Papel del ESAD en el tratamiento del dolor. Análisis pre-post intervención en un entorno rural

Objetivos: determinar la frecuencia de uso de analgésicos en pacientes terminales atendidos en domicilio, analizando factores que pudieran intervenir en la percepción del dolor, además de las actuaciones llevadas a cabo. Material y métodos: estudio analítico prospectivo e intervencional con pacientes derivados al Equipo de Soporte para Atención Domiciliaria (ESAD) de Barbastro. Variables estudiadas: edad, sexo, número de visitas, tiempo de seguimiento, presencia de dolor y de otros síntomas concomitantes, Escala Visual Analógica (EVA), diagnóstico, analgésicos previos y post intervención, dosis media previa de analgésicos y post-intervención. Estudio estadístico con SPSS 15.0. Resultados: n = 638, 53,9 % hombres (n = 344), edad media 79,64 ± 10,8 años, 56 % oncológicos (n = 357), seguimiento medio 56 ± 56,56 días, media de 2,68 ± 2,5 visitas por proceso. Dolor en primera visita 43,3 % (n = 276), EVA media 6,54 ± 1,87, dolor 47,1 % de hombres (n = 162) y 38,8 % de mujeres (n = 114) (p < 0,05), dolor en 56,6 % de oncológicos (n = 202) y en 26,3 % de crónico-dependientes (n = 74) (p < 0,001). No diferencias en EVA entre grupos. Entre analgésicos pautados en pacientes con dolor controlado y sin controlar previa intervención del ESAD encontramos diferencias estadísticamente significativas (p < 0,005) en morfina y tramadol, y con mayor significación (p < 0,001) en fentanilo transdérmico y transmucoso, paracetamol, metamizol y AINE, todos más frecuentes en dolor no controlado. Las dosis medias previas de todos estos fármacos no mostraron diferencias significativas entre los grupos, aunque eran mayores en el grupo de dolor no controlado. En estos, se pautan o modifican analgésicos, encontrándose diferencias estadísticamente significativas pre post-intervención (p < 0,001) en fentanilo transdérmico y transmucoso, tramadol, paracetamol, metamizol, AINE, pregabalina y con p < 0,05 en gabapentina. Se obtiene diferencias (p < 0,05) únicamente en las dosis posteriores a la actuación del ESAD en fentanilo transdérmico y codeína. Obtenemos correlaciones positivas entre dolor y anorexia, ansiedad, depresión e insomnio; en pacientes oncológicos entre dolor y ansiedad e insomnio, y en pacientes crónico-dependientes entre dolor, náuseas y depresión. No diferencias entre grupos en uso previo de benzodiacepinas, antidepresivos y otros tratamientos, aunque sí en clínica de depresión, ansiedad e insomnio. Tras intervención, diferencias significativas en uso de estos tratamientos y de sedación. Conclusiones: Tras la actuación del ESAD se puede apreciar el aumento progresivo de todas las medicaciones analgésicas; se debería realizar una valoración completa de la sintomatología del paciente y un tratamiento de síntomas multifactorial, además de interrogar al paciente de forma adecuada acerca de la presencia de síntomas asociados, dada la elevada correlación de los mismos

Declive funcional y presencia de síntomas en cuidados paliativos: ¿causa o consecuencia?

