Supportive Care in Cancer最新文献

Purpose: A conceptualisation of subjective financial distress as a consequence of a cancer diagnosis and treatment is still missing due to a lack of a comprehensive model accounting for all relevant dimensions of financial effects of cancer experienced by patients. Our goal was to derive a model for the German healthcare system to shed light on the complex process of financial effects of cancer.

Methods: The model was developed through systematic literature review and qualitative studies, including interviews with 18 cancer patients and a focus group with 4 social services representatives. The iterative process of model development was accompanied by an ongoing exchange in the interdisciplinary research team.

Results: The developed model of financial effects of cancer experienced by patients consists of three dimensions: (1) actual and anticipated financial disadvantages, (2) behavioural and cognitive coping strategies, and (3) subjective financial distress conceptualised as negative effects in different aspects of daily living: employment, living situation, family, social participation, health promoting lifestyle, additional personally preferred treatments, navigating the health system, and a further area so-called unspecific.

Conclusion: Subjective financial distress is driven by different financial effects of cancer experienced by patients and is perceived as negative in various aspects of daily living. While the identified categories of daily living can be observed in countries with universal healthcare coverage, the content and degree of each subcategory depend on country-specific characteristics. The introduced model can be used to inform the development of a new patient-reported outcome measure (PROM).

Trial registration number: NCT05319925 (registration date, 2022-06-01).

Purpose: Hematopoietic stem cell transplantation (HSCT) is a physically and psychosocially complex process for patients and their families, and nurses play a key role in coordinating patient care. This study aimed to explore nurses' perspectives on caregiver engagement in the care of patients undergoing hematopoietic stem cell transplantation.

Methods: A qualitative descriptive design with purposive sampling was used. Data were collected through semi-structured interviews with eleven nurses working in a bone marrow transplantation unit in Ankara. The data were analyzed using thematic analysis.

Results: Five main themes and ten sub-themes were identified. The main themes were 1) Nurses' expectations and caregiver involvement, 2) Impact of caregiver's engagement, 3) Caregiver strain and challenges, 4) Support needs of caregivers, and 5) Nurses' role in supporting caregivers.

Conclusions: Nurses perceived that caregiver engagement positively improves patient outcomes but also noted that this placed a significant burden on caregivers. Nurses play a pivotal role in addressing the challenges and supporting caregivers through emotional support, education, and advocacy. Targeted interventions, such as education, psychological support, and enhanced communication, are crucial for supporting caregivers effectively and improving the well-being of both caregivers and patients.

Purpose: Patient navigation programs have demonstrated intervention efficacy associated with barrier reduction and health outcome improvements in the context of cancer care. Greater characterization of barriers and barrier resolution likelihoods may support program optimization.

Methods: A 3-month longitudinal, non-comparative community-focused (i.e., lay navigator) patient navigation program was implemented at an NCI-designed cancer center between 2018 and 2021. Barriers to cancer care were reported by patients (n = 207) at pre-intervention and re-assessed at post-intervention. Descriptive analyses examined patient-level associations among pre-intervention barriers and post-intervention rates of barrier resolution. Logistic regressions were conducted at the barrier level and patient level to estimate the likelihood of barrier resolution associated with Health Access, Financial, and Psychosocial barrier domains.

Results: Participants reported an average of 3.54 distinct barriers to cancer care. Barriers associated with Health Access and Financial domains were most frequently endorsed. Post-navigation, barriers were found to differ in their resolution rates. At the barrier domain level, resolution rates differed significantly (X²(2) = 7.826, p = 0.02), with Financial barriers significantly less likely (OR = 0.61; 95% CI = 0.41, 0.89) to be resolved. For participants who reported barriers exclusively within the Financial domain, the odds of any of their barriers being "resolved" were approximately 77% lower compared to participants who reported barriers in other domains.

