Supportive Care in Cancer最新文献

Purpose: Long-term follow-up (LTFU) outpatient clinics play a primary role in screening, preventing, and addressing late effects after hematopoietic cell transplantation (HCT). Following the 2018 nationwide survey, which led to the development of standardized nationwide tools to deliver information to HCT survivors, we re-evaluated changes in the current status of LTFU clinics.

Methods: We targeted 267 HCT centers certified by the Japanese society for transplantation and cellular therapy. Several questionnaire categories were retained from the 2018 survey to compare results (e.g., LTFU clinic establishment and institutional practices for late-effect screening).

Results: The response rate was high in both adult (90%) and pediatric HCT centers (88%), and the establishment rate of post-HCT LTFU clinics increased to 82% (adult, 90%; pediatric, 64%). Pediatric centers were more likely to continue follow-up of patients who received HCT beyond 5 years post-HCT. Regarding transitional medical care for long-term survivors at non-HCT institutions, only a few HCT centers conducted routine transitions to specific referral facilities. We observed significant changes in recommendations for secondary cancer screenings compared to 2018, with a substantial decrease in the proportions of "not routinely included as a screening issue."

Conclusions: In the future, it is essential to create a sustainable follow-up system, establish networks with non-HCT facilities, and educate patients to encourage behavioral changes for lifelong health screenings.

Purpose: To systematically evaluate and synthesize qualitative evidence on the lived experiences of self-management engagement among adult patients with hematologic malignancies to inform the development of targeted interventions.

Methods: A systematic literature search was conducted across eight databases (including PubMed, Embase, Web of Science, Cochrane Library, CINAHL, CNKI, WanFang, and CBM) from inception to July 2025, with an updated search performed in January 2026. Sixteen qualitative studies involving adults (≥ 18 years) with hematologic malignancies were included. The methodological quality of the included studies was appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist (2020). Data were synthesized using the thematic synthesis method.

Results: This meta-synthesis integrated findings from 16 studies involving adults with diverse hematologic malignancies across 11 countries, covering trajectories from active treatment to long-term survivorship. Using NVivo 15.0 for inductive thematic analysis, the synthesis established four overarching analytical themes reflecting the unique demands of this population: (1) The Hidden Work: Vigilance and Risk Management, which details the hyper-vigilance required for infection prevention, bleeding risks, and continuous physiological monitoring; 2) Psychological Labor and Emotional Adaptation, encompassing the cognitive burden of dyadic coping, protective buffering, and managing the pervasive fear of relapse; 3) Engagement Capacity: Drivers and Resources, which bridges intrinsic drivers with the essential knowledge and skills required for self-management; and 4) The Context of Care Continuum, highlighting the systemic barriers and information gaps encountered during critical disease transitions.

Conclusion: This meta-synthesis indicates that self-management engagement in hematologic malignancies extends beyond task adherence to involve continuous "risk work" and significant emotional labor within the family unit. Findings suggest that nursing interventions should prioritize targeted strategies, such as sepsis-prevention education and dyadic coping support, over generic approaches. Addressing these specific, high-stakes demands is critical for optimizing patient safety and quality of life throughout complex treatment transitions.

Purpose: Healthcare transition readiness is crucial for adolescent and young adult childhood cancer survivors (AYA CCS) to ensure continuity of care as they move from pediatric to adult healthcare services. A systematic review of the evidence linking social determinants of health (SDoH) and healthcare transition readiness is needed to provide valuable insights into the impact of disparities on transition.

Methods: A mixed-methods systematic review (MMSR) was conducted on studies published through November 2025. Quantitative data were extracted to assess measurable outcomes related to healthcare transition readiness and SDoH, while qualitative studies exploring the perceptions and experiences of AYA CCS, their families, and healthcare providers on transition readiness were analyzed using thematic synthesis. The final synthesis followed a convergent integrated approach, guided by the Healthy People 2030 SDoH framework.

Results: Seventeen studies (five quantitative and twelve qualitative) were included. Healthcare access and quality emerged as the most influential SDoH, with consistent evidence showing that relationships with knowledgeable healthcare providers, and access to health insurance and healthcare services were associated with healthcare transition readiness. Social and community context - including parental and peer support - also contributed to readiness. Evidence for economic stability was mixed, while education access and quality and neighborhood factors were the least examined and remain inconclusive. Integrated analysis indicated that structural (e.g., insurance, provider access) and relational SDoH (e.g., communication quality, family and peer support) influence healthcare transition readiness among AYA CCS. CONCLUSIONS AND IMPLICATIONS: This MMSR provides a comprehensive understanding of how SDoH impact healthcare transition readiness among AYA CCS. The findings underscore the need for future research to address gaps in the current literature and to improve transition outcomes and reduce disparities during the transition process in this population.

