Is clarithromycin a potential treatment for cachexia in people with lung cancer?: a feasibility study

Clarithromycin may improve cachexia and survival in non-small cell lung cancer (NSCLC), but adequately controlled data are lacking. This study was undertaken primarily to inform the feasibility and scale of a phase III trial. Eligible consenting patients with stage IV NSCLC and cachexia were to be randomized to receive either clarithromycin 250 mg twice daily or placebo for eight weeks. Aspects of trial feasibility recorded included numbers eligible, approached and recruited, together with adherence and completion of treatment and assessments. Over 6 months, none of 125 patients identified fulfilled the entry criteria. The commonest reasons for ineligibility were the use of an excluded concurrent drug (45, 36%), brain metastases (22, 18%), poor performance status (21, 17%) and current chemotherapy (15, 12%). A phase III trial of clarithromycin using these entry criteria is not feasible in this setting. Other macrolides that have a lower risk of a drug–drug interaction may be more practical to pursue

‘There’s something about admitting that you are lonely’ – prevalence, impact and solutions to loneliness in terminal illness: An explanatory sequential multi-methods study

BACKGROUND: Loneliness is a prevalent societal issue and can impact on a person’s physical and mental health. It is unclear how loneliness impacts on end of life experiences or how such feelings can be alleviated. AIM: To explore the perceived prevalence, impact and possible solutions to loneliness among people who are terminally ill and their carers in Northern Ireland through the lens of health and social care professionals. DESIGN: An explanatory multi-method study. SETTING/PARTICIPANTS: An online survey (n = 68, response rate 30%) followed by three online focus groups with palliative and end of life care health and social care professionals (n = 14). Data were analysed using descriptive statistics and thematic analysis. RESULTS: Loneliness was perceived by professionals as highly prevalent for people with a terminal illness (92.6%) and their carers (86.8%). Loneliness was considered a taboo subject and impacts on symptoms including pain and breathlessness and overall wellbeing at end of life. Social support was viewed as central towards alleviating feelings of loneliness and promoting connectedness at end of life. Four themes were identified: (1) the stigma of loneliness, (2) COVID-19: The loneliness pandemic (3) impact of loneliness across physical and mental health domains and (4) the power of social networks. CONCLUSION: There is a need for greater investment for social support initiatives to tackle experiences of loneliness at end of life. These services must be co-produced with people impacted by terminal illness to ensure they meet the needs of this population

sj-pdf-1-pmj-10.1177_02692163221122269 – Supplemental material for ‘There’s something about admitting that you are lonely’ – prevalence, impact and solutions to loneliness in terminal illness: An explanatory sequential multi-methods study

Supplemental material, sj-pdf-1-pmj-10.1177_02692163221122269 for ‘There’s something about admitting that you are lonely’ – prevalence, impact and solutions to loneliness in terminal illness: An explanatory sequential multi-methods study by Jeffrey R Hanna, Tracey McConnell, Craig Harrison, Katarzyna A Patynowska, Anne M Finucane, Briony Hudson, Sharon Paradine, Angela McCullagh and Joanne Reid in Palliative Medicine</p