Endpoints in clinical trials in cancer cachexia: where to start?
Purpose of review The lack of agreement and knowledge of optimal endpoints in cachexia trials have impeded progress in finding interventions counteracting the devastating effects cancer cachexia has on morbidity and mortality. An endpoint should both be sensitive enough to detect change and specific enough not to be influenced by other conditions or treatments. Recent findings There is a wealth of potential and applied endpoints in trials investigating cachexia. As of today, there is no generally acknowledged consensus, but assessments of key factors such as body composition should continue to be applied. However, the impact and effect size necessary to achieve clinical benefit using these endpoints are not clear. Further, the use of other endpoints assessing physical function, symptom evaluation and quality of life remains to be elucidated. Summary It is essential that endpoints are clinically relevant and further research is therefore needed to develop endpoints that are meaningful for patients with cachexia.
A phase II trial was proposed to define the efficacy of a short-course radiotherapy for symptomatic palliation of metastatic or locally advanced oesophageal cancer in a low resourced setting where only a 2D-radiotherapy technique was available. Results showed that the delivery of a total dose of 12 Gy in 4 fractions, twice-a-day, over 2 days, ≥ 8 hours apart, was tolerated and effective for the symptomatic palliation of metastatic or locally advanced oesophageal malignancies.
Large cell neuroendocrine carcinoma (LCNEC) and small cell lung carcinoma (SCLC) are aggressive neuroendocrine tumors with poor survival rates [1 –3]. For stage IV SCLC, treatment has not advanced significantly over the last decades and consists of palliative chemotherapy. The same applies to stage IV LCNEC, were no standard treatment exists and palliative chemotherapy with SCLC and non-small cell lung cancer (NSCLC) regimens are both deeme d appropriate . Recently, targeted therapy focusing on delta like protein 3 (DLL3) has received attention to improve outcomes for SCLC and LCNEC .
CONCLUSION: Indian patients with colon cancer, at a tertiary referral center, tend to present at more advanced stages of the disease as compared to the West. However, curative treatment with surgery and chemotherapy offers similar survival outcomes when compared stage for stage.
This article gives an outline of the history, existing radiotherapy facilities and future trends related to radiotherapy practice in India.
Sushma BhatnagarIndian Journal of Palliative Care 2019 25(4):485-486
Conclusions: There is a significant burden of psychosocial and spiritual concerns among patients with advanced incurable illness in Bangladesh, with sadness being very frequent and of high intensity. Family and friends provide significant emotional and practical support to patients who are seriously ill, but very few patients access any professional support for these concerns.
Conclusion: There is substantial inadequacy in pain management in patients with cancer. The BPI-SF should be routinely used to evaluate pain severity, and analgesics should be prescribed equitably without discrimination with regard to gender and socioeconomic status of patients.
Conclusion: We found no significant effects on the procedural pain in any of the treatment groups compared to placebo. There were only mild side effects. The doses of ketamine might be insufficient for this painful and stressful procedure.
Conclusion: This RCT shows that perioperative pregabalin may not have a role in the prevention of chronic pain after breast surgeries.
Conclusion: Patients with advanced carcinoma GB were managed with various palliative procedures with the aim to improve the quality of life of patients because of jaundice, loss of appetite, nausea, pain, etc. Symptoms are distressing for patients.