European Journal of Cancer Care最新文献

Background: Disruptions in activity-rest rhythms are common in terminal cancer patients, yet continuous monitoring of these changes is challenging. The effects of opioids and psychotropic drugs on sleep quality remain inadequately understood.

Objectives: (i) To objectively evaluate temporal changes in diurnal (8:00 a.m.–8:00 p.m.) and nocturnal (8:00 p.m.–8:00 a.m.) activity-rest rhythms over the final 2 weeks of life in terminal cancer patients using a nonwearable actigraph and (ii) to assess the adjusted impact of opioid and psychotropic drug use on these rhythms.

Design: A longitudinal study.

Settings/Participants: Twenty-six terminal cancer patients in a Japanese palliative care unit.

Measurements: A nonwearable actigraph was placed under the mattress to continuously monitor activity-rest rhythms. Measured parameters included time in bed (TIB: minutes), total sleep time (TST), wake after sleep onset (WASO), sleep efficiency (SE: 0%–100%), activity score (0–960 counts/min; higher values indicate greater activity), and movement index (MI: percentage of time moving in bed; higher values suggest restlessness).

Results: As death approached, diurnal TIB and SE increased, indicating reduced daytime activity. Nocturnal sleep metrics fluctuated irregularly, with an increase in MI, suggesting deteriorating sleep quality. Opioid users exhibited a higher MI and lower SE both day and night compared to nonusers. Psychotropic drug users showed a decreased nocturnal MI and improved SE.

Conclusion: Terminal cancer patients experience decreased daytime activity and unstable nocturnal sleep as death nears. Opioid use correlates with inadequate rest, while psychotropic drugs may enhance nocturnal sleep quality. Continuous nonwearable monitoring offers valuable insights for optimizing end-of-life care.

Background: The growing number of breast cancer survivors underscores the need for tailored follow-up care, particularly focussing on person-centred outcomes in surgical follow-ups. Electronic patient-reported outcome measures (ePROMs) have the potential to enhance person-centred care (PCC) by systematically integrating patient perspectives into clinical practice. However, the barriers and facilitators for the utilization of ePROMs in surgical breast cancer follow-ups remain unclear.

Methods: This study utilized a sequential explanatory mixed-methods design. Quantitative data were collected via a survey among healthcare professionals (HCPs) to assess their familiarity with and perspectives on ePROMs. These findings informed focussed ethnographic qualitative research, including participant observations and interviews, to explore the practical application of ePROMs in clinical practice. Data integration involved a joint display analysis to develop comprehensive insights.

Results: While most HCPs (88%) expressed interest in learning more about ePROMs, only 20% agreed that ePROMs improved treatment and care. Time constraints (reported by 56%) and limited system integration (68% were unfamiliar with access via EMR) were reported as key barriers. Nurses prioritized experiential and patient-specific approaches, often relying on intuition rather than systematic use of ePROMs, whereas surgeons viewed ePROMs as tools for improving resource allocation and surgical outcomes. Knowledge gaps and a lack of organizational support were prevalent, hindering the consistent application of ePROMs in routine care.

Conclusions: ePROMs have untapped potential to transform surgical follow-ups in breast cancer care by aligning clinical practices with person-centred outcomes. Effective integration requires addressing technical and organizational barriers, enhancing HCPs’ competencies and fostering a supportive culture for systematic ePROM utilization. Tailored implementation strategies are a key to fully realizing the benefits of ePROMs in achieving PCC.

Cancer is a major health priority in Europe and the risk of mortality is greater than for any other disease. Cancer care is complex, and interprofessional care has been identified as a key aspect in providing best-practice treatment and care for patients with cancer. Proximity of providers and fruitful interactions within the cancer care network are relevant to collaborative care models to tackle the complexity of cancer care. Pharmacists have been increasingly recognized as being well positioned to promote health and educate patients about their diseases and the appropriate use of prescribed medicines including anticancer agents. Although hospital pharmacists are acknowledged members of cancer care teams, community pharmacists are an untapped health resource, not fully integrated into the cancer care network, and often perceived as mere drug sellers rather than potential cancer patient allies. In this work, a panel of European experts explored the role of pharmacists and their integration into the cancer care network and developed actionable suggestions to take advantage of pharmacists’ role as medication experts with the final aim of optimizing cancer care.

Background: Electrochemotherapy (ECT) has emerged as a promising targeted therapy to enhance drug delivery and minimize systemic side effects in cancer patients. However, concerns about tumor lysis syndrome (TLS) and other complications persist, particularly in patients with large solid tumors.

Methods: This study evaluated the clinical outcomes, adverse effects including TLS occurrence and survival rates of ECT in 15 patients with advanced or metastatic solid tumors at Emam Khomeini Hospital from November 2023 to November 2024.

Results: The study included 15 patients (60% female, 40% male) with a median age of 55 years. Tumor types included sarcoma (20%), squamous cell carcinoma (40%), invasive ductal carcinoma (33%), and angiosarcoma (7%). Eleven patients achieved complete remission, while four showed partial response. No cases of stable disease or progression were observed. The mean tumor area reduction was 90%, with an 84% overall survival rate for 3 months. No patients developed TLS, and adverse effects were minimal, with only four patients experiencing transient acidosis post-ECT. There was no significant difference between disease-free survival (DFS) of various tumor types, while recurrent tumors had better DFS in comparison with nonrecurrent ones.

