Supportive Care in Cancer最新文献

Objectives: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy, affecting more than half of cancer patients. This scoping review aimed to summarize the incidence and factors associated with falls in patients with CIPN and to visually map the distribution of existing evidence, thereby providing a theoretical foundation for the development of preventive measures and intervention strategies.

Methods: A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Chinese Biomedical Literature Database (CBM), Knowledge Infrastructure (CNKI), Chongqing VIP Information (CQVIP), and Wan Fang Data. The search included articles published from database inception to August 16, 2024. To enhance the synthesis of evidence, a bubble plot-based evidence map was constructed.

Results: A total of 11,649 records were identified, of which 19 studies were included. Most were quantitative non-randomized studies (n = 17): eight achieved a quality rating of 100%, eight scored 80%, and one scored 60%. Two studies were quantitative descriptive (one scored 80% and one scored 40%). Sixteen studies reported the incidence of fallers among CIPN patients, ranging from 5.6% to 57.4%. Seventeen studies examined fall-related factors in CIPN, which were categorized into 11 groups. Within the evidence map, high-quality and high-OR evidence was observed for CIPN symptoms/severity, advanced or unknown cancer stage, and chronic liver disease. CIPN-related factors were the most frequently reported, followed by demographic factors, suggesting that these domains, particularly those with both high quality and high OR, should be prioritized as targets for future intervention strategies. The adjusted odds ratios (ORs) ranged from 0.997 to 2.67.

Conclusion: Falls are common among patients with CIPN, with high-quality evidence primarily concentrated in the domains of CIPN-related burden, demographic and clinical characteristics of participants, and comorbidities. Future research should (1) conduct multicenter prospective longitudinal cohort studies with time-updated measurements of CIPN and treatment exposures, using standardized definitions of falls and observation windows; (2) strengthen outcome measurement by following COSMIN/Delphi recommendations, including the development of a gold-standard CIPN scale, specification of assessor qualifications, standardized training, and reporting of inter-rater reliability; and (3) re-examine currently unadjusted signals within rigorously controlled multivariable models.

Introduction: Physical prehabilitation is a key element of multimodal preoperative care, but there is a lack of standardized, home-based exercise protocols, particularly in gynecological oncology. This gap, together with organizational barriers to supervised programs, may limit the feasibility and implementation of prehabilitation in many centers. The aim of this study was to present an original set of home-based physical exercises developed for patients with gynecological cancer undergoing cytoreductive surgery and to compare it with existing recommendations from the literature.

Methods: A structured literature search was conducted in PubMed, Medline, EMBASE, and PsycINFO using predefined terms related to prehabilitation, cancer, and physical exercise. Eligible studies were reviewed by two independent investigators. Based on this review and clinical experience, we developed a set of aerobic and resistance exercises tailored to the needs of gynecological oncology patients, designed to be safe, feasible, and performed at home without specialized equipment.

Results: Eight studies describing prehabilitation exercise interventions were identified, of which only one addressed gynecological oncology specifically. Most existing programs relied on supervised or hybrid interventions and rarely provided detailed descriptions of exercises. In contrast, our proposed set includes structured aerobic activity and five resistance exercises focusing on abdominal, core, and paraspinal muscles, illustrated with infographics and supplemented with educational materials to ensure patient adherence at home.

Conclusion: Evidence regarding home-based prehabilitation exercise programs in gynecological oncology remains scarce. Our proposed exercise set is, to our knowledge, the first detailed, practical, and reproducible home-based protocol for this patient population and may facilitate broader implementation of prehabilitation across oncological centers.

Background: Colorectal cancer (CC) is the third most common cancer globally. Despite advances in treatment, patients often experience long-term psychological, physical, and social challenges during and after treatment. Specialised cancer care, including the role of cancer nurses, is critical in supporting patients throughout their treatment journey.

Aims: This study aimed to explore the experiences of CC patients in Australia in navigating the healthcare system, coping with their diagnosis, and receiving support from specialised cancer nurses and support networks.

Method: An exploratory qualitative design was used. Semi-structured interviews were conducted with nine CC patients (seven females, two males), aged 34-72 years. Interviews were analysed using reflexive thematic analysis.

