bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid use in impending versus pathologic proximal femur fractures.
Authors: Yu Austin , Jones Conor M. , Vijayakumar Gayathri , Turkmani Amr , Cargill Andre , Colman Matthew W. , Gitelis Steven , Blank Alan T. 
Published: June 2024

e24061 Background: Pathologic and impending fractures commonly occur in the proximal femur, and patients may be prescribed opioids prior to surgery and often require opioids for postoperative pain relief. This study compared postoperative opiate usage and ambulatory functional status in patients with impending versus pathologic fractures in the proximal femur. Methods: This was a retrospective review of patients using opioids postoperatively who underwent internal fixation for a pathologic or impending fracture between 2016 and 2022. Preoperative and postoperative opioid usage as well as ambulation status and risk factors at three and six months associated with postoperative opioid use were recorded. Results: Twenty-four pathologic fractures and twenty-three impending fractures were included. Preoperative opioid daily morphine milligram equivalent (MME) was significantly higher in the pathologic fracture group (p = 0.021), but there were no significant differences at three or six months. In the impending fracture group, daily MME at three months was significantly higher than preoperative daily MME (p = 0.018) but returned to preoperative levels at six months. There was statistically significant improvement in ambulation status in the combined cohort (p = 0.008) and impending fracture cohort (p = 0.016) at 6 months. Conclusions: Although patients did not experience a significant postoperative change in opioid use, patients with pathologic fractures notably required higher opioid dosages and there was overall improvement in function following fixation. Future studies should examine postoperative opioid use with careful consideration of concurrent pain management pain therapies and tumor characteristics.[Table: see text]
Advance care planning and predictive factors among Brazilian patients with cancer from an outpatient palliative care program.
Authors: Ananda Gomes Sarah Ananda , Silva Danielle , Sorice Flavia , Barreto Arantes Alexandra , Rodrigues Martins Matheus , de Paula Silva Elaine Cristina , Amaral Fagner , Peixoto Rafaela , Ferrari Renata , Laloni Mariana , Bergerot Cristiane Decat , Ferrari Bruno Lemos 
Published: June 2024

e24062 Background: Advance care planning (ACP) is crucial for informed decision-making in patient care. However, barriers such as time constraints and discomfort with discussions hinder widespread ACP adoption. A previous study (Cohen et al. JNCCN 2023) indicated a low ACP engagement rate (17%), but participation in a palliative care program has shown potential to increase this proportion. Therefore, we sought to determine the prevalence of ACP and identify associated predictor factors among patients with cancer in Brazil enrolled in an outpatient palliative care (OPC) program. Methods: A retrospective analysis was performed from November 2022 to December 2023. Eligible patients were those who passed away during the study period and had received care from an OPC program at one of the largest private joint cancer centers in Latin America. We assessed the prevalence of ACP and explored its potential associations with clinical characteristics (age, gender and type of cancer), OCP support (follow-up period, appointments and family support), and end-of-life care (treatment in the past month, intensive care unit (ICU) admission in the past month, home care service referrals, and place of death).Comparative analyses involved two groups: those who had undergone ACP and those who had not (no-ACP). Logistic models were employed. Results: A total of 849 patients were included in the final analyses. Patients’ characteristics were well balanced between groups. Most patients were women (56%), with an average of 68.2 years (SD =15.3). Patients were mostly diagnosed with gastrointestinal (36%), breast (13%), and lung (13%) cancers. Notably, 43% of patients had ACP, significantly higher than literature controls (95% confidence interval [CI]= 22-31%, P = 0.001). Among the factors associated with ACP, clinical characteristics were not significant. However, OCP support and end-of-life care were significantly predicted by ACP, including the follow-up period (MACP= 179 vs. Mno-ACP= 101; P = 0.001), family support (MACP= 0.6 vs. Mno-ACP= 0.3; P < 0.001) , ICU admission at the last 30 days of life (ACP = 28% vs. no-ACP = 72%; P < 0.001), and home care service referral (ACP = 72% vs. no-ACP = 28%; P < 0.001). Conclusions: These findings underscore that prolonged engagement with the OPC program is associated with increased adoption of ACP among Brazilian patients with cancer. Given the scarcity of data from developing countries, our findings suggest that the OPC program plays a pivotal role in optimizing end-of life care support through ACP.
The efficacy of ketamine for pain management in patients with cancer: A systematic review.
Authors: Azari Leila , Saleh Anaraki Kimia , Hemati Homa , Tavasolian Ronia , Shahdab Sareh , Tomlinson Stephanie M. , Bobonis Babilonia Margarita , Huang Jeffrey , Tometich Danielle , Turner Kea , Jim Heather S.L. , Alishahi Tabriz Amir 
Published: June 2024

