Supportive Care in Cancer最新文献

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.

Background: Despite well-documented benefits of physical activity (PA), adherence remains poor among head and neck cancer (HNC) patients. Emotional factors significantly influence PA behaviors in this population, yet their underlying interaction pathways are poorly understood. This study aimed to identify the influence of emotional factors on PA behavior in HNC patients using an extended theory of planned behavior (TPB).

Methods: Adhering to the STROBE checklist, we conducted a cross-sectional survey of 304 HNC patients. Path analysis and mediation analysis were employed to examine factors associated with PA behavior and their interrelationships.

Results: A high percentage of HNC patients (53.90%) were physically inactive. The path model demonstrated good fit: χ²/df = 1.644, NFI = 0.968, TLI = 0.969, CFI = 0.987, IFI = 0.987, RMSEA = 0.047. The model explained 44.50% of the variance in PA behaviors (R² = 0.445). Path analysis revealed that perceived behavioral control exerted the strongest influence on PA behavior, followed by intention, planning, perceived benefits and barriers, subjective norms, and attitudes.

Conclusion: Enhancing PA behaviors in HNC patients is imperative. The extended TPB model was useful for understanding PA intentions and behaviors among HNC patients in China. Interventions that incorporate the emotional factors identified in our study may provide an effective framework for supporting PA in this population.

Purpose: Given the impact of place of death (PoD) on end-of-life quality and policy planning, this study examined the distribution and determinants of PoD among older adults receiving palliative care in Taiwan, with a focus on service models and referral-to-death intervals.

Methods: This population-based study analyzed linked data from the Health and Welfare Data Science Center in Taiwan for 177,403 decedents aged ≥ 65 years who received palliative care and died between 2010 and 2020. Multivariable logistic regression was employed to examine associations between PoD and individual characteristics, hospital attributes, palliative care models, and referral-to-death intervals.

Results: Hospital was the most common PoD (61.5%), followed by home (35.8%). Home death was more likely among females (OR 1.08, 95% CI 1.05-1.10), those aged 75-79 years (OR 1.29, 95% CI 1.25-1.34), cancer decedents (OR 1.40, 95% CI 1.36-1.45), and those receiving palliative care in private hospitals (OR 1.31, 95% CI 1.28-1.34). Use of home palliative care (OR 3.93, 95% CI 3.71-4.16) or home care combined with shared-care services during admission (OR 3.89, 95% CI 3.72-4.06) was strongly associated with home death. Referrals longer than 180 days were associated with a lower likelihood of hospital death (OR 0.84, 95% CI 0.79-0.90).

Conclusion: Among older palliative care recipients, early referral and access to home-based and shared-care services play a significant role in promoting home death. Optimizing end-of-life care may require integrating these elements into palliative care policy and service planning.