Martin Chasen

The Meaning‐Making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: a randomized controlled pilot study

Objective: This pilot study aimed to provide supportive evidence for the acceptability and usefulness of the Meaning‐Making intervention (MMi) in patients newly diagnosed with Stage III or IV ovarian cancer, and to provide estimates of parameters needed to design a full‐scale study.

A descriptive review of the factors contributing to nutritional compromise in patients with head and neck cancer

IntroductionMalnutrition has been known to be associated with adverse outcomes in cancer patients. Patients who have been and/or are being treated for head and neck cancer have a compromised nutritional status. Nutritional deficits have a significant impact on mortality, morbidity, and quality of life.DiscussionThe wasting in cancer cachexia involves loss of muscle and fat and reflects a catabolic metabolism induced by an abnormal host response to tumor presence and/or tumor factors. Disturbances of various physiological functions like taste, smell, dysphagia, xerostomia apart from cachexia can contribute to long-term nutritional complications and outcome.ConclusionImproved management of patients in posttreatment for head and neck cancer may require a multimodal approach by a multidisciplinary team and is best commenced earlier in the trajectory of the disease.

Prevalence of emotional distress in newly diagnosed lung cancer patients.

Goals of workDistress is defined by the National Comprehensive Cancer Network as a multifactorial unpleasant emotional experience of a psychological, social, and/or spiritual nature that may interfere with the ability to cope effectively with cancer. We investigated the prevalence and associated symptoms of distress in newly diagnosed lung cancer patients.Patients and methodsBetween November 2005 and July 2007, 98 newly diagnosed lung cancer patients completed an assessment. The Distress Thermometer (DT) and Edmonton Symptom Assessment Scale (ESAS) were used as screening tools.Main resultsFifty (51%) patients reported clinically significant distress (≥4) on the DT. Of those, 26 (52%) patients reported high levels of depression, nervousness, or both on ESAS. The remaining 24 (48%) patients had elevated levels of distress but no significant depression or nervousness. A correlation between the DT and the total ESAS score was observed (Pearson correlation = 0.46). The ten items of the ESAS together explained 46% of the variability in DT scores. The depression and nervousness ESAS items were significant predictors of DT score (p < 0.01 for both items). However, once the two psychosocial items, depression and nervousness, were removed from the total ESAS score, leaving only physical symptoms and the sleeplessness item, the predictive power of the model decreased to R² = 0.12.ConclusionsThe prevalence of distress in lung cancer patients is high. The DT appears to discriminate between physical and emotional distress. This easily measured score may determine which patients require further intervention for emotional distress.

Rehabilitation: Long-Term Physical and Functional Changes Following Treatment

OBJECTIVES To describe the life altering issues that survivors of a head and neck cancer report post treatment and discuss multidimensional rehabilitation approaches. DATA SOURCES Published journal articles, literature reviews, research reports, book chapters. CONCLUSION Survivors and their family caregivers encounter many changes during the first 3 months following treatment for head and neck cancer, placing them at risk of multiple adjustment difficulties. Progressive weight loss, loss of energy, strength, muscle endurance and decreased functioning severely compromise healthy adjustment and quality of life. IMPLICATIONS FOR NURSING PRACTICE Nurses can help patients and family identify survivorship issues to be managed at home. Planning, exploring, coaching, practicing skills with survivors and their family caregivers, providing specific information, and linking them with resources can help them bridge this transition into extended survivorship.

A retrospective study of the role of an occupational therapist in the cancer nutrition rehabilitation program

PurposeThe purpose of the study was to determine how frequently each domain of activity was addressed and how frequently specific interventions were used by an occupational therapist (OT) with cancer patients who attended an 8-week Cancer Nutrition and Rehabilitation (CNR) program.MethodsSixty-two patients with cancer were assessed. All received interventions by the OT within the CNR program. The following activity domains: (1) self-care, (2) productivity, and (3) leisure that were addressed during appointments with the OT were recorded following each visit. Seven categories of interventions were predetermined and their use was recorded using a checklist.ResultsDescriptive statistics were conducted and revealed that 36% of the therapist’s time was spent assessing patients’ functional capacity while 64% was spent providing interventions. The OT’s interventions addressed leisure and exercise (54%), productive activities such as housework and paid employment (32%), and basic activities of daily living (14%). The frequency of specific interventions provided were as follows: 40% in teaching of energy conservation and activity management techniques, 33% in goal setting/support and counseling, 9% in cognitive retraining/stimulation, 6% in communication with community agencies, and 4% in teaching of joint and bone protection techniques, help with management of neuropathies, and education on scar management respectively.ConclusionIt is suggested that OTs practicing in oncology use a variety of interventions to better address productive and leisure activities. The data suggests that limitations in these areas were more prevalent than in self-care activities. Further study is needed to examine OT interventions in oncology.

Efficacy and safety of rolapitant for prevention of chemotherapy-induced nausea and vomiting over multiple cycles of moderately or highly emetogenic chemotherapy.

