Supportive Care in Cancer最新文献

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.

Purpose: To examine breast cancer survivors' perspectives on the prototype (paper-draft) of a clinical decision tool to support individualized exercise prescriptions and discussions within clinical settings.

Methods: A sample of ≥90 female breast cancer survivors aged ≥35 years across the U.S. were recruited to complete an online survey that collected data on survivors' characteristics and perspectives of a prototype of the tool. Survey items were adapted from validated pre-existing instruments and refined via cognitive interviews.

Results: Ninety-eight of the 142 individuals screened were deemed eligible and completed the survey. Most breast cancer survivors agreed that a tool would be useful (84.7%) and increase confidence to discuss exercise with a healthcare provider (74.5%). Among tool uses, the highest agreement was found for education (84.1%) and encouragement to exercise (79.3%). Improving the ability to do everyday tasks (74.0%), quality-of-life (72.6%), and energy (71.4%) were rated as the top exercise benefits to include in a tool. Agreement on tool usefulness, uses, and inputs varied by survivors' demographic, clinical, and contextual characteristics. For example, agreement that a tool would increase their confidence to discuss exercise was lower among younger survivors (<50 years, 67.7%) than older survivors (≥50 years, 78.5%).

Conclusions: An evidence-based clinical decision tool offering individualized exercise information could support exercise prescriptions and discussions within clinical settings. However, a one-size-fits-all tool may not address existing disparities in exercise participation. Further research among underserved women is needed.

Purpose: Improved survival rates for childhood cancer have resulted in survivors experiencing increased physical and psychosocial late effects. Post-traumatic growth (PTG) refers to positive psychosocial changes in response to trauma, in this case, cancer diagnosis and treatment. The role of PTG in long-term follow-up care (LTFU) is unknown. The aim of this study was to examine the lived experiences of PTG in survivors of childhood cancer, specifically in the context of LTFU.

Methods: We completed an exploratory qualitative study using patient-oriented research methods. Eligible participants were Canadian adult survivors of childhood cancer, at least 5 years post-diagnosis or 2 years post-treatment. Demographic data were gathered by digital survey and summarized using descriptive statistics. Virtual focus transcripts were analyzed using reflexive thematic analysis.

Results: Twenty-two survivors of childhood cancer (mean age 29.2 years, predominantly female and white) participated across five virtual focus groups, with 4 to 6 participants per group. Four key themes emerged: Life Perspectives, Self-Advocacy/Empowerment, Career Choices, and Sharing the Lived Experience. Participants reported shifts in life outlook and priorities, with many pursuing health-related careers. Self-advocacy skills were gained from their cancer experiences, which were felt to be required in the LTFU setting. Finally, survivors valued and gained meaning from sharing their lived experiences.

Conclusion: The PTG themes of Self-Advocacy/Empowerment and Sharing the Lived Experience are novel contributions to the literature. PTG may offer an avenue to improve patient engagement and adherence with LTFU, and future interventions should encourage its incorporation.

Purpose: Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse drug reaction mostly associated to the use of bone-modifying agents. Preventive dental strategies aim to reduce its risk, but the comparative benefit of structured long-term interventions versus a single pre-treatment dental visit remains unclear. This study assessed the impact of a structured long-term, multidomain dental prevention protocol compared with a single baseline dental assessment in patients receiving an oncological-based, high dose (HD) regime of Zoledronic acid (ZA).

Methods: Between 2012 and 2015, two Southern Italian university hospitals enrolled adult cancer and myeloma patients initiating ZA. Participants received either the Standard Protocol (SP), a single pre-treatment dental visit, or the Intensive Protocol (IP), which added scheduled follow-ups and periodontal care. MRONJ was diagnosed using SICMF-SIPMO clinical and radiological criteria.

Results: 202 patients (M/F = 83/119; mean age 63.3 years), were stratified into a SP group (n = 115) and an IP group (n = 87). Eighteen patients developed MRONJ (8.9%). The MRONJ frequency was significantly higher in the SP group (13.9%) compared to the IP group (2.3%) (p = 0.004). MRONJ cases in the SP group showed poorer oral hygiene, a higher rate and severity of periodontitis alongside, and higher post-extraction onset rate.

Conclusion: Multidomain dental prevention long-term protocol was found to be effective in reducing the incidence of MRONJ by ZA therapy, compared to a single pre-therapy dental intervention, with a potential change of case characteristics. These findings support integrating routine dental evaluation and periodontal maintenance into cancer and myeloma care pathways to improve patient safety and oral outcomes.

Purpose: Understanding patients' opinions and beliefs regarding how to support an active life and decrease sedentary behavior (SB) during treatment is necessary to inform effective interventions for reduced SB. Therefore, the purpose was to explore the opinions and beliefs of patients receiving neo- or adjuvant cancer treatment on how to support the decrease in SB and how to replace sedentary time.

Methods: A purposive sample of patients receiving neo- or adjuvant cancer treatment for breast (n = 10), prostate (n = 5), or colorectal cancer (n = 7) partook in five focus group interviews. Transcripts from the interviews were analyzed with a thematic analysis.

