Supportive Care in Cancer最新文献

Background: Patients with primary liver cancer (PLC) experience a range of symptoms in the early postoperative period. Symptoms include cancer-related symptoms and adverse effects of treatment. Exploring the core symptoms and their dynamics in the early post-hepatectomy patients may help provide better symptom management programs.

Objective: The purpose of this study was to identify the core symptoms in early post-hepatectomy patients and to explore the trajectory of their dynamics.

Methods: During the period from March 2021 to September 2022, a total of 281 patients diagnosed with PLC and undergoing radical curative surgery were recruited from the hepatobiliary surgery departments of two hospitals in Eastern China, among whom 249 individuals (88.6%) agreed to participate in the study. A comprehensive symptom assessment was administered to the patients 1-2 days after surgery (T1) and 1-2 days before discharge (T2). Network analysis was used to identify core symptoms in early post-hepatectomy patients based on symptom severity.

Results: The network analysis identified the core symptoms of dry mouth, pain, abdominal distension, the lack of appetite, and nausea at T1. In contrast, at T2, the lack of appetite, pain, shortness of breath, and disturbed sleep were revealed. At the two early time points, while the results of the network structure test showed no statistically significant difference in the overall symptom network structure, there was a significant difference in the results for the core symptoms.

Conclusion: Our study demonstrates the need to identify core symptoms in the early post-hepatectomy to improve symptom management in PLC patients. It is crucial to apply network analysis as an essential component of cancer care.

Objective: This study is to develop and validate a robust risk prediction model for mild cognitive impairment (MCI) in patients with malignant haematological diseases after haematopoietic stem cell transplantation (HSCT).

Methods: In this study, we analysed the clinical data of the included patients. Logistic regression analysis was used to identify independent risk factors for cognitive impairment after HSCT in patients with malignant haematological diseases, and a risk prediction model was constructed. Multiple cohorts of patients with haematological malignancies after HSCT (282 cases) from the Affiliated Hospital of Xuzhou Medical University and the First People's Hospital of Yancheng City between April 2019 and February 2022, and patients from the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University between March 2022 and July 2023 were used for external validation. Logistic regression analysis was performed to develop the predictive model. The predictive value and consistency of the model were evaluated using the area under the curve (AUC) and calibration method, respectively. Decision curve analysis (DCA) was performed to access the utility of the model.

Results: Approximately half (52.26%) of the patients in the study developed mild cognitive impairment (MCI). Older age, allogeneic HSCT, anxiety, graft-versus-host disease, and longer hospital stay were associated with a higher risk of developing MCI. ROC curve analysis confirmed the sound performance of the predictive model and external validation, with AUC of 0.897 and 0.789 respectively. The direction of the calibration curves of the training and validation sets is closer to the diagonal (ideal curve), indicating good model consistency; the DCA curves also show that the model has good predictive ability and stability.

Conclusions: We conclude that it is possible to predict mild cognitive impairment with readily available, mostly pretransplant predictors. The accuracy of the risk prediction models can be improved for use in clinical practice, possibly by adding pretransplant patient-reported functioning and comorbidities.

Purpose: Longitudinal collection of patient experience data promotes continual high-quality care and guides quality improvement (QI) work. The purpose of this study was to investigate patient experience in the radiation department during COVID-19 and compare results to previous data collected in 2019.

Methods: Patient experience data was collected using the Your Voice Matters (YVM) survey. Recruitment occurred between April and June 2022. Consecutive patients were approached to complete the YVM regarding their consultation or radiation treatment appointment. The proportion of patients with positive experience scores was calculated for 2022 results. Unadjusted results were compared between 2019 and 2022. The adjusted analysis included logistic regression modelling to evaluate factors associated with an overall positive experience. Content analysis was completed for current qualitative data.

Results: Overall, 400 patients completed the YVM regarding their consultation or radiation treatment. The most favorable experiences included polite reception staff and feeling respected and listened to. Compared to 2019, there was no significant difference in overall experience scores. Results showed improvements in wait times for consultations (p < 0.01) and treatments (p < 0.01). Despite improvements, wait times and contacting the clinic remain areas with the lowest scores. In 2022, patients with breast cancer had greater odds of a positive experience compared to lung.