e24069 Background: Managing cancer-related pain poses significant challenges, prompting research into alternative approaches such as the study of ketamine. This systematic review aims to analyze and summarize the impact of ketamine as an adjuvant to opioid therapy for cancer-related pain. Methods: We conducted a literature review in MEDLINE, EMBASE, and Scopus, spanning from January 1, 1982, to October 20, 2022. Abstracts were screened against inclusion criteria, and eligible studies underwent a thorough full-text review. Data were extracted from the included studies, and a framework analysis approach was employed to summarize the evidence regarding ketamine's use in patients with cancer. The quality of included studies was assessed using the NIH Quality Assessment Tool for controlled intervention studies. Results: A total of 22 studies conducted between 2001 and 2019 were included, all assessed as having good quality. Three studies focusing on intrathecal administration of ketamine following oncological surgery demonstrated a substantial improvement in pain scores and a reduction in postoperative morphine requirements. Two studies exploring intramuscular use concluded that it led to improved pain scores. In contrast, three studies on subcutaneous administration and two studies on topical ketamine did not exhibit a significant impact on reducing pain scores or alleviating chemotherapy-induced peripheral neuropathy. Findings from two studies on oral administration and eight studies on intravenous administration indicated that intravenous ketamine reduced postoperative morphine requirements, while oral ketamine had no discernible effect on lowering pain scores. Conclusions: The use of intrathecal ketamine demonstrates significant improvement in post-op oncological pain and refractory cancer pain, resulting in lowered pain scores and decreased morphine requirements. Further research is essential to ascertain the extent to which incorporating ketamine with opioids in cancer pain treatment can enhance pain outcomes, especially in morphine-tolerant patients.
The use of complementary and alternative medicine (CAM) among patients with cancer in Hawaii.
Authors: Matriz Jobel , Hamachi April , Fukui Jami Aya 
Published: June 2024

e24070 Background: Complementary and alternative medicine (CAM) involves medical products and practices that are not part of standard medical care. Various studies demonstrate potential benefits of CAM in alleviating certain side effects associated with cancer and cancer treatments. Our project aims to elucidate the prevalence, pattern of use, and proposed benefits of CAM among Hawaii residents with cancer. Methods: Our questionnaire based study recruited cancer patients from several outpatient oncology clinics across Oahu (n = 126). Patients were asked about CAM use and associated symptom benefit. Sociodemographic information was collected along with details about cancer type, treatment, and associated side effects. Participation was anonymous and optional. Results: At least one CAM therapy was used by 72/126 (57.1%) patients, while 54 (42.9%) did not use any CAM therapy. Among the CAM therapies, meditation and herbal supplements were most commonly used 26 (36.6%), followed by massage 25 (32.4%), and yoga 18 (25.4%). Stress reduction was the most common symptom benefit identified for various CAM therapies including meditation 13 (50%), herbal supplement 13 (50%), massage 13 (52%), and yoga 14 (77.8%). Anxiety reduction was another symptom benefit reported for meditation 13 (50%). Massage 13 (52%), CBD 14 (82.4%), and acupuncture 9 (64.3%) were also used for pain reduction. THC 12 (75%) and CBD 14 (82.4%) were used for sleep. Among the CAM users (n = 72), 52 (72.2%) did not speak to their clinician about CAM. We found that 107 (84.9%) patients experienced at least one side effect. The most common side effects experienced by patients were fatigue 81 (64.3%), hair loss 61 (48.4%), and constipation and/or diarrhea 57 (45.2%). The most commonly reported demographic information were the following: 95 (75.4%) female, 57 (45.2%) Asian, 33 (26.2%) 60-69 years old, 80 (63.5%) with breast cancer, and 33 (26.2%) with stage 4. Conclusions: We discovered that stress reduction is a symptom benefit associated with the most commonly used CAM therapies by cancer patients in Hawaii. Other symptom benefits involve anxiety, pain, and sleep. The modalities utilized were similar to nonpharmacologic therapies recommended by the NCCN guidelines for cancer survivorship, with the exception of herbal supplements. There is a lack of physician discussion regarding CAM use, which could impact the cancer burden in Hawaii. [Table: see text]
Trends in palliative care utilization among patients with ovarian cancer in the United States.
Authors: Adkoli Anusha , Tomita-Barber Jasmine , Patel Ankoor , Liu Nancy , Greenberg Patricia , Patankar Sonali , Girda Eugenia 
Published: June 2024

