Supportive Care in Cancer最新文献

Purpose: Emergency medical service (EMS) transport during the terminal stages of cancer may result in cardiopulmonary arrest (CPA) and resuscitation, which may not align with patient preferences. The characteristics and care experiences of CPA patients have not been well studied in Japan. We described the characteristics and end-of-life (EOL) care experiences of terminal cancer patients with and without CPA at EMS transport.

Methods: We conducted a secondary analysis of a nationwide mortality follow-back survey (2019-2020) using structured questionnaires completed by bereaved family members linked to death certificate data. We analyzed 4,939 patients with terminal cancer who were transported by EMS in the final month of life and died in hospitals between 2017 and 2018. The patients were categorized according to their CPA status at EMS transport.

Results: Among the 4,939 patients, 178 (3.6%) experienced CPA during EMS transport. The CPA group had a higher proportion of lung cancers and lower proportion of colorectal and hepatobiliary/pancreatic cancers. They were less likely to have a do-not-resuscitate (DNR) order (55.9% vs. 92.6%) or to have engaged in resuscitation (46.5% vs. 62.1%) or EOL discussions (39.5% vs. 50.8%). In addition, the CPA group reported lower out-of-pocket medical expenses (41.2% under ¥100,000 versus 21.7%), lower symptom burden, and a slightly higher perceived quality of death.

Conclusions: Patients transported in CPA experienced fewer EOL discussions, showed socioeconomic disparities, and had distinct perceptions of the quality of death. These findings emphasize the need to enhance advanced care planning communication and emergency preparedness in EOL cancer care.

Objective: To evaluate the effectiveness of neuromuscular compression bandage in preventing seroma after surgical treatment of breast cancer.

Methods: This randomized clinical trial included women over 18 years old undergoing mastectomy. The control group followed the institution's standard routine of using a suction drain, whereas the intervention group was assigned to receive a compressive bandage for 1 week in addition to the drain.

Results: A total of 124 women were assigned to the intervention group and 125 to the control group. There was no statistically significant difference in sociodemographic, clinical, or treatment variables, nor in the incidence of seroma between groups (odds ratio [OR], defined as the ratio between the odds of an event occurring in the intervention group versus the control group = 1.59; 95% CI: 0.91-2.76; p = 0.102). Seroma was the most frequent complication (71.1%). After 7 days, the drain was removed in 66.3% of participants, 53.3% in the control group, and 46.7% in the intervention group (OR = 0.69; 95% CI: 0.41-1.17; p = 0.166). The median total punctured volume was 154 mL. There was no significant difference in the frequency of punctures > 154 mL between the groups (39.8% vs. 60.2%; OR = 1.77; 95% CI: 0.98-3.22; p = 0.059).

Conclusion: The use of a compressive neuromuscular bandage was not effective in preventing seroma after mastectomy.

Purpose: Breast cancer treatments cause hormonal and sexual alterations that can leave physical and psychological sequelae. The purpose of this study is to establish the incidence of pelvic floor dysfunction (PFD) in female breast cancer survivors and its relationship with the cancer treatment received, as well as the impact on quality of life.

Methods: We conducted a matched cross-sectional observational study involving 150 female breast cancer survivors from Alicante (Spain) and 287 age-matched women as a control group. Demographic, anthropometric, obstetric, and lifestyle habits data were collected for all participants, and data related to breast cancer were additionally collected for breast cancer survivors. The Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) were included.

Results: A greater number of breast cancer survivors had menopause compared to the control group. When selecting only participants with menopause, cancer survivors were younger than the control group females with menopause. A higher prevalence of urinary incontinence, pelvic organ prolapse, and flatus incontinence was observed in cancer survivors. Breast cancer survivors presented more PFD symptoms and a greater negative impact on quality of life. Treatment with chemotherapy, radiotherapy, and hormone therapy had a greater negative impact on pelvic function.

Conclusions: The early onset of menopause among breast cancer survivors has a negative impact on pelvic function and quality of life. The association of this symptomatology with the type of cancer treatment received suggests the need to assess and monitor pelvic function from the time of cancer diagnosis and treatment.

Objective: The study aimed to evaluate the effect of the Roy adaptation model (RAM)-based patient education on adaptation levels to the disease, mental health, and life satisfaction of elderly patients undergoing laparoscopic radical gastrectomy.

Methods: The study adapted a pretest-posttest randomized clinical trial design with a comparison between the RAM group (giving RAM-based patient education plus usual care; n = 80) and the usual care group (giving usual care pathways; n = 80). The primary outcome measure was physiologic-physical, self-concept, role function, and interdependence adaption levels measured by the subscales of the Functional Assessment of Cancer Therapy-Gastric Module (FACT-Ga). Secondary outcome measures were mental health measured by the Hospital Anxiety and Depression Scale (HADS) and life satisfaction by the Life Satisfaction Index A (LSI-A).

