Supportive Care in Cancer最新文献

Purpose: The present study aimed to examine (a) how fatigue severity changes during the course of chemotherapy in patients with hematologic cancer and (b) whether cytokines (IL-1 alpha, IL-1 beta, IL-6) are associated with fatigue change after controlling for demographic and clinical factors (e.g., hemoglobin/hematocrit, medications, comorbid conditions).

Methods: This observational cohort study used data from 148 hematological cancer patients four times: prior to chemotherapy, on the last day of chemotherapy, 1 week after the chemotherapy completion, and 1 month after baseline assessment. Latent growth curve modeling was used to examine the longitudinal association of fatigue severity with cytokines and hemoglobin.

Results: A quadratic growth curve model fit the data well, indicating model tenability, and explained a large amount of variance in fatigue across measurement time points. Fatigue slightly increased toward the end of chemotherapy and decreased with time after chemotherapy completion. The influence of IL-6 on fatigue was significant at all time points except at the last assessment occasion (i.e., 1 month after the baseline assessment). The influence of IL-6 on fatigue was independent (unique) from the impact of hemoglobin level. Age and chemotherapy given for the first line of treatment significantly influenced the rate of fatigue change over time. Age also influenced the change pattern's shape.

Conclusions: Fatigue severity changes across the course of chemotherapy within the context of IL-6 activity, not the hemoglobin level. The influence of IL-6 may be limited during and shortly after chemotherapy. These findings inform the development of new symptom management strategies.

Alopecia associated with use of endocrine therapy is an underreported adverse effect despite its significant impact on a patient's quality of life. There is a lack of published evidence for the treatment and management of endocrine therapy-induced alopecia (EIA). Current therapeutic strategies for EIA in breast cancer patients primarily include pharmacologic agents for androgenic alopecia given the similar underlying pathophysiology and clinical presentation of hair loss of EIA and other causes of alopecia. This review aims to summarize select prescription and non-prescription agents (i.e., over-the-counter products, nutraceuticals, dietary supplements) that may be used for EIA including general efficacy and safety. Further studies are needed in the breast cancer population to better understand the place in therapy and efficacy of these pharmacologic agents for EIA.

Purpose: Chronic hematological malignancies progress slowly, potentially manifesting symptoms spanning months to years. HM-PRO is developed as a comprehensive clinical tool for assessing symptoms in hematology. The aim was to investigate the effect of a nurse-led systematic approach to symptom identification and management using HM-PRO in outpatient care in patients with chronic hematological malignancies.

Methods: This is a randomized trial including 94 patients to investigate an intervention comprising (1) HM-PRO data collection, (2) HM-PRO assessment guided by an algorithm, and (3) nurse-led tailored symptom management. The control arm received standard follow-up care. The primary outcome was change in QoL. Secondary outcomes were change in prevalence of physical and psychological symptoms.

Results: A statistically significant difference in QoL change scores over time favored the intervention (diff. 10.3; p = .04). For secondary endpoints, a significant between group difference in change over time for severity scores was observed in fatigue (diff. - 13.6; p = .003), overall symptom burden (diff. - 0.7 points; p = .029), emotional functioning (diff. 10.0; p < .0001), and anxiety (diff. - 2.5; p = .001).

Conclusion: A 12-month nurse-led symptom management intervention within hematology significantly improved QoL, emotional functioning, fatigue, anxiety, and overall symptom burden over time. This is the first randomized trial investigating nurse-led clinical application of the HM-PRO questionnaire providing knowledge on the efficacy of systematic symptom management in clinical practice. This study highlights both the pivotal role of nurses and multidisciplinary support and the inherent value of tailored symptom management.

Trial registration: Clinical trial registration number: NCT04757545 (02/12/2021).

