Medications In Cancer Patients Research Articles

Adverse drug reactions and drug-related problems with supportive care medications among the oncological population

AimThe current study emphasizes the impact of adverse drug reactions (ADRs) and Drug-Related Problems (DRPs) caused by supportive care medications administered with chemotherapy.MethodThis is a longitudinal observational study carried out at the Ramaiah Medical College Hospital in Bengaluru, Karnataka, India, at the Department of Oncology. The data was recorded using a specifically created data collecting form. Based on the PCNE (Pharmaceutical Care Network Europe), DRPs are identified. The WHO probability scale, Modified Hartwig and Siegel for ADR severity assessment, Naranjo's algorithm for causality assessment, Rawlins and Thompson for predictability assessment, and Modified Shumock and Thornton for preventability assessment were all utilized. The OncPal guideline was considered in terms of the precision of supportive care medications regarding the reduction of ADRs in cancer patients.ResultWe enrolled 302 patients,166 (55%) female and 136 (45%) male (SD 14.378) (mean 49.97), patients with one comorbidity 59(19.6%) and multimorbidity (two or more) 45(14.9%), the DRPs identified were found to be 153 (50.6%); only P2 (safeties of drug therapy PCNE) were considered in this study. ADRs which are identified 175(57.9%) contributed/caused by the supportive care medications. WHO probability scale: 97 (32.1%) possible and 60 (19.9%) unlikely; Naranjo’s algorithm: 97 (32.1%) unlikely and 69 (22.8%) possible; ADR severity assessment scale (Modified Hartwig and Siegel): 95 (31.5%) mild and 63 (20.9%) moderates; Rawlins and Thompson for determining predictability of an ADR: 33 (10.9%) predictable and 137 (45.5%) non-predictable; and Modified Shumock and Thornton for determining preventability of an ADR: 81 (26.8%) probably preventable and 90 (29.8%) non-preventable. The statistical comparison through preforming t-test and measuring Chi-Square between group with ADRs and without ADRs shows in some variables, significantly (Alcohol consumption status, P = .019) and Easter Cooperative Oncology Group (ECOG) performance status P < 0.001.ConclusionComprehensive assessment of supportive medications in cancer patients would enhance the patient management and therapeutic outcome. The potential adverse drug reactions (ADRs) caused by supportive care medications can contribute to longer hospital stays and interact with the systemic anti-cancer treatment. The health care professionals should be informed to monitor the patients clinically administered with supportive medications.

Assessment of polypharmacy, potentially inappropriate medications, and drug-drug interactions in older patients with cancer.

This study aimed to determine polypharmacy, potentially inappropriate medications, and potential drug-drug interactions in elderly patients hospitalized in the oncology services of a university hospital in Turkey. This retrospective cross-sectional study was conducted between September 2021 and September 2022 on cancer patients over 65 years old hospitalized at Suleyman Demirel University Medical Faculty Hospital in Isparta, Turkey. Potentially inappropriate medications were defined according to the 2023 Beers Criteria of the American Geriatrics Society. Potential drug-drug interactions were determined with Medscape® drug interaction checker. The median (min-max) of drugs used by the patients was 6 (2-15). Most of the patients (74.3%) had polypharmacy. Approximately half of the patients (51.4%) had potentially inappropriate medications. The most commonly used potentially inappropriate medications were diuretics (22.1%), metoclopramide (11.4%), antidepressant drugs (7.9%), and opioids (6.4%). The presence of comorbidities, mental, behavioral, and neurodevelopmental disorders, circulatory system diseases, and respiratory system diseases were found to be statistically significantly higher in the group with potentially inappropriate medication than in the group without potentially inappropriate medication (p < 0.05). In total, 98 patients (70%) had at least one potential drug-drug interaction. Potential drug-drug interactions were minor in 33.3%, major in 57.5%, serious in 7.74%, and contraindicated in 0.22. According to our study, polypharmacy, potentially inappropriate medications, and potential drug-drug interactions were high in elderly cancer patients. It is important to determine potential drug-drug interactions and potentially inappropriate medications in cancer patients by a multidisciplinary team, including the clinical pharmacist, to prevent possible negative consequences.

