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Determinants of Quality of Life in Breast Cancer: Meta-Analytic Structural Equation Modeling of Studies 乳腺癌患者生活质量的决定因素:meta分析结构方程模型研究
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-02-28 DOI: 10.1155/2023/8302610
M. Mansourian, Razieh Bazrafshan, Zahra Malakoutikhah, T. Jafari-Koshki, G. Vaseghi
Objective. Quality of life (QoL) is a major concern in breast cancer (BC) patients. Despite efforts, no study has comprehensively addressed determinants of QoL in patients with BC. This study aimed to synthesize evidence on QoL correlations using the meta-analytic structural equation modeling (MASEM) approach. Methods. Our search in PubMed, Web of Science, Scopus, and Cochrane databases resulted in 5,238 initial relevant papers, 73 of which were eligible for final analysis with a total of 44,121 patients. We used a two-stage procedure of correlation-based MASEM to examine the relationship between QoL and body mass index (BMI), physical activity (PA), sleep, depression, fatigue, and stress. Results. Final MASEM model suggested that PA (path coefficient = 0.33, 95% CI = −0.0444; 0.6334), fatigue (path coefficient = −0.23, 95% CI = −0.6825; 0.0361), and stress (path coefficient = −0.22, 95% CI = −0.5143; 0.6875) were the most important factors related to QoL in patients with breast cancer. Final model identified variables responsible for 68% of the variation in QoL in BC. Conclusion. QoL is an important outcome in the treatment course of BC. Large-scale and meta-analysis studies could help patients to have a life with improved quality.
客观的生活质量(QoL)是癌症(BC)患者关注的主要问题。尽管做出了努力,但没有一项研究全面解决BC患者生活质量的决定因素。本研究旨在使用元分析结构方程建模(MASEM)方法综合生活质量相关性的证据。方法。我们在PubMed、Web of Science、Scopus和Cochrane数据库中搜索了5238篇初始相关论文,其中73篇符合最终分析条件,共有44121名患者。我们使用基于相关性的MASEM两阶段程序来检查生活质量与体重指数(BMI)、体力活动(PA)、睡眠、抑郁、疲劳和压力之间的关系。后果最终的MASEM模型表明PA(路径系数 = 0.33,95%CI = −0.0444;0.6334),疲劳(路径系数 = −0.23,95%CI = −0.6825;0.0361)和应力(路径系数 = −0.22,95%CI = −0.5143;0.6875)是影响癌症患者生活质量的最重要因素。最终模型确定了造成不列颠哥伦比亚省生活质量68%变化的变量。结论生活质量是BC治疗过程中的一个重要结果。大规模的荟萃分析研究可以帮助患者改善生活质量。
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引用次数: 0
Treatment and Survival in Acute Leukemia: A New South Wales Study Comparing Adolescents and Young Adults with Children and Adults 急性白血病的治疗和生存:新南威尔士州的一项比较青少年和年轻人与儿童和成年人的研究
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-02-09 DOI: 10.1155/2023/8600327
Ming Li, A. Anazodo, L. Dalla-Pozza, Paola Kabalan Baeza, D. Roder, D. Currow
Objective. To investigate age differences in treatment and survival from acute lymphoblastic (ALL) and acute myeloid leukemia (AML). Methods. 1053 ALL/566 AML patients diagnosed in 2003–2015 on the New South Wales Cancer Registry were included. Treatment within 12 months from diagnosis was assessed using linked registry, hospital, and health-insurance data. Differences by age at diagnosis in treatment and survival were investigated using socio-demographically adjusted regression analyses, with adolescents and young adults (AYA, 15–24 years) as the reference category. Results. Children were less likely than AYA to start ALL treatment >3 days from diagnosis (adjusted odds ratio (aOR 0.39, 95% CI 0.27–0.57)) and to have multiple treatment types (aOR 0.22, 95% CI 0.14–0.34). For AML, aOR of treatment start >3 days was 0.16 (95% CI 0.09–0.29) for children compared with AYA, with no age differences in treatment types. Five-year disease-specific survival for ALL was 84%. Children were less likely than AYA to die from ALL (adjusted subhazard ratio (aSHR 0.32, 95% CI 0.22–0.50)). For AML, the corresponding survival was 73% without an age difference. Children having multiple treatment types for ALL had an increased risk of mortality at aSHR 2.67 (95% CI 1.53–4.67), but not adults at 1.26 (95% CI 0.67–2.47) (interaction p  = 0.017). Time from diagnosis to initial treatment start and initial treatment type were not associated with mortality outcomes after adjusting for socio-demographic variables. Conclusion. Children with ALL had better survival. ALL Mortality were negatively associated with multiple treatment types.
客观的研究急性淋巴细胞白血病(ALL)和急性髓系白血病(AML)治疗和生存的年龄差异。方法。包括2003-2015年在新南威尔士州癌症登记处诊断的1053名ALL/566名AML患者。12内治疗 使用关联的登记、医院和健康保险数据对诊断后的几个月进行评估。使用社会人口学调整的回归分析,对青少年和年轻人(AYA,15-24 年)作为参考类别。后果儿童开始ALL治疗的可能性比AYA低>3 诊断后的天数(调整比值比(aOR 0.39,95%CI 0.27–0.57))和多种治疗类型(aOR 0.22,95%CI 0.14–0.34)。对于AML,治疗开始的aOR>3 与AYA相比,儿童的天数为0.16(95%CI 0.09–0.29),治疗类型没有年龄差异。ALL的5年疾病特异性生存率为84%。儿童死于ALL的可能性低于AYA(调整后的亚致死率(aSHR 0.32,95%CI 0.22–0.50))。AML的相应生存率为73%,没有年龄差异。有多种ALL治疗类型的儿童在aSHR 2.67(95%CI 1.53–4.67)时死亡率增加,但在1.26(95%CI 0.67–2.47)时成人死亡率没有增加(交互作用p = 0.017)。在调整了社会人口学变量后,从诊断到初始治疗开始的时间和初始治疗类型与死亡率结果无关。结论ALL患儿存活率较高。ALL死亡率与多种治疗类型呈负相关。
