Supportive Care in Cancer最新文献

Objective: Oncology patients often experience pain, sleep problems, and discomfort during palliative care. Hand massage is a nonpharmacological method that can relax the patient and help alleviate these problems. This study aimed to examine the effect of hand massage on pain, comfort, and sleep quality in palliative oncology patients.

Materials and methods: A randomized, controlled experimental study was conducted with a sample of 76 oncology patients treated in the palliative care clinic of a public hospital. The patients were randomly allocated to the experimental and control groups. The experimental group (n = 38) received a total of 16 sessions of hand massage, performed twice a day, 2 days per week for 4 weeks. The control group (n = 38) received no intervention. The patients' pain, sleep quality, and comfort were assessed before and at 1, 2, and 4 weeks after the start of the intervention using the Visual Analog Scale for pain, the Pittsburg Sleep Quality Index, the General Comfort Questionnaire, and a smart wristband.

Results: Demographic characteristics and pre-intervention pain, sleep quality, and comfort scores showed no statistical differences between the groups (p > 0.05). The experimental group reported significantly lower pain intensity and greater comfort than the control group starting from week 2 (p < 0.05). In addition, subjective sleep quality assessed using the PSQI and objective sleep parameters (sleep duration and sleep score) measured by a smart wristband, including objective sleep duration and objective sleep score, were significantly better in the experimental group than in the control group from the first week (p < 0.05).

Conclusion: Hand massage is an effective method for reducing pain and increasing sleep quality and comfort in palliative oncology patients.

Clinical trial registration no: NCT06360614.

Purpose: To explore the moderated mediating effect involving perceived loneliness and economic burden in the association between social support and mental health among lung cancer patients.

Methods: A total of 614 valid questionnaires were collected from December 2023 to February 2024 using convenience sampling. Social support was assessed with the Social Support Rating Scale, mental health with the General Health Questionnaire, and perceived loneliness with the Cancer Loneliness Scale. Theoretical hypotheses were tested using moderated mediation analysis.

Results: More than half of participants were female (65.8%), and half of them were aged between 40 and 60 (53.7%). The majority had been diagnosed with adenocarcinoma (94.1%) and were classified as having stage I lung cancer (85.8%). A quarter (24.6%) of participants reported a high level of economic burden. Perceived loneliness partially mediated the relationship between social support and mental health. Economic burden moderated the relationship between perceived loneliness and mental health. For objective support, perceived loneliness served as a mediator among high-burden participants. For support utilization, perceived loneliness served as a mediator among low-burden participants. In terms of subjective support, perceived loneliness exerted a mediating effect among all patients.

Conclusion: Providing social support may improve mental health outcomes by alleviating feelings of loneliness among lung cancer patients. Intervention strategies should be tailored to patients' economic burden: providing supportive resources such as financial assistance, psychoeducation programs, and social activities for patients with high economic burden, while promoting resource utilization such as patient navigation programs for those with lower economic burden.

Purpose: Few studies have evaluated the long-term effects of head and neck cancer (HNC) and its treatment. Therefore, the objective was to study nutritional rehabilitation needs by assessing nutritional problems, dietary adjustments, muscle mass, muscle strength, physical performance, prevalence of sarcopenia, and health-related quality of life (HRQoL) among long-term HNC survivors.

Methods: This cross-sectional study included HNC survivors more than 5 years after diagnosis. Nutritional status, sarcopenia, and physical performance were assessed through questions about dietary adjustments, muscle mass (bioelectrical impedance analysis), grip strength, and maximum walking speed measurements. HRQoL and nutrition impact symptoms (NISs) were assessed using quality of life questionnaires from the European Organization for Research and Treatment of Cancer (EORTC), QLQ-C30 and QLQ-HN35, and were compared with reference values from a normal Swedish population.

