Neuromotor tolerability and behavioural characterisation of cannabidiolic acid, a phytocannabinoid with therapeutic potential for anticipatory nausea

Rationale: Anticipatory nausea (AN) is a poorly controlled side-effect experienced by chemotherapy patients. Currently, pharmacotherapy is restricted to benzodiazepine anxiolytics, which have limited efficacy, significant sedative effects, and induce dependency. The non-psychoactive phytocannabinoid, cannabidiolic acid (CBDA), has shown considerable efficacy in pre-clinical AN models, however determination of its neuromotor tolerability profile is crucial to justify clinical investigation. Provisional evidence for appetite-stimulating properties also requires detailed investigation. Objectives: To assess the tolerability of CBDA in locomotor activity, motor coordination and muscular strength tests, and additionally for ability to modulate feeding behaviours. Methods: Male Lister hooded rats administered CBDA (0.05-5 mg/kg; p.o.) were assessed in habituated open field (for locomotor activity), static beam and grip strength tests. A further study investigated whether these CBDA doses modulated normal feeding behaviour. Finally, evidence of anxiolytic-like effects in the habituated open field prompted testing of 5 mg/kg CBDA for anxiolytic-like activity in unhabituated open field, light/dark box and novelty-supressed feeding (NSF) tests. Results: CBDA had no adverse effects upon performance in any neuromotor tolerability test, however anxiolytic-like behaviour was observed in the habituated open field. Normal feeding behaviours were unaffected by any dose. CBDA (5 mg/kg) abolished the increased feeding latency in the NSF test induced by the 5-HT1AR antagonist, WAY-100,635, indicative of anxiolytic-like effects, but had no effect on anxiety-like behaviour in the novel open field or light/dark box. Conclusions: CBDA is very well tolerated and devoid of the sedative side-effect profile of benzodiazepines, justifying its clinical investigation as a novel AN treatment

Psychological distress, unmet needs, symptom prevalence and social support in cancer survivors completing potentially curative primary treatment

Objectives: The physical and psychosocial consequences of cancer can be distressing for many survivors. Identifying those with high levels of distress at treatment completion will enable targeted intervention. This project examined levels of distress and factors which contribute to distress in a sample of Australian cancer survivors completing potentially curative treatment. Methods: 125 survivors (response rate 85%) completing primary treatment for breast, prostate, colorectal, Hodgkins or diffuse large B-cell lymphomas completed validated measures of distress (Brief Symptom Inventory), unmet need (Cancer Survivors Unmet Needs Survey), social support (ENRICHD Social Support Inventory) and symptom prevalence (Memorial Symptom Assessment Scale). Results: Haematological survivors reported the highest levels of clinically significant distress (30%), compared to colorectal (26%), breast (18%) or prostate survivors (10%). Mean differences between haematological and prostate survivors were significant (p<0.003). Many survivors experienced lack of energy (77%), difficulty sleeping (67%) and feeling drowsy (61%). Those experiencing more physical symptoms reported significantly higher distress than those with fewer symptoms (p<0.001). 66% of survivors reported at least one unmet need (mean=5 of possible 35 needs), most frequently reporting need for help managing concerns about cancer returning (25%). Higher distress correlated with symptom prevalence (r=0.659, p<0.001), unmet needs (r=0.379, p<0.001) and lack of social support (r=−0.193, p<0.031). Conclusions: Many cancer survivors experience psychological distress, unmet needs, sleeping difficulties and other persistent symptoms at treatment completion, requiring increased support. This study highlights the need to identify these issues to allow targeted interventions to improve physical and psychosocial morbidity

Multidisciplinary care in cancer: do the current research outputs help?

This review examined whether the increased attention on multidisciplinary care (MDC) in cancer over the last 10 years has been underpinned by an increase in methodologically vigorous intervention research in this field. Electronic search of Medline and CINAHL databases. This review examined whether the proportion of (1) data-based and (2) intervention research meeting Cochrane Effective Practice and Organisation of Care (EPOC) criteria increased between two time periods (1997–2001 and 2002–2006). Papers meeting the following inclusion criteria were identified: relevant to MDC for cancer patients; included the term ‘multidisciplinary’ in the abstract; published in English; published between 1997 and 2006. The proportion of data-based papers did not increase over time, nor did the proportion of intervention papers using EPOC-accepted designs. Only three intervention studies using EPOC-accepted designs were identified, all in the later time period. MDC is widely advocated in cancer care. This review indicates a pressing need to focus attention on the development of rigorous intervention research. Such research should answer important questions such as which models of MDC are most effective, for which outcomes and for which patients

Unmet needs, psychological distress and quality of life in men commencing radiotherapy for prostate cancer

