Supportive Care in Cancer最新文献

Purpose: Breast cancer-related lymphedema (BCRL) is a well-known complication of breast cancer treatment, which often includes chemotherapy. This study aimed to investigate the association between chemotherapy and the risk of developing BCRL in patients with new-onset breast cancer.

Methods: This nationwide retrospective cohort study utilized data from the Korean National Health Insurance database and the Korea National Cancer Incidence Database (2006-2017). Using 1:1 propensity score matching, 37,202 participants who received chemotherapy and 37,202 who did not receive chemotherapy were included in the analysis. Cox proportional hazard regression models were employed to examine the association between chemotherapy and the risk of developing BCRL.

Results: Among the 74,404 participants, 11,508 (15.5%) were diagnosed with BCRL during the follow-up period. Compared with patients who did not receive chemotherapy, the risk of BCRL was higher in patients undergoing chemotherapy (hazard ratio [95% confidence interval]: 1.95 [1.87-2.04]). Furthermore, compared to patients who did not receive chemotherapy, the risk of BCRL was confirmed in the taxane (3.38 [3.19-3.58]), antimetabolite (1.79 [1.67-1.91]), and anthracycline (1.49 [1.41-1.56]) chemotherapy groups.

Conclusion: Chemotherapy administration following a diagnosis of breast cancer increases the risk of BCRL. Therefore, vigilant monitoring for BCRL, particularly in patients undergoing chemotherapy with taxanes, antimetabolites, or anthracyclines, is warranted during follow-up.

Purpose: Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating toxicity of many drugs used in cancer treatment. There are numerous available strategies for preventing or treating CIPN, but few are guideline-recommended, due to limited evidence of their effectiveness. The primary objective of this survey was to understand what strategies patients used to prevent or treat CIPN, and to understand their perceptions around CIPN prevention and treatment.

Methods: The Multinational Association of Supportive Care in Cancer (MASCC) Neurological Complications Study Group created a cross-sectional online survey to recruit individuals who are currently or had previously received neurotoxic chemotherapy treatment and self-reported peripheral neuropathy. Descriptive statistics were reported.

Results: Most of the 447 survey participants did not use any CIPN prevention strategy (71%), though given options of any strategy the plurality preferred a prescribed medication or supplement (30%). The most common treatment strategy used was exercise (47%), with some patients trying prescription medications including non-guideline recommended gabapentin (33%) or guideline-recommended duloxetine (8%) options. Nearly half of participants (49%) used at least one non-prescribed medication for treating CIPN. Patients often followed suggestions of their medical oncology clinical team, but sometimes relied on the internet or other patients to recommend non-prescription strategies.

Conclusion: In the absence of many guideline-recommended strategies for CIPN prevention and treatment, some patients use options with minimal evidence of effectiveness. Additional research is needed to determine which strategies are effective for prevention and treatment so these can be implemented in practice to improve treatment outcomes in patients with cancer.

Background: Fatigue is a common and unpleasant symptom experienced by many cancer patients. One method that has been suggested to reduce fatigue is deep diaphragmatic breathing. However, there is limited information available regarding the effectiveness of this technique for patients with advanced cancers. As a result, this study was conducted to investigate the impact of deep diaphragmatic breathing on fatigue in patients with gastrointestinal tract cancers that have spread to other parts of the body.

Methods: This study, conducted in the oncology departments of Imam Reza (AS) Kermanshah Hospital in 2022, aimed to investigate the effects of an intervention test on 44 patients with malignant gastrointestinal cancer. Inclusion criteria include metastatic cancer of the gastrointestinal tract, the patient's consent to cooperate, and the age of 18-65 years. Exit criteria also include transfer from the oncology department, death, misdiagnosis, and non-cooperation The patients were selected as available and randomly assigned to two groups: an experimental group and a control group. The intervention test was performed by the experimental group twice a day for 10 days, with each session lasting for 10 min. Before and after the intervention, both groups completed research tools, which included Piper's fatigue questionnaire and a demographic information checklist. The data collected was analyzed using SPSS version 25 software.

Findings: According to the findings, before the intervention, the average total fatigue was measured at 5.15 ± 1.98 in the case group and 4.43 ± 1.74 in the control group, with no significant difference between the two groups (p = 0.213). However, after the intervention, the average total fatigue decreased to 3.59 ± 1.91 in the case group, whereas it increased to 6.14 ± 1.91 in the control group, with a significant difference between the two groups (p = 0.001).

Conclusion: The study revealed that the method used in the treatment had a significant impact on reducing fatigue in patients. Considering its low cost and high feasibility, it is recommended to include this approach in the care plan for patients and make it a part of their routine.

Trial registration: IRCT20220104053628N1, date: 2022-02-05.

