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Impact of surgery for stage IA non-small-cell lung cancer on patient quality of life
Background There is a paucity of literature comparing quality of life (QoL) before and after surgery in stage IA lung cancer, where surgical resection is the recommended curative treatment.
Objective To assess the impact of surgery on physical and mental health-related QoL in patients with stage IA lung cancer treated with surgical resection.
Methods Participants in the I-ELCAP cohort who were diagnosed with their first primary pathologic stage IA non-small-cell lung cancer, underwent surgery, and provided follow-up information on QoL 1 year later were included in the present analysis (N = 107). QoL information was collected using the SF-12 (12-item Short Form Health Survey), which generates 2 component scores related to mental health and physical health.
Results Statistical analyses indicated that physical health QoL was significantly worsened from before surgery to after surgery, whereas mental health QoL marginally improved from before to after surgery. Physical health QoL worsened for women from baseline to follow-up, but not for men. Only lobectomy (not limited resection) had an impact on QoL from before to after surgery.
Limitations Results are considered preliminary given the small sample size and multiple comparisons.
Conclusions The current study findings have implications for lung cancer health care professionals in regard to how they can most effectively present the possible impact of surgery on quality of life to this subset of patients in which disease has not yet significantly progressed.
Funding/sponsorship Gift from Sonia Lasry Gardner, in memory of her father, Moise Lasry.
Click on the PDF icon at the top of this introduction to read the full article.
Background There is a paucity of literature comparing quality of life (QoL) before and after surgery in stage IA lung cancer, where surgical resection is the recommended curative treatment.
Objective To assess the impact of surgery on physical and mental health-related QoL in patients with stage IA lung cancer treated with surgical resection.
Methods Participants in the I-ELCAP cohort who were diagnosed with their first primary pathologic stage IA non-small-cell lung cancer, underwent surgery, and provided follow-up information on QoL 1 year later were included in the present analysis (N = 107). QoL information was collected using the SF-12 (12-item Short Form Health Survey), which generates 2 component scores related to mental health and physical health.
Results Statistical analyses indicated that physical health QoL was significantly worsened from before surgery to after surgery, whereas mental health QoL marginally improved from before to after surgery. Physical health QoL worsened for women from baseline to follow-up, but not for men. Only lobectomy (not limited resection) had an impact on QoL from before to after surgery.
Limitations Results are considered preliminary given the small sample size and multiple comparisons.
Conclusions The current study findings have implications for lung cancer health care professionals in regard to how they can most effectively present the possible impact of surgery on quality of life to this subset of patients in which disease has not yet significantly progressed.
Funding/sponsorship Gift from Sonia Lasry Gardner, in memory of her father, Moise Lasry.
Click on the PDF icon at the top of this introduction to read the full article.
Background There is a paucity of literature comparing quality of life (QoL) before and after surgery in stage IA lung cancer, where surgical resection is the recommended curative treatment.
Objective To assess the impact of surgery on physical and mental health-related QoL in patients with stage IA lung cancer treated with surgical resection.
Methods Participants in the I-ELCAP cohort who were diagnosed with their first primary pathologic stage IA non-small-cell lung cancer, underwent surgery, and provided follow-up information on QoL 1 year later were included in the present analysis (N = 107). QoL information was collected using the SF-12 (12-item Short Form Health Survey), which generates 2 component scores related to mental health and physical health.
Results Statistical analyses indicated that physical health QoL was significantly worsened from before surgery to after surgery, whereas mental health QoL marginally improved from before to after surgery. Physical health QoL worsened for women from baseline to follow-up, but not for men. Only lobectomy (not limited resection) had an impact on QoL from before to after surgery.
Limitations Results are considered preliminary given the small sample size and multiple comparisons.
Conclusions The current study findings have implications for lung cancer health care professionals in regard to how they can most effectively present the possible impact of surgery on quality of life to this subset of patients in which disease has not yet significantly progressed.
Funding/sponsorship Gift from Sonia Lasry Gardner, in memory of her father, Moise Lasry.
Click on the PDF icon at the top of this introduction to read the full article.
Management of epidermal growth factor receptor inhibitor-associated rash: a systematic review
New therapies for antiemetic prophylaxis for chemotherapy
A number of new advances have occurred in the management of chemotherapy-related nausea and vomiting (CINV). A new neurokinin-1 receptor antagonist (NK1RA), netupitant, has been combined with palonosetron in a single oral tablet for treating the effects of moderately emetogenic chemotherapy (MEC) and highly emetogenic chemotherapy (HEC). Rolapitant, another NK1RA, unlike aprepitant, has a long half-life and does not block CYP-3A4 and therefore has fewer drug interactions. Olanzapine reduces nausea more effectively than aprepitant in patients who are receiving HEC and is a better rescue antiemetic than is metoclopramide. Ginger lacks efficacy as an antiemetic agent for CINV. Although there was some evidence in a pilot study of gabapentin as an antiemetic, it was no better in reducing CINV than was placebo. Compliance to guidelines in multiple settings ranges from 50%-60% but is improved by computerized order entry of antiemetics and recommendations displayed with chemotherapy.
Click on the PDF icon at the top of this introduction to read the full article.
