Supportive Care in Cancer最新文献

Purpose: Provide evidence supporting the integration of music therapy in cancer patients receiving infusion therapy.

Methods: This prospective cohort observational study examined 55 adult cancer patients while receiving infusion therapy at a tertiary care center. Forty-nine patients completed three consecutive music therapy sessions, allowing paired data analysis. Participants completed the Edmonton Symptom Assessment Scale (ESAS) before and after each session, and the State-Trait Anxiety Inventory-6 (STAI-6) survey at the beginning and end of the study.

Results: Music therapy was associated with highly significant improvements in wellbeing and reductions in levels of anxiety, depression, tiredness, and pain (P < 0.0001). Of the 49 subjects who completed the three sessions, 13, 10, and 16 reported being entirely calm, relaxed, and content at the study's entry, increasing to 36, 34, and 30, respectively, at the conclusion (P < 0.008). Subjects at study entry reporting no tension increased from 24 to 40 at study exit (P = 0.0013), for not worrying from 14 to 32 (P = 0.0005), and for not being upset from 39 to 43 (P = 0.254). We found no loss of efficacy of music therapy benefits throughout the three visits (P < 0.001) and a modest cumulative carryover anxiolytic effect from sessions one to three (P = 0.003). Both passive and active engagement showed comparable significant efficacy. Preference for passive music therapy was associated with higher pre-session anxiety and tiredness scores (P < 0.001).

Conclusion: Music therapy benefits cancer patients undergoing infusion therapy. Larger trials are needed to assess long-term outcomes and elucidate the underlying mechanisms.

Purpose: Pain interfering with daily life (PIDL) affects the quality of life of patients with cancer beyond pain intensity. This study was aimed at identifying clinical factors associated with PIDL, defined as pain interfering with mobility/posture, sleep, eating, or excretion.

Methods: This retrospective observational study included 1798 hospitalized patients with malignancy who underwent at least one pain assessment between 2016 and 2022, yielding 5394 assessments. Associations between PIDL and clinical variables-including demographics, primary malignancy site, number of assessments, survival duration, pain severity, anxiety/worry, emotional distress during the previous week, pain medication, analgesic efficacy, and side effects-were examined using univariable and multivariable analyses.

Results: The mean age was 69.5 ± 11.2 years, and 59.7% were male. The median number of assessments per patient was two (IQR 1-4). PIDL was independently more frequent in younger patients and in men and more common in those with malignancies of the female genital organs or hematologic system and in those with fewer assessments. Higher pain severity (NRS ≥ 4), anxiety/worry, and emotional distress (NRS ≥ 4) were associated with increased odds of PIDL. Opioid use, analgesic inefficacy, and medication-related side effects were also associated with a higher likelihood of PIDL. Among these variables, anxiety/worry (OR 2.36, 95% CI 2.01-2.76) and emotional distress (OR 2.19, 95% CI 1.87-2.56) showed stronger associations with PIDL than pain severity (OR 1.65, 95% CI 1.42-1.92).

Conclusions: Psychological distress was more strongly associated with PIDL than pain severity, warranting further investigation into the directionality of this relationship.

Purpose: Digital tools facilitate the timely collection of patient-reported outcome and experience measures (ePROMs/PREMs), but there is no consistent reporting on the technical and content adaptations made essential to implementing these digital tools in a specific context. Adaptations made to ePROMs/ePREMs can improve data quality, clinical management, and patient outcomes. We explored how studies report on adaptations and the reasons and types of these during an implementation process of ePROMs/ePREMs systems in routine cancer care.

Methods: We conducted a systematic scoping review. We searched PubMed, Embase, PsychINFO, and CINAHL (inception-May 5, 2023), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Guided by the Population, Concept, and Context (PCC) framework, data were extracted and summarised in tables in four dimensions: context, content, evaluation, and training.

Results: The systematic search found n = 5597 publications, and n = 20 were included (85% published since 2019). No studies reported on ePREMs. Various data collection methods and stakeholders were utilised to make adaptations, guided by one or more implementation frameworks (80% of studies). Common types of adaptations included changing context (e.g. complex onboarding), content (e.g. readability) (all studies), evaluation (e.g. alerts), and training (e.g. patients and clinicians). The use of an implementation framework did not affect the types of adaptations made.