Investigating the risk factors for nonadherence to analgesic medications in cancer patients: Establishing a nomogram model

ObjectiveThe substantial prevalence of nonadherence to analgesic medication among individuals diagnosed with cancer imposes a significant strain on both patients and healthcare resources. The objective of this study is to develop and authenticate a nomogram model for assessing nonadherence to analgesic medication in cancer patients. MethodsClinical information, demographic data, and medication adherence records of cancer pain patients were gathered from the Affiliated Hospital of Chengde Medical University between April 2020 and March 2023. The risk factors associated with analgesic medication nonadherence in cancer patients were analyzed using the least absolute selection operator (LASSO) regression model and multivariate logistic regression. Additionally, a nomogram model was developed. The bootstrap method was employed to internally verify the model. Discrimination and accuracy of the nomogram model were evaluated using the Concordance index (C-index), area under the receiver Operating characteristic (ROC) curve (AUC), and calibration curve. The potential clinical value of the nomogram model was established through decision curve analysis (DCA) and clinical impact curve. ResultsThe study included a total of 450 patients, with a nonadherence rate of 43.33%. The model incorporated seven factors: age, address, smoking history, number of comorbidities, use of nonsteroidal antiinflammatory drugs (NSAIDs), use of opioids, and PHQ-8. The C-index of the model was found to be 0.93 (95% CI: 0.907–0.953), and the ROC curve demonstrated an AUC of 0.929. Furthermore, the DCA and clinical impact curves indicate that the built model can accurately predict cancer pain patients' medication adherence performance. ConclusionsA nomogram model based on 7 risk factors has been successfully developed and validated for long-term analgesic management of cancer patients.

Recommendations by the Spanish Society of Hospital Pharmacy, the Spanish Society of Oncology Nursing and the Spanish Society of Medical Oncology for the safe management of antineoplastic medication in cancer patients

ObjectiveTo define recommendations that permit safe management of antineoplastic medication, minimise medication errors and improve the safety of cancer patients undergoing treatment. MethodBy reviewing the literature and consulting the websites of various health organisations and agencies, an expert committee from the Spanish Society of Hospital Pharmacy and the Spanish Society of Medical Oncology defined a set of safe practices covering all stages of providing cancer therapy to patients. The Spanish Society of Oncology Nursing revised and endorsed the final list. ResultsIn total, 68 recommendations arranged in 5 sections were defined. They include issues concerning the training of health professionals, the technological resources needed, treatment planning, informing the patient and his family, the processes of prescribing, preparing, dispensing and administering cancer therapy (orally, parenterally or intrathecally), assessing patient adherence and treatment toxicity. ConclusionsIt is essential for healthcare establishments to implement specific measures designed to prevent medication errors, in order to ensure the safety of cancer patients treated with antineoplastic medication.

The Prevalence of Drug-Drug Interactions and Reported Therapy Related Side Effects in Oncology Out-Patients

Objective: The use of multiple medications in cancer patients is unavoidable; thus, adverse drug-drug interactions are frequent. This study aims to assess the prevalence of potential drug interactions in oncology patients visiting the outpatient chemotherapy unit.&#x0D; Method: Demographic and health-related information of patients visiting an outpatient chemotherapy unit was recorded using a pre-prepared form. A comprehensive list of all concurrently used medications was compiled and checked for interactions with the Micromedex online drug interaction tool.&#x0D; Results: A total of 179 adult patients were included. We recorded an average of 9.3 drugs per patient with 79 patients using more than 10 drugs. A total of 1671 drugs including 303 chemotherapeutic agents were assessed for drug-drug interactions. A total of 374 interactions, of which 203 were significant, were recorded in 118 (65.9%) patients with an average of 3.2 interactions per patient. Only 46 major interactions were recorded for anticancer agents. Cyclophosphamide (n=13) and cisplatin (n=12) were involved in most interactions. The number of interactions correlated with the number of drugs used (p=.001) and the presence of comorbidities (p=.002). The presence of comorbidities increased the risk of interaction by 1.21 (p=.04). Recorded side effects were not correlated to drug interactions.&#x0D; Conclusion: Medication review in cancer patients is essential in establishing all medications used by patients. Routine assessment in terms of potential drug interactions and evaluation of these interactions by a qualified pharmacist may help in optimizing patient outcomes.

