Supportive Care in Cancer最新文献

Purpose: Accurate estimation of energy needs is essential for effective nutrition interventions to improve outcomes in head and neck cancer (HNC). However, predictive equations used to estimate energy requirements may be inaccurate in cancer populations. To inform effective intervention delivery, this systematic review synthesised evidence regarding resting or total energy expenditure (REE or TEE) measured using reference methods (indirect calorimetry or doubly labelled water) in adults with any stage of HNC.

Methods: Four databases (Ovid MEDLINE, Embase, CINAHL plus, Cochrane Central Register of Controlled Trials) were searched, and eligible studies included comparisons of energy expenditure to non-cancer controls, predictive equations, wearable devices, or repeated measurements before and after treatment. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

Results: Eleven studies (n = 439) were included. All measured REE using indirect calorimetry; none assessed TEE or wearable devices. One study compared REE to non-cancer controls (n = 40 per group) and found no significant difference. Pooled pre-treatment REE was 1502 kcal/day (10 studies, n = 431). Measured REE was higher than predicted (mean difference 110 kcal/day, p = 0.001, eight studies, n = 333, low certainty) and decreased following treatment (mean difference -140 kcal/day, p < 0.001, five studies, n = 176, low certainty); differences were < 10% of overall REE and not considered clinically important.

Conclusion: At the group level, REE was relatively stable throughout HNC treatment and reasonably estimated with predictive equations. However, to ensure accuracy in REE determination at the individual level, increased uptake of indirect calorimetry in HNC research is needed to guide clinical practice.

Prospective registration: PROSPERO, 23 May 2024 (CRD 2024533495).

Purpose: Patients with head and neck squamous cell carcinoma (HNSCC) undergoing curative radiotherapy or chemoradiotherapy often experience adverse effects affecting physical and psychosocial health, which can lead to a deconditioning cycle, worsening side effects, treatment tolerance and quality of life. This multicenter phase II study evaluated whether physical rehabilitation combined with nutritional care could improve exercise tolerance and reverse the deconditioning cycle.

Methods: Patients with localized HNSCC undergoing curative radiotherapy or chemoradiotherapy were randomized into two groups. One group engaged in a physical rehabilitation (PR) program, including quadriceps electrical stimulation three times a week during treatment, followed by three weekly sessions of home-based ergocycle training for 12 weeks, while the control (CT) group received standard care. Both groups received nutritional care. Success of the PR program was defined as a 40% increase in the patient's baseline endurance time or the ability of the patient to sustain the activity for 30 min at three months.

Results: Seventy patients were included, with 33 patients in the PR group. The success rate was higher in the PR group program (68%, CI 95% 48-84) than to the CT group (27%, CI 95% 16-48). From T0 to T2, the median endurance time changed by + 54% in PR vs. -55% in CT. No significant difference was observed regarding quality of life.

Conclusions: Our results highlight that physical rehabilitation combined with nutritional care is feasible in this setting, and could improve exercise tolerance without modifying patient's quality of life. It emphasizes the crucial role of physical activity during cancer treatment.

Clinical trial registration number: NCT02135185 on February 6, 2014 (retrospectively registered).

Purpose: Oral frailty screening and care for elderly cancer patients undergoing chemotherapy have yet to be integrated into cancer care protocols, and there persists a notable deficiency in knowledge concerning the experiences of elderly cancer patients suffering from oral frailty. This study aims to explore the experiences and responses of elderly Chinese cancer patients undergoing chemotherapy for oral frailty.

Methods: Beginning in February 2024, a purposive sampling approach was used to select elderly cancer patients undergoing chemotherapy who scored four or higher on the Oral Frailty Index-8 scale for semi-structured interviews. Two researchers analyzed the data using interpretive phenomenological research methods.

Results: Twenty-five elderly cancer patients undergoing chemotherapy with oral frailty were recruited. Four themes were identified: (1) The eroded mouth, impairment and decline; (2) confronting a failing body, at a loss and exhausted; (3) navigating uncertainty, helplessness and struggles; and (4) finding a new balance, transcendence and personal growth. Among these four themes, the researchers developed 13 subthemes.