Conclusion: In this community-focused patient navigation program, barriers in the Financial domain proved to be the most difficult to resolve. The amenability of specific barriers to resolution via patient navigation can guide program tailoring and optimization.

Purpose: To determine the feasibility and effectiveness of two forms of social support (peer and peer plus virtual professional support) on quality of life, feelings of support, and exercise levels in older adult survivors of cancer.

Methods: We conducted a pilot randomized controlled trial. Participants were randomized to the AgeMatchPLUS (peer support plus weekly qualified exercise professional support) or AgeMatch (peer support only) group. The primary outcome was feasibility (measured by recruitment, retention, adherence rates). Secondary outcomes included quality of life, social support, exercise volume, and physical activity enjoyment. Outcomes were measured at baseline (T1), post-intervention (10-weeks post baseline (T2)), post-tapering (14-weeks post baseline (T3)), and at 6-months follow-up (T4). Data was analyzed using descriptive statistics and a multiple linear regression was performed for all secondary outcomes to determine estimates of effect between groups.

Results: Virtual peer and professional exercise-related social support are feasible for older adults survivors of cancer. Those matched with a peer in addition to virtual professional support demonstrated improved exercise-related social support and resistance training volume post-intervention. No other significant differences were found between groups, with both groups significantly increasing their exercise levels across the study.

Conclusion: We demonstrated the feasibility and benefit of peer matching, both independently and alongside professional support, for older survivors of cancer. Future research efforts should examine the effectiveness of this intervention on a larger scale and compare outcomes to a no intervention group.

Registry: This trial was registered on clinicaltrials.gov (NCT05549479, August 23, 2022).

Purpose: This study used contemporaneous networks and cross-lagged panel network (CLPN) to examine how the Simplified Sitting Badunjin (SSBDJ) intervention interacted with the fatigue, sleep disturbances, and quality of life (QoL) at different follow-up stages in advanced cancer patients.

Methods: This was a secondary analysis of a randomized controlled trial. Data were collected at baseline (T0), 4 weeks (T1), 8 weeks (T2), 12 weeks (T3) of the intervention, and 4 weeks (T4) after the intervention. A total of 3 constructs with 16 dimensions (fatigue severity, fatigue interference, sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, daytime dysfunction, physical discomfort, food related concerns, healthcare concerns, support, negative emotions, existential distress, sense of alienation, value of life) were included in the symptom network, which consists of contemporaneous and cross-lagged panel networks.

Results: A total of 175 participants were included in the network analysis. Within the contemporaneous network, "Fatigue interference" emerged as the central symptom in both the intervention and control groups (intervention group: EI value = 1.249 (T1), 2.610 (T2); control group: EI value = 1.462 (T1), 1.950 (T2)). In the longitudinal network analysis, SSBDJ was strongly negatively associated with fatigue severity and interference at T0 → T1 (β = -0.497, -0.504) and T1 → T2 (β = -0.210, -0.256). Additionally, fatigue consistently served as a central node within the networks, demonstrating the highest out-expected influence across 12-week intervention period. The impact of fatigue (out-EI: r = 2.641) on sleep disturbances and quality of life tended to exert independent influence in the mid stage of intervention (T2 → T3). Furthermore, fatigue (out-predictability: r = 1.993) remained a dominant predictor of sleep disturbances and quality of life even after the intervention (T3 → T4).

Conclusion: This study enhances the understanding of the longitudinal relationships between the SSBDJ intervention, fatigue, sleep disturbances, and QoL among patients with advanced cancer. It could provide an important insight for designing precise symptom management strategies in mind-body exercise interventions among this population.

Purpose: In the last days of life, saying good-bye between terminally ill patients and their family members-sharing meaningful final conversations-is considered a core element of a good death. However, the role of healthcare professionals in facilitating this process remains insufficiently examined. This study aimed to assess bereaved family members' perceptions of (1) the achievement of saying good-bye and (2) the appropriateness of support timing.

