Supportive Care in Cancer最新文献

Purpose: Treatment for head and neck cancer (HNC), such as surgery and chemoradiotherapy, can reduce oral function and affect quality of life (QoL). However, whether HNC treatment affects QoL via the decline of oral function remains unclear. This study aimed to investigate the relationship among cancer treatment, QoL, and actual oral function in HNC survivors.

Methods: A total of 100 HNC survivors who had completed definitive treatment for HNC at least 6 months prior to enrollment were enrolled in this cross-sectional study. QoL was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 summary score. Oral diadochokinesis (ODK), tongue pressure, moisture level on the mucosal surface, and mouth opening were measured. Information on age, sex, tumor site, tumor stage, history of HNC treatment, height, body weight, and lifestyle were collected from medical records. Structural equation modeling (SEM) was conducted to analyze the indirect/direct associations among HNC treatment, QoL, and oral function.

Results: In total, 100 HNC survivors (58 males and 42 females; age range, 30-81 years, median, 67 years) were analyzed. Overall, 63 patients (63.0%) were diagnosed as oral cancer, 66 (66.0%) developed advanced cancer (stage 3/4), and 58 (58.0%) underwent reconstruction surgery in 100 HNC survivors. The SEM results supported the hypothesized structural model (root mean square error of approximation = 0.044, comparative fit index = 0.990, Tucker-Lewis index = 0.986). Surgery with neck dissection and reconstruction for advanced cancer had indirect effects on lower QoL via ODK and mouth opening.

Conclusion: HNC treatment is indirectly associated with QoL via oral function in HNC survivors.

Background: Pain is reported in 66% of cancer patients with advanced disease. Adequate pain management is a cornerstone of comprehensive supportive cancer care.

Purpose: The purpose of this study was to assess pain management in Oncology Units in Belgium.

Methods: A descriptive research design was applied. A structured questionnaire developed by a writing committee was sent to 37 healthcare professionals in 2021. Twenty-four replied.

Results: In most centers, pain management is organized through the pain clinic (91.7%), followed by a multidisciplinary team (83.3%) and the palliative care unit (75%). Eighty-seven percent use tools to assess the pain, mostly for in-patients. Pain guidelines are applied in 17 centers with the ESMO guidelines being the most often mentioned. Mild to moderate pain is managed with paracetamol, non-steroidal anti-inflammatory drugs, and tramadol. All centers handle severe pain with strong opioids, including buprenorphine and fentanyl. Only 62% are concerned about the side effects of strong opioids. In case of neuropathic pain, treatments with pregabalin, gabapentine, and tricyclic antidepressants are the most common, followed by opioids and interventional therapies for refractory neuropathic pain. Asking advice to the pain clinic, combination therapy and opioid rotation are used for patients with inadequate analgesia. Eighty to 90% of the centers have access to intraspinal and epidural techniques, respectively. An active teaching program on pain relief is offered in 66%, but only 33% of the centers do active research focused on pain management.

Conclusions: This is the first survey on pain management in the Belgian centers. Surprisingly only one-third of the health professionals ask advice to the pain clinic in case of inadequate pain relief, meaning that we are far away from a multidisciplinary patient-centered approach. Therefore, the BSMO Supportive Care Task Force promotes the development of an interdisciplinary committee in every oncology unit.

Background: This is a retrospective study to identify if Glasgow Prognostic Score (GPS) is associated with length of hospital stay (LOS) in haematological cancer.

Methods: The participants were adult inpatients at a single centre in between 2018 and 2022. Serum levels of CRP and albumin were measured at admission. GPS was calculated as follows: point "0" as CRP < 10 mg/L and albumin ≥ 35 g/L; point "2" as CRP ≥ 10 mg/L and albumin < 35 g/L; point "1" as either CRP ≥ 10 mg/L or albumin < 35 g/L. Patients with point "0" were classified as low risk whilst point "2" as high risk. LOS was defined as the interval between the admission and discharge date.

Results: As a result, the average age was 59.6 ± 12.6 years and the average LOS was 6.0 days (IQR = 2 days, 11 days). Of 1621 patients, 8.8% of them were high risk. GPS was associated with LOS (β = 2.7 days; 95% CI = 0.8 days, 4.6 days; p trend < 0.001) after full adjustment. Each point of GPS was associated with 1.9 days (95% CI = 1.4 days, 2.4 days) longer in LOS with full adjustment. The association was more prominent in younger patients (< 65 years), patients with leukaemia and myelodysplastic syndrome, and those with normal body weight status (18.5-24 kg/m²), compared with their counterparts.

Conclusion: GPS was associated with LOS in Chinese patients with haematological cancer, indicating GPS could be a useful tool to predict outcome.