e24083 Background: Palliative care is a resource that is utilized for patients with serious illnesses to focus on symptom management, quality of life, and goals of care for patients and their families. It can be initiated at any point in illness course with benefit beginning as early as the time of diagnosis. This study's objective is to evaluate trends in inpatient palliative care utilization and associated factors in patients with ovarian cancer. Methods: We performed a retrospective cohort study using the National Inpatient Sample (NIS) from 2010-2020. Patients with ovarian, fallopian tube, and primary peritoneal cancer and palliative care (PC) utilization were identified using ICD-10 codes. Chi square and t tests were used to evaluate differences between patients who received PC versus patients who did not. Multivariate and multinomial logistic regression was utilized to determine factors associated with PC use. Results: A total of 479,169 patients with a diagnosis of ovarian cancer were included, of which 58,970 (12.3%) utilized inpatient PC. Between 2010 and 2020, there was a significant upwards trend in PC usage in patients hospitalized with a diagnosis of ovarian cancer from 6.9% to 18.1%. Median age of patients using PC was 67 compared to 65 among those not using PC (p < 0.001). PC utilization was more prevalent among patients with a diagnosis of depression (8.7% v 6.4%; p < 0.001), Black race (12.4% v 10.3%; p < 0.001), in urban environments (94.0% v 92.2%; p < 0.001), and those at hospitals designated as teaching status (72.4% v 66.8%; p < 0.001). In a multivariate regression analysis, the odds of palliative care utilization were 1.59times higher (p < 0.001) for patients with moderate loss of function compared to patients with minor loss of function. Patients with hospital stays 0-3 days were more likely to utilize palliative care compared to 4-7 days (p < 0.001) Multinomial logistic regression for disposition among patients using palliative care to additional care versus routine care was 1.59 times higher in patients with 8+ days hospital stay compared to 4-7 days. For those with shorter stays of 1-3 days versus 4-7 days patients were 1.65 times more likely to die versus routine care. Conclusions: The use of inpatient PC for patients with ovarian cancer increased over time. Palliative care utilization was associated with older age, Black race, depression, and treatment in urban environments or in teaching hospitals. The utilization of inpatient palliative care was higher in patients with more extreme losses of function. These patients were more likely to have shorter lengths of stay due to a higher disposition of death over routine care. Given these findings, patients receiving palliative care may be sicker and closer to the end of life than those who do not. Although there have been higher rates of inpatient palliative care over time, there is still room for earlier implementation.
Natural supplementation to effectively combat cancer-related fatigue: Evidence from a meta-analysis on the use of guarana.
Authors: Maselli-Schoueri Jean Henri , Nazareth Aguiar Pedro , Del Giglio Auro 
Published: June 2024