Introduction: Commencing radiotherapy (RT) for prostate cancer (PC) is a difficult time when the high need for information and support is often unreported by men and undetected by health professionals. This aim of this paper was to examine unmet needs, distress and quality of life in Australian men commencing potentially curative RT for PC. Methods: A large, consecutive sample of 332 men (response rate 72%) completed standardised measures when commencing radiotherapy including: Supportive Care Needs Survey (SCNS), Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT) and Expanded Prostate Cancer Index Composite (EPIC). Results: Probable clinical anxiety was reported using HADS by 21% of participants and 7% reported probable depression. Clinically significant distress on the DT was reported by 20% of participants. Ninety-three percent reported at least one unmet need on SCNS (mean=13 from 34 needs). Sexual functioning was reported to be a considerable problem on the EPIC by 36% of men. High needs correlated with higher anxiety, depression and distress across all domains (p<.01). Younger men (<65yrs) had significantly higher psychological needs than older men (p=.045) while rural patients had higher depression scores than metropolitan patients (p=.032). Those who had undergone previous prostatectomy or androgen deprivation had significantly lower sexual quality of life (p<0.0005), higher levels of unmet sexual needs (p<0.001) and higher physical daily living needs (p<0.0005). Men who had undergone androgen deprivation or had higher risk disease also had significantly higher levels of depression (p<0.0005). Conclusions: Many men with prostate cancer experience high levels of unmet needs, psychological morbidity and poor sexual functioning when commencing radiotherapy, despite a good prognosis. Subgroups of men at high risk of poor psychosocial outcomes, notably those who have had previous treatments, may benefit from targeted, early intervention and increased support

A nurse-led group consultation intervention to reduce psychological morbidity and unmet needs in men with prostate cancer during radiotherapy: a randomised controlled trial

Introduction: Radiotherapy (RT) for localised prostate cancer(PC) can result in physical and psychosocial difficulties which continue over time and can adversely impact patients quality of life(QoL). This study evaluated a nurse-led group-based intervention to reduce psychological morbidity, unmet needs and improve QoL in these men using a randomised controlled trial. Methods: A consecutive sample of 315 men (response rate 72%; attrition 4%) were randomised to the intervention or current best practice. The intervention comprised four nurse-led group-consultations (beginning, middle, end of RT and six weeks post-RT). Consultations focused on anatomy, treatment expectations, physical and emotional impact, side-effects and self-management strategies, survivorship issues and facilitating peer-based discussions. Reliable and valid measures were completed at treatment commencement, treatment completion and six months post-treatment to assess unmet needs (SCNS:Supportive Care Needs Survey), psychological morbidity (HADS:Hospital Anxiety Depression Scale, and prostate-specific QoL (EPIC:Expanded Prostate Index Composite). Results: Mean HADS-A, HADS-D and SCNS domain scores were relatively low at baseline for both study groups. Linear mixed models analysis revealed significant time, and group x time, interactions for HADS-D (p<0.05). Rate of decline in HADS-D was greater among intervention than control participants. Notably, rate of decline in HADS-D was modified by pre-baseline androgen deprivation therapy (ADT;p<0.05). Group x time interactions were not significant for HADS-A, SCNS or EPIC domains, but most time effects were (p<0.05). Change trajectories for the time effects were typically modified by pre-baseline ADT (p<0.05). Conclusions: The intervention package was effective in significantly reducing depression, particularly in men who had prior ADT, but not in reducing anxiety, unmet needs or improving QoL issues. The delivery of information and support required by men with PC by group rather than individual consultations was a clinically feasible and acceptable model of service delivery. Further investigation into the benefits of nurse-led management, including economic advantages, is warranted

A nurse-led group consultation intervention to reduce psychological morbidity and unmet needs in men with prostate cancer during radiotherapy

Abstract not available

Increased primary health care use in the first year after colorectal cancer diagnosis

OBJECTIVE: The view that the general practitioner (GP) should be more involved during the curative treatment of cancer is gaining support. This study aimed to assess the current role of the GP during treatment of patients with colorectal cancer (CRC). DESIGN: Historical prospective study, using primary care data from two cohorts. SETTING: Registration Network Groningen (RNG) consisting of 18 GPs in three group practices with a dynamic population of about 30,000 patients. SUBJECTS: Patients who underwent curative treatment for CRC (n = 124) and matched primary care patients without CRC (reference population; n = 358). MAIN OUTCOME MEASURES: Primary healthcare use in the period 1998-2009. FINDINGS: Patients with CRC had higher primary healthcare use in the year after diagnosis compared with the reference population. After correction for age, gender, and consultation behaviour, CRC patients had 54% (range 23-92%) more face-to-face contacts, 68% (range 36-108%) more drug prescriptions, and 35% (range -4-90%) more referrals compared with reference patients. Patients consulted their GP more often for reasons related to anaemia, abdominal pain, constipation, skin problems, and urinary infections. GPs also prescribed more acid reflux drugs, laxatives, anti-anaemic preparations, analgesics, and psycholeptics for CRC patients. CONCLUSIONS: The GP plays a significant role in the year after CRC diagnosis. This role may be associated with treatment-related side effects and psychological problems. Formal guidelines on the involvement of the GP during CRC treatment might ensure more effective allocation and communication of care between primary and secondary healthcare services