The efficacy and safety of ketamine for depression in patients with cancer: A systematic review

Management of depression in the oncology population includes supportive psychotherapeutic interventions with or without psychotropic medication, which take time to demonstrate effectiveness. Fast-acting interventions, like ketamine, can provide a rapid antidepressant effect; however, there has been limited research on effects of ketamine among cancer patients. The objective of this review is to provide an overview of research on the efficacy and safety of ketamine on depression in patients with cancer. We reviewed the published literature in MEDLINE® (via PubMed®), EMBASE, and Scopus from 1 January 1982 to 20 October 2022. We screened the retrieved abstracts against inclusion criteria and conducted a full-text review of eligible studies. Following extraction of data from included studies, we used a framework analysis approach to summarize the evidence on using ketamine in patients with cancer. All 5 included studies were randomized clinical trials conducted in inpatient settings in China. In all included studies ketamine was administered intravenously. Three studies used only racemic ketamine, and two studies used both S-ketamine and racemic ketamine. All included studies reported ketamine a tolerable and effective drug to control depression symptoms. Included studies showed administration of sub-anesthesia ketamine significantly improves postoperative depression among patients with cancer. [Abstract copyright: © 2023 The Author(s).

A Randomized Placebo-Controlled Trial of Bupropion for Cancer-Related Fatigue: Study Design and Procedures

Background: Cancer-related fatigue is a significant problem and is associated with poor quality of life. Behavioral interventions include exercise and cognitive-behavioral therapy, which survivors may be unwilling or unable to adopt. Pharmacologic interventions (e.g., selective serotonin reuptake inhibitors) have been disappointing. One potential therapy is the antidepressant bupropion, a norepinephrine-dopamine reuptake inhibitor that targets both inflammation and the hypothalamic-pituitary-adrenal axis. The current study is intended to provide a rigorous test of the efficacy and tolerability of bupropion for cancer-related fatigue. Methods: A randomized, double-blind, placebo-controlled trial will examine the effects of bupropion on cancer-related fatigue. The trial will be conducted nationwide through the University of Rochester Medical Center (URMC) National Cancer Institute Community Oncology Research Program (NCORP). Disease-free breast cancer survivors (n = 422) who completed chemotherapy and/or radiotherapy 12-60 months previously and report significant fatigue will be randomized 1:1 to receive bupropion (300 mg/day) or placebo. Outcomes will be assessed at baseline and the 12-week follow-up. The primary outcome, fatigue, will be measured with the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F). Secondary outcomes include quality of life, depression, and drug tolerability. Exploratory outcomes include cognition and symptomatology. Potential biological mechanisms and genetic moderators of cancer-related fatigue will also be explored. Discussion: This study is the first placebo-controlled trial to our knowledge to evaluate bupropion for cancer-related fatigue. Positive results could revolutionize the treatment of cancer-related fatigue, as bupropion is safe, inexpensive, widely-available, and may be more tolerable and acceptable for many patients than current, limited treatment options

Cultural Adaptation of a Supportive Care Needs Measure for Hispanic Men Cancer Survivors

Objective. Research with ethnic minority populations requires instrumentation that is cultural and linguistically relevant. The aim of this study was to translate and culturally adapt the Cancer Survivor Unmet Needs measure into Spanish. Methods. We describe the iterative, community-engaged consensus-building approaches used to adapt the instrument for Hispanic male cancer survivors. We used an exploratory sequential mixed method study design. Methods included translation and back-translation, focus groups with cancer survivors (n = 18) and providers (n = 5), use of cognitive interview techniques to evaluate the comprehension and acceptability of the adapted instrument with survivors (n = 12), ongoing input from the project\u27s community advisory board, and preliminary psychometric analysis (n = 84). Results. The process emphasized conceptual, content, semantic, and technical equivalence. Combining qualitative and quantitative approaches offered a rigorous, systematic, and contextual approach to translation alone and supports the cultural adaptation of this measure in a purposeful and relevant manner. Conclusion. Our findings highlight the importance of going beyond translation when adapting measures for cross-cultural populations and illustrate the importance of taking culture, literacy, and language into consideration

