Supportive Care in Cancer最新文献

Purpose: The present study aims to reveal the relationship between the empathic tendencies and sleep quality of caregivers of cancer patients.

Material and method: This cross-sectional study was conducted with caregivers of cancer patients registered in the oncology unit of a hospital between May and July 2024 (n = 346). The study data were collected using a sociodemographic information form, the Empathic Tendency Scale, and the Pittsburgh Sleep Quality Index. The data were analyzed using the Pearson correlation and hierarchical regression analyses as well as descriptive statistics.

Findings: 59.5% of the participants were female and 88.2% lived with patients. 62.7% of the cancer patients were male and 61.1% were partially dependent in daily life activities. The caregivers had a mean total score of 70.58 ± 16.85 on the Empathic Tendency Scale and a mean total score of 4.40 ± 3.94 on the Pittsburgh Sleep Quality Index. It was found that there was a negative, strong, and statistically significant relationship between the mean total scores on the Empathic Tendency Scale and the Pittsburgh Sleep Quality Index (r = - 0.924; p < 0.001). According to the hierarchical regression model, certain sociodemographic features of the caregivers explained the variance in empathic tendency (Adj. R² = 0.607; p < 0.001), whereas when sleep quality components were added to the model, the variance in empathic tendency was explained (Adj. R² = 0.896; p < 0.001).

Conclusion: The caregivers of cancer patients were found to have high empathic tendencies, which was associated with high sleep quality. Furthermore, low empathic tendencies among the caregivers were found to be primarily associated with increasing length of care and advancing patient age. The findings underscore the pivotal role that empathic approaches play in enhancing the quality of care, underscoring the necessity for augmented interventions that prioritize a compassionate approach, and the management of empathy in caregivers of cancer patients.

Purpose: This study aimed to examine the existing literature on the grief experienced by siblings of cancer patients who have died, focusing on adaptation processes, emotional impact, and support needs of this population during and after the illness.

Methods: The current scoping review follows the PRISMA-ScR guidelines. Peer-reviewed articles that explored the experiences of sibling grief due to oncological death were included. The search was conducted on twelve databases in July 2023. Thirty-four studies were included.

Results: Findings evidenced a lack of sample representativity. Moreover, coping with grief depends on several facilitating and hindering factors. Quality of the sibling bond, passage of time, recreational activities, social support, healthcare professionals' communication during illness and after death, and cultural practices are among the most common facilitating factors. Conversely, isolation, inadequate social support, and a lack of information about illness and death may hinder grief coping. Intervention studies play a key role in assessing social support and helping individuals construct meaning around death and loss. Recommendations for a better approach to managing grief in siblings are reported.

Conclusion: The topic studied could benefit from further research as no study includes samples from low- and middle-income countries. A better understanding of how the sibling bond affects grief and coping is needed to tailor interventions for these populations. A cohesive response from healthcare professionals, community-based support, and school-based support is needed to accompany the family and the bereaved sibling during illness and after the patient's death.

Purpose: Family members predominantly serve as the primary caregivers for cancer patients. However, the experiences of caregivers in regions lacking palliative care support have not been thoroughly investigated, particularly when elderly cancer patients enter the terminal phase. This study aims to explore the experiences of caregivers for elderly cancer patients in the terminal stage, focusing on areas with limited palliative care resources. This study aims to identify the suffering and desires of caregivers, providing a foundation for enhancing palliative care services in economically underdeveloped regions.

Methods: A qualitative study was conducted from March to October 2023. Face-to-face, in-depth, semi-structured interviews were employed to collect data from 13 Chinese family caregivers of elderly terminal cancer patients. Participants were recruited using purposive sampling. The interview data were analyzed using Colaizzi's seven-step analysis method. The study's rigor was ensured through the application of Lincoln and Guba's criteria.

Results: The analysis of gathered data reveals a pernicious cycle wherein physical challenges and psychological distress exacerbate one another, further compounded by a dearth of support. This intricate interplay underscores the complex relationship between physical, psychological, and support-related needs.

