Supportive Care in Cancer最新文献

Background: Remote monitoring using electronic patient-reported outcomes (ePROs) may help identify immune-related adverse events (irAEs) and direct self-management. There is no consensus regarding thresholds to alert providers about potentially severe irAEs or when to instigate evidence-based self-management. We aimed to develop consensus around alert thresholds and self-management advice for side-effects suggestive of an irAE which can be deployed as part of remote monitoring systems.

Methods: A two-round international modified Delphi survey including co-authors of major international irAE guidelines and selected immuno-oncology experts was conducted. Round 1 (R1): participants reviewed alert thresholds graded as per the Common Terminology Criteria for Adverse Events (CTCAE) and self-management statements for 36 side-effects. Participants stated whether they agreed or disagreed with the proposed thresholds and self-management statements. If ≥ 75% of participants agreed, consensus was reached. Prior to Round 2 (R2), thresholds and self-management statements that did not reach consensus in R1 were modified. In R2, participants were asked whether they agreed or disagreed with the modifications.

Results: In R1, 34 participants responded (North America: 18, 52.9%; Europe: 12, 35.3%; Asia-Pacific: 4, 11.8%; median duration of experience in current role, 13.5 years (range, 3-46 years)), with 33 complete responses received. Twenty-nine alert thresholds and 33 self-management statements reached consensus. For R2, seven alert thresholds were increased from CTCAE Grade 1 to 2 based on participant comments, and three self-management statements were amended. Six self-management statements which achieved consensus were amended and re-presented in R2. In R2, 31 participants responded (North America: 18, 58.1%; Europe: 9, 29%; Asia-Pacific: 4, 12.9%; median duration of experience in current role, 13 years (range, 3-40 years)), with 30 complete responses received. All seven alert thresholds and nine self-management statements achieved consensus.

Conclusion: This survey developed international consensus regarding alert thresholds and self-management advice for common, clinically relevant side-effects suggestive of an irAE for ePRO monitoring systems with international applicability. Self-management statements will inform written materials for patients.

Purpose: There are over 18 million cancer survivors in the U.S., with a projected increase of 24.4% over the next decade. Currently, little is known about the relationship between a cancer survivor's caregiving responsibility and their psychological distress. This study examines whether cancer survivors who assume the role of informal caregivers (surviving caregivers) experience greater psychological distress than cancer survivors without caregiving responsibilities.

Methods: Data were drawn from the National Cancer Institute's Health Information National Trends Survey (HINTS5, Cycles 1 through 4, 2017-2020). The analytical sample included 2,579 U.S. cancer survivors. Caregiving responsibility was self-reported, and psychological distress was assessed through the Patient Health Questionnaire-4 (PHQ-4). Accounting for the complex design features of HINTS and jackknife replicate weights, a multivariable multinomial logistic regression model was fit to compute adjusted odds ratios (aORs) and their associated 95% confidence intervals (CIs).

Results: Overall, 19.3% of cancer survivors had mild psychological distress, and 10.9% had moderate to severe psychological distress. Approximately 19.1% of the cancer survivors self-reported caregiving responsibilities. Compared to cancer survivors with no caregiving responsibilities, surviving caregivers had more than twofold greater odds of experiencing mild (aOR = 2.25; 95% CI: 1.17, 4.29) and moderate to severe (aOR = 2.18; 95% CI: 1.07, 4.46) psychological distress. Other factors associated with greater psychological distress among cancer survivors included female sex, lower perceived health status, and having one or more chronic diseases.

Conclusions: Our findings indicate that caregiving among cancer survivors has a substantial adverse impact on their mental and emotional well-being. Cancer surviving caregivers are a distinct subgroup that navigates both survivorship and caregiving burdens at the same time. There is a need to identify and develop tailored interventions, programs, and resources for this vulnerable group of cancer survivors.

Objective: To develop an appropriate intervention utilizing acceptance and commitment therapy (ACT) tailored specifically for cancer patients undergoing radiotherapy, and to investigate its impact on hope, psychological resilience, psychological flexibility, and psychological distress among cancer patients receiving proton and heavy ion therapy.

Methods: Eighty participants were allocated into an intervention group (n = 40) or a control group (n = 40) based on their admission time. The control and intervention groups underwent a 3-week health education program, with the intervention group additionally participating in a 3-week, 6-session acceptance and commitment therapy (ACT) group psychological intervention. Discrepancies in hope levels, psychological resilience, psychological flexibility, and psychological distress between the two groups were assessed at baseline, post-intervention, and a 3-month follow-up using linear mixed-effects analysis (LMM).

