European Journal of Cancer Care最新文献

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.

Objective: The use of immune checkpoint inhibitors in cancer treatment provides significant clinical benefits, but it is also associated with some side effects. While these drugs enable the immune system to respond more aggressively to cancer cells, they can sometimes lead to excessive immune responses that may damage normal tissues. This qualitative study aims to explore the experiences of cancer patients receiving immunotherapy.

Methods: This study is a qualitative research conducted on the experiences of cancer patients receiving immunotherapy at a university hospital in Istanbul, Turkey, between June 2024 and January 2025. The standards for reporting qualitative research studies reporting guidelines were used to report this study. Data collection was conducted through semistructured face-to-face interviews.

Results: This study explores the experiences of cancer patients undergoing immune checkpoint inhibitor treatment. The research identified five main themes. These themes include patients’ anxiety and uncertainty about the disease process, their need for information, feelings of trust, expectations for the future and hope, economic problems, and financial burdens, as well as gaps in knowledge regarding treatment-related toxic effects.

Conclusion: This research has provided valuable insights into the experiences and challenges faced by cancer patients receiving immune checkpoint inhibitor treatment. It highlights the need for healthcare professionals to inform patients about the treatment process and potential side effects and to properly manage their expectations regarding the effectiveness of the treatment.

Background and Objectives: Cancer-related fatigue is a multifactorial condition that affects most people undergoing chemotherapy. To elucidate potential biological underpinnings of fatigue, this study tested correlations between patient-reported fatigue and (1) functional measures and (2) transcriptomics of whole blood.

Methods: Women undergoing chemotherapy were recruited to a cross-sectional study. Participants reported subjective fatigue on the Functional Assessment for Chronic Illness Therapy-Fatigue (FACIT-F) and Brief Fatigue Inventory (BFI) questionnaires. Participants completed upper- and lower-body functional assessments as an objective fatigability measure. Fasted blood samples were analyzed for complete blood counts (CBCs) to quantify cell type, and RNA-Seq on whole blood was investigated for a distinct transcriptional signature in patients with high vs. low fatigue. Principal component analysis revealed that transcriptomic profiles clustered based on the neutrophil level, lymphocyte level, and several other clinical factors, which were accounted for when assessing differentially expressed genes.

Results: Participants had breast (n = 29) or uterine (n = 1) cancer, were 53.4 ± 13.5 years old, and identified as Black/African American (56%) or White (44%). Hand grip strength, static fatigue index, and sit-to-stand assessments were not associated with FACIT-F fatigue subscale responses. From RNA-Seq data, higher fatigue was associated with fewer SH3RF1 transcripts (p = 4.1e-3) and more CAPRIN2 transcripts (p = 8.2e-3). Unbiased gene ontology/pathway analyses revealed perturbed biological processes in mitochondrial function, chiefly aerobic respiration (normalized effect size [ES] = −2.1), electron transport chain (ES = −1.9), generation of precursor metabolites and energy (ES = −1.8), and fatty acid oxidation (ES = −2.0), which tended to be downregulated among participants with more fatigue. Cellular components analyses consistently showed downregulation of mitochondrial proteins among those with higher fatigue (ESs = −1.7–−2.2). Future studies should investigate dietary, physical activity, and/or pharmaceutical interventions to optimize the efficiency of mitochondrial energy production during treatment to mitigate fatigue.

Extracellular vesicles (EVs) and their molecular content are known as deterministic messengers between tumor-stromal cells involved in cancer development, including hematologic malignancies. Particularly, EVs and exosomes enriched in miRNAs are believed to mediate a wide range of behavioral changes in tumors cells. The objective of this review was to explore the role of miRNAs carried by EVs, including exosomes, in the prognosis, drug resistance, and microenvironmental interactions contributing to the pathogenesis of main hematologic cancers. Our literature review was conducted in PubMed, Web of Knowledge, and Scopus to gather the most recent publications in this area. Exploring the findings of relevant studies highlighted the indispensable contribution of microvesicular and exosomal miRNAs when it comes to evaluating the outcomes of hematologic neoplasms. The strong link between some of exomiRs and survival of patients with leukemias and multiple myeloma deserves to be the subject of future clinical studies. In fact, miRNAs transferred by exosomes derived from various sources, including tumors cells and close and distant cancer-associated stromal and endothelial cells, believed to trigger cellular processes involved in drug resistance and poor clinical outcomes in individuals suffering from hematologic neoplasms. Our review can provide researchers with novel ideas to explore the role of EV- and exosome-derived miRNAs in the clinicopathogenic outcomes of blood cancers.