Results: The RAM group showed shortened time to flatus and first oral intake, and reduced postoperative hospitalization compared to the usual care group (p < 0.05). The analysis of covariance controlling for baseline scores suggested that a significantly main effect of treatment in patient's scores in each FACT-G subscale, FACT-G total, gastric cancer subscale, and FACT-Ga total, HADS-A, HADS-D, and LSI-A. The RAM group had higher scores of physical well-being (η² = 0.10), emotional well-being (η² = 0.12), functional well-being (η² = 0.11), and social well-being (η² = 0.06) subscales of FACT-Ga, FACT-G total (η² = 0.30), gastric cancer subscale (η² = 0.10), and FACT-Ga total (η² = 0.28), lower scores of HADS-A (η² = 0.12) and HADS-D (η² = 0.11), and a higher score of LSI-A (η² = 0.12) than the usual care group at 1 month post intervention.

Conclusion: These results demonstrate that RAM-based patient education could effectively increase adaptation levels to the disease, improve mental health, and life satisfaction of elderly patients undergoing laparoscopic radical gastrectomy.

Purpose: This study aimed to evaluate whether the Cancer and Aging Research Group (CARG) score is suitable for assessing chemotherapy toxicity risk in older adults with cancer.

Methods: Studies that enrolled older cancer patients undergoing chemotherapy and compared incidence of chemotherapy toxicity in three CARG score categories- low CARG (0-5), intermediate CARG (6-9), and high CARG (10-23), were identified using PubMed and EMBASE, as well as screening the references of reviewed studies. Studies that performed receiver operating characteristic (ROC) analysis and reported area under curve (AUC) were also included. A meta-analysis was conducted to calculate the risk ratio (RR) of ≥ grade 3 toxicity and integrate AUC.

Results: Twenty-three studies published between 2019 and 2025 were included in our analysis with a total of 4,140 older patients who underwent various types of chemotherapy. Nineteen studies reported categorical results and 14 studies reported AUC. Higher CARG category patients had a significantly higher incidence of ≥ grade 3 chemotherapy toxicity than lower CARG category patients (Intermediate CARG vs. low CARG; RR [95% CI]: 1.26 [1.07-1.48], p = 0.006, I² = 74%. High CARG vs. intermediate CARG; RR [95% CI]: 1.30 [1.15-1.46], p < 0.001, I² = 67%. High CARG vs. low CARG; RR [95% CI]: 1.68 [1.32-2.15], p < 0.001, I² = 86%.). Integrated AUC was 0.633 (95% CI: 0.558-0.709).

Conclusions: The CARG score is an effective tool for assessing the risk of ≥ grade 3 chemotherapy toxicity in older adults as part of geriatric assessment.

Purpose: As people live longer after a cancer diagnosis, there is an increasing need to focus on chronic disease state management in the primary care setting. Particular attention to appropriate statin prescribing in cancer survivors is warranted given a heightened risk of atherosclerotic cardiovascular disease (ASCVD). The purpose of this study was to further understand cardiovascular care in cancer survivors by identifying the proportion of cancer survivors with a prescription for appropriate statin therapy and to identify associated factors.

Methods: A retrospective cohort study was conducted to identify cancer survivors aged 40-75 years with a diagnosis of breast, lung, colorectal, or lymphatic and hematopoietic cancers cared for within family medicine clinics in a large academic health system. Statin prescriptions were assessed to identify the percentage of statin candidates prescribed a statin based on a diagnosis of ASCVD or type 2 diabetes.

Results: Data from 8763 cancer survivors were included in the final analysis. Among patients with ASCVD, 66% were prescribed a statin. In patients with type 2 diabetes without ASCVD, 58% were prescribed a statin. Female sex was negatively associated with statin prescribing (OR 0.88, 95% CI 0.80-0.97).

Conclusions: Statins are underutilized in cancer survivors, as they are in the general population. This may present an area of health disparity given the heightened risk of ASCVD in cancer survivors. Cancer survivors suffer from a heightened risk of death from CVD. As survivors enjoy longer lifespans after diagnosis, there is a need to optimize cardiometabolic disease state management in this high-risk population.

Purpose: To describe the frequency of opioid-induced neurotoxicity (OINT) after opioid conversion (OC) to methadone using the Stop-and-Go (SAG) method in cancer patients with inadequate pain control, and to identify factors associated with OINT.

