Supportive Care in Cancer最新文献

Purpose: Exercise has the potential to improve and maintain physical function, alleviate symptoms, improve quality of life, and influence prognosis in patients with advanced lung cancer. This systematic review and meta-analysis of randomized controlled trials (RCTs) primarily examined the impact of exercise on physical function, with a focus on cardiorespiratory fitness.

Methods: A systematic search of PubMed, Cochrane Library, Web of Science, and CINAHL was conducted from inception to June 28, 2024. Eligible RCTs examined exercise interventions in patients with advanced lung cancer, evaluating physical function, symptoms, quality of life, and prognosis. Subgroup analyses were performed based on measurement sites and items. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for quantitative outcomes, and a random-effects model was used for data pooling.

Results: Nine RCTs (from 4,262 retrieved articles) were included in the meta-analysis. The results indicated that patients who participated in exercise interventions had greater improvements in VO₂peak (SMD 0.38; p = 0.01), muscle strength, and physical activity than those in the control group. Additionally, exercise was associated with greater reductions in fatigue and improvements in quality of life. Since only one study reported on prognosis, a meta-analysis could not be performed for this outcome.

Conclusions: We conclude that exercise plays a crucial role in improving cardiorespiratory fitness, muscle strength, quality of life, and fatigue in patients with advanced lung cancer, highlighting the importance of incorporating exercise into their cancer care. However, future studies, including head-to-head comparative trials, are required to clarify the effects of different exercise types and their impact on prognosis. PROSPERO Registration Number: CRD42024575482.

Background: Virtual reality (VR) technology is increasingly being used in supportive care for cancer patients, aiming to improve their discomfort symptoms and enhance their health status and quality of life. Understanding patients' feedback and insights is crucial for improving the application of virtual reality among cancer patients. While numerous qualitative studies have examined the experiences and perspectives of cancer patients during their treatment with virtual reality, a comprehensive synthesis of these insights is missing. This review of qualitative evidence aimed to explore the experiences and perceptions of patients receiving VR therapy in cancer, providing guidance for the treatment and rehabilitation of cancer patients with VR technology.

Methods: A computerised search of the Cochrane Library, PubMed, Embase, CINAHL, Web of Science Core Collection, CNKI, Wanfang, Vip and SinoMed was conducted to identify relevant qualitative studies. The enrolled participants were adult patients with cancer who were 18 years of age or older. The search covered the period from establishing each database until May 2025. The Joanna Briggs Institute criteria for qualitative research were utilised to evaluate the quality of the studies. The data included in the literature were analyzed and integrated by "thematic synthesis" to formalize the identification and development of themes.

Results: A total of 12 studies were included, encompassing data from cancer patients with an age range of 20 to 83 years. Findings were integrated into 12 sub-themes and 4 themes: (1) experiences of cancer patients receiving VR therapy. (2) perceived benefits of VR therapy for cancer patients. (3) barriers to VR therapy for cancer patients. (4) needs and expectations of cancer patients receiving VR therapy. Each encompassed sub-themes.

Conclusion: While most patients develop a strong interest in VR therapy and are willing to try it, some cancer patients express doubts and resistance due to poor human-computer interaction experiences, discomfort such as nausea or dizziness, or economic factors. Participants reported that VR therapy may serve as an effective approach to alleviate patients' physical pain, relieve psychological stress, and promote the recovery process. Additionally, cancer patients receiving VR therapy face various barriers and have put forward some needs and preferences to better apply VR therapy. Future studies should be conducted according to patients' feedback and suggestions on how to further optimize and improve VR therapy.

Registration: PROSPERO CRD420251053989.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a prevalent adverse effect linked to neurotoxic chemotherapeutic agents. Current pharmacological treatments exhibit limited efficacy and notable adverse effects. The clinical effectiveness of non-pharmacological therapies, like acupuncture, physical exercise (PE), cryotherapy (CR), and compression therapy, requires systematic comparison. This study employs a network meta-analysis (NMA) to appraise the efficacy and preventive effects of various non-pharmacological interventions on CIPN.