Diagnosing rare cancers is challenging and often leads to prolonged diagnostic trajectories. This study investigated the diagnostic trajectory of patients with rare cancers in The Netherlands. Data from 1541 patients were recruited via patient advocacy in a national online survey on their diagnostic trajectory, such as first general practitioner (GP) consultation to hospital referral and number of hospital visits before final diagnosis. Differences between solid vs. non-solid tumours and EURACAN domains were explored. Diagnostic timelines varied from less than 3 months to over 12 months. Most patients (76.0%) first consulted their GP before going to a hospital. 76.3% of all patients were referred to a hospital within less than 3 months. 32.1% reported receiving an incorrect diagnosis, and 44.6% of them underwent treatment or medication for the (perceived) incorrect diagnosis. Patients with solid vs. non-solid rare cancers trajectories differed significantly for treatment hospital, route to diagnosis, correctness of initial diagnosis, and number of hospital visits before correct diagnosis (all p < 0.001). Patients with neuroendocrine (NET; 21.7%) and endocrine tumours (17.5%) experienced longer GP-to-hospital visit waiting times. Patients with non-solid cancers often received a correct diagnosis after one hospital visit (75%) when compared with patients with solid cancer (2+ = 57.7%). Those with rare skin cancer and non-cutaneous melanoma, head and neck, and thoracic cancer visited multiple hospitals before an accurate diagnosis (56.7%, 53.8%, and 50.0%). Patients with rare cancers face significant challenges with diagnostic delays and inaccuracies. Researching symptom signatures and investing in regional clinical networks might improve diagnostic timelines.

Background: Cancer-related fatigue symptoms persist throughout the radiotherapy period in patients with esophageal cancer and show a continuous worsening trend, which seriously affects the quality of survival of patients. Therefore, monitoring patients' fatigue status promptly, recognizing highly fatigued patients, and providing physical and psychological support are essential for improving their quality of life. As a positive psychological trait, self-efficacy can influence the level of fatigue in patients undergoing radiotherapy for esophageal cancer. However, the pathways by which self-efficacy affects cancer-related fatigue remain unclear.

Objective: The aim of this study is to investigate the factors influencing cancer-related fatigue in patients undergoing radiation therapy for esophageal cancer and to investigate the role of social support as a mediator between self-efficacy and cancer-related fatigue using the theory of unpleasant symptoms.

Methods: The study used a descriptive survey approach, and data were collected at a tertiary hospital in Nanjing between October 2022 and May 2023. A total of 225 patients with esophageal cancer undergoing radiotherapy completed the Demographic Characteristics Scale, Cancer-Related Fatigue Scale, Self-Efficacy Scale, and Social Support Rating Scale. The data were statistically analyzed using SPSS version 26.0 (IBM, CHINA) and SPSS PROCESS 3.3 plug-in.

Results: The cancer-related fatigue score of Chinese patients undergoing radiotherapy for esophageal cancer was 27.27 ± 7.26, which shows a high level of fatigue. Social support partially mediates the relationship between self-efficacy and cancer-related fatigue.

Conclusion: The findings may help medical personnel identify factors that influence cancer-related fatigue in patients undergoing radiotherapy for esophageal cancer and develop reasonable management strategies.

Purpose: Patients with multiple myeloma (MM) experience significant symptom burden. We used a symptom monitoring app to longitudinally characterize the MM treatment experience in detail based on line of therapy (LOT).

Methods: Adults with MM on active treatment completed weekly symptom monitoring surveys. Patients on their 4th LOT or greater were considered heavily pretreated. We characterized moderate to very severe (MOD-VS) symptom prevalence, weekly symptom burden, symptom bother (FACT-GP5), and health-related quality of life (HR-QoL) (EORTC QLQ-C30 Item 30) per LOT.

Results: We considered 109 patients on LOT < 4 and 47 on LOT ≥ 4. The top MOD-VS symptoms were fatigue (71.6% of patients), muscle pain (59.8%), general pain (51.6%), numbness/tingling (48.4%), and insomnia (47.6%). More patients on LOT ≥ 4 experienced numbness/tingling (66.7% vs. 41.3%; OR 2.84, 95% CI 1.27-6.37; p = 0.0098) and fatigue (83.3% vs. 65.6%; OR 2.60, 95% CI 0.96-7.09; p = 0.0557). Some symptoms (fatigue, muscle pain, anxiety) persisted for months among patients on LOT ≥ 4, but patients on LOT < 4 also had unmet longitudinal needs (numbness/tingling, dyspnea). Patients on LOT ≥ 4 had more weeks with ≥ 3 MOD-VS symptoms (27.1% of weeks vs. 15.7%; OR 2.56, 95% CI 1.07-6.08; p = 0.0337) and experienced high symptom bother more often (39.1% of surveys vs. 30.0%; OR 4.23, 95% CI 1.37-13.10; p = 0.0123). HR-QoL was similar between groups.

