Supportive Care in Cancer最新文献

Background: Prior research indicates that engaging in physical activity during chemotherapy can positively influence both physical and psychological parameters in individuals with hematological neoplasms. However, the most effective type, level, intensity, and frequency of exercise remains unclear.

Patients and methods: We enrolled 53 patients to a clinical trial assessing a partly supervised hybrid training program including both strength and endurance components, commencing at onset of induction therapy (T0) for hematological malignancies, including AML (n = 29), ALL (n = 5), and NHL (n = 19). Endpoints to evaluate efficacy included muscle strength in kg, cardiovascular fitness in steps, balance in scores, quality of life (QoL), and fatigue. Data were compared at three time points: the beginning of treatment (T0), during consolidation (T1), and 12 ± 2 weeks later (T2).

Results: Average adherence to protocol specified activities was 63.2% (± 40.0% s.d.) for participants without a stem cell transplant (No-SCT) and 51.5% (± 29.3% s.d.) for participants with AML between T0 and T2. No serious adverse reactions related to the exercise program were reported. Positive correlations were found between adherence and hand strength (T0-T1: left: r = 0.48, p < 0.05; right: r = 0.56, p < 0.05) for patients without stem cell transplant as therapy, as well as a strong association between higher adherence and lower appetite loss between T1 and T2 (No-SCT: r = -0.67, p = 0.001; AML: r = -0,49, p = 0,03). In participants with AML, it was also shown that higher adherence at T2 was associated with reduced symptom burden due to financial problems (r = -0,65, p = 0,004). However, other aspects of quality of life and fatigue showed only weak to moderate correlations with adherence.

Conclusion: This partly supervised hybrid exercise program during inpatient and outpatient care of patients with hematological cancer was safe and feasible. While useful in maintaining hand strength and reducing appetite loss in some patients, as well as reducing symptom burden due to financial problems in other patients, ambiguity was likely due to confounding factors, such as underlying disease biology and response to treatment. Corresponding author: Johanna Huesmann (johuesmann@gmx.de) (TRN: DRKS00034396, Date of registration: 07.06.2024; retrospectively registered).

Purpose: Oral mucositis (OM) reflects a complex interplay of several risk factors. Machine learning (ML) is a promising frontier in science, capable of processing dense information. This study aims to assess the performance of ML in predicting OM risk in patients undergoing head and neck radiotherapy.

Methods: Clinical data were collected from 157 patients with oral and oropharyngeal squamous cell carcinoma submitted to radiotherapy. Grade 2 OM or higher was considered (NCI). Two dataset versions were used; in the first version, all data were considered, and in the second version, a feature selection was added. Age, smoking status, surgery, radiotherapy prescription dose, treatment modality, histopathological differentiation, tumor stage, presence of oral cancer lesion, and tumor location were selected as key features. The training process used a fivefold cross-validation strategy with 10 repetitions. A total of 4 algorithms and 3 scaling methods were trained (12 models), without using data augmentation.

Results: A comparative assessment was performed. Accuracy greater than 55% was considered. No relevant results were achieved with the first version, closest performance was Decision Trees with 52% of accuracy, 42% of sensitivity, and 60% of specificity. For the second version, relevant results were achieved, K-Nearest Neighbors outperformed with 64% accuracy, 58% sensitivity, and 68% specificity.

Conclusion: ML demonstrated promising results in OM risk prediction. Model improvement was observed after feature selection. Best result was achieved with the KNN model. This is the first study to test ML for OM risk prediction using clinical data.

Purpose: Acute radiation dermatitis (ARD) is a frequent side effect experienced by breast cancer patients undergoing radiotherapy. This study aimed to assess the efficacy and safety of a topical cream containing aminoacryl tRNA synthetase complex interacting 1 (AIMP1)-derived peptide (AdP) in mitigating radiation dermatitis (RD) in breast cancer patients undergoing radiotherapy.

Methods: An 8-week single-center, prospective pilot study was conducted to compare the clinical efficacy and safety of an AdP-containing cream with a control cream lacking AdP for the mitigation of RD. Fifteen patients undergoing radiotherapy applied the test cream to the right side and the control cream to the left side of the radiation exposure site, bisected by the nipple line. RD was evaluated at baseline and at weeks 2, 4, 6, and 8, employing the 5-point grading system advocated by the Radiation Oncology Group (RTOG).

Results: The average RTOG score was lower on the test side in comparison to the control side, and a less pronounced increase in melanin index was observed on the test side. However, these differences were not statistically significant. Both sides exhibited increased skin hydration and decreased transepidermal water loss. Analyzing the maximum RTOG scores throughout the study, RD of maximum grades 1 and 2 was noted in 54.5% and 45.5% of patients on the test side. On the control side, the maximum grades 1 and 2 were observed in 45.5% and 54.5% of patients respectively.

Conclusion: The AdP-containing cream did not prove to be more effective than the control cream without AdP in mitigating RD. However, the total incidence of RD in our study was notably lower than previously documented, illustrating the protective effects of both the test and control creams.

