Supportive Care in Cancer最新文献

Purpose: This study aimed to identify independent risk factors for skeletal-related events(SREs) during denosumab treatment in patients with bone-metastatic stage IV lung adenocarcinoma by integrating multidimensional clinical parameters, thereby providing an evidence-based foundation for risk stratification and targeted management.

Methods: In this retrospective cohort study, patients with stage IV lung adenocarcinoma and radiologically confirmed bone metastases diagnosed at Xuanhan County People's Hospital between July 2021 and December 2023 were enrolled. All patients received standardized denosumab therapy (120 mg subcutaneously every 4 weeks ± 7 days). Baseline demographic, laboratory, and treatment response data were extracted from the electronic medical record system. Univariate analyses were used to screen candidate variables, followed by multivariate logistic regression to identify independent predictors. Model fit was assessed using the Hosmer-Lemeshow test.

Results: A total of 111 patients were included (median age, 65.5 years; 50.45% male). During follow-up, 27 patients (24.3%) experienced SREs. Multivariate analysis identified a prior history of bisphosphonate use as an independent protective factor against SREs (odds ratio [OR], 0.191; 95% confidence interval [CI], 0.049-0.741 P = 0.017), while Pretreatment hypocalcemia and smoking were both significantly associated with increased risk.

Conclusions: This study is the first to demonstrate in a county-level hospital cohort that a history of bisphosphonate use serves as an independent protective factor against SREs during denosumab treatment, while Pretreatment hypocalcemia and smoking history significantly increase SREs risk. These findings provide critical evidence for individualized management of stage IV lung adenocarcinoma patients with bone metastases.

Purpose: To describe the prescription and use of psychoactive medications among cancer patients in low- and middle-income countries (LMICs) and explore the factors influencing their prescription and use.

Methods: This systematic review was conducted following the PRISMA guidelines. Six electronic databases were searched. We included observational studies that investigated the prescription and use of psychoactive medications among adult cancer patients in low- and middle-income countries (LMICs) according to the 2024 World Bank's classification. Eligible studies specifically focused on the use of these medications for the management of psychological disorders in this population.

Results: Ten studies were included in the systematic review. Psychoactive medications prescribed were antidepressants, benzodiazepines, non-benzodiazepine/Z-drugs, and antipsychotics (both typical/first-generation and atypical/second-generation). Several factors, such as comorbidities, polypharmacy, geographical disparities, and health insurance coverage, influenced the prescription and use of these medications. Potentially inappropriate use of antidepressants and benzodiazepines was observed, particularly among elderly patients with multimorbidity. Underdiagnosis and undertreatment of mental health disorders were also reported, often leading to inadequate management of psychological distress in cancer patients.

Conclusion: In conclusion, this review highlights the complexity of prescribing and using psychoactive medications among cancer patients. Their use is influenced by multiple factors, including comorbidities, polypharmacy in older adults, and socioeconomic disparities that affect access to healthcare.

Purpose: This prospective study evaluated the impact of computer-aided design/manufacturing (CAD/CAM) palatal augmentation prostheses (PAPs) rehabilitation on maximum tongue pressure in tongue cancer patients underwent glossectomy.

Methods: Twelve patients (7 men, 5 women; mean age 53.2 years) with T1N0M0 or T2N0M0 tongue cancer that had undergone a type IIIa glossectomy without radiotherapy or chemotherapy were enrolled. All the participants had intact palates for good retention of PAP. Six weeks postoperatively, maxillary arches were scanned with an intraoral scanner; PAPs were digitally designed to lower the palatal vault utilizing CAD and then were fabricated from biocompatible PMMA via 3D printing and delivered. Patients wore the PAP daily and performed tongue-PAP contact exercises for at least four hours per day over six months. Maximum tongue pressure was measured using the Iowa Oral Performance Instrument before PAP delivery and after six months of rehabilitation. Statistical analysis was conducted using ANOVA with p < 0.05 considered significant.

Results: Mean maximum tongue pressure increased from 16.93 ± 13.16 kPa pre-rehabilitation to 26.93 ± 15.60 kPa post-rehabilitation (median: 11.9 to 21.9 kPa). ANOVA showed a significant improvement (F = 5.31, p = 0.0038).

