Supportive Care in Cancer最新文献

Purpose: Gastrointestinal (GI) malignancies are major contributors to global cancer-related mortality, with many patients experiencing severe nutritional decline and immune suppression due to chemotherapy. Enteral immunonutrition (EIN), which includes immune-modulating nutrients, has shown promise in improving nutrition, reducing chemotherapy-related side effects, and enhancing immune function, but its role in advanced GI cancer patients undergoing chemotherapy is not well-studied.

Methods: This randomized, controlled study involved 28 patients with advanced GI malignancies, assigned to either standard nutrition or EIN for 42 days. Key measures included nutritional status, immune markers, quality of life (QoL), and chemotherapy-related toxicities. The study also used a preclinical mouse model to evaluate EIN's impact on tumor growth and intestinal health during chemotherapy.

Results: Patients in the EIN group demonstrated significantly improved serum albumin levels on day 28 (P = 0.03) and a higher CD4 + /CD8 + T-cell ratio on day 42 (P < 0.01) compared to controls. EIN supplementation significantly mitigated chemotherapy-induced fatigue and improved QoL scores on days 28 and 42 (P < 0.05). Repeated measures analysis revealed a substantial reduction in pro-inflammatory cytokines (IL-1, IL-6) and an increase in the anti-inflammatory cytokine IL-10 in the EIN group (P < 0.05). Preclinical findings showed that EIN significantly reduced tumor volume (P < 0.05) and preserved the integrity of the intestinal mucosal barrier, evidenced by higher ZO-1 and Occludin expression (P < 0.05).

Conclusion: These findings suggest that EIN during chemotherapy enhances nutritional and immune status, reduces inflammation, and improves QoL, warranting further large-scale trials to confirm its benefits in cancer care.

Trial registration: This trial was registered on the Chinese Clinical Trial Register (ChiCTR2400084224) on 13-05-2024.

Purpose: Access to appropriate supportive care resources and services is essential to improve outcomes for cancer survivors. This study aimed to identify, evaluate and content-map Australian online supportive care resources and services for people living with pancreatobiliary cancers.

Methods: A structured online search was conducted of Australian cancer organisations to identify pancreatobiliary cancer resources and services. Resources and service sites were evaluated (cost, readability, active engagement, diversity (age, sex, gender and culture), consumer voice) and content mapped against published categories of informational needs.

Results: A total of 180 unique online resources and seven service webpages were identified from 19 Australian cancer organisations. On evaluation, 99% resources and services were free to access, 44% of resources were deemed readable (year 8 reading level or below), 24% of resources demonstrated diversity and 24% of all resources and service sites included a cancer survivor voice. Information gaps were identified with topic categories such as body image and sexuality, rehabilitation, prognosis, and interpersonal and social issues.

Conclusions: There is room for improvement across existing online resources. Co-design of an online resource hub, a centralised collection of accessible and appropriate resources is warranted to maximise support and improve the health outcomes of pancreatobiliary cancers survivors and caregivers. Australian pancreatobiliary cancer survivors and caregivers would benefit from better resources that adhere to best practice standards of online support. Future research should explore ways to reduce the information seeking burden and increase the quality of information.

Objective: The effective management of pain in patients diagnosed with gastrointestinal (GI) and genitourinary (GU) cancer remains a clinical challenge, particularly in acute care settings. The objective of this study was to evaluate and compare the analgesic efficacy and safety profiles of intravenous paracetamol, tramadol, and their combination in patients presenting with malignancy-associated acute pain.

Methods: In this prospective, single-blind, randomized controlled trial, 108 adult patients with GI or GU malignancy-related pain (NRS ≥ 4) were randomly assigned to receive paracetamol (1 g), tramadol (100 mg), or their combination. The severity of pain was measured using the Numerical Rating Scale (NRS) at 0, 30, 60, and 120 min after treatment. The primary outcome of the study was a change in pain scores; secondary outcomes included the requirement for rescue analgesia and adverse events.

Results: While all groups demonstrated a reduction in pain over time, the combination therapy group achieved significantly greater reductions in both absolute and percentage pain scores at 60 and 120 min (p < 0.001), and required less rescue analgesia (2.8% vs. 19.4-25.0%). No significant increase in adverse effects (hypotension, desaturation, nausea) was observed in the combination group.

Conclusion: The co-administration of paracetamol and tramadol intravenously resulted in superior and sustained analgesia when compared with monotherapy, without an increase in adverse effects. These findings provide support for the utilization of this combination as a safe and effective multimodal strategy in the acute management of cancer-related pain in the emergency department.