A number of new advances have occurred in the management of chemotherapy-related nausea and vomiting (CINV). A new neurokinin-1 receptor antagonist (NK1RA), netupitant, has been combined with palonosetron in a single oral tablet for treating the effects of moderately emetogenic chemotherapy (MEC) and highly emetogenic chemotherapy (HEC). Rolapitant, another NK1RA, unlike aprepitant, has a long half-life and does not block CYP-3A4 and therefore has fewer drug interactions. Olanzapine reduces nausea more effectively than aprepitant in patients who are receiving HEC and is a better rescue antiemetic than is metoclopramide. Ginger lacks efficacy as an antiemetic agent for CINV. Although there was some evidence in a pilot study of gabapentin as an antiemetic, it was no better in reducing CINV than was placebo. Compliance to guidelines in multiple settings ranges from 50%-60% but is improved by computerized order entry of antiemetics and recommendations displayed with chemotherapy.
Click on the PDF icon at the top of this introduction to read the full article.
A number of new advances have occurred in the management of chemotherapy-related nausea and vomiting (CINV). A new neurokinin-1 receptor antagonist (NK1RA), netupitant, has been combined with palonosetron in a single oral tablet for treating the effects of moderately emetogenic chemotherapy (MEC) and highly emetogenic chemotherapy (HEC). Rolapitant, another NK1RA, unlike aprepitant, has a long half-life and does not block CYP-3A4 and therefore has fewer drug interactions. Olanzapine reduces nausea more effectively than aprepitant in patients who are receiving HEC and is a better rescue antiemetic than is metoclopramide. Ginger lacks efficacy as an antiemetic agent for CINV. Although there was some evidence in a pilot study of gabapentin as an antiemetic, it was no better in reducing CINV than was placebo. Compliance to guidelines in multiple settings ranges from 50%-60% but is improved by computerized order entry of antiemetics and recommendations displayed with chemotherapy.
Click on the PDF icon at the top of this introduction to read the full article.
Idarucizumab given the nod as the first specific antidote for an oral anticoagulant
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Cannabinoids in cancer treatment settings
Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
Smoking after breast cancer diagnosis a risk factor in cancer death
Women who smoke before or after a diagnosis of breast cancer have a significantly higher risk for death from breast cancer, respiratory tract cancers, and other causes than never smokers or quitters, follow-up results of a population-based prospective observation study show.
Among a subcohort of 4,562 women from the ages of 20 to 70, those who were active smokers within 1 year of a breast cancer diagnosis had a 25% greater risk for death from breast cancer, 14-fold higher risk for death from respiratory cancer, 6-fold risk for death from other respiratory diseases, and 2-fold higher risk for death from cardiovascular disease, found Dr. Michael N. Passarelli of the University of California, San Francisco, and his colleagues.
“Our study reinforces the importance of cigarette smoking cessation in women with breast cancer. For the minority of breast cancer survivors who continue to smoke after their diagnoses, these results should provide additional motivation to quit,” they write (J Clin Oncol. 2016 Jan 25. doi: 10.1200/JCO.2015.63.9328).
The investigators studied a cohort of 4,562 women who had taken part in the Collaborative Breast Cancer and Women’s Longevity Study, conducted in Massachusetts, New Hampshire, and Wisconsin. The study enrolled 20,691 women diagnosed from 1988 through 2008 with incident localized or regional invasive breast cancer.
The investigators re-contacted 4,562 participants a median of 6 years after their diagnosis. For women who reported smoking after breast cancer diagnosis, they calculated survival from the date of return of the questionnaire to the date of death or the end of follow-up.
The authors also created pre- and post-diagnosis proportional hazard regression models controlling for body mass index, education, parous status, age at first birth, menopausal status, family history of breast cancer, use of post-menopausal hormones, alcohol consumption, and the number of years between date of diagnosis and return of the study questionnaire.
For women who reported being active smokers within 1 year before a breast cancer diagnosis, hazard ratios (HR) for death from various causes were as follows (all statistically significant as shown by confidence intervals): breast cancer, HR 1.25; respiratory cancer, HR 14.48; other respiratory disease, HR 6.02; cardiovascular disease, HR 2.08.
For the 434 women (10%) who reported active smoking after diagnosis, the HR for breast-cancer death vs. never smokers was 1.72. Compared with women who continued to smoke, women who quit smoking after diagnosis had a lower risk for both breast-cancer death (a non-significant trend) and respiratory-cancer deaths (HR 0.39).
Women who smoke before or after a diagnosis of breast cancer have a significantly higher risk for death from breast cancer, respiratory tract cancers, and other causes than never smokers or quitters, follow-up results of a population-based prospective observation study show.
Among a subcohort of 4,562 women from the ages of 20 to 70, those who were active smokers within 1 year of a breast cancer diagnosis had a 25% greater risk for death from breast cancer, 14-fold higher risk for death from respiratory cancer, 6-fold risk for death from other respiratory diseases, and 2-fold higher risk for death from cardiovascular disease, found Dr. Michael N. Passarelli of the University of California, San Francisco, and his colleagues.
“Our study reinforces the importance of cigarette smoking cessation in women with breast cancer. For the minority of breast cancer survivors who continue to smoke after their diagnoses, these results should provide additional motivation to quit,” they write (J Clin Oncol. 2016 Jan 25. doi: 10.1200/JCO.2015.63.9328).
The investigators studied a cohort of 4,562 women who had taken part in the Collaborative Breast Cancer and Women’s Longevity Study, conducted in Massachusetts, New Hampshire, and Wisconsin. The study enrolled 20,691 women diagnosed from 1988 through 2008 with incident localized or regional invasive breast cancer.
