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Yoneda T, Hiasa M, Okui T, Hata K. Cancer-nerve interplay in cancer progression and cancer-induced bone pain. J Bone Miner Metab 2023; 41:415-427. [PMID: 36715764 DOI: 10.1007/s00774-023-01401-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/05/2023] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Cancer-induced bone pain (CIBP) is one of the most common and debilitating complications associated with bone metastasis. Although our understanding of the precise mechanism is limited, it has been known that bone is densely innervated, and that CIBP is elicited as a consequence of increased neurogenesis, reprogramming, and axonogenesis in conjunction with sensitization and excitation of sensory nerves (SNs) in response to the noxious stimuli that are derived from the tumor microenvironment developed in bone. Recent studies have shown that the sensitized and excited nerves innervating the tumor establish intimate communications with cancer cells by releasing various tumor-stimulating factors for tumor progression. APPROACHES In this review, the role of the interactions of cancer cells and SNs in bone in the pathophysiology of CIBP will be discussed with a special focus on the role of the noxious acidic tumor microenvironment, considering that bone is in nature hypoxic, which facilitates the generation of acidic conditions by cancer. Subsequently, the role of SNs in the regulation of cancer progression in the bone will be discussed together with our recent experimental findings. CONCLUSION It is suggested that SNs may be a newly-recognized important component of the bone microenvironment that contribute to not only in the pathophysiology of CIBP but also cancer progression in bone and dissemination from bone. Suppression of the activity of bone-innervating SNs, thus, may provide unique opportunities in the treatment of cancer progression and dissemination, as well as CIBP.
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Affiliation(s)
- Toshiyuki Yoneda
- Department of Biochemistry, Osaka University Graduate School of Dentistry, Suita, Osaka, 565-0871, Japan.
| | - Masahiro Hiasa
- Department of Biomaterials and Bioengineering, University of Tokushima Graduate School of Dentistry, Tokushima, Tokushima, Japan
| | - Tatsuo Okui
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Kenji Hata
- Department of Biochemistry, Osaka University Graduate School of Dentistry, Suita, Osaka, 565-0871, Japan
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Shin J, Harris C, Oppegaard K, Kober KM, Paul SM, Cooper BA, Hammer M, Conley Y, Levine JD, Miaskowski C. Worst Pain Severity Profiles of Oncology Patients Are Associated With Significant Stress and Multiple Co-Occurring Symptoms. J Pain 2022; 23:74-88. [PMID: 34298161 PMCID: PMC10788964 DOI: 10.1016/j.jpain.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/27/2021] [Accepted: 07/07/2021] [Indexed: 12/27/2022]
Abstract
Little is known about the associations between pain, stress, and co-occurring symptoms in oncology patients. Purpose was to identify subgroups of patients with distinct worst pain profiles and evaluate for differences among the subgroups in demographic and clinical characteristics, as well as stress and symptom scores. Oncology outpatients (n = 1305) completed questionnaires prior to their second or third chemotherapy cycle. Worst pain intensity was assessed 6 times over 2 chemotherapy cycles using a 0 to 10 numeric rating scale. The 371 patients (28.4%) who had ≤1 occurrence of pain over the 6 assessments were classified as the None class. For the remaining 934 patients whose data were entered into the latent profile analysis, 3 distinct worst pain profiles were identified (ie Mild [12.5%], Moderate [28.6%], Severe [30.5%]). Compared to None class, Severe class had fewer years of education and a lower annual income; were less likely to be employed and married; less likely to exercise on a regular basis, had a higher comorbidity burden, and a worse functional status. Compared to None class, Severe class reported higher levels of general, disease-specific, and cumulative life stress and lower levels of resilience, as well as higher levels of depressive symptoms, anxiety, fatigue, sleep disturbance, and cognitive dysfunction. This study is the first to identify distinct worst pain profiles in a large sample of oncology patients receiving chemotherapy and associated risk factors. PERSPECTIVE: Unrelieved pain remains a significant problem for oncology patients receiving chemotherapy. High levels of stress and co-occurring symptoms contribute to a more severe pain profile in these patients.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, San Francisco, California
| | - Carolyn Harris
- School of Nursing, University of California, San Francisco, California
| | - Kate Oppegaard
- School of Nursing, University of California, San Francisco, California
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California
| | | | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, California; School of Medicine, University of California, San Francisco, California.
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Baek SK, Shin SW, Koh SJ, Kim JH, Kim HJ, Shim BY, Kang SY, Bae SB, Yun HJ, Sym SJ, Han HS, Gil HY. Significance of descriptive symptoms and signs and clinical parameters as predictors of neuropathic cancer pain. PLoS One 2021; 16:e0252781. [PMID: 34403429 PMCID: PMC8370612 DOI: 10.1371/journal.pone.0252781] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/21/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Evaluation of symptoms and signs for the management of neuropathic cancer pain (NCP) is challenging. This study aimed to identify clinical predictors of NCP and symptoms and signs most relevant of those in Korean patients. Methods This nationwide, descriptive, cross-sectional, multicenter, observational study included 2,003 cancer patients aged ≥20 years who reported a visual analog scale (VAS) score ≥1 for pain and provided informed consent for participation. The Douleur Neuropathic (DN4) questionnaire (score ≥4) was used to determine symptoms and signs as well as the presence of NCP. Results The prevalence of NCP was associated with age <65 years [OR, 1.57; 95% CI, 1.270–1.934], disease duration >6 months (OR, 1.57; 95% CI, 1.232–2.012), stage IV cancer (OR, 0.75; 95% CI, 0.593–0.955), history of chemotherapy (OR, 1.74; 95% CI, 1.225–2.472), and moderate-to-severe cancer pain (OR, 2.05; 95% CI, 1.671–2.524) after multivariate analysis. The most common descriptive symptoms of NCP were tingling, electric shock, and pins and needles. For NCP patients in the presence or absence of the clinical predictors, pins and needles (p = 0.001) and painful cold (p<0.001) symptoms were significantly frequent in patients with moderate-to-severe pain. Tingling, numbness, and touch hypoesthesia (p = 0.022, 0.033, 0.024, respectively) were more frequent in those with longer cancer duration and hyperesthesia (p = 0.024) was more frequent in young patients. Conclusion Age <65 years, disease duration >6 months, stage IV cancer, history of chemotherapy, and moderate-to-severe cancer pain, were identified as predictors of NCP. Some symptoms and signs of NCP were associated with these predictors. Further studies are warranted on the pathogenesis and management of NCP with respect to the symptoms and signs, and factors associated with pain severity in Korean patients.
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Affiliation(s)
- Sun Kyung Baek
- Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea
| | - Sang Won Shin
- Internal Medicine, Korea University College of Medicine, Seoul, South Korea
- * E-mail:
| | - Su-Jin Koh
- Department of Hematology-Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea
| | - Jung Han Kim
- Internal Medicine, Kangnam Sacred-Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hyo Jung Kim
- Internal Medicine, Hallym University Sacred Heart Hospital Anyang, Anyang, South Korea
| | - Byoung Yong Shim
- Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Seok Yun Kang
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Sang Byung Bae
- Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Hwan Jung Yun
- Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Sun Jin Sym
- Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Ha Yeong Gil
- Medical Affairs, Internal Medicine, Pfizer Pharmaceuticals Korea Ltd., Seoul, South Korea
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Park SH, Eber MR, Fonseca MM, Patel CM, Cunnane KA, Ding H, Hsu FC, Peters CM, Ko MC, Strowd RE, Wilson JA, Hsu W, Romero-Sandoval EA, Shiozawa Y. Usefulness of the measurement of neurite outgrowth of primary sensory neurons to study cancer-related painful complications. Biochem Pharmacol 2021; 188:114520. [PMID: 33741328 PMCID: PMC8154668 DOI: 10.1016/j.bcp.2021.114520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 12/25/2022]
Abstract
Abnormal outgrowth of sensory nerves is one of the important contributors to pain associated with cancer and its treatments. Primary neuronal cultures derived from dorsal root ganglia (DRG) have been widely used to study pain-associated signal transduction and electrical activity of sensory nerves. However, there are only a few studies using primary DRG neuronal culture to investigate neurite outgrowth alterations due to underlying cancer-related factors and chemotherapeutic agents. In this study, primary DRG sensory neurons derived from mouse, non-human primate, and human were established in serum and growth factor-free conditions. A bovine serum albumin gradient centrifugation method improved the separation of sensory neurons from satellite cells. The purified DRG neurons were able to maintain their heterogeneous subpopulations, and displayed an increase in neurite growth when exposed to cancer-derived conditioned medium, while they showed a reduction in neurite length when treated with a neurotoxic chemotherapeutic agent. Additionally, a semi-automated quantification method was developed to measure neurite length in an accurate and time-efficient manner. Finally, these exogenous factors altered the gene expression patterns of murine primary sensory neurons, which are related to nerve growth, and neuro-inflammatory pain and nociceptor development. Together, the primary DRG neuronal culture in combination with a semi-automated quantification method can be a useful tool for further understanding the impact of exogenous factors on the growth of sensory nerve fibers and gene expression changes in sensory neurons.
