tbuckley/cabot-search huggingface dataset:
The role of shared decision-making in cancer pain management: Insights from a systematic review.
Authors: Andrea L Monteiro, Andro Yousef, Karen Sweiss, Robert DiDomenico, Lisa K. Sharp
Journal: Journal of Clinical Oncology (2024)

e24078 Background: Effective pain management in cancer care is crucial for patient quality of life. Shared decision-making (SDM) interventions are increasingly recognized for their potential to improve patient outcomes by facilitating patient engagement in care decisions. This systematic review synthesizes evidence on the impact of SDM interventions in cancer pain management. Methods: This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a comprehensive search across multiple databases, including PubMed, EMBASE, Scopus, CINAHL, PsycINFO, Web of Science, and the Cochrane Library. The search also extended to grey literature sources such as conference proceedings, dissertations, and unpublished reports to ensure a thorough coverage of the subject matter. Our search strategy employed a combination of MeSH terms and keywords related to 'decision making,' 'patient participation,' 'pain management,' and 'cancer.' This strategy was tailored to each database's unique syntax and search operators. Results: Ten studies, including six pilot and feasibility studies and four randomized controlled trials (RCTs) and Preintervention-Postintervention studies, were systematically reviewed. The interventions implemented diverse SDM strategies ranging from digital tools and personalized education to clinical decision support systems, targeting key aspects of pain management and patient-provider communication. Frequent intervention components included patient-reported outcome dashboards, symptom management support, and educational resources for pain management. The Tailored Education and Coaching (TEC) intervention notably increased pain-specific patient communication by 31%, while the PAINRelieveIt intervention did not significantly impact analgesic adherence but effectively reduced pain misconceptions among caregivers. Some interventions, like the Carevive CPS, showed high patient involvement in SDM (94.1%) and compliance with quality oncology practice initiative metrics (98%). However, the effectiveness of these interventions varied, with some showing no significant impact on primary pain outcomes. The variability in measured outcomes such as pain intensity, analgesic adherence, and patient satisfaction indicates a context-dependent effectiveness of SDM interventions, highlighting the importance of personalized approaches and the role of implementation strategies in influencing patient engagement and intervention success. Conclusions: SDM interventions in cancer pain management are diverse in structure and impact. Some interventions show promise in improving communication and reducing misconceptions, but their direct effect on pain outcomes varies.
Association of plasma kynurenine (KYN) with plasma osteopontin (OPN) in patients with locally invasive breast cancer.
Authors: Adam Ephraim, Chanbormey Leatheng, Ziyao Eric Lu, Xiaoqing Xia, Jonathan P. Pirruccello, Jonathan D Marotti, Todd MacKenzie, Mary D. Chamberlin
Journal: Journal of Clinical Oncology (2024)

e12551 Background: OPN is a matricellular protein implicated in several aggressive malignancies as both a prognostic marker and mechanistic driver of tumor development and metastasis, but little is known about what drives its increased expression in these settings. KYN, the biochemically active metabolite of tryptophan metabolism, is known to be involved in cancer immune evasion, cancer cell proliferation, chromosomal instability, angiogenesis, metastatic dissemination, and chemoresistance. In this study, we demonstrate that OPN levels are significantly elevated in plasma of patients requiring breast surgery for suspicious masses and is directly correlated with KYN plasma levels, which were also elevated in this population. Methods: We prospectively collected peripheral blood samples of 60 patients who required routine breast surgery for either benign or malignant masses. Plasma was obtained by centrifugation from the collected blood samples that were stored at -80℃. Samples were collected prior to any treatments or surgeries. This study is IRB approved, and participants provided written informed consent. High-performance liquid chromatography (HPLC) tandem mass spectrometry was carried out by the Dartmouth Clinical Pharmacology Shared Resource. Logistic regression was used to assess relationships among variables in the study population using the R language. Results: There is strong evidence to suggest that plasma KYN is directly related to OPN plasma levels in this group of 60 patients’ plasma samples with a correlation coefficient of 0.296 (p=0.024), 95% CI [0.0414-0.515]. Based on the p-value and confidence interval, there is statistical evidence to suggest a positive significant linear relationship between plasma KYN and OPN levels. Increased age and BMI, menopausal status, KYN’s substrate Tryptophan (TRP), and TNFα correlated neither with OPN levels nor event free survival (as defined by disease progression, complications including fractures, development of metabolic disease, or occurrence of secondary malignancy). Conclusions: Our data demonstrates a statistically significant linear relationship between KYN and OPN in plasma samples of patients undergoing breast surgery for suspicious lesions—offering new mechanistic insights into OPN—a biomarker implicated in cancer metastasis across several different cancer types. This data suggests that KYN, which is a known agonist of several harmful cancer-driving pathways, is directly related to OPN concentration in plasma of patients with early breast cancer. Further research investigating systemic concentrations of OPN in plasma is essential for gaining a comprehensive understanding of its mechanisms in tumor metastasis, as well as for exploring targeted therapeutic strategies to mitigate its detrimental effects.
Analysis of the fecal metagenome in pelvic radiation survivors with or without chronic gastrointestinal toxicity.
Authors: Bailey Nelson, Senu Apewokin, Hope Esslinger, Jordan Kharofa
Journal: Journal of Clinical Oncology (2024)

