Supportive Care in Cancer最新文献

Introduction: Structured, easy-to-interpret approaches are needed to facilitate preference-sensitive decision-making about cancer treatments. The TrialTalk method incorporates a verbal component and a pen-and-paper diagram that outlines the diagnosis, prognostic implications, treatment options, potential outcomes, and anticipated impacts on daily life. This pilot study examined (1) oncologists' ability to learn and then implement the tool in their clinical practice and (2) the effect of the TrialTalk method on clinical trial consent and enrollment.

Methods: Twenty-seven oncologists from a single academic institution were randomly assigned to the intervention group (n = 14) or the control group (n = 13). Intervention group oncologists completed a single, 2-hour TrialTalk training program including a didactic, simulated session with patient actors and feedback from the trainer. Additional feedback and question/answer sessions were available. Oncologists in the control group did not receive TrialTalk training. Clinical trial decisions were collected from patients seen by oncologists in both groups.

Results: Intervention oncologists demonstrated fidelity with the tool after training. Patients of oncologists in the intervention group were significantly more likely to consent to participate in clinical trials than patients of oncologists in the control group (92.9% vs. 82.4%, p = 0.04). Actual enrollment rates after signing consent were equal in both groups (78.2% in the intervention group vs. 73.3% in the control group).

Conclusion: Patients who met with TrialTalk-trained oncologists were more likely to sign consent to participate in a clinical trial. The decision-making conversation with the oncologist is a critical moment for patients considering clinical trial participation, and targeting these encounters has the potential to increase overall trial participation rates.

Trial registration: ClinicalTrials.gov ID: NCT03656276.

Objective: To evaluate the effect of zinc supplements in preventing chemotherapy and radiotherapy-related oral mucositis (OM) in cancer patients.

Methods: We retrieved randomized controlled trials (RCTs) on the prevention of OM after chemotherapy and radiotherapy using zinc supplements. These studies were sourced from nine databases, including PubMed, Embase, Cochrane, Web of Science, Scopus, and SinoMed, covering the period from their inception to October 2025. Two researchers independently screened studies and extracted data. The Cochrane risk of bias tool was used to assess the quality of the included studies, and Stata 16.0 software was used for analysis.

Results: A total of 16 randomized controlled trials (RCTs) comprising 17 comparison groups and involving approximately 1076 patients were included. Zinc supplementation significantly delayed the onset of OM (MD = 1.37, 95% CI: 0.78 to 1.95, P < 0.001). Regarding the overall incidence of OM, zinc significantly reduced the risk at both 2 weeks (RR = 0.69) and 7-9 weeks (RR = 0.33) of treatment. For severe OM (grade ≥ 3), zinc exhibited a significant protective effect at both 2 weeks and 5-6 weeks of treatment (RR = 0.26 for both time points). Subgroup analyses revealed key dose duration, and administration route effects: (1) In the early phase of treatment (2 weeks), topical zinc demonstrated a beneficial trend in reducing both the incidence and severity of OM; (2) in the mid-to-late phase (5-6 weeks), oral administration of moderate to high doses (≥ 150 mg/day) was markedly effective in preventing severe OM (RR = 0.07, 95% CI: 0.02 to 0.36), showing superior efficacy compared to topical application; (3) zinc supplementation significantly alleviated pain scores at 3 and 6 weeks of treatment (MD = -1.82 and -2.02, respectively), as well as xerostomia symptoms at 6 weeks (MD = -0.60, 95% CI: -0.81 to -0.40, P < 0.001).

Conclusion: Zinc supplementation is safe and effective, demonstrating a significant time-dependent, bimodal therapeutic effect: it reduces the incidence of OM during the second and the seventh to ninth weeks and significantly decreases the occurrence of severe OM in the second and fifth to sixth weeks. Additionally, zinc supplementation offers certain benefits in alleviating oral pain and xerostomia. A phased intervention strategy is recommended: in the early stage, combine zinc with topical agents to control symptoms, and in the mid-to-late stages, administer oral medium-to-high doses (≥ 150 mg/day) to prevent severe OM, particularly in patients with head and neck tumors.