Results: Four overarching themes emerged. First, challenges navigating the healthcare system, identified participants' frustrations with delays, miscommunication, and fragmented care. Second, emotional impact of a CC diagnosis and treatment, captured the shock, fear, and isolation experienced, particularly following sudden diagnoses. Third, value of specialised cancer nurses and support networks, highlighted the emotional reassurance and practical guidance provided by community-based nurses and support services. Fourth, physical and mental coping strategies included participants' use of mindfulness, physical activity, and dietary changes to regain a sense of control.

Conclusion: Specialised cancer nurses played a crucial role in enhancing patient care by addressing both medical and emotional needs. Improving communication, ensuring continuity of care, and providing personalised support are key recommendations for improving the healthcare experience of CC patients in Australia.

Background: Breast cancer is the leading cancer among Nigerian women and is commonly diagnosed at an advanced stage; yet the everyday realities that influence patient outcomes and well-being remain underexplored. Understanding the lived experiences of Nigerian breast cancer patients is critical for developing culturally appropriate, supportive, and palliative care services.

Aim: To explore the lived experiences, needs and coping strategies of women living with and beyond breast cancer in Nigeria.

Design: Qualitative study using a constructivist-interpretivist paradigm. Semi-structured, in-depth interviews were conducted online via Microsoft Teams, audio and/or video-recorded, and transcribed verbatim. Data were analysed inductively using the Framework Method, with double coding to ensure rigour.

Setting/participants: Twenty-eight women (aged 29-63 years; mean 42 years) receiving care at two oncology centres were purposively sampled between June 2024 and March 2025. Most had stage II or III disease and had lived with cancer for at least 6-12 months.

Results: Four inter-linked themes described the women's experiences: (1) "For several months, I saw myself like a ghost amongst people"-emotional, physical, economic and social upheaval following diagnosis; (2) "But I have to talk to myself, I need to encourage myself to keep going"-personal, spiritual and peer-based coping resources; (3) "I just know that there should be a lot more awareness" of the care continuum-structural, financial and informational barriers, including catastrophic out-of-pocket costs and fragmented care pathways; (4) "It is the emotional trauma"-reframing illness, personal growth and an expressed desire to support other patients. Across the themes, women stressed unmet psychosocial needs, reliance on faith communities, and the paucity of formal peer-support or counselling services.

Conclusions: Participants reported navigating a complex interplay of financial toxicity, systemic delays, and profound psychosocial distress, and many described drawing on spiritual practices, self-encouragement, and peer connections to cope; several also expressed a desire to support other women by sharing advice or lived experience while going through the care pathway. Strengthening palliative and supportive care in Nigeria should prioritise: (1) financial-protection mechanisms to reduce treatment abandonment; (2) streamlined referral/navigation systems; and (3) integrated psychosocial and peer-support interventions that acknowledge spiritual coping. Further research should investigate survivor-led support models and assess the effectiveness of culturally tailored communication training for oncology teams.

Purpose: Randomized controlled trials (RCTs) of acupuncture in oncology offer strong internal validity but limited generalizability. Real-world evidence is needed to assess feasibility, effectiveness, and adherence in routine practice.

Methods: We conducted a retrospective analysis of real-world data from cancer patients receiving group Traditional Chinese acupuncture (ACP) in an outpatient oncology setting (2015-2022). Symptoms (anxiety, fatigue, hot flashes, neuropathy, pain, sleep) were rated on a 0-10 numeric scale before each session. Clinical improvement was defined as a ≥ 1-point decrease in severity.

Results: A total of 2,239 patients underwent ACP (83% female; mean age 57 ± 12; 57% breast cancer). Common symptoms included pain (61%), sleep issues (50%), fatigue (45%), hot flashes (42%), anxiety (40%), and neuropathy (40%); 68% had ≥ 2 symptoms, median baseline severity 5-6. Females and younger patients had higher symptom burden. By session two, all symptoms improved statistically, with anxiety and hot flashes showing clinical improvement; by session three, all improvements were statistically and clinically significant. Benefits were similar across age and gender. Adherent patients (≥ 2 sessions) were older with higher symptom burden.

