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  • A pilot survey of ventilated cancer patients' perspectives and recollections of early mobility in the intensive care unit.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Steven H Hsu,Claudine Campbell,Amanda K Weeks,Maryann Herklotz,Natalie Kostelecky,Stephen M Pastores,Neil A Halpern,Louis P Voigt

    PURPOSE To determine the level of recall, satisfaction, and perceived benefits of early mobility (EM) among ventilated cancer patients after extubation in the intensive care unit (ICU). METHODS A survey of patients' perceptions and recollections of EM was administered within 72 h of extubation. Data on recall of EM participation, activities achieved, adequacy of staffing and rest periods, strength to participate, activity level of difficulty, satisfaction with staff instructions, breathing management, and overall rating of the experience were analyzed. The Confusion Assessment Method for ICU (CAM-ICU) was used for delirium screening. RESULTS Fifty-four patients comprised the study group. Nearly 90% reported satisfaction with instructions, staffing, rest periods, and breathing management during EM. Participants indicated that EM maintained their strength (67%) and gave them control over their recovery (61%); a minority felt optimistic (37%) and safe (22%). Patients who achieved more sessions and "out-of-bed" exercises had better recall of actual activities compared with those who exercised in bed. Overall, patients with CAM-ICU-positive results (33%) performed less physical and occupational therapy exercises. CONCLUSIONS Ventilated cancer patients reported an overall positive EM experience, but factual memory impairment of EM activities was common. These findings highlight the needs and the importance of shaping strategies to deliver a more patient focused EM experience.

    更新日期:2020-01-11
  • Dressings for the central venous catheter to prevent infection in patients undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Renata Cristina de Campos Pereira Silveira,Paula Elaine Diniz Dos Reis,Elaine Barros Ferreira,Fernanda Titareli Merizio Martins Braga,Cristina Maria Galvão,Alexander Michael Clark

    PURPOSE To identify the most effective dressing for covering long-term central venous catheter exit site to prevent catheter-related infections and skin irritation in patients undergoing hematopoietic stem cell transplantation. METHODS Systematic Review. The search was performed in the following electronic databases: CINAHL, Cochrane Library CENTRAL, EMBASE, LILACS, PubMed, Scopus, and Web of Science. Google Scholar was used for the gray literature search. RESULTS Seven studies were included which tested different arrangements of dressings: sterilized gauze and adhesive tape with a transparent polyurethane film (n = 2), transparent polyurethane film with a different replacement interval frequency (n = 2), transparent polyurethane film with and without chlorhexidine released continuously by the dressing at the site of intravascular catheter insertion (n = 2), and dressings vs. no dressings (n = 1). The meta-analysis for catheter-related infection prevention showed no difference between type of dressing (RR 1.76, [95% CI 0.82; 3.75], I2 0%) and for the replacement frequency at different intervals (RR 1.04, [95% CI 0.67; 1.61], I2 0%). The meta-analysis for skin irritation evaluated the transparent polyurethane film replacement frequency and indicated that a longer dressing replacement interval (10 to 15 days) reduces the risk of developing this outcome (RR 0.71, 0.52; 0.96, 95% CI, I2 24%). CONCLUSIONS Regarding the type of the dressing, there is no evidence indicating the best dressing. Although there is no evidence available for the ideal replacement frequency, the risk to develop skin irritation is reduced in longer dressing replacements intervals.

    更新日期:2020-01-11
  • Health-related quality of life in adult patients with brain metastases after stereotactic radiosurgery: a systematic, narrative review.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Eline Verhaak,Karin Gehring,Patrick E J Hanssens,Neil K Aaronson,Margriet M Sitskoorn

    PURPOSE A growing number of patients with brain metastases (BM) are being treated with stereotactic radiosurgery (SRS), and the importance of evaluating the impact of SRS on the health-related quality of life (HRQoL) in these patients has been increasingly acknowledged. This systematic review summarizes the current knowledge about the HRQoL of patients with BM after SRS. METHODS We searched EMBASE, Medline Ovid, Web-of-Science, the Cochrane Database, PsycINFO Ovid, and Google Scholar up to November 15, 2018. Studies in patients with BM in which HRQoL was assessed before and after SRS and analyzed over time were included. Studies including populations of several types of brain cancer and/or several types of treatments were included if the results for patients with BM and treatment with SRS alone were described separately. RESULTS Out of 3638 published articles, 9 studies met the eligibility criteria and were included. In 4 out of 7 studies on group results, overall HRQoL of patients with BM remained stable after SRS. In small study samples of longer-term survivors, overall HRQoL remained stable up to 12 months post-SRS. Contradictory results were reported for physical and general/global HRQoL, which might be explained by the different questionnaires that were used. CONCLUSIONS In general, SRS does not have significant negative effects on patients' overall HRQoL over time. Future research is needed to analyze different aspects of HRQoL, differences in individual changes in HRQoL after SRS, and factors that influence these changes. These studies should take into account several methodological issues as discussed in this review.

    更新日期:2020-01-11
  • Differences in the health, mental health and health-promoting behaviours of rural versus urban cancer survivors in Australia.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Kate M Gunn,Narelle M Berry,Xingqiong Meng,Carlene J Wilson,James Dollman,Richard J Woodman,Robyn A Clark,Bogda Koczwara

    PURPOSE People affected by cancer who live in rural Australia experience inferior survival compared to their urban counterparts. This study determines whether self-reported physical and mental health, as well as health-promoting behaviours, also differ between rural and urban Australian adults with a history of cancer. METHODS Weighted, representative population data were collected via the South Australian Monitoring and Surveillance System between 1 January 2010 and 1 June 2015. Data for participants with a history of cancer (n = 4295) were analysed with adjustment for survey year, gender, age group, education, income, family structure, work status, country of birth and area-level relative socioeconomic disadvantage (SEIFA). RESULTS Cancer risk factors and co-morbid physical and mental health issues were prevalent among cancer survivors regardless of residential location. In unadjusted analyses, rural survivors were more likely than urban survivors to be obese and be physically inactive. They were equally likely to experience other co-morbidities (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, arthritis or osteoporosis). With adjustment for SEIFA, rural/urban differences in obesity and physical activity disappeared. Rural survivors were more likely to have trust in their communities, less likely to report high/very high distress, but equally likely to report a mental health condition, both with and without adjustment for SEIFA. CONCLUSIONS There is a need for deeper understanding of the impact of relative socioeconomic disadvantage on health (particularly physical activity and obesity) in rural settings and the development of accessible and culturally appropriate interventions to address rural cancer survivors' specific needs and risk factors.

    更新日期:2020-01-11
  • Educational video intervention improves knowledge and self-efficacy in identifying malnutrition among healthcare providers in a cancer center: a pilot study.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Patricia G Wolf,Joanna Manero,Kirsten Berding Harold,Morgan Chojnacki,Jennifer Kaczmarek,Carli Liguori,Anna Arthur

    PURPOSE Cancer is the second leading cause of death in the USA, and malnutrition secondary to cancer progression and treatment side effects is common. While abundant evidence indicates that nutrition support improves patient outcomes, it is estimated that up to half of malnutrition cases are misclassified or undiagnosed. The use of a multidisciplinary team to assess nutrition status has been observed previously to reduce delays in nutritional support. Hence, educating all members of the oncology healthcare team to assess nutrition status may encourage earlier diagnosis and lead to improved patient outcomes. Thus, the objective was to perform a pilot study to assess change in knowledge and self-efficacy among oncology team members after watching an educational video about malnutrition. METHODS A pre-test post-test educational video intervention was given to 77 ambulatory oncology providers during weekly staff meetings at a community ambulatory oncology center in central Illinois. Change in knowledge and self-efficacy in malnutrition assessment and diagnosis was measured and acceptability of the brief educational video format was also observed. RESULTS Mean test scores improved by 1.95 ± 1.48 points (p < 0.001). Individual occupational groups improved scores significantly (p ≤ 0.005) except for specialty clinical staff. Self-efficacy improved from 38 to 70%. 90.8% of participants indicated the educational video improved their confidence in assessing malnutrition. CONCLUSIONS The educational video was well accepted and improved knowledge and self-efficacy of malnutrition assessment and diagnosis among ambulatory oncology providers. Wider implementation of such an educational intervention and longitudinal testing of knowledge retention and behaviors change is warranted.

    更新日期:2020-01-11
  • An in-hospital clinical care pathway with integrated decision support for cancer pain management reduced pain intensity and needs for hospital stay.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Erik Torbjørn Løhre,Morten Thronæs,Cinzia Brunelli,Stein Kaasa,Pål Klepstad

    PURPOSE A clinical care pathway for pain management in a palliative care unit was studied with outcomes related to patients, physicians, and health care service. Mandatory use of patient-reported outcome measures (PROMs) and physician-directed decision support (DS) were integrated parts of the pathway. METHODS Adult cancer patients with pain intensity (PI) ≥ 5 (NRS 0-10) at admission were eligible. The patients reported average and worst PI at admission, day four, and discharge. The physicians completed the DS at admission and day four. The DS presented potential needs for treatment changes based on pain severity and pathophysiology. The physicians reported treatment changes due to input from the DS system. The two primary outcomes were average and worst PI changes from admission to discharge. Hospital length of stay (LOS) was registered. RESULTS Of 52 included patients, 41 were discharged alive. For those, the mean average PI at admission and at discharge was 5.8 and 2.4, respectively, a reduction of 3.4 points (CI 95% 2.7-4.1). The corresponding worst pain intensities were 7.9 and 3.8, a reduction of 4.1 points (CI 95% 3.4-4.8). The physicians completed DS forms for all patients. Fifty-five percent (CI 95% 41-69) of the patients had pain intervention changes based on the DS. A significant reduction in LOS (4.4 days, CI 95% 0.5-8.3) was observed during the study period. CONCLUSIONS The interventions were implemented according to the intentions and PI was reduced as hypothesized. For evaluation of generalizability, the interventions should be studied in other settings and with a controlled design.

