Systematic review of nutrition interventions in older patients with cancer: A synthesis of evidence and a future research priority

INTRODUCTION

Older patients with cancer (65 years and older) are a growing population with unique nutrition-and treatment-related issues that accelerate aging. Nutrition interventions attenuate nutritional decline, muscle loss, and risk of malnutrition and sarcopenia in patients with cancer, however the evidence for older patients with cancer is limited. The aim of this systematic review was to evaluate the efficacy of nutrition interventions on nutritional status, body weight/composition and clinical outcomes in older patients with cancer and to identify future research priority areas.

MATERIALS AND METHODS

Three databases were systematically searched from inception until January 2024. Eligible studies were randomised controlled trials (RCT) evaluating a nutrition intervention in older patients with cancer that reported nutrition-related and clinical outcomes. Studies including older patients were determined by the mean age ≥ 65 years with the error to the mean > 60 years. Between-group differences in nutritional and clinical outcomes were extracted.

RESULTS

Eleven studies describing nine RCTs were included in this review. Three trials specifically included patients 65 years and older. Most interventions intended to reduce malnutrition risk across a mix of cancer types and treatments, and one trial was designed to reduce comorbidities after treatment. Changes in dietary intake (n = 4), nutrition status (n = 1), weight (n = 5), and muscle mass (n = 3) were inconsistently reported, but preliminary evidence showed dietary counselling with oral nutrition supplements (ONS) resulted in improved weight maintenance in patients with pancreatic cancer. There was limited evidence of a benefit from nutrition interventions on treatment tolerance or quality of life. The heterogeneous findings in methodological design, including dietary prescription and frequency of consultations and reporting of outcomes, inhibits evidence-based recommendations for older adults with cancer.

DISCUSSION

Nutrition interventions designed specifically to address nutrition-related issues unique to older patients with cancer is a clear research priority. Research specifically targeting older patients post treatment, a period during which treatment-related side effects still occur, is limited. To support the growing population of older patients with cancer, future research must consistently report the dietary prescription, adherence to nutritional requirements, and clearly-defined nutrition-related parameters and clinical outcomes that are specific to older patients.

Nursing approaches in home chemotherapy: A systematic review

AIM

To systematically explore the existing literature by examining nursing approaches to home chemotherapy treatment.

BACKGROUND

With the rising number of patients with cancer, home chemotherapy has gained prominence. Nurses play a crucial role in this process and bear significant responsibilities.

INTRODUCTION

Home chemotherapy is increasingly recognized as a safe and effective alternative, relieving hospitals by managing the rising number of patients with cancer, decreasing workload and costs, and reducing pressure on the healthcare system.

METHODS

The study follows the PRISMA 2020 checklist and is registered in the International Prospective Register of Systematic Reviews (PROSPERO). Literature searches were conducted from February 15 to 16, 2024, assisted by an expert librarian, across PubMed, Cochrane Library, Scopus, CINAHL, Web of Science, and Google Scholar. Three researchers assessed the methodological quality of the included studies. EndNote version 20.1 was used to manage references and remove duplicates. Seven studies that met the inclusion criteria were reviewed in full text and included in the analysis.

RESULTS

The study's distribution includes 4 observational studies, 2 cohort studies, and 1 qualitative study. By country, the distribution is Italy (n = 2), England, Japan, the Netherlands, Korea, and Argentina (n = 1 each). Evaluated using Joanna Briggs Institute (JBI) checklists, three studies were of good quality, and four were of medium quality.

CONCLUSIONS

Nurses' responsibilities, such as patient education, treatment monitoring, and side effect management, are essential in home care. Therefore, developing evidence-based protocols to guide these practices is necessary.

CONCLUSION AND IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY

Nurses play a crucial role in enhancing treatment adherence by educating patients and their families about the chemotherapy process and managing side effects to prevent complications. Home care services reduce patients' reliance on hospitals, offering economic and psychological benefits. Further research is needed to emphasize the importance of specialized nursing education in this area.

The frequency and reasons for missed nursing care in Australian perioperative nurses: A national survey

AIM

To describe Australian perioperative nurses' reported frequency and reasons for missed nursing care in the operating room.

DESIGN

Cross-sectional online survey conducted in March-April 2022.

METHODS

A census of Australian perioperative nurses who were members of a national professional body were invited to complete a survey that focussed on their reported frequency of missed nursing care and the reasons for missed nursing care in the operating room using the MISSCare Survey OR.

RESULTS

In all, 612 perioperative nurses completed the survey. The perioperative and intraoperative nursing care tasks reported as most frequently missed included time-intensive tasks and communication with multiple surgical team members present. The most frequently reported reasons for missed care were staffing-related (e.g. staff number, skill mix, fatigue and complacency) and affected teamwork. There were no significant differences in the frequency of missed care based on perioperative nurse roles. However, there were statistically significant differences between nurse management, circulating/instrument nurses and recovery room nurses in reasons for missed care.

CONCLUSIONS

Much of the missed care that occurs in the operating room is related to communication practices and processes, which has implications for patient safety.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Understanding the types of nursing care tasks being missed and the reasons for this missed care in the operating room may offer nurse managers deeper insights into potential strategies to address this situation.

REPORTING METHOD

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Reliability, validity, and sensitivity of the Chinese Life Attitude Self-rating Questionnaire for Breast Cancer

RATIONALE, AIMS AND OBJECTIVES

Psychometrics of the Chinese Life Attitude Self-rating Questionnaire for Breast Cancer (LASQ-BC) has not yet been conducted in a larger sample of women with breast cancer. This study aimed to examine the reliability, validity, and sensitivity of the LASQ-BC in Chinese mainland female breast cancer patients.

METHOD

This is a cross-sectional study. Reliability was determined by Cronbach's α and Guttman split-half coefficient. Convergent and discriminant validity were evaluated via item-subscale and item-total score correlations. Factorial validity was estimated using a principal component analysis with varimax rotation. Sensitivity was identified via Cohen's effect size (ES) and an independent sample t-test between the new and recurrent cases. Multiple linear regression analysis was used to further examine sensitivity of the LASQ-BC under the influence of newly diagnosed breast cancer (yes vs. no).

RESULTS

A total of 429 patients completed the questionnaire. Cronbach's α of the LASQ-BC was 0.96, ranging from 0.86 to 0.92 for the four subscales (i.e., choice and responsibility, life meaning, benevolence, and life experiences). The Guttman split-half coefficient was 0.90. The hypothesised item-subscale and item-total score correlations were higher than the critical value of 0.50. Four factors were extracted from the 23 items, explaining 69.29% of the total variance. Eligible ES (range: 0.38-0.48) was found in the four subscales and total score between the new and recurrent cases (independent sample t-test), and under the influence of newly diagnosed breast cancer (yes vs. no; multiple linear regression analysis).

CONCLUSION

The Chinese LASQ-BC has acceptable reliability, validity, and sensitivity in women with breast cancer of mainland China. It can be used to female breast cancer patients as an invaluable metric and a crucial instrument for assessing and discerning those grappling with a suboptimal life attitude, and in gauging the efficacy of psychological interventions tailored to enhance this perspective.

Does Spiritual Well-Being Affect Death Anxiety and Psychological Resilience in Cancer Patients?

This study was conducted to research the effects of spiritual well-being on death anxiety and psychological resilience in cancer patients. This cross-sectional, descriptive and correlational study was carried out with 260 cancer patients who were admitted to oncology and haematology outpatient clinic of a university hospital in east of Turkey between October 2021 and April 2022. The data were collected by using "Personal Information Form", "Spiritual Well-being Scale (FACIT-sp), Death Anxiety Scale (DAS) and The Brief Resilience Scale (BRS). It was found that mean DAS total score of cancer patients was 12.51 ± 3.39, while their mean FACIT-sp total score was 26.10 ± 6.93 and their mean BRS total score was 16.1 ± 7.05. It was found that FACIT-sp total score affected DAS and BRS total score positively, while DAS total score affected BRS total score negatively (p < .001). It was found that cancer patients had moderate level of spiritual well-being and psychological resilience and high level of death anxiety. It was also found that death anxiety and psychological resilience of cancer patients increased as their spiritual well-being levels increased. Psychological resilience was found to decrease as death anxiety increased.

Beyond cancer treatment: dermo-aesthetic and other wellness recommendations for breast cancer patients

Breast cancer, a prevalent malignancy among women, has various physical and psychological impacts. This comprehensive review offers an in-depth look at multidisciplinary dermo-aesthetic intervention approaches, emphasizing the balance between oncological therapies and the management of these effects. The information presented spans specialties such as aesthetic medicine, plastic surgery, dermatology, physiotherapy, nutrition, odontology, and gynecology. This review, which serves as a clinical guide, aims to establish a safe protocol for non-medical interventions involving oncologists, physicians, and specialists from various areas in patients with breast cancer focused on improving their quality of life. This work offers personalized and integrative care strategies for the eradication of cancer. However, it is still necessary for patients to consult with their oncologist before undergoing any dermo aesthetic treatment. However, it is still necessary for patients to consult with their oncologist before undergoing any dermo aesthetic treatment.

Psychosocial and emotional management of work experience in palliative care nurses: A qualitative exploration

BACKGROUND

Palliative care, a crucial aspect of healthcare, faces challenges in psychosocial and emotional management among nurses. With an increasing need for palliative services globally, addressing the emotional well-being of nurses becomes pivotal.

AIM

To explore nurses' psychosocial and emotional work experiences in a palliative care department. The focus is on understanding the challenges, identifying coping strategies, and assessing the impact on professional and private life when facing those experiences.