Conclusion: CAD/CAM PAP rehabilitation significantly improved the maximum tongue pressure in glossectomy patients, suggesting potential benefits for oral-phase swallowing efficiency. Early postoperative delivery through a digital workflow minimized tongue-palate distance, enabling prompt exercises, and accelerating functional recovery. This approach represents an innovative rehabilitation strategy. Integration of pressure sensors into PAPs could enable real-time monitoring of tongue activity, expanding their role as dynamic training devices.

Background: Loss of muscle mass is a common concern among patients with cancer. The aim of this study was to examine whether meeting the World Health Organization physical activity guidelines in combination with a higher vs. lower than the recommended daily allowance (RDA) protein intake is associated with greater appendicular lean soft tissue index (ALSTI) in adults aged 40-59 years with cancer from the National Health and Nutrition Examination Survey.

Methods: Participants were categorized by physical activity levels (moderate ≥ 150 min/week or vigorous ≥ 75 min/week) and protein intake (> 0.8 vs. ≤ 0.8 g/kg/day) assessed via two interviewer-administered 24-h dietary recalls. ALSTI was calculated using dual-energy X-ray absorptiometry (kg/m²). Linear regression models estimated associations, adjusting for demographic, clinical, and dietary covariates.

Results: Among 169 participants (mean age 51.0 ± 5.6 years; 69% women, mean ALSTI 7.74 ± 1.66 kg/m²), those meeting vigorous or moderate physical activity guidelines with higher protein intake did not show a significant association with ALSTI in the fully adjusted models (vigorous: β = 0.08, standard error (SE) 0.12, p = 0.53; moderate: β = -0.05, SE 0.15, p = 0.76). However, a significantly positive link was found in those meeting both vigorous and moderate physical activity (β = 0.40, b SE 0.02, p < 0.01).

Conclusions: Meeting vigorous or moderate physical activity guidelines in combination with higher vs. lower protein intake was not associated with ALSTI in adults with cancer. However, meeting both was positively linked to ALSTI. Longitudinal and interventional studies using objective measures and longitudinal designs are needed to clarify the role of physical activity with adequate protein intake in preserving muscle health in this clinical population.

Purpose: This scoping review explores how machine learning (ML) and natural language processing (NLP) are used to detect, characterize, and predict neurocognitive symptoms in cancer survivors across age groups. The review had two goals: (1) to compare ML and NLP applications in understanding cancer-related cognitive impairment (CRCI) among age-stratified survivors and (2) to identify research gaps that could inform future survivorship care.

Methods: Following PRISMA-ScR guidelines, a comprehensive literature search was conducted across PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar from 2014 to 2025. Studies were included if they used ML or NLP to assess neurocognitive outcomes in posttreatment cancer survivors. Studies without defined ML/NLP methods, a survivorship focus, or peer review were excluded.

Results: The final review included 27 studies with 3584 participants. Most studies used supervised ML models such as random forest and support vector machines. Key applications included predicting patient-reported outcomes and identifying biomarkers via neuroimaging. Most studies focused on adult survivors, with limited research in older adult (n = 4), AYA (n = 1), and pediatric (n = 3) populations specifically, despite their high risk for long-term CRCI.

Conclusion: ML and NLP show promise for CRCI detection. Future research should prioritize developing age-specific ML/NLP models for underrepresented populations, particularly older adults, AYA, and pediatric survivors, while establishing standardized validation frameworks. Additionally, interdisciplinary collaboration and integration into clinical workflows will be essential for effective implementation.

Purpose: Bleeding complications significantly contribute to morbidity and mortality of patients with hematologic malignancies. Although there is some evidence for treatment and prevention of uterine bleeding in patients with cancer, there is no specific guidance used universally for hematologic malignancies. This study evaluated prescribing patterns of agents used for treatment and prevention of uterine bleeding in patients receiving intensive chemotherapy for hematologic malignancies to provide guidance for a standardized approach for treatment and prevention of uterine bleeding within a single health system.

