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Nicholson G, Carlson KB, Hernandez RK, Schenfeld J, Cadieux B, Henry D, De Sousa Barbosa VJ, Saad H. Treatment Patterns of Bone-targeting Agents Among Solid Tumor Patients With Bone Metastases: An Analysis of Electronic Health Record Data in the United States From 2014 to 2018. Am J Clin Oncol 2024; 47:177-184. [PMID: 38200688 DOI: 10.1097/coc.0000000000001075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVES This study evaluated real-world treatment patterns of approved bone-targeting agents (BTAs) with various mechanisms of action-pamidronate, zoledronic acid, and denosumab-for the prevention of skeletal-related events in patients with bone metastases (BM) from solid tumors. METHODS Adult patients with BM secondary to solid tumors between January 1, 2014, and December 31, 2018, were identified from the Flatiron Health Oncology Services Comprehensive Electronic Records database and categorized by BTA use and therapy type. Time from diagnosis to initiation, persistence (mean time on treatment), and compliance (≥12 administrations/year) with BTA with up to 4 years of follow-up were examined. RESULTS This study included 27,268 patients with BM (breast cancer, 32.7%; lung cancer, 16.5%; prostate cancer, 17.2%; and other solid tumors, 33.6%); of these, 41.4% initiated denosumab after BM diagnosis; 21.3%, zoledronic acid; 0.6%, pamidronate; and 36.7% had no treatment record. Mean (SD) time to initiation for denosumab or zoledronic acid was 68.6 (157.0) days (denosumab, 70.3 (160.4) days; zoledronic acid, 65.2 [150.2] days). Mean persistence and compliance (first year of treatment) were significantly higher for denosumab than for zoledronic acid (22.0 vs. 14.9 mo [ P <0.0001] and 42.3% vs. 34.8% [ P <0.0001], respectively). Treatment compliance was the highest in patients with breast cancer (denosumab, 48.2%; zoledronic acid, 39.1%). CONCLUSION Real-world BTA treatment patterns in the United States suggest that over one-third of patients with BM secondary to solid tumors remain untreated and less than 50% of the patients received ≥12 administrations/year of BTA therapy.
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Affiliation(s)
- Gina Nicholson
- EpidStrategies, a Division of ToxStrategies, Inc., Katy, TX
| | | | | | | | - Benoit Cadieux
- Department of Medical Affairs, Amgen Inc., Thousand Oaks, CA
| | - David Henry
- University of Pennsylvania, Pennsylvania Hospital, Philadelphia, PA
| | | | - Hossam Saad
- Department of Medical Affairs, Amgen Inc., Thousand Oaks, CA
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Guckenberger M, Dahele M, Ong WL, Sahgal A. Stereotactic Body Radiation Therapy for Spinal Metastases: Benefits and Limitations. Semin Radiat Oncol 2023; 33:159-171. [PMID: 36990633 DOI: 10.1016/j.semradonc.2022.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Progress in biological cancer characterization, targeted systemic therapies and multimodality treatment strategies have shifted the goals of radiotherapy for spinal metastases from short-term palliation to long-term symptom control and prevention of compilations. This article gives an overview of the spine stereotactic body radiotherapy (SBRT) methodology and clinical results of SBRT in cancer patients with painful vertebral metastases, metastatic spinal cord compression, oligometastatic disease and in a reirradiation situation. Outcomes after dose-intensified SBRT are compared with results of conventional radiotherapy and patient selection criteria will be discussed. Though rates of severe toxicity after spinal SBRT are low, strategies to minimize the risk of vertebral compression fracture, radiation induced myelopathy, plexopathy and myositis are summarized, to optimize the use of SBRT in multidisciplinary management of vertebral metastases.
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Ibrahim M, Cardiff K, Nhan I, Savarimuthu V, Yao K, Kasai S, Posel N, Soicher J. Development of an evidence-based educational resource in oncology: 'Living safely with bone metastases'. PEC INNOVATION 2022; 1:100064. [PMID: 37213771 PMCID: PMC10194355 DOI: 10.1016/j.pecinn.2022.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/14/2022] [Accepted: 07/11/2022] [Indexed: 05/23/2023]
Abstract
Objective To create an evidence-based patient education resource to better support cancer patients with bone metastases in carrying out safe movements during activities of daily living, to maintain their bone health and reduce the risk of fractures. Methods A quality improvement project was conducted in three phases: Development of the Resource, Preliminary Feedback and Revision, and French Canadian Translation. Results The educational resource Living Safely with Bone Metastases focuses on safe movement, activities of daily living, and exercise, organized within the sections Move with care, Stay safe in different environments and Follow an exercise program prescribed by a physiotherapist. Translation yielded a Canadian French version Vivre en toute sécurité avec des métastases osseuses. Conclusion Living Safely with Bone Metastases is an accessible online and paper resource for patients and healthcare professionals, in order to promote ongoing disease management of individuals with bone metastases. Innovation Cancer patients with bone metastases are at high risk of pathological fractures however resources on fracture prevention are lacking. Living Safely with Bone Metastases is an innovative health education resource that fills an important gap in oncology practice and has the potential to reduce the occurrence of fractures.
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Affiliation(s)
- Marize Ibrahim
- Oncology Physiotherapy, Hope and Cope, Segal Cancer Centre, Jewish General Hospital, 3755 Côte Sainte Catherine, Montreal H3T 1E2, Canada
| | - Katrina Cardiff
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal H3G 1Y5, Canada
| | - Isabelle Nhan
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal H3G 1Y5, Canada
| | - Vanissa Savarimuthu
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal H3G 1Y5, Canada
| | - Kathryn Yao
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal H3G 1Y5, Canada
| | - Shie Kasai
- Patient Education Office, McGill University Health Centre, 4920 de Maisonneuve West, Suite 301, Montreal H3Z 1N1, Canada
| | - Nancy Posel
- Patient Education Office, McGill University Health Centre, 4920 de Maisonneuve West, Suite 301, Montreal H3Z 1N1, Canada
| | - Judith Soicher
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal H3G 1Y5, Canada
- Corresponding author at: School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Room D39, Canada.
