A systematic review and meta-analysis examining the effects of cannabis and its derivatives in adults with malignant CNS tumors

Abstract Background Primary CNS tumors constitute a heterogeneous group of neoplasms that share a considerable morbidity and mortality rate. To help control tumor growth and clinical outcomes (overall survival, progression-free survival, quality of life) symptoms, patients often resort to alternative therapies, including the use of cannabis. Despite rapidly growing popularity, cannabis and its impact on patients with primary malignant CNS tumors is understudied. Methods To shed light on the lack of scientific evidence in this field, in November 2018 we conducted a search and examination of cannabis in neuro-oncology in major journal databases and bibliographies of selected articles, and through abstracts of annual meetings using prespecified criteria in line with the Cochrane Collaboration guidelines. Results We identified 45 publications, of which 9 were selected. Five studies were included. Publication dates ranged from 2004 to 2018 and included varying histologies of primary brain tumors. The average survival at 1 year was 56.09% (95% CI: 48.28-63.9). There was no difference in risk ratio (RR) for death at 1 year between groups (RR: 1.069 [95% CI: 0.139-8.25]). We found strong evidence of heterogeneity (Q = 74.0%; P = .021). We found no statistical evidence of publication bias (P = .117; SD = 1.91). Conclusions There was limited moderate-quality evidence that supports the use of cannabinoids as adjuvant to the standard of care in the treatment of brain and CNS tumors. There was very low-quality evidence suggesting that cannabinoids were associated with adult-onset gliomas. Further prospective clinical trials are necessary to adequately evaluate the impact of cannabinoids on CNS tumors, specifically on survival and quality of life.

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Oral Immunotherapy for Food-Allergic Children: A Pro-Con Debate

10.20944/preprints202102.0465.v1 ◽

2021 ◽

Author(s):

Francesca Mori ◽

Mattia Giovannini ◽

Simona Barni ◽

Rodrigo Jiménez-Saiz ◽

Daniel Munblit ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Trials ◽

Food Allergy ◽

Meta Analysis ◽

Scientific Evidence ◽

Standard Of Care ◽

Oral Immunotherapy ◽

Patient Reported

The prevalence of food allergy has increased in recent years, especially in children. Food allergen avoidance and symptomatic drugs in case of an allergic reaction remain the standard of care in food allergy. Nevertheless, increasing attention has been given to the possibility to treat food allergy, through immunotherapy, particularly oral immunotherapy (OIT). Several OIT protocols and clinical trials have been published. Most of them focus on children allergic to milk, egg, or peanuts, although recent studies developed protocols for other foods, such as wheat and different nuts. OIT efficacy in randomized controlled trials is usually evaluated as the possibility for patients to achieve desensitization, while the issue of a possible long-term sustained unresponsiveness has not been completely addressed. Here, we evaluated current OIT knowledge, focusing on the results of clinical trials and current guidelines. Specifically, we wanted to highlight what is known in terms of OIT efficacy and effectiveness, safety, and impact on quality of life. For each aspect, we reported the pros and the cons, inferable from published literature. In conclusion, even though many protocols, reviews and meta-analysis have been published on this topic, OIT remains a controversial therapy and no definitive generalized conclusion may be drawn so far. It should be an option provided by specialized teams, when both patients and their families are prone to adhere to the proposed protocol. Efficacy, long-term effectiveness, possible role of adjuvant therapies, risk of severe reactions including anaphylaxis or eosinophilic esophagitis, and impact on the quality of life of both children and caregivers are all aspects that should be discussed before starting OIT. Future studies are needed to provide firm clinical and scientific evidence, which should also consider patient reported outcomes.

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Oral Immunotherapy for Food-Allergic Children: A Pro-Con Debate

Frontiers in Immunology ◽

10.3389/fimmu.2021.636612 ◽

2021 ◽

Vol 12 ◽

Author(s):

