Western Hospital,Western Health

Introduction Despite increased awareness of its multi-dimensional nature, pain remains often underestimated, and its management across different therapeutic areas remains complex. A patient-centred approach is needed to bridge the gap between clinical assessment and individual experience. This project aimed to explore the pain experience across different therapeutic areas through narrative medicine (NM). DIAMOND, the project name, is not an acronym but a symbol meant to shed light on physical and mental pain. Methods DIAMOND involved 19 Italian centres and collected narratives from patients experiencing chronic pain, epilepsy, Gram-positive infections or depression, as well as from their caregivers and treating clinicians. Narratives and socio-demographic data were collected anonymously via a dedicated platform. Narratives were analysed using MAXQDA (VERBI Software, Berlin, Germany), applying NM classifications and content analysis; metaphors used by participants to describe pain were also analysed. Results Narratives were collected from 64 patients and 56 caregivers; 20 clinicians contributed 40 parallel charts, all of which were included in the analysis. Pain emerged as a deeply embodied and emotional experience, often described through metaphors of darkness, oppression and distortion. At diagnosis, fear, anxiety and disbelief predominated; however, over time, some participants reported acceptance and resilience. Caregivers described significant emotional, relational and economic burdens, often reporting feelings of helplessness and a sense of responsibility. Clinicians presented more progressive narratives, often focusing on technical aspects of care. The narratives revealed a perceptual gap between patients, caregivers and clinicians, especially regarding the emotional meaning of illness and treatment. The narrative process was seen as beneficial by most participants, supporting inner reflection. Conclusion This pioneering NM initiative mapped the lived experience of pain across multiple conditions, incorporating the perspectives of patients, caregivers and clinicians. NM proved essential in identifying unmet needs and emotional drivers of care, fostering more empathetic, patient-centred approaches in pain management.

Background:With the increasing use of medical cannabis (MC), there is growing evidence suggesting that MC may be an effective therapeutic for chronic sleep, pain, and anxiety conditions. However, further evaluation is warranted to evaluate the heterogeneous patient outcomes of authorized cannabis treatment. Aims:To assess the effectiveness of authorized cannabis on pain, sleep duration, anxiety, and depression in patients presenting to clinics over a 6-month time period. Methods:This long-term prospective observational multicenter study utilized data from adult Canadian patients in the Medical Cannabis Real-World Evidence study. With physician guidance, patients were able to choose from Health Canada-verified MC products via a national pharmacy platform. Validated questionnaires were administered at Weeks 0, 6, 12, and 24 to assess pain interference (PROMIS, 6-30), pain score (NPRS, 0-10), sleep duration, anxiety (GAD-7, 0-21), depression (PHQ-9, 0-27), and quality of life (EQ-5D-3 L, 0-10). Outcomes were analyzed using descriptive statistics and generalized estimating equations models as both a per-protocol and intention-to-treat basis. Results:Improvements in pain, anxiety, depression, and QoL were observed from Baseline to Week 24. Decreases were observed in PROMIS Pain Interference - 4.6 (CI - 6.02 to - 3.17, n = 137), Numeric Pain Rating Scale - 1.19 (CI - 1.7 to -0.68, n = 137), General Anxiety Disorder-7 - 2.24 (CI - 3.5 to - 0.99, n = 139), Patient Health Questionnaire-9 depression -2.79 (CI - 4.29 to -1.3, n = 141), and EQ-5D-3 L - 0.56 (CI -0.96 to -0.16, n = 139). Conclusions:At Week 24, outcomes in chronic pain, anxiety, depression, and quality of life improved. Although 85% of patients in our study had an MC indication for pain, no outcomes met their minimal clinically significant thresholds at Week 24. These observations align with existing evidence, yet there remains some discrepancies in the current literature. Our findings highlight the need for future studies to characterize MC administration, dose, and specific product relationships.

OBJECTIVE:To report long-term outcomes from the OVARIO trial of niraparib plus bevacizumab maintenance following first-line platinum-based chemotherapy with bevacizumab in advanced ovarian cancer. METHODS:The phase 2, single-arm, open-label trial enrolled adult patients with stage IIIB-IV epithelial ovarian, fallopian tube, or primary peritoneal cancer (NCT03326193). Patients were required to have attempted debulking surgery and have a complete or partial response or no evidence of disease following first-line, platinum-based chemotherapy with ≥3 cycles of bevacizumab. The primary endpoint was 18-month progression-free survival (PFS) rate, per RECIST. Secondary endpoints included PFS, overall survival (OS), safety, and health-related quality of life (HRQOL) as assessed by the Functional Assessment of Cancer Therapy-Ovarian Symptoms Index (FOSI). Final analysis cutoff date, August 12, 2024. RESULTS:The median duration of follow-up was 65.7 months. Among evaluable patients (N = 105), PFS results were consistent with the primary analysis. Median OS (95% CI) was 61.1 months (44.9 months-not evaluable [NE]; 52.4% maturity) in the overall population, NE (58.2 months-NE) in the homologous recombination-deficient, 38.7 months (21.9-63.8 months) in the homologous recombination-proficient, and 39.8 months (21.7 months-NE) in the homologous recombination status not determined subgroups. Most patients (73.3%) received subsequent anticancer therapy; 30.5% received subsequent PARP inhibitor therapy. No new safety signals were identified; safety remained consistent with the primary analysis. Per FOSI, HRQOL was not negatively affected. CONCLUSION:In OVARIO, median OS was 61.1 months in the overall population. Safety was consistent with known safety profiles of niraparib and bevacizumab as monotherapies.

Evidence for diet-driven immunomodulation remains limited in terms of practical tools. This pilot study prospectively evaluated the dietary POLA index in 51 women aged 25–45 years and living in Kraków, Poland. At baseline (2022), 7-day dietary intake and physical activity were recorded; stool samples were analyzed for gut microbiota composition; short-chain fatty acids were quantified using high-performance liquid chromatography; and fecal secretory IgA (sIgA), human β-defensin-2 (HBD-2), and calprotectin levels were measured by the enzyme-linked immuno-sorbent assay. In June 2023, post-baseline incidence of COVID-19 and influenza was self-reported. Participants were categorized into a group with beneficial immunomodulation (BIM, POLA score ≤ 5) and a group with unbeneficial/highly unbeneficial immunomodulation (UBIM + HUBIM, POLA score > 5). The incidence of COVID-19 or influenza was 7.7% (1/13) in the BIM group vs. 36.8% (14/38) in the UBIM + HUBIM group. After adjusting for age and smoking, the UBIM + HUBIM group had higher odds of infection compared with the BIM group (adjusted OR = 6.53; 95% CI: 1.02–129.85), corresponding to a higher absolute risk of 47.9% (95% CI 26.1–70.6) versus 12.3% (95% CI 1.4–58.1). The BIM group more often met the fiber and micronutrient adequacy targets and showed a higher proportion of sIgA levels within the reference range (92.3% vs. 60.5%), along with lower fecal succinic acid concentrations (median 3.27 mg/g vs. 4.32 mg/g). In this cohort, a favorable POLA score was associated with lower self-reported COVID-19 or influenza incidence and an sIgA profile suggestive of intestinal immune homeostasis. As this pilot study is underpowered, findings should be interpreted as exploratory and hypothesis-generating. Nonetheless, results support the POLA index as a practical diet-quality metric with potential immunomodulatory relevance.