Introducción: Diversas publicaciones han relacionado el declive funcional con la aparición de síntomas,especialmente psicológicos o psiquiátricos, como ansiedad y depresión. Por otra parte, un trastorno depre-sivo inicial o previo al declive funcional también suele empeorarlo. Nos planteamos conocer la relaciónentre la existencia de declive funcional medido mediante descenso en índice de Barthel (IB) y la presenciade síntomas. Material y métodos: Estudio analítico prospectivo con los pacientes derivados a un Equipo de Soportepara Atención Domiciliaria (ESAD).Resultados: Seiscientos treinta y ocho casos, 53,9% (N = 344) hombres, 56% (N = 357) oncológicos y 44%(N = 281) no oncológicos. La edad media fue 79,64 ± 10,8 a˜nos. Obtuvimos diferencias significativas(p < 0,001) en declive funcional medido mediante descenso medio en el IB entre pacientes oncológicos(34,4) y no oncológicos (12,12). Encontramos diferencias significativas (p < 0,001) en todos los sínto-mas registrados (dolor, disnea, anorexia, náuseas, ansiedad, depresión e insomnio) con mayor frecuenciaen pacientes oncológicos, salvo en el caso de la agitación psicomotriz. En pacientes con mayor grado dedeclive funcional, con descensos en IB superior a 20 puntos, se detectó mayor presencia de síntomas. Salvodeterminados analgésicos, no hubo diferencias en los tratamientos previos; sí encontramos diferenciasen diversos tratamientos pautados por el ESAD. Conclusiones: La existencia de declive funcional y su grado pueden verse relacionados con la apariciónde síntomas, especialmente en el paciente oncológico. Introduction Several publications have related functional decline to the appearance of symptoms, especially psychiatric or psychological ones, such as anxiety and depression. Moreover, an initial depressive disorder or prior to functional decline usually worsens it. It was decided to investigate the relationship between the presence of functional decline, measured by a decrease in the Barthel index (BI), and the presence of symptoms. Material and methods A prospective analytical study conducted on patients referred to a Home Care Support Team (HCST). Results The study included 638 cases, of which 53.9% (N = 344) were male, 56% (N = 357) with cancer and 44% (N = 281) geriatric. The mean age was 79.64 years + - 10.8. Significant differences (P<.001) were found in functional decline measured by mean decline in the BI between cancer (34.4) and non-cancer patients (12.12). Significant differences (P<.001) were also found in all recorded symptoms (pain, dyspnoea, anorexia, nausea, anxiety, depression, and insomnia), more frequently in cancer patients, except psychomotor agitation. A higher presence of symptoms was detected in patients with greater functional decline, with decreases in BI above 20 points. There were no differences in previous treatments, except in certain analgesics. Differences were found in the different treatments prescribed by HCST. Conclusions The presence of functional decline and its level may be related to the appearance of symptoms, especially in cancer patients

Biochemical markers of bone turnover and clinical outcome in patients with renal cell and bladder carcinoma with bone metastases following treatment with zoledronic acid: The TUGAMO study

Background: Levels of bone turnover markers (BTM) might be correlated with outcome in terms of skeletal-related events (SRE), disease progression, and death in patients with bladder cancer (BC) and renal cell carcinoma (RCC) with bone metastases (BM). We try to evaluate this possible correlation in patients who receive treatment with zoledronic acid (ZOL). Methods: This observational, prospective, and multicenter study analysed BTM and clinical outcome in these patients. Serum levels of bone alkaline phosphatase (BALP), procollagen type I amino-terminal propeptide (PINP), and beta-isomer of carboxyterminal telopeptide of type I collagen (b-CTX) were analysed. Results: Patients with RCC who died or progressed had higher baseline b-CTX levels and those who experienced SRE during follow-up showed high baseline BALP levels. In BC, a poor rate of survival was related with high baseline b-CTX and BALP levels, and new SRE with increased PINP levels. Cox univariate analysis showed that b-CTX levels were associated with higher mortality and disease progression in RCC and higher mortality in BC. Bone alkaline phosphatase was associated with increased risk of premature SRE appearance in RCC and death in BC. Conclusion: Beta-isomer of carboxy-terminal telopeptide of type I collagen and BALP can be considered a complementary tool for prediction of clinical outcomes in patients with BC and RCC with BM treated with ZOLNovartis Oncology Spain for supporting this stud

Usefulness of bone turnover markers as predictors of mortality risk, disease progression and skeletal-related events appearance in patients with prostate cancer with bone metastases following treatment with zoledronic acid: TUGAMO study

