Asia-Pacific journal of clinical oncology最新文献

Introduction: Physical activity and body fatness affect breast cancer development and outcome. There is a tendency to reduce physical activity in the early stages of breast cancer treatment, but exercise interventions are rarely implemented during this period.

Objective: This study aimed to longitudinally assess the physical activity in patients with breast cancer during the first year after surgery and to investigate the factors associated with inactivity.

Design: A retrospective cohort study.

Setting: A university hospital.

Participants: We reviewed the medical records of patients with breast cancer who visited the cancer rehabilitation clinic more than once.

Interventions: Not applicable.

Main outcome measures: Physical activity was assessed using the International Physical Activity Questionnaire. Body fatness was evaluated by calculating body mass index and body fat proportion obtained using bioimpedance. The physical function and health-related quality of life (HRQoL) were also assessed.

Results: A total of 130 patients were included. At initial evaluation, the total amount of physical activity was 1942.8 ± 2977.4 METs, with 46 (35.4%) participants categorized as inactive. The number of overweight/obese participants was 81 (62.3%), and 45 individuals had a high fat proportion (>35.0%). At follow-up, there were no statistically significant changes in all parameters. However, the total amount of physical activity was increased to 2045.2 ± 2561.1 METs, and the number of inactive participants was reduced to 35 (26.2%) without statistical significance. Additionally, the number of overweight/obese participants was reduced to 76 (58.5%), and the number of participants with a high fat proportion was reduced to 35 (26.9%), without statistical significance. Physical function and HRQoL did not significantly change. The factors associated with inactivity included leg strength, chemotherapy at baseline, and body fat proportion at follow-up.

Conclusions: Many patients with breast cancer remain inactive after surgery and some begin engaging in physical activity after a few months. Chemotherapy, poor strength, and a high fat proportion are considered barriers to physical activity.

Aim: Support groups are an effective way to improve quality of life (QoL) in cancer patients. Targeted support groups for head and neck cancer (HNC) can also help patients address specific treatment and survivorship challenges. The aim of this study is to understand the characteristics of existing HNC support groups in the Australian setting and identify any gaps in service provision.

Methods: Existing HNC support groups were identified through an online search and their online information was assessed by adopting the perspective of a person with HNC. Support groups were considered eligible for this study if they were based in Australia and served HNC patients, their caregivers, friends, or family members.

Results: Of the 26 support groups identified in the online search, more than half were based in major cities (n = 16) with three support groups across inner regional areas and three across outer regional areas. There were no support groups identified in remote areas of Australia. Most support groups took place in-person (n = 18) across a variety of physical settings, including hospitals (n = 10) and community spaces (n = 7). Topics frequently covered included: Education and information, sharing experiences and socializing, treatment and side effects, wellness and well-being, and carer support.

Conclusions: There is a need for HNC support groups outside of metropolitan areas, particularly in remote Australia. We must therefore identify means of supporting current and future groups in providing and promoting their valuable service to HNC patients across all locales.

Background: To investigate the expression and associations of putative stem cell markers with survival in patients with locally advanced gastric cancer (GC) receiving neoadjuvant chemotherapy.

Methods: This study included 180 patients with locally advanced GC who received neoadjuvant chemotherapy and subsequent radical gastrectomy between June 2010 and December 2014. Surgical paraffin samples from the enrolled patients were collected. Tissue microarrays were used to detect the expression patterns of 10 putative stem cell markers; immunohistochemistry was used to evaluate the expression patterns of CD133 and SOX2 in GC and adjacent tissues. The prognostic values of these tumor markers for survival in GC were evaluated.

Results: Following adjustments for sex and age, high CD133 and SOX2 expression levels after neoadjuvant chemotherapy were associated with poor survival in GC patients (p = 0.012 and = 0.022, respectively). Subgroup analysis showed that CD133 and SOX2 expression levels in the T_2-4 population after neoadjuvant chemotherapy were negatively associated with survival in GC patients (p = 0.017 and 0.036, respectively). The BAX expression level in the N₀ population after neoadjuvant chemotherapy was positively associated with survival in GC patients (p = 0.045). In the N₁₊₂₊₃ population, a higher E-cadherin expression level after neoadjuvant chemotherapy was associated with longer survival among GC patients (p = 0.006).

Conclusions: The CD133 and SOX2 expression levels after neoadjuvant chemotherapy are independent predictors of survival in locally advanced GC patients receiving neoadjuvant chemotherapy, and higher CD133 and SOX2 expression levels were associated with lower mortality rates.

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.