Supportive Care in Cancer最新文献

Purpose: The primary purpose was to assess the feasibility and acceptability of a group health coaching (GHC) program with cancer patients and survivors; secondarily, to determine the preliminary effects of GHC on several behavioral lifestyle factors.

Methods: GHC was provided to people diagnosed with cancer via videoconference by trained health coaches across six GHC sessions over a 3-month period. Qualitative and quantitative data were collected. Data on recruitment, attrition, attendance, fidelity, retention, safety, and barriers and facilitators to implementation were assessed. Participant-reported outcomes collected via surveys included physical activity, eating habits, perceived stress, anxiety, depression, sleep, and quality of life, followed by post-program focus groups and in-depth interviews. Survey results were analyzed using repeated measures multilevel modeling. Qualitative data was analyzed using inductive thematic analysis.

Results: Overall, 26 participants with a variety of cancer types attended an average of 74% of coaching sessions. The intervention was feasible to implement and found acceptable by participants and health coaches. Over the course of the intervention, there was a moderate increase in total weekly physical activity minutes (baseline = 365.25, follow-up = 510.30, p = 0.032, d = 0.50), and a small increase in weekly moderate-vigorous physical activity frequency (baseline = 4.07 bouts, follow-up = 5.44 bouts, p = 0.045, d = 0.39). Additionally, a moderate increase was found in functional well-being (baseline = 16.30, follow-up = 18.93, p < 0.001, d = 0.50). CONCLUSIONS AND IMPLICATIONS: GHC may be a feasible and acceptable way to promote behavior change for physical activity in cancer patients and survivors, reducing cancer burden and enhancing functional well-being.

Purpose: This pilot study aimed to identify patients with cognitive impairment by a stepped-care use of patient-reported outcome measures (PROMs) and complementary online cognitive tests implemented in routine clinical practice.

Methods: Self-reported cognitive functioning was measured in breast cancer or melanoma patients, 6 months after start of treatment, with two items of the EORTC QLQ-C30. Scores below a predefined threshold of 75 indicated clinically relevant cognitive impairment. Subsequent objective cognitive functioning was assessed with an online test battery, consisting of seven tests. Impaired cognitive functioning was defined as a z score of ≤  - 1.5 on 2 or more tests, a z score of ≤  - 2 on one single test, or both. Descriptive statistics were used to analyze the prevalence of impairment.

Results: In total, 261 patients completed PROMs 6 months after start treatment; 38/154 (25%) melanoma and 43/107 (40%) breast cancer patients reported clinically relevant self-reported cognitive impairment. Of them, 12/38 (32%) melanoma and 15/43 (35%) breast cancer patients opted for complementary online cognitive testing. Of those completing formal tests, objectively measured cognitive impairment was identified in 4/12 (33%) melanoma and 10/15 (67%) breast cancer patients.

Conclusion: A significant number of patients report cognitive problems 6 months after starting treatment. Only onethird was able and/or expressed the need for further diagnostics. Among those who were formally tested, 33-67% had cognitive impairment, which is 3-9% of the total group that completed PROMs in routine care.

Implications for cancer survivors: This pilot study suggests that a stepped care pathway for cognitive problems is relevant and also mangable in terms of clinical care.

Purpose: Reproductive concerns are prevalent in the female breast cancer patient population and increase existential distress. Although self-disclosure significantly correlated reproductive concerns, the exact mechanism of action is unknown. Based on previous theoretical studies on couples' cancer-related communication problems and intimacy in couples, this study constructed a chain mediation model to investigate whether the two variables mediate the relationship between self-disclosure and reproductive concerns.

Methods: A cross-sectional survey was conducted from August 2023 to July 2024 at Jiangxi Cancer Hospital. A total of 280 female breast cancer patients completed the Distress Disclosure Index, Couples' Cancer-Related Communication Problems Scale, Quality Relationship Index, and Reproductive Concerns After Cancer Scale. Data description and Pearson's correlation analysis were performed through SPSS 26.0 software. Serial mediation effect analysis and testing were performed through Hayes' Process 4.1 program.