Integrating multi-omics data to identify dysregulated modules in endometrial cancer.

Cancer is generally caused by genetic mutations, and differentially expressed genes are closely associated with genetic mutations. Therefore, mutated genes and differentially expressed genes can be used to study the dysregulated modules in cancer. However, it has become a big challenge in cancer research how to accurately and effectively detect dysregulated modules that promote cancer in massive data. In this study, we propose a network-based method for identifying dysregulated modules (Netkmeans). Firstly, the study constructs an undirected-weighted gene network based on the characteristics of high mutual exclusivity, high coverage and complex network topology among genes widely existed in the genome. Secondly, the study constructs a comprehensive evaluation function to select the number of clusters scientifically and effectively. Finally, the K-means clustering method is applied to detect the dysregulated modules. Compared with the results detected by IBA and CCEN methods, the results of Netkmeans proposed in this study have higher statistical significance and biological relevance. Besides, compared with the dysregulated modules detected by MCODE, CFinder and ClusterONE, the results of Netkmeans have higher accuracy, precision and F-measure. The experimental results show that the multiple dysregulated modules detected by Netkmeans are essential in the generation, development and progression of cancer, and thus they play a vital role in the precise diagnosis, treatment and development of new medications for cancer patients.

Risk factors for developing medication-related osteonecrosis of the jaw when preserving the tooth that can be a source of infection in cancer patients receiving high-dose antiresorptive agents: a retrospective study.

To retrospectively investigate whether apical lesion, alveolar bone loss, probing pocket depth, or local infectious symptoms were associated with the onset of medication-related osteonecrosis of the jaw (MRONJ) in patients treated with high-dose antiresorptive agents who did not undergo tooth extraction. The study included 92 patients receiving high-dose antiresorptive agent therapy who had teeth with apical lesion ≧ 3mm, alveolar bone loss ≧ 1/2, probing pocket depth ≧ 4mm, or local infection symptoms such as swelling, pain, and pus discharge, but did not undergo tooth extraction. Univariate and multivariate Cox regression analyses were performed to determine the relationship between each variable and MRONJ onset. MRONJ developed in 15 of 92 patients (35 of 404 teeth) from 74 to 1883days (median, 383days) after the first visit. Multiple Cox regression analysis revealed that a lower number of teeth, diabetes, increased leukocyte count, administration of antiresorptive agents for 180days or more, local infection symptoms, apical lesion ≧ 3mm, and probing pocket depth ≧ 4mm were significantly correlated with the development of MRONJ. It is recommended that teeth with apical lesion ≧ 3mm, probing pocket depth ≧ 4mm, or local infection symptoms are extracted before or as early as possible after beginning of medication in cancer patients receiving high-dose antiresorptive agent therapy to prevent the development of MRONJ.

Psychotropic medication utilisation in adult cancer patients in China: A cross-sectional study based on national health insurance database

BackgroundPsychotropic medications are useful to treat psychiatric disorders which are frequently underdiagnosed and undertreated in cancer patients. Evidence on utilisation of psychotropic medications in cancer patients was absent in China. This study aimed to analyse the prevalence and the potential predictors of psychotropic medication use in adult cancer patients in China. MethodsWe analysed cross-sectional data from the China Health Insurance Association database in 2015–2017, which contained health care utilisation information for a national representative sample of basic medical insurance beneficiaries. Cancer patients aged above 18 were identified by International Classification of Disease 10th revision code C00–C97. Psychotropic medications were defined following the Anatomical Therapeutic Chemical codes: antipsychotics (N05A), anxiolytics (N05B), hypnotics and sedatives (N05C), and antidepressants (N06A, N06CA). We calculated the prevalence of psychotropic medication use in cancer patients, and applied multivariable logistic regression to identify its potential predictors. FindingsA total of 260,364 adults with cancer were identified in the database, of which 48,111 (18•5%) were prescribed at least one psychotropic medication comprising antipsychotics (3763, 1•4%), anxiolytics (15,902, 6•1%), hypnotics and sedatives (37,040, 14•2%), and antidepressants (2379, 0•9%). Patients with solid tumours had higher prevalence of psychotropic medication use than patients with lymphoid and hematopoietic malignancies (e.g. female genital organs, adjusted odds ratio (OR)=2•25, 95%CI=2•09–2•44). The prevalence of psychotropic medication use in cancer patients in the Eastern region was significantly higher than those of cancer patients in the Western regions (OR=2•33, 95%CI=2•27–2•40). Compared with the Urban Rural Resident Basic Medical Insurance beneficiaries, cancer patients covered by the Urban Employee Basic Medical Insurance were more likely to use psychotropic medications (OR=1•18, 95%CI=1•15–1•20). Midazolam was the most frequently used psychotropic (21,728, 45•2%), and flupentixol–melitracen was the most commonly used antidepressant (1176, 2•4%) among all psychotropic medication users in the sample. InterpretationThe prevalence of psychotropic medication use in Chinese adult cancer patients was inequitable. Further attention will be needed to be paid to the mental health of cancer patients in China. FundingNo funding.

