Renal function and symptoms/adverse effects in opioid-treated patients with cancer

Abstract Purpose Most patients with cancer undergo multiple administrations of anticancer drugs during treatment, resulting in chronic impairment of their reproductive health. As improved treatment options increase cancer survival, it has become increasingly important to address fertility issues in cancer survivors. In this study, we examined the pathophysiological effects of multiple exposures to cyclophosphamide (Cy) on the ovaries of mice and their underlying molecular mechanism. Methods Female C57BL/6 mice were intraperitoneally injected with 100 mg/kg Cy six times over 2 weeks; 4 weeks later, the mice were sacrificed and their ovaries, sera, and oocytes were collected for histological observation, measurement of anti-Müllerian hormone levels, and assessment of oocyte quantity and quality in response to hormonal stimulation. Gene expression changes in Cy-treated ovaries were examined by microarray and bioinformatics analyses. Results After repeated Cy exposure, the anti-Müllerian hormone level was decreased, and follicle loss and impairments in the quality of oocyte were irreversible. The expression levels of genes involved in folliculogenesis, oogenesis, and zona pellucida glycoprotein transcription displayed sustained alterations in Cy-exposed ovaries even after 4 weeks. Conclusion The adverse effects of Cy on ovarian function and oocytes remained even after chemotherapy was complete. Therefore, strategies to prevent ovarian damage or restore ovarian function after treatment are required to safeguard the fertility of young cancer survivors.

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Study of Adverse Effect Profile of Zoledronic Acid Infusion Among Patients with Cancer: A Retrospective Analysis

International Journal of Cancer Management ◽

10.5812/ijcm.106132 ◽

2020 ◽

Vol 13 (10) ◽

Author(s):

Lina Elsalem ◽

Haneen A. Basheer ◽

Ayat Alshoh ◽

Abdullah Abu-Aqoulah ◽

Hussein Alsa'di ◽

...

Keyword(s):

Zoledronic Acid ◽

Adverse Effects ◽

Biochemical Parameters ◽

Symptomatic Treatment ◽

Serum Levels ◽

Mean Values ◽

Protein Levels ◽

Patients With Cancer ◽

Significant Difference ◽

Pre Treatment

Background: Zoledronic acid (ZA) is widely used in the management of cancer-related bone events. It, however, might be associated with serious adverse effects. Objectives: To evaluate ZA adverse effects and changes in biochemical parameters related to ZA toxicities among patients with cancer. Methods: Ninety-eight oncology patients, who were prescribed ZA intravenous (IV) infusion, were interviewed to assess whether they experienced ZA related symptoms, including acute events and serious adverse effects. ZA’s effects on the serum levels of different biochemical parameters were retrospectively assessed by checking patients’ electronic medical records. Results: The most commonly reported adverse effects were: myalgia (48%), bone pain (36.7%), influenza-like symptoms (34.7%), headache (31.6%), and pyrexia (22.45%) with decreasing frequency of such adverse effects upon repeated infusions. Serious side effects including jaw osteonecrosis, cardiac, and renal problems were not reported. A small, but statistically significant reduction in serum calcium, creatinine, and total protein levels was observed upon comparing levels before and after the first IV infusion of ZA (P ≤ 0.031). No significant change was recorded with other serum electrolytes including phosphorus, sodium, potassium, and magnesium as well as urea levels (P ≥ 0.271). No significant difference was determined in terms of final serum levels of all parameters in comparison to pre-treatment (P ≥ 0.059), except for potassium, where a significant reduction was observed (P = 0.003). Notably, the mean values of all parameters were within the normal range. Conclusions: ZA acute events resolved with symptomatic treatment and reduced with repeated IV infusions. ZA appears as a safe treatment modality for skeletal-related events among patients with cancer and the reported adverse effects should not affect patients’ compliance.

