Asia-Pacific journal of clinical oncology最新文献

Background: Cancer guidelines recommend pre- and rehabilitation; however, current research shows these services are not well integrated into clinical practice. To date, there has been no prospective audit of Australian lung cancer exercise services or the people accessing these services. The aim of this study was to describe the exercise pre- and rehabilitation services available to people with thoracic cancer and the characteristics of people with thoracic cancer attending these services in Australia.

Methods: Prospective, observational, multicenter, 5-day, point-prevalence study. Australian healthcare services likely to provide exercise services to people with thoracic cancer were contacted to participate. Conduct and reporting followed the CROSS guidelines.

Results: A total of 397 services were contacted, and 203 responded (51%). Overall, 67% (n = 137) accepted thoracic cancer referrals, and 107 (78%) completed the survey. Most exercise services were targeted at respiratory disease (58%, n = 60) compared with 31% cancer-specific (n = 33) and 5% lung cancer-specific (n = 5). A total of 73 patients with thoracic cancer attended programs across 41 sites (38%). Mean (SD) age was 68.5 (9.7) years. Overall, 4% of patients (n = 3) were culturally and linguistically diverse, and none identified as Aboriginal or Torres Strait Islander. A total of 19 outcomes were used in 51 combinations to assess participants (n = 70), and 12 exercise interventions were delivered in 45 combinations (n = 67).

Conclusions: One-third of responding exercise programs did not offer exercise services to people with thoracic cancer. Almost two-thirds of services that accept referrals did not have a thoracic cancer patient attend their service. High heterogeneity in outcome measures and exercise interventions was observed.

Background: Pneumocystis jirovecii pneumonia (PCP) is an unrecognized infection in non-HIV patients, particularly those with solid and hematologic malignancies. These patients experience higher mortality rates. This study aims to describe the incidence, initial characteristics, management, and outcomes of PCP at a tertiary cancer care center.

Methods: This retrospective observational study included all patients who underwent P. jirovecii PCR testing at our center from January 2019 to January 2022. PCP was diagnosed in PCR-positive patients. Data on demographics, treatment, and outcomes were extracted from medical records. The primary outcomes were ICU admission and 21-day mortality. Statistical analysis compared PCR-positive and PCR-negative patients, with a specific focus on lung cancer patients, and analyzed determinants of 21-day mortality in PCP patients.

Results: Of the 345 patients suspected of PCP, 54 (15.7%) were diagnosed with PCP. PCP patients were generally older. None of the PCP patients were on prophylaxis, compared to 14.8% of PCR-negative patients. In lung cancer patients, age and radiotherapy within the past year were significantly associated with a PCP diagnosis. The 21-day mortality rate among PCP patients was 35.4%. Independent risk factors for mortality included age and hematologic malignancy, while recent chemotherapy and higher neutrophil counts were associated with lower mortality.

Conclusion: PCP is associated with the highest mortality in patients with hematologic malignancies and lung cancer. The findings underscore the importance and efficacy of prophylaxis in at-risk groups and should raise awareness for the diagnosis of PCP in overlooked populations, such as older cancer patients and those undergoing radiotherapy.

It was aimed to explore an alternative solution to manage T1 glottic cancer patients. One hundred seventy-three patients were enrolled. Seventy-eight cases were treated with type I and proved to be microinvasion cancer. Of them, 21 willingly selected followed up and 57 were further undergone type II. Ninety-five underwent type III and confirmed to be superficial invasion cancer in which Reinke's space was invaded. Five(23.8%), four(7.0%) and nine (9.5%)cases separately relapsed in type I, II and III. No significant difference was observed (p>0.05). 5/60, 5/11 and 8/102 patients respectively replaced in negative, positive and uncertain margin groups. There were remarkable differences among them (p<0.05). The recurrence rate is still low for patients with early glottic cancer undergone vocal cord resection using CO₂ laser, and the appropriate surgical method should be selected for a diverse range of glottic cancer to avoid overtreatment. Patients with positive incisal margins have a relatively high recurrence rate and should take this situation seriously.

Purpose: Patients who smoke tobacco during and after a cancer diagnosis have poorer health outcomes. Oncology healthcare providers (HCPs) are crucial to providing smoking cessation support. The study examined the characteristics associated with differences in HCPs' smoking cessation practices.

Methods: As part of the Care to Quit trial, a cross-sectional survey exploring smoking cessation practices was completed by HCPs across nine cancer centers in New South Wales and Victoria, Australia.

Results: One hundred and seventy-seven HCPs completed the survey. Over half of the HCP respondents reported asking patients their smoking status, but fewer than half advised patients about the benefits of quitting, referred patients to behavioral support such as Quitline, or offered pharmacotherapy medication. All components of the "3A's" model (Ask, Advise, Act) were more likely to be completed by doctors compared to registered nurses (OR: 7.86, 95% CI: 3.64, 16.95, p<0.001), by those with more years of practice (OR: 0.26, 95% CI: 0.07-0.93, p = 0.039), and those who had received smoking cessation training (OR: 3.91, 95% CI: 1.80, 8.48, p = 0.001). Multivariate analyses also identified differences in the amount of cancer-specific advice provided between occupation type (p<0.001) and years of practice (p = 0.021).

