Disability in activities of daily living among adults with cancer: A systematic review and meta-analysis

Functional disability in basic and instrumental activities of daily living among older adults globally: a systematic review and meta-analysis

INTRODUCTION

Functional disability in older adults refers to difficulties in performing daily activities. It is usually evaluated based on an individual's ability to carry out basic activities of daily living and instrumental activities of daily living. Although existing studies provide valuable insights, comprehensive global data on functional disability in basic and instrumental activities of daily living among older adults remain limited. This study aims to review existing research worldwide to estimate the overall pooled prevalence of functional disability in these areas.

METHODS

Systematic searches were conducted across EMBASE, Scopus, PubMed/MEDLINE, and Google Scholar from May 5 to July 11, 2024. Cross-sectional studies worldwide on functional disability in basic and instrumental activities of daily living among adults aged 60 and older, published in English up to July 11, 2024 were included. Studies were excluded if they did not report the outcomes of interest, were inaccessible, case reports, low quality, review articles, or published in languages other than English. Data extraction and cleaning were performed using Microsoft Excel, and STATA version 17 was used to compute the pooled effect size with 95% confidence intervals (CIs) for functional disability in both basic activities of daily living and instrumental activities of daily living among older adults. To derive these estimates, we used weighted averages, where each study's prevalence was weighted by the inverse of its variance. Study heterogeneity was assessed using the Cochrane I² statistic and its associated p-value. Subgroup analysis and meta-regression were conducted to identify sources of heterogeneity. Sensitivity analysis was used to evaluate the impact of individual studies on the overall results. Publication bias was assessed with Egger's test and funnel plots, and was addressed through trim-and-fill analysis.

RESULTS

This review includes 35 studies with a total of 133,827 participants. The pooled prevalence of functional disability in basic activities of daily living was estimated at 26.07% (95% CI: 19.04-32.74), while on instrumental activities of daily living, it was estimated at 45.15% (95% CI: 36.02-54.29). After applying the trim-and-fill method, the adjusted overall prevalence of disability in basic activities of daily living was 15.12%, (a 95% CI: 11.25-19.13%). Subgroup analysis showed highest prevalence in Africa (BADL: 42.91%, IADL: 69.34%) and lowest in Asia (BADL: 19.15%, IADL: 32.66%). Participants aged 65 and above, those in institutional settings, and studies with smaller sample sizes tended to report higher levels of functional disability.

CONCLUSIONS

Nearly one-fourth of the study participants had functional disability related to basic activities of daily living, while about half experienced disability in instrumental activities of daily living. This emphasizes the need for continued effort in improving the quality of life and support systems for individuals facing functional disability, particularly in instrumental activities.

IADL for identifying cognitive impairment in Chinese older adults: insights from cross-lagged panel network analysis

BACKGROUND

As China has entered an aging society, the prevention of cognitive impairment is of great importance. The progression of cognitive impairment is usually a slow and continuous process, with Instrumental Activities of Daily Living (IADL) serving as a sensitive indicator for early prediction of cognitive decline. The objective of this study was to utilize longitudinal network analysis to pinpoint the most sensitive indicators of IADLs to identify cognitive impairment in different populations, and to offer practical recommendations for preventing cognitive impairment among older adults in China.

METHODS

A total of 2,781 participants were selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2014-2018). Cognitive function and IADLs were assessed by Mini-mental State Examination (MMSE) and Chinese modified Lawton scale, respectively. In this study, the cross-lagged panel network (CLPN) model was employed to construct three separate networks for all Chinese older adults, male Chinese older adults, and female Chinese older adults, respectively. Two centrality indices were used to quantify symptom centrality in directed CLPN: In-Expected-Influence (IEI) and Out-Expected-Influence (OEI).

RESULTS

In the IADLs and cognitive function networks, "Use public transit," "Make food" and "Walk 1 km" emerged as the most influential and important indicators. The edge "Use public transit → Attention and Calculation" was the strongest edge connection in all three networks. Among older adult males, "General ability" exhibited the most influence on other cognitive domains, followed by "Language," while "Attention and Calculation" had a weaker influence. Conversely, among older adult females, "Attention and Calculation" was the most influential factor, followed by "General ability" and "Language."

CONCLUSIONS

This study provides new insights into the associations between specific IADL activities and cognitive function domains among Chinese older adults. Concentrate on monitoring limitations related to "Use public transit," "Make food" and "Walk 1 km," and promoting broader life-space mobility may be beneficial to preventing the decline of cognitive function. The findings underscore the importance of targeting interventions not only by specific cognitive domains, but also potentially by gender.

CLINICAL TRIAL NUMBER

Not applicable.

What are the determinants of functional decline in older adults with cancer? Results from the INCAPAC study

INTRODUCTION

Older adults with cancer are exposed to greater difficulties in carrying out their daily activities due to cancer itself, its treatment, or both. The aim of this study was to describe functional decline after cancer diagnosis and to investigate the determinants of this decline among older individuals with cancer.

MATERIALS AND METHODS

Using the Gironde cancer registries, older subjects (≥65 years) with a diagnosis of cancer between 2005 and 2018 were identified in three prospective cohorts on aging. Functional decline was defined as an increase of 1 point for Activities of Daily Living (ADL), 2 points for Instrumental Activities of Daily Living (IADL), and 3 points for the overall score (ADL + IADL) between cancer pre- and post-diagnosis visits. Logistic regression models were used to identify determinants of functional decline among older subjects who underwent a post-diagnostic assessment. Additionally, multinomial logistic regression models were performed to account for individuals who had died prior to the post-diagnostic cancer visit.

RESULTS

A total of 306 individuals followed-up after the cancer diagnosis were included (median age at cancer diagnosis: 83; 44 % female). Older age at cancer, low educational level, impaired initial functional status, and poor five-year cancer-related prognosis were significantly associated with functional decline across all three scores. Multinomial logistic regression analyses (n = 489) yielded similar results, but only cancer-related factors, specifically unfavorable vital prognosis, were associated with higher risk of death.

DISCUSSION

Functional decline in older individuals with cancer is both multifactorial and multidimensional. Further studies are needed to disentangle the effects of cancer and aging.

A Comparative Study of Anticipatory Grief in Caregivers of Patients With Alzheimer's Disease and Hematological Malignancy

BACKGROUND

Anticipatory grief (AG) is a common experience that affects caregivers of patients with chronic illnesses, particularly Alzheimer's disease. Cognitive disorders leading to social death produce a greater impact on the relationship, and thus on AG, than physical disorders.

OBJECTIVE

The purpose of this study is to examine the prevalence and severity of AG in caregivers of patients with major neurocognitive disorder due to Alzheimer's disease (MNCD-AD) compared to hematological malignancies and to identify the characteristics associated with AG.

METHODS

A total of 132 dyads (patients and their caregivers) completed measures of AG, caregiver burden, anxiety, and depressive symptoms, as well as mental status.

RESULTS

The point prevalence of significant AG was similar in the MNCD-AD (57.6%) and hematological malignancy (51.5%) groups. There was no statistically significant difference between the groups in terms of the severity of AG (48.77 ± 17.98 vs 44.18 ± 15.57, respectively). However, the personal sacrifice burden was significantly higher in the MNCD-AD group (P = 0.043). The severity of AG of caregivers is correlated with caregiver burden (r = 0.735), cognitive decline (r = 0.575), and neuropsychiatric symptoms (R = 0.627) of the MNCD-AD patient.

CONCLUSIONS

The results of the study highlighted that the disease type can influence the AG of caregivers in a qualitative rather than a quantitative manner. Future studies are recommended to consider effects of psychological or interpersonal factors on AG. In addition, psychiatric comorbidities among family caregivers of MNCD-AD patients should be examined.

Health and Socio-Demographic Factors Affecting Happiness Among Korean Adults with Moderate and Severe Disabilities: A National Survey-Based Study

Background and Objectives: This study identified health-related factors that affect the happiness of Korean adults with disabilities based on the disability level. Materials and Methods: Data of 7581 adults with disabilities aged 20 or older were collected from the 2023 Survey on the Status of Persons with Disabilities. The collected data were analyzed using frequency and multivariate logistic regression analyses. Results: Among individuals with moderate disability, males were less happy than females. Those with elementary school or lower education levels were less happy than those with college or higher education levels. Those who experienced stress, sadness and despair, suicidal thoughts, or discrimination were less happy than those who did not. In contrast, married individuals were happier than unmarried individuals. Those who exercised, went out alone, engaged in paid work, or participated in social activities were happier than those who did not. Among individuals with severe disabilities, males were less happy than females. Those with lower levels of education were less happy than those with higher levels of education. Those who experienced stress, sadness and despair, suicidal thoughts, suicide attempts, difficulty in communication, or discrimination were less happy than those who did not. Those who perceived their body as very thin were less happy than those who perceived it as very obese. Those who suffered from chronic disease were less happy than those who did not. In contrast, those aged 20-29 were happier than those aged 80 years or older. Married individuals were happier than unmarried ones. Those who exercised, went out alone, engaged in paid work, or participated in social activities were happier than those who did not. Conclusions: Factors affecting the happiness of Korean individuals with disabilities differ depending on the disability degree. Therefore, health policies, plans, and support measures must be established based on the disability degree to support daily physical activities, along with health services facilitating physical activity.

Voices of care: navigating difficult conversations among caregivers and individuals with Parkinson's disease

PURPOSE

This study explores the experiences of informal caregivers in navigating difficult conversations with individuals living with Parkinson's disease, and other key figures such as family members and health professionals.

METHODS

Utilizing a post-positive paradigm and inductive approach, we conducted semi-structured interviews with seven caregivers to gain in-depth insights into their experiences.

RESULTS

Findings reveal that Parkinson's disease introduces layers of complexity to navigating difficult conversations, which evolve over the disease's progression. Conversations were categorized across three dimensions: degree of interaction, response orientation, and emotional valence, resulting in a biaxial framework of difficult disclosures, frank conversations, relational conversations, and planful conversations. Key mediating factors shaping these conversations included relationship strength, individual skills, personality traits, faith, and preparation efforts.

