Objective: This study aims to analyze the annual trends in postoperative 131I treatment frequency among differentiated thyroid cancer (DTC) patients and systematically evaluate the changes in psychological status and quality of life across different treatment stages, thereby providing an evidence-based foundation for developing precise patient support strategies.
Methods: We conducted a retrospective analysis of 1651 patients with nondistant metastatic DTC treated between 2018 and 2023 to examine trends in 131I therapy. In addition, an observational analysis of routinely collected questionnaire data from 2024 was performed, including a psychological stress scale, the Hospital Anxiety and Depression Scale (HADS), and the Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), to assess patients' psychological status and quality of life as part of standard clinical follow-up across different treatment stages.
Results: The adoption of single-dose 131I therapy for nonmetastatic DTC rose markedly from 5.99% (2018) to 98.34% (2023) (χ2 = 87.407, p < 0.05), surpassing 92% after 2020. This shift was accompanied by a 38.9% reduction in treatment-cycle psychological distress (p < 0.001), though acceptance decreased by 6.6% at the 6-12-month assessment stage (p = 0.028). Willingness for multiple therapies declined 28.1% (p < 0.05), with variations by sex, education, and physician. HADS scores improved at subsequent assessment stages, and baseline anxiety was significantly associated with increased psychological risk at later stages (r = 0.534). Quality of life initially declined but showed subsequent improvement across treatment stages (p < 0.01).
Conclusion: Under the trend of single-session 131I therapy, a phase-specific health education system for high-risk groups is suggested. It may help strengthen pre-treatment cognitive intervention and post-treatment psychological support and provide a theoretical reference for improving adherence and long-term quality of life.
Background: To explore the current situation and influencing factors of resilience in patients with lung cancer undergoing chemotherapy, and to provide a basis for constructing a comprehensive and effective resilience enhancement program for patients with lung cancer undergoing chemotherapy.
Methods: Using descriptive qualitative research and purposive sampling method, 20 patients with lung cancer undergoing chemotherapy from October to December 2024 in the oncology department of a tertiary general hospital in Wuxi City, Jiangsu Province, China were interviewed semi-structured. The data were organized and coded with the help of Nvivo 14.0 software, and themes were distilled using the traditional content analysis method.
Results: A total of three themes and eight sub-themes were derived. The resilience status of patients with lung cancer undergoing chemotherapy was reflected in cognitive deficiency and a casual attitude. The protective factors for resilience among patients with lung cancer undergoing chemotherapy included intrinsic positive traits, multiple support networks, and professional medical support. The risk factors for resilience among patients with lung cancer undergoing chemotherapy included the damage of disease treatment, heavy economic burden, and lack of disease knowledge.
Conclusions: The study found that resilience among patients with lung cancer undergoing chemotherapy is multifaceted, shaped by a complex interplay of factors. Medical care, family, and society should jointly provide help to promote the protective factors of resilience and overcome the risk factors of resilience through collaborative efforts aimed at bolstering resilience, ultimately enhancing the quality of life for patients with lung cancer during chemotherapy.
Purpose: This study aimed to investigate the impact of a functional training prehabilitation program supported by the Prehab® App on the functional capacity, physical activity level, and symptoms of anxiety and depression in cancer patients undergoing major surgery.
Methods: This before-and-after experimental study was conducted with 38 patients who had a limited ability to attend a fully supervised prehabilitation program, scheduled for tumour resection at Hospital Clinic-Barcelona. Outcome measures included: Functional capacity assessed by the 30″ sit-to-stand test (30″ STS), Physical activity (PA) measured by the self-reported PA questionnaire: Yale Physical Activity Score (YPAS) and weekly step count via activity trackers; and the psychological status measured by the Hospital Anxiety and Depression Scale (HADS). All the variables were recorded at the beginning of the prehabilitation program (baseline) and the end of the program (before surgery). The statistical analysis was conducted using the paired-samples t-test.
