, and musculoskeletal pain scores. Linear mixed models compared the average difference between arms across time points during the initial 2-year treatment period adjusting for cycle 1 day 1 (C1D1) PRO scores, demographic and clinical variables. The average differences between arms (palbo+ET vs ET alone) and the two-sided (1-[0.05/8]) x 100% confidence intervals, adjusted for multiple comparisons, were calculated. Analysis of covariance compared the average between-arm differences by endpoint at 3 years. Results: The PRO intention to collect population included 4688 (81%) of the overall trial pts, and was clinically and demographically representative of the remaining 1073 pts. Each analysis population, with measures at C1D1 and at least 1 post-C1D1 assessment for each PRO endpoint, comprised ≥ 89% of the 4688 pts and the proportions were similar between arms. After adjustment for baseline covariates, on average, no clinically important differences between arms were observed for any of the eight endpoints over the 2 year treatment period (Table 1). All effect sizes were below the pre-specified 0.2 threshold. These PRO results were similar at the 3 year time point. Conclusions: No clinically significant differences in either patient-reported QOL or symptom severity were found, on average, between participants in the two PALLAS treatment arms while either taking palbo+ET or ET alone, or after study-wide termination of palbo. In general, the addition of palbociclib in the adjuvant breast cancer setting did not contribute to increased symptom burden within this survivorship population. Further analyses will examine the relationship between PROs and treatment discontinuation by arm and study time point. Support: AFT, Pfizer, https://acknowledgments.alliancefound.org
Table 1.Results of the Patient-Reported QOL and Symptom Severity Analyses Between the Two Treatment Arms During the First 2 Years of PALLASPRO Endpoint *Palbo + ET Adjusted average score (95% CI)ET alone Adjusted average score (95% CI)Average Difference + (Palbo + ET vs ET alone)[99.38% CI] Clinically ++ Important DifferenceEORTC QLQ-C30 Global Health Status/QOL71.7 (71.2, 72.2)74.0 (73.5, 74.5)-2.3 (-3.3, -1.4)**NoBrief Fatigue Inventory Score2.3 (2.2, 2.3)2.1 (2.0, 2.1)0.2 (0.1, 0.3)NoModified Brief Pain Inventory - Severity Score2.3 (2.2, 2.3)2.4 (2.4, 2.5)-0.2 (-0.3, -0.1)NoModified Brief Pain Inventory - Interference Score1.7 (1.6, 1.7)1.7 (1.6, 1.7)0.0 (-0.1, 0.1)NoEORTC QLQ-BR23 Alopecia1.4 (1.4, 1.4)1.3 (1.3, 1.3)0.1 (0.1, 0.1)NoBreast Cancer Prevention Trial - Hot Flash Symptoms1.2 (1.2, 1.3)1.2 (1.2, 1.3)0.0 (-0.1, 0.1)NoBreast Cancer Prevention Trial - Vaginal Problems0.8 (0.8, 0.8)0.8 (0.7, 0.8)0.0 (0.0, 0.1)NoBreast Cancer Prevention Trial - Musculoskeletal Pain1.2 (1.2, 1.2)1.3 (1.3, 1.3)-0.1 (-0.2, 0.0)No* For the EORTC QLQ-C30 Global Health Status/QOL subscale, higher scores indicate better QOL. For all other PRO endpoints, higher scores indicate worse symptom levels. ** The lower bound of the one-sided CI (adjusted for multiple comparisons) was -3.3. Because the lower limit is greater than the pre-specified non-inferiority margin of -3.44, non-inferiority of palbo+ET relative to ET-alone was concluded. The non-inferiority margin corresponds to a 0.2 SD in the EORTC QLQ-C30 global health/QOL score. +The average difference was adjusted for the following baseline covariates: Cycle 1 day 1 score, region (if applicable), age category, first adjuvant ET, race, ethnicity, N-stage, T-stage, histological grade, PgR, prior chemotherapy, ECOG Performance Status. ++Based on each instrument’s published clinically relevant cut-offs, if available. After calculating Cohen’s d treatment effect sizes, (i.e. by dividing the average difference by the ET-alone arm standard deviation from cycle 1 day 1), all effect sizes were below the pre-specified 0.2 threshold, and would not be considered clinically important.
