Effects of megestrol acetate in patients with cancer anorexia‑cachexia syndrome – a systematic review and meta‑analysis

PurposeOpioids are recommended for moderate-to-severe cancer pain; however, in patients with cancer, impaired hepatic function can affect opioid metabolism. The aim of this systematic review was to evaluate the evidence for the use of opioids in patients with cancer with hepatic impairment.MethodsA systematic review was conducted and the following databases searched: AMED (−2021), MEDLINE (−2021), EMBASECLASSIC + EMBASE (−2021) and Cochrane Central Register of Controlled Trials (−2021). Eligible studies met the following criteria: patients with cancer-related pain, taking an opioid (as defined by the WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents); >18 years of age; patients with hepatic impairment defined using recognised or study-defined definitions; clinical outcome hepatic impairment related; and primary studies. All eligible studies were appraised using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsThree studies (n=95) were eligible but heterogeneity meant meta-analysis was not possible. Each individual study focused on only one each of oxycodone±hydrocotarnine, oxycodone/naloxone and morphine. No recommendations could be formulated on the preferred opioid in patients with hepatic impairment.ConclusionsMorphine is the preferred opioid in hepatic impairment owing to clinical experience and pharmacokinetics. This review, however, found little clinical evidence to support this. Dose adjustments of morphine and the oxycodone formulations reviewed remain necessary in the absence of quality evidence. Overall, the quality of existing evidence on opioid treatments in cancer pain and hepatic impairment is low and there remains a need for high-quality clinical studies examining this.

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Rikkunshito for upper gastrointestinal syndrome in patients with cancer: a systematic review and meta-analysis protocol

10.37766/inplasy2020.10.0068 ◽

2020 ◽

Author(s):

Hong Liu ◽

Chuan Zheng ◽

Yuting Wang ◽

Ran Yan ◽

Fengming You ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Patients With Cancer ◽

Upper Gastrointestinal ◽

Analysis Protocol

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The effect of music intervention on patients with cancer‐related pain: A systematic review and meta‐analysis of randomized controlled trials

Journal of Advanced Nursing ◽

10.1111/jan.14184 ◽

2019 ◽

Vol 75 (12) ◽

pp. 3362-3373 ◽

Cited By ~ 2

Author(s):

Şefika Tuğba Yangöz ◽

Zeynep Özer

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Music Intervention ◽

Patients With Cancer ◽

Randomized Controlled

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Clinical Characteristics and Outcomes of COVID-19–Infected Cancer Patients: A Systematic Review and Meta-Analysis

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa168 ◽

2020 ◽

Cited By ~ 3

Author(s):

Hua Zhang ◽

Han Han ◽

Tianhui He ◽

Kristen E Labbe ◽

Adrian V Hernandez ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Case Fatality Rate ◽

Meta Analysis ◽

Univariate Analysis ◽

Case Fatality ◽

The United States ◽

Fatality Rate ◽

Patients With Cancer ◽

Increased Risk

Abstract Background Previous studies have indicated coronavirus disease 2019 (COVID-19) patients with cancer have a high fatality rate. Methods We conducted a systematic review of studies that reported fatalities in COVID-19 patients with cancer. A comprehensive meta-analysis that assessed the overall case fatality rate and associated risk factors was performed. Using individual patient data, univariate and multivariable logistic regression analyses were used to estimate odds ratios (OR) for each variable with outcomes. Results We included 15 studies with 3019 patients, of which 1628 were men; 41.0% were from the United Kingdom and Europe, followed by the United States and Canada (35.7%), and Asia (China, 23.3%). The overall case fatality rate of COVID-19 patients with cancer measured 22.4% (95% confidence interval [CI] = 17.3% to 28.0%). Univariate analysis revealed age (OR = 3.57, 95% CI = 1.80 to 7.06), male sex (OR = 2.10, 95% CI = 1.07 to 4.13), and comorbidity (OR = 2.00, 95% CI = 1.04 to 3.85) were associated with increased risk of severe events (defined as the individuals being admitted to the intensive care unit, or requiring invasive ventilation, or death). In multivariable analysis, only age greater than 65 years (OR = 3.16, 95% CI = 1.45 to 6.88) and being male (OR = 2.29, 95% CI = 1.07 to 4.87) were associated with increased risk of severe events. Conclusions Our analysis demonstrated that COVID-19 patients with cancer have a higher fatality rate compared with that of COVID-19 patients without cancer. Age and sex appear to be risk factors associated with a poorer prognosis.

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Neutropenic diets to prevent cancer infections: updated systematic review and meta-analysis

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-001742 ◽

2019 ◽

pp. bmjspcare-2018-001742 ◽

Cited By ~ 4

Author(s):

Mohamad Bassam Sonbol ◽

Tania Jain ◽

Belal Firwana ◽

Talal Hilal ◽

Thomas Deleon ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Cell Transplant ◽

Regular Diet ◽

Patients With Cancer ◽

Transplant Patients ◽

Haematopoietic Cell ◽

Significant Difference ◽

Neutropenic Patients ◽

Meta Analyses

IntroductionMultiple studies have questioned the benefit of neutropenic diets in decreasing infections in patients with cancer, but recent surveys showed that such diets are still prescribed. In this study, we sought to evaluate the effectiveness of neutropenic diet in decreasing infection and mortality in neutropenic patients with cancer with neutropenia. This review is an update of a previously published systematic review.Materials and methodsWe searched different databases to identify comparative studies that investigated the effect of neutropenic diet compared with regular diet in neutropenic adults and children with cancer. We conducted random‐effects meta‐analyses using the Der‐Simonian and Laird method to pool treatment effects from included studies. Outcomes of interest were mortality, bacteremia/fungemia, major infections, quality of life, and the composite outcome for neutropenic fever and/or infection.ResultsWe included six studies (five randomised) with 1116 patients, with 772 (69.1%) having underwent haematopoietic cell transplant. There was no statistically significant difference between neutropenic diet and regular diet in the rates of major infections (relative risk [RR] 1.16; 95% CI 0.94 to 1.42) or bacteremia/fungemia (RR 0.96; 95% CI 0.60 to 1.53). In haematopoietic cell transplant patients, neutropenic diet was associated with a slightly higher risk of infections (RR 1.25; 95% CI 1.02 to 1.54). No difference in mortality was seen between neutropenic diet and regular diet (RR 1.08, 95% CI 0.78 to 1.50).ConclusionThere is currently no evidence to support the use of neutropenic diet or other food restrictions in neutropenic patients with cancer. Patients and clinicians should continue to follow the safe food-handling guidelines as recommended by the U.S. Food and Drug Administration.

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