Abstracts for MASCC/ISOO Annual Meeting 2019

Effects of cognitive-behavioral therapy for insomnia compared with controls among cancer survivors: a systematic review and meta-analysis of randomized trials

BACKGROUND

Insomnia is highly prevalent among cancer survivors. Meta-analyses examining the effects of cognitive-behavioral therapy for insomnia (CBT-I) among cancer survivors have focused on within-group (pre-to-post-intervention) changes, with calls to better evaluate treatment effects.

OBJECTIVE

To conduct a systematic-review and meta-analysis and evaluate the effects of cognitive-behavioral therapy for insomnia (CBT-I) among cancer survivors, compared with controls, on insomnia.

METHODS

We followed recommendations from the Cochrane Handbook and PRISMA guidelines. We comprehensively searched 8 databases (CINAHL/ClinicalTrials.gov/Cochrane Central/Embase/MEDLINE/PEDro/PsychInfo/Web of Science) and included randomized controlled trials (RCTs) in which adult cancer survivors with clinically-significant insomnia were randomized to CBT-I or control conditions that included usual care, wait-list, attention, or sleep hygiene education only. We designated the primary outcome as end-of-intervention Insomnia Severity Index (ISI) and secondary outcomes included sleep diary parameters, fatigue, and health-related quality of life (HRQL). We analyzed between-group mean differences (MD's), standardized-mean-differences (SMD's), and interpreted results using minimal clinically important difference (MCID) thresholds as endorsed by the American College of Physicians (ACP) or SMD thresholds. We rated evidence certainty using GRADE, facilitated by GRADEpro GDT.

RESULTS

We included 19 RCTs involving 1,803 participants. Participant mean age was 55 and time-since-diagnosis was 2.5 years; 94% were women, mostly survivors of breast cancer. At end-of-intervention, compared with controls, CBT-I improved ISI [MD (95% CI): -4.4 (-5.3, -3.5) points; assessed in 13 trials] that did not reach the MCID threshold (i.e., ≥ 6 points) to suggest that many patients derived clinically-important benefit, but is higher than half of the minimal-important-change (MIC) (i.e., 3-<6 points, including 95% CI), suggesting that an appreciable number of patients derived clinically-important benefit. Subjective sleep diary (assessed in 12 trials) sleep latency, wake after sleep onset, sleep efficiency, fatigue (11 trials), and HRQL (10 trials) were also improved; however, on average, none of the improvements reached their respective MCID or SMD thresholds to suggest that many patients derived clinically-important benefits. In pre-specified subgroup analyses, no intervention or cancer-related characteristics meaningfully changed results. Evidence certainty was low-to-very-low, primarily due to heterogeneity, performance, publication, and/or reporting bias.

CONCLUSION

Compared with controls, CBT-I improved insomnia at an average magnitude greater than half of the MIC but did not reach the MCID threshold, suggesting that an appreciable number, not many, of cancer survivors derived clinically-important benefit. Strategies are needed to improve insomnia for many cancer survivors, particularly among non-responders to first-line CBT-I.

PROTOCOL REGISTRATION

PROSPERO (CRD42022332584).

Dyadic effects of perceived burden and psychological distress on quality of life among Chinese advanced cancer patients and their caregivers

This study aims to explore the mediating role of psychological distress in the association between perceived burden and quality of life (QoL) in advanced cancer patient-caregiver dyads. 241 dyads in five tertiary hospitals in a province were investigated by using the Edmonton Symptom Assessment System, Zarit Burden Interview, the Patient Health Questionnaire-4, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative scores, and the Short Form Health Survey 8. The actor-partner interdependence mediation model (APIMeM), which assesses both individual (actor) and interdependent (partner) effects within dyadic relationships, was employed to analyze how burden and psychological distress interact across dyad members. Analysis was conducted using Mplus v8.0. Regarding the actor effects, the mediating role of psychological distress between perceived burden and QoL was confirmed in advanced cancer patients (B = -0.223, p = 0.001) and their caregivers (B = -0.168, p < 0.001). Regarding the partner effects, there were no significant correlations between caregiver burden and patients' psychological distress (B = 0.015, p = 0.199), patients' QoL (B = 0.113, p = 0.278), or the indirect association of caregiver burden with patients' QoL through psychological distress (B = -0.034, p = 0.259). However, caregivers' psychological distress was positively correlated with patients' symptom burden and mediated the association between patients' symptom burden and caregivers' QoL (B = -0.090, p = 0.001). The study highlights the importance of taking a dyadic perspective in the context of advanced cancer. Dyadic interventions targeting their perceived burden and psychological distress may be beneficial to their QoL.

