Supportive Care in Cancer最新文献

Objective: To characterize the oral microbiome of patients with head and neck squamous cell carcinoma (HNSCC) before and during radiotherapy (RT), compared to healthy individuals. Evaluating the impact of oral microbiome in the clinical outcomes one year following the end of RT.

Methods: Oral samples were collected from HNSCC patients who underwent RT using the following regimens: no dose received (T0), dose 12-16 Gy (T1), dose 30-36 Gy (T2) and dose ≥ 60 Gy (T3). Samples from healthy individuals were also collected only once as a control group. Regions V1-V2 of the 16S rRNA were sequenced by Illumina and analyzed using Mothur.

Results: 49 patients with HNSCC and 25 healthy individuals were included. At T0, HNSCC patients showed a lower abundance of Firmicutes and Streptococcus (p = 0.011, p = 0.002) and a higher abundance of Bacteroidetes (p = 0.005) compared to healthy individuals. During RT, Fusobacterium (p = 0.017) and Porphyromonas (p = 0.0008) decreased, while Streptococcus increased at T1 (p = 0.001). By T3, the differences in Firmicutes, Bacteroidetes, and Streptococcus between the control and HNSCC groups were no longer significant (p > 0.3). Patients with higher initial abundances of Porphyromonas (p = 0.012) and Fusobacterium (p = 0.017) had poorer outcomes, including recurrence, metastasis, and death. In contrast, disease-free patients had a higher abundance of Streptococcus (p = 0.004).

Conclusion: Oral microbiome dysbiosis was found in HNSCC patients. By the end of RT, the main initial differences in phylum and genus abundance observed at T0 between the control and HNSCC groups were no longer present. Higher abundances of Fusobacterium and Porphyromonas were associated with poor outcomes.

Purpose: Global childhood cancer survival outcomes correlate with regional contextual factors, yet upfront treatment decision-making for children with advanced or poor prognosis cancer in low- and middle-income countries (LMICs) is not well understood. This study aimed to (1) characterize the landscape of contextual factors that shape physician decision-making at diagnosis for these children in LMICs and (2) describe physician rationales for if/when to offer treatment with non-curative intent, including how they define "poor prognosis" during treatment decision-making.

Methods: An international panel of pediatric oncologists practicing in LMICs participated in two focus groups structured for the collaborative generation of factors influencing treatment decision-making, including consideration of non-curative treatment pathways at diagnosis. Thematic analysis of qualitative data was conducted, followed by member checking.

Results: Eleven pediatric oncologists participated, representing all global regions defined by the World Health Organization. Participants identified a broad range of factors influencing decision-making across multiple levels, including the individual, hospital, health system, community, and country levels. All participants agreed that treatment with non-curative intent could be offered at diagnosis in certain contexts, and diverse definitions for poor prognosis were described.

Conclusions: Upfront treatment decision-making for children with advanced or poor prognosis cancer in LMICs is variable and challenging. Difficulties with decision-making in LMICs may be amplified by inconsistent definitions of poor prognosis and underrepresentation of the factors that influence treatment decision-making within existing decision-making frameworks or childhood cancer treatment guidelines. Future research should explore decision-making approaches, preferences, and challenges in depth from the perspectives of pediatric cancer patients, families, and multidisciplinary clinicians.

Background: Patients with head and neck squamous cell carcinoma (HNSCC) face several physical, emotional, and psychological challenges throughout treatment. Cisplatin-based chemoradiotherapy (CRT) is an effective but toxic treatment, with an increased risk for toxicities in patients with low skeletal muscle mass (SMM). Consequently, these patients are anticipated to experience greater treatment-related difficulties. We aimed to explore the experiences of patients with HNSCC and low SMM regarding cisplatin-based CRT.

Methods: A descriptive qualitative study was conducted, interviewing seven patients 3 months after CRT using a topic guide. Thematic analysis of semi-structured interviews was conducted, to create a multi-dimensional understanding of patients' experiences during and after cisplatin-based CRT.

Results: Prior to CRT themes included pre-treatment information, expectations towards treatment and trial, psychosocial circumstances, and supporting network. During CRT themes included toxicities, psychosocial impact, and supporting network. After CRT themes included reflection on period during CRT, psychosocial circumstances, informal support from networks and healthcare workers, and ongoing toxicities.

Conclusion: Most patients experience cisplatin-based CRT as a life-changing and distressing life event but cope through various strategies and supporting networks. Tailored counseling, ideally with on-demand consultations, is recommended. No differences were noted in patients' perceptions of their cisplatin regimen.

Purpose: Adolescents and young adults (AYA) with cancer require highly individualized, age-specific end-of-life care. This study identified the characteristics of AYA patients with cancer receiving home-based palliative care and explored their unique needs and challenges compared with other age groups.