Results: Three themes were identified in the analysis: participants describe that the decrease of SB and replacing time in sedentary behavior can be supported by Healthcare and employer engagement, Socialization, and lastly by Self-help. For instance, early information and encouragement from healthcare personnel, adaptations at work, support from relatives and peers, as well as finding routines and setting goals were considered important for reducing SB. Focusing on daily activities and joyful activities were examples of ways to replace sedentary time.

Conclusions: Interventions for reducing SB may benefit from addressing several aspects from the patient's life and focusing on replacing SB with daily activities and not only on health-enhancing physical activity. Healthcare staff should provide early information and continuous encouragement for patients about reducing sedentary behavior during oncological treatment. Collaboration with patients to identify and implement practical strategies such as support from family and friends, workplace adaptations, and goal setting may be helpful.

Background: The aim of this study was to describe functional outcomes during the first 6 months after surgery, providing an overview of the recovery trajectory based on tumour anatomical location.

Methods: A retrospective observational cohort study was conducted. All patients who underwent lower limb resection and reconstruction between January 2019 and December 2023 and received postoperative rehabilitation were consecutively enrolled. Postoperative complications, walking recovery, and climbing three steps were assessed early after surgery. Joint range of motion, muscle strength, timed up and go test, 6-min walking test, and Toronto Extremity Salvage Score were collected at 3 and 6 months of follow-up. The outcomes achieved by the patients were stratified based on the anatomical location of the reconstruction.

Results: A total of 92 patients were included. Patients with pelvic, proximal femoral, and proximal tibial reconstructions had a markedly higher likelihood of failing to perform early stair climbing compared with those with distal femur reconstruction, which showed the best early functional outcomes (non-execution rates: 87%, 75%, and 85%, respectively). A similar pattern was observed at 3 months for joint mobility, muscle strength, and motor performance. By the second follow-up, these differences tended to diminish, particularly for proximal femoral and proximal tibial reconstructions, whereas pelvic reconstruction consistently remained associated with the slowest recovery. Despite this improvement, muscle strength recovery continued to be significantly lower in these groups (p = 0.021). Autonomy recovery analysis confirmed this gradient, showing a 22.9-point deficit (95% CI -46.5 to -0.6) in patients with pelvic reconstruction.

Conclusion: Compared with patients undergoing distal femur reconstruction, those undergoing pelvic reconstruction showed slower and less satisfactory functional recovery, whereas patients with proximal femur and proximal tibia reconstructions experienced delayed but progressive improvement. Recovery trajectories differ according to anatomical site, and these findings provide practical reference points to guide individualised physiotherapy planning and set realistic location-specific rehabilitation goals.

Trial registration: The study has been registered in the clinicaltrial.gov database with number NCT06376539 (first submitted 15/04/2024).

Psychiatric symptoms are frequently found in patients with cancer and often require specific pharmacological treatment. Depression seems to be the most common psychiatric disorder followed by adjustment disorders, anxiety, and delirium. Psychiatric comorbidities are responsible for worse quality of life and low adherence to anticancer treatment. Many different psychiatric drugs are beneficial, but there are increasing risks of drug-drug interactions (DDIs) with anticancer drugs. We conducted a PRISMA-compliant systematic review (PROSPERO registered) on drug-drug interactions between psychiatric and anticancer medications, using predefined search terms in electronic databases and specialized interaction software. Only six studies met the predefined inclusion criteria, confirming a significant lack of evidence on this topic. The available studies were often limited by small sample sizes, inadequate controls, or insufficient assessment of drug interactions. Our expanded search in drug interaction software allowed us to cross-reference results and identify clinically relevant interactions. The aim of this paper is to collect and summarize in a user-friendly format the most significant DDIs and to show unfavorable and potentially dangerous combination of drugs.

Purpose: Breast cancer is the most commonly diagnosed cancer among women, and breast cancer survivors face ongoing challenges related to physical, psychological, and social well-being. Social media-based interventions have emerged as potential tools for knowledge dissemination, emotional support, and health management, yet their effectiveness remains under-researched. This review identifies gaps in the current literature and offers recommendations to guide future research and improve social media use in survivorship care.

Methods: A comprehensive literature search was conducted using PubMed, MEDLINE, Embase, CINAHL, Web of Science, and Google Scholar to identify studies published from database inception through March 2025 that examined the use of social media interventions. Studies were categorized into key themes: knowledge acquisition, social support, psychological health, and physical health outcomes.

Results: Breast cancer survivors may use social media interventions for knowledge acquisition, allowing them to exchange information, engage in peer support, and access expert resources. While these platforms improve understanding of treatment-related concerns, challenges such as misinformation and information overload remain. Social media interventions offer emotional support, fostering peer connections and reducing isolation, often through hashtags that allow individuals to connect, share experiences, and seek emotional support, and allow for anonymous self-expression. However, the emotional amplification of shared suffering may heighten distress. For psychological health, mixed findings suggest that social media has no effect or, in some cases, a negative impact on anxiety and depression experienced by breast cancer survivors. Social media interventions promoting physical activity promise to improve exercise adherence and health outcomes, though long-term effects remain unclear.

Conclusion: Social media interventions have the potential to improve knowledge acquisition and support for breast cancer survivors. Future research should focus on randomized controlled trials to better understand the impact of social media interventions on social support and well-being.