Conclusions: Patients at our institution continued to have positive experiences over time, despite the pandemic. Improvements were most evident with wait times. Other items including contacting the clinic remain areas for improvement. These results guided various QI work in our department to improve communication, clinic flow, and other aspects of patient experience.

Introduction: The study's primary goal is to investigate differences in postprandial glycaemic response (PPGR) to beverages with varying glycaemic index (i.e. low and medium) between breast cancer survivors (BCS) with chronic pain and healthy pain-free controls (HC). The secondary goal of the study is to investigate the potential link between PPGR and pain-related outcomes in BCS with chronic pain.

Methods: In this study, 15 BCS and 15 HC were included. After 12 h of fasting, subjects were randomised between drinking a beverage made with 50 g of sucrose (medium) or isomaltulose (low) within 250 ml water. Blood glucose levels were monitored at fasting as well as at 15, 30, 45, 60, 90 and 120 min following beverage consumption. Furthermore, each participant was evaluated using several experimental pain measurements, including pressure pain thresholds (PPT), electrical detection threshold, electrical pain threshold, temporal summation and electrical offset analgesia (OA).

Results: The BCS group had significantly higher PPGR to sucrose (p = .001) than the HC group. Furthermore, when PPGR to sucrose was compared to PPGR to isomaltulose within the groups, the BCS group showed a considerably larger difference (p = .012). Additionally, correlation analyses indicated both positive and negative associations between PPGR after sucrose intake and specific pain measurements (PPT-tibialis (r = .599), OA (r_s = - .549), respectively) in BCS, and a positive association between the difference in PPGR between sucrose and isomaltulose and PPT-tibialis (r = .622).

Conclusion: These findings suggest that medium glycaemic index beverage intakes result in significantly higher blood glucose responses (i.e. PPGR) than low-glycaemic index beverage intakes in BCS. Additionally, BCS show an impaired glycaemic response to medium glycaemic index beverage intake and that the impaired glycaemic response might be related to pain sensitivity and endogenous analgesia in BCS. Furthermore, the higher glycaemic response to sucrose and greater difference in the amount of change in PPGR (when isomaltulose was substituted for sucrose) compared to HC highlight the importance of understanding how dietary choices with a lower glycaemic index can alter glycaemic regulation in BCS with chronic pain.

Purpose: Chronic graft-versus-host-disease (cGVHD), an inflammatory condition affecting allogeneic hematopoietic cell transplantation (HCT) survivors, is associated with a range of debilitating physical and psychological sequela. Yet HCT recipients with cGVHD are virtually absent from survivorship intervention research. We conducted a randomized clinical trial to evaluate the feasibility and preliminary efficacy of a multidisciplinary group coping skills intervention (Horizons) tailored to meet these patients' unique needs. For this follow-up qualitative analysis, we evaluated the perceived impact of the Horizons intervention by the group participants.

Methods: We purposefully selected a subset of Horizons participants (n = 19) to complete audio-recorded exit interviews via semi-structured interview guide. We used rapid analysis to characterize participant feedback in three domains: (1) motivations to participate, (2) perceived benefits of participation, and (3) impacts of participation.

Results: Findings highlight participants' motivations to participate centered on desires to connect with others living with cGVHD and to help future patients. Perceived benefits of participation focused on the following categories: (1) connecting with other survivors, (2) learning about cGVHD, and (3) learning coping strategies to manage specific cGVHD symptoms. Impacts of participation on everyday life variably reflected categories of (1) increased sense of empowerment to contact their care team with questions and concerns, (2) increased support and validation in their struggles with cGVHD, and (3) renewed motivation or progress toward personal and health-specific goals.

Conclusion: Study findings demonstrate participants' appreciation for a group-based opportunity to connect with others living with cGVHD and strengthen skills for navigating cGVHD challenges. Results support the ongoing need for evidence-based interventions to improve quality of life among HCT survivors.

Trial registration: www.

Clinicaltrials: gov , identifier NCT04479995. Date of Registration: July 21, 2020.

Purpose: This study evaluates the feasibility of a comprehensive supervised exercise program (CSEP) for head and neck cancer (HNC) patients during and after (chemo)radiotherapy, integrating quantitative and qualitative data to identify participation barriers and facilitators.