Conclusion: The development and provision of respite services, enhancement of death education, improvement of physicians' communication skills regarding end-of-life information, and establishment of supportive home care plans are deemed necessary. It is recommended that local governments refine the palliative care system, ensuring seamless integration of palliative care from top-tier hospitals to communities and homes. These measures aim to meet caregivers' expectations while assisting them in overcoming their challenges. The findings herein not only contribute to the improvement of local palliative care services but also offer valuable insights for the enhancement of global palliative care provision.

Purpose: Chemoimmunotherapy is the primary treatment approach for non-small cell lung cancer (NSCLC); however, it is associated with immune-related adverse events (irAEs). Corticosteroids can control irAEs through their anti-inflammatory and immunosuppressive effects. Dexamethasone (DEX) is a potent corticosteroid commonly used to prevent chemotherapy-induced nausea and vomiting (CINV). This study aimed to the association of corticosteroids used to alleviate CINV and irAE occurrence.

Methods: This retrospective study included patients with NSCLC who underwent chemoimmunotherapy across eight hospitals. Cases lacking aprepitant use were excluded. All corticosteroids for CINV were standardized to intravenous DEX doses, and cutoff values were calculated using receiver operating characteristic curve analysis. Logistic regression analysis was performed to investigate irAE risk factors.

Results: The cutoff value for DEX was 15.9 mg (area under the curve, 0.58; 95% confidence interval, 0.45-0.70; sensitivity, 0.63; specificity, 0.61), with 99 and 76 patients in the DEX < 15.9 and ≥ 15.9 mg groups, respectively. Patients in the DEX < 15.9 mg group had a significantly higher incidence of irAE than patients in the DEX ≥ 15.9 mg group (P = 0.03). Multivariate analysis identified that DEX < 15.9 mg was a risk factor for irAEs (P = 0.04; odds ratio: 2.51; 95% confidence interval, 1.03-6.09).

Conclusion: Corticosteroids with DEX equivalent doses of < 15.9 mg in combination with aprepitant for CINV may elevate the risk of irAEs. Therefore, diligent monitoring for irAEs occurrence is warranted in regimens utilizing DEX-equivalent corticosteroid doses of < 15.9 mg combined with aprepitant for CINV prevention.

Purpose: This cross-sectional study aimed to investigate the incidence and related factors of financial toxicity among nasopharyngeal carcinoma (NPC) patients and propose strategies for improvement.

Methods: Patients with nasopharyngeal carcinoma were recruited from December 2022 to June 2023 in Changsha, Hunan Province, China, using convenience sampling. A questionnaire survey focusing on financial toxicity among patients with nasopharyngeal carcinoma was conducted. The assessment tools used in this study include Comprehensive Scores for Financial Toxicity Based on the Patient-Reported Outcome Measures (COST-PROM), Medical Coping Modes Questionnaire (MCMQ), and Perceived Social Support Scale (PSSS).

Results: A total of 155 patients with nasopharyngeal carcinoma were included in the study. The incidence of financial toxicity among participants was found to be 65.8%, with an average COST score of 22.45 ± 7.91. A significant negative correlation was shown between MCMQ scores and financial toxicity in patients (r = -0.235, p = 0.003), while a significant positive correlation was demonstrated between the PSSS scores and financial toxicity (r = 0274, p = 0.001). The multiple linear regression analysis showed that personal monthly income, MCMQ scores, and PSSS scores were related to financial toxicity in patients with nasopharyngeal carcinoma.

Conclusion: This study revealed a high prevalence of financial toxicity in patients with nasopharyngeal carcinoma. The medical staff needs to identify the financial toxicity early and adopt appropriate strategies to help patients with nasopharyngeal carcinoma return to work, guide them to choose positive medical coping modes, and access more excellent social support.

Purpose: Unplanned readmissions have profound medical and financial implications for patients and hospitals. Cancer patients are particularly susceptible to readmission and often face complex care needs. This quality improvement project aimed to identify factors associated with avoidable hospitalizations among oncology patients.

Methods: Hospital discharges of adult cancer patients at Stony Brook University Hospital (June 2021-July 2022) were reviewed to identify unplanned 30-day readmissions. Readmissions were categorized as avoidable or unavoidable. Factors analyzed included patient demographics, cancer characteristics, social factors, outpatient follow-up, and palliative care involvement.