CONCLUSION

Our findings offer valuable insights for clinicians, highlighting the importance of supporting caregivers in these difficult conversations. By understanding the dimensions and mediating factors involved, clinicians can provide tailored guidance and resources, fostering more effective communication strategies. This knowledge can enhance clinical practice by promoting a collaborative approach where both caregivers and individuals with Parkinson's disease feel supported and understood throughout their interactions.

Utilization outcomes of a cancer rehabilitation (CRNav) program: getting to the quadruple aim in cancer care

BACKGROUND

A cancer rehabilitation navigation (CRNav) program is an evidence-based care delivery model that uses a rehabilitation professional in the navigation role to support oncology care delivery, provide functional screening for early identification of impairment, and coordinate care delivery services to optimize early rehabilitation. There is limited research showing how a CRNav impacts healthcare utilization. The objective of this study was to assess utilization data for a CRNav Program and demonstrate how the program influences the effectiveness of cancer care delivery and patient and provider satisfaction.

METHODS

Data was collected from the electronic health record of the Brooks Rehabilitation/Halifax systems at a community cancer center to assess program and service utilization over 3.2 years using a retrospective design.

RESULTS

Over 3.2 years, the CRNav program received 1585 referrals and screened 1447 (91.3%) patients. Of the 1447 screenings performed, 73.6% were recommended to receive outpatient rehabilitation (n = 1065). Among patients screened, breast cancer was the most common cancer diagnosis (47%) followed by head and neck cancers (14%). There were 638 total rehabilitation visits identified for patients who were seen for services within the health system, with physical therapy encounters accounting for the greatest number (n = 462). The most common reasons for receiving physical therapy services included lymphedema (27%), pain (25%), and limited range of motion (12%). Patients reported high satisfaction (≥ 95.4%) in the areas of how well rehabilitation met expectations and overall satisfaction with the rehabilitation experience.

CONCLUSIONS

Using a CRNav in a community cancer center resulted in efficient care of patients with cancer, improved patient satisfaction and patient outcomes, and an enhanced clinician experience. This program provides a value-based approach to care supporting the quadruple aim and improving the identification and management of cancer-related functional morbidity.

Ophthalmic rehabilitation in oncology care

Ophthalmic rehabilitation refers to the multidisciplinary approach to restoring, maximizing, and preserving the visual function and quality of life for patients affected by ocular manifestations of cancer or its treatments. Besides its approach to low vision, ophthalmic rehabilitation also encompasses a series of reconstructive interventions to mitigate anatomic deficits that may interplay with visual impairment. A gamut of oncologic conditions may result in ocular disabilities, including primary intraocular tumours, secondary metastases, or adverse effects of systemic therapies such as chemotherapy, radiation, and surgery. Methods of ophthalmic rehabilitation are evolving constantly and involve the prescription of optical aids and adaptive technologies to enhance remaining vision, as well as supportive training and counselling to address psychosocial effects. Although studies in low vision have mostly covered aspects of rehabilitation in inherited and degenerative eye conditions, ophthalmic rehabilitation within the context of cancer carries specificities that have been poorly explored in the literature on ophthalmology and oncology. This review aims to build on the trends of low vision management, ocular oncology treatments, orbital reconstructive surgery, and visual therapy to revise the published rationale behind evaluating and managing patients facing debilitating ocular sequelae as the result of cancer.

An App-Based Intervention With Behavioral Support to Promote Brisk Walking in People Diagnosed With Breast, Prostate, or Colorectal Cancer (APPROACH): Process Evaluation Study

BACKGROUND

The APPROACH pilot study explored the feasibility and acceptability of an app (NHS Active 10) with brief, habit-based, behavioral support calls and print materials intended to increase brisk walking in people diagnosed with cancer.

OBJECTIVE

Following UK Medical Research Council guidelines, this study assessed the implementation of the intervention, examined the mechanisms of impact, and identified contextual factors influencing engagement.

METHODS

Adults (aged ≥18 y) with breast, prostate, or colorectal cancer who reported not meeting the UK guidelines for moderate-to-vigorous physical activity (≥150 min/wk) were recruited from a single hospital site in Yorkshire, United Kingdom. They were randomly assigned to the intervention or control (usual care) arm and assessed via quantitative surveys at baseline (time point 0 [T0]) and 3-month follow-up (time point 1 [T1]) and qualitative exit interviews (36/44, 82%) at T1. The process evaluation included intervention participants only (n=44). Implementation was assessed using data from the T1 questionnaire exploring the use of the intervention components. The perceived usefulness of the app, leaflet, and behavioral support call was rated from 0 to 5. Behavioral support calls were recorded, and the fidelity of delivery of 25 planned behavior change techniques was rated from 0 to 5 using an adapted Dreyfus scale. Mechanisms of impact were identified by examining T0 and T1 scores on the Self-Reported Behavioural Automaticity Index and feedback on the leaflet, app, call, and planner in the T1 questionnaire and qualitative interviews. Contextual factors influencing engagement were identified through qualitative interviews.

RESULTS

The implementation of the intervention was successful: 98% (43/44) of the participants received a behavioral support call, 78% (32/41) reported reading the leaflet, 95% (39/41) reported downloading the app, and 83% (34/41) reported using the planners. The mean perceived usefulness of the app was 4.3 (SD 0.8) in participants still using the app at T1 (n=33). Participants rated the leaflet (mean 3.9, SD 0.6) and the behavioral support call (mean 4.1, SD 1) as useful. The intended behavior change techniques in the behavioral support calls were proficiently delivered (overall mean 4.2, SD 1.2). Mechanisms of impact included habit formation, behavioral monitoring, and support and reassurance from the intervention facilitator. Contextual factors impacting engagement included barriers, such as the impact of cancer and its treatment, and facilitators, such as social support.

CONCLUSIONS

The APPROACH intervention was successfully implemented and shows promise for increasing brisk walking, potentially through promoting habit formation and enabling self-monitoring. Contextual factors will be important to consider when interpreting outcomes in the larger APPROACH randomized controlled trial.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s40814-022-01028-w.

Systemic inflammation and changes in physical well-being in patients with breast cancer: a longitudinal study in community oncology settings

BACKGROUND

Chemotherapy adversely affects physical well-being and inflammation may be related to changes in physical well-being. We evaluated the association of systemic inflammation with changes in physical well-being.

METHODS

In a prospective study of 580 patients with stages I-III breast cancer we assessed immune cell counts, neutrophil:lymphocyte ratio (NLR), lymphocyte:monocyte ratio (LMR), and platelet:lymphocyte ratio (PLR) within 7 days before chemotherapy (pre-chemotherapy). Physical well-being was assessed using the Functional Assessment of Cancer Therapy: General-Physical Well-being subscale (FACT-PWB) pre-chemotherapy and 1 month and 6 months post-chemotherapy. Clinically meaningful decline in physical well-being was determined as decreasing FACT-PWB by more than one point from pre-chemotherapy level, and non-resilience defined as having decline post-chemotherapy and not returning to within one-point of pre-chemotherapy FACT-PWB by 6 months post-chemotherapy. Multivariable logistic regressions examined the association between inflammation and changes in physical well-being, adjusting for sociodemographic and clinical characteristics.

RESULTS

Fifty-nine percent (310/529) and 36% (178/501) of participants had physical well-being decline post-chemotherapy and 6 months post-chemotherapy, respectively. Fifty percent (147/294) were non-resilient. Low NLR and PLR were associated with 1.78 (P = .01) and 1.66 (P = .02) fold greater odds of having a decline in physical well-being 6 months post-chemotherapy compared to those with high NLR and PLR, respectively. Low NLR and PLR were associated with 1.92 (P = .02) and 2.09 (P = 0.01) fold greater odds of being non-resilient 6 months post-chemotherapy compared to those with high NLR and PLR, respectively.

CONCLUSION

Low NLR and PLR were associated with chemotherapy-induced changes in physical well-being independent of sociodemographic and clinical risk factors.

Impact of Bone-Modifying Agents on Post-Bone Metastasis Survival Across Cancer Types

BACKGROUND

Bone metastasis is associated with a poor prognosis. Bone-modifying agents (BMA) are commonly used for the prevention or treatment of skeletal-related events (SRE) in patients with bone metastasis; however, whether or not treatment with BMA improves survival remains unclear. In this study, we investigated whether BMA was involved in post-bone metastasis survival.

METHODS

A total of 539 cancer patients were retrospectively analyzed to identify significant independent factors in post-bone metastasis survival.

RESULTS

Among the overall population, patients with the following cancers had a median survival longer than 24 months: thyroid, 97.2 months; breast, 51.5 months; prostate, 47.2 months; and kidney, 38.8 months. In contrast, median post-bone metastasis survival was significantly shorter in gastrointestinal (GI) (6.5 months), head and neck (6.3 months), and urinary tract (3.4 months) cancers. In non-small cell lung cancer (NSCLC), the log-rank test demonstrated that the epidermal growth factor receptor (EGFR) mutation was a significant factor for post-bone metastasis survival: EGFR mutation (-) n = 67, median post-bone metastasis survival 11.5 months (95% CI: 6.0-15.2); EGFR mutation (+) n = 39, median post-bone metastasis survival 28.8 months (95% CI: 18.1-35.7) (p < 0.05). Intriguingly, treatment with BMA was a significant positive prognostic factor: BMA (-) n = 203, median post-bone metastasis survival 7.8 months (95% CI: 5.8-12.5); BMA (+) n = 336, median post-bone metastasis survival 21.9 months (95% CI: 16.1-26.4) (p < 0.001). Moreover, the Cox proportional hazards model showed that this was particularly evident in cancer types with poor prognosis such as GI cancer (hazard ratio [HR]: 0.62, 95% CI: 0.40-0.95; p < 0.05) and NSCLC without the epidermal growth factor receptor (EGFR) mutation (HR: 0.56, 95% CI: 0.34-0.91; p < 0.05).

