European Journal of Cancer Care最新文献

Background: Breast cancer survivors (BCSs) often face long-term complications, with upper-limb lymphedema and cancer-related fatigue (CRF) being challenging. This study aimed to investigate the relationship between upper-limb lymphedema and fatigue among BCSs.

Method: This cross-sectional study was performed on 102 BCSs, of which 31 (30.4%) had breast cancer–related lymphedema. Duration, stage, and excess volume were considered as indicators of breast cancer–related lymphedema severity. QoL was measured using the EORTC QLQ-C30. The score of the fatigue symptom scale was used based on EORTC QLQ-C30 for CRF assessment. Also, the brief fatigue inventory was used to measure the severity of fatigue among participants.

Results: The mean fatigue symptom scale and brief fatigue inventory scores were 37.90 ± 24.59 and 3.69 ± 1.25, respectively. The mean fatigue symptom scale was significantly different among BCSs with BMI ≤ 25 and BMI > 25 (29.59 ± 24.49 vs. 41.51 ± 23.88, p = 0.026). Also, the mean brief fatigue inventory was significantly different among BCSs with the number of dissected lymph nodes (LNs) ≤ 5 and > 5 (3.52 ± 1.18 vs. 4.08 ± 1.34, p = 0.042). Additionally, women with breast cancer–related lymphedema had significantly higher scores of fatigue symptom scale and brief fatigue inventory (46.59 ± 27.12 vs. 34.11 ± 22.56, p = 0.03, and 4.75 ± 1.21 vs. 3.22 ± 0.96, p = 0.001, respectively). Except for a weak correlation between BMI and fatigue symptom scale and brief fatigue inventory (r: 0.279, p = 0.004, and r: 0.313, p = 0.001, respectively), there was no other significant relationship between CRF and study variables such as breast cancer–related lymphedema duration, stage, and excess volume. Meanwhile, fatigue symptom scale and brief fatigue inventory were significantly correlated with global health and functional scale scores of EORTC QLQ-C30. The ROC curve which models the diagnostic efficacy for fatigue symptom scale showed an AUC of 0.634 (p = 0.034, 95% CI: 0.510–0.759), while the ROC curve which models the diagnostic efficacy for brief fatigue inventory showed an AUC of 0.821 (p < 0.001, 95% CI: 0.735–0.908).

Conclusion: This study highlighted that while breast cancer–related lymphedema was associated with increased CRF, the severity of lymphedema did not significantly correlate with CRF. Additionally, CRF might be an indicator of breast cancer–related lymphedema among BCSs.

Purpose: To understand the consequences of diseases and treatment such as cancer and thus the needs of patients for surveillance and care and to improve quality of life, patients should be assessed using a holistic approach. However, instruments to create such a holistic view do not exist and the development presents unique challenges. Therefore, this study presents a method for the development of a holistic assessment questionnaire using cancer-related fatigue (CRF) as a case.

Method: We started with (1) the definition of our construct of interest (CRF) on the theme level followed by (2) item selection, an iterative process of searching for validated questionnaires that together cover the full holistic construct. The construct definition on theme level (1) was too broad and was, therefore, redefined on the element level (construct > theme > element) based on interviews with relevant stakeholders. Hereafter, item selection (2) was performed on the element level based on a priority list, psychometric properties (e.g., discriminative parameter value) and consultation of experts and future users. Lastly, (3) items were reformulated.

Results: Initial CRF construct definition (1) resulted in 110 relevant validated questionnaires with over three thousand items, requiring a construct redefinition on element level. Seventy-two items from 21 validated questionnaires were included (2) in the preliminary holistic assessment questionnaire. For item reformulation (3), easy language was used to better suit the target population.

Conclusion: Tailoring care to the individual requires a holistic view. This article presents a novel method to develop a holistic assessment questionnaire, including an example for CRF, with several recommendations for cancer-specific instrument development. Although the development process of a holistic assessment questionnaire is time-consuming, more late and long-term effects of cancer are multidimensional and could benefit from a holistic approach in their assessment to enable personalised care, thereby improving quality of life and reducing societal impact.

