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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
Phenothiazines, such as prochlorperazine...
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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
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Cancer survival analysis focuses on quantifying and interpreting the time from a key starting point, such as diagnosis or the initiation of treatment, to a specific endpoint, such as remission or death. This analysis provides critical insights into treatment effectiveness and factors that influence patient outcomes, helping to shape clinical decisions and guide prognostic evaluations. A cornerstone of oncology research, survival analysis tackles the challenges of skewed, non-normally...
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The randomization process involves assigning study participants randomly to experimental or control groups based on their probability of being equally assigned. Randomization is meant to eliminate selection bias and balance known and unknown confounding factors so that the control group is similar to the treatment group as much as possible. A computer program and a random number generator can be used to assign participants to groups in a way that minimizes bias.
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Acupoint Application Combined with Acupressure as an Adjunctive Therapy for Chemotherapy-Induced Nausea and Vomiting
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A Sequential Multiple Assignment Randomized Trial of Symptom Management After Chemotherapy.

Alla Sikorskii1, Terry Badger2, Chris Segrin3

  • 1Department of Psychiatry (A.S.), College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA.

Journal of Pain and Symptom Management
|February 21, 2023
PubMed
Summary

The Symptom Management and Survivorship Handbook (SMSH) may be effective alone for cancer survivors. Telephone Interpersonal Counseling (TIPC) can be added for those with persistent depression and comorbidities.

Keywords:
Chemotherapydepressioninterpersonal counselingsequential multiple assignment randomized trialsymptom management

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Author Spotlight: Methodologies and Advancements of Chronic Pain Management Research
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Area of Science:

  • Oncology
  • Psychiatry
  • Health Services Research

Background:

  • Cancer survivors often face persistent symptoms post-chemotherapy.
  • Effective symptom management strategies are crucial for improving survivors' quality of life.

Purpose of the Study:

  • To evaluate the optimal sequencing of two interventions for managing cancer survivor symptoms.
  • To compare the effectiveness of the Symptom Management and Survivorship Handbook (SMSH) alone versus SMSH with added Telephone Interpersonal Counseling (TIPC).

Main Methods:

  • A sequential multiple assignment randomized trial involving 451 solid tumor survivors.
  • Survivors were stratified by symptom management need (high/low) and randomized to SMSH or SMSH+TIPC.
  • Non-responders to SMSH on depression were re-randomized to continue SMSH or add TIPC.

Main Results:

  • No overall main effects of randomized arms or dynamic treatment regimes (DTRs) were observed.
  • A significant interaction indicated SMSH alone was favored in early stages for some, while SMSH+TIPC was favored in later stages for others.
  • Treatment effectiveness varied based on baseline depression and comorbidity levels.

Conclusions:

  • The Symptom Management and Survivorship Handbook (SMSH) shows potential as a standalone symptom management tool.
  • Adding Telephone Interpersonal Counseling (TIPC) is beneficial for patients with elevated depression and comorbidities who do not respond to SMSH alone.
  • Personalized sequencing of interventions may optimize symptom management for cancer survivors.