    更新日期:2020-01-11
  • Primary care physicians' perspectives of the survivorship care for older breast cancer survivors: a pilot study.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Jessica L Krok-Schoen,Jennifer DeSalvo,Dori Klemanski,Christian Stephens,Anne M Noonan,Seuli Brill,Maryam B Lustberg

    PURPOSE To evaluate primary care physicians' (PCPs) role in survivorship care of older breast cancer survivors, their experiences and opinions of survivorship care plans (SCPs), and suggestions for improving care coordination and facilitation of SCPs among older (≥ 65 years) breast cancer survivors. METHODS A web-based questionnaire was completed individually by PCPs about their training and what areas of survivorship they address under their care. A subset of survey participants were interviewed about survivorship care, care coordination, and the appropriateness and effects of SCPs on older breast cancer survivors' outcomes. RESULTS Physician participants (N = 29) had an average of 13.5 years in practice. PCPs surveyed that their main role was to provide general health promotion and their least common role was to manage late- and/or long-term effects. Semi-structured interviews indicated that the majority of PCPs did not receive a SCP from their patients' oncologists and that communication regarding survivorship care was poor. Participants' suggestions for improvements to SCPs and survivorship care included regular communication with oncologists, delegation from oncologists regarding roles, and mutual understanding of each other's roles. CONCLUSION PCPs indicated that survivorship care and SCPs should be improved, regarding communication and roles related to their patients' survivorship. PCPs should assume an active role to enhance PCP-oncologist communication. Future research in PCPs' role in survivorship care in a broad, diverse cancer survivor population is warranted. IMPLICATIONS FOR CANCER SURVIVORS More attention needs to focus on the importance of PCPs, as they are an integral part of dual management for older breast cancer survivors post-treatment.

    更新日期:2020-01-11
  • Usefulness of Kinect sensor-based reachable workspace system for assessing upper extremity dysfunction in breast cancer patients.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-05-31
    Kyeong Eun Uhm,Seunghwan Lee,Gregorij Kurillo,Jay J Han,Jung-Hyun Yang,Young Bum Yoo,Jongmin Lee

    PURPOSE Recently, the utility of the Kinect sensor-based reachable workspace analysis system for measuring upper extremity outcomes of neuromuscular and musculoskeletal diseases has been demonstrated. Here, we investigated its usefulness for assessing upper extremity dysfunction in breast cancer patients. METHODS Twenty unilateral breast cancer patients were enrolled. Upper extremity active range of motion was captured by the Kinect sensor, and reachable workspace relative surface areas (RSAs) were obtained. The QuickDASH was completed to assess upper extremity disability. General and breast cancer-specific quality of life (QOL) were assessed by the EORTC QLQ-C30 and EORTC QLQ-BR23. RESULTS The total RSA ratio of the affected and unaffected sides ranges from 0.64 to 1.11. Total RSA was significantly reduced on the affected versus unaffected side (0.659 ± 0.105 vs. 0.762 ± 0.065; p = 0.001). Quadrant 1 and 3 RSAs were significantly reduced (0.135 ± 0.039 vs. 0.183 ± 0.040, p < 0.001; 0.172 ± 0.058 vs. 0.217 ± 0.031, p = 0.006). Total RSA of the affected side was strongly correlated with the numeric pain rating scale during movement (r = - 0.812, p < 0.001) and moderately with the QuickDASH (r = - 0.494, p = 0.027). Further, quadrant 3 RSA was correlated with EORTC QLQ-C30 role functioning (r = 0.576, p = 0.008) and EORTC QLQ-BR23 arm symptoms (r = - 0.588, p = 0.006) scales. CONCLUSIONS The Kinect sensor-based reachable workspace analysis system was effectively applied to assess upper extremity dysfunction in breast cancer patients. This system could potentially serve as a quick and simple outcome measure that provides quantitative data for breast cancer patients.

    更新日期:2020-01-11
  • Risk assessment of febrile neutropenia and evaluation of G-CSF use in patients with cancer: a real-life study.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Elif Aras,Aygin Bayraktar-Ekincioglu,Saadettin Kilickap

    PURPOSE The guidelines suggest using granulocyte-colony stimulating factor (G-CSF) for febrile neutropenia (FN) as prophylaxis in chemotherapy protocols with the risk of 10-20% after assessment of patient's risk factors. Therefore, the aim of this study is to assess the risk of FN by using the Patient Risk Score (PRS) and evaluating G-CSF use and its side effects by a clinical pharmacist at an outpatient clinic. METHODS The study was conducted from May 2017 until November 2017 at the University Hospital oncology outpatient clinic. Patients who receive chemotherapy protocols with FN risk of 10-20% and > 20% and were initiated G-CSF were included. The patients' risk factors were assessed by the PRS, and the side effects were monitored for 3 months by a clinical pharmacist via a patient self-reported monitoring card. RESULTS A total of 118 patients were included (286 interviews) in the study. There was a significant increase between the first and third visits on the PRS total scores of patients (p = 0.034). The patterns of G-CSF use showed that 34.7% undertreated, 22.8% overtreated, and 42.3% of patients were correctly treated for the prophylaxis. The severity of G-CSF-related musculoskeletal pain was increased on the second and third days of treatment. CONCLUSIONS The use of G-CSFs for FN prophylaxis is recommended; however, there may be a group of patients who are inadequately or unnecessarily treated. Therefore, patients should be assessed for the risk of developing FN in each cycle of chemotherapy and a regular risk assessment by using the PRS can be implemented in the monitoring process.

    更新日期:2020-01-11
  • Profile of anemia in acute lymphoblastic leukemia patients on maintenance therapy and the effect of micronutrient supplementation.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-05-28
    Jogamaya Pattnaik,Smita Kayal,Biswajit Dubashi,Debdatta Basu,K V Vinod,H Nandeesha,Ponraj Madasamy,Ranjith C S Kumar,Unni S Pillai,Naresh Jadhav

    BACKGROUND Anemia is a common finding and important cause of morbidity in patients with acute lymphoblastic leukemia (ALL) at diagnosis or during the course of its protracted treatment. We studied profile of anemia in ALL patients on maintenance therapy and evaluated specific micronutrients as cause of this anemia. PATIENTS AND METHODS ALL patients who were on maintenance therapy and had grade ≥ 2 anemia were recruited for the study. Serum iron studies, folate, and vitamin B12 were done to identify micronutrient deficiency and to initiate supplementation with specific components if found to be deficient. Toxicities, improvement of anemia, micronutrient levels, and disease outcome were studied after 3 months. RESULTS From March 2015 to September 2016, 105 ALL patients were found to be on maintenance fulfilling the inclusion criteria. Overall, the proportion of anemia was 80%(N = 84). Majority had normocytic normochromic anemia (71%). Macrocytic anemia was seen in 18% and microcytic hypochromic in 9.5%. In patients with anemia of grade ≥ 2 (N = 84), 38 patients (45%) had biochemical deficiency of serum folate, and 7 (8%) had vitamin B12 deficiency. No biochemical evidence of iron deficiency was found. Supplementation of deficient micronutrients improved anemia: mean hemoglobin significantly increased from 8.06 ± 1.63 to 10.78 ± 1.53 (p < 0.001) at 3 months; and reduced treatment toxicities, mean number of febrile neutropenia episodes (p = 0.007), and treatment interruptions of > 2 weeks (p = 0.002) were lowered. Patients with anemia had significantly more relapses (N = 14,64%) compared to patients without anemia (N = 8,36%), (p = 0.040). CONCLUSION Timely identification and correction of micronutrient deficiencies causing anemia in ALL patients on maintenance can enhance treatment outcomes.

    更新日期:2020-01-11
  • Sleep disturbance and cancer-related fatigue symptom cluster in breast cancer patients undergoing chemotherapy.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Rina S Fox,Sonia Ancoli-Israel,Scott C Roesch,Erin L Merz,Sarah D Mills,Kristen J Wells,Georgia Robins Sadler,Vanessa L Malcarne

    PURPOSE Sleep disturbance and cancer-related fatigue (CRF) are among the most commonly reported symptoms associated with breast cancer and its treatment. This study identified symptom cluster groups of breast cancer patients based on multidimensional assessment of sleep disturbance and CRF prior to and during chemotherapy. METHODS Participants were 152 women with stage I-IIIA breast cancer. Data were collected before chemotherapy (T1) and during the final week of the fourth chemotherapy cycle (T2). Latent profile analysis was used to derive groups of patients at each timepoint who scored similarly on percent of the day/night asleep per actigraphy, the Pittsburgh Sleep Quality Index global score, and the five subscales of the Multidimensional Fatigue Symptom Inventory-Short Form. Bivariate logistic regression evaluated if sociodemographic/medical characteristics at T1 were associated with group membership at each timepoint. RESULTS Three groups (Fatigued with sleep complaints, Average, Minimal symptoms) were identified at T1, and five groups (Severely fatigued with poor sleep, Emotionally fatigued with average sleep, Physically fatigued with average sleep, Average, Minimal symptoms) at T2. The majority of individuals in a group characterized by more severe symptoms at T1 were also in a more severe symptom group at T2. Sociodemographic/medical variables at T1 were significantly associated with group membership at T1 and T2. CONCLUSIONS This study identified groups of breast cancer patients with differentially severe sleep disturbance and CRF symptom profiles prior to and during chemotherapy. Identifying groups with different symptom management needs and distinguishing groups by baseline sociodemographic/medical variables can identify patients at risk for greater symptom burden.

    更新日期:2020-01-11
  • Lung cancer and family-centered concerns.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Josephine Feliciano,Alexander Chang,Deepti Venkatraman,Samara Brooks,Ciara Zagaja,David Ettinger,Christine Hann,Jarushka Naidoo,Ranh Voong,Russell Hales,Michelle Turner,Valerie Peterson,Joann Bodurtha

    BACKGROUND Genetic and environmental interactions predispose certain groups to lung cancer, including families. Families or caregiving units experience the disease interdependently. We have previously evaluated the concerns and preferences of patients in addressing the lung cancer experience and cancer risks in their families. This qualitative study evaluates the concerns and preferences of family members and caregivers of patients with lung cancer in the lung cancer experience and familial cancer risks. METHODS We held focus groups to discuss the format and timing of addressing these preferences and concerns. Qualitative data generated was analyzed using a grounded theory approach. RESULTS Five focus groups totaling 19 participants were conducted. Seven themes were identified: (1) journey to lung cancer diagnosis has core dimensions for patient and family, (2) importance of communication between patients, families, and providers, (3) challenges for caregivers and family, (4) mixed perceptions of lung cancer causation among relatives, (5) discussion of cancer risk with relatives has complex dynamics, (6) impact of diagnosis on family health behaviors and screening, (7) role of genetic counseling. CONCLUSIONS Family members of patients with lung cancer are interested in discussing risk factors, prevention, and diagnoses and also would like access to other supportive services do learn about and cope with some of the stresses and barriers they experience in the family lung cancer journey. The diagnosis represents a potential teachable moment with the opportunity to reduce the risk of LC development or improve early detection in LC patient's family members.

