PURPOSE: Multimodal care for cancer cachexia is needed. This study examined factors associated with practicing multimodal cachexia care among physicians and nurses engaging in cancer care. METHODS: This was a preplanned secondary analysis of a survey investigating clinicians' perspectives on cancer cachexia. Data of physicians and nurses were used. Data on knowledge, skills, and confidence in multimodal cachexia care were obtained. Nine items on practicing multimodal cachexia care were evaluated. Participants were divided into two groups as practicing multimodal cachexia care (above median value for the nine items) or not. Comparisons were made using the Mann-Whitney U test or chi-square test. Multiple regression analysis was performed to identify the factors of practicing the multimodal care. RESULTS: Total of 233 physicians and 245 nurses were included. Significant differences were observed between the groups: female sex ( P = .025), palliative care versus oncology specialization ( P < .001), the number of clinical guidelines used ( P < .001), the number of symptoms used ( P = .005), training for cancer cachexia ( P = .008), knowledge on cancer cachexia ( P < .001), and confidence in cancer cachexia management ( P < .001). Palliative care specialization (partial regression coefficient [ B] = 0.85; P < .001), the number of clinical guidelines used ( B = 0.44; P < .001), knowledge on cancer cachexia ( B, 0.94; P < .001), and confidence in cancer cachexia management ( B = 1.59; P < .001) were statistically significant in multiple regression analysis. CONCLUSION: Specialization in palliative care, specific knowledge, and confidence were associated with the practice of multimodal care for cancer cachexia.

Background: How clinicians treat patients with terminal dyspnea widely varies, which could hamper quality care. We visualized comprehensive pharmacological treatment delivered by palliative care physicians.Aim: To examine adherence to a comprehensive pharmacological treatment algorithm for patients with terminal dyspnea, and to explore its outcomes during 48 h.Design: A multicenter cohort study at five sites (February 2020 to June 2021).Setting/Participants: We prospectively enrolled consecutive patients with advanced cancer, Eastern Cooperative Oncology Group performance status 3–4, and moderate/severe dyspnea. Participating palliative care physicians initiated algorithm‐based treatment. The primary outcome was the proportion of adherence to the treatment algorithm over 24 h (predefined goal, 70%). We evaluated the adherence, goal achievement, and dyspnea level with a numerical rating scale (NRS), as well as adverse events over 48 h.Results: All 108 patients received algorithm‐based pharmacological treatment. Among 96 and 87 patients who were alive at 24 and 48 h, respectively, 96 (100%; 95% confidence interval [CI] = 96%–100%) and 82 (94%; 95%CI = 87%–98%) continued to receive the algorithm treatment, respectively, and 66 (69%; 95%CI = 59%–77%) and 64 (74%; 95%CI = 63%–82%) achieved the treatment goals, respectively. Using a complete case analysis with paired t‐tests, mean dyspnea NRS scores significantly reduced from 7.3 (standard error, 0.2) at the baseline to 4.9 (0.3) at 24 h (n = 72; p < 0.001), and 7.2 (0.3) at the baseline to 4.6 (0.4) at 48 h (n = 55; p < 0.001). Most adverse events were mild to moderate.Conclusions: The comprehensive pharmacological treatment algorithm was feasible, and the study data supports its preliminary efficacy and safety. The use of this algorithm may help clinicians improve care for patients with terminal dyspnea.

Severe pain in patients with breast cancer is associated with poorer survival outcomes, yet the mechanisms linking nociceptive signaling to tumor progression remain unclear. In a clinical cohort, breast cancer patients whose moderate or severe pain improved under specialized palliative care exhibited significantly longer survival than those with persistent pain. Serum levels of calcitonin gene-related peptide (CGRP) and substance P (SP), neuropeptides that can be released from sensory neurons, were elevated in breast cancer patients with uncontrolled pain, correlating positively with pain intensity and negatively with overall survival. In vitro, supernatants from depolarized human iPSC-derived sensory neurons containing CGRP, SP, and the endogenous κ-opioid receptor (KOR) ligand dynorphin attenuated docetaxel efficacy, promoted epithelial-mesenchymal transition, and enhanced migration in human triple-negative breast cancer (TNBC) cells, accompanied by Gi protein-coupled activation of the PI3K-Akt signaling pathway. In vivo, optogenetic activation of sensory neurons significantly accelerated tumor growth following orthotopic transplantation of murine TNBC cells, whereas combined blockade of CGRP and SP receptors suppressed this effect. Similarly, in patient-derived xenograft models of TNBC, dual receptor blockade effectively abrogated tumor progression. Conversely, in vitro treatment with dynorphin enhanced the cytotoxic efficacy of docetaxel, accompanied by the inhibition of PI3K-Akt signaling, whereas in vivo administration of the peripherally restricted KOR agonist nalfurafine methiodide markedly suppressed tumor growth. These findings establish a bidirectional neural-tumor axis in breast cancer progression. Therapeutically, combined blockade of CGRP/SP signaling with peripheral KOR agonism may present a novel strategy to enhance chemotherapy efficacy in TNBC patients.

Background: Serum C-reactive protein (CRP) levels are correlated with patient outcomes in cancer. This study aimed to determine associations between the CRP level and the dietary intake, symptoms, and eating-related distress (ERD). Methods: We conducted a multicenter survey among advanced cancer patients. Information on patient characteristics was retrieved from the electronic medical records. Data on patient outcomes were obtained through the questionnaire. Patients were categorized into the low CRP group (<5 mg/dL) and the high CRP group (≥5 mg/dL). Comparisons were calculated using the Mann–Whitney U test or chi-squared test. To assess associations between CRP levels and ERD, multivariate logistic regression analysis was performed. Results: A total of 191 patients were enrolled and divided into the low CRP group (n = 117) and the high CRP group (n = 74). The high CRP group had a more reduced dietary intake (p = 0.002) and more severe appetite loss (p = 0.008). The total scores of the ERD questionnaire (both the long and short versions) were significantly higher in the high CRP group (p = 0.040 and 0.029). The high CRP group also had significantly higher risks for ERD, as assessed using the long and short versions of the questionnaire (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.10–4.11; OR 2.06, 95% CI 1.05–4.05). Conclusions: High CRP levels were significantly associated with reduced dietary intake, appetite loss, and ERD. A serum CRP value of 5 mg/dL may be a useful indicator for initiating cancer cachexia care.