Results: LMM analyses revealed that at the end of the intervention, scores for hope and psychological resilience were higher in the intervention group compared to the control group (P = 0.025, P = 0.003), and scores for psychological flexibility were lower in the intervention group (P = 0.001). Furthermore, at the 3-month follow-up, HHI scores remained higher in the intervention group compared to the control group (P = 0.015). In contrast, scores for psychological flexibility and psychological distress were lower in the intervention group (P = 0.001, P = 0.001). These differences persisted even after adjusting for baseline values.

Conclusion: A psychological intervention program based on the ACT model of treatment helps to promote psychological recovery in cancer patients with radiotherapy. Evidence is provided for the effectiveness of positive clinical psychological interventions.

Trial registration: The study was registered in the Chinese Clinical Trial Registry (ChiCTR2300068349) on 15th February, 2023.

Introduction: In 2023, 35,000 new cases of breast cancer were diagnosed, becoming the first type of tumour diagnosed in Spain. This tumour and its treatments generate important changes in the patient's quality of life. Alterations in the range of motion, pain and both physical and psychological disability are some of the effects that breast cancer generates in patients. Physical prehabilitation could be an opportunity to prevent some of these adverse effects.

Objective: The objective of this review was to analyse the changes in objective and subjective variables in patients with breast cancer who undergo prehabilitation compared to those who perform other interventions.

Material and method: Eight databases were used for the bibliographic search of the present review. Following the selected inclusion and exclusion criteria, seven studies were analysed. The quality of these studies was assessed with the PEDro scale. The structural characteristics of the various articles were examined, as well as the objective (ROM and biomarker) and subjective study variables (pain, physical and mental recovery, quality of life and psychological aspects.

Results: A total of 1054 patients were analysed in the present review. All objective variables improved in the group that underwent physical prehabilitation. Subjective variables also improved in said group, although the improvement achieved in psychological aspects was not maintained over time.

Conclusion: Physical prehabilitation is an interesting strategy to generate changes in breast cancer patients.

Purpose: Increasing physical activity (PA) is safe and associated with improved health outcomes in patients with metastatic breast cancer (MBC). Mobile health (mHealth) PA interventions that allow for remote monitoring and tailoring to abilities may be particularly useful for MBC patients. However, limited data exist on the acceptability of these interventions for MBC patients. This study examined the acceptability of Fit2ThriveMB, a highly tailored mHealth intervention targeting increased daily steps in MBC patients.

Methods: Insufficiently active women with MBC ((N = 25) M_age = 57.2, SD = 11.9) received the Fit2ThriveMB intervention (Fit2ThrviveMB app, Fitbit, weekly coaching calls) for 12 weeks. Participants completed an online questionnaire (n = 22) and semi-structured interview (n = 23) at 12 weeks to assess intervention acceptability. Quantitative data were analyzed using descriptive statistics. Interviews were analyzed and coded using thematic content analysis and consensus review.

Results: All (n = 23) participants indicated they were satisfied with the intervention, Fit2ThriveMB app design, and Fitbit usability via questionnaire. Four themes emerged from qualitative interview data: (1) Overall satisfaction with implementation, (2) Social interaction is important, but within-app social features need improvement, (3) Fit2ThriveMB was encouraging and enhanced accountability, (4) Fit2ThriveMB helped form sustainable habits. Participants were generally satisfied with the intervention. However, areas for improvement were identified for some study features.

Conclusions: Findings indicate Fit2ThriveMB was acceptable among people with MBC. Further refinement of Fit2ThriveMB social feed features and step count goals is warranted for future testing in fully powered trials with a larger sample size.

Objective: To compare the treatment of osteoradionecrosis (ORN) using a protocol that incorporates antimicrobial photodynamic therapy with a conventional treatment protocol.

Methodology: This retrospective study analyzed 55 patients diagnosed with ORN at a reference hospital between 2002 and 2021. Patients were treated using two different clinical protocols. Clinical treatment success was defined as the epithelialization of the ORN lesion, along with the absence of pain and local infection.

Results: A total of 53 ORN lesions were included, with a median development time of 30 months. The patient cohort was predominantly male (83.02%), with a median age of 58 years. The main causes of ORN were prosthetic trauma (28.30%) and dental extractions due to infection (32.07%). Good oral hygiene and hygiene of the lesion were identified as protective factors for achieving clinical success, with a significant correlation to lesion epithelialization (p ≤ 0.0001). ORN developed more rapidly in tumors of the oral cavity, with a median time of 8 months, compared to oropharyngeal tumors, which had a median time of 39 months (p = 0.01).