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Affiliation(s)
- Sun H Park
- Department of Cancer Biology and Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Matthew R Eber
- Department of Cancer Biology and Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Miriam M Fonseca
- Department of Anesthesiology, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Chirayu M Patel
- Department of Cancer Biology and Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Katharine A Cunnane
- Department of Anesthesiology, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Huiping Ding
- Department of Physiology and Pharmacology, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science and Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Christopher M Peters
- Department of Anesthesiology, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Mei-Chuan Ko
- Department of Physiology and Pharmacology, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Roy E Strowd
- Department of Neurology and Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - John A Wilson
- Department of Neurosurgery, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Wesley Hsu
- Department of Neurosurgery, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | | | - Yusuke Shiozawa
- Department of Cancer Biology and Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA.
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Groot OQ, Paulino Pereira NR, Bongers MER, Ogink PT, Newman ET, Verlaan JJ, Raskin KA, Lozano-Calderon SA, Schwab JH. Do Cohabitants Reliably Complete Questionnaires for Patients in a Terminal Cancer Stage when Assessing Quality of Life, Pain, Depression, and Anxiety? Clin Orthop Relat Res 2021; 479:792-801. [PMID: 33165035 PMCID: PMC8083839 DOI: 10.1097/corr.0000000000001525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/15/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with bone metastases often are unable to complete quality of life (QoL) questionnaires, and cohabitants (such as spouses, domestic partners, offspring older than 18 years, or other people who live with the patient) could be a reliable alternative. However, the extent of reliability in this complicated patient population remains undefined, and the influence of the cohabitant's condition on their assessment of the patient's QoL is unknown. QUESTIONS/PURPOSES (1) Do QoL scores, measured by the 5-level EuroQol-5D (EQ-5D-5L) version and the Patient-reported Outcomes Measurement Information System (PROMIS) version 1.0 in three domains (anxiety, pain interference, and depression), reported by patients differ markedly from scores as assessed by their cohabitants? (2) Do cohabitants' PROMIS-Depression scores correlate with differences in measured QoL results? METHODS This cross-sectional study included patients and cohabitants older than 18 years of age. Patients included those with presence of histologically confirmed bone metastases (including lymphoma and multiple myeloma), and cohabitants must have been present at the clinic visit. Patients were eligible for inclusion in the study regardless of comorbidities, prognosis, prior surgery, or current treatment. Between June 1, 2016 and March 1, 2017 and between October 1, 2017 and February 26, 2018, all 96 eligible patients were approached, of whom 49% (47) met the selection criteria and were willing to participate. The included 47 patient-cohabitant pairs independently completed the EQ-5D-5L and the eight-item PROMIS for three domains (anxiety, pain, and depression) with respect to the patients' symptoms. The cohabitants also completed the four-item PROMIS-Depression survey with respect to their own symptoms. RESULTS There were no clinically important differences between the scores of patients and their cohabitants for all questionnaires, and the agreement between patient and cohabitant scores was moderate to strong (Spearman correlation coefficients ranging from 0.52 to 0.72 on the four questionnaires; all p values < 0.05). However, despite the good agreement in QoL scores, an increased cohabitant's depression score was correlated with an overestimation of the patient's symptom burden for the anxiety and depression domains (weak Spearman correlation coefficient of 0.33 [95% confidence interval 0.08 to 0.58]; p = 0.01 and moderate Spearman correlation coefficient of 0.52 [95% CI 0.29 to 0.74]; p < 0.01, respectively). CONCLUSION The present findings support that cohabitants might be reliable raters of the QoL of patients with bone metastases. However, if a patient's cohabitant has depression, the cohabitant may overestimate a patient's symptoms in emotional domains such as anxiety and depression, warranting further research that includes cohabitants with and without depression to elucidate the effect of depression on the level of agreement. For now, clinicians may want to reconsider using the cohabitant's judgement if depression is suspected. CLINICAL RELEVANCE These findings suggest that a cohabitant's impressions of a patient's quality of life are, in most instances, accurate; this is potentially helpful in situations where the patient cannot weigh in. Future studies should employ longitudinal designs to see how or whether our findings change over time and with disease progression, and how specific interventions-like different chemotherapeutic regimens or surgery-may factor in.
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Affiliation(s)
- Olivier Q Groot
- O. Q. Groot, N. R. P. Pereira, M. E. R. Bongers, P. T. Ogink, E. T. Newman, K. A. Raskin, S. A. Lozano-Calderon, J. H. Schwab, Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
- O. Q. Groot, P. T. Ogink, J. J. Verlaan, Department of Orthopaedic Surgery, University Medical Center Utrecht - Utrecht University, Utrecht, the Netherlands
| | - Nuno Rui Paulino Pereira
- O. Q. Groot, N. R. P. Pereira, M. E. R. Bongers, P. T. Ogink, E. T. Newman, K. A. Raskin, S. A. Lozano-Calderon, J. H. Schwab, Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
- O. Q. Groot, P. T. Ogink, J. J. Verlaan, Department of Orthopaedic Surgery, University Medical Center Utrecht - Utrecht University, Utrecht, the Netherlands
| | - Michiel E R Bongers
- O. Q. Groot, N. R. P. Pereira, M. E. R. Bongers, P. T. Ogink, E. T. Newman, K. A. Raskin, S. A. Lozano-Calderon, J. H. Schwab, Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
- O. Q. Groot, P. T. Ogink, J. J. Verlaan, Department of Orthopaedic Surgery, University Medical Center Utrecht - Utrecht University, Utrecht, the Netherlands
| | - Paul T Ogink
- O. Q. Groot, N. R. P. Pereira, M. E. R. Bongers, P. T. Ogink, E. T. Newman, K. A. Raskin, S. A. Lozano-Calderon, J. H. Schwab, Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
- O. Q. Groot, P. T. Ogink, J. J. Verlaan, Department of Orthopaedic Surgery, University Medical Center Utrecht - Utrecht University, Utrecht, the Netherlands
| | - Erik T Newman
- O. Q. Groot, N. R. P. Pereira, M. E. R. Bongers, P. T. Ogink, E. T. Newman, K. A. Raskin, S. A. Lozano-Calderon, J. H. Schwab, Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
- O. Q. Groot, P. T. Ogink, J. J. Verlaan, Department of Orthopaedic Surgery, University Medical Center Utrecht - Utrecht University, Utrecht, the Netherlands
| | - Jorrit-Jan Verlaan
- O. Q. Groot, N. R. P. Pereira, M. E. R. Bongers, P. T. Ogink, E. T. Newman, K. A. Raskin, S. A. Lozano-Calderon, J. H. Schwab, Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
- O. Q. Groot, P. T. Ogink, J. J. Verlaan, Department of Orthopaedic Surgery, University Medical Center Utrecht - Utrecht University, Utrecht, the Netherlands
| | - Kevin A Raskin
- O. Q. Groot, N. R. P. Pereira, M. E. R. Bongers, P. T. Ogink, E. T. Newman, K. A. Raskin, S. A. Lozano-Calderon, J. H. Schwab, Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
- O. Q. Groot, P. T. Ogink, J. J. Verlaan, Department of Orthopaedic Surgery, University Medical Center Utrecht - Utrecht University, Utrecht, the Netherlands
| | - Santiago A Lozano-Calderon
- O. Q. Groot, N. R. P. Pereira, M. E. R. Bongers, P. T. Ogink, E. T. Newman, K. A. Raskin, S. A. Lozano-Calderon, J. H. Schwab, Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
- O. Q. Groot, P. T. Ogink, J. J. Verlaan, Department of Orthopaedic Surgery, University Medical Center Utrecht - Utrecht University, Utrecht, the Netherlands
| | - Joseph H Schwab
- O. Q. Groot, N. R. P. Pereira, M. E. R. Bongers, P. T. Ogink, E. T. Newman, K. A. Raskin, S. A. Lozano-Calderon, J. H. Schwab, Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
- O. Q. Groot, P. T. Ogink, J. J. Verlaan, Department of Orthopaedic Surgery, University Medical Center Utrecht - Utrecht University, Utrecht, the Netherlands
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Heussner MJ, Folger JK, Dias C, Massri N, Dahdah A, Vermeer PD, Laumet G. A Novel Syngeneic Immunocompetent Mouse Model of Head and Neck Cancer Pain Independent of Interleukin-1 Signaling. Anesth Analg 2021; 132:1156-1163. [PMID: 33323783 PMCID: PMC7969384 DOI: 10.1213/ane.0000000000005302] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pain is one of the first presenting symptoms in patients with head and neck cancer, who often develop chronic and debilitating pain as the disease progresses. Pain is also an important prognostic marker for survival. Unfortunately, patients rarely receive effective pain treatment due to our limited knowledge of the mechanisms underlying head and neck cancer pain (HNCP). Pain is often associated with neuroinflammation and particularly interleukin (IL)-1 signaling. The purpose of this study is to develop a novel syngeneic model of HNCP in immunocompetent mice to examine the contribution of IL-1 signaling. METHODS Male C57BL/6 mice were injected with a murine model of human papillomavirus (HPV+)-induced oropharyngeal squamous cell carcinoma in their right hindlimb to induce tumor growth. Pain sensitivity was measured via von Frey filaments. Spontaneous pain was assessed via the facial grimace scale. IL-1β was measured by quantifying gene expression via quantitative polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA). RESULTS Pain hypersensitivity and spontaneous pain develop quickly after the implantation of tumor cells, a time when tumor volume is still insignificant. Spinal and circulating IL-1β levels are significantly elevated in tumor-bearing mice. Blocking IL-1 signaling either by intrathecal administration of interleukin-1 receptor antagonist (IL-1ra) or by genetic deletion (interleukin-1 receptor knockout [Il1r1-/-]) does not alleviate HNCP. CONCLUSIONS We established the first syngeneic model of HNCP in immunocompetent mice. Unlike inflammatory or nerve-injured pain, HNCP is independent of IL-1 signaling. These findings challenge the common belief that pain results from tissue compression or IL-1 signaling in patients with head and neck cancer.