e24041 Background: Whole pelvis radiation therapy (WPRT) is often used as a definitive or adjuvant treatment in patients with genitourinary, gynecologic, and gastrointestinal (GI) malignancies. Irradiation of nearby bowel can cause acute and chronic GI symptoms, which can affect patients’ quality of life. Radiation therapy has been shown to alter the microbial flora and may select for pathogenic species, which may enhance toxicity. Characteristics of the fecal metagenome in patients with or without chronic GI toxicity is unknown. Severity of GI symptoms can vary between patients who receive a similar radiation dose to normal bowel; therefore, there is a critical need to evaluate the interaction of RT and microbial species in the development of toxicity. Methods: An institutional database was used to identify survivors that completed WPRT for prostate, gynecologic, and anal cancer within the last 5 years. Patients were excluded if they had evidence of recurrent disease requiring additional therapy. Eligible patients were asked to participate via telephone. Consenting patients provided a stool sample and completed a customized PRO-CTCAE form (scale 1-5) assessing chronic GI symptoms. Comprehensive shotgun metagenomics were performed on stool. Stool was sequenced using an Illumina NextSeq500. The fecal metagenome in patients with or without chronic GI symptoms were compared. Patients were dichotomized by PRO-CTCAE diarrhea score (0-1 [mild] vs ≥2 [moderate-severe]). Raw reads were processed with Kneaddata for trimming, Kracken2 for taxonomic profiling, and Bracken for abundance estimation for bacterial, fungal and viral genomes using sequences from the National Center for Bioinformatics to determine quantitative genus and species differences. For microbial diversity assessments, estimated inverse Simpson and Shannon indices were performed. Results: Fecal metagenome and PRO-CTCAE results were available for 13 survivors. Thirty percent (n = 4) of patients reported moderate to severe diarrhea. The mean age was 66 years, 38% were male, 46% received concurrent or adjuvant chemotherapy, and the mean time from completion of WPRT to stool analysis was 34 months (range 14-62 months). Conventional radiation bowel constraints were met for each patient. Several species were enriched in patients with mild GI toxicity. Notably, Akkermansia muciniphilia had the largest differential enrichment in patients with without chronic GI toxicity. Conclusions: In this cohort of patients, A. muciniphilia, a mucin-degrading bacteria that modulates the gut barrier integrity and mucin layer thickness, was enriched in patients with no to mild diarrhea compared to patients with moderate to severe diarrhea. A. muciniphilia supplementation has been shown to decrease systemic inflammation in Western diet-fed mice. Evaluation of A. muciniphilia as a radioprotective gut bacterium warrants further evaluation.
The effect of epidural steroid injections for the management of spinal malignancy-related pain.
Authors: Dongsik Lim, Minhye Chang, Sunmin Kim, Yu Jung Kim, Francis Sahngun Nahm, Pyung Bok Lee, Eun Joo Choi
Journal: Journal of Clinical Oncology (2024)

