Supportive Care in Cancer最新文献

Purpose: Most chemotherapy reactions occur outside of the hospital; therefore, providing transitional care (TC) to patients is essential. However, patients' preferences for TC remain poorly understood. This study aims to investigate the preferences and willingness to pay for TC among breast cancer patients.

Methods: Data were collected using a discrete choice experiment from a large general hospital in North China. The study used six attributes to describe the preferences of patients for TC. Conditional logit and mixed logit models were applied to assess patient preferences, estimate willingness to pay, and simulate uptake probabilities across different scenarios.

Results: A total of 261 respondents completed the survey. The study showed that patients strongly preferred a TC to be provided by a specialist doctor and specialist nurse (β = 0.925; p < 0.001) and were willing to pay CNY¥105.381. The service content most preferred was symptom management, psychological care, and rehabilitation guidance (β = 0.286; p < 0.001), and patients were willing to pay CNY¥32.606. The forms of services most preferred were at outpatient clinics (β = 0.239; p < 0.001), and patients were willing to pay CNY¥27.285. Low out-of-pocket expense was preferred by patients (β = - 0.009; p < 0.001). When TC was provided by a specialist doctor and specialist nurse in an outpatient clinic in conjunction with multidimensional care services and out-of-pocket payment of CNY¥20 per visit, the probability of breast cancer patients' participation increased to 91.39%.

Conclusion: The results of this study suggest that breast cancer patients have strong preferences for the provider, content, and form of transitional care (TC), as well as for minimizing out-of-pocket costs.

Objectives: Thrombotic microangiopathy (TMA) is associated with carfilzomib, but the potential association between bortezomib or ixazomib exposure and TMA is still unknown. Besides, the knowledge of carfilzomib-induced TMA is based mainly on case reports. We aim to quantify the risk and better characterize the clinical features of proteasome inhibitor (PI)-induced TMA.

Methods: Data from 2004 to 2023 on TMA events induced by PIs were retrieved from the FDA Adverse Event Reporting System (FAERS) database and conducted disproportionality analyse. Case reports/series from 2004 to 2023 on PI-induced TMA were extracted and analyzed retrospectively.

Results: FAERS pharmacovigilance data identified 225 TMA cases across 213 individuals related to PIs therapy. PIs were significantly associated with TMA (n = 213, ROR 1.71 [1.49-1.96]; EBGM 1.70 [1.52]), and carfilzomib had the greatest proportion (58.7%) and highest positive signal values (n = 125, ROR 17.97 [15.04-21.47]; EBGM 17.49 [15.07]) of TMA. Sixty cases (median age: 63 years) from 35 studies showed evidence of TMA, with 37 (61.7%) were male. The typical initial symptoms were gastrointestinal symptoms (45.3%), fever (24.5%), fatigue/asthenia (20.8%), neurological signs (18.9%), and dyspnea (17.0%). The median time to TMA onset was 8 days. Most patients presented with hemolytic anemia (98.1%), thrombocytopenia (96.6%), and acute kidney injury (96.7%). Cessation of PIs and treatment with plasma exchange therapy (25.0%), hemodialysis (31.7%), and eculizumab (26.7%) were associated with improved hematologic outcomes (96.3%) and renal outcomes (93.3%).

Conclusion: This study identified PIs agents with significant reporting associations with TMA. A prompt diagnosis of TMA and supportive treatments are necessary for patients receiving PIs concurrent with anemia, thrombocytopenia, and acute kidney injury.

Purpose: To develop models using different machine learning algorithms to predict high-risk symptom burden clusters in breast cancer patients undergoing chemotherapy, and to determine an optimal model.

Methods: Data from 647 breast cancer patients were analyzed to develop a model predicting high-risk symptom burden clusters. Five machine learning algorithms, including an artificial neural network (ANN), a decision tree (DT), a support vector machine (SVM), a random forest (RF), and extreme gradient boosting (XGBoost), were tested, as was traditional logistic regression. Performance was evaluated by deriving the predictive accuracy, precision, discriminatory capacity, calibration, and clinical utility, and an optimal model was identified.

Results: A model based on the RF algorithm exhibited better accuracy, precision, and discriminatory capacity than the other models. The area under the receiver operator curve was 0.91, the sensitivity was 65.8%, the specificity was 93.5%, the positive predictive value was 98.02%, and the false positive rate was only 0.91%.

Conclusion: The model created using the RF algorithm was excellent in terms of predictive accuracy and precision, and can be used for early identification of the risk of self-reported symptom burden clusters in breast cancer patients undergoing chemotherapy.