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Affiliation(s)
- Matthew J. Heussner
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Joseph K. Folger
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
| | - Christina Dias
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Noura Massri
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
| | - Albert Dahdah
- Department of Microbiology & Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA
| | - Paola D. Vermeer
- Cancer Biology and Immunotherapies Group, Sanford Research, Sioux Falls, SD 57104, USA
| | - Geoffroy Laumet
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Abstract
PURPOSE Cancer is of increasing prevalence in less-developed countries. However, research on the patients' quality of life (QoL) in these countries is very limited. The aim of this study was to examine QoL of cancer patients in Africa. METHOD A sample of 256 cancer patients treated in an Ethiopian hospital was examined with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EORTC QLQ-C30, the Multidimensional Fatigue Inventory, and the Hospital Anxiety and Depression Scale. A group of 1664 German cancer patients served as a comparison group. RESULTS Most of the scales of the EORTC QLQ-C30 showed acceptable reliability in the Ethiopian sample. Compared with the German cancer patients, the Ethiopian patients showed lower QoL in most dimensions, especially in financial difficulties, physical functioning, pain, and appetite loss (effect sizes between 0.52 and 0.75). Illiteracy, tumor stage, and treatment (surgery and chemotherapy) were associated with QoL in the Ethiopian sample. QoL was strongly correlated with fatigue, anxiety, and depression. CONCLUSION The EORTC QLQ-C30 is a suitable instrument for measuring QoL in Ethiopia. The detriments in QoL in the Ethiopian patients indicate specific cancer care needs for the patients in a developing country.
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Affiliation(s)
- Yemataw Wondie
- Department of Psychology, University of Gondar, Gondar, Ethiopia
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.
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Ramos DDBM, Araújo MTDMF, Araújo TCDL, Silva YA, Dos Santos ACLA, E Silva MG, Paiva PMG, Mendes RL, Napoleão TH. Antinociceptive activity of Schinus terebinthifolia leaf lectin (SteLL) in sarcoma 180-bearing mice. J Ethnopharmacol 2020; 259:112952. [PMID: 32416247 DOI: 10.1016/j.jep.2020.112952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGY RELEVANCE Schinus terebinthifolia Raddi leaves have been used in folk medicine due to several properties, including antitumor and analgesic effects. The variable efficacy and adverse effects of analgesic drugs have motivated the search for novel antinociceptive agents. It has been reported that the S. terebinthifolia leaf lectin (SteLL) has antitumor activity against sarcoma 180 in mice. AIM OF THE STUDY This work aimed to evaluate whether SteLL would reduce cancer pain using an orthotopic tumor model. MATERIALS AND METHODS A sarcoma 180 cell suspension was inoculated into the right hind paws of mice, and the treatments (150 mM NaCl, negative control; 10 mg/kg morphine, positive control; or SteLL at 1 and 2 mg/kg) were administered intraperitoneally 24 h after cell inoculation up to 14 days. Spontaneous nociception, mechanical hyperalgesia, and hot-plate tests were performed. Further, the volume and weight of the tumor-bearing paws were measured. RESULTS SteLL (2 mg/kg) improved limb use during ambulation. The lectin (1 and 2 mg/kg) also inhibited mechanical hyperalgesia and increased the latency time during the hot-plate test. Naloxone was found to reverse this effect, indicating the involvement of opioid receptors. The tumor-bearing paws of mice treated with SteLL exhibited lower volume and weight. CONCLUSION SteLL reduced hyperalgesia due to sarcoma 180 in the paws of mice, and this effect can be related to its antitumor action.
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Affiliation(s)
- Dalila de Brito Marques Ramos
- Campus Amilcar Ferreira Sobral, Universidade Federal do Piauí, Floriano, Piauí, Brazil; Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Yasmym Araújo Silva
- Laboratório de Oncologia Experimental, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | | | - Mariana Gama E Silva
- Laboratório de Oncologia Experimental, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - Patrícia Maria Guedes Paiva
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Rosemairy Luciane Mendes
- Laboratório de Oncologia Experimental, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - Thiago Henrique Napoleão
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
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9
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Demir IE, Reyes CM, Alrawashdeh W, Ceyhan GO, Deborde S, Friess H, Görgülü K, Istvanffy R, Jungwirth D, Kuner R, Maryanovich M, Na'ara S, Renders S, Saloman JL, Scheff NN, Steenfadt H, Stupakov P, Thiel V, Verma D, Yilmaz BS, White RA, Wang TC, Wong RJ, Frenette PS, Gil Z, Davis BM. Clinically Actionable Strategies for Studying Neural Influences in Cancer. Cancer Cell 2020; 38:11-14. [PMID: 32531270 DOI: 10.1016/j.ccell.2020.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Neuro-glial activation is a recently identified hallmark of growing cancers. Targeting tumor hyperinnervation in preclinical and small clinical trials has yielded promising antitumor effects, highlighting the need of systematic analysis of neural influences in cancer (NIC). Here, we outline the strategies translating these findings from bench to the clinic.
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Affiliation(s)
- Ihsan Ekin Demir
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany; Department of General Surgery, HPB-Unit, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; CRC 1321 Modelling and Targeting Pancreatic Cancer, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
| | - Carmen Mota Reyes
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; CRC 1321 Modelling and Targeting Pancreatic Cancer, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Wasfi Alrawashdeh
- Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK
| | - Güralp O Ceyhan
- Department of General Surgery, HPB-Unit, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Sylvie Deborde
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; CRC 1321 Modelling and Targeting Pancreatic Cancer, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Kivanc Görgülü
- Comprehensive Cancer Center Munich, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Rouzanna Istvanffy
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; CRC 1321 Modelling and Targeting Pancreatic Cancer, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - David Jungwirth
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; CRC 1321 Modelling and Targeting Pancreatic Cancer, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Rohini Kuner
- Department of Molecular Pharmacology, Institute of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Maria Maryanovich
- Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Shorook Na'ara
- Department of Otolaryngology, Head and Neck Surgery, and the Laboratory for Applied Cancer Research, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel; Head and Neck Center, Rambam Healthcare Campus, Haifa, Israel
| | - Simon Renders
- Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ) and DKFZ-ZMBH Alliance, 69120 Heidelberg, Germany; Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), 69120 Heidelberg, Germany; Department of Internal Medicine V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jami L Saloman
- Department of Medicine, Division of Gastroenterology, Hepatology, & Nutrition, Center for Neuroscience at the University of Pittsburgh, Pittsburgh Center for Pain Research and Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nicole N Scheff
- Hillman Cancer Center and Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hendrik Steenfadt
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; CRC 1321 Modelling and Targeting Pancreatic Cancer, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Pavel Stupakov
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; CRC 1321 Modelling and Targeting Pancreatic Cancer, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Vera Thiel
- Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ) and DKFZ-ZMBH Alliance, 69120 Heidelberg, Germany; Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), 69120 Heidelberg, Germany; Department of Internal Medicine V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Divij Verma
- Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Bengi Su Yilmaz
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; CRC 1321 Modelling and Targeting Pancreatic Cancer, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Ruth A White
- Division of Hematology and Oncology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Timothy C Wang
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul S Frenette
- Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ziv Gil
- Department of Otolaryngology, Head and Neck Surgery, and the Laboratory for Applied Cancer Research, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel; Head and Neck Center, Rambam Healthcare Campus, Haifa, Israel
| | - Brian M Davis
- Center for Neuroscience at the University of Pittsburgh, Pittsburgh Center for Pain Research and Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Kang JH, Koh SJ, Oh SY, Kim RB, Shin SH, Lee YG, Kim BS, Ryoo HM, Yoon SY, Jang JS, Oh HS, Choi YJ, Lee MH, Lee KH. Interference with daily functioning by breakthrough pain in patients with cancer. Support Care Cancer 2020; 28:5177-5183. [PMID: 32056013 DOI: 10.1007/s00520-020-05329-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the association between quality of life (QOL) and breakthrough cancer pain (BTCP) intensity in patients who met the commonly accepted definition of BTCP. METHODS This study was a subset analysis of a South Korean multicenter, non-interventional, cross-sectional, nationwide survey. Participants were recruited from March 2016 to December 2017. BTCP was defined as a controlled background pain of less than a numeric rating scale (NRS) of 3 and any flare-up pain intensity. Pain intensity data were collected using the Brief Pain Inventory (BPI), which includes an interference assessment of the affective and physical domains. Patients were categorized by BTCP intensity into mild (NRS 1-3), moderate (4-6), and severe (7-10) groups. RESULTS Of the 969 screened patients with cancer, 679 had ≤ NRS 3 background pain, of whom 438 completed the BPI. Of these 438 patients, 40, 204, and 194 were in the mild, moderate, and severe BTCP groups, respectively. The median NRS of BTCP was 6.0 (interquartile range = 5.0-8.0). Patients with moderate-severe BTCP had significantly higher interference with daily functioning (IDF) scores than did mild BTCP patients (3.3 vs. 5.7; p < 0.01). Both domains of IDF were significantly hampered proportionally by increased BTCP intensity (p < 0.001). The median total IDF scores of the no, moderate, and severe BTCP groups were 3.3, 5.0, and 6.9, respectively. Furthermore, IDF depended on BTCP intensity, duration, and frequency (p < 0.01) but not on pain type and cause. CONCLUSION An increase in BTCP intensity is likely to result in IDF, regardless of the cause or type of BTCP.