METHODS

A phenomenologic-hermeneutical study involving semi-structured interviews was conducted to comprehend the lived experiences of ten nurses working in a hospital's palliative care department in Spain. Hermeneutic analysis was employed to extract patterns and insights from their experiences. The COREQ checklist was used to report this study.

FINDINGS

Palliative care nurses perceived insufficient preparation in emotional management, grappling with complex family interactions and unique work dynamics. They highlighted the significance of self-protection strategies, experience, clinical sessions, and external resources. Limited training in emotional resilience and challenges posed by the COVID-19 pandemic emerged as organisational barriers. Nurses expressed a desire for enhanced training and resources.

CONCLUSION

The study uncovered a deficiency in the emotional preparedness of palliative care nurses, impacting their professional and personal lives. Despite positive aspects, the emotional toll necessitates attention and intervention.

IMPLICATIONS FOR NURSING POLICY

Comprehensive emotional training for palliative care nurses, addressing barriers, providing resources, and acknowledging emotional labour is necessary. Reinstating paused training sessions and considering specific challenges like those posed by the pandemic are vital. Supporting nurses in their professional and private lives is crucial for sustaining quality care in palliative care departments.

Cardiotoxicity following thoracic radiotherapy for lung cancer

Radiotherapy is the standard of care treatment for unresectable NSCLC, combined with concurrent chemotherapy and adjuvant immunotherapy. Despite technological advances in radiotherapy planning and delivery, the risk of damage to surrounding thoracic tissues remains high. Cardiac problems, including arrhythmia, heart failure and ischaemic events, occur in 20% of patients with lung cancer who undergo radiotherapy. As survival rates improve incrementally for this cohort, minimising the cardiovascular morbidity of RT is increasingly important. Problematically, the reporting of cardiac endpoints has been poor in thoracic radiotherapy clinical trials, and retrospective studies have been limited by the lack of standardisation of nomenclature and endpoints. How baseline cardiovascular profile and cardiac substructure radiation dose distribution impact the risk of cardiotoxicity is incompletely understood. As Thoracic Oncology departments seek to expand the indications for radiotherapy, and as the patient cohort becomes older and more comorbid, there is a pressing need for cardiotoxicity to be comprehensively characterised with sophisticated oncology, physics and cardio-oncology evaluations. This review synthesises the evidence base for cardiotoxicity in conventional radiotherapy, focusing on lung cancer, including current data, unmet clinical needs, and future scientific directions.

Improving cancer outcomes through enhanced leadership and strategy training for cancer healthcare professionals - A course developed by the European School of Oncology (ESO), the European Cancer Organization (ECO) and Sharing Progress in Cancer Care (SPCC)

Leadership as a key building block of a health system plays a crucial role in achieving high performance and helps deliver change and shape the policy agenda and its implementation. Echoing the emerging need for effective leaders in Oncology, the "Improving Cancer Outcomes and Leadership Course" was developed jointly by the European School of Oncology (ESO), the European Cancer Organization (ECO) and Sharing Progress in Cancer Care (SPCC). The course was offered as a hybrid event online and in Warsaw in June 2022. It aimed to introduce early and mid-career cancer healthcare professionals of all disciplines and professions to the expertise required to develop strategic plans, support and collaborate in relevant applied health research, develop implementation approaches and acquire the skill sets required to support leadership and change management within their countries and regions. A total of 47 participants, mainly from Europe, participated and prepared 'case discussions' of organisational challenges or projects aiming to improve health care in their regions. These were deliberated and further developed in 3 break out groups. A qualitative evaluation of the course impact performed 2 years after the course showed that most participants remained in contact with each other, the majority had implemented learnings from the course to help improve cancer outcomes, 87 % had further developed their projects that were presented during the breakout sessions and of those 89 % felt that the discussions that were held during course had actively helped them to develop and potentially apply these projects. Finally, 77 % have thought of or initiated a different project than the one they discussed during the course, based on ideas coming from the discussions during or after the course. Here we describe the course, give three examples of topics discussed in Warsaw and present plans for the future.

The Experiences of Female Partners of Patients With Erectile Dysfunction Due to Prostate Cancer Treatment in China: A Qualitative Exploration

BACKGROUND

Because of sociocultural factors, Chinese female partners of patients with prostate cancer (PC) may have perspectives and needs that differ from the more published reports of female partners living in Western cultures.

OBJECTIVES

The aim of this study was to explore the experiences of female partners of patients with PC experiencing erectile dysfunction in China.

INTERVENTIONS/METHODS

In this interpretive descriptive design, qualitative data were collected from semistructured telephone interviews with purposively sampled participants from the urology outpatient unit in a hospital in South China. The interviews were audiotaped, transcribed, and analyzed using a constant comparison approach.

RESULTS

Three themes emerged from the analysis of the participants' narratives: ( a ) acceptance of ceasing sex; ( b ) preserving intimacy through caregiving; and ( c ) the need for sexual health-related information.

CONCLUSION

Participants in this study reported that their own sexuality and intimacy were affected by their partner's erectile dysfunction, but they adjusted to sexuality and intimacy changes through their caregiving of their husbands owing to Chinese traditional perspectives on women's obligations. They also reported having unmet informational needs in improving sexual well-being for the sake of their partners, lending further support to the likely benefit of couple-based educational interventions addressing sexual wellness in dyads affected by PC and erectile dysfunction.

IMPLICATIONS FOR PRACTICE

The present study findings highlighted the need for more research attention to the support of Chinese female partners of patients with PC regarding sexual and intimate topics.

Enhanced Recovery After Surgery for patients undergoing radical cystectomy: Surgeons' perspectives and recommendations ten years after its implementation

BACKGROUND AND OBJECTIVES

Enhanced Recovery After Surgery (ERAS) guidelines for Radical Cystectomy (RC) were published over ten years ago. Aim of this systematic review is to update ERAS recommendations for patients undergoing RC and to give an expert opinion on the relevance of each single ERAS item.

METHODS

A systematic review was performed to identify the impact of each single ERAS item on RC outcomes. Embase and Medline (through Pubmed) were searched systematically. Relevant articles were selected and graded. For each ERAS item, a level of evidence was determined. An e-Delphi consensus was then performed amongst an international panel with renowned experience in RC to provide recommendations based on expert opinion.

KEY FINDINGS AND LIMITATIONS

Preoperative medical optimization and avoiding bowel preparation are highly recommended. Robotic-assisted RC with intracorporeal urinary diversion is moderately recommended and can help in applying other ERAS items, such as early mobilization. Medical thromboprophylaxis should be administered and nasogastric tube should be removed at the end of surgery. Perioperative fluid restriction as well as opioid-sparing anesthesia protocols should be implemented. Generally, consensus was reached on most ERAS items, with the exception of epidural anesthesia (no consensus), resection site drainage (consensus against), and type of urinary drainage. Limitations include the lack of a multidisciplinary approach to the present consensus, giving however a highly specialized surgical opinion on ERAS.

CONCLUSIONS

and clinical implications: The current study updates ERAS recommendations for patients undergoing RC and suggests application of ERAS by a panel of experts in the field.

'Regrets become a lasting source of pain': A qualitative study on family caregivers' experiences leading up to a relative's death

BACKGROUND

Death preparations can benefit families both before and during bereavement. While these preparations are culturally influenced, evidence from non-Western cultures, like Eastern Asia, is limited.

AIM

To explore how family caregivers prepare for a relative's death in Taiwan.

DESIGN

A qualitative interview study analysed with reflexive thematic analysis.

SETTING/PARTICIPANTS

Twenty-two primary family caregivers following a death involving specialist palliative care were interviewed.

RESULTS

An overarching theme was 'getting everything right to have no regrets between the dead and the living'. Within this, two themes focussed upon improving the dying relative's outcomes and the families' subsequent bereavement: (1) 'making the right end-of-life decisions is crucial but complex', exploring preparations to involve (or not) the dying relative in making choices to minimise regrets. Participants often felt they understood the dying relative's wishes so respected their preferences while maintaining family harmony through consensus-building and professional guidance. (2) 'becoming a competent caregiver is the priority', addressing preparations for fulfilling responsibilities, making sacrifices and developing caregiving competence to ensure the dying relative's comfort. This would help reduce feelings of regret about not having done enough.

CONCLUSION

Preparing for end-of-life decisions and caregiving is important for participants to reduce regret, benefiting subsequent bereavement. Of particular importance is family involvement and consensus-building in end-of-life decisions, reflecting Taiwan's family-led culture. These findings can inform clinical practices in family-centric decision-making cultures where healthcare workers should be aware of the need to build consensus, sometimes without involving the dying person. Future research should include patients' and healthcare professionals' perspectives.

Oncofertility Barriers in Nurses Caring for Women with Breast Cancer

Despite the importance of oncofertility care in supporting women coping with fertility challenges after breast cancer, the practice of oncofertility care among nurses remains suboptimal. There is an urgent need to investigate oncofertility barriers faced by nurses caring for women with breast cancer. A cross-sectional online study was conducted among registered nurses caring for women with breast cancer. A self-developed questionnaire and the Oncofertility Barriers Scale (OBS) were used to assess participants' characteristics and self-perceived barriers. A score ≥ 3 indicates a high level of oncofertility barriers requiring further attention. 372 nurses completed the survey, with 45.54% reporting a score of ≥ 3 on the OBS. Notably, 85% of participants reported high levels of barriers in at least one domain and 27.42% reported barriers in all six domains of the scale. The most commonly reported barrier was "Stereotype of cancer patients" (71%). Nurses without fertility training, those who did not read fertility-related guidelines, and those in departments lacking such guidelines reported significantly higher barriers (all p < 0.05). The prevalence of oncofertility barriers among nurses is high. Educational programs should be developed to address these barriers, improving the quality of oncofertility care for women with breast cancer.