    更新日期:2020-01-11
  • Religion as a determining factor for invasive care among physicians in end-of-life patients.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Caroline Souza Dos Anjos,Rafaela Melo Campos Borges,Ananda Castro Chaves,Ana Cecília de Souza Lima,Mateus Biola Melo Pereira,Maressa Lenguble Gasparoto,Paula Damaris Chagas Barrioso,William Hiromi Fuzita

    OBJECTIVE Describe the knowledge of physicians in an Oncology Clinic and a school hospital, of both the private health network, located in Manaus-AM about palliative care (PC), and define the role of religion in medical care of patients with advanced severe illness, with no disease modifying therapy. METHOD This is a cross-sectional, descriptive, and observational study. After signing the Free and Informed Consent Term, the physicians included completed a professional membership record and answered questions about a hypothetical clinical case through multiple choice answers. The clinical case described a patient with advanced chronic disease not a candidate for disease-modifying therapy in the final phase of life. The questions involved aspects related to nutrition, venous access, and hospitalization in the intensive care unit (ICU). RESULTS A total of 31 physicians from different specialties were included. About 67.7% consider their knowledge about PC insufficient, and none of the participants is unaware of this modality of care. The prevalence of invasive behaviors related to patient nutrition, venous access, and indication of ICU and cardiopulmonary resuscitation (CPR) was higher among physicians without religion (HR = 1.84; HR = 2.89; HR = 1.04, respectively) than among those who follow a religion. CONCLUSION Absence of religion is associated with higher invasive behaviors on the part of physicians. Further studies are needed to better define this relationship.

    更新日期:2020-01-11
  • Development and evaluation of the Cancer Symptom Management System: Symptom Management Improves your LifE (SMILE)-a randomized controlled trial.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Sun Young Rha,Jung Mo Nam,Jiyeon Lee

    PURPOSE To develop a Cancer Symptom Management System: Symptom Management Improves your LifE (SMILE) and evaluate the effect and feasibility of the system in cancer symptom management. METHODS The Cancer Symptom Management System: SMILE was developed, and a nonblinded, randomized controlled trial was conducted. Cancer patients starting adjuvant or palliative chemotherapy (CTx) were enrolled and randomized to control (symptom monitoring), experimental 1 (Exp 1; symptom monitoring + report), or experimental 2 (Exp 2; symptom monitoring + report + Oncology Nursing Society putting evidence into practice (ONS PEP)-guided evidence-based symptom management education) groups in a 1:2:2 ratio (N = 249). To evaluate whether symptom management education provided additional benefit to continuous symptom monitoring, the Exp 1 and Exp 2 groups were compared utilizing Mann-Whitney U test and generalized estimating equations (n = 199). RESULTS Symptom severity (symptom total score) at each measurement point was not different among the three groups (p > .05). Fatigue and sleep disturbance changes were different between Exp 1 and Exp 2 among patients receiving adjuvant CTx (p = .042 and p = .008). Fatigue gradually decreased after a peak at the 1st CTx cycle in Exp 2, whereas Exp 1 experienced increasing fatigue until the 3rd CTx cycle. A gradual decrease in sleep disturbance was observed in Exp 2 after the 2nd CTx cycle, whereas Exp 1 experienced a steady increase in the symptom. Participants were willing to participate in symptom monitoring using the cancer symptom management system. Symptom management education was easy to follow and helpful. CONCLUSION The application of the Cancer Symptom Management System: SMILE incorporating ONS PEP-guided evidence-based symptom management education effectively managed fatigue and sleep disturbance after adjuvant CTx. The feasibility of the system has been demonstrated. Incorporating the system into electronic medical systems and integrating provider input will be necessary.

    更新日期:2020-01-11
  • An immunotherapy survivor population: health-related quality of life and toxicity in patients with metastatic melanoma treated with immune checkpoint inhibitors.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Aine O'Reilly,Peta Hughes,Jasmine Mann,Zhuangming Lai,Jhia Jiat Teh,Emma Mclean,Kim Edmonds,Karla Lingard,Dharmisha Chauhan,Joanna Lynch,Lewis Au,Aileen Ludlow,Natalie Pattison,Theresa Wiseman,Samra Turajlic,Martin Gore,James Larkin,Olga Husson

    PURPOSE The immune checkpoint inhibitors (ICIs) have resulted in subgroups of patients with metastatic melanoma achieving high-quality durable responses. Metastatic melanoma survivors are a new population in the era of cancer survivorship. The aim of this study was to evaluate metastatic melanoma survivors in terms of health-related quality of life (HRQoL), immune-related adverse events (irAEs) and exposure to immunosuppressive agents in a large single centre in the UK. METHODS We defined the survivor population as patients with a diagnosis of metastatic melanoma who achieved a durable response to an ICI and had been followed-up for a minimum of 12 months from initiation of ICI without disease progression. HRQoL was assessed using SF-36. Electronic health records were accessed to collect data on demographics, treatments, irAEs and survival. HRQoL data was compared with two norm-based datasets. RESULTS Eighty-four metastatic melanoma survivors were eligible and 87% (N = 73) completed the SF-36. ICI-related toxicity of any grade occurred in 92% of patients and 43% had experienced a grade 3 or 4 toxicity. Almost half (49%) of the patients required steroids for the treatment of ICI-related toxicity, whilst 14% required treatment with an immunosuppressive agent beyond steroids. Melanoma survivors had statistically significant lower HRQoL scores with regard to physical, social and physical role functioning and general health compared with the normative population. There was a trend towards inferior scores in patients with previous exposure to ipilimumab compared with those never exposed to ipilimumab. CONCLUSIONS Our results show that metastatic melanoma survivors have potentially experienced significant ICI-related toxicity and experience significant impairments in specific HRQoL domains. Future service planning is required to meet this population's unique survivorship needs.

    更新日期:2020-01-11
  • A nurse-led paediatric oncology fast-track clinic proves a successful ambulatory intervention for patients
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-09
    A. Wong, M. Glogolia, P. W. Lange, S. Dale, M. Chappell, T. Soosay Raj, D. Hanna, L. Devaraja, C. Williams, J. Williamson, R. Conyers

    To assess the impact of a pilot nurse-led paediatric oncology fast-track clinic (OFTC) for complications and side effects following chemotherapy within a paediatric tertiary hospital.

    更新日期:2020-01-09
  • The use of complementary medicine in palliative care in France: an observational cross-sectional study
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-09
    Marilene Filbet, Janet Schloss, Jean-Baptiste Maret, Helene Diezel, Per J. Palmgren, Amie Steel

    Abstract Purpose Palliative care for cancer deals with physical, psychosocial, and spiritual issues faced by cancer patients, their families, communities, and healthcare providers. Research on complementary medicine (CM) use in France is limited despite high rates of reported CM use in other countries including by palliative patients. This study describes the use of CM by individuals receiving palliative care in Lyon, France. Design This study employed an observational cross-sectional survey design. Setting/participants The study was conducted in three palliative care centers in Lyon, France; two tertiary hospitals and one palliative care unit (3 sites). Inpatients and outpatients visiting the palliative care clinic with a primary diagnosis of cancer at each study site were invited to participate. Results Of 138 eligible patients, 100 completed the survey (RR 72.4%). The majority (90.7%) reported using CM in the previous 6 months or since their primary cancer diagnosis. Participant CM use was either the same (20.7%) or increased since their primary cancer diagnosis (33.7%). Average out-of-pocket expenses associated with CM use in the previous 6 months or since diagnosis were €157.40 (SD €330.15). The most common CM health professional visited was an aromatherapist (72.7%), a Coupeurs de feu (38.6%), osteopath (28.6%) and naturopath (15.3%). The most common CM used were aromatherapy oils (33.7%), homeopathy (30.0%), and vitamins (29.4%). Conclusion This second survey on CM use in France; is the first conducted in palliative care centers. Results show people with cancer in Lyon, France, have a very high prevalence of CM utilization.

    更新日期:2020-01-09
  • Changes in body weight and serum liver tests associated with parenteral nutrition compared with no parenteral nutrition in patients with acute myeloid leukemia during remission induction treatment
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-08
    Rianne van Lieshout, Lidwine W. Tick, Jeanne P. Dieleman, Stephanie Custers, Marieke S. van Dongen, Debbie van der Lee, Anne R. Schaaphok, Merel Snellen, Harry C. Schouten, Sandra Beijer

    Abstract Purpose Differences in body weight changes and serum liver tests (LTs) in acute myeloid leukemia (AML) patients receiving parenteral nutrition (PN) versus no PN during remission induction (RI) treatment were assessed. Methods Retrospectively, differences in body weight changes and serum LTs in AML patients (n = 213) who received PN versus no PN during RI treatment in one of three Dutch hospitals between 2004 and 2015 were assessed. Weekly body weight and serum LT registrations were collected from medical records. Patients’ body weight changes were compared between the hospitals where PN is applied upon first indication of inadequate oral intake (PN hospitals) and the hospital where use of PN is limited to severe cases only (no-PN hospital) using repeated measures mixed model analysis. Differences in severity of serum LT elevations, according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, were assessed between patients who did and did not receive PN using chi-square or Fisher’s exact tests, and multiple logistic regression analysis. Results Compared with patients of the PN hospitals, patients of the no-PN hospital experienced significantly more body weight loss during RI treatment (between-group difference 7.2%, 95% CI 4.0–10.3%). Furthermore, PN was associated with transient mild to moderate elevations of liver enzymes, but not with raised median total bilirubin levels nor with occurrence of CTCAE grade 3–4 LT elevations. Conclusion Frequent compared with exceptional use of PN in AML patients during RI treatment better preserved body weight, without clinically relevant (CTCAE grade 3–4) elevations in serum LTs.

    更新日期:2020-01-08
  • Determining the prevalence and severity of cancer cachexia in advanced non-small cell lung cancer and its relationship with chemotherapy outcomes
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-08
    Rhys White, C. Elizabeth Weekes, Robert Grant, Christine Baldwin, Hafez Ahmed

    Cancer cachexia (CC) is a syndrome characterised by an ongoing loss of skeletal muscle mass associated with reduced tolerance to treatment. This study explored the prevalence and severity of CC in advanced non-small cell lung cancer (NSCLC) patients and determined its relationship with chemotherapy outcomes.

