Supportive Care in Cancer最新文献

Purpose: Effective lymphoedema management relies on early detection and treatment during its reversible phase, underlining the importance of accurate measurement tools. This systematic review aims to identify measurement instruments for quantitatively diagnosing lymphoedema and their diagnostic accuracy.

Methods: Literature was systematically searched on the diagnostic accuracy of instruments for assessing soft tissue oedema across body parts in adults. Inclusion criteria encompassed studies establishing diagnostic accuracy (sensitivity and/or specificity) of instruments for quantifying oedema through volume changes, tissue characteristics, or lymphatic system function. Searches included Embase, Medline, Web of Science, and CINAHL databases from inception to March 18, 2024. Methodological quality was assessed using the COSMIN checklist for criterion validity and QUADAS-2. Diagnostic value was evaluated through the Youden index, and the level of evidence was established using a new best-evidence synthesis approach.

Results: A total of 44 studies were included, identifying 14 index measurement instruments. The most frequently studied instruments were tape measurements, ultrasound, and multi-frequency bio-impedance analysis (MF-BIA). Instruments with very high diagnostic value (Youden index ≥ 0.90) included MF-BIA, perometry, and MRI. However, the quality of evidence supporting these instruments was lacking. Nine different instruments served as references, with tape measurements, consensus criteria, and water volumetry being the most applied.

Conclusion: This review underscores the complexity of accurately diagnosing lymphoedema, with no single instrument emerging as a definitive gold standard. Clinicians must weigh the available evidence and consider the clinical context, such as early detection, when selecting measurement instruments for diagnosing lymphoedema.

Purpose: To assess opioid consumption, availability, and policy alignment for cancer-related pain management in primary health care (PHC)-based inpatient hospice and palliative care (HPC) services in China.

Methods: A multicomponent analysis was conducted, including (1) a cross-national comparison of opioid consumption using International Narcotics Control Board (INCB) data (2020-2022); (2) a census-based assessment of opioid stocking and use in all PHC institutions providing inpatient HPC in a provincial system (2019-2023); and (3) a policy review comparing national Essential Medicines List (EML) with international recommendations. Opioid use was standardized as defined daily doses per million inhabitants per day (S-DDDpm).

Results: China's mean opioid consumption (168 S-DDDpm) was less than half the Asian average (368 S-DDDpm) and far below comparable economies. From 2019 to 2023, the proportion of PHC institutions stocking strong opioids rose from 22.5% to 30.2%, yet total consumption declined from 240.3 to 145.3 S-DDDpm (compound annual growth rate: -11.8%). Regional disparities existed. The national EML included only morphine, omitting most internationally recommended strengths and dosage forms.

Conclusion: Opioid access for cancer-related pain management in China's PHC-based HPC services remains critically inadequate. Expanding essential drug formularies, diversifying formulations, and strengthening PHC prescribing capacity are urgent priorities to reduce disparities and improve quality of life for patients with advanced cancer.

Purpose: This study aimed to evaluate the efficacy and potential pharmacological interaction of naldemedine and magnesium oxide (MgO) in the management of opioid-induced constipation (OIC) in cancer patients, with a particular focus on the impact of different MgO doses on treatment outcomes.

Methods: A total of 171 patients who received opioid therapy were included in this study. The outcome variable was defecation. Daily defecation status during the observation period was extracted from electronic medical records. To assess the effects and potential interaction between naldemedine and MgO on defecation, a generalized estimating equations (GEE) model with a logit link function was used to account for within-patient clustering. Predicted probabilities of defecation were calculated based on the fitted GEE model.

Results: The probability of defecation increased with higher doses of MgO. Among patients receiving both MgO and naldemedine, the likelihood of defecation was significantly higher at MgO doses ≤ 1500 mg compared to those receiving MgO alone. However, at doses > 1500 mg, naldemedine did not add further benefit. Naldemedine was independently associated with improved bowel movements, regardless of MgO use. The association between MgO and defecation also strengthened with increasing doses. No significant interaction between naldemedine and MgO was observed at any dose.

Conclusion: The concomitant use of MgO and naldemedine was associated with improved defecation, although no statistically significant interaction was detected. However, the added benefit of naldemedine may be limited at higher MgO doses. Naldemedine may be particularly effective in patients with constipation during opioid therapy that is insufficiently responsive to conventional laxatives, especially when an increase in MgO is difficult due to risks such as hypermagnesemia.

