Supportive Care in Cancer最新文献

Purpose: Cognitive and psychological symptoms in neuropsychiatric disorders have been linked to blood cell parameters, including neutrophil-to-lymphocyte ratios (NLRs), systemic immune-inflammation indices (SIIs), and platelet-to-lymphocyte ratios (PLRs). It remains unclear whether cognitive impairments in haematological cancers are associated with biological vulnerabilities reflected in these parameters. We examined whether cognitive and psychological morbidity correlated with blood cell parameters before, during, and after chemotherapy in individuals with aggressive lymphoma.

Methods: Neuropsychological testing and self-reported questionnaires were administered at diagnosis, mid-chemotherapy, and 6-8 weeks post-treatment (n = 30). Regression models assessed associations between cognition and blood cell parameters. Bootstrapped Pearson correlations examined relationships between NLRs, SIIs, PLRs, and psychological symptoms. To test specificity, similar analyses were conducted in healthy controls (n = 72).

Results: In individuals with aggressive lymphoma, NLRs, SIIs, and PLRs correlated with impairments in inhibitory control, cognitive flexibility, delayed recall, and working memory across time points (p < 0.05). A disconnect emerged between these parameters and subjective self-reports. At diagnosis, lower NLRs, SIIs, and PLRs were associated with worse objective cognitive performance but better perceived cognition. Mid-chemotherapy, higher NLRs correlated with worse delayed recall but fewer reported depression and anxiety symptoms (p < 0.05). No significant associations were observed in healthy controls.

Conclusion: Cognitive impairment was associated with blood cell parameters in individuals with aggressive lymphoma, indicating distinct biological patterns of dysfunction before, during, and after chemotherapy. The disconnect between objective neuropsychological performance and subjective self-reports reinforces the value of incorporating biomarkers into cognitive assessments in this population.

Objective: This study aimed to evaluate the effectiveness of whole-course high-quality nursing care combined with individualized nutritional intervention in patients undergoing spinal surgery during the perioperative period.

Methods: In this single-center, single-blind randomized controlled trial, patients were assigned to receive either routine perioperative care or whole-course high-quality nursing care combined with individualized nutritional intervention. Outcomes included pain level (visual analog scale, VAS), functional recovery (Berg balance scale, BBS), 6-min walking distance (6MWD), nutritional status (albumin, total protein), activities of daily living (ADL), quality of life, incidence of complications, and nursing satisfaction.

Results: Compared with the control group, the intervention group had significantly lower VAS scores, higher BBS scores, longer 6MWD, and improved albumin and total protein levels (all P < 0.05). ADL and quality-of-life scores were higher in the intervention group, accompanied by greater nursing satisfaction and a lower incidence of postoperative complications (P < 0.05).

Conclusion: Whole-course high-quality nursing management combined with nutritional intervention effectively improves pain control, functional recovery, nutritional status, daily living ability, and quality of life while reducing postoperative complications and improving nursing satisfaction in patients undergoing spinal surgery.

Background: Pain is common in advanced cancer, and its assessment is recognized as crucial for effective management. However, real-world evidence on pain prevalence, relief, and the impact of structured pain assessment across cancer types at the end of life remains limited.

Methods: We analyzed data from 215,317 patients who died from cancer reported to the Swedish Register of Palliative Care (2011-2023). Data are based on validated end-of-life questionnaires completed by healthcare providers after the patient's death. Patient characteristics and provider-reported pain outcomes (prevalence of pain, severe pain, structured pain assessment usage, pain relief) were evaluated. Pain prevalence and relief across cancer types were examined through multivariable logistic regression analyses.

Results: Overall, 82% of patients experienced pain and 35% severe pain during their final week of life. Highest pain prevalence occurred in pancreatic, prostate, and bone/soft tissue cancer and lowest in brain/CNS cancers. Complete pain relief was reported in 77% of patients, with lowest odds in patients with prostate and bone/soft tissue cancer and highest odds in patients with brain/CNS cancer. Pain assessment using validated tools was reported in 57% of patients, ranging from 49% in hematological malignancies to 64% in pancreatic cancer. Structured pain assessment was significantly associated with higher odds of complete pain relief both overall (adjusted OR 1.27, 95% CI 1.24-1.30) and across most cancer types.