    更新日期:2020-01-08
  • Oral cannabinoid for the prophylaxis of chemotherapy-induced nausea and vomiting—a systematic review and meta-analysis
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-08
    Ronald Chow, Crystal Valdez, Natalie Chow, Daniel Zhang, James Im, Emily Sodhi, Michael Lock

    Chemotherapy-induced nausea and vomiting (CINV) is a burdensome adverse event frequently associated with chemotherapy treatment of cancer. Evidence suggests that cannabinoid CB2 receptors are present in brainstem neurons, and thus, there may exist a role for cannabinoids to counter CINV. The aim of this paper is to conduct a systematic review and meta-analysis of the efficacy and safety of oral cannabinoids compared with other treatments as documented in randomized controlled trials (RCTs).

    更新日期:2020-01-08
  • Age and gender differences in financial distress among hematopoietic cell transplant survivors
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-08
    Salene M. W. Jones, Jean C. Yi, Heather S. L. Jim, Alison W. Loren, Navneet S. Majhail, Joseph Uberti, Victoria Whalen, Wendy M. Leisenring, Mary E. D. Flowers, Stephanie J. Lee, Karen L. Syrjala

    Cancer has long-term financial consequences. Adolescent and young adult (AYA) and middle-aged cancer survivors may experience more financial toxicity than older adults. This study examined age differences in financial distress in hematopoietic cell transplant survivors and whether these differences result from measurement bias, more financial barriers to care, or an overall higher level of distress.

    更新日期:2020-01-08
  • Is Xbox 360 Kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery?
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-06
    Özlem Feyzioğlu, Selvi Dinçer, Arzu Akan, Zeliha Candan Algun

    Breast cancer surgery may be associated with pain and physical symptoms in the upper limbs. Functional impairment and pain-related avoidance of movement may further increase disability level. This study aimed to investigate the potential effects of early postoperative virtual reality (VR) therapy on pain, range of motion (ROM), muscle strength, functionality, and fear of movement.

    更新日期:2020-01-06
  • Aerobic capacity attainment and reasons for cardiopulmonary exercise test termination in people with cancer: a descriptive, retrospective analysis from a single laboratory
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-04
    Daniel Santa Mina, Darren Au, Efthymios Papadopoulos, Meagan O’Neill, Camilla Diniz, Lianne Dolan, Jeffrey Lipton, Eugene Chang, Jennifer M. Jones

    Aerobic exercise prescriptions in clinical populations commonly involve target intensities based on cardiopulmonary exercise tests (CPET). CPETs are often discontinued prior to a patient achieving true maximum oxygen consumption (VO2 max) which can adversely affect exercise dose and efficacy monitoring; however, reasons for early discontinuation are poorly reported. Accordingly, we explored the CPET termination reasons in persons with cancer participating in exercise intervention studies.

    更新日期:2020-01-04
  • The haematopoietic stem cell transplant survivors’ sense of coherence about their experiences: a qualitative study
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Umairah Bte Mohamed Sharin, Chung Cheng Jordan Hwang, Wei How Darryl Ang, Violeta Lopez

    To explore the experiences of haematopoietic stem cell transplant survivors attending the long-term follow-up unit.

    更新日期:2020-01-04
  • Inter-rater reliability in performance status assessment among healthcare professionals: an updated systematic review and meta-analysis
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Ronald Chow, Eduardo Bruera, Jennifer S. Temel, Monica Krishnan, James Im, Michael Lock

    Survival prediction for patients with incurable malignancies is invaluable information during end-of-life discussions, as it helps the healthcare team to appropriately recommend treatment options and consider hospice enrolment. Assessment of performance status may differ between different healthcare professionals (HCPs), which could have implications in predicting prognosis. The aim of this systematic review and meta-analysis is to update a prior systematic review with recent articles, as well as conduct a meta-analysis to quantitatively compare performance status scores.

    更新日期:2020-01-04
  • Discussing sexuality in cancer care: towards personalized information for cancer patients and survivors
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Leonore F. Albers, Mirjam A. van Belzen, Christel van Batenburg, Vivian Engelen, H. Putter, Rob C.M. Pelger, Henk W. Elzevier

    Abstract Introduction The needs of cancer patients and survivors regarding discussing sexuality are frequently unmet, with many not receiving adequate information. To optimize information about sexuality and cancer, patients’ perspective is needed. The goals of this study were to investigate what kind of information Dutch cancer patients need, their ideas on how to improve communication, and to identify patients who are more in need of information regarding sexuality. Methods The Dutch Federation of Cancer Patient Organizations developed and conducted a nationwide 28-item online survey. The survey was distributed among cancer patients and survivors. Results In total, 2657 (ex) cancer patients participated, with a median age of 61 years, and half were male (45.2%). Of the respondents, 65% were in need of information about sexuality. Patients ≤ 61 years (p < 0.001), patients with a self-reported negative effect of cancer on sexuality (p < 0.001) and patients who were diagnosed less than 2 years ago (p < 0.04) reported a higher need for information. Regardless of type of cancer, patients were most in need of practical tips and practical information regarding sexuality. To enhance communication about sexuality, 64% of the respondents suggested that it would be of help if care providers give information as standard care. Conclusions (Ex) cancer patient prefer to receive standard information about sexuality by their care providers. According to patients’ preferences, information must include practical tips. Age, self-reported negative effect on sexuality status and time from diagnoses influenced the need for information.

    更新日期:2020-01-04
  • Experiences and needs of patients with incurable cancer regarding advance care planning: results from a national cross-sectional survey
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Mariken E. Stegmann, Olaf P. Geerse, Dorien Tange, Carol Richel, Linda Brom, Vivian Engelen, Saskia F. A. Duijts

    Abstract Introduction Patients faced with incurable cancer may experience a lack of support from their physician throughout and after treatment. Studies on the needs and experiences of these patients are scarce. In this study, we explored the needs and experiences of patients diagnosed with incurable cancer regarding the conversation, in which they were told that their cancer was incurable, the care received after this conversation, and their preferences regarding end-of-life conversations. Methods Data were cross-sectionally collected through a national online survey in the Netherlands (September 2018). Descriptive statistics and correlation coefficients were reported and subgroups were compared. Results Six hundred fifty-four patients (mean age 60 years; 58% women) completed the survey. Patients were primarily diagnosed with breast cancer (22%) or a hematological malignancy (21%). Patients reported a strong need for emotional support during the conversation, in which they were told their cancer was incurable (mean score 8.3; scale 1–10). Their experienced satisfaction with received emotional support was mediocre (mean score 6.4; scale 1–10). Of those patients who felt like they did not receive any additional care (37%) after the diagnosis, the majority expressed a clear need for this kind of care (59%). Mostly, support pertained to psychosocial issues. Regarding conversations about the end of life, most patients (62%) expressed a need to discuss this topic, and preferred their healthcare provider to initiate this conversation. Conclusion Care for patients with incurable cancer can be further improved by tailoring conversations to specific needs and timely providing appropriate supportive care services.

    更新日期:2020-01-04
  • A predictive model of fear of cancer recurrence for patients undergoing chemotherapy
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Se Jin Hong, Nah-Mee Shin, Sunyoung Jung

    Abstract Purpose A number of cancer patients experience fear of cancer recurrence (FCR), which affects their psychological adjustment. This study tested the hypothesized model of FCR to predict psychological adjustment in cancer patients undergoing chemotherapy. Methods A total of 203 patients, who had been diagnosed with either breast cancer or colorectal cancer and were undergoing chemotherapy, were recruited from two university hospitals in Seoul, Korea. Data were collected using validated questionnaires and were analyzed using SPSS 24.0 and AMOS 25.0 program for structural equation modeling procedures. Results The fit index of the hypothesized model was appropriate. Symptom distress, contextual factors, FCR, and illness representations had statistically significant direct, indirect, and total effects on psychological adjustment. These variables explained 76% of the total variance of the psychological adjustment in cancer patients undergoing chemotherapy. Fear of cancer recurrence was a mediating factor for the effects of symptom distress, contextual factors, and illness representation on psychological adjustment. Conclusions Based on these results, interventions aimed at reducing symptom distress and FCR, and improving social support, optimism, and illness representations, may be useful for the successful psychological adjustment of cancer patients undergoing chemotherapy.

    更新日期:2020-01-04
  • A prospective study on oral adverse effects in head and neck cancer patients submitted to a preventive oral care protocol
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Marilia Oliveira Morais, Allisson Filipe Lopes Martins, Ana Paula Gonçalves de Jesus, Sebastião Silvério de Sousa Neto, Arthur Wilson Florêncio da Costa, Carlos Henrique Pereira, Angélica Ferreira Oton-Leite, Nilceana Maya Aires de Freitas, Cláudio Rodrigues Leles, Elismauro Francisco Mendonça

    To evaluate the occurrence and severity of oral complications, number of radiotherapy (RT) interruptions and quality of life (QoL) in a population of head and neck cancer patients receiving a preventive oral care program (POCP) and photobiomodulation therapy (PBMT).

    更新日期:2020-01-04
  • Peripherally inserted central catheters in allogeneic hematopoietic stem cell transplant recipients
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Elena Mariggiò, Anna Paola Iori, Alessandra Micozzi, Antonio Chistolini, Roberto Latagliata, Paola Berneschi, Massimo Giampaoletti, Ursula La Rocca, Antonella Bruzzese, Walter Barberi, Robin Foà, Salvatore Giacomo Morano

    Abstract Background Central venous catheters (CVC) are essential for the management of patients with hematologic malignancies, facilitating chemotherapy infusion, antibiotics, parenteral nutrition, blood products, and blood samples collection. In this population, peripherally inserted central catheters (PICC) seem to be associated with lower complications, compared with conventional percutaneously inserted devices (CICC). Data on the PICC in allogeneic hematopoietic stem cell recipients (allo-HSCT) are limited. Methods We have prospectively evaluated the safety and efficacy of 100 polyurethanes or silicone PICC, inserted into 100 adult allo-HSCT recipients, at the Hematology of Sapienza University of Rome (Italy), between October 2012 and August 2017. Results The median duration of PICC placement was 117 days. Overall, 68% of patients maintained the device for the entire transplant procedure and PICC were removed after day 100 from allo-HSCT; of these, 44% did not experienced any PICC-related complications. Catheter-related bloodstream infections (CRBSI) occurred in 32% of patients (2.5/1000 PICC days), associated with thrombosis in 8 cases. CRBSI were observed in 42% of patients with polyurethane and 20% with silicone PICC (p = 0.02). Catheter-related thrombosis occurred in 9% of patients, never requiring anticipated PICC removal. Mechanical complications occurred in 15% of cases (1.2/1000 PICC days). On the whole, adverse events were manageable and did not affect transplant outcome. No deaths related to PICC-complications were observed. Conclusions PICC are a safe and reliable long-term venous access in allo-HSCT recipients.