Purpose: Geriatric co-management is associated with a lower postoperative mortality among older adults with cancer. This might be due to a higher use of rehabilitation services such as physical therapy (PT) or occupational therapy (OT). In this study, we assess the relationship between geriatric co-management and PT /OT use.

Methods: This is a retrospective cohort study of adults aged 75 years and older with cancer who underwent elective surgery at Memorial Sloan Kettering Cancer Center between February 2015 and February 2018. We used two separate multivariable logistic regression models for PT and OT, adjusted for age at surgery, gender, American Society of Anesthesiology score, preoperative albumin, operative time, and estimated blood loss. We also evaluated the association between frailty and receipt of PT and or OT using separate models by additionally including frailty as a primary predictor.

Results: Of the 1650 patients, 308 (19%) did not receive PT or OT, 747 (45%) received only PT, and 593 (36%) received both PT and OT. Geriatric co-management was significantly associated with higher PT use (OR = 1.58, 95% CI = 1.19, 2.11, p = 0.002) and higher OT use (OR = 1.36, 95% CI = 1.08, 1.71, p = 0.010). The associations between geriatric co-management and rehabilitation service remained after additional adjustment for frailty. Higher degree of frailty was also associated with higher PT use (OR = 1.11, 95% CI = 1.01, 1.22, p = 0.033) and higher OT use (OR = 1.25, 95% CI = 1.15, 1.34, p < 0.0001).

Conclusions: Geriatric co-management and frailty were associated with greater use of PT and OT. Future studies should investigate the impact of geriatric co-management on functional recovery.

Purpose: Evoking awe using virtual reality appears to be a promising intervention that has potential to positively impact physical and psychological well-being. The purpose of this exploratory study was to investigate the acceptability and potential benefits of a VR experience of awe for patients undergoing cancer treatment.

Methods: Twenty cancer patients viewed a 5-min VR nature experience designed to induce awe and completed questionnaires assessing anxiety, symptom distress, spirituality, and connectedness to nature. Qualitative interviews assessed acceptability and ways to improve the intervention.

Results: The VR experience effectively induced awe. Following the experience, participants reported decreased anxiety and symptom distress and increased feelings of spirituality and connectedness to nature. Participants enjoyed the experience and said they would use it again and would recommend it to others.

Conclusion: VR nature interventions that induce awe are worthy of future investigation as a psychological approach to support cancer patients undergoing treatment.

Purpose: As awareness increases related to young athletes diagnosed with cancer, it is essential to gain deeper insight into their backgrounds, experiences, and unique goals to effectively offer personalized care. Therefore, the purpose of this study was to explore the lived experiences of collegiate athletes in the USA diagnosed with cancer, reflecting on their academic and athletic successes during their cancer experiences.

Methods: A phenomenological design to study the nature and states of lived experiences in collegiate athlete cancer survivors diagnosed with cancer between the ages of 10 and 39 years old was implemented for this study. Eighteen collegiate athlete cancer survivors (78% female and 22% male) participated in semi-structured interviews. The interviews were audio and video recorded using the Zoom videoconferencing software.

Results: The mean age at the time of the enrollment was 22.3 ± 1.6 years. Seventeen participants (94%) identified as white/Caucasian. Five themes related to successes emerged from the thematic analysis: (1) academic successes, including academic accommodations, renewed determination; (2) athletic successes, including return to play, physical fitness/health; (3) athletic identity, including athletic mindset, body awareness, recovery advantages; (4) post-cancer growth, including renewed sense of purpose, new appreciation for life/sport, spiritual growth, finding silver linings, personal strength and personal growth, new possibilities, positive changes in relationships; and (5) support successes, including medical support, community support, college/university support, spiritual/religious support, financial/insurance support, athletic support.

Conclusion: As research on young cancer survivors continues to increase, there is a pressing need to investigate their lived experiences. The findings from this study and the emerging themes carry significance to the cancer community. Further investigation is imperative, especially concerning the impact of cancer on collegiate athletes.

Purpose: The primary treatment for localised soft tissue sarcoma (STS) is surgery. Surgery for lower limb sarcoma is associated with poorer functional outcomes than other anatomical sites. Rehabilitation is essential, yet provision is not standardised, and patient experience of current service delivery is unknown. This study therefore aimed to explore patients' experiences of rehabilitation in the surgical pathway for lower limb STS at a United Kingdom (UK) specialist centre.

Methods: A qualitative, descriptive phenomenological study was undertaken to explore patients' rehabilitation experiences. Eight patients who had undergone lower limb STS surgery at a specialist centre were purposively sampled. Data were collected through semi-structured interviews and analysed using thematic analysis.