Early Prediction of Pembrolizumab-Induced Hypothyroidism Based on the Neutrophil-to-Lymphocyte Ratio

Introduction Pembrolizumab, an immune checkpoint inhibitor targeting programmed death-1 (PD-1)/PD-1 ligand (PD-L1), has demonstrated antitumor effects but can cause immune-related adverse events (irAEs) such as hypothyroidism. The neutrophil-to-lymphocyte ratio (NLR) may be linked to pembrolizumab efficacy and irAE risk. This study investigated the relationship between NLR trends and hypothyroidism onset, assessing its predictive potential. Methods This retrospective study analyzed 136 patients with advanced or recurrent cancer treated with pembrolizumab at The Jikei University Hospital, Tokyo, Japan, from February 2017 to September 2023. Patients were categorized based on hypothyroidism development, and their baseline NLR and time to treatment failure (TTF) were compared. NLR trends before hypothyroidism onset were also evaluated. Patients were further stratified based on onset timing (<90 days vs. ≥90 days), and NLR parameters prior to onset were also compared. Results Hypothyroidism occurred in 33 of 136 patients (24%). The hypothyroidism group had a significantly lower baseline NLR (P = 0.006) and longer TTF (P = 0.006). No significant NLR changes were observed before hypothyroidism onset (P = 0.626). However, the maximum NLR until onset was significantly lower in patients with early-onset hypothyroidism (<90 days) (P = 0.016). In contrast, no significant differences were observed in the mean and minimum NLR. A receiver-operating characteristic (ROC) analysis identified a maximum NLR cutoff of 4.3 for predicting early-onset hypothyroidism (P = 0.002, area under the curve (AUC) = 0.770). Conclusions A low baseline NLR was associated with hypothyroidism onset, and a persistently low NLR may contribute to early onset. These findings suggest that continuous NLR monitoring during pembrolizumab treatment may aid in predicting the risk of hypothyroidism and facilitate its appropriate management.

The Impact of a Positive Body Image Program (Body Image Awareness Seminars) on the Positive and Negative Body Image of Individuals Living With Cancer

OBJECTIVE

Using action research principles to address gaps in existing interventions, and in consultation with members and administrators of Wellspring Canada, the purpose of the current study was to adapt and examine the impact of a novel (concept, content, and inclusivity) positive body image program (Body Image Awareness Seminars; BIAS) on positive and negative body image in individuals living with cancer.

METHODS

The project used a single-group pretest-posttest design with a 6-week follow-up. Over the 6-week program, 37 participants engaged in 90-min weekly group sessions consisting of researcher-led psychoeducation, group discussion, and activities grounded in positive body image research. Each seminar had a unique theme designed to promote respect, acceptance, and appreciation for the body. Participants completed the Body Image Scale, Body Appreciation Scale-2, Functionality Appreciation Scale, Measure of Body Apperception, Appearance Evaluation subscale, and Self-Compassion Scale anonymously using Qualtrics at the 3 data collection points. Homework assignments included optional readings and writing exercises based on the positive body image tenet taught that week.

RESULTS

Participants reported statistically significant improvements in positive body image (i.e., body appreciation, functionality appreciation), self-compassion, and negative body image (i.e., body image distress and disturbance, investment in body integrity and appearance evaluation), which were sustained at the 6-week follow-up in a subsample of participants (n = 11).

CONCLUSIONS

This study suggests that the adapted BIAS program can lead to improvements in both positive and negative body image in individuals living with diverse types of cancer. Results support the implementation of BIAS in the standard of care for those living with cancer to continue to affect positive change.

Comparative efficacy of HPV 16/18 DNA and E6/E7 mRNA testing in detecting high-grade cervical lesions (CIN2+) in women with cervical biopsies

The study evaluated the efficacy of HPV 16/18 E6/E7 mRNA detection in women with abnormal cervical histology. A total of 99 cervical biopsy samples were analyzed, including 49 benign, 16 with cervical intraepithelial neoplasia grade 1 (CIN1), 9 with CIN2/3, and 25 with cervical cancers. Samples were tested for HPV 16/18 using both DNA and mRNA RT-PCR methods. The findings revealed a sensitivity of 85.3 % (29/34) for the HPV DNA test and 76.5 % (26/34) for the mRNA test in detecting CIN2+ lesions. Notably, the E6/E7 mRNA test demonstrated greater specificity for CIN2+ at 75.4 % (49/65), compared to 52.3 % (34/65) for the DNA test. The prevalence of positive results for both tests increased with the severity of squamous cell abnormalities. However, the HPV 16/18 E6/E7 mRNA test provided superior specificity, making it a more effective method for cervical cancer screening in this region, offering more precise results than DNA testing alone.

Patterns of Complementary Medicine Utilization in Patients With Breast Cancer and Colorectal Cancer: A Cross-Sectional Study at a Tertiary Referral Hospital in Yogyakarta, Indonesia

PURPOSE

The utilization of complementary medicine (CM) in patients with cancer brings substantial challenges to optimal cancer care by posing a risk of side effects and drug interaction, and might delay cancer care delivery. We aimed to characterize the patterns and predictors of CM utilization in patients with breast cancer (BC) and patients with colorectal cancer (CRC), and the impact on presentation and diagnosis interval.

METHODS

We interviewed patients with BC and patients with CRC using a semistructured questionnaire to gather sociodemographic, clinical, presentation and diagnosis interval, and CM utilization data. The domains of CM used were categorized according to the classification of the National Institutes of Health/National Center for Complementary and Integrative Health.

RESULTS

One hundred forty-two patients with BC and 227 patients with CRC (N = 369) were included. The prevalence of CM utilization was 69.9%, with biologically based therapies being the most commonly used type. Younger age, higher educational attainment, and a greater number of health facility visits before diagnosis were significantly associated with higher odds of CM utilization (odds ratio [OR], 2.05 [95% CI, 1.19 to 3.54]; P = .010; OR, 1.07 [95% CI, 1.02 to 1.11]; P = .007, respectively). The diagnosis interval was significantly longer in patients who used CM compared to nonusers (incidence rate ratio [IRR], 2.74 [95% CI, 1.77 to 4.26]; P < .001). A greater number of CM modalities used were significantly associated with longer presentation and diagnosis intervals (IRR, 1.68 [95% CI, 1.06 to 2.66]; P = .027; IRR, 1.62 [95% CI, 1.04 to 2.52]; P = .033, respectively).

CONCLUSION

A significant portion of the local patients with BC and patients with CRC used CM. CM utilization was associated with age, education, number of health facility visits, and prolonged diagnosis interval. These findings underscore the need for CM disclosure among patients for better patient education and monitoring.

The Influence of Emotional Intelligence on Shared Governance Councils Effectiveness Among Nurses Participating in Shared Governance Councils in an Oncology Setting

OBJECTIVE

This study aimed to assess the influence of emotional intelligence (EI) on shared governance councils' effectiveness among oncology nurses who participate in these councils.

BACKGROUND

Literature suggests that EI enhances job satisfaction, caring behavior, communication, and patient outcomes.

METHODS

This study used a cross-sectional design. The study took place at a large cancer hospital in Jordan. A convenience sample of 176 was used. The data were collected using self-administered questionnaires, the Wong and Law Emotional Intelligence Scale, and the Council Health Survey (CHS).

RESULTS

The findings indicated a significantly elevated degree of EI among oncology nurses, with a mean (SD) score of 5.8 (0.73) out of 7. The CHS score was 4.15 out of 5. The multiple regression analysis yielded a significant result, with an F statistic of 12.617 and degrees of freedom of 4 and 157. The P value was <0.001.

CONCLUSION

Findings support integrating more EI initiatives into nursing education and professional development.

Analyzing the Symptom Clusters Among Children With Acute Lymphoblastic Leukemia During Chemotherapy Based on Electronic Nursing Records

BACKGROUND

Children with acute lymphoblastic leukemia often experience various physical and psychological symptoms during chemotherapy. Previous studies have used predetermined symptom inventories to analyze the complex relationships between these symptoms, which has certain limitations.

OBJECTIVE

The aim of this study was to explore the dynamic changes in symptom clusters among children with acute lymphoblastic leukemia during chemotherapy using electronic nursing records.

METHODS

Electronic nursing records for 2021 (N = 14 490) were obtained from a pediatric hematology department. A natural language processing tool was used to identify the presence of 46 symptoms in 3 chemotherapy phases of induction, consolidation, and maintenance. Incidence of symptom documentation was calculated by notes and patients, and principal component analysis and cluster analysis were performed for symptoms with an incidence above 15%.

RESULTS

The most common symptoms included bleeding, cough, and vomiting. The number of symptom clusters in each chemotherapy period was 7, 6, and 4, respectively. There were upper gastrointestinal, respiratory system, lower gastrointestinal, skin-related, psychological, self-image disorder, and other discomfort symptom clusters in the induction period. Notably, the upper gastrointestinal, respiratory system, lower gastrointestinal, and skin-related symptom clusters persisted through the consolidation and maintenance periods. Neurological and other discomfort symptom clusters were observed during the consolidation period.

