Supportive Care in Cancer最新文献

Objective: To systematically review the intervention content and efficacy of auriculotherapy in alleviating cancer-related fatigue symptom clusters, analyze its current application status and existing limitations, and provide references for clinical practice and future research.

Methods: A scoping review was adopted. Systematic searches were conducted in databases including CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, Cochrane Library, Embase, and CINAHL. The search period spanned from the inception of each database to May 15, 2025. Relevant data from the included studies were extracted and analyzed.

Results: Fourteen studies with a total sample size of 1208 participants were ultimately included. The interventions primarily targeted the pain-fatigue-sleep disturbance symptom cluster and the fatigue-anxiety symptom cluster. Auricular acupressure was the most common intervention, with an average of five to 12 auricular points selected. Shenmen, subcortex, and sympathetic were the top three most frequently used auricular points. The intervention durations ranged from 3 days to 8 weeks, with frequencies of intervention of three to six times per day. The common intervention methods included auricular acupressure, auricular acupuncture, and auricular laser therapy.

Conclusion: Auriculotherapy is simple to operate, low in cost, and highly safe and was associated with potential benefits in the management of cancer-related fatigue symptom clusters, though intervention protocols varied widely. However, the current intervention protocols are not standardized, and there is a lack of unified symptom cluster assessment tools. Future research should standardize the intervention protocols and optimize the evaluation tools and auricular intervention regimens, so as to further enhance the clinical value of auriculotherapy in the management of cancer-related fatigue symptom clusters.

Purpose: To inform development of centralised, evidence-based clinical trials resources for Australians with ovarian cancer, a structured understanding of knowledge gaps and resource needs was essential. The study aimed to assist resource development by assessing awareness, information access, and participation in clinical trials of ovarian cancer patients.

Methods: A national, cross-sectional online survey among Australians with ovarian cancer was conducted between October and November 2024. Descriptive and inferential statistics along with qualitative content analyses were conducted. Associations were examined using Chi-Square and Fisher Exact tests.

Results: Surveys from 272 respondents indicated moderate knowledge ( $\overline{x}$ = 4.46/10, SD = 2.34) and a high perception of importance of clinical trials ( $\overline{x}$ = 9.27/10, SD = 1.17). 56% of respondents reported not receiving clinical trials information and 44% had sought information themselves. Respondents preferred information by email newsletter (34%), through health professional discussions (20%) and accessing an online information hub (17%). Information access enablers included clinicians being knowledgeable about clinical trials, personalised discussions, and access to a centralised information source. Barriers included fragmented information across websites, use of complex medical language and competing responsibilities as caregivers. A qualitative analysis of open-ended responses (n = 96) revealed three core themes: 'we need better solutions to help find information and participate in clinical trials', 'weighing up options' in their decision to participate, and 'we want to help improve outcomes for women in the future'.

Conclusions: Results from this study of Australians with ovarian cancer inform actionable change through development of evidence-based, tailored resources. Further solutions and evaluation of intervention effectiveness will continue through sector collaboration.

Purpose: Although survival rates in childhood cancer have improved with more effective, risk-adapted multimodal treatments, oral mucositis remains one of the most common treatment-related oral complications. This study evaluated the impact of an oral mucositis care protocol on the severity of mucositis.

Methods: This prospective randomized controlled study was conducted with 30 pediatric oncology patients aged 6 to 18 years. The sample included children with hematologic malignancies (predominantly acute lymphoblastic leukemia) and solid tumors. The data were collected using a descriptive information form, the Children's International Mucositis Evaluation Scale (ChIMES), and the WHO Oral Mucositis Grading Scale. Standard care was applied to the control group. For the intervention group, an oral care protocol was prepared, and the patients received training. The oral care intervention was applied for 14 days and monitored by the researcher. The patients were monitored for oral mucositis on Days 0, 3, 7, and 14. Those in the intervention group received a calendar for documenting their oral care practices.

Results: The ChIMES scores showed a significant difference between the groups and were lower in the intervention group (z = 0.010; p = 0.011). The WHO scale results revealed significant differences between the groups on Day 7 (Z = -3.106; p = 0.002) and Day 14 (Z = -2.841; p = 0.005).

Conclusion: At the end of the study, the severity of mucositis was lower in the patients who received the oral mucositis care protocol. It is recommended that a standardized oral care protocol specific to children be developed and that education on oral mucositis care be provided to children and their parents from the beginning of hospitalization.

Clinical trial registration: ClinicalTrials.gov (Identifier: NCT06711315; Registration date: 29 November 2024).

Purpose: While some studies have investigated the effectiveness of exercise interventions during adjuvant chemotherapy in cancer patients, the findings are inconclusive. This systematic review and meta-analysis aimed to quantify the effectiveness of exercise interventions specifically in patients with colorectal cancer (CRC) during adjuvant chemotherapy.