Methods: This nationwide cross-sectional survey included bereaved family members of cancer patients who died in inpatient hospices or palliative care units in Japan. Families evaluated two outcomes and ten professional practices. Exploratory factor analysis identified practice domains, and multivariate logistic regression examined their associations with the outcomes.

Results: Of 954 questionnaires distributed, 683 were returned (71.5%), and 384 were analyzed. Among respondents, 17.5% disagreed that they had been able to say good-bye, and 12.4% felt support was provided too late. Four professional practice domains were identified. "Clarifying the patient's estimated prognosis" was significantly associated with all outcomes. Furthermore, "Encourage families to say good-bye not to miss the moment to talk" was associated with family-perceived achievement of saying good-bye with marginal statistical significance (p = 0.054).

Conclusions: Clear and timely prognostic communication may help patients convey meaningful last words to their families.

Purpose: Depression and anxiety are often undertreated in patients with cancer, and brief, robust screening measures are needed. The objective was to assess the sensitivity and specificity of the Edmonton Symptom Assessment System-Revised (ESAS-r) anxiety and depression items against the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7-item scale (GAD-7) (reference measures).

Methods: We conducted a analysis of baseline data from the evaluation of a real-world patient-reported outcome measure (PROM) screening program. Patients with cancer completed the ESAS-r, PHQ-9, and GAD-7. Receiver operating characteristic analysis assessed ESAS-r depression and anxiety item accuracy by calculating area under the curve (AUC) and 95% confidence intervals (95% CI). Youden's index guided suggested screening cutoffs. Analyses were conducted for the entire sample, followed by exploratory analyses stratified by sex, age, income, and education.

Results: Of 375 eligible participants, 177 with complete data were included. The AUCs were excellent against the reference measures: 0.81 (95% CI: 0.73-0.90) for depression and 0.83 (95% CI: 0.70-0.96) for anxiety. Optimal cutoffs were ≥ 2 for depression (sensitivity: 0.83, specificity: 0.66) and ≥ 4 for anxiety (sensitivity: 0.83, specificity: 0.79), with low positive predictive values (0.32 and 0.31, respectively). Exploratory stratified analyses suggested comparable performance across subgroups, anxiety prevalence in males (2%) was too low for meaningful analysis.

Conclusion: The AUCs for the depression and anxiety ESAS-r items were excellent, at 0.81 and 0.83, respectively. Findings support ESAS-r-D ≥ 2 and ESAS-r-A ≥ 4 as thresholds to identify those in need of further assessment, but professional judgment and previous findings should also be considered.

Purpose: Exercise has the potential to improve and maintain physical function, alleviate symptoms, improve quality of life, and influence prognosis in patients with advanced lung cancer. This systematic review and meta-analysis of randomized controlled trials (RCTs) primarily examined the impact of exercise on physical function, with a focus on cardiorespiratory fitness.

Methods: A systematic search of PubMed, Cochrane Library, Web of Science, and CINAHL was conducted from inception to June 28, 2024. Eligible RCTs examined exercise interventions in patients with advanced lung cancer, evaluating physical function, symptoms, quality of life, and prognosis. Subgroup analyses were performed based on measurement sites and items. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for quantitative outcomes, and a random-effects model was used for data pooling.

Results: Nine RCTs (from 4,262 retrieved articles) were included in the meta-analysis. The results indicated that patients who participated in exercise interventions had greater improvements in VO₂peak (SMD 0.38; p = 0.01), muscle strength, and physical activity than those in the control group. Additionally, exercise was associated with greater reductions in fatigue and improvements in quality of life. Since only one study reported on prognosis, a meta-analysis could not be performed for this outcome.

Conclusions: We conclude that exercise plays a crucial role in improving cardiorespiratory fitness, muscle strength, quality of life, and fatigue in patients with advanced lung cancer, highlighting the importance of incorporating exercise into their cancer care. However, future studies, including head-to-head comparative trials, are required to clarify the effects of different exercise types and their impact on prognosis. PROSPERO Registration Number: CRD42024575482.