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Affiliation(s)
- Jung Hun Kang
- Department of Internal Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Republic of Korea
| | - So Yeon Oh
- Department of Internal medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Rock Bum Kim
- Department of Preventive Medicine, Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seong Hoon Shin
- Department of Internal Medicine, Division of Hemato-Oncology, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bong-Seog Kim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Hun Mo Ryoo
- Department of Internal Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - So Young Yoon
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Joung Soon Jang
- Department of Internal Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Ho-Suk Oh
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Young Jin Choi
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Moon Hee Lee
- Department of Internal Medicine, Inha University Hospital, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Kyung-Hee Lee
- Department of Internal Medicine, Yeungnam University, Daegu, Republic of Korea.
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11
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Huo W, Liu Y, Lei Y, Zhang Y, Huang Y, Mao Y, Wang C, Sun Y, Zhang W, Ma Z, Gu X. Imbalanced spinal infiltration of Th17/Treg cells contributes to bone cancer pain via promoting microglial activation. Brain Behav Immun 2019; 79:139-151. [PMID: 30685532 DOI: 10.1016/j.bbi.2019.01.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 12/30/2022] Open
Abstract
Increasing evidence suggests that T cells participate in the pathology of neuropathic pain, as well as the activation of microglia. However, whether T cells infiltrate into the spinal cord and contribute to the development of bone cancer pain (BCP) remains unknown. Here, we used a mouse model of BCP to show that numbers of T cells infiltrated into the spinal cord after sarcoma cell implantation with increased BCP, and most infiltrating T cells in the spinal cord were CD3+CD4+ T cells. Both Th17 and Treg subpopulations were analyzed by immunofluorescence. Treg cells in the spinal cord were transiently up-regulated, followed by an imbalance towards Th17 afterwards, and elevated IL-17/IL-17A levels were observed in both blood and spinal cord. Meanwhile, TGF-β, IL-6, and IL-23, the factors which regulate Th17/Treg differentiation, increased their expressions during the development of BCP. Additionally, IL-17A receptor (IL-17AR) was found to be expressed on microglia, and the level of IL-17AR increased with activated microglia during BCP development. Furthermore, BCP was ameliorated when IL-17/IL-17A neutralizing antibodies were intrathecally injected, accompanied with inhibited Th17/Treg infiltration and suppressed microglial activation. In conclusion, T cells infiltrated into the spinal cord with the imbalance of Th17/Treg towards Th17 during the development of BCP, which could promote the microglial activation and further increased BCP, while neutralizing IL-17/IL-17A in the spinal cord could ameliorate BCP. Our results suggest that targeting the imbalanced Th17/Treg infiltration in the spinal cord could be a novel strategy for BCP therapy.
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Affiliation(s)
- Wenwen Huo
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Yue Liu
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Yishan Lei
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Ying Zhang
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Yulin Huang
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Yanting Mao
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Chenchen Wang
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Yu'e Sun
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Wei Zhang
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Zhengliang Ma
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing 210008, Jiangsu Province, China.
| | - Xiaoping Gu
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing 210008, Jiangsu Province, China.
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12
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Ouyang XY, Yang C, Zhu Z, Li J, Sun YH, Ding G, Ji YH, Jiang F. [Cancer pain, a serious threat to patientsmemory]. Sheng Li Xue Bao 2019; 71:343-349. [PMID: 31008495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A large number of cancer patients suffer from pain. Growing evidence suggested that pain might be a serious risk factor for cancer patients. The shared modulators and modulation pathways between neural system and tumor cells, such as various neurotransmitters and neurogenic cytokines, provide essential basis for the effect of pain on tumor. In this article, we reviewed some possible mechanism of this process from two aspects: the systematic regulation of central nervous system on endocrine and immunity, and the regional regulation of peripheral nerves on tumor cells. The aim of this review is to provide more innovative knowledge about pain and cancer and to emphasize the importance of anti-pain in the therapy of cancer.
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Affiliation(s)
- Xue-Yan Ouyang
- Oncology Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Chao Yang
- Scientific Research Management Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch, Shanghai 202150, China
| | - Zhen Zhu
- Xinhua Translational Institute for Cancer Pain, Shanghai 202150, China
| | - Jing Li
- Oncology Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yun-Heng Sun
- Oncology Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Gang Ding
- Oncology Department, Shanghai International Medical Center, Shanghai 201318, China.
| | - Yong-Hua Ji
- Xinhua Translational Institute for Cancer Pain, Shanghai 202150, China.
| | - Feng Jiang
- Scientific Research Management Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch, Shanghai 202150, China.
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13
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Tombal B, Saad F, Penson D, Hussain M, Sternberg CN, Morlock R, Ramaswamy K, Ivanescu C, Attard G. Patient-reported outcomes following enzalutamide or placebo in men with non-metastatic, castration-resistant prostate cancer (PROSPER): a multicentre, randomised, double-blind, phase 3 trial. Lancet Oncol 2019; 20:556-569. [PMID: 30770294 DOI: 10.1016/s1470-2045(18)30898-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the PROSPER trial, enzalutamide significantly improved metastasis-free survival in patients with non-metastatic, castration-resistant prostate cancer. Here, we report the results of patient-reported outcomes of this study. METHODS In the randomised, double-blind, placebo-controlled, phase 3 PROSPER trial, done at 254 study sites worldwide, patients aged 18 years or older with non-metastatic, castration-resistant prostate cancer and a prostate-specific antigen doubling time of up to 10 months were randomly assigned (2:1) via an interactive voice web recognition system to receive oral enzalutamide (160 mg per day) or placebo. Randomisation was stratified by prostate-specific antigen doubling time and baseline use of a bone-targeting agent. The primary endpoint was metastasis-free survival, reported elsewhere. Secondary efficacy endpoints, reported here, were pain progression (assessed by the Brief Pain Inventory Short Form [BPI-SF] questionnaire) and health-related quality of life (assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-PR25], the EuroQoL 5-Dimensions 5-Levels health questionnaire visual analogue scale [EQ-5D-FL, EQ-VAS], and the Functional Assessment of Cancer Therapy-Prostate [FACT-P] questionnaires). Patients completed questionnaires at baseline, week 17, and every 16 weeks thereafter until treatment discontinuation. We used predefined questionnaire thresholds to identify clinically meaningful changes. Enrolment for PROSPER is complete and follow-up continues. This trial is registered with ClinicalTrials.gov, number NCT02003924. FINDINGS Between Nov 26, 2013, and June 28, 2017, 1401 patients were enrolled and randomly assigned to receive enzalutamide (n=933) or placebo (n=468). Median follow-up was 18·5 months (IQR 10·7-29·2) in the enzalutamide group and 15·1 months (7·4-25·9) in the placebo group. Patient-reported outcome scores at baseline were similar between groups. Changes in least squares mean from baseline to week 97 favoured enzalutamide versus placebo for FACT-P social and family wellbeing (0·30 [95% CI -0·25 to 0·85] vs -0·64 [-1·51 to 0·24]; difference 0·94 [95% CI 0·02 to 1·85]; p=0·045) and disfavoured enzalutamide versus placebo for EORTC QLQ-PR25 hormonal treatment-related symptoms (1·55 [0·26 to 2·83) vs -1·83 [-3·86 to 0·20]; difference 3·38 [1·24 to 5·51]; p=0·0020); neither of these changes were clinically meaningful. No significant differences were observed between treatments for changes from baseline to week 97 in any other patient-reported outcome score. Time to clinically meaningful pain progression as assessed by BPI-SF pain severity was longer with enzalutamide than with placebo (median 36·83 months, [95% CI 34·69 to not reached [NR] vs NR; hazard ratio [HR] 0·75 [95% CI 0·57 to 0·97]; p=0·028); there was no significant difference for BPI-SF item 3 or pain interference. Time to clinically meaningful symptom worsening was longer with enzalutamide than with placebo for EORTC QLQ-PR25 urinary symptoms (median 36·86 months [95% CI 33·35 to NR] vs 25·86 [18·53 to 29·47]; HR 0·58 [95% CI 0·46 to 0·72]; p<0·0001) and bowel symptoms (33·15 [29·50 to NR] vs 25·89 [18·43 to 29·67]; 0·72 [0·59 to 0·89]; p=0·0018), and clinically meaningful health-related quality of life as assessed by FACT-P total score (22·11 [18·63 to 25·86] vs 18·43 [14·85-19·35]; 0·83 [0·69 to 0·99]; p=0·037), emotional wellbeing (36·73 [33·12 to 38·21] vs 29·47 [22·18 to 33·15]; 0·69 [0·55 to 0·86]; p=0·0008), and prostate cancer subscale (18·43 [14·85 to 18·66] vs 14·69 [11·07 to 16·20]; 0·79 [0·67 to 0·93]; p=0·0042), although there was no significant difference for other FACT-P scores. Time to clinically meaningful deterioration in EORTC QLQ-PR25 hormonal treatment-related symptoms was shorter with enzalutamide than with placebo (median 33·15 months [95% CI 29·60 to NR] vs 36·83 [29·47 to NR]; HR 1·29 [95% CI 1·02 to 1·63]; p=0·035). Time to deterioration of EQ-VAS was significantly longer for enzalutamide than for placebo (median 22·11 months [95% CI 18·46 to 25·66] vs 14·75 [11·07 to 18·17]; HR 0·75 [95% CI 0·63 to 0·90]; p=0·0013). INTERPRETATION Patients with non-metastatic, castration-resistant prostate cancer receiving enzalutamide had longer metastasis-free survival than did those who received placebo, while maintaining low pain levels and prostate cancer symptom burden and high health-related quality of life. Enzalutamide showed a clinical benefit by delaying pain progression, symptom worsening, and decrease in functional status, compared with placebo. These findings suggest that enzalutamide is a treatment option that should be discussed with patients presenting with high-risk, non- metastatic, castration-resistant prostate cancer. FUNDING Astellas Pharma Inc, Medivation LLC (a Pfizer Company).
