Supportive Care in Cancer最新文献

Purpose: As breast cancer survival rates improve, attention is shifting toward long-term health outcomes, including oral health. This study evaluated the dental prosthesis needs of breast cancer survivors using a nationally representative sample and examined variations by menopausal status at diagnosis.

Methods: This nationwide cross-sectional study analyzed data from 14,886 Korean women aged ≥ 19 years who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2016 to 2021. Among these, 214 participants reported a history of breast cancer. Multivariable logistic regression was used to compare prosthetic needs and dental care utilization between breast cancer survivors and non-cancer controls, with subgroup analyses stratified by menopausal status at diagnosis.

Results: Breast cancer survivors had significantly greater needs for fixed prostheses than the non-breast cancer controls (OR 1.102, 95% CI 1.018-1.194). Postmenopausal survivors were more likely to require fixed prostheses (OR 1.56, p < 0.001), while premenopausal survivors had greater partial denture needs (OR 5.549, p = 0.009) than the non-breast cancer controls. No significant differences in dental visit frequency or self-perceived oral health were observed between groups.

Conclusion: Breast cancer diagnosis was significantly associated with higher prosthetic needs, though survivors did not perceive their oral health as worse and demonstrated dental care behaviors comparable to non-cancer individuals. These findings highlight a potential gap in survivor awareness and underscore the need for integrating oral health assessment into survivorship care planning. Targeted dental interventions and awareness programs may improve quality of life for breast cancer survivors.

Chemotherapy-induced alopecia (CIA) remains a distressing side effect of cancer treatment, affecting patients' quality of life and psychological well-being. Scalp cooling is a promising intervention to prevent hair loss, yet challenges related to cost, accessibility, and environmental impact limit its widespread adoption. This narrative systematic review analyzed 52 studies published between 2014 and 2024 on innovations in scalp cooling technologies, focusing on cost-effectiveness, sustainability, and accessibility for low-income cancer patients. Findings indicate that gel-based, cryogel, and silicone-based cooling caps offer practical, affordable alternatives to machine-operated systems, while biodegradable and recyclable materials enhance environmental sustainability. Additionally, solar-powered and reusable designs show potential for use in low-resource settings. Overall, evidence suggests that affordable and eco-friendly scalp cooling solutions can significantly improve equity in cancer care by making hair-preserving interventions more accessible and sustainable.

Purpose: Long-term breast symptoms (pain, sensitivity, swelling and skin problems) after breast cancer treatment can affect survivors' quality-of-life. The trajectory of breast symptoms over time and risk factors associated with their development are not well understood.

Methods: This study built on the work of the international prospective REQUITE cohort study. Patients who underwent breast-conserving surgery and adjuvant radiotherapy (± chemotherapy) completed the EORTC-QLQ-BR23 questionnaire items relating to breast symptoms at four timepoints up to 24 months following radiotherapy. Patients at were re-contacted to complete additional psychometric questionnaires on different aspects of pain perception and the Hospital Anxiety & Depression Scale (HADS), with 237 respondents.

Results: Average breast symptoms peaked on completion of radiotherapy but returned to levels equal to or below baseline by 24 months. Patients with more severe breast symptoms at baseline continued to have worse symptoms long-term. In multivariable mixed models, higher breast symptom scores were associated with smoking (p = 0.036), any analgesic use at baseline (p = 0.005), and post-operative haematoseroma (p = 0.034), while older age and use of intensity modulated radiotherapy (IMRT) were protective (p =  < 0.001 and p = 0.045 respectively). Psychometric questionnaire scores for life interference and pain severity perception were associated with persistently increased breast symptoms at 24 months on multivariable analysis, while anxiety (as determined by HADS) was associated on univariable analysis.

Conclusions and implications for cancer survivors: This study identifies several risk factors for persistent breast symptoms including younger age, smoking, and post-operative haematoseroma. This particularly highlights the importance of smoking cessation and use of IMRT in women at higher risk of side effects.

Purpose: People with head and neck cancer (HNC) are faced with complex oral health needs. To prevent complications and promote optimal health outcomes, patient education and access to relevant information resources about oral health before and after cancer treatment is crucial. The aim of this study is to identify existing web-based information resources for people affected by HNC, relating to oral health pre-, during and post-cancer treatment.

Methods: A scoping review was conducted following Arksey and O'Malley's methodological framework, adhering to the PRISMA-ScR checklist. Three pre-determined search terms "dental care" "oral health" "head and neck cancer" were searched on PubMed, Yahoo, Google, and Bing. Results from pages 1-10 were reviewed. Resources that met eligibility criteria were collated, screened, and evaluated against specified indicators. Descriptive analysis was used to determine variation between resources.