Background: Virtual reality (VR) technology is increasingly being used in supportive care for cancer patients, aiming to improve their discomfort symptoms and enhance their health status and quality of life. Understanding patients' feedback and insights is crucial for improving the application of virtual reality among cancer patients. While numerous qualitative studies have examined the experiences and perspectives of cancer patients during their treatment with virtual reality, a comprehensive synthesis of these insights is missing. This review of qualitative evidence aimed to explore the experiences and perceptions of patients receiving VR therapy in cancer, providing guidance for the treatment and rehabilitation of cancer patients with VR technology.

Methods: A computerised search of the Cochrane Library, PubMed, Embase, CINAHL, Web of Science Core Collection, CNKI, Wanfang, Vip and SinoMed was conducted to identify relevant qualitative studies. The enrolled participants were adult patients with cancer who were 18 years of age or older. The search covered the period from establishing each database until May 2025. The Joanna Briggs Institute criteria for qualitative research were utilised to evaluate the quality of the studies. The data included in the literature were analyzed and integrated by "thematic synthesis" to formalize the identification and development of themes.

Results: A total of 12 studies were included, encompassing data from cancer patients with an age range of 20 to 83 years. Findings were integrated into 12 sub-themes and 4 themes: (1) experiences of cancer patients receiving VR therapy. (2) perceived benefits of VR therapy for cancer patients. (3) barriers to VR therapy for cancer patients. (4) needs and expectations of cancer patients receiving VR therapy. Each encompassed sub-themes.

Conclusion: While most patients develop a strong interest in VR therapy and are willing to try it, some cancer patients express doubts and resistance due to poor human-computer interaction experiences, discomfort such as nausea or dizziness, or economic factors. Participants reported that VR therapy may serve as an effective approach to alleviate patients' physical pain, relieve psychological stress, and promote the recovery process. Additionally, cancer patients receiving VR therapy face various barriers and have put forward some needs and preferences to better apply VR therapy. Future studies should be conducted according to patients' feedback and suggestions on how to further optimize and improve VR therapy.

Registration: PROSPERO CRD420251053989.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a prevalent adverse effect linked to neurotoxic chemotherapeutic agents. Current pharmacological treatments exhibit limited efficacy and notable adverse effects. The clinical effectiveness of non-pharmacological therapies, like acupuncture, physical exercise (PE), cryotherapy (CR), and compression therapy, requires systematic comparison. This study employs a network meta-analysis (NMA) to appraise the efficacy and preventive effects of various non-pharmacological interventions on CIPN.

Methods: The study adhered to the PRISMA guidelines. Eight Chinese and English databases (up to October 2025) were searched. A fixed-effect NMA was executed using Bayesian methods to appraise the effects of interventions like acupuncture, CR, and PE on the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity questionnaire, the Numerical Rating Scale, the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-CIPN twenty-item scale, and the incidence of CIPN. Additionally, the risk of bias was appraised using the Cochrane tool.

Results: In total, 27 studies were included, comprising 2136 patients. The NMA indicated that, compared to medication, PE can effectively alleviate neurotoxicity (mean difference [MD]: - 9.9, 95% credible interval [CrI] [- 16, - 4.3]). Acupuncture exhibited superior efficacy in modulating peripheral nerve symptoms (MD: - 2.4, 95% CrI [- 3.8, - 1.1]), alleviating neuropathic pain (MD: - 1.1, 95% CrI [- 1.2, - 1.0]), and reducing the incidence of CIPN (MD: 0.23, 95% CrI [0.071, 0.52]).

Conclusion: PE can notably improve neurotoxicity. Acupuncture can alleviate clinical symptoms related to sensory and motor functions in CIPN. Additionally, it is effective in reducing neuropathic pain and might serve as a preventive measure against the onset of CIPN.