Radiotherapy- or chemotherapy-induced oral mucositis (RIOM/CIOM) presents significant challenges in cancer treatment, severely impacting patients' quality of life (QoL) and therapeutic outcomes. Despite advancements, existing prevention and treatment measures have notable limitations. RIOM/CIOM involves a multifaceted interplay of inflammatory cascades orchestrated by the innate immune response. Furthermore, dysbiosis of oral and intestinal microbiota, triggered by anticancer therapy, exacerbates mucosal damage through intricate interactions with the innate immune system. This review provides an update on pivotal signaling pathways governing the initiation and progression of RIOM/CIOM. It also elucidates the intricate relationship between microbiota dysbiosis and dysregulation of oral mucosal immune homeostasis. Moreover, potential interventions targeting these pathogenic mechanisms are summarized, offering valuable insights for further exploration of RIOM/CIOM's complex pathophysiology and the development of more effective interventions.

Background: Cannabinoids have potential efficacy as prophylaxis for chemotherapy-induced nausea and vomiting (CINV), but no recent meta-analysis has reported on their relative efficacy compared to other antiemetics. The aim of this meta-analysis is to examine the relative efficacy of cannabinoids for prophylaxis of CINV.

Methods: A literature search was conducted in OVID Medline, EMBASE, and Cochrane Central Register of Controlled Trials from inception up until March 2024. Articles were included if they reported on complete response, no nausea, no vomiting or no use of rescue medications, and were randomized controlled trials with cannabinoids in one arm. Meta-analysis was conducted for each endpoint and for a composite endpoint amalgamating existing endpoints. Subgroup analyses by medication used in control arm and by study design were conducted. Cumulative and leave-one-out analysis was also conducted. Type I error was set at 0.05.

Results: A total of 26 studies were included in this meta-analysis, of which 23 were published before the 2000s. Nearly half of the included studies had some concern for bias. Cannabinoid had superior overall CINV control compared to placebo (RR 2.65, 95% CI 1.70-4.12, I² = 0.00%). However, there was no difference between cannabinoid and active treatment alternatives (most using dated single-agent regimens) for any outcomes. A recent phase II/III trial demonstrated superior efficacy of THC:CBD for secondary prevention of CINV when used as adjunctive therapy alongside modern antiemetic regimens, albeit mostly without olanzapine.

Conclusions: There is scant evidence for efficacy of cannabinoids for CINV in the era of triple and quadruple antiemetics. Although THC:CBD showed promised in a recent trial, further trials should examine its safety and efficacy in the context of regimens containing olanzapine.

Purpose: Explore the preventive effects of varying intensity progressive resistance exercise on breast cancer-related lymphedema.

Methods: A total of 114 breast cancer patients who underwent axillary lymph node dissection at Tangshan People's Hospital from January to April 2024 were included. Participants were randomly assigned to three groups: the control group received conventional care; intervention group 1 received conventional care + low-intensity progressive resistance exercise; and intervention group 2 received routine nursing + moderate and high-intensity progressive resistance exercise. Body composition and grip strength were assessed pre-intervention, post-intervention, and at 3 and 6 months follow-up to compare differences among the groups.

Results: (1) Body composition: At post-intervention, 3 and 6 months follow-up, segmental water differences and extracellular water ratios, along with 1- and 5-kHz SFBIA in both intervention groups, were lower than in the control group. Intervention group 2 had a lower extracellular water ratio than group 1 at post-intervention, and at 3 months follow-up, group 2 showed lower water differences and extracellular water ratios than group 1, with slight variations at 6 months (P < 0.001). (2) Grip strength: At post-intervention, 3 months and 6 months follow-up, grip strength in intervention group 1 and intervention group 2 was higher than that in control group, and the difference was statistically significant (P < 0.001).

Conclusion: Resistance exercise enhances muscle strength and prevents lymphedema, with moderate-high-intensity exercise proving more effective than low intensity. Adverse events were minimal, suggesting that increasing resistance exercise intensity, while considering participants' conditions, may yield better preventive outcomes.