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Affiliation(s)
- Bertrand Tombal
- Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
| | - Fred Saad
- Centre hospitalier de l'Université de Montréal/CRCHUM, Montreal, Quebec, Canada
| | - David Penson
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Maha Hussain
- Northwestern University Robert H Lurie Comprehensive Cancer Center, Chicago, IL, USA
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14
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Abstract
Neuropathic cancer pain (NCP) is caused by nerve damage attributable to the cancer per se, and/or treatments including chemotherapy, radiotherapy, and surgery; the prevalence is reported to be as high as 40%. The etiologies of NCP include direct nerve invasion or nerve compression by the cancer, neural toxicity, chemotherapy, and radiotherapy. NCP is subdivided into plexopathy, radiculopathy, and peripheral neuropathies, among several other categories. The clinical characteristics of NCP differ from those of nociceptive pain in terms of both the hypersensitivity symptoms (burning, tingling, and an electrical sensation) and the hyposensitivity symptoms (numbness and muscle weakness). Recovery requires several months to years, even after recovery from injury. Management is complex; NCP does not usually respond to opioids, although treatments may feature both opioids and adjuvant drugs including antidepressants, anticonvulsants, and anti-arrhythmic agents, all of which improve the quality-of-life. This review addresses the pathophysiology, clinical characteristics and management of NCP, and factors rendering pain control difficult.
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Affiliation(s)
- So Young Yoon
- Division of Oncology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
- Correspondence to Jeeyoung Oh, M.D. Department of Neurology, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: +82-2-2030-7564 Fax: +82-2-2030-5169 E-mail:
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15
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Malik SH, Hafeez H, Malik NH, Rehman Ghafoor AU. Coeliac Plexus Neurolysis For Pancreatic Cancer Patients; Retrospective Analysis Of Shaukat Khanum Memorial Cancer Hospital & Research Centre Experience. J Ayub Med Coll Abbottabad 2018; 30:516-519. [PMID: 30632327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Among all the abdominal cancers, pancreatic cancer is the second most common one. Majority of the patients present with an excruciating pain when they are diagnosed with the disease. Coeliac plexus neurolysis (CPN) is a procedure that can control the pain in pancreatic cancer while precluding further consumption of analgesics in higher doses and quantity. The procedure of neurolysis is performed by injecting phenol/alcohol into the coeliac plexus ganglionic neural network. There is a high proportion of pain relief with CPN in up to 80% of the patients. AIM The aim of our study is to assess the pain relief after CPN, reduction in analgesics consumption and evaluation of patient satisfaction post procedure. METHODS A cross sectional study was done and we collected the retrospective data from December 2016 to November 2017. A total of 35 patients of either gender (male and female) were included in this study. Neurolysis was done with transcrural approach using 6% phenol. Follow up of patients was done after 1 and 4 weeks of the procedure. The patients were evaluated for pain scores on numeric rating scale (NRS), reduction in analgesia and patient satisfaction regarding the procedure and pain relief. The analysis was based on mean values. RESULTS Total numbers of patients were 35. The mean age was 54.11±12.51 (SD) years with a male to female percentage of 31.43% and 68.57%. Follow up was done after 1 week and 4 weeks. Patients reported decrease in mean pain score (1 from 9 in Males and 0 from 9 in Females), reduction in analgesics (81.8% among Males and 18.2% among Females) and over all patient's satisfaction was (72.7% Males and 27.3% Females). CONCLUSIONS It has been observed from the results that CPN works effectively for pancreatic cancer patients. There is a strong recommendation of neurolysis in patients with pancreatic cancer pain as it improves the pain scores, significant reduction in analgesia consumption with good patient satisfaction.
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Affiliation(s)
- Sara Haider Malik
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Haroon Hafeez
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Nimra Haider Malik
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
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16
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Jordan JT, Smith MJ, Walker JA, Erdin S, Talkowski ME, Merker VL, Ramesh V, Cai W, Harris GJ, Bredella MA, Seijo M, Suuberg A, Gusella JF, Plotkin SR. Pain correlates with germline mutation in schwannomatosis. Medicine (Baltimore) 2018; 97:e9717. [PMID: 29384852 PMCID: PMC5805424 DOI: 10.1097/md.0000000000009717] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Schwannomatosis has been linked to germline mutations in the SMARCB1 and LZTR1 genes, and is frequently associated with pain.In a cohort study, we assessed the mutation status of 37 patients with clinically diagnosed schwannomatosis and compared to clinical data, whole body MRI (WBMRI), visual analog pain scale, and Short Form 36 (SF-36) bodily pain subscale.We identified a germline mutation in LZTR1 in 5 patients (13.5%) and SMARCB1 in 15 patients (40.5%), but found no germline mutation in 17 patients (45.9%). Peripheral schwannomas were detected in 3 LZTR1-mutant (60%) and 10 SMARCB1-mutant subjects (66.7%). Among those with peripheral tumors, the median tumor number was 4 in the LZTR1 group (median total body tumor volume 30 cc) and 10 in the SMARCB1 group (median volume 85cc), (P=.2915 for tumor number and P = .2289 for volume). mutation was associated with an increased prevalence of spinal schwannomas (100% vs 41%, P = .0197). The median pain score was 3.9/10 in the LZTR1 group and 0.5/10 in the SMARCB1 group (P = .0414), and SF-36 pain-associated quality of life was significantly worse in the LZTR1 group (P = .0106). Pain scores correlated with total body tumor volume (rho = 0.32471, P = .0499), but not with number of tumors (rho = 0.23065, P = .1696).We found no significant difference in quantitative tumor burden between mutational groups, but spinal schwannomas were more common in LZTR1-mutant patients. Pain was significantly higher in LZTR1-mutant than in SMARCB1-mutant patients, though spinal tumor location did not significantly correlate with pain. This suggests a possible genetic association with schwannomatosis-associated pain.
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Affiliation(s)
- Justin T. Jordan
- Department of Neurology
- Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Miriam J. Smith
- Centre for Genomic Medicine, St Mary's Hospital, Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - James A. Walker
- Department of Neurology
- Molecular Neurogenetics Unit, Center for Genomic Medicine
| | - Serkan Erdin
- Molecular Neurogenetics Unit, Center for Genomic Medicine
| | - Michael E. Talkowski
- Department of Neurology
- Molecular Neurogenetics Unit, Center for Genomic Medicine
| | | | - Vijaya Ramesh
- Department of Neurology
- Molecular Neurogenetics Unit, Center for Genomic Medicine
| | - Wenli Cai
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School
| | - Gordon J. Harris
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School
| | - Miriam A. Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School
| | - Marlon Seijo
- Cancer Center, Massachusetts General Hospital, Boston, MA
| | | | - James F. Gusella
- Department of Neurology
- Molecular Neurogenetics Unit, Center for Genomic Medicine
- Department of Genetics, Harvard Medical School, Boston, MA
| | - Scott R. Plotkin
- Department of Neurology
- Cancer Center, Massachusetts General Hospital, Boston, MA
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17
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Watanabe M, Narita M, Hamada Y, Yamashita A, Tamura H, Ikegami D, Kondo T, Shinzato T, Shimizu T, Fukuchi Y, Muto A, Okano H, Yamanaka A, Tawfik VL, Kuzumaki N, Navratilova E, Porreca F, Narita M. Activation of ventral tegmental area dopaminergic neurons reverses pathological allodynia resulting from nerve injury or bone cancer. Mol Pain 2018; 14:1744806918756406. [PMID: 29357732 PMCID: PMC5802605 DOI: 10.1177/1744806918756406] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/03/2017] [Accepted: 12/13/2017] [Indexed: 02/02/2023] Open
Abstract
Chronic pain induced by nerve damage due to trauma or invasion of cancer to the bone elicits severe ongoing pain as well as hyperalgesia and allodynia likely reflecting adaptive changes within central circuits that amplify nociceptive signals. The present study explored the possible contribution of the mesolimbic dopaminergic circuit in promoting allodynia related to neuropathic and cancer pain. Mice with ligation of the sciatic nerve or treated with intrafemoral osteosarcoma cells showed allodynia to a thermal stimulus applied to the paw on the injured side. Patch clamp electrophysiology revealed that the intrinsic neuronal excitability of ventral tegmental area (VTA) dopamine neurons projecting to the nucleus accumbens (N.Acc.) was significantly reduced in those mice. We used tyrosine hydroxylase (TH)-cre mice that were microinjected with adeno-associated virus (AAV) to express channelrhodopsin-2 (ChR2) to allow optogenetic stimulation of VTA dopaminergic neurons in the VTA or in their N.Acc. terminals. Optogenetic activation of these cells produced a significant but transient anti-allodynic effect in nerve injured or tumor-bearing mice without increasing response thresholds to thermal stimulation in sham-operated animals. Suppressed activity of mesolimbic dopaminergic neurons is likely to contribute to decreased inhibition of N.Acc. output neurons and to neuropathic or cancer pain-induced allodynia suggesting strategies for modulation of pathological pain states.
