Supportive Care in Cancer最新文献

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.

Cancer navigation guides patients through cancer care, addressing barriers like late diagnosis, financial constraints, and emotional distress. In Africa, it supports early detection, treatment, and survivorship amid poor infrastructure and limited access. Expanding these programs can reduce mortality and improve outcomes. Cancer cases are rising rapidly in Africa and are expected to double by 2050. Access to care is hindered by limited facilities, few trained oncologists, geographic barriers, cultural stigma, high treatment costs, and lack of screening programs. Most services are urban-centered, leaving rural areas underserved. Financial hardship, poor governance, inadequate research funding, and scarce cancer registries worsen the problem. Coordinated, sustainable efforts are needed to improve cancer prevention, treatment, and care. Patient navigation significantly enhances cancer care in sub-Saharan Africa by addressing barriers to early detection, diagnosis, treatment, and support. Navigators facilitate screening, improve awareness, and coordinate care across healthcare levels. They reduce treatment delays, offer psychosocial support to patients and caregivers, and help with financial, transport, and lodging challenges. Successful programs in South Africa, Uganda, and Nigeria demonstrate improved outcomes, including increased screenings, faster diagnoses, and better treatment adherence, showcasing the transformative impact of navigation on cancer control in resource-limited settings. Strengthening cancer navigation systems is essential, focusing on healthcare infrastructure, workforce training, policy reform, and community engagement. Key strategies include expanding cancer centers, integrating trained patient navigators (both clinical and non-clinical navigators), leveraging telemedicine and AI, and increasing collaborations. Formal navigator certification, education campaigns, and improved health financing are crucial. These efforts aim to improve cancer detection, treatment, and outcomes across Africa's diverse healthcare settings.

Background: While perceived stress in non-small cell lung cancer (NSCLC) is typically associated with psychological distress, it can also co-occur with positive adaptation, such as benefit finding. It is unclear whether resourcefulness may mediate this association.

Aims: To examine whether resourcefulness mediates the association between perceived stress and benefit finding in patients with NSCLC.

Methods: A cross-sectional study was conducted among NSCLC patients at a single oncology hospital between February and June 2025. Data were collected using a structured questionnaire comprising demographic and clinical characteristics, the Perceived Stress Scale (PSS), the Resourcefulness Scale (RSS), and the Benefit Finding (BF) Scale. Data analysis was performed using SPSS 27.0 and Amos 28.0. Descriptive statistics, independent t-tests, one-way ANOVA, Pearson's correlation, and multiple regression were conducted. To examine the potential mediating pathway of resourcefulness, a structural equation model (SEM) was constructed. The model's goodness-of-fit was assessed using common indices, including χ2/df, GFI, AGFI, NFI, RFI, TLI, CFI, and RMSEA.

Results: A total of 326 NSCLC patients participated. The structural equation model demonstrated a good fit. Path analysis revealed that perceived stress was significantly associated with benefit finding, both directly (β = 0.345, p < 0.001) and indirectly via resourcefulness (β = 0.039, p < 0.001). This provides evidence that resourcefulness partially mediates the relationship between perceived stress and benefit finding in this patient group.

Conclusion: This study found that, among NSCLC patients, higher perceived stress was associated with greater benefit finding, both directly and indirectly through increased resourcefulness. These results suggest that moderate perceived stress may stimulate resourcefulness, which, in turn, helps patients find positive aspects of their experience. Supporting patients' resourcefulness may help them manage stress and achieve better psychological adaptation.

Objective: This randomized controlled trial aimed to evaluate the efficacy of electroacupuncture combined with nutritional intervention for cancer-related sarcopenia compared to nutritional intervention alone. Muscle thickness and elasticity were assessed using ultrasonography to calculate relevant parameters. By integrating these objective measures with conventional indicators and scales, this study aimed to provide a more comprehensive and intuitive evaluation of changes in muscle function, thereby offering a basis for the clinical application of electroacupuncture combined with nutritional intervention in the treatment of cancer-related sarcopenia.

Methods: Seventy participants were randomly assigned to either a control group receiving nutritional intervention alone or an experimental group receiving electroacupuncture combined with nutritional intervention for 12 weeks. Primary outcome measures included the appendicular skeletal muscle index (ASMI), dominant handgrip strength, 6-m walk time, and multiparameter ultrasound indices. Secondary outcomes included the Mini Nutritional Assessment (MNA), Short Physical Performance Battery (SPPB), body mass index (BMI), and body fat percentage. All measurements were taken at baseline and after the intervention.

Results: The study cohort predominantly consisted of patients diagnosed with gastrointestinal cancers. Following the intervention, participants in the control group demonstrated significant improvements in appendicular skeletal muscle index (ASMI), dominant handgrip strength, body mass index (BMI), ultrasound-derived muscle thickness, and Mini Nutritional Assessment (MNA) scores. However, no statistically significant changes were observed in the 6-m walking speed, body fat percentage, a-Ratio, or short physical performance battery (SPPB) scores. In contrast, the experimental group exhibited statistically significant enhancements across all measured outcomes, including ASMI, handgrip strength, 6-m walking speed, BMI, body fat percentage, muscle thickness by ultrasound, a-Ratio, MNA scores, and SPPB scores. Moreover, the magnitude of improvement in the experimental group surpassed that observed in the control group.

Conclusion: This study demonstrates that electroacupuncture combined with nutritional intervention effectively improves muscle mass, dominant handgrip strength, physical performance, nutritional status, and body composition in patients with gastrointestinal cancer-related sarcopenia, with no significant safety concerns. This approach is worthy of clinical promotion to enhance the quality of life and prognosis of these patients.

Purpose: We aimed to understand patients' initial experiences with targeted oral anticancer agents (OAAs). We investigated symptoms experienced and how symptom severity affected patient confidence to manage and seek care for symptoms and OAA adherence.

Methods: We conducted a longitudinal prospective cohort study of patients during the first 8 weeks of targeted OAA treatment at an NCI-designated cancer center. Participants completed patient-reported outcome measures (PROMs) online at three timepoints. Descriptive statistics quantified demographics, cancer characteristics, symptom severity, confidence, and OAA adherence. Logistic regression was used to estimate confidence and adherence by each symptom at each timepoint. Mixed effects logistic regressions accounted for repeated measures and time effects on outcomes.

Results: Participants (n = 59) reported severe symptoms at all timepoints. Tiredness and drowsiness were most frequently reported as severe. Participants' confidence increased from timepoint 1 to 3. Most participants reported high confidence (61-86%) and excellent adherence (75-80%) across all timepoints, but 20-25% had less than excellent OAA adherence. High confidence to manage symptoms was positively associated with older age. Confidence to manage symptoms was inversely related to the severity of depression, tiredness, drowsiness, constipation, and tingling/numbness.

Conclusion: Confidence to manage symptoms increased with time on OAAs, but severe symptoms persisted. Although self-reported OAA adherence was high, a notable number of participants reported suboptimal adherence. Relationships between confidence, symptom severity, and adherence should be identified in clinical settings to evaluate patients who may need extra clinical support during OAA treatment.