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引用次数: 0
Correlation of CTSD, P63, and Ki67 Expressions with Risk Assessment of Oesophageal Squamous-Cell Carcinoma CTSD、P63和Ki67的表达与食管鳞状细胞癌风险评估的相关性
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-02-08 DOI: 10.1155/2023/5197471
Yufang Chen, Qianqian Gao, F. Raza, Hajra Zafar, Ziyan Li, Jingyao Zeng, Meihua Wang, P. Huang, Jianhua Su
Objective. Creatine kinase (CK), cathepsin D (CTSD), Ki67, and tumour protein 63 (p63) have been proven to participate in the growth of some cancers. However, available literature suggested paucity of data on their involvement in oesophageal squamous-cell carcinoma (ESCC) development. Methods. We ascertained the presence of CK, CTSD, Ki67, and p63 expressions in ESCC to demonstrate the association between differentiation of ESCC and expressions of the abovementioned proteins. We collected related information on 48 patients prior to their division into well and poor differentiation groups, which were analysed retrospectively. Positive rates of protein expression were evaluated via immunohistochemistry. The proteins that were expressed positively in all the cases were selected. Comparison of the proteins within two groups was done to analyse the correlation between tumour differentiation and their expression. Results. We observed that CTSD, p63, and Ki67 were significantly and highly expressed in poorly differentiated patients with ESCC. Conclusions. This finding may suggest that the proteins were involved in ESCC progression, which may evidentially serve as potential markers of early identification and risk assessment of ESCC.
目标。肌酸激酶(CK)、组织蛋白酶D (CTSD)、Ki67和肿瘤蛋白63 (p63)已被证明参与某些癌症的生长。然而,现有文献表明缺乏它们参与食管鳞状细胞癌(ESCC)发展的数据。方法。我们确定了CK、CTSD、Ki67和p63在ESCC中的表达,以证明ESCC的分化与上述蛋白的表达之间的关联。我们收集了48例患者在分化良好组和分化不良组之前的相关信息,并对其进行回顾性分析。免疫组化评价蛋白表达阳性率。选择在所有情况下表达阳性的蛋白。比较两组内的蛋白,分析肿瘤分化与其表达之间的相关性。结果。我们观察到CTSD、p63和Ki67在低分化ESCC患者中显著且高表达。结论。这一发现可能表明这些蛋白参与了ESCC的进展,这显然可以作为ESCC早期识别和风险评估的潜在标志。
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引用次数: 0
Variations in Patterns of Care of Rectal Cancer Patients in South Australia According to Sociodemographic Characteristics:A Registry Study 南澳大利亚癌症患者社会形态特征的护理模式变化:一项注册表研究
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-02-07 DOI: 10.1155/2023/7974059
A. Ebert, M. Short, L. Pule, L. Marcu, E. Buckley
Objective. To explore variations in patterns of care over three decades for a subgroup of rectal cancer patients in South Australia according to sociodemographic characteristics. Methods. This study evaluated three decades of retrospective data from the South Australian Clinical Cancer Registry. A total of 4,131 patients diagnosed with rectal cancer between 1982 and 2015 and treated in South Australian public hospitals were included. Study outcomes were age at diagnosis, area of primary residence, cancer stage, and primary treatment (surgery, chemotherapy, or radiotherapy). Results. There was a significantly lower likelihood of conventional therapy for the elderly. Adjusted odds of receiving surgery or radiotherapy decreased by 70% and those of receiving chemotherapy by 90% in the 80+ age group, compared to the 50–59 age group. No significant variation was detected according to area-level socioeconomic status or remoteness. Conclusion. Socioeconomic factors showed little impact on the receipt of therapies for rectal cancer patients in South Australia. Variation in treatment by age, irrespective of disease stage or period of diagnosis, requires further investigation.
客观的根据社会人口学特征,探讨南澳大利亚一个直肠癌症患者亚组三十年来护理模式的变化。方法。这项研究评估了南澳大利亚临床癌症登记处三十年的回顾性数据。1982年至2015年间,共有4131名患者被诊断为癌症,并在南澳大利亚州公立医院接受治疗。研究结果包括诊断时的年龄、主要居住地、癌症分期和主要治疗(手术、化疗或放疗)。后果老年人接受常规治疗的可能性明显较低。与50-59岁年龄组相比,80岁以上年龄组接受手术或放疗的调整几率降低了70%,接受化疗的调整几率下降了90%。根据地区级别的社会经济地位或偏远程度,未发现显著差异。结论社会经济因素对南澳大利亚直肠癌症患者接受治疗的影响很小。治疗因年龄而异,无论疾病分期或诊断期如何,都需要进一步调查。
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引用次数: 0
The Expression of Serum lncRNA MIR17HG in Patients with Multiple Myeloma and Its Clinical Significance 多发性骨髓瘤患者血清lncRNA MIR17HG的表达及其临床意义
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-02-07 DOI: 10.1155/2023/1728909
Hongfeng Ge, Shue Li, Jiangzhou Feng, Hailiang Chu
