{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T04:24:48Z","timestamp":1787372688613,"version":"build-2736575974"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Support Care Cancer"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Loss of appetite and weight loss are major concerns in patients with pancreatic cancer. The aim of this study was to evaluate the associations of corticosteroid therapy with weight change and appetite in the long term, in patients with advanced pancreatic cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a post hoc analysis of the previously performed randomized, controlled MISTRAL trial in patients with advanced pancreatic cancer. Data on weight and appetite at baseline and after approximately 1, 2, 3 and 4\u00a0months were used. The association between corticosteroid exposure and weight change was calculated using mixed linear regression, models adjusted for sex, age, randomization arm and performance status. Appetite was analyzed comparing those without and with corticosteroids during 3 days before appetite assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Two hundred forty-four patients (121 women) were included. Patients who received corticosteroid therapy at any time during the 4\u00a0months had less appetite (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), lower performance status (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and lower BMI (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05) compared to those not receiving corticosteroids. Patients receiving corticosteroids had a larger weight loss of on average 1.48% during a month of follow-up compared to those not receiving corticosteroids (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009\u2212\u20091.48, 95% CI\u2009=\u2009\u2009\u2212\u20092.11 to\u2009\u2212\u20090.84). Patients exposed to corticosteroids reported poorer appetite at every time point than those not exposed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In long-term follow-up, corticosteroid treatment was associated with greater weight loss and poorer appetite among patients with advanced pancreatic cancer. These findings may partly be explained by a higher symptom burden among patients receiving corticosteroids. Future prospective trials are warranted to clarify the effect of long-term corticosteroid treatment on weight and appetite.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00520-026-10585-2","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T18:10:37Z","timestamp":1774721437000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Associations of corticosteroid therapy with weight change and appetite in patients with advanced pancreatic cancer \u2013 a post hoc analysis from the MISTRAL trial"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0253-7819","authenticated-orcid":false,"given":"Charlotte","family":"Goodrose-Flores","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie E.","family":"Bonn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Bj\u00f6rkhem-Bergman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin","family":"Wode","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"issue":"45","key":"10585_CR1","doi-asserted-by":"publisher","first-page":"79884","DOI":"10.18632\/oncotarget.20168","volume":"8","author":"M Muscaritoli","year":"2017","unstructured":"Muscaritoli M, Lucia S, Farcomeni A, Lorusso V, Saracino V, Barone C, Plastino F, Gori S, Magarotto R, Carteni G et al (2017) Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget 8(45):79884\u201379896","journal-title":"Oncotarget"},{"issue":"5","key":"10585_CR2","doi-asserted-by":"publisher","first-page":"2898","DOI":"10.1016\/j.clnu.2021.02.005","volume":"40","author":"M Muscaritoli","year":"2021","unstructured":"Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, H\u00fctterer E, Isenring E, Kaasa S et al (2021) ESPEN practical guideline: clinical nutrition in cancer. Clin Nutr (Edinburgh, Scotland) 40(5):2898\u20132913","journal-title":"Clin Nutr (Edinburgh, Scotland)"},{"key":"10585_CR3","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16091696","author":"S Pandey","year":"2024","unstructured":"Pandey S, Bradley L, Del Fabbro E (2024) Updates in cancer cachexia: clinical management and pharmacologic interventions. Cancers (Basel). https:\/\/doi.org\/10.3390\/cancers16091696","journal-title":"Cancers (Basel)"},{"issue":"1","key":"10585_CR4","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s00520-012-1514-8","volume":"21","author":"A Bye","year":"2013","unstructured":"Bye A, Jordh\u00f8y