Conclusion: The proposed treatment protocol, which includes antimicrobial photodynamic therapy, demonstrated greater effectiveness compared to the conventional protocol, achieving clinical success in 75% of the lesions analyzed in a shorter timeframe (p ≤ 0.0001). Additionally, maintaining proper oral and lesion hygiene is crucial for successful outcomes, and ORN develops more rapidly in patients with oral cavity tumors.

Purpose: Exercising during cancer treatment reduces fatigue, improves quality of life, and increases survival, yet 60-70% of Australians undergoing cancer treatment do not meet current physical activity (PA) recommendations. This study aimed to explore barriers and enablers to PA amongst people undergoing cancer treatment and develop a video resource targeting these barriers.

Methods: The study was guided by the capability, opportunity, motivation, behaviour (COM-B) and behaviour change wheel (BCW) frameworks. Focus groups were conducted with people undergoing cancer treatment. Thematic analysis of qualitative data generated themes representing barriers and enablers to PA which were mapped to behaviour change techniques (BCTs) and incorporated into a video.

Results: Four focus groups were conducted with 15 participants (mean age 57, range 21-75). Eighteen themes were generated and mapped to six domains of the COM-B. The main barriers to exercise were physical (cancer-related fatigue), psychological (fear of overexertion), and inconsistent messaging. Enabling factors included accessible information about PA and incorporating PA into the care plan. Six BCTs were identified: information about health consequences; information about emotional consequences; demonstration of the behaviour; social comparison; information about others' approval; and credible source. These were incorporated into the production of an 11-minute video.

Conclusion: This research facilitated development of a novel, theory-informed video aimed at improving uptake of PA amongst people undergoing cancer treatment. Evaluating the acceptability and effectiveness of the video is needed to support implementation of this intervention into standard care.

Implications for cancer survivors: Incorporating BCTs into a video promoting PA may enhance PA uptake and health outcomes for people undergoing cancer treatment.

Purpose: The growing number of athletes diagnosed with cancer requires a better understanding of their background, experiences, and specific goals to provide personalized care. Therefore, the purpose of this study was to explore the lived experiences of collegiate athletes in the United States diagnosed with cancer, reflecting on various barriers and challenges because of their cancer diagnosis, as they relate to their athletic participation and educational experiences.

Methods: This qualitative study used a phenomenological approach to study the nature and states of lived experiences in collegiate athlete cancer survivors diagnosed with cancer between the ages of 10 and 39 years old. Eighteen collegiate athlete cancer survivors (14 females and 4 males) participated in semi-structured interviews.

Results: The mean age at the time of the interviews was 22.3 ± 1.6 years. Seventeen participants (94%) identified as white/Caucasian. Five themes related to challenges emerged from the interviews: (1) academic challenges, (2) athletic challenges, (3) gaps in support, (4) side effects, and (5) mental health challenges. The mental health needs of collegiate athlete cancer survivors have been notably reported.

Conclusion: As research on young cancer survivors increases, there is an opportunity for a deeper understanding of their lived experiences. The themes that emerged from this study are important and meaningful to increase the educational and athletic support as well as the mental and physical health of these survivors.

Objective: The effect of Meaning-Centered Interventions (MCI) in advanced cancer patients requires further comprehensive research.

Methods: Two researchers independently searched the PubMed, EMBASE, SCOPUS, Cochrane, and PsycINFO databases to investigate the impact of MCI on anxiety and depressive symptoms, sense of meaning, and quality of life (QoL) in patients with advanced cancer from inception to April 2024. Statistical analyses were conducted using standardized mean difference (SMD) as the effect size with Stata 17.0 software for analysis, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was employed to assess the certainty of evidence.

Results: Data from 12 eligible studies, involving a total of 1,459 participants, were included in the review. The analysis found that 3 studies with 321 participants reported an improvement in the quality of life (QoL) of patients with advanced cancer within one month after the intervention, compared to the control group (SMD, 0.27; 95% CI, 0.03 to 0.52; I² = 0%; p = 0.03). However, this effect did not persist during the 2-6 months following the intervention. In addition, 4 studies with 434 participants indicated that MCI was associated with an enhanced sense of meaning (SMD, 0.22; 95% CI, 0.09 to 0.36; I² = 0%; p = 0.002). Furthermore, 8 studies with 1,192 participants and 7 studies with 1,156 participants found that MCI was associated with a reduction in depressive symptoms (SMD, -0.15; 95% CI, -0.24 to -0.05; I² = 44.8%; p = 0.002) and anxiety symptoms (SMD, -0.16; 95% CI, -0.26 to -0.07; I² = 46.3%; p = 0.001), respectively.

Conclusions: Moderate-quality evidence indicates that MCI enhances the sense of meaning among patients with advanced cancer and reduces depressive and anxiety symptoms, but it does not improve their QoL.