Purpose: Our study aimed to design patient-centered interventions and test their feasibility, acceptability, and effectiveness in improving oral endocrine therapy (OET) adherence in underserved Black women.

Methods: This prospective study included adult, Black women on OET for either the prevention or treatment of breast cancer (BC) at Harris Health in Houston, TX, USA. The first intervention was a motivational interviewing (MI)-based telephone intervention consisting of six monthly calls. The second intervention was a one-time viewing of a theater-based educational video. OET adherence 6 months before and during the MI intervention was measured using the proportion of days covered (PDC) and compared using a paired t-test. Participants also completed a survey at the end of both interventions to determine their acceptability. The survey responses were summarized descriptively.

Results: The majority of participants in MI (n = 20) and video (n = 25) interventions were satisfied with the intervention they received. During MI, the most common barriers identified were adverse drug reactions (hot flashes and muscle/joint pain) and forgetfulness. Three major cultural themes arose in our qualitative analysis: religion/spirituality, family, and trust in healthcare providers. Sixty-five percent of patients showed improved PDC during the intervention, while 24% of individuals who did not complete all 6 MI phone calls did not show improved PDC. There was no significant difference in OET adherence during the MI intervention.

Conclusion: A 6-month telephonic MI intervention and a one-time educational video were each feasible and acceptable approaches for promoting OET adherence in underserved Black women for prevention or treatment of BC.

Purpose: To map the evidence related to radiation recall dermatitis (RRD) in cancer patients previously treated with radiotherapy.

Methods: A scoping review was conducted following the methodology outlined by the JBI Collaboration. The search was performed in PubMed, CINAHL, LILACS, Scopus, Web of Science Core Collection, Cochrane, and grey literature using Google Scholar and ProQuest on January 28, 2025. Studies published in any language and without restrictions on publication year were included.

Results: This review incorporated 210 studies on RRD in cancer patients, with a predominance of case reports and case series (84.7%). Approximately 48% of cases were reported in breast cancer patients. Among these studies, 92 primary articles documented 201 instances of RRD. A significant association was identified with antineoplastic agents (73.6%), predominantly due to chemotherapy, with docetaxel identified as the most frequently reported agent (13.5%). The radiotherapy doses administered ranged from 8 to 65 Grays, and the time intervals between radiotherapy and the onset of the RRD-triggering agent varied widely, from hours to 40 years. This condition can cause symptoms such as erythema, dry and moist desquamation, edema, itching, pain, ulceration, necrosis, and bleeding.

Conclusion: RRD is a significant adverse event, particularly among women with breast cancer, most commonly associated with chemotherapy involving docetaxel and doxorubicin. COVID-19 infection and vaccination have also been reported as potential new triggers of RRD. Further research is needed to clarify the underlying mechanisms and to optimize therapeutic strategies for at-risk patients.

Purpose: Extended hospitalization can lead to fatigue, sleep disturbance, anxiety, depression, and functional decline in cancer patients. This retrospective observational study examined reasons for referral to inpatient one-on-one Yoga Therapy (YT) consultations and observed the delivery of YT to address symptoms. Exploratory analyses examined patient-reported outcomes (PROs) following a single YT session.

Methods: Data from inpatient YT consultations from January 2020 to March 2023 were evaluated. Information included demographics, referral reason, and self-reported symptom burden before and after YT using the modified Edmonton Symptom Assessment Scale (mESAS). Changes in mESAS scores were evaluated by the Wilcoxon signed-rank test.

Results: Pre-post mESAS responses were available for 88/130 YT referrals. Most patients were female (n = 88; 67.7%) and white (n = 101; 77.7%), with a mean age of 53.1. The most common cancer diagnosis was leukemia (19.2%), and 40.8% had metastatic disease. The primary referral reasons were fatigue (76.9%), anxiety/stress reduction (76.2%), and quality of life (62.3%). The highest patient-reported symptoms pre-YT were Fatigue (x ̅ = 5.26), decreased Well-Being (x ̅ = 4.89), and Sleep disturbances (x ̅4.66). Following YT, participants reported clinically and statistically significant reductions in Fatigue (mean difference (MD) = -1.62, p < 0.001, ES = 0.82), Anxiety (MD = -1.56, p < 0.001, ES = 0.78), and Pain (MD = 1.44, p < 0.001, ES = 0.79), with significant reductions in mESAS components except Financial Distress and Spiritual Pain. Change scores were larger for patients scoring ≥ 4 on a specific symptom pre-YT.

Conclusions: Findings suggested that a single inpatient YT intervention provided immediate relief from symptom burden, especially for those reporting high symptom burden. The long-term effects of inpatient YT merits further study as a non-pharmacologic intervention to reduce symptom burden in patients with cancer.