Purpose: Breast cancer survivors face challenges maintaining labor market attachment, potentially impacting their health and economy. Yet, the broader public health impact on how labor market attachment patterns compare with women in the general population by socioeconomic group and disease stage remains unknown. Most previous studies have only included employed women, limiting their relevance for broader population-level planning. This study aimed to address these gaps.

Methods: Using Danish registries, we identified women aged 25-55 years diagnosed with stage I-III breast cancer during 2002-2018. For each, we matched 10 comparison women on age, region, and surgery date (index). We assessed sick leave, workforce detachment, and disability pension up to 10 years, emigration, death, or 31 December 2023. We calculated incidence rates and used negative binomial regression to estimate rate differences and ratios, stratified by stage, education, cohabitation, and a social vulnerability index (rSVI, range 0-14, where rSVI < 5 indicated lowest vulnerability).

Results: Among 13,443 breast cancer survivors and 134,430 comparisons, survivors more often had long education, a partner, and a lower rSVI. Breast cancer survivors had higher incidence rates of sick leave 0-2 years after index, but slightly lower rates of workforce detachment and disability pension. From year 3 onwards, rates of all outcomes were slightly higher in breast cancer survivors. Rates of workforce detachment and disability pensions were particularly elevated among survivors with advancing stage and lower socioeconomic position. Notably, the relative estimates were greatest among women with a partner, medium/long education, or lower rSVI.

Conclusion: By assessing labour market outcomes among all breast cancer survivors regardless of their employment status, this study provides population-relevant evidence on the long-term public health consequences of breast cancer. While women with advanced stage and lower socioeconomic position had the highest incidence of work force detachment and disability pension, the greatest relative impact of breast cancer occurred among high-resource survivors-likely reflecting their lower baseline risk.

Purpose: Effective parent-child communication is central to coping with psychosocial challenges of pediatric cancer, yet few studies have examined how caregivers and children perceive their communication. This study investigated differences between caregiver and child reports of communication and associations with family relationship quality. We hypothesized children would report more open and positive communication than caregivers report, reflecting directional discrepancies in communication quality.

Methods: Seventy-six caregiver-child dyads (N = 152) were recruited from two Midwestern pediatric hospitals. Children aged 8-17 with cancer and their caregivers independently completed measures of parent-child communication (PCCS) and family relationships (PROMIS). Descriptive statistics, correlations, and paired- and independent-samples t-tests examined differences and associations across dyads. Exploratory Actor-Partner Interdependence Models (APIM) investigated dyadic associations between child and caregiver communication and child family relationships.

Results: Caregivers (10-item: M = 3.90, SD = 0.55; 20-item: M = 3.94, SD = 0.58) and children (M = 4.15, SD = 0.61) reported generally high-quality communication. However, significant differences emerged: children rated caregivers as more attentive listeners (t(74) = 2.53, p = .01, Cohen's d = 0.29), emotionally open (t(74) = 2.30, p = .02, Cohen's d = 0.27), and willing to discuss problems (t(74) = 2.86, p = .005, Cohen's d = 0.33) than caregivers reported children. Across correlation and APIM analyses, child-reported communication was strongly associated with child-reported family relationships and caregiver-reported communication was strongly associated with caregiver-reported child family relationships (actor effects). Older caregiver and child age was linked to lower communication scores.

Conclusions: Interdependent caregiver and child perceptions of communication represent an underrecognized factor influencing family functioning in pediatric cancer. Findings underscore the importance of routine communication assessment and highlight the need for developmentally tailored interventions.

Introduction: Treatment for childhood acute lymphoblastic leukemia (ALL) can result in hepatotoxicity. Despite being a common complication of ALL therapy, mechanisms and biomarkers of treatment-associated hepatotoxicity (TAH) are not well described.

Methods: We conducted lipidomic profiling to identify plasma lipids associated with TAH in children receiving ALL therapy utilizing a nested case-control framework. TAH was defined as (1) transaminitis: ALT/AST ≥ CTCAE grade 3, and/or (2) conjugated hyperbilirubinemia: > 3.0 mg/dL during induction therapy or > 2.0 mg/dL post induction. A total of 90 patients (45 matched pairs) treated at Texas Children's Hospital between 2012 and 2021 were selected for lipidomic profiling, with controls matched to cases based on the availability of samples collected at similar time points in therapy. Lipidomic profiling quantified 1056 lipids, with 751 retained after quality control. Associations with TAH were evaluated using multivariable conditional logistic regression controlling for age, diagnostic BMI z-score, race/ethnicity, and induction intensity.

Results: The cohort was 55% male, 50% Hispanic, with a mean diagnostic age of 5 years. We identified 110 lipids nominally associated with TAH post-sample collection (p < 0.05). Lipid classes phosphatidylcholines (PCs; Holm-p = 5 × 10^-6) and sphingomyelins (SMs; Holm-p = 0.0009) were significantly enriched in cases.