Purpose: To explore symptom clusters, symptom experiences, and self-management strategies in patients with cervical cancer undergoing concurrent chemoradiotherapy.

Methods: A qualitative descriptive approach was used. Semi-structured interviews were conducted with patients with cervical cancer using an interview guide. The audio recording of the interviews was transcribed. Thematic analysis was conducted using Colaizzi's seven-step framework.

Results: Thirteen participants were interviewed. The mean age of the participants was 47 years. Three themes were identified: (a) Struggle for survival among patients reintegrating into society; (b) Overcoming self-management challenges; and (c) Resilience and adaptation in the face of adversity.

Conclusion: Individuals diagnosed with cervical cancer who undergo concurrent chemoradiotherapy often experience various clusters of symptoms. Despite facing challenges in self-management, these patients maintain a positive attitude and persistently strive to coexist harmoniously with their health conditions.

Objective: Prostate cancer (PCa) is an external stressor that can affect both patients and partners, but dyadic research in this area is limited. This study, guided by the vulnerability-stress-adaptation model, examines how PCa distress affects relationship satisfaction through psychological flexibility and self-esteem.

Methods: The study used a cross-sectional design with a total sample size of 314 dyads. The actor-partner interdependence model was applied to examine both actor and partner effects. Covariates were also examined.

Results: PCa distress negatively predicted psychological flexibility in both patients ( $\beta$ = - .93, p < .001) and partners ( $\beta$ = - 0.70, p < .001). Psychological flexibility, in turn, positively predicted self-esteem in both patients ( $\beta$ = 0.19, p < .001) and partners ( $\beta$ = 0.19, p < .001). Self-esteem significantly predicted relationship satisfaction for both patients ( $\beta$ = 0.22, p < .001) and partners ( $\beta$ = 0.22, p < .001). The indirect effects of PCa distress on relationship satisfaction via psychological flexibility and self-esteem were significant for both patients ( $\beta$ = - .093, p < .001) and partners ( $\beta$ = - .078, p < .001). Additionally, a significant indirect effect of partners' PCa distress on patients' relationship satisfaction was observed ( $\beta$ = - .055, p < .01).

Conclusion: The findings highlight the critical role of psychological flexibility and self-esteem in mediating the impact of PCa distress on relationship satisfaction for both patients and partners. Tailored interventions aimed at enhancing psychological flexibility to support relationship functioning in couples coping with PCa may be effective.

Purpose: As part of survivorship care, many health authorities recommend survivorship care plans (SCPs). The aim of this study was to understand survivors' SCP receipt and use, clinical/demographic factors associated with use, and providers' SCP practices.

Methods: We surveyed Australian and New Zealand survivors of adult and childhood cancer (including parent proxies for survivors aged < 16 years). We fitted binomial logistic regression models to examine the relationship between survivors' clinical and sociodemographic characteristics, and SCP receipt. We also surveyed oncology health providers regarding current SCP provision practices, perceived receipt, and usefulness.

Results: We recruited 1123 cancer survivors (499 adult cancer survivors and 624 childhood cancer survivors, including 222 parent proxies) and 21 healthcare providers. 10.7% of adult and 22.0% of childhood cancer survivors recalled receiving SCPs. SCP receipt was more likely for adult cancer survivors diagnosed with prostate cancer, low-risk cancer diagnoses and older at study participation, and childhood cancer survivors treated with chemotherapy or younger at study participation. Across both groups, a higher level of education attainment was predictive of SCP use. Most healthcare providers estimated that < 15% of adult and > 75% of childhood cancer survivors received SCPs.

Conclusions: Few survivors of adult or childhood cancer reported receiving a SCP, and there were sociodemographic and clinical differences in those who did and did not receive and use their SCP. SCP recipients used and valued them, but healthcare providers indicated potential areas for improvement with SCP provision. Consideration may be needed regarding SCP format, presentation and content.

Introduction: Scalp cooling is standard-of-care for prevention of chemotherapy-induced alopecia (CIA), with proven safety and efficacy. Limb cryotherapy has shown promise in preventing chemotherapy-induced peripheral neuropathy (CIPN). The safe application of concomitant scalp and limb cryotherapies during chemotherapy is crucial due to concerns about potential interactions, including central hypothermia, yet limited data exist on their safe delivery in this context. Here we report a prospective, single-arm study assessing feasibility, safety, and tolerability of concomitant scalp cooling and limb cryocompression in healthy volunteers, and in cancer patients undergoing chemotherapy.