Citation Format: Michelle Joy Naughton, David Zahrieh, Michael Gnant, Nicholas Zdenkowski, Julie Lemieux, Jun J Mao, Vesna Bjelic-Radisic, Eileen Shinn, Marija Balic, Christoph Thomssen, Jane Neisel, Manuel Ruiz-Echarri, Sibylle Loibl, Claudine Isaacs, David Cameron, Fernando Manuel Henao Carrasco, Matthew Goetz, Viktor Wette, Gustavo Werutsky, Hope Rugo, Marcus Vetter, Ling-Ming Tseng, Kathy Miller, Florian Fitzal, Juan Miguel Gil Gil, Haeseong Park, Barbro Linderholm, Emilio Bajetta, Zoneddy Dayao, Aleix Prat, Karin Ehrhardt, Otto Metzger, Amal Arahmani, Ernest Law, Ann Partridge, Lisa Carey, Alex Zoroufy, Amylou Dueck, Dominik Hlauschek, Angela DeMichele, Erica Mayer. Quality of life and symptom severity in the PALLAS randomized trial of palbociclib with adjuvant endocrine therapy in early breast cancer (AFT-05) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-01.
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Affiliation(s)
| | | | | | | | - Julie Lemieux
- Center Hospitalier Universitaire de Quebec, Universite Laval, Quebec City, QC, Canada
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York City, NY
| | | | | | | | | | | | | | | | | | - David Cameron
- Cancer Research UK Edinburgh Center, Edinburgh, United Kingdom
| | | | | | | | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Hope Rugo
- University of California, San Francisco, CA
| | | | | | - Kathy Miller
- Indiana University Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | - Emilio Bajetta
- Institute of Oncology, Polyclinic Hospital, di Monza, Italy
| | | | | | - Karin Ehrhardt
- Austrian Breast and Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Otto Metzger
- Dana Farber Cancer Institute/Alliance, Boston, MA
| | | | | | | | - Lisa Carey
- University of North Carolina, Chapel Hill, NC
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Zhu YJ, Wu XY, Wang W, Chang XS, Zhan DD, Diao DC, Xiao J, Li Y, Ma D, Hu M, Li JC, Wan J, Wu GN, Ke CF, Sun KY, Huang ZL, Cao TY, Zhai XH, Chen YD, Peng JJ, Mao JJ, Zhang HB. Acupuncture for Quality of Life in Gastric Cancer Patients Undergoing Adjuvant Chemotherapy. J Pain Symptom Manage 2022; 63:210-220. [PMID: 34563627 DOI: 10.1016/j.jpainsymman.2021.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 12/23/2022]
Abstract
CONTEXT Patients with gastric cancer experience health-related quality of life (HRQOL) decline during adjuvant chemotherapy following gastrectomy. OBJECTIVES This pilot study aimed to evaluate the preliminary effect and feasibility of electro-acupuncture (EA) for HRQOL and symptom burden in these patients. METHODS In this open-label, multicenter, parallel controlled trial, gastric cancer patients who planned to receive adjuvant chemotherapy were randomly assigned to receive high-dose EA (seven times each chemotherapy cycle for three cycles), low-dose EA (three times each chemotherapy cycle), or usual care only. The acupoints prescription consisted of bilateral ST36, PC6, SP4, and DU20, EX-HN3, and selected Back-shu points. Patients completed the Functional Assessment of Cancer Therapy-Gastric (FACT-Ga) weekly, and the Edmonton Symptom Assessment System (ESAS). The primary outcome was the difference among the groups on the gastric cancer subscale (GaCS) of the FACT-Ga. RESULTS Of the 66 randomized patients, 58 were analyzed according to intention-to-treat principle, and 45 were in the per-protocol set (PPS). The average scores in PPS of GaCS were 52.12±9.71, 51.85±12.36, and 45.37±8.61 in high-dose EA, low-dose EA, and control groups, respectively. EA was significantly associated with improved average GaCS scores when compared with control group (51.98±10.91 vs. 45.37±8.61, P = 0.039). EA treatment also produced ESAS relief at the end of intervention (14.36 ± 12.28 vs. 23.91 ± 15.52, P = 0.027). Participants in EA groups had fewer grade ≥3 leukopenia (0% vs. 15.79%, P = 0.031) and neutropenia (2.56% vs. 26.31%, P = 0.012). CONCLUSION EA showed promising effects in improving HRQOL, controlling symptom burden, and reducing toxicity during adjuvant chemotherapy in gastric cancer patients. Future adequately powered trials are feasible and needed to confirm the specific effect of EA.