Background/aims: Social connectedness is increasingly recognised as influencing health outcomes in cancer caregivers; however, there is little understanding of factors which foster feelings of social connectedness among caregivers when providing care. We sought to examine from the caregivers' perspective, factors which contribute to perceived social connection when providing care to someone with cancer.

Methods: Semi-structured interviews were conducted with 20 caregivers of people with cancer. Participants were recruited through social media and were eligible if they were aged 18 + years and had provided care to someone with cancer in the preceding 3 years. Data were analysed thematically using NVivo.

Results: Following thematic analysis of interview data, six overarching themes emerged detailing caregivers' experiences with social support, networks, and connectedness. Themes included: people in caregivers' social networks and communication frequency, supportive communication with people in social networks, challenges with talking with others and seeking support, receiving instrumental support from social networks, impact of the carer role on friendships and community activities, and factors which fostered perceived connectedness.

Conclusions: For caregivers of people with cancer, our qualitative findings suggest the importance of receiving emotional and instrumental support from social networks to cope with, and alleviate the stress and strain of providing care. Development and empirical testing of strategies and interventions that improve social support seeking and subsequently perceived connectedness among caregivers are recommended to improve health and wellbeing.

Purpose: Chemoradiotherapy (CRT) for head and neck cancer (HNC) often causes dysphagia. The risk of dysphagia increases during CRT tends to become more severe after finishing CRT, and persists for a few weeks thereafter. Thus, understanding the changes in swallowing physiology during and immediately after CRT is essential. This study aimed to clarify the changes in the swallowing response during and early after CRT and identify associated factors.

Methods: This retrospective study enrolled 107 patients with HNC who underwent CRT. We measured pharyngeal delay time (PDT) and laryngeal elevation delay time (LEDT) as indicators of the timing of the swallowing response at three time points: at CRT initiation (baseline), at 40-Gy irradiation during CRT (mid-CRT) and within 2 weeks following the completion of CRT (early post-CRT) as primary outcomes; and subgroup analyses based on clinical parameters, such as tumor sites, T stage, N stage, and opioid use at 40-Gy irradiation as secondary outcomes.

Results: Both PDT and LEDT were significantly prolonged between baseline and mid-CRT (PDT: p = 0.003, LEDT: p = 0.002) and between baseline and early post-CRT (PDT, p = 0.001; LEDT, p < 0.001). N2c/N3 and opioid use at 40-Gy irradiation showed prolonged PDT and LEDT at mid-CRT and early post-CRT.

Conclusion: PDT and LEDT were prolonged at mid-CRT irradiation and further extended at early post-CRT. Additionally, N2c/N3 involvement, which typically necessitates bilateral neck irradiation fields and opioid use at mid-CRT, may constitute as risk factors for a delayed swallowing response.

Purpose: Adolescent and young adult (AYA) malignant brain tumour (BT) survivors are at risk of adverse health outcomes, which may impact their health-related quality of life (HRQoL). This study aimed to investigate the (1) prevalence of physical and psychological adverse health outcomes, (2) the HRQoL, and (3) the association of adverse health outcomes and HRQoL among long-term AYA-BT survivors. Adverse health outcomes and HRQoL were compared to other AYA cancer (AYAC) survivors.

Methods: A cross-sectional secondary data analysis of the SURVAYA study among 133 AYA-BT and 3877 AYAC survivors was conducted. Participant self-reported adverse health outcomes and HRQoL scores were analysed and compared between the two populations. Associations with HRQoL were assessed using linear regression modelling with AIC-based backward elimination.

Results: AYA-BT survivors faced significant issues of fatigue (47.6%), future uncertainty (45.2%), and medical conditions like vision (34.4%), speech, taste, or smell (26.2%) impairments, cancer recurrence, and metastasis (25.4%). Neurocognitive symptoms were identified as BT-specific issues (13.6-33.6%). Compared to AYAC survivors, AYA-BT survivors reported significantly (p < 0.05) lower functioning scores on the role, cognitive, emotional, and social HRQoL, with cognitive (56.0%) and emotional (40.0%) domains being the most affected. Adverse health outcomes were negatively associated with HRQoL, ranging from small to large clinical relevance.

Conclusion: Long-term AYA-BT survivors were identified as a highly burdened population, affected by multifaceted issues and multidimensional detriments in HRQoL years beyond their cancer diagnosis. This study highlights the necessity of long-term follow-up and a holistic, multidisciplinary approach to survivorship care to ultimately improve the quality of AYA-BT survivorship.

Background: Transcutaneous electrical stimulation after breast cancer surgery has been utilized for various purposes, but the full efficacy of this treatment approach on postoperative symptoms remains unclear.

Aim: This study aimed to answer the question: Does transcutaneous electrical nerve stimulation significantly impact postoperative patient outcomes in individuals undergoing breast cancer surgery?