Introduction: Cancer is a major global health problem with a significant burden in both developed and developing countries. Given the rapid growth and high acceptance of wearable devices (WDs) in cancer management, this systematic review aims to explore the outcomes of WDs in the management of cancer patients.

Methods: A structured search of PubMed, Cochrane, Web of Science, and Scopus databases was conducted according to the PRISMA statement guidelines. The search was limited to studies published from December 2015 to December 2023, yielding a total of 3617 studies. After quality assessment using the CASP checklists version 2018, 45 articles were included in the final review. Data analysis was performed using thematic analysis.

Results: Of the 45 studies included in the review, 33 were randomized clinical trials. Notably, a significant proportion of these trials (n = 14, or 31.1%) were published in 2021, and the majority were conducted in the United States (51.1%). The findings revealed that WDs were most frequently used in breast cancer studies, accounting for 53% of the total. Fitbit devices were the most commonly used among the various types of WDs, appearing in 62.2% of the cases. The review also identified 75 concepts that were initially grouped into 21 themes, which were then consolidated into six categories: physical activity, mental wellness, quality of life, clinical outcomes, administrative outcomes, and technology acceptance.

Conclusions: Cancer care requires effective methods, and the use of WDs results in high adherence rates and the ability to provide valuable data at all stages of the patient journey. WDs help improve patient outcomes by measuring health metrics such as step count, heart rate, energy expenditure, and sleep regulation.

Purpose: The purpose of this study is to recapitulate the influencing factors of breast cancer patients’ return-to-work (RTW).

Methods: Pairs of researchers screened and extracted data from included studies independently. Data were analyzed by using Stata 12.0 Software. The odds ratios (ORs) with 95% confidence intervals (CIs) in the study were used to combine the data, and between-study heterogeneity was investigated by using I² statistics. Sensitivity analyses were carried out through a step-by-step exclusion of the literature. Funnel plots were employed for a quantitative assessment of publication bias in the included literature.

Results: 23 identified studies were eligible for this synthesis. The pooled incidence of RTW was 65.0%. The factors associated with RTW of breast cancer patients were as follows: age, receipt of radiotherapy or not, presence of comorbidities or not, cancer stage, receipt of axillary lymph node dissection or not, surgical modality, having children or not, anxiety symptoms, work patterns, cognitive functioning, and physical functioning.

Conclusion: Addressing the identified barriers and strengthening the facilitators to RTW can further improve the RTW rates of breast cancer patients and then promote early reintegration into society.

Purpose: To improve the understanding of what influences the motivation of children and adolescents diagnosed with cancer to engage in exercise during the first six months of treatment.

Materials and Methods: Qualitative design using semistructured interviews with children (6–17 years) diagnosed with cancer (n = 12) and their parents (n = 12). A deductive thematic analysis based on self-determination theory was applied.

Results: Three predefined themes described different aspects of motivation for exercise during treatment.

Amotivation: Treatment-related illness and fatigue causing amotivation was described as a dominant barrier. Exercise driven by negative reinforcements facilitated short-term exercise engagement but was perceived as amotivation.

Controlled Regulation: Exercise regulated by exercise professionals could facilitate and introject positive experiences with exercise (i.e., ameliorated side effects) and create confidence in physical capabilities.

Autonomous Self-Regulation: An autonomy-supportive approach using cocreation and age-appropriate and treatment-regulated exercise, facilitated trust, and confidentiality with exercise professionals.

Conclusion: Motivation for exercise is a dynamic interplay that can be facilitated or negatively affected by treatment, parents, peers, and external regulation. Exercise interventions should use an individual and autonomy-supportive approach, encompassing treatment-related daily variations of physical capacity. Externally regulated motivation can facilitate exercise on a short-term basis when children are inactive or hesitant to engage in exercise.