Purpose: Biannual ultrasound-based hepatocellular carcinoma (HCC) surveillance is standard practice for individuals with cirrhosis and subgroups with non-cirrhotic hepatitis B. While this practice improves cancer-related survival, the detection of false-positive results can lead to additional testing which poses both physical and psychosocial risks. Our study explored the psychosocial consequences of false-positive ultrasound results in participants undergoing HCC surveillance.

Methods: We performed a qualitative study with semi-structured interviews to understand the psychosocial impact of participants who received a false-positive ultrasound result during HCC surveillance until no new themes emerged. Key themes were analysed using the Framework Approach.

Results: Ten participants with cirrhosis or non-cirrhotic hepatitis B were recruited. Most had a poor understanding of the role of ultrasound in HCC surveillance. Some participants experienced significant anxiety with existential concerns impacting family and work life. Others remained uninformed about the risk for HCC and did not experience significant psychosocial impacts. The lack of understanding about the role of surveillance and the potential for false positives contributed to unpredictable psychosocial consequences. Despite experiencing surveillance-related harm, all participants wished to continue regular surveillance.

Conclusion: Our findings highlight a need for improved health literacy about the purpose and potential harms of HCC surveillance. Optimising surveillance protocols to minimise false-positive findings may also further alleviate physical and psychosocial harm.

Purpose: Oncology-embedded supportive care facilitates comfort-focused end-of-life care in cancer patients, but its effectiveness in Muslim-majority settings is unknown. We compared end-of-life outcomes between hospice-eligible Muslim cancer patients managed within this model and non-cancer patients without such integration.

Methods: This retrospective cohort study (2021-2024) at a Middle Eastern tertiary hospital included hospice-eligible Muslim adults who died during an acute-care admission. Cancer patients were managed by an oncology-embedded supportive service and compared with non-cancer patients. The primary outcome was a comfort-oriented care composite reflecting goal-concordant care (do-not-attempt-resuscitation [DNAR] at death without ICU admission). Multivariable analysis adjusted for key confounders, including age, comorbidities, and palliative care involvement.

Results: Of 54,122 admissions and 2171 deaths, 796 hospice-eligible patients were analyzed (401 cancer, 395 non-cancer). The comfort-oriented care composite was achieved more often in cancer patients (71% vs 35%, p < 0.001). Cancer patients had earlier DNAR transitions (median 7 vs 13 days after admission), lower ICU utilization (21% vs 58%), and fewer aggressive interventions in the final 24 h (34% vs 70%), all p < 0.001. In multivariable analysis, cancer diagnosis (aOR 2.24, 95% CI 1.39-3.59) and palliative involvement (aOR 3.18, 95% CI 2.03-4.99) independently predicted comfort-oriented care.

Conclusions: An oncology-embedded supportive care model in a Muslim-majority setting was associated with earlier transitions to comfort-focused care and less aggressive end-of-life interventions among hospice-eligible cancer patients. The contrast with non-cancer patients highlights the importance of structured supportive care integration and demonstrates that models adapted to cultural and religious contexts can effectively support comfort-focused care.

Purpose: Optimizing long-term health outcomes and minimizing healthcare utilization are crucial for outpatient allogeneic hematopoietic stem cell transplantation (allo-HSCT) survivors. Hospital-free days (HFDs) serve as patient-centered indicators of healthcare burden and physical stability. Although vitamin D (25(OH)D) has immunomodulatory effects, its relationship with HFDs in survivors in remission remains unclear. We investigated the predictive value of serum 25(OH)D levels for HFDs and hospitalization-free survival (HFS).

Methods: This prospective single-center study enrolled 51 adult allo-HSCT survivors in complete remission who visited outpatient clinics. Serum 25(OH)D levels were measured. The primary outcome was HFDs (days alive and out-of-hospital) over 3 years, categorized into four ordered groups. The secondary outcome was HFS (time to death, relapse, or hospitalization). Multivariable ordinal logistic (HFDs) and Cox proportional hazards (HFS) regression analyses were performed, adjusting for confounders using stepwise selection.