Conclusion: Pain remains highly prevalent in patients with cancer at the end of life, with variation in both occurrence and relief across cancer types. Structured pain assessment was consistently associated with higher odds of complete pain relief. These findings underscore the importance of routine, systematic pain assessment and tailored pain management strategies in end-of-life cancer care.

Purpose: Increased distress has been associated with impairment related to cancer treatment and with post-traumatic growth (PTG), but the influence of treatment-related impairment on PTG has not been explored. This study aimed to understand the lived experience of PTG for cancer survivors living with treatment-related impairment.

Methods: Hermeneutic phenomenology was used to develop a deep understanding of the lived experience of adult cancer survivors living with ongoing treatment-related impairment who had experienced self-perceived PTG following their cancer experience. Semi-structured individual interviews conducted with eight participants were transcribed, manually coded, and thematically analysed.

Results: This study demonstrated that people with ongoing treatment-related impairment can experience PTG through coping with cancer. PTG was both a coping process and an outcome of coping with adversity. Participants experienced growth outcomes in the domains of new possibilities, relating to others, personal strength, and appreciation of life. Participants first experienced a state of incongruence arising from the intrusion of cancer, which challenged their existing world view and self-concept. They reported using coping strategies to manage distress, enabling productive meaning making. A notable absence of distress about impairment was attributed to participants facing this later in their cancer trajectory when meaning making was well established, and their experience of impairment more readily assimilated.

Conclusion: The extent of PTG in cancer survivors may depend on the degree of incongruence they experience and their ability to accommodate these contradictions to develop new meaning. Further research is needed to understand how early or visible treatment-related impairment influences cancer survivors' PTG.

Objectives: While online interventions increase access to support, self-guided online programs have lower engagement and (potentially) efficacy than guided programs. However, the acceptability of guided programs to cancer survivors is less established. This study qualitatively explored whether the addition of guidance via two brief coaching calls to the Healthy Living after Cancer (HLaC) Online program, an online lifestyle intervention, was feasible and more acceptable than the self-guided version.

Methods: Participants were adult Australian cancer survivors randomized to receive either HLaC Online + coaching (n = 25) or HLaC Online (n = 27) as part of a larger clinical trial. Semi-structured telephone interviews were conducted (n = 21), and transcripts were analyzed via framework analysis, using deductive analysis of four a priori feasibility domains (adaption, acceptability, demand, practicality) and inductive analysis to generate novel subthemes. Recruitment ceased when content saturation was achieved.

Results: Feedback suggested guidance was a positive adaption, with benefits including high acceptability, practicality through program understanding, and maintenance of behavior change. Control participants reported high demand for coaching calls and lower acceptability.

Conclusions: Feedback suggested that Australian cancer survivors found coaching calls acceptable and feasible, more so than the self-guided program. HLaC Online + coaching supported Australian cancer survivors to interact with the program more effectively than without coaching and achieve reported benefits in both physical and psychosocial health, suggesting better survivorship outcomes. Future research should implement the addition of coaching calls at a larger scale, to establish whether calls impact efficacy and engagement.

Purpose: This study aimed to assess the impact of complex decongestive therapy (CDT) on proprioception, balance, light touch sensation, and two-point discrimination (2PD) in patients with lower extremity lymphedema (LLL) post-endometrial and cervical cancers.

Methods: The study included 72 patients diagnosed with LLL, who were randomly assigned using a block randomization method into two groups: a study group (n = 36) receiving CDT and a control group (n = 36) receiving no intervention. Patients were assessed before and after treatment using a digital goniometer for proprioception at 15°, 45°, and 60° knee flexion angles, a single-leg balance test with eyes open and closed, and a 30-s chair-stand test for balance assessment. Sensation was evaluated using Semmes Weinstein Monofilaments for light touch sensation and an aesthesiometer for 2PD.

Results: Significant improvements were observed in knee flexion at 15°, 45°, and 60° in the study group compared to the control group (p < 0.001, p < 0.001, and p < 0.001, respectively). Although there was no difference between groups in single-leg balance with eyes open (p = 0.074) and closed (p = 0.919), improvements were noted within the study group before and after treatment (p < 0.001). There was no significant difference between groups in light touch sensation, while the 2PD parameter improved in the study group (p = 0.012).