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Pain management

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0064 ◽

2020 ◽

pp. 629-633

Author(s):

Marie Fallon

Keyword(s):

Quality Of Life ◽

Pain Management ◽

Pain Relief ◽

Adverse Effects ◽

Cancer Pain ◽

Daily Functioning ◽

Opioid Analgesia ◽

Patients With Cancer ◽

Good Pain Relief

Pain occurs in more than 50% of patients with advanced disease, interferes with daily functioning and quality of life, and is very often undertreated. Patients can find it difficult to articulate the character of their pains, but it is important to determine whether it is somatic, neuropathic, or visceral since this has important implications for management. For most patients with cancer pain, a three-step approach combining simple or opioid analgesia (depending on severity) along with an adjuvant analgesic (depending on cause) will result in good pain relief, but the challenge is to achieve good pain relief without unacceptable adverse effects.

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Understanding American Indian Perceptions Toward Radiation Therapy

Cancer Control ◽

10.1177/1073274820945991 ◽

2020 ◽

Vol 27 (3) ◽

pp. 107327482094599

Author(s):

Samir H. Patel ◽

Sasha Ebrahimi ◽

Donald W. Northfelt ◽

Timothy E. Mathews ◽

Farhia M. Omar ◽

...

Keyword(s):

Radiation Therapy ◽

Adverse Effects ◽

American Indian ◽

Alaska Native ◽

Medical Center ◽

Transportation Cost ◽

Survey Study ◽

Cost Of Treatment ◽

Patients With Cancer ◽

To Receive

Many American Indian (AI) and Alaska native (AN) patients do not complete guideline-concordant cancer care for the 4 most common cancers. Our aim was to better understand AI/AN attitudes toward radiation therapy (RT). Patients eligible for this survey study were AI/AN patients with cancer at the Phoenix Indian Medical Center who either received previous RT or were recommended to receive RT. An 18-item questionnaire was administered to each of the 50 participants from October 1, 2018, through February 15, 2019. Willingness to travel for RT was compared to respondent characteristics, concerns regarding RT, and obstacles to obtain RT. Duration of RT was important to 78% of patients: 24% would consider traveling 25 miles or more for a standard course, and 48% would travel that distance for a shorter course ( P < .001). The top-ranked barriers to RT were transportation, cost of treatment, and insurance compatibility. The top-ranked concerns about RT were adverse effects, cost of treatment, and fear of RT. Concerns about adverse effects were associated with the radiation team’s inability to explain the treatment ( P = .05). Transportation concerns were significantly associated with accessibility ( P = .02), communication with the RT team ( P = .02), and fear of RT ( P = .04). AI/AN patients are concerned about the adverse effects of RT and the logistics of treatment, particularly costs, transportation, and insurance compatibility. Use of culturally specific education and hypofractionation regimens may increase acceptance of RT for AI/AN patients with cancer, and this hypothesis will be tested in a future educational intervention-based study.

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Immune-related Adverse Effects and Outcome of Patients With Cancer Treated With Immune Checkpoint Inhibitors

Anticancer Research ◽

10.21873/anticanres.14063 ◽

2020 ◽

Vol 40 (3) ◽

pp. 1219-1227 ◽

Cited By ~ 1

Author(s):

ONDREJ FIALA ◽

ONDREJ SOREJS ◽

JAN SUSTR ◽

RADEK KUCERA ◽

ONDREJ TOPOLCAN ◽

...

Keyword(s):

Adverse Effects ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Patients With Cancer

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Oxycodone-induced neurotoxicity secondary, to concurrent voriconazole use in a patient with cancer

Journal of Opioid Management ◽

10.5055/jom.2017.0381 ◽

2017 ◽

Vol 13 (3) ◽

pp. 141 ◽

Cited By ~ 3

Author(s):

Lana Alghothani, MD ◽

Jillian Gustin, MD

Keyword(s):

Chronic Pain ◽

High Risk ◽

Adverse Effects ◽

Advanced Disease ◽

Hematologic Malignancies ◽

Patients With Cancer ◽

Concurrent Use ◽

Underlying Malignancy ◽

Risk Patients ◽

Active Disease

Chronic pain is common in patients with underlying malignancy with prevalence of up to 70 percent in those with advanced disease. Opioids are often used for those with both active disease and chronic cancer-related pain. In high-risk patients with hematologic malignancies and pneumonia, the Infectious Diseases Society of America recommends empiric antifungal therapy, often with voriconazole or another similar azole agent. Thus, patients with cancer are commonly on medications, such as antifungals, that have the potential to interact with opioids, causing adverse effects. Our case demonstrates severe neurotoxicity due to the concurrent use of voriconazole and oxycodone.