Purpose: Bioelectrical impedance analysis (BIA) has emerged as a simple, noninvasive method for evaluating skeletal muscle. However, BIA is sensitive to fluctuations in body water and can overestimate skeletal muscle mass, which may obscure true changes, particularly in the early post-transplant period, when body water content often increases. In this study, we explored whether correction formulas originally used in the dialysis field to estimate ideal dry weight could be applied to skeletal muscle measurements to reduce overestimation of skeletal muscle mass.

Methods: This retrospective observational study included patients who underwent allogeneic hematopoietic stem cell transplantation. Physical function and body composition were assessed before transplantation and 4 weeks after transplantation. Physical function was evaluated using knee extensor strength and the six-minute walk distance (6MWD). Body composition was assessed using appendicular skeletal muscle mass (ASM) as an index of muscle quantity, phase angle as an index of muscle quality, and the extracellular-to-total body water ratio (ECW/TBW) as an indicator of fluid balance. A correction formula for estimating ideal dry body weight was applied to adjust ASM. Differences between unadjusted and adjusted ASM were compared at each time point. Pre- and post-transplant changes in phase angle and ECW/TBW were also evaluated.

Results: Sixty-four adult patients aged 20-70 years (median age, 51.5 years) were included. After transplantation, adjusted ASM differed significantly from unadjusted ASM. Knee extensor strength, 6MWD, and phase angle (median, 4.4°to 3.9°, p < 0.001) decreased significantly, whereas ECW/TBW increased significantly (median, 0.391 to 0.399; p < 0.001). Unadjusted ASM did not change significantly from pre- to post-transplantation (median, 17.7 to 17.5 kg; p = 0.17), whereas adjusted ASM decreased significantly (median, 17.6 to 17.2 kg; p = 0.01).

Conclusion: Applying a dialysis-derived adjustment formula to skeletal muscle measurements may help correct overestimation of skeletal muscle mass due to increased body water content in the early post-transplant period. After transplantation, both adjusted ASM and phase angle decreased significantly. These results suggest that BIA may have potential utility during the immediate post-transplant period, although its clinical applicability requires further validation.

Purpose: This study was conducted to evaluate the impact of the ONKOSIS mobile application, developed within the scope of the study, on the management of chemotherapy-related symptoms and quality of life.

Methods: This randomized controlled, single-blind experimental design study was carried out with the participation of 199 patients at the Kocaeli University Semahat Aracı Oncology and Palliative Care Center, Outpatient Chemotherapy Unit. In the study, which used simple randomization, the intervention group consisted of 98 patients and the control group consisted of 101 patients. During chemotherapy treatment, in addition to standard care for symptom management, the intervention group used the ONKOSIS mobile application, while the control group used a demo mobile application. The study data were obtained through the Diagnostic Form, Nightingale Symptom Assessment Scale, Coping with Chemotherapy Symptoms Form, and patient satisfaction survey. The follow-up frequency was planned according to the type of treatment protocol applied to the patients. Patients who received four cycles of treatment were followed up after the 2nd, 3rd, and 4th cycles, while patients who received six cycles of treatment were followed up after the 2nd, 4th, and 6th cycles.

Results: The study group had a mean age of 47.18 ± 13.83; 74.4% were female. Treatment cycles of 2, 3, or 4 weeks were provided for 26.6% of patients receiving treatment for gastrointestinal cancer, 21.6% for breast cancer, and 17.1% for lung cancer. Sociodemographic and clinical characteristics were similar between groups. Although the intervention group exhibited greater initial symptom burden (higher N-SAS scores at T1/T2), their symptom trajectory improved significantly over time compared to the control group, supporting the role of mHealth in enhancing outcomes. The use of ONKOSIS improved quality of life and patient satisfaction but did not reduce unscheduled healthcare visits.

Conclusion: The ONKOSIS mobile application was found to be an effective tool in supporting symptom management and improving the quality of life for cancer patients during the treatment process. It was determined that the widespread adoption of the mobile application in cancer care could contribute to improving patient outcomes and enhancing care quality.

Trial registration: ClinicalTrials.gov ID: NCT05946070. Registered on June 22, 2023.

Background: Telehealth-delivered education offers a practical approach to chemotherapy teaching and symptom self-management support. Advanced practice providers (APPs) play an increasingly vital role in guiding oncology patients through treatment, particularly in managing symptoms and reducing preventable emergency department (ED) use. This study evaluated whether an APP-led telehealth symptom education and monitoring (TSEM) intervention improved symptom self-management engagement and reduced ED utilization in patients with cancer.