Results: Almost 80% of 114 participating survivors needed dietary adjustments, most commonly extra liquid with meals and/or moist food and increased time to consume meals. Relatively few patients had reduced muscle mass and low BMI, and none had sarcopenia. Compared with reference values, survivors reported severe HNC-specific symptoms on the EORTC QLQ-HN35. Survivors with the most problems swallowing solid food had a higher NIS burden and more problems with role and social functioning.

Conclusions: In this cross-sectional study, many long-term HNC survivors experienced chronic NISs and had worse HRQoL than a matched reference group from the normal population. The findings suggest that survivors with nutritional problems may have adapted and used dietary adjustments to facilitate food intake. For some survivors, nutritional rehabilitation may be needed long after treatment has ended.

Background: The deprescribing process, which aims to reduce or stop unnecessary medications, remains an area with limited research, especially in patients nearing end of life. Therefore, we aimed to explore the views, barriers and facilitators of patients, their carers and community palliative care nurses about deprescribing for patients nearing end of life.

Methods: This qualitative study was conducted in Hospis Malaysia, Kuala Lumpur, between September 2021 and August 2022. We recruited patients on ≥ 5 medications, their carers who were ≥ 18 years, and community palliative care nurses from Hospis Malaysia. Nurses were recruited because they conducted home visits, could identify patients who may benefit from deprescribing, and could initiate deprescribing following consultation with physicians. Individual in-depth interviews were conducted using a topic guide. Thematic analysis was used to analyse the transcribed interviews.

Results: Five patients, 9 carers and 11 community palliative care nurses participated. Three themes emerged: (1) use of medications at end of life (2) social influences affecting deprescribing and (3) factors influencing deprescribing. Deprescribing was regarded as essential. Deprescribing was favoured when medication risks outweighed benefits, when medication was financially unsustainable, when swallowing difficulties arose, or when simplifying medication regimens was desired. Conversely, fears of medical relapse and perceived loss of hope acted as barriers. Nurses demonstrated a strong understanding of deprescribing and could implement deprescribing due to robust organisational support. Their confidence was bolstered by consistent guidance from hospice physicians and timely information from pharmacy teams.

Conclusion: Deprescribing was deemed essential for patients nearing end of life by patients, carers, and community palliative care nurses. Future research should broaden its scope to encompass diverse healthcare systems and settings, examining how cultural and professional factors influence end-of-life care, thus offering a more comprehensive understanding of deprescribing in various contexts.

Purpose: To explore the rates of medical service utilisation in people with and without cancer and the characteristics related to these rates.

Methods: Data of respondents aged ≥ 25 years from two Australian National Health Surveys 2014-2015 and 2020-2021 were linked to medical services records from the Medicare Benefits Schedule through the Person Level Integrated Data Asset. Comparisons by cancer status and age group (< 65 years versus ≥ 65 years) were conducted using negative binomial regression, while latent class analysis (LCA) was used to explore patterns of medical service use.

Results: A total of 3636 people with cancer and 18,477 people without cancer were included. Relative to younger adults without cancer, the rate of any medical services was highest in older adults with cancer (adjusted rate ratio (aRR) = 1.43; 95% CI = 1.35-1.52). This was followed by younger adults with cancer (aRR = 1.31; 95% CI = 1.25-1.38) and older adults without cancer (aRR = 1.12; 95% CI = 1.06-1.18). Characteristics associated with a higher rate of medical services use were older age, being unemployed, having polypharmacy, and a higher number of health conditions in both cancer and non-cancer groups. LCA identified three distinct patterns of medical service use including an older group of cancer survivors with a higher burden of comorbidities and polypharmacy and complex needs for multiple types of services.

Conclusion: Cancer, age, multimorbidity and polypharmacy are strongly associated with medical service use. Research into predictors of health service use is crucial to inform the development of optimal approaches for care delivery, such as integrated onco-geriatric service models, tailored for populations with the highest usage.