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Jakob A, Zahn MO, Nusch A, Werner T, Schnell R, Frank M, Hamm N, Däßler KU, Losem C, Welslau M, Hoevel P, Potthoff K. Real-world patient-reported outcomes of breast cancer or prostate cancer patients receiving antiresorptive therapy for bone metastases: Final results of the PROBone registry study. J Bone Oncol 2022; 33:100420. [PMID: 35340302 PMCID: PMC8941198 DOI: 10.1016/j.jbo.2022.100420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/15/2022] [Accepted: 02/27/2022] [Indexed: 11/27/2022] Open
Abstract
Background In breast cancer and prostate cancer patients, bone metastases (BM) present the main cause of morbidity and often cause debilitating pain, impaired functioning and subsequent deterioration of quality of life (QoL). The management of BM is still challenging. Maintenance or improvement in QoL is the main goal of treatment. Antiresorptive treatment, such as denosumab and bisphosphonates, can help to reduce the frequency of skeletal complications, to control bone pain and potentially to improve QoL. The optimal time point for initiation of antiresorptive therapy is still discussed controversially. In patients with BM, bone pain can be used as a surrogate measure of QoL. However, limited data exist on health-related QoL in patients with BM under antiresorptive treatment. The PROBone registry study evaluated complaints and limitations caused by BM of breast and prostate cancer patients using patient-reported outcomes (PROs) in real-world in Germany. Methods Between 2014 and 2019, 500 patients with histological confirmation of advanced breast or prostate cancer, diagnosed with BM at start of their first antiresorptive therapy were prospectively enrolled in 65 outpatient-centers specialized in medical oncology across Germany. Changes of QoL were assessed monthly from baseline until a maximum of 12 months using the validated pain score Functional Assessment of Cancer Therapy Quality of Life Measurement in patients with bone pain (FACT-BP) supplemented by questions on general pain and on the impact of time spent for treatment of illness on patients' daily activities. Statistical analysis was performed descriptively by relative and absolute frequencies. Results In total, 486 patients were eligible for final analysis, of these 310 were diagnosed with breast cancer and 176 with prostate cancer. Median age was 67 years for breast cancer and 76 years for prostate cancer patients. 79.7% of breast cancer and 59.7% of prostate patients started antiresorptive treatment within 3 months after diagnosis of BM. More than 75% of patients suffered from bone pain at study inclusion. In total 52% of breast cancer patients and 47.9% of prostate cancer patients reported to take pain medication during the observation period. In breast and prostate cancer patients an initial pain reduction after start of BTA was observed: General pain and bone pain levels as well as the median FACT-BP score showed a constant improvement over the first months and maintained stable at a constant level afterwards. Subgroup analysis showed that patients without pain at baseline reported distinctly better FACT-BP scores throughout the whole observation period than patients with pain at baseline. Looking at time-stress (M)-scores, younger breast cancer patients (<65 years) showed highest burden especially during the first months of treatment. Conclusions Our results indicate overall good adherence to current guideline recommendation, with most breast and prostate cancer patients starting antiresorptive therapy within the first 3 months after diagnosis of BM. This point gains even more importance as our data support current recommendations by ESMO guidelines as well as by German evidence-based S3-guidelines for diagnosis and treatment of breast and prostate cancer to initiate bone-targeted agents (BTA) as soon as BM are diagnosed, to keep pain levels at the lowest level possible, to minimize the debilitating effects of metastatic bone pain and maintain a good QoL. Bone pain management by an early use of BTA following BM diagnosis might improve patient care.
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Affiliation(s)
- Andreas Jakob
- Tumor Center Aarau, Hirslanden Medical Center, Switzerland
| | | | - Arnd Nusch
- Practice for Hematology and Internal Oncology, Ratingen, Germany
| | | | - Roland Schnell
- Practice for Internal Oncology and Hematology, Frechen, Germany
| | | | | | | | - Christoph Losem
- Medical Care Center for Oncology and Hematology, Neuss, Germany
| | - Manfred Welslau
- Medical Care Center at Hospital Aschaffenburg GmbH, Aschaffenburg, Germany
| | - Petra Hoevel
- Medical Care Center at General Hospital Celle, Celle, Germany
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Abstract
Recent decades have demonstrated significant strides in cancer screening, diagnostics and therapeutics. As such there have been dramatic changes in survival following a diagnosis of cancer.
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Affiliation(s)
- Matthew R D Brown
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | | | - David J Magee
- The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.