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Affiliation(s)
- Moe Watanabe
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
| | - Michiko Narita
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
| | - Yusuke Hamada
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
| | - Akira Yamashita
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
| | - Hideki Tamura
- Life Science Tokyo Advanced Research Center (L-StaR), Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
| | - Daigo Ikegami
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Takashige Kondo
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
| | - Tatsuto Shinzato
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
| | - Takatsune Shimizu
- Department of Pathophysiology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
| | - Yumi Fukuchi
- Department of Pathophysiology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
| | - Akihiro Muto
- Department of Pathophysiology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
| | - Hideyuki Okano
- Life Science Tokyo Advanced Research Center (L-StaR), Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
- Department of Physiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Akihiro Yamanaka
- Department of Neuroscience II, Research Institute of Environmental Medicine, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, Japan
| | - Vivianne L Tawfik
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Naoko Kuzumaki
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
| | - Edita Navratilova
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Frank Porreca
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Minoru Narita
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
- Life Science Tokyo Advanced Research Center (L-StaR), Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa-ku, Tokyo, Japan
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18
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Oh SY, Shin SW, Koh SJ, Bae SB, Chang H, Kim JH, Kim HJ, Hong YS, Park KU, Park J, Lee KH, Lee NR, Lee JL, Jang JS, Hong DS, Lee SS, Baek SK, Choi DR, Chung J, Oh SC, Han HS, Yun HJ, Sym SJ, Yoon SY, Choi IS, Shim BY, Kang SY, Kim SR, Kim HJ. Multicenter, cross-sectional observational study of the impact of neuropathic pain on quality of life in cancer patients. Support Care Cancer 2017; 25:3759-3767. [PMID: 28689250 PMCID: PMC5658461 DOI: 10.1007/s00520-017-3806-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/22/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Neuropathic cancer pain (NCP) is a common and potentially debilitating symptom in cancer patients. We investigated the prevalence of NCP, as well as its management and association with QOL. METHODS Cancer patients with pain ≥1 on the visual analogue scale (VAS) were surveyed with the Douleur Neuropathique (DN4) questionnaire, the Brief Pain Inventory-Short Form (BPI-SF), and the EuroQOL five dimensions (EQ-5D) questionnaire. The associations between NCP and pain severity or NCP and QOL, while controlling for variables relevant to QOL, were then analyzed. RESULTS A total of 2003 patients were enrolled in this survey; the prevalence of NCP was 36.0% (n = 722, 95% CI, 32.5-39.5). We found that NCP in cancer patients was closely correlated to a higher pain severity (BPI-SF; 4.96 ± 1.94 versus 4.24 ± 2.02, p < 0.001), and in patients with NCP, pain more severely interfered with daily living, as compared to those without NCP (BPI-SF; 4.86 ± 2.71 versus 4.41 ± 2.87, p < 0.001). Patients with NCP also had worse QOL than those without NCP, as measured by EQ-5D index score (0.47 ± 0.30 vs. 0.51 ± 0.30, p = 0.005), and this was confirmed using multivariate analysis (p < 0.001), even after controlling for other variables such as age, sex, disease stage, cancer duration, radiotherapy, chemotherapy, and comorbidities. Importantly, adjuvant analgesics were used in less than half of patients with NCP (n = 358, 46.4%). CONCLUSIONS We found that NCP in cancer patients was significantly associated with a worsened QOL, and current management is inadequate. Therefore, future research aimed at developing improved strategies for management of NCP is required.
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Affiliation(s)
- So Yeon Oh
- Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Sang Won Shin
- Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 136-705, Republic of Korea.
| | - Su-Jin Koh
- Internal Medicine, Ulsan University College of Medicine, Ulsan, South Korea
| | - Sang Byung Bae
- Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Hyun Chang
- Internal Medicine, Seoul National University Bundang Hospital, Soengnam-Si, South Korea
| | - Jung Han Kim
- Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, South Korea
| | - Hyo Jung Kim
- Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Young Seon Hong
- Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Keon Uk Park
- Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, South Korea
| | - Jeanno Park
- Internal Medicine, Bobath Memorial Hospital, KyungGi, Soengnam-Si, South Korea
| | - Kyung Hee Lee
- Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | - Na Ri Lee
- Internal Medicine, Chonbuk National University College of Medicine, Chonbuk, South Korea
| | - Jung Lim Lee
- Internal Medicine, Daegu Fatima Hospital, Daegu, South Korea
| | - Joung Soon Jang
- Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Dae Sik Hong
- Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Seung-Sei Lee
- Internal Medicine, Sungkyunkwan University College of Medicine Kangbuk Samsung Hospital, Seoul, South Korea
| | - Sun Kyung Baek
- Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea
| | - Dae Ro Choi
- Internal Medicine, Hallym University Chuncheon Medical Center, Chuncheon, South Korea
| | - Jooseop Chung
- Internal Medicine, Pusan National University Hospital, Pusan, South Korea
| | - Sang Cheul Oh
- Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Hye Sook Han
- Internal Medicine, Chungbuk National University College of Medicine, Chungbuk, South Korea
| | - Hwan Jung Yun
- Internal Medicine, Chungnam National University College of Medicine, Chungnam, South Korea
| | - Sun Jin Sym
- Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - So Young Yoon
- Internal Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - In Sil Choi
- Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Byoung Yong Shim
- Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Seok Yun Kang
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Sung Rok Kim
- Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Hyun Joo Kim
- Corporate Affairs & Health and Value, Pfizer Pharmaceutical Korea Ltd., Seoul, South Korea
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19
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Qi X, Chen L, Zhang X, Han M, He W, Su Y, Wang X, Jing X, Zhu B. [Distribution of algesia sensitized acupoints in the patients of intestinal cancer]. Zhongguo Zhen Jiu 2017; 37:963-966. [PMID: 29354918 DOI: 10.13703/j.0255-2930.2017.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To judge whether algesia sensitization of some acupoints is existed and whether the acupoint algesia sensitization area is expanded in the patients of intestinal cancer. METHODS Totally, 30 patients of intestinal cancer and 30 healthy subjects were included. The electronic Von Fray was used to determine the pressure-pain thresholds at 13 acupoints relevant with gastrointestinal disorders and the reference points at the sites 1 cun and 2 cun lateral to those points as well as the sites at the corresponding nerve segments. Compared with the pressure-pain thresholds at the reference points of the different segments, the relative value was calculated. The changes were analyzed in the pressure-pain thresholds at the relevant acupoints on the body surface in the patients of intestinal cancer as compared with the relative pressure-pain thresholds in the healthy volunteers. RESULTS The pressure-pain thresholds at Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), Quchi (LI 11) and Dachangshu (BL 25) in the patients of intestinal cancer were all significantly reduced as compared with those of the healthy subjects (P<0.05, P<0.01, P<0.001). At the non-acupoint sites 1 cun and 2 cun lateral to those acupoints as well as at the sites of the same segments, the pressure-pain thresholds were reduced significantly as compared with the control group (P<0.05, P<0.01, P<0.001). Particularly, the sensitization zone of Yinlingquan (SP 9) focused on the acupoint, the site 1 cun lateral to it as well as the non-acupoint sites of the same segments (P<0.01, P<0.001). CONCLUSION The acupoint sensitization is displayed at Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), Quchi (LI 11), Dachangshu (BL 25) and Yinlingquan (SP 9) and the sensitization area is expended in the patients of intestinal cancer.