Conclusions: This review summarises the types of adaptations made to oncology ePROMs during implementation. To date, there has been no agreed system to capture adaptations of ePROMs in oncology, nor a system or framework to assess ePROMs efficacy.

Purpose: Limited English proficiency (LEP) is associated with poor cancer outcomes, and written information about systemic anticancer treatment (SACT) is often provided in English only. Unsupervised machine translation of medical information is common, but its effectiveness and accuracy are unclear. This study aimed to (a) compare professional and machine translation of written SACT information and (b) investigate whether providing a bilingual SACT consent form altered comprehension of key information during an interpreted SACT consent consultation.

Methods: This randomised study included healthy, Bengali- or Sylheti-speaking adults with LEP across London, UK. Participants were randomised twice. First, they were allocated to either a machine translation or professional (human) translation of an English language SACT information booklet. Second, 1-2 weeks later, participants underwent a simulated SACT consent consultation with a doctor and interpreter, and were allocated to either a conventional English-only SACT consent form or a bilingual English-Bengali consent form.

Results: After reading the translated booklet, 19/121 participants (15.7%) met the primary outcome of understanding treatment intent, with no difference by translation type (multivariate OR = 0.99, p = 0.99). The machine-translated booklet contained 11 meaning-changing errors, compared to 1 in the professional translation. Of 91 participants completing the consent consultation, randomisation to the bilingual translated SACT form was associated with higher odds of understanding treatment intent (multivariate OR = 3.73, p = 0.01).

Conclusion: In this study, a bilingual English-Bengali consent form improved comprehension amongst LEP participants and may hold value in other language-discordant settings. Unsupervised machine translation of a patient information booklet introduced more errors than professional translation, but most individuals receiving either translation type did not comprehend crucial information; other information formats should be explored.

Trial registration: University College London Research Ethics Committee approved this study as a low-risk application on 28 October 2024 at 15:15, reference number: AH/2024/52-6625/003. The statistical analysis plan of the study was registered in the Open Science Framework,  https://osf.io/axg5d .

Purpose: This study aims to assess for indications of stigma and attitudes toward cannabis among cancer survivors (CS) who use or consider the use of cannabis.

Methods: This study employed a convergent, parallel mixed methods design utilizing focus group and questionnaire data to assess the presence of stigma among a sample of CS (n = 23) who use (n = 10) and do not use (n = 13) cannabis to manage symptoms. CS were recruited from a multi-site observational study in the Northeast U.S. region that assesses cannabis use among oncology patients.

Results: A total of 23 CS participated in this study. In general, this sample appeared to have positive attitudes towards cannabis, as indicated by quantitative results, and most CS felt accepting or neutral about other CS using cannabis, irrespective of whether they used or not. Most CS did not indicate experiences of stigma for cannabis use, did not feel judged by their medical providers, and indicated a feeling of empowerment to do whatever was needed to feel better. However, several CS reported intentional nondisclosure to their providers. Many CS discussed the presence of opioid-related stigma, both perceived from society and internalized, which appeared to play an important role in their symptom-management decision-making.

Conclusions: Findings from this study suggest that while cannabis stigma may not be commonplace for CS, some do experience it. Further, opioid stigma appears to be perceived and intertwined in the decision-making processes for CS in this sample.

Background: Total laryngectomy, the surgical removal of the larynx, is a life-saving procedure for individuals with advanced laryngeal or hypopharyngeal cancer. While the physical consequences of this surgery are well documented, the psychological, emotional, and social adjustment to life post-surgery is less well understood. The aim of this study was to explore the lived experience of adjustment within the first 6 months following a laryngectomy.

Methods: A longitudinal multimethods study was undertaken at St. Vincent's Hospital, Melbourne, Australia, involving patients scheduled for total laryngectomy between August 2018 and April 2020. Data were collected in one-to-one, in-depth, semi-structured interviews at 2 weeks post-hospital discharge and at 3 and 6 months post-surgery. Psychological distress was assessed preoperatively and prior to semi-structured interviews, using the Distress Thermometer. Interview data were analysed using inductive thematic analysis.

Results: Four participants completed all three interviews, and a further two participants completed one interview each. Three phases of adjustment were identified: (1) Not normal life, (2) Never going to be the same again, and (3) Just get on with it. Emotional distress was moderate 2 weeks following hospital discharge but reduced significantly by 6 months post-surgery.

