Supportive Care in Cancer最新文献

Background: Effective education and awareness regarding breast cancer are critical. Traditional educational methods often fail to meet the diverse information needs of patients. Patients should be provided with tailored, accessible information to improve their retention and understanding of disease-related information.

Purpose: This systematic review and meta-analysis evaluated the effectiveness of chatbots for providing breast cancer education. By examining patient satisfaction with and the usability and efficacy of chatbot interventions, this study seeks to support the integration of chatbot technology into cancer education.

Methods: This review, which was conducted in accordance with PRISMA guidelines, included studies from MEDLINE, Embase, and the Cochrane Library up to May 2024. The main inclusion criterion was chatbot interventions for breast cancer education. Meta-analysis was performed using Review Manager and Open Meta-Analyst software.

Results: Of the 208 articles initially identified, 6 studies met the inclusion criteria, involving a total of 1342 women with early-stage or at-risk hereditary breast cancer. The meta-analysis revealed that most participants (85 to 99%) reported high satisfaction with chatbot interventions for breast cancer education, with no significant differences in satisfaction compared to genetic counselors or physicians. The chatbot interventions also showed positive effects on knowledge acquisition (mean proportion = 90.8%) and alleviated patients' symptoms significantly more than routine care.

Conclusion: This study demonstrated that chatbots can effectively provide personalized and interactive educational support, enhancing patients' understanding and retention of disease-related information. The integration of chatbot technology into educational programs can empower patients, ultimately promoting breast cancer awareness and prevention.

Objective: This study aimed to explore the social factors of patients and caregivers, including those related to their wishes for home-based end-of-life care that influence its fulfillment.

Methods: A secondary analysis was conducted using the dataset (home-based end-of-life care N = 625, hospital end-of-life care N = 7603) Comprehensive patient-based survey conducted by The Study on Quality Evaluation of Hospice and Palliative Care by Bereaved Caregivers (J-HOPE 4) and multivariate analysis (multiple logistic regression) to explore the impact of social factors of patients and caregivers on the fulfillment of home-based end-of-life care. The explanatory variables included 11 social factors of patients, such as age and sex, and 18 social factors of primary caregivers.

Results: For patients with medical expenses less than 900 USD (OR, 2.05), annual income of fewer than 36,000 USD (OR 0.669), preferences for home care (OR 1.49), preferences to die at home (OR 1.58), wish to die at home (OR 1.52), and lack of patient's financial well-being (OR 0.72) were significant factors associated with home-based end-of-life care. Significant factors relating to caregivers included male caregivers (OR 0.66), poor mental state (OR 0.79), ability to provide daily care (OR 3.02), experience of caring for a deceased family member (OR 0.66), presence of alternative caregivers (OR 0.78), and cohabitation with caregivers (OR 1.47).

Conclusion: Patient preferences, social situations, primary caregivers' social situations, and mental states influenced home-based end-of-life care.

Objective: The present study aimed to examine the efficacy of Mindfulness-Based Cancer Recovery (MBCR) training on fatigue and sleep quality of Iranian female patients with cancer.

Method: Thirty female patients with cancer were randomized to one of the MBCR and control groups. Subjects of the MBCR group received 8 sessions of MBCR training, while subjects of the control group received a 1-day didactic stress management seminar (SMS). All participants responded to the Cancer Fatigue Scale (CFT) and the Pittsburgh Sleep Quality Scale (PSQL) as pre- and post-test measures.

Results: Using MANCOVA for analyzing data revealed a significant improvement in the level of fatigue among subjects of the MBCR group compared to the controls; however, MBCR had no significant effect on the level of sleep quality.

Conclusion: The Mindfulness-Based Cancer Recovery program can be considered an effective approach to reducing fatigue for Iranian female patients with cancer. The clinical implications of this finding require further investigation.

Trial registration: The study was registered with the Iranian Registry of Clinical Trials (IRCT) on 24 June 2024; see [IRCT20240315061296N1].

Purpose: Lung cancer remains one of the most diagnosed cancers in Canada and continues to be the leading cause of cancer deaths in Canada, responsible for 25% of all cancer deaths. Prior studies consistently report poor experiences of people with lung cancers. The study purpose was to explore the reasons for consistently poorer reported experience of people with lung cancer compared to people with gastrointestinal cancers, who previously have reported positive cancer care experiences within the same context, and to better understand key differences that influence patient experience.

Methods: This qualitative study used semi-structured interviews of people living with lung cancer (LC) and gastrointestinal cancers (GIC) undergoing radiotherapy at a tertiary cancer centre. Thematic content analysis was conducted to analyse interview transcripts. A person-centred care framework was used to guide the development of the interview guide and data analysis.

Results: We interviewed 16 participants (10 LC and 6 GIC). Participants with LC reported poor experience leading to and at the time of their cancer diagnosis, including delays in their diagnosis and anxiety related to their diagnosis. Most participants in both groups reported severe symptoms prior to their radiotherapy. However, the symptoms of people living with LC further worsened during the radiation therapy with the addition of treatment side effects, while the symptoms of people living with GIC were better controlled during treatment. Participants living with LC noted poor communication, gaps in coordination and uncertainty. They acknowledged awareness of support services and other resources, but they reported no interest in accessing them.