CONCLUSIONS

Treatment with BMA is recommended not only for the prevention and/or treatment of SRE, but also may have a positive impact on post-bone metastasis survival, particularly in cancers with typically poor post-bone metastasis survival such as GI cancer and NSCLC without the EGFR mutation.

Longitudinal trends and predictors of limitations in activities of daily living in community-dwelling older adults: evidence from the KLoSA study

Background

As life expectancy increases, the number of older adults with functional limitations is also increasing. Functional limitations are associated with adverse health outcomes such as reduced independence, diminished quality of life (QoL), and disability. Therefore, identifying which activities of daily living (ADLs) are limiting and understanding the influencing factors are crucial for developing tailored interventions. Although various factors influence ADL limitations, few studies have identified the longitudinal factors associated with each ADL. This study explores the longitudinal trends and factors associated with the ADL total score and functional limitations with each ADL among older adults in Korea.

Methods

Using data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2020, we analyzed 1,388 people aged 65 and older who had no ADL limitations in 2006. An ADL limitation was defined as partial or complete dependence in any of the following ADLs: getting dressed, washing face and hands, bathing, eating, transferring, toileting, and continence. We used repeated measures analysis of variance and multivariate logistic regression to investigate the trends and predictors of ADL limitations over a 14-year period.

Results

In 2006, the mean age of the participants was 69.88 years (SD = ±4.11), and 60.20% were female. The prevalence of total ADL limitations and limitations in each of the seven ADLs increased gradually during the 14 years of follow up. In 2020, the ADL items with the highest prevalence of limitations were bathing, getting dressed, and washing face and hands. The common significant predictors for total ADL limitations and limitation in the top three ADLs were age and cognitive function.

Conclusion

ADL limitations among Korean older adults significantly increase over time, which highlights the need for integrated early intervention and continuous support for bathing limitations, including the application of integrated assistive technologies. In particular, because age and cognitive function were identified as the major predictors for limitations in both total ADLs and the top three ADLs, early assessment and appropriate intervention strategies need to consider those factors to prevent ADL limitations in older adults or to meet the immediate needs of those already experiencing ADL limitations. This approach could enhance the QoL for older adults and contribute to the development of long-term healthcare plans.

Behavior change theory and behavior change technique use in cancer rehabilitation interventions: a secondary analysis

BACKGROUND

There is limited evidence depicting ways that behavioral theory and techniques have been incorporated into cancer rehabilitation interventions. Examining their use within cancer rehabilitation interventions may provide insight into the active ingredients that can maximize patient engagement and intervention effectiveness.

AIM

This secondary analysis aimed to describe the use of behavior change theory and behavior change techniques (BCTs) in two previously conducted systematic reviews of cancer rehabilitation interventions.

DESIGN

Secondary analysis of randomized controlled trials (RCTs) drawn from two systematic reviews examining the effect of cancer rehabilitation interventions on function and disability.

SETTING

In-person and remotely delivered rehabilitation interventions.

POPULATION

Adult cancer survivors.

METHODS

Data extraction included: behavior change theory use, functional outcome data, and BCTs using the Behavior Change Technique Taxonomy (BCTTv1). Based on their effects on function, interventions were categorized as "very", "quite" or "non-promising". To assess the relative effectiveness of coded BCTs, a BCT promise ratio was calculated (the ratio of promising to non-promising interventions that included the BCT).

RESULTS

Of 180 eligible RCTs, 25 (14%) reported using a behavior change theory. Fifty-four (58%) of the 93 BCTs were used in least one intervention (range 0-29). Interventions reporting theory use utilized more BCTs (median=7) compared to those with no theory (median=3.5; U=2827.00, P=0.001). The number of BCTs did not differ between the very, quite, and non-promising intervention groups (H(2)=0.24, P=0.85). 20 BCTs were considered promising (promise ratio >2) with goal setting, graded tasks, and social support (unspecified) having the highest promise ratios.

CONCLUSIONS

While there was a wide range of BCTs utilized, they were rarely based on theoretically-proposed pathways and the number of BCTs reported was not related to intervention effectiveness.

CLINICAL REHABILITATION IMPACT

Clinicians should consider basing new interventions upon a relevant behavior change theory. Intentionally incorporating the BCTs of goal setting, graded tasks, and social support may improve intervention efficacy.

The Importance of Nutrition in Cancer Care: A Narrative Review

PURPOSE OF REVIEW

Cancer, a complex disease affecting millions globally, presents considerable challenges for both patients and health care providers. Within the broad spectrum of cancer care, nutrition plays a key role in supporting patients throughout their journey. This narrative review examines the role of nutrition in cancer care, exploring its impact on treatment outcomes, nutritional status, current dietary recommendations, physical activity, palliative care, and finally, as a nutritional encouragement for cancer survivors.

RECENT FINDINGS

Evidence indicates that cancer and anticancer treatments frequently cause malnutrition and loss of muscle mass, which can exacerbate symptoms, impair immune function, and hamper recovery. Therefore, adequate nutritional support is crucial for maintaining strength, controlling symptoms, and optimizing treatment tolerance in patients with cancer. Several factors influence nutritional needs and dietary recommendations, including cancer type, treatment, and individual patient characteristics. Nutritional care aims not only to ensure sufficient energy and protein intake, but also to manage specific symptoms such as dysgeusia, nausea, and dysphagia. Registered dietitians play a crucial role in providing personalized nutritional guidance, monitoring nutritional status, and implementing interventions to address emerging challenges in cancer care. Furthermore, recent research has underscored the benefits of dietary interventions in cancer treatment. From targeted nutritional supplements to more invasive nutritional support, interest in how nutrition can affect cancer risk and treatment outcomes is increasing. Overall, this review highlights the critical role of nutritional care in comprehensive cancer treatment. By recognizing and meeting dietary demands throughout the entire cancer journey, health care professionals can improve patients' well-being, response to treatment, and long-term prognosis.

Embedding rehabilitation into cancer care continuum: an implementation study

OBJECTIVES

To implement and evaluate a rehabilitation-inclusive service delivery model at a tertiary cancer hospital.

METHODS

The "Rehab-Toolkit", a structured assessment tool comprising validated functional measures, was introduced in an inpatient cancer service. Consecutive inpatients were enrolled, and a Reach, Effectiveness, Adoption, Implementation, and Maintenance framework guided the analysis of barriers and facilitators for subacute care at clinic and system levels.

RESULTS

The implementation of the Rehab-Toolkit was incorporated into routine inpatient care. Major pre-implementation barriers included: absence of routine standardized functional assessment tools, limited coordination amongst acute and subacute care providers, low awareness of rehabilitation medicine amongst patients and professionals, and insufficient engagement of subacute care with interdisciplinary stakeholders in clinical decision-making. Following the intervention, there was a notable increase in awareness and the contributory role of subacute rehabilitation services, rehabilitation "needs" assessment, and referral pathways. Recommendations for process change included: development of clinical pathways, establishment of subacute referral systems and discharge coordinator roles, inclusion of subacute rehabilitation services in acute interdisciplinary team meetings, enhanced staff education and knowledge.

CONCLUSION

Integration of rehabilitation services into cancer care can proactively manage functional morbidity. While the implementation process proved feasible and effective, robust process evalu-ation and longer term follow-up are necessary for sustained success.

Exploring what influences the uptake of cancer rehabilitation services: a realist informed mixed-methods study

OBJECTIVES

To investigate how uptake of cancer rehabilitation services is affected by information provision and whether it is influenced by people's perception and attitudes towards rehabilitation interventions and therapies.

DESIGN

This study followed a realist informed mixed-methods design. Descriptive secondary analysis of a cancer rehabilitation database containing information about number of people attending services, their diagnosis and sex and semi-structured interviews with people affected by cancer (PABC) and healthcare professionals (HCPs) were conducted.

SETTING

Cancer rehabilitation services located in two cancer centres in South Wales, UK.

PARTICIPANTS

PABC who received care from any of the included cancer rehabilitation services. HCPs providing cancer rehabilitation at any of the included services.

INTERVENTIONS

Exercise-based cancer rehabilitation, fatigue management, acupuncture and allied health professional support were provided as cancer rehabilitation.

RESULTS

Twenty HCPs and 15 PABC were recruited for semi-structured interviews across the two services. The number of database records used for the secondary analysis ranged from 212 to 347 between 2014 and 2017. Based on descriptive analysis of these records and thematic analysis of HCPs' interviews, uptake of cancer rehabilitation services often fluctuated. This could be attributed to PABC reporting issues with information provision on available services. Based on PABC's accounts, they learnt about cancer rehabilitation in various ways, often by chance via word of mouth. Information provision was influenced by several issues including lack of consensus on what cancer rehabilitation means, the wider multidisciplinary team's (MDT) perception and knowledge on cancer rehabilitation, the prevailing medical model in healthcare and the lack of routine provision of services. The perception and attitude of PABC did not seem to inhibit uptake and information provision.

CONCLUSIONS

To modify these inhibiting issues, the education of the wider MDT regarding the aim, modalities and importance of cancer rehabilitation is crucial.

Support roles, carer burden, and decision-making preferences of carers of older adults with cancer

INTRODUCTION

Older adults with cancer value the perspectives of significant others and their carers regarding decision-making about treatment. Understanding the support provided by carers, and their perspectives on involvement in treatment decision-making, can help us improve our communication with patients and their supports. We aimed to describe the roles, burden, and decision-making preferences of carers of older adults with cancer.

MATERIALS AND METHODS

We performed a cross-sectional survey of carers of older adults (≥65y) with cancer at three centres in Sydney, Australia. Type, frequency, and perspectives on providing care were evaluated using Likert scales. Preferred and perceived role in treatment decision-making by modified Control Preferences Scale, and carer burden by Zarit Burden Index (ZBI-12), were evaluated. Preferred role in decision-making and carer burden were compared between groups (culturally and linguistically diverse backgrounds [CALD], sex, and carer age ≥ 65) by chi-squared or t-tests.