Methods: The study adhered to the PRISMA guidelines. Eight Chinese and English databases (up to October 2025) were searched. A fixed-effect NMA was executed using Bayesian methods to appraise the effects of interventions like acupuncture, CR, and PE on the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity questionnaire, the Numerical Rating Scale, the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-CIPN twenty-item scale, and the incidence of CIPN. Additionally, the risk of bias was appraised using the Cochrane tool.

Results: In total, 27 studies were included, comprising 2136 patients. The NMA indicated that, compared to medication, PE can effectively alleviate neurotoxicity (mean difference [MD]: - 9.9, 95% credible interval [CrI] [- 16, - 4.3]). Acupuncture exhibited superior efficacy in modulating peripheral nerve symptoms (MD: - 2.4, 95% CrI [- 3.8, - 1.1]), alleviating neuropathic pain (MD: - 1.1, 95% CrI [- 1.2, - 1.0]), and reducing the incidence of CIPN (MD: 0.23, 95% CrI [0.071, 0.52]).

Conclusion: PE can notably improve neurotoxicity. Acupuncture can alleviate clinical symptoms related to sensory and motor functions in CIPN. Additionally, it is effective in reducing neuropathic pain and might serve as a preventive measure against the onset of CIPN.

Background: Despite well-documented benefits of physical activity (PA), adherence remains poor among head and neck cancer (HNC) patients. Emotional factors significantly influence PA behaviors in this population, yet their underlying interaction pathways are poorly understood. This study aimed to identify the influence of emotional factors on PA behavior in HNC patients using an extended theory of planned behavior (TPB).

Methods: Adhering to the STROBE checklist, we conducted a cross-sectional survey of 304 HNC patients. Path analysis and mediation analysis were employed to examine factors associated with PA behavior and their interrelationships.

Results: A high percentage of HNC patients (53.90%) were physically inactive. The path model demonstrated good fit: χ²/df = 1.644, NFI = 0.968, TLI = 0.969, CFI = 0.987, IFI = 0.987, RMSEA = 0.047. The model explained 44.50% of the variance in PA behaviors (R² = 0.445). Path analysis revealed that perceived behavioral control exerted the strongest influence on PA behavior, followed by intention, planning, perceived benefits and barriers, subjective norms, and attitudes.

Conclusion: Enhancing PA behaviors in HNC patients is imperative. The extended TPB model was useful for understanding PA intentions and behaviors among HNC patients in China. Interventions that incorporate the emotional factors identified in our study may provide an effective framework for supporting PA in this population.

Purpose: Given the impact of place of death (PoD) on end-of-life quality and policy planning, this study examined the distribution and determinants of PoD among older adults receiving palliative care in Taiwan, with a focus on service models and referral-to-death intervals.

Methods: This population-based study analyzed linked data from the Health and Welfare Data Science Center in Taiwan for 177,403 decedents aged ≥ 65 years who received palliative care and died between 2010 and 2020. Multivariable logistic regression was employed to examine associations between PoD and individual characteristics, hospital attributes, palliative care models, and referral-to-death intervals.

Results: Hospital was the most common PoD (61.5%), followed by home (35.8%). Home death was more likely among females (OR 1.08, 95% CI 1.05-1.10), those aged 75-79 years (OR 1.29, 95% CI 1.25-1.34), cancer decedents (OR 1.40, 95% CI 1.36-1.45), and those receiving palliative care in private hospitals (OR 1.31, 95% CI 1.28-1.34). Use of home palliative care (OR 3.93, 95% CI 3.71-4.16) or home care combined with shared-care services during admission (OR 3.89, 95% CI 3.72-4.06) was strongly associated with home death. Referrals longer than 180 days were associated with a lower likelihood of hospital death (OR 0.84, 95% CI 0.79-0.90).

Conclusion: Among older palliative care recipients, early referral and access to home-based and shared-care services play a significant role in promoting home death. Optimizing end-of-life care may require integrating these elements into palliative care policy and service planning.

Background: Periodontitis is a known risk factor for oral squamous cell carcinoma (OSCC), but its impact on postoperative outcomes remains unclear.

Methods: This retrospective study included 552 OSCC patients who underwent radical surgery with free flap reconstruction. Patients were classified into three groups: no periodontitis (N = 169), mild periodontitis (N = 148), and severe periodontitis (N = 235), based on preoperative computed tomography evaluations of alveolar bone and tooth loss. Data on demographics, surgical details, laboratory results, and complications were collected. Generalized estimating equations and multivariable regression analysis were used to evaluate the association between periodontal status and short-term postoperative outcomes.