Conclusion: This study identified gaps in patient experience of people living with LC compared to GIC and proposed ideas for quality improvement projects, including expediting the diagnosis process, enhancing communication with patients around their lung cancer diagnosis, improved symptom management, and timing of supportive care services.

Purpose: The present study investigated the clinical feasibility of replacing a part of conventional physiotherapy (PT) with Nintendo Wii® for the recovery of motor function and activities of daily living (ADL) in patients with glioma.

Methods: This study included 10 patients with first-episode gliomas who were admitted to the neurosurgery department of a tertiary hospital. According to the patients' preferences, they were allocated to conventional PT or Wii® rehabilitation groups in which a part of the conventional PT sessions were replaced with Wii® training. The Fugl-Meyer Assessment (FMA), Short Physical Performance Battery (SPPB), Functional Independence Measure (FIM), and Hospital Anxiety and Depression Scale (HAD) measures were compared between the treatment groups using the Mann-Whitney U test.

Results: The Wii® rehabilitation and conventional PT groups included four (age 39 [26-53] years, n = 2 each WHO grade III and IV) and six patients (age 72 [59-80] years; all WHO grade IV), respectively. No patient dropouts were observed. The beneficial changes did not differ significantly between the conventional PT and Wii® groups (FMA: 1.0 vs. 1.5, SPPB: - 1.0 vs. - 0.5, FIM: - 2.5 vs. 2.5, HAD: 6 vs. 0). No adverse events such as falls were observed in either treatment group.

Conclusion: Wii® rehabilitation had comparable effects with conventional PT for the inpatient rehabilitation of patients with glioma, with no adverse effects. Wii® rehabilitation showed potential as a home-based training modality because no physical assistance was required. Further investigation will be required because of the selection bias as a non-randomized trial.

Implications for cancer survivors: Exergame Wii® could be an effective rehabilitation tool for brain tumor patients.

Background: Enteral nutrition (EN) is commonly used for nutritional support in patients with cancer. Whether inflammation, one of the driving factors of malnutrition and cancer, affects the association between EN and short-term prognosis and medical costs in patients with cancer remains unclear. We aimed to investigate the association between EN and short-term prognosis of patients with cancer and the effect of inflammation on EN-associated medical costs.

Methods: This multicentre prospective cohort study evaluated patients with pathologically confirmed solid tumours. After admission, all patients who received EN, including oral or tube feeding, were assigned to the EN group. The log-rank test was used to identify the optimal cutoff values for inflammatory markers. Cox regression analysis was used to analyse the associations among EN, inflammation, and prognosis. Propensity score matching was used to balance biases between the EN and non-EN groups and validate the stability of the results.

Results: A total of 5121 patients were included, with 2965 (57.90%) men and an average age of 59.06 (11.30) years. A total of 462 patients received EN, with 390 (84.4%) receiving oral nutritional supplementation. During the 90-day follow-up, 304 patients died. In the low inflammation group, there was no association between EN and short-term prognosis (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.39-2.18). In the high inflammation group, EN significantly improved the short-term prognosis (HR = 0.48, 95% CI = 0.30-0.76). In patients with low inflammation (p < 0.001), EN increased hospitalisation costs (p < 0.001) without reducing length of stay (LOS) (p = 0.15). In patients with high inflammation, EN did not increase hospitalisation expenses (p = 0.47) but reduced the LOS (p = 0.004).

Conclusion: EN can improve the short-term prognosis of patients with high inflammation and reduce LOS without increasing the hospitalisation expenses. Baseline inflammation levels may serve as effective indicators for personalised and precise EN treatment.

Clinical trial registration: ChiCTR1800020329 (chictr.org.cn).

Background: The research aimed to collect experience and viewpoints related to the nutrition management of patients with digestive tract cancers from medical care staff, patients, and family caregivers and provide reasonable and effective references for the mode of nutrition management of these patients.

Methods: Using a phenomenological qualitative research method, six physicians, six nurses, three nutritionists, six patients, and six family caregivers from a tertiary A cancer hospital in Jiangsu Province were chosen by purposive sampling methods from February to June 2023. Data was collected through semi-structured in-depth interviews and analyzed by the content analysis method.

Results: Data analysis revealed two major themes, each with four subcategories: current status of clinical nutrition management tract cancers which consisted of "lack of whole-process nutrition management model," "inadequate role of nutrition management professionals," "lack of a mechanism for continuous improvement of nutrition management quality," and "lack of nutrition science popularization and training system" and influencing factors of clinical nutrition management that contained "patient-related factors," "family-related factors," "medical staff-related factors," and "hospital environment and policy-related factors."

Conclusions: Nutritional management of digestive cancer patients is currently inadequate and should be viewed through an integrated perspective. Improvements should be made at four angles: patient, family, healthcare provider, and hospital environment by establishing a multidisciplinary nutritional management team.