Aim: The faecal immunochemical test (FIT) is now widely used in English primary care to triage people who exhibit signs or symptoms of colorectal cancer (CRC). National guidelines for FIT implementation were based on data that acknowledged limitations. This study examines FIT accuracy in primary care patients with low- and high-risk symptoms of CRC.

Methods: This study describes a retrospective cohort study in South Yorkshire, UK (n = 2029). Consecutive symptomatic adult patients in primary care undergoing a FIT between 01/04/2021 and 30/04/2021 were assessed. A threshold > 10 μg Hb/g was defined as a positive FIT result. Lower gastrointestinal tract (LGI) investigations were the reference standard. Follow-up over 24 months was used to identify serious colorectal diseases (CRC, high-risk polyps and inflammatory bowel disease [IBD]).

Results: Five hundred and fifteen (25.4%) patients had a positive FIT. The CRC prevalence was 1.2% (24/2029). Nineteen (79.1%) of the 24 CRC cases had NG12 symptoms, with two (8.3%) having a negative FIT. For CRC detection, FIT showed 91.7% sensitivity (95% CI: 71.5%–98.5%), 75.4% specificity (95% CI: 73.4%–77.2%), 4.3% positive predictive value (PPV) (95% CI: 2.8%–6.5%) and 99.9% negative predictive value (NPV) (95% CI: 99.5%–99.97%). Combining CRC, high-risk polyps and IBD increased PPV and specificity but decreased sensitivity and NPV.

Conclusions: In primary care, FIT safely triages patients having at-risk CRC risk symptoms. Negative FIT results indicate a low likelihood of CRC and supports safety-netting interventions.

Background: Long noncoding RNAs (lncRNAs) are reported that play an important role in regulating tumorigenesis. This study aims to develop a ferroptosis-related lncRNA gene signature for predicting biochemical recurrence of prostate cancer (PCa) and prove a functional lncRNA BCRP3 as a promotor toward PCa progression.

Methods: The ferroptosis-related lncRNA were identified by interoperating the databases of The Cancer Genome Atlas (TCGA) and FerrDb. A predictive model for biochemical recurrence of PCa was established based on the LASSO Cox regression. Kaplan–Meier cures were applied in the measurement of the impact on patients’ survival caused by key lncRNAs. Meanwhile, the molecular assays of CCK8, EdU, wound healing, and Transwell were conducted to evaluate the tumor-suppressive effect of BCRP3 in vitro.

Results: This study presented that 17 differentially expressed ferroptosis-related lncRNAs were confirmed and further screened out 9 key lncRNAs for the establishment of risk model. The nomogram involved the risk model was also proved with an excellent predictive performance toward 1-, 3-, and 5-year survival with the area of curves (AUC) as 0.77, 0.79, and 0.65 separately. Notably, the lncRNA BCRP3 was significantly correlated with the survival of PCa patients based on multivariate Cox regression. Additionally, downregulation of BCRP3 effectively inhibited the proliferation, migration, and invasion of PC3 cells which further proved its anti-tumor function.

Conclusion: We developed a ferroptosis-related lncRNA risk model for predicting biochemical recurrence, which assisting in the clinical therapy of patients with PCa.

Purpose: To investigate the relationship between the changes of lactate dehydrogenase (LDH), neuron-specific enolase (NSE), keratin-19 fragment antigen 21-1 (cyfra21-1), and liver metastases of lung cancer.

Methods: Eighty patients who had lung cancer that had spread to their liver diagnosed in our hospital from October 2021 to October 2023 (Group A), 80 individuals with advanced lung cancer who have metastasized to other sites (Group B), and 80 individuals with lung cancer who have not spread (control group) were selected as the study objects. LDH, NSE, and serum cyfra21-1 levels of patients in the three groups were detected, and pathological results were used as the diagnostic gold standard. ROC curves were drawn to examine the clinical value of NSE, cyfra21-1, and LDH levels in the distinct types of lung cancer identification of liver metastases.