Results: The median patient age was 67.7 years. In multivariable analysis, higher serum 25(OH)D levels significantly predicted better HFD outcomes (adjusted odds ratio = 1.13 per ng/mL; 95% CI = 1.04-1.24; p = 0.001). Higher 25(OH)D levels also independently predicted improved HFS (adjusted hazard ratio = 0.89 per ng/mL; 95% CI = 0.82-0.95; p = 0.001). The Kaplan-Meier analysis confirmed better HFS in patients with 25(OH)D levels above the median (log-rank p = 0.029). Chronic graft-versus-host disease and time since SCT were associated with 25(OH)D levels.

Conclusion: In outpatient allo-HSCT survivors, higher serum 25(OH)D levels independently predicted HFDs, suggesting reduced healthcare burden and improved HFS. Vitamin D status warrants further investigation as a potential modifiable target for enhancing long-term HSCT outcomes.

Purpose: Hospitalization at home (HaH) has demonstrated clinical efficacy and improved patient experience in general medicine inpatients. We conducted a quasi-experimental design study of our institution's experience with HaH among patients with multiple myeloma (MM) who received chemotherapy in the hospital and continued their hospitalization at home to complete the rest of their care.

Methods: We conducted a retrospective chart review of patients with MM who received chemotherapy with dexamethasone, cyclophosphamide, etoposide, and cisplatin with or without bortezomib (DCEP ± V) in the hospital and then continued their hospitalization at home from September 2020 to May 2023. The control cohort was all patients with MM who received DCEP ± V and lived in a zip code excluded from HaH's catchment area. Demographics, length of stay (LOS), 30-day hospital readmissions, and emergency room (ER) visits were extracted from the electronic health record. Primary endpoints were 30-day hospital readmissions and 30-day ER visits. We hypothesized that the HaH cohort was non-inferior to the control cohort.

Results: We identified 24 HaH episodes of care and 62 in the control cohort. Patients enrolled in HaH were younger and more racially diverse. The HaH cohort had a mean total LOS, both hospital plus HaH LOS, of 16 (SD = 4.5) vs. 19.2 (SD = 11.9) days in the control (p = 0.198). Mean HaH LOS was 8.7 days (SD = 3.9), with 208.8 inpatient-bed days saved. Thirty-day hospital admissions as defined by CMS were 0% vs 1.6% in the HaH and control cohort, respectively; the 30-day ER visits had an odds ratio of 1.07 (95% CI = 0.91, 1.26), indicating non-inferiority. Successful HaH admissions occurred for 92% (95% CI = 80.6%, 100%) of care episodes.

Conclusion: Successful HaH admissions occurred for 92% of care episodes and provided significant hospital bed days saved. HaH demonstrated non-inferiority for healthcare utilization compared to standard inpatient monitoring, showcasing its potential to optimize resource utilization among this cohort of patients with MM receiving inpatient chemotherapy. These findings support the integration of HaH programs into oncology care and further studies are warranted to expand and refine HaH implementation in this population.

Purpose: We examined trends in emotional distress among survivors of childhood and adolescent and young adult (CAYA) cancers.

Methods: We analyzed the 2008-2018 National Health Interview Survey (NHIS) data among individuals (n = 6451) who were diagnosed with cancer between 0 and 39 years of age. Emotional distress was assessed using the validated Kessler 6-item scale. Respondents rated how often they felt nervous, hopeless, restless, or fidgety, so sad that nothing could cheer them up, that everything was an effort, and worthless in the past 30 days. Responses were scored and added to produce a range of 0-24. We classified emotional distress as mild/no (score of less <5), moderate (score between 5 and 12), or severe distress (≥ 13). Joinpoint regression estimated yearly increases/decreases in psychological distress using annual percent changes.

Results: Overall, the proportion of individuals experiencing mild/no psychological distress increased by 1.68% annually between 2008 and 2014 and then decreased by 1.34% annually between 2014 and 2018, although not statistically significant. The proportion of individuals experiencing moderate distress decreased by 3.06% annually between 2008 and 2014 and then increased by 4.18% annually between 2014 and 2018, although not statistically significant. The proportion of individuals experiencing severe distress remained stable between 2008 and 2014 and then decreased by 7.36% annually between 2014 and 2018, although not statistically significant. No statistically significant trend in emotional distress was observed when stratified by patients' demographics and access to mental health services.