The investigators re-contacted 4,562 participants a median of 6 years after their diagnosis. For women who reported smoking after breast cancer diagnosis, they calculated survival from the date of return of the questionnaire to the date of death or the end of follow-up.
The authors also created pre- and post-diagnosis proportional hazard regression models controlling for body mass index, education, parous status, age at first birth, menopausal status, family history of breast cancer, use of post-menopausal hormones, alcohol consumption, and the number of years between date of diagnosis and return of the study questionnaire.
For women who reported being active smokers within 1 year before a breast cancer diagnosis, hazard ratios (HR) for death from various causes were as follows (all statistically significant as shown by confidence intervals): breast cancer, HR 1.25; respiratory cancer, HR 14.48; other respiratory disease, HR 6.02; cardiovascular disease, HR 2.08.
For the 434 women (10%) who reported active smoking after diagnosis, the HR for breast-cancer death vs. never smokers was 1.72. Compared with women who continued to smoke, women who quit smoking after diagnosis had a lower risk for both breast-cancer death (a non-significant trend) and respiratory-cancer deaths (HR 0.39).
Women who smoke before or after a diagnosis of breast cancer have a significantly higher risk for death from breast cancer, respiratory tract cancers, and other causes than never smokers or quitters, follow-up results of a population-based prospective observation study show.
Among a subcohort of 4,562 women from the ages of 20 to 70, those who were active smokers within 1 year of a breast cancer diagnosis had a 25% greater risk for death from breast cancer, 14-fold higher risk for death from respiratory cancer, 6-fold risk for death from other respiratory diseases, and 2-fold higher risk for death from cardiovascular disease, found Dr. Michael N. Passarelli of the University of California, San Francisco, and his colleagues.
“Our study reinforces the importance of cigarette smoking cessation in women with breast cancer. For the minority of breast cancer survivors who continue to smoke after their diagnoses, these results should provide additional motivation to quit,” they write (J Clin Oncol. 2016 Jan 25. doi: 10.1200/JCO.2015.63.9328).
The investigators studied a cohort of 4,562 women who had taken part in the Collaborative Breast Cancer and Women’s Longevity Study, conducted in Massachusetts, New Hampshire, and Wisconsin. The study enrolled 20,691 women diagnosed from 1988 through 2008 with incident localized or regional invasive breast cancer.
The investigators re-contacted 4,562 participants a median of 6 years after their diagnosis. For women who reported smoking after breast cancer diagnosis, they calculated survival from the date of return of the questionnaire to the date of death or the end of follow-up.
The authors also created pre- and post-diagnosis proportional hazard regression models controlling for body mass index, education, parous status, age at first birth, menopausal status, family history of breast cancer, use of post-menopausal hormones, alcohol consumption, and the number of years between date of diagnosis and return of the study questionnaire.
For women who reported being active smokers within 1 year before a breast cancer diagnosis, hazard ratios (HR) for death from various causes were as follows (all statistically significant as shown by confidence intervals): breast cancer, HR 1.25; respiratory cancer, HR 14.48; other respiratory disease, HR 6.02; cardiovascular disease, HR 2.08.
For the 434 women (10%) who reported active smoking after diagnosis, the HR for breast-cancer death vs. never smokers was 1.72. Compared with women who continued to smoke, women who quit smoking after diagnosis had a lower risk for both breast-cancer death (a non-significant trend) and respiratory-cancer deaths (HR 0.39).
FROM THE JOURNAL OF CLINICAL ONCOLOGY
Key clinical point: Smoking is a significant risk factor for death from breast cancer and other causes.
Major finding: Women who actively smoked within a year before a breast cancer diagnosis had a 25% higher risk for breast cancer death than never smokers.
Data source: Follow-up cohort of 4,562 women from a population-based prospective cohort study.
Disclosures: The study was funded by grants from the National Cancer Institute and Susan G. Komen Foundation. The authors had no relevant conflicts of interest to disclose.
DEA’s rescheduling of hydrocodone tied to declines in prescribing
Prescriptions for hydrocodone analgesics abruptly and markedly declined after the U.S. Drug Enforcement Administration reclassified them from schedule III to the more restrictive schedule II of the Controlled Substances Act, according to a research letter to the editor published online in JAMA Internal Medicine Jan. 25.
Hydrocodone, usually formulated in combination with nonopioid analgesics, is one of the most frequently abused opioids, accounting for nearly 100,000 abuse-related emergency department visits during one recent year. In October 2014, the DEA rescheduled these agents to subject them to more rigorous control, said Christopher M. Jones, Pharm.D., MPH, of the Department of Health and Human Services, Washington, and his associates.
To assess any effect this rescheduling had on prescribing patterns, the investigators analyzed information in the IMS Health National Prescription Audit, a database that captures nearly 80% of all prescriptions dispensed from U.S. pharmacies, focusing on the 3 years before and the 1 year after rescheduling. They also analyzed information in an American Medical Association database to assess prescribing of hydrocodone combination agents across medical specialties during the year after rescheduling.
Prescriptions for hydrocodone combination agents decreased by 22% after rescheduling, and those for hydrocodone combination tablets decreased by 16%. There were 26.3 million fewer prescriptions for hydrocodone combination products, and 1.1 billion fewer hydrocodone combination tablets in the year after rescheduling.
Most of this decline (74%) was attributable to a profound reduction in refills, which is “consistent with the prohibition on prescription refills for schedule II medications,” Dr. Jones and his associates said (JAMA Intern Med. 2016 Jan 25. doi: 10.1001/jamainternmed.2015.7799).
In contrast, prescriptions for nonhydrocodone combination opioid analgesics increased by 5%, and those for nonhydrocodone tablets by 1%, during the year after rescheduling.
The reductions in prescribing occurred across most medical specialties. Surgeons and primary care physicians accounted for the largest decreases in both hydrocodone-containing prescriptions (-38.4% and -22.9%, respectively) and tablets (-30.8% and -17.1%, respectively). Oncologists, emergency medicine specialists, and nurse practitioners and physician assistants also contributed heavily to the declines. Dentists and physical/rehabilitation/occupational medicine specialists accounted for smaller reductions.
In contrast, pain medicine specialists showed modest increases in prescriptions for hydrocodone combination products and tablets.
“Future research should examine whether these changes are sustained, have had an effect on access for patients, and are associated with the desired goals of reduced abuse, addiction, and overdose,” Dr. Jones and his associates noted.
This study was funded by the U.S. Food and Drug Administration. Dr. Jones and his associates reported having no relevant financial disclosures.
Prescriptions for hydrocodone analgesics abruptly and markedly declined after the U.S. Drug Enforcement Administration reclassified them from schedule III to the more restrictive schedule II of the Controlled Substances Act, according to a research letter to the editor published online in JAMA Internal Medicine Jan. 25.
Hydrocodone, usually formulated in combination with nonopioid analgesics, is one of the most frequently abused opioids, accounting for nearly 100,000 abuse-related emergency department visits during one recent year. In October 2014, the DEA rescheduled these agents to subject them to more rigorous control, said Christopher M. Jones, Pharm.D., MPH, of the Department of Health and Human Services, Washington, and his associates.
To assess any effect this rescheduling had on prescribing patterns, the investigators analyzed information in the IMS Health National Prescription Audit, a database that captures nearly 80% of all prescriptions dispensed from U.S. pharmacies, focusing on the 3 years before and the 1 year after rescheduling. They also analyzed information in an American Medical Association database to assess prescribing of hydrocodone combination agents across medical specialties during the year after rescheduling.
Prescriptions for hydrocodone combination agents decreased by 22% after rescheduling, and those for hydrocodone combination tablets decreased by 16%. There were 26.3 million fewer prescriptions for hydrocodone combination products, and 1.1 billion fewer hydrocodone combination tablets in the year after rescheduling.
Most of this decline (74%) was attributable to a profound reduction in refills, which is “consistent with the prohibition on prescription refills for schedule II medications,” Dr. Jones and his associates said (JAMA Intern Med. 2016 Jan 25. doi: 10.1001/jamainternmed.2015.7799).
In contrast, prescriptions for nonhydrocodone combination opioid analgesics increased by 5%, and those for nonhydrocodone tablets by 1%, during the year after rescheduling.
The reductions in prescribing occurred across most medical specialties. Surgeons and primary care physicians accounted for the largest decreases in both hydrocodone-containing prescriptions (-38.4% and -22.9%, respectively) and tablets (-30.8% and -17.1%, respectively). Oncologists, emergency medicine specialists, and nurse practitioners and physician assistants also contributed heavily to the declines. Dentists and physical/rehabilitation/occupational medicine specialists accounted for smaller reductions.
In contrast, pain medicine specialists showed modest increases in prescriptions for hydrocodone combination products and tablets.
“Future research should examine whether these changes are sustained, have had an effect on access for patients, and are associated with the desired goals of reduced abuse, addiction, and overdose,” Dr. Jones and his associates noted.
This study was funded by the U.S. Food and Drug Administration. Dr. Jones and his associates reported having no relevant financial disclosures.
Prescriptions for hydrocodone analgesics abruptly and markedly declined after the U.S. Drug Enforcement Administration reclassified them from schedule III to the more restrictive schedule II of the Controlled Substances Act, according to a research letter to the editor published online in JAMA Internal Medicine Jan. 25.
Hydrocodone, usually formulated in combination with nonopioid analgesics, is one of the most frequently abused opioids, accounting for nearly 100,000 abuse-related emergency department visits during one recent year. In October 2014, the DEA rescheduled these agents to subject them to more rigorous control, said Christopher M. Jones, Pharm.D., MPH, of the Department of Health and Human Services, Washington, and his associates.
To assess any effect this rescheduling had on prescribing patterns, the investigators analyzed information in the IMS Health National Prescription Audit, a database that captures nearly 80% of all prescriptions dispensed from U.S. pharmacies, focusing on the 3 years before and the 1 year after rescheduling. They also analyzed information in an American Medical Association database to assess prescribing of hydrocodone combination agents across medical specialties during the year after rescheduling.
Prescriptions for hydrocodone combination agents decreased by 22% after rescheduling, and those for hydrocodone combination tablets decreased by 16%. There were 26.3 million fewer prescriptions for hydrocodone combination products, and 1.1 billion fewer hydrocodone combination tablets in the year after rescheduling.
Most of this decline (74%) was attributable to a profound reduction in refills, which is “consistent with the prohibition on prescription refills for schedule II medications,” Dr. Jones and his associates said (JAMA Intern Med. 2016 Jan 25. doi: 10.1001/jamainternmed.2015.7799).
In contrast, prescriptions for nonhydrocodone combination opioid analgesics increased by 5%, and those for nonhydrocodone tablets by 1%, during the year after rescheduling.