e24087 Background: Cancer-related fatigue (CRF) is one of the most common symptoms reported and is estimated to affect up to 90% of cancer patients during the course of the disease. CRF may persist even after the end of cancer treatment. There is no definitive effective treatment with a high level of evidence and several alternatives have been sought after to aid traditional medications, with emphasis on natural supplements as a form of adjuvant treatment. In previous studies carried out by the Department of Oncology at ABC Medical School, a purified extract of Guarana ( Paullinia cupana), a plant native to the Amazon, showed promising results in clinical trials with patients undergoing chemotherapy, but with a limited number of patients and, thus, lower level of evidence. Therefore, the present study carried out a systematic review and meta-analysis of the supplementation of Guarana and its derivatives to combat CRF to produce more robust evidence regarding its possible therapeutic effect. Methods: Systematic review with meta-analysis registered at the International Prospective Register of systematic reviews (PROSPERO) under code CRD42023484144. Two independent researchers searched for articles in English on PUBMED, MEDLINE and Cochrane Library using controlled vocabulary (MeSH terms) and keywords related to CFR, Guarana and its related terms. Eligible studies were selected based on predefined criteria and were assessed for quality according to Cochrane Handbook for Systematic Reviews of Interventions. Data extraction was independently performed by two reviewers – any discrepancies were resolved by a third researcher. On the rare occasions in which a study was published as an abstract and then published as a full article, only its complete version was considered eligible for inclusion to avoid duplicates and reduce risk of bias. All analyses were conducted with RevMan 5.4.1 and employed random-effects model. Results: Of the 117 articles found, 4 full articles and 1 abstract were added to the meta-analysis, comprehending a total of 229 patients and the years of 2007-2023. With high heterogeneity between studies (I² = 78%, Chi² = 18.51, df = 4, P = 0.0010), our analysis found benefit in using guarana to combat CRF: Standard Mean Difference -0.77 (IC95% -1.34; -0.21), Test for overall effect: Z = 2.68 (P = 0.007). Conclusions: Our analysis supports the use of Guarana to combat Cancer-Related Fatigue. Further investigation with prospective randomized controlled trials should be carried out to validate our findings.
A phase II trial to assess the impact of β2 adrenergic blockade in immune checkpoint inhibitor (ICI)– refractory metastatic triple negative breast cancer (mTNBC).
Authors: Gandhi Shipra , Roy Arya Mariam , Minderman Hans , Rosario Spencer , Repasky Elizabeth A. 
Published: June 2024

TPS1141 Background: In PD-L1+ mTNBC patients (pts), the standard of care treatment is chemotherapy and pembrolizumab (P) in the first-line setting. It has been shown that acquired resistance to P occurs as a result of immune exhaustion. Further, our group and others have demonstrated that chronic β2-adrenergic receptor (β-AR) signaling suppresses CD8+ cytotoxic T lymphocytes (CTL) function, drives their exhaustion, and increases the numbers of immunosuppressive myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs) in the tumor microenvironment (TME), thus supporting tumor proliferation. Consequently, abrogation of β-AR signaling using the pan β-blocker propranolol or β-AR-/- knockout mice increased the intratumoral frequency of CTLs and elevated the CTL:Treg ratio (Bucsek et al. Cancer Res. 2017; PMID: 28819022). Similarly, mouse tumor models also demonstrated decreased exhaustion markers (PD1, TIM3, LAG3) on CTLs when β-AR was blocked, via propranolol (Qiao G et al. Cancer Immunol Res. 2021, PMID: 33762351). Confirming this phenomenon, we have shown, in a prospective clinical trial in metastatic melanoma, that β-AR blockade with propranolol significantly increased response to P with an objective response rate (ORR) of 78%, as opposed to 30-40% with P monotherapy (Gandhi et al, Clin Cancer Res 2021, PMID: 33127652). Therefore, we hypothesize that using propranolol in an ICI refractory population should improve responses to ICIs. Methods: This is a phase II single-arm, non-randomized single-center study for mTNBC pts. Participants will bewomen >=18 yrs with PD-L1+ mTNBC, who have progressed on treatment with chemotherapy and P in the upfront setting. They will continue P every 3 weeks in addition to 30 mg propranolol twice a day, based on our ongoing clinical trial in metastatic melanoma (NCT03384836) which has demonstrated safety with this combination. Treatment will continue until disease progression per irRECIST. The primary endpoint is ORR, defined as complete or partial response to treatment. The secondary endpoint is safety, 6-month progression-free survival and overall survival. As an exploratory endpoint, changes in tumor and blood immune markers will be assessed. In stage 1, n1=12 evaluable pts will be enrolled. If ≥ 1/12 response is observed, then the study will continue to enroll another n2=9 pts for a total of n=21, otherwise it will be suspended for futility. If ≥ 3/21 responses are observed, then the proposed therapy will be considered promising. Pre- and post-treatment tumor biopsies and sequential blood samples will be analyzed for changes in stress-induced biomarkers (epinephrine, norepinephrine, and frequency of CTL, MDSC, Treg) and expression of exhaustion markers (PD1, TIM3, LAG3). The study is currently open. Clinical trial information: NCT05741164 .
Olanzapine Plus Triple Antiemetic Therapy for the Prevention of Carboplatin-Induced Nausea and Vomiting: A Randomized, Double-Blind, Placebo-Controlled Phase III Trial
Authors: Inui Naoki , Suzuki Takahito , Tanaka Kazuki , Karayama Masato , Inoue Yusuke , Mori Kazutaka , Yasui Hideki , Hozumi Hironao , Suzuki Yuzo , Furuhashi Kazuki , Fujisawa Tomoyuki , Matsuura Shun , Nishimoto Koji , Matsui Takashi , Asada Kazuhiro , Hashimoto Dai , Fujii Masato , Niwa Mitsuru , Uehara Masahiro , Matsuda Hiroyuki , Koda Keigo , Ikeda Masaki , Inami Nao , Tamiya Yutaro , Kato Masato , Nakano Hideki , Mino Yasuaki , Enomoto Noriyuki , Suda Takafumi 
Published: June 2024

