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Monsen RE, Lerdal A, Nordgarden H, Gay CL, Herlofson BB. A comparison of the prevalence of dry mouth and other symptoms using two different versions of the Edmonton Symptom Assessment System on an inpatient palliative care unit. BMC Palliat Care 2024; 23:75. [PMID: 38493155 PMCID: PMC10943902 DOI: 10.1186/s12904-024-01405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Symptom assessment is key to effective symptom management and palliative care for patients with advanced cancer. Symptom prevalence and severity estimates vary widely, possibly dependent on the assessment tool used. Are symptoms specifically asked about or must the patients add them as additional symptoms? This study compared the prevalence and severity of patient-reported symptoms in two different versions of a multi-symptom assessment tool. In one version, three symptoms dry mouth, constipation, sleep problems were among those systematically assessed, while in the other, these symptoms had to be added as an "Other problem". METHODS This retrospective cross-sectional study included adult patients with advanced cancer at an inpatient palliative care unit. Data were collected from two versions of the Edmonton Symptom Assessment System (ESAS): modified (ESAS-m) listed 11 symptoms and revised (ESAS-r) listed 9 and allowed patients to add one "Other problem". Seven similar symptoms were listed in both versions. RESULTS In 2013, 184 patients completed ESAS-m, and in 2017, 156 completed ESAS-r. Prevalence and severity of symptoms listed in both versions did not differ. In ESAS-m, 83% reported dry mouth, 73% constipation, and 71% sleep problems, but on ESAS-r, these symptoms were reported by only 3%, 15% and < 1%, respectively. Although ESAS-r severity scores for these three symptoms were higher than on ESAS-m, differences did not reach statistical significance. CONCLUSION We identified significant differences in patient symptom reporting based on whether symptoms like dry mouth, obstipation and sleep problems were specifically assessed or had to be added by patients as an "Other problem".
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Affiliation(s)
- Ragnhild Elisabeth Monsen
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, Oslo, 0317, Norway.
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway.
| | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, Oslo, 0317, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Hilde Nordgarden
- National Resource Centre for Oral Health in Rare Disorders, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Caryl L Gay
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, USA
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Unit of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology - Head and Neck Surgery Division for Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
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Zhao Y, Luo H, Ren X, Jia B, Li J, Wang L, Li J. The P2Y 1 receptor in the colonic myenteric plexus of rats and its correlation with opioid-induced constipation. BMC Gastroenterol 2024; 24:23. [PMID: 38191294 PMCID: PMC10773096 DOI: 10.1186/s12876-024-03119-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024] Open
Abstract
This study was designed to explore the expression changes of P2Y1 receptors in the distal colonic myenteric layer of rats. An opioid induced constipation(OIC) rat model was generated by intraperitoneal (i.p) injection of loperamide. At 7 days post-treatment, the model rats were assessed by calculating the fecal water content and the gastrointestinal transit ratio. The immunofluorescence (IF)-based histochemical study was used to observe the distribution of P2Y1 receptors in the distal colonic myenteric plexus. Western blotting (WB) was performed to evaluate the expression changes of P2Y1 proteins in the myenteric layer, and the electrophysiological approaches were carried out to determine the regulatory roles of P2Y1 receptors on distal colonic motor function. IF showed that P2Y1 receptors are co-expressed MOR in the enteric nerve cells of the distal colonic myenteric plexus. Moreover, the WB revealed that the protein levels of P2Y1 were significantly decreased in the distal colonic myenteric layer of OIC rats. In vitro tension experiments exhibited that the P2Y1 receptor antagonist MRS2500 enhanced the spontaneous contraction amplitude, adding EM2 and β-FNA did not have any effect on MRS2500. Therefore, P2Y1 receptor expression could be associated with the occurrence of OIC in this rat model and the regulation of colonic motility by MOR may be related to the release of purine neurotransmitters such as ATP in the colonic nervous system.
