European Journal of Cancer Care最新文献

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

Objectives: Diffuse large B cell lymphoma (DLBCL) is a common and malignant subtype of lymphoma. Dysregulated lncRNA HCG18 has been reported to serve as tumor regulators in various human cancers. The expression and significance of lncRNA human leukocyte antigen complex Group 18 (HCG18) in the occurrence and development of HCG18 were confirmed in this study aiming to provide a potential biomarker for the screening and monitoring of DLBCL.

Methods: This study enrolled 82 DLBCL patients and the HCG18 levels in tissues were detected using polymerase chain reaction (PCR). Kaplan–Meier and Cox analyses were employed to assess its prognostic significance. In DLBCL cells, HCG18 was silenced by cell transfection, and its function in cell growth and metastasis was evaluated by cell counting kit-8 (CCK8) and Transwell assays.

Results: HCG18 was significantly upregulated in DLBCL tumor tissues, predicting the adverse outcomes of DLBCL patients and being correlated with the advanced malignant subtypes, Ann-Arbor stage, and high international prognostic index (IPI) of patients. In vitro, HCG18 negatively regulated the expression of miR-494-3p in DLBCL cells. Silencing HCG18 dramatically suppressed the proliferation, migration, and invasion of DLBCL cells, which was reversed by the knockdown of miR-494-3p.

Conclusions: Upregulated HCG18 served as a prognostic biomarker of DLBCL and promoted the development of DLBCL by negatively modulating miR-494-3p, which provides a candidate target for the clinical therapy of DLBCL.

Background: Telemedicine, use of telecommunication and information technology to provide remote healthcare, is an alternative to face-to-face consultations to support sustainability, increase quality and improve patient experience at lower cost. Using telephone in routine follow-up potentially improves healthcare access, convenience, and choice. However, research identifies health disparity and inequality for some. We focus on haemato-oncology due to the patients’ clinical and psychosocial vulnerability, complex disease behaviour, treatment, and care needs.

Objective: To undertake a realist review of the relevant literature to develop theories of what works, for whom, why and under what circumstances when telephone consultations are used for routine follow-up in haemato-oncology and haematopoietic stem cell transplant (HSCT).

Methods: Electronic database, grey literature and forward citation searches (using Google scholar) identified studies assessing outcomes related to telephone consultations in haemato-oncology and HSCT patients. Included studies were assessed for relevance and rigour. Relationships between contexts (C), mechanisms (M), and outcomes (O) were extracted from sources. CMO configurations were developed and refined iteratively. A stakeholder group of cancer patients contributed to their refinement.

Results: Eleven included studies were synthesised. Final programme theory was developed from 19 CMOCs and included five inter-related themes: healthcare professional (HCP) relationship, confidence in telephone telemedicine, receiving care closer to home, COVID-19 and service resources. Findings highlight the importance of considering context at different levels: individual, interpersonal, institutional, and infrastructural. Final theory shows that key contextual factors (e.g., patient-HCP relationship) influence the workings of key mechanisms (e.g, trust and adherence) in producing outcomes and explain why, how and for whom telephone consultation works in this context.

Conclusions: This is the first realist synthesis in this area. The final programme theory suggests that individual patient-related contextual factors and the HCP-patient relationship should be considered by health professionals offering telephone consultations since these factors likely influence health inequality and patient safety.

Background: The persistence of CD8⁺ Tex in the tumor microenvironment and their interactions with tumor cells and other immune cells are the keys to tumor immune escape and treatment failure. Transcription factors play a key role in the regulation of gene expression in cells. Few studies have fully clarified the characteristics of T cell exhaustion transcription factors in SKCM.

Methods: In the TCGA, GSE54467, GSE59455, and GSE65904 cohorts, an integrative machine learning analysis procedure comprising 10 algorithms was performed to develop a T cell exhaustion transcription factor signature (TTS). The relevance of TTS in predicting the advantages of immunotherapy was assessed using a number of measures, including tumor immune dysfunction and exclusion (TIDE) score, tumor mutation burden (TMB) score, immunophenoscore, intratumor heterogeneity score, and three immunotherapy datasets (IMvigor210, GSE91061, and GSE78220).

