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11 Aug, 17 | by James Smallbone, Publishing Assistant

Retrospective review of serotonergic medication tolerability in patients with neuroendocrine tumors with biochemically proven carcinoid syndrome.

Shi DD, Yuppa DP, Dutton T, et al.

Cancer. 2017 Jul 15;123(14):2735-2742

A retrospective review of patients with metastatic carcinoid tumours and elevated serotonin levels who received serotonergic antidepressants was performed to evaluate the effect of serotonergic antidepressants on the carcinoid syndrome. 52 patients were identified who received a total of 73 courses of serotonergic antidepressants, most commonly citalopram, followed by trazodone and sertraline. The median duration of treatment with serotonergic drugs was 4.8 months, with 38% of patients taking them for more than 6 months. No apparent adverse interaction of the serotonergic antidepressants on the carcinoid syndrome was reported in 45 patients (62%); 7 (10%) were categorized as having an unlikely adverse interaction, and 6 (8%) as having a likely adverse interaction; common symptoms were flushing and diarrhoea. No patients developed a carcinoid crisis requiring emergency care or hospitalisation.

http://onlinelibrary.wiley.com/doi/10.1002/cncr.30633/abstract

Composed by Elaine Boland.

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28 Jul, 17 | by James Smallbone, Publishing Assistant

Prevalence and incidence of chronic pain with or without neuropathic characteristics in patients with cancer.

Bouhassira D, Luporsi E, Krakowski I.

Pain. 2017 Jun;158(6):1118-1125.

A prospective observational study in France recruited 1805 cancer patients attending out-patients for cancer treatment from 12 oncology units. A clinical examination, DN4 questionnaire and Brief Pain Inventory were used to detect and characterise the pain. Chronic pain characterised as due to the tumour, cancer treatment, or not related to cancer. The overall prevalence of chronic pain was reported as 28%, with 21% of these patients having characteristics neuropathic pain; an overall prevalence of 5%. Pain with neuropathic characteristics was more commonly reported by patients with lung, breast, or head and neck cancers. Patents with a neuropathic element to their pain reported a higher pain intensity and pain interference. This study also looked at the incidence of chronic pain in patients who had no chronic pain at first visit but subsequently developed pain. Three months after initial assessment, the incidence of chronic pain varied from 12% to 20% and at 6 months, from 20% to 28%.

https://www.ncbi.nlm.nih.gov/pubmed/28267066

Composed by Elaine Boland.

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29 Apr, 17 | by James Smallbone, Publishing Assistant

Cost analysis of a prospective multi-site cohort study of palliative care consultation teams for adults with advanced cancer: Where do cost-savings come from?

May P, Garrido MM, Cassel JB, Kelley AS, Meier DE, Normand C, Smith TJ, Morrison RS.

Palliat Med. 2017 Apr;31(4):378-386.

 

A prospective multi-site cohort study in three US hospitals included 863 patients with advanced cancer and analysed the cost-differences associated with early palliative care consultation (within 2 days of admission), later palliative care and usual care. 226 were seen by a palliative care team during their hospital admission (177 seen within 2 days of admission) and 637 received usual care only. This study showed that patients receiving early palliative care had less treatment and shorter length of stay; however there was minimal cost differences between the early and late palliative care consultations groups.

 

Composed by Elaine Boland.

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22 Apr, 17 | by James Smallbone, Publishing Assistant

Comparing the symptom experience of cancer patients and non-cancer patients.

Deshields TL, Penalba V, Liu J, Avery J.

Support Care Cancer. 2017 Apr;25(4):1103-1109.

 

This study focussed on symptom burden of 301 consecutive patients from a general medical clinic and 558 cancer patients from a tumour registry who completed the Memorial Symptom Assessment Scale. Results showed that pain was more prevalent in non-cancer patients (p<0.05) and was reported as more frequent, severe and distressing. The overall symptom burden was higher for cancer patients (p=0.01) together with the psychological subscale scores (p<0.05).

The prevalence of dry mouth, mouth sores, feeling nervous, worry, cough, and dizziness was not significant between the groups of patients. There was no difference in the physical or the global distress index sub-scale scores when comparing both groups.

 

Composed by Elaine Boland.

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15 Apr, 17 | by James Smallbone, Publishing Assistant

Predictors of Complicated Grief and Depression in Bereaved Caregivers: A Nationwide Prospective Cohort Study.

Nielsen MK, Neergaard MA, Jensen AB, et al.

J Pain Symptom Manage. 2017 Mar;53(3):540-550

 

A prospective survey of 3635 caregivers to terminally ill patients in Denmark was conducted. 2420 were bereaved within six months and of the survey, 2125 (88%) [mean age 62 years, 70% female] completed a post-loss follow-up questionnaire

At baseline, around 15% were identified as having severe pre-loss grief symptoms and experienced moderate to severe depressive symptoms. Six months after the bereavement, complicated grief was reported in 7.6% and 12.1% had moderate to severe depressive symptoms. The predictors of complicated grief and post-loss depressive symptom were pre-loss depressive symptoms (adjusted OR=5.6), being a partner (adjusted OR=2.2) and low educational level (adjusted OR=2.0). 26% of caregivers who reported severe pre-loss grief symptoms developed complicated grief and 33% developed post-loss depressive symptom.

