Supportive Care in Cancer最新文献

Aim: To evaluate the characteristics of patients with advanced cancer who die in an acute palliative care unit (APCU), and the risk factors for death in APCU.

Methods: Adult consecutive patients with advanced cancer admitted to the APCU in a period of 13 months were prospectively assessed. At APCU admission, epidemiologic data, characteristics of admission, cachexia, being on-off anticancer treatment, and Edmonton Symptom Assessment System (ESAS) and MDAS (Memorial Delirium Assessment Scale) were assessed. Patients who died in APCU were extrapolated from the entire sample. A similar random sample of patients who were discharged alive in the same study period, matched for age and gender, was selected for comparison.

Results: Fifty-four patients (12%) died in APCU. Statistical differences between died and discharged patients were found in MDAS (p =  < 0.0005), admission for cognitive/clinical decline (p =  < 0.0005), referral from specialistic home palliative care (p < 0.0005), cachexia (p = 0.018), being off cancer treatment (p =  < 0.0005), and symptom burden (total ESAS) (p = 0.002). At the multivariate analysis, independent factors associated with dying in APCU were MDAS (p = 0.006), referral from specialistic home palliative care (p = 0.025), being off cancer treatment (p = 0.002), pain and dyspnea intensity (< 0.05 and p = 0.038, respectively), and total ESAS (p = 0.025).

Conclusion: Mortality risk in APCU is associated with home palliative care referral, high symptom burden, and being off-cancer treatment. More proactive and timely end-of-life care is needed for these patients.

Purpose: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect in patients with breast cancer undergoing chemotherapy. This study aimed to assess the effects of three different intermittent hypothermia temperatures applied to the hands and feet on CIPN symptoms in patients with breast cancer undergoing chemotherapy.

Methods: In total, 108 patients were randomly divided into three experimental groups (n = 36). Patients wore cold gloves and foot covers (groups 1-3, three 10 °C intervals from 0 to - 30 °C) for 15 min before and after each infusion. CIPN symptoms and their interference with activities of daily living (ADL) were assessed before the intervention and after the third and sixth cycles. Hypothermia tolerability and safety were also evaluated.

Results: Baseline characteristics were similar across groups. After three intervention cycles, the scores were lower in group 3 than in group 1 for finger/hand numbness, toe/foot numbness, finger/hand/toe/foot discomfort, muscle/joint pain, and arm/leg weakness. After six intervention cycles, group 3 showed lower scores than group 1 for finger/hand tingling, toe/foot tingling, and difficulty maintaining balance. After six cycles of intervention, the influence of CIPN on ADL in all dimensions (except getting along with others) and the total score was lower in group 3 than in group 1. Additionally, CIPN symptoms and effects on activities of daily living were significant across time, groups, and interactions.

Conclusions: Intermittent hand-foot therapy (- 20 to - 30 °C) was the most effective for improving symptoms and ability to perform day-to-day activities. All temperatures tested were well-tolerated and safe.

Purpose: The increasing survival rates of oncology patients have led to a corresponding increase in long-time survivors living with chronic cancer-related pain. Data is scarce on the care situation for this distinct clinical entity and on specific therapy requirements, such as interdisciplinary, multimodal pain therapy (IMPT). Our cross-sectional study aimed to assess the current care situation, distinct chronification factors, and optimization potential. This survey addresses this need in Germany, but also provides results with international implications.

Methods: Via an online survey, German Pain Society members involved in the treatment of long-time survivors with chronic cancer-related pain assessed the current care situation, chronification factors, specific treatment needs, and the required practitioner's expertise. The German Pain Society's Cancer Pain Working Group created the non-validated questionnaire using the Delphi method.

Results: One hundred fifty-nine Pain Society members across 70% of Germany's postal regions answered our survey. Respondents (primarily physicians, and 75% with + 6 years of experience) assessed the care situation as worse for chronic cancer-related pain compared to acute pain. Only 10% of the sites provided specific therapy for chronic cancer-related pain (mostly via outpatient treatment). Compared to non-cancer-related pain, additional, cancer-specific chronification factors were assumed, especially at psychological levels, and these need incorporating into therapies. A majority of practitioners recommended cancer-specific IMPT and specific pain expertise for this distinct clinical entity.

Conclusions: Members from the German Pain Society assume that there are relevant deficits in the care of long-term survivors with chronic cancer-related pain. The situation may be assessed differently by other groups, e.g., oncologists, and the data relates to Germany. Nevertheless, considering the raising survival rates, it can be supposed that there is reason to be concerned about an increasing care deficit. Thus, besides expanding the range of available treatment and raising awareness, IMPT with specially trained personnel should be developed to address the care needs of cancer survivors experiencing chronic cancer-related pain.

People affected by breast cancer experience a multitude of toxicities and unmet needs across physical, cognitive, psychosocial, and economic domains that adversely impact their quality of life. High-quality and diverse supportive care is required to improve outcomes and rehabilitation for people affected by breast cancer. However, the availability and access to high-quality supportive care services is limited due to factors including cost and demand. As such, many people affected by breast cancer do not receive optimal supportive care. The Think Pink Foundation facilitates free-of-charge supportive care services to breast cancer survivors, their families, and caregivers through 'The Living Centre'. Think Pink seeks to provide a high-quality survivorship care model that overcomes barriers associated with the economic burden of cancer. Within its suite of services, The Living Centre offers ongoing exercise classes, creative therapy, support groups, specialist breast cancer nurse consultations, wellness services, and education support through face-to-face and online service provision. This paper outlines the development, model of care, service provision, and planning for future outcomes and economic evaluation of The Living Centre as a supportive care model for others to consider establishing in their local context. This paper may therefore directly inform the development of cancer survivorship care services globally to increase equitable access to optimal supportive care.