Conclusion: The experiences and coping processes of oral frailty in elderly cancer patients undergoing chemotherapy are complex, encompassing both positive and negative physical and psychological experiences. Oncology nurses must emphasize the oral health of elderly cancer patients undergoing chemotherapy and integrate oral frailty screening and care throughout the entire cancer treatment process.

Objective: To evaluate the effectiveness of pharmacist-led medication therapy management services (MTMs) in managing cancer pain for home-based patients under a medical consortium model.

Methods: A prospective randomized controlled trial was conducted involving 100 discharged cancer patients with moderate-to-severe pain. Participants were randomly assigned to either the MTMs intervention group or the conventional care group. Outcome measures, including pain scores, pain relief levels, medication adherence, and anxiety levels, were assessed at 24 h after admission (baseline), 7 days, 1 month, and 3 months of follow-up.

Results: After 3 months, both groups exhibited significant reductions in pain scores compared to the 24-h baseline (P < 0.01). However, the intervention group demonstrated significantly lower pain scores (3.54 ± 0.76 vs 4.50 ± 1.18) and higher pain relief rates (CR + PR: 36.0% vs 12.0%). The proportion of patients with poor adherence in the intervention group was significantly lower than that of the control group (P < 0.01), and the improvement rate in medication adherence was significantly higher (50% vs 6%, P < 0.01). Furthermore, the intervention group showed a lower level of anxiety (P < 0.01) and a greater improvement in anxiety (38% vs 12%, P < 0.01).

Conclusion: The implementation of standardized MTMs by pharmacists within the medical consortium effectively extended pharmaceutical care to the home setting. This intervention improved pain relief, enhanced medication adherence, and reduced anxiety among cancer pain patients; these findings support the potential for broader clinical application of this pharmacist-led model within integrated healthcare systems.

Purpose: This study aimed to establish and validate a machine learning model for predicting moderate-to-severe cancer-related fatigue (CRF) 2 years after completion of anti-tumor therapy in breast cancer patients.

Methods: Clinical and laboratory data from 183 patients were retrospectively collected. Candidate predictors were screened using multivariate logistic regression, and seven algorithms-logistic regression, decision tree, random forest, support vector machine, extreme gradient boosting (XGBoost), k-nearest neighbor, and naïve Bayes-were constructed in the training cohort and validated in the testing cohort. Model performance was assessed by discrimination, calibration, and decision curve analysis.

Results: The 2-year incidence of moderate-to-severe CRF was 54.0%. Eight independent predictors were identified, including age, body mass index, histological grade, menopausal status, hemoglobin, platelet count, neutrophil count, and systemic immune-inflammation index. Models built on these features demonstrated variable performance, with XGBoost showing the most favorable balance. It achieved an AUC of 0.983 in the training set and 0.766 in the validation set, with robust accuracy, sensitivity, and specificity. Calibration plots indicated good agreement between predicted and observed risks, while decision curve analysis confirmed higher net clinical benefit across a wide range of thresholds.

Conclusion: The XGBoost-based model provided reliable long-term CRF risk prediction, supporting early identification of high-risk patients and informing personalized survivorship care.

Purpose: Obtaining firsthand insight into breast cancer facilitates a detailed understanding of women with breast cancer' emotional experiences, thereby promotes holistic cancer care. This study aimed to identify the emotions experienced by women undergoing mastectomy during the disease and treatment process.

Methods: This qualitative study, based on a descriptive phenomenological design, was conducted using semi-structured interviews to explore the emotions of women who had undergone mastectomy during the diagnosis and treatment stages. Twenty-nine breast cancer women with breast cancer aged 27-68 who had undergone mastectomy participated in the study, which was carried out in the general surgery clinic of a university hospital. The data obtained from the interviews were subjected to thematic analysis.

Results: It was found that women undergoing mastectomy experience a wide range of emotions at all stages of breast cancer and develop corresponding coping strategies. Five themes emerged from the analysis: emotions related to diagnosis, emotions related to treatment, future-oriented emotions, coping strategies, and family and social relationships. Unlike the findings reported in the literature, this study revealed that women often expressed reactions such as "wanting to die" or "not feeling anything" during the diagnosis process. In terms of family relationships, diverse factors such as divorce, spousal psychological violence, spousal support, and physical violence were noted.

