Supportive Care in Cancer最新文献

Purpose: Patients with advanced prostate cancer (aPC) often face significant treatment-related financial hardship. Given the critical role non-physician clinicians play in helping patients access prescribed treatments, we sought to explore their perspectives on factors contributing to treatment-related financial toxicity.

Methods: We conducted semi-structured interviews with non-physician clinicians who care for patients with aPC. We used purposive sampling to capture diverse perspectives across practice types (academic, community), and settings (rural, urban, suburban). Participants described their perceptions and experiences regarding delivering aPC treatment, managing prior authorizations, handling insurance-related concerns, and aligning treatment preferences. We conducted content analysis with theme generation, with 30% of transcripts double coded to ensure rigor and trustworthiness in theme identification.

Results: We interviewed 20 non-physician clinicians, including social workers, financial navigators, pharmacists, and nurses. Four themes emerged from the coded interviews. First, a lack of trust and/or empowerment in patient-clinician relationships left patients lacking support to navigate financial challenges. Second, inefficient resource allocation-including financial, educational, and institutional support-intensified the financial burden on patients. Third, communication gaps between clinicians, patients, and payers hindered treatment coordination and access to assistance. Last, variability across clinical practices, patient demographics and needs, and insurance policies contributed to an unpredictable treatment environment, furthering financial distress and potential inequities in care.

Conclusion: Lack of trust and empowerment, resource gaps, poor communication, and systemic variability all contribute to financial toxicity for patients with aPC. Targeted strategies to improve trust, resource allocation, and communication can better support patients with aPC in managing treatment-related financial burden.

Purpose: NEPA, a fixed-antiemetic combination of netupitant and palonosetron, is available via two administration routes (oral and intravenous). A new oral suspension was developed to offer a more convenient option for patients. This study evaluated the bioequivalence between the oral capsule and the oral suspension.

Methods: Open-label, randomized, single-center phase I trial conducted according to a two-treatment, four-period, two-sequence replicative design. Two treatments were investigated for bioequivalence: a 10-mL oral suspension (Test [T]) and the hard capsule (Reference [R]), both containing 300 mg netupitant/0.5 mg palonosetron. Healthy individuals were randomized (1:1) to receive two doses of both Test and Reference formulations, in either T-R-T-R or R-T-R-T sequence. The primary objective was to demonstrate AUC_0-t bioequivalence of netupitant and palonosetron after a single dose of Test and Reference formulations.

Results: In total, 72 participants were included. The geometric mean plasma concentration-time profiles of netupitant and palonosetron were similar for the Test and Reference formulations. The AUC_0-t geometric means of both analytes were similar for the Test and Reference formulations. The 90% confidence interval of the Test/Reference ratios for AUC_0-t of netupitant and palonosetron were within the acceptance range for bioequivalence of 80-125%. The AUC_0-t variability was moderate for netupitant and low for palonosetron. Both formulations were well tolerated.

Conclusion: The NEPA oral suspension is pharmacokinetically bioequivalent to the capsule formulation in healthy individuals, with no new safety concerns. These findings support NEPA oral suspension as a potentially beneficial option for patients who prefer an oral suspension over a hard capsule and for those with swallowing difficulties. EUCT Number: 2023-504355-28-00 (25/08/2023).

Purpose: The interpretation of patient-reported outcomes (PROs) in oncology research lacks a shared understanding of clinical relevance among interest groups. Terms like minimal important differences and clinically meaningful change aim to aid interpretation but remain inconsistently conceptualized. This study explores interest-holders' perspectives to support setting-specific definitions of clinical relevance in PRO research.

Methods: An online survey was distributed via international networks to multi-professional interest-holders. Responses to an open-ended question regarding participants' understanding of clinical relevance were analyzed using qualitative content analysis to identify recurring themes and patterns within the quotes.

Results: The survey included 92 participants: clinical practitioners (38.5%), academic researchers (47.3%), industry researchers (8.8%), and patients/patient representatives (rep.) (5.5%). Five clusters emerged reflecting facets of clinical relevance: (a) patient value (e.g., impact on well-being), (b) practical implications (e.g., treatment changes), (c) external criteria (e.g., physiological changes), (d) statistical approaches (e.g., 10% difference), and (e) proxy value (e.g., physician's perspective). Practitioners primarily focused on patient value (55.6%), while academic researchers showed a similar distribution but with greater variance across clusters. In contrast, industry researchers more frequently emphasized external criteria (20.0%) and proxy value (20.0%) compared to other groups. Patient value and statistical approaches were not mentioned by the same participants, nor were external criteria and practical implications.