CONCLUSION

Symptom clusters of children with acute lymphoblastic leukemia at various stages of chemotherapy showed a certain level of stability and dynamics, informing healthcare providers in developing continuous symptom management.

IMPLICATIONS FOR PRACTICE

Medical staff should explore targeted intervention programs based on characteristics of symptom clusters at different chemotherapy stages, to improve the efficiency of symptom management and alleviate the symptom burden of children.

Association of Smoking and Alcohol with Abdominal Aortic Calcification in the General Middle-Aged and Elderly Populations

Background

Research results on the association between alcohol consumption and abdominal aortic calcification (AAC) has yielded inconsistent results. There is a paucity of evidence on the association of smoking and alcohol consumption with AAC in the general middle-aged and elderly population, including age subgroups. This study utilizes nationwide survey data to explore these associations.

Methods

Data from middle-aged and elderly National Health and Nutrition Examination Survey (NHANES) 2013-2014 participants receiving dual X-ray absorptiometry were analyzed. AAC severity was assessed using a scoring system with a maximum value of 24. Presence of AAC was defined as an AAC score >0, and severe AAC as an AAC score ≥6. Binary logistic regression was employed for analyzing the association of smoking and alcohol consumption-related indices with the presence of AAC, while cumulative odds logistic regression explored their associations with severe AAC.

Results

Data of 3135 participants were analyzed. Investigation in the entire population found that smoking history was linked to both AAC and severe AAC. In contrast, alcohol consumption history was not linked to AAC or severe AAC. After adjusting for confounders, the findings confirmed a significant association of smoking history with AAC and severe AAC. No significant associations were found for current alcohol consumption with either AAC or severe AAC. Compared with never smokers, former smokers and current smokers experienced increased AAC risk. Former smokers had a significantly lower AAC risk compared to current smokers. Compared with never alcohol consumers, neither former nor current alcohol consumers experienced a different AAC risk. No difference in AAC risk was found between former and current alcohol consumers. Individuals consuming more than 2 drinks of alcohol per day suffered from a significant increase in risk of AAC. Subgroup analyses found elderly ever and current smokers suffered from a significantly elevated AAC risk, as did middle-aged ever smokers. Elderly ever and current alcohol consumers also experienced increased risk of AAC.

Conclusions

Smoking history is significantly associated with both AAC and severe AAC. The cardiovascular benefits associated with smoking cessation primarily manifest as reduction in risk of AAC presence rather than severe AAC. Elderly smokers are exposed to a greater risk of AAC. In contrast, alcohol consumption shows no association with severe AAC. Alcohol consumption is not associated with AAC except in heavy drinking and elderly subpopulations.

Transitions in patterns of family resilience and their associations with parent-child interaction: A longitudinal study using latent transition analysis among families of children with chronic illness

OBJECTIVE

This study aimed to investigate transitions in patterns of family resilience among Chinese families of children with chronic illness over a one-year period, as well as their relationship to parent-child interaction.

METHODS

A representative sample of parents of children with chronic illness was drawn from two hospitals in Zhejiang Province, China, using convenience sampling. A total of 214 parents were assessed for family resilience, parent-adolescent communication, and child-parent relationships at three time points with a one-year interval: baseline (T1), 6 months (T2), and 12 months (T3) after the baseline survey.

RESULTS

Latent profile analysis identified three distinct patterns, including (1) low family resilience, (2) moderate family resilience, and (3) high family resilience. The latent transition analysis revealed four transition patterns: stable low (72.4 %), stable moderate-high (22.5 %), improved from low to either high or moderate (4.2 %), and worsened from high to moderate (0.9 %). A one-way ANOVA revealed significant effects of the transition patterns of family resilience on open family communication, intimacy, and conflict within parent-child relationships.

CONCLUSIONS

The high proportion within the "stable low" transition pattern and the enduring stability of family resilience over time underscore the significance of early intervention efforts aimed at enhancing family resilience or mitigating its decline among families of children with chronic illness.

The Role of Life Satisfaction and Optimism for Successful Aging in Mid and Late Life

Guided by the Rowe and Kahn model, the current study examined the longitudinal association of objective and subjective components of successful aging (SA) with individuals' life satisfaction and level of optimism across adulthood aiming to validate the related scanty existing research. Data were from waves 2 and 3 (2004-14) of the Midlife in the United States (MIDUS) study. Using structural equation modeling, we examined (N = 2,040) whether subjective life satisfaction (wave 2) has any effect on a composite measure of SA (wave 3) while controlling for baseline sociodemographic and health factors. We also examined the mediation effects of optimism in the above associations. Findings revealed that life satisfaction has a significant positive effect on SA; also, this effect is bidirectional. Further, high optimism positively mediated the bidirectional association between life satisfaction and SA. This study identified life satisfaction and optimism as having potentially positive impacts on achieving SA in middle-aged and older adults.

Weight censorial score: estimation of the weight loss during concurrent chemo-radiotherapy in nasopharyngeal carcinoma patients by image features predicts prognosis

PURPOSE

Bodyweight loss is commonly found in Nasopharyngeal Carcinoma patients during Concurrent Chemo-radiotherapy (CCRT) and has implications for treatment decisions. However, the prognostic value of this weight loss remains uncertain. We addressed it by proposing a novel index Weight Censorial Score (WCS) that characterizes the patient-specific CCRT response on actual to estimated weight loss.

METHODS

A retrospective study included 315 patients from two independent hospitals. An Estimated WCS (eWCS) was obtained through linear regression of image and dosimetry features. The eWCS was converted to an estimated net weight loss (nWL), with its accuracy evaluated. The Determined WCS (dWCS) was calculated by centering and scaling the post-RT actual nWL with patient's pre-RT body information. The ratio of dWCS to eWCS (WCS ratio) reflected the actual to estimated weight loss of a patient. The prognostic ability of WCS ratio dichotomized at 1 was evaluated.

RESULTS

The mean absolute error of estimated to actual nWL was 1.84 kg. Patients who had their actual WL larger than estimated WL were found to have significantly worse OS (p = 0.005, HR = 3.35[1.45-7.73]), PFS (p = 0.038, HR = 1.86[1.03-3.35]), and DMFS (p = 0.050, HR = 2.20[1.00-4.85]), respectively, in multivariable cox analysis. They were also found not to benefit from adjuvant chemotherapy (p = 0.572), whereas the adjuvant chemotherapy provided significant PFS benefit in patients with actual WL smaller than estimated WL (p = 0.036, HR = 0.53[0.29-0.96]).

CONCLUSION

The nWL of patient during CCRT can be reasonably estimated by dosimetry factors at pre-RT stage. The prognostic value of the actual to expected weight loss holds promise for highlighting vulnerable patients after CCRT.

Relationship Between Preoperative Fasting Duration and Anxiety Levels With Postoperative Pain, Nausea-Vomiting, and Sleep Quality in Orthopedic Surgical Patients: A Cross-Sectional Study

This study is a cross-sectional study aimed to determine the association between preoperative fasting time and anxiety level and early postoperative pain intensity, nausea-vomiting severity, and sleep quality in patients undergoing orthopedic surgery. The study was conducted between March and June 2024 and completed with 188 patients. In the study, patient information form, Amsterdam Preoperative Anxiety and Information Scale, and Richards-Campbell Sleep Questionnaire were used. Correlation analysis indicated a significant negative correlation between postoperative sleep quality and pain intensity. There was a significant positive correlation between preoperative anxiety level and preoperative solid food fasting and fluid fasting times. According to the multiple linear regression model, preoperative anxiety level was found to have a significant effect on pain severity, and pain severity at the postoperative 24th hour significantly affected postoperative sleep quality. Adjusting patients' fasting durations prior to surgical interventions according to evidence-based guideline recommendations and monitoring anxiety closely are simple, practical, and safe measures that could alleviate postoperative pain and nausea-vomiting and improve sleep quality, potentially enhancing outcomes, comfort, and the quality of care.

Evaluation of fear of falling, balance, and kinesiophobia in earthquake survivors: A comparative study between older and young adults

Objectives

This study aims to evaluate fear of falling, balance, and kinesiophobia among survivors of the earthquake that occurred in Türkiye on February 6th, 2023 and to identify potential predictors of fear of falling and impaired balance.

Patients and methods

In this single-center, cross-sectional study, a total of 260 Kahramanmaraş earthquake survivors (105 males, 155 females; median age: 44.0 years; range, 18 to 91 years) between May 08, 2024 and July 08, 2024 were included. The sociodemographic data including age, sex, body mass index (BMI), marital status (single, married, widow), education status (years), monthly income (Turkish Lira [TL]), smoking status (never smoked, smoking before the earthquake or started smoking after the earthquake), alcohol intake (never, regular use of alcohol before the earthquake, or started alcohol consumption after the earthquake) of the participants were recorded. Comorbidities were evaluated using the modified Charlson Comorbidity Index (CCI), anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), post-traumatic stress disorder (PTSD) using the National Stressful Events Survey for PTSD-Short Scale (NSESSS-PTSD), sleep disorders using the Jenkins Sleep Evaluation Scale (JSS), fear of falling using the Falls Efficacy Scale (FES), functional balance using the Berg Balance Scale (BBS), and kinesiophobia using the Tampa Scale for Kinesiophobia (TSK).

Results

Of the survivors (n=260), 4.6% and 33.8% experienced loss of first-degree relatives and house damage, respectively. The FES and TSK scores were higher, while the BBS score was lower in older adults (n=56) compared to younger counterparts (n=204) (p<0.001). Multivariate linear regression analysis revealed that increased age affected the BBS (β=-0.124; 95% CI: -0.263 - -0.185; p<0.001) and FES scores (β=0.404; 95% CI: 0.255 - 0.451; p<0.001). The PTSD-SS score had a significant effect on the FES score (β=0.915; 95% CI: 0.734 - 1.110; p<0.001).

