ABSTRACT
BACKGROUND: Approximately 75% of people with pancreatic cancer experience pain, and >50% of them have cachexia (weakness and wasting of the body). However, there is considerable uncertainty regarding the management of these distressing symptoms. OBJECTIVE: Our primary objectives are to compare the relative benefits and harms of different interventions for pain in people with unresectable pancreatic cancer and for prevention and treatment of cachexia due to pancreatic cancer, through systematic reviews and network meta-analysis. Our secondary objectives are to develop an evidence-based clinical care pathway to manage pain and prevent and treat cachexia in people with pancreatic cancer through surveys and focus groups involving patients, carers, and health care professionals. METHODS: We will perform 2 systematic reviews of the literature related to pain and cachexia in people with pancreatic cancer using searches from Cochrane Library, MEDLINE, Embase, Science Citation Index, and trial registries. Two researchers will independently screen for eligibility and identify randomized controlled trials (no language or publication status restriction), comparing interventions for pain or cachexia based on full-texts for articles shortlisted during screening. We will assess risk of bias in the trials using the Cochrane risk of bias tool (version 2.0) and obtain data related to baseline prognostic characteristics, potential effect modifiers and outcome data related to overall survival, health-related quality of life, treatment-related complications, and resource utilisation. We aim to conduct network meta-analysis on outcomes with multiple treatment comparisons where possible, otherwise, meta-analysis with direct comparisons, or narrative synthesis. We will perform various subgroup and sensitivity analyses. Using information obtained from both systematic reviews, we will conduct 2 surveys: one directed to patients or carers to assess acceptability of interventions, and the other to health care professionals to assess feasibility of delivery in the National Health Service. Four mixed focus groups will be conducted to evaluate findings and foster consensus in the development of the care pathway. RESULTS: Funding was awarded from April 2022 (NIHR202727). Both systematic review protocols were prospectively registered on PROSPERO in May 2022. Formal searches began thereafter. Approval by the University College London Research Ethics Committee (23563/001) was received in December 2022. Data collection began in January 2023; data analysis will begin in May 2023 (completion expected by October 2023). CONCLUSIONS: This study will comprehensively encompass major interventions for management of pain in people with unresectable pancreatic cancer, and prevention and treatment of cachexia in people with pancreatic cancer. Key stakeholders will facilitate the development of an evidence-based care pathway, ensuring both acceptability and feasibility. The project ends in April 2024 and published results are expected within 12 months of completion. We aim to present the findings through patient group websites, conferences, and publications, irrespective of the findings, in a peer-reviewed journal. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46335.
ABSTRACT
OBJECTIVE: The aim of this study was to assess the intake of calcium, magnesium, iron, zinc, potassium and sodium with drinking water among 19-26 years old women, students at the Warsaw University of Life Sciences (SGGW). MATERIAL AND METHODS: Data on intake of drinking water and food products were collected based on 4-day record method. Information about kind of water usage to prepare beverages and meals were obtained by using a specific questionnaire. Minerals concentrations in water samples were assessed using the atomic spectrophotometer absorption (ASA) technique. RESULTS: The average consumption of drinking water equaled 870 +/- 389 cm3/d (100-2738 cm3/d). The drinking water used by the women for meals or beverages preparation contributed in 9,8% of calcium and 3,8% of magnesium to their daily diet. Contribution of tap water in the intake of calcium and magnesium depended on the contents of these minerals in water, and amounted from 6,0% (< or = 68,3 mg calcium on dm3 water--1st quartile) to 14,8% (> 112 mg/dm3--4th quartile) for calcium and from 2,9% (< or = 10,9 mg/dm3) to 4,7% (> 15,4 mg/dm3) for magnesium. The contribution of iron, zinc, potassium and sodium was low, and not exceeded 2%. Comparing the average content of minerals in non-boiled and boiled tap water the cooking process influenced the levels of calcium (95,8 +/- 31,8 vs 89,7 +/- 31,1 mg/dm3), magnesium (12,1 +/- 3,24 vs. 12,7 +/- 3,04 mg/dm3), zinc (0,35 +/- 0,87 vs. 0,17 +/- 0,89 mg/dm3), potassium (3,31 +/- 2,67 vs. 3,66 +/- 4,18 mg/dm3) and sodium (23,2 +/- 15,4 vs. 25,9 +/- 17,2 mg/dm3). Nevertheless, from the nutritional point of view the differences in the concentrations of these minerals were insignificant. Conclusions. Drinking water can be an important source of calcium and magnesium in diet, wherein the amount of the supplied element depends on its content in drinking water used for preparing beverages and/or meals.