Discussion: We identified plasma lipid profiles, characterized by elevated PCs and SMs with reduced triglycerides, associated with the incidence of TAH in children with ALL. Similar patterns have been linked to metabolic liver disease in adults and children. These findings suggest lipid dysregulation may contribute to TAH susceptibility and highlight candidate biomarkers for future validation in larger cohorts.

Purpose: Patients with terminal cancer often have swallowing dysfunction (dysphagia), which is associated with quality of life. Dysphagia has been reported to be associated with cancer treatment, physical decline, or poor eating posture. However, its relationship with activities of daily living (ADLs) and eating posture has rarely been studied. This study examined these associations in patients with terminal cancer.

Methods: This cross-sectional observational study included patients admitted to a palliative care unit between November 2018 and April 2024 who underwent rehabilitation. Data included age, sex, swallowing function (Functional Oral Intake Scale [FOIS]), ADLs (Functional Independence Measure [FIM]), eating posture (upright sitting, chair sitting, full gatch-up, high-angle, low-angle), and Palliative Prognostic Index (PPI). Patients were categorized into tube-dependent (FOIS 1-3) and oral intake (FOIS 4-7) groups. Group comparisons used the Mann-Whitney U test. Multivariate logistic regression examined associations between swallowing function, ADLs, eating posture, adjusting for age, sex, PPI, and sleepiness.

Results: Among 201 patients (mean age 82.0 ± 10.8 years), 26.4% were tube-dependent. Swallowing function was significantly associated with mFIM (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = 0.002), cFIM (OR 1.07, 95% CI 1.02-1.12, P = 0.002), total FIM (OR 1.03, 95% CI 1.01-1.05, P < 0.001), and upright sitting (OR 2.92, 95% CI 1.12-7.62, P = 0.029).

Conclusion: Swallowing function in patients with terminal cancer was associated with ADLs and eating posture. The cross-sectional design limits causal inference, and prospective studies are needed.

Purpose: Allogenic hematopoietic stem cell transplantation (allo-HSCT) is a curative treatment for hematological disorders but often results in micronutrients deficiency and complications. Vitamin C, a potent antioxidant, may improve endothelial function, tissue protection, and immune recovery. This study evaluated the effects of early high-dose vitamin C supplementation on plasma vitamin C levels and post-HSCT complications.

Methods: In this pilot, triple-blind, placebo-controlled trial, 31 adult allo-HSCT patients were randomized to receive intravenous vitamin C (50 mg/kg/day) or placebo from day + 1 to + 14, followed by oral vitamin C (500 mg/day) or placebo until day + 100. Plasma vitamin C levels were measured at days 0, + 7, + 15, and discharge. Patients were monitored for post-HSCT complications until day + 100.

Results: Plasma vitamin C levels were significantly higher in the vitamin C group at all time points (P < 0.001). Trends toward reduced acute graft-versus-host disease (33% vs. 44%), lower oral mucositis severity (46.6% vs. 62.5%), and shorter duration (7.5 ± 3.6 vs. 9.1 ± 3.7 days) were observed, though not statistically significant. No significant adverse events were reported.

Conclusion: High-dose vitamin C effectively corrected plasma levels, and while trends toward reduced complications were observed in allo-HSCT patients, larger trials are needed to confirm these findings.

Purpose: The Veterans Health Administration created initiatives to enhance the monitoring of Social Determinants of Health (SDOH) among Veterans in the primary care setting. There remains suboptimal communication between primary care and cancer care specialties.

Methods: In-depth interviews were conducted at a VA medical center among primary care physicians, social workers, and cancer care physicians. Participants described how SDOH affect Veterans with cancer and identified strengths and weaknesses in the current communication channels between specialties. Interviews were audio-recorded, transcribed, and coded. Key themes were identified using inductive analysis based on the grounded theory.

Results: There were four major themes: (1) social issues disrupt treatment and lead to worse outcomes; (2) social challenges drive Veterans' attention and resources away from their treatment; (3) navigating current systems requires institutional experience to overcome barriers; (4) all members of the care team have a role in addressing SDOH. The most common SDOH affecting this population include housing instability, transportation, food insecurity, and social support. SDOH and communication between care settings were considered primary barriers to care for Veterans with cancer.

Conclusion: The opportunity to improve the social support and care for Veterans with cancer would be enhanced by a structured and purposeful discussion to include social issues before treatment begins. The findings helped to inform the development of two interventions: creating an accessible template in the electronic medical record to summarize SDOH needs and the inclusion of primary care physicians and social workers at the initial tumor board discussion for Veterans with a new diagnosis of cancer.