Background and purpose: Radiation dermatitis (RD) is often experienced by cancer patients undergoing radiation therapy (RT) and can negatively impact the quality of life of patients. The Skindex-16 questionnaire is an instrument that measures the impact of skin conditions on patient quality of life. The Skindex-16 has been validated for use in assessing many benign conditions, however it has not yet been validated for the assessment of patient-reported outcomes (PROs) for patients experiencing RD.

Materials and methods: A group of 42 breast cancer patients enrolled in a StrataXRT study for RD were analyzed. Increases in Skindex-16 scores indicate worsening symptoms. To validate the Skindex-16, scores were compared at baseline, 2 weeks, and 3 months post-RT. Skindex-16 scores were also compared to scores from the Common Terminology Criteria of Adverse Events (CTCAE) for RD and the Radiation-Induced Skin Reaction Assessment Scale (RISRAS) using various statistical analyses at baseline, 2 weeks, and 3 months post-RT.

Results: Skindex-16 scores were found to be low at baseline and 3 months post-RT but peaked at 2 weeks post-RT. Significant worsening scores from baseline to 2 weeks post-RT were found in a longitudinal assessment of Skindex-16 items for several items on the patient portion of the RISRAS, but only two items on the healthcare professional RISRAS component. Skindex-16 scores showed no significant relationship to CTCAE scores.

Conclusion: This validation of the Skindex-16 questionnaire indicates that it is reliable to be used for the assessment of PROs for cancer patients experiencing RD. However, the PROs assessed by Skindex-16 do not correlate with clinician-reported outcomes.

Objective: The purpose of this study was to clarify the relationship between hope, psychological distress, and quality of life (QOL) of patients with advanced cancer undergoing cancer pharmacotherapy and their related factors.

Methods: Participants were patients with advanced lung, colorectal, and breast cancer undergoing outpatient pharmacotherapy. The Herth Hope Index, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy-General were used as measurement tools in a cross-sectional survey. Data were analyzed using descriptive statistics, correlation analysis, t-test, one-way analysis of variance (ANOVA), and Structural Equation Modeling (SEM).

Results: The number of valid responses to the questionnaire survey was 200 (91.7%). SEM included hope, psychological distress, QOL, social support, economic deprivation, physical symptoms, and performance status. The goodness of fit index for SEM was 0.989, adjusted goodness of fit index was 0.960, comparative fit index was 1.000, and root mean square error of approximation was 0.001. Hope had a negative impact on psychological distress (β = - 0.46) and a positive impact on QOL (β = .19).

Conclusion: Hope was shown to be a predictor of psychological distress and QOL in patients with advanced cancer receiving pharmacotherapy. Predictors of hope were social support and economic deprivation. The results suggest that early intervention for patients with characteristics that tend to lower levels of hope is effective in reducing patient anxiety and depression and improving QOL.

Purpose: Research has shown that mind-body practices like meditation and yoga can improve quality of life among female cancer survivors. Yet, correlates of the likelihood to use these practices are unknown in the USA. The goal of this study was to use recent data from the 2022 National Health Interview Survey (NHIS) to establish the prevalence and correlates of meditation and yoga practices among female cancer survivors in the USA, as well as among survivors who report high or frequent anxiety.

Methods: Using data from the NHIS, we identified eligible female respondents who had reported being diagnosed with cancer (N = 1,945). We identified factors associated with meditation and yoga practice use through self-reported surveys.

Results: Our sample (N = 1945) was primarily White (82.9%), 65 years or older (55.2%), heterosexual (97.2%), lived in medium/small metro areas (35.3%) in the South (36.6%), did not report frequent or high anxiety (63.9%), 21.5% used meditation, and 16.8% used yoga. Our results showed that among female survivors with high or frequent anxiety, there were higher odds of using yoga among those living in large central metro areas or who reported other cancers.

Conclusion: Use of meditation and yoga practices after cancer diagnosis remains uncommon. To best reach diverse survivors who may benefit from evidence-based mind-body practices, tailoring may be needed.