Methods: A systematic review of randomized controlled trials was conducted. Because of the limited number of studies included, it was not feasible to perform a meta-analysis. English-language publications from 2013 and 2024 that investigated the effects of transcutaneous electrical stimulation in breast cancer surgery patients were included. Electronic databases such as Web of Science, PubMed, Scopus, EBSCO, ScienceDirect, Cochrane Central Register of Controlled Trials, and Wiley Online Library were searched. Two independent investigators assessed the studies using the revised JBI risk of bias tool. Data from randomized trials were extracted by two researchers using the Cochrane data collection tool.

Results: Our comprehensive literature review identified 251 studies. After rigorous assessment, 12 articles met our inclusion criteria. Title and abstract screening excluded seven studies that did not involve surgery, used treatments other than TENS, included acupuncture, or did not measure pain outcomes. Among these, five studies involving 776 patients examined the effects of transcutaneous electrical stimulation on pain management in breast cancer surgery. In all of the studies reviewed, transcutaneous electrical stimulation had a beneficial effect on postoperative pain.

Conclusion: Transcutaneous electrical stimulation has significantly alleviated pain associated with breast cancer surgery. This therapeutic modality has improved patient satisfaction with analgesia by relieving pain; reducing analgesic use; reducing postoperative nausea and vomiting; increasing blood levels of IL-2, IFN-γ, and IL-2/IL-4 ratio; and reducing skin sensitivity. Transcutaneous electrical stimulation devices may improve postoperative patient outcomes and enhance the recovery process in people undergoing breast cancer surgery. The results of this study are limited by heterogeneity and the small number of included studies. Future research should prioritize standardization of intervention procedures and investigation of the long-term effects of TENS in postoperative care.

Registration: This study was registered in the PROSPERO registration system under the number CRD42024523558.

Purpose: To determine whether body awareness and upper extremity functionality are affected in patients with or without lymphedema development after breast cancer surgery (BCS) in comparison with individuals without a history of cancer.

Methods: The study included a total of 102 individuals, including 34 who developed lymphedema after BCS (mean age: 43.88 ± 12.13 years), 34 who did not develop lymphedema after BCS (age: 44.67 ± 11.20 years), and 34 without a history of any cancer surgery (age: 45.41 ± 12.13 years). The participants' demographic data were recorded. Body awareness was evaluated using the Body Awareness Questionnaire, and upper extremity functionality was evaluated using the Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire.

Results: The demographic data of the groups were similar (p > 0.05). While there were differences between the BCS groups in terms of operative time (p < 0.001) and operated breast (p = 0.001), the number of lymph nodes dissected and the type of surgery performed were homogeneously distributed (p > 0.05). Body awareness and upper extremity functionality were significantly lower in the lymphedema group than in the BCS group without lymphedema and the control group (p = 0.021 and p < 0.001, respectively).

Conclusion: The development of upper extremity lymphedema after BCS adversely affects both body awareness and upper extremity functionality.

Purpose: This systematic review aimed to assess the updated literature for the prevention of salivary gland hypofunction and xerostomia induced by non-surgical cancer therapies.

Methods: Electronic databases of MEDLINE/PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCT) that investigated interventions to prevent salivary gland hypofunction and/or xerostomia. Literature search began from the 2010 systematic review publications from the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) up to February 2024. Two independent reviewers extracted information regarding study design, study population, cancer treatment modality, interventions, outcome measures, methods, results, risk of bias (RoB version 2), and conclusions for each article.

Results: A total of 51 publications addressing preventive interventions were included. Eight RCTs on tissue-sparing radiation modalities were included showing significant lower prevalence of xerostomia, with unclear effect on salivary gland hypofunction. Three RCTs on preventive acupuncture showed reduced prevalence of xerostomia but not of salivary gland hypofunction. Two RCTs on muscarinic agonist stimulation with bethanechol suggested a preventive effect on saliva flow rate and xerostomia in patients undergoing head and neck radiation or radioactive iodine therapy. Two studies on submandibular gland transfer showed higher salivary flow rates compared to pilocarpine and lower prevalence of xerostomia compared to no active intervention. There is insufficient evidence on the effectiveness of vitamin E, amifostine, photobiomodulation, and miscellaneous preventive interventions.

Conclusion: This systematic review continues to support the potential of tissue-sparing tecniques and intensity-modulated radiation therapy (IMRT) to preserve salivary gland function in patients with head and neck cancer, with limited evidence on other preventive strategies, including acupuncture and bethanecol. Preventive focus should be on optimized and new approaches developed to further reduce radiation dose to the parotid, the submandibular, and minor salivary glands. As these glands are major contributors to moistening of the oral cavity, limiting the radiation dose to the salivary glands through various modalities has demonstrated reduction in prevalence and severity of salivary gland hypofunction and xerostomia. There remains no evidence on preventive approaches for checkpoint inhibitors and other biologicals due to the lack of RCTs.