Efficacy of olanzapine for quality of life improvement among patients with malignant tumor: A systematic review

Abstract

Background Cancer patients always experience an ongoing deterioration in health‐related quality of life (HRQoL). There is a strengthening awareness of health care professionals of taking HRQoL, which is a patient‐reported outcome measures (PROMs), into consideration when they make an adequate selection in clinical practice. Olanzapine, an antipsychotic agent, has been demonstrated to be a safe and effective agent in improving cancer‐related symptoms. Aim To review the efficacy and safety of olanzapine in improving HRQoL among adults with malignant tumor. Methods Eligible studies were retrieved from an electronic database search of the Cochrane, Medline, CINAHL plus, Pubmed, Embase, PsycINFO, Web of Science, and Scopus. The methodological quality of selected studies was evaluated, and the relevant data were extracted and synthesized. Results While studies differed in target population, olanzapine‐based treatment regimen, and HRQoL measurement tools, results have shown that olanzapine has a positive impact on cancer patients' general HRQoL status, functional outcomes, and/or symptoms improvement. Besides, no serious toxicities attributable to olanzapine were observed in all studies included. Conclusion While further studies are needed especially which adopted the HRQoL as primary outcome through comprehensive measures, olanzapine could still be recommended in the palliative care.

A Review of Olanzapine in the Treatment of Cancer Anorexia-Cachexia Syndrome

“…We noticed that the definitions of CAS varied (e.g., 10% loss over 6 months [32] versus ≥ 5% weight loss [35]) among studies, and we suggest that utilizing standardized diagnostic criteria for cancer cachexia in future studies and practice would be helpful [3]. We noted that two studies included participants on concurrent chemotherapy [35,48] and one study excluded them [35]. Those who are on emetogenic chemotherapy will likely have added benefits, since olanzapine is an antiemetic agent for chemotherapy-induced nausea and vomiting [49,50].…”

“…Those who are on emetogenic chemotherapy will likely have added benefits, since olanzapine is an antiemetic agent for chemotherapy-induced nausea and vomiting [49,50]. In a systemic review by Ji M et al investigating the changes in quality of life among patients who received olanzapine, five out of six studies enrolled participants on moderately or highly emetogenic chemotherapy [48]. While all studies in the review involved advanced cancer patients, olanzapine for CAS has been studied in stage III and IV gastric, lung, hepatopancreatic, and colon cancer in prospective randomized studies [33,35].…”

Does an Antipsychotic Hold the Key to Nausea Treatment in Cancer Patients? A Review on the Anti-Nausea Effects of Olanzapine in Oncology

“…Because olanzapine has a background in psychiatry 10,[12][13][14] , it is prudent to also comment on the possible relationship between mental health and cancer-related nausea and vomiting. Pain and anxiety commonly interplay between each other, with pain being a common feature in cancer, whether it be caused by physical causes such as metastasis, RT, or chemotherapy 1,6 , or psychosocial causes such as social exclusion, existential fears, or reduced quality of life 9 .…”

“…Olanzapine works via a variety of mechanisms, and is known to be an atypical second-generation thienobenzodiazepine antipsychotic 10,12 with blockade of dopamine (D1, D2, D3, D4 receptors) and serotonin (5-HT2a, 5-HT2c, 5-HT3, 5-HT6) [12][13][14] , the former of which (specifically the D2 and D3 receptors) exerts its antinausea properties in the postrema region 6 , and together purported to work on the chemoreceptor trigger zone (CTZ) and vomiting center of the brain 24 . Olanzapine also works via the blockade of catecholamines at alpha1 adrenergic receptors (α1), acetylcholine at muscarinic receptors, (M1, M2, M3, M4) and histamine at H1 receptors [12][13][14] . Overall, in its action against the centers of vomiting in the brain and entero-chromaffin cells, olanzapine has antinausea effects which in turn allow for beneficial action against anorexia.…”

“…It was back in 2003 when olanzapine was first found to be effective in the treatment and prevention of nausea in patients who are palliating and being treated with opioids 28 , with its antiemetic effects confirmed in the early 2000s 7,10 . As for quality of life, some sources have noted that olanzapine has an influence on improvement of symptoms and functional outcomes 14 , along with a propensity to increase appetite 18 and boost well-being 6 . Although this review focuses on the antiemetic effects of olanzapine, one study suggests that quality of life studies is essential in oncology, as they may serve as a possible replacement to studies centered on survival in patients with advanced cancer 14 .…”