The Underestimated and Overlooked Burden of Diarrhea and Constipation in Cancer Patients

Effects of integrative telehealth-based nutrition care with and without oral nutritional supplements in patients with liver and colorectal cancer: A randomized controlled trial

OBJECTIVES

This study investigated the effects of post-discharge integrative telehealth-based nutritional care alone versus post-discharge integrative telehealth-based nutritional care combined with high-calorie/high-protein oral nutritional supplements (HCHP-ONS) on the nutritional status and quality of life in patients with hepatocellular carcinoma (HCC) or colorectal cancer (CRC) at risk of malnutrition.

METHODS

We recruited HCC or CRC patients who were at moderate to high risk of malnutrition, defined as a score of 4-9 on the abridged Patient-Generated Subjective Global Assessment (aPG-SGA), and randomly assigned them to either a telehealth nutritional care-control group (C group) or a telehealth nutritional care combined with HCHP-ONS group (C+O group) for a 3-month intervention. In group C, a dietitian provided monthly telehealth-based nutritional assessments and guidance through a mobile application (LINE) or phone calls. In the C+O group, in addition to telehealth-based nutritional assessments and guidance, patients received a daily can of HCHP-ONS, which provided 425 kcal and 19.1 g of protein per serving. Blood tests, anthropometric indicators, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and a nutritional status assessment were conducted monthly.

RESULTS

Results showed that the C+O group had significantly reduced malnutrition risk scores at the 1st, 2nd, and 3rd months. By the 3rd month, the C+O group showed significant improvement in the Prognostic Nutritional Index (PNI), and notable improvements in diarrhea and respiratory distress scores.

CONCLUSIONS

In patients with HCC and CRC who were at risk of malnutrition, integrative telehealth-based nutritional care via LINE or phone calls effectively reduced malnutrition risk, maintained PNI, and supported quality of life (QOL). The addition of HCHP-ONS further enhanced nutritional outcomes, leading to greater improvements in PNI, diarrhea, and dyspnea by the 3rd month.

Incidence and management of diarrhoea associated with abemaciclib and endocrine therapy for hormone-receptor positive, HER2-negative metastatic breast cancer: the UK patients' experiences

PURPOSE

Addition of a CDK4/6 inhibitor to endocrine therapy (ET) prolongs survival in HR + /HER2-metastatic breast cancer (MBC). Gastrointestinal side effects, predominantly diarrhoea and abdominal pain, are common in patients receiving abemaciclib. This can potentially increase symptom burden, reduce quality of life (QoL) and affect treatment adherence. This longitudinal mixed-methods study with a 6-month follow-up explored patients' outcomes and experiences.

METHODS

Participants (n = 44) completed validated QoL measures at study-entry and at 1, 3 and 6 months. Weekly diarrhoea diaries with free-text response options assessed bowel movements and self-management strategies. Optional interviews gathered insight in patients' experiences.

RESULTS

Forty-two participants completed study measures at study-entry and 24 at 6 months. 17/42 reported no gastrointestinal side-effects. Above threshold diarrhoea (≥ 3 loose/liquid stools daily) was reported at least once by 25/42, with 3/42 having persistent symptoms. Strategies to control diarrhoea, employed by 28/42, included dietary modifications, non-prescribed medication-use and nonadherence (dose interruption or reduction). Meaningful decline on the QoL diarrhoea subscale was observed in 12/37 at 1 month, 13/28 at 3 months and 8/23 at 6 months. Free-text analysis showed that diarrhoea disrupted everyday life in those affected.

CONCLUSION

A proportion of this small sample of MBC patients treated with abemaciclib and ET-reported diarrhoea which affected symptom burden and QoL. Close symptom monitoring alongside targeted supportive/educational interventions should be introduced to reduce the negative impact on patients' lives.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: ISRCTN17281696.