    更新日期:2020-01-04
  • Understanding breast cancer survivors’ financial burden and distress after financial assistance
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Jessica N. Semin, David Palm, Lynette M. Smith, Sarah Ruttle

    Abstract Purpose Little is known about how breast cancer may impact survivors’ financial well-being. This study aims to investigate the financial status, burden, and opinions of breast cancer survivors who received short-term financial assistance, emotional support, and resource navigation from a community organization during treatment. Methods Clients previously served by the community organization were mailed a 16-question survey (n = 751) to elicit their perspective on financial status and burden before, during, and after diagnosis and treatment along with general demographic and opinion items. Results 136 surveys (18.1%) were returned yielding 118 (15.7%) suitable for analyses. Clients’ average age was 54.3 years. Most were female (99.2%), Caucasian (66.1%), and diagnosed with Stage 1 or 2 breast cancer (58.5%). Clients reported significantly worse (p < 0.001) financial status after being diagnosed compared to before diagnosis. Financial distress was highest during cancer treatment (mean = 3.92, SD = 0.85), lowest prior to treatment (mean = 2.48, SD = 1.05), and remained high after treatment (mean = 3.59, SD = 1.05). Those with higher distress after treatment were significantly (p = 0.01) more likely to report lower social support during treatment. Conclusions Breast cancer survivors reported worsening financial status and distress after being diagnosed and during treatment despite receiving short-term financial assistance, emotional support, and resource navigation. Survivors’ financial distress after treatment remained higher than before treatment. However, most felt receiving financial assistance improved their quality of life and made them feel more in control of financial decision-making. Breast cancer survivors who feel they have low social support during treatment may feel higher financial distress posttreatment.

    更新日期:2020-01-04
  • Patient-level factors associated with chronic opioid use in cancer: a population-based cohort study
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Colleen A. Cuthbert, Yuan Xu, Shiying Kong, Devon J. Boyne, Brenda R. Hemmelgarn, Winson Y. Cheung

    Concerns around chronic opioid use (COU), misuse, and harms have led to increased scrutiny of opioid prescribing in oncology. There is lack of research examining patient-level factors associated with COU. Our aim was to examine patient-level factors associated with COU in newly diagnosed cancer patients.

    更新日期:2020-01-04
  • Inpatient folate testing at an academic cancer center: single-year experience
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Zachary D. Epstein-Peterson, Diane G. Li, Jessica A. Lavery, Brooke Barrow, Ishita Chokshi, Deborah Korenstein

    The value of testing for folate deficiency has been scrutinized recently given low prevalence of deficiency with widespread dietary fortification. Numerous studies have shown folate testing to be low yield overall. However, the value of such testing in the inpatient cancer population has not been defined.

    更新日期:2020-01-04
  • Implementing routine communication about costs of cancer treatment: perspectives of providers, patients, and caregivers
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    M. C. Haverfield, A. E. Singer, C. Gray, A. Shelley, A. Nash, K. A. Lorenz

    Rising costs in oncology care often impact patients and families directly, making communication about costs and financial impacts of treatment crucial. Cost expenditures could offer opportunities for estimation and prediction, affording personalized conversations about financial impact. We sought to explore providers’, patients’, and caregivers’ preferences towards implementing communication about cost, including when, how, and by whom such information might be provided.

    更新日期:2020-01-04
  • Sarcopenia as a risk factor of severe laboratory adverse events in breast cancer patients receiving perioperative epirubicin plus cyclophosphamide therapy
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Ayako Ueno, Kazushige Yamaguchi, Moe Sudo, Shiro Imai

    Abstract Purpose Sarcopenia has been reported to be associated with higher mortality and increased toxicity of chemotherapy in breast cancer patients. However, evidence from Asian countries is scarce. Here, we investigated the association between sarcopenia and the frequency of severe laboratory adverse events due to perioperative chemotherapy in Japanese breast cancer patients. Methods Eighty-two patients with breast cancer receiving perioperative epirubicin plus cyclophosphamide therapy were evaluated. Skeletal muscle of the cross-sectional area at the third lumbar vertebra was measured by computed tomography, and sarcopenia was defined as skeletal muscle index < 40 cm2/m2. Laboratory toxicity during all cycles of perioperative chemotherapy was assessed. The study endpoint was the frequency of severe (grade 3 or more) laboratory adverse events. Results Overall, 10 patients (12.2%) were classified as sarcopenic. The frequency of severe laboratory adverse events was 28.0%, and this was significantly higher in sarcopenic patients compared to non-sarcopenic patients (70% vs. 22.2%, odds ratio 7.9 (95% CI, 1.6–52.8), p = 0.004). Neither of body weight, body mass index, area of visceral adipose tissue, subcutaneous adipose tissue, nor skeletal muscle density was significantly associated with the frequency of severe laboratory adverse events. Conclusion Sarcopenia was a significant risk factor of severe laboratory toxicity in breast cancer patients receiving perioperative epirubicin plus cyclophosphamide therapy. This finding raises the potential use of body composition assessment to predict the risk of chemotherapy toxicity and determine an individualized treatment strategy.

    更新日期:2020-01-04
  • The impact of the caregiver-oncologist relationship on caregiver experiences of end-of-life care and bereavement outcomes
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Amy W. An, Susan Ladwig, Ronald M. Epstein, Holly G. Prigerson, Paul R. Duberstein

    The quality of the relationship between oncologists and cancer patients has been associated with caregiver bereavement outcomes, but no studies have examined whether the perceived quality of the relationship between cancer caregivers and oncologists is associated with caregiver experiences of end-of-life care or psychological adjustment after the patient’s death.

    更新日期:2020-01-04
  • The perception of Israeli oncology staff members regarding advance care planning
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-03
    Gil Bar-Sela, Shlomit Bagon, Inbal Mitnik, Svetlana Baziliansky, Avigail Bar-Sella, Olga Vornicova, Tzahala Tzuk-Shina

    Abstract Background Advance care planning (ACP) defines end-of-life care in accordance with the patients’ preferences. It is highly important during mental and/or physical deterioration, which prevents patients from expressing their wishes. Despite various attempts worldwide to promote the issue, it is not well established, suggesting various challenges in the implementation of the process in the medical system. The current study aimed to evaluate the perception of Israeli oncology staff members regarding the process. Methods Physicians and nurses from a division of oncology participated in the study. They completed the study’s questionnaires, which included quantitative items regarding staff and patients’ motives and barriers, as well as qualitative questions to better evaluate their understanding regarding the process. Results According to staff members, the optimal time to complete the forms is during the final stages of the disease. Making the right medical decisions and avoiding unnecessary medical procedures were rated as the main motives for patients in the process. The communication factor was perceived as the main barrier for patients, as well as the main motive and barrier for staff. The central role of communication was demonstrated in the qualitative section as well. Various differences were demonstrated between staff members who talked with patients about ACP and those who did not. Conclusion The study demonstrated the central role of communication in the process of ACP from the staff’s perception. This highlights the need to further promote training programs for staff members to establish better interactions and communication skills when dealing with end-of-life issues.

    更新日期:2020-01-04
  • Prevention of postoperative pneumonia by perioperative oral care in patients with esophageal cancer undergoing surgery: a multicenter retrospective study of 775 patients
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-02
    Sakiko Soutome, Takumi Hasegawa, Taihei Yamguchi, Kumiko Aoki, Naritomo Kanamura, Takao Mukai, Junichi Yamazoe, Masaya Nishikawa, Emiko Isomura, Kazuto Hoshi, Masahiro Umeda

    Abstract Purpose Postoperative pneumonia is one of the major complications after esophageal cancer surgery. The risk factors associated with postoperative pneumonia are poor general health, smoking, decreased pulmonary function, diabetes mellitus, surgical stress, old age, postoperative aspiration, and oral hygiene. In this study, we examined the effect of perioperative oral care on reducing postoperative pneumonia since the evidence to-date is not clear. Methods A multicenter, retrospective investigation of the relationship between perioperative oral care and incidence of postoperative pneumonia in patients undergoing esophageal cancer surgery was conducted. A total of 775 patients who underwent thoracoscopic esophageal resection at 25 hospitals between 2016 and 2017 were enrolled in the study. Various factors were examined for correlation with development of postoperative pneumonia. Results Multivariate analysis showed that old age, smoking habit, lower hemoglobin, higher creatinine, postoperative dysphagia, and lack of oral care intervention were independent risk factors for pneumonia. Oral care was more effective in preventing pneumonia in hospitals in which the incidence of postoperative pneumonia was lower than 20%, while it was not effective in hospitals in which the incidence was higher than 20%. Conclusion Results of the study suggest that it is recommended to carry out perioperative oral care in esophageal cancer surgery.

    更新日期:2020-01-04
  • Sociodemographic, clinical, psychosocial, and healthcare-related factors associated with beliefs about adjuvant endocrine therapy among breast cancer survivors
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-02
    Arnethea L. Sutton, Teresa M. Salgado, Jun He, Alejandra Hurtado-de-Mendoza, Vanessa B. Sheppard

    Abstract Objective Adjuvant endocrine therapy (AET) reduces the risk of recurrence and mortality in women with hormone receptor–positive breast cancer. However, adherence to AET remains suboptimal. Women’s beliefs about medication have been associated with medication adherence. The purpose of this study was to identify multilevel factors associated with women’s beliefs about AET. Methods Beliefs about AET, measured using the Belief about Medicines Questionnaire (BMQ), sociodemographic (e.g., age), psychosocial (e.g., religiosity), and healthcare factors (e.g., patient-provider communication), were collected via survey. Clinical data were abstracted from medical records. Two stepwise regression analyses models were performed to assess relationships between variables and necessity and concern beliefs. Results In our sample of 572 women, mean BMQ concern score was 11.19 and mean necessity score was 13.85 (range 5–20). In the regression models, higher ratings of patient-provider communication were associated with lower concern and higher necessity beliefs. Higher concern beliefs were related to more AET-related symptoms (Β = 0.08; 95% CI 0.06 to 0.10; p < 0.001), lower patient satisfaction (Β = − 0.07; 95% CI − 0.09 to − 0.04; p < 0.001), and higher religiosity (Β = 0.05; 95% CI 0.01 to 0.08; p = 0.007). Higher necessity beliefs were associated with prior chemotherapy use (Β = 0.11; 95% CI 0.06 to 0.16; p < 0.005) and less education (Β = 1.00; 95% CI 0.27 to 1.73; p = 0.008). Conclusions Modifiable factors are related to women’s AET beliefs. Healthcare interactions may play a key role with regard to shaping women’s beliefs about their AET medication.