Methods: This multicenter retrospective cohort study included adult hospitalized cancer patients who underwent OC to methadone using the SAG method for poor pain control at two comprehensive cancer centers between January 2018 and October 2022. Patients were monitored 14 days after OC, and variables related to OINT were analyzed. Ethical approval was obtained.

Results: A total of 372 patients underwent OC using the SAG method. The mean morphine-equivalent daily dose (MEDD) before OC was 212.2 mg (SD 128). OINT occurred in 70 patients (18.8%). Methadone was permanently discontinued in 2 patients (2.8%) and temporarily withheld in 7, while 61 were managed with hydration and a 15-20% methadone dose reduction. No patient required naloxone. OINT was less frequent in younger patients (mean age 59.4 vs. 63 years; p = 0.032) and showed a trend toward lower incidence in women (13% vs.22%; p = 0.065). Preexisting cognitive impairment or delirium was associated with OINT (52.4% vs.16.8%; p < 0.001). The mean time from OC to death was shorter among patients with OINT (2.1 months; SD 3.9) compared with those without OINT (3.6 months; SD 6.4; p = 0.012).

Conclusion: OC to methadone using the SAG method in patients with low-to-moderate MEDD was associated with a relatively low OINT frequency (18.8%). These findings suggest that SAG method in patients with low-to-moderate MEDD before OC may be safe, particularly for younger patients and those without cognitive impairment.

Background: Cancer treatments often cause skin toxicities that disrupt therapy and reduce patients' quality of life, yet research on their management in the Middle East is scarce. This study aims to examine the practices and challenges of managing skin-related adverse effects in cancer patients.

Methods: A mixed-method survey was conducted on a sample of dermatologists and oncologists practicing in Middle Eastern countries who were invited to participate in Pierre Fabre's annual Middle East Medical Convention. A brief online questionnaire, distributed to 250 dermatologists and 19 oncologists, using both quantitative and qualitative approaches, assessed the frequency, types, and management of skin conditions, alongside perceived barriers and referral practices.

Results: The study included responses from 117 dermatologists and 19 oncologists. Oncologists encountered cancer-related skin manifestations considerably more often, with 44.4% seeing such cases daily compared to 8.1% of dermatologists (p < 0.001). Notable differences were also observed in the types of skin conditions reported, such as nail changes, which were significantly more frequent among dermatologists (72.6% vs. 31.6%, p < 0.001), whereas hand-foot syndrome was markedly more commonly observed among oncologists (89.5% vs. 6.0%, p < 0.001). Dermatologists reported feeling very comfortable managing these conditions more often than oncologists (50.4% vs. 10.5%, p = 0.004). Key barriers included the severity of skin conditions, selecting appropriate dermo-cosmetic products, and limited knowledge in onco-dermatology. The qualitative analysis highlighted oncologists' challenges in managing skin toxicities under three main themes: (1) preventing cancer treatment interruptions, (2) limited specialized dermatologic knowledge and support, and (3) addressing patient-centered issues.

Conclusion: Findings reveal differing perspectives between dermatologists and oncologists and underscore the need for greater collaboration to optimize the management of cancer-related skin toxicities.

Purpose: Children of parents with cancer face elevated risks of anxiety, depression, and impaired social-emotional functioning. Cancer support camps may mitigate these psychosocial challenges by fostering connection, resilience, and expression. However, no validated tools exist to measure quality of life outcomes specific to this context. This study aimed to develop and evaluate the Kids' Experience of Summer Enrichment Measure (KESEM), a parent-report tool assessing psychosocial well-being among children attending a cancer support camp due to a parent's cancer.

Methods: A secondary analysis of survey data collected from 2021 to 2024 by a national non-profit providing free, week-long summer camps to children (aged 6-18) affected by parental cancer was conducted. The KESEM, a new 12-item measure embedded in post-camp evaluations, was examined using principal components factor analysis and internal consistency reliability testing: convergent validity was assessed as well.

Results: Responses from N = 1802 parents and N = 184 children were studied. Analysis revealed a two-factor structure: (i) Well-being and Belonging (α = 0.93) and (ii) Empowerment (α = 0.92)-accounting for 67.2% of the measure's variance. The total scale demonstrated high internal consistency (α = 0.94). In subgroup analysis, parent and child scores supported convergent validity of parental reporting on children's quality of life, and were not influenced by child age: F (1, 168) = 0.03, p = 0.87. Concordantly, the majority of parents (78%) strongly agreed that camp was favorably impactful and would recommend it to others.

Conclusion: The KESEM is a promising parent-reported assessment tool for measuring quality of life outcomes in children attending cancer support camps. Such camps may offer meaningful psychosocial benefits to children coping with parental cancer.