Nutritional risk, functional decline, and symptom burden in lung cancer: a study based on PG-SGA scores and biochemical data

Objective

This study aims to investigate the relationship between nutritional status and quality of life (QOL) in patients with lung cancer, analyze the clinical application of nutritional support, and explore its association with biochemical markers and physical function.

Methods

A total of 270 hospitalized lung cancer patients were enrolled. Demographic characteristics, cancer staging, and treatment details were collected. Nutritional and functional status were assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), Nutritional Risk Screening 2002 (NRS-2002), and Karnofsky Performance Status (KPS) scores. Quality of life was evaluated with the EORTC QLQ-C30 questionnaire. The relationships between nutritional status, blood biochemical markers, body composition, and quality of life were analyzed.

Results

Among the 270 hospitalized lung cancer patients analyzed, 74.81% were male, and 80.74% were aged over 65 years. PG-SGA scores indicated that 38.89% of patients were at high nutritional risk (PG-SGA ≥ 9), and 77.04% had not received nutritional support. PG-SGA scores were significantly correlated with several biochemical indicators (e.g., prealbumin, total bilirubin, alanine aminotransferase, and lymphocyte count) and nutritional parameters (e.g., NRS-2002, KPS scores, body weight, and mid-upper arm circumference). Patients with higher PG-SGA scores had significantly lower scores in physical functioning, role functioning, emotional functioning, and social functioning, alongside more severe symptoms such as fatigue, nausea, and pain. Further analysis revealed a negative correlation between PG-SGA scores and overall health status (r = -0.687, p < 0.001) and positive correlations with symptoms such as fatigue, nausea, pain, and insomnia (r > 0.5, p < 0.001).

Conclusion

Nutritional status significantly impacts the quality of life in patients with lung cancer. PG-SGA scores are strongly associated with patients' functional abilities and symptom burden. Despite the low utilization of nutritional support, particularly in high-risk groups, improving nutritional interventions may effectively enhance functional status and quality of life in these patients.

Effect of Qigong exercise on quality of life and cortisol in patients with cancer: a non-randomized controlled trial

PURPOSE

The aim of this study was to investigate the effect of a 6-month Guolin Qigong on quality of life and serum cortisol among patients with cancer.

METHODS

This study was a two-arm and non-randomized controlled trial. Forty-nine patients with cancer who were over 18 years of age and diagnosed with cancer were enrolled in this study and assigned to either the Guolin Qigong intervention group (IG, n = 26) or the usual care group (UC, n = 23) for 6 months. During the Guolin Qigong exercise, the participants completed a training program consisting of five sessions per week and 40-60 min per session. The UC group maintained their usual lifestyle. The main outcomes included self-reported quality of life (European Organization for Research and Treatment of Cancer, EORTC-QLQ-C30) and well-being (General Well-Being Schedule, GWB). The second outcome was stress-related hormone serum cortisol measured by enzyme-linked immunosorbent assay. All measurements were assessed at baseline and 6 months.

RESULTS

Forty-nine participants (57.4% females, 26 in IG vs 23 in UC) were enrolled in the study, and forty-five participants completed all tests after the 6-month intervention (48.9% females, 25 in IG vs 20 in UC). Compared to the UC group, quality of life, physical function, and pain significantly improved in the IG (P < 0.05). Similarly, some sub-scales of GWB improved in the IG group compared to the UC group, especially for cheerful distracted and overall score (P < 0.05). However, there was no significant difference in serum cortisol between the two groups either at baseline or after intervention (P > 0.05).

CONCLUSIONS

Six-month Guolin Qigong could improve quality of life, physical function, and pain, and have a beneficial effect on the well-being of cancer patients. Further studies are warranted to confirm these results.

Resilience mediates the impact of caregiver burden on quality of life among informal caregivers of gastrointestinal cancer patients receiving adjuvant chemotherapy: A cross-sectional study

PURPOSE

The unclear relationships between caregiver burden, resilience, and quality of life among informal caregivers of patients with Gastrointestinal cancer receiving adjuvant chemotherapy prompted this study. The objective was to explore these relationships and investigate the mediating role of resilience.