MS, Skjegstad G, Ledsaak O, Iversen PO, Hjermstad MJ (2013) Symptoms in advanced pancreatic cancer are of importance for energy intake. Support Care Cancer 21(1):219\u2013227","journal-title":"Support Care Cancer"},{"issue":"3","key":"10585_CR5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0152172","volume":"11","author":"A Hendifar","year":"2016","unstructured":"Hendifar A, Osipov A, Khanuja J, Nissen N, Naziri J, Yang W, Li Q, Tuli R (2016) Influence of body mass index and albumin on perioperative morbidity and clinical outcomes in resected pancreatic adenocarcinoma. PLoS ONE 11(3):e0152172","journal-title":"PLoS ONE"},{"issue":"1","key":"10585_CR6","doi-asserted-by":"publisher","first-page":"17","DOI":"10.21037\/jgo.2017.11.10","volume":"9","author":"AE Hendifar","year":"2018","unstructured":"Hendifar AE, Chang JI, Huang BZ, Tuli R, Wu BU (2018) Cachexia, and not obesity, prior to pancreatic cancer diagnosis worsens survival and is negated by chemotherapy. J Gastrointest Oncol 9(1):17\u201323","journal-title":"J Gastrointest Oncol"},{"key":"10585_CR7","doi-asserted-by":"publisher","DOI":"10.3390\/nu12061543","author":"KA Poulia","year":"2020","unstructured":"Poulia KA, Sarantis P, Antoniadou D, Koustas E, Papadimitropoulou A, Papavassiliou AG, Karamouzis MV (2020) Pancreatic cancer and cachexia-metabolic mechanisms and novel insights. Nutrients. https:\/\/doi.org\/10.3390\/nu12061543","journal-title":"Nutrients"},{"issue":"5","key":"10585_CR8","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1634\/theoncologist.2018-0266","volume":"24","author":"AE Hendifar","year":"2019","unstructured":"Hendifar AE, Petzel MQB, Zimmers TA, Denlinger CS, Matrisian LM, Picozzi VJ, Rahib L, Precision Promise C (2019) Pancreas cancer-associated weight loss. Oncologist 24(5):691\u2013701","journal-title":"Oncologist"},{"key":"10585_CR9","doi-asserted-by":"crossref","unstructured":"Liu Z, Gou A, Wu X (2023) Liver metastasis of pancreatic cancer: the new choice at the crossroads. Hepatobiliary Surg Nutr 12:88\u201391","DOI":"10.21037\/hbsn-22-489"},{"issue":"Suppl 1","key":"10585_CR10","doi-asserted-by":"publisher","first-page":"S117","DOI":"10.1007\/s00592-003-0042-x","volume":"40","author":"SB Heymsfield","year":"2003","unstructured":"Heymsfield SB (2003) Measurements of energy balance. Acta Diabetol 40(Suppl 1):S117-121","journal-title":"Acta Diabetol"},{"issue":"4","key":"10585_CR11","doi-asserted-by":"publisher","first-page":"3007","DOI":"10.1007\/s00520-021-06633-8","volume":"30","author":"C Capit\u00e3o","year":"2022","unstructured":"Capit\u00e3o C, Coutinho D, Neves PM, Capelas ML, Pimenta NM, Santos T, M\u00e4kitie A, Ravasco P (2022) Protein intake and muscle mass maintenance in patients with cancer types with high prevalence of sarcopenia: a systematic review. Support Care Cancer 30(4):3007\u20133015","journal-title":"Support Care Cancer"},{"issue":"5","key":"10585_CR12","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1097\/PPO.0000000000000405","volume":"25","author":"H Greenlee","year":"2019","unstructured":"Greenlee H, Santiago-Torres M, McMillen KK, Ueland K, Haase AM (2019) Helping patients eat better during and beyond cancer treatment: continued nutrition management throughout care to address diet, malnutrition, and obesity in cancer. Cancer J (Sudbury, Mass) 25(5):320\u2013328","journal-title":"Cancer J (Sudbury, Mass)"},{"issue":"1","key":"10585_CR13","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1200\/JCO.2014.56.1894","volume":"33","author":"L Martin","year":"2015","unstructured":"Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, Strasser F, Thoresen L, Jagoe RT, Chasen M et al (2015) Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol 33(1):90\u201399","journal-title":"J Clin Oncol"},{"issue":"33","key":"10585_CR14","doi-asserted-by":"publisher","first-page":"8500","DOI":"10.1200\/JCO.2005.01.8010","volume":"23","author":"T Yavuzsen","year":"2005","unstructured":"Yavuzsen T, Davis MP, Walsh D, LeGrand S, Lagman R (2005) Systematic review of the treatment of cancer-associated anorexia and weight loss. J Clin Oncol 23(33):8500\u20138511","journal-title":"J Clin Oncol"},{"issue":"1","key":"10585_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00520-009-0722-3","volume":"18","author":"G Mantovani","year":"2010","unstructured":"Mantovani G, Madeddu C (2010) Cancer cachexia: medical management. Support Care Cancer 18(1):1\u20139","journal-title":"Support Care Cancer"},{"issue":"21","key":"10585_CR16","doi-asserted-by":"publisher","first-page":"2438","DOI":"10.1200\/JCO.20.00611","volume":"38","author":"EJ Roeland","year":"2020","unstructured":"Roeland EJ, Bohlke K, Baracos VE, Bruera E, Del Fabbro E, Dixon S, Fallon M, Herrstedt J, Lau H, Platek M et al (2020) Management of cancer cachexia: ASCO guideline. J Clin Oncol 38(21):2438\u20132453","journal-title":"J Clin Oncol"},{"issue":"9","key":"10585_CR17","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1007\/s00520-007-0395-8","volume":"16","author":"A Sturdza","year":"2008","unstructured":"Sturdza A, Millar BA, Bana N, Laperriere N, Pond G, Wong RK, Bezjak A (2008) The use and toxicity of steroids in the management of patients with brain metastases. Support Care Cancer 16(9):1041\u20131048","journal-title":"Support Care Cancer"},{"issue":"1","key":"10585_CR18","doi-asserted-by":"publisher","DOI":"10.1186\/1710-1492-9-30","volume":"9","author":"D Liu","year":"2013","unstructured":"Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, Brown JP, Cohen A, Kim H (2013) A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol 9(1):30","journal-title":"Allergy Asthma Clin Immunol"},{"issue":"3","key":"10585_CR19","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1002\/art.21984","volume":"55","author":"JR Curtis","year":"2006","unstructured":"Curtis JR, Westfall AO, Allison J, Bijlsma JW, Freeman A, George V, Kovac SH, Spettell CM, Saag KG (2006) Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum 55(3):420\u2013426","journal-title":"Arthritis Rheum"},{"issue":"11","key":"10585_CR20","first-page":"347","volume":"121","author":"K Wode","year":"2024","unstructured":"Wode K, Kienle GS, Bjor O, Fransson P, Sharp L, Elander NO, Bernhardson BM, Johansson B, Edwinsdotter Ardnor C, Scheibling U et al (2024) Mistletoe extract in patients with advanced pancreatic cancer: a double-blind, randomized, placebo-controlled tial (MISTRAL). Dtsch Arztebl Int 121(11):347\u2013354","journal-title":"Dtsch Arztebl Int"},{"key":"10585_CR21","doi-asserted-by":"publisher","unstructured":"Wode K, Bj\u00f6r O, Elander N O, Fransson P, Henriksson R, Sharp L, Scheibling U, Johansson B, H\u00f6k Nordberg J, Kienle GS\u00a0(2025) Mistletoe extract in patients with advanced pancreatic cancer: health-related quality of life in a double-blind, Randomized, Placebo-Controlled Trial (MISTRAL).\u00a0Palliative Medicine, 2026, Accepted for publication. https:\/\/doi.org\/10.1177\/02692163261437609\/","DOI":"10.1177\/02692163261437609\/"},{"issue":"1","key":"10585_CR22","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-020-04581-y","volume":"21","author":"K Wode","year":"2020","unstructured":"Wode K, H\u00f6k Nordberg J, Kienle GS, Elander NO, Bernhardson BM, Sunde B, Sharp L, Henriksson R, Fransson P (2020) Efficacy of mistletoe extract as a complement to standard treatment in advanced pancreatic cancer: study protocol for a multicentre, parallel group, double-blind, randomised, placebo-controlled clinical trial (MISTRAL). Trials 21(1):783","journal-title":"Trials"},{"issue":"5","key":"10585_CR23","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1093\/jnci\/85.5.365","volume":"85","author":"NK Aaronson","year":"1993","unstructured":"Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365\u2013376","journal-title":"J Natl Cancer Inst"},{"issue":"6","key":"10585_CR24","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1016\/S0959-8049(99)00047-7","volume":"35","author":"D Fitzsimmons","year":"1999","unstructured":"Fitzsimmons D, Johnson CD, George S, Payne S, Sandberg AA, Bassi C, Beger HG, Birk D, Buchler MW, Dervenis C et al (1999) Development of a disease specific quality of life (QoL) questionnaire module to supplement the EORTC core cancer QoL questionnaire, the QLQ-C30 in patients with pancreatic cancer. EORTC study group on quality of life. Eur J Cancer 35(6):939\u2013941","journal-title":"Eur J Cancer"},{"issue":"6","key":"10585_CR25","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1097\/00000421-198212000-00014","volume":"5","author":"MM Oken","year":"1982","unstructured":"Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6):649\u2013655","journal-title":"Am J Clin Oncol"},{"issue":"3","key":"10585_CR26","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1097\/SPC.0000000000000655","volume":"17","author":"T Duffy","year":"2023","unstructured":"Duffy T, Kochanczyk M (2023) Practical cancer cachexia management in palliative care - a review of current evidence. Curr Opin Support Palliat Care 17(3):177\u2013185","journal-title":"Curr Opin Support Palliat