The reductions in prescribing occurred across most medical specialties. Surgeons and primary care physicians accounted for the largest decreases in both hydrocodone-containing prescriptions (-38.4% and -22.9%, respectively) and tablets (-30.8% and -17.1%, respectively). Oncologists, emergency medicine specialists, and nurse practitioners and physician assistants also contributed heavily to the declines. Dentists and physical/rehabilitation/occupational medicine specialists accounted for smaller reductions.
In contrast, pain medicine specialists showed modest increases in prescriptions for hydrocodone combination products and tablets.
“Future research should examine whether these changes are sustained, have had an effect on access for patients, and are associated with the desired goals of reduced abuse, addiction, and overdose,” Dr. Jones and his associates noted.
This study was funded by the U.S. Food and Drug Administration. Dr. Jones and his associates reported having no relevant financial disclosures.
FROM JAMA INTERNAL MEDICINE
Key clinical point: The DEA’s reclassifying of hydrocodone analgesics from schedule III to the more restrictive schedule II produced an abrupt and marked decline in prescriptions.
Major finding: There were 26.3 million fewer prescriptions for hydrocodone combination products and 1.1 billion fewer prescriptions for hydrocodone combination tablets in the year after rescheduling.
Data source: An analysis of a nationally representative prescription database during the 3 years before and the 1 year after the DEA rescheduled hydrocodone.
Disclosures: This study was funded by the U.S. Food and Drug Administration. Dr. Jones and his associates reported having no relevant financial disclosures.
Acupressure improves persistent fatigue in breast cancer survivors
SAN ANTONIO – Self-administered acupressure focused on enhancing relaxation significantly reduced persistent fatigue symptoms in breast cancer survivors, according to a randomized clinical trial presented at the San Antonio Breast Cancer Symposium.
“Self-administered relaxation acupressure offers an inexpensive, easy-to-learn method to manage fatigue and co-occurring poor sleep quality and overall quality of life in breast cancer survivors with persistent fatigue,” said Suzanna M. Zick, N.D., MPH, of the department of family medicine, and the complementary and alternative medicine research center at the University of Michigan, Ann Arbor.
She conducted the study because persistent fatigue is arguably the most common and debilitating symptom experienced by breast cancer survivors, affecting 30% of women for up to 10 years after they’ve completed their breast cancer therapy. Yet treatment options remain limited, she said.
Acupressure is a form of traditional Chinese medicine in which pressure is applied to a few specific acupoints on the body using the fingers, thumbs, or a device. Two forms were evaluated in the three-arm, single-blind clinical trial: relaxation acupressure, traditionally used to improve sleep, and stimulation acupressure, which targets pressure points that boost energy.
Dr. Zick presented a 10-week study in which 288 breast cancer survivors who had completed cancer therapy other than hormone treatment at least 12 months before and who still experienced persistent fatigue as defined by a score of 4 or more on the validated Brief Fatigue Inventory. Participants were randomized single-blind to usual care as directed by their physician or to 6 weeks of relaxation or stimulation acupressure, which they administered on their own after receiving instruction. After 6 weeks, women were instructed to stop the acupressure. They were reassessed at week 10 to determine whether acupressure had a sustained carryover effect.
At 6 weeks, 66% of the relaxation acupressure group and 61% of the stimulation acupressure cohort had achieved a normal Brief Fatigue Inventory score of less than 4, as did only 31% of the usual-care controls. Both acupressure groups showed maintenance of benefit at week 10, after 4 weeks of no acupressure, indicating the self-treatment isn’t something patients need to do continuously in order to derive the desired effect.
While both forms of acupressure were similarly effective at reducing complaints of fatigue, there was an important difference between the two. Only relaxation acupressure resulted in significant improvement in sleep quality as measured on the Pittsburgh Sleep Quality Index. Moreover, relaxation acupressure but not stimulation acupressure resulted in quality-of-life improvements on the somatic, fitness, and social support subscales of the Long-Term Quality of Life scale. However, neither form of acupressure had a significant on the spiritual subscale, the quality-of-life instrument’s fourth subscale.
“We really have to conclude that even though both forms of acupressure reduce fatigue to a similar extent, relaxation acupressure is the one we should think about as being more effective,” Dr. Zick said.
One might have predicted, incorrectly as it turns out, that breast cancer survivors complaining of persistent fatigue would find stimulation acupressure to be more beneficial than relaxation acupressure. Dr. Zick suspects the two techniques might reduce chronic fatigue via different mechanisms. She and her coinvestigators have conducted brain imaging studies that show patients with persistent cancer-related fatigue have three neurochemical markers: elevated brain levels of insular glutamate, which causes excitation, as well as high brain levels of creatine phosphokinase and proinflammatory cytokines. In their next round of imaging studies, the investigators plan to see whether the two forms of acupressure have differing effects on this markers.
Session moderator Dr. Norah Lynn Henry liked the concept of self-administered acupressure.
“The great thing about this is you don’t have to make appointments with an acupuncturist. You can do it at home. But is acupressure ready for prime time in clinical practice?” asked Dr. Henry, a medical oncologist at the University of Michigan.
“My answer is yes,” Dr. Zick replied, “because it’s got pretty much zero side effects, it’s inexpensive, and it’s easy to learn. If it doesn’t work for a person then they can just stop, but if it works, great.”
As the next step in this research, Dr. Zick and her coinvestigators hope to develop a smartphone app to deliver instruction in self-administered relaxation acupressure in a readily accessible way.
Her clinical trial was funded by the National Cancer Institute. She reported having no financial conflicts.