Results: Twenty-one web-based information resources were eligible and derived from five countries, USA (7), Australia (7), UK (5), Canada (1), and New Zealand (1). Most resources were published in the previous 5 years and included information pre-, during and post-cancer treatment. Sixteen resources tailored to people with HNC included information on oral health or dental care, with nine of these on the topic alone.

Conclusion: A uniform approach to information resources is critical to improving oral health outcomes. This study's identification of differences between existing web-based resources prompts the need for further research, particularly into the acceptability and validity of pre-, during and post-cancer treatment dental care and oral health information for people affected by HNC.

Background: Depression occur more frequently in cancer patients than in the general population. However, the association between inflammatory biomarkers and depression in cancer survivors is not well understood. This study aimed to examine the correlation between inflammatory biomarkers and depression in patients with solid tumors and to identify clinical and biological factors related to this association.

Methods: The cross-sectional cohort study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018, including 2,926 cancer survivors aged 20 years and older. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and inflammatory biomarkers were derived from blood count measurements. Prevalence and regression analyses were conducted to evaluate the associations between inflammatory biomarkers and depression in patients with solid tumors, and the robustness of the models was assessed through sensitivity analyses.

Result: Among the 2,926 cancer survivors, 25.80% exhibited depression, including mild (15.52%), moderate (8.95%), and severe (1.33%) cases. Patients with digestive system cancers (OR = 1.63, 95% CI: 1.18-2.24, P = 0.003) and those with reproductive system cancers (OR = 1.47, 95% CI: 1.12-1.93, P = 0.005) were significantly associated with a higher prevalence of depression. Further subgroup analysis revealed that, in colorectal cancer patients, female (OR = 2.33, 95% CI [1.15-4.74], P = 0.020), neutrophil (NE) counts above 6.4 (OR = 4.02, 95% CI [1.36-11.90], P = 0.012) and monocyte (MO) counts above 0.8 (OR = 3.21, 95% CI [1.03-10.00], P = 0.045) were positively associated with depression, whereas age under 45 years (OR = 1.826, 95% CI [1.073-3.106], P = 0.026) was associated with depression in patients with uterine tumors. In addition, sensibility analysis conducted in the subgroup of colorectal cancer patients with mild depressive symptoms indicated that the observed associations were robust.

Conclusion: Depression is common among cancer survivors, particularly in those with digestive and reproductive system cancers. In colorectal cancer patients, female sex and elevated neutrophil and monocyte counts were associated with higher prevalence of depression, while younger age was associated with depression in uterine cancer patients. These findings highlight the potential relevance of inflammatory biomarkers in understanding depression among cancer survivors. Future longitudinal studies are warranted to further explore the temporal and biological relationships underlying these associations.

Purpose: Despite insurance coverage, cancer patients often face significant financial burdens. This study examined how commercially insured cancer patients utilize employer-provided virtual healthcare navigation services for financial concerns.

Methods: We analyzed chat conversations between care coordinators and members with cancer who used virtual navigation services provided by Included Health during 2022-2023-a third-party vendor contracted by employers to deliver navigation as an ancillary benefit. Included Health is not an insurance company and does not approve claims, determine coverage, or make payment decisions. Services included benefits routing, provider search, clinician referrals, care management, and expert medical opinions. Using natural language processing, we categorized financial discussions into four levels: no financial mention, financial inquiry, financial concern, and financial stress. We used chi-square and t-tests to examine differences across categories.

Results: Of 18,001 eligible cancer patients, 27.4% (n = 4937) used navigation services. The most utilized services were benefits routing (49.9%), self-service provider search (42.5%), and care coordinator assistance for finding in-network clinicians (39.3%). Among members using chat functionality, 82% raised financial matters: 30% made financial inquiries (e.g., coverage verification), 37% expressed financial concerns (e.g., insurance payment issues), and 14% reported financial stress affecting well-being. The remaining 18% had no financial mentions. Members reporting financial stress were more likely to use concierge referral services (55.4% vs. 44.1%, p < 0.01), expert medical opinions (18.6% vs. 12.4%, p = 0.01), and case management programs (27.9% vs. 17.5%, p < 0.01) compared to those reporting financial concerns without impact.

Conclusions: The high prevalence of financial concerns among commercially insured cancer patients using independent, third-party navigation services demonstrates that insurance alone does not shield patients from financial stress. Members' willingness to discuss financial concerns with care coordinators indicates that virtual navigation services can serve as an important resource for identifying and addressing financial toxicity in cancer care.