Care"},{"issue":"3","key":"10585_CR27","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1177\/0269216320986717","volume":"35","author":"J Hardy","year":"2021","unstructured":"Hardy J, Haywood A, Rickett K, Sallnow L, Good P (2021) Practice review: evidence-based quality use of corticosteroids in the palliative care of patients with advanced cancer. Palliat Med 35(3):461\u2013472","journal-title":"Palliat Med"},{"key":"10585_CR28","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13050985","author":"C Klasson","year":"2021","unstructured":"Klasson C, Helde Frankling M, Lundh Hagelin C, Bjorkhem-Bergman L (2021) Fatigue in cancer patients in palliative care-a review on pharmacological interventions. Cancers (Basel). https:\/\/doi.org\/10.3390\/cancers13050985","journal-title":"Cancers (Basel)"},{"issue":"4","key":"10585_CR29","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1080\/02841860500401167","volume":"45","author":"SH Lundstrom","year":"2006","unstructured":"Lundstrom SH, Furst CJ (2006) The use of corticosteroids in Swedish palliative care. Acta Oncol 45(4):430\u2013437","journal-title":"Acta Oncol"},{"key":"10585_CR30","unstructured":"WHO: https:\/\/iahpc.org\/what-we-do\/research\/palliative-care-essentials\/iahpc-essential-medicines-for-palliative-care\/"},{"issue":"2","key":"10585_CR31","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1177\/1049909118797283","volume":"36","author":"LR Jaward","year":"2019","unstructured":"Jaward LR, O\u2019Neil TA, Marks A, Smith MA (2019) Differences in adverse effect profiles of corticosteroids in palliative care patients. Am J Hosp Palliat Care 36(2):158\u2013168","journal-title":"Am J Hosp Palliat Care"},{"key":"10585_CR32","doi-asserted-by":"crossref","unstructured":"Fabi A, Bhargava R, Fatigoni S, Guglielmo M, Horneber M, Roila F, Weis J, Jordan K, Ripamonti CI (2020) clinicalguidelines@esmo.org EGCEa: Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment. Ann Oncol 31(6):713\u2013723","DOI":"10.1016\/j.annonc.2020.02.016"},{"issue":"29","key":"10585_CR33","doi-asserted-by":"publisher","first-page":"3221","DOI":"10.1200\/JCO.2013.54.3926","volume":"32","author":"O Paulsen","year":"2014","unstructured":"Paulsen O, Klepstad P, Rosland JH, Aass N, Albert E, Fayers P, Kaasa S (2014) Efficacy of methylprednisolone on pain, fatigue, and appetite loss in patients with advanced cancer using opioids: a randomized, placebo-controlled, double-blind trial. J Clin Oncol 32(29):3221\u20133228","journal-title":"J Clin Oncol"},{"issue":"25","key":"10585_CR34","doi-asserted-by":"publisher","first-page":"3076","DOI":"10.1200\/JCO.2012.44.4661","volume":"31","author":"S Yennurajalingam","year":"2013","unstructured":"Yennurajalingam S, Frisbee-Hume S, Palmer JL, Delgado-Guay MO, Bull J, Phan AT, Tannir NM, Litton JK, Reddy A, Hui D et al (2013) Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo-controlled trial in patients with advanced cancer. J Clin Oncol 31(25):3076\u20133082","journal-title":"J Clin Oncol"},{"issue":"10","key":"10585_CR35","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1177\/0269216313486952","volume":"27","author":"NJ Preston","year":"2013","unstructured":"Preston NJ, Fayers P, Walters SJ, Pilling M, Grande GE, Short V, Owen-Jones E, Evans CJ, Benalia H, Higginson IJ et al (2013) Recommendations for managing missing data, attrition and response shift in palliative and end-of-life care research: part of the MORECare research method guidance on statistical issues. Palliat Med 27(10):899\u2013907","journal-title":"Palliat Med"}],"container-title":["Supportive Care in Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-026-10585-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00520-026-10585-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-026-10585-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T03:46:30Z","timestamp":1787370390000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00520-026-10585-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,28]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10585"],"URL":"https:\/\/doi.org\/10.1007\/s00520-026-10585-2","relation":{},"ISSN":["0941-4355","1433-7339"],"issn-type":[{"value":"0941-4355","type":"print"},{"value":"1433-7339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,28]]},"assertion":[{"value":"23 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Stockholm\u2019s Regional Ethical Review Board (Dnr 2016\/122\u201331\/2) and conducted in accordance with the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all participants before study inclusion.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"383"}}