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Han X, Huang R, Meng T, Yin H, Song D. The Roles of Magnetic Resonance-Guided Focused Ultrasound in Pain Relief in Patients With Bone Metastases: A Systemic Review and Meta-Analysis. Front Oncol 2021; 11:617295. [PMID: 34458131 PMCID: PMC8387143 DOI: 10.3389/fonc.2021.617295] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/19/2021] [Indexed: 01/06/2023] Open
Abstract
Objective Cancer pain, the most common skeleton-related event of bone metastases, significantly disturbs patients' life. MRI-guided focused ultrasound (MRgFUS) is a therapeutic option to relieve pain; however, its efficacy and safety have not been fully explored. Therefore, we aim to conduct a meta-analysis on studies reporting MRgFUS for patients with bone metastases. Methods Randomized controlled trials (RCT) and non-RCTs on MRgFUS treatment for patients with bone metastases were collected using PubMed, MEDLINE In-Process (US National Library of Medicine), National Institutes of Health (US National Library of Medicine), Embase (Elsevier), Web of Science, CINAHL, and the Cochrane Library between August 2007 and September 2019. Data on quantitative pain assessment before/after MRgFUS, response rate, and complication were extracted and analyzed. Results Fifteen eligible studies with 362 patients were selected in this meta-analysis. The average pain score was 6.74 (95% CI: 6.30-7.18) at baseline, 4.15 (95% CI: 3.31-4.99) at 0-1 week, 3.09 (95% CI: 2.46-3.72) at 1-5 weeks, and 2.28 (95% CI: 1.37-3.19) at 5-14 weeks. Compared with baseline, the pain improvement at 0-1 week was 2.54 (95% CI: 1.92-3.16, p < 0.01), at 1-5 weeks was 3.56 (95% CI: 3.11-4.02, p < 0.01), and at 5-14 weeks was 4.22 (95% CI: 3.68-4.76, p < 0.01). Change from baseline in OMEDD at 2 weeks after treatment was -15.11 (95% CI: -34.73, 4.50), at 1 month after treatment was -10.87 (95% CI: -26.32, 4.58), and at 3 months after treatment was -5.53 (95% CI: -20.44, 9.38). The overall CR rate was 0.36 (95% CI: 0.24-0.48), PR rate was 0.47 (95% CI: 0.36-0.58), and NR rate was 0.23 (95% CI: 0.13-0.34). Among 14 studies including 352 patients, 93 (26.4%) patients with minor complications and 5 (1.42%) patients with major complications were recorded. Conclusion This meta-analysis identifies MRgFUS as a reliable therapeutic option to relieve cancer pain for patients with metastatic bone tumors with controllable related complications.
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Affiliation(s)
- Xiaying Han
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Runzhi Huang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Division of Spine, Department of Orthopedics, Tongji Hospital affiliated to Tongji University School of Medicine, Shanghai, China.,Tongji University School of Medicine, Shanghai, China
| | - Tong Meng
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huabin Yin
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dianwen Song
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Ribi K, Thürlimann B, Schär C, Dietrich D, Cathomas R, Zürrer-Härdi U, von Briel T, Anchisi S, Bohanes P, Blum V, von Burg P, Mannhart M, Caspar CB, von Moos R, Mark M. Quality of life and pain in patients with metastatic bone disease from solid tumors treated with bone-targeted agents- a real-world cross-sectional study from Switzerland (SAKK 95/16). BMC Cancer 2021; 21:182. [PMID: 33607966 PMCID: PMC7893880 DOI: 10.1186/s12885-021-07903-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Bone-targeted agents (BTAs) are widely used in the management of patients with bone metastases from solid tumors. Knowledge of the impact of their routine care use on patient-reported pain and bone pain-related quality of life (QoL) is limited. Methods This real world, cross-sectional study enrolled patients over a 3-month period through oncologists across Switzerland. Patients were ≥ 18 years, had solid tumors and at least one bone metastasis, and received routine care for bone metastases. Physicians provided data on BTA-related practices, risk of bone complications and BTA regimen. Patients completed questionnaires about pain (BPI-SF), general and bone pain-related QoL (FACT-G, FACT-BP) and treatment satisfaction (FACIT-TS-G). Results Eighteen sites recruited 417 patients. Based on the FACT-BP, 42% of the patients indicated not having bone pain. According to the BPI-SF, 28% reported no, 43% mild, 14% moderate, and 15% severe pain, respectively. Patients not treated with a BTA had better overall QoL (FACT-G: p = 0.031) and bone pain-related QoL (FACT-BP, p = 0.007) than those treated with a BTA. All pain and other QoL scales did not differ between groups. Patients perceived at ‘low risk of bone complications’ by their physician not receiving a BTA reported less pain and better QoL than those considered at ‘low risk’ but receiving BTA treatment or those considered at ‘high risk’ regardless of BTA treatment. Overall satisfaction with the treatment was good; almost 50% of patients reporting that they were completely satisfied. Conclusions Overall, pain and QoL did not differ according to BTA treatment or physicians’ risk perception. Patient with low risks not receiving BTA treatment reported least pain and highest QoL scores. These results may suggest that treating physicians assess bone complication risk appropriately and treat patients accordingly, but they need to be confirmed by objective determination of longitudinal skeletal complication risk. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07903-8.
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Affiliation(s)
- Karin Ribi
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland.
| | | | - Corinne Schär
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Daniel Dietrich
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | | | | | | | | | - Pierre Bohanes
- Centre de Chimiothérapie Anti-Cancéreuse, Lausanne, Switzerland
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Abstract
Bone is the most frequent site for metastasis for many cancers, notably for tumours originating in the breast and the prostate. Tumour cells can escape from the primary tumour site and colonize the bone microenvironment. Within the bone, these disseminated tumour cells, as well as those arising in the context of multiple myeloma, may assume a state of dormancy, remaining quiescent for years before resuming proliferation and causing overt metastasis, which causes bone destruction via activation of osteoclast-mediated osteolysis. This structural damage can lead to considerable morbidity, including pain, fractures and impaired quality of life. Although treatment of bone metastases and myeloma bone disease is rarely curative, disease control is often possible for many years through the use of systemic anticancer treatments on a background of multidisciplinary supportive care. This care should include bone-targeted agents to inhibit tumour-associated osteolysis and prevent skeletal morbidity as well as use of appropriate local treatments such as radiation therapy, orthopaedic surgery and specialist palliative care to minimize the impact of metastatic bone disease on physical functioning. In this Primer, we provide an overview of the clinical features, the pathophysiology and the specific treatment approaches to prevent and treat bone metastases from solid tumours as well as myeloma bone disease.