RESULTS

One-hundred and fourteen returned surveys were included (23 partially completed). Carer characteristics: median age 55y (range 24-90), female (74 %), child (49 %) and spouse (35 %) of the care-recipient. Care-recipient characteristics: median age 75y (range 65-96), receiving anti-cancer treatment (85 %), and CALD background (44 %). Carers were frequently involved in communication and information gathering (45 % -80 %) and supported instrumental activities of daily living (IADLs) (43 % - 81 %) more frequently than basic activities of daily living (ADLs) (2-13 %). Most (91 %) preferred to be present when treatment options were discussed. Their preferred role in treatment decision-making was passive in 66 %, collaborative in 30 %, and active in 4 %, with most (72 %) playing their preferred role. The preferred role was associated with carer age (p = 0.01) and CALD background (p = 0.04), with younger (<65y) carers and those caring for CALD older adults preferring a more passive role. Carer burden was 'low' in 29 %, 'moderate' in 31 %, and 'high' in 39 %, and providing psychological support was rated most challenging.

DISCUSSION

Carers of older adults with cancer play varied support roles, particularly in communication and information gathering. Carers prefer to be present for discussions about treatment options, though favour a passive role in treatment decision-making, upholding patient autonomy. Understanding the communication preferences of carers is an important consideration when supporting the patient in deciding treatment options and direction of care.

Breast Cancer and Risk of Depression: A Comparative Cross-Sectional Study Among Women With and Without Breast Cancer in Addis Ababa, Ethiopia

PURPOSE

The extent of symptoms of depression among patients with breast cancer compared with those without the disease is not well documented in Ethiopia and other sub-Saharan African countries.

MATERIALS AND METHODS

This study examines the prevalence of symptoms of depression in women with breast cancer (n = 436) compared with those without breast cancer (n = 856) in Addis Ababa, Ethiopia, through a comparative cross-sectional study using a validated questionnaire, the Patient Health Questionnaire-9. The association between breast cancer diagnosis and symptoms of depression was evaluated using a multivariable binary logistic regression model.

RESULTS

About 39.2% of women with breast cancer had some level of symptoms of depression compared with 23.8% of women without the disease. By severity of symptoms of depression, 13.1% of women with breast cancer reported moderate to severe symptoms of depression compared with 6.8% of women without the disease. Sixty-three percent of women with breast cancer reported difficulties performing routine daily activities, compared with 36.7% of women without the disease. In the multivariable-adjusted model, women with breast cancer were 2 times (adjusted odds ratio, 2.26 [95% CI, 1.49 to 3.44]) more likely to report symptoms of depression compared with those without the disease. Likewise, women with breast cancer were 4.78 (95% CI, 3.51 to 6.52) times more likely to report difficulty in performing routine daily activities compared with women without the disease.

CONCLUSION

Four in 10 women with breast cancer in Addis Ababa reported having symptoms of depression, which was considerably higher than women in the general population. This finding emphasizes the importance of addressing psychosocial needs among women with breast cancer to enhance quality of life and potentially extend longevity.

Use of implementation mapping to develop a multifaceted implementation strategy for an electronic prospective surveillance model for cancer rehabilitation

BACKGROUND

Electronic Prospective Surveillance Models (ePSMs) remotely monitor the rehabilitation needs of people with cancer via patient-reported outcomes at pre-defined time points during cancer care and deliver support, including links to self-management education and community programs, and recommendations for further clinical screening and rehabilitation referrals. Previous guidance on implementing ePSMs lacks sufficient detail on approaches to select implementation strategies for these systems. The purpose of this article is to describe how we developed an implementation plan for REACH, an ePSM system designed for breast, colorectal, lymphoma, and head and neck cancers.

METHODS

Implementation Mapping guided the process of developing the implementation plan. We integrated findings from a scoping review and qualitative study our team conducted to identify determinants to implementation, implementation actors and actions, and relevant outcomes. Determinants were categorized using the Consolidated Framework for Implementation Research (CFIR), and the implementation outcomes taxonomy guided the identification of outcomes. Next, determinants were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy of strategies using the CFIR-ERIC Matching Tool. The list of strategies produced was refined through discussion amongst our team and feedback from knowledge users considering each strategy's feasibility and importance rating via the Go-Zone plot, feasibility and applicability to the clinical contexts, and use among other ePSMs reported in our scoping review.

RESULTS

Of the 39 CFIR constructs, 22 were identified as relevant determinants. Clinic managers, information technology teams, and healthcare providers with key roles in patient education were identified as important actors. The CFIR-ERIC Matching Tool resulted in 50 strategies with Level 1 endorsement and 13 strategies with Level 2 endorsement. The final list of strategies included 1) purposefully re-examine the implementation, 2) tailor strategies, 3) change record systems, 4) conduct educational meetings, 5) distribute educational materials, 6) intervene with patients to enhance uptake and adherence, 7) centralize technical assistance, and 8) use advisory boards and workgroups.

CONCLUSION

We present a generalizable method that incorporates steps from Implementation Mapping, engages various knowledge users, and leverages implementation science frameworks to facilitate the development of an implementation strategy. An evaluation of implementation success using the implementation outcomes framework is underway.

Predictors of increasing disability in activities of daily living among people with advanced respiratory disease: a multi-site prospective cohort study, England UK

PURPOSE

Disability in activities of daily living (ADL) is a common unmet need among people with advanced respiratory disease. Rehabilitation could help prolong independence, but indicators for timely intervention in this population are lacking. This study aimed to identify trajectories of disability in ADLs over time, and predicting factors, in advanced respiratory disease.

METHOD

Multi-site prospective cohort study in people with advanced non-small cell lung cancer (NSCLC), chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD), recruited from hospital or community services, throughout England. Disability in basic (Barthel Index) and instrumental (Lawton-Brody IADL Scale) ADLs were assessed monthly over six months. Visual graphical analysis determined individual trajectories. Multivariate logistic regression examined predictors of increasing disability in basic and instrumental ADLs.

FINDINGS

Between March 2020 and January 2021, we recruited participants with a diagnosis of NSCLC (n = 110), COPD (n = 72), and ILD (n = 19). 151 participants completed ≥3 timepoints and were included in the longitudinal analysis. Mobility limitation was an independent predictor of increasing disability in instrumental ADLs (odds ratio, 1⋅41 [CI: 1⋅14-1⋅74], p = 0⋅002).

CONCLUSION

Mobility limitation could be used as a simple referral criterion across people with advanced respiratory disease to ensure timely rehabilitation that targets independence in ADLs.

Physical and emotional status, quality of life and activities of daily living in terminal cancer: prospective cohort study

OBJECTIVE

Physical functioning (PF), emotional functioning (EF), overall quality of life (QOL) and activities of daily living (ADL) such as walking and toilet transfer are the primary outcomes of dignity in patients with terminal cancer. However, few studies have investigated the association of PF, EF and overall QOL with ADL based on end-of-life stages in patients with cancer who are receiving at-home palliative care.

METHODS

This prospective cohort study included 88 patients with terminal cancer receiving home-based rehabilitation as part of their home-based palliative care at the Mariana Home Nursing Station (Nagoya-city, Aichi, Japan). The variables were measured at 4 and 2 weeks before death of patients. PF, EF and overall QOL scores were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care and ADL were assessed using the Functional Independence Measure-motor items. Multiple regression analysis was used to examine the association, considering the effect of physical symptoms.

RESULTS

PF and overall QOL scores at 4 and 2 weeks before death were significantly associated with toilet transfer and walking scores, even after considering the influence of physical symptoms. EF scores were significantly associated with toilet transfer and walking scores 4 weeks before death, but not 2 weeks before death.

CONCLUSIONS

In addition to managing physical symptoms, supporting ADL such as walking and toilet transfer is necessary to maintain PF, EF and overall QOL in patients with terminal cancer receiving home-based palliative care. This may help preserve their dignity, even in deteriorating general condition.

Implementing a Clinical Pathway for Needs Assessment and Supportive Care Interventions

Despite advances in clinical cancer care, cancer survivors frequently report a range of persisting issues, unmet needs, and concerns that limit their ability to participate in life roles and reduce quality of life. Needs assessment is recognized as an important component of cancer care delivery, ideally beginning during active treatment to connect patients with supportive services that address these issues in a timely manner. Despite the recognized importance of this process, many health care systems have struggled to implement a feasible and sustainable needs assessment and management system. This article uses an implementation science framework to guide pragmatic implementation of a needs assessment clinical system in cancer care. According to this framework, successful implementation requires four steps including (1) choosing a needs assessment tool; (2) carefully considering the provider level, clinic level, and health care system-level strengths and barriers to implementation and creating a pilot system that addresses these factors; (3) making the assessment system actionable by matching needs with clinical workflow; and (4) demonstrating the value of the system to support sustainability.

Impact of a Multidisciplinary Supportive Care Model Using Distress Screening at an Asian Ambulatory Cancer Center: A Cluster Randomized Controlled Trial

PURPOSE

The Accessible Cancer Care to Enable Support for Cancer Survivors (ACCESS) program adopts a multidisciplinary supportive care model with routine distress screening to triage newly diagnosed cancer survivors for additional support on the basis of distress levels. This study aimed to evaluate the clinical impact of ACCESS over 1 year.

METHODS

We performed cluster random assignment at the oncologist level in a 1:1 ratio to receive ACCESS or usual care. Participants 21 years and older, newly diagnosed with breast or gynecologic cancer, and receiving care at National Cancer Centre Singapore were included. Outcomes assessed every 3 months for 1 year included quality of life (QoL) (primary), functioning, physical and psychological symptom burden, and activity levels. Data were analyzed using mixed-effects models.

RESULTS

Participants from 16 clusters (control = 90, intervention = 83) were analyzed. The ACCESS program did not significantly improve QoL (primary outcome). However, compared with usual care recipients, ACCESS recipients reported higher physical functioning (P = .017), role functioning (P = .001), and activity levels (P < .001) at 9 months and lower psychological distress (P = .025) at 12 months. ACCESS recipients screened with high distress had poorer QoL, lower role and social functioning, and higher physical symptom distress at 3 months but had comparable scores with ACCESS recipients without high distress after 12 months.