Conclusion

The Kahramanmaraş earthquake caused detrimental effects. Older people were more affected in terms of balance, fear of falling, and kinesiophobia. Increased age and post-traumatic stress are significantly associated with fear of falling following the earthquake. As a potential risk factor for fear of falling, post-traumatic stress should be managed properly in survivors of such disasters, particularly in those at older age.

A Descriptive Qualitative Study of Religion and Spirituality's Role in Critical Illness Decision-Making Among Black and White Family Caregivers

BACKGROUND

Spiritual beliefs and spiritual support from clinicians can affect medical decision-making and coping during times of serious illness.

RESEARCH QUESTION

How do religion and spirituality affect the critical illness experience of Black and White family caregivers of patients who are critically ill?

STUDY DESIGN AND METHODS

Twenty-one semistructured interviews were conducted with Black and White family caregivers of patients admitted to ICUs in a southeastern United States health system between January 3, 2023, and May 11, 2023. Eligible family caregivers either reported unmet spiritual needs or a high degree of importance of spirituality in their lives. Participants were asked how spirituality affected medical decision-making and coping while their loved ones were seriously ill. Coders were masked to participant race during thematic analysis.

RESULTS

Of 21 family caregivers, 9 caregivers (42.9%) were Black and 12 caregivers (57.1%) were White. Black and White family caregivers generally were middle-aged (mean [SD]: 50.6 [13.6] years and 61.7 [10.7] years, respectively) and female (n = 7 [77.8%] and n = 9 [75.0%], respectively). We observed that clinicians showed less engagement about spirituality with Black compared with White family caregivers in this sample. Black family caregivers felt more comfortable discussing their spirituality with members of their community, such as pastors or friends. A common belief among all family caregivers in this sample was that God, rather than the medical team, was in control of their loved one's outcome. This was accompanied by a shared desire for accessible spiritual spaces in the ICU and proactive clinician engagement in their spirituality.

INTERPRETATION

Although spirituality served as an important coping mechanism for all family caregivers in this sample, racial differences in spiritual support offered to family caregivers were identified. Ensuring that multidisciplinary critical care teams are prepared to deliver culturally competent spiritual care is a priority.

High Symptom Burden Predicts Poorer Quality of Life Among Children and Adolescents Receiving Hematopoietic Stem Cell Transplantation or Chimeric Antigen Receptor T-Cell Therapy

BACKGROUND

Children with cancer and other serious illnesses experience symptom burden during hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy, yet limited research has characterized how these symptoms interact with overall quality of life over time.

OBJECTIVE

The aim of this study was to examine the longitudinal relationship between symptoms and quality of life in children receiving hematopoietic stem cell transplantation or chimeric antigen receptor T-cell therapy.

METHODS

A multisite study design was used to collect symptom and quality of life information at pre-cell infusion and days +30, +60, and +90 from children (N = 140) receiving hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy. A longitudinal parallel process model was used to characterize the relationship between symptoms and quality of life.

RESULTS

Children (mean age, 8.4 years) received allogeneic transplant (57.9%), autologous transplant (25.7%), or chimeric antigen receptor T-cell therapy (16.4%). Symptom prevalence was highest at baseline (>50%) for pain, fatigue, nausea, vomiting, and low appetite. Quality of life scores were worse at baseline (mean [SD], 69.5 [15.8]) and improved by 10 points by day +90. The longitudinal model indicated high symptom prevalence at baseline predicted worse quality of life at both baseline and day +90.

CONCLUSIONS

Children felt worse early in the treatment trajectory and improved by day +90. The level of symptom burden predicted the overall quality of life at all time points.

IMPLICATIONS FOR PRACTICE

Children experiencing high symptom burden should receive frequent assessment and enhanced symptom management throughout the treatment trajectory to mitigate negative impacts on quality of life.

Exploring the Influence of Virtual Reality on Psychological Variables Within Paediatric Oncology Treatment: A Systematic Review

INTRODUCTION

Virtual reality (VR) is a burgeoning technology with applications across healthcare. It remains unclear what the effect of VR on psychological factors within paediatric oncology is.

METHOD

A systematic review was conducted according to PRISMA guidelines. 436 records were screened against the inclusion and exclusion criteria, with adult focused studies, those with an unclear definition of VR, and non-oncology-based studies excluded. Once final studies were identified, an effect direction plot and narrative review was completed.

RESULTS

Seventeen records met criteria. Ten studies were RCTs, the remaining studies (n = 7) were various designs. Psychological factors included impact on anxiety, distress, depression, and positive psychological variables.

CONCLUSIONS

Some studies indicated some positive effects on psychological variables whilst other results from the studies were mixed, with non-significant findings. It is difficult to reach firm conclusions regarding the effect of VR, given the poor quality of studies, risk of bias, and the unresolved issue of how the quality of VR platform may influence outcomes.

Translation and Psychometric Evaluation of the Chinese Version of the Gynecological Cancers Awareness Scale

OBJECTIVE

To translate the Gynecological Cancers Awareness Scale (GCAS) into Chinese and validate its reliability and validity in assessing awareness of gynecologic cancer prevention and treatment among women in China.

DESIGN

Descriptive psychometric study.

SETTING

People's Republic of China.

PARTICIPANTS

Adult women who lived in China (N = 434).

METHODS

We conducted the research in two phases. Phase 1 involved the translation and adaptation of the GCAS into Chinese. Phase 2 involved administering a cross-sectional survey using an electronic questionnaire.

RESULTS

The translated GCAS had a Cronbach's α of .92, an intraclass correlation coefficient of 0.83, and an adequate content validity index. We used exploratory factor analysis to identify four factors that explained 64.01% of the variance and found that most fit indices in the confirmatory factor analysis were acceptable.

CONCLUSION

Among our participants, the Chinese version of the GCAS was a valid and reliable tool for assessing awareness of gynecologic cancer risk, prevention, and treatment among women in China.

Effectiveness of nurse-led interventions on psycho-social aspects among adolescents

Adolescence is a critical developmental stage marked by significant psychological and social challenges. Effective interventions during this period are essential for fostering long-term mental health. Hence, a true experimental pretest-posttest control group design involving 20 ninth-grade students from government-aided and private schools in Coimbatore, Tamil Nadu was completed. The eight-week nurse-led intervention included sessions on emotional self-awareness, stress coping, resilience building and mindfulness. The intervention group exhibited significant improvements in emotional regulation (mean increase of 9.8, p < 0.001) and resilience (mean increase of 22.6, p < 0.001) compared to the control group, which showed no significant changes. Further, a moderate positive correlation (r = 0.35, p = 0.05) was observed between gains in emotional regulation and resilience within the intervention group.

Effects of Health Education on Self-efficacy, Negative Emotions, and Life Quality in Breast Cancer Patients: A Systematic Review and Meta-analysis

BACKGROUND

Breast cancer patients encounter challenges managing acute and chronic symptoms during and after treatment, leading to emotional fluctuations and diminished quality of life. Health education aims to improve knowledge and life skills; however, its specific impact on breast cancer patients' self-efficacy is unclear.

OBJECTIVE

To assess the effects of health education on self-efficacy, depressive symptoms, anxiety, distress, and life quality in breast cancer patients.

METHODS

Randomized controlled studies were systematically screened in 7 databases from inception of the database to May 1, 2024. Literature quality was assessed using the Cochrane Risk of Bias Assessment tool. Results were pooled using random-effects meta-analyses and reported as standardized mean difference. Heterogeneity was reported using I2 statistic.

RESULTS

Sixteen articles were included. Participants in the intervention group exhibited enhanced self-efficacy in posttest (standardized mean difference [SMD], 0.12; 95% confidence interval [CI], 0.01-0.23; P = .04, I2 = 8%) and during the follow-up period (SMD, 0.30; 95% CI, 0.09-0.52; P = .006, I2 = 63%), decreased depressive symptoms (SMD, -0.30; 95% CI, -0.52 to -0.08; P = .0007, I2 = 17%), and increased life quality (SMD, 0.25; 95% CI, 0.01-0.49; P = .04, I2 = 48%) during the follow-up period.

CONCLUSIONS

Health education can enhance self-efficacy, reduce depressive symptoms, and improve the life quality of breast cancer patients. However, more rigorous research is needed to evaluate their effectiveness due to suboptimal blinding.

IMPLICATIONS FOR PRACTICE

The study underscores the critical role of health education in breast cancer management, emphasizing the necessity of integrating comprehensive health education programs into standard care protocols.

Physical activity levels and influencing factors among colorectal cancer patients: A cross-sectional study

BACKGROUND

Numerous studies have reported that a majority of colorectal cancer patients in China have low levels of physical activity. Early identification of relevant factors is beneficial for formulating physical activity interventions. This study aimed to describe the status of physical activity in colorectal cancer patients and determine psychosocial predictors of low levels of physical activity.

METHODS

We conducted a cross-sectional survey of 230 hospitalized patients with colorectal cancer in a tertiary hospital in Hubei Province. The research utilized a self-designed general information questionnaire, International Physical Activity Questionnaire Short Form (IPAQ-SF), Social Support Rating Scale (SSRS), Brief Illness Perception Questionnaire (BIPQ), and Posttraumatic Growth Inventory (PTGI) as assessment tools. SPSS 25.0 was used for descriptive statistical analysis, Chi-squared test, Student's t-test, and binary logistic regression analysis.