Methods: This retrospective cohort study analyzed the medical records of AYA patients with cancer to compare home-based palliative care characteristics with those of older age groups. The study included 81 AYA patients with cancer aged 16-39 years who had received home palliative care at a single institution from 2013 to 2023. They were compared with 5,017 patients with cancer aged 40 years and older. Patient background, duration of home end-of-life care, sedation, and association with social factors were examined retrospectively from medical records.

Results: The median age of AYA patients with cancer was 34 years; 65.4% were female. The primary cancer sites were gastrointestinal (34.6%) and thoracic (23.5%), with 80.0% at Stage IV. The median home care duration was 28.5 days, shorter than that for older patients (40 days) (p < 0.0001). Home care rates were similar between AYA and older patients (82.4% vs. 79.9%, p = 0.16). Sedation was more common in the 30-39 age group than in the 16-29 group (33.3% vs. 6.3%, p = 0.049).

Conclusion: AYA patients with cancer achieved a high rate of end-of-life care at home, although their duration of home care was shorter. The characteristics of home care varied depending on the primary site and age, highlighting the importance of creating highly individualized care plans.

Purpose: Radiodermatitis (RD) is an adverse effect of radiation therapy. RD can negatively impact quality of life and can also hinder treatment in cancer patients. Photobiomodulation therapy (PBMT) has the potential to treat RD at the cellular level, and it is more promising compared to other therapy alternatives. This review aims to examine the effectiveness of PBMT for the treatment and management of RD in cancer patients undergoing radiation therapy.

Methods: The methodology followed for the review was based on the framework proposed by Arksey and O'Malley, and the extensions by Levac et al. This involved a literature search in Scopus, PubMed, Embase, and Cochrane without any time limit, for original articles on the basis of the inclusion criteria, i.e., studies focusing on the effectiveness of PBMT on RD in cancer patients undergoing radiation therapy as an anticancer treatment. The review has been reported on the basis of the PRISMA-ScR checklist.

Results: A total of 14 studies were reviewed, of which only 2 (14.28%) studies reported no significant effect of PBMT on RD; the remaining studies reported positive outcomes (85.71%) with no adverse effects. Among studies with positive outcomes, PBMT has been shown to be beneficial in reducing the severity of RD. Furthermore, PBMT application has been studied as a preventive measure (35.71%), treatment and management (50%), and for both the prevention and cure of RD (14.29%).

Conclusion: Overall, PBMT can be considered a reliable and effective treatment modality for reducing the severity of RD. However detailed studies related to the long-term effects of PBMT, its effect on pain intensity and quality of life (QoL) will aid in better assessment of the technique. More clinical trials with a broader sample size could also aid in fine-tuning the efficacy of PBMT treatment modalities.

Purpose: To determine the effectiveness of uni- or multimodal prehabilitation on several outcomes in patients undergoing neoadjuvant therapy before cancer surgery.

Methods: A systematic search was carried on May 1, 2023, using four major databases (SCOPUS, Web of Science, Medline (Ovid and Pubmed)) and updated monthly until February 2024. Inclusion criteria included (i) any original articles (any design), (ii) adult patients undergoing neoadjuvant therapy (NAT) prior to surgical resection, (iii) participation in uni- or multimodal prehabilitation programs during NAT, and (iv) reporting on any functional, treatment-related, or perioperative outcome. Two reviewers independently conducted the search and screened all records. Risk of bias was assessed using the Johanna Briggs Institute Appraisal Tools independently by two reviewers. A random-effects meta-analysis was performed for all outcomes with two or more studies.

Results: A total of 30 records met the inclusion criteria and were analyzed. Studies showed that prehabilitation during NAT can be feasible in most settings and increase or prevent the loss of cardiorespiratory fitness (CRF), maintain or improve muscle mass, and improve pathological response and treatment completion compared to no prehabilitation, but the certainty of the evidence is low to moderate. However, according to our findings, prehabilitation has little to no effect on postoperative complications and length of hospital stay as well as in health-related quality of life.

Conclusions: Prehabilitation during NAT might be feasible and associated with improvements in cardiorespiratory fitness, muscle mass, and treatment response/completion with low-to-moderate certainty of evidence. Insufficient data on safety is available at this stage.

Purpose: Children continue to experience chemotherapy-induced nausea and vomiting (CINV), despite effective antiemetic medications. Recommendations in clinical practice guidelines are underpinned by narrative syntheses and meta-analyses that compare only two treatments. This means not all antiemetics have been compared to one another, and estimates remain imprecise. We apply network meta-analysis (NMA) to overcome these limitations by comparing multiple treatments simultaneously.

Methods: A systematic review identified and critically appraised RCTs comparing antiemetics recommended and licensed for the prevention of CINV in children. Bayesian NMA compared and ranked antiemetic effectiveness for the outcomes complete (CR) and partial response (PR) in the acute, delayed, and overall phases, nausea, and decreased food intake. Antiemetics given with and without dexamethasone were compared in separate networks as their underlying populations differed.