Results: There was no remarkable variation in pathological types among the three groups (p > 0.05), but there were remarkable variations in TNM stage and lymph node metastasis among the three groups (p < 0.05). The levels of cyfra21-1, NSE, and LDH in Group A and Group B were greater compared to those in the control group (p < 0.05), and the levels of cyfra21-1, NSE, and LDH in Group A were greater compared to those in Group B (p < 0.05). The critical value, sensitivity, specificity, and area under the curve (AUC) of serum cyfra21-1 in the distinct identification of liver metastasis of lung cancer were 8.22 ng/mL, 37.42%, 65.18%, and 0.508, respectively. The critical value, sensitivity, specificity, and AUC of NSE for distinct types of lung cancer identification of liver metastases were 23.96 ng/mL, 64.56%, 81.23%, and 0.723, respectively. The critical value, sensitivity, specificity, and AUC of LDH for differential diagnosis of liver metastasis of lung cancer were 304.78 U/L, 75.65%, 85.73%, and 0.821.

Conclusion: The serum levels of NSE, cyfra21-1, and LDH in patients with liver metastasis of lung cancer were remarkably greater compared to patients without liver metastasis, which can be useful as a clinical auxiliary in determining lung cancer metastasis.

Objective. The number of cancer survivors is increasing, and the high prevalence of frailty not only reduces quality of life but also affects the treatment of cancer patients. This study aimed to identify the prevalence and risk factors of frailty in cancer patients and to construct a nomogram to predict the probability of frailty. Methods. Nine hundred fifty-eight cancer patients were included in this retrospective study, randomly divided into a development set (n = 680) and a validation set (n = 278). Frailty was assessed using the Tilburg frailty indicator (TFI). Social support, medical coping styles, and psychological distress were assessed by the Social Support Self-Rating Scale (SSRS), Medical Coping Modes Questionnaire (MCMQ), and distress thermometer (DT), respectively. Results. The prevalence of frailty in cancer patients was 45.93%. Cancer patients who exercised regularly, ate a balanced diet, and actively coped with diseases were less likely to become frail. The risk factors for frailty identified by a multivariate analysis were parenteral nutrition, advanced TNM staging, vegetarian diet, unemployment, psychological distress ≥4, low physical activity, and negative coping styles. These risk factors were used to construct a nomogram, and the C-index, calibration curve, and decision curve analysis (DCA) were used to assess the performance of the nomogram. The C-index was 0.762, and the calibration curve showed satisfactory coherence. The net benefit of the nomogram was better between threshold probabilities of 17%–96% in DCA. Conclusion. Special focus needs to be placed on frail cancer patients due to their high prevalence and severe outcomes. Clinical medical workers could use this nomogram to identify high-risk patients and intervene early to prevent frailty.

Objective. Decision-making in advanced cancer with a limited prognosis is particularly challenging: constantly evolving therapeutic algorithms with new treatment options that show marginal benefits have to be balanced with end-of-life decision-making. But existing decision support tools for advanced cancer patients are rare, not routinely used in clinical practice and do not sufficiently meet patients’ needs. Therefore, our project explores the experienced decision-making process in advanced lung cancer to derive recommendations for the use of shared decision-making in this context. Methods. 20 semistructured interviews with lung cancer patients, their relatives, and healthcare professionals were conducted. All data were transcribed verbatim and analyzed with a thematic content analysis. Results. The decision-making process of advanced cancer patients is mainly characterized by a lack of perceived options. Physicians do not adequately present palliative care as an alternative or additional support for these patients. Being confronted with limited options that only include active cancer treatment patients tend to choose a more paternalistic decision model leaving the treatment decision to their physicians and accepting aggressive treatments uncritically. Conclusion. A paternalistic decision-making model in advanced cancer may neglect individual wishes, values, and preferences of patients and promote a feeling of powerlessness. Empowerment of these patients is needed with context-specific SDM tools and trainings of professionals to avoid overtreatment and facilitate the timely integration of palliative care. This trial is registered in DRKS00023674.

