Patient-caregiver relationship in cancer fatigue and distress. A dyadic approach

Moral conflicts among patients-caregivers dyads in oncological care pathway: a systematic review of the ethical literature

PURPOSE

Cancer patients are most often accompanied by at least one caregiver along the oncological care path. Since cancer has been defined as a "family disease", patients may rely on caregivers to take medical decisions. In some cases, they arrive at shared decisions, and in other cases, they experience some conflict, with negative implications on the care process. No systematic collection of "moral conflicts", i.e., conflicts pertaining to ethically related issues, occurring among patients and their caregivers in cancer care path is available in current bioethics literature.

METHODS

Using PRISMA guidelines, we conducted a systematic review of bioethics literature, broadly considered, in five major databases: PubMed, Web of Science™, PsycINFO, Cinahl and Philosopher's Index. Titles, abstracts and full texts of identified papers were screened for relevance. The snowball technique and citation tracking were used to identify relevant publications. Data analysis and synthesis were conducted in line with the QUAGOL methodology.

RESULTS

Twenty-two publications were included. Publication dates ranged from 1999 to 2021. We distinguished four different types of conflict: "conflict between values", "conflict between interests", "conflict related to decisional responsibilities and autonomous decision-making" and "relational conflicts related to existential and/or ontological differences". Conflict among patients and caregivers can be exacerbated by several factors both related to caregiver's characteristics, family history and disease.

CONCLUSION

The evidence collected shows the importance of considering also the ethical dimension of the oncological care process, especially in its decisional component.

Exploring the gut microbiome’s influence on cancer-associated anemia: Mechanisms, clinical challenges, and innovative therapies

BACKGROUND

Anemia is a prevalent and challenging complication in patients with hematologic and solid malignancies, which stems from the direct effects of malignancy, treatment-induced toxicities, and systemic inflammation. It affects patients’ survival, functional status, and quality of life profoundly. Recent literature has highlighted the emerging role of the gut microbiome in the pathogenesis of cancer-associated anemia. The gut microbiota, through its intricate interplay with iron metabolism, inflammatory pathways, and immune modulation, may either exacerbate or ameliorate anemia depending on its composition, and functional integrity. Dysbiosis, characterized by disruption in the gut microbial ecosystem, is very common in cancer patients. This microbial imbalance is implicated in anemia causation through diminished iron absorption, persistent low-grade inflammation, and suppression of erythropoiesis.

AIM

To consolidate current evidence regarding the interplay between gut microbiome and anemia in the setting of malignancies. It aims to provide a detailed exploration of the mechanistic links between dysbiosis and anemia, identifies unique challenges associated with various cancer types, and evaluates the efficacy of microbiome-focused therapies. Through this integrative approach, the review seeks to establish a foundation for innovative clinical strategies aimed at mitigating anemia and improving patient outcomes in oncology.

METHODS

A literature search was performed using multiple databases, including Google Scholar, PubMed, Scopus, and Web of Science, using a combination of keywords and Boolean operators to refine results. Keywords included “cancer-associated anemia”, “gut microbiome”, “intestinal microbiota”, “iron metabolism”, “gut dysbiosis”, “short-chain fatty acids”, “hematopoiesis”, “probiotics”, “prebiotics”, and “fecal microbiota transplantation”. Articles published in English between 2000 and December 2024 were included, with a focus on contemporary and relevant findings.

RESULTS

Therapeutic strategies aimed at restoration of gut microbial homeostasis, such as probiotics, prebiotics, dietary interventions, and fecal microbiota transplantation (FMT), can inhibit anemia-causing pathways by enhancing microbial diversity, suppressing detrimental flora, reducing systemic inflammation and optimizing nutrient absorption.

CONCLUSION

Gut dysbiosis causes anemia and impairs response to chemotherapy in cancer patients. Microbiome-centered interventions, such as probiotics, prebiotics, dietary modifications, and FMT, have shown efficacy in restoring microbial balance, reducing inflammation, and enhancing nutrient bioavailability. Emerging approaches, including engineered probiotics and bacteriophage therapies, are promising precision-based, customizable solutions for various microbiome compositions and imbalances. Future research should focus on integrating microbiome-targeted strategies with established anemia therapies.

Long-term Financial Toxicity after CAR T-cell Therapy among Patients in Remission and Their Caregivers

BACKGROUND

The long-term financial toxicity for patients who received Chimeric Antigen Receptor (CAR) T-cell therapy and their caregivers remains under-explored.