Results: Sixteen RCTs (3115 patients receiving moderately (MEC) or highly emetogenic chemotherapy (HEC)) were included. When given with dexamethasone, NK1 antagonists with ondansetron ranked highest for CR and PR in the acute and overall phases, PR in the delayed phase, and decreased food intake. Post hoc analysis shows further a benefit of adding olanzapine to regimens of aprepitant and ondansetron. Ondansetron ranked lower than palonosetron, for CR in the delayed and overall phases, and ondansetron was less effective than palonosetron for nausea prevention. Rankings for other regimens, including those given without dexamethasone, were uncertain or inconsistent across outcomes.

Conclusions: Our findings serve to support the current recommendations of olanzapine (when given with aprepitant and ondansetron) and NK1 antagonists' regimens receiving HEC, but note that evidence of a significant difference in relative benefit, between patients receiving MEC and HEC, does not yet exist. Recommendations for palonosetron as the preferred 5HT3 antagonists may be extended, particularly, to those who are at high risk of nausea.

Background: Since 2017, terminally ill parents with dependent children under the age of 18 have been able to record an audiobook for their dependent children. This service allows them to narrate how they would like to be remembered in their voice. The family audiobook is a professionally supported, voluntary, free service that is unique in Germany. There is little research on digital memories for children. The study aims to understand how this service is used and its influence on children through responses of terminally ill parents and close persons.

Methods: An anonymous online survey, accessible between September 2023 and November 2023, was conducted among terminally ill parents and their close persons with support from the Family Audiobook Association in Germany. Analyses were carried out using SPSS.

Results: 186 respondents, 95 terminally ill parents, and 91 close persons completed the online survey. Almost all terminally ill parents felt eased to have recorded a family audiobook. The two groups showed differences in how they used the family audiobook and how often they listened to it. While some children listen to the family audiobook with their bereaved parents or friends, other children are not yet ready for this, according to the open-ended responses of terminally ill parents and close persons.

Conclusions: The family audiobook provides a valuable opportunity for terminally ill parents with dependent children under the age of 18 to tell their own biographical story, offer support to the bereaved in remembering, and preserve the voice of the deceased for the children. In addition, this approach could help healthcare professionals to reduce the stress associated with providing end-of-life care for terminally ill parents.

Currently, in Australia, 1 in 8 women are diagnosed with breast cancer. A common adjuvant treatment for breast cancer is radiation therapy (RT). The amalgamation of side effects caused by RT treatment can ultimately affect a patient's quality of life (QoL). With increasing breast cancer survival, a greater focus on the non-lethal consequences of this disease and its treatment is warranted. Exercise and nutrition have proven beneficial in promoting and supporting overall health and managing chronic diseases. Furthermore, exercise has demonstrated improvement and sustainment to QoL. The focus of this scoping literature review was to determine the scale of evidence regarding the effectiveness of exercise and/or nutritional interventions for women with breast cancer receiving radiation therapy. An online search of five databases was conducted to identify studies published between 2000 and 2023. The 58 studies included in the scoping review comprised 46 interventions and 4615 women with breast cancer who received radiation therapy participated. Most studies (90%; n = 52) were 'exercise only' based, 3% (n = 2) were 'nutrition only', and the remaining 7% (n = 4) of studies were combined exercise and nutrition interventions. The findings from this review highlight most studies are dedicated to investigating exercise. Further research is required to fully understand the potential benefits of these interventions and their synergistic impact on the quality of life of women with breast cancer receiving radiation therapy.

Aim: The aim was to assess the characteristics of patients who required imaging studies during admission to an acute supportive palliative care unit (ASPCU).

Methods: A consecutive number of patients who performed imaging studies during ASPCU admission in a month period were assessed. Epidemiological data, ongoing anticancer treatment, cancer diagnosis, reasons for admission, referral, and type of imaging study were recorded. Indications, findings, consequent actions for treatment, prognosis, and discharge were also collected.

Results: Twenty-one of 56 patients admitted to ASPCU in the period taken into consideration were assessed. Pain and deterioration of the general condition were the most frequent indications for admission. Computed tomography (CT) was the most frequent imaging study performed. Indications for performing imaging studies depended on individual clinical needs. Findings suggested different clinical decisions, after a comprehensive oncological and palliative care assessment and family conference, the most frequent of which was to withdraw oncological treatments. The majority of patients underwent transition to palliative care and were discharged home or to hospice.

Conclusion: Imaging studies were of paramount importance for clinical treatment and decision-making process in an intensive ASPCU. There is the need to explore the need and the possible outcomes of imaging studies, as well cost-effectiveness in any ASPCU.