Conclusion: This study sheds new light on the lived experience of adjustment following total laryngectomy, highlighting a clear pattern of psychological, emotional, and social transition in the acute healing period. The findings underscore the importance of timely, multidisciplinary support that aligns with patients' evolving needs. Understanding the phases of adjustment provides clinicians with a framework to proactively guide and personalise care during this vulnerable period.

Introduction: The impact of socioeconomic factors on cancer outcomes is well documented; however, their role in access to and receipt of care within universal health systems for advanced lung cancer is less established. We investigated inequalities in specialized cancer consultation and treatment for stage IV non-small cell lung cancer (NSCLC).

Methods: We used a population-based cohort with administrative health data to study people aged 18+ diagnosed with stage IV NSCLC between 2010 and 2022 in Ontario. We measured consultations with medical oncologists, radiation oncologists, and thoracic surgeons as well as systemic therapy, radiation, surgery, and palliative care in the year following diagnosis, comparing consultation and treatment rates across quintiles of census measures of community material resources. Multivariable cause-specific Cox proportional hazards regression, accounting for death, was used.

Results: We included 32,902 stage IV NSCLC patients. People living in the least materially resourced neighborhoods were less likely to have a cancer-directed consultation with a medical oncologist, radiation oncologist, or thoracic surgeon (hazard ratio [HR] = 0.91; 95% confidence interval [CI] 0.87-0.94) and less likely to receive any cancer-directed treatment (HR = 0.90; 95% CI 0.86-0.94) compared to those with the most material resources. We did not detect a difference in the rate of palliative care (HR = 1.04; 95% CI 1.00-1.08). Results were consistent in urban but not rural populations.

Conclusions: We identified inequities in access to cancer-directed consultation and treatment among adults with stage IV NSCLC by material resources, limited to urban and suburban populations. Future research should explore root causes and identify interventions to address these inequities.

Aim: To synthesize qualitative evidence on the experiences and perceptions of social isolation in colorectal cancer patients with ostomy.

Methods: A systematic qualitative meta-synthesis was conducted. Nine electronic databases (PubMed, Web of Science, EBSCO, Cochrane, Scopus, CNKI, Wanfang, VIP, and CBM) were searched from inception to November 2024. Qualitative studies exploring experiences of social isolation in ostomy patients were included. Methodological quality was assessed using the CASP checklist. Data were analyzed via a meta-aggregative approach.

Results: Eleven studies were included. Four synthesized findings were identified: (1) antecedents and multidimensional perceptions of social isolation, (2) social relationship rupture and structural transformation, (3) psychological distress and self-identity crisis, and (4) multidimensional support needs and positive adaptation. Social isolation arose from physiological limitations, self-care challenges, and stigma, leading to behavioral withdrawal, family tension, and emotional distress. Support and self-adjustment were found to facilitate coping.

Conclusions: Social isolation in ostomy patients is a multifaceted phenomenon shaped by individual, relational, and environmental factors. A comprehensive support framework involving healthcare providers, families, and communities is essential to mitigate social isolation and promote social reintegration. Future interventions should adopt dyadic or systemic approaches to address communal challenges.

Implications for cancer survivors: Ostomy patients may experience significant social isolation influenced by complex factors. Holistic, needs-based support from multiple stakeholders is crucial to facilitate adaptation and improve quality of life.

Quality of life (QoL) and mental well-being are critical outcomes for cancer patients undergoing radiotherapy (RT). This systematic review examined the impact of patient education and care interventions on QoL and psychological well-being among adults receiving RT. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; 33 studies were identified from 723 screened articles. Most interventions, such as structured education, counseling, and multidisciplinary support, demonstrated significant improvements in at least one QoL domain, reduced anxiety or depression, and increased patient satisfaction compared with standard care. Key factors influencing effectiveness included age, education level, social support, and treatment duration. Overall, evidence supports the integration of individualized patient education and supportive care into radiotherapy practice. Routine use of patient-reported outcome measures (PROMs), such as the EORTC QLQ-C30, can facilitate early identification of declining well-being and guide tailored interventions to enhance patient outcomes. The objective of this study is to systematically review evidence on the effect of patient education and care interventions on quality of life, mental well-being, and patient satisfaction among cancer patients receiving radiotherapy.