抗がん剤副作用情報の入手に関する経験と患者の服薬調節行動の関連性

抗がん剤副作用情報の入手に関する経験と患者の服薬調節行動の関連性

Use of Non-Cancer Medications in New Zealand Women at the Diagnosis of Primary Invasive Breast Cancer: Prevalence, Associated Factors and Effects on Survival.

Background: Assessing the use of multiple medications in cancer patients is crucial as such use may affect cancer outcomes. This study reports the prevalence of non-cancer medication use at breast cancer diagnosis, its associated factors, and its effect on survival. Methods: We identified all women diagnosed with primary invasive breast cancer between 1 January 2007 and 31 December 2016, from four population-based breast cancer registries, in Auckland, Waikato, Wellington, and Christchurch, New Zealand. Through linkage to the pharmaceutical records, we obtained information on non-cancer medications that were dispensed for a minimum of 90 days’ supply between one year before cancer diagnosis and first cancer treatment. We performed ordered logistic regressions to identify associated factors and Cox regressions to investigate its effect on patient survival. Results: Of 14,485 patients, 52% were dispensed at least one drug (mean—1.3 drugs; maximum—13 drugs), with a higher prevalence observed in patients who were older, treated at a public facility, more economically deprived, and screen-detected. The use of 2–3 drugs showed a reduced non-breast cancer mortality (HR = 0.75, 95%CI = 0.60–0.92) in previously hospitalised patients, with other groups showing non-significant associations when adjusted for confounding factors. Drug use was not associated with changes in breast cancer-specific mortality. Conclusions: Non-cancer medication use at breast cancer diagnosis was common in New Zealand, more prevalent in older and disadvantaged women, and showed no effect on breast cancer-specific mortality, but a reduction in other cause mortality with the use of 2–3 drugs.

The use of antihypertensive medications in cancer patients on chemo immunotherapy: Protection or not?

e19238 Background: Antihypertensive medications is a widely used in the cancer patients due to comorbid hypertension. The following analysis was devoted to find if any particular group can provide nephroprotective effect for patient that is receiving chemo immunotherapy. Methods: A retrospective cohort of the 95 patients, who received chemo immunotherapy in the infusion center of Mercy Fitzgerald Hospital in 2018-2020 were analyzed. We divided patient in 4 groups. Those who were receiving beta-blockers - group 1, angiotensin-converting enzyme/angiotensin receptor blockers – group 2, dihydropyridine calcium channel blocker – group 3, non-dihydropyridine calcium channel blocker – group 4. KDIGO criteria were used to identify patients with Acute Kidney Injury (AKI). Chi-square test was used to estimate if there is association between using specific group of anti-hypertensives medications and AKI. Results: 12 out of 95 patients in the study developed AKI. In group 1 5 had AKI and 23 not, p = .032. Group 2 included 3 patient who developed AKI and 22 who did not, p = 0.91. Group 3 group had 6 patients with AKI and 10 without, p = 0.001. Group 4 had 10 patients and none of them had AKI, p = 0.16. Conclusions: In our study we found that patient who were using the dihydropyridine calcium channel blocker (amlodipine) had a higher incidence of the AKI then patients, who were using other groups of the anti-hypertensive medications. Large prospective studies may be necessary to confirm that use of amlodipine in patients who undergo chemo immunotherapy is associated with higher incidence of the AKI and should be avoided in the treatment of this patients.

