Supportive Care in Cancer最新文献

Purpose: Breast cancer is the most common malignancy among women in India, with patients often experiencing high symptom burden and compromised quality of life (QoL). Despite evidence supporting early supportive care integration, significant implementation gaps persist in low- and middle-income countries (LMICs). This study addresses the lack of feasible intervention models for resource-constrained settings and inadequate characterization of mechanisms through which early supportive care improves outcomes-particularly symptom-specific contributions and financial burden reduction.

Methods: This single-centre, randomised controlled trial at All India Institute of Medical Sciences, New Delhi, randomised 110 newly diagnosed adult female breast cancer patients (1:1) into intervention (early supportive care plus standard care) or control (standard care only) groups. Supportive care included symptom management, psychosocial counselling, and educational support. Outcomes were assessed at baseline and 3 months using EORTC QLQ-C30 and Edmonton Symptom Assessment Scale (ESAS). Statistical analyses included t-tests, multivariate regression, and mediation modelling.

Results: Both groups showed significant QoL improvement, but greater symptom reduction occurred in the intervention group (mean ± SD ESAS reduction: 30.69 ± 15.51 vs. 22.9 ± 15.99; p = 0.014). Fatigue and pain were significantly lower in the supportive care group (Cohen's d = 0.55 [95% CI:0.17,0.94] and 0.38 [95% CI:0.00,0.75], respectively). Financial burden significantly reduced (p = 0.001), with higher patient and caregiver satisfaction (p = 0.032). Mediation analysis confirmed pain reduction as a key QoL predictor (p < 0.001).

Conclusions: Early supportive care integration significantly reduces symptom burden, enhances psychological well-being, and lowers financial stress, supporting its inclusion as standard adjunct cancer care in developing countries, providing actionable evidence for policymakers in LMICs.

Purpose: To explore the level of patient activation (PA) and its subgroups among postoperative breast cancer patients, and to analyze the differences and influencing factors across these subgroups.

Methods: A cross-sectional study was conducted from May to December 2024 using convenience sampling. A total of 230 postoperative breast cancer patients from a tertiary hospital in China completed questionnaires including general information, the Patient Activation Measure, the Posttraumatic Growth Inventory, the Social Impact Scale (for stigma), and the Perceived Social Support Scale. Latent profile analysis was used to identify PA subgroups. Differences among subgroups were analyzed using ANOVA, Kruskal-Wallis, or chi-square tests, followed by multinomial logistic regression to determine influencing factors.

Results: The average PA score was 51.0 ± 11.5, indicating that patients recognize their important role in disease management but lack the confidence and knowledge to take action. Three PA subgroups were identified: high PA-relatively proactive type (30.4%), moderate PA-knowledge deficient type (46.1%), and low PA-passive dependent type (23.5%). Protective factors for higher PA included urban residence, being employed, higher posttraumatic growth, and monthly family income ≥ 3000 yuan (all P < 0.05). Obstructive factors included not undergoing breast-conserving surgery and higher perceived stigma (both P < 0.05).

Conclusion: The PA score of postoperative breast cancer patients is classified at the second level, revealing three distinct categories with clear classification characteristics. Clinicians can identify patients exhibiting varying PA traits based on readily available demographic and disease-related data in clinical practice. This enables them to implement targeted interventions tailored to the specific characteristics and influencing factors of each group, ultimately enhancing PA levels.

Purpose: Cancer survivors with multiple chronic conditions (MCC) are a growing population with complex health needs, yet little is known about their care experiences and healthcare team trust.

Methods: This mixed methods study used a convenience sample of 441 adult cancer survivors recruited through online survey platforms. Participants completed surveys assessing care coordination, care access, healthcare team trust, and whether their care team included a social worker, navigator, or care coordinator during the 12 months after diagnosis. Twelve survivors also participated in semi-structured interviews. Relationships between care coordination and care access with healthcare team trust were examined using multivariable logistic regression followed by qualitative analysis of interviews.

Results: Overall 20.4% reported low trust in their healthcare team, 51.5% reported at least one care coordination problem, and 27.2% reported at least one care access issue. The adjusted prevalence odds ratios for low healthcare team trust were 14.5 times higher for cancer survivors who reported problems with care coordination (95% CI, 6.73, 31.29) and 6.3 times higher for care access problems (95% CI, 3.66, 10.69) compared with survivors reporting no problems. Having a social worker, coordinator, or navigator did not moderate these associations (p-values > 0.05). Participants described medical paternalism, transparency, honesty, established relationships, intergenerational trust, empathy and respect, and credibility as key experiences and attributes associated with trust.

Conclusion: Experiencing care problems was associated with reporting lower trust in one's healthcare team among cancer survivors with MCC, which represents potential modifiable points for intervention to improve trust, health outcomes, and quality of life.

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.

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).

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.