Francesca Mori ◽

Mattia Giovannini ◽

Simona Barni ◽

Rodrigo Jiménez-Saiz ◽

Daniel Munblit ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Trials ◽

Food Allergy ◽

Meta Analysis ◽

Scientific Evidence ◽

Standard Of Care ◽

Oral Immunotherapy ◽

Patient Reported

The prevalence of food allergy has increased in recent years, especially in children. Allergen avoidance, and drugs in case of an allergic reaction, remains the standard of care in food allergy. Nevertheless, increasing attention has been given to the possibility to treat food allergy, through immunotherapy, particularly oral immunotherapy (OIT). Several OIT protocols and clinical trials have been published. Most of them focus on children allergic to milk, egg, or peanut, although recent studies developed protocols for other foods, such as wheat and different nuts. OIT efficacy in randomized controlled trials is usually evaluated as the possibility for patients to achieve desensitization through the consumption of an increasing amount of a food allergen, while the issue of a possible long-term sustained unresponsiveness has not been completely addressed. Here, we evaluated current pediatric OIT knowledge, focusing on the results of clinical trials and current guidelines. Specifically, we wanted to highlight what is known in terms of OIT efficacy and effectiveness, safety, and impact on quality of life. For each aspect, we reported the pros and the cons, inferable from published literature. In conclusion, even though many protocols, reviews and meta-analysis have been published on this topic, pediatric OIT remains a controversial therapy and no definitive generalized conclusion may be drawn so far. It should be an option provided by specialized teams, when both patients and their families are prone to adhere to the proposed protocol. Efficacy, long-term effectiveness, possible role of adjuvant therapies, risk of severe reactions including anaphylaxis or eosinophilic esophagitis, and impact on the quality of life of both children and caregivers are all aspects that should be discussed before starting OIT. Future studies are needed to provide firm clinical and scientific evidence, which should also consider patient reported outcomes.

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Impact of aquatic exercise on persons with kidney disease: a systematic review and meta-analysis

Archivos de Medicina del Deporte ◽

10.18176/archmeddeporte.0008 ◽

2020 ◽

Vol 37 (5) ◽

pp. 339-347

Author(s):

D Rodríguez Rey ◽

MA Sanchez-Lastra ◽

C Ayán Pérez

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Kidney Disease ◽

Physical Exercise ◽

Meta Analysis ◽

Scientific Evidence ◽

Aquatic Exercise ◽

The Impact

Objective: Analyze the scientific evidence on the effects that aquatic physical exercise has on people with chronic kidney disease (CKD). Material and method: A systematic review was carried out following the checklist Preferred Reporting Items for Systematic review and Meta-Analysis Protocols, with the objective of locating the largest number of investigations that aimed to identify the effects of the practice of aquatic physical exercise in people with ERC. A search of the PubMed, PEDro, Scopus and Cochrane databases were carried out until March 2019, using the PEDro, CERT, MINORS and NIH scales to determine the methodological quality of the same. Results: Five investigations were located, two of them were randomized control trials, another two studies comparatives and one was uncontrolled. The mean score and the median obtained after applying PEDro scale were 4 and 4 respectively. All the interventions proposed aerobic exercise programs, being generally of short duration and highly supervised, without any adverse effects arising from their practice. In a large part of the studies, significant effects were observed in physical condition, physiological parameters and quality of life, to a lesser extent. The practice of exercise had no significant impact on either the activity of the disease or the perceived pain in patients. Conclusions: Practice of aquatic exercise is beneficial in people with ERC. More longitudinal studies are needed to assess the impact of aquatic exercises as well as its effect and quality of life in long term.

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The Burden of Hidradenitis Suppurativa Signs and Symptoms in Quality of Life: Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18136709 ◽

2021 ◽

Vol 18 (13) ◽

pp. 6709

Author(s):

Trinidad Montero-Vilchez ◽

Pablo Diaz-Calvillo ◽

Juan-Angel Rodriguez-Pozo ◽

Carlos Cuenca-Barrales ◽

Antonio Martinez-Lopez ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Hidradenitis Suppurativa ◽

Meta Analysis ◽

Scientific Evidence ◽

Signs And Symptoms ◽

Sexual Distress ◽

The Mean ◽

The Impact

Hidradenitis suppurativa (HS) is a chronic, recurrent and debilitating inflammatory skin disease of the hair follicle that usually presents as painful, deep-seated inflamed lesions in the apocrine gland-bearing areas of the body. HS patients suffer from uncomfortable signs and symptoms, such as pain, pruritus, malodour and suppuration, which may impair patients’ quality of life (QoL). Although HS patients frequently experience these signs and symptoms, they are only occasionally assessed by clinicians and, unexpectedly, the scientific evidence available is limited and heterogeneous. The aim of this study is to summarize the evidence regarding the impact of HS signs and symptoms on QoL to serve as a basis for future research and help clinicians to consider them in the daily care of HS patients. A systematic review and meta-analysis were conducted following PRISMA Guidelines. The following search algorithm was used: (hidradenitis or “acne inversa”) and (pain or itch or odour or malodour or suppuration or oozing or drainage) and (“quality of life”). The literature search identified 836 references, 17 of them met the eligible criteria and were included for analysis, representing 4929 HS patients. Mean age of the participants was 36.28 years and there was a predominance of female sex among study participants. The BMI of the population was in the range of over-weight and about two out five patients were active smokers. Studies included patients with mild to moderate HS, with a mean disease duration of 13.69 years. The HS signs and symptoms assessed were pain, pruritus, malodour and suppuration. Overall, the higher intensity of a sign or symptom correlated with poorer general QoL or specific QoL dimensions including sexual distress, anxiety, depression and sleep. The most frequently employed tool to assess QoL was the Dermatology Life Quality Index (DLQI). DLQI was used in 52.9% of the studies (9/17) with a mean value of 10.70 (2.16 SD). The scores employed to assess signs and symptoms severity were subjective and varied between studies, being the numerical rating scale (NRS) for each of the most used symptoms. The mean NRS value for pain was 3.99 and the mean NRS for pruritus was 4.99. In conclusion, we have summarized, categorized and analyzed the scientific evidence regarding signs and symptoms in HS patients and their impairment in QoL. Their assessment should be thorough and included during routine evaluation of HS patients to motivate therapeutic modifications and increase patients’ health.