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Affiliation(s)
- Yan-Juan Zhu
- Department of Oncology (Y.J.Z., X.S.C., D.D.Z., Y.D.C., H.B.Z.), Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome (Y.J.Z., H.B.Z.), Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research (Y.J.Z., H.B.Z.), Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Yu Wu
- Gastrointestinal Surgery (X.Y.W., G.N.W.), Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Wei Wang
- Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine (W.W., D.C.D., J.W.), the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xue-Song Chang
- Department of Oncology (Y.J.Z., X.S.C., D.D.Z., Y.D.C., H.B.Z.), Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dan-Dan Zhan
- Department of Oncology (Y.J.Z., X.S.C., D.D.Z., Y.D.C., H.B.Z.), Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De-Chang Diao
- Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine (W.W., D.C.D., J.W.), the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian Xiao
- Medical Oncology, the Sixth Affiliated Hospital (J.X., T.Y.C., X.H.Z.), Sun Yat-sen University, Guangzhou, China
| | - Yong Li
- Gastrointestinal Surgery (Y.L.), Guangdong Provincial People's Hospital, Guangzhou, China
| | - Dong Ma
- Gastrointestinal Oncology (D.M.), Guangdong Provincial People's Hospital, Guangzhou, China
| | - Ming Hu
- Gastrointestinal Surgery (M.H., C.F.K.), the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian-Chang Li
- Gastrointestinal Surgery (J.C.L., Z.L.H.), Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Jin Wan
- Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine (W.W., D.C.D., J.W.), the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guan-Nan Wu
- Gastrointestinal Surgery (X.Y.W., G.N.W.), Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Chuan-Feng Ke
- Gastrointestinal Surgery (M.H., C.F.K.), the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kai-Yu Sun
- Gastrointestinal Surgery (K.U.S., J.J.P.), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhi-Liang Huang
- Gastrointestinal Surgery (J.C.L., Z.L.H.), Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Tai-Yuan Cao
- Medical Oncology, the Sixth Affiliated Hospital (J.X., T.Y.C., X.H.Z.), Sun Yat-sen University, Guangzhou, China
| | - Xiao-Hui Zhai
- Medical Oncology, the Sixth Affiliated Hospital (J.X., T.Y.C., X.H.Z.), Sun Yat-sen University, Guangzhou, China
| | - Ya-Dong Chen
- Department of Oncology (Y.J.Z., X.S.C., D.D.Z., Y.D.C., H.B.Z.), Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian-Jun Peng
- Gastrointestinal Surgery (K.U.S., J.J.P.), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Jun J Mao
- Department of Medicine (J.J.M.), Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Hai-Bo Zhang
- Department of Oncology (Y.J.Z., X.S.C., D.D.Z., Y.D.C., H.B.Z.), Guangdong Provincial Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome (Y.J.Z., H.B.Z.), Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research (Y.J.Z., H.B.Z.), Guangzhou University of Chinese Medicine, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine (H.B.Z.), the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou China.