Conclusion: This study confirms ECT as an effective and safe treatment for large solid tumors, with significant tumor regression and no serious complications such as TLS. These findings support ECT as a viable alternative method for patients with primary tumors, inoperable or treatment-resistant ones.

Objectives: This study aimed to identify factors that influence appointment adherence in postradiotherapy surveillance (PRS) and to evaluate the impact of a telephone reminder system on improving patient adherence among breast and prostate cancer patients.

Methods: A retrospective cross-sectional study was conducted to analyze data from patients scheduled for PRS within a period of 6 months. A total of 468 consecutive patients who were treated with breast or prostate irradiation were divided into two groups: those who attended their appointments and those who did not. Telephone reminders were used as interventions for nonattendees, with a first reminder (I1) followed by a second reminder (I2) in case of nonresponse. Data analysis included univariate and multivariable models to assess factors that affect adherence.

Results: Out of 468 patients, 363 patients (77.6%) initially attended their scheduled appointments. The first telephone reminder increased adherence to 92.7% (434/468 patients). A second reminder further increased the attendance rate to 94.7% (443/468 patients). Marital status was a significant factor, with single individuals having more than three times the odds of nonattendance compared to married individuals. A trend toward significance was found for cigarette smoking as a possible further factor for nonattendance. No significant difference was found between the two groups in any of the other patient-, tumor- or treatment-related characteristics.

Conclusions: Telephone reminders significantly increase appointment adherence in PRS practice, with the first reminder showing the most substantial effect. Single patients have a particularly high risk of nonparticipation, highlighting the need for targeted interventions.

Advances in Knowledge: This study demonstrates the effectiveness of telephone reminders as a cost-effective strategy to improve adherence in PRS surveillance practice, particularly among the high-risk groups, such as single patients.

In some cases, against medical advice, a person with cancer decides not to undergo any conventional, evidence-based cancer treatments including chemotherapy, radiotherapy hormone therapy and others. Estimates for treatment refusal range from 2.6% to 14.55%. Refusing evidence-based conventional cancer treatments is linked to rapid deterioration, poor prognosis and a higher risk of premature death. This study aimed to explore oncology health professionals’ experiences and views on why patients refuse standard cancer treatments. We employed an in-depth qualitative research design, adopting a social constructionist framework. Fourteen health professionals in Western Australia (WA) with experience working in oncology were interviewed. Four themes were identified: ‘They want to do it their way’; ‘Keeping the door open’; ‘It can be draining’; and ‘Where to from here?’. We found that treatment refusal had a disproportionate impact on individuals, families, health professionals and the health system, including time spent engaging with patients contemplating refusing treatment. The issue is complex and multifaceted, with several motivations for treatment refusal. Statistics on 5-year survival rates need to be presented in a number of ways so that people understand what these statistics mean. General information on cancer regarding incidence, treatments and survival rates could be presented via social media so that we reach more people. Supports for oncology health professionals are needed including training to prevent compassion fatigue and burnout.

Objectives: To perform a cost-effectiveness analysis based on primary data from a cohort of patients with localized prostate cancer followed throughout 10 years, comparing radical prostatectomy, brachytherapy, and external beam radiotherapy (EBRT) and applying disease-specific utilities, from a national health system’s perspective.

Materials and Methods: Patients diagnosed with localized prostate cancer were consecutively recruited in 2003–2005 from 10 Spanish hospitals (n = 674) (ClinicalTrials.gov number: NCT01492751). The expanded prostate cancer index composite (EPIC) and short-form 36 (SF-36) questionnaires were administered through telephone interviews before treatment and annually during follow-up. The outcome measures to evaluate the incremental cost-effectiveness ratio between treatments (ICER) were quality-adjusted life-years (QALYs), calculated by the patient-oriented prostate utility scale (PORPUS) utility index, obtained with a mapping from the EPIC and the SF-36, and survival data. Ten-year medical activities were used to derive costs. Both unweighted and propensity score-weighted analyses were performed.

Results: The weighted mean of 10-year QALYs was the highest for radical prostatectomy (8.53), followed by brachytherapy (8.49) and external radiotherapy (8.20), but the difference was only statistically significant with the latter. Costs were significantly higher for brachytherapy (€21,348) than radical prostatectomy (€12,281) and EBRT (€7,560). Compared to EBRT, the weighted ICER for radical prostatectomy was €14,169/QALY gained and €48,417/QALY for brachytherapy.

Conclusion: Our findings support that radical prostatectomy was the most cost-effective alternative, but the differences in effectiveness among the three treatments were small. The incremental cost of radical prostatectomy and brachytherapy compared to EBRT, however, does not justify restricting these alternatives.