Results: Of the 468 hospitalized cancer patients, 96 (21%) were readmitted within 30 days of discharge. Most readmitted patients had stage IV disease (51%). Fifty-seven percent of patients were symptomatic on index admission compared to 100% on readmission. Pain was the most frequently reported symptom, increasing from 36 patients (38%) on index admission to 54 (56%) on readmission (p < 0.001). Notably, 16 patients (17%) were discharged on comfort-focused care and 11 (12%) died inpatient on readmission. Palliative care was consulted 2.3 times more frequently during readmission compared to index admission. Readmissions were determined to be avoidable for 27 patients (28%). A complaint of failure to thrive on readmission (p < 0.04), no identifiable post-discharge caretaker (p < 0.009), being symptomatic at index admission (p < 0.04), and not attending an outpatient visit prior to readmission (p < 0.05) were associated with avoidable readmissions.

Conclusion: Timely outpatient support and early palliative care involvement to manage symptoms and optimize care transitions are readily addressable measures that may reduce avoidable readmissions among advanced-stage cancer patients.

Purpose: Even with antiemetic prophylaxis, patients undergoing cancer chemotherapy often still experience chemotherapy-induced nausea and vomiting (CINV). Neurokinin-1 (NK-1) receptor antagonists will prevent CINV effectively but are not affordable for patients of low socioeconomic status.

Methods: In this group sequential, response adaptive randomized double-blinded clinical trial, patients of low socioeconomic who cannot afford NK-1 receptor antagonists, planned for highly emetogenic chemotherapy (HEC) agents received olanzapine 5 mg plus pregabalin 75 mg or placebo orally for five days add-on to standard antiemetic therapy (injection ondansetron 8 mg + injection dexamethasone 12 mg on day one followed by oral dexamethasone 8 mg on days 2 to 4). The primary outcome was the difference in the proportion of patients with "overall no nausea" between groups. Following the interim analysis, the allocation ratio was modified, resulting in more patients being assigned to the well-performing arm.

Results: Initially, 30 patients were equally randomized into two groups. As the experimental group performed well in the interim analysis, the allocation ratio was changed to 2:1 for the subsequent period. Finally, the experimental group (n = 36) performed better in terms of "overall no nausea" than the control group(n = 18) (41.6% vs. 5.5%, p = 0.008). Sedation and dizziness were significantly greater in the experimental group compared to the standard-of-care group.

Conclusion: Olanzapine 5 mg plus pregabalin 75 mg add-on to a combination of dexamethasone and ondansetron will significantly prevent the incidence of CINV compared to a combination of dexamethasone and ondansetron alone. However, the combination is associated with sedation and dizziness as adverse events.

Trial registration: Clinical trial registry-India (CTRI/2021/08/035451). Registration Date: 05/08/2021.

Malignant ascites (MA) and repeated paracentesis can impair a patient's quality of life (QOL). The aim was to perform an interim analysis of safety and changes in patients' QOL in an ongoing prospective, multicentre (conducted within the Central and Eastern European Gynaecologic Oncology Group (CEEGOG)) trial on symptomatic MA drainage with a patient-controlled central vascular catheter (CVC) inserted into the abdominal cavity. CVC (14-Ga) was inserted into the abdominal cavity of patients with symptomatic MA, and drainage was controlled by patients at home. The rate and quality of complications were classified according to Common Terminology Criteria for Adverse Events Version 5.0. QOL was evaluated before and 10-14 days after/during drainage with standardized QLQ-C15-PAL, SGA, and FACIT-TS-G questionnaires. Wilcoxon and Chi-squared tests were used. Among 113 recruited patients (2015-2022), seven patients experienced complications (6.2%), and there was one patient with a serious adverse event (death on the 9th day after catheter insertion, classified as not related to the intervention). Adverse events included local infection (n = 2) (resolved after oral antibiotics), catheter obstruction (n = 2), catheter self-removal (n = 2) (re-insertion performed), and nausea (n = 1). When comparing the assessment before and after/during drainage, we found the significantly better global QOL (mean 31.8 vs. 47.8, p < 0.001), improvement in physical (52.6 vs. 64.4, p < 0.001) and emotional functioning (50.7 vs. 65.4, p < 0.001); symptoms were significantly less intense: fatigue (66.7 vs. 50.9, p < 0.001), nausea and vomiting (37.8 vs. 21.4, p < 0.001), pain (53.9 vs. 34.1, p < 0.001), dyspnoea (48.5 vs. 22.3, p < 0.001), insomnia (49.1 vs. 34.3, p < 0.001), appetite loss (56.3 vs. 40.3, p < 0.001), and constipation (31.0 vs. 25.2, p = 0.007), and more patients had no pain on eating (71.3% vs. 82.9%, p = 0.04). Most patients (78%) were satisfied, 83% would recommend the procedure to others, and 90% would choose intervention again. The interim analysis provided data on the safety and improvement of patients' QOL after MA drainage via patient-controlled CVC inserted into the abdominal cavity, thus justifying the continuation of recruitment for the main trial without changes in the protocol.

