The use of opioids to control cancer pain could be insufficient. Interventional techniques such as a cryoablation have emerged as alternatives to opioids.
Objectives
To summarize the current ...scientific evidence on the use of cryoablation to control cancer pain.
Methods
A systematic search of the Scopus, PubMed, and Cochrane databases was performed. All articles published before December 31, 2015, whose title or specified cancer pain control as the endpoint were selected. Articles without s and all nonsystematic reviews were excluded.
Results
22 articles were included: 1 randomized clinical trial (RCT), 2 non‐RCTs, 1 ambispective study, 9 retrospective studies, 2 nonspecified cohort studies, 3 case series, and 4 case reports. 496 patients with 580 lesions were treated. Lung cancer was the most common primary tumor. 82.8% of the metastases were bone metastases, with or without soft tissue involvement. Cryoablation decreased mean pain scores by 62.5% at 24 hours post‐cryoablation, by 70% at 3 months, and by 80.9% at 6 months. Cryoablation was associated with a 44.2% improvement in quality of life after 4 weeks and a 59.6% improvement at 8 weeks. The need for opioids decreased by 75% at 24 hours and by 61.7% at 3 months. Cryoablation in combination with radiotherapy, vertebroplasty, or bisphosphonates appears to be better than cryoablation alone. Complications were highly variable among the studies, but no fatal complications were reported.
Conclusions
Cryoablation is effective in controlling cancer pain without relevant side effects. However, more studies are needed to confirm these results.
Although concurrent chemoradiotherapy (cCRT) increases survival in patients with inoperable, locally advanced non-small-cell lung cancer (NSCLC), there is no consensus on the treatment of elderly ...patients. The aim of this study was to determine the prognostic value of the comprehensive geriatric assessment (CGA) and its ability to predict toxicity in this setting.
We enrolled 85 consecutive elderly (⩾75 years) participants, who underwent CGA and the Vulnerable Elders Survey (VES-13). Those classified as fit and medium-fit by CGA were deemed candidates for cCRT (platinum-based chemotherapy concurrent with thoracic radiation therapy), while unfit patients received best supportive care.
Fit (37%) and medium-fit (48%) patients had significantly longer median overall survival (mOS) (23.9 and 16.9 months, respectively) than unfit patients (15%) (9.3 months, log-rank P=0.01). In multivariate analysis, CGA groups and VES-13 were independent prognostic factors. Fit and medium-fit patients receiving cCRT (n=54) had mOS of 21.1 months (95% confidence interval: 16.2, 26.0). In those patients, higher VES-13 (⩾3) was associated with shorter mOS (16.33 vs 24.3 months, P=0.027) and higher risk of G3-4 toxicity (65 vs 32%, P=0.028).
Comprehensive geriatric assessment and VES-13 showed independent prognostic value. Comprehensive geriatric assessment may help to identify elderly patients fit enough to be treated with cCRT.
Introduction.
Most clinical reports on methadone rotation describe outcomes in hospitalized patients. The few studies that have included outpatients are retrospective. The aim of this study was to ...assess the efficacy and safety of methadone as a second‐line opioid in adult patients with advanced cancer after rotation in routine clinical practice at a palliative care outpatient clinic.
Patients and Methods.
This was a prospective, open‐label study of 145 patients whose treatment was rotated from other opioids to methadone. Informed consent was obtained in all cases. The main outcome measure was change in the variable “worst pain” at day 28. Pain and pain interference were assessed with the Brief Pain Inventory, with side effects evaluated according to the Common Terminology Criteria for Adverse Events version 3.0. Pain levels were evaluated at study entry and at days 3, 7, 9, 14, 21, and 28.
Results.