Conclusion: Heavily pretreated patients experienced greater symptom burden and bother, but patients at earlier LOTs also had unmet needs. Interventions are needed to improve symptom management in MM regardless of LOT, but most pressingly for heavily pretreated patients.

Purpose: This study examined the associations of device-measured moderate-to-vigorous physical activity (MVPA) and sedentary time as well as self-reported MVPA with health-related quality of life (HRQoL) in patients with localized renal cell cancer (RCC) in the recovery phase after surgery.

Methods: At 3 months post-surgery, 341 patients with stage I-III RCC participating in the ReLife study wore an ActivPAL3 device to determine MVPA and sedentary time. The SQUASH questionnaire was used for assessing self-reported MVPA, and the EORTC QLQ-C30 for assessing HRQoL (range 0-100). Multivariable linear regression models were used to examine the cross-sectional associations of MVPA and sedentary time with HRQoL.

Results: The highest (≥ 6.7 h/week) versus lowest (≤ 2.7 h/week) quartile of MVPA was associated with a better global health status (β, 10.2; 95% CI, 5.1, 15.3), summary score (β, 4.6; 95% CI, 1.1, 8.1), physical (β, 7.7; 95% CI, 3.8, 11.6), role (β, 12.4; 95% CI, 4.7, 20.2), and social functioning (β, 7.3; 95% CI, 0.2, 14.4), and lower fatigue (β, - 11.2; 95% CI, - 18.1, - 4.2). Results for self-reported MVPA were in the same direction but weaker. The lowest (≤ 8.8 h/day) versus highest (≥ 11.5 h/day) quartile of sedentary time was associated with better physical functioning (β, 4.6; 95% CI, 0.8, 8.5).

Conclusions: In patients with localized RCC, higher MVPA 3 months post-surgery was associated with better HRQoL outcomes including less fatigue whereas lower sedentary time was only associated with better physical functioning. This information can contribute to the development of physical activity guidelines and interventions to improve HRQoL.

Purpose: In this study, we explored the work of Halasartan (Stop Cancer), an Israeli nongovernmental organization (NGO) and unique social support network for cancer patients and survivors aged 18-44, during a war period. Drawing on the conservation of resources (COR) theory, we examined whether self-efficacy, social support, psychological distress, and participation in activities that were geared toward alleviating the war situation at Time 1 (T1) would predict engagement in such activities at Time 2 (T2).

Methods: A longitudinal design with two time-points was used, and NGO members completed self-report questionnaires. At T1, the cohort comprised 250 members (cancer patients/ survivors); at T2, there were 213. However, only 90 NGO members completed the questionnaires at both time-points.

Results: A significant reduction in psychological distress was observed over time among participants engaged in the NGO's activities, but no differences were observed in participants' self-efficacy or social support. Moreover, participation in NGO activities during wartime at T2 was predicted by biological sex (female), lower self-efficacy, and participation in NGO activities at T1.

Conclusion: Halasartan (Stop Cancer) played a pivotal role in offering a sense of normalcy, community, and support to young-adult cancer patients and survivors during a period of war. The study underscores the essential nature of NGO activities tailored to the unique needs of this demographic, particularly in times of crisis. A broader implementation of such supportive interventions to enhance the well-being of vulnerable populations is suggested.

Background and purpose: Clinicians use the CTCAE scale to grade radiation dermatitis (RD) based on edema, erythema, and desquamation. The purpose of this study was to correlate the CTCAE scores with the severity of patient-reported symptoms using a skin symptom assessment (SSA) and the Radiation-Induced Skin Reaction Assessment Scale (RISRAS).

Materials and methods: This is a secondary analysis of a randomized controlled trial involving 376 patients receiving Mepitel Film or standard-of-care for RD prophylaxis. The highest symptom categories for SSA and patient-component RISRAS assessments were selected from all time points, and a summary analysis and Spearman correlation coefficient was calculated for patients with CTCAE Grades 0, 1, 2, 3, and Grade 2/3, respectively. Analyses were conducted across all patients, within each treatment arm, and between arms in patients with only Grade 2 or 3 toxicity.

Results: Weak correlations between CTCAE scores and all patient-reported skin symptoms were found across the entire cohort and each treatment arm (p < 0.05). Patients with Grade 2 (n = 72) and Grade 3 RD (n = 24) reported similar rates of patient-reported moderate-to-severe skin symptoms (11-72% vs 14-79%), with no significant difference in rates of individual moderate-to-severe symptom between these cohorts (p > 0.05). Between treatment arms, rates of patient-reported moderate-to-severe scores were similar for most symptoms.

Conclusion: CTCAE RD scores are weakly correlated with patient-reported skin symptoms and cannot distinguish between patients with severe patient-reported outcomes. Clinicians should consider the limitations of CTCAE grading and incorporate patient-reported outcomes within clinical practice.