Methods: Safety and tolerability of concomitant scalp cooling and limb cryocompression were evaluated in healthy volunteers and then in cancer patients receiving weekly paclitaxel chemotherapy. Limb cryocompression was administered starting at 11 °C, with thermoregulation allowed up to 25 °C to accommodate patient tolerance. Core body temperature changes, adverse events (CTCAE v4.0), and tolerance to cryotherapy were documented. EORTC Quality of Life Questionnaire-CIPN20 scores were evaluated before the start of chemotherapy (QoL_pre), after the last cycle of chemotherapy (QoL_post), and 3 months after the last cycle of chemotherapy (QoL_3m). Physician grading of CIA was documented using CTCAE v4.0, and results at baseline and at completion of weekly paclitaxel were compared.

Results: Concomitant scalp and limb cryocompression at 11 °C was safe and tolerable in healthy volunteers (n = 3). Fifteen patients enrolled in the study and 13 completed the entire treatment, with negligible core body temperature changes (- 0.18 °C ± 0.37). Eight patients completed all 12 cycles of cryocompression at 11 °C while some required thermoregulation (range 14 °C to 18 °C). One patient completed all cryotherapy cycles at 25 °C and another withdrew due to intolerance to 25 °C. There were no occurrences of ≥ Grade 2 neuropathy. QoL was preserved and scores remained stable at QoL_3m (18 (18-21); median (IQR)) compared to QoL_pre (18 (18-19)). Patients who underwent cryocompression at lower temperatures showed better preservation of QoL scores (QoL_3m 18 (18-20)) than the others (QoL_3m 26 (22-31)). 11/13 patients (85%) demonstrated preservation or improvement of CIA.

Conclusion: Delivery of concomitant scalp cooling and limb cryocompression is feasible, safe, and tolerable. Larger studies are needed, and currently ongoing, to investigate the efficacy of limb cryocompression for CIPN prevention.

Purpose: This study aimed to explore current central vascular access device (CVAD) management practices in pediatric cancer care globally and compare practices across high-income and middle-income (i.e., upper middle-income and lower middle-income) countries.

Methods: A descriptive cross-sectional international survey was conducted between May 2022 and December 2023. Clinicians involved in CVAD insertion/management for pediatric cancer patients were invited to participate through established clinical networks globally. The survey covered CVAD management practices, including dressings, securements, routine care, and maintenance procedures.

Results: A total of 220 responses from 42 countries were received. Polyurethane dressings were most commonly used across all CVAD types (55-65/34.2-40.4). Bordered dressings were the primary securement method for all CVAD types (69-96/161, 42.9-59.6%). Routine practices varied, with 31/102 (30.4%) assessing CVADs hourly during infusion in high-income countries and 22 (37.3%) assessing every shift in middle-income countries. Heparin and normal saline were the commonly used solutions for flushing and locking. Chlorhexidine 2% in 70% alcohol was the predominant decontamination solution in high-income countries (64/102, 62.8%), while alcohol was more common in middle-income countries (22/59, 37.3%). Differences were observed between high-income and middle-income countries in the types of dressings, securements, and maintenance practices used.

Conclusion: This study revealed significant variability in CVAD management practices for pediatric cancer care globally, particularly between high-income and middle-income countries. These findings highlight the need for standardized, evidence-based guidelines considering resource availability and contextual factors to improve CVAD management in pediatric oncology across diverse healthcare settings.

Cancer and cancer therapies dramatically impact nutritional status, leading to malnutrition and weight loss. Cancer centers struggle with inadequate staffing of oncology certified Registered Dietitian Nutritionists (RDN) to provide appropriate nutritional care. Evidence suggests RDN interventions can increase lean body mass, enhance weight maintenance, promote quality of life, and improve cancer treatment adherence. There is, however, limited literature about practical approaches to RDN staffing models for ambulatory cancer centers. The Atrium Health Levine Cancer Section of Oncology Nutrition was formalized in 2016 and now consists of 15 RDNs across 23 practice locations. In 2022, 14 clinical RDNs and one Wellness RDN completed over 16,000 encounters across 9,700 new and established patients. The RDNs are involved with nutrition and wellness education, quality improvement projects, subspeciality integration, and telenutrition. We describe the history and organization of a successful clinical and academic Section of Oncology Nutrition within a major multisite cancer center. We also review challenges and lessons learned regarding this important and novel development.