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Affiliation(s)
- Yuqiong Zhao
- Department of Human Anatomy and Histoembryology, College of Basic Medical Sciences, Ningxia Medical University, 1160 Shengli Street, 750001, Yinchuan, Ningxia Hui Autonomous Region, P.R. China
| | - Huijuan Luo
- Department of Human Anatomy and Histoembryology, College of Basic Medical Sciences, Ningxia Medical University, 1160 Shengli Street, 750001, Yinchuan, Ningxia Hui Autonomous Region, P.R. China
| | - Xiaojie Ren
- Department of Human Anatomy and Histoembryology, College of Basic Medical Sciences, Ningxia Medical University, 1160 Shengli Street, 750001, Yinchuan, Ningxia Hui Autonomous Region, P.R. China
| | - Binghan Jia
- Department of Human Anatomy and Histoembryology, College of Basic Medical Sciences, Ningxia Medical University, 1160 Shengli Street, 750001, Yinchuan, Ningxia Hui Autonomous Region, P.R. China
| | - Jinzhao Li
- Department of Human Anatomy and Histoembryology, College of Basic Medical Sciences, Ningxia Medical University, 1160 Shengli Street, 750001, Yinchuan, Ningxia Hui Autonomous Region, P.R. China
| | - Lixin Wang
- The Medical Laboratory Center of General Hospital of Ningxia Medical University, 804 Shengli Street, 750001, Yinchuan, Ningxia Hui Autonomous Region, P.R. China.
| | - Junping Li
- Department of Human Anatomy and Histoembryology, College of Basic Medical Sciences, Ningxia Medical University, 1160 Shengli Street, 750001, Yinchuan, Ningxia Hui Autonomous Region, P.R. China.
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Kanbayashi Y, Shimizu M, Ishizuka Y, Sawa S, Yabe K, Uchida M. Factors associated with non-response to naldemedine for opioid-induced constipation in cancer patients: A subgroup analysis. PLoS One 2022; 17:e0278823. [PMID: 36490241 PMCID: PMC9733844 DOI: 10.1371/journal.pone.0278823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Opioid-induced constipation (OIC) is one of the most common adverse events of opioid therapy and can severely reduce quality of life (QOL). Naldemedine is the orally available peripheral-acting μ-opioid receptor antagonist approved for OIC treatment. However in daily clinical practice, some cancer patients show insufficient control of OIC even while receiving naldemedine. OBJECTIVE To identify factors associated with non-response to naldemedine in cancer patients. METHODS This study retrospectively analyzed 127 cancer patients prescribed naldemedine at Seirei Hamamatsu General Hospital in Japan between November 2016 and June 2021. For the regression analysis of factors associated with OIC, variables were extracted manually from electronic medical records. Naldemedine had been prescribed by the attending physician after the presence of OIC had been defined with reference to Rome IV diagnostic criteria. Naldemedine was evaluated as "effective" in cases where the number of defecations increased at least once in the first 3 days after starting naldemedine. Multivariate logistic regression analysis was performed to identify factors associated with non-response to naldemedine. The data used were from the group of patients who received naldemedine in our previous study. RESULTS Factors significantly associated with non-response to naldemedine included chemotherapy with taxanes within 1 month of evaluation of naldemedine effect (odds ratio [OR] = 0.063; 95% confidence interval [CI] = 0.007-0.568), and addition of or switching to naldemedine due to insufficient efficacy of prior laxatives (OR = 0.352, 95% CI = 0.129-0.966). CONCLUSION The identification of factors associated with non-response to naldemedine prescribed for OIC may help improve QOL among cancer patients.