Conclusion: Acupuncture appears effective for common cancer symptoms in real-world settings, with evidence suggesting that benefits are sustained between sessions and requiring multiple treatments for optimal effect. Both sexes and age groups experienced similar improvements, though utilization was lower among males and older adults. Expanding insurance coverage could improve access and reduce disparities. Adherence was high, and integration into outpatient oncology care proved feasible and sustainable. These findings warrant examination in RCTs.

Background: Regular physical activity improves quality of life in cancer patients, yet adherence to guidelines remains low. Community-based exercise programmes offer scalable solutions, but determinants of programme completion and engagement are underexplored.

Objectives: This study evaluated factors associated with completion of a 12-session community-based cancer exercise programme. It also examined factors related to achieving ≥ 150 min of weekly physical activity following programme completion, considering sociodemographic characteristics, cancer type, prior exercise history, and referral pathway.

Methods: Data from 918 cancer patients enrolled in the programme were analysed. Associations between age, gender, ethnicity, education, housing status, referral location, referrer type, prior exercise history, and cancer type with programme completion and post-programme physical activity levels were examined using chi-squared tests and logistic regression.

Results: Participants from multiple ethnic backgrounds had higher odds of completing the 12-session programme compared with White participants (OR = 2.529, 95% CI 1.217-5.259, p = .013). Asian participants had lower odds of meeting physical activity guidelines of ≥ 150 min per week (OR = 0.532, 95% CI 0.294-0.965, p = .038). Achieving ≥ 150 min of weekly physical activity was positively associated with higher education (OR = 1.862, p < .001), homeownership (OR = 0.177, p < .001), self-referral (OR = 1.875, p = .035), referral from Barnet (OR = 2.410, p = .002) or Islington & Camden (OR = 2.425, p < .001), female gender (OR = 1.650, p = .004), and age ≥ 72 years (OR = 2.494, p = .002). Non-homeownership was the strongest negative factor associated with not reaching the ≥ 150-min physical activity guideline (p < .001).

Conclusion: Ethnicity was the only factor significantly associated with programme completion. In contrast, multiple factors, particularly non-homeownership, strongly influenced achieving recommended activity levels post-programme. These findings suggest the potential importance of social and environmental factors in shaping engagement and sustained physical activity in community cancer exercise programmes. Addressing these factors may improve participation, inclusivity, and long-term health outcomes for people living with and beyond cancer.

Background: The MASCC (Multinational Association for Supportive Care in Cancer) score is widely used to identify low-risk febrile neutropenia (FN) patients eligible for outpatient management. However, its performance specifically in patients with solid tumors remains insufficiently validated.

Methods: We conducted a retrospective cohort study at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) between 2011 and 2022. Adult patients admitted for FN secondary to chemotherapy for solid tumors were included. Patients were classified as high-risk (MASCC < 21) or low-risk (MASCC ≥ 21). The primary outcome was the score's ability to predict an uncomplicated clinical course with a specificity of 95%. Secondary outcomes included ICU admission, mortality, duration of hospitalization, intravenous antibiotics, neutropenia, and potential days saved with outpatient treatment.

Results: Among 329 oncologic patients, 227 (69%) were classified as low risk. The MASCC score showed a sensitivity of 83.5% (95% CI 77.8-88.2%) and a specificity of 57.3% (95% CI 47.8-66.4%) for predicting the absence of complications. ICU admission rates were significantly lower among low-risk patients (0.4% vs. 32.7%, p < 0.001), as were mortality rates (0.9% vs. 16.8%, p < 0.001). Median hospitalization duration was 4 days [IQR (interquartile range) 3-6] for low-risk patients compared to 6 days [IQR 4-10] for high-risk patients (p < 0.001). Applying outpatient eligibility criteria could have prevented 486 hospitalization days across 161 patients, with 80.7% experiencing no complications.

Conclusion: The MASCC score does not accurately identify solid tumor FN patients who would evolve without complications, given its moderate specificity. However, it remains associated with a substantial reduction in hospitalization burden among low-risk patients. Clinical judgment remains essential in outpatient management decisions. Integrating additional clinical parameters may further improve risk stratification in this population.