    更新日期:2020-01-04
  • Reporting of paclitaxel-induced peripheral neuropathy symptoms to clinicians among women with breast cancer: a qualitative study
    Support. Care Cancer (IF 2.754) Pub Date : 2020-01-02
    Teresa M. Salgado, Caroline S. Quinn, Emily K. Krumbach, Iris Wenceslao, Martha Gonzalez, Holly L. Reed, Jillian G. Syverson, Rebecca S. Etz, Kiran Vangipuram, Melissa R. Barker, N. Lynn Henry, Karen B. Farris, Daniel L. Hertz

    Abstract Purpose Cases of chemotherapy-induced peripheral neuropathy (CIPN) under-reporting have been sporadically described in the literature, but no studies have focused on actively examining this behavior. Our primary aim was to identify women who purposefully under-reported CIPN, along with reasons for doing so. A secondary aim was to explore factors enabling or hindering communication of CIPN to clinicians. Methods Semi-structured interviews were conducted with women with breast cancer who had received paclitaxel in a prospective observational study. The interview guide was developed based on factors hypothesized to influence side effect disclosure to clinicians. Interviews were recorded, transcribed verbatim, and thematically content analyzed. Results Thirty-four women were interviewed. Three main themes emerged from the analysis: (1) enablers of CIPN reporting (e.g., positive relationship with the oncology team, sufficient appointment time, existence of alternative communication channels to office visits, expectation of CIPN as a side effect); (2) deterrents to CIPN reporting (e.g., perception of need to complete the full course of therapy, fear of treatment discontinuation, lack of knowledge of long-term consequences of CIPN); and (3) balancing survival versus functional impairment due to CIPN. Women prioritized efficacy over CIPN until physical functioning was meaningfully affected. No patients reported purposeful CIPN under-reporting, but three women admitted having considered doing so. Conclusions Despite the lack of evidence of CIPN withholding, women considered both the effectiveness and the toxicity of paclitaxel treatment, as well as beliefs about treatment and long-term consequences of CIPN and relationship with the oncology team, when deciding whether to report CIPN symptoms.

    更新日期:2020-01-04
  • Correction to: Effects of relaxation on self-esteem of patients with cancer: a randomized clinical trial
    Support. Care Cancer (IF 2.754) Pub Date : 2019-09-05
    Mehdi Harorani, Masoomeh Noruzi Zamenjani, Mohamad Golitaleb, Fahimeh Davodabady, Sima Zahedi, Ali Jadidi, Masoud Rezaei

    Cancellation of Open Access.

    更新日期:2020-01-04
  • Healthcare professionals' perspectives of barriers and facilitators in implementing physical activity programmes delivered to cancer survivors in a shared-care model: a qualitative study.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Charlotte IJsbrandy,Wim H van Harten,Winald R Gerritsen,Rosella P M G Hermens,Petronella B Ottevanger

    BACKGROUND The positive impact of physical activity programmes has been recognised, but the current uptake is low. Authorities believe delivering these programmes in a shared-care model is a future perspective. The present study aimed to identify the barriers and facilitators affecting physical activity programme implementation in a shared-care model delivered with the cooperation of all the types of healthcare professionals involved. METHODS Thirty-one individual interviews with primary healthcare professionals (PHPs) and four focus group interviews with 39 secondary healthcare professionals (SHPs) were undertaken. We used Grol and Flottorp's theoretical models to identify barriers and facilitators in six domains: (1) physical activity programmes, (2) patients, (3) healthcare professionals, (4) social setting, (5) organisation and (6) law and governance. RESULTS In the domain of physical activity programmes, those physical activity programmes that were non-tailored to the patients' needs impeded successful implementation. In the domain of healthcare professionals, the knowledge and skills pertaining to physical activity programmes and non-commitment of healthcare professionals impeded implementation. HCPs expressed their concerns about the negative influence of the patient's social network. Most barriers occurred in the domain of organisation. The PHPs and SHPs raised concerns about ineffective collaboration and networks between hospitals. Only the PHPs raised concerns about poor communication, indeterminate roles, and lack of collaboration with SHPs. Insufficient and unclear insurance coverage of physical activity programmes was a barrier in the domain of law and governance. CONCLUSIONS Improving the domain of organisation seems the most challenging because the collaboration, communication, networks, and interactive roles between the PHPs and SHPs are all inadequate. Survivor care plans, more use of health information technology, improved rehabilitation guidelines, and better networks might benefit implementing physical activity programmes.

    更新日期:2019-11-01
  • "Triggers" for early palliative care referral in patients with cancer: a review of urgent unplanned admissions and outcomes.
    Support. Care Cancer (IF 2.754) Pub Date : null
    Rebecca Gemmell,Nadia Yousaf,Joanne Droney

    PURPOSE Benefits of early palliative referral in oncology are well documented. Palliative care referral "triggers" may help identify patients for referral. Many triggers have been proposed, but are not commonly used. This study reviewed the timing of palliative care involvement for patients in a tertiary referral oncology hospital, and whether the use of a trigger tool prior to admission would have facilitated earlier referral. METHODS This was a retrospective cohort study of cancer patients who died during an unplanned admission between November 2014 and October 2015. A literature review identified seven palliative care referral tools which were included in this analysis, and compared by identifying common themes. Each tool was applied to patients by reviewing electronic patient records. Timing of palliative referral and whether patients met any triggers within 6 months before their terminal admission were assessed. RESULTS A total of 159 patients were identified. Forty-six percent were referred to palliative care prior to terminal admission. Application of 6 out of 7 trigger tools would have resulted in the majority of patients (up to 91.2%) referred to palliative care prior to admission. Most patients (52.2%) were referred only during their terminal admission. Patients known to palliative care before admission (N = 73) were reviewed quicker than those who were not (N = 86) (median (range) 1 day (0-23 days) versus 5 days (0-59 days), p < 0.00001). CONCLUSIONS In this patient cohort, a palliative referral trigger tool may have proactively identified most patients prior to their terminal admission. Prospective testing of trigger tools in oncology populations is warranted.

    更新日期:2019-11-01
  • Oral morphine drops for prompt relief of breathlessness in patients with advanced cancer-a randomized, double blinded, crossover trial of morphine sulfate oral drops vs. morphine hydrochloride drops with ethanol (red morphine drops).
    Support. Care Cancer (IF 2.754) Pub Date : null
    Birgit Aabom,Gunnar Laier,Poul Lunau Christensen,Tine Karlsson,May-Britt Jensen,Birte Hedal

    PURPOSE Episodic breathlessness is frequent in palliative cancer patients. Opioids are the only pharmacological agents with sufficient evidence in treatment. In Denmark, the main recommendation is red morphine drops (RMD), an off-label solution of morphine, ethanol, and red color (cochenille) described since 1893 (Pharmacopoea Danica). In 2015, the Danish Medicines Agency increased focus on off-label medicines and recommended registered morphine drops without ethanol instead. However, our palliative patients told us that RMD was better. For that reason, we conducted a clinical trial to clarify any perceived difference between the two types of drops. METHODS We conducted a randomized, double blinded, crossover trial. Patients were asked to perform standardized activity (2-min walk) aiming to provoke breathlessness. Primary endpoint (breathlessness NRS) and secondary endpoints (saturation, pulse, respiratory frequency) were measured before (t = 0) and after test medicine at t = 1, t = 3, t = 5, t = 10, and t = 20 min. After 2-4 days (washout period), the patients repeated the test, receiving the alternative drops in a blinded setup (crossover). RESULTS In the first 3 min, the relative drop in breathlessness for morphine drops with ethanol (RMD) was significant more than for morphine drops without ethanol. We found no significant difference in secondary endpoints. CONCLUSIONS A conclusion could be that ethanol might facilitate morphine absorption in the mouth. Our results needs further research of opioid absorption in the mouth as well as trials, testing morphine vs. more lipophilic opioids. The RMD drops are cheap, easy to use, and noninvasive and keep the patient independent of health care professionals.

    更新日期:2019-11-01
  • Response to the letter to the Editor concerning our article "High adherence of patients with multiple myeloma who receive treatment with immunomodulatory drugs (IMIDS) in hematology/oncology group practices in Germany".
    Support. Care Cancer (IF 2.754) Pub Date : 2019-11-09
    Stefan Feiten,Geothy Chakupurakal,Hans Peter Feustel,Michael Maasberg,Burkhard Otremba,Peter Ehscheidt,Manfred Hensel,Richard Hansen,Rudolf Weide

    更新日期:2019-11-01
  • The use of stretching devices for treatment of trismus in head and neck cancer patients: a randomized controlled trial.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-11-09
    Sarah J van der Geer,Harry Reintsema,Jolanda I Kamstra,Jan L N Roodenburg,Pieter U Dijkstra

    PURPOSE To compare the effects of two stretching devices, the TheraBite® Jaw Motion Rehabilitation System™ and the Dynasplint Trismus System®, on maximal mouth opening in head and neck cancer patients. METHODS Patients were randomly assigned to one of two exercise groups: the TheraBite® Jaw Motion Rehabilitation System™ group or the Dynasplint Trismus System® group. Patients performed stretching exercises for 3 months. During the three study visits, maximal mouth opening was measured and the patients completed questionnaires on mandibular function and quality of life. RESULTS In our study population (n = 27), five patients did not start the exercise protocol, eight patients discontinued exercises, and two patients were lost to follow-up. No significant differences regarding the change in mouth opening between the two devices were found. Patients had an increase in MMO of 3.0 mm (IQR - 2.0; 4.0) using the TheraBite® Jaw Motion Rehabilitation System™ and 1.5 mm (IQR 1.0; 3.0) using the Dynasplint Trismus System®. Exercising with either stretching device was challenging for the patients due to the intensive exercise protocol, pain during the exercises, fitting problems with the stretching device, and overall deterioration of their medical condition. CONCLUSIONS The effects of the two stretching devices did not differ significantly in our study population. The factors described, influencing the progression of stretching exercises, need to be taken into account when prescribing a similar stretching regimen for trismus in head and neck cancer patients. TRIAL REGISTRATION NTR - Dutch Trial Register number: 5589.