 

Composed by Elaine Boland.

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7 Apr, 17 | by James Smallbone, Publishing Assistant

A systematic review of prognostic factors at the end of life for people with a hematological malignancy.

Button E, Chan RJ, Chambers S, Butler J, Yates P.

BMC Cancer. 2017 Mar 23;17(1):213.

 

This systematic review looked at identifying prognostic factors in the last 3 months of life that are associated with increased risk of mortality for haematological malignancy; most patients were predominantly treated with aggressive curative or life-prolonging intent. This included 28 studies; mostly were in the intensive care unit settings and retrospective. The prognostic factors were categorised into 5 groups, mainly: demographics; interventions (eg: vasopressor support or mechanical ventilation), physiological complications (eg: bone marrow or multi-organ failure); disease characteristics; and laboratory blood values. Using the QUIPS tool, most studies were of moderate quality, three were high quality and one study was rated to be of low quality.

 

Composed by Elaine Boland.

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4 Mar, 17 | by bbutcher

Caregivers’ Perspectives on the Use of Long-Term Oxygen Therapy for the Treatment of Refractory Breathlessness: A Qualitative Study

Aileen Collier, Katrina Breaden, Jane L. Phillips, Meera Agar, Caroline Litster, David C. Currow.

J Pain Symptom Manage. 2017 Jan;53(1):33-39.

 

A qualitative study of the perspectives of 20 caregivers in the palliative setting of patients on long-term oxygen therapy (LTOT) for the treatment of refractory breathlessness was conducted using semi-structured interviews.

The main theme reported was that caregivers felt helpless and regarded oxygen as a life sustaining for people on LTOT and was vital in managing distressing symptoms and quality of life. However it also had financial costs and burdens including equipment, the noise from the concentrator, struggling with independence and leaving the house. The authors conclude that the possible harms of LTOT are underrated and highlight the importance of providing information and education about the appropriate use of LTOT.

 

Composed by Elaine Boland.

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20 Feb, 17 | by bbutcher

Prevalence of cancer chemotherapy-related problems, their relation to health-related quality of life and associated supportive care: a cross-sectional survey.

Wagland, Richardson A, Ewings S, Armes J, Lennan E, Hankins M, Griffiths P.

Support Care Cancer. 2016 Dec;24(12):4901-4911.

 

This study surveyed the prevalence of 17 problems whilst undergoing chemotherapy and people’s experiences of supportive care in 363 patients from six cancer centres in the UK. The EQ5D measure was also used. The response rate was 43%. The most common problem was tiredness/fatigue with 90% responders. Over 50% reported changes in sense of taste, difficulty managing everyday tasks, trouble sleeping, constipation, low mood, feeling sick, anxious, loss of appetite and unable to concentrate/forgetful.  In a multivariate model, difficulty with everyday tasks and work was significantly associated with health-related quality of life. Patients experienced less severe problems if they received supportive care; over a fifth stated that they never received support for emotional and social problems.

 

Composed by Elaine Boland.

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31 Jan, 17 | by bbutcher

Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis.

Kavalieratos D, Corbelli J, Zhang D, Dionne-Odom JN, Ernecoff NC, Hanmer J, Hoydich ZP, Ikejiani DZ, Klein-Fedyshin M, Zimmermann C, Morton SC, Arnold RM, Heller L, Schenker Y.

JAMA. 2016 Nov 22;316(20):2104-2114. doi: 10.1001/jama.2016.16840.

A narrative meta-analysis of randomized clinical trials (RCT) of palliative care interventions in adults with life-limiting illness was performed. 43 RCTs were included and involved 12,731 patients and 2479 caregivers (cancer and non-cancer). 23 RCTs were included in the meta-analysis. Palliative care interventions were associated with statistically and clinically significant improvements in physical symptoms and quality of life at 1 to 3 months. There was no association between palliative care and survival. There were improvements in patient and caregiver satisfaction with care, advance care planning and lower health care utilization with palliative care. When only the low risk of bias RCTs were meta-analysed, no statistically significant and clinically important associations remained.

 

Composed by Elaine Boland

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15 Jan, 17 | by bbutcher

Relationship between Opioid Treatment and Rate of Healing in Chronic Wounds.

Shanmugam VK, Couch KS, McNish S, Amdur RL.

Wound Repair Regen. 2016 Nov 16. doi: 10.1111/wrr.12496. [Epub ahead of print]

450 people participated in this longitudinal observational study to investigate the relationship between opioids and wound healing.  Using fixed-effects models and time-to-event analysis, opioid dose was significantly associated with total wound surface area (p<0.0001); subjects with mean opioid dose ≥10mg were significantly less likely to heal than those with no opioid (HR 0.67 [0.49-0.91], p=0.011) after adjusting for wound size. People who never had opioids healed faster than those who received opioids (p=0.0009). The authors plan to correlate the exposure of opioids and clinical outcome data with tissue mRNA expression array data which might help understand the molecular mechanisms that may contribute to delayed wound healing.

 

Composed by Elaine Boland

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