Methods: A comprehensive literature search was conducted using 6 electronic databases. Eligible studies included randomized controlled trials (RCTs), non-RCTs, single-arm intervention studies, and retrospective cohort studies that implemented structured exercise interventions. Exercise capacity, lower and upper extremity muscle strength, fatigue, pain, chemotherapy-induced peripheral neuropathy, anxiety, depression, and quality of life were defined as outcomes. A meta-analysis was performed to quantify the effectiveness of exercise interventions during adjuvant chemotherapy on each outcome. Additionally, the feasibility of the exercise interventions was investigated.

Results: Nine studies met the inclusion criteria for the present systematic review. In the RCTs, exercise interventions during adjuvant chemotherapy significantly reduced fatigue (standardized mean difference [SMD]: -0.53 [95% confidence interval {CI}: -1.04, -0.01]) and depression (SMD: -0.34 [95% CI: -0.55, -0.13]), but had no significant effect on exercise capacity, lower and upper extremity muscle strength, pain, anxiety, and quality of life. Adherence to exercise interventions during adjuvant chemotherapy ranged from 58 to 100%. No adverse events were reported, or reporting was not provided.

Conclusions: This systematic review revealed that exercise interventions during adjuvant chemotherapy effectively reduce fatigue and depression in patients with CRC, though the effect may be small. The implementation of exercise interventions during adjuvant chemotherapy may be safe.

Background: Talquetamab (TAL), a first-in-class bispecific antibody targeting GPRC5D and CD3, has demonstrated high efficacy in heavily pretreated relapsed and refractory multiple myeloma (RRMM), achieving response rates of approximately 70%. However, TAL is frequently associated with on-target, off-tumor oral toxicities.

Objective: This study aimed to review the features of oral toxicities related to TAL.

Methods: A comprehensive review of the recent literature on TAL-associated oral toxicities was conducted. Extracted data included time to onset, incidence, severity grading, and reported management strategies for these adverse events.

Results: Oral effects are hypothesized to arise from immune activation against epithelial cells expressing GPRC5D in the tongue, salivary glands, and hard keratinized tissues. Clinical studies, including the MonumenTAL-1 trial, have reported dysgeusia in up to 72% of patients, dry mouth in 39%, and dysphagia in 24% of patients. Such toxicities typically arise within a few weeks of initiating TAL therapy and tend to persist. They can significantly impair nutrition and quality of life, often leading to weight loss exceeding 6% of baseline body weight. Current management is largely supportive, including corticosteroid mouthwashes, saliva stimulants, nutritional counseling, and TAL dose adjustments, with limited efficacy. The ongoing TALISMAN trial is evaluating prophylactic interventions such as dexamethasone mouthwash and pregabalin.

Conclusion: Oral toxicities often emerge early and may persist throughout the therapy. Consequently, early recognition, preventive care, and multidisciplinary management are essential to mitigate oral complications and preserve quality of life in patients receiving TAL.

Background: Chemotherapy and immunotherapy-induced peripheral neuropathy affects up to 68% of cancer patients and may persist long after treatment, substantially impairing daily functioning and quality of life. While exercise therapy has demonstrated benefits in lower-limb polyneuropathy (PNP), evidence for upper-extremity symptoms remains scarce. The VISCIPH B pilot study investigated the effect of two supervised exercise interventions for PNP of the upper extremities using exploratory analyses of symptom response.

Methods: In this single-center randomized controlled pilot trial (DRKS00023287), 61 cancer patients with symptomatic upper-extremity PNP were randomized (1:1) to either (a) combined sensorimotor plus vibration exercise (PNPEX) or (b) moderate resistance exercise (MREX). Both interventions were carried out supervised twice weekly over 12 weeks. Feasibility outcomes included adherence, retention, assessment completeness, and safety of the exercise interventions. Symptom outcomes were assessed with the FACT/GOG-Ntx questionnaire, measures of pain (NRS), depth sensitivity (Rydel-Seiffer tuning fork), and quality of life (EORTC QLQ-C30).

Results: Feasibility criteria showed high adherence (86%) and retention (69%) rates. A total of 42 patients (mean age 53.3 years, 36% male) completed the intervention with no reported intervention-related adverse events. In the exploratory effect analyses, 50% of PNPEX participants (10/20) were classified as responders, compared to 14% (3/21) in MREX (OR = 5.45, p = 0.043). FACT/GOG-Ntx scores improved significantly in PNPEX (p = 0.017) but not in MREX (p = 0.46), resulting in a significant difference between the two groups (p = 0.05). Patient-reported outcomes revealed significant improvements in the PNPEX group regarding numbness and tingling (NRS), depth sensitivity at four of the eight tested bone sites and global health (p = 0.001).

Conclusion: The VISCIPH B pilot trial confirmed the feasibility, safety, and acceptance of supervised exercise for upper-extremity PNP in cancer patients. Significant improvements in patient-reported and functional outcomes indicate that combined sensorimotor and vibration exercise can meaningfully reduce PNP symptoms and should be evaluated in larger trials.

Purpose: Caregivers of patients diagnosed with cancer experience stress associated with their roles and responsibilities as a caregiver. These stressors contribute to psychosocial issues among this population and many caregivers experience loneliness. A caregiver's neighborhood context and financial circumstances could be associated with loneliness. The current study had two objectives: (1) examine the associations among area deprivation index, household income, and loneliness for caregivers of patients with cancer and (2) identify potential interaction effects between area deprivation index and household income on loneliness.