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Affiliation(s)
- Yuko Kanbayashi
- Faculty of Pharmacy, Department of Education and Research Center for Clinical Pharmacy, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- * E-mail:
| | - Mayumi Shimizu
- Department of Pharmacy, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yuichi Ishizuka
- Department of Pharmacy, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shohei Sawa
- Department of Pharmacy, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Katsushige Yabe
- Department of Pharmacy, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Mayako Uchida
- Department of Education and Research Center for Pharmacy Practice, Doshisha Women’s College of Liberal Arts, Kyotanabe, Japan
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Krüger W, Buchhold B, Nonnenberg D, Neumann T, Schneidewind L, Schmidt CA. Implementation of Palliative Care in Clinical Practice in German Units for Allogeneic Stem Cell Transplantation: A Nationwide Survey. Am J Hosp Palliat Care 2021; 38:1212-1217. [PMID: 33433238 DOI: 10.1177/1049909120986963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Allogeneic stem cell transplantation (alloSCT) is a curative therapy for otherwise fatal diseases, however it is associated with a considerable morbidity and mortality. In consequence, it can be assumed that a considerable percentage of patients would benefit from high-quality palliative care (PC) during their course of disease. To assess the standard of PC in German transplant centers, a questionnaire was sent out to all German centers recognized from the EBMT membership list and the annually ZKRD report (n = 52). The response rate was not as high as expected with n = 27 (51,9%), even after reminding by phone calls or by e-mails. In brief, palliative care after allogeneic stem cell transplantation shows a wide variation in Germany. This is true for structures, processes and measures. A national standard for SCT-patients has not been established so far and there are no pre-conditions concerning palliative care after alloSCT for a certification by the EBMT according the JACIE standards. There is a considerable need for a crosslinking of alloSCT with PC. Clear standards should be established by the scientific societies concerning personnel, structure and processes.
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Affiliation(s)
- William Krüger
- Clinic for Internal Medicine C - Haematology, Oncology, Stem Cell transplantation and Palliative Care, Greifswald, Germany
| | - Britta Buchhold
- Institute of Medical Psychology, 60634University-Medicine Greifswald, Greifswald, Germany
| | - Dennis Nonnenberg
- Clinic for Internal Medicine C - Haematology, Oncology, Stem Cell transplantation and Palliative Care, Greifswald, Germany
| | - Thomas Neumann
- Clinic for Internal Medicine C - Haematology, Oncology, Stem Cell transplantation and Palliative Care, Greifswald, Germany
| | - Laila Schneidewind
- Clinic for Internal Medicine C - Haematology, Oncology, Stem Cell transplantation and Palliative Care, Greifswald, Germany
| | - Christian A Schmidt
- Clinic for Internal Medicine C - Haematology, Oncology, Stem Cell transplantation and Palliative Care, Greifswald, Germany
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Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective cohort study. Support Care Cancer 2020; 28:5315-5321. [PMID: 32124025 DOI: 10.1007/s00520-020-05364-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/17/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Opioid-induced constipation (OIC) is the most common side effect in patient-prescribed opioids for cancer pain treatment. Current guidelines recommend routine prescription of a laxative for preventing OIC in all patients prescribed an opioid unless a contraindication exists. We determined patterns of prescription of laxative agents in patients with lung cancer initiating opioids. METHODS We performed a retrospective cohort study evaluating the prescription of laxatives for OIC to adult patients with incident lung cancer seen in the Veteran's Affairs (VA) system, between January 1, 2003, and December 31, 2016. Exposure to laxative agents was categorized as follows: none, docusate monotherapy, docusate plus another laxative, and other laxatives only. Prevalence of OIC prophylaxis was analyzed using descriptive statistics. Linear regression was performed to identify time trends in the prescription of OIC prophylaxis. RESULTS Overall, 130,990 individuals were included in the analysis. Of these, 87% of patients received inadequate prophylaxis (75% no prophylaxis and 12% docusate alone), while 5% received OIC prophylaxis with the unnecessary addition of docusate to another laxative. Through the study period, laxative prescription significantly decreased, while all other categories of OIC prophylaxis were unchanged. We noted an inverse relationship with OIC prophylaxis and likelihood of a diagnosis of constipation at 3 and 6 months. CONCLUSIONS In this study of veterans with lung cancer, almost 90% received inadequate or inappropriate OIC prophylaxis. Efforts to educate physicians and patients to promote appropriate OIC prophylaxis in combination with systems-level changes are warranted.
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