Supportive Care in Cancer最新文献

Purpose: Improvements in the treatment of advanced cancer have increased life expectancy but have also increased the costs to healthcare systems, patients and their families. A systematic review is needed to summarize research work on the cost of cancer. The primary objective was to describe the characteristics and methodology of studies investigating the cost of cancer during the palliative phase. Secondary objectives were to assess whether palliative care interventions influence the costs of advanced cancer and to describe the costs explored and models used in cost-effectiveness studies.

Method: According to the PRISMA guideline (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), Pubmed, Web of Science, NHS, EconLit and Google Scholar databases were screened from 11/01/2020 to 03/01/2024. All types of methods about the costs of the palliative phase of solid cancer were accepted. Study characteristics, economic perspective, time horizon and the type of costs explored were collected.

Results: Of the 498 studies identified, 66 were included in the final analysis. Most (60%) used a retrospective methodology. Almost all (65, 98%) studied direct costs, and only 12 (18%) studied indirect costs. No article assessed intangible costs or the total cost of the palliative phase of cancer. The payer's perspective was most commonly adopted (39, 59%). The time horizon was less than 6 months in most cases (41, 63%). Eighteen studies (86%) highlighted that PC interventions were cost-effective.

Conclusion: Existing evidence suggests that palliative care is cost-effective from the hospital and payer's perspective. More research is needed to evaluate the cost of informal caregiving and out-of-pocket expenses borne by patients.

Purpose: In Denmark, the prevalence of head and neck cancer is approximately 17.000, and the incidence is increasing. The disease and treatment of this condition may lead to severe physical, psychological, and social consequences. However, the literature indicates a lack of rehabilitation services and insufficient professional resources in the municipal setting resulting in unmet rehabilitation needs. The aim of this study is to gain an understanding of the challenges and rehabilitation needs experienced by citizens treated for head and neck cancer.

Methods: A qualitative study using semi-structured interviews was employed. Paul Ricoeur's interpretation theory was used to analyze the data.

Findings: Citizens treated for head and neck cancer experience the need for targeted assistance to manage the consequences following treatment for head and neck cancer and the need for adequate information and specialized professional competencies in municipal rehabilitation. The findings highlight a dual need: support from healthcare professionals and opportunities for patients to connect with others who have undergone treatment for head and neck cancer, as part of municipal rehabilitation.

Conclusion: The study contributes to an understanding of the citizen perspective on rehabilitation needs and informs and enhances knowledge about municipal rehabilitation interventions for citizens treated for head and neck cancer. However, the findings also indicate the complexity of the referral process, highlighting the need for further research on barriers and facilitators to referral and access to municipal rehabilitation.

Purpose: Aromatase inhibitor-associated musculoskeletal symptoms (AIMSS) are the most common adverse effects experienced by breast cancer patients. This scoping review aimed to systematically synthesize the predictors/risk factors and outcomes of AIMSS in patients with early-stage breast cancer.

Methods: A systematic search was conducted in PubMed, Web of Science, EMBASE, CINAHL, and the China National Knowledge Internet (CNKI) from inception to December 2024 following the scoping review framework proposed by Arksey and O'Malley (2005).

Results: A total of 5,008 studies were identified, and 98 were included in this review. The risk factors for AIMSS included psychosocial and demographic factors (e.g., age, BMI, menstrual status, and anxiety), clinical factors (e.g., history of chemotherapy, preexisting pain, and musculoskeletal diseases) and gene polymorphisms (e.g., ESR1, OPG, RANKL, TCL1A, and CYP19A1). The outcomes of AIMSS encompassed physical, psychological, behavioral, and survival-related impacts.

Conclusion: This scoping review synthesized the available evidence on predictors, risk factors, and outcomes of AIMSS, providing a foundation for developing risk prediction models and enhancing symptom management strategies.

Purpose: As cancer care is increasingly delivered in the home, more tasks and responsibilities fall on patients and their informal care partners. These time costs can present significant mental, physical, and financial burdens, and are undercounted in current measures of time toxicity that only consider care received in formal healthcare settings.

Methods: Semi-structured qualitative interviews were conducted with patients with gastrointestinal cancer and informal care partners at a single tertiary cancer center between March and October 2023. Interviews explored cancer care tasks conducted when home, associated time burdens, how these time burdens compared to facility-based care, and whether home-based care should be included in objective measures of time toxicity. Two coders transcribed interviews and analyzed data using a grounded theory approach.