Methods: Demographic data and baseline surveys for our study were derived from a larger clinical trial of caregivers of patients with cancer receiving outpatient palliative care. Participants were geocoded to determine their census block group and corresponding area deprivation index percentile. Linear models were estimated to assess associations among area deprivation index, household income, and loneliness, and models were subsequently adjusted for several demographic and caregiving context covariates.

Results: The results showed that there was no significant association between area deprivation index and loneliness but did indicate an association between household income and loneliness: caregivers with annual household incomes less than $70,000 experienced greater loneliness on average than those with annual household incomes greater than $70,000. There was no detectable interaction effect of area deprivation index and household income on loneliness.

Conclusion: These results indicate that financial and income data should be considered when developing clinical practices or infrastructure to ameliorate loneliness in caregivers of patients with cancer.

Objective: Cancer-related pain remains a major challenge in inpatient oncology care, affecting a large proportion of patients with advanced malignancies. This retrospective cohort study was aimed at evaluating whether implementation of a standardized painless ward model was associated with improved cancer pain control and hospitalization outcomes compared with conventional ward-based care.

Methods: This single-center retrospective cohort study included 848 hospitalized patients with pathologically confirmed malignancies and cancer-related pain. Patients admitted before painless ward implementation (general ward, January 2021-December 2022; n = 422) were compared with those admitted after implementation (painless ward, January 2023-December 2024; n = 426). Baseline pain intensity was assessed at admission using the Numerical Rating Scale (NRS). Pain reassessment was performed by trained oncology nursing staff at least once daily and every 4 h when NRS > 4, with physician reassessment when clinically indicated. Pain outcomes at discharge, change in pain intensity during hospitalization (ΔNRS), length of stay (LOS), and prolonged hospitalization (LOS > 10 days) were evaluated. Multivariable linear regression analyses were performed to adjust for baseline pain and demographic factors.

Results: Patients managed in the painless ward experienced a greater reduction in pain intensity during hospitalization compared with those in the general ward, with a lower prevalence of severe pain (NRS ≥ 7: 15.5% vs. 24.4%) and a lower mean NRS score (3.70 ± 2.27 vs. 4.35 ± 2.62; P < 0.01). Gender- and age-related differences in pain severity observed under conventional care were not observed following painless ward implementation. The painless ward was also associated with a shorter mean LOS (10.15 ± 7.53 vs. 11.72 ± 7.49 days) and a lower proportion of prolonged hospitalization (36.6% vs. 48.1%). Baseline pain severity at admission was higher in the painless ward group (mean NRS 7.39 ± 1.86) than in the general ward group (6.11 ± 2.33; P < 0.001). Despite this, patients managed in the painless ward experienced a greater reduction in pain intensity during hospitalization (mean ΔNRS -3.69 ± 1.30 vs. -1.76 ± 0.68; P < 0.001). After adjustment for baseline NRS, age, and gender, admission to the painless ward remained independently associated with greater pain reduction (β =  -2.00, 95% CI -2.14 to -1.85; P < 0.001). The painless ward was also associated with a shorter mean LOS and a lower proportion of prolonged hospitalization.

Conclusion: This real-world study suggests that implementation of a standardized painless ward model is associated with better inpatient cancer pain control, shorter hospitalization duration, and attenuation of demographic differences in pain severity. These findings should be interpreted as associative and warrant confirmation in prospective studies.

Purpose: Evidence suggests that physical activity and exercise interventions can mitigate cancer treatment side effects. However, an improved understanding of how physical activity/exercise can be embedded within cancer care pathways is needed. We examined what is known about the barriers and facilitators to implementing physical activity/exercise interventions in the adjuvant cancer treatment pathway from a patient and healthcare professional perspective. The protocol was registered a priori with PROSPERO in March 2023.

Methods: Electronic databases (CINAHL Plus, MEDLINE, PsycINFO and Cochrane) were searched for quantitative, qualitative, and mixed methods evidence from 2004 to 2025. Quality appraisal was undertaken using the appropriate Critical Appraisal Skills Programme tools. Barriers and facilitators were inductively coded into themes and then mapped to the Capability-Opportunity-Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF). Thematic meta-synthesis was applied to the data.

Results: Fifteen qualitative, twelve quantitative and two mixed methods studies met the inclusion criteria. Three core themes emerged that influenced implementation: exercise intervention, organisational setting and impact of cancer. The barriers and facilitators identified by patient and healthcare professional participants were relevant to all the COM-B constructs, with the most prevalent TDF domains being skills, knowledge, environmental context and resources, social influences and optimism.

Conclusion: Findings emphasise knowledge and education, previous experience with exercise, resources, motivation, gender, age, social factors, positive promotion, individualised programming throughout treatment and access to credible practitioners as nuanced perspectives between patients and healthcare professionals. These converging perspectives are influential determinants to help identify potential solutions for embedding exercise within cancer treatment pathways.