SAN ANTONIO – Self-administered acupressure focused on enhancing relaxation significantly reduced persistent fatigue symptoms in breast cancer survivors, according to a randomized clinical trial presented at the San Antonio Breast Cancer Symposium.
“Self-administered relaxation acupressure offers an inexpensive, easy-to-learn method to manage fatigue and co-occurring poor sleep quality and overall quality of life in breast cancer survivors with persistent fatigue,” said Suzanna M. Zick, N.D., MPH, of the department of family medicine, and the complementary and alternative medicine research center at the University of Michigan, Ann Arbor.
She conducted the study because persistent fatigue is arguably the most common and debilitating symptom experienced by breast cancer survivors, affecting 30% of women for up to 10 years after they’ve completed their breast cancer therapy. Yet treatment options remain limited, she said.
Acupressure is a form of traditional Chinese medicine in which pressure is applied to a few specific acupoints on the body using the fingers, thumbs, or a device. Two forms were evaluated in the three-arm, single-blind clinical trial: relaxation acupressure, traditionally used to improve sleep, and stimulation acupressure, which targets pressure points that boost energy.
Dr. Zick presented a 10-week study in which 288 breast cancer survivors who had completed cancer therapy other than hormone treatment at least 12 months before and who still experienced persistent fatigue as defined by a score of 4 or more on the validated Brief Fatigue Inventory. Participants were randomized single-blind to usual care as directed by their physician or to 6 weeks of relaxation or stimulation acupressure, which they administered on their own after receiving instruction. After 6 weeks, women were instructed to stop the acupressure. They were reassessed at week 10 to determine whether acupressure had a sustained carryover effect.
At 6 weeks, 66% of the relaxation acupressure group and 61% of the stimulation acupressure cohort had achieved a normal Brief Fatigue Inventory score of less than 4, as did only 31% of the usual-care controls. Both acupressure groups showed maintenance of benefit at week 10, after 4 weeks of no acupressure, indicating the self-treatment isn’t something patients need to do continuously in order to derive the desired effect.
While both forms of acupressure were similarly effective at reducing complaints of fatigue, there was an important difference between the two. Only relaxation acupressure resulted in significant improvement in sleep quality as measured on the Pittsburgh Sleep Quality Index. Moreover, relaxation acupressure but not stimulation acupressure resulted in quality-of-life improvements on the somatic, fitness, and social support subscales of the Long-Term Quality of Life scale. However, neither form of acupressure had a significant on the spiritual subscale, the quality-of-life instrument’s fourth subscale.
“We really have to conclude that even though both forms of acupressure reduce fatigue to a similar extent, relaxation acupressure is the one we should think about as being more effective,” Dr. Zick said.
One might have predicted, incorrectly as it turns out, that breast cancer survivors complaining of persistent fatigue would find stimulation acupressure to be more beneficial than relaxation acupressure. Dr. Zick suspects the two techniques might reduce chronic fatigue via different mechanisms. She and her coinvestigators have conducted brain imaging studies that show patients with persistent cancer-related fatigue have three neurochemical markers: elevated brain levels of insular glutamate, which causes excitation, as well as high brain levels of creatine phosphokinase and proinflammatory cytokines. In their next round of imaging studies, the investigators plan to see whether the two forms of acupressure have differing effects on this markers.
Session moderator Dr. Norah Lynn Henry liked the concept of self-administered acupressure.
“The great thing about this is you don’t have to make appointments with an acupuncturist. You can do it at home. But is acupressure ready for prime time in clinical practice?” asked Dr. Henry, a medical oncologist at the University of Michigan.
“My answer is yes,” Dr. Zick replied, “because it’s got pretty much zero side effects, it’s inexpensive, and it’s easy to learn. If it doesn’t work for a person then they can just stop, but if it works, great.”
As the next step in this research, Dr. Zick and her coinvestigators hope to develop a smartphone app to deliver instruction in self-administered relaxation acupressure in a readily accessible way.
Her clinical trial was funded by the National Cancer Institute. She reported having no financial conflicts.
SAN ANTONIO – Self-administered acupressure focused on enhancing relaxation significantly reduced persistent fatigue symptoms in breast cancer survivors, according to a randomized clinical trial presented at the San Antonio Breast Cancer Symposium.
“Self-administered relaxation acupressure offers an inexpensive, easy-to-learn method to manage fatigue and co-occurring poor sleep quality and overall quality of life in breast cancer survivors with persistent fatigue,” said Suzanna M. Zick, N.D., MPH, of the department of family medicine, and the complementary and alternative medicine research center at the University of Michigan, Ann Arbor.
She conducted the study because persistent fatigue is arguably the most common and debilitating symptom experienced by breast cancer survivors, affecting 30% of women for up to 10 years after they’ve completed their breast cancer therapy. Yet treatment options remain limited, she said.
Acupressure is a form of traditional Chinese medicine in which pressure is applied to a few specific acupoints on the body using the fingers, thumbs, or a device. Two forms were evaluated in the three-arm, single-blind clinical trial: relaxation acupressure, traditionally used to improve sleep, and stimulation acupressure, which targets pressure points that boost energy.
Dr. Zick presented a 10-week study in which 288 breast cancer survivors who had completed cancer therapy other than hormone treatment at least 12 months before and who still experienced persistent fatigue as defined by a score of 4 or more on the validated Brief Fatigue Inventory. Participants were randomized single-blind to usual care as directed by their physician or to 6 weeks of relaxation or stimulation acupressure, which they administered on their own after receiving instruction. After 6 weeks, women were instructed to stop the acupressure. They were reassessed at week 10 to determine whether acupressure had a sustained carryover effect.