NCMP-19. STROKE IN CANCER PATIENTS

Abstract Patients with malignancy have an increased tendency for venous and arterial embolism, and for increased risk for bleeding. Clinical decisions regarding anticoagulation in this population has been challenging and complicated by the availability of various anticoagulants. Currently, there is no evidence-based guideline available for the prevention of arterial embolism and thrombosis, such as stroke, in cancer patients. The aim of the study is to assess the use of anticoagulant medications in cancer patients who suffer a stroke. ICD-9/-10 codes were used to identify patients with cancer who were admitted between September 1, 2017 and November 30, 2017 to the Buffalo General Hospital with the diagnosis of stroke. Chart review was used to verify the history of cancer and stroke and to collect additional information. The diagnosis of acute stroke and cancer were verified in 87 patients. Among them, 31 patients had active malignancy. Of the 31 patients, 9 were diagnosed with intracranial hemorrhage and 22 with ischemic strokes. Of the 9 patients with intracranial hemorrhage,3 were anticoagulated and 1 patient was off anticoagulation. Of the 22 patients with ischemic stroke, 4 patients were anticoagulated, although 1 patient was underdosed based on INR. Seven of the 22 patients were taken off of anticoagulation; 3 had side effects and 4 were awaiting a surgical procedure. Five of the 9 patients with intracranial hemorrhage and 10 of the 22 patients with ischemic stroke were made comfort care and passed away shortly after the diagnosis of stroke.

1607P - Deprescribing potentially inappropriate medication in cancer patients

BackgroundDue to their advanced age many cancer patients with unfavorable prognosis suffer from comorbidities, and thus the risk of consuming potentially inappropriate medication (PIM). It is vital to deprescribe drugs with potential harmful effects or no short-term benefit for lowering pill.Hence, we examined the degree of deprescription of potentially inappropriate medication (PIM) in patients suffering from cancer. MethodsRetrospective, register-based study of all patients with newly diagnosed breast, prostate, pancreatic, and lung cancer, diagnosed at a hospital in the Capital Region of Denmark (1.8 million inhabitants) from 2012-2014. Patients with insufficient staging information or other malignancy except non-melanoma skin-cancer were excluded. Information about medication, comorbidity and mortality was extracted from the electronic health records.PIM were defined as: acetylsalicylic acid, calcium channel blockers, statins, thiazides, and bisphosphonates. The study was approved by the Danish Patient Safety Authority (No. 3-3013-1884/1/) and the Danish Data Protection Agency (No. BFH-2016-058). ResultsTable1607PTableBreast (n=3,959)/prostate cancer (n=3,535) (total n=7,494)Lung (n=2,824)/pancreatic cancer (n=617) (n=3,441)Gender (Women)52%50%Age mean (sd)65 (12)70 (10)1-year Survival97%46%Metastatic disease6.7%52%Co-morbiditiesDiabetes4.0 %9.7 %Hypertension12 %23 %Atrial fibrillation4.7 %8.7 %Ischemic heart disease6.4 %11.6 %Heart failure2.2 %5.6 %Ischemic stroke1.5 %2.8 %Medication1-year deprescription/total treated§Acetylsalicylic acid250/1,443 (17%)398/928 (43%)Calcium channel blockers135/1,048 (13%)284/659 (43%)Statins187/1,769 (11%)501/1,066 (47%)Thiazide diuretics175/954 (18%)259/534 (49%)Bisphosphonates26/319 (8.2%)64/171 (37%)(Patients not surviving 1 year and treatment continuing until death does not count towards deprescribed)§Deprescribed during the first year after cancer-diagnosis/total number of patients treated ConclusionsOur findings show that oncologists and physicians have a rational approach to deprescription in patients suffering from cancer with short-term (pancreatic and lung cancer) respectively long-term (breast and prostate cancer) survival rates. However, several patients were continuing potential inappropriate medications in the terminal stage of cancer. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