Conclusions: CDT may not fully address sensory deficits in patients with LLL. Balance issues appear to worsen with lymphedema progression regardless of treatment. However, CDT shows promise in improving kinesthesia.

Clinical trial registration: This is listed with study ID: NCT06204510.

Purpose: What are the perceptions and practices regarding protein energy malnutrition (PEM) screening and assessment for patients with cancer among health professionals working in the cancer setting, and how have these perceptions and practices changed since the COVID-19 pandemic?

Methods: A repeated cross-sectional study was conducted in 2018 (pre-COVID-19) and 2024 (post-COVID-19) using a study-specific online 24-item questionnaire. Qualified health professionals working as clinicians in the cancer setting were eligible. The survey was disseminated via professional associations internationally. Data were analysed in Stata/MP 18.5.

Results: Of N = 282 participants included (n = 197 pre-COVID-19, n = 85 post-COVID-19), most were dietitians (39%) from Oceania (29%). The reporting of workplace nutrition screening policies increased between pre- and post-COVID-19, especially in North America (56% to 100%, p = 0.013). Barriers to nutrition screening remained consistent pre- and post-COVID-19 except in North America where limited awareness increased (50% to 93%, p = 0.019) and in Oceania where there was a decrease in incorrect use of a screening tool (63% to 36%, p = 0.027). Nutrition screening and assessment implementation remained mostly unchanged, except for an increase in patient self-screening (15% to 28%; p = 0.029) and fewer non-admission assessments conducted in Oceania.

Conclusion: While some positive changes were observed between the pre- and post-COVID-19 period, nutrition screening and assessment continue to face many barriers. This has led to a lack of improvement or decline in nutrition screening and assessment practices in most regions and settings. PEM identification must evolve to ensure early detection for best patient care and in preparedness for future global health events.

Background: The growing global cancer burden highlights the urgent need to improve long-term outcomes among cancer survivors. Age-related biological changes may modify the associations between lifestyle factors and mortality, yet the joint effects of diagnostic age and lifestyle factors remain poorly understood.

Methods: Cancer survivors diagnosed between 2010 and 2018 in Guangzhou were followed up until 2023. Associations of lifestyle factors with all-cause mortality risk were examined, stratified by early-onset (< 50 years) and late-onset (≥ 50 years) cancers. Interactions were evaluated on multiplicative and additive scales.

Results: Among 22,079 cancer survivors, 10,839 deaths occurred during a median follow-up of 4.14 years. An antagonistic interaction of diagnostic age with physical activity on all-cause mortality risk was observed. Compared with inactivity, physical activity (≥ 150 min/week) was associated with a 15% lower risk of all-cause mortality (restricted mean survival time [RMST] difference: 0.29 years) in early-onset survivors and a 23% lower risk in late-onset survivors (RMST difference: 0.69 years). A synergistic interaction of diagnostic age with sleep duration was observed. Compared with 7 h/day, short sleep duration (≤ 5 h/day) was associated with a higher mortality risk (RMST difference: -0.43 years) in early-onset survivors, while 8 h/day was associated with a lower risk in late-onset survivors (RMST difference: 0.13 years).

Conclusions: Sufficient physical activity and sleep duration were significantly associated with improved survival, with their effects varying by diagnostic age. These findings underscore the importance of tailored lifestyle management strategies for early-/late-onset cancer survivors to mitigate mortality burden.

This scoping review examines the implementation of exercise interventions aimed at reducing fatigue in patients with cancer. Effective programs typically involve moderate-intensity aerobic or combined aerobic and resistance exercises, performed about 30 min per session, three to five times weekly over 12 weeks. Above these FITT-based parameters, it has been found that exercise effectiveness depends on treatment context, patients' characteristics, and the alignment between program demands and individuals' capacity. The review identifies three key issues: current programs emphasize physical training over holistic rehabilitation, often neglecting patients' broader functional needs; process evaluations of interventions are insufficient, limiting understanding of how and why programs succeed or fail; and methodological weaknesses, including inadequate measures of adherence and a lack of theoretical frameworks, reduce the reliability and generalizability of findings. To enhance exercise effectiveness for fatigue, future interventions should adopt patient-centered, theory-driven approaches that integrate both outcome and process evaluations, addressing physical, emotional, and social dimensions to support long-term engagement and improve quality of life.