Quality of life in patients with malignant spinal cord compression: a systematic review

INTRODUCTION

Malignant spinal cord compression (MSCC) is an oncological emergency that may result in a devastating combination of malignancy and disability. Existing quality of life (QoL) questionnaires commonly used in MSCC literature (EORTC QLQ-C30, BM-22, Brief Pain Inventory, and Spine Oncology Study Group Outcomes) may not capture all the commonly reported symptoms and lack specificity to MSCC. The primary objective of this systematic review is to determine unmet patient needs and underreported QoL issues and compile a comprehensive list of QoL issues. The secondary objective of this review is to compile all existing QoL tools and questionnaires and determine whether any QoL issues are not addressed in the existing tools currently used in the literature.

METHODS

A literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases between 1946 and February 6, 2023, to compile all QoL issues and existing questionnaires used to assess QoL in patients with MSCC. All study designs were included given that they discussed QoL issues specific to patients with MSCC.

RESULTS

The results of this systematic review identified the most frequently discussed QoL issues in the literature studying MSCC. This included direct symptoms of MSCC such as back pain, paralysis, limb weakness/numbness, and urinary/bowel incontinence. Indirect symptoms coming from radiotherapy treatment such as dysphagia, painful swallowing, mouth pain, dry mouth, diarrhea, fatigue, and nausea/vomiting were also noted. Other symptoms resulting from corticosteroid treatment included difficulty sleeping, blurring of vision, weight gain, and mood disturbance. Patients also experienced psychosocial issues such as anxiety, depression, emotional distress, low self-esteem, concerns about dependence on others, concerns about getting home, and fear about their prognosis and future.

CONCLUSION

This review highlights the QoL issues specific to patients with MSCC and QoL tools capturing these issues. Relevance of QoL issues identified in this systematic review must be prospectively validated by patients and healthcare professionals with experience in treating MSCC.

Effectiveness of Acupuncture for Relieving Chemotherapy-Induced Bone Marrow Suppression: A Systematic Review with a Meta-analysis and Trial Sequential Analysis

Objective: Bone marrow suppression is the most common side effect of chemotherapy that may lead to discontinuation for treatment pertaining to patients during the therapy course. Acupuncture may relieve bone marrow suppression with regulation hematopoietic function during chemotherapy. The purpose of this study is to evaluate the effectiveness of acupuncture in relieving chemotherapy-induced bone marrow suppression and determine the effects of acupuncture on bone marrow function. Design: PubMed, Embase, Cochrane Library, Medline OVID, CINAHL Plus, Web of Science, and Chinese articles in the Airiti Library and China National Knowledge Infrastructure databases were searched up to February 2023. Publications in both English and Chinese were eligible for inclusion without any limitations on the publication date. Only randomized controlled trials investigating the impact of acupuncture on chemotherapy-induced bone marrow suppression were considered. In addition, a trial sequential analysis was performed to assess the adequacy of the current sample size. Results: A total of 25 studies met the inclusion criteria. Acupuncture was found to increase the levels of hematopoietic cytokine granulocyte colony-stimulating factor (G-CSF) (Hedges' g = 0.79, p < 0.001), as well as stimulate the production of white blood cells (Hedges' g = 0.69, p < 0.001), red blood cells (Hedges' g = 0.37, p = 0.01), neutrophils (Hedges' g = 0.66, p < 0.001), absolute neutrophil count (Hedges' g = 0.89, p = 0.01), hemoglobin (Hb) (Hedges' g = 0.37, p = 0.02), platelets (Hedges' g = 0.50, p < 0.001), and natural killer (NK) cells (Hedges' g = 1.30, p = 0.02). Further, the levels of platelets and NK cells were observed to increase cumulatively over time. Conclusions: Acupuncture may improve chemotherapy-induced bone marrow suppression due to increasing levels of the hematopoietic cytokine, G-CSF and further relieving chemotherapy-induced bone marrow suppression. PROSPERO Registration: This review was registered with PROSPERO (International Prospective Register of Systematic Reviews: CRD42020185813).