Results: Self-disclosure was found to be negatively associated with reproductive concerns and couples' cancer-related communication problems, but positively associated with intimacy. After controlling for sociodemographic variables, including age, matrimonial, number of children, and hormone receptor, the direct effect of self-disclosure on reproductive concerns was significant (Effect =  - 0.320; 95% CI, - 0.465 to - 0.178). In addition, three other indirect pathways of action were also significant: (1) through couples' cancer-related communication problems (Effect =  - 0.113; 95% CI, - 0.181 to - 0.045), (2) through intimate relationships (Effect =  - 0.110, 95% CI - 0.187 to - 0.043), and (3) through the chain-mediated effects of couples' cancer-related communication problems and intimacy (Effect =  - 0.025; 95% CI, - 0.054 to - 0.007). The total indirect effect of the three pathways of action was 43.66%.

Conclusions: Self-disclosure not only directly affects reproductive concerns in female breast cancer patients, but also indirectly through couples' cancer-related communication problems and intimacy, as well as sequential mediation of the two. Interventions targeting the above factors can help promote self-disclosure in female breast cancer patients, reduce couples' cancer-related communication problems, and improve intimacy, thereby alleviating reproductive concerns after cancer.

Purpose: There is increased demand for lifestyle interventions earlier on the cancer continuum (i.e., during curative-intent treatment). To address this need, researchers face unique challenges intervening in the short period of time after diagnosis, but before initiation of chemotherapy and/or surgery. During the peak of the COVID-19 pandemic, transitions to remote/digital platforms became both mandatory and immediate.

Methods: This case study details the rapid transition to a remote/digital study embraced by our team as we recruited patients newly diagnosed with breast cancer to a pilot study. The pilot's purpose was to characterize the relationships between physical activity (PA) and cognitive and mental health during breast cancer treatment.

Results: We reflect on the lessons learned during this pilot study with a particular focus on three emergent challenges: digital data collection, recruitment during active breast cancer treatment, and participant burden. We used a systematic implementation framework to track adaptations made to meet the evolving needs of patients and clinicians, while adhering to institutional protocols.

Conclusions: This case study provides important insights into the delicate balance between patient, clinician, and institutional needs in the breast cancer setting, particularly when delivering digital interventions during treatment.

Implications for cancer survivors: Careful attention should be paid to protocols for remote research to ensure that it is feasible, acceptable, and rigorous for all cancer survivors.

Purpose: To study the safety of resuming antitumor therapy in tumor patients infected with COVID-19.

Methods: We collected the clinical information of patients with tumors who were infected with COVID-19 and resume antitumor therapy between December 2022 and June 2023. Information about antitumor therapy, COVID-19-related symptoms, laboratory tests, antitumor therapy-related adverse events (AEs), and re-infection with COVID-19 were recorded. Primary endpoints included the incidence of AEs and re-infection of COVID-19. The secondary endpoints included the incidence and duration of COVID-19 related symptoms.

Results: The most common COVID-19 symptoms were fever (39.5%), cough (37.2%), and fatigue (44.2%). Most patients' symptoms lasted no more than a week Two patients were re-infected with COVID-19. All-grade AEs with an incidence rate > 10% included anemia, increased gamma-glutamyl transferase (GGT), anorexia, neutropenia, hypocalcemia, leukopenia, thrombocytopenia, increased alanine aminotransferase, increased aspartate aminotransferase, hypokalemia, hyponatremia, and nausea. Grade 3-4 AEs with an incidence rate higher than 5% included anemia, neutropenia, leukopenia, thrombocytopenia, anorexia, and vomiting. The incidence of AEs before and after COVID-19 infection did not show a significant difference.

Conclusion: Resuming antitumor therapy early after SARS-CoV-2 test turned negative did not increase antitumor therapy-related AEs or the incidence of re-infection in COVID-19 infection patients.

Purpose: To examine socioeconomic disparities in health-related quality of life (HRQoL) and healthcare use during the last year of life of patients with advanced cancer.

Methods: Data was used from a prospective, longitudinal, multicenter, observational study of patients with advanced cancer in forty Dutch hospitals (eQuiPe). Adult patients with stage IV cancer completed 3-monthly questionnaires until death. Socioeconomic position (SEP) was defined as estimated income on street-level. Mixed-effects regression analysis was used to identify associated factors.