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QOL-36. USE OF CANNABINOIDS IN THE PEDIATRIC CENTRAL NERVOUS SYSTEM TUMOR POPULATION

Neuro-Oncology ◽

10.1093/neuonc/noaa222.695 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii438-iii438

Author(s):

Kathleen Dorris ◽

Jessica Channell ◽

Ashley Mettetal ◽

Molly Hemenway ◽

Natalie Briones ◽

...

Keyword(s):

Quality Of Life ◽

Central Nervous System ◽

Nervous System ◽

Cell Activity ◽

Cns Tumors ◽

Low Grade ◽

Tumor Type ◽

Central Nervous System Tumor ◽

The Impact

Abstract BACKGROUND Cannabinoids, including cannabidiol (CBD) and tetrahydrocannabinol (THC), are a class of compounds found in marijuana. Numerous studies in adults have examined cannabinoid use in management of cancer-related symptoms such as nausea, anorexia, and pain. Less is known about the use in the pediatric oncology population. METHODS A prospective observational study has been ongoing since 2016 at Children’s Hospital Colorado to evaluate cannabinoids’ impact using PedsQL™ modules on quality of life of pediatric patients with central nervous system (CNS) tumors who are 2–18 years old. Laboratory assessments of T-cell activity and pharmacokinetics of CBD, THC and associated metabolites are in process. Diaries with exploratory information on cannabinoid use patterns are being collected. RESULTS Thirty-three patients (14:19; male:female) have been enrolled with a median age of 6.4 years (range, 2.9–17.7 years). The most common tumor type in enrolled patients is embryonal tumors (13/33; 39%). Nine (27%) patients have low-grade glial/glioneuronal tumors, and eight (24%) had high-grade/diffuse midline gliomas. The remaining patients had ependymoma or craniopharyngioma. The median time on cannabinoids is 9 months. Most (n=20) patients have used oral products with CBD and THC. One patient continues on cannabinoid therapy in follow up. Preliminary immune function analyses identified impaired neutrophil superoxide anion production and chemotaxis in patients taking cannabinoids at early time points on therapy. CONCLUSIONS Families of children with various CNS tumors are pursuing cannabinoid therapy for both antitumor and supportive care purposes. Analysis of the impact of cannabinoids on patients’ quality of life is ongoing.

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Exercise efficacy and prescription during treatment for pancreatic ductal adenocarcinoma: a systematic review

BMC Cancer ◽

10.1186/s12885-020-07733-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dominic O’Connor ◽

Malcolm Brown ◽

Martin Eatock ◽

Richard C. Turkington ◽

Gillian Prue

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Pancreatic Cancer ◽

Adjuvant Therapy ◽

Physical Function ◽

Meta Analysis ◽

Ductal Adenocarcinoma ◽

Key Stakeholders ◽

The Impact

Abstract Background Surgical resection remains the only curative treatment for pancreatic cancer and is associated with significant post-operative morbidity and mortality. Patients eligible for surgery, increasingly receive neo-adjuvant therapy before surgery or adjuvant therapy afterward, inherently exposing them to toxicity. As such, optimizing physical function through exercise during treatment remains imperative to optimize quality of life either before surgery or during rehabilitation. However, current exercise efficacy and prescription in pancreatic cancer is unknown. Therefore, this study aims to summarise the published literature on exercise studies conducted in patients with pancreatic cancer undergoing treatment with a focus on determining the current prescription and progression patterns being used in this population. Methods A systematic review of four databases identified studies evaluating the effects of exercise on aerobic fitness, muscle strength, physical function, body composition, fatigue and quality of life in participants with pancreatic cancer undergoing treatment, published up to 24 July 2020. Two reviewers independently reviewed and appraised the methodological quality of each study. Results Twelve studies with a total of 300 participants were included. Heterogeneity of the literature prevented meta-analysis. Exercise was associated with improvements in outcomes; however, study quality was variable with the majority of studies receiving a weak rating. Conclusions High quality evidence regarding the efficacy and prescription of exercise in pancreatic cancer is lacking. Well-designed trials, which have received feedback and input from key stakeholders prior to implementation, are required to examine the impact of exercise in pancreatic cancer on key cancer related health outcomes.