Objective. Multiple myeloma (MM) represents a malignant tumor with abnormal proliferation of plasma cells. The current study sought to investigate the changes in serum lncRNA MIR17HG (long noncoding RNA miR-17-92a-1 cluster host gene) levels in MM patients and its values in assessing the accuracy of MM diagnosis and predicting diagnosis. Methods. First, 108MM patients and 85 healthy controls were enrolled as the study subjects. The serum levels of MIR17HG in all subjects were determined by RT-qPCR. MM patients were clinically staged according to the Durie-Salmon (DS) and international staging system (ISS), and the levels of serum MIR17HG were compared among patients at different stages. The correlation of serum MIR17H level with serum creatinine (Scr), lactate dehydrogenase (LDH), and albumin (ALB) was analyzed using the Pearson method. The accuracy of the serum MIR17HG level in identifying MM was evaluated using receiver operating characteristic curves. The progression-free survival (PFS) and overall survival (OS) curves of MM patients were plotted using the Kaplan–Meier method. Results. Serum MIR17HG levels were up-regulated in MM patients and elevated with the development of DS and ISS stages. The serum MIR17HG was positively correlated with Scr and LDH and negatively correlated with ALB in MM patients. Serum MIR17HG level >1.485 could evaluate the accuracy of identifying MM. The PFS and OS were significantly shortened in MM patients with elevated MIR17HG levels. Conclusion. Our findings collectively indicate that the serum MIR17HG can aid the evaluation of accurate MM identification, and a high serum MIR17HG level can predict poor prognosis of patients with MM.
客观的多发性骨髓瘤(MM)是一种浆细胞异常增殖的恶性肿瘤。本研究旨在研究MM患者血清lncRNA MIR17HG(长非编码RNA miR-17-92a-1簇宿主基因)水平的变化及其在评估MM诊断准确性和预测诊断中的价值。方法。首先,108MM患者和85名健康对照被纳入研究对象。通过RT-qPCR测定所有受试者的血清MIR17HG水平。根据Durie Salmon(DS)和国际分期系统(ISS)对MM患者进行临床分期,并比较不同分期患者的血清MIR17HG水平。采用Pearson法分析血清MIR17H水平与血清肌酐(Scr)、乳酸脱氢酶(LDH)和白蛋白(ALB)的相关性。使用受试者操作特征曲线评估血清MIR17HG水平在识别MM中的准确性。使用Kaplan–Meier方法绘制MM患者的无进展生存期(PFS)和总生存期(OS)曲线。后果MM患者血清MIR17HG水平上调,并随着DS和ISS分期的发展而升高。MM患者血清MIR17HG与Scr、LDH呈正相关,与ALB呈负相关。血清MIR17HG水平>1.485可评价MM鉴别的准确性。MIR17HG水平升高的MM患者PFS和OS显著缩短。结论我们的研究结果共同表明,血清MIR17HG可以帮助评估MM的准确识别,高血清MIR117HG水平可以预测MM患者的不良预后。
{"title":"The Expression of Serum lncRNA MIR17HG in Patients with Multiple Myeloma and Its Clinical Significance","authors":"Hongfeng Ge, Shue Li, Jiangzhou Feng, Hailiang Chu","doi":"10.1155/2023/1728909","DOIUrl":"https://doi.org/10.1155/2023/1728909","url":null,"abstract":"Objective. Multiple myeloma (MM) represents a malignant tumor with abnormal proliferation of plasma cells. The current study sought to investigate the changes in serum lncRNA MIR17HG (long noncoding RNA miR-17-92a-1 cluster host gene) levels in MM patients and its values in assessing the accuracy of MM diagnosis and predicting diagnosis. Methods. First, 108MM patients and 85 healthy controls were enrolled as the study subjects. The serum levels of MIR17HG in all subjects were determined by RT-qPCR. MM patients were clinically staged according to the Durie-Salmon (DS) and international staging system (ISS), and the levels of serum MIR17HG were compared among patients at different stages. The correlation of serum MIR17H level with serum creatinine (Scr), lactate dehydrogenase (LDH), and albumin (ALB) was analyzed using the Pearson method. The accuracy of the serum MIR17HG level in identifying MM was evaluated using receiver operating characteristic curves. The progression-free survival (PFS) and overall survival (OS) curves of MM patients were plotted using the Kaplan–Meier method. Results. Serum MIR17HG levels were up-regulated in MM patients and elevated with the development of DS and ISS stages. The serum MIR17HG was positively correlated with Scr and LDH and negatively correlated with ALB in MM patients. Serum MIR17HG level >1.485 could evaluate the accuracy of identifying MM. The PFS and OS were significantly shortened in MM patients with elevated MIR17HG levels. Conclusion. Our findings collectively indicate that the serum MIR17HG can aid the evaluation of accurate MM identification, and a high serum MIR17HG level can predict poor prognosis of patients with MM.","PeriodicalId":11953,"journal":{"name":"European Journal of Cancer Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41596392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Multiple Levels of Influence on Lifestyle Behaviors among Cancer Survivors in Racial and Ethnic Minority Groups: A Systematic Review. 种族和少数民族癌症幸存者生活方式行为的多重影响:一项系统综述
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-01-01 Epub Date: 2023-07-13 DOI: 10.1155/2023/8504968
Dalnim Cho, Seokhun Kim, Scherezade K Mama, Maria C Swartz, Yimin Geng, Qian Lu