Methods: Evaluation of prescribing patterns was performed via a dual-center, retrospective chart review of patients receiving intensive chemotherapy for hematologic malignancies and receiving preventative therapies, and/or treatment for uterine bleeding between January 1, 2018, and September 1, 2021. A guideline for the health system was drafted based on an assessment of results.

Results: A total of 91 patients were evaluated. For prevention of uterine bleeding, 68% of patients received leuprolide acetate alone. For treatment of uterine bleeding, 25% of patients required initiation of and/or increased doses of medroxyprogesterone. Fifty-seven percent of patients with uterine bleeding had adjustment of their baseline platelet transfusion goal from ≥ 10 K/cu mm to a goal of ≥ 20 K/cu mm or greater.

Conclusions: Based on data from the retrospective chart review, an institutional guideline was created, including recommendations for patients to receive a 3-month formulation of leuprolide acetate with concomitant oral medroxyprogesterone at 20 mg/day for prevention of uterine bleeding. Further prospective studies are needed to determine optimal strategies for prevention and treatment of uterine bleeding in this patient population.

Purpose: Understanding how to optimally measure symptoms and wellbeing of people with advanced cancer is crucial for supporting patient-centered care. We aimed to (1) compare repeated in-the-moment assessments (experience sampling methods/ESM) and retrospective assessments (traditional patient-reported outcome measures/PROMS) of symptoms and well-being among people with advanced breast or lung cancer; and (2) explore factors associated with discrepancies between these methods.

Methods: In an observational study among people with advanced breast or lung cancer, participants completed up to 60 in-the-moment ESM assessments over 7 days, followed by a 7-day recall (i.e., retrospective) questionnaire covering the same period. We compared in-the-moment and retrospective scores of 16 symptom and wellbeing items visually and through correlations. We examined factors associated with discrepancies using linear regression.

Results: We analyzed 1676 in-the-moment assessments from 36 participants. Visually, higher in-the-moment scores were associated with higher retrospective scores across the sample. But, participants with identical retrospective scores often had different means (especially when they had higher recalled scores) and fluctuation patterns of in-the-moment scores. Item correlations between in-the-moment and retrospective scores ranged between .24 and .70. The largest discrepancies occurred for pain (Mdiff = -13.2) and tiredness (Mdiff = -12.4). Several parameters of in-the-moment scores and participants' active treatment status were associated with discrepancies.

Conclusion: Individuals' retrospective symptom and wellbeing scores positively correlated with their in-the-moment scores over 1 week. Pain and tiredness showed the largest discrepancies. In-the-moment scores revealed considerable variability between individuals and fluctuations over time, which may be relevant to assess depending on the clinical or research objective.

Purpose: The aim of this study was to study the effect of transcranial stimulation with photobiomodulation (tPBM) in patients suffering from chemobrain.

Method: Patients referred to a consultation dedicated to the management of post-chemotherapy cognitive impairment were included. The FACT-Cog (overall score and subscale) French version was used to assess perceived cognitive impairment and impact on quality of life for each patient before and at the end of tPBM treatment. All patients included were treated for chemobrain using transcranial stimulation by PBM for a minimum of 10 weeks (10 sessions, 1 session per week). The PBM consisted of transcranial stimulation delivered using a Vielight Neuro Duo 4® PBM device (in Gamma mode) for 20 min. Differences between pre- and post-treatment proportions were assessed with the McNemar test for paired data. Differences between FACT-Cog scores (total score and subscale) were assessed by the Wilcoxon signed-rank test.

Results: Thirty-one women were included (mean age 52.1 ± 9.0 years). Mean total FACT-Cog score prior to tPBM was 63.3 ± 19.8. After the course of tPBM sessions, the mean total FACT-Cog score was 101.2 ± 20.1 (p < 0.001). Twenty-nine patients improved cognitive performance and, in 9 patients (29.0%), the FACT-Cog score had normalized. There was no significant difference between the proportion with anxiety or depression before vs after tPBM (p = 0.22 for anxiety, p = 0.62 for depression).

Conclusion: Transcranial stimulation by PBM shows therapeutic perspectives for the management of chemobrain.