Literature Collection

Older patients have disproportionally poorer survival outcomes for ovarian cancer in the UK. Half of new diagnoses occur in those aged >65 years. Older patients are more likely to have other medical comorbidities reducing their fitness to receive chemotherapy or undergo cytoreductive surgery resulting in fewer patients receiving treatment. The Holistic Integrated Care in Ovarian Cancer (HICO) programme introduced a structured holistic patient assessment with both universal and targeted interventions to improve physical function and psychological well-being to reduce inequalities due to age, frailty, physical and psychosocial problems. The aim of the project was to evaluate the feasibility and impact of the intervention in patients being considered for the treatment of ovarian cancer. During the implementation of the project, all recruited patients underwent a holistic assessment followed by prehabilitation and rehabilitation support from physiotherapists, occupational therapists, dietitians, geriatricians, nurse specialists and psychologists according to need. The HICO intervention was successfully integrated into the patient pathway in both trusts. Patients who participated in the HICO project provided positive feedback. Overall global health scores improved in 59.6% of the 57 patients who undertook at least two assessments (p=0.006). The proportion of patients who underwent platinum doublet chemotherapy in the HICO cohort was higher (76.2%) compared with a retrospective cohort (57.6%) (p=0.0189). However, no significant difference in the rate of cytoreductive surgery was shown. The proportion of patients alive at 1 year from diagnosis was higher in the HICO intervention group (88.9%) compared with the historical cohort (80.0%) despite higher stage in the HICO group. Although not statistically significant (p=0.289), these data are not yet mature and further study is ongoing. Initial data on costs of ovarian cancer care demonstrated no increase, although the data are not yet mature. This pilot project was funded through the Ovarian Cancer Action IMPROVE UK Pilot Award scheme.

Background: The use of the natural product, kratom, has increased significantly in recent years. The active compounds in kratom have been shown to produce both opioid and stimulant-like effects. While kratom is marketed as a safe, non-addictive method to treat pain and opioid withdrawal, there have been reports demonstrating that kratom is physiologically addictive and linked to overdose deaths. A limited number of case-reports are available describing treatment of kratom use disorder in middle-aged adults, generally in the context of chronic pain and in inpatient settings. Our case is unique in that we describe outpatient treatment of kratom use disorder in a young adult with comorbid attention deficit hyperactivity disorder (ADHD) and in the absence of chronic pain. Case: A 20-year-old college student with ADHD presented to an office-based opioid agonist treatment clinic (OBOT) for treatment of kratom use disorder. He was unable to attend inpatient or residential substance use treatment due to work and school obligations. Additionally, he had stopped taking his prescribed stimulant due to cardiac side effects. The OBOT team successfully initiated buprenorphine-naloxone (BUP/NAL) sublingual films via home induction to treat his kratom use disorder. The patient is being monitored monthly with plans to slowly taper his BUP/NAL dose as tolerated. Discussion: We present a case of a young adult male with kratom use disorder, complicated by a diagnosis of ADHD, successfully treated with BUP/NAL via home induction. The patient is currently kratom-free, reports improved mood and sleep patterns since initiating BUP/NAL, and is able to once again tolerate his ADHD stimulant medication. Healthcare providers should be aware of the use of kratom and consider utilizing BUP/NAL to treat dependence to this botanical drug.