Purpose: This study aimed to assess the factors influencing self-reported taste and smell disturbances in patients with colorectal cancer.

Methods: A total of 152 participants were enrolled in the study. All subjects completed surveys that assessed taste and smell alterations using the Taste and Smell Survey (TSS), linear analog self-assessment (LASA), Patient-Generated Subjective Global Assessment (PG-SGA), and Pittsburgh Sleep Quality Index (PSQI). The TSS gathered data on the nature of taste and smell changes and their impact on quality of life. LASA was employed to evaluate the quality of life in cancer patients, while PG-SGA was used to indicate the nutritional status of the participants. PSQI was used to evaluate sleep quality.

Results: Among the 152 colorectal cancer patients, the total TSS score was 5.68 ± 2.84. No changes were observed in 5 cases (3.3%), mild changes in 58 cases (38.2%), and moderate to severe changes in 89 cases (58.6%). The severity of taste and smell disturbances increased with tumor stage, the cycle of chemotherapy, deteriorating sleep quality, and poor nutritional status, displaying significant correlations. Additionally, 83 patients (54.6%) complained of taste abnormalities, while 81 (53.3%) reported smell abnormalities.

Conclusion: Taste and smell disturbances are prominent in colorectal cancer patients. Taste abnormalities are significantly correlated with tumor stage, the cycle of chemotherapy, sleep quality, and nutritional status. Recognizing the high prevalence of taste and smell abnormalities and the influencing factors among patients with colorectal cancer may aid in predicting and understanding the severity of these symptoms more effectively.

Purpose: The experience of cancer diagnosis and treatment is associated with significant stress. While religion and spirituality (R/S) can provide crucial support, many patients also experience R/S distress. Screening for distress has gained recognition, with tools evolving to address spiritual needs; however, existing screening measures have limitations. This study aims to validate screening items for R/S distress among cancer patients undergoing treatment, using a standardized chaplain assessment as a reference standard.

Methods: The study involved adult cancer patients undergoing outpatient treatment at Rush Cancer Center. Procedures included researcher-administered screening questions and the ONC-5 spiritual assessment interview with a board-certified chaplain. Data included demographics, illness variables, and R/S measures. Eight single-item and two multi-item screening measures were evaluated against the ONC-5. Analysis entailed descriptive statistics and sensitivity/specificity determination.

Results: Study participants (N = 71) were predominantly female (53.5%) with common cancers (breast, colon/rectum, and lung). R/S distress was evident in 19.7%. Single-item screeners exhibited sensitivities from 14 to 71% and specificities from 72 to 98%. The King 2-question combination showed 71% sensitivity and 63% specificity. The Rush protocol demonstrated 36% sensitivity and 88% specificity. Post hoc analyses of two-item combinations did not enhance sensitivity.

Conclusion: This study evaluated R/S distress screening items among outpatient cancer patients. The single-item screener asking whether participants' R/S provided all the strength and comfort needed now performed best with a sensitivity and specificity of 71% and 83%, respectively. Despite limitations, our findings underscore the importance of refining R/S distress screening tools in oncology care.