Prevention and treatment of cisplatin-induced ototoxicity in adults: A systematic review.

OBJECTIVES: Ototoxicity is a common disabling side effect of platinum-based chemotherapy. This study aimed to assess the evidence on the management of platinum-induced ototoxicity in adult cancer patients. METHODS: Four databases were searched up to 1 November 2022. Original studies were included if they reported on a pharmacologic or non-pharmacologic intervention to prevent or treat platinum ototoxicity in adults. The articles' quality was assessed via two grading scales. RESULTS: Nineteen randomised controlled trials and five quasi-experimental studies with 1673 patients were analysed. Eleven interventions were identified, nine pharmacological and two non-pharmacological. Six of the interventions (sodium thiosulphate, corticoids, sertraline, statins, multivitamins and D-methionine) showed mild benefits in preventing cisplatin-induced ototoxicity. Only one trial assessed corticoids as a potential treatment. Overall, only six trials were deemed with a low risk of bias. The majority of studies inadequately documented intervention-related adverse effects, thereby limiting safety conclusions. CONCLUSIONS: Current interventions have mild benefits in preventing cisplatin-induced ototoxicity in adult cancer patients. Sodium thiosulphate is the most promising intervention as a preventive strategy. Rigorous, high-quality research is warranted, encompassing an evaluation of all potential symptoms and innovative treatment modalities.

Subcutaneous Levetiracetam Administration in Latino Patients on Home Care.

Background: Levetiracetam has a favorable pharmacology profile to be used subcutaneously. However, its subcutaneous use is still considered off-label as this is beyond its license. The evidence base for its safety, tolerability, and efficacy is limited to observational studies. Objectives: To report the safety and efficacy of subcutaneous levetiracetam in Latino patients on home care. Design: Observational retrospective case series study. Subjects: Consecutive sample of Latino adults with life-limiting illnesses. Methods: A case series framework with 4 domains (selection, ascertainment, causality, and reporting) to ensure reporting quality was used. Additionally, 8 relevant outcomes established in a previous comprehensive review, were collected and reported. Adverse reactions were documented using the Common Terminology Criteria for Adverse Events. Results: Fifteen Latino patients with oncological and non-oncological diagnoses received subcutaneous levetiracetam for a mean of 21 days on home care. Levetiracetam was most frequently initiated subcutaneously due to loss of the oral route. The average dosage of subcutaneous levetiracetam was 1200 mg. Only 1 patient required a dose adjustment, and only 2 patients experienced a total of 5 seizures during the therapy trial. No adverse reactions were reported. Conclusions: Subcutaneous levetiracetam appears to be effective and safe. This case series of Latino patients in home care expands the evidence of its use in the home care setting. The preliminary data reported by now on multiple case series warrants robust trials.

Revisión sistemática sobre beneficios de psicodélicos en pacientes al final de la vida con malestar emocional / Systematic review of emotional distress management with psychedelics in end-of-life care

Antecedentes y objetivo: Los pacientes en cuidados paliativos experimentan con frecuencia malestar emocional al final de la vida, lo que genera sufrimiento y plantea desafíos para los profesionales de la salud, ya que los tratamientos convencionales tienen un beneficio limitado. Nuestro objetivo fue revisar sistemáticamente la evidencia sobre sustancias psicodélicas que han surgido como alternativa para el manejo del malestar emocional al final de la vida. Materiales y métodos: Se realizó una revisión sistemática en PubMed, Ovid Medline y CINHAL hasta el 13 de septiembre de 2022. Se incluyeron artículos originales con un diseño controlado aleatorizado que reportaran el uso de psicodélicos (psilocibina, ácido lisérgico de dietilamida, dipropiltriptamina o ayahuasca) en el tratamiento de síntomas de malestar emocional de pacientes al final de la vida. Resultados: Se encontraron 6 ensayos clínicos controlados referentes al tema. Cuatro evaluaron la psilocibina en 113 pacientes y reportaron reducción del malestar emocional dado por síntomas de ansiedad, depresión, desmoralización, desesperanza e ideación suicida en los pacientes paliativos. Dos estudios evaluaron el ácido lisérgico de dietilamida en 54 pacientes y hallaron una reducción en la ansiedad, depresión, temor a la muerte y mejoría en la calidad de vida. No se encontró ningún estudio que evaluara la dipropiltriptamina o la ayahuasca en cuidados paliativos. Ninguno de los psicodélicos evaluados causó efectos adversos serios ni duraderos. Conclusiones: La psilocibina y el ácido lisérgico de dietilamida son tratamientos experimentales con resultados prometedores por su seguridad, duración y efectividad para los síntomas de malestar emocional refractarios en pacientes al final de la vida. (AU)

Background and goals: Patients in palliative care often experience emotional distress at the end of life, which creates suffering and poses challenges for health professionals, since conventional treatments have limited benefits. Our goal was to systematically review the evidence about the psychedelic substances that have emerged as an alternative for the management of emotional distress in end-of-life care. Materials and methods: A systematic review was carried out in PubMed, Ovid Medline, and CINHAL until September 13, 2022. Original articles with a randomized controlled design were included that reported the use of psychedelics (psilocybin, lysergic acid diethylamide, dipropyltryptamine or ayahuasca) in the treatment of symptoms of emotional distress in palliative care patients at the end of life.Results: Six controlled clinical trials related to the topic were found. Four studies evaluated psilocybin in 113 patients and reported a reduction of emotional distress symptoms such as anxiety, depression, demoralization, hopelessness, and suicidal ideation in palliative patients. Two studies evaluated lysergic acid diethylamide in 54 patients and found reduced anxiety, depression, fear of death, and improved quality of life. No studies were found that evaluated dipropyltryptamine or ayahuasca in palliative care. None of the evaluated psychedelics caused severe or lasting adverse effects. Conclusions: Psilocybin and lysergic acid diethylamide are experimental treatments with promising results because of their safety, duration, and effectiveness for refractory emotional distress symptoms in patients at the end of life. (AU)

Cancer and Non-cancer Fatigue Treated With Bupropion: A Systematic Review.

CONTEXT: Fatigue is a predominant and distressing symptom in cancer and non-cancer conditions for which there is a paucity of recommendations for pharmacological interventions. Bupropion is a novel treatment whose efficacy and safety in the treatment of fatigue are unknown. OBJECTIVES: This study aimed to systematically assess the evidence on the efficacy and safety of bupropion in the treatment of fatigue in people with cancer and non-cancer conditions. METHODS: PubMed, EMBASE, and Ovid Medline databases were searched up to July 26, 2022. Studies were included if they reported bupropion as an intervention for cancer and non-cancer-related fatigue and used an objective scale to assess symptom outcomes. Experimental and quasi-experimental studies in adult patients published in English were included. RESULTS: This review reports on seven studies (three randomized studies, three non-randomized studies, and one case series) that enrolled a total of 584 patients. Bupropion was tested in five studies for treating cancer-related fatigue and in two studies for treating fatigue in non-cancer conditions. The reviewed studies were heterogeneous in relation to the scales used to assess fatigue. Six out of seven studies reported that bupropion significantly reduced the fatigue burden without causing major adverse effects. These positive results must be taken with caution caused by the small sample sizes and low quality of the studies reviewed. CONCLUSION: Bupropion may prove to be an effective and safe intervention for fatigue in cancer and non-cancer conditions. A high-quality randomized trial is warranted to test current preliminary results.