Purpose: Aspiration pneumonia is a life-threatening adverse event of radiotherapy in patients with oral cavity cancer. This study aimed to evaluate the association between muscle mass changes and aspiration pneumonia after radiotherapy.

Materials and methods: This study comprised 1,122 patients with oral cavity cancer who underwent surgery and post-operative radiotherapy between 2010 and 2021 at two tertiary centers. Changes in skeletal muscle index (SMI) were measured using pre- and mid-radiotherapy computed tomography scans at the C3 vertebral level. The primary and secondary outcomes were aspiration pneumonia and overall survival, respectively.

Results: With a median follow-up of 5.6 (interquartile range: 2.9-9.2) years, 125 (11.1%) patients developed aspiration pneumonia. Patients with aspiration pneumonia tended to have older age, poorer performance status, smoking, and higher mean dose to swallowing organs. Patients with aspiration pneumonia lost more SMI during radiotherapy than those without it (-3.4% vs. -1.0%; p < 0.001). After adjusting for clinical and dosimetric factors, an increase in SMI change during radiotherapy was independently associated with a lower risk of aspiration pneumonia in the overall population (hazard ratio: 0.78 per 1% increase, p < 0.001) or subgroups stratified by pre-radiotherapy SMI tertile. The occurrence of aspiration pneumonia was independently associated with poorer overall survival (hazard ratio: 2.81, p < 0.001). A 1% increase in SMI change during radiotherapy was independently associated with better overall survival (hazard ratio: 0.78, p < 0.001).

Conclusions: Increased muscle mass during radiotherapy was associated with a lower risk of aspiration pneumonia, which in turn was associated with overall survival.

Purpose: Patients with metastatic or unresectable gastro-oesophageal cancers (mGECs) have poor prognoses and often face high symptom burdens and rates of disease-related complications. Second-line treatments offer modest survival gains, which need to be balanced with treatment toxicities. Time toxicity (TT) is increasingly recognised as a hidden toxicity of cancer therapy, and thus, this study aimed to quantify TT to patients undergoing second-line treatment for mGECs.

Methods: This was a retrospective cohort study across three major hospitals in Sydney, Australia. Records were reviewed for all patients who received second-line systemic therapy for mGECs over 10 years. TT was defined as the number of days patients spent physically interacting with the healthcare system.

Results: Eighty patients were identified, with the majority male (83%) and a median age of 64 years. The median time on second-line treatment was 2.4 months, and the median overall survival from the commencement of second-line treatment was 5.8 months. Patients spent a median 25% of days in physical contact with healthcare, of which 20% were planned encounters (e.g. clinic appointments, scheduled investigations, and treatment days). TT was lower in patients who remained on second-line treatment for more than 2 months versus those on treatment less than 2 months (29% vs. 23%, p < 0.001). One in eight patients died within 30 days of receiving second-line treatment.

Conclusion: Patients on second-line treatment for mGEC spent 1 in 4 days in contact with healthcare, and 30-day mortality following systemic treatment was high. These findings may guide decisions and informed consent surrounding second-line treatment in mGECs.

Background: Breast cancer is a common cancer among women, often causing lasting physical and cognitive issues like memory and attention problems. Few studies have explored the combined effect of Pilates and lymphatic massage on cognition.

Objective: This study examined the impact of 12 sessions of Pilates and lymphatic massage on cognitive function in breast cancer survivors aged 30-60.

Methods: Seventy-five survivors were randomly assigned to Pilates, Pilates plus lymphatic massage, or control groups (25 each). Cognitive tests (N-back, Stroop, CPT) were used. Data were analyzed with ANCOVA (p < 0.05).

Results: Compared to the control group, both intervention groups demonstrated significant improvements in memory (F = 31.46, p = 0.001) and sustained attention (F = 6.82, p = 0.002), while there were no significant differences between the two intervention groups. However, Stroop test indices for attention did not show significant changes (p > 0.05).

Conclusion: Notably , comparisons between the two intervention groups revealed no significant difference, suggesting that lymphatic massage plus Pilates did not offer additional cognitive benefits beyond those provided by Pilates alone. A structured program of Pilates and lymphatic massage offers a promising, non-invasive approach for improving cognitive outcomes in breast cancer survivors.