CONCLUSION

Compared with usual care, participation in the ACCESS program did not yield QoL improvement but showed earlier functioning recovery related to activities of daily living and reduced psychological distress. Routine distress screening is a promising mechanism to identify survivors with poorer health for more intensive supportive care.

Sociodemographic and clinical characteristics associated with rehabilitation services utilization in older women with early-stage breast cancer from SEER-Medicare 2009-2018

PURPOSE

Rehabilitation services are recommended by clinical practice guidelines following breast cancer treatment, yet little is known about how utilization may vary by patient-level characteristics which we aimed to study using SEER-Medicare data.

METHODS

Data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database was used to identify non-metastatic breast cancer survivors aged ≥ 66 years diagnosed between 2011 and 2016. Rehabilitation services delivered 0-11 months post-diagnosis were identified via outpatient or physician visit claims. Descriptive statistics and associations between patient characteristics and rehabilitation services were calculated using modified Poisson models estimating relative risk (RR) and corresponding 95% confidence intervals (CIs).

RESULTS

Of 55,539 breast cancer survivors, 33% (n = 18,244) had received any type of rehabilitative services. Survivors were a mean age of 75 years (SD 6.7), 88% White, 86% urban-dwelling, and 21% Medicare/Medicaid dually enrolled. In adjusted models, patients aged > 75 vs. ≤ 75 were 6% (RR 0.94, 95% CI 0.92-0.96) less likely to have received rehabilitative services. Survivors in an area with greater educational attainment vs. less educational attainment, White vs. non-White, or living in a rural vs. urban area were 26% (1.26, CI 1.22-1.30), 6% (1.06, CI 1.02-1.11), and 6% (1.06, CI 1.02-1.10) more likely to have received rehabilitative services, respectively.

CONCLUSION

The largest differences in rehabilitation utilization were observed for survivors of differing educational and treatment statuses.

IMPLICATIONS FOR CANCER SURVIVORS

Further research is needed on barriers, access, and delivery of rehabilitation services, specifically for breast cancer survivors who are older-aged, non-White, or Medicare/Medicaid dual eligible.

Implementation of a Cancer Rehabilitation Navigation Program: a qualitative analysis of implementation determinants and strategies

BACKGROUND

Cancer rehabilitation navigation (CRNav) is a care delivery model that expedites identification and management of symptom-related functional morbidity for individuals undergoing cancer treatment. A CRNav program is unique in that it embeds a cancer rehabilitation professional in the cancer center for patient screening and assessment. The implementation of CRNav programs has not been studied and doing so could facilitate greater uptake of these programs.

METHODS

Using implementation science frameworks, we conducted a qualitative, post-implementation analysis of a CRNav program that was implemented in 2019. Semi-structured, 1:1 interviews were guided by the Consolidated Framework for Implementation Research (CFIR) and a combination of deductive and inductive analyses, using a priori established codes, was used to assess the implementation context, and identify emergent themes of barriers and facilitators to implementation. Participant described implementation strategies were characterized and defined using the Expert Consensus Recommendations for Implementing Change (ERIC) taxonomy.

RESULTS

Eleven stakeholders including physicians, administrators, clinical staff, and patients, involved with program development and the implementation effort, participated in interviews. Predominant barriers to implementation included developing the program infrastructure, and lack of awareness of rehabilitation services among oncology professionals, predominant facilitators of implementation included; physical co-location of the navigator in the cancer center, individual characteristics of the navigator, and unique characteristics of the program. Strategies described that supported implementation included developing stakeholder interrelationships, evaluating and iteratively adapting the program, creating infrastructure, training and education, and supporting clinicians.

CONCLUSION

This analysis uses implementation science to methodically analyze and characterize factors that may contribute to successful implementation of a CRNav program. These findings could be used alongside a prospective context-specific analysis to tailor future implementation efforts.

IMPLICATIONS FOR CANCER SURVIVORS

Implementing a CRNav program expedites a patient's direct contact with a rehabilitation provider complementing the cancer care delivery team, and providing an additive and often missing service.

Effects of concurrent aerobic and strength training in women diagnosed with non-metastatic breast cancer: a systematic review and meta-analysis

PURPOSE

To investigate the potential impact of concurrent aerobic and strength training (CT) on women diagnosed with breast cancer.

METHODS

Articles published in English and indexed in the PubMed, Web of Science, SPORTDiscus, The Cochrane Library, PsycINFO, EMBASE, and CINAHL Plus databases from their inception to 12 December 2023 were searched. Eligible studies were randomized controlled trials that involved CT and assessed cardiorespiratory fitness, cancer-related fatigue, and quality of life (QoL) using specialized tools. Subgroup analyses were conducted as per treatment status and characteristics. Risk of bias was evaluated with the Cochrane risk-of-bias tool (RoB 2.0).

RESULTS

This study included 29 studies involving 2071 participants. CT was found to significantly improve patients' cardiorespiratory fitness (weighted mean difference = 4.24 mL/kg/min, 95% confidence interval (CI) = 1.93-6.55, P < 0.001), cancer-related fatigue (standardized mean difference (SMD) =  - 0.74, 95% CI =  - 1.05 to - 0.44, P < 0.001), and QoL (SMD = 0.76, 95% CI = 0.50-1.01, P < 0.001). The analysis of secondary outcomes found that CT could significantly improve patients' body composition, anxiety, pain, sleep disorders, and anorexia and enhance upper and lower limb muscle strength, but was ineffective on depression.

CONCLUSION

For women with breast cancer, CT significantly enhances cardiorespiratory fitness, alleviates cancer-related fatigue, and improves QoL. The health benefits of CT are inferior in the postmenopausal cohort compared to the overall study population.

IMPLICATIONS FOR CANCER SURVIVORS

CT is advisable for female breast cancer survivors due to its significant effectiveness in mitigating cancer-related fatigue, enhancing cardiorespiratory fitness, and improving the QoL.

Predictors of changes in resilience among spousal caregivers of patients with advanced cancer within the first 6 months after initial treatment

BACKGROUND

While previous research has established that resilience is affected by various factors, these studies have primarily focussed on individual variables associated with resilience, without providing insights into how to influence the rate of change in resilience.

AIM

To examine the trajectory of resilience and identify the factors associated with changes in resilience among spousal caregivers of patients with newly diagnosed advanced cancer receiving treatment during the first 6 months.

DESIGN

An observational longitudinal study.

METHODS

A total of 312 spousal caregivers of patients with newly diagnosed advanced cancer were recruited from January 2022 to December 2022 in Yancheng, China. Three data collection points were established, spanning from the first month to 6 months after initial cancer treatment. A latent growth model was employed to depict the resilience trajectory at various time points. A latent growth model with time-invariant covariates was adopted to determine the factors influencing resilience trajectory. The study adhered to the STROBE checklist for proper reporting.

RESULTS

Throughout the follow-up period, the participants experienced a significant increase in resilience. Gender, family income, the patient's health status, spirituality and belief in familism were significantly associated with the baseline resilience level. Moreover, family income, the patient's health status, spirituality, caregiver burden and belief in familism were significantly associated with the rate of resilience change over time.

CONCLUSIONS

Spousal caregivers demonstrated a linear increase in resilience during the first 6 months after initial treatment. Meanwhile, changes in resilience were influenced by multiple factors during the early phase of cancer treatment. Thus, more attention should be paid to early identification and implementation of targeted interventions.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should understand the change in resilience among spousal caregivers and conduct timely mental health interventions to enhance the resilience of families affected by cancer.

PATIENT OR PUBLIC CONTRIBUTION

The Guidance for Reporting Involvement of Patients and the Public-Short Form reporting checklists were used to improve patient and public involvement.

Telephone consultation for cancer survivors with unclarified need for rehabilitation in a primary healthcare setting: a mixed methods process evaluation

PURPOSE

To evaluate the implementation of telephone consultations to assess cancer patients' needs for rehabilitation, with focus on patients' acceptance, health professionals' experience and contextual factors.

METHODS

A mixed methods process evaluation was conducted at a primary healthcare rehabilitation clinic. Cancer survivors above 18 years of age with an unclarified rehabilitation need at discharge from hospital, was offered a telephone consultation provided by health professionals. Data on implementation and acceptability were collected using medical records systems, data collection forms and semi-structured interviews with six patients and two health professionals.

RESULTS

Eighty-one cancer survivors were referred to the intervention, and 54% continued to further rehabilitation. The telephone consultations were executed approximately eight days after referral and took on average 44 min to deliver. Overall, the patients found that the telephone consultation addressed what they considered the most important topics, and the health professionals found the intervention to be acceptable. Both patients and health professionals reported challenges regarding the referral process.

CONCLUSION

Patient acceptance of the intervention was high, and the telephone consultation was implemented to a high degree, resulting in more than half of the patients continuing to further rehabilitation. Patients' and health professionals' perspectives provided valuable insights about contextual factors.

A systematic review of rehabilitation programs for cognitive impairment related to breast cancer: Different programs at different times?

BACKGROUND

"Cancer Related Cognitive Impairment" (CRCI) defines cognitive disorders related to cancer and its treatments. Many people with breast cancer experience signs of CRCI (incidence between 20 and 30 %) and, although several intervention options exist, there is no established standard of care. Our main objective was to provide a detailed description of the methods and results of randomized controlled trials of interventions for CRCI in breast cancer survivors, paying particular attention to the timing of the interventions within the care pathway.

METHODS

We conducted a systematic literature review following the PRISMA guidelines from 01 to 01-2019 to 16-07-2023 and included randomized controlled trials of interventions for CRCI after breast cancer with at least one objective cognitive assessment as a primary or secondary outcome.

RESULTS

Among 228 identified studies, 35 (including 2821 participants) were retained for inclusion. The interventions were classified into 4 categories: cognitive rehabilitation, physical activity, complementary therapy and pharmacological treatment. Our analysis revealed that pharmacological interventions have no effect, whereas physical activity interventions proposed in the months following the initial cancer treatment improve Quality of Life and Speed of Information Processing while interventions proposed later improve Memory and Attention (Cognitive Rehabilitation) and Perceived Cognitive Function and Depression/Anxiety/Mood (Complementary Therapies).