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Stopeck A, Brufsky A, Kennedy L, Bhatta S, Bhowmik D, Buchanan J, Despiegel N, Hechmati G. Cost-effectiveness of denosumab for the prevention of skeletal-related events in patients with solid tumors and bone metastases in the United States. J Med Econ 2020; 23:37-47. [PMID: 31364885 DOI: 10.1080/13696998.2019.1651122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims: Bone complications (also known as skeletal-related events [SREs]) pose significant health and financial burdens on patients with bone metastases. Denosumab demonstrated superiority over zoledronic acid in delaying the time to first SRE. This study examined the lifetime cost-effectiveness of denosumab vs zoledronic acid from both US payer and societal perspectives.Methods: This analysis used a lifetime Markov model and included patients with breast cancer, prostate cancer, and other solid tumors and bone metastases. The societal perspective included direct medical, direct non-medical, and indirect costs associated with denosumab and zoledronic acid; the payer perspective included direct medical costs only. Bone complication rates for each tumor type were estimated from three pivotal phase 3 studies and modified to reflect real-world incidence.Results: From a societal perspective, compared with zoledronic acid, denosumab use resulted in an incremental cost of $9,043, an incremental benefit of 0.128 quality-adjusted life-years (QALYs), a lifetime cost per QALY of $70,730, and a net monetary benefit (NMB) of $10,135 in favor of denosumab. Direct drug costs for denosumab ($28,352) were higher than zoledronic acid/untreated ($578), but were offset by reduced costs associated with bone complications. From a payer perspective, denosumab use was associated with an incremental cost of $13,396, and an incremental benefit of 0.128 QALYs, for a cost of $104,778 per QALY and an NMB of $5,782 in favor of denosumab.Limitations: Some model inputs had limited information and, given that the results may be sensitive to changes in these inputs, our findings should be interpreted within the context of the data inputs and modeling assumptions used in the analysis.Conclusions: Denosumab is a cost-effective option to prevent bone complications in patients with solid tumors when considering both payer and broader societal perspectives.
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Affiliation(s)
- Alison Stopeck
- Division of Hematology/Oncology, Stony Brook Cancer Center, Stony Brook, NY, USA
| | - Adam Brufsky
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Sumi Bhatta
- Global Health Economics, Amgen Inc, Thousand Oaks, CA, USA
| | | | | | | | - Guy Hechmati
- Global Health Economics, Amgen Inc, Thousand Oaks, CA, USA
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10
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Barnadas A, Muñoz M, Margelí M, Chacón JI, Cassinello J, Antolin S, Adrover E, Ramos M, Carrasco E, Jimeno MA, Ojeda B, González X, González S, Constenla M, Florián J, Miguel A, Llombart A, Lluch A, Ruiz-Borrego M, Colomer R, Del Barco S. BOMET-QoL-10 questionnaire for breast cancer patients with bone metastasis: the prospective MABOMET GEICAM study. J Patient Rep Outcomes 2019; 3:72. [PMID: 31865481 PMCID: PMC6925605 DOI: 10.1186/s41687-019-0161-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/15/2019] [Indexed: 11/18/2022] Open
Abstract
Background Bone metastasis (BM) is the most common site of disease in metastatic breast cancer (MBC) patients. BM impacts health-related quality of life (HRQoL). We tested prospectively the psychometric properties of the Bone Metastasis Quality of Life (BOMET-QoL-10) measure on MBC patients with BM. Methods Patients completed the BOMET-QoL-10 questionnaire, the Visual Analogue Scale (VAS) for pain, and a self-perceived health status item at baseline and at follow-up visits. We performed psychometric tests and calculated the effect size of specific BM treatment on patients´ HRQoL. Results Almost 70% of the 172 patients reported symptoms, 23.3% experienced irruptive pain, and over half were receiving chemotherapy. BOMET-QoL-10 proved to be a quick assessment tool performing well in readability and completion time (about 10 min) with 0–1.2% of missing/invalid data. Although BOMET-QoL-10 scores remained fairly stable during study visits, differences were observed for patient subgroups (e.g., with or without skeletal-related events or adverse effects). Scores were significantly correlated with physician-reported patient status, patient-reported pain, symptoms, and perceived health status. BOMET-QoL-10 scores also varied prospectively according to changes in pain intensity. Conclusions BOMET-QoL-10 performed well as a brief, easy-to-administer, useful, and sensitive HRQoL measure for potential use for clinical practice with MBC patients. Trial registration NCT03847220. Retrospectively registered on clinicaltrials.gov (February the 20th 2019).
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Affiliation(s)
- A Barnadas
- Medical Oncology Department, Hospital de la Santa Creu I Sant Pau, C/Sant Antoni Maria Claret, 167, 08041, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.