Conclusion: Conceptual understanding of clinical relevance varies by professional background, highlighting its multifaceted nature. These findings, identifying distinct conceptual clusters across interest groups, provide a foundation for developing harmonized, context-specific definitions of clinical relevance in PRO research.

Objective: Although sexual health is recognized as a fundamental component of well-being, it may be a neglected aspect of care within the context of patients after radical cystectomy, which examines the perception of sexual distress as a result of undergoing radical cystectomy, which helps inform healthcare service providers.

Methods: This study employed a methodological integration of grounded theory (GT) and phenomenology. We selected two tertiary hospitals that assisted in the recruitment process. An interview advisory committee was established to guide the research design and using a data form for documenting persona characteristics as well as a semi-structured interview. With maximum differentiated sampling based on the grading of the Index of Sexual Satisfaction (ISS), which allowed for a comprehensive understanding of sexual distress, 15 patients were included, 10 were in the high-scoring subgroup, and 5 were in the low-scoring subgroup. The Consolidated Criteria for Reporting Qualitative Research (COREQ) were used to ensure a consistent process throughout the study.

Results: A total of four themes and 14 sub-themes were distilled: significant symptoms of sexual distress (sexual dysfunction and interruption of sexual intercourse), negative emotional dilemmas (reduced self-esteem and self-confidence, anxiety and depression, and fear and avoidance of sexual life), multiple changes in marital relationships (decreased intimacy, communication barriers, role change of husbands and wives, and partner's understanding and support), positive coping styles, and the need for sexual rehabilitation (active seeking for medical help, trying alternatives, psychological adjustment, facing problems with the partner and redefining intimate relationships, and looking forward to professional guidance for sexual distress).

Conclusion: The sexual life of patients after radical cystectomy faces multiple problems, which suggests that healthcare professionals should pay attention to the sexual health needs of patients, including partners in the rehabilitation process, and work together with sex therapists and psychological counselors to formulate individualized sexual rehabilitation programs to improve the quality of their sexual lives. Therefore, screening for sexual problems and providing counseling services for patients after radical cystectomy care planning are recommended.

Background: Radiotherapy (RT) is a cornerstone in cancer management, but late radiation tissue injury (LRTI) remains a relevant clinical issue, affecting approximately 5% of patients and significantly impacting quality of life. Hyperbaric oxygen therapy (HBOT), by enhancing tissue oxygenation and promoting neovascularization, has been proposed both as a treatment for RT-induced toxicities and as a potential radiosensitizer. However, available evidence is heterogeneous and often limited by small cohorts.

Methods: A systematic review of PubMed, Embase, and Cochrane databases was conducted in September 2025. Eligible studies, published between 2000 and 2025, evaluated HBOT in patients receiving RT. Exclusion criteria included reviews, case reports with < 4 patients, and non-English publications. Data extraction included study design, patient and treatment characteristics, HBOT parameters, outcomes, and toxicity.

Results: Forty-two studies (2785 patients) were included, of which 28 were retrospective and 5 randomized controlled trials. Median age was 59 years; most patients were female. HBOT was primarily applied for toxicity management, with a median of 34.5 sessions at 2.45 atm. The pelvic district accounted for the largest patient cohort, with HBOT yielding high response rates (67-100%) for hemorrhagic cystitis. In breast and head-neck cancer, HBOT improved quality of life and toxicity profiles in retrospective reports, but randomized trials failed to demonstrate consistent benefit. Limited data suggested potential benefit in preventing cerebral radionecrosis and a speculative radiosensitizing role in gliomas. HBOT was overall safe, with mild adverse events such as barotrauma and transient myopia.

Conclusions: HBOT shows promising activity in mitigating late RT toxicities, particularly in pelvic toxicities, while evidence in other anatomical sites remains conflicting. Its hypothesized radiosensitizing role is largely speculative. Given the heterogeneity and low evidence level of existing studies, well-designed prospective trials are needed to clarify patient selection, optimal HBOT parameters, and its potential integration with RT.