Results: A single interviewer conducted semi-structured interviews with 15 patients and 18 care partners, and identified five major themes: (1) unexpected home-based care activities are time burdensome; (2) other burdens interact with and impact time burdens; (3) time burdens evolve over the disease course and differentially impact patients and care partners; (4) several factors influence the choice of home-based versus in-facility care; and (5) home-based care is generally perceived as less time-burdensome than in-facility care. Overall, 12 of 33 (36%) participants recommended including days with home-based care in the current contact days measure of time toxicity.

Conclusion: In addition to characterizing time burdens associated with home-based cancer care, this study builds on existing literature to explore if and how to incorporate days with home-based care into the contact days measure.

Purpose: Sleep quality contributes to the improvement of quality of life in cancer patients. However, sleep disturbances, of variable and heterogeneous etiologies, are common and frequently overlooked in lung cancer patients. The present study undertakes a rapid review of available peer-reviewed literature on sleep quality in lung cancer patients, specifically non-small-cell lung cancer patients.

Design: MEDLINE, Embase, and CENTRAL online databases were used to identify 513 published articles from which 26 publications were selected through abstract and title screening, full-text review, and quality assessment.

Results: Most publications (96.15%) involved observational studies, including 12 cross-sectional studies, 6 longitudinal studies, and 6 descriptive comparative studies. Sleep quality was assessed using either subjective or objective measures or both. Sleep disturbances were found in 45-97% of patients. Poor sleep efficiency and frequent night-time awakenings were consistently reported, whereas discrepancies were found concerning sleep duration and sleep latency.

Conclusion: Our rapid review of the literature confirms that sleep disorders, which impair quality of life, remain frequent and often neglected in this patient population. Assessment of sleep quality in patients with non-small-cell lung cancer should be the subject of further studies into how to better identify and characterize them to implement appropriate therapeutic strategies, using a global approach to improve quality of life despite the underlying cancerous disease.

Objective: Breast cancer is one of the most common types of cancer in China and worldwide. Apart from cancer, a majority of breast cancer patients suffer from various psychological disorders concurrently. The purpose of this study is to understand the actual experiences of breast cancer patients participating in Virtual Reality (VR) for psychological intervention, and to provide a theoretical basis for the development of VR psychological rehabilitation in China.

Methods: Twenty-three breast cancer patients who met the inclusion criteria were selected using purposive sampling method for this qualitative study. Semi-structured interviews were conducted to explore their experiences with VR psychological rehabilitation. The data were analyzed, summarized, and generalized using the Colaizzi analysis method.

Results: The results of the interviews were consistent with the PAC structural analysis. Three themes and six sub-themes captured how patients felt about adopting VR for their psychological rehabilitation, including parent ego state (the feeling of loss when expectations are not met, improvement of sleep), adult ego state (relief of psychological stress, optimization, and recommendations for VR therapy), and child ego state (novel and fun immersive experience, contagiousness of variable emotions).

Conclusion: Breast cancer patients participating in the VR psychological rehabilitation had a favorable experience. To maximize the benefit of VR psychological rehabilitation, healthcare professionals should comprehensively assess the psychological state of breast cancer, optimize VR technology, and enable patients to enter the adult ego state. The new model of VR psychological rehabilitation needs to be further explored.

Purpose: Cancer-related cognitive impairment (CRCI) can have a profound impact on the lives of cancer survivors. A multitude of subjective and objective assessment tools exist to assess the presence and severity of CRCI. However, no purpose-built tool exists to assess the unmet needs of cancer survivors directly relating to CRCI. This paper details the development and initial validation of the Multinational Association of Supportive Care in Cancer - Unmet Needs Assessment of Cancer-Related Cognitive Impairment Impact (the MASCC COG-IMPACT).

Methods: A multistep mixed-methods measurement development and validation approach was taken with a strong emphasis on co-design. Qualitative interviews were conducted with cancer survivors (n = 32) and oncology health professionals (n = 19), followed by a modified Delphi survey with oncology health professionals (n = 29). Cognitive interviews with cancer survivors (n = 22) over two rounds were then conducted to finalise the penultimate version of the unmet needs assessment tool for CRCI. Four-hundred and ninety-one (n = 491) cancer survivors then completed the MASCC COG-IMPACT and other established measures to inform structural, reliability, validity, acceptability, appropriateness, and feasibility analyses.

Results: The final MASCC COG-IMPACT is a 55-item and eight subscale tool including two indices: "difficulties" and "unmet needs". The MASCC COG-IMPACT was found to have strong structural validity, convergent validity, discriminant validity, internal consistency, and test-retest reliability. The MASCC COG-IMPACT was also found to be highly acceptable, appropriate, and feasible.