e24052 Background: Spinal malignancy-related pain is common in cancer patients. There are several treatment options from systemic steroid injection to surgical treatment. Epidural steroid injection (ESI) is one of commonly performed treatment. The purpose of this study is to assess the effect of ESI in spinal malignancy-related pain. Methods: We retrospectively reviewed our cases who was diagnosed with spinal metastatic cancer, and received ESI from January 2021 to December 2022. The primary outcome was pain intensity (Visual Analogue Scale score, 0-10) at baseline, 1, 3 and 6 months after ESI. Patients with a pain reduction of more than 50% at 1 month after ESI were classified as success group (S), and others were classified as failure group (F). The secondary outcomes were change of MEDD (morphine equivalent daily dose, mg/day) at same time points. Also, each patient’s demographic data, ECOG, history of previous radiotherapy, and survival duration following ESI. Results: Totally 135 patients were enrolled, and 80 patients were analyzed. Of the 80 patients, 47 and 33 patients were classified into the S and F group, respectively (Table 1). Patients who had previous radiotherapy was 68.1% in S group, but only 48.5% in F group (p = 0.04). The 80% of group S survived over 6 months, compared to 39% of group F (p &lt; 0.001). There were significant differences in VAS scores between S and F groups at all-time points during the follow-up period (P &lt; 0.001) and MEDD was significantly lower in the S group at 1 (p = 0.02) and 3 months (p &lt; 0.01). Conclusions: This study demonstrates that ESI effectively reduce pain and opioid use in patients with spinal malignancy-related pain. Given the observed survival periods, it can be inferred that earlier intervention with ESI is more likely to yield beneficial outcomes. [Table: see text]
Curcumin add-on improves quality of life in patients with locally or advanced head and neck cancer receiving nutritional intervention.
Authors: Tawasapon Thambamroong, Kasan Seetalarom, Siriwimon Saichaemchan, Khunthong Peechatanan, Jarearnjit Phavirunsiri, Naiyarat Prasongsook
Journal: Journal of Clinical Oncology (2024)

e24051 Background: The CurChexia study, NCT04208334, is a phase IIa randomized control trial. The study demonstrates the benefits of adding 4,000 mg of curcumin to the standard nutritional intervention. This addition helps to increase muscle mass and delay the decrease in other body composition parameters. However, clinicians require treatment that maintains or improves the quality of life (QoL) of head and neck cancer patients. In this report, we present the QoL data. Methods: Patients participating in the study were required to complete the EORTC QLQ-C30 version 3.0 questionnaire in the Thai edition. The questionnaire was given at the beginning of the study, at the end of week 4, at the end of the study, or in week 8. The results were scored following the EORTC scoring guidelines and compared between the group that received the curcumin add-on and the standard nutritional intervention (control). The patients needed to complete all sections of the EORTC QLQ-C30, and no data was missing. Results: Ten of the 20 patients were given curcumin, while the others were in the control group. Based on the EORTC QLQ-C30, there was an improvement in the median global health status, but it was not significant between the curcumin and control groups. However, the curcumin group improved all functional status parameters, particularly physical functioning ( p= 0.001) and emotional functioning ( p= 0.023). Regarding symptom scales, curcumin significantly reduced pain symptoms ( p= 0.033) and increased appetite ( p= 0.001) compared to the control group. The other parameters that could have affected QoL did not show significant differences between the two groups. Conclusions: The CurChexia study indicates that curcumin has shown promising results in improving muscle mass, enhancing quality of life, and increasing appetite, thereby establishing its position as a noteworthy phytonutrient. However, it is important to note that further research is necessary to understand the extent of its benefits fully. Clinical trial information: NCT04208334 .
Testosterone replacement therapy (TRT) in patients with locoregional prostate cancer (LPC) treated with prior androgen deprivation therapy (ADT): A single center review.
Authors: Mostafa Aglan, Sumanth Khadke, Brendan Connell
Journal: Journal of Clinical Oncology (2024)

