PRAIS Two perspectives. Current cancer pain research 12/4/2015. More complex thinking in cancer pain studies. Usual thinking in cancer pain studies

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1 PRC European Palliative Care Research Centre PRAIS The Palliative Radiotherapy And Study PRAIS Two perspectives Predict response from radiotherapy given for bone cancer Pål Klepstad Dept. Intensive Care Medicine St Olavs University Hospital Trondheim, Norway Current cancer research Typically cancer studies inclusion criteria are: Age > 18 years Evidence of malignant disease intensity NRS > 3 (moderate or severe ) Able to comply with study procedures What we actually do say is that for cancer in relation to one size fits all. Are these cancers equal? Usual thinking in cancer studies More comple thinking in cancer studies Analgesics Tumor biology Analgesics Surrounding tissue Personality factors intensity Compression distention of structures CNS changes Personality factors intensity 1

2 Mechanisms of cancer induced bone Immune cells involved in tumor and in the tumor surroundings. Immune signals influence CNS function is linked to several symptoms in cancer Drawing R. Habberstad Lozano Ondoua et al, Neurosci Lett Middlemiss et al, Clin Oncol Watkins et al, Science Direct 2006: CRP and cancer is related Il 6 and cancer is related inflammation genes and cancer are related PTGS2 gene NFKBIA gene IL 8 gene IL 6 gene IL 8 gene IL 6 The Palliative Radiotherapy And Study PRAIS Palliative radiotherapy of bone metastasis. Classification, inflammatory biomarkers, and longitudinal clinical follow up 2

3 Study Design Ph.D project: Ragnhild Habberstad Study coordinator: Trude Camilla Salvesen Centers: Trondheim, Oslo, Ålesund, Milan, Edinburgh/Glasgow, Amman, Lleida The study will include 1000 adult patients in a multicenter, multinational longitudinal observation study of patients administered for bone cancer. COMMISSION ITEM INCLUSION 3 WEEKS 8 WEEKS 16 WEEKS 24 WEEKS 1 YEAR Health care provider Screening for inclusion -Doctor Hospitalization Simplified the table translates to that we will follow Concomitant diseases Planned radiotherapy Educational status X Department category Living situation Previous treatment New cancer treatment Previous anti-cancer treatment Ongoing anti-cancer treatment Medication Pathological fractures Oncological status Karnofsky Performance Status Episodic question Survival status Cacheia Depression Before and after and For one year Health care provider CT-scan for bodycomposition () () () () () -Radiation therapist Blood for biobank Blood for biochemical analysis Weight / height Patient Blood samples PG-SGA In cancer patients intensities Episodic questions LANSS EOC QLQ-C15 Primary Current situation biomarkers predictors of response to palliative for bone cancer? All have Response Less No response Still 3

4 Optimal aim Predict response from for bone cancer All have Set of predictors for response given not given free interventions Which inflammatory substances are associated with cancer? A clinical eperimental set up. relief Not relief One year follow up cacheia in patients with metastatic cancer disease? depression in patients with metastatic cancer disease? in patients with metastatic cancer disease? 4

5 Sum it up As for other s basic research is needed As for other s clinical research is needed Future goal is targeted treatment on the origin of cancer 5