Purpose: This study aimed to identify independent risk factors for skeletal-related events(SREs) during denosumab treatment in patients with bone-metastatic stage IV lung adenocarcinoma by integrating multidimensional clinical parameters, thereby providing an evidence-based foundation for risk stratification and targeted management.

Methods: In this retrospective cohort study, patients with stage IV lung adenocarcinoma and radiologically confirmed bone metastases diagnosed at Xuanhan County People's Hospital between July 2021 and December 2023 were enrolled. All patients received standardized denosumab therapy (120 mg subcutaneously every 4 weeks ± 7 days). Baseline demographic, laboratory, and treatment response data were extracted from the electronic medical record system. Univariate analyses were used to screen candidate variables, followed by multivariate logistic regression to identify independent predictors. Model fit was assessed using the Hosmer-Lemeshow test.

Results: A total of 111 patients were included (median age, 65.5 years; 50.45% male). During follow-up, 27 patients (24.3%) experienced SREs. Multivariate analysis identified a prior history of bisphosphonate use as an independent protective factor against SREs (odds ratio [OR], 0.191; 95% confidence interval [CI], 0.049-0.741 P = 0.017), while Pretreatment hypocalcemia and smoking were both significantly associated with increased risk.

Conclusions: This study is the first to demonstrate in a county-level hospital cohort that a history of bisphosphonate use serves as an independent protective factor against SREs during denosumab treatment, while Pretreatment hypocalcemia and smoking history significantly increase SREs risk. These findings provide critical evidence for individualized management of stage IV lung adenocarcinoma patients with bone metastases.

Purpose: To describe the prescription and use of psychoactive medications among cancer patients in low- and middle-income countries (LMICs) and explore the factors influencing their prescription and use.

Methods: This systematic review was conducted following the PRISMA guidelines. Six electronic databases were searched. We included observational studies that investigated the prescription and use of psychoactive medications among adult cancer patients in low- and middle-income countries (LMICs) according to the 2024 World Bank's classification. Eligible studies specifically focused on the use of these medications for the management of psychological disorders in this population.

Results: Ten studies were included in the systematic review. Psychoactive medications prescribed were antidepressants, benzodiazepines, non-benzodiazepine/Z-drugs, and antipsychotics (both typical/first-generation and atypical/second-generation). Several factors, such as comorbidities, polypharmacy, geographical disparities, and health insurance coverage, influenced the prescription and use of these medications. Potentially inappropriate use of antidepressants and benzodiazepines was observed, particularly among elderly patients with multimorbidity. Underdiagnosis and undertreatment of mental health disorders were also reported, often leading to inadequate management of psychological distress in cancer patients.

Conclusion: In conclusion, this review highlights the complexity of prescribing and using psychoactive medications among cancer patients. Their use is influenced by multiple factors, including comorbidities, polypharmacy in older adults, and socioeconomic disparities that affect access to healthcare.

Purpose: This prospective study evaluated the impact of computer-aided design/manufacturing (CAD/CAM) palatal augmentation prostheses (PAPs) rehabilitation on maximum tongue pressure in tongue cancer patients underwent glossectomy.

Methods: Twelve patients (7 men, 5 women; mean age 53.2 years) with T1N0M0 or T2N0M0 tongue cancer that had undergone a type IIIa glossectomy without radiotherapy or chemotherapy were enrolled. All the participants had intact palates for good retention of PAP. Six weeks postoperatively, maxillary arches were scanned with an intraoral scanner; PAPs were digitally designed to lower the palatal vault utilizing CAD and then were fabricated from biocompatible PMMA via 3D printing and delivered. Patients wore the PAP daily and performed tongue-PAP contact exercises for at least four hours per day over six months. Maximum tongue pressure was measured using the Iowa Oral Performance Instrument before PAP delivery and after six months of rehabilitation. Statistical analysis was conducted using ANOVA with p < 0.05 considered significant.

Results: Mean maximum tongue pressure increased from 16.93 ± 13.16 kPa pre-rehabilitation to 26.93 ± 15.60 kPa post-rehabilitation (median: 11.9 to 21.9 kPa). ANOVA showed a significant improvement (F = 5.31, p = 0.0038).

Conclusion: CAD/CAM PAP rehabilitation significantly improved the maximum tongue pressure in glossectomy patients, suggesting potential benefits for oral-phase swallowing efficiency. Early postoperative delivery through a digital workflow minimized tongue-palate distance, enabling prompt exercises, and accelerating functional recovery. This approach represents an innovative rehabilitation strategy. Integration of pressure sensors into PAPs could enable real-time monitoring of tongue activity, expanding their role as dynamic training devices.