e24045 Background: In LPC, ADT may be combined with radiation therapy (RT) for 4-24 months. Post-ADT, a significant proportion of men experience prolonged hypogonadism. TRT can alleviate symptoms and improve metabolic outcomes. Contrary to longstanding concerns, there is no substantial evidence of increased prostate cancer recurrence in patients (pts) treated with single modalities (surgery or RT). However, sparse data ( &lt; 100 cases published to our knowledge) exist regarding recurrence risk of LPC with TRT after prior ADT, where baseline T levels may fall below the androgen receptor saturation point. Methods: We retrospectively abstracted clinical data from hospital records of men with stage I – IVA PC, treated with prior concurrent ADT and RT and subsequently received TRT between January 2014 and September 2023. Extracted data included demographics, cancer diagnosis/staging, ADT/TRT treatment details and PSA and clinical outcomes. The co-primary endpoints were change in PSA and incidence of PC recurrence. Results: 21 pts met criteria. Median age was 77. ISUP Grade Groups (GG) included: GG1: 2, GG2: 2, GG3: 8, GG4: 2, and GG5: 7. AJCC 8th ed. stages were: I: 2, II: 7, III: 7, IV-A: 5. The median duration of prior ADT was 8 months (IQR 5 – 17) and the median interval from RT to TRT was 19 months (IQR: 12 – 44). Prior to TRT, the median testosterone level was 30.5 ng/dL (IQR: 17-76). TRT formulations included: injection: 6, oral: 4, topical: 13. The median follow-up period from the start of TRT was 13 months, and the median duration on TRT was 10 months (IQR: 5-22). TRT was ongoing in 15 (71.4%) pts and discontinued in 6 (28.6%). Reasons for discontinuation included testosterone recovery (1), hospice (not PC related) (2), no perceived benefit (2), MD concern for PSA rise (1). After TRT, the median testosterone level was 336 ng/dL (IQR: 207-462). Median PSA pre- and post-TRT were undetectable and 0.08 ng/dL, respectively. None of the subjects experienced PC recurrence or PC-specific mortality. One pt showed PSA bounce without recurrence. Median BMI was unchanged before (28.3 kg/m2) and after (27.7 kg/m2) TRT (p = 0.48). Due to the nature of the study, quality of life measures and metabolic parameters could not be systematically abstracted. Conclusions: In men with LPC who remained hypogonadal long-term after prior ADT and RT, we found that TRT was not associated with a significant rise in median PSA and no cases of PC recurrence were documented. This included many with a history of very high-risk cancers (eg. GG ≥ 4, Stage ≥ III). This study adds to the sparse existing literature in this clinical setting and together they support the case for a prospective trial utilizing TRT in patients who remain hypogonadal after ADT and radiation.
Establishing palliative care in tribal and rural Indian setting: A participatory action research approach.
Authors: Dr. Kahkasha, Saurabh Varshney, Sushma Bhatnagar
Journal: Journal of Clinical Oncology (2024)

e24085 Background: We established a palliative care center in the tribal area of Santhal Pargana, India, under a tertiary care facility, as a crucial step in addressing the palliative needs of oncology patients. This study assesses the center's inaugural year, focusing on referral patterns, morphine consumption, and pain management. Methods: Data from all patients visiting the palliative care outpatient department (OPD) in 2023 were prospectively collected and analyzed. The study focused on key palliative care indicators, including morphine consumption, patient referrals, and the mean Numeric Rating Scale (NRS) pain score after initial consultation. The PAR approach was utilized to tailor services to the community's needs. Results: The center observed an increase in patient referrals, from 8 new patients in January to 19 by December. The patient demographic primarily comprised individuals with head and neck cancer (43%), followed by breast cancer (28%) and gall bladder cancer (12%), alongside other types such as cervix, sarcomas, lung, and adult hematolymphoid malignancies. Bone metastasis was present in 46 (55.4%) patients at initial presentation. Morphine consumption demonstrated a notable rise, from 840 mg in May to 2860 mg in December, totaling 9800 mg for the year. The mean NRS pain score improved significantly from 6.5 in January to 4.3 post-initial consultation. The center maintained an overall median of 3 consultations per patient, and bereavement support was provided to 13 (15.7%) patients. Conclusions: The integration of the Participatory Action Research approach, specifically the CTC-5, was instrumental in the successful initiation and expansion of palliative care services within the center. The structured training, mentorship, and organizational restructuring, facilitated by the program, were crucial in establishing a modest palliative care infrastructure. This comprehensive approach not only enhanced care delivery but also ensured the sustainability and adaptability of palliative services, effectively addressing the gap in palliative care in rural, tribal settings.
Head and neck cancer survivors’ perception of lymphedema care.
Authors: Cristina Kline-Quiroz, Barbara A. Murphy, Sheila H. Ridner, Derek Smith, David G. Schlundt, Kemberlee Bonnet
Journal: Journal of Clinical Oncology (2024)

