Supportive Care in Cancer最新文献

Background: With the advent of drugs designed to selectively target the KRAS-G12C mutant protein, sotorasib and adagrasib have exhibited remarkable efficacy in patients with KRAS G12C mutant lung cancers. Nevertheless, the safety profiles of these agents in a real-world context remain undisclosed.

Methods: Data was systematically extracted from the FDA Adverse Event Reporting System (FAERS) website from January 2021 to December 2023, focusing on adverse events associated with KRAS G12C inhibitors, sotorasib and adagrasib.

Results: The predominant adverse events attributed to KRAS G12C inhibitors predominantly encompassed general disorders and administration site conditions, investigations, and gastrointestinal disorders. Among these, the significant adagrasib-related adverse events comprised nausea, diarrhea, vomiting, asthenia, dizziness, and weight loss. Notably, incidences of renal failure were also documented in patients receiving adagrasib. Conversely, the primary adverse events associated with sotorasib included diarrhea, nausea, abnormal hepatic function, elevated levels of aspartate aminotransferase and alanine aminotransferase, and hepatotoxicity. It is noteworthy that a considerable number of adverse events manifested within the inaugural month following the initiation of therapy with KRAS G12C inhibitors.

Conclusion: Although most adverse effects are reversible, vigilance is warranted particularly for nephrotoxicity and hepatotoxicity during the administration of KRAS G12C inhibitors.

Objectives: Due to disease- or therapy-associated immunosuppression, oncological patients suffer from significantly higher morbidity and mortality due to infections transmitted by respiratory pathogens such as Streptococcus pneumoniae and influenza virus. Although the German Standing Committee on Vaccination (STIKO) provides specific recommendations for vaccination against these pathogens, there is no data on vaccination rates in this high-risk population.

Methods: Data from the interventional EVO study were analyzed to provide information on vaccination rates against Streptococcus pneumoniae and influenza virus in oncological patients. Numbers presented in this publication summarize baseline and follow-up data of the control group; thus, data were not influenced by the intervention.

Results: Data of 370 patients were analyzed; 20.5% of patients were treated for hematological malignancies and 79.5% for solid cancer. 28.1% of patients had received vaccination against influenza and 32.2% against Streptococcus pneumoniae; for the latter only 7.3% according recommendations. While vaccination rates where even lower for patients with thoracic carcinoma (influenza 26.7% and Streptococcus pneumoniae 6.0% according to STIKO recommendations), rates in patients with multiple myeloma were remarkably higher (39.0% and 14.6%).

Conclusions: Despite strong recommendations to vaccinate and the clear clinical need to prevent infections in the vulnerable group of oncological patients, only the minority was vaccinated against Streptococcus pneumoniae or influenza, underlining the urgent need for better vaccination strategies in this high-risk population.

Purpose: Results from the pilot Group-basEd Telehealth behavioral Weight Loss (GET-WEL) Program (NCT04855552) showed that fewer Black breast cancer survivors (BCS) enrolled than White BCS. Black participants also lost less weight than White participants. Little is known about mitigating factors or how best to implement such programs equitably. In this study, we explored facilitators and barriers in Black and White BCS who did or did not participate in GET-WEL.

Methods: BCS who are overweight or obese (body mass index (BMI) ≥ 25 kg/m²) and who had previously been assessed for their willingness to participate in GET-WEL were invited to participate in a semi-structured telephone interview conducted from June to August 2023. Interviewees were purposefully sampled from those who did (participants) and did not (non-participants) enroll in GET-WEL. Interviews were coded and analyzed via comparative thematic analysis.

Results: Of the 24 interviewees, 9 (8 White, 1 Black) were GET-WEL participants, and 15 (8 White, 6 Black, 1 Asian) were non-participants. There were no thematic differences between Black and White BCS. Most non-participants lacked awareness that the Program was recruiting. Program accountability, session flexibility, and pre-existing exercise routines emerged as facilitators while inability to identify enjoyable physical activities, difficulty accessing healthy foods, and competing work/life priorities emerged as barriers.

Conclusion: Our results suggest that enhancing Program awareness and outreach may increase enrollment in minoritized BCS. Resources providing healthy foods and support to ease competing work/life priorities may help BCS maintain healthy lifestyles during and after GET-WEL. These results may help inform future large-scale GET-WEL implementation.

Purpose: To determine the current incidence and impact of chemotherapy-associated food aversions in a variety of cancer types.