Objective: This systematic review aimed to provide a critical summary of studies of physical activity (PA) and diet among racial/ethnic minority cancer survivors. Guided by the socio-ecological model, we identified factors across multiple levels-individual, family/social support, provider/team, and organization/local community/policy environment-that affect PA and diet among racial/ethnic minority survivors.

Methods: We searched the Ovid MEDLINE, EBSCO CINAHL, Ovid PsycInfo, and PubMed databases. We extracted the behavior of focus (i.e., PA and diet), cancer type, race/ethnicity, and the level(s) of influence (and the corresponding factor(s)), and each eligible study investigated individual (e.g., demographic characteristics, psychological factors), family/social support, provider/team (e.g., healthcare provider recommendations), and organization/local community/policy environment (e.g., neighborhood/social environment).

Results: Of 1,603 studies identified, 23 unique studies were eligible. Most studies included breast cancer survivors (n = 19) and Black survivors (n = 13). Seventeen studies assessed associations between PA and factors at the level of the individual (16 studies), family/social support (two studies), provider/team (one study), or organization/local community/policy environment (four studies). Eleven studies assessed associations between diet and factors at the level of the individual (11 studies), family/social support (two studies), provider/team (one study), or organization/local community/policy environment (two studies). Only five studies simultaneously investigated factors across multiple levels. Most demographic and cancer-related factors were not associated with PA or diet. Overall, factors from social-cognitive theories (e.g., self-efficacy) were positively associated with PA. Less consensus was found regarding diet because fewer studies existed, and they also investigated a diverse range of eating behaviors.

Conclusions: There is a critical need for studies of PA and diet that investigate multiple levels of influence particularly for Asian American survivors, male survivors, and cancers other than breast cancer. Social-cognitive theories may help guide the designing of multilevel PA interventions for racial/ethnic minority survivors. Studies assessing overall eating quality or adherence to dietary guidelines are needed.