Methods: This retrospective study included 120 patients with gastrointestinal (GI), lung, or sarcoma cancers treated at a single academic institution. The intervention group (n = 61) received a tailored telehealth education session from specialized oncology APPs within seven days of treatment initiation. The control group (n = 59) received standard patient education. Outcomes included ED visits and symptom self-management engagement, measured via medical record-documented patient-initiated symptom support calls. Data were analyzed using multivariable binary logistic, linear, and negative-binomial regression models adjusted for demographic, clinical covariates.

Results: The intervention did not significantly reduce ED utilization overall. Patients with GI cancer in the TSEM group had increased odds of ED visits. However, patients in the TSEM group made significantly more symptom self-management calls (74% higher rate; p < 0.05), especially those with GI cancer, suggesting increased patient engagement in managing treatment-related symptoms.

Conclusions: APP-led telehealth education enhanced patient engagement in symptom self-management but did not reduce ED visits. Tailored, cancer-specific education delivered by APPs may empower patients to manage symptoms earlier. Further prospective, multi-site research is needed to assess the long-term impact on acute care utilization and quality outcomes in broader, diverse oncology populations.

Background: Home-based maintenance treatment is necessary for patients with breast cancer-related lymphedema even after their treatment regimen is finished. There is limited understanding regarding the involvement and experiences of family caregivers in effectively managing lymphedema. Therefore, this study aims to explore the daily experiences of family caregivers in order to enhance their home care plans for lymphedema management.

Methods: Employing phenomenological research methods, semi-structured interviews were conducted with 12 family caregivers responsible for the care of breast cancer-related lymphedema patients. The content of the interviews was transcribed and analyzed using Nvivo12.0 software and Colaizzi's 7-step method.

Results: A total of three themes and eight subthemes were extracted from this study: (1) a fragmented understanding of lymphedema; (2) contradictory caregiving behaviors; and (3) systemic challenges in daily care.

Conclusions: By qualitatively exploring the caregiving experiences through interviews with these 12 family caregivers, this study offers valuable insights to medical professionals involved in patient care services. It is recommended that a family-centered empowerment model (FCEM) be employed as a basis for developing and implementing a comprehensive family management program aimed at equipping family caregivers with professional knowledge, enhancing their ability to manage lymphedema effectively, promoting patients' health recovery, and improving their overall well-being.

Choosing Wisely (CW) campaign addresses the global challenge of reducing waste in healthcare by discouraging unnecessary interventions, minimizing harm, and promoting evidence-based care. Barriers like limited awareness among healthcare professionals and the lack of global mapping of recommendations hinder its implementation. We conducted a comprehensive scoping review mapping the literature on CW recommendations in oncology from 2012 to 2024. A total of 220 recommendations were gathered from 19 studies and 20 recognized international websites. These recommendations explored the importance of personalizing screening, staging, and treatment based on individual risk factors, such as life expectancy and biomarker status. The findings suggest a global shift toward patient-centered oncology care, focusing on personalized, evidence-based treatments and minimizing unnecessary interventions. Developing recommendations based on resource-stratified guidelines is vital for improving the adoption of CW, particularly in low- and middle-income countries, as it ensures that recommendations are aligned with local healthcare needs and available resources.

Objective: To document radiographic changes visible on panoramic radiographs following intensity-modulated radiation therapy (IMRT).

Patients and methods: This is a retrospective study including 143 patients (120 males and 23 females) with a history of oropharyngeal cancer treated with IMRT at Memorial Sloan Kettering Cancer Center between 2005 and 2015 and seen at our Dental Service prior to starting radiation therapy. For each patient, one pre-IMRT panoramic radiograph closest to the IMRT start date and one post-IMRT panoramic radiograph that was most recent were evaluated, for a total of 286 panoramic radiographs.

Results: There was no significant relationship found in the maxilla between any of the radiographic changes following IMRT either in the ipsilateral or the contralateral side of the primary tumor. In the mandible, there was significant relationship between the development of periodontal ligament space widening without epicenter (p = 0.046) and radiographically visible vertical defects (p = 0.029) in the ipsilateral IMRT. There was no significant association found between radiographically visible furcation, localized horizontal bone loss, vertical defects, and perio-endo lesions with ipsilateral IMRT.

Conclusion: These results indicate that subclinical radiographic changes in the mandible are common after IMRT and that they should be monitored closely as they likely indicate the level of devitalization of the periodontium after IMRT. These patients should be scheduled for frequent recall visits with their dentists to minimize the risk of future oral surgical interventions that could lead to debilitating conditions such as osteoradionecrosis of the jaw.