OBJECTIVE Rolapitant, a novel neurokinin-1 receptor antagonist (RA), was shown to protect against delayed chemotherapy-induced nausea and vomiting (CINV) during the first cycle of moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC) in randomized, double-blind trials. This analysis explored the efficacy and safety of rolapitant in preventing CINV over multiple cycles of MEC or HEC. PATIENTS AND METHODS Patients in one phase III MEC, one phase II HEC, and two phase III HEC clinical trials were randomized to receive oral rolapitant (180 mg) or placebo in combination with a 5-hydroxytryptamine type 3 RA and dexamethasone. Regardless of response in cycle 1, patients could continue the same antiemetic treatment for up to six cycles. On days 6-8 of each subsequent chemotherapy cycle, patients reported the incidence of emesis and/or nausea interfering with normal daily life. Post hoc analyses of pooled safety and efficacy data from the four trials were performed for cycles 2-6. RESULTS Significantly more patients receiving rolapitant than control reported no emesis or interfering nausea (combined measure) in cycles 2 (p = 0.006), 3 (p < 0.001), 4 (p = 0.001), and 5 (p = 0.021). Over cycles 1-6, time-to-first emesis was significantly longer with rolapitant than with control (p < 0.001). The incidence of treatment-related adverse events during cycles 2-6 was similar in rolapitant (5.5%) and control (6.8%) arms. No cumulative toxicity was observed. CONCLUSIONS Over multiple cycles of MEC or HEC, rolapitant provided superior CINV protection and reduced emesis and nausea interfering with daily life compared with control and remained well tolerated.

Rolapitant for the treatment of chemotherapy-induced nausea and vomiting: a review of the clinical evidence

Chemotherapy-induced nausea and vomiting (CINV), both acute and delayed, has a dramatic effect on the well-being and quality of life of patients with cancer. Improved understanding of the mechanisms involved in CINV has led to the development of agents targeting the 5-HT3 receptor as well as the NK-1 receptor. Antiemetic prophylaxis given to patients receiving highly emetogenic chemotherapy combines agents blocking the 5-HT3 and NK-1 receptors along with corticosteroids given regularly and repeatedly. Rolapitant is a long-acting NK-1 receptor antagonist with proven efficacy in controlling CINV as part of the prophylaxis regimen. This review will detail the clinical efficacy and safety of rolapitant in the treatment of patients with cancer receiving highly or moderately emetogenic chemotherapy.

Immunomodulatory agents for the treatment of cachexia.

Purpose of reviewIn patients with advanced cancer, AIDS and end-stage organ diseases, symptoms of cachexia syndrome include decrease in appetite, weight loss, decreased performance status, and an increase in the systemic inflammatory response. Inflammatory cytokines and other immune interactions affect the lean tissue mass and body fat. It is hopeful that modulation of these inflammatory interactions may contribute to the delay in the development and treatment of cachexia. This review summarizes the current state of the art. Recent findingsThis article covers the role of inflammatory response in cachexia, measurement of inflammatory response, mechanism and measurement of cachexia, immunomodulation in cancer, drugs targeting inflammatory cytokines, effect of exercise in cachexia, and treatment of cancer cachexia using immunomodulatory agents. SummaryUnderstanding the immune response associated with cachexia may improve future pharmacological modification of the cytokines. In addition, the multifactorial contributions to the mechanisms of cachexia indicate that a multimodal approach may be necessary to treat cachexia and its associated symptoms.

Rehabilitation for patients with advanced cancer

Physicians embrace the concept of rehabilitation, but may think of it only as it relates to restoring function through exercise. We use a broader definition that applies to patients with advanced cancer. Cancer rehabilitation is a process that assists a person with a cancer diagnosis to obtain

Recent developments in the clinical pharmacology of rolapitant: subanalyses in specific populations

Knowledge of the involvement of the neurokinin substance P in emesis has led to the development of the neurokinin-1 receptor antagonists (NK-1 RAs) for control of chemotherapy-induced nausea and vomiting (CINV), in combination with serotonin type 3 receptor antagonists and corticosteroids. The NK-1 RA rolapitant, recently approved in oral formulation, has nanomolar affinity for the NK-1 receptor, as do the other commercially available NK-1 RAs, aprepitant and netupitant. Rolapitant is rapidly absorbed and has a long half-life in comparison to aprepitant and netupitant. All three NK-1 RAs undergo metabolism by cytochrome P450 (CYP) 3A4, necessitating caution with the concomitant use of CYP3A4 inhibitors, but in contrast to aprepitant and netupitant, rolapitant does not inhibit or induce CYP3A4. However, rolapitant is a moderate inhibitor of CYP2D6, and concomitant use with CYP2D6 substrates with narrow therapeutic indices should be avoided. Aprepitant, netupitant, and rolapitant have all demonstrated efficacy in the control of delayed CINV in patients receiving moderately and highly emetogenic chemotherapy in randomized controlled trials, including over multiple cycles of chemotherapy. We reviewed recent post hoc analyses of clinical trial data demonstrating that rolapitant is efficacious in the control of CINV in patient populations with specific tumor types, namely, breast cancers, gastrointestinal/colorectal cancers, and lung cancers. In addition, we show that rolapitant has efficacy in the control of CINV in specific age groups of patients receiving chemotherapy (<65 and ≥65 years of age). Overall, the safety profile of rolapitant in these specific patient populations was consistent with that observed in primary analyses of phase 3 trials.