Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with gastric cancer.

The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with gastric cancer (GC), published in late 2022 and the updated ESMO Gastric Cancer Living Guideline published in July 2023, were adapted in August 2023, according to previously established standard methodology, to produce the Pan-Asian adapted (PAGA) ESMO consensus guidelines for the management of Asian patients with GC. The adapted guidelines presented in this manuscript represent the consensus opinions reached by a panel of Asian experts in the treatment of patients with GC representing the oncological societies of China (CSCO), Indonesia (ISHMO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO), coordinated by ESMO and the Japanese Society of Medical Oncology (JSMO). The voting was based on scientific evidence and was independent of the current treatment practices, drug access restrictions and reimbursement decisions in the different Asian regions represented by the 10 oncological societies. The latter are discussed separately in the manuscript. The aim is to provide guidance for the optimisation and harmonisation of the management of patients with GC across the different regions of Asia, drawing on the evidence provided by both Western and Asian trials, whilst respecting the differences in screening practices, molecular profiling and age and stage at presentation. Attention is drawn to the disparity in the drug approvals and reimbursement strategies, between the different regions of Asia.

American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015: recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis

OBJECTIVE: To provide evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). METHODS: A core group led the development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946-2014), PubMed (1966-2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework. RESULTS: In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS. CONCLUSION: These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas.(AU)

Changes in Anxiety and Depression Scores on Patients within a Community Specialist Weight Management Service (SWMS).

Background: Morbid obesity has multiple negative consequences for psychological health. These patients are described as depressed, anxious, and impulsive, with low self-esteem and impaired quality of life. The severity of these psychological disorders has been related to the degree of obesity Abiles et al, [1]. In addition, emotional eating is a driver of weight gain in the obese, and depression is linked to disrupted eating patterns. Therefore, an effective weight loss program should include psychological management of these patients. The Specialist Weight Management Service (SWMS) offers clinical psychology intervention, alongside diet and exercise, with the hope that improving psychological health, leads to improved clinical outcomes for patients. Aim: This service evaluation aims to investigate if specialist psychological intervention of patients with moderate to high depression and/or anxiety scores; enrolled in the specialist weight management service is improved during their treatment in the service, and if clinical outcomes (specifically weight) are therefore improved. Methods: All patients assessed by the SWMS team were asked to complete an anxiety and depression measurement score (GAD7 and PHQ9) Spitzer et al, [2] before coming to their assessment appointment with the dietitian. The PHQ9 (Patient Health Questionnaire) is a multiplechoice self-report inventory, used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform. It was designed for use in the primary care setting. The GAD7 (Generalized Anxiety Disorder 7) is a self-reported questionnaire for screening and severity measuring of generalized anxiety disorder. A score above 10 in either questionnaire indicated there may be a need for psychological input, and patients were referred to the SWMS clinical psychologist for further assessment. Patients were then assessed by the psychologist to see if further psychological intervention was required. Psychological interventions and treatments included motivational interviewing, brief solution focused therapy, cognitive behavioural therapy, and acceptance and commitment therapy. Treatment was tailored to each individual patient and their personal treatment needs. The number of sessions each patient received was between 2 and 10. With most patients having an average of 6 one-hour sessions on a fortnightly basis. The same questionnaires were then repeated at the 3 month point. As this project was a service evaluation, ethics were not required. All data was anonymised before being evaluated. Results: N= 297 patients were assessed by the SWMS team dietitian during the review period (2010 to 2012). A further psychological assessment was indicated for n=119 patients, n=67 of these required psychological intervention as described above. The mean BMI in cohort was 42.7kg/m2. The mean PHQ9 score at baseline was 14 and GAD7 9. Table 1 shows the basic demographic data of the cohort. Table 1 Shows the demographic details the cohort. Table 2 shows the mean PHQ9 scores at baseline and 3 months, mean change after 3 months, range of change in scores and % of patients who improved their scores in the treatment and nontreatment group. Fisher’s exact test was used to compare the changes in PHQ9 scores in the two groups over 3 months: p=0.72. Chi squared test used to see if there is a significant difference between the numbers of those that improved their PHQ9 scores between the two groups: p=0.47. Therefore the change was not statistically significant. Table 3 shows the % of patients in the treatment and non-treatment group that gained weight, lost ≤5% of their initial body weight or >5%. Using chi squared test to see if there is a significant difference between the intervention and non-intervention group in terms weight change. Non of the weight changes were statistically significant. Table 4 shows the mean GAD7 score at baseline and after 3 months, the mean change in scores between the two groups, the range of change and the of % patients who improved their scores amongst the two groups. Fisher’s exact test was used to compare the changes in scores of the treatment and non-treatment group: p=1. Chi squared test was used to compare the numbers of those that improved their GAD7 scores between the two groups: p=0.64. The results were not statistically significant. Discussion: This evaluation looked at the effect of psychology intervention on weight loss and self-reported anxiety and depression using patient questionnaires in a community SWMS. It was observed that the intervention group had a higher proportion of patients who gained weight. Possible explanations for this from anecdotal observation may be due to the complex relationships these patients have with food and emotional eating, however, without further research it is difficult to ascertain the reason for is. Therefore, further long-term research into this area is required. Although not statistically significant, the results suggest that depression scores did improve with intervention after 3 months. However, there was no indication that the intervention had any effect on anxiety scores. Conclusions: The results suggest that psychological intervention helps improve patients depression scores, although in this evaluation this did not translate into weight loss. Further long term research in needed to see if weight loss increases with increased length of intervention in SWMS.