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Affiliation(s)
- Xuezhi Qi
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Lizhen Chen
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xiaoning Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Mingjuan Han
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Wei He
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yangshuai Su
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xiaoyu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xianghong Jing
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Bing Zhu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
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20
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Galiè E, Villani V, Terrenato I, Pace A. Tapentadol in neuropathic pain cancer patients: a prospective open label study. Neurol Sci 2017; 38:1747-1752. [PMID: 28699105 DOI: 10.1007/s10072-017-3035-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/14/2017] [Indexed: 12/20/2022]
Abstract
Many chemotherapy treatments induce peripheral neuropathy (CIPN). These patients often experience neuropathic pain (NP) that reduces the quality of life. The aim of this prospective, open label study was to evaluate the efficacy and tolerability of tapentadol (TP) in patients affected by CIPN. CIPN were consecutively enrolled in a prospective open label study at the Neuro-Oncology Unit of the Regina Elena National Cancer Institute in Rome. During the titration phase, each patient initially received doses of TP 50 mg twice a day. All patients underwent pain intensity (NRS) and DN4. For evaluation of quality of life, patients underwent EORTC QLQ-C30 and EORTC QLQ-CIPN2 QLQ-CIPN20. We enrolled 31 patients, 19 were females with a median age of 60 years. After 3 months of treatment with TP, 22 patients completed the statistical package for social sciences (SPSS). Nineteen patients out of 22 showed a response to treatment (86%). We also observed that TP reduced the NRS and DN4 values from baseline to the last visit in a significant way (p < 0.001, respectively). Seven patients (22.5%) discontinued the TP therapy after the first week of occurrence of side effects. Furthermore, we observed that TP improved also the global health status measured by EORT QLQ-C30. TP is well tolerated and efficacy in the treatment of NP. The important reduction of neuropathic pain, the improvement in NRS and QoL scores after therapy with TP makes it a candidate in the management of patients suffering from neuropathic pain of CIPN also as a first line of therapy.
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Affiliation(s)
- Edvina Galiè
- Neuro-Oncology Unit, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Veronica Villani
- Neuro-Oncology Unit, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Irene Terrenato
- Biostatistic Unit-Scientific Direction, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Andrea Pace
- Neuro-Oncology Unit, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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21
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Rocque GB, Halilova KI, Varley AL, Williams CP, Taylor RA, Masom DG, Wright WJ, Partridge EE, Kvale EA. Feasibility of a Telehealth Educational Program on Self-Management of Pain and Fatigue in Adult Cancer Patients. J Pain Symptom Manage 2017; 53:1071-1078. [PMID: 28185891 PMCID: PMC8641243 DOI: 10.1016/j.jpainsymman.2016.12.345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/12/2016] [Accepted: 12/29/2016] [Indexed: 02/08/2023]
Abstract
CONTEXT Pain and fatigue are common symptoms among cancer patients and often lead to substantial distress. Innovative self-management programs for pain and fatigue are needed. OBJECTIVES The primary objective was to assess the feasibility of a telehealth pain and fatigue self-management program among adult cancer patients. Secondary objectives included assessment of differences in patient characteristics, recruitment, and retention of patients based on two screening strategies: 1) navigator-collected, patient-reported pain or fatigue and 2) in-clinic, physician-identified pain or fatigue. METHODS This prospective, nonrandomized, pre-post evaluation assessed feasibility, which was defined as 50% of eligible patients choosing to participate and completing the intervention. Patient demographics and patient-reported outcomes (patient activation, distress, symptoms, and quality of life) were collected at baseline and study completion. Differences in baseline characteristics were compared between cohorts and for patients who did vs. did not graduate from the program. RESULTS The program did not meet feasibility requirements because of only 34% of eligible patients choosing to participate. However, 50% of patients starting the program graduated. Differences in baseline characteristics and retention rates were noted by recruitment strategy. At baseline, 27.3% of navigated patients were at the highest activation level compared with 7.1% in the physician-referred, non-navigated patients (P = 0.17); more than 15% of non-completers were at the lowest activation level compared with 9% of completers (P = 0.85). CONCLUSION Telehealth self-management program for pain and fatigue may be better accepted among selected segments of cancer patients. Larger scale studies are needed to assess the efficacy of this program in a more selective activated population.
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Affiliation(s)
- Gabrielle B Rocque
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Karina I Halilova
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allyson L Varley
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Courtney P Williams
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | - Edward E Partridge
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth A Kvale
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
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22
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van der Velden JM, Versteeg AL, Verkooijen HM, Fisher CG, Chow E, Oner FC, van Vulpen M, Weir L, Verlaan JJ. Prospective Evaluation of the Relationship Between Mechanical Stability and Response to Palliative Radiotherapy for Symptomatic Spinal Metastases. Oncologist 2017; 22:972-978. [PMID: 28469043 DOI: 10.1634/theoncologist.2016-0356] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 03/07/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A substantial number of patients with spinal metastases experience no treatment effect from palliative radiotherapy. Mechanical spinal instability, due to metastatic disease, could be associated with failed pain control following radiotherapy. This study investigates the relationship between the degree of spinal instability, as defined by the Spinal Instability Neoplastic Score (SINS), and response to radiotherapy in patients with symptomatic spinal metastases in a multi-institutional cohort. METHODS AND MATERIALS The SINS of 155 patients with painful thoracic, lumbar, or lumbosacral metastases from two tertiary hospitals was calculated using images from radiotherapy planning CT scans. Patient-reported pain response, available for 124 patients, was prospectively assessed. Pain response was categorized, according to international guidelines, as complete, partial, indeterminate, or progression of pain. The association between SINS and pain response was estimated by multivariable logistic regression analysis, correcting for predetermined clinical variables. RESULTS Of the 124 patients, 16 patients experienced a complete response and 65 patients experienced a partial response. Spinal Instability Neoplastic Score was associated with a complete pain response (adjusted odds-radio [ORadj] 0.78; 95% confidence interval [CI] 0.62-0.98), but not with an overall pain response (ORadj 0.94; 95% CI 0.81-1.10). CONCLUSIONS A lower SINS, indicating spinal stability, is associated with a complete pain response to radiotherapy. This supports the hypothesis that pain resulting from mechanical spinal instability responds less well to radiotherapy compared with pain from local tumor activity. No association could be determined between SINS and an overall pain response, which might indicate that this referral tool is not yet optimal for prediction of treatment outcome. IMPLICATIONS FOR PRACTICE Patients with stable painful spinal metastases, as indicated by a Spinal Instability Neoplastic Score (SINS) of 6 or lower, can effectively be treated with palliative external beam radiotherapy. The majority of patients with (impending) spinal instability, as indicated by a SINS score of 7 or higher, will achieve a (partial) response after palliative radiotherapy; however, some patients might require surgical intervention. Therefore, it is recommended to refer patients with a SINS score of 7 or higher to a spine surgeon to evaluate the need for surgical intervention.
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Affiliation(s)
- Joanne M van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne L Versteeg
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Charles G Fisher
- Division of Spine, Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Spine Surgery Institute at Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Edward Chow
- Sunnybrook Odette Cancer Centre, University of Toronto, Ontario, Canada
| | - F Cumhur Oner
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marco van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lorna Weir
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Jorrit-Jan Verlaan
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
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23
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Abstract
PURPOSE OF REVIEW In this article, we will discuss the current understanding of bone pain and muscle weakness in cancer patients. We will describe the underlying physiology and mechanisms of cancer-induced bone pain (CIBP) and cancer-induced muscle wasting (CIMW), as well as current methods of diagnosis and treatment. We will discuss future therapies and research directions to help patients with these problems. RECENT FINDINGS There are several pharmacologic therapies that are currently in preclinical and clinical testing that appear to be promising adjuncts to current CIBP and CIMW therapies. Such therapies include resiniferitoxin, which is a targeted inhibitor of noceciptive nerve fibers, and selective androgen receptor modulators, which show promise in increasing lean mass. CIBP and CIMW are significant causes of morbidity in affected patients. Current management is mostly palliative; however, targeted therapies are poised to revolutionize how these problems are treated.
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Affiliation(s)
- Daniel P Milgrom
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Neha L Lad
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Leonidas G Koniaris
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Teresa A Zimmers
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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Franklin AE, Lovell MR, Boyle F. A Case of Opioid Toxicity on Conversion From Extended-Release Oxycodone and Naloxone to Extended-Release Oxycodone in a Patient With Liver Dysfunction. J Pain Symptom Manage 2017; 53:e1-e2. [PMID: 27825847 DOI: 10.1016/j.jpainsymman.2016.10.354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/27/2016] [Accepted: 10/07/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Abigail E Franklin
- HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia.
| | - Melanie R Lovell
- HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia; Northern Clinical School and Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Frances Boyle
- Department of Medical Oncology, The University of Sydney, Sydney, New South Wales, Australia; Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney, New South Wales, Australia
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Affiliation(s)
- Vincent Maida
- University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Division of Palliative Medicine, William Osler Health System, Toronto, Ontario, Canada.