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Effect of duloxetine on chemotherapy-induced painful peripheral neuropathy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.181 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 181-181 ◽

Cited By ~ 1

Author(s):

Yasuo Hirayama ◽

Takeshi Terui ◽

Kazuhiko Koike ◽

Toshiro Kusakabe ◽

Hiroto Horiguthi ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Adverse Effects ◽

Medical Information ◽

Japanese Patients ◽

Drop Out ◽

University Hospital ◽

Open Label ◽

Patients With Cancer ◽

Vas Scores ◽

Primary Hypothesis

181 Background: Approximately 20% to 40% of patients with cancer who receive neurotoxic chemotherapy will develop painful chemotherapy-induced peripheral neuropathy. Smith et. al firstly reported that duloxetine was effective on above neuropathy after taxanes and platinums (JAMA 2013), so we planed to evaluate the duloxetine effect in Japanese patients after above drugs and more expanding drugs include vinca alkaloids and bortezomib. Methods: Patients were randomized to receive either duloxetine followed by vitamin(V)B12 or VB12 by duloxetine. The initial treatment consisted of 20 mg of duloxetine or 1.5g VB12 for the first week and 40mg of duloxetine or VB12 daily for 3 additional weeks (an open label, randomized, crossover). Dose reduction by the adverse effects was permitted. The primary hypothesis was that duloxetine would be more effective than VB12 in decreasing chemotherapy-induced peripheral neuropathic pain. Numbness and Pain severity were assessed weekly using visual analogue scale (VAS). This research was approved by the Research Ethics Committee of Higashi Sapporo Hospital and University Hospital Medical Information Network (UMIN) Center in Japan.Thirty-four cases (Breast cancer: taxanes 2, gastric cancer: taxane 5, colon cancer: oxaliplatin 6, Malignant lymphoma: vincristine 13, multiple myeloma: bortezomib 8) were made an entry in our institution. Five cases dropped out because of the adverse effect with sleepy and general malaise. Results: Obvious improvements of VAS scores of numbness and pain were observed in duloxetine group. Significant differences of delta VAS (pre VAS scale – 4 weeks VAS after drug administration) were observed between duloxetine group and VB12 group in the aspect of numbness (p=0.02) and pain (p=0.03). Conclusions: Among patients with painful chemotherapy-induced peripheral neuropathy, the use of duloxetine compared with VB12 for 4 weeks resulted in a reduction in numbness and pain, but there are many cases with drop out by the adverse effects. Clinical trial information: 000011554.

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Influenza Vaccination in Cancer Patients Undergoing Systemic Therapy

Clinical Medicine Insights Oncology ◽

10.4137/cmo.s13774 ◽

2014 ◽

Vol 8 ◽

pp. CMO.S13774 ◽

Cited By ~ 16

Author(s):

Mahmoud A. Shehata ◽

Nagla Abdel Karim

Keyword(s):

Adverse Effects ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Cancer Patients ◽