Purpose: Chemotherapy dose-limiting toxicities (DLT) pose a significant challenge in successful colon cancer treatment. Body composition analysis may enable tailored interventions thereby supporting the mitigation of chemotherapy toxic effects. This study aimed to evaluate and compare the effectiveness of using three-dimensional (3D) CT body composition measures from the entire lumbar spine levels (L1-L5) versus a single vertebral level (L3), the current gold standard, in predicting chemotherapy DLT in colon cancer patients.

Methods: Retrospective analysis of 184 non-metastatic colon cancer patients receiving adjuvant chemotherapy was performed. DLT was defined as any occurrence of dose reduction or discontinuation due to chemotherapy toxicity. Using artificial intelligence (AI) auto-segmentation, 3D body composition measurements were obtained from patients' L1-L5 levels on CT imaging. The effectiveness of patients' 3D L3 body composition measurement and incorporating data from the entire L1-L5 (including L3) region in predicting DLT was examined.

Results: Of the 184 patients, 112 (60.9%) experienced DLT. Neuropathy was the most common toxicity (49/112, 43.8%) followed by diarrhea (35.7%) and nausea/vomiting (33%). Patients with DLT had lower muscle volume at all lumbar levels compared to those without. The machine learning model incorporating L1-L5 data and patient clinical data achieved high predictive performance (AUC = 0.75, accuracy = 0.75), outperforming the prediction using single L3 level (AUC = 0.65, accuracy = 0.65).

Conclusion: Evaluating a patient's body composition allowed prediction of chemotherapy toxicities for colon cancer. Incorporating fully automated body composition analysis of CT slices from the entire lumbar region offers promising performance in early identification of high-risk individuals, with the ultimate aim of improving patient's quality of life.

Purpose: Compare the effects of low-intensity and moderate-intensity exercise on physical functioning in breast cancer survivors.

Methods: Women aged 50 + years and post-primary treatment for stage 0 to III breast cancer were randomly assigned to a 6-month low-intensity (LIG) or moderate-intensity (MIG) exercise group. Participants were instructed to walk (low- or moderate-intensity) for 30 min five days a week, followed by flexibility exercises, and do strengthening and balance exercises twice weekly. Exercise adherence was facilitated with seven individual counseling sessions tapered over six months and a Theory of Planned Behavior-based booklet. Assessments occurred at baseline, 6 months (post-intervention), and 12 months. Primary measures were PROMIS Physical Functioning, PROMIS Global Health, and six-minute walk test (6MWT).

Results: Of 101 women randomized, 65 (64.4%) completed the study. No statistically significant between-group differences occurred at post-intervention or 12 months. Compared to baseline, within-group improvements in PROMIS physical functioning occurred (LIG increased from 45.87 ± 7.58 to 48.37 ± 7.13 post-intervention (p = 0.01); MIG increased from 45.26 ± 7.27 to 49.53 ± 8.80 post-intervention (p = 0.002) and 48.91 ± 9.29 at 12 months (p = 0.02)). Similarly, Global Health physical health improved (LIG increased from 46.04 ± 5.00 to 49.19 ± 5.76 post-intervention (p = 0.001); MIG increased from 45.06 ± 6.59 to 48.20 ± 7.33 post-intervention (p = 0.005) and 48.49 ± 7.89 at 12 months (p = 0.007)). 6MWT improved between post-intervention and 12 months for the LIG (469.99 ± 64.69 m to 492.19 ± 68.64 m, p = 0.008) and between baseline and post-intervention for the MIG (471.01 ± 62.69 m to 495.88 ± 66.64 m, p = 0.006).

Conclusion: Both low and moderate-intensity exercise led to significant improvement in physical functioning. When feasible and acceptable, prescribing low-intensity exercise can yield important benefits.

Trial registration number: ClinicalTrials.gov identifier: NCT02982564.

Objective: The present conflict in Israel has led to a surge in cases of acute stress disorder (ASD). The study examined a training program for integrative medicine (IM) providers working in supportive and palliative care settings, teaching clinical skills for treating ASD.

Methods: A 10-h online training program, designed by supportive care trained IM and mental health professionals was attended by a group of 32 IM providers. The impact of the course was assessed using pre- and post-training questionnaires, which underwent qualitative evaluation. Three open-ended questions addressed expectations from the program, anticipated barriers to combining IM with mental health interventions, and explored willingness for multi-disciplinary collaboration. A conventional content analysis was used, where coding categories are derived directly from the text data. Narratives were analyzed using ATLAS.ti software for systematic coding.

Results: Narrative themes identified within the group of 32 trainees included expectations regarding facilitating a multi-disciplinary integrative model of care, enriching the ASD-related clinical "toolbox," increasing the effectiveness of IM treatments, and reducing IM treatment-associated risks. Insights were provided for bridging communication gaps between IM practitioners and mental health providers, supporting the multi-disciplinary collaboration.

Conclusions: ASD-focused training for IM practitioners may increase their level of clinical skills and advance collaboration with mental health providers. Future research examining the feasibility of the integrative model and its implementation in supportive care setting is warranted.