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Porta-Sales J, Garzón-Rodríguez C, Villavicencio-Chávez C, Llorens-Torromé S, González-Barboteo J. Efficacy and Safety of Methadone as a Second-Line Opioid for Cancer Pain in an Outpatient Clinic: A Prospective Open-Label Study. Oncologist 2016; 21:981-7. [PMID: 27306912 DOI: 10.1634/theoncologist.2015-0503] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/09/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Most clinical reports on methadone rotation describe outcomes in hospitalized patients. The few studies that have included outpatients are retrospective. The aim of this study was to assess the efficacy and safety of methadone as a second-line opioid in adult patients with advanced cancer after rotation in routine clinical practice at a palliative care outpatient clinic. PATIENTS AND METHODS This was a prospective, open-label study of 145 patients whose treatment was rotated from other opioids to methadone. Informed consent was obtained in all cases. The main outcome measure was change in the variable "worst pain" at day 28. Pain and pain interference were assessed with the Brief Pain Inventory, with side effects evaluated according to the Common Terminology Criteria for Adverse Events version 3.0. Pain levels were evaluated at study entry and at days 3, 7, 9, 14, 21, and 28. RESULTS Rotation to methadone was performed for the following reasons: poor pain control (77.9%), opioid side effects (2.1%), or both (20%). The mean daily oral morphine equivalent dose before rotation was 193.7 mg. The median worst and average pain scores decreased significantly (p < .0001) from baseline to day 28: The median worst pain score decreased from 9 (interquartile range [IQR]: 8-10) to 6 (IQR: 3-8), and the median average pain score decreased from 6 (IQR: 5-7) to 4 (IQR: 2-5). The proportions of patients with moderate to severe worst and average pain decreased by 30.3% and 47.5%, respectively, by day 28. No increase in opioid toxicity was observed during the study. CONCLUSION In outpatients with advanced cancer, rotation to methadone as a second-line opioid was efficacious and safe when using a tiered scheme with close follow-up by experienced health professionals. IMPLICATIONS FOR PRACTICE The results of this study, conducted prospectively under real clinical conditions, support the efficacy and safety of oral methadone as a second-line opioid in ambulatory patients with cancer. Moreover, these findings corroborate previously reported outcomes in retrospective outpatient studies and prospective studies that evaluated inpatient populations. Although more research into methadone rotation strategies is still needed, this study describes a successful tiered scheme of oral methadone rotation that was proven safe and effective during follow-up.
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Affiliation(s)
- Josep Porta-Sales
- Palliative Care Service, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Garzón-Rodríguez
- Palliative Care Service, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | | | - Silvia Llorens-Torromé
- Palliative Care Service, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Jesús González-Barboteo
- Palliative Care Service, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain Center for Health and Social Studies, University of Vic, Barcelona, Spain
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Ye X, Lu D, Chen X, Li S, Chen Y, Deng L. A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of Shuangbai San for Treating Primary Liver Cancer Patients With Cancer Pain. J Pain Symptom Manage 2016; 51:979-86. [PMID: 26921496 DOI: 10.1016/j.jpainsymman.2015.12.330] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 12/24/2015] [Accepted: 12/24/2015] [Indexed: 02/08/2023]
Abstract
CONTEXT Shuangbai San is a Chinese herb preparation used externally to treat pain. There have been few randomized controlled trials addressing the safety and usefulness of Shuangbai San, such as its effect on pain relief and quality of life (QOL) improvement. OBJECTIVES This study was conducted to evaluate the effect of Shuangbai San on relieving pain and improving QOL in primary liver cancer patients with cancer pain. METHODS A total of 134 primary liver cancer patients with mild pain (numerical rating scale [NRS] ≤ 3), either locally in the liver or in the upper abdomen, were enrolled and randomly allocated to the group receiving Shuangbai San or the control group (receiving placebo). The primary outcome measures were the NRS score and QOL scales, including the QOL scale for patients with liver cancer, version 2.0 and the European Organization for Research and Treatment of Cancer QOL Questionnaire-C30. The secondary outcome measures included the Karnofsky Performance Status score, blood indicators, and liver and kidney function before and after treatment. RESULTS The NRS scores decreased more significantly in the Shuangbai San group than in the placebo group (P < 0.05) at the corresponding time points. The changes in the scores for the physical function, psychological function, and symptoms/adverse effects domains of the QOL scale for patients with liver cancer, version 2.0 and the physical, emotional, and cognitive domains of the European Organization for Research and Treatment of Cancer QOL Questionnaire-C30 were significantly greater in the Shuangbai San group than in the placebo group (P < 0.05). The changes in the scores for the other domains were not significantly different (P > 0.05). CONCLUSION The use of Shuangbai San can relieve mild pain in liver cancer patients and improve their QOL.
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Affiliation(s)
- Xiaowei Ye
- Department of Oncology, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Dongyan Lu
- Department of Oncology, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
| | - Xinlin Chen
- Department of Preventive Medicine and Biostatistics, School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Suihui Li
- Department of Oncology, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yao Chen
- Department of Oncology, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Li Deng
- Department of Oncology, Guangzhou Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
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Kim YJ, Dev R, Reddy A, Hui D, Tanco K, Park M, Liu D, Williams J, Bruera E. Association Between Tobacco Use, Symptom Expression, and Alcohol and Illicit Drug Use in Advanced Cancer Patients. J Pain Symptom Manage 2016; 51:762-768. [PMID: 26703372 DOI: 10.1016/j.jpainsymman.2015.11.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 11/24/2015] [Accepted: 11/28/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Limited knowledge exists examining the association between smoking status, symptom expression, and alcohol or illicit drug use. OBJECTIVES The goal of this study was to clarify these associations in patients with advanced cancer. METHODS We retrospectively reviewed 560 charts and identified 300 consecutive advanced cancer patients who completed a comprehensive smoking questionnaire. Data including the Edmonton Symptom Assessment System, Cut down/Annoyed/Guilty/Eye opener (CAGE) alcoholism screening questionnaire, illicit drug use history, and daily opioid requirements-morphine equivalent daily dose-were collected. RESULTS Among 300 patients, 119 (40%) were never smokers, 148 (49%) former smokers, and 33 (11%) current smokers. The most common malignancies were gastrointestinal (28%) and lung (20%). Current smokers were more likely to be single (P < 0.01) and significantly younger than former smokers (P < 0.001) but did not differ in age from never smokers. Never smokers were more likely to be female (P < 0.001). Current smokers reported significantly higher pain expression than former and never smokers (median 7 vs. 5.5 vs. 5, respectively, P = 0.02), higher CAGE positivity (42% vs. 21% vs. 3%, P < 0.001) and were more likely to have a history of illicit drug use (33% vs. 16% vs. 3%, P < 0.001). The morphine equivalent daily dose was not significantly different according to smoking status. CONCLUSION In advanced cancer, patients who were former or current smokers were significantly more likely to have a history of CAGE positivity and illicit drug use compared with never smokers. Current smokers expressed significantly higher pain. A smoking history may be a marker of an increased risk of opioid misuse.
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Affiliation(s)
- Yu Jung Kim
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA; Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Rony Dev
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
| | - Akhila Reddy
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Kimberson Tanco
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Minjeong Park
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Diane Liu
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Janet Williams
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Davies A, Mundin G, Vriens J, Webber K, Buchanan A, Waghorn M. The Influence of Low Salivary Flow Rates on the Absorption of a Sublingual Fentanyl Citrate Formulation for Breakthrough Cancer Pain. J Pain Symptom Manage 2016; 51:538-45. [PMID: 26706627 DOI: 10.1016/j.jpainsymman.2015.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/08/2015] [Accepted: 11/09/2015] [Indexed: 11/15/2022]
Abstract
CONTEXT Salivary gland hypofunction may affect the absorption of drugs through the oral mucosa, which in turn may affect their clinical efficacy (e.g., onset of action). OBJECTIVES The aim of this study was to assess the pharmacokinetics of a sublingual fentanyl orally disintegrating tablet (Abstral, Prostrakan Inc.) in a group of cancer patients with salivary gland hypofunction. METHODS Nine cancer patients with salivary gland hypofunction underwent a series of three pharmacokinetic studies with the sublingual fentanyl orally disintegrating tablet. In the first phase, the patients received no pretreatment; in the second phase, the patients were allowed to moisten the oral cavity before dosing; in the third phase, the patients were given pilocarpine hydrochloride (saliva stimulant) before dosing. Fentanyl concentrations were measured using a method of high-performance liquid chromatography with validated tandem mass spectrometric detection. RESULTS The Tmax was longer, the Cmax was lower, the AUC0-30 lower, and the AUClast lower in the phase involving no pretreatment; the Tmax/Cmax/AUC0-30/AUClast were similar in the phase involving moistening of the oral cavity and the phase involving giving pilocarpine hydrochloride. CONCLUSION The pharmacokinetics of the sublingual fentanyl orally disintegrating tablet appear to be negatively affected by the presence of salivary gland hypofunction, although the moistening of the oral cavity before dosing results in a pharmacokinetic profile similar to that seen with the giving of pilocarpine hydrochloride.
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Affiliation(s)
- Andrew Davies
- Royal Surrey County Hospital, Guildford, Surrey, United Kingdom.
| | - Gill Mundin
- Mundipharma Research Ltd., Cambridge, Cambridgeshire, United Kingdom
| | - Joanna Vriens
- Princess Alice Hospice, Esher, Surrey, United Kingdom
| | - Kath Webber
- Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - Alison Buchanan
- Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - Melanie Waghorn
- Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
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30
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Chulkova VA, Vasilieva NG, Chernenko OA. [Pain in cancer and psychological methods of its correction]. Vopr Onkol 2016; 62:529-534. [PMID: 30475550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Physical pain can be a major component of cancer patient’s suffering but suffering itself covers much more different sides of a human being than physical manifestations and often happens in the absence of physical pain. Suffering or total pain include physical pain, social pain, psychological pain and spiritual pain, which have a mutual influence on each other. The efficacy of treatment of total pain in cancer patients may be increased by additional use of psychological methods of its correction.
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