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Liou KT, Lynch KA, Nwodim O, Popkin K, Greene JS, Atkinson TM, Bradt J, Mao JJ. Comparison of Depressive Symptom Outcomes in Hospitalized Adult Cancer Patients Receiving Music Therapy or Massage Therapy. J Pain Symptom Manage 2022; 63:e155-e159. [PMID: 34563626 PMCID: PMC8816855 DOI: 10.1016/j.jpainsymman.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
CONTEXT Depressive symptoms are prevalent and associated with greater healthcare utilization among hospitalized adults with cancer. Music therapy and massage therapy are available at many National Cancer Institute (NCI)-Designated Cancer Centers and recommended by the American Society of Clinical Oncology for depressive symptoms, but a paucity of studies have compared these two therapies. OBJECTIVES We conducted a retrospective, multi-method program evaluation of single, first-time music therapy and massage therapy sessions delivered to hospitalized adults with cancer. METHODS The study was conducted at an NCI-Designated Comprehensive Cancer Center between February 2018 and October 2019. We assessed depressive symptoms with the Edmonton Symptom Assessment Scale (ESAS) depression item. We also invited patients to provide free-text comments describing their treatment experience. RESULTS Among 1764 patients (61.2% women, 72.7% white), 350 received music therapy and 1414 received massage therapy; music therapy was associated with a 0.4 point greater reduction (95% 0.3 to 0.6, P < 0.001) in the ESAS depression score relative to massage therapy. When analyses were restricted to the 452 (25.6%) patients with moderate-to-severe depressive symptoms (ESAS score ≥ 4), music therapy was associated with a 1.2 point greater reduction (95% CI 0.7 to 1.7, P < 0.001) relative to massage therapy, a clinically meaningful difference. In free-text comments, music therapy was described as energizing, uplifting, and evocative, whereas massage therapy was described as calming and relaxing. CONCLUSION Among hospitalized adult cancer patients, both music therapy and massage therapy were associated with reduced depressive symptoms, but music therapy was associated with a greater reduction than massage therapy.
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Affiliation(s)
- Kevin T Liou
- Integrative Medicine Service, Department of Medicine (K.T.L., K.P., J.S.G., J.J.M.), Memorial Sloan Kettering Cancer Center, New York, New York, USA.
| | - Kathleen A Lynch
- Department of Psychiatry and Behavioral Sciences (K.A.L., T.M.A.), Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ogechi Nwodim
- The Ohio State University College of Medicine (O.N.), Columbus, Ohio, USA
| | - Karen Popkin
- Integrative Medicine Service, Department of Medicine (K.T.L., K.P., J.S.G., J.J.M.), Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jane S Greene
- Integrative Medicine Service, Department of Medicine (K.T.L., K.P., J.S.G., J.J.M.), Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences (K.A.L., T.M.A.), Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joke Bradt
- Department of Creative Arts Therapies (J.B.), College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine (K.T.L., K.P., J.S.G., J.J.M.), Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Deng G, Bao T, Ryan EL, Benusis L, Hogan P, Li QS, Dries A, Konner J, Ahles TA, Mao JJ. Effects of Vigorous Versus Restorative Yoga Practice on Objective Cognition Functions in Sedentary Breast and Ovarian Cancer Survivors: A Randomized Controlled Pilot Trial. Integr Cancer Ther 2022; 21:15347354221089221. [PMID: 35861215 PMCID: PMC9403449 DOI: 10.1177/15347354221089221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Many cancer survivors experience cancer-related cognitive impairment (CRCI).