AIMS

The aim of this research is to describe the financial toxicity of patients who are in remission one to five years after receiving CAR T-cell therapy and their caregivers and explore associations between social determinants of health (SDoH), clinical factors, and health-related quality of life (HRQoL) with financial toxicity.

METHODS

This cross-sectional study included adults who had received CAR T-cell therapy for a hematologic malignancy and their current or former informal caregivers. Patients and caregivers completed measures of financial toxicity, HRQoL, and a demographic survey, while patients also completed cognitive function and symptom burden measures. Descriptive and bivariate statistics were used in this exploratory analysis.

RESULTS

There were 58 patients and 31 caregivers study participants. Financial toxicity was relatively low, 25% of patients reported mild to moderate and 18% of caregivers reported mild to severe financial toxicity. Patient financial toxicity was significantly associated with patient income, HRQoL domains, the mental HRQoL summary score, and symptom burden. Caregiver financial toxicity was significantly associated with caregiver age, employment status, HRQoL domains, and the mental HRQoL summary score.

CONCLUSIONS

Patients and caregivers reported low levels of financial toxicity in the present study: A majority of patients (75%) and caregivers (81%) experienced zero to minimal financial toxicity. Certain patients and caregivers at higher risk for financial toxicity may benefit from targeted interventions coupled with supportive care to address other HRQoL needs.

Contribution of fatigue experienced by Parkinson's Disease patients on caregiver burden

BACKGROUND

Fatigue is a common non-motor symptom (NMS) in Parkinson's disease (PD), affecting up to 50% of patients. It is suggested that PD-related fatigue may contribute to the burden perceived by caregivers.

OBJECTIVE

This study aims to evaluate the impact of PD-related fatigue on caregiver burden.

METHODS

Data were obtained from PD patients and their primary caregivers recruited at the Centre for Neurodegenerative Diseases and the Aging Brain, Tricase (Italy), as part of the Non-motor International Longitudinal Study (NILS). Fatigue was assessed using the Fatigue Severity Scale (FSS), while the Caregiver Burden Inventory (CBI) was completed by carers. Univariate and multivariable regression models were employed to assess the relationship of patients' characteristics and non-motor symptoms with caregiver burden.

RESULTS

A total of 61 patients were included. Univariate analysis showed disease duration, NMS burden, depression, cognitive performance, and FSS score as potential clinical predictors of CBI. After multivariable analysis, only FSS score and disease duration remained significantly associated with caregiver burden.

CONCLUSION

Patients' fatigue significantly impacts caregivers in PD. Our study fills the gap in the literature exploring this association and emphasizing fatigue assessment to improve the well-being of both individuals with PD and caregivers.

Evaluating a nurse-led narrative interview intervention with cancer patients with a first diagnosis: A feasibility study

Narrative Medicine and Nursing are clinical-supporting intervention methodologies that aim to enhance professionals' communication skills and place patients at the heart of their therapeutic path. A narrative interview (NI) is a communication tool between practitioner and patient. The role of NI is debated extensively in the literature, but no studies focus on its use by nurses responsible for first-diagnosed cancer patients. This study aimed to evaluate the feasibility and utility of NI, carried out by Nurses, in managing people recently diagnosed with cancer. A pilot mixed-methods study with before-and-after-intervention evaluation, qualitative longitudinal data analysis, and concurrent data triangulation was conducted. The Mini-Mental Adjustment to Cancer assessed disease adaptation, while the Psychological Distress Inventory investigated psychological distress. The qualitative analysis of the narrative interviews assessed the usefulness of this intervention. 13 out of 14 eligible patients took voluntary part in the study. Of those, 9 (69 %) completed T1 and T2 questionnaires and NI. The following five themes emerged from thematic analysis: reaction to the disease, feelings related to the new condition of life, changes, importance of relationships and perception of care. Patients reported being highly stressed and recognized the importance of a supporting social network for better coping with the condition. The adoption of an NI approach at the time of cancer diagnosis is feasible. Due to the limited sample size, it is unclear if NI may positively impact psychological distress in this patient population. Further studies would benefit from the integration of an additional investigation tool aiming to clarify whether NI promotes disease awareness in cancer patients. Furthermore, the recruitment of a larger sample is equally recommended.