RESULTS

The prevalence of low physical activity among colorectal cancer patients was 52.5%. Binary logistic regression analysis revealed that monthly per capita household income of 3000-5000 yuan (OR = 0.274, 95% CI: 0.080-0.942), monthly per capita household income > 5000 yuan (OR = 0.191, 95% CI: 0.037-0.992), duration of diagnosis between 7 and 12 months (OR = 0.132, 95% CI: 0.030-0.587), social support score (OR = 0.802, 95% CI: 0.679-0.947), illness perception score (OR = 1.136, 95% CI: 1.019-1.266), and posttraumatic growth scores (OR = 0.915, 95% CI: 0.847-0.989) were independent predictors of physical activity in colorectal cancer patients.

CONCLUSIONS

Overall, colorectal cancer patients in China have low levels of physical activity. These findings may provide valuable insights for healthcare professionals to identify individuals with low levels of physical activity and to develop effective intervention strategies. In future clinical practice, healthcare providers can promote physical activity in colorectal cancer patients through interventions aimed at enhancing social interactions, improving proper knowledge and understanding of the disease, and fostering posttraumatic growth.

Issues related to grooming among postmastectomy patients: An Indian perspective

BACKGROUND

The surgical management of breast cancer results in the alteration of breast volume and clothing style, including designs of dresses, brassiere wearing, and use of breast prosthesis among the patients. It is important to understand the changing needs of breast cancer survivors related to their grooming practices. The current study provides data regarding the practices related to grooming associated with the changes in breast volume of breast cancer survivors.

MATERIALS AND METHODS

The study was conducted at a tertiary care center in northern India. A total of 191 breast cancer survivors attending the outpatient department for follow-up were enrolled consecutively. Apart from collecting data regarding the sociodemographic profile and clinical profile, a questionnaire was used to assess the grooming practices of the participants. They were ensured of the confidentiality of their information.

RESULTS

The unaffected breast had a significantly higher mean volume than the affected breast. After surgery, 60% were wearing brassieres. Pain at the surgical site was the most frequent justification for not wearing the brassiere. Only 10% of the participants were using breast prostheses. Some of these women were customizing prostheses using silicon, cotton, or towels. Around 40% of the participants said that they felt uncomfortable when using any of the prostheses. Most of them favored wearing cotton fabric after surgery.

CONCLUSION

Awareness regarding postmastectomy clothing may enhance the self-image of the survivors. It is recommended to have breast cancer clinics to provide counseling services for the survivors of breast cancer.

15 years supporting adherence to oral anti-cancer treatment: use of the MASCC Oral Agent Teaching Tool (MOATT) worldwide, a review for the future

INTRODUCTION

The MASCC Oral Agent Teaching Tool (MOATT®) was developed to address the challenges of patient education and adherence in the context of oral anticancer agents. Despite its evidence-based design and global availability, there is limited documentation on its application in clinical practice and research. This review aims to assess the extent of MOATT usage and evaluate the impact on patient outcomes.

METHODS

A scoping review was conducted following Joanna Briggs Institute and PRISMA-ScR reporting standards. Databases included CINAHL, Embase, PsycInfo, Web of Science, and PubMed. Inclusion criteria were studies published between 2010 and 2023 that used MOATT in clinical practice or research. Two reviewers independently screened and extracted data, with discrepancies resolved by consensus.

FINDINGS

Seventeen studies met the inclusion criteria, from nine countries. The MOATT was most used by nurses and pharmacists to guide patient education when initiating new oral anticancer therapies. Reported outcomes included improved patient knowledge, understanding of medication regimens, and comfort in managing treatments. However, only six studies assessed medication adherence, with mixed results. The tool was adapted in various settings, yet there was a notable lack of detailed reports on its usage and outcomes, highlighting underutilization and potential barriers to broader implementation.

CONCLUSION

The MOATT is a valuable tool for supporting patients on oral anticancer agents yet is underutilized in practice. Future research should focus on understanding the barriers to its adoption, exploring patient and provider perspectives, and integrating implementation science to enhance its use in diverse clinical contexts.

Professional Competence and Spiritual Care Provision Among Zambian Maternal Healthcare Providers: Through the Lens of Watson's Theory of Human Caring

Purpose: Spiritual care is a multifaceted and integral part of holistic health within the medical standard of care, and it is a crucial component of healthcare providers' (HCPs) job descriptions. This study aimed to investigate Zambian HCPs' professional competence and practice of spiritual care in maternal healthcare settings, with a comparative focus on nurses. Methods: A cross-sectional design was applied among 311 maternal HCPs using an online survey with two validated instruments: Professional Competence in Spiritual Care (PCSC) and the Nurse Spiritual Care Therapeutics Scale (NSCTS). Results: Most participants were females (63.0%) and nurses or midwives (25.1% each). The mean PCSC score was 135.4 (SD = 26.5), indicating excellent competence in spiritual care. The mean NSCTS score was 24.5 (SD = 14.2), indicating that HCPs seldom provide spiritual care. No significant differences were found in PCSC scores across different HCPs (p = 0.065). However, midwives and medical practitioners scored significantly higher on NSCTS compared to nurses (p < 0.001). Conclusions: Zambian HCPs demonstrate excellent competence in spiritual care but seldom provide it. Nurses appear to provide inadequate spiritual care compared to other HCPs. These findings highlight the need for further investigation to identify barriers preventing nurses from delivering comprehensive spiritual care.

Effects of laughter therapy on improving physical and psychological symptoms among cancer patients: a systematic review and meta-analysis

INTRODUCTION

Cancer is a major cause of death worldwide and laughter therapy is used as a complementary therapy for cancer treatment. This study aimed to investigate the effects of laughter therapy on psychological symptoms (stress, anxiety, and depression) and physical symptoms (pain, fatigue, and sleep quality) among cancer patients.

METHODS

Eight databases were searched, with the search period was limited to April 2024. Quality assessment of the included randomized controlled trials was performed according to the criteria for evaluating randomized controlled trials in the Cochrane Handbook for Systematic Reviews of Interventions. The RevMan 5.4 software was used for the data analysis.

RESULTS

Nine randomized controlled trials were included in this systematic review and meta-analysis. The quality of the included studies was relatively high. The results showed that laughter therapy can effectively improve cancer patients' stress, anxiety, depression, pain, and fatigue, but has no effect on sleep quality.

CONCLUSIONS

Laughter therapy is a low-cost, easy-to-implement intervention that may have potential benefits in improving psychological symptoms (stress, anxiety, and depression) and physical symptoms (pain and fatigue) among cancer patients. Laughter therapy has the characteristics of high safety, strong interaction, and strong feasibility. It may promote communication between patients and between patients and medical healthcare, enhance the trust relationship between medical staff, and potentially improve the quality of life for cancer patients. Healthcare professionals should consider laughter therapy as a potential adjunctive therapy, but its implementation should be tailored to individual patient needs and supported by robust evidence.

Psychosocial wellbeing of patients with breast cancer following surgical treatment in Northern Nigeria

BACKGROUND

Breast cancer is the most commonly diagnosed cancer and a leading cause of cancer-related deaths among women globally. The cases of breast cancer have continued to rise in Nigeria and surgery remains one of the commonest treatment modalities. However, little is known about the psychosocial wellbeing of patients with breast cancer following surgery in Sub-Saharan Africa. The study investigates the psychosocial well-being and its determinants among patients with breast cancer post-surgery.

METHODS

This cross-sectional study was conducted among 72 patients with breast cancer post-surgery in Northern Nigeria. A clinico-demographic questionnaire, the World Health Organization Quality of Life Brief (WHOQOL-BREF), and the 12-item General Health Questionnaire (GHQ-12) were administered to all participants to gather information on their background and psychosocial wellbeing.

RESULTS

The participants' mean (± SD) age was 45.94 (± 9.05) years. The prevalence of psychological distress was 36.1% based on GHQ-12. A three-factor analysis of the GHQ-12 showed participants' mean (± SD) scores for anxiety/depression, social dysfunction, and loss of confidence were 9.25 (± 3.93), 14.17 (± 5.62) and 4.59 (± 1.97) respectively. About 15% (n = 11) of the participants reported their QoL as poor with mean total score of 50.91 (± 12.62), and social relationship 9.81 (± 5.09) was mostly affected across the four domains of WHOQOL-BREF. A lack of psychological counseling pre-surgery, unemployment, low level of education, post-surgical complications, and presence of psychological distress were associated with poor QoL. However, a lack of psychological counseling, post-surgical complications, and psychological distress were key predictors of poor QoL after controlling for cofounders.

CONCLUSION

Evidence informed holistic care is indicated among individuals with surgical treatment for breast cancer. There is a need for resources, capacity development and training of healthcare professionals involved in the management of breast cancer to deliver holistic care to enhance their psychosocial wellbeing. Future prospective studies are needed to inform evidence-based psychosocial interventions.

Stigma and self-perceived burden in postoperative liver cancer patients: the mediating role of financial toxicity

Purpose

To investigate the mediating effect of financial toxicity on stigma and self-perceived burden in patients with liver cancer after surgery.

Methods

Using a convenience sampling method, 236 postoperative liver cancer patients treated at a tertiary hospital in Nanjing from April 2024 to July 2024 were selected for the study. Questionnaires were administered, including a general information survey, the Social Impact Scale (SIS), the Self-Perceived Burden Scale for Cancer Patients (SPBS-CP), and the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy Version 2 (COST-FACIT-V2). Data were analyzed using SPSS 22.0 for descriptive statistics, correlation analysis, and regression analysis. MPlus 8.3 was employed to examine the mediating effect of financial toxicity between stigma and self-perceived burden, and the Bootstrap method was used to test the significance of the mediation effect.