We conducted a randomized controlled pilot trial of 2 types of yoga practice
and evaluated their effects on participants’ objective cognitive
function. Methods: Sedentary breast or ovarian cancer survivors were randomized to practice
either restorative yoga (with more meditative practice and minimal physical
exertion) or vigorous yoga (with considerable physical exertion and minimal
meditative practice) in 60-minute supervised sessions 3 times a week for
12 weeks, followed by 12 weeks of home practice. We used the NIH Toolbox
Cognition Domain to evaluate participants at baseline, week 12, and week
24. Results: We enrolled 35 participants. For women in the restorative yoga group, overall
cognitive function was statistically significantly improved at weeks 12 and
24 compared to baseline (P = .03 and 0.004; Cohen’s
D = 0.3 and 0.5). Fluid cognitive function also
significantly improved at weeks 12 and 24 (P = .02 and
0.0007; Cohen’s D = 0.3 and 0.6), whereas improvements in
crystallized cognition were not significant. For women in the vigorous yoga
group, significant improvement was only seen in tasks of crystallized
cognition at week 24 (P = .03; Cohen’s
D = 0.5). Between-group comparisons showed that at week 24,
women in the restorative yoga group had significantly higher scores on fluid
cognition tasks. Conclusions: Patients who participated in yoga practice demonstrated improvement in
objective cognitive function over time. Restorative yoga may be more
effective in improving fluid cognitive function at week 24 when compared to
vigorous yoga. These promising findings should be confirmed in definitive
studies. Trial registration: Clinicaltrials.gov; NCT02305498 (Date Registered: December 2, 2014)
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Affiliation(s)
- Gary Deng
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Pasha Hogan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qing S Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Annika Dries
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jason Konner
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tim A Ahles
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Yang M, Liou KT, Garland SN, Bao T, Hung TKW, Li SQ, Li Y, Mao JJ. Acupuncture versus cognitive behavioral therapy for pain among cancer survivors with insomnia: an exploratory analysis of a randomized clinical trial. NPJ Breast Cancer 2021; 7:148. [PMID: 34848737 PMCID: PMC8633385 DOI: 10.1038/s41523-021-00355-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023] Open
Abstract
Pain and insomnia often co-occur and impair the quality of life in cancer survivors. This study evaluated the effect of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on pain severity among cancer survivors with comorbid pain and insomnia. Using data from the CHOICE trial that compared acupuncture versus CBT-I for insomnia among cancer survivors, we analyzed the effect of interventions on pain outcomes in 70 patients with moderate to severe baseline pain. Interventions were delivered over eight weeks. We assessed average pain severity (primary outcome) and pain interference at baseline, week 8, and week 20. We further defined insomnia and pain responders as patients who achieved clinically meaningful improvement in insomnia and pain outcomes, respectively, at week 8. We found that compared with baseline, the between-group difference (-1.0, 95% CI -1.8 to -0.2) was statistically significant favoring acupuncture for reduced pain severity at week 8 (-1.4, 95% CI -2.0 to -0.8) relative to CBT-I (-0.4, 95% CI-1.0 to 0.2). Responder analysis showed that 1) with acupuncture, insomnia responders reported significantly greater pain reduction from baseline to week 4, compared with insomnia non-responders (-1.5, 95% CI -2.7 to -0.3); 2) with CBT-I, pain responders reported significantly greater insomnia reduction at week 8, compared with pain non-responders (-4.7, 95% CI -8.7 to -1.0). These findings suggest that among cancer survivors with comorbid pain and insomnia, acupuncture led to rapid pain reductions, which contributed to a decrease in insomnia, whereas CBT-I had a delayed effect on pain, possibly achieved by insomnia improvement.
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Affiliation(s)
- Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Kevin T Liou
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Sheila N Garland
- Department of Psychology and Discipline of Oncology, Memorial University, 232 Elizabeth Avenue, St. John's, NL A1B 3×9, Canada
| | - Ting Bao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Tony K W Hung
- Department of Medicine, Division of Solid Tumor Oncology, Head & Neck Oncology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Susan Q Li
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Jun J Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA.