e24046 Background: Secondary lymphedema and fibrosis occurs in more than 90% of HNC survivors. Given the progressive nature of lymphedema, prompt identification and treatment are essential. Treatment of HNC related lymphedema is fraught by numerous barriers. Advanced pneumatic compression devices (APCD) may address critical barriers. We conducted a phase 3 randomized multi-site trial in HNC survivors with treatment naïve lymphedema comparing usual care to APCD. Here in we report a qualitative analysis of participants treatment experience. Methods: Semi-structured interviews were audio recorded and transcribed after participants completed the 6 th -month visit (N = 14 usual care, N = 23 APCD). Questions addressed treatment experience, perceptions of care, barriers, and facilitators. A hierarchical coding system was developed and refined using the interview guide and preliminary review of the transcripts. Transcripts were coded by experienced qualitative researchers. The coded transcripts were analyzed using an iterative inductive-deductive approach and based on our theoretical framework. Results: Participants were 65% male, 35% female and identified as 92% white, 5% black, and 5% Hispanic. The average age was 62 with a range of 32-82. We identified two distinct and one common set of barriers and facilitators. For usual care, health system (care coordination, logistics) and therapist factors (perceived skills and demeanor) were important while device characteristics (fit, comfort) were important for the APCD. Cognitive affective factors (self-efficacy, knowledge, outcome expectations, frustration) were similar for both therapies and interacted with the device/system characteristics. Conclusions: We identified distinct treatment barriers and facilitators for usual lymphedema care and treatment with APCD. Barriers identified in this study highlight practice changing opportunities to address system issues and develop interventions to enhance care and quality of life. Utilization of both treatment strategies may allow tailoring of treatments thus optimizing outcomes. Clinical trial information: NCT04797390 .
Unveiling the influence of SGLT2 inhibitors on clinical outcomes in patients with cancer with therapy-related cardiac dysfunction: A meta-analysis and systemic review.
Authors: Nouman Shafique, Safia Shaikh, Khurram Irshad, - Muhibullah, Abdul Qadeer, Yochitha Pulipati, Sheraz Ahmad Tariq, Shammas Bajwa, Navneet Kaur, Roha Saeed Memon, Shahroze Ahmed, Syed Mujtaba Ali Naqvi, Ahmed Muaaz Umer, Usman Ali Akbar, Sana Khan, Zainab Javeed, Ali Ghaffar, Muhammad Usama Gillani, Munis Raza, Robert W. Kirchoff
Journal: Journal of Clinical Oncology (2024)

e24003 Background: Cancer patients undergoing chemotherapy suffer from a variable degree of cancer therapy–related cardiac dysfunction and heart failure (HF). It is known that sodium glucose co-transporter 2 (SGLT2) inhibitors improve outcomes in patients with HF independent of diabetes mellitus and left ventricular ejection fraction; our study aims to investigate the potential benefits of SGLT2 inhibitory therapy specifically in cancer patients undergoing chemotherapy. Methods: We performed an electronic search on PubMed, Embase, and Cochrane, from the inception of databases till January 29, 2024, to identify all the articles that compared the use of SGLT2 inhibitors in adult (≥18 years) with type 2 diabetes mellitus and exposure to cardiotoxic antineoplastic therapy, subsequently diagnosed with cardiomyopathy, heart failure, or LVEF &lt; 40%. The data was extracted and pooled using a random effects model to calculate the odds ratio (OR) with a respective 95% confidence interval (CI). R software (v.4.3) was used for all statistical analyses. Results: Our search identified three observational studies with a total of 3,164 patients (SGLT2- inhibitor group: 1,550; Control group: 1,614). We found that the use of SGLT2 inhibitors was associated with a lower risk of all-cause mortality (OR: 0.25 [0.20, 0.31]; I 2 = 16%; p &lt; 0.001), hospitalizations from heart failure (OR: 0.25 [0.10, 0.62]; I 2 = 0%; p = 0.003), and acute exacerbation of heart failure (OR: 0.35 [0.27, 0.47]; I 2 = 0%; p &lt; 0.001). Conclusions: Our findings suggest a favorable association between the use of SGLT2 inhibitors and reduced mortality, as well as improved cardiac clinical outcomes in cancer patients undergoing chemotherapy. However, further validation through large-scale studies and randomized controlled trials across diverse malignancies is warranted to establish the efficacy of these drugs. [Table: see text]