Purpose: Patients with cancer often experience declines in quality of life (QoL), functional capacity, psychosocial health, and body composition, alongside cancer-related fatigue. Aerobic and resistance exercise interventions have shown potential in mitigating these effects. This review evaluated the impact of such interventions on QoL, fatigue, body composition, functional capacity, and psychosocial health across both the commonly studied cancers such as breast, prostate, lung, and colorectal, as well as the less-studied types, including lymphoma, ovarian, multiple myeloma and head and neck cancers.

Methods: Systematic searches were conducted across PubMed, Cochrane, ScienceDirect, Scopus, and EBSCOhost, identified 25 randomised controlled trials (RCTs) from an initial 18,116 studies. The 25 RCTs were assessed using the TESTEX scale and PRISMA guidelines.

Results: Aerobic and/or resistance training showed to provide beneficial improvements in a number of measures during and after cancer treatment across  cancer types. Qulity of life improved in 12 (of 13) trials that reported QoL. , There was a reported reduction in cancer-related fatigue in 9 (out of 10 ) studies that reported this measure. Significant enhancements in lean body mass and fat mass, were found in 6 of 8 trials that reported body composition. Functional capacity improved in 7 of 12 trials that reported this variable. Psychosocial outcomes showed mixed results, with significant improvements reported in 2 out of 7 trials that measured depression and anxiety. Moderate-intensity exercise, performed three times per week, demonstrated the most consistent benefits. Specific improvements from exercise were found in patients suffering from breast, prostate, lymphoma, multiple myeloma, colorectal, lung, and head and neck cancer. There was a notable lack of trials meeting the inclusion/exclusion criteria that specifically focused on ovarian cancer patients.

Conclusion: Structured aerobic and resistance exercise showed to significantly improve QoL, fatigue, body composition, and functional capacity in cancer patients. Integrating tailored exercise into cancer rehabilitation can enhance recovery. Future trials should aim to standardise outcome measures and improve adherence across diverse cancer populations.

Objectives: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy, affecting more than half of cancer patients. This scoping review aimed to summarize the incidence and factors associated with falls in patients with CIPN and to visually map the distribution of existing evidence, thereby providing a theoretical foundation for the development of preventive measures and intervention strategies.

Methods: A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Chinese Biomedical Literature Database (CBM), Knowledge Infrastructure (CNKI), Chongqing VIP Information (CQVIP), and Wan Fang Data. The search included articles published from database inception to August 16, 2024. To enhance the synthesis of evidence, a bubble plot-based evidence map was constructed.

Results: A total of 11,649 records were identified, of which 19 studies were included. Most were quantitative non-randomized studies (n = 17): eight achieved a quality rating of 100%, eight scored 80%, and one scored 60%. Two studies were quantitative descriptive (one scored 80% and one scored 40%). Sixteen studies reported the incidence of fallers among CIPN patients, ranging from 5.6% to 57.4%. Seventeen studies examined fall-related factors in CIPN, which were categorized into 11 groups. Within the evidence map, high-quality and high-OR evidence was observed for CIPN symptoms/severity, advanced or unknown cancer stage, and chronic liver disease. CIPN-related factors were the most frequently reported, followed by demographic factors, suggesting that these domains, particularly those with both high quality and high OR, should be prioritized as targets for future intervention strategies. The adjusted odds ratios (ORs) ranged from 0.997 to 2.67.

Conclusion: Falls are common among patients with CIPN, with high-quality evidence primarily concentrated in the domains of CIPN-related burden, demographic and clinical characteristics of participants, and comorbidities. Future research should (1) conduct multicenter prospective longitudinal cohort studies with time-updated measurements of CIPN and treatment exposures, using standardized definitions of falls and observation windows; (2) strengthen outcome measurement by following COSMIN/Delphi recommendations, including the development of a gold-standard CIPN scale, specification of assessor qualifications, standardized training, and reporting of inter-rater reliability; and (3) re-examine currently unadjusted signals within rigorously controlled multivariable models.

Introduction: Physical prehabilitation is a key element of multimodal preoperative care, but there is a lack of standardized, home-based exercise protocols, particularly in gynecological oncology. This gap, together with organizational barriers to supervised programs, may limit the feasibility and implementation of prehabilitation in many centers. The aim of this study was to present an original set of home-based physical exercises developed for patients with gynecological cancer undergoing cytoreductive surgery and to compare it with existing recommendations from the literature.