Rotation to methadone was performed for the following reasons: poor pain control (77.9%), opioid side effects (2.1%), or both (20%). The mean daily oral morphine equivalent dose before rotation was 193.7 mg. The median worst and average pain scores decreased significantly (p < .0001) from baseline to day 28: The median worst pain score decreased from 9 (interquartile range IQR: 8–10) to 6 (IQR: 3–8), and the median average pain score decreased from 6 (IQR: 5–7) to 4 (IQR: 2–5). The proportions of patients with moderate to severe worst and average pain decreased by 30.3% and 47.5%, respectively, by day 28. No increase in opioid toxicity was observed during the study.
Conclusion.
In outpatients with advanced cancer, rotation to methadone as a second‐line opioid was efficacious and safe when using a tiered scheme with close follow‐up by experienced health professionals.
Implications for Practice:
The results of this study, conducted prospectively under real clinical conditions, support the efficacy and safety of oral methadone as a second‐line opioid in ambulatory patients with cancer. Moreover, these findings corroborate previously reported outcomes in retrospective outpatient studies and prospective studies that evaluated inpatient populations. Although more research into methadone rotation strategies is still needed, this study describes a successful tiered scheme of oral methadone rotation that was proven safe and effective during follow‐up.
This prospective, open‐label study of 145 patients with advanced cancer assessed the efficacy and safety of methadone as a second‐line opioid after rotation from other opioids. The main outcome measure, assessed with the Brief Pain Inventory and the CTCAE, was change in the variable “worst pain” at day 28. The median worst pain and average pain scores decreased significantly (30.3% and 47.5%, respectively) at day 28.
Constipation is a common symptom in patients receiving antitumoral treatment. The mechanisms underlying antitumoral agent-induced constipation (ATAIC) are poorly defined. This systematic review aimed ...to analyze and synthesize the available information related to the prevalence, etiology, and treatment of ATAIC.
A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted. The review included human studies written in English, French, or Spanish involving patients with cancer and containing information about the prevalence, etiology, and treatment of ATAIC.
A total of 73 articles were included. The reported prevalence ranged from 0.8% to 86.6%. Six studies reported an ATAIC prevalence of over 50%. The prevalence rates of constipation of grades 3 and 4 ranged between 0 and 11%. The importance of enteric neuronal integrity in gastrointestinal function was reported. The articles with the highest levels of evidence in relation to ATAIC treatment obtained in this systematic review studied treatments with acupuncture, sweet potato, osteopath, probiotics, and moxibustion.
The prevalence of constipation in patients undergoing antitumoral treatment is very diverse. Studies specifically designed to report the prevalence of antineoplastic treatment-induced constipation are needed. The importance of enteric neuronal integrity in gastrointestinal function was described. Thus, neuroprotection could be an area of research for the treatment of chemotherapy-induced gastrointestinal disorders.
QT prolongation is related to the development of ventricular arrhythmias such as Torsade de Pointes (TdP) that can lead to sudden cardiac death. Several drugs used in the treatment of patients with ...advanced cancer may induce QT prolongation due to their interference with cardiac ion channels. Some patients may be at higher risk if predisposing factors are present. Herein we present the case of a patient with advanced cancer under anti-tumor treatment with radical intention that developed a reversible drug-induced QT prolongation when simultaneously treated with methadone, haloperidol and fluoxetine that presented with chest pain and bradycardia. An approach to cancer patients at risk for drug-induced QT prolongation is discussed highlighting the need of a thorough medication review with a special focus in the patient with polypharmacy.
Receiving a diagnosis of lung cancer is an emotional event, not least because it is usually diagnosed at advanced stages with limited life expectancy. Although evidence-based educational, emotional, ...and social interventions exist, they reach few patients and usually when it is too late.
This project will be carried out in a comprehensive center for cancer care and health research, aiming to study the efficacy, costs, and utility of an eHealth ecosystem to meet the psychosocial needs of patients with advanced lung cancer.