Oxaliplatin, a third-generation platinum-based chemotherapeutic agent, has emerged as a widely adopted therapeutic option for the management of multiple cancer types. Oxaliplatin-induced peripheral neuropathy (OIPN) represents a prevalent and clinically relevant adverse effect of oxaliplatin-based chemotherapy, frequently prompting treatment dose reduction or even therapy discontinuation. OIPN is characterized by two distinct features of acute onset and chronic accumulation and shows a high degree of sensitivity to cold stimuli. The pathogenesis of OIPN is complex, involving multiple targets and various cell types contributing to neuropathy. Additionally, the mechanisms of OIPN may interfere with and superimpose on each other, necessitating combination therapies for effective management. However, despite extensive preclinical and clinical investigations, no preventive therapies have demonstrated significant clinical efficacy and established treatment for painful OIPN remain limited. It is of paramount importance to comprehensively understand and analyze OIPN. The present review summarizes the most recent advances in the field of studies on OIPN, the overview of pathogenesis, incidence, risk factors, clinical syndrome, and management of OIPN.

Purpose: Breakthrough cancer pain (BTcP) is an evolving clinical challenge, with limited guideline-specific direction. This study aimed to identify gaps in breakthrough cancer pain (BTcP) diagnosis and management in Australia and propose practical, evidence-informed actions to improve assessment, prescribing and equitable access to effective analgesia.

Methods: A gap analysis was conducted between September 2023 and September 2024, using three hybrid roundtable meetings involving 13 medical and nursing clinicians and researchers. Participants were selected for expertise in BTcP, including rapid-onset opioids (ROOs) policy development, BTcP research and education. A targeted review of the literature and guidelines framed the discussions. Meetings were recorded, transcribed and iteratively member-checked; thematic synthesis identified key gaps and potential solutions.

Results: Five interrelated gaps were identified: (1) inconsistent definitions of BTcP undermining case identification and research comparability; (2) assessment and measurement gaps with uptake of validated tools limited by perceived respondent burden and clinical utility; (3) heterogeneous approach to BTcP with limited comparative evidence guiding ROOs versus immediate-release opioid use and dosing strategies; (4) implementation and systems barriers including workflow, prescribing complexity and clinician training needs; (5) equity in opioid supply and restricted access to vulnerable populations. Recommended actions include Delphi consensus on definition, development and validation of subtype-sensitive assessment tools, pragmatic comparative effectiveness and implementation studies, co-designed prescribing templates and stakeholder engagement to address supply chain and regulatory barriers.

Conclusions: Sequential, coordinated efforts-consensus building, measurement development, targeted research, co-designed implementation supports and supply chain planning-are required to advance equitable, evidence-based BTcP care in Australia.

Introduction: Lymphedema is chronic and can be a consequence of cancer treatment. Little is known about the range of movement (ROM) of the limbs with lymphedema. We aimed to quantify the ROM in patients with lymphedema to assess the impact of lymphedema and multilayer bandaging on mobility.

Methods: A motion analysis system quantified ROM. The ankle and knee of 22 patients (57 years, 14 females) with lower limb lymphedema (mainly secondary to gynecological or urological cancer) were evaluated. The wrist and elbow of 21 women (58 years) affected by upper limb lymphedema secondary to breast cancer were studied. Tests were repeated on the lymphedematous limb before (L) and after (B) bandaging, and with the compression garment (G, only for upper limb). The contralateral healthy limb (H) was set as a reference.

Results: Lymphedema limited the knee maximal flexion (H 97.7°; L 83.1°) and the forearm rotation (H 140°, L 131°). Bandaging further limited the maximal knee ROM (70°). Bandaging restricted the maximal ROM of the ankle, elbow (H 147°, B 130°; only flexion limited), and wrist (H 113°, B 86°; both extension and flexion limited). Bandaging limits the ROM of the knee (H 40.7°; B 36.6°), ankle (H 29.6°; B 25.3°), and elbow (L 59°, B 54°) during the dynamic test. G limited the rotation of the forearm (111°). Data reported as median.

Conclusion: Lymphedema and its treatment introduce important restrictions on joint mobility that may impact the quality of life, as adequate joint dorsiflexion is necessary for daily functional activities.