Clinical Outcomes ◽

Influenza Infection ◽

Immunological Response ◽

Morbidity And Mortality ◽

Serological Response ◽

Patients With Cancer

Background Cancer patients often experience preventable infections, including influenza A and B. These infections can be a cause of significant morbidity and mortality. The increased risk of infection may be because of either cancer itself or treatment-induced immunosuppression. 1 Influenza immunization has been shown to decrease the risk of influenza infection in patients with intact immunity. 2 In cancer patients, active immunization has been shown to confer protective immunity against several infections at similar rates to healthy individuals, which has translated into decreased duration and severity of infection and potentially improved morbidity and mortality. 3 Objectives 1. To assess the efficacy of influenza vaccination in stimulating immunological response in patients with cancer during chemotherapy compared to control groups. 2. To assess the efficacy of influenza vaccination in preventing confirmed influenza and influenza-like illness and/or stimulating immunological response in children with cancer treated with chemotherapy, compared to placebo, no intervention, or different dosage schedules. 3. To determine the adverse effects associated with influenza vaccination in patients with cancer. Search Methods We searched MEDLINE/PubMed database for articles published from 1964 to 2013 using the search terms “cancer,” “adult,” “influenza vaccination,” and “chemotherapy.” Selection Criteria We included studies based on systematic sampling with defined clinical criteria irrespective of the vaccination status of cancer patients. Studies measure the serological response or clinical response to compare between the study group and the control group. Studies assessed the inactivated influenza vaccines and live attenuated influenza vaccine (LAIV) protective serological reaction and the clinical outcomes after vaccination. Data Collection and Analysis Two independent authors assessed the methodological quality of included studies and extracted data. Main Results We included 16 studies (total number of participants = 1,076). None of the included studies reported clinical outcomes. All included studies reported on influenza immunity and adverse reaction on vaccination. We included 6 solid tumor studies and 10 hematological studies. In 12 studies, the serological response to influenza vaccine was compared in patients receiving chemotherapy (n = 425) versus those not receiving chemotherapy (n = 376). In three studies, the serological responses to influenza vaccination in patients receiving chemotherapy are compared to that in healthy adult. Measures used to assess the serological responses included a four-fold rise increase in antibody titer development of hemagglutination inhibition (HI) titer >40, and pre- and post-vaccination geometric mean titers (GMTs). Immune responses in patients receiving chemotherapy were consistently weaker (four-fold rise of 17–52%) than in those who had completed chemotherapy (50–83%) and healthy patients (67–100%). Concerning adverse effects, oncology patients received influenza vaccine, and the side effects described were mild local reactions and low-grade fever. No life-threatening or persistent adverse effects were reported. Authors’ Conclusion Patients with solid and some of hematological tumors are able to mount a serological response to influenza vaccine, but it remains unclear how much this response protects them from influenza infection or its complications. Meanwhile, influenza vaccine appears to be safe in these patients. While waiting results of randomized controlled trials to give us more details about the clinical benefits of the influenza vaccination, the clinicians should consider the currently proved benefits of influenza vaccination on management of the cancer patients undergoing systematic chemotherapy such as decrease in the duration and severity of the of the disease, and significant decrease in influenza-associated morbidity and mortality in these high-risk patients. 3

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Interventional Therapies for Cancer Pain Management: Important Adjuvants to Systemic Analgesics

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2007.0075 ◽

2007 ◽

Vol 5 (8) ◽

pp. 851-858 ◽

Cited By ~ 12

Author(s):

Anthony Eidelman ◽

Traci White ◽

Robert A. Swarm

Keyword(s):

Pain Management ◽

Adverse Effects ◽

Cancer Pain ◽

Pain Control ◽

Analgesic Efficacy ◽

Cancer Pain Management ◽

Patients With Cancer ◽

Inflammatory Drugs ◽

Control Pain ◽

Interventional Therapies

Optimized use of systemic analgesics fails to adequately control pain in some patients with cancer. Commonly used analgesics, including opioids, nonopioids (acetaminophen and non-steroidal anti-inflammatory drugs), and adjuvant analgesics (anticonvulsants and antidepressants), have limited analgesic efficacy, and their use is often associated with adverse effects. Without adequate pain control, patients with cancer not only experience the anguish of poorly controlled pain but also have greatly diminished quality of life and may even have reduced life expectancy. Interventional pain therapies are a diverse set of procedural techniques for controlling pain that may be useful when systemic analgesics fail to provide adequate control of cancer pain or when the adverse effects of systemic analgesics cannot be managed reasonably. Commonly used interventional therapies for cancer pain include neurolytic neural blockade, spinal administration of analgesics, and vertebroplasty. Compared with systemic analgesics, which generally have broad indications for control of pain, individual interventional therapies generally have specific, narrow indications. When appropriately selected and implemented, interventional pain therapies are important components of broad, multimodal cancer pain management that significantly increases the proportion of patients able to experience adequate pain control.

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