We will enroll 76 patients with advanced lung cancer into an eHealth ecosystem of stepped and personalized psychosocial care for 9 months. These patients will be compared with another 76 receiving usual care in a non-inferiority randomized controlled trial. The following main outcomes will be measured every 3 months: emotional distress, spirituality, demoralization, quality of life, and medication adherence. Secondary outcomes will include symptomatology, health education, cost-utility analyses, usability and satisfaction with the platform, and time to detect emotional needs and provide care. Baseline differences between groups will be measured with the Student t-test or chi-square test, as appropriate. We will then compare the main outcomes between groups over time using multilevel linear models, report effect sizes (Hedges' g), and assess non-inferiority. The cost-utility of both interventions will be considered in terms of quality adjusted life years and quality of life given the costs of providing each treatment.
This randomized controlled trial should provide new evidence on the efficacy and cost-utility of an eHealth ecosystem to deliver personalized and timely psychosocial care to patients with advanced lung cancer.
ClinicalTrials.gov ID “NCT05497973”.
•Around 60% of patients with advanced lung cancer suffer clinically significant psychological distress•First digital early stepped psychosocial care tailored to cover lung cancer patients’ necessities•The ecosystem is based on four levels: distress monitoring, health literacy peer support and online psychotherapy•This eHealth psychosocial program may offer a compliant and cost-effective person-centred care
Approximately 20% of established malignant bowel obstruction (MBO) patients do not respond to pharmacological treatment. In these cases, venting percutaneous radiologic gastrostomy (VPRG) may be ...useful. Existing evidence is based on retrospective studies with methodological limitations. The purpose of this study is to describe safety and effectiveness for symptom control after VPRG placement in a prospective cohort of MBO patients.
Complications of VPRG placement, symptom control, destination on discharge and survival were analysed.
Twenty-one patients were included, 13 (61.9%) of whom were women. Mean age was 62.7 years (36-85). Local pain (n=8, 38.1%) and peristomal leakage (n=4, 19%) were the most frequent minor complications. No major complications occurred. Nausea and vomiting were relieved in most patients (n=20, 95.2%) after VPRG, and small quantities of liquid diet were introduced to these patients. Median time to death after VPRG was 13 days (IQR 8.6-17.4). Thirteen patients (61.9%) were discharged, with seven of them (33.3%) returning home.
When pharmacological treatment fails, the use of VPRG in MBO patients may be feasible, safe and effective.
The goal of this study is to describe the development of a new tool, the Psychosocial and Spiritual Needs Evaluation scale Instrumento de Evaluación de Necesidades Psicosociales y Espirituales del ...Enfermo al Final de Vida (ENP-E), designed to assess the psychosocial needs of end-of-life (EOL) patients. And, secondarily, to describe the face validity and psychometric properties of this instrument in the Spanish-speaking context.
The scale was developed through a seven-stage process: (1) literature review; (2) expert panel establishment; (3) discussion and agreement on the most relevant dimensions of psychosocial care; (4) description of key indicators and consensus-based questions to evaluate such dimensions; (5) assessment of the scale by external palliative care (PC) professionals; (6) evaluation by patients; and (7) analysis of scale's psychometrics properties. To assess content validity, 30 PC professionals and 20 patients evaluated the questionnaire. To determine psychometric properties, 150 participants completed these scales: the ENP-E; the Hospital Anxiety and Depression Scale; item 15 from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative; and the Distress Thermometer.
All respondents evaluated the tool as "excellent." In terms of construct validity, the internal consistency (Cronbach's alpha = 0.74) and temporal stability (test-retest r = 0.74, p < 0.1) were both adequate. On the factorial analysis, four factors (emotional-wellbeing, social support, spiritual, and information) explained 58.4% of the variance. This scale has a sensitivity of 76.3%, specificity of 78.9%, and the cutoff is 28.
To provide quality PC to EOL patients, it is essential to determine the psychosocial factors that influence well-being. This requires the use of reliable and specific instruments. The ENP-E is a novel tool that provides a systematic, holistic assessment of the psychosocial needs of EOL patients. Its routine use would allow clinicians to monitor such needs over time. This would, in turn, permit comprehensive, highly individualized interventions to improve effective PC approach.
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