METHODS

Between June 2022 and March 2023, totally 206 informal caregivers, who were responsible for patients undergoing postoperative chemotherapy for Gastrointestinal cancer in a public hospital, participated in this study. They completed standardized questionnaires assessing demographic information, caregiver burden, resilience, and quality of life. We performed structural equation modeling with Amos 26.0 to validate the hypothesized relationship between resilience, caregiver burden, and quality of life, and used the bootstrapping method to detect resilience's mediating effect.

RESULTS

Moderate caregiver burden existed for caregivers (42.11 ± 12.82), and caregivers reported lower quality of life, with physical health scores of 44.92 ± 10.61 and mental health scores of 45.62 ± 11.91. Moreover, caregiver burden exhibited a negative predictive relationship with mental health (rs = -0.329, P < 0.01), physical health (rs = -0.236, P < 0.01) and resilience (rs = -0.393, P < 0.01). The structural equation modeling showed that resilience acted as a crucial role in mediating the adverse impact of caregiver burden on mental health (β = -0.210, P < 0.001), and the tested model matches the data very well.

CONCLUSIONS

Regarding informal caregivers of patients undergoing chemotherapy for Gastrointestinal cancer, their caregiving burden negatively affects quality of life, while resilience partially mediates the impact of caregiving burden on mental health.

Non-pharmacological interventions for chemotherapy-induced diarrhoea and constipation management: A scoping review

PURPOSE

Chemotherapy-induced diarrhoea (CID) and constipation (CIC) are among the most common and severe gastrointestinal symptoms related to chemotherapy. This review aimed to identify and describe the evidence for non-pharmacological interventions for the management of CID and CIC.

METHODS

The scoping review was based on the Joanna Briggs Institute methodology and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Evidence from five databases were included: CINAHL, MEDLINE, Embase, PubMed, and APA PsycInfo. Data were systematically identified, screened, extracted and synthesised narratively to describe the evidence for non-pharmacological interventions and their effects on CID and CIC.

RESULTS

We included 33 studies, of which 18 investigated non-pharmacological interventions for CID management, six for CIC management, and nine for both CID and CIC management. Interventions were categorized into five groups, including (1) digital health interventions, (2) physical therapies, (3) diet and nutrition therapies, (4) education, and (5) multimodal. Diet and nutrition therapies were the most common to report potential effectiveness for CID and CIC outcomes. Most of the interventions were implemented in hospitals under the supervision of healthcare professionals and were investigated in randomised control trials.

CONCLUSIONS

The characteristics of non-pharmacological interventions were diverse, and the outcomes were inconsistent among the same type of interventions. Diet and nutritional interventions show promise but further research is needed to better understand their role and to contribute to the evidence base. Nurses are well placed to assess and monitor for CIC and CID, and also deliver effective non-pharmacological interventions.

Loperamide induces protective autophagy and apoptosis through the ROS/JNK signaling pathway in bladder cancer

Bladder cancer is one of the most common carcinomas in the human urinary system worldwide. Loperamide, known as an antidiarrheal drug, exerts anti-tumor activities against various cancers. However, the effect of loperamide on bladder cancer cells remains unclear. Our study aimed to investigate the effect of loperamide on bladder cancer and explore the underlying mechanisms. We found that loperamide suppressed the proliferation of 5637 and T24 cells in a dose-dependent manner. Loperamide treatment showed both pro-apoptotic and pro-autophagic effects on bladder cancer cells. Moreover, it was revealed that loperamide induced reactive oxygen species (ROS) accumulation, leading to the activation of c-Jun N-terminal kinase (JNK) signaling pathway. Notably, ROS scavenger N-acetyl-L-cysteine (NAC) and JNK inhibitor SP600125 effectively attenuated the induction of autophagy and apoptosis triggered by loperamide. Finally, blocking autophagy with CQ could significantly enhance the anti-cancer effect of loperamide both in vitro and in vivo. Overall, these findings demonstrated that loperamide induced autophagy and apoptosis through the ROS-mediated JNK pathway in bladder cancer cells. Our results suggest that the strategy of combining loperamide with autophagy inhibitor CQ may provide a therapeutic option for the treatment of bladder cancer.