Purpose: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication associated with antiresorptive and antiangiogenic therapies, particularly in oncology patients. Ozone therapy has been proposed as a supportive treatment due to its antimicrobial and tissue-regenerative properties, but its clinical efficacy remains uncertain.

Methods: This systematic review and meta-analysis, registered in PROSPERO (CRD42025631661), followed PRISMA 2020 guidelines. A comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, Cochrane Library, and gray literature. We included clinical studies using ozone therapy in adults with MRONJ. Studies combining ozone with other experimental interventions were excluded. Data on patient characteristics, protocols, and outcomes were extracted. A meta-analysis of proportions was performed using a random-effects model with logit transformation and Hartung-Knapp adjustment. Risk of bias was assessed using Joanna Briggs Institute tools.

Results: Six studies involving 178 patients (65.7% female; mean age ~ 65.9 years) were included. Ozone therapy was administered in gaseous or oil-based formulations, with varied frequencies and application methods. The pooled clinical success rate was 71% (95% CI: 55%-84%), with moderate heterogeneity (I² = 41.9%). Sensitivity analyses confirmed the robustness of the results. No adverse effects were reported. Improvements in pain and quality of life were frequently observed. All studies were classified as having low risk of bias.

Conclusions: Ozone therapy may be associated with clinical benefits in MRONJ management. However, the evidence is of very low certainty due to methodological limitations and heterogeneity. Randomized clinical trials with standardized protocols are needed to clarify its role in supportive care.

Purpose: Cancer is a leading cause of death and disability. Chemotherapy is one of the most common treatments. Physical activity (PA) can improve chemotherapy side effects, fatigue, adherence, survival rates and quality of life. However, people who are undergoing chemotherapy are insufficiently active. This review aimed to identify the barriers to PA in adults who are undergoing chemotherapy for the treatment of cancer.

Methods: Databases were searched for articles that met the eligibility criteria and screened to determine eligibility and risk of bias using the Clinical Appraisal Study Programme Qualitative Checklist. Studies included adults aged > 18 years who were currently undergoing chemotherapy for any type or stage of cancer. Reflexive thematic analysis was used to develop themes, which were deductively mapped to the capability, opportunity, motivation behaviour (COM-B) model and presented narratively. The behaviour change wheel intervention functions enabled identification of potential strategies to address barriers.

Results: A total of 9774 articles were screened. Twenty studies were eligible, including 1085 participants. Side effects of cancer and chemotherapy, other health conditions (capability), knowledge gaps, accessibility, environmental factors, and lack of social support (opportunity); negative emotional response, not having time/prioritising other commitments, and low motivation (motivation) were identified as barriers to PA. Fatigue was the most commonly identified single barrier. Intervention functions to improve PA levels include environmental restructuring, education, training and enablement.

Conclusion: The most commonly reported barriers to PA in people who are undergoing chemotherapy included side effects of cancer and chemotherapy, not having time/prioritising other commitments, knowledge and accessibility. Changes to service accessibility and delivery, and education for the cancer care team and people who are undergoing chemotherapy should be implemented to support increasing PA levels.

Purpose: To examine the prevalence and characteristics of cancer patients in Australia who experienced a delay in starting treatment, according to best practice standards in the Optimal Care Pathways (OCPs).

Methods: A cross-sectional analysis was conducted with 640 adults who accessed Cancer Council Queensland subsidised accommodation while receiving cancer care in a major city. Treatment delay was defined as a diagnosis-to-treatment interval exceeding OCP recommendations.

Results: The median time from diagnosis to treatment was 4.4 weeks (interquartile range: 2.1-8.9 weeks). Of the 494 participants whose data were assessable against OCPs, 199 (40%) experienced a treatment delay. Delay was not associated with age, gender, geographic remoteness, comorbidities, or treatment modality. Participants without private health insurance had higher odds of delay compared to those with insurance (adjusted odds ratio [aOR] = 1.68, 95% confidence interval [CI] = 1.02-2.78), and participants with breast (aOR = 0.32, 95% CI = 0.14-0.74) or skin (aOR = 0.23, 95% CI = 0.09-0.61) cancers had lower odds of delay than those with other cancer types.

Conclusion: Adherence to OCP recommendations was low compared to the generally accepted quality target of 70-85%, with two in five cancer patients experiencing a delay in commencing treatment. Low adherence to these recommendations underscores the need to strengthen system-wide support and accountability measures, particularly for those facing disparities in access to cancer care related to health insurance status and cancer type.