客观的本系统综述旨在对癌症少数民族幸存者的体力活动(PA)和饮食研究进行批判性总结。在社会生态模型的指导下,我们确定了影响种族/少数民族幸存者PA和饮食的多个层面的因素——个人、家庭/社会支持、提供者/团队和组织/当地社区/政策环境。方法。我们搜索了Ovid MEDLINE、EBSCO CINAHL、Ovid PsycInfo和PubMed数据库。我们提取了关注行为(即PA和饮食)、癌症类型、种族/民族和影响水平(以及相应的因素),每个符合条件的研究调查了个人(例如,人口统计学特征、心理因素)、家庭/社会支持、提供者/团队(例如,医疗保健提供者建议),以及组织/当地社区/政策环境(例如邻里/社会环境)。后果在确定的1603项研究中,有23项独特的研究符合条件。大多数研究包括癌症幸存者(n = 19) 和黑人幸存者(n = 13) 。17项研究在个人(16项研究)、家庭/社会支持(两项研究),提供者/团队(一项研究)或组织/当地社区/政策环境(四项研究)层面评估了PA与因素之间的关系。11项研究从个人(11项研究)、家庭/社会支持(两项研究),提供者/团队(一项研究)或组织/当地社区/政策环境(两项调查)的层面评估了饮食与因素之间的关系。只有五项研究同时调查了多个层面的因素。大多数人口统计学和癌症相关因素与PA或饮食无关。总体而言,来自社会认知理论的因素(如自我效能感)与PA呈正相关。由于研究较少,人们对饮食的共识较少,而且他们还调查了各种各样的饮食行为。结论。迫切需要对PA和饮食进行研究,以调查多个层面的影响,特别是对亚裔美国人幸存者、男性幸存者和癌症以外的癌症。社会认知理论可能有助于指导为种族/少数民族幸存者设计多层次PA干预措施。需要进行评估整体饮食质量或是否遵守饮食指南的研究。
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引用次数: 0
Timely integration of palliative care into cancer care 及时将姑息治疗纳入癌症治疗
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-11-24 DOI: 10.1111/ecc.13764
Natasja Johanna Helen Raijmakers, Lia van Zuylen, Carl Johan Fürst
<p>In this issue, we have a Special Supplement focusing on palliative care. Despite many advances in oncology, the number of people living with incurable cancer is increasing, and cancer is still one of the leading causes of death in the world. In 2020, nearly 10 million people died due to cancer, which is nearly one in six deaths word wide (WHO, <span>n.d.-a</span>). Patients with incurable cancer need palliative care. Palliative care is defined by the WHO as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual (WHO, <span>n.d.-b</span>).</p><p>A wide body of research has demonstrated the added value of early palliative care; a landmark study published in the New England Journal of Medicine demonstrated that early specialist palliative care leads to improved quality of life in patients with metastatic non-small-cell lung cancer (Temel et al., <span>2010</span>). Moreover, these positive effects of palliative care on quality of life and symptom burden have been confirmed in many studies and meta-analyses (Bakitas et al., <span>2015</span>; Davis et al., <span>2015</span>; El-Jawahri et al., <span>2011</span>; Fulton et al., <span>2019</span>; Gaertner et al., <span>2017</span>; Groenvold et al., <span>2017</span>; Haun et al., <span>2017</span>; Kavalieratos et al., <span>2016a</span>; Maltoni et al., <span>2016</span>; Temel et al., <span>2017</span>; Vanbutsele et al., <span>2020</span>; Zimmermann et al., <span>2014</span>). In this issue, Huo et al. and Hoomani Majdabadi et al. both synthesised the most recent evidence of the effects of early palliative care on patients with incurable cancer and concluded that patients receiving early palliative care have better quality of life (Hoomani Majdabadi et al., <span>2022</span>; Huo et al., <span>2022</span>). Huo et al. also showed that palliative care resulted in reduced symptom burden, improved mood, improved survival and increased likelihood of dying at home (Huo et al., <span>2022</span>). Early integration of palliative care not only has benefits for patients but also for family caregivers including less caregiver burden and higher quality of life (Dionne-Odom et al., <span>2015</span>; el-Jawahri et al., <span>2017</span>; Kavalieratos et al., <span>2016b</span>; McDonald et al., <span>2017</span>; O'Hara et al., <span>2010</span>). Moreover, Zomerdijk et al. complemented these results by showing that palliative care can promote preparedness of caregivers of thoracic cancer patients (Zomerdijk et al., <span>2022</span>).</p><p>This growing recognition of palliative care as an integral aspect of cancer care has led to several (inter)national guidelines to improve the integration of palliative care in oncology. However, bridgin