PURPOSE We evaluated the efficacy and safety of antiemetic therapy with olanzapine, a neurokinin-1 receptor antagonist (RA), a 5-hydroxytryptamine-3 (5-HT3) RA, and dexamethasone for preventing chemotherapy-induced nausea and vomiting in patients receiving carboplatin-containing chemotherapy. PATIENTS AND METHODS Chemotherapy-naïve patients scheduled to receive carboplatin (AUC ≥5) were randomly assigned to receive either olanzapine 5 mg once daily (olanzapine group) or placebo (placebo group) in combination with aprepitant, a 5-HT3 RA, and dexamethasone. The primary end point was the complete response (CR; no vomiting and no rescue therapy) rate in the overall phase (0-120 hours). Secondary end points included the proportion of patients free of nausea and safety. RESULTS In total, 355 patients (78.6% male, median age 72 years, 100% thoracic cancer), including 175 and 180 patients in the olanzapine and placebo groups, respectively, were evaluated. The overall CR rate was 86.9% in the olanzapine group versus 80.6% in the placebo group. The intergroup difference in the overall CR rate was 6.3% (95% CI, –1.3 to 13.9). The proportions of patients free of chemotherapy-induced nausea in the overall (88.6% in the olanzapine group v 75.0% in the placebo group) and delayed (89.7% v 75.6%, respectively) phases were significantly higher in the olanzapine group than in the placebo group (both P < .001). Somnolence was observed in 43 (24.6%) and 41 (22.9%) patients in the olanzapine and placebo groups, respectively, and no events were grade ≥3 in severity. CONCLUSION The addition of olanzapine was not associated with a significant increase in the overall CR rate. Regarding the prevention of nausea, adding olanzapine provided better control in patients receiving carboplatin-containing chemotherapy, which needs further exploration.
Navigating Skin Delivery Horizon: An Innovative Approach in Pioneering Surface Modification of Ultradeformable Vesicles
Authors: Nayak Devika , Rathnanand Mahalaxmi , Tippavajhala Vamshi Krishna 
Published: June 2024

AbstractIn the dynamic landscape of pharmaceutical advancements, the strategic application of active pharmaceutical ingredients to the skin through topical and transdermal routes has emerged as a compelling avenue for therapeutic interventions. This non-invasive approach has garnered considerable attention in recent decades, with numerous attempts yielding approaches and demonstrating substantial clinical potential. However, the formidable barrier function of the skin, mainly the confinement of drugs on the upper layers of the stratum corneum, poses a substantial hurdle, impeding successful drug delivery via this route. Ultradeformable vesicles/carriers (UDVs), positioned within the expansive realm of nanomedicine, have emerged as a promising tool for developing advanced dermal and transdermal therapies. The current review focuses on improving the passive dermal and transdermal targeting capacity by integrating functionalization groups by strategic surface modification of drug-loaded UDV nanocarriers. The present review discusses the details of case studies of different surface-modified UDVs with their bonding strategies and covers the recent patents and clinical trials. The design of surface modifications holds promise for overcoming existing challenges in drug delivery by marking a significant leap forward in the field of pharmaceutical sciences.