Journal Article Annotations
2023, 2nd Quarter
Annotations by Christian Bjerre Real, MD, MMCI, Deepti Chopra, MBBS, MPH, Daniel McFarland, MD, Marie Tobin, MD, Barbara Lubrano di Ciccone, MD.
Rose et al., systematically reviewed effects of exercise interventions in patients undergoing and immediately after gynecological cancer treatment. They found that exercise programs help with improvement in physical strength, mobility and help maintain activities of daily living, which may influence quality of life (QOL). Effects on QOL and mental well-being were mixed.
Strength and weaknesses:
Exercise interventions have been extensively studied in breast, prostate, and colorectal cancer, so focusing on gynecological cancers is a strength of this paper. Additional strengths are that a majority of their findings are supported by level II evidence and that the effect of exercise on fatigue is reviewed. The discussion the safety of such interventions and how difficult it is study the influence of exercise prescription on outcomes. One notable limitations of this article is that the median sample size of studies was 35, which likely influenced many outcome measures. Overall, it is a nicely written paper.
Exercise oncology promotes regular activity; however, exercise has only been studied in limited cancer types, and there are no specific guidelines for creating a rehabilitation program for patients undergoing cancer treatment. Understanding the effect of exercise on various cancer types may help shape rehabilitation program for patients and improve adjustment during or after cancer treatment.
In this study, Aburizik et al., found that Black women have a significantly lower probability of being referred to psycho-oncology services. Black women had significantly lower odds of referral to psycho-oncology services compared to White men, White women, and Black men combined. When compared with a higher caseload, a lower nurse caseload was associated with increased referral to psycho-oncology services for White men, White women, and Black men. In contrast, for Black women, the effect of caseload on referral to psycho-oncology services was not significant.
Strength and weaknesses:
Mortality rates for Black women with cancer, especially breast cancer, exceed their racial and ethnic counterparts. A strength of this study is the evaluation of the negative impact of combined sexism and racism on the treatment of psychosocial distress as measured by referral rates to psycho-oncology services. Additionally, the study employed matching techniques and considered many covariables to address the relatively small number of Black cancer patients. A weakness of the study is the failure to identify the reasons for non-referral even in the case of high reported psychosocial distress. For example, some patients may have declined referral to psycho-oncology services.
By examining the impact of gendered racial disparities on one aspect of cancer care, this study highlights several important needs: the need for education to address provider implicit bias, the need to develop a thoughtful and deliberate system of referral to psycho-oncology services, and the need to address the role of gendered racial disparities in healthcare inequity.
This is a secondary analysis of a large phase 3 randomized trial, J-FORCE, that demonstrated efficacy of olanzapine to prevent nausea and vomiting in patients receiving highly emetogenic chemotherapy (e.g., high dose cisplatin or anthracycline) when given alongside a standard prophylactic anti-emetic regimen of three medications. This secondary analysis found that olanzapine was beneficial for preventing chemotherapy induced nausea and vomiting regardless of any additional features that might make the patient particularly susceptible to nausea and vomiting including sex, age, cisplatin dose, history of motion sickness, a habit of imbibing alcohol, or a history of nausea and vomiting with pregnancy for several days after given chemotherapy.
Strength and weaknesses:
This was a randomized trial with the endpoint of efficacy defined as no use of rescue medications from 24-120 hours after chemotherapy. The secondary analysis reviewed issues related to predisposition to nausea and vomiting from chemotherapy. This is an important point because one may question the use of adding olanzapine for all patients receiving highly emetogenic chemotherapy due to its side effect profile. This secondary analysis was not powered to definitively answer these questions.
The use of olanzapine as an anti-nausea medicine in the setting of chemotherapy should be well understood by C-L psychiatrists who may be asked to weigh in its use. As non-psychiatric clinicians become increasingly comfortable using this psychotropic, C-L psychiatrists should guide oncologists in its use.