Supportive Care in Cancer最新文献

Introduction: The impact of socioeconomic factors on cancer outcomes is well documented; however, their role in access to and receipt of care within universal health systems for advanced lung cancer is less established. We investigated inequalities in specialized cancer consultation and treatment for stage IV non-small cell lung cancer (NSCLC).

Methods: We used a population-based cohort with administrative health data to study people aged 18+ diagnosed with stage IV NSCLC between 2010 and 2022 in Ontario. We measured consultations with medical oncologists, radiation oncologists, and thoracic surgeons as well as systemic therapy, radiation, surgery, and palliative care in the year following diagnosis, comparing consultation and treatment rates across quintiles of census measures of community material resources. Multivariable cause-specific Cox proportional hazards regression, accounting for death, was used.

Results: We included 32,902 stage IV NSCLC patients. People living in the least materially resourced neighborhoods were less likely to have a cancer-directed consultation with a medical oncologist, radiation oncologist, or thoracic surgeon (hazard ratio [HR] = 0.91; 95% confidence interval [CI] 0.87-0.94) and less likely to receive any cancer-directed treatment (HR = 0.90; 95% CI 0.86-0.94) compared to those with the most material resources. We did not detect a difference in the rate of palliative care (HR = 1.04; 95% CI 1.00-1.08). Results were consistent in urban but not rural populations.

Conclusions: We identified inequities in access to cancer-directed consultation and treatment among adults with stage IV NSCLC by material resources, limited to urban and suburban populations. Future research should explore root causes and identify interventions to address these inequities.

Aim: To synthesize qualitative evidence on the experiences and perceptions of social isolation in colorectal cancer patients with ostomy.

Methods: A systematic qualitative meta-synthesis was conducted. Nine electronic databases (PubMed, Web of Science, EBSCO, Cochrane, Scopus, CNKI, Wanfang, VIP, and CBM) were searched from inception to November 2024. Qualitative studies exploring experiences of social isolation in ostomy patients were included. Methodological quality was assessed using the CASP checklist. Data were analyzed via a meta-aggregative approach.

Results: Eleven studies were included. Four synthesized findings were identified: (1) antecedents and multidimensional perceptions of social isolation, (2) social relationship rupture and structural transformation, (3) psychological distress and self-identity crisis, and (4) multidimensional support needs and positive adaptation. Social isolation arose from physiological limitations, self-care challenges, and stigma, leading to behavioral withdrawal, family tension, and emotional distress. Support and self-adjustment were found to facilitate coping.

Conclusions: Social isolation in ostomy patients is a multifaceted phenomenon shaped by individual, relational, and environmental factors. A comprehensive support framework involving healthcare providers, families, and communities is essential to mitigate social isolation and promote social reintegration. Future interventions should adopt dyadic or systemic approaches to address communal challenges.

Implications for cancer survivors: Ostomy patients may experience significant social isolation influenced by complex factors. Holistic, needs-based support from multiple stakeholders is crucial to facilitate adaptation and improve quality of life.

Quality of life (QoL) and mental well-being are critical outcomes for cancer patients undergoing radiotherapy (RT). This systematic review examined the impact of patient education and care interventions on QoL and psychological well-being among adults receiving RT. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; 33 studies were identified from 723 screened articles. Most interventions, such as structured education, counseling, and multidisciplinary support, demonstrated significant improvements in at least one QoL domain, reduced anxiety or depression, and increased patient satisfaction compared with standard care. Key factors influencing effectiveness included age, education level, social support, and treatment duration. Overall, evidence supports the integration of individualized patient education and supportive care into radiotherapy practice. Routine use of patient-reported outcome measures (PROMs), such as the EORTC QLQ-C30, can facilitate early identification of declining well-being and guide tailored interventions to enhance patient outcomes. The objective of this study is to systematically review evidence on the effect of patient education and care interventions on quality of life, mental well-being, and patient satisfaction among cancer patients receiving radiotherapy.

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.