Results: Three main themes were identified: (1) Accessing the right services at the right time. Participants described good access to inpatient rehabilitation post-operatively but delays and challenges in accessing local services affected continuity of care. Rehabilitation gaps pre-operatively, and in facilitating return to meaningful activities, were described; (2) "Communication is key" - providing knowledge and support to navigate uncertainty. Unclear and unrealistic expectations of recovery were challenging. Communication was key to patients feeling supported and facilitating access to rehabilitation; (3) The importance of person-centred rehabilitation. Collaborative, person-centred rehabilitation optimised motivation and engagement.

Conclusion: Participants experienced good access to inpatient rehabilitation post-operatively. In contrast, gaps and delays at other timepoints led to missed opportunities to support preparation for, and recovery from, surgery. A multidisciplinary approach across settings from diagnosis, to deliver person-centred rehabilitation, may improve access, expectation management and continuity of care.

Introduction: Patients receiving hospice care at the end of life often suffer from a variety of ailments. They may need medication to alleviate symptoms for the rest of their lives. The most common and recommended way to take opioids and steroids is orally. Less frequently, the subcutaneous or intravenous routes are used. The intranasal route is a relatively uncommon but interesting alternative for administering drugs.

Aim: The study aims to identify hospice patients who may benefit from changing the standard opioid and steroid administration route to intranasal delivery.

Material and methods: The electronic medical records of all home and inpatient hospice patients (both rural and urban) were analyzed between February and April 2024. The study focused on the magnitude and type of problems associated with taking medications via standard routes and assessed the potential for changing to an intranasal route of administration.

Results: Patients who were prescribed morphine, dexamethasone, or both during co-administration were included in the analysis. Of the 282 patients receiving hospice care over the study period, 95 met the inclusion criteria (33.7%). According to the researcher's original survey 87% of patients experienced issues with taking medications through the standard route. Among the problems related to oral medicines, consciousness disorders were the most significant at 66%. For subcutaneous administration, the main issues were reluctance to inject at 19% and lack of cooperation from caregivers at 20%.

Conclusion: The profile of a hospice patient who may benefit from intranasal administration of symptomatic drugs includes patients with impaired consciousness, aversion to subcutaneous injections, and reluctance to administer injections by caregivers.

We have taken great interest in the topic of red light therapy (RLT) for the treatment of hair loss secondary to cancer therapies. On April 7, 2024, we searched through two private Facebook groups (Fig. 1) intended for patients who used scalp cooling for prevention of chemotherapy-induced hair loss. In these groups, we found several posts inquiring about the use of RLT (Fig. 2). Posts ranged from patients asking if others in the group have used RLT, if RLT is safe to use while scalp cooling, and recommendations for how long to wait to initiate RLT after chemotherapy infusions are completed. Despite the rise in popularity of RLT for the management of hair loss, to date, only two clinical trials have included patients with cancer treatment-induced hair loss, which showed higher hair counts and increased quality of life in those who used RLT [1, 2]. Furthermore, no formal recommendations from oncologists or scalp cooling companies have been made to help guide patients when considering using RLT.

Purpose: The aim of this study is to investigate the additional effects of the Knack maneuver and comprehensive lifestyle recommendations to pelvic floor muscle training (PFMT) in individuals with post-prostatectomy urinary incontinence (PP-UI).

Methods: Seventy-one individuals with symptom of PP-UI were included. Individuals were randomly assigned to study groups (Group I: PFMT + Knack + Comprehensive Lifestyle Recommendations, Group II: PFMT + Knack, Group III: PFMT alone). Assessments were performed at the baseline and at the end of the 8th week. The primary outcome was the subjective severity and impact of UI. Secondary outcomes were objective severity of UI, health-related quality of life (QoL) and patient global impression of severity and improvement. Descriptive and outcome measures were compared between study groups using the Kruskal-Wallis test. The Games-Howell post hoc test was also used to indicate which groups differ.

Results: A total of 66 patients were included in the final analysis. Per protocol analysis in all three groups showed significant improvements in all primary and secondary outcomes in eight weeks. The group of patients who had the PFMT + Knack + Comprehensive Lifestyle Recommendations had the greatest improvement in all outcome measures (p < 0.001). In addition, while PFMT + Knack showed superiority in terms of subjective UI severity and effect of UI on daily life, compared to PFMT alone (p < 0.001), there was no inter-group differences for objective UI severity and other subdomains of QoL (p > 0.05).

Conclusion: Adding comprehensive lifestyle recommendations and/or Knack maneuver to traditional PFMT is more effective in the management of post-prostatectomy UI in the short term. Further long-term follow-up studies should be planned to investigate compliance and response to these combined interventions.

Clinical trial registration number: ClinicalTrials.gov NCT04804839. Date of registration: 03/17/2021.