Age-related differences in the occurrence, severity, and distress of symptoms in older patients at the initiation of chemotherapy

BACKGROUND

Evaluate for differences in occurrence, severity, and distress ratings for 32 symptoms between younger older adults (YOA, < 70 years) and older adults (OA, ≥ 70 years) at initiation of chemotherapy.

METHODS

Patients (n = 125) were recruited prior to the initiation of chemotherapy and completed the Memorial Symptom Assessment Scale. Differences in occurrence, severity, and distress ratings were evaluated using Independent sample t-tests and Chi-square or Fisher's exact tests.

RESULTS

On average, the older patients reported ten concurrent symptoms that equates with a moderate symptom burden. Symptoms with the highest occurrence rates were not always the most severe and/or the most distressing. Few age-related differences were found in patients' symptom experiences. When age-related differences were identified, OA reported lower occurrence, severity, and distress ratings. Nine of the ten symptoms with highest occurrence rates were common for both age groups. For severity and distress, only half of the symptoms were common. In terms of severity and distress, all of the top ten ranked symptoms were in the moderate to severe range.

CONCLUSIONS

Both YOA and OA reported a moderate symptom burden and severity and distress scores in the moderate to severe range. The symptoms with the highest occurrence rates were not always the most severe/or the most distressing. Our findings suggest that different dimensions of the symptom experience (i.e., occurrence, severity, and distress) warrant evaluation in older oncology patients.

Insights from Bacterial 16S rRNA Gene into Bacterial Genera and Predicted Metabolic Pathways Associated with Stool Consistency in Rectal Cancer Patients: A Proof of Concept

PURPOSE

To examine if gut microbial taxa abundances and predicted functional pathways correlate with Bristol Stool Form Scale (BSFS) classification at the end of neoadjuvant chemotherapy and radiation therapy (CRT) for rectal cancer.

METHODS

Rectal cancer patients (n = 39) provided stool samples for 16S rRNA gene sequencing. Stool consistency was evaluated using the BSFS. Gut microbiome data were analyzed using QIIME2. Correlation analysis were performed in R.

RESULTS

At the genus level, Staphylococcus positively correlates (Spearman's rho = 0.26), while Anaerofustis, Roseburia, Peptostreptococcaceae unclassified, Ruminococcaceae UBA1819, Shuttleworthia, Ca. Soleaferrea, Anaerostignum, Oscillibacter, and Akkermansia negatively correlate with BSFS scores (Spearman's rho -0.20 to -0.42). Predicted pathways, including mycothiol biosynthesis and sucrose degradation III (sucrose invertase), were positively correlated with BSFS (Spearman's rho = 0.03-0.21).

CONCLUSION

The data support that in rectal cancer patients, stool consistency is an important factor to include in microbiome studies. Loose/liquid stools may be linked to Staphylococcus abundance and to mycothiol biosynthesis and sucrose degradation pathways.

Factors Determining the Level of Acceptance of Illness and Satisfaction with Life in Patients with Cancer

INTRODUCTION

Cancer threatens life and brings about many negative emotions in patients, which influence their satisfaction with life and contribute to a low level of their acceptance of illness. This is why the acceptance of illness is a serious problem among patients with cancer; contributes to the intensification of symptoms; and influences the patient's physical, mental, emotional, social, and spiritual condition.

AIM

The purpose of this work is to assess the acceptance of illness and satisfaction with life in patients with cancer, as well as to identify social, demographical, and clinical factors that significantly differentiate their acceptance of illness and satisfaction with life.