Purpose: Patients receiving immunotherapy need to have a good understanding of how immunology works and which toxicities they can expect. This study aimed to assess patients' knowledge on their immunotherapies and their quality of life before and after receiving immunotherapy for the first time in a cancer centre.

Methods: From July 2018 to September 2020, all patients treated at the cancer centre receiving first-time immunotherapy were invited to participate in a cross-sectional descriptive study. Non-probabilistic sampling was used to recruit 138 patients, who answered a basal ad hoc questionnaire with ten items assessing their previous knowledge on immunotherapy. Clinical variables were collected from records and by advanced clinical specialist nurses' interviews, and quality of life was evaluated at 2 points (basal and 8 weeks of treatment), using the European Organisation for Research and Treatment of Cancer-Quality of Life C30 scale.

Results: Our descriptive analysis of 138 participants with solid tumours showed that 98.5% knew they were receiving immunotherapy. Regarding complications, 89.8% reported that skin reactions were a major problem. The pre-post comparison of overall health status/health-related quality of life did not show significant changes with treatment.

Conclusion: Our participants were comprised primarily of men with lung cancer, receiving care at a multidisciplinary outpatient unit where they got information from their oncologist and were later assessed by clinical nurse specialists. Almost all considered themselves to be well informed, despite receiving the immunotherapy for the first time. Specific expertise, skills and abilities of the health team, oncologist and nurses providing the care that patients receiving immunotherapy needs are essential.

Purpose: To summarise the extent and type of evidence in relation to adverse events (AEs) associated with the use of cannabis-based products (CBP) in people living with cancer.

Methods: The Joanna Briggs Institute (JBI) methodology for scoping reviews was applied. A search was performed in MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Scopus, Web of Science Core Collections and AMED (Ovid) from their inception to 7 May 2023. Primary studies reporting AEs associated with any form of natural or synthetic CBP use in any cancer care setting and location were included.

Results: One hundred fifty-two studies were included, with the most prevalent being randomised controlled trials (RCTs) (n = 61), followed by non-randomised controlled trials (n = 26) and case reports (n = 23). CBP was mainly used in gastrointestinal, liver, or peritoneal cancer (n = 98) and haematological or lymphoid cancer (n = 92), primarily to manage nausea and vomiting (n = 78) and cancer pain (n = 37). The most common CBP ingredients were combinations of THC and CBD (n = 69), synthetic THC (n = 47), single compounds of THC (n = 42) and CBD (n = 16) with diverse forms, administration routes and doses. The primary methods of administration were oral (n = 94) and inhalation (n = 54). A broad range of AEs were reported; the most common were related to the nervous system (n = 118), psychiatric (n = 101) and gastrointestinal system (n = 81). Diverse patient characteristics, significant under-reporting and low-quality reporting were observed in many studies.

Conclusions: More rigorous research designs that prioritise comprehensive, standardised reporting of AEs and CBP use are required to fully elucidate the safety profile of CBP use in cancer care.

Purpose: We aimed to identify metastatic breast cancer (MBC) patients' preferences for exercise programs and identify patients' characteristics associated with these preferences, to facilitate implementation of exercise programs for MBC patients.

Methods: We used data from a multinational cross-sectional survey conducted among MBC patients. Patients reported their preferred exercise frequency, intensity, type, session duration, and supervision mode. We used latent class analysis to identify subgroups with similar preferences and descriptive statistics to compare demographic and clinical characteristics of patients within subgroups.

Results: Four distinct classes were identified based on data from 409 participants. Class 1 (47% of participants) is characterized by a preference for moderate exercise with supervision within the health care setting. Most participants in this class had bone metastases. Class 2 (30%) is characterized by a preference for vigorous exercise with supervision. This class included participants who were, on average, younger, and had a higher education level. Class 3 (13%) is characterized by a preference for active walking. These participants were less likely to have bone metastases or comorbidities. Class 4 (10%) is characterized by a preference for recreational walking and included participants who were, on average, older, and less likely to be employed.

Conclusion: We identified four classes of patients with different preferences for exercise programs. Many patients with MBC express exercise preferences that meet the current guideline recommendations. Some patients with MBC may benefit from targeted education to align their preferences and behavior with the amount of exercise that is necessary to gain health benefits.

Purpose: This study aimed to investigate the impacts of breast cancer-related lymphedema (BCRL) severity on shoulder function including range of motion, strength, muscle activation patterns, and patient-reported disability.

Methods: A cross-sectional, observational study design was utilized. Seventy-five women with unilateral BCRL were recruited and categorized into mild, moderate, and severe groups based on limb swelling severity. Outcomes included shoulder range of motion, isometric strength, Disabilities of Arm Shoulder and Hand (DASH) scores for disability, and surface electromyography (EMG) of shoulder muscles. Data were analyzed using parametric and nonparametric tests.

Results: Increasing lymphedema severity was associated with progressive declines in shoulder mobility, strength, and function. Severe cases showed markedly reduced shoulder flexion, abduction, rotation, and extension range of motion along with decreased isometric flexor and abductor strength versus mild cases (p < 0.001). Higher pain levels (p < 0.001) and DASH disability scores (p < 0.001) were noted in severe BCRL. Surface EMG revealed impaired activation patterns including reduced amplitudes (p < 0.001) and delayed onsets (p < 0.001) in the deltoids, rotator cuff, and scapular muscles with greater impairment.

Conclusions: Advancing BCRL severity was associated with substantial declines in shoulder mobility, strength, neuromuscular activation, pain threshold, and upper limb functionality. These quantitative results demonstrate impaired shoulder joint control underlying disability in arm elevation and daily tasks. The progressive nature of these deficits highlights the relationship between lymphedema severity and shoulder dysfunction in breast cancer survivors.