Owing to the limited validity of clinical data on the treatment of prostate cancer (PCa) and bone metastases, biochemical markers are a promising tool for predicting survival, disease progression and skeletal-related events (SREs) in these patients. The aim of this study was to evaluate the predictive capacity of biochemical markers of bone turnover for mortality risk, disease progression and SREs in patients with PCa and bone metastases undergoing treatment with zoledronic acid (ZA). Methods: This was an observational, prospective and multicenter study in which ninety-eight patients were included. Patients were treated with ZA (4mg every 4 weeks for 18 months). Data were collected at baseline and 3, 6, 9, 12, 15 and 18 months after the beginning of treatment. Serum levels of bone alkaline phosphtase (BALP), aminoterminal propeptide of procollagen type I (P1NP) and beta-isomer of carboxiterminal telopeptide of collagen I (b-CTX) were analysed at all points in the study. Data on disease progression, SREs development and survival were recorded. Results: Cox regression models with clinical data and bone markers showed that the levels of the three markers studied were predictive of survival time, with b-CTX being especially powerful, in which a lack of normalisation in visit 1 (3 months after the beginning of treatment) showed a 6.3-times more risk for death than in normalised patients. Levels of these markers were also predictive for SREs, although in this case BALP and P1NP proved to be better predictors. We did not find any relationship between bone markers and disease progression. Conclusion: In patients with PCa and bone metastases treated with ZA, b-CTX and P1NP can be considered suitable predictors for mortality risk, while BALP and P1NP are appropriate for SREs. The levels of these biomarkers 3 months after the beginning of treatment are especially importantThis study was supported by Novartis Oncology Spai

Nivolumab-associated Stevens-Johnson syndrome in a patient with lung cancer

Nivolumab is a fully human immunoglobulin G4 immune checkpoint inhibitor antibody approved for use in the treatment of several malignancies such as lung cancer. Cutaneous reactions to checkpoint inhibitors are frequent, appearing in approximately 40% of patients. Although most of the reactions are well tolerated, these drugs can lead to severe cutaneous adverse reactions, but a quick recognition of the symptoms can significantly decrease their mortality. In this case report, we describe a patient with metastatic squamous lung cell carcinoma suffering from nivolumab-induced Stevens-Johnson syndrome with severe skin denudation and mucosal involvement

Papel del ESAD en el tratamiento del dolor: Análisis pre-post intervención en un entorno rural