| | - M Muñoz
- Medical Oncology Department, Hospital Clinic i Provincial, C/ Villarroel n° 170, 08036, Barcelona, Spain
| | - M Margelí
- Medical Oncology Department, Ctra, Hospital Germans Trias i Pujol, Canyet s/n, 08916 Badalona, Barcelona, Spain
| | - J I Chacón
- Medical Oncology Department, Hospital Virgen de la Salud, Avda. Barber, n° 30, 45005, Toledo, Spain
| | - J Cassinello
- Medical Oncology Department, Hospital General de Guadalajara, C/ Donantes de Sangre, s/n, 19002, Guadalajara, Spain
| | - S Antolin
- Medical Oncology Department, Complejo Hospitalario U. A Coruña, C/ Xubias de Abaixo s/n, 15006, A Coruña, Spain
| | - E Adrover
- Medical Oncology Department, Complejo Hospitalario Universitario de Albacete, C/ Hermanos Falcó n° 37, 02006, Albacete, Spain
| | - M Ramos
- Medical Oncology Department, Centro Oncológico de Galicia, C/ Doctor Camilo Veiras s/n, 15009, A Coruña, Spain
| | - E Carrasco
- GEICAM (Spanish Breast Cancer Group), Avda. de los Pirineos n° 7, 28703 San Sebastián de los Reyes, Madrid, Spain
| | - M A Jimeno
- GEICAM (Spanish Breast Cancer Group), Avda. de los Pirineos n° 7, 28703 San Sebastián de los Reyes, Madrid, Spain
| | - B Ojeda
- Medical Oncology Department, Hospital de la Santa Creu I Sant Pau, C/Sant Antoni Maria Claret, 167, 08041, Barcelona, Spain
| | - X González
- Medical Oncology Department, Hospital General de Catalunya, Carrer de Pedro Pons 1, 08195, Sant Cugat del Valles, Barcelona, Spain
| | - S González
- Medical Oncology Department, Hospital Mutua de Terrassa, Barcelona, Plaza del Dr. Robert n°5, 08221, Terrassa, Barcelona, Spain
| | - M Constenla
- Medical Oncology Department, Complejo Hospitalario De Pontevedra, Calle Mourente s/n, 36071, Pontevedra, Galicia, Spain
| | - J Florián
- Medical Oncology Department, Hospital Comarcal de Barbastro, Ctra. Nacional 240, s/n, 22300, Barbastro, Huesca, Spain
| | - A Miguel
- Medical Oncology Department, Hospital Althaia Manresa, C/ Dr. Joan Soler, s/n, 08243, Manresa, Barcelona, Spain
| | - A Llombart
- Medical Oncology Department, Hospital Arnau de Vilanova, Avda. Alcalde Rovira Roure, 80, 25198, Lleida, Spain
| | - A Lluch
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.,Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - M Ruiz-Borrego
- Medical Oncology Department, Hospital Virgen del Rocío, Avda. Manuel Siurot, s/n, 41013, Sevilla, Spain
| | - R Colomer
- Medical Oncology Department, Hospital Universitario La Princesa, C/ Diego de León n° 62, 28006, Madrid, Spain
| | - S Del Barco
- Medical Oncology Department, Hospital U. Josep Trueta, Avda. De França s/n, 17007, Gerona, Spain
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Abstract
Bone is a major site of haematogenous tumour cell spread in renal cell carcinoma (RCC), and most patients with RCC will develop painful and functionally disabling bone metastases at advanced disease stages. The prognosis of these patients is generally poor and the treatment is, therefore, aimed at palliation. However, RCC-associated bone metastases can be curable in select patients. Current data support a multimodal management strategy that includes wide resection of lesions, radiotherapy, systemic therapy, and other local treatment options, which can improve quality of life and survival. Nevertheless, the optimal approach for metastatic bone disease in RCC has not yet been defined and practical recommendations are rare. To improve the management and outcomes of patients with RCC and bone metastases, the International Kidney Cancer Coalition and the interdisciplinary working group on renal tumours of the German Cancer Society convened a meeting of experts with a global perspective to perform an unstructured review and elaborate on current treatment strategies on the basis of published data and expertise. The panel formulated recommendations for the diagnosis and treatment of patients with RCC and metastasis to the bone. Furthermore, the experts summarized current challenges and unmet patient needs that should be addressed in the future. In this Expert Consensus, Grünwald et al. summarize their recommendations for the diagnosis and treatment of patients with renal cell carcinoma and metastasis to the bone. They also outline current challenges and unmet patient needs that should be addressed in the future.
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Walz S, Maas M, Stenzl A, Todenhöfer T. Bone Health Issues in Patients with Prostate Cancer: An Evidence-Based Review. World J Mens Health 2019; 38:151-163. [PMID: 31081297 PMCID: PMC7076314 DOI: 10.5534/wjmh.190044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/23/2019] [Indexed: 01/13/2023] Open
Abstract
Bone health in prostate cancer patients represents a prerequisite for acceptable quality of life and optimal outcome of this disease. The major threat for bone health in prostate cancer displays cancer treatment induced bone loss as well as the development of bone metastases. In recent years, several new pharmaceuticals targeting bone metabolism such as denosumab or androgen pathway targeting drugs (abiraterone acetate and enzalutamide) have been approved for the treatment of progressive disease aiming to interrupt the vicious circle of bone metastasis and aberrant bone resorption. This development raised the awareness of the pivotal role of bone health in prostate cancer and introduced (symptomatic) skeletal related events as an important end point in recent clinical trials. Bone targeted drugs have become standard of care in patients with metastatic castration resistant prostate cancer, their role in metastatic hormone sensitive prostate cancer has been discussed controversely. In oligometastatic prostate cancer patients several promising approaches in metastasis directed therapy, including conventional surgery, stereotactic ablative radiation and image-guided single-fraction robotic stereotactic radiosurgery (CyberKnife®) were launched but are not in routine clinical use until now caused by sparse clinical evidence.
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Affiliation(s)
- Simon Walz
- Department of Urology, Eberhard Karls University, Tuebingen, Germany
| | - Moritz Maas
- Department of Urology, Eberhard Karls University, Tuebingen, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University, Tuebingen, Germany
| | - Tilman Todenhöfer
- Department of Urology, Eberhard Karls University, Tuebingen, Germany.
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Abstract
Increasing numbers of those living with and beyond cancer presents a clinical challenge for pain specialists. A large proportion of these patients experience pain secondary to their disease or its treatment, impeding rehabilitation and significantly impacting upon their quality of life. The successful management of this pain presents a considerable challenge. This review aims to outline current concepts and treatment options, while considering nuances within pain assessment and the use of large-scale data to help guide further advances.