A nationwide survey of hospital pharmacist interventions to improve polypharmacy for patients with cancer in palliative care in Japan

BackgroundThere is no nationwide data on polypharmacy in palliative care in Japan. In this study, the research committee of the Japanese Society for Pharmaceutical Palliative Care and Sciences conducted an online survey on polypharmacy and inappropriate prescriptions involving its members who worked as hospital pharmacists.MethodsThe online questionnaire included questions about hospital pharmacist interventions for cancer patients who regularly used six or more drugs during a two-month period from October to November 2017.ResultsOf 2618 hospital pharmacists, 359 responded (13.7%). With regard to cancer patients receiving opioids, 40.9 and 22.3% of the respondents replied that percentages of patients prescribed six or more regular medications were “40–69%” and “70–99%,” respectively. Regarding patients on polypharmacy, 73.0% of the respondents reported a low or moderate rate of inappropriate prescriptions, with responses such as “long-term administration of irresponsible or aimless medications”, “adverse drug reactions,” and “duplication of the pharmacological effect”. Furthermore, 24.2, 46.8, and 23.4% of respondents replied that the rates of drug reduction due to pharmacist recommendations were “0”, “1–39%”, and “more than 40%,” respectively. Pharmacist interventions decreased the use of inappropriate medications, including antiemetics, gastrointestinal medications, and hypnotic sedatives, and reduced or prevented adverse drug reactions such as extrapyramidal symptoms, delirium, and sleepiness. Similar results were obtained for cancer patients who did not use opioids. However, the rates of cancer patients on polypharmacy and with reduction of inappropriate medications by pharmacist interventions were significantly higher in cancer patients receiving opioids. Finally, recommendations of board-certified pharmacists in palliative pharmacy contributed to a decrease in the use of inappropriate medications in cancer patients on polypharmacy (p = 0.06).ConclusionThis nationwide survey clarified pharmacist interventions for polypharmacy in palliative care in Japan. Our data showed frequent polypharmacy in cancer patients receiving opioids, and benefits of pharmacist interventions, especially by board-certified pharmacists in palliative pharmacy, for reducing inappropriate medications and improving adverse drug reactions.Trial registrationThe study approval numbers in the institution; 0046. Registered November 6, 2017.

Recommendations by the Spanish Society of Hospital Pharmacy, the Spanish Society of Oncology Nursing and the Spanish Society of Medical Oncology for the safe management of antineoplastic medication in cancer patients

AimTo define recommendations that permit safe management of antineoplastic medication, minimise medication errors and improve the safety of cancer patients undergoing treatment.MethodsBy reviewing the literature and consulting the websites of various health organisations and agencies, an expert committee from the Spanish Society of Hospital Pharmacy and the Spanish Society of Medical Oncology defined a set of safe practices covering all stages of providing cancer therapy to patients. The Spanish Society of Oncology Nursing revised and endorsed the final list.ResultsIn total, 68 recommendations arranged in five sections were defined. They include issues concerning the training of health professionals, the technological resources needed, treatment planning, informing the patient and his/her family, the processes of prescribing, preparing, dispensing and administering cancer therapy (orally, parenterally or intrathecally), assessing patient adherence and treatment toxicity.ConclusionsIt is essential for healthcare establishments to implement specific measures designed to prevent medication errors, in order to ensure the safety of cancer patients treated with antineoplastic medication.

Frequency of concomitant use of opioids and psychoactive medications among cancer patients referred to outpatient palliative care at a comprehensive cancer center.