Results

The self-perceived burden score, stigma score, and financial toxicity score were (31.72 ± 7.52), (58.92 ± 8.69), and (18.62 ± 6.80), respectively. The financial toxicity and self-perceived burden were negatively correlated (r=-0.270,P=0.001). There was a positive correlation between stigma and self-perceived burden (r=0.586,P=0.000). Financial toxicity partially mediated the relationship between stigma and self-perceived burden, accounting for 4.84% of the total effect.

Conclusion

Stigma can influence the self-perceived burden of liver cancer patients through financial toxicity. Clinical nurses should prioritize alleviating patients' stigma while also paying close attention to their financial toxicity status, providing feasible assistance in a timely manner to reduce their self-perceived burden.

Lived experiences of gynaecological cancer survivors in Oman: a qualitative study

OBJECTIVE

A significant number of patients with gynaecological cancers survive their disease and are considered cured. However, the diagnosis of cancer and its treatment can affect quality of life adversely. We sought to explore the lived experiences of women surviving gynaecological cancers in Oman.

METHODS

Omani patients with gynaecological cancers who had completed their treatment more than 1 year ago and were following up in the medical oncology clinic at a major cancer centre in Oman were interviewed. A qualitative study design was employed using face-to-face semistructured individual interviews. To prevent recall bias, women diagnosed with cancer within the past 5 years only were included. The sample size was determined using data saturation, where data collection revealed no new information. All interviews were tape recorded and transcribed verbatim. Transcripts were analysed using a standardised thematic analysis approach.

RESULTS

Four main themes emerged: 'Beliefs and attitudes'; 'Living with Treatment Complications'; 'Living with cancer' and 'Coping with the Cancer Journey'.

CONCLUSIONS

The diagnosis of cancer had a profound effect on the lives of women with gynaecological cancer. The diagnosis negatively affected their lives throughout their cancer journey due to social role changes, fertility and sexual problems. Religion and social support played major roles in coping with the disease. This is the first study describing the lived experiences of Muslim and Omani survivors of gynaecological cancers and may help to determine their survivorship needs.

Caregivers of patients with cancer: perceived stress, quality of life and immune function

OBJECTIVES

To examine the mediating effect of quality of life (QoL) on the relationship between perceived stress and immune function in Korean family caregivers of patients with cancer.

METHODS

In this cross-sectional study, 89 family caregivers of patients with cancer completed perceived stress and QoL questionnaires. Immune function was assessed using two proinflammatory biomarkers, IL-6 and tumour necrosis factor-alpha (TNF-α). Multiple parallel mediator regression was conducted using four mediators (burden, lifestyle disruption, positive adaptation and financial concern) representing the subscales of QoL related to caregiving.

RESULTS

Psychological (indirect effect (ab)=-0.52, 95% CI -1.25 to -0.01) and physical (ab=-0.44, 95% CI -1.07 to -0.05) stress had a significant indirect effect on IL-6 levels attributed to lifestyle disruption associated with caregiving. Psychological (ab=-0.97, 95% CI -2.37 to -0.11) and physical (ab=-1.10, 95% CI -2.87 to -0.08) stress also had a significant indirect effect on TNF-α as a result of financial concerns owing to caregiving. Other indirect effects of psychological/physical stress on inflammation were not significant.

CONCLUSION

This study demonstrated that the effects of perceived psychological and physical stress on IL-6 and TNF-α levels were mediated by the caregiver's QoL, especially lifestyle disruption and financial concerns. Stress management and improvement of caregivers' QoL related to lifestyle disruption and financial issues should be considered to reduce the negative effects of caregiving on immune function.

Psychometric evaluation of the Chinese version of the Patient Self-Advocacy Scale using classical test theory and item response theory

BACKGROUND

Patient self-advocacy plays a crucial role in improving cancer patients' quality of life, but there is no validated instrument to assess this concept among Chinese head and neck cancer patients. This study aimed to cross-culturally translate the Patient Self-Advocacy Scale (PSAS) and evaluate its psychometric properties using classical test theory and item response theory.

METHODS

The PSAS underwent cross-cultural adaptation based on Brislin's translation model and a cross-sectional survey of 302 head and neck cancer patients at a tertiary hospital in Tianjin was conducted from November 2023 to August 2024. Classical test theory was used for item analysis and validation of reliability (internal consistency, test-retest reliability) and validity (content validity, construct validity). Item response theory was applied to evaluate model fit, reliability, item difficulty, and measurement invariance.

RESULTS

Classical test theory analysis demonstrated good item discrimination with item-total correlations ranging from 0.776 to 0.942 and critical ratios from 13.269 to 33.170 (p < 0.05), as well as good internal consistency (Cronbach's α = 0.942 for the total scale) and test-retest reliability (ICC = 0.840 for the total scale, p < 0.001). I-CVI values ranged from 0.80 to 1.00, with an S-CVI of 0.95. The three-factor model demonstrated good fit (χ2/df = 2.595, RMSEA = 0.090, SRMR = 0.072, CFI = 0.966, IFI = 0.966, TLI = 0.956). Rasch analysis indicated a good model fit and reliability (person/item separation index > 1.5, person/item reliability coefficient > 0.9). The Wright map showed good matching between item difficulty and person ability. Differential item functioning (DIF) analysis revealed no significant differences across gender.

CONCLUSION

The Chinese version of PSAS demonstrates satisfactory psychometric properties among head and neck cancer patients and provides healthcare providers with a tool to assess patients' self-advocacy, potentially facilitating patient-centered care and self-management in clinical practice and improving patients' health and quality of life outcomes.

Culturally Sensitive Approaches in Psychosocial Interventions to Enhance Well-Being of Immigrant Adults Diagnosed with Breast Cancer: A Systematic Review

OBJECTIVE

The objective is to synthesize the literature on culturally sensitive approaches in psychosocial interventions to enhance the well-being of immigrant adults diagnosed with breast cancer.

METHODS

We conducted a systematic review following the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and reporting literature searches, and a multi-database search strategy of qualitative research studies and reports published in academic journals and grey literature within a 20-year duration.

RESULTS

We extracted data from twenty-two studies that met the inclusion criteria. Content analysis revealed experiences of cultural considerations in the care and psychosocial well-being of immigrants such as the development of culturally responsive care models; barriers and gaps in culturally responsive care in rural communities; patient information, education, and culturally responsive care; cultural stigma, and self-perception of the access, use, and role of healthcare providers, the impact of cancer and linguistically appropriate care; and challenges with psychosocial well-being and culturally responsive care.

CONCLUSIONS

Concerns relating to psychosocial well-being of immigrant adults diagnosed with breast cancer are consistently described in the literature. Interventions exist to address psychosocial well-being; however, none have been developed or tested in immigrant adults diagnosed with breast cancer. Addressing the psychosocial well-being of immigrant adults will require the integration of culturally appropriate considerations in care to attitudes impacting patient care and reported outcomes.

Incidence and Risk Factors of Lower Limb Deep Vein Thrombosis in Psychiatric Inpatients by Applying Machine Learning to Electronic Health Records: A Retrospective Cohort Study

Background

Psychiatric inpatients face an increased risk of deep vein thrombosis (DVT) due to their psychiatric conditions and pharmacological treatments. However, research focusing on this population remains limited.

Methods

This study analyzed 17,434 psychiatric inpatients at Huzhou Third Municipal Hospital, incorporating data on demographics, psychiatric diagnoses, physical illnesses, laboratory results, and medication use. Predictive models for DVT were developed using logistic regression, random forest, support vector machine (SVM), and XGBoost (Extreme Gradient Boosting). Feature importance was assessed using the random forest model.

Results

The DVT incidence among psychiatric inpatients was 1.6%. Predictive model performance, measured by the area under the curve (AUC), showed logistic regression (0.900), random forest (0.885), SVM (0.890), and XGBoost (0.889) performed well. Logistic regression and random forest models exhibited optimal overall performance, while XGBoost excelled in recall. Significant predictors of DVT included elevated D-dimer levels, age, Alzheimer's disease, and Madopar use.

Conclusion

Psychiatric inpatients require vigilance for DVT risk, with factors like D-dimer levels and age serving as critical indicators. Machine learning models effectively predict DVT risk, enabling early detection and personalized prevention strategies in clinical practice.

Patterns and influencing factors of savoring in caregivers of advanced cancer patients: a latent profile study

OBJECTIVE

Caregivers' positive affect benefits patients' and their well-being. Savoring is one important emotion regulation strategy to manage positive affect. Limited information about patterns of savoring hinders the development of targeted interventions to promote cancer caregivers' emotional well-being. The purpose of this study was to identify latent patterns of savoring and investigate influencing factors associated with the identified patterns among caregivers of people with advanced cancer.

METHODS

Latent profile analysis was performed to identify savoring patterns based on savoring beliefs and strategies in 404 informal caregivers of patients with advanced cancer. Multinomial logistic regression analysis examined associated factors regarding different savoring profiles.