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Affiliation(s)
- David Magee
- Department of Pain Medicine, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Sabina Bachtold
- Department of Pain Medicine, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Matthew Brown
- Department of Pain Medicine, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.,Targeted Approaches to Cancer Pain Group, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - Paul Farquhar-Smith
- Department of Pain Medicine, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
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Wakabayashi H, Wakisaka S, Hiraga T, Hata K, Nishimura R, Tominaga M, Yoneda T. Decreased sensory nerve excitation and bone pain associated with mouse Lewis lung cancer in TRPV1-deficient mice. J Bone Miner Metab 2018; 36:274-285. [PMID: 28516219 DOI: 10.1007/s00774-017-0842-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/12/2017] [Indexed: 02/08/2023]
Abstract
Bone pain is one of the most common and life-limiting complications of cancer metastasis to bone. Although the mechanism of bone pain still remains poorly understood, bone pain is evoked as a consequence of sensitization and excitation of sensory nerves (SNs) innervating bone by noxious stimuli produced in the microenvironment of bone metastases. We showed that bone is innervated by calcitonin gene-related protein (CGRP)+ SNs extending from dorsal root ganglia (DRG), the cell body of SNs, in mice. Mice intratibially injected with Lewis lung cancer (LLC) cells showed progressive bone pain evaluated by mechanical allodynia and flinching with increased CGRP+ SNs in bone and augmented SN excitation in DRG as indicated by elevated numbers of pERK- and pCREB-immunoreactive neurons. Immunohistochemical examination of LLC-injected bone revealed that the tumor microenvironment is acidic. Bafilomycin A1, a selective inhibitor of H+ secretion from vacuolar proton pump, significantly alleviated bone pain, indicating that the acidic microenvironment contributes to bone pain. We then determined whether the transient receptor potential vanilloid 1 (TRPV1), a major acid-sensing nociceptor predominantly expressed on SNs, plays a role in bone pain by intratibially injecting LLC cells in TRPV1-deficient mice. Bone pain and SN excitation in the DRG and spinal dorsal horn were significantly decreased in TRPV1 -/- mice compared with wild-type mice. Our results suggest that TRPV1 activation on SNs innervating bone by the acidic cancer microenvironment in bone contributes to SN activation and bone pain. Targeting acid-activated TRPV1 is a potential therapeutic approach to cancer-induced bone pain.
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Affiliation(s)
- Hiroki Wakabayashi
- Department of Biochemistry, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Orthopaedic Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Satoshi Wakisaka
- Department of Oral Anatomy and Developmental Biology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toru Hiraga
- Department of Biochemistry, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Histology and Cell Biology, Matsumoto Dental University, 1780 Gobara‑Hirooka, Shiojiri, Nagano, 399‑0781, Japan
| | - Kenji Hata
- Department of Biochemistry, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Riko Nishimura
- Department of Biochemistry, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Makoto Tominaga
- Okazaki Institute of Integrative Bioscience, National Institutes of Natural Sciences, 5-1 Higashiyama Myodaijicho, Okazaki, Aichi, 444-8787, Japan
| | - Toshiyuki Yoneda
- Department of Biochemistry, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Division of Hematology and Oncology, Indiana University School of Medicine, 980 W Walnut St, Indianapolis, IN, 46202, USA.
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Sert İU, Kilic O, Akand M, Saglik L, Avunduk MC, Erdemli E. The role of vitamin E in the prevention of zoledronic acid-induced nephrotoxicity in rats: a light and electron microscopy study. Arch Med Sci 2018; 14:381-387. [PMID: 29593813 PMCID: PMC5868662 DOI: 10.5114/aoms.2016.60227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/07/2016] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Bisphosphonates are widely used in metastatic cancer such as prostate and breast cancer, and their nephrotoxic effects have been established previously. In this study we aimed to evaluate both the nephrotoxic effects of zoledronic acid (ZA) and the protective effects of vitamin E (Vit-E) on this process under light and electron microscopy. MATERIAL AND METHODS A total of 30 male Sprague-Dawley rats were divided into 3 groups. The first group constituted the control group. The second group was given i.v. ZA of 3 mg/kg once every 3 weeks for 12 weeks from the tail vein. The third group received the same dosage of ZA with an additional i.m. injection of 15 mg Vit-E every week for 12 weeks. Tissues were taken 4 days after the last dose of ZA for histopathological and ultrastructural evaluation. Paller score, tubular epithelial thickness and basal membrane thickness were calculated for each group. RESULTS For group 2, the p-values are all < 0.001 for Paller score, epitelial thickness, and basal membrane thickness. For group 3 (ZA + Vit. E), the p-values are < 0.001 for Paller score, 0.996 for epitelial thickness, and < 0.001 basal membrane thickness. Significant differences were also observed in ultrastructural changes for group 2. However, adding Vit-E to ZA administration reversed all the histopathological changes to some degree, with statistical significance. CONCLUSIONS Administration of ZA had nephrotoxic effects on rat kidney observed under both light and electron microscopy. Concomitant administration of Vit-E significantly reduces toxic histopathological effects of ZA.
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Affiliation(s)
- İbrahim Unal Sert
- Department of Urology, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Ozcan Kilic
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Murat Akand
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Lutfi Saglik
- Department of Urology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Mustafa Cihat Avunduk
- Department of Pathology, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Esra Erdemli
- Department of Histology and Embryology, School of Medicine, Ankara University, Ankara, Turkey
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Brook N, Brook E, Dharmarajan A, Dass CR, Chan A. Breast cancer bone metastases: pathogenesis and therapeutic targets. Int J Biochem Cell Biol 2018; 96:63-78. [DOI: 10.1016/j.biocel.2018.01.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/31/2017] [Accepted: 01/04/2018] [Indexed: 01/03/2023]
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Corli O, Roberto A, Bennett MI, Galli F, Corsi N, Rulli E, Antonione R. Nonresponsiveness and Susceptibility of Opioid Side Effects Related to Cancer Patients' Clinical Characteristics: A Post-Hoc Analysis. Pain Pract 2018; 18:748-757. [PMID: 29220110 DOI: 10.1111/papr.12669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/08/2017] [Accepted: 11/23/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The response to opioids is not always positive in cancer patients. A considerable proportion of patients do not respond (nonresponders [NRs]) or experience severe toxicity. The aim of this analysis was to assess the role of demographic characteristics, pain features, comorbidities, and ongoing therapy on the lack of efficacy and on the occurrence of severe adverse drug reactions (ADRs). METHODS This is a post-hoc analysis of a randomized controlled trial that involved 520 patients and aimed to evaluate the efficacy and safety of 4 strong opioids. Patients who presented with unchanged or worsened pain compared to the first visit were considered to be NRs. As for toxicity, severe ADRs with an incidence of greater than 10% were evaluated. Univariate and multivariate logistic models were used. RESULTS 498 patients were analyzed. Liver metastases and breakthrough pain (BTP) were found to increase the risk for nonresponse. Conversely, a high basal pain intensity significantly decreased the same risk. Constipation risk was worsened by previous weak opioid therapy but decreased with aging and with the use of transdermal opioids. Risk for drowsiness was aggravated by bone metastases and concomitant treatment with anticoagulant, antidiabetic, and central nervous system drugs. Risk for confusion increased with antidiabetics, antibiotics, and previous weak opioid therapy but decreased when fentanyl was used. Occurrence of nausea increased in patients with a high rating on the Karnofsky Performance Status Index. Risk for xerostomia was higher in women and in patients treated with antidiabetic or long-term opioids. CONCLUSIONS Several clinical variables are correlated with opioid response in cancer patients. In particular, the presence of BTP is associated with nonresponse. Additionally, patients who receive polypharmacological therapy are more likely to experience opioid adverse events.