Initial Evaluation of the Validity and Reliability of the Culturally Adapted Spanish CaSUN (S-CaSUN)

Purpose: There is a dearth of knowledge and limited research on the needs of Hispanic male cancer survivors (HMCSs). There is a clear need for the development of culturally and linguistically adapted needs assessment tools that are valid and reliable for use among the growing HMCS population. Thus, the purpose of this paper is to describe the field testing and psychometric evaluation of the translated and culturally adapted Spanish Cancer Survivor Unmet Needs Measure (S-CaSUN). Methods: Hispanic male cancer survivors (n = 84) completed the Spanish CaSUN (S-CaSUN), the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-General Population (FACT-GP). Construct validity of the S-CaSUN was assessed by correlation analysis among aforesaid measures. A test-retest procedure with 2-week delay was used to examine reproducibility with a participant subsample (n = 50). Cronbach’s alpha was computed to assess internal consistency of the S-CaSUN. Results: Construct validity of the S-CaSUN was estimated by moderate correlation with the HADS anxiety (r = 0.55, P \u3c 0.001) and depression scales (r = 0.60, P \u3c 0.001) and the FACT-GP (r = − 0.62, P \u3c 0.001). The test-retest correlation coefficient for the S-CaSUN was 0.78. Cronbach’s alpha was 0.96. Field testing yielded a mean S-CaSUN score of 38.3 (SD = 26.2); all needs and positive change items were endorsed. Conclusion: Findings from field testing and preliminary psychometric evaluation of the S-CaSUN provide initial evidence of validity and reliability of the measure and highlight the importance of going beyond translation when adapting measures to take culture, literacy, and language into consideration. Implications for Cancer Survivors: Reliable, culturally, and linguistically valid instruments facilitate identification of unique unmet needs of Hispanic cancer survivors that, in turn, can be addressed with evidence-based interventions. As cancer centers continue to develop survivorship programs, the S-CaSUN may be useful for a growing group of cancer survivors

The efficacy of ketamine for pain management in patients with cancer: A systematic review

Copyright © 2024 American Society of Clinical Oncology. All rights reserved.e24069 Background: Managing cancer-related pain poses significant challenges, prompting research into alternative approaches such as the study of ketamine. This systematic review aims to analyze and summarize the impact of ketamine as an adjuvant to opioid therapy for cancer-related pain. Methods: We conducted a literature review in MEDLINE, EMBASE, and Scopus, spanning from January 1, 1982, to October 20, 2022. Abstracts were screened against inclusion criteria, and eligible studies underwent a thorough full-text review. Data were extracted from the included studies, and a framework analysis approach was employed to summarize the evidence regarding ketamine's use in patients with cancer. The quality of included studies was assessed using the NIH Quality Assessment Tool for controlled intervention studies. Results: A total of 22 studies conducted between 2001 and 2019 were included, all assessed as having good quality. Three studies focusing on intrathecal administration of ketamine following oncological surgery demonstrated a substantial improvement in pain scores and a reduction in postoperative morphine requirements. Two studies exploring intramuscular use concluded that it led to improved pain scores. In contrast, three studies on subcutaneous administration and two studies on topical ketamine did not exhibit a significant impact on reducing pain scores or alleviating chemotherapy-induced peripheral neuropathy. Findings from two studies on oral administration and eight studies on intravenous administration indicated that intravenous ketamine reduced postoperative morphine requirements, while oral ketamine had no discernible effect on lowering pain scores. Conclusions: The use of intrathecal ketamine demonstrates significant improvement in post-op oncological pain and refractory cancer pain, resulting in lowered pain scores and decreased morphine requirements. Further research is essential to ascertain the extent to which incorporating ketamine with opioids in cancer pain treatment can enhance pain outcomes, especially in morphine-tolerant patients