在这一期,我们有一个特别的副刊,重点是姑息治疗。尽管肿瘤学取得了许多进展,但患有无法治愈的癌症的人数正在增加,癌症仍然是世界上主要的死亡原因之一。2020年,近1000万人死于癌症,占全世界死亡人数的近六分之一(世卫组织,未注明日期)。患有不治之症的癌症患者需要姑息治疗。世卫组织将姑息治疗定义为一种方法,通过对疼痛和其他身体、社会心理和精神问题的早期识别和无可挑剔的评估和治疗来预防和减轻痛苦,从而改善面临与危及生命的疾病相关问题的患者及其家属的生活质量(世卫组织,n.d.b)。大量研究已经证明了早期姑息治疗的附加价值;发表在《新英格兰医学杂志》上的一项具有里程碑意义的研究表明,早期专科姑息治疗可改善转移性非小细胞肺癌患者的生活质量(Temel et al., 2010)。此外,姑息治疗对生活质量和症状负担的这些积极作用已在许多研究和荟萃分析中得到证实(Bakitas et al., 2015;Davis et al., 2015;El-Jawahri et al., 2011;Fulton et al., 2019;Gaertner et al., 2017;Groenvold et al., 2017;Haun et al., 2017;Kavalieratos等人,2016a;Maltoni et al., 2016;Temel et al., 2017;Vanbutsele et al., 2020;Zimmermann et al., 2014)。在本期中,Huo等人和Hoomani Majdabadi等人都综合了早期姑息治疗对无法治愈的癌症患者影响的最新证据,并得出结论,接受早期姑息治疗的患者生活质量更好(Hoomani Majdabadi等人,2022;霍等人,2022)。Huo等人也表明,姑息治疗可以减轻症状负担,改善情绪,提高生存率,增加在家死亡的可能性(Huo等人,2022)。早期整合姑息治疗不仅有利于患者,也有利于家庭照顾者,包括减轻照顾者负担和提高生活质量(Dionne-Odom et al., 2015;el-Jawahri et al., 2017;Kavalieratos等,2016b;McDonald等人,2017;O'Hara et al., 2010)。此外,Zomerdijk等人补充了这些结果,表明姑息治疗可以促进胸部癌症患者护理人员的准备(Zomerdijk等人,2022)。人们越来越认识到姑息治疗是癌症治疗的一个组成部分,这导致了几个(国际)国家指南,以改善姑息治疗在肿瘤学中的整合。然而,弥合研究、政策和实践之间的差距似乎具有挑战性。众所周知,仍然有许多无法治愈的癌症患者没有得到及时的姑息治疗。Mojtahedi等人的研究表明,在美国,胆囊癌(一种罕见的预后不良的癌症)住院患者中只有10%接受了姑息治疗。幸运的是,在过去10年中,这一群体使用姑息治疗的情况略有增加(Mojtahedi等人,2021年)。同样在瑞典,正如Adolfsson等人所显示的,来自各个医院部门的医生表示,尽管对姑息治疗纳入肿瘤学的好处持积极态度,但他们仍然在癌症发展的较晚阶段引入姑息治疗(Adolfsson等人,2022)。很高兴认识到,与癌症患者相比,非癌症患者在临终阶段经历了更差的医院护理,包括症状管理、情感支持和与医疗保健专业人员的沟通质量,如Kasdorf等人(2022)所示。显然,将姑息治疗整合到癌症治疗中是具有挑战性的,并且仍然不是最佳的。将姑息治疗及时纳入癌症治疗的已知障碍包括缺乏时间和对物理领域和癌症定向治疗的关注。对姑息治疗作为临终关怀的误解以及对死亡和临终的污名化也会阻碍姑息治疗的及时整合。我们如何克服这些障碍?早期识别需要姑息治疗的患者很重要,常规使用评估工具可以有所帮助。识别有潜在姑息治疗需求的患者的一个工具是惊喜问题:“如果这个病人在未来12个月内死亡,我会感到惊讶吗?”Stoppelenburg等人表明,惊喜问题可以相当好地预测住院癌症患者的死亡,并有助于更早地启动姑息治疗(Stoppelenburg等人,2022)。另一种工具是临床虚弱量表(CFS),尽管在肿瘤学领域的应用仍然有限,但Welford等人发现,在成年肿瘤住院患者中,CFS与预后和出院时的护理需求相关,可能有助于预测成年肿瘤住院患者的预后(Welford等人,2022)。 此外,在对254名晚期癌症患者亲属的横断面研究中,Bakker等人表明,尤其是那些提供更多非正式照顾的伴侣,表现出更高水平的照顾者激活。此外,照顾者的激活程度越高,照顾者负担越低,抑郁症状越少,社会幸福感越好(Bakker et al., 2022)。总之,将姑息治疗纳入癌症治疗的好处是无可争辩的,但我们仍然需要更多地了解如何,何时,何地以及由谁提供姑息治疗,以进一步推进姑息治疗纳入癌症治疗。此外,基本的姑息治疗知识和行为对于任何照顾危及生命的疾病(如无法治愈的癌症)患者的医疗保健专业人员都是必不可少的。
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引用次数: 0
Distress screening for patients with malignant diseases: Role in assuring psycho-oncological support 恶性疾病患者的痛苦筛查:在确保心理肿瘤支持中的作用
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-11-24 DOI: 10.1111/ecc.13746
Norbert Schäffeler, Stephan Zipfel, Andreas Stengel
<p>Dear Editor,</p><p>In the recently published machine-learning study by Günther et al., nonperformed distress screening was identified as a central predictor for a lack of adequate psycho-oncological care. We too are convinced that distress screening is essential for the management of psycho-oncological care and would like to underline the authors' arguments with our findings.</p><p>Our electronic screening (ePOS) has been carried out at the Comprehensive Cancer Center Tübingen-Stuttgart, Germany, since 2010. All organ cancer centres have been connected since 2017. The evaluation of the data has been approved by the local ethics committee (783/2020BO2). We use the Hornheide Screening Instrument (Strittmatter et al., <span>2002</span>) as distress measure to manage psycho-oncological care. We were able to collect complete data for <i>n</i> = 22,356 in almost 27,000 screenings carried out until 12/2021. About 29.6% of them shows distress requiring treatment. In the Distress Thermometer (<i>n</i> = 13,983), this is 50.6%. We also use PHQ-2 (<i>n</i> = 10,452) to screen for depression (15.0% suprathreshold) and GAD-2 (<i>n</i> = 8732) to screen for anxiety (17.8% suprathreshold). All measures suggest that, as hypothesised by the authors, the number of 15% of patients in contact with psychological–psychiatric care is well below need. In our two-stage screening, we explicitly ask patients ‘Do you currently need support in coping with the disease or psycho-oncological counselling?’ as a self-assessment (Schaeffeler et al., <span>2015</span>; Teufel et al., <span>2014</span>), which is 15.1% of <i>n</i> = 23,495 patients across all tumour entities and age groups affirm.</p><p>Günther et al. identified patients with skin cancer as risk group for not receiving appropriate psycho-oncological services. Filtering our screenings 24.3% of the patients in skin clinic (<i>n</i> = 8695) has an indication for psycho-oncological care according to the HSI. In this group, however, significantly fewer (6.3%) report a subjective need for themselves. This probably explains part of why the diagnosis of skin cancer was identified as a risk factor.</p><p>A second identified risk group is patients aged 65 and older at time of screening. About 26.9% of them reported an elevated distress in HSI, and 9.4% affirmed a subjective need. These proportions are higher for those younger than 64, with 31.2% overthreshold in the HSI and 18.5% with subjective need. This supports the hypothesis that younger patients will ask for support while older do less often. But we do not know if older patients possibly received other counselling instead.</p><p>A third risk group patients who do not have a psychiatric diagnosis have been identified. We do not have data on diagnosed mental illness but asked patients about current or former psychotherapy and/or psychiatric treatment. Out of <i>n</i> = 10,653 patients who answered, 8.8% were in in previous or current treatment. Of them, 47.6% are supra
亲爱的编辑,在最近发表的由g nther等人进行的机器学习研究中,未进行的痛苦筛查被确定为缺乏适当心理肿瘤护理的主要预测因素。我们也相信,痛苦筛查对于心理肿瘤护理的管理是必不可少的,并希望通过我们的发现强调作者的论点。我们的电子筛查(ePOS)自2010年以来一直在德国宾根-斯图加特综合癌症中心进行。自2017年以来,所有器官癌症中心都已联网。数据的评估已获得当地伦理委员会(783/2020BO2)的批准。我们使用Hornheide筛查仪(stritmatter et al., 2002)作为管理心理肿瘤护理的痛苦措施。我们能够在近27,000次筛查中收集到n = 22,356的完整数据,直到2021年12月。其中约29.6%的人表现出需要治疗的痛苦。在遇险温度计(n = 13,983)中,这是50.6%。我们还使用PHQ-2 (n = 10452)筛查抑郁(15.0%的阈值)和GAD-2 (n = 8732)筛查焦虑(17.8%的阈值)。所有的测量都表明,正如作者所假设的那样,15%的患者接受心理-精神治疗的人数远远低于需求。在我们的两阶段筛查中,我们明确询问患者“您目前在应对疾病方面是否需要支持或心理肿瘤咨询?”’作为自我评估(Schaeffeler et al., 2015;Teufel et al., 2014),在所有肿瘤实体和年龄组的n = 23,495名患者中,这一比例为15.1%。g nther等人将皮肤癌患者确定为未接受适当心理肿瘤服务的危险群体。筛选我们的筛查,根据HSI, 24.3%的皮肤门诊患者(n = 8695)有心理肿瘤治疗的指征。然而,在这一群体中,报告主观需求的人数明显减少(6.3%)。这可能部分解释了为什么皮肤癌被诊断为一种危险因素。第二个确定的风险群体是筛查时年龄在65岁及以上的患者。约26.9%的人报告HSI的痛苦程度升高,9.4%的人肯定有主观需求。这些比例在64岁以下的人群中更高,在恒生指数中超过阈值的比例为31.2%,主观需求为18.5%。这支持了一种假设,即年轻的患者会要求支持,而年长的患者会要求支持的次数较少。但我们不知道老年患者是否可能接受其他咨询。第三个风险群体是没有精神病诊断的患者。我们没有诊断出精神疾病的数据,但询问了患者目前或以前的心理治疗和/或精神治疗情况。在10653名回答问题的患者中,8.8%的人之前或目前正在接受治疗。其中47.6%的人HSI超过阈值,39.8%的人有主观需求。那些没有报告适当治疗但仍然表明使用不足的人的负担确实较低:28.3%的人在HSI中得分较高,15.4%的人认为主观需要治疗。不幸的是,我们在系统中没有关于肿瘤委员会的表现或住院治疗时间的可评估数据,第四组和第五组的风险。我们同意作者的观点,即用于引导心理肿瘤治疗途径的筛查可以显著改善护理——其他服务,如姑息治疗也可以包括在内。然而,我们也想指出,并非每个在筛查中表现出严重痛苦的人实际上都需要治疗,原因多种多样(例如,充分的社会心理支持,优先考虑其他问题,……)。在我们看来,如果将心理肿瘤困扰筛查与心理肿瘤服务信息相结合,并如先前报道的那样,让患者参与支持或反对这种专业支持治疗的决策过程,则可以更有效地改善护理(Schäffeler et al., 2017)。对心理肿瘤筛查治疗数据的回顾性匿名评价由负责任的伦理委员会审查并批准。作者宣称他们没有竞争利益。
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引用次数: 0
‘When I can ride my bike, I think, am I at all as sick as they say?’ An exploration of how men with advanced lung cancer form illness perceptions in everyday life “当我能骑自行车的时候,我想,我是不是真的像他们说的那样病了?”研究晚期肺癌患者如何在日常生活中形成疾病认知
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-11-16 DOI: 10.1111/ecc.13751
Jesper Larsen Maersk, Elizabeth Rosted, Line Lindahl-Jacobsen

