Supportive Care in Cancer最新文献

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.

Purpose: This study aimed to explore the attitudes, challenges, and support needs related to pulmonary rehabilitation (PR) among patients with oral and maxillofacial cancers and their caregivers in China.

Methods: We conducted semi-structured, in-depth interviews with a purposive sample of patients, both pre- and post-surgery, and their caregivers at a tertiary hospital in Chengdu, China. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.

Results: A total of 14 participants (7 patients and 7 caregivers) were interviewed. Five key themes and thirteen sub-themes emerged: (1) perceptions and attitudes toward PR, (2) multifactorial influences on participation, (3) preferences for PR education formats, (4) challenges in engaging with PR, and (5) psychological burden and the need for information support.

Conclusion: This study offers critical insights into the barriers and facilitators of PR for oral and maxillofacial cancer patients in China. Findings underscore the need for culturally tailored, patient-centered PR programs that address both physical and psychological recovery. Improved PR initiatives could enhance pulmonary function, quality of life, and overall outcomes for this vulnerable population, offering valuable implications for healthcare stakeholders and policymakers in China and similar settings worldwide.

Purpose: Oral mucositis (OM) is a common and debilitating adverse effect associated with chemoradiotherapy in nasopharyngeal carcinoma. This study aimed to investigate the association between Latexin (LXN) polymorphism and acute toxicity of oral mucositis.

Methods: A total of 238 nasopharyngeal carcinoma (NPC) patients were enrolled. LXN genotypes were analyzed by the Sequenom MassARRAY system. Multivariate logistic regression was performed to assess the association of LXN polymorphisms and chemoradiotherapy-induced toxicities. Multifactor and generalized multifactor dimensionality reduction methods were applied to calculate the SNP-SNP interaction.

Results: Our study showed that the frequency of the AG genotype of rs1492908 was significantly lower in the grade 3-4 oral mucositis group compared to the grade 0-2 group (14.1% vs. 27.1%, respectively). Patients carrying the LXN rs1492908 AG genotype exhibited a decreased risk of severe oral mucositis (OR = 0.452, 95% CI = 0.213-0.959, P = 0.039). Stratification analysis further revealed that the rs1492908 AG genotype conferred protective effects against oral mucositis in specific patient populations, including those aged ≥ 47 years (OR = 0.340, P = 0.041), body mass index (BMI) ≥ 24 (OR = 0.286, P = 0.035), WHO type Ⅲ histology (OR = 0.212, P = 0.007), and receiving a higher radiotherapy dose (planning gross tumor volume of nasopharynx (pGTVnx) ≥ 71 Gy) (OR = 0.158, P = 0.016). Additionally, SNP-SNP interaction analysis identified that the combination of rs1492908, rs9841, rs8455, rs2639655, and rs56321207 was the best multi-locus model for oral mucositis.

Conclusion: This study is the first to establish a link between NPC chemoradiotherapy-induced oral mucositis risk and LXN polymorphisms in the Chinese Han population.