Conclusion: We found that trends in emotional distress among survivors of CAYA cancers have not changed significantly over the 2008-2018 decade, overall and when stratified by gender, race/ethnicity, marital status, and visit to a mental health professional within the past year.

Purpose: To critically synthesise qualitative research to understand the experiences of supportive care needs in people affected by ovarian cancer and their informal caregivers.

Method: A qualitative systematic review has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The Joanna Briggs meta-aggregation methodology was utilised. Electronic databases were searched for all qualitative studies irrespective of research design by an expert systematic review librarian. Data extraction and methodological quality assessment were performed.

Results: A total of 26 studies were included which represented a total sample of 962 participants inclusive of 842 patients and 120 informal caregivers. There were a total of 133 individual findings included in this review, which were synthesised into four main findings that emerged: (1) awareness around ovarian cancer, (2) communication in the healthcare sector, (3) everything that comes with the disease, (4) what the future holds.

Conclusion: This review identified that while some women living with ovarian cancer experienced suffering and distress, others reported emotional wellbeing and comfort needs met. There were gaps in service from both the informal caregiver and women ranging from before diagnosis even to post-treatment and beyond. Service redesign needs to occur with a focus on (1) improved awareness around ovarian cancer signs and symptoms, (2) effective communication strategies within and across healthcare providers, (3) increased information and support for both women and their informal caregiver throughout the cancer trajectory, and (4) developing survivorship care plans to promote wellness.

Background: Multimodal rehabilitation programs represented comprehensive preoperative intervention strategies designed to optimize patients' physical, nutritional, and psychological status. These programs have shown potential benefits in enhancing recovery, improving quality of life, and optimizing functional outcomes across various clinical contexts.

Objective: This review aimed to evaluate the feasibility and clinical effectiveness of home-based multimodal prehabilitation for patients undergoing colorectal cancer surgery.

Methods: A systematic review and meta-analysis were conducted using RevMan 5.4. The primary outcome was the change in the 6-min walk test (6MWT) during the preoperative period. Secondary outcomes included 30-day postoperative complications, emergency department visits, hospital readmission, and mental health outcomes measured using the Hospital Anxiety and Depression Scale (HADS).

Results: Prehabilitation significantly improved the preoperative 6MWT [MD = 40.61, 95% CI (6.23, 74.99), P = 0.02]. However, no significant improvement was observed at 4-6 weeks [MD = 49.67, 95% CI (-35.50, 134.84), P = 0.25] or 8 weeks postoperatively [MD = 26.58, 95% CI (-8.88, 62.04), P = 0.14]. Prehabilitation did not significantly affect total hospitalization, 30-day postoperative complications, emergency department visits, or readmission rates. Additionally, no significant improvements were found in HADS-anxiety or HADS-depression scores at 8 weeks.

Conclusions: Home-based multimodal prehabilitation significantly improved physical function before colorectal cancer surgery; however, these benefits were not sustained postoperatively. More intensive or prolonged programs, combined with postoperative rehabilitation, may be necessary to maintain preoperative gains. Larger trials with extended follow-up periods are needed to confirm long-term clinical effects.

Trial registration: The study protocol was registered in PROSPERO (CRD42023439715).

Purpose: This correspondence serves to critically evaluate the meta-analysis by Lin et al. regarding chatbot-led breast cancer education, focusing on specific methodological weaknesses that may undermine its core findings.

Methods: We performed a rigorous appraisal of the original study's methodology, specifically scrutinizing their data synthesis process, the inclusion criteria for trials, and the conceptual clarity of the outcome measures used to gauge chatbot performance.

Results: Our analysis revealed three primary concerns: (1) the reliance on a mere six studies raises concerns about the generalizability of the results; (2) a major unit-of-analysis error occurred where multiple intervention arms from a single study were incorrectly "double-counted" as independent data points; and (3) there was a clear conceptual conflation between "usability" and "educational efficacy, leading to ambiguous interpretations of the chatbots' actual impact.

Conclusion: Given these identified flaws, the evidence presented in the meta-analysis remains inconclusive and should be approached with skepticism. To advance the field, we urge the development of larger-scale randomized controlled trials and the consistent application of validated instruments, such as the System Usability Scale (SUS), to ensure more reliable data in digital health research.