Results: Most patients underwent upper gastrointestinal surgery, and the prehabilitation program had a mean duration of 6.5 weeks. Participants showed notable improvements in functional capacity assessed by 30″ STS, physical activity assessed by YPAS and in the psychological status after the intervention.
Conclusion: A functional training prehabilitation program supported by the Prehab® App appears to be effective in improving functional capacity, physical activity and psychological status in cancer patients undergoing major surgery.
Objectives: To determine the prevalence and factors associated with malnutrition in older adults with cancer upon admission for outpatient treatment.
Methods: This cross-sectional study was conducted with older adults with cancer admitted to an oncogeriatrics outpatient clinic from 2015 to 2020 in the Northeast of Brazil. Sociodemographic data, lifestyle, and clinical variables were collected. Nutritional status was assessed using the Mini Nutritional Assessment short-form (MNA-SF) and classified as normal nutritional status (12 to 14 points), at risk of malnutrition (8 to 11 points), or malnourished (0 to 7 points). The multivariate Poisson regression was used to verify the association between the independent variables and malnutrition.
Results: A total of 1954 patients were included. Of these, 14.9% were at risk of malnutrition, and 31.5% were malnourished. The risk factors for malnutrition were female gender (prevalence ratio [PR] = 1.28; 95% confidence interval [CI] = 1.03-1.59), upper gastrointestinal tumor (PR = 2.39; 95%CI = 1.66-3.45), colon, rectum, anus, and anal canal tumors (PR = 2.54; 95%CI = 1.77-3.64), lung tumor (PR = 2.35; 95%CI = 1.37-4.02), metastasis (PR = 1.37; 95%CI = 1.11-1.70), history of falls (PR = 1.27; 95%CI = 1.01-1.61), sedentary lifestyle (PR = 1.46; 95%CI = 1.11-1.93), and risk of depression (PR = 1.42; 95%CI = 1.16-1.73).
Conclusion: The prevalence of nutritional risk and malnutrition was relatively high in older adults with cancer at the beginning of outpatient treatment. These findings underscore the need for routine malnutrition screening at admission in oncology outpatient settings to ensure early identification and management. The associated factors were easily identifiable within standard clinical evaluations, supporting the feasibility of systematic screening.
Purpose: Adenocarcinoma of the pancreas (PANC) is an aggressive and often incurable cancer, associated with disease-related symptoms and poor outcomes. A comprehensive approach to care, including a focus on symptom management and quality of life, is essential. Introducing a palliative care approach early in the cancer journey improves survival and quality of life and decreases healthcare costs. However, barriers exist to providing early palliative care. This study is aimed at assessing the acceptability and impact of a novel clinical nurse specialist (CNS)-led early palliative care initiative on quality of care for patients with PANC.
Methods: Patients with PANC in the pre- and post-CNS eras were identified using the Manitoba Cancer Registry and CNS clinical database. Acceptability of the CNS initiative was measured by capturing those who agreed to CNS consultation. Quality measures included the proportion enrolled in a community-based palliative care program early (within 8 weeks of diagnosis) and late (within 2 weeks of death). Descriptive statistics were used. Chi-square tests were used to test for significance between the two eras.
Results: The CNS model was acceptable, with 93.3% of patients accepting consultation. There were fewer late referrals to community palliative care programs with the involvement of a CNS (p = 0.02) and a trend towards more early referrals (p = 0.07), suggesting an improvement in quality of care. After CNS consultation, 33% of patients declined either a diagnostic biopsy, medical oncology consultation, or both, facilitating decisions in line with patient goals of care.
Conclusions: The CNS-led model for PANC was acceptable to patients and associated with timely referral to community-based palliative care. This model provides an opportunity to address patient goals of care early and decrease unwanted procedures and consultations.
Purpose: Effective lymphoedema management relies on early detection and treatment during its reversible phase, underlining the importance of accurate measurement tools. This systematic review aims to identify measurement instruments for quantitatively diagnosing lymphoedema and their diagnostic accuracy.