At 6 weeks, 66% of the relaxation acupressure group and 61% of the stimulation acupressure cohort had achieved a normal Brief Fatigue Inventory score of less than 4, as did only 31% of the usual-care controls. Both acupressure groups showed maintenance of benefit at week 10, after 4 weeks of no acupressure, indicating the self-treatment isn’t something patients need to do continuously in order to derive the desired effect.
While both forms of acupressure were similarly effective at reducing complaints of fatigue, there was an important difference between the two. Only relaxation acupressure resulted in significant improvement in sleep quality as measured on the Pittsburgh Sleep Quality Index. Moreover, relaxation acupressure but not stimulation acupressure resulted in quality-of-life improvements on the somatic, fitness, and social support subscales of the Long-Term Quality of Life scale. However, neither form of acupressure had a significant on the spiritual subscale, the quality-of-life instrument’s fourth subscale.
“We really have to conclude that even though both forms of acupressure reduce fatigue to a similar extent, relaxation acupressure is the one we should think about as being more effective,” Dr. Zick said.
One might have predicted, incorrectly as it turns out, that breast cancer survivors complaining of persistent fatigue would find stimulation acupressure to be more beneficial than relaxation acupressure. Dr. Zick suspects the two techniques might reduce chronic fatigue via different mechanisms. She and her coinvestigators have conducted brain imaging studies that show patients with persistent cancer-related fatigue have three neurochemical markers: elevated brain levels of insular glutamate, which causes excitation, as well as high brain levels of creatine phosphokinase and proinflammatory cytokines. In their next round of imaging studies, the investigators plan to see whether the two forms of acupressure have differing effects on this markers.
Session moderator Dr. Norah Lynn Henry liked the concept of self-administered acupressure.
“The great thing about this is you don’t have to make appointments with an acupuncturist. You can do it at home. But is acupressure ready for prime time in clinical practice?” asked Dr. Henry, a medical oncologist at the University of Michigan.
“My answer is yes,” Dr. Zick replied, “because it’s got pretty much zero side effects, it’s inexpensive, and it’s easy to learn. If it doesn’t work for a person then they can just stop, but if it works, great.”
As the next step in this research, Dr. Zick and her coinvestigators hope to develop a smartphone app to deliver instruction in self-administered relaxation acupressure in a readily accessible way.
Her clinical trial was funded by the National Cancer Institute. She reported having no financial conflicts.
AT SABCS 2015
Key clinical point: Acupressure is an easily learned, effective method for self-treatment of persistent fatigue in breast cancer survivors.
Major finding: Two-thirds of breast cancer survivors with persistent fatigue experienced significant improvement in response to 6 weeks of self-administered relaxation acupressure, compared with 31% of usual-care controls.
Data source: This was a 10-week, single-blind study involving 288 breast cancer survivors with persistent fatigue who were randomized to relaxation acupressure, stimulation acupressure, or usual care.
Disclosures: The study was sponsored by the National Cancer Institute. Dr. Zick reported having no financial conflicts.
Neurosurgeon memoir illuminates the journey through cancer treatment and acceptance of mortality
Dr. Paul Kalanithi, a neurosurgeon who had just completed his residency at the Stanford (Calif.) University, died of metastatic lung cancer last year, but he left a memoir of his experiences as a physician, a patient, and a dying man that was published on Jan. 12. His book, “When Breath Becomes Air” (New York: Random House, 2016), recounts the many years of working to exhaustion and deferring of life experiences and pleasures that are necessary to complete medical training.
In a review of the book, Janet Maslin wrote, “One of the most poignant things about Dr. Kalanithi’s story is that he had postponed learning how to live while pursuing his career in neurosurgery. By the time he was ready to enjoy a life outside the operating room, what he needed to learn was how to die.”
Dr. Kalanithi reflected on the profound grief and sense of loss that comes with a diagnosis that he knew meant imminent death. The memoir also reveals his search for meaning and joy, and finally, his acceptance of mortality. He opted for palliative care and his memoir, along with the epilogue written by his wife, Dr. Lucy Kalanithi, gives insight into the value of the palliative path to patients and their families in dire medical crises.
Dr. Paul Kalanithi, a neurosurgeon who had just completed his residency at the Stanford (Calif.) University, died of metastatic lung cancer last year, but he left a memoir of his experiences as a physician, a patient, and a dying man that was published on Jan. 12. His book, “When Breath Becomes Air” (New York: Random House, 2016), recounts the many years of working to exhaustion and deferring of life experiences and pleasures that are necessary to complete medical training.
In a review of the book, Janet Maslin wrote, “One of the most poignant things about Dr. Kalanithi’s story is that he had postponed learning how to live while pursuing his career in neurosurgery. By the time he was ready to enjoy a life outside the operating room, what he needed to learn was how to die.”
Dr. Kalanithi reflected on the profound grief and sense of loss that comes with a diagnosis that he knew meant imminent death. The memoir also reveals his search for meaning and joy, and finally, his acceptance of mortality. He opted for palliative care and his memoir, along with the epilogue written by his wife, Dr. Lucy Kalanithi, gives insight into the value of the palliative path to patients and their families in dire medical crises.