240 Background: There are potential severe effects when patients taking opioids receive other psychoactive medications. However, such combinations are sometimes necessary in palliative care. The purpose of this study was to determine the frequency of concomitant use of opioids + psychoactive medications in cancer patients referred to our outpatient palliative care center. Methods: Retrospective data obtained from consecutive consults was analyzed to determine the frequency of patients on opioids alone versus concomitant opioids + psychoactive medications at first presentation to our clinic. Association of type of medication with demographics and baseline characteristics was evaluated by Wilcoxon rank sum test for continuous variables and Chi-square (Fisher's exact) test for categorical variables. Results: Among 541 consecutive consult visits, 365 (67%) patients were taking opioids at the time of referral to our clinic: 209 (57%) were on opioids alone while 156 (43%) were on concomitant opioids + psychoactive medications [69 (44%) were on Opioid + Benzodiazepine, 46 (30%) were Opioid + Antidepressants, 41(26%) were on both). Patients in the concomitant groups were on higher Morphine Equivalent Daily Dose (MEDD, p = 0.007), had higher Edmonton Symptom Assessment Scores (ESAS) for pain (p = 0.017), anxiety (p &lt; 0.001), depression (p &lt; 0.001) and spiritual pain (p = 0.03). Conclusions: A large proportion (156, 43%) of cancer patients referred to outpatient palliative care was on concomitant opioids + psychoactive medications. These patients were on higher doses of opioids with higher levels of pain and psycho-social distress at the time of first presentation. Further studies are required to better understand the clinical implications of concomitant use of opioids + psychoactive medications in such patients.

Marijuana Utilization in Cancer Patients: A Comprehensive Analysis of National Health and Nutrition Examination Survey Data from 2005-2014

Cannabis can improve symptoms of nausea and anorexia and may even serve as an alternative to narcotic pain medication in cancer patients. Data on substance use, including marijuana utilization, in cancer patients is limited. We used a population-based dataset to examine the utilization of marijuana and other substance use among cancer patients. We hypothesized that the use of marijuana among cancer patients would be greater than non-cancer patients and that it would increase in more recent years. Publicly available population-based datasets from the National Health and Nutrition Examination Survey (NHANES) were compiled for respondents aged 20-60 for years 2005 to 2014, based on availability of data for two variables of interest - cancer diagnosis and marijuana utilization. Propensity scores were calculated for each subject based on age, sex, race, education, and self-reported health status, then cases (respondents with a cancer diagnosis) were matched 1:2 to controls (respondents with no cancer diagnosis). Behavioral characteristics (current [within past 30 days] and recent [within past 12 months] marijuana use; smoking; binge alcohol; illicit drugs; and prescription narcotics) were compared between cancer patients and propensity score matched controls. Univariable logistic regressions and two-proportion Z-tests were performed; two tailed P < 0.05 was considered significant. Of 19,604 respondents, 826 cancer patients were matched to 1,652 controls. Among cancer patients, 40.3% currently used marijuana compared with 38.0% of non-cancer patients. Cancer patients were more likely to smoke cigarettes (odds ratio [OR] = 1.26, 95% CI = 1.07-1.49; P = 0.007), and take prescription narcotics (OR = 2.36, 95% CI = 1.79-3.12; P < 0.0001), with a trend toward being more likely to currently use marijuana (OR = 1.35, 95% CI = 0.99-1.84; P = 0.056). There was no difference in binge alcohol or illicit substance use among respondents. Cancer patients using marijuana in the last 12 months were more likely to take prescribed narcotics (OR = 1.90, 95% CI = 1.28-2.82; P = 0.0015). Among cancer patients, current marijuana utilization increased significantly over 10 years (Z = 2.20; P = 0.028) but prescription narcotic use did not (Z = 1.78, P = 0.08). From 2005-2014, the proportion of cancer patients currently using marijuana increased by 20.8%, compared with 4.6% among non-cancer patients. In this population-based dataset, 40% of cancer patients reported current marijuana use, and utilization of marijuana increased significantly over the last 10 years among these patients. Cancer patients using marijuana in the last year were more likely to take prescription narcotics. This work provides insight into the evolving role of cannabis use among cancer patients and as a potential adjunct to narcotic pain medication.