    更新日期:2019-11-01
  • Is heart rate variability a valuable method to investigate cardiac autonomic dysfunction in subjects with leukemia? A systematic review to evaluate its importance in clinical practice.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-08-25
    Jociele M Kirizawa,David M Garner,Claudia Arab,Vitor E Valenti

    Impaired cardiovascular and autonomic function during treatment and during recovery from leukemia has been indicated. In this context, heart rate variability (HRV) is a non-invasive measure that describes the oscillations of the intervals between consecutive heart beats (RR intervals), influenced by the autonomic nervous system. We intend to review literature showing HRV changes in leukemia subjects. The articles selected in the current review were attained up to March 2018, and the search was limited to articles in English language, published in peer-reviewed journals, with both adult and child age samples. The articles were investigated in the five electronic databases: PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Clinical Trials, Scientific Electronic Library Online (SciELO), and Excerpta Medica dataBASE (EMBASE). Towards the end of the research, 9 studies were included. Subjects undergoing treatment for leukemia have reduced HRV, signifying decreased vagal control of heart rate. The subjects that undertook leukemia treatment and their survivors experienced a reduction in HRV with subsequent recovery, but the recovery time is ill defined. HRV is reduced in leukemia subjects who progress to neuropathy secondary to chemotherapy, accompanied by cardiac dysfunction. We advocate the use of HRV to evaluate autonomic function and decide the treatment to prevent autonomic impairment in leukemia subjects.

    更新日期:2019-11-01
  • Effects of relaxation on self-esteem of patients with cancer: a randomized clinical trial.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-08-17
    Mehdi Harorani,Masoomeh Noruzi Zamenjani,Mohamad Golitaleb,Fahimeh Davodabady,Sima Zahedi,Ali Jadidi,Masoud Rezaei

    BACKGROUND AND OBJECTIVES Cancer is usually associated with decreased self-esteem. Relaxation is one of the most effective methods to promote self-esteem of patients with chronic diseases. Hence, the present study aimed to investigate the effects of relaxation on self-esteem of patients with cancer. METHODS This randomized clinical trial was conducted on 80 patients with cancer. The samples were selected by convenience sampling method and were randomly divided into experimental and control groups. In the experimental group, the patients implemented relaxation techniques once a day for 30 min during 60 consecutive days in addition to receiving routine care, while patients in the control group received only routine care. Before and after the intervention, the Persian version of the Coopersmith Self-Esteem Inventory (CSEI) was completed. RESULTS After the interventions, significant differences were observed between groups in favor of the relaxation group in total score of CSEI and all its subscales (P = 0.0001). In the experimental group, a significant increase in total score and all subscales of CSEI was observed after the intervention (P = 0.001), whereas in the control group, a significant decrease was found in all dimensions (P = 0.001). CONCLUSION The relaxation seems to be potentially effective in promoting self-esteem of patients with cancer. Further studies, particularly randomized clinical trials with higher sample size and more power, are needed to confirm the obtained findings.

    更新日期:2019-11-01
  • MASCC recommendations on the management of constipation in patients with advanced cancer.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-08-10
    Andrew Davies,Charlotte Leach,Ricardo Caponero,Andrew Dickman,David Fuchs,Judith Paice,Anton Emmanuel

    PURPOSE The Palliative Care Study Group of the Multinational Association for Supportive Care in Cancer formed a subgroup to develop evidence-based recommendations on the management of constipation in patients with advanced cancer. METHODS These recommendations were developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews/trials respectively. The recommendations were categorised by the level of evidence and a "category of guideline" based on the level of evidence (i.e. "recommendation", "suggestion", or "no guideline possible"). RESULTS The group produced 15 recommendations, with varying levels of evidence and so varying categories of guideline. The recommendations relate to the assessment, the treatment, and the re-assessment of constipation. CONCLUSIONS These recommendations provide a framework for the management of constipation in advanced cancer, although every patient needs individualised management.

    更新日期:2019-11-01
  • Revisiting the physiology of nausea and vomiting-challenging the paradigm.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-08-08
    Rita J Wickham

    PURPOSE The predominant neurotransmitters and receptors for acute and delayed chemotherapy-induced nausea and vomiting (CINV) are represented in the current paradigm, which reflects successful control of emesis. However, control of nausea (N) lags behind management of vomiting (V). This review aims to re-examine and incorporate new information about the mechanisms of V and N. METHODS The initial literature search focused on CINV. Keywords in articles led to subsequent discovery of publications focused on N&V in other medical and scientific fields (e.g., gastroenterology, neurology, cannabinoid science, neuropharmacology, and motion sickness). Using keywords to identify other sources continued until no further recent, meaningful publications were found. RESULTS More than 86% of references were from recent non-oncology journals and books, suggesting there are many areas for cross-fertilization research into mechanisms and management of N&V-particularly of N, which involves overlapping and dissimilar CNS areas from V. Information from cited articles was incorporated into visual representation of N&V, which is certainly not exhaustive but supports highly complex processes in the stomach and gut, the vagus nerve and spinal cord neurons, the nucleus tractus solitarii, and the anterior insular cortex and anterior cingulate cortex with input from the amygdala. CONCLUSIONS These data support the idea that mechanisms for N, whatever the cause, must be highly similar. Continued research into nausea, including patient-reported evaluation and outcomes, is important; interventions for nausea could be considered adjuvants to current standard of care antiemetics and be individualized, depending on patient-reported efficacy and adverse effects and preferences.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Hope-related goal cognitions and daily experiences of fatigue, pain, and functional concern among lung cancer patients.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-06-04
    Laurie E Steffen,Jennifer S Cheavens,Kevin E Vowles,Jennifer Gabbard,Huynh Nguyen,Gregory N Gan,Martin J Edelman,Bruce W Smith

    PURPOSE Cross-sectional research suggests that thinking about multiple ways to reach goals (hope pathways) and the belief that one can reach them (hope agency) may be adaptive for lung cancer patients. We examined the between-person and within-person associations among aspects of hope agency and pathways thinking, daily fatigue, pain, and functional concerns (e.g., sense of independence, usefulness) among lung cancer patients during active treatment. METHODS Data from a daily diary study were used to examine relations among hope agency, hope pathways, fatigue, pain, and functional concern in 50 patients with advanced lung cancer. Participants were accrued from one outpatient cancer center and completed the study between 2014 and 2015. RESULTS Adjusting for covariates and the previous day's symptoms or concern, patients who engaged in higher pathways thinking reported lower daily symptoms, whereas those who engaged in higher agency thinking reported less functional concern. Within-person increases in pathways thinking were associated with less daily fatigue, pain, and functional concern; within-person increases in agency thinking were associated with less daily fatigue and pain. Models examining symptoms and concerns as predictors of hope suggested within-person increases in functional concern and fatigue and pain were related to lower agency and pathways thinking the same day. Patients with higher fatigue and pain did not report lower agency or pathways thinking, but patients with more functional concern did. CONCLUSIONS Increases in hope pathways thinking may be associated with lower symptoms and better functioning in lung cancer patients. This suggests that it is important to determine the efficacy of interventions that emphasize the pathways the component of hope.

    更新日期:2019-11-01
  • Impact of protocol change on individual factors related to course of adverse reactions to chemotherapy for breast cancer.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-05-06
    Daniela Polessa Paula,Vanessa I do Brasil Costa,Rosane V Jorge,Flávio F Nobre

    PURPOSE Asthenia, myalgia, arthralgia, mucositis, abdominal pain, diarrhea, and neutropenia are adverse reactions commonly reported by women undergoing chemotherapy. Traditional approaches do not take into account the effect that chemotherapeutic changes and variable interactions can cause in adverse reactions. We aimed to identify the impact of the change of a chemotherapy protocol within the same treatment in profiles associated with adverse reactions. METHODS A total of 166 women admitted to the Brazilian National Institute of Cancer (INCA) were followed. Polymorphisms, clinical variables, and FAC-D protocols (3 cycles of cyclophosphamide, 5-fluorouracil, and doxorubicin followed by 3 cycles of docetaxel) composed the set of independent variables analyzed. Reaction levels were recorded at the end of each chemotherapy cycle via interviews. Marginal models were fitted. RESULTS The results of marginal models for non-hematological reactions revealed that the docetaxel phase was associated with increased reaction levels compared with the FAC phase. In addition, the set of factors associated with the reactions changed in each protocol. The post-menopausal status was related to high levels of asthenia in docetaxel protocol whereas CYP2B6 polymorphism (rs3745274) was related to high levels in FAC protocol. Regarding the docetaxel phase, high levels of abdominal pain and mucositis were related to CBR3 gene (rs8133052) polymorphism and diabetes respectively. CONCLUSION The results suggest the need for monitoring non-hematological reactions during the docetaxel phase of FAC-D treatment. The factors related to more severe reactions depend on the chemotherapy protocol used.

    更新日期:2019-11-01
  • Low paravertebral muscle mass in patients with bone metastases from lung cancer is associated with poor prognosis.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-05-06
    Sho Dohzono,Ryuichi Sasaoka,Kiyohito Takamatsu,Masatoshi Hoshino,Hiroaki Nakamura

    PURPOSE Low skeletal muscle mass has been associated with poor prognosis in patients with advanced lung cancer. However, little is known about the relationship between skeletal muscle mass and overall survival in patients with bone metastases from lung cancer. The objective of the present study was to evaluate the prognostic value of low trunk muscle mass in predicting overall survival in these patients. METHODS The data from 198 patients who were diagnosed with bone metastases from lung cancer from April 2009 to May 2017 were retrospectively reviewed. The areas of the psoas and paravertebral muscles were measured at the level of the third lumbar vertebra on computed tomography scans taken at the time nearest to the diagnosis of bone metastasis. Muscle area was evaluated for male and female cohorts separately using different cutoff points. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival. RESULTS The overall survival of patients in the lowest quartile for psoas muscle area or paravertebral muscle area was significantly shorter than that of patients above the 25th percentile for muscle area (p < 0.001). Multivariate analyses showed that paravertebral muscle mass (hazard ratio, 1.73; 95% confidence interval, 1.17-2.56; p = 0.006), epidermal growth factor receptor-targeted therapy, and performance status were independent prognostic factors. CONCLUSIONS Low paravertebral muscle mass was associated with shorter survival, independently of known prognostic factors.