Objective. To explore the factors influencing the spiritual care needs of patients with advanced cancer. Method. A sample of 321 patients with advanced cancer, who have been treated in the Affiliated Cancer Hospital of Zhengzhou University from December 2022 to February 2023, was recruited. Clinical data of patients participating in this study were collected via a customized questionnaire. The validated Chinese version of the spiritual care needs scale was used to evaluate patients’ spiritual care needs. Statistical analyses included the unpaired t-test, analysis of variance, and multiple linear regression. Result. The average score of spiritual care needs was 33.81 ± 7.76 points. Multiple regression analysis revealed that age (t = 4.24 and P < 0.01), occupation (t = 2.971 and P < 0.01), and alcohol consumption (t = 3.477 and P < 0.01) significantly influenced spiritual care needs. Patients with age, occupation, and alcohol consumption negatively impact spiritual needs, that is, the older the age, the smaller the spiritual needs. Individuals who engaged in business units, individual businesses, or had a drinking habit had lower spiritual needs. Conclusion. The scores of spiritual care needs in patients with advanced cancer were influenced by factors such as age, occupation, and alcohol consumption.

Objective. To estimate proportions of contacts to the general practitioner (GP) among people with specific and nonspecific lung cancer symptoms, respectively, in the Danish general population and to analyse the associations between health literacy and these contacts based on smoking status. Methods. A total of 67,280 randomly selected individuals aged ≥40 years were invited to a survey concerning symptoms and healthcare seeking. This study included lung cancer symptoms, GP contacts, smoking status, four aspects of health literacy, and socioeconomics. Descriptive statistics and multivariable logistic regression models were applied. Results. Of 22,055 respondents, 23% reported at least one specific lung cancer symptom, while 47% reported at least one nonspecific symptom. GP contacts ranged from 30% (tiredness) to 60% (shortness of breath). Individuals who currently smoke had lower odds of GP contacts. The health literacy aspect “Feeling understood and supported” increased the likelihood of GP contact, while “Having sufficient information” decreased the likelihood. Smoking status did not modify these associations. Conclusion. Efforts targeting individuals at risk of postponing healthcare seeking with lung cancer symptoms are needed. This study highlights aspects of health literacy that may be addressed in interventions increasing both individuals and community-based health literacy responsiveness and enhanced chances of timely healthcare seeking.

Background. T cell exhaustion (TEX) is a state of T cells that is characterized by poor function of effectors and increased expression of inhibitory signals. However, the heterogeneity and prognostic values of TEX in lung adenocarcinoma (LUAD) remain not fully understood. Methods. Based on the Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) transcriptomic profiles, we screened differentially expressed lncRNAs, miRNAs, and mRNAs and identified differentially expressed TEXs. Univariate cox and LASSO regression analyses were performed to construct TEX-related prognostic signature and risk score and validated their expression using real-time PCR assay. We then investigated the potential mechanism, immune landscape, and antitumor therapy response in LUAD. Results. A total of 315 DE-lncRNAs, 161 DE-miRNAs, and 2589 DEGs were screened, and then 80 DE-TEXGs were identified in LUAD. Based on univariate cox and LASSO regression analyses, CCNA2 and SLC2A1 were identified as TEX-related prognostic signatures, and the risk score subsequently was calculated. LUAD patients were divided into high- and low-risk groups, and high-risk groups were involved in poor survival status, immunosuppression, and more sensitive to anti-CTLA4 therapy. Finally, a TEX-related ceRNA network was constructed and validated based on DE-lncRNAs, DE-miRNAs, and TEX-related prognostic signatures. Conclusion. We constructed the TEX-related prognostic signature and its relevant ceRNA network and discovered the molecular mechanism and prognostic values of TEX in LUAD.