Methods: Literature was systematically searched on the diagnostic accuracy of instruments for assessing soft tissue oedema across body parts in adults. Inclusion criteria encompassed studies establishing diagnostic accuracy (sensitivity and/or specificity) of instruments for quantifying oedema through volume changes, tissue characteristics, or lymphatic system function. Searches included Embase, Medline, Web of Science, and CINAHL databases from inception to March 18, 2024. Methodological quality was assessed using the COSMIN checklist for criterion validity and QUADAS-2. Diagnostic value was evaluated through the Youden index, and the level of evidence was established using a new best-evidence synthesis approach.
Results: A total of 44 studies were included, identifying 14 index measurement instruments. The most frequently studied instruments were tape measurements, ultrasound, and multi-frequency bio-impedance analysis (MF-BIA). Instruments with very high diagnostic value (Youden index ≥ 0.90) included MF-BIA, perometry, and MRI. However, the quality of evidence supporting these instruments was lacking. Nine different instruments served as references, with tape measurements, consensus criteria, and water volumetry being the most applied.
Conclusion: This review underscores the complexity of accurately diagnosing lymphoedema, with no single instrument emerging as a definitive gold standard. Clinicians must weigh the available evidence and consider the clinical context, such as early detection, when selecting measurement instruments for diagnosing lymphoedema.
Purpose: To assess opioid consumption, availability, and policy alignment for cancer-related pain management in primary health care (PHC)-based inpatient hospice and palliative care (HPC) services in China.
Methods: A multicomponent analysis was conducted, including (1) a cross-national comparison of opioid consumption using International Narcotics Control Board (INCB) data (2020-2022); (2) a census-based assessment of opioid stocking and use in all PHC institutions providing inpatient HPC in a provincial system (2019-2023); and (3) a policy review comparing national Essential Medicines List (EML) with international recommendations. Opioid use was standardized as defined daily doses per million inhabitants per day (S-DDDpm).
Results: China's mean opioid consumption (168 S-DDDpm) was less than half the Asian average (368 S-DDDpm) and far below comparable economies. From 2019 to 2023, the proportion of PHC institutions stocking strong opioids rose from 22.5% to 30.2%, yet total consumption declined from 240.3 to 145.3 S-DDDpm (compound annual growth rate: -11.8%). Regional disparities existed. The national EML included only morphine, omitting most internationally recommended strengths and dosage forms.
Conclusion: Opioid access for cancer-related pain management in China's PHC-based HPC services remains critically inadequate. Expanding essential drug formularies, diversifying formulations, and strengthening PHC prescribing capacity are urgent priorities to reduce disparities and improve quality of life for patients with advanced cancer.
Purpose: This study aimed to evaluate the efficacy and potential pharmacological interaction of naldemedine and magnesium oxide (MgO) in the management of opioid-induced constipation (OIC) in cancer patients, with a particular focus on the impact of different MgO doses on treatment outcomes.
Methods: A total of 171 patients who received opioid therapy were included in this study. The outcome variable was defecation. Daily defecation status during the observation period was extracted from electronic medical records. To assess the effects and potential interaction between naldemedine and MgO on defecation, a generalized estimating equations (GEE) model with a logit link function was used to account for within-patient clustering. Predicted probabilities of defecation were calculated based on the fitted GEE model.
Results: The probability of defecation increased with higher doses of MgO. Among patients receiving both MgO and naldemedine, the likelihood of defecation was significantly higher at MgO doses ≤ 1500 mg compared to those receiving MgO alone. However, at doses > 1500 mg, naldemedine did not add further benefit. Naldemedine was independently associated with improved bowel movements, regardless of MgO use. The association between MgO and defecation also strengthened with increasing doses. No significant interaction between naldemedine and MgO was observed at any dose.
Conclusion: The concomitant use of MgO and naldemedine was associated with improved defecation, although no statistically significant interaction was detected. However, the added benefit of naldemedine may be limited at higher MgO doses. Naldemedine may be particularly effective in patients with constipation during opioid therapy that is insufficiently responsive to conventional laxatives, especially when an increase in MgO is difficult due to risks such as hypermagnesemia.
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