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Lynch KA, Merdjanoff A, Wilson D, Chiarello L, Hay J, Mao JJ. "Moving Forward": Older Adult Motivations for Group-Based Physical Activity After Cancer Treatment. Int J Behav Med 2021; 29:286-298. [PMID: 34585330 PMCID: PMC8478005 DOI: 10.1007/s12529-021-10018-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/04/2022]
Abstract
Background Engagement in physical activity (PA) post-treatment can improve health outcomes and quality of life among cancer survivors. The purpose of this study is to explore United States (US) older adult cancer survivors’ (OACS) reasons for engaging in group-based PA classes, to identify themes supporting exercise motivations in the context of cancer recovery. Methods OACS participating in a fitness program at a large US comprehensive cancer center completed semi-structured interviews. Transcripts were analyzed using modified grounded theory, and demographic data were analyzed descriptively. Results Modified grounded theory analysis (n = 25; age M = 70.92, SD = 10.82; 9 cancer types) identified individual rationales for exercise grounded in collective experience. Participants’ internal motivations for PA are shaped by the desire for control over an uncertain future and post-treatment body, obtained by literally “moving forward” post-cancer; this is supported by external motivations for social connections that present a positive model of survivorship, within a setting that instills confidence and safety. Conclusions Exercise can be a way for older adults to tap into internal and external motivations that support cancer survivorship. Interventions that make explicit connections between exercise and cancer recovery, facilitate interpersonal interaction, and promote a sense of safety may be the most effective. The concepts identified in this study can inform the development of future interventions to improve long-term behavior change among OACS and evaluate existing PA programs.
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Affiliation(s)
- Kathleen A Lynch
- Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA. .,Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA.
| | - Alexis Merdjanoff
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA
| | - Donna Wilson
- Department of Integrative Medicine, Memorial Sloan Kettering Cancer Center, 1429 1st Avenue, New York, NY, 10021, USA
| | - Lauren Chiarello
- Department of Integrative Medicine, Memorial Sloan Kettering Cancer Center, 1429 1st Avenue, New York, NY, 10021, USA
| | - Jennifer Hay
- Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Jun J Mao
- Department of Integrative Medicine, Memorial Sloan Kettering Cancer Center, 1429 1st Avenue, New York, NY, 10021, USA
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Genovese TJ, Gehrman P, Yang M, Li Y, Garland SN, Orlow I, Mao JJ. Genetic Predictors of Response to Acupuncture or Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: An Exploratory Analysis. J Pain Symptom Manage 2021; 62:e192-e199. [PMID: 33716034 PMCID: PMC9297333 DOI: 10.1016/j.jpainsymman.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT Insomnia is a common problem affecting cancer survivors. While effective nonpharmacological treatments are available, it is unknown whether individual genetic characteristics influence treatment response. OBJECTIVES We conducted an exploratory analysis of genetic associations with insomnia treatment response in a randomized trial of cognitive behavioral therapy for insomnia (CBT-I) vs. acupuncture in a heterogeneous group of cancer survivors. METHODS We successfully genotyped 136 participants for 11 genetic variants. Successful treatment response was defined as a reduction in Insomnia Severity Index score of at least eight points from baseline to week 8. We used Fisher exact tests to evaluate associations between genotype and treatment success for each treatment arm, for an alpha level of 0.05 with unadjusted and Holm-Bonferroni-adjusted P-values. RESULTS We found that more carriers of COMT rs4680-A alleles responded to acupuncture compared to the GG carriers (63.6% vs. 27.8%, P = 0.013). More carriers of the NFKB2 rs1056890 CC genotype also responded to acupuncture compared to TT or CT carriers (72.2% vs. 38.9%, P = 0.009). There were no significant differences found between any of the tested gene variants and CBT-I response. None of the results remained statistically significant after adjustment for multiple testing. CONCLUSION In cancer survivors, specific variants in the COMT and NFKB2 genes are potentially associated with response to acupuncture but not to CBT-I. Confirming these preliminary results will help inform precision insomnia management for cancer survivors.
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Affiliation(s)
- Timothy J Genovese
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip Gehrman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - MingXiao Yang
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sheila N Garland
- Departments of Psychology and Oncology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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