CONCLUSION

CRCI is multifactorial and affected individuals frequently experience high levels of fatigue, pain, anxiety and depression and are most likely to benefit from holistic approaches that include cognition, physical activity, relaxation, psychoeducation, group support and/or psychological counselling. Thus, rehabilitation programs should be designed on multi-modal approaches, using innovative, cost-effective delivery methods that increase access to treatment, and intervention outcomes should be evaluated using measures of participation.

DATABASE REGISTRATION

The review was recorded on Prospero (01-03-2020), with the registration number 135,627.

The effect of occupational therapy services on hospital readmission for patients with cancer in acute care settings: a retrospective data analysis

PURPOSE

This study examined how the use of occupational therapy services affected the likelihood of hospital readmission within 30 days for patients with cancer diagnoses.

METHODOLOGY

This was a retrospective observational study. Patient medical records were analyzed from a National Cancer Institute Hospital over a 5-year period with a sample size of 6614 patients included for analysis in an unadjusted logistic regression model and 1920 patients analyzed in an adjusted logistic regression model. Various factors, including the use of occupational therapy services as well as individual factors such as pain levels, cancer stage, and living environment, were considered in relation to readmission status. Logistic regression analyses were used to assess the provision of occupational therapy service's association with 30-day hospital readmissions.

RESULTS

Patients who received occupational therapy services had a statistically significant decrease in their risk of a 30-day hospital readmission compared to patients with cancer who did not receive occupational therapy services. In an unadjusted analysis, patients with cancer who had occupational therapy services were 33.5% (OR = 0.665) less likely to be readmitted within 30 days compared to a patient who did not have occupational therapy services (p < 0.001). In an analysis after adjusting for patient health-related factors, patients with cancer who had occupational therapy services were 22.2% (OR = 0.778) less likely to readmit to a hospital compared to a patient who did not have occupational therapy services (p < 0.046).

CONCLUSION

The results of the study are intended to contribute to the body of knowledge on the benefits of occupational therapy services on an individual as well as a health systems-based level for patients with cancer diagnoses while hospitalized.

IMPLICATIONS FOR CANCER SURVIVORS

The knowledge of the utility of occupational therapy services for patients with cancer diagnoses while in the hospital can assist providers, patients, and hospital leadership in understanding some of the potential benefits for patient care and healthcare systems at large while seeking to avoid the deleterious effects from a hospital readmission.

Sex Differences in Anxiety and Depression Conditions among Cancer Patients: A Systematic Review and Meta-Analysis

(1) Background: Evidence suggested inconsistent results in anxiety and depression scores among female and male cancer patients. The present systematic review and meta-analysis aimed to assess how anxiety and depression conditions among cancer patients vary according to sex. (2) Methods: This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The protocol was registered in PROSPERO with id no. CRD42024512553. The search strategy involved combining keywords using Boolean operators, including "Anxiety", "Cancer", and "Depression", across several databases: Embase, PubMed, Scopus, and Web of Science. The outcomes were evaluated using the Hospital Anxiety and Depression Scale (HADS). (3) Results: Data were collected from five studies, enrolling a total of 6317 cancer patients, of whom 2961 were females and 3356 males. For each study, HADS-A and HADS-D scores were considered, also differentiating HADS scores according to cancer typology, and then three different meta-analyses were performed. Generally, females reported significantly higher levels of depression scores than males and, conversely, males reported significantly greater levels of anxiety than females. (4) Conclusions: Previous studies suggested higher rates of depression and anxiety conditions in females than in males, but the present data highlighted controversial findings, since males reported significantly higher levels of anxiety than females. In this scenario, the theoretical approach justified females being more open than males to expressing anxiety or depression conditions. It would be necessary for healthcare professionals to improve effective measures purposed at assessing and mitigating depressive symptoms in cases of advanced cancer, thereby improving their mental health, given the high rates of depression in advanced cancer patients, due to the difficulty level of performing their daily living activities, which deteriorate further over time.

Coping target checklist for home-based older adults living with disabilities and their spousal caregivers

BACKGROUND

The substantial rise in the population of older adults living with disabilities is a prominent concern, presenting a profound challenge for healthcare and social welfare systems. Community-based home care is seen as an effective approach to meet the care needs of older adults living with disabilities.

OBJECTIVE

To construct a coping target checklist for home-based older adults living with disabilities and their spousal caregivers.

METHODS

The initial draft was developed based on a comprehensive literature review, followed by two rounds of Delphi correspondence final version.

RESULTS

A comprehensive literature review resulted in the development of 7 modules, 20 topics. After round 1, 3 items were removed, 3 sections, 1 topic and 1 objective were new additions, 16 items were modified, split or combined. Four sections, 3 sections (Individual coping target for spousal caregivers, Individual coping target for older adults living with disabilities, and Shared coping target), 7 modules, 18 topics and 49 objectives were finally identified in round 2. The content of the list tool is derived from three perspectives: self-management strategies for older adults living with disabilities, caregiving strategies for spousal caregivers, and combined.

CONCLUSIONS

The coping target checklist was intended to be evidence-based and reflective of a practical direction for home-based older adults living with disabilities and their spousal caregivers living at home.

The bidirectional relationship between activities of daily living and frailty during short-and long-term follow-up period among the middle-aged and older population: findings from the Chinese nationwide cohort study

Objective

Frailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals.

Methods

The data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs.

Results

In cross-sectional analysis, BADL [OR = 6.660 (4.519-9.815)], IADL [OR = 5.950 (4.490-7.866)], and ADL [OR = 5.658 (4.278-7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574-9.933)], IADL [OR = 6.042 (4.555-8.016)] and ADL [OR = 5.735 (4.333-7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150-3.379), ADL: HR = 1.920 (1.146-3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085-3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126-2.939)] and IADL [HR = 1.724 (1.103-2.694)].

Conclusion

In middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up.

Do Contemporary Cancer Survivors Experience Better Quality of Life? Evaluating a Decade of SEER Medicare Health Outcomes Survey Data

BACKGROUND

A cancer diagnosis may have deleterious effects on health-related quality of life (HRQOL) as adults age. This study examined differences in HRQOL between cancer and matched noncancer Medicare beneficiaries over 65, within and across two time periods.

METHODS

We used novel matching methods on data from the Surveillance, Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) data resource. We matched SEER-MHOS respondents with cancer from a recent period (2015-2019) to respondents with cancer from an earlier period (2008-2012). We then matched these two cohorts, without replacement, to contemporary cohorts without cancer diagnoses. We estimated Veteran's RAND 12-Item Short Form Survey Physical Component Summary (PCS) and Mental Component Summary (MCS) scores for all cohorts.

RESULTS

Our analysis found significantly higher mean MCS scores in the recent period for those with cancer relative to the recent noncancer control group. Breast and lung cancer presented positive and statistically significant trends. We found statistically insignificant differences in PCS scores between the two time periods. No cancer sites had different PCS scores over time compared with the comparison group.

CONCLUSIONS

Mental health for those with cancer improved more between 2008 and 2019 than a matched noncancer comparison group. Physical health remained stable across time. These findings highlight the importance of including a matched noncancer group when evaluating HRQOL outcomes.

IMPACT

SEER-MHOS respondents with cancer report stable PCS scores across 15 years of data and higher MCS scores relative to noncancer controls.

Establishing a research partnership to investigate functional loss and rehabilitation towards the end of life

Background

Functional loss, the inability to perform necessary or desired tasks, is a common consequence of life-limiting illnesses and associated symptoms (pain, fatigue, breathlessness, etc.) and causes suffering for patients and families. Rehabilitation, a set of interventions designed to address functional loss, is recognised as essential within palliative care, as it can improve quality of life and reduce care costs. However, not everyone has equal access to rehabilitation. Despite limited life expectancy or uncertain ability to benefit from interventions, palliative rehabilitation services are often absent. This is partly due to a lack of high-quality research around optimal models of rehabilitation. Research in this area is methodologically challenging and requires multidisciplinary and cross-speciality collaboration.

Aim and objectives

We aimed to establish and grow a United Kingdom research partnership across diverse areas, commencing with partners from Edinburgh, East Anglia, Lancashire, Leeds, London and Nottingham, around the topic area of functional loss and rehabilitation in palliative and end-of-life care. The objectives were to (1) develop a multidisciplinary, cross-speciality research partnership, (2) generate high-priority unanswered research questions with stakeholders, (3) co-design and submit high-quality competitive research proposals, including (4) sharing topic and methodological expertise, and (5) to build capacity and capability to deliver nationally generalisable studies.

Activities

The partnership was established with professionals from across England and Scotland with complementary areas of expertise including complex palliative and geriatric research, physiotherapy, nursing, palliative medicine and psychology. Research questions were generated through a modified version of the Child Health and Nutrition Research Initiative, which allowed for the collation and refinement of research questions relating to functional loss and rehabilitation towards the end of life. Partnership members were supported through a series of workshops to transform research ideas into proposals for submission to stage one calls by the National Institute for Health and Care Research. The partnership not only supported students, clinicians and public members with training opportunities but also supported clinicians in securing protected time from clinical duties to allow them to focus on developing local research initiatives.

Reflections

Through our partnership we established a network that offered researchers, clinicians, students and public members the chance to develop novel skills and explore opportunities for personal and professional development around the topic area of functional loss and rehabilitation in palliative and end-of-life care. The partnership was crucial to foster collaboration and facilitate exchange of ideas, knowledge and experiences to build joint research study proposals.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) programme as award number NIHR135171. A plain language summary of this article is available on the NIHR Journals Library website https://doi.org/10.3310/PTHC7598.

Exercise Training Benefits Health-Related Quality of Life and Functional Capacity during Breast Cancer Chemotherapy: A Randomized Controlled Trial

PURPOSE

To examine the effectiveness of a supervised exercise training program (SETP) on health-related quality of life (HRQoL) and functional capacity in women with breast cancer (BC) undergoing chemotherapy.