Background: Individuals living with and beyond head and neck cancer (HNC) often experience many consequences related to the cancer and its treatment which can persist long-term and have detrimental effects on overall quality of life. Despite the potentially profound impact of these consequences of cancer, the evidence around long-term outcomes among individuals living with and beyond HNC is varied. The objective of this study is to describe the evidence on long-term outcomes among individuals living with and beyond HNC.

Methods: This scoping review followed Joanna Briggs Institute methodology and was reported according to the PRISMA-ScR checklist. Structured language, keywords, and synonyms were used for each concept (patients diagnosed with HNC, outcomes, long-term) were used to search six databases. Eligible studies were those that reported outcomes beyond survival and recurrence at least 5-years after diagnosis of HNC. Two independent reviewers conducted screening (title and abstract then full-text screening), and data abstraction using a standardized form. The abstracted data from the evidence sources was synthesized using descriptive statistics, and qualitative data was categorized into themes.

Results: The search identified 6072 potential evidence sources, of which 2339 full-texts were screened and 166 met eligibility criteria and were included. Most commonly, evidence sources were studies conducted in the USA (35%) between 2020 and 2023 (30%) and were cohort studies (70%). The included evidence sources represent 82,008 patients who were mostly males (69%). The most frequently reported outcomes were treatment-related effects, followed by disease progression and control, psychosocial impact, and physical symptoms/functional status. Quality-of-life was also reported (33%) with heterogeneous measures and reporting.

Conclusions: This study found a large body of evidence exploring long-term outcomes among individuals living with and beyond HNC; however, there were gaps in evidence exploring the relationship between psychosocial outcomes and a rich understanding of the patient experience. Additionally, the considerable variability in methods, outcome measurement and reporting suggests a more standardized approach to long-term cancer outcomes research, and adherence to reporting checklists.

Purpose: Definitive chemoradiotherapy (dCRT) can achieve durable local control and even cure in patients with locally advanced esophageal cancer. However, survival benefit may be accompanied by a decline in health-related quality of life (HRQoL) owing to experienced adverse effects. This study aims to investigate HRQoL in patients with locally advanced esophageal cancer receiving dCRT in a real-world setting.

Methods: Patients with locally advanced esophageal squamous cell carcinoma or adenocarcinoma receiving dCRT (≥ 50.4 Gy/28 fractions with concomitant weekly chemotherapy) were eligible. Patient-reported outcome measures were prospectively collected using the validated questionnaires EORTC-QLQ-C30 and EORTC-QLQ-OG25 at baseline and every 3 months thereafter for 2 years. Clinical data were obtained from the Netherlands Cancer Registry. Longitudinal HRQoL outcomes were compared to baseline using mixed effect models.

Results: 318 patients were included with a median age of 70 years. The total number of available questionnaires across all timepoints was 718. Out of 318 alive patients, 223 (70.1%) returned a questionnaire at baseline, which declined to 71 out of 195 (36.4%) at 2 years. Global health status at baseline was 70.6 (95% CI 68.1-73.1) and remained stable over time. Patients reported significantly lower physical (-13.0), role (-18.9), cognitive (-6.6), and social functioning (-14.4) at 3 months compared to baseline (all p < 0.0001). Social and cognitive functioning scores recovered to baseline level at 6 months. Physical and role functioning, and the symptom scales fatigue and dyspnea, remained impaired until 2 years after baseline. Significant improvements were observed for anxiety, eating restrictions, odynophagia and dysphagia at nearly all time points, but most pronounced at 12 or 18 months.

Conclusions: Our study showed that where global health status remained stable from 6 months after dCRT, the burden of disease-specific symptoms decreased. Social and cognitive functioning first deteriorated but recovered over time, whereas the decline in physical functioning, role functioning, fatigue and dyspnea did not recover to baseline level. These findings can provide valuable insights to address concerns regarding the impact of dCRT on HRQoL within the context of shared decision-making.