MATERIALS AND METHODS

The study involved 120 patients with cancer aged 18 to 88. The study was conducted in the form of a questionnaire based on standard research tools: Acceptance of Illness (AIS), Satisfaction with Life Scale (SWLS), and Numerical Rating Scale (NRS). Social, demographical, and clinical data were collected in the original questionnaire.

RESULTS

A group of 120 patients was studied, including 55.83% (n = 67) women and 44.16% (n = 53) men. The average age was 56. A general acceptance-of-illness index obtained by the patients was 21.6 ± 7.32 and a general satisfaction-with-life index was 19.14 ± 5.78. The statistical analysis indicated a significant correlation between the acceptance of illness and the intensity of pain (rHO = -0.19; p < 0.05), fatigue ((Z = 1.92; p > 0.05), and diarrhoea (t₍₁₁₈₎ = 2.54; p < 0.05). The correlation between the intensity of pain and satisfaction with life was negative (rHO = -0.20; p < 0.05).

CONCLUSION

The greater acceptance of illness, the greater satisfaction with life in patients with cancer. Pain, fatigue, and diarrhoea decrease the acceptance of illness. In addition, pain decreases the level of satisfaction with life. Social and demographical factors do not determine the level of acceptance of illness and satisfaction with life.

Nonpharmacological approaches for improving gut resilience to chemotherapy

PURPOSE OF REVIEW

Mucositis of the gastrointestinal tract is a debilitating side effect of chemotherapy that negatively influences treatment tolerance and patient life quality. This review will evaluate the recent literature on nonpharmacological strategies that have the potential to improve chemotherapy-induced mucositis (CIM).

RECENT FINDINGS

Alternatives to pharmacological approaches have shown great promise in preventing CIM. Natural products, including curcumin, ginseng, quercetin, and patchouli all show potential in mitigating CIM. In addition, dietary patterns, such as the elemental diet, high fiber diet, and diets high in amino acids have documented benefits in preventing CIM. Perhaps the greatest advancement coming to this arena in recent years is in the field of probiotics. Indeed, research on single species as well as probiotic mixtures show potential in reducing CIM insofar as probiotics are now being suggested for treatment of CIM by governing bodies. Although behavioral interventions including psychological interventions and exercise interventions have shown promise in reducing cancer therapy-related side effects, more work in this domain is warranted and particularly in the context of CIM.

SUMMARY

Alternatives to pharmacological approaches show great potential for use in prevention and treatment of CIM and should be further developed for use in the clinic.

Chemotherapy-associated oral microbiome changes in breast cancer patients

Cytotoxic chemotherapy with or without a combination of humanized monoclonal antibodies is regarded as the gold standard of personalized medicine for the treatment of breast cancer patients. Significant medication-related side effects are common accompanying phenomena for these patients, such as oral discomfort, mucositis, or even osteonecrosis of the jaw. In this study, we analyze the saliva samples of 20 breast cancer patients at three time points throughout their chemotherapy: at the baseline prior to treatment initiation (T1), after four-to-six cycles of chemotherapy (T2), and 1 year after the start of the treatment (T3) to investigate and characterize the long-term effects of chemotherapy on the oral microbiome. We aimed to characterize changes in the oral bacterial microbiome based on 16S rRNA gene amplicon analysis during chemotherapeutic treatment, as a potential target to treat common oral side effects occurring during therapy. The chemotherapeutic drugs used in our study for patient treatment were trastuzumab, docetaxel, pertuzumab, epirubicin, and cyclophosphamide. We find a significant increase in the relative abundance of potentially pathogenic taxa like Escherichia/Shigella and non-significant trends in the relative abundance of, for example, Actinomyces ssp. In conclusion, the role of microbiota in the oral side effects of chemotherapeutic treatment needs to be considered and should be analyzed in more detail using larger patient cohorts. Oral side effects in breast cancer patients undergoing chemotherapy are a common burden and should be treated for a better tolerability of the therapy.