Effect of exercise on pancreatic cancer patients during treatment: a scoping review of the literature

INTRODUCTION

Exercise can lower the risk of developing pancreatic cancer and has the potential to improve physical fitness and quality of life in patients with the disease. Yet, the effects of exercise training during pancreatic cancer treatment remain poorly characterized. This hampers the development of evidence-based disease-specific exercise recommendations.

PURPOSE

The purpose of this review was to describe and interpret the effect of exercise on physiological, QoL, and cancer-specific outcomes reported in clinical trials among pancreatic cancer patients during treatment.

METHODS

We conducted a scoping review of the literature according to the framework proposed by Arksey and O'Malley. Articles published prior to December 2021 were retrieved from PubMed, EMBASE, and Scopus. We only included studies that prescribed structured cardiorespiratory and/or resistance exercise in pancreatic cancer patients undergoing treatment.

RESULTS

A total of 662 references were retrieved, of which 24 are included in the review. Twelve articles were randomized controlled trials and 12 were single-arm trials. Overlap in the trials from which data were reported occurred in 16 articles. Moderate intensity exercise was most commonly prescribed, reported feasible for most patients, with potential to enhance physical fitness and QoL. However, exercise adherence and beneficial effects may diminish with disease progression. Limited evidence suggests exercise may benefit cancer-specific outcomes.

CONCLUSION

The results of this review indicate that exercise is feasible during pancreatic cancer treatment. Exercise can also improve physical fitness and QoL. However, its beneficial effects may fall with advanced disease and more rigorous research is needed to develop precise exercise protocols for this population.

Every Story Is Different: Experiences With Body Changes Related to Cancer

One of the important aspects of stakeholder engagement in cancer care and system planning is hearing from individuals who have been diagnosed with cancer about the impact of the diagnosis and treatment on their lives. Hearing stories from the perspectives of cancer survivors offers opportunity to gain new insight and understanding about experiences of being diagnosed and treated for cancer. This article presents ten short narratives about survivors' perspectives on body image and cancer. Each story is unique but, taken together, the picture they create is one of facing challenges, discovering personal resilience, and moving forward to engage in living. The stories emphasize the importance of communication and support from healthcare providers and understanding needs for a person-centered cancer care system.

A pooled analysis of adding olanzapine to guideline-recommended antiemetic therapy for breast cancer patients treated with an anthracycline and cyclophosphamide in prospective and retrospective studies

PURPOSE

As an antipsychotic agent that targets multiple neurotransmitter receptors, olanzapine has been added to antiemetic therapies. For better understanding the application of olanzapine in antiemetic strategies for breast cancer patients who suffered anthracycline plus cyclophosphamide-induced nausea and vomiting, we comprehensively reviewed the antiemetic researches related to olanzapine and pooled-analyzed the results to confirm the efficacy and safety of olanzapine in breast cancer.

METHODS

PubMed, Web of Science, EMBASE, and Cochrane CENTRAL databases were searched from inception through Sep 15, 2021. Both prospective and retrospective studies were eligible. The primary outcomes were complete response (defined as no vomiting and no use of rescue medications) and no nausea rate, and the secondary outcome was treatment-related adverse events.

RESULTS

Four studies with 466 breast cancer patients were identified in the pooled analysis. In the acute period (0-24 h), the olanzapine group had significantly higher rates of complete response (71.3% vs 48.1%, odds ratio [OR]: 2.66, 95% confidence interval [CI] 1.39-5.11, p = 0.003) and no nausea (70.0% vs 43.0%, OR: 3.55, 95% CI 1.76-7.18, p = 0.04) than the placebo group, while in the delayed period, the olanzapine group was also superior to the placebo group in terms of the complete response (82.5% vs 63.3%, OR: 3.81, 95% CI 1.58-9.15, p = 0.003) and no nausea (66.3% vs 51.9%, OR: 2.08, 95% CI 1.03-4.21, p = 0.04) rates. During the overall period in prospective studies, the proportions of complete response (50.0% vs 34.2%, OR: 1.93, p = 0.04) and no nausea (51.3% vs 25.3%, OR: 3.40, p = 0.0006) in the olanzapine group were higher than those in the placebo group.