Methods: Cancer patients aged 18 years and older who received chemotherapy infusions at the outpatient chemotherapy unit of a university hospital between May 2022 and April 2023 were included in the study (n = 243). To monitor the occurrence of food aversions, participants were asked to complete a food preference questionnaire each time they visited the outpatient chemotherapy unit.

Results: During the one-year survey period, one in four cancer patients receiving outpatient chemotherapy developed food aversions, and one in four of them complained of interference with daily life due to eating problems at the same time or later. The median time to the onset of food aversion was 46 (interquartile range 36-77) days after the start of chemotherapy. The incidence of food aversions was significantly higher in patients who were women, had a digestive, gynecologic, or breast cancer, and received more cytotoxic agents in chemotherapy. Patients who developed food aversions tended to lose more body weight than those who did not.

Conclusion: Food aversions were still common among cancer patients undergoing chemotherapy. Even an aversion to a single food may have affected the patient's nutritional status. Healthcare professionals should closely monitor the occurrence of food aversions, especially in the early days of chemotherapy induction, to detect an increasing risk of malnutrition.

Trial registration: Not applicable.

Purpose: Treatment for head and neck cancer (HNC), such as surgery and chemoradiotherapy, can reduce oral function and affect quality of life (QoL). However, whether HNC treatment affects QoL via the decline of oral function remains unclear. This study aimed to investigate the relationship among cancer treatment, QoL, and actual oral function in HNC survivors.

Methods: A total of 100 HNC survivors who had completed definitive treatment for HNC at least 6 months prior to enrollment were enrolled in this cross-sectional study. QoL was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 summary score. Oral diadochokinesis (ODK), tongue pressure, moisture level on the mucosal surface, and mouth opening were measured. Information on age, sex, tumor site, tumor stage, history of HNC treatment, height, body weight, and lifestyle were collected from medical records. Structural equation modeling (SEM) was conducted to analyze the indirect/direct associations among HNC treatment, QoL, and oral function.

Results: In total, 100 HNC survivors (58 males and 42 females; age range, 30-81 years, median, 67 years) were analyzed. Overall, 63 patients (63.0%) were diagnosed as oral cancer, 66 (66.0%) developed advanced cancer (stage 3/4), and 58 (58.0%) underwent reconstruction surgery in 100 HNC survivors. The SEM results supported the hypothesized structural model (root mean square error of approximation = 0.044, comparative fit index = 0.990, Tucker-Lewis index = 0.986). Surgery with neck dissection and reconstruction for advanced cancer had indirect effects on lower QoL via ODK and mouth opening.

Conclusion: HNC treatment is indirectly associated with QoL via oral function in HNC survivors.

Background: Pain is reported in 66% of cancer patients with advanced disease. Adequate pain management is a cornerstone of comprehensive supportive cancer care.

Purpose: The purpose of this study was to assess pain management in Oncology Units in Belgium.

Methods: A descriptive research design was applied. A structured questionnaire developed by a writing committee was sent to 37 healthcare professionals in 2021. Twenty-four replied.

Results: In most centers, pain management is organized through the pain clinic (91.7%), followed by a multidisciplinary team (83.3%) and the palliative care unit (75%). Eighty-seven percent use tools to assess the pain, mostly for in-patients. Pain guidelines are applied in 17 centers with the ESMO guidelines being the most often mentioned. Mild to moderate pain is managed with paracetamol, non-steroidal anti-inflammatory drugs, and tramadol. All centers handle severe pain with strong opioids, including buprenorphine and fentanyl. Only 62% are concerned about the side effects of strong opioids. In case of neuropathic pain, treatments with pregabalin, gabapentine, and tricyclic antidepressants are the most common, followed by opioids and interventional therapies for refractory neuropathic pain. Asking advice to the pain clinic, combination therapy and opioid rotation are used for patients with inadequate analgesia. Eighty to 90% of the centers have access to intraspinal and epidural techniques, respectively. An active teaching program on pain relief is offered in 66%, but only 33% of the centers do active research focused on pain management.

Conclusions: This is the first survey on pain management in the Belgian centers. Surprisingly only one-third of the health professionals ask advice to the pain clinic in case of inadequate pain relief, meaning that we are far away from a multidisciplinary patient-centered approach. Therefore, the BSMO Supportive Care Task Force promotes the development of an interdisciplinary committee in every oncology unit.

Background: This is a retrospective study to identify if Glasgow Prognostic Score (GPS) is associated with length of hospital stay (LOS) in haematological cancer.