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Affiliation(s)
- Oscar Corli
- Pain and Palliative Care Research Unit, Oncology Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Anna Roberto
- Pain and Palliative Care Research Unit, Oncology Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, U.K
| | - Francesca Galli
- Methodology for Clinical Research Laboratory, Oncology Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Nicole Corsi
- Pain and Palliative Care Research Unit, Oncology Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Eliana Rulli
- Methodology for Clinical Research Laboratory, Oncology Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Raffaella Antonione
- Struttura Operativa Complessa di Medicina, Ospedale San Polo, AAS 2 Bassa Friulana Isontina, Monfalcone, Italy
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Brown M, Farquhar-Smith P. Pain in cancer survivors; filling in the gaps. Br J Anaesth 2017; 119:723-736. [DOI: 10.1093/bja/aex202] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Hang LH, Xu ZK, Wei SY, Shu WW, Luo H, Chen J. Spinal SET7/9 may contribute to the maintenance of cancer-induced bone pain in mice. Clin Exp Pharmacol Physiol 2017; 44:1001-1007. [PMID: 28557056 DOI: 10.1111/1440-1681.12789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/14/2017] [Accepted: 05/17/2017] [Indexed: 11/29/2022]
Abstract
Cancer-induced bone pain (CIBP) profoundly influences patients' quality of life. Exploring the mechanisms by which CIBP occurs is essential for developing efficacious therapies. Various studies have shown that proinflammatory factors were involved in CIBP. SET domain containing lysine methyltransferase 7/9 (SET7/9) may modulate the expression of NF-κB-dependent proinflammatory genes in vitro. However, whether SET7/9 may participate in the maintenance of CIBP remains unknown. In this study, NCTC 2472 cells were inoculated into the intramedullary space of the femur to establish a mouse model of CIBP. Upregulation of spinal SET7/9 expression was related to pain behaviours in tumour-inoculated mice. Intrathecal cyproheptadine (10 or 20 nmol) attenuated response to painful stimuli in a dose-dependent manner. Moreover, there was a concomitant decrease in spinal SET7/9 and RANTES expression. The antinociceptive effects of cyproheptadine were abolished by pre-intrathecal administration of SET 7/9 (0.2 μg) for 30 minutes before intrathecal cyproheptadine (20 nmol) administration. These results indicated that spinal SET7/9 may contribute to the maintenance of CIBP in mice. Hence, targeting of spinal SET7/9 might be a useful alternative therapy for the treatment of CIBP.
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Affiliation(s)
- Li-Hua Hang
- Department of Anesthesiology, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China
| | - Zhen-Kai Xu
- Department of Anesthesiology, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China
| | - Shi-You Wei
- Department of Anesthesiology, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China
| | - Wei-Wei Shu
- Department of Anesthesiology, the Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Hong Luo
- Department of Anesthesiology, the Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jian Chen
- Department of General Surgery, the First People's Hospital of Kunshan affiliated to Jiangsu University, Kunshan, Jiangsu, China
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White P, Arnold R, Bull J, Cicero B. The Use of Corticosteroids as Adjuvant Therapy for Painful Bone Metastases: A Large Cross-Sectional Survey of Palliative Care Providers. Am J Hosp Palliat Care 2016; 35:151-158. [DOI: 10.1177/1049909116683720] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Bone metastases are a common complication in patients with advanced cancer but little is known regarding current practice patterns of palliative care providers when prescribing corticosteroids as adjuvant therapy for painful bone metastases. Objective: To identify current practice patterns among palliative care providers when prescribing corticosteroids for the treatment of painful bone metastases. Methods: A cross-sectional, online survey of the membership of the American Academy of Hospice and Palliative Medicine. Providers were asked to report how frequently they prescribed corticosteroids as adjuvant therapy in patients with painful bone metastases, and to specify the corticosteroid, dosage, treatment duration, and the gastroprotective strategy most frequently utilized. Results: Seven hundred sixty-five participants responded to the survey and 600 (78%) of respondents completed the survey. Ninety-eight percent of respondents completing the survey reported having prescribed corticosteroids as adjuvant pain therapy, and 66% ordered corticosteroids for the majority of their patients with painful bone metastases. Dexamethasone was the most widely prescribed corticosteroid. Eight milligrams divided twice daily was the most common dosage selected and once started, it was usually continued indefinitely. Conclusion: Corticosteroids are commonly prescribed as adjuvant therapy in the treatment of painful bone metastases in patients with limited life expectancy. Dexamethasone is the most commonly selected corticosteroid by American palliative care providers with variation existing among providers regarding dosing schedule, treatment duration, and gastroprotective strategies. Clinical trials comparing a total daily dose of four versus eight milligrams of dexamethasone would be clinically useful to inform evidence-based practice.