Conclusions: Having breast cancer triggers profound emotional fluctuations in women, such as fear, uncertainty, burnout, and disturbances in self-perception. While hope and optimism for the future are fueled by positive emotions such as social support and a desire to see children happy, negative experiences such as cancer stigma and psychological violence increase the emotional burden. Supportive care teams are recommended to enhance psychosocial support services, promote the emotional well-being of women after mastectomy, strengthen family and social participation, develop individualized care plans, and implement holistic approaches through team-based care.

Background: Transoral endoscopic head and neck surgery is an important modality in hypopharyngeal carcinoma therapy. Minimally invasive techniques and nerve protection are important components of Enhanced Recovery After Surgery principles. However, the limited surgical space and the challenges in identifying the internal branch of the superior laryngeal nerve (ibSLN) pose difficulties during this procedure. This study investigated the effects of preserving the ibSLN during transoral laser surgery on the postoperative swallowing rehabilitation of patients diagnosed with pyriform sinus carcinoma.

Methods: A prospective cohort study with a retrospective control group was performed, including 42 patients with pyriform sinus carcinoma who had previously undergone transoral laser surgery. The participants were categorized into the ibSLN dissection and control groups. In the ibSLN dissection group, the ibSLN was exposed and dissected without nerve lesions. Traditional transoral surgery without proactive ibSLN dissection was performed in the control group. Demographics, operative data, postoperative swallowing function, tube removal time, and postoperative hospitalization time were evaluated and compared between both groups.

Results: Although the surgery time was longer in the ibSLN dissection group, the normal food intake, tube removal time, and postoperative hospitalization times were significantly shorter than those in the control group (P < 0.05). The MD Anderson Dysphagia Inventory (MDADI) scores after surgery significantly improved in the ibSLN dissection group. At 14 days post-surgery, significant improvements were observed in the four MDADI subset scores: global (P < 0.001), emotional (P < 0.05), functional (P < 0.05), and physical (P < 0.05). The postoperative water swallowing test showed a significantly faster swallowing speed in the ibSLN dissection group compared to the control group (P < 0.001). Fiberoptic endoscopic evaluation of swallowing showed a reduction in the epiglottic mobility impairment, aspiration, and residue in the pyriform fossa in the ibSLN dissection group, although the difference was not statistically significant.

Conclusions: Identification and dissection of the ibSLN can be successfully performed during transoral laser surgery in patients with pyriform sinus carcinoma. ibSLN dissection during transoral laser surgery has the potential to mitigate the risk of ibSLN damage, thereby facilitating enhanced recovery after surgery.

Purpose: Fatigue is one of the most common and troublesome symptoms in cancer survivors and is strongly correlated with pain. We evaluated the effect of acupuncture versus usual care for fatigue among cancer survivors with chronic pain.

Methods: We analyzed data from a randomized clinical trial comparing the effect of electro-acupuncture (EA) or battlefield acupuncture (BFA) versus waitlist control (WLC) for chronic musculoskeletal pain in cancer survivors. Analysis included participants who reported moderate or severe fatigue at baseline. Interventions were delivered over 10 weeks. Fatigue severity was measured using the Brief Fatigue Inventory (BFI).

Results: Among 274 participants (mean age 61.0 years [standard deviation (SD)] 12.8; 73.0% women), the baseline BFI worst fatigue score was 7.1 (SD 1.7). EA and BFA were associated with reductions in worst fatigue score of 2.4 points (95% confidence interval [CI]: - 2.9 to - 1.9) and 2.0 points (95% CI: - 2.5 to - 1.5) from baseline to week 12. There was no significant between-group difference. A higher proportion of patients in both EA and BFA experienced clinically meaningful fatigue improvement compared to WLC (61.2% and 51.6% vs. 37.3%, p = 0.019). Fatigue reductions persisted at week 24 (EA: -2.1 points [95% CI: -2.6 to -1.7]; BFA: -2.2 points [95% CI: -2.8 to -1.7]).

Conclusion: Cancer survivors with chronic pain experienced clinically meaningful and durable fatigue reductions when receiving either EA or BFA.

Implications for cancer survivors: These findings support the clinical utility of acupuncture as an evidence-based option for managing fatigue in cancer survivors with pain.

Trial registration: ClinicalTrials.gov Identifier: NCT02979574; November 30, 2016.