Supportive Care in Cancer最新文献

Objective: The purpose of this study was to clarify the relationship between hope, psychological distress, and quality of life (QOL) of patients with advanced cancer undergoing cancer pharmacotherapy and their related factors.

Methods: Participants were patients with advanced lung, colorectal, and breast cancer undergoing outpatient pharmacotherapy. The Herth Hope Index, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy-General were used as measurement tools in a cross-sectional survey. Data were analyzed using descriptive statistics, correlation analysis, t-test, one-way analysis of variance (ANOVA), and Structural Equation Modeling (SEM).

Results: The number of valid responses to the questionnaire survey was 200 (91.7%). SEM included hope, psychological distress, QOL, social support, economic deprivation, physical symptoms, and performance status. The goodness of fit index for SEM was 0.989, adjusted goodness of fit index was 0.960, comparative fit index was 1.000, and root mean square error of approximation was 0.001. Hope had a negative impact on psychological distress (β = - 0.46) and a positive impact on QOL (β = .19).

Conclusion: Hope was shown to be a predictor of psychological distress and QOL in patients with advanced cancer receiving pharmacotherapy. Predictors of hope were social support and economic deprivation. The results suggest that early intervention for patients with characteristics that tend to lower levels of hope is effective in reducing patient anxiety and depression and improving QOL.

Purpose: Research has shown that mind-body practices like meditation and yoga can improve quality of life among female cancer survivors. Yet, correlates of the likelihood to use these practices are unknown in the USA. The goal of this study was to use recent data from the 2022 National Health Interview Survey (NHIS) to establish the prevalence and correlates of meditation and yoga practices among female cancer survivors in the USA, as well as among survivors who report high or frequent anxiety.

Methods: Using data from the NHIS, we identified eligible female respondents who had reported being diagnosed with cancer (N = 1,945). We identified factors associated with meditation and yoga practice use through self-reported surveys.

Results: Our sample (N = 1945) was primarily White (82.9%), 65 years or older (55.2%), heterosexual (97.2%), lived in medium/small metro areas (35.3%) in the South (36.6%), did not report frequent or high anxiety (63.9%), 21.5% used meditation, and 16.8% used yoga. Our results showed that among female survivors with high or frequent anxiety, there were higher odds of using yoga among those living in large central metro areas or who reported other cancers.

Conclusion: Use of meditation and yoga practices after cancer diagnosis remains uncommon. To best reach diverse survivors who may benefit from evidence-based mind-body practices, tailoring may be needed.

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 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.

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.

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.