Methods: A structured literature search was conducted in PubMed, Medline, EMBASE, and PsycINFO using predefined terms related to prehabilitation, cancer, and physical exercise. Eligible studies were reviewed by two independent investigators. Based on this review and clinical experience, we developed a set of aerobic and resistance exercises tailored to the needs of gynecological oncology patients, designed to be safe, feasible, and performed at home without specialized equipment.

Results: Eight studies describing prehabilitation exercise interventions were identified, of which only one addressed gynecological oncology specifically. Most existing programs relied on supervised or hybrid interventions and rarely provided detailed descriptions of exercises. In contrast, our proposed set includes structured aerobic activity and five resistance exercises focusing on abdominal, core, and paraspinal muscles, illustrated with infographics and supplemented with educational materials to ensure patient adherence at home.

Conclusion: Evidence regarding home-based prehabilitation exercise programs in gynecological oncology remains scarce. Our proposed exercise set is, to our knowledge, the first detailed, practical, and reproducible home-based protocol for this patient population and may facilitate broader implementation of prehabilitation across oncological centers.

Background: Colorectal cancer (CC) is the third most common cancer globally. Despite advances in treatment, patients often experience long-term psychological, physical, and social challenges during and after treatment. Specialised cancer care, including the role of cancer nurses, is critical in supporting patients throughout their treatment journey.

Aims: This study aimed to explore the experiences of CC patients in Australia in navigating the healthcare system, coping with their diagnosis, and receiving support from specialised cancer nurses and support networks.

Method: An exploratory qualitative design was used. Semi-structured interviews were conducted with nine CC patients (seven females, two males), aged 34-72 years. Interviews were analysed using reflexive thematic analysis.

Results: Four overarching themes emerged. First, challenges navigating the healthcare system, identified participants' frustrations with delays, miscommunication, and fragmented care. Second, emotional impact of a CC diagnosis and treatment, captured the shock, fear, and isolation experienced, particularly following sudden diagnoses. Third, value of specialised cancer nurses and support networks, highlighted the emotional reassurance and practical guidance provided by community-based nurses and support services. Fourth, physical and mental coping strategies included participants' use of mindfulness, physical activity, and dietary changes to regain a sense of control.

Conclusion: Specialised cancer nurses played a crucial role in enhancing patient care by addressing both medical and emotional needs. Improving communication, ensuring continuity of care, and providing personalised support are key recommendations for improving the healthcare experience of CC patients in Australia.

Purpose: Randomized controlled trials (RCTs) of acupuncture in oncology offer strong internal validity but limited generalizability. Real-world evidence is needed to assess feasibility, effectiveness, and adherence in routine practice.

Methods: We conducted a retrospective analysis of real-world data from cancer patients receiving group Traditional Chinese acupuncture (ACP) in an outpatient oncology setting (2015-2022). Symptoms (anxiety, fatigue, hot flashes, neuropathy, pain, sleep) were rated on a 0-10 numeric scale before each session. Clinical improvement was defined as a ≥ 1-point decrease in severity.

Results: A total of 2,239 patients underwent ACP (83% female; mean age 57 ± 12; 57% breast cancer). Common symptoms included pain (61%), sleep issues (50%), fatigue (45%), hot flashes (42%), anxiety (40%), and neuropathy (40%); 68% had ≥ 2 symptoms, median baseline severity 5-6. Females and younger patients had higher symptom burden. By session two, all symptoms improved statistically, with anxiety and hot flashes showing clinical improvement; by session three, all improvements were statistically and clinically significant. Benefits were similar across age and gender. Adherent patients (≥ 2 sessions) were older with higher symptom burden.

Conclusion: Acupuncture appears effective for common cancer symptoms in real-world settings, with evidence suggesting that benefits are sustained between sessions and requiring multiple treatments for optimal effect. Both sexes and age groups experienced similar improvements, though utilization was lower among males and older adults. Expanding insurance coverage could improve access and reduce disparities. Adherence was high, and integration into outpatient oncology care proved feasible and sustainable. These findings warrant examination in RCTs.