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EXPRESS: The benefit of exercise-based rehabilitation programmes in patients with pulmonary hypertension: a systematic review and meta-analysis of randomized controlled trials

Pulmonary Circulation ◽

10.1177/20458940211007810 ◽

2021 ◽

pp. 204589402110078

Author(s):

Lu Yan ◽

Wence Shi ◽

Zhi-hong Liu ◽

Qin Luo ◽

Zhihui Zhao ◽

...

Keyword(s):

Quality Of Life ◽

Pulmonary Hypertension ◽

Randomized Controlled Trials ◽

Exercise Capacity ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

The Mean ◽

Quality Evidence

Background: Several studies have suggested that exercise capacity and quality of life are reduced in patients with pulmonary hypertension (PH), and exercise-based rehabilitation can improve exercise capacity and quality of life in patients with PH. The aim of this study is to assess the efficacy and safety of exercise-based rehabilitation in patients with PH through a meta-analysis of randomized controlled trials. Methods: We searched PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials up to November 2018. All randomized controlled trials (RCTs) comparing exercise capacity and quality of life between patients undergoing exercise-based rehabilitation and those undergoing non-exercise training were included. Data were extracted separately and independently by two investigators, and discrepancies were arbitrated by the third investigator. We used the random-effects model to analyze the results, the GRADE to assess the risk of bias in the included studies, and I Â² statistic to estimate the degree of heterogeneity. Results: Nine RCTs are included, however, only seven RCTs were able to extract data. Including inpatients and outpatients, the total number of participants was 234, most of whom were diagnosed as pulmonary artery hypertension (PAH). The study duration ranged from 3 to15 weeks. The mean six-minute walk distance after exercise training was 51.94 metres higher than control (27.65 to 76.23 metres, n=234, 7 RCTs, low quality evidence), the mean peakÂ oxygen uptakeÂ Â was 2.96 ml/kg/minute higher (2.49 to 3.43 ml/kg/minute, n=179, 4 RCTs, low-quality evidence) than in the control groupÂ . Concluded: Our finding suggest that an exercise-based training program positively influences exercise capacity in patients with PH.

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The impact on quality of life in patients with burning mouth syndrome: a systematic review and meta-analysis

Oral Surgery Oral Medicine Oral Pathology and Oral Radiology ◽

10.1016/j.oooo.2020.11.019 ◽

2020 ◽

Author(s):

Juliana Vianna Pereira ◽

Ana Gabriela Costa Normando ◽

Carla Isabelly Rodrigues-Fernandes ◽

César Rivera ◽

Alan Roger Santos-Silva ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Meta Analysis ◽

Burning Mouth Syndrome ◽

Burning Mouth ◽

The Impact

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Short and long-term quality of life outcomes in children after surgery for Hirschsprung Disease or Anorectal Malformations: A systematic review and meta-analysis

10.31219/osf.io/zqbgx ◽

2020 ◽

Author(s):

Irina Oltean ◽

Emily Beveridge ◽

Lamia Hayawi ◽

Vid Bijelic ◽

Ahmed Nasr

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Psychosocial Functioning ◽

Meta Analysis ◽

Hirschsprung Disease ◽

Cochrane Collaboration ◽

Anorectal Malformations ◽

Case Control Studies ◽

Social And Emotional

There is paucity of evidence examining quality of life in children with HD and ARM prioritizing dimensions other than physical functioning, such as psychosocial functioning in a precise manner. As such, we have developed a systematic review protocol to narratively and quantitatively summarize the physical and psychosocial functioning of children affected by HD and ARM in hopes of addressing this limitation. The following databases were searched on Nov 5, 2019: MEDLINE including Epub Ahead of Print, In-Process & Other Non-Indexed Citations (1946 to October 25, 2019) and Embase (1947 to 2019 October 25) and the CENTRAL Trials Registry of the Cochrane Collaboration (September 2019 Issue) using the Ovid interface. Searches were limited to English, to journal articles, and articles published since 2006. This review will identify retrospective and prospective cohort studies, case-control studies, case studies with greater than 5 participants, and randomized-control trials where the quality of life (i.e., physical and/or social functioning) of children aged 0-18 years with either anorectal malformations or Hirschprung’s disease is reported by children or parent proxies. Understanding the quality of life of children affected by HD and ARM after surgery will help clinical practitioners, specifically surgeons, create tailored and comprehensive protocols for managing these diseases while recognising the physical, social, and emotional toll they can inflict on children.

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