Trial Registration: ClinicalTrials.gov identifier: NCT01492751

Objectives: Self-reported health-related quality of life (HRQoL) is a critical metric for evaluating clinical outcomes. Although the HRQoL of patients with nasopharyngeal carcinoma (NPC) has been widely studied, the performance of these assessments in clinical practice remains uncertain, and there is a significant gap in the quality evaluation of the scales used. This review aimed to systematically evaluate self-reported HRQoL scales for patients with NPC, thereby providing guidelines for the informed selection of assessment tools.

Design: A systematic review based on the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology and following the PRISMA guidelines.

Methods: PubMed, Web of Science, Embase, CINAHL, PsycINFO, CNKI, SinoMed, and WanFang databases were systematically searched from their inception until August 2024. The included studies must report the assessment of measurement properties of HRQoL scales designed for NPC. Two authors independently screened the eligible literature, extracted data, and evaluated their methodological and psychometric quality. The measurement properties of HRQoL scales for NPC were evaluated according to COSMIN systematic review guidelines. Additionally, the GRADE approach was used to grade the quality of evidence.

Results: Among 17 instruments across 19 studies, all demonstrated adequate content validity, construct validity, and internal consistency. However, information on cross-cultural validity, criterion validity, reliability, hypothesis testing, and responsiveness was limited. High-quality evidence on psychometric properties was provided for HRQoL instruments for Cancer Patients-Nasopharyngeal Cancer (QLICP-NA), the Functional Assessment of Cancer Therapy-Nasopharyngeal (FACT-NP), and the Quality of Life Scale for Nasopharyngeal Carcinoma Patients Version 2 (QoL-NPC V2).

Conclusion: The measurement characteristics of QLICP-NA, FACT-NP, and QoL-NPC V2 scales were comprehensively assessed, exhibiting good methodological quality, strong measurement attributes, and robust supporting evidence. Therefore, these scales are recommended for evaluating the quality of life of patients with NPC. However, further validation of the remaining assessment tools is required.

Relevance to Clinical Practice: Our findings will help healthcare professionals select suitable instruments for patients with NPC.

Introduction: Individuals with Li–Fraumeni syndrome (LFS) face an increased risk for multiple cancers. LFS is caused by pathogenic variants in the TP53 gene and individuals with LFS are recommended intense cancer surveillance programs to improve survival. Unmet supportive care needs (uSCN) are understudied for this rare condition. This study aims to investigate uSCN to draw implications for improving healthcare for individuals with LFS in Germany.

Methods: Using a mixed-methods approach, affected individuals completed the German version of the Supportive Care Needs Survey Short Form (SCNS-SF-34) and semistructured qualitative interviews. Participants were recruited through newsletters, social media, personal contact, and during routine surveillance appointments at University Hospital Heidelberg and Hannover Medical School between March 2020 and June 2021. Descriptive statistics were used to analyze the quantitative data. The interviews were audio-recorded, transcribed, and analyzed via content analysis.

Results: Seventy individuals with LFS completed the survey, from which 20 have also participated in the qualitative interview. The highest number of unmet needs was indicated by the domain “psychological needs” (M = 36.90, SD = 28.91), followed by “information and health system needs” (M = 26.97, SD = 25.17). An unmet need in the domain “sexuality” was indicated by 25%–33% of participants. Interview analysis revealed four main need categories: psychological, health system and information, communication, and daily living.

Conclusion: Individuals with LFS reported primarily unmet psychological and informational needs. Unmet needs may dynamically change during the different trajectories of individuals with LFS (initial diagnosis, surveillance, cancer onset, and treatment). A regular assessment and increased awareness for uSCN would be beneficial for addressing different needs at different time points.

Background: Ovarian cancer is the third most prevalent gynecological malignancy globally. M2 macrophages play crucial roles in promoting angiogenesis, cancer cell proliferation, metastasis, and immunosuppression.

Methods: We identified markers associated with M2 macrophages using weighted gene co-expression network analysis. A machine learning approach, encompassing ten algorithms, was employed to construct a macrophage M2-related signature (MRS) based on data from TCGA, GSE14764, and GSE140082 datasets. The predictive value of MRS for immunotherapy response was assessed using immunophenoscore, TIDE score, tumor mutational burden (TMB) score, and immune escape score.

Results: The optimal MRS, developed using the lasso algorithm, emerged as an independent risk factor and demonstrated robust performance in predicting overall survival in ovarian cancer patients. The C-index of our MRS surpassed that of clinical stage, tumor grade, and several established prognostic signatures. Patients with lower risk score exhibited higher ESTIMATE score, increased levels of immune cells, elevated PDI and CTLA4 immunophenoscore, higher TMB score, lower TIDE score, reduced immune escape score, and decreased IC50 values for certain drugs. The nomogram for survival prediction showed significant potential for clinical application in forecasting 1-, 3-, and 5-year overall survival rates in ovarian cancer patients.

Conclusion: Our study developed a stable MRS for ovarian cancer, which serves as a valuable indicator for predicting prognosis and drug sensitivity in this disease. Further prospective studies should be performed to further explore the role of MRS in predicting the clinical outcome and immunotherapy benefits of ovarian cancer patients.

Trial Registration: ClinicalTrials.gov identifier: NCT02108652