METHODS

Ninety-three women with early-stage BC were randomly allocated to a SETP plus usual care (exercise, n = 47) or usual care alone (UC, n = 46). The SETP included three sessions per week, combining aerobic and resistance training, conducted concurrently over the chemotherapy. The EORTC Cancer Quality-of-Life-Questionnaire-Core-30 (QLQ-C30) and the BC-specific module (QLQ-BR23) were used to assess HRQoL. Functional capacity was analyzed by maximum voluntary handgrip strength (MVHS) and by the 30-s chair sit-to-stand test (30-s CST). These endpoints were assessed at baseline (t0); middle (t1; after 8 or 12 wk of t0); and at the end of chemotherapy (t2; after 20 wk of t0). Mean changes from baseline were assessed by an intention-to-treat approach.

RESULTS

Mixed linear model analyses showed that Exercise group experienced less deterioration in several domains of QLQ-C30 at t2, including in global health status/QoL (Δ = 9.39 units; P = 0.034), QLQ-C30 summary score (Δ = 8.08 units; P < 0.001), physical (Δ = 15.14 units; P < 0.001), role ( Δ = 21.81 units; P < 0.001), cognitive (Δ = 9.16 units; P = 0.032) and social functioning (Δ = 11.67 units; P = 0.038), compared with the UC group. Similarly, Exercise group exhibited significant lower levels of fatigue (Δ = -20.19 units; P < 0.001) and appetite loss (Δ = -13.69 units; P = 0.034), compared with the UC group. Significant between-group differences were observed on MVHS of the tumor/surgery upper limb side (Δ = 2.64 kg; P < 0.001) and contralateral limb (Δ = 2.22 kg; P < 0.001), and on the 30-s CST score (Δ = 3.56repetitions; P < 0.001), favoring the Exercise group. No differences were observed on QLQ-BR23 domains.

CONCLUSIONS

Exercise training was an effective complementary therapy to prevent the deterioration of HRQoL and functional capacity during chemotherapy in women with early-stage BC.

Unmet Needs and Care Delivery Gaps Among Rural Cancer Survivors

Community-based healthcare delivery systems frequently lack cancer-specific survivorship support services. This leads to a burden of unmet needs that is magnified in rural areas. Using sequential mixed methods we assessed unmet needs among rural cancer survivors diagnosed between 2015 and 2021. The Supportive Care Needs Survey (SCNS) assessed 5 domains; Physical and Daily Living, Psychological, Support and Supportive Services, Sexual, and Health Information. Needs were analyzed across domains by cancer type. Survey respondents were recruited for qualitative interviews to identify care gaps. Three hundred and sixty two surveys were analyzed. Participants were 85% White (n = 349) 65% (n = 234) female and averaged 2.03 years beyond cancer diagnosis. Nearly half (49.5%) of respondents reported unmet needs, predominantly in physical, psychological, and health information domains. Needs differed by stage of disease. Eleven interviews identified care gap themes regarding; Finding Support and Supportive Services and Health Information regarding Care Delivery and Continuity of Care. Patients experience persistent unmet needs after a cancer diagnosis across multiple functional domains. Access to community-based support services and health information is lacking. Community based resources are needed to improve access to care for long-term cancer survivors.

Falls prechemotherapy and toxicity-related hospitalization during adjuvant chemotherapy for breast cancer in older women: Results from the prospective multicenter HOPE trial

BACKGROUND

Older women with breast cancer frequently experience toxicity-related hospitalizations during adjuvant chemotherapy. Although the geriatric assessment can identify those at risk, its use in clinic remains limited. One simple, low-cost marker of vulnerability in older persons is fall history. Here, the authors examined whether falls prechemotherapy can identify older women at risk for toxicity-related hospitalization during adjuvant chemotherapy for breast cancer.

METHODS

In a prospective study of women >65 years old with stage I-III breast cancer treated with adjuvant chemotherapy, the authors assessed baseline falls in the past 6 months as a categorical variable: no fall, one fall, and more than one fall. The primary end point was incident hospitalization during chemotherapy attributable to toxicity. Multivariable logistic regression was used to examine the association between falls and toxicity-related hospitalization, adjusting for sociodemographic, disease, and geriatric covariates.

RESULTS

Of the 497 participants, 60 (12.1%) reported falling before chemotherapy, and 114 (22.9%) had one or more toxicity-related hospitalizations. After adjusting for sociodemographic, disease, and geriatric characteristics, women who fell more than once within 6 months before chemotherapy had greater odds of being hospitalized from toxicity during chemotherapy compared to women who did not fall (50.0% vs. 20.8% experienced toxicity-related hospitalization, odds ratio, 4.38; 95% confidence interval, 1.66-11.54, p = .003).

CONCLUSIONS

In this cohort of older women with early breast cancer, women who experienced more than one fall before chemotherapy had an over 4-fold increased risk of toxicity-related hospitalization during chemotherapy, independent of sociodemographic, disease, and geriatric factors.

The feasibility and acceptability of an app-based intervention with brief behavioural support (APPROACH) to promote brisk walking in people diagnosed with breast, prostate and colorectal cancer in the UK

INTRODUCTION

Increased moderate to vigorous physical activity (MVPA) can improve clinical and psychosocial outcomes for people living with and beyond cancer (LWBC). This study aimed to assess the feasibility and acceptability of trial procedures in a pilot randomised controlled trial (RCT) of a theory-driven app-based intervention with behavioural support focused on promoting brisk walking (a form of MVPA) in people LWBC (APPROACH).

METHODS

Participants diagnosed with breast, prostate or colorectal cancer were recruited from a single UK hospital site. Assessments at baseline and 3 months included online questionnaires, device-measured brisk walking (activPAL accelerometer) and self-reported weight and height. Participants were randomised to intervention or control (care as usual). The intervention comprised a non-cancer-specific app to promote brisk walking (National Health Service 'Active 10') augmented with print information about habit formation, a walking planner and two behavioural support telephone calls. Feasibility and acceptability of trial procedures were explored. Initial estimates for physical activity informed a power calculation for a phase III RCT. A preliminary health economics analysis was conducted.

RESULTS

Of those medically eligible, 369/577 (64%) were willing to answer further eligibility questions and 90/148 (61%) of those eligible were enrolled. Feasibility outcomes, including retention (97%), assessment completion rates (>86%) and app download rates in the intervention group (96%), suggest that the trial procedures are acceptable and that the intervention is feasible. The phase III RCT will require 472 participants to be randomised. As expected, the preliminary health economic analyses indicate a high level of uncertainty around the cost-effectiveness of the intervention.

CONCLUSIONS

This pilot study demonstrates that a large trial of the brisk walking intervention with behavioural support is both feasible and acceptable to people LWBC. The results support progression onto a confirmatory phase III trial to determine the efficacy and cost-effectiveness of the intervention.

Instrumental activities of daily living in older patients with metastatic prostate cancer: results from the meet-URO network ADHERE prospective study

Instrumental activities of daily living (IADL) are significant health indicators closely related to executive functions and able to detect mild cognitive impairment. A decline in IADL usually precedes ADL limitation, including taking medications, and may therefore predict a cognitive decline. We aimed to investigate the association of patients' IADL score with other clinical factors, with a particular focus on the presence of a caregiver, and the impact on adherence to androgen receptor pathway inhibitors (ARPIs) and survival outcomes within the Meet-URO 5-ADHERE study. It was a large prospective multicentre observational cohort study monitoring adherence to ARPIs in 234 metastatic castrate-resistant PC (mCRPC) patients aged ≥ 70. We observed an association between impaired IADL and lower geriatric G8 scores (p < 0.01), and lower adherence to ARPIs whether assessed by pill counting (p = 0.01) or self-reported by the patient himself (p = 0.03). The combination of an IADL < 6 and the absence of a caregiver resulted in a significantly high risk of non-adherence to the ARPIs at the multivariable analysis (HR 9.23, 95% confidence interval 2.28-37.43, p = 0.01). IADL alongside the geriatric G8 scales represent essential tools to identify frail and less auto-sufficient patients who are extremely vulnerable particularly if not supported by a caregiver and have the highest risk of nonadherence to ARPIs.

Trajectories of Activities of Daily Living in the Last Eight Weeks of Life Among Patients With Terminal Cancer in a Palliative Care Unit: A Retrospective Study

Background

Although cancer patients' activities of daily living (ADL) are reported to decline before death, ADL trajectories have not been sufficiently clarified due to limitations in the assessment and analysis methods.

Objectives

To clarify the multiple trajectories of ADL in patients with terminal cancer using a comprehensive assessment measure.

Design

This was a retrospective observational study.

Setting/Study Subjects

Cancer patients aged ≥18 years discharged at death from a single-center palliative care unit.

Measurements

Functional Independence Measure (FIM) total scores for eight weeks retrospectively.

Results

In total, 306 patients were analyzed. Group-based trajectory modeling analysis estimated four groups as the best model for the FIM trajectory over eight weeks using the following trajectories: (1) a No Decline group, in which ADL did not decline until just before death; (2) a Rapid Decline group, in which ADL declined rapidly two weeks before death from a trajectory similar to the No Decline group; (3) a Moderate Disability and Slow Decline group, in which the patient slowly declined from requiring mild-to-severe assistance; and (4) a Severe Disability group, in which the patient continuously required severe assistance.

Conclusions

Multiple ADL trajectories were identified in the last eight weeks of life of patients with terminal cancer. These findings suggest that palliative care needs to be tailored to the characteristics of each patient.

CaRE@ELLICSR: Effects of a clinically integrated, group-based, multidimensional cancer rehabilitation program

BACKGROUND

Although oncology clinical practice guidelines recognize the need and benefits of exercise, the implementation of these services into cancer care delivery remains limited. We developed and evaluated the impact of a clinically integrated 8-week exercise and education program (CaRE@ELLICSR).

METHODS

We conducted a mixed methods, prospective cohort study to examine the effects of the program. Each week, participants attended a 1-h exercise class, followed by a 1.5-h education session. Questionnaires, 6-min walk tests (6MWT), and grip strength were completed at baseline (T0), 8 weeks (T1), and 20 weeks (T2). Semi-structured interviews were conducted with a sub-sample of participants about their experience with the program.