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Affiliation(s)
- Patrick White
- BJC Hospice, St Louis, MO, USA
- Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Robert Arnold
- Division of General Internal Medicine, Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Palliative and Supportive Institute, UPMC Health System, Pittsburgh, PA, USA
| | - Janet Bull
- Four Seasons Compassion for Life, Flat Rock, NC, USA
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Hang LH, Li SN, Dan X, Shu WW, Luo H, Shao DH. Involvement of Spinal CCR5/PKCγ Signaling Pathway in the Maintenance of Cancer-Induced Bone Pain. Neurochem Res 2016; 42:563-571. [PMID: 27848062 DOI: 10.1007/s11064-016-2108-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/21/2016] [Accepted: 11/10/2016] [Indexed: 01/24/2023]
Abstract
Cancer-induced bone pain (CIBP) is a challenging medical problem that considerably influences cancer patients' quality of life. Currently, few treatments have been developed to conquer CIBP because of a poor understanding of the potential mechanisms. Our previous work has proved that spinal RANTES (a major ligand for CCR5) was involved in the maintenance of CIBP. In this study, we attempted to investigate whether spinal CCR5 and its downstream PKCγ pathway is involved in the maintenance of CIBP. Inoculation of Walker 256 cells into the tibia could induce a marked mechanical allodynia with concomitant upregulation of spinal CCR5 and p-PKCγ expression from day 6 to day 15 after inoculation. Spinal CCR5 was prominently expressed in microglia, and mechanical allodynia was attenuated by intrathecal injection of DAPTA (a specific antagonist of CCR5) with downregulation of spinal CCR5 and p-PKCγ expression levels at day 15 in inoculated rats. Pre-intrathecal injection of RANTES could reverse the anti-allodynia effects of DAPTA. Intrathecal administration of GF109203X (an inhibitor of PKC) could alleviate mechanical allodynia as well as decrease of spinal p-PKCγ expression level, but no influence on spinal CCR5 level. Our findings suggest that CCR5/PKCγ signaling pathway in microglia may contribute to the maintenance of CIBP in rats.
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Affiliation(s)
- Li-Hua Hang
- Department of Anesthesiology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu, People's Republic of China.
| | - Shu-Na Li
- Department of Otorhinolaryngology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu, People's Republic of China
| | - Xiang Dan
- Department of Anesthesiology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu, People's Republic of China
| | - Wei-Wei Shu
- Department of Anesthesiology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu, People's Republic of China
| | - Hong Luo
- Department of Anesthesiology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu, People's Republic of China
| | - Dong-Hua Shao
- Department of Anesthesiology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu, People's Republic of China
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Minimally invasive techniques for pain palliation in extraspinal bone metastases: a review of conventional methods and cryoablation. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Acquavella J, Ehrenstein V, Schiødt M, Heide-Jørgensen U, Kjellman A, Hansen S, Larsson Wexell C, Herlofson BB, Noerholt SE, Ma H, Öhrling K, Hernandez RK, Sørensen HT. Design and methods for a Scandinavian pharmacovigilance study of osteonecrosis of the jaw and serious infections among cancer patients treated with antiresorptive agents for the prevention of skeletal-related events. Clin Epidemiol 2016; 8:267-72. [PMID: 27499646 PMCID: PMC4959599 DOI: 10.2147/clep.s107270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective Osteonecrosis of the jaw (ONJ) is a recognized complication of potent antiresorptive therapies, especially at the doses indicated to prevent skeletal complications for cancer patients with bone metastases. This paper describes the rationale and methods for a prospective, post-authorization safety study of cancer patients treated with antiresorptive therapies. Methods As part of a comprehensive pharmacovigilance plan, developed with regulators’ input, the study will estimate incidence of ONJ and of serious infections among adult cancer patients with bone metastases treated with denosumab (120 mg subcutaneously) or zoledronic acid (4 mg intravenously, adjusted for renal function). Patients will be identified using routinely collected data combined with medical chart review in Denmark, Sweden, and Norway. Followup will extend from the first administration of antiresorptive treatment to the earliest of death, loss-to-follow-up, or 5 years after therapy initiation. Results will be reported for three treatment cohorts: denosumab-naïve patients, zoledronic acid-naïve patients, and patients who switch from bisphosphonate treatment to denosumab. ONJ cases will be identified in three newly established national ONJ databases and adjudicated by the committee that functioned during the XGEVA® clinical trials program. Conclusion This study will provide a real world counterpart to the clinical trial-estimated risks for ONJ and serious infections for cancer patients initiating denosumab or zoledronic acid. The establishment of ONJ databases in the three Scandinavian countries will have potential benefits outside this study for the elucidation of ONJ risk factors and the evaluation of ONJ treatment strategies.
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Affiliation(s)
- John Acquavella
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Schiødt
- Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Kjellman
- Department of Urology, Karolinska University Hospital; Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Svein Hansen
- Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
| | - Cecilia Larsson Wexell
- Department of Oral and Maxillofacial Surgery, Södra Älvsborg Hospital, Borås, Sweden; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Sven Erik Noerholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Haijun Ma
- Global Biostatistical Science, Amgen Inc., Thousand Oaks, CA, USA
| | | | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
This article updates the 2002 Jamie von Roenn article about "the palliation of commonly observed symptoms in older patients, including pain, neuropsychiatric, gastrointestinal, and respiratory symptoms." When palliative care was last covered in Clinics in Geriatric Medicine, President George W. Bush had just signed the No Child Left Behind Act, Homeland Security was being established, Michael Jackson won the Artist of the Century Award at the American Music Awards, and gas cost $1.61 a gallon. What has changed in the last decade and a half?
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Affiliation(s)
- Thomas J Smith
- Palliative Medicine, Johns Hopkins Medical Institutions, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Blalock 369, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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