Results: The optimal prognostic TTS developed by the LASSO algorithm acted as an independent risk factor and had a stable and powerful performance in predicting the overall survival rate of SKCM patients, with the AUC of 1-, 3-, and 5-year ROC curve being 0.785, 0.812, and 0.839 in the TCGA cohort. SKCM patients with low TTS scores exhibited a lower TIDE score, lower immune escape score, lower intratumor heterogeneity score and higher TMB score, and higher PD1 and CTLA4 immunophenoscore. Gene sets implicated in angiogenesis, NOTCH signaling, hypoxia, and glycolysis exhibited lower scores in SKCM patients with low TTS scores. In vitro experiments showed that FOXM1 was upregulated in SKCM and knockout of FOXM1 inhibited tumor cell proliferation.

Conclusion: The current study constructed a novel TTS in SKCM, which acted as an indicator for predicting the clinical outcome and immunotherapy response of SKCM patients.

Background: Breast cancer is the most common cancer diagnosis among women in Sweden, and 20% of cases are women younger than 50 years. For many of these women, the diagnosis occurs during a period of active parenting, when they are responsible for the emotional and practical care of young children. This dual burden, coping with a life-threatening illness while maintaining a caregiving role, can lead to increased emotional strain, altered family dynamics and challenges in communication and support. The aim of this qualitative study was to explore the parenting experiences of women with breast cancer who have minor children, focusing on challenges, needs and interactions with the healthcare services.

Methods: A self-selected sample of 131 mothers, living in Sweden, aged 25–60 years, who were diagnosed within the past five years participated. Participants were recruited via social media, patient organizations and oncology clinics. An online questionnaire was used to collect data between January and May 2023, which consisted of, among other things, sociodemographic information and an open-ended question about parenthood. The responses to the open-ended question were analysed using conventional content analysis.

Results: The analysis resulted in five categories: a significant impact on mothering and an increased emotional burden; challenges in communication within the family; a broad range of experiences of healthcare support from significantly lacking to positive experiences; the need for emotional and practical support from family, partners, relatives and school and the emotional and social impact on the children.

Conclusion: The findings highlight that there is a clear need for more accessible and structured support from the healthcare services to address the unique needs of mothers with breast cancer and their children, ensuring better communication, psychosocial care and practical assistance throughout the illness trajectory.

Objective: Research has been conducted worldwide from the perspective of data detection in the hope of understanding the factors influencing the survival of stage IV cancer patients. However, the majority of existing research has only focused on single influencing variables. We collected the basic information, cancer type, sites of metastasis, performance status, pain, comorbidities, and relevant laboratory test data of inpatients with stage IV cancer to conduct a comprehensive assessment of the factors influencing survival period.

Methods: A cohort study design was adopted, in which data were collected from the medical records of stage IV cancer patients undergoing cancer treatment at a teaching hospital in Northern Taiwan from January 2018 to December 2022.

Results: Data were collected from the medical records of 739 stage IV cancer patients, among whom 488 patients passed away. The mortality risks of patients who had gastric or esophageal cancer and those who had hepatic cancer, cholangiocarcinoma, or pancreatic cancer were higher than those who had head and neck cancer. Furthermore, the mortality risks were higher for those with a body mass index (BMI) < 25 kg/m², liver metastases, Eastern Cooperative Oncology Group performance status scores of 2 or higher, and peptic ulcers. Regarding blood test values, the mortality risks of stage IV cancer patients with albumin < 3.5 g/dL, hemoglobin (Hgb) < 10.0 gm/dL, and C-reactive protein (CRP) ≥ 10.0 gm/dL were also higher.

Conclusions: Cancer stage and metastasis conditions are beyond their control; however, effort can be devoted to maintaining the BMI and performance status of stage IV cancer patients, treating their peptic ulcers, and monitoring their albumin, Hgb, and CRP levels. These variables can serve as a reference for medical personnel in care decisions regarding stage IV cancer patients.