Dr. Paul Kalanithi, a neurosurgeon who had just completed his residency at the Stanford (Calif.) University, died of metastatic lung cancer last year, but he left a memoir of his experiences as a physician, a patient, and a dying man that was published on Jan. 12. His book, “When Breath Becomes Air” (New York: Random House, 2016), recounts the many years of working to exhaustion and deferring of life experiences and pleasures that are necessary to complete medical training.
In a review of the book, Janet Maslin wrote, “One of the most poignant things about Dr. Kalanithi’s story is that he had postponed learning how to live while pursuing his career in neurosurgery. By the time he was ready to enjoy a life outside the operating room, what he needed to learn was how to die.”
Dr. Kalanithi reflected on the profound grief and sense of loss that comes with a diagnosis that he knew meant imminent death. The memoir also reveals his search for meaning and joy, and finally, his acceptance of mortality. He opted for palliative care and his memoir, along with the epilogue written by his wife, Dr. Lucy Kalanithi, gives insight into the value of the palliative path to patients and their families in dire medical crises.
David Bowie’s death inspires blog on palliative care
The death of David Bowie, iconic musician and artist, on Jan. 10 inspired palliative care specialist Dr. Mark Taubert to write a blog about end-of-life scenarios and the importance of advance care planning. The blog, which begins by thanking Mr. Bowie for his many artistic contributions, continues by suggesting that his planned death at home will inspire many people in similar health crises to consider palliative care. The palliative care conversation between a doctor and a patient facing death can be challenging but can lead to what Dr. Taubert called “a good death” at home with symptoms managed and loved ones nearby. Mr. Bowie’s son, Duncan Jones, tweeted a link to the blog in the days after his father’s death.
Dr. Taubert found himself speaking with a patient who was facing probable death in the near future, and both doctor and patient found inspiration in Mr. Bowie’s final music project and his death at home with his family. Dr. Taubert and his patient were able to have the conversation about palliative care at end-of-life in part because they were both impressed with what Mr. Bowie was able to achieve in his last months. “Your story became a way for us to communicate very openly about death, something many doctors and nurses struggle to introduce as a topic of conversation,” he wrote.
Dr. Taubert of the Velindre NHS Trust in Cardiff, Wales, noted that, although palliative care is a highly developed skill with many resources to help patients at the end of life, “this essential part of training is not always available for junior healthcare professionals, including doctors and nurses, and is sometimes overlooked or under-prioritized by those who plan their education. I think if you [David Bowie] were ever to return (as Lazarus did), you would be a firm advocate for good palliative care training being available everywhere.”
The death of David Bowie, iconic musician and artist, on Jan. 10 inspired palliative care specialist Dr. Mark Taubert to write a blog about end-of-life scenarios and the importance of advance care planning. The blog, which begins by thanking Mr. Bowie for his many artistic contributions, continues by suggesting that his planned death at home will inspire many people in similar health crises to consider palliative care. The palliative care conversation between a doctor and a patient facing death can be challenging but can lead to what Dr. Taubert called “a good death” at home with symptoms managed and loved ones nearby. Mr. Bowie’s son, Duncan Jones, tweeted a link to the blog in the days after his father’s death.
Dr. Taubert found himself speaking with a patient who was facing probable death in the near future, and both doctor and patient found inspiration in Mr. Bowie’s final music project and his death at home with his family. Dr. Taubert and his patient were able to have the conversation about palliative care at end-of-life in part because they were both impressed with what Mr. Bowie was able to achieve in his last months. “Your story became a way for us to communicate very openly about death, something many doctors and nurses struggle to introduce as a topic of conversation,” he wrote.
Dr. Taubert of the Velindre NHS Trust in Cardiff, Wales, noted that, although palliative care is a highly developed skill with many resources to help patients at the end of life, “this essential part of training is not always available for junior healthcare professionals, including doctors and nurses, and is sometimes overlooked or under-prioritized by those who plan their education. I think if you [David Bowie] were ever to return (as Lazarus did), you would be a firm advocate for good palliative care training being available everywhere.”
The death of David Bowie, iconic musician and artist, on Jan. 10 inspired palliative care specialist Dr. Mark Taubert to write a blog about end-of-life scenarios and the importance of advance care planning. The blog, which begins by thanking Mr. Bowie for his many artistic contributions, continues by suggesting that his planned death at home will inspire many people in similar health crises to consider palliative care. The palliative care conversation between a doctor and a patient facing death can be challenging but can lead to what Dr. Taubert called “a good death” at home with symptoms managed and loved ones nearby. Mr. Bowie’s son, Duncan Jones, tweeted a link to the blog in the days after his father’s death.
Dr. Taubert found himself speaking with a patient who was facing probable death in the near future, and both doctor and patient found inspiration in Mr. Bowie’s final music project and his death at home with his family. Dr. Taubert and his patient were able to have the conversation about palliative care at end-of-life in part because they were both impressed with what Mr. Bowie was able to achieve in his last months. “Your story became a way for us to communicate very openly about death, something many doctors and nurses struggle to introduce as a topic of conversation,” he wrote.
Dr. Taubert of the Velindre NHS Trust in Cardiff, Wales, noted that, although palliative care is a highly developed skill with many resources to help patients at the end of life, “this essential part of training is not always available for junior healthcare professionals, including doctors and nurses, and is sometimes overlooked or under-prioritized by those who plan their education. I think if you [David Bowie] were ever to return (as Lazarus did), you would be a firm advocate for good palliative care training being available everywhere.”