Objectives: To determine the frequency of use of analgesics in terminal patients attended in home, and factors that may be involved in pain perception, in addition to the interventions carried out. Methods: prospective, interventional and analytical study in patients attended to Homecare Support Team (HSCT) of Barbastro. Variables studied: age, sex, number of visits, time tracking, presence of pain and other concomitant symptoms, Visual Analogic Scale (VAS), diagnosis, analgesics previous and post-intervention, previous and post-intervention average dose of analgesics. Statistical study with SPSS 15.0. Results: n = 638, men 53.9 % (n = 344), mean age 10.8 ± 79.64 years, cancer patient 56 % (n = 357), mean follow-up time 56 ± 56.56 days, 2.5 ± 2.68 mean visits per process. Pain in first visit 43.3 % (n = 276), mean VAS 6.54 ± 1.87, pain 47.1 % of men (n = 162) and 38.8 % of women (n = 114) (p < 0.05), pain in oncology 56.6 % (n = 202) and 26.3 % of non-cancer patients (n = 74) (p < 0.001). No differences between groups in VAS. Before intervention by HCST we found statistically significant differences (p < 0.005) on morphine and tramadol, and greater significance (p < 0.001) in transdermal and transmucosal fentanyl, paracetamol, metamizol and NSAIDs, all more common in uncontrolled pain. Previous mean doses of all these drugs showed no significant differences between groups, although they were higher in the group of uncontrolled pain. In these, analgesics were prescribed or modified, being statistically significant difference pre-post-intervention (p < 0.001) in transdermal and transmucosal fentanyl, tramadol, paracetamol, metamizol, NSAIDs, pregabalin and with p < 0.05 in gabapentin. Was obtained difference (p < 0.05) in mean dose only in transdermal fentanyl and codeine dose post-intervention of HCST. We obtain positive correlations between pain and anorexia, anxiety, depression and insomnia; in cancer patients between pain and anxiety and insomnia, and non-cancer patients between pain, nausea and depression. No differences between groups in previous use of benzodiazepines, antidepressants and other treatments; there was differences in depression, anxiety and insomnia. After intervention, we obtain significant differences in use of these treatments and sedation. Conclusions: after intervention of HCST there was gradual increase of all analgesic; it should conduct a full assessment of the patient's symptoms and treatment of multifactorial symptoms in addition to questioning the patient adequately about the presence of associated symptoms, given the high correlation of them.Objetivos: Determinar la frecuencia de uso de analgésicos en pacientes terminales atendidos en domicilio, analizando factores que pudieran intervenir en la percepción del dolor, además de las actuaciones llevadas a cabo. Material y métodos: Estudio analítico prospectivo e intervencional con pacientes derivados al Equipo de Soporte para Atención Domiciliaria (ESAD) de Barbastro. Variables estudiadas: edad, sexo, número de visitas, tiempo de seguimiento, presencia de dolor y de otros síntomas concomitantes, Escala Visual Analógica (EVA), diagnóstico, analgésicos previos y post-intervención, dosis media previa de analgésicos y post-intervención. Estudio estadístico con SPSS 15.0. Resultados: n = 638, 53,9 % hombres (n = 344), edad media 79,64 ± 10,8 años, 56 % oncológicos (n = 357), seguimiento medio 56 ± 56,56 días, media de 2,68 ± 2,5 visitas por proceso. Dolor en primera visita 43,3 % (n = 276), EVA media 6,54 ± 1,87, dolor 47,1 % de hombres (n = 162) y 38,8 % de mujeres (n = 114) (p < 0,05), dolor en 56,6 % de oncológicos (n = 202) y en 26,3 % de crónico-dependientes (n = 74) (p < 0,001). No diferencias en EVA entre grupos. Entre analgésicos pautados en pacientes con dolor controlado y sin controlar previa intervención del ESAD encontramos diferencias estadísticamente significativas (p < 0,005) en morfina y tramadol, y con mayor significación (p < 0,001) en fentanilo transdérmico y transmucosa, paracetamol, metamizol y AINE, todos más frecuentes en dolor no controlado. Las dosis medias previas de todos estos fármacos no mostraron diferencias significativas entre los grupos, aunque eran mayores en el grupo de dolor no controlado. En estos, se pautan o modifican analgésicos, encontrándose diferencias estadísticamente significativas pre-post intervención (p < 0,001) en fentanilo transdérmico y transmucosa, tramadol, paracetamol, metamizol, AINE, pregabalina y con p < 0,05 en gabapentina. Se obtiene diferencias (p < 0,05) únicamente en las dosis posteriores a la actuación del ESAD en fentanilo transdérmico y codeína. Obtenemos correlaciones positivas entre dolor y anorexia, ansiedad, depresión e insomnio; en pacientes oncológicos entre dolor y ansiedad e insomnio, y en pacientes crónico-dependientes entre dolor, náuseas y depresión. No diferencias entre grupos en uso previo de benzodiacepinas, antidepresivos y otros tratamientos, aunque sí en clínica de depresión, ansiedad e insomnio. Tras intervención, diferencias significativas en uso de estos tratamientos y de sedación. Conclusiones: Tras la actuación del ESAD se puede apreciar el aumento progresivo de todas las medicaciones analgésicas; se debería realizar una valoración completa de la sintomatología del paciente y un tratamiento de síntomas multifactorial, además de interrogar al paciente de forma adecuada acerca de la presencia de síntomas asociados, dada la elevada correlación de los mismos

Single-nucleotide polymorphism associations with efficacy and toxicity in metastatic castration-resistant prostate cancer treated with cabazitaxel

Background: The aim of this study was to evaluate the impact of certain single-nucleotide polymorphisms (SNPs) in cabazitaxel activity and toxicity in patients with metastatic castration-resistant prostate cancer (mCRPC). Patients & methods: 56 SNPs in five genes (CYP3A4, CYP3A5, ABCB1, TUBB1 and CYP2C8) were genotyped in 67 mCRPC patients and their correlation with outcomes analyzed. Results:TUBB1-rs151352 (hazard ratio: 0.52) and CYP2C8-rs1341164 (hazard ratio: 0.53) were associated with better overall survival, and CYP2C8-rs1058932 with biochemical progression (odds ratio: 6.60) in multivariate analysis. ABCB1-rs17327624 correlated with severe toxicity ≥ grade 3 (odds ratio: 8.56) and CYP2C8-rs11572093 with asthenia (odds ratio: 8.12). Conclusion: Genetic variants in mCRPC patients could explain different outcomes with cabazitaxel. Nonetheless, the small sample size and the high number of SNPs analyzed mean that the results are only hypothesis-generating and require further validation.Consejería de Salud de la Junta de Andalucía (PI-0286-2014)2.638 JCR (2021) Q3, 194/279 Pharmacology & Pharmacy0.458 SJR (2021) Q3, 242/347 GeneticsNo data IDR 2020UE