Conclusion: The MASCC COG-IMPACT may facilitate optimal care and referral in line with a cancer survivor's CRCI-related difficulties and unmet needs. The MASCC COG-IMPACT may also be used to explore factors and contributors to CRCI-related difficulties and unmet needs. Overall, the MASCC COG-IMPACT is a highly reliable and valid tool for the assessment of CRCI-related difficulties and unmet needs in both clinical and research settings. The MASCC COG-IMPACT and supporting materials can be accessed on the MASCC webpage or via the MASCC COG-IMPACT Open Science Framework webpage ( https://osf.io/5zc3a/ ).

Purpose: Our study aim was to understand the (human and organizational) factors influencing fall risk among people with hematological malignancies using the Reason model as a framework, providing insights that can inform the development of safe and effective fall management strategies.

Methods: Purposive sampling was employed to conduct semi-structured interviews with 13 people with hematological malignancies and 12 nurses from the hematology department of a tertiary grade A hospital in Guangzhou from December 2023 to February 2024. The topic analysis method was utilized to analyze the interview data.

Results: Factors influencing fall risk among people with hematological malignancies were categorized into four themes: (1) precondition of unsafe arts (lack of work experience in junior nurses, poor patient compliance, adverse drug reactions, inadequate ward facilities); (2) unsafe supervision (inadequate inspection management, inadequate accompanying capacity); (3) unsafe arts (variability in subjective assessment, lack of bidirectional education); and (4) organizational influences (limited nursing human resources, lack of organizational process management models).

Conclusion: The specific fall risk factors among people with hematological malignancies, as summarized based on the Reason model framework, provide a theoretical basis and direction for the construction of specialized fall risk assessment tools, aiming to improve the quality of fall management for inpatients and reduce the incidence of falls.

Background: Informal caregivers may face challenges, especially during the pre-transplant phase. We have learned about the challenges faced by informal caregivers during hematopoietic stem cell transplantation; there is a lack of consensus about the challenges faced by them before transplantation. We identified the psychosocial well-being of informal caregivers to patients before hematopoietic stem cell transplantation.

Method: A systematic review was conducted and analyzed in two subsets: one qualitative and one quantitative. (PROSPERO ID: CRD42023410710; 03/04/2022). An electronic literature search of PubMed, EMBASE, Medline, CINAHL, and PsycINFO was conducted up to July 2024. Full-text review and quality appraisal were completed independently and in duplicate by two reviewers with conflicts resolved by a third reviewer. Qualitative and quantitative data were tabulated together using thematic synthesis and then categorized according to outcomes of interest.

Results: Nineteen quantitative studies, two qualitative, and two mixed studies were included. Informal caregivers experience high levels of anxiety and depression before transplantation, facing varying degrees of psychological distress, stress, post-traumatic stress disorder, negative perceptions of transplant expectations, and moderate to severe caregiving burden. Qualitative research has identified two key themes: the empowering effect of information and the emotional burden of uncertainty.

Conclusion: Caregivers endure considerable emotional strain, caregiving burden, and unmet needs during the pre-transplant period. Medical staff must attend to the mental health and specific needs of informal caregivers before transplantation. Integrating informal caregivers into cancer care is essential to enhance the quality of nursing and, consequently, to optimize patient outcomes.

Purpose: The symptom representations (i.e., beliefs and attitudes) that people with cancer hold about their symptom experience can impact how they self-manage their symptoms. Having two or more chronic conditions (multimorbidity) can complicate illness representations. Little is known about symptom representations in people with cancer and multimorbidity.

Methods: This qualitative descriptive study was conducted with a sample of adults with a diagnosis of cancer and at least one additional chronic condition. Semi-structured interviews were conducted to understand their symptom representations. Leventhal's Common-Sense Model of Illness Representations (i.e., identity, consequences, cure/control, timeline, and cause) provided the guiding framework. A qualitative thematic analysis was used to identify codes, themes, and subthemes.

Results: The mean age of the participants (n = 17) was 62.1 years and primary cancer sites were gastrointestinal, thoracic, or head/neck. Five themes were identified: (1) perceiving and living with symptoms, (2) being unable to do things, (3) self-management behaviors, (4) domino theory, and (5) a side effect of conditions. These themes aligned with Leventhal's Common-Sense Model dimensions. The interaction among diagnoses and multimorbidity was identified by a minority of participants.

Conclusion: People with cancer and multimorbidity described symptom representations primarily in the context of cancer. Consistent with previous research, symptoms negatively impacted their lives, and their representations include an understanding of how symptoms interact. Few participants described their symptoms within the larger context of multimorbidity. Future research is needed to determine how symptom representations impact their communication patterns with providers and coping behaviors.