Supporting carers to manage pain medication in cancer patients at the end of life: A feasibility trial

Background: Carers of people with advanced cancer play a significant role in managing pain medication, yet they report insufficient information and support to do so confidently and competently. There is limited research evidence on the best ways for clinicians to help carers with medication management. Aims: To develop a pain medicines management intervention (Cancer Carers Medicines Management) for cancer patients’ carers near the end of life and evaluate feasibility and acceptability to nurses and carers. To test the feasibility of trial research procedures and to inform decisions concerning a full-scale randomised controlled trial. Design: Phase I-II clinical trial. A systematic, evidence-informed participatory method was used to develop CCMM: a nurse-delivered structured conversational process. A two-arm, cluster randomised controlled feasibility trial of Cancer Carers Medicines Management was conducted, with an embedded qualitative study to evaluate participants’ experiences of Cancer Carers Medicines Management and trial procedures. Setting: Community settings in two study sites. Participants: Phase I comprises 57 carers, patients and healthcare professionals and Phase II comprises 12 nurses and 15 carers. Results: A novel intervention was developed. Nurses were recruited and randomised. Carer recruitment to the trial was problematic with fewer than predicted eligible participants, and nurses judged a high proportion unsuitable to recruit into the study. Attrition rates following recruitment were typical for the study population. Cancer Carers Medicines Management was acceptable to carers and nurses who took part, and some benefits were identified. Conclusion: Cancer Carers Medicines Management is a robustly developed medicines management intervention which merits further research to test its effectiveness to improve carers’ management of pain medicines with patients at the end of life. The study highlighted aspects of trial design that need to be considered in future research.

The effects of a palliative care program on antidepressant use and continuing maintenance medications in near end-of-life oncology patients (the HEALED study)

The use of antidepressants and maintenance medications for cancer patients in a palliative care setting is controversial. The effectiveness of antidepressants and consequences of discontinuing maintenance medications are unknown in this population. Compare the quality of life of patients taking and not taking antidepressants at entry to a palliative care clinic, and to observe maintenance medication use in this population, along with consequences of stopping them. Prospective, monthly review of medications, quality of life, and hospitalizations were recorded from oncology patients that attended a palliative care clinic. In addition, a retrospective chart review of medications and hospitalizations of oncology patients that did and did not attend a palliative care clinic was performed. Forty-three prospective patients were enrolled. Patients had similar quality of life whether or not they were taking antidepressants (p = 0.52). Number of maintenance medications at entry and at final evaluation did not change (p = 0.45). No hospitalizations were caused by discontinuation of maintenance medications. QOL of patients did not decline after coming to the clinic based on the baseline and second FACT-G questionnaires (p = 0.84). Fifty-six patients were included in the retrospective portion of this study. The non-palliative care patients had higher proportions of maintenance medications and rates of hospitalizations when compared to the palliative care patients. Quality of life is essentially the same between palliative care patients, whether they are receiving antidepressants or not.

Managing Cardiotoxicity of Chemotherapy

The increase in survivorship of cancer patients makes the understanding of the available options for prevention and treatment of cardiotoxicity induced by antineoplastic agents a crucial topic both for cardiologists and oncologists. The most frequent and typical clinical manifestation of cardiotoxicity is asymptomatic or symptomatic left ventricular dysfunction, which may progress to overt heart failure. It may be induced not only by conventional cancer therapy, like anthracyclines, but also by new antitumoral targeted therapy such as trastuzumab. The current standard for monitoring cardiac damage during antineoplastic treatment, mainly based on the quantification of left ventricular ejection fraction, detects cardiac toxicity only when a functional impairment has already occurred. Evaluation of cardiac biomarkers such as troponin, however, has shown excellent sensitivity in the early detection of cardiotoxicity by the identification of patients with subclinical cardiac injury that precedes the development of cardiac dysfunction. The use of angiotensin-converting enzyme inhibitors in patients with troponin elevation during chemotherapy may be an effective tool to prevent left ventricular ejection fraction reduction and late cardiac events. There are no well established recommendations for treatment of cancer patients who develop cardiac dysfunction. Angiotensin-converting enzyme inhibitors and beta-blockers have proven to be effective in this setting. However, there are concerns in using these medications in cancer patients, and therefore the tendency is to treat patients only if symptomatic. However, the clinical benefit of these medications may be more evident in asymptomatic patients, and the recovery of cardiac function strongly depends on the amount of time elapsed from the end of chemotherapy to the start of heart failure therapy. This observation suggests that the early detection of cardiac damage is crucial and early use of angiotensin-converting enzyme inhibitors and beta-blockers should be considered in patients with left ventricular dysfunction induced by antineoplastic agents.