Methods: The participants were adult inpatients at a single centre in between 2018 and 2022. Serum levels of CRP and albumin were measured at admission. GPS was calculated as follows: point "0" as CRP < 10 mg/L and albumin ≥ 35 g/L; point "2" as CRP ≥ 10 mg/L and albumin < 35 g/L; point "1" as either CRP ≥ 10 mg/L or albumin < 35 g/L. Patients with point "0" were classified as low risk whilst point "2" as high risk. LOS was defined as the interval between the admission and discharge date.

Results: As a result, the average age was 59.6 ± 12.6 years and the average LOS was 6.0 days (IQR = 2 days, 11 days). Of 1621 patients, 8.8% of them were high risk. GPS was associated with LOS (β = 2.7 days; 95% CI = 0.8 days, 4.6 days; p trend < 0.001) after full adjustment. Each point of GPS was associated with 1.9 days (95% CI = 1.4 days, 2.4 days) longer in LOS with full adjustment. The association was more prominent in younger patients (< 65 years), patients with leukaemia and myelodysplastic syndrome, and those with normal body weight status (18.5-24 kg/m²), compared with their counterparts.

Conclusion: GPS was associated with LOS in Chinese patients with haematological cancer, indicating GPS could be a useful tool to predict outcome.

Diagnosing rare cancers is challenging and often leads to prolonged diagnostic trajectories. This study investigated the diagnostic trajectory of patients with rare cancers in The Netherlands. Data from 1541 patients were recruited via patient advocacy in a national online survey on their diagnostic trajectory, such as first general practitioner (GP) consultation to hospital referral and number of hospital visits before final diagnosis. Differences between solid vs. non-solid tumours and EURACAN domains were explored. Diagnostic timelines varied from less than 3 months to over 12 months. Most patients (76.0%) first consulted their GP before going to a hospital. 76.3% of all patients were referred to a hospital within less than 3 months. 32.1% reported receiving an incorrect diagnosis, and 44.6% of them underwent treatment or medication for the (perceived) incorrect diagnosis. Patients with solid vs. non-solid rare cancers trajectories differed significantly for treatment hospital, route to diagnosis, correctness of initial diagnosis, and number of hospital visits before correct diagnosis (all p < 0.001). Patients with neuroendocrine (NET; 21.7%) and endocrine tumours (17.5%) experienced longer GP-to-hospital visit waiting times. Patients with non-solid cancers often received a correct diagnosis after one hospital visit (75%) when compared with patients with solid cancer (2+ = 57.7%). Those with rare skin cancer and non-cutaneous melanoma, head and neck, and thoracic cancer visited multiple hospitals before an accurate diagnosis (56.7%, 53.8%, and 50.0%). Patients with rare cancers face significant challenges with diagnostic delays and inaccuracies. Researching symptom signatures and investing in regional clinical networks might improve diagnostic timelines.

Background: Cancer-related fatigue symptoms persist throughout the radiotherapy period in patients with esophageal cancer and show a continuous worsening trend, which seriously affects the quality of survival of patients. Therefore, monitoring patients' fatigue status promptly, recognizing highly fatigued patients, and providing physical and psychological support are essential for improving their quality of life. As a positive psychological trait, self-efficacy can influence the level of fatigue in patients undergoing radiotherapy for esophageal cancer. However, the pathways by which self-efficacy affects cancer-related fatigue remain unclear.

Objective: The aim of this study is to investigate the factors influencing cancer-related fatigue in patients undergoing radiation therapy for esophageal cancer and to investigate the role of social support as a mediator between self-efficacy and cancer-related fatigue using the theory of unpleasant symptoms.

Methods: The study used a descriptive survey approach, and data were collected at a tertiary hospital in Nanjing between October 2022 and May 2023. A total of 225 patients with esophageal cancer undergoing radiotherapy completed the Demographic Characteristics Scale, Cancer-Related Fatigue Scale, Self-Efficacy Scale, and Social Support Rating Scale. The data were statistically analyzed using SPSS version 26.0 (IBM, CHINA) and SPSS PROCESS 3.3 plug-in.

Results: The cancer-related fatigue score of Chinese patients undergoing radiotherapy for esophageal cancer was 27.27 ± 7.26, which shows a high level of fatigue. Social support partially mediates the relationship between self-efficacy and cancer-related fatigue.

Conclusion: The findings may help medical personnel identify factors that influence cancer-related fatigue in patients undergoing radiotherapy for esophageal cancer and develop reasonable management strategies.