Results: A total of 639 patients were included, 14% with a lower SEP, 59% medium SEP and 28% higher SEP. Patients with a lower SEP were more often lower educated (40% vs. 18%, p < 0.001) and less often reported to have a partner (61% vs. 90%, p < 0.001) than those with a higher SEP. In the last year of life, patients with lower SEP were more likely to experience disease-related financial difficulties than those with higher SEP (28% vs. 12%, p = 0.001; β 8.2, 95%CI 2.9-13.3). No significant associations were found between SEP and HRQoL, hospital admissions or emergency department admissions. Although, patients with lower SEP had more frequent (≥ 5 per month) interactions with healthcare professionals than patients with higher SEP in the last year of life (OR 1.9, 95%CI 1.0-3.5).

Conclusion: Some socioeconomic disparities are present during the last year of life of patients with advanced cancer. It is important for clinicians to be aware of the greater financial impact and higher healthcare utilization in patients with a lower SEP to ensure equitable end-of-life care.

Purpose: Sex influences chemotherapy-induced nausea and vomiting (CINV). However, in clinical practice, males and females receive the same antiemetic prophylaxis. We compared CINV between sexes in patients with different emetic risk schemes and evaluated the predisposing factors and main adverse effects caused by antiemetics.

Methods: Prospective observational study conducted in a tertiary-care hospital from February 2023 to May 2024 in patients starting chemotherapy or a new treatment line. CINV was evaluated using MASCC antiemetic tool, in acute (< 24 h) and delayed phases (24-120 h). Results were analyzed using χ² test or Fisher's exact test. The primary endpoint was complete response (CR) rate, defined as no CINV and no use of rescue medication. Univariate and multivariate logistic regressions were used to identify patient-related risk factors associated with non-CR.

Results: A total of 176 completed questionnaires (CQ): 94 for males and 82 for females were collected. The proportion of males who remained emesis-free was superior to females in the acute phase (100% versus 92.7%, p = 0.009). Likewise, a higher proportion of males remained nausea-free in the acute (91.5% versus 79.3%, p = 0.021) and delayed phase (90.4% versus 79.3%, p = 0.037). In females, young age (< 60 years) and previous nausea and vomiting during pregnancy may contribute to non-CR. A high proportion of patients reported adverse events like constipation and insomnia. Females suffered more constipation than males (52.4% versus 37.2%, p = 0.043).

Conclusion: Females experienced more CINV than males, with the consequences that entail. Antiemetic prophylaxis should be personalized, considering sex and age and not only the chemotherapy emetic potential.

Purpose: Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect in patients treated with gemcitabine (GEM) and nanoparticle albumin-bound paclitaxel (nab-PTX) for pancreatic cancer, negatively impacting their quality of life. This study aimed to identify risk factors for significant CIPN development in a real-world setting of GEM + nab-PTX treatment to inform effective management strategies.

Methods: Patients with unresectable pancreatic cancer who received GEM + nab-PTX (n = 140) were retrospectively assessed. The primary endpoint was to identify the risk factor(s) associated with the development of problematic grade ≥ 2 CIPN within six months of treatment initiation. We also evaluated factors associated with all-grade CIPN and compared CIPN incidence across specific patient groups.

Results: The incidence of grade ≥ 2 CIPN was 35.0%, with 63.6% of patients experiencing symptoms of any grade. Multivariate Cox proportional hazard regression analysis identified baseline preexisting neuropathy as an independent risk factor for developing grade ≥ 2 CIPN (adjusted hazard ratio 4.03, 95% confidence interval 1.82-8.96, P = 0.0006). Conversely, dose modification of nab-PTX at or within 4 weeks of treatment initiation emerged as a protective factor (0.45, 0.22-0.91, P = 0.03). Additionally, the cumulative incidence of grade ≥ 2 CIPN was significantly lower and delayed in patients who underwent dose modification within 4 weeks compared to those who did not in the population with preexisting neuropathy (P = 0.01).

Conclusion: Baseline preexisting neuropathy significantly increases the risk, while early dose modification of nab-PTX serves as a protective factor against developing grade ≥ 2 CIPN in patients receiving GEM + nab-PTX treatment for pancreatic cancer.