    更新日期:2019-11-01
  • A survey of oncology healthcare professionals' knowledge and attitudes toward the use of music as a therapeutic tool in healthcare.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-05-06
    Mary Jane Esplen,Bev Foster,Sarah Pearson,Jiahui Wong,Chelsea Mackinnon,Isabel Shamsudeen,Katharine Cecchin

    BACKGROUND Music as a therapeutic tool, defined as "music care," can help manage physical and psychological symptoms in individuals with cancer. There is further need to understand interest level and the potential role of music care among health professionals working in the field of oncology. PURPOSE To investigate knowledge of and attitudes toward the use of music as a therapeutic tool in cancer and palliative care, as well as to identify barriers associated with learning to use music in care among health professionals. METHODS Participants (N = 204), mostly nurses working in oncology and palliative care, completed a survey to assess awareness, knowledge, and attitudes toward the use of music in healthcare practice. RESULTS In total, 55.5% of participants reported being "somewhat or very knowledgeable" about how to apply/use music therapy for the management of symptoms or on how to make a music therapy referral or for any application of music care. Participants demonstrated a high interest level in learning how to incorporate music into practice (mean = 4.05; SD = 1.045). CONCLUSION While there is generally high interest and perceived value among nurses in music care interventions, knowledge level about such interventions was low. The study has implications for knowledge translation and education needed to further support uptake and use of music care in nursing practice.

    更新日期:2019-11-01
  • Music, heart rate variability, and symptom clusters: a comparative study.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-05-03
    Shu-Chuan Chen,Ming-Lee Yeh,Hsiu-Ju Chang,Mei-Feng Lin

    PURPOSE This study aimed to explore the possible range of change of a single-session music intervention (SMI) on symptom clusters and neurological reactivity for women with breast cancer undergoing chemotherapy. METHODS A parallel and randomized, controlled study with repeated measures design was used. A total of 100 women with breast cancer were randomly assigned to the SMI or a control group. The outcome measurements of symptom cluster were collected using the Multidimensional Fatigue Symptom Inventory, Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and the neurological reactivity with heart rate variability at four time points: before commencement of the intervention (T0), immediately afterward (T1), 1 week later (T2), and 3 weeks after the intervention (T3). RESULTS Of the 50 women in each group, 46 in the SMI and 48 in the control group completed the post-test at T3. Multivariate analysis of variance indicated that the SMI group had a medium effect in change of symptom clusters compared to the control group at T2. Moreover, after adjusting for baseline between normal and higher levels of sympathetic tone activity, significant differences existed in fatigue and depression at T2 and sleep disturbance at T3. CONCLUSIONS A single-session music intervention can be effectively used to reduce symptom clusters for women with breast cancer. Targeting those who have a higher level of sympathetic tone activity is recommended.

    更新日期:2019-11-01
  • Patterns of primary health care service use of Indigenous Australians diagnosed with cancer.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-05-03
    Patricia C Valery,Christina M Bernardes,Audra de Witt,Jennifer Martin,Euan Walpole,Gail Garvey,Daniel Williamson,Judith Meiklejohn,Gunter Hartel,Isanka U Ratnasekera,Ross Bailie

    PURPOSE The role of general practitioners in cancer care has expanded in recent years. However, little is known about utilization of primary health care (PHC) services by patients with cancer, particularly among socio-economically disadvantaged groups. We describe utilization of PHC services by patients with cancer, and the nature of the care provided. The study focuses on a disadvantaged group in Australia, namely Indigenous Australians. METHODS A retrospective audit of clinical records in ten PHC services in Queensland, Australia. Demographic and clinical data of Indigenous Australians diagnosed with cancer during 2010-2016 were abstracted from patient's medical records at the PHC services. The rates of cancer-related visits were calculated using person years at risk as a denominator. RESULTS A total of 138 patients' records were audited. During 12 months following the cancer diagnosis, patients visited the PHC service on average 5.95 times per year. Frequency of visits were relatively high in remote areas and among socioeconomic disadvantaged patients (IRR = 1.87, 95%CI 1.61-2.17; IRR = 1.79, 95%CI 1.45-2.21, respectively). Over 80% of visits were for seeking attention for symptoms, wound care, and emotional or social support. Patients who did not undergo surgery, had greater comorbidity, received chemotherapy and/or radiotherapy, and male gender had significantly greater rate of visits than their counterparts. CONCLUSION The frequency of utilization of PHC services, especially by patients with comorbidities, and the range of reasons for attendance highlights the important role of PHC services in providing cancer care. The reliance on PHC services, particularly by patients in remote and disadvantaged communities, has important implications for appropriate resourcing and support for services in these locations.

    更新日期:2019-11-01
  • Unintentional weight loss, its associated burden, and perceived weight status in people with cancer.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-05-03
    Eva Y N Yuen,Alexandra K Zaleta,Shauna McManus,Joanne S Buzaglo,Thomas W LeBlanc,Kathryn Hamilton,Kevin Stein

    PURPOSE Unintentional weight loss (UWL) is a prevalent problem in people with cancer and is associated with poorer psychosocial outcomes. A gap exists in understanding whether and how perceived and/or weight status impacts experiences of UWL. Thus, we sought to examine subjective experiences of UWL in people with cancer, and whether perceived and/or actual weight status impacts these experiences. METHODS Participants were recruited through Cancer Support Community's Cancer Experience Registry® and related networks. Participants completed an online survey that included the FAACT Anorexia-Cachexia subscale, and 19 items that captured six themes related to "beliefs and concerns" (positive beliefs, psychosocial impact, physical impact, cancer outcomes, self-esteem, relationships with others). Perceived weight status (PWS) was assessed using a single item. Body mass index (BMI) was calculated using self-reported weight and height measurements. RESULTS Of 326 respondents, 114 reported experiencing UWL. Over one-third misperceived their weight, with 29% perceiving weight status as below their BMI status. UWL in those with perceived weight status of overweight/obese was associated with positive beliefs. However, being underweight by BMI or perceiving oneself as underweight were both associated with greater concerns about weight loss. Perceived weight status of underweight compared to normal or overweight/obese weight status was associated with poorer psychosocial well-being, personal control, self-esteem, and relationships with others. CONCLUSION In people with cancer, perceived weight status, rather than BMI, had greater impact on negative "beliefs and concerns" about UWL. Findings suggest assessment of both perceived and actual BMI to address the impact of UWL on psychosocial wellbeing.

    更新日期:2019-11-01
  • Nutritional parameters associated with hospital admissions in patients being treated for head and neck cancer.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-05-03
    Amanda M Duffy,Mark Halaki,Allan Spigelman,Venessa Chin,Richard M Gallagher,Victoria M Flood

    PURPOSE This study analysed nutritional parameters (baseline body mass index (BMI), weight changes and enteral nutrition (EN) use, and their association with hospital admissions during radiotherapy in patients with head and neck cancer (HNC)). METHODS A retrospective review of patients diagnosed with HNC and treated with radiotherapy between October 2012 and April 2014 was conducted. Data on each subject's diagnosis, age, sex, chemotherapy, previous surgery, EN use, weight changes, and BMI were examined for their association with hospital admissions during treatment. RESULTS Eighty-three patients were included, mean age (±standard deviation) = 61 (± 11 years). Thirty-four percent had self-reported weight loss at diagnosis, and mean BMI was 26.2 ± 5.3 kg/m2. Mean weight change during treatment was - 5.1 ± 6.2%. Ten patients used EN, with mean weight stabilisation during EN use (0.3 ± 5.1%). Higher presenting BMI, younger age, and definitive radiotherapy ± chemotherapy predicted greater weight loss (p < 0.05). Critical weight loss ≥ 5% was associated with a higher number of hospital admissions for nutrition reasons (n = 10) (p = 0.011) compared with those without critical weight loss (n = 2). EN use was associated with a higher number of nutrition-related admissions; however, it did not predict length of stay among those admitted. CONCLUSION Critical weight loss during radiotherapy was associated with unplanned nutrition-related hospital admissions. Higher BMI was associated with greater weight loss during radiotherapy, whilst EN use assisted in weight preservation. Further research around patient selection for nutritional interventions aimed at preventing critical weight loss and unplanned hospital admissions is needed.

    更新日期:2019-11-01
  • The risk of bloodstream infection associated with totally implantable venous access ports in cancer patient: a systematic review and meta-analysis.
    Support. Care Cancer (IF 2.754) Pub Date : 2019-05-03
    Meng Jiang,Chang-Li Li,Chun-Qiu Pan,Li Yu

    OBJECTIVE This systematic review and meta-analysis aimed to provide evidence-based guidance to better understand the risk of central line-associated bloodstream infection (CLABSI) in cancer patients who received totally implantable venous access ports (TIVAPs) compared with those who received external central venous catheters (CVCs). METHODS A systematic search of PubMed, Web of science, Embase, and the Cochrane Library was carried out from inception through Oct 2018, with no language restrictions. Trials examining the risk of CLABSI in cancer patients who received TIVAPs compared with those who received external CVCs were included. Two reviewers independently reviewed, extracted data, and assessed the risk of bias of each study. A random-effect model was used to estimate relative risks (RRs) with 95% CIs. RESULTS In all, 26 studies involving 27 cohorts and 5575 patients reporting the incidence of CLABSI in patients with TIVAPs compared with external CVCs were included. Pooled meta-analysis of these trials revealed that TIVAPs were associated with a significant lower risk of CLABSI than were external CVCs (relative risk [RR], 0.44; 95% confidence interval [CI], 0.31-0.62; P < 0.00001), which was confirmed by trial sequential analysis for the cumulative z curve entered the futility area. Subgroup analyses demonstrated that CLABSI reduction was greatest in adult patients (RR [95% CI], 0.35 [0.22-0.56]) compared with pediatric patients who received TIVAPs (RR [95% CI], 0.55 [0.38-0.79]). CONCLUSIONS TIVAP can significantly reduce the risk of CLABSI compared with external CVCs.

    更新日期:2019-11-01
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