Conclusion: The need for smoking cessation care training in oncology continues to be apparent. Training in prescribing pharmacotherapies (for doctors) or supporting the use of pharmacotherapies (for nurses) is a particular "gap." Differences between the roles and engagement of doctors and nurses in relation to smoking cessation care should be carefully considered when developing site-specific models of cessation care and providing training.

Introduction: Hypersensitivity reactions (HSRs), an unpredictable and sometimes harmful reaction, may hamper the effectiveness of chemotherapy and lead to the need for drug switching. The recall of ranitidine from the drug market due to the N-nitrosodimethylamine production necessitates the identification of a proper alternative for the prevention of HSRs. Our study aimed to evaluate the efficacy of oral famotidine in the prevention of HSRs in patients who received chemotherapy agents, particularly platinum-based and taxanes.

Methods: A total of 426 patients who were treated with platinum-based agents or taxanes as part of their regimen were divided into two groups. The famotidine group, including 213 patients, received the standard premedication along with an oral dose of 40 mg famotidine the night before and 1 h prior to the chemotherapy session. The control group, also including 213 patients, received only the standard premedication without famotidine.

Results: Based on the results of this study, six patients in the control group experienced HSRs with a range of varying severities. No HSRs were observed by any of the patients in the famotidine group (p-value = 0.022).

Conclusion: Administration of oral famotidine is beneficial in preventing chemotherapy-induced HSRs.

Clinical trial registration: It was also registered with the Iran Clinical Trial Centre under code IRCT20160310026998N13.

Aim: Smoking is a chronic relapsing condition that is under-reported in oncology settings. People who report current smoking (CS) and those who report recently quitting smoking (RQ) should receive cessation support when they are diagnosed with cancer. The study aimed to identify whether differences exist in the smoking cessation support given to CS and RQ in oncology and what advice is given regarding the benefits of cessation.

Method: A survey exploring smoking cessation practices was completed by oncology clinicians (medical, nursing, and allied health) at nine cancer centers in Australia. Data were analyzed using mixed-effects ordinal regression modeling.

Results: Across the 177 clinicians completing the survey, the reported provision of smoking cessation care was significantly higher for CS than for RQ in relation to asking about smoking status (odds ratio [OR] 3.03, p = 0.001), advice on the benefits of quitting (OR 2.86, p = 0.001), and advice to call the Quitline (OR 5.08, p < 0.001). Exploratory analyses indicated doctors and nurse specialists were four times more likely to report referring CS to a Quitline compared to RQ (OR 4.38, p = 0.001; OR 4.29, 95%, p = 0.005, respectively). The cessation benefits that clinicians most often cited to their patients was that quitting "can reduce the chance of developing treatment complications and side effects".

Conclusion: The relative lack of smoking cessation care provided to RQ in oncology suggests that the high risk of smoking relapse is not well-recognized. Greater awareness and training are needed regarding advising RQ about the survival-specific benefits of continuing to not smoke, offering referrals, and offering follow-up support.

Shortening treatment time with moderately hypofractionated radiotherapy benefits patients by reducing inconvenience and costs, but its use in the definitive treatment of unresectable Stage 3 non-small cell lung cancer is controversial due to lack of level one evidence and toxicity concerns. Pivotal systemic therapy trials utilize conventionally fractionated chemoradiation at 2 Gy per fraction given over 6 weeks. In practice, 4 weeks of chemoradiation at 2.75 Gy per fraction is sometimes employed to reduce the treatment burden for selected patients, especially those who are older or have comorbidities. It is uncertain if the two fractionation regimens are similar in biologically effectiveness, especially with varying systemic therapy. This systematic review aimed to collate the survival and toxicity outcomes for 4 weeks of moderately hypofractionated chemoradiation, using > 50 -60 Gy in 20 fractions. Eight studies met the eligibility criteria; seven studies were from a database search of MEDLINE, EMBASE, Cochrane Library, and Web of Science and one study was added later. Two studies were prospective randomized trials and six were retrospective cohort studies. No study included immunotherapy. The historical evidence has been limited, but emerging data is promising, especially when compared to outcomes of standard chemoradiation. Thus, further investigation of this strategy is justified.

Introduction: Despite the increased demand for medical cannabis (MC), MASCC guidelines state that there is insufficient evidence of its efficacy and safety. Although research has explored medical professionals' perceptions of MC, there is to our knowledge minimal research exploring patients' perceptions, particularly in an Australian cancer setting.

Methods: A survey of Australian cancer patients attending oncology outpatient clinics was performed. Patients were ≥ 18 years and had a confirmed diagnosis of cancer (solid or hematological).

Results: A total of 413 patients were approached between April 2019 and March 2020 out of which 82% (350) consented to participate. A total of 19% (67/350) were using MC. Despite being used for symptom control, such as pain (61%), and, in some cases for perceived anticancer activity (12% to cure, and 16% to slow the cancer), only a minority of users believed that the evidence was of high quality for these indications (28% for physical benefits and 29% for anticancer activity). Nonusers were even more skeptical of the evidence for these indications (17% and 11%, respectively). Only a minority of patients (31% of users and 8% of nonusers) accessed information on MC from clinicians. Most instead relied on resources such as TV, friends, family, social media, and websites.

Conclusion: This study demonstrates current real-world cancer patients' perceptions on the evidence for MC, the sources of information used to shape their health beliefs, and compares users to nonusers. The results highlight the need for treating teams to combat potential misinformation that patients may be accessing about MC and provide information on treatments with stronger evidence.