Methods: To investigate the feasibility of the CSEP, a mixed-method study was performed. For the quantitative part, first, adherence to and safety of the CSEP were considered as quantitative feasibility outcome measures. Second, two questionnaires evaluated acceptability, adherence, feasibility, therapeutic support, and overall evaluation at 12 weeks and 6 months after the start of the radiotherapy. Additionally, focus groups were held to discuss acceptability, adherence, expectations, feasibility, therapeutic support, and overall evaluation. The quantitative and qualitative data were integrated and discussed via a joint display table.

Results: Quantitative data were available from 32 participants. Three focus groups with in total 11 participants were organized. Overall adherence to the CSEP was 72%, and no serious adverse events were reported, confirming the program's safety. Adherence and feasibility posed challenges; hospital sessions had higher adherence due to better motivation and guidance, whereas home sessions faced issues like lack of motivation and time constraints. Participants highlighted the program's individualization as a significant strength.

Conclusion: The CSEP was positively received, deemed safe, and feasible during and after HNC treatment, with participants recommending it to other HNC patients.

Trial registration: Trial Registration: ClinicalTrials.gov Identifier: NCT05256238 (Registered on February 25, 2022).

Objectives: To analyze the presence of nutritional impact symptoms (NIS) throughout radiotherapy treatment in the head and neck, thorax, abdomen, and pelvis areas.

Methods: A prospective cohort study was conducted with individuals undergoing radiotherapy for cancer. Three assessments were carried out: at the start of radiotherapy, midway through, and in the last week of treatment. Clinical, anthropometric data, and the Patient-Generated Subjective Global Assessment (PG-SGA) were used to assess symptoms.

Results: A total of 254 participants were evaluated at the start, 165 at the midpoint, and 120 at the end of the treatment. More than half of the participants at all stages were elderly. At the start, 51.6% were women, while at the end, 57.5% were men. Pelvic tumors were the most common, followed by tumors in the head and neck and thorax. The prevalence of NIS increased from 58.2% at the beginning to 76.9% at the midpoint (RR 1.32; 95% CI 1.17-1.48; p =  < 0.001) and 78.3% at the end of treatment (RR 1.34; 95% CI 1.18-1.52; p =  < 0.001). Odynophagia was the most reported symptom among patients with head and neck tumors, increasing from 24.5 to 66.6%, and from 3.0 to 22.2% by the end of treatment in patients with thoracic tumors. Diarrhea was common at the end of treatment among those with abdominal (69.2%) and pelvic (35.8%) tumors.

Conclusion: NIS increased during radiotherapy. The location of tumors influences symptom prevalence, highlighting the need for continuous nutritional support.

Purpose: Childhood cancer survivors (CCS) are at risk for therapy-related late effects. Physical activity (PA) can minimize some late effects risk, but rates of PA are low in CCS. We aimed to determine how perception of survivor health status and presence of chronic conditions are associated with patient- or proxy-reported PA.

Methods: This cross-sectional, retrospective study of CCS (6-25 years; ≥ 1 year off-therapy) defined low PA as < 5 days per week with ≥ 60 minutes/day of patient- or proxy-reported activity. Participants completed PROMIS Global Health questions assessing perceptions of overall, physical, and mental health. Presence of chronic conditions was abstracted from the health record and defined as ≥ 2 late effects. Multivariable logistic regressions were performed to identify associations between physical activity and health status or chronic conditions.

Results: Of 284 CCS, 71.8% reported low PA. Negative perceived overall, physical, and mental health status were present in 5.6%, 10.6%, and 15.9% of CCS, respectively, with presence of chronic conditions in 49.7%. Low PA was directly associated with female sex (p = 0.002) and poor physical (p = 0.01) and mental (p = 0.02) health status, and inversely associated with relapsed/refractory disease (p = 0.03). Presence of chronic conditions was not associated with low PA (p = 0.68); however, all CCS with chronic graft-versus-host disease or vision impairment had low PA.

Conclusion: Low PA is an issue for CCS, especially females, and is associated with negative perceived physical and mental health. Future PA interventions for CCS should address perceived physical and mental health, and focus on specific at-risk sub-groups.