Results: Patients with mild or severe periodontitis had significantly higher risks of surgical site infection (SSI) (OR = 3.46, P = 0.012) and postoperative fever (OR = 10.93, P < 0.001). The average body temperature on the first three postoperative days (B = 0.22, P < 0.001), maximum temperature (B = 0.35, P < 0.001), and fever duration (B = 0.47, P < 0.001) were significantly higher in the periodontitis groups. Infection-related laboratory markers were consistently elevated within 1 week postoperatively in periodontitis patients (all P for trend < 0.05). Subgroup analysis revealed that the association between periodontitis and SSI was particularly pronounced in patients aged ≤ 60 years (OR = 4.12, P = 0.035), males (OR = 15.92, P = 0.010), those with longer operative durations (OR = 3.17, P = 0.019), smokers (OR = 27.93, P = 0.015), and patients without diabetes (OR = 3.85, P = 0.012).

Conclusion: The severity of periodontitis is significantly associated with postoperative infectious complications in OSCC patients. The management of periodontitis may be important in improving postoperative outcomes for OSCC surgery.

Purpose: Breaking bad news (BBN) in pediatric oncology is emotionally complex and often poorly supported by training or guidelines. The OKRA-Compass, developed through participatory research, provides practical recommendations aiming to enhance BBN quality in German pediatric oncology settings. This paper aims to track insights into the everyday BBN routine.

Methods: After 6 weeks implementing the OKRA-Compass in five pediatric oncology clinics, a focus group and written feedback captured user experiences. Using thematic analysis, researchers coded and analyzed data to assess perceived changes. The participatory approach included co-researchers, and findings were linked to the Compass's Delphi-based theses for deeper insight.

Results: Applying the OKRA-Compass revealed four key outcomes: (1) Considering BBN as a complex process, (2) addressing the multi-layered needs of BBN receivers, (3) encouraging new paths for shared decision-making, and (4) cultivating awareness of the needs of healthcare professionals. Interdisciplinary use enhanced preparation, communication, and emotional safety while highlighting the need for structured training and institutional anchoring of BBN practices.

Conclusion: The OKRA-Compass supports high-quality, individualized BBN by structuring communication, fostering emotional attunement, and promoting shared decision-making. It enhances interdisciplinary collaboration and self-reflection among healthcare providers. Findings highlight its practical relevance, though broader evaluation is needed. The tool offers a promising framework for improving communication culture in pediatric oncology. This process demands a readiness to adapt, allocate resources, and invest in enhancing team communication skills.

Objective: To explore the potential profiles of cancer-related fatigue (CRF) in colorectal cancer patients and their relationship with exercise adherence.

Methods: A cross-sectional study was conducted with 329 patients with colorectal cancer in Wuhan, Hubei Province China from March to September 2024. Data were collected using general information questionnaires, the Cancer Fatigue Scale, and the Exercise Adherence Scale. Latent profile analysis was applied to explore the latent profiles of CRF. Multivariate logistic regression was used to analyze the sociodemographic variables in each profile, and ANOVA was used to explore the relationships between CRF profiles and exercise adherence.

Results: CRF in colorectal cancer patients can be categorized into three profiles: low CRF cognitively clear group (n = 138, 41.9%), moderate CRF balanced group (n = 165, 50.2%), and high CRF severe physical group (n = 26, 7.9%). Multivariate logistic regression analysis showed that living arrangements, recurrence and/or metastasis, the number of chemotherapies, and BMI were influencing factors for the profiles of CRF in colorectal cancer patients. There were statistically significant differences in the scores of various dimensions and the total score of exercise adherence among colorectal cancer patients with different profiles of CRF (P < 0.05).

Conclusion: CRF in colorectal cancer patients can be divided into three profiles, and there are differences in exercise adherence among colorectal cancer patients with different profiles of CRF. It is recommended that healthcare professionals develop targeted interventions based on the different profiles of colorectal cancer patients to improve their exercise adherence and enhance their quality of life.