Objective

The purpose of this study was to explore how men with advanced lung cancer form perceptions of their illness in everyday life and how this influences perceptions about rehabilitation.

Methods

Constructivist grounded theory principles guided the collection and analysis of data from in-depth interviews with 10 men with advanced lung cancer.

Results

The findings show that the men's illness perception was fluid, contextual and formed by interrelated factors. Engaging in daily activities and maintaining everyday life was a strong influence on their illness perception.

Conclusion

In order to make rehabilitation relevant to men with lung cancer, consideration should be given to how the men's everyday lives may be incorporated into the service provision.

目的探讨晚期肺癌患者如何在日常生活中形成对自己疾病的认知,以及这种认知如何影响他们对康复的认知。方法以建构主义扎根理论为指导,对10例晚期肺癌患者进行深度访谈。结果男性的疾病感知是流动的、情境性的,是由相关因素形成的。参与日常活动和维持日常生活对他们的疾病感知有很大影响。结论为了使康复与男性肺癌患者相关,应考虑如何将男性的日常生活融入到服务中。
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引用次数: 1
Patient preference attributes in eHealth interventions for cancer-related fatigue: A scoping review 电子健康干预癌症相关疲劳的患者偏好属性:范围综述
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-11-16 DOI: 10.1111/ecc.13754
Lian Beenhakker, Annemieke Witteveen, Kim A. E. Wijlens, Ester J. M. Siemerink, Marije L. van der Lee, Christina Bode, Sabine Siesling, Miriam M. R. Vollenbroek-Hutten

Introduction

Cancer-related fatigue (CRF) is one of the most reported long-term effects breast cancer patients experience after diagnosis. Many interventions for CRF are effective, however, not for every individual. Therefore, intervention advice should be adjusted to patients' preferences and characteristics. Our aim was to develop an overview of eHealth interventions and their (preference sensitive) attributes.

Methods

eHealth interventions were identified using a scoping review approach. Eligible studies included breast cancer patients and assessed CRF as outcome. Interventions were categorised as physical activity, mind–body, psychological, ‘other’ or ‘combination’. Information was extracted on various (preference sensitive) attributes, like duration, intensity, peer support and costs.

Results

Thirty-five interventions were included and divided over the intervention categories. (Preference sensitive) attributes varied both within and between these categories. Duration varied from 4 weeks to 6 months, intensity from daily to own pace. Peer support was present in seven interventions and costs were known for six.

Conclusion

eHealth interventions exist in various categories, additionally, there is much variation in (preference sensitive) attributes. This provides opportunities to implement our overview for personalised treatment recommendations for breast cancer patients struggling with CRF. Taking into account patients' preferences and characteristics suits the complexity of CRF and heterogeneity of patients.

癌症相关性疲劳(CRF)是乳腺癌患者诊断后最常见的长期影响之一。许多针对慢性肾功能衰竭的干预措施是有效的,然而,并不是对每个人都有效。因此,干预建议应根据患者的偏好和特点进行调整。我们的目的是概述电子健康干预措施及其(偏好敏感)属性。方法采用范围审查方法确定电子健康干预措施。符合条件的研究包括乳腺癌患者,并评估CRF作为结果。干预措施被分类为身体活动、身心活动、心理活动、“其他”或“组合”。从各种(偏好敏感的)属性中提取信息,如持续时间、强度、同伴支持和成本。结果共纳入35项干预措施,按干预类别划分。(偏好敏感)属性在这些类别内部和类别之间都是不同的。持续时间从4周到6个月不等,强度从每天到自己的节奏。7项干预措施中有同伴支持,6项干预措施的费用是已知的。结论电子卫生干预措施种类繁多,且(偏好敏感)属性差异较大。这为实施我们的概述提供了机会,为与CRF斗争的乳腺癌患者提供个性化治疗建议。考虑患者的偏好和特点,符合CRF的复杂性和患者的异质性。
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引用次数: 4
期刊
European Journal of Cancer Care
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