RESULTS

Three latent profiles of savoring were identified. Individuals in high level of savoring (HS, 33.4%) showed the highest level of savoring and positive affect. Compared with HS, caregivers in low level of savoring (LS, 9.4%) and medium level of savoring (MS, 57.2%) showed lower savoring and lower positive affect. Active coping(βMS = -0.109, βLS = -0.252, p<0.001)was the strongest protecting factor for both MS and LS, while passive coping (β = 0.146, p = 0.008) was a risk factor for LS. Non-assistance from others (β = 0.677, p = 0.015) and unemployment (β = 1.287, p = 0.007)were the strongest risk factors for the MS and LS subgroup, respectively.

CONCLUSIONS

Caregivers' savoring patterns appear to vary at different levels. Oncological professionals should pay attention to caregivers with passive coping, unemployment, and lack of assistance for designing targeted savoring training to promote emotional well-being.

Identifying palliative home care needs of patients with advanced cancer: a cross-sectional study

Background

Home-based palliative care is an ideal model for providing continuous, effective, and timely care at the patient's home. However, the timely recognition of palliative home care needs remains a clinical challenge, and few studies have described the characteristics of palliative care needs and quality of life at home.

Objectives

To identify the palliative home care needs of patients with advanced cancer and explore the influencing factors in addressing these needs.

Methods

In this cross-sectional study, convenience samples were collected from four cities in mainland China between May 2020 and November 2021. The revised Problems and Needs in Palliative Care-short version was used to evaluate palliative home care needs. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 was used to evaluate the participants' quality of life. We used SPSS version 23.0 for all statistical analyses. Descriptive statistics, Wilcoxon rank sum test, Spearman rho correlation independent t-test, and multiple linear regression were performed to analyze the data.

Results

Completed the survey. The patients' palliative home care needs were primarily related to physical symptoms, home health care services, and psychological issues. For items, the top three palliative home care needs were related to financial needs, "extra expenditures because of the disease" (75.9%), psychological issues, "fear of getting worse" (72.8%), and "fear of physical suffering" (67.9%). Multiple linear regression analysis revealed that 53.5% of palliative home care needs could be explained by the Karnofsky Performance Status and quality of life: physical, role, emotional, and financial difficulties dimensions.

Conclusion

The palliative home care needs were associated with patients' quality of life and financial difficulties. These findings may contribute to provide a framework for palliative home care service, and help to identify specific interventions.

Japanese version of the cancer needs questionnaire-young people (CNQ-YP-J): translation and preliminary validation

BACKGROUND

Adolescent and young adult (AYA) patients with cancer experience complex physical and psychosocial development as well as diverse lifestyle changes. Therefore, each patient may have generation-specific needs. This study aimed to develop a Japanese version of the Cancer Needs Questionnaire-Young People (CNQ-YP), namely the CNQ-YP-J, and to verify its reliability and validity among Japanese AYA patients with cancer.

METHODS

The CNQ-YP-J was developed using a standardized translation methodology. Content validity was assessed by a group of experts, and a pilot test was conducted with six AYA cancer patients. A total of 87 AYA patients with cancer participated in this study. After exploratory factor analysis, the scale's reliability was examined using Cronbach's α, item-total correlations, and the intraclass correlation coefficient (ICC) of the retest. Criterion-related validity was analysed using correlations between total needs, concerns about physical effects, and quality of life (QOL).

RESULTS

The factor analysis revealed an eight-factor structure, different from the original scale, with one item excluded, resulting in a 69-item scale. Cronbach's α coefficient and ICC were above the minimum acceptable criterion of 0.70, demonstrating high reliability. Concerning criterion-related validity, high needs were positively correlated with high concerns about physical effects and negatively correlated with QOL.

CONCLUSIONS

The CNQ-YP-J developed in this study is a reliable and potentially valid scale that comprehensively assesses the needs of AYA cancer patients in the treatment environment as well as their daily lives. We hope that the use of this scale as a measure of the needs of AYA cancer patients in various settings, including clinical practice, will lead to the provision of optimal medical care and development of support systems, as well as the promotion of information.

Summary of the best evidence for the management of kinesiophobia in patients after cardiac surgery

BACKGROUND

This study aimed to systematically search for relevant evidence on the management of kinesiophobia in patients after cardiac surgery both home and abroad. The evidence was evaluated and integrated to provide reference for clinical practice.

METHODS

According to the '6S' evidence pyramid model, evidence related to managing kinesiophobia in patients after cardiac surgery were systematically searched from relevant domestic and foreign guideline websites and professional association websites and databases from the date of their establishment to December 31, 2024. The quality of the literature was evaluated by two master's students who had completed their professional training and assessment at the Evidence-based Nursing Center of Fudan University. These students also extracted and summarised the pertinent evidence that met the literature quality evaluation standards.

RESULTS

Sixteen studies were included, including two guidelines, three expert consensus, six systematic reviews, two meta-analyses, and threerandomizedcontrolled trials. A total of 20 pieces of evidence were formed in seven aspects: management principles, exercise guidance, pain management, psychological intervention, health education, social support, and follow-up management.

CONCLUSIONS

The comprehensive evidence summarised in this study for managing kinesiophobia in patients after cardiac surgery can provide resources for clinical translation. These insights can inform the development of kinesiophobia management plans to support the rapid recovery of patients after major surgery.

TRIAL REGISTRATION

This study was registered at the Center for Evidence-Based Nursing of Fudan University (registration number ES20245486).

CLINICAL TRIAL NUMBER

This study was registered at the Center for Evidence-Based Nursing of Fudan University (registration number ES20245486).This study is a summary of the best evidence and does not involve clinical trials and, therefore, no Clinical trial number.

Influence of gut microbial metabolites on tumor immunotherapy: mechanisms and potential natural products

In recent years, tumor immunotherapy has made significant breakthroughs in the treatment of malignant tumors. However, individual differences in efficacy have been observed in clinical practice. There is increasing evidence that gut microbial metabolites influence the efficacy of distal tumor immunotherapy via the gut-liver axis, the gut-brain axis and the gut-breast axis, a process that may involve modulating the expression of immune cells and cytokines in the tumor microenvironment (TME). In this review, we systematically explore the relationship between gut microbial metabolites and tumor immunotherapy, and examine the corresponding natural products and their mechanisms of action. The in-depth exploration of this research area will provide new ideas and strategies to enhance the efficacy of tumor immunotherapy and mitigate adverse effects.

Current Status and Influencing Factors of Self-management Positivity in Patients With Head and Neck Neoplasms: A Cross-sectional Study

BACKGROUND

Self-management positivity is important for patients to improve treatment outcomes, reduce healthcare costs, and provide an intrinsic motivation to gain hope and self-confidence in coping with their illness. In clinical practice, it has been found that head and neck cancer (HNC) patients have a lower level of self-management positivity.

OBJECTIVE

To investigate the degree of self-management positivity among patients with HNC and analyze its influencing factors.

METHODS

A cross-sectional survey of 215 patients in the radiotherapy department was conducted using the Patient Activation Measure 13 (PAM13), Health Literacy Management Scale, Acceptance of Illness Scale, Cancer Loneliness Scale, and General Self-efficacy Scale.

RESULTS

The PAM13 score of patients with HNC was 63.48 ± 14.7 at level 3. Multiple linear regression analysis showed that widowhood (β = -.127; P < .05), monthly family income per capita (β = .234; P < .01), disease duration (β = .154; P < .01), health literacy (β = .215; P < .01), loneliness (β = -.128; P < .05), disease acceptance (β = .144; P < .05), and self-efficacy (β = .152; P < .01) were the influencing factors of self-management positivity, which accounted for 37.9% of the total variance.

CONCLUSION

Patients' self-management positivity still needs to be improved. Medical staff should attach great importance to patients' psychological dynamics and actively popularize health knowledge in order to effectively enhance self-management enthusiasm.

IMPLICATIONS FOR PRACTICE

It is imperative that we give adequate attention to the self-management positivity of HNC patients. In addition, our country can try to incorporate PAM13 into the healthcare system, using the scale to identify patients who lack self-management awareness, knowledge, and ability and are at risk of readmission upon admission or discharge.

Impact of baseline glucocorticoids (GCs) on cardiotoxic events and myocardial damage related to immune checkpoint inhibitors: a retrospective clinical research

BACKGROUND

Immune checkpoint inhibitors (ICIs)-associated cardiotoxic events (CEs) are of increasing concern. Existing research about glucocorticoids (GCs) on immunotherapy focused on ICIs' efficacy and patients' outcome. The influence of GCs on ICIs-associated CEs and myocardial damage (MD) remains unknown.

RESEARCH DESIGN AND METHODS

This single-center retrospective study included patients treated with ICIs from 2018 to 2022, with follow-up period ending on 30 June 2023. The incidence, risk factors of ICIs-associated CEs, especially MD were described. Additionally, the impact of baseline GCs was assessed by propensity score matching (PSM) to mitigate intergroup differences and ensure comparability.

RESULTS

Among 1018 patients, 204 (20.04%) experienced ICIs-associated CEs, including 71 (6.97%) with MD. The mean follow-up time was 40.39 (95% CI 38.47-42.31) weeks. The median time to onset of MD was the shortest at 12.57 weeks (IQR 5.29-25.14). Tumor type, co-medication with platinum and angiogenesis inhibitors may be influential factors of MD. After PSM, the relative risks of CEs (OR 0.4625,95%CI 0.2514-0.7235, p = 0.0020) and MD (OR 0.3254, 95% CI 0.1190-0.8898, p = 0.0378) in GCs1 ≥ 20 mg group were both significantly lower than those in GCs1 < 20 mg.

CONCLUSION

GCs ≥ 20 mg during the first ICIs treatment cycle is significantly associated with the reduced risks of both ICIs-associated CEs and MD.