CONCLUSION

Highly emetogenic chemotherapy breast patients could benefit from olanzapine-contained antiemetic therapy. Furthermore, since the cost is low, olanzapine is worth further clinical application and promotion.

Prevention of Oxaliplatin-Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis

Background

Oxaliplatin-induced peripheral neuropathy (OIPN) has significant clinical impact on the quality of life for cancer patients and is a dose limiting toxicity. Trials studying preventive measures have been inconclusive. A systematic review and meta-analysis were conducted to evaluate the existing pharmacological and non-pharmacological interventions to prevent chronic OIPN.

Methods

Literature databases PubMed-MEDLINE, Embase and Scopus, were searched from 1 Jan 2005 to 08 Aug 2020 and major conferences’ abstracts were reviewed for randomized controlled trials that examined the efficacy of any preventive measure for OIPN. The primary outcome measure was the incidence of chronic OIPN with a preventive intervention as compared to placebo or no intervention. The pooled risk ratio and its 95% confidence interval were calculated using a random effects model. A network meta-analysis was conducted to derive indirect evidence of any preventive effect of an intervention against placebo when original trials compared one intervention against another.

Results

Forty-four trials were analyzed describing 29 chemoprotective interventions, including combinations, and 1 non-pharmacological intervention. Ratings were assessed via a combination of outcomes with quality assessment using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Of the 30 interventions examined, there were six interventions supporting potential efficacy, 11 interventions with insufficient evidence and 13 interventions not recommended.

Conclusion

Currently, there is insufficient certainty to support any intervention as effective in preventing OIPN. Of note is that most of these studies have focused on pharmacological interventions; non-pharmacological interventions are underexplored. Further research on ways to limit OIPN is needed.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225095, Prospero Registration Number: CRD42021225095.

The Balance Between the Effectiveness and Safety for Chemotherapy-Induced Nausea and Vomiting of Different Doses of Olanzapine (10 mg Versus 5 mg): A Systematic Review and Meta-Analysis

INTRODUCTION

The aim of this study is to rigorously review the efficacy and safety of olanzapine in chemotherapy-induced nausea and vomiting (CINV) settings including (1) at 5- and 10-mg doses, and (2) the setting of highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC).

METHODS

Embase, Pubmed, and Cochrane Library were searched from the establishment of the database through April 18, 2021. The primary efficacy endpoints were the rate of complete response (CR; no emesis and no rescue), in the acute (0-24 h post-chemotherapy), delayed (24-120 h post-chemotherapy), and overall (0-120 h post-chemotherapy) phases. The secondary efficacy endpoints were the rates of complete control (CC, no nausea, and no emesis), for each phase. Safety endpoints were the rate of somnolence, as assessed by Common Terminology Criteria for Adverse Events (CTCAE) criteria. The Mantel-Haenszel, random, or fixed-effect analysis model was used to compute risk ratios and accompanying 95% confidence intervals for each endpoint. For endpoints that statistically favored one arm, absolute risk differences were computed to assess whether there is a 10% or greater difference, used as the threshold for clinical significance by MASCC/ESMO.

RESULT

Nine studies reported the use of 10 mg olanzapine to prevent CINV; three studies reported the use of 5 mg olanzapine to prevent CINV. When olanzapine was administered at 10 mg for HEC patients, the six endpoints were statistically and clinically better than the control group. For MEC patients, four out of six endpoints were better than the control group. When olanzapine is administered at 5 mg for MEC patients, four endpoints have statistical and clinical advantages. The sedative effects of 10 and 5 mg olanzapine were statistically more significant than those of the control group. The sedative effect of the 10-mg olanzapine group was more significant than that of the 5-mg olanzapine group, both statistically and clinically.

CONCLUSION

5 mg olanzapine may be as effective as 10 mg olanzapine for patients with HEC and MEC, and its sedative effect is lower than 10 mg olanzapine. Fewer studies on 5 mg olanzapine have led to uncertain data. In the future, more randomized controlled trials of 5 mg olanzapine are needed to study the balance between the effectiveness and safety of olanzapine.