RESULTS

Between September 2017 and February 2020, 277 patients enrolled in the program and 210 consented to participate in the research study. The mean age of participants was 55 years. Participants were mostly female (78%), white/Caucasian (55%) and half had breast cancer (50%). Participants experienced statistical and clinically meaninful improvements from T0 to T1 in disability, 6MWT, grip strength, physical activity, and several cancer-related symptoms. These outcomes were maintained 3 months after program completion (T2). Qualitative interviews supported these findings and three themes emerged from the interviews: (1) empowerment and control, (2) supervision and internal program support, and (3) external program support.

CONCLUSIONS

This study demonstrates the impact of overcoming common organizational barriers to deliver exercise and rehabilitation as part of routine care. CaRE@ELLICSR demonstrated clinically meaningful improvements in patient-reported and functional outcomes and was considered beneficial and important by participants for their recovery and wellbeing.

Risk of Parkinson's disease-related death in cancer survivors: A population-based study in Japan

BACKGROUND

The risk of Parkinson's disease (PD)-related death in patients with cancer largely unexplored.

METHODS

We analyzed data from the Neoplasms ANd other causes of DEath (NANDE) study, which investigates the causes of death in patients with cancer in Japan. Standardized mortality ratios (SMRs) were calculated to compare the risk of PD-related deaths in patients with cancer to that of the general population. Poisson regression models were employed to estimate the relative risk of PD-related death in the subgroups.

RESULTS

The cohort included 548,485 patients with cancer, yielding 2,047,398 person-years at risk from 1995 to 2013. During the study period, 242,250 patients died and 145 deaths were attributable to PD. The SMR for PD-related death was 2.34 (95% confidence interval [CI]: 1.99-2.75). Patients who were diagnosed with cancer before 70 years of age had a high SMR (>5) for PD-related deaths. The SMR of patients with mouth-to-stomach cancers (lip, oral cavity, pharynx, esophagus, and stomach cancers) was 3.72 (95% CI: 2.84-4.86), while that of those with other cancers was 1.93 (95% CI: 1.57-2.37). The multivariate Poisson regression model revealed that patients with mouth-to-stomach cancers were more likely to die of PD than those without (relative risk 2.07, 95 % CI; 1.46-2.93).

CONCLUSIONS

Patients with cancer are at a high risk of PD-related death; particularly, mouth-to-stomach cancers and potentially obstructing medication for PD are attributable to a high mortality risk. Careful management, including adequate PD treatment, would benefit cancer survivors with PD and reduce the risk of PD-related death.

Physical health and function trajectories in adults with cancer: psychosocial predictors of class membership

PURPOSE

To prospectively examine different trajectories of recovery, across different aspects of physical health and function and to examine trajectory class membership.

METHODS

This prospective study enrolled 569 recently diagnosed adult cancer patients (Mage = 58.7) between 2019 and 2022 identified through the Rapid Case Ascertainment resource of The Yale Cancer Center. Patients were diagnosed with breast (63.8%), prostate (25.3%), or colorectal cancer (10.9%) within six-months of baseline assessment. Participants completed comprehensive psychosocial and health survey measures (SF-12) through REDCap at five time points. Growth mixture modeling examined unconditional distinct trajectories for four aspects of physical health and function. We fit logistic regression and multinomial logistic regression models to estimate associations between psychosocial predictors of trajectory class membership for each of the four aspects.

RESULTS

We identified distinct trajectories of physical health and function. Over one-third (38.4%) of the sample experienced low and declining scores in their ability to accomplish work/regular daily activities due to physical health. Over half (54.9%) demonstrate moderately stable general health with no improvement over time. A small but significant subset of the sample (3%, 5.7%, 5%) was in the moderate and declining groups with sharp decline in physical function, bodily pain, and general health, after treatment. Different predictors of trajectory class membership were also found.

CONCLUSIONS

Our results showed heterogeneity in physical health and function trajectories and different patterns of predictors for each aspect of physical health and function. Findings have the potential to inform screening and intervention efforts to help those who may need additional support.

Effectiveness of continuity of care after robot-assisted laparoscopic adrenalectomy under ambulatory mode: a single-center intervention study

To investigate the effectiveness of continuity of care after robot-assisted adrenal tumor resection under ambulatory mode. Patients who underwent robot-assisted laparoscopic adrenalectomy (RALA) in the ambulatory surgery department and urology department of our hospital from January 2022 to January 2023 were selected as study subjects. Among them, 50 patients in the Department of Urology as the control group were given routine care. The 50 patients in the ambulatory surgery department as the observation group were given continuity of care on the basis of routine care. Observation indexes include: wound healing, blood pressure, blood potassium, renal function impairment, self-care ability in daily life, medication compliance, follow-up rate, and patient satisfaction. There were no remarkable discrepancies between the two groups in terms of demographic data and basic preoperative conditions of the patients. Compared with the control group, the observation group significantly improved the patients' wound healing, postoperative blood pressure and blood potassium and kidney function (P value all < 0.05). Compared with the control group, the observation group significantly improved postoperative patients' ADL scores, follow-up rates within three months after surgery, and patient satisfaction scores (P value all < 0.05). For patients receiving ambulatory mode robot-assisted laparoscopic adrenalectomy, continuity of care can effectively reduce postoperative complications, improve patients' postoperative self-care ability in daily life, medication compliance and follow-up rate, and improve patient satisfaction, which is worthy of promotion and application by nursing workers.

End-of-life walking ability in cancer patients with spinal metastases

BACKGROUND

Even terminal cancer patients desire to walk to the toilet by themselves until the very last day. This study aimed to describe the walking ability of patients with spinal metastases at the end-of-life stage and identify the factors affecting this ability.

METHODS

Among 527 patients who first visited our multidisciplinary team for bone metastasis between 2013 and 2016, 56 patients who had spinal metastases with a Spinal Instability Neoplastic Score ≥7 and died during follow-up were included. We collected general clinical data, performance status, Frankel classification, epidural spinal cord compression scale and Spinal Instability Neoplastic Score at the first consultation. Patients' last day of walking and date of death were also examined. Univariate analyses (chi-squared tests) were performed to identify the factors that impacted walking ability 30 and 14 days before patients' death.

RESULTS

A total of 56 patients were extracted, and 57.1% (32/56) and 32.7% (16/49) of patients were ambulatory 30 and 14 days before death, respectively. Their performance status (P = 0.0007), Frankel grade (P = 0.012) and epidural spinal cord compression grade (P = 0.006) at the first examination, and administration of bone modifying agents during follow-up period (P = 0.029) were significantly related to walking ability 30 days before death. Among ambulatory patients 30 days before death, those with Spinal Instability Neoplastic Score ≥10 (P = 0.005), especially with high scores of collapse (P = 0.002) and alignment (P = 0.002), were less likely to walk 14 days before death. The walking period in the last month of their life was significantly longer in patients with total Spinal Instability Neoplastic Score 7-9 (P = 0.009) and in patients without collapse (P = 0.040) by the Wilcoxon test.

CONCLUSION

The progression of spinal metastasis, especially neurological deficit, at the initial consultation were associated with walking ability 30 days before death, and spinal stability might be crucial for preserving walking ability during the last month. Early diagnosis and implementation of appropriate bone management might be important for the end-of-life walking ability.

Assessing patient-reported outcomes (PROs) and patient-related outcomes in randomized cancer clinical trials for older adults: Results of DATECAN-ELDERLY initiative

As older adults with cancer are underrepresented in randomized clinical trials (RCT), there is limited evidence on which to rely for treatment decisions for this population. Commonly used RCT endpoints for the assessment of treatment efficacy are more often tumor-centered (e.g., progression-free survival). These endpoints may not be as relevant for the older patients who present more often with comorbidities, non-cancer-related deaths, and treatment toxicity. Moreover, their expectation and preferences are likely to differ from younger adults. The DATECAN-ELDERLY initiative combines a broad expertise, in geriatric oncology and clinical research, with interest in cancer RCT that include older patients with cancer. In order to guide researchers and clinicians coordinating cancer RCT involving older patients with cancer, the experts reviewed the literature on relevant domains to assess using patient-reported outcomes (PRO) and patient-related outcomes, as well as available tools related to these domains. Domains considered relevant by the panel of experts when assessing treatment efficacy in RCT for older patients with cancer included functional autonomy, cognition, depression and nutrition. These were based on published guidelines from international societies and from regulatory authorities as well as minimum datasets recommended to collect in RCT including older adults with cancer. In addition, health-related quality of life, patients' symptoms, and satisfaction were also considered by the panel. With regards to tools for the assessment of these domains, we highlighted that each tool has its own strengths and limitations, and very few had been validated in older adults with cancer. Further studies are thus needed to validate these tools in this specific population and define the minimum clinically important difference to use when developing RCTs in this population. The selection of the most relevant tool should thus be guided by the RCT research question, together with the specific properties of the tool.

Impact of Lifestyle Interventions on Gynecologic Cancers: Beyond Diet and Exercise

A Lifestyle Medicine approach to compliment cancer care is less commonly researched or implemented for women with gynecologic cancers as compared to better funded malignancies such as breast, prostate, and colorectal. Yet, several gynecologic malignancies are linked to obesity, estrogen/metabolic signaling pathways, and altered tumor microenvironment which could benefit greatly from a lifestyle medicine program. Lifestyle medicine, an evidenced-based branch of science, has expanded to the prevention and treatment of disorders caused by lifestyle factors (including cancer). Modifiable lifestyle factors such as obesity, lack of physical activity/nutrient density, microbial dysbiosis, sleep disturbance, and chronic stressors contribute greatly to cancer morbidity and mortality worldwide. This overarching area of research is evolving with some subtopics in their infancy requiring further investigation. Modern tools have allowed for better understanding of mechanisms by which adiposity and inactivity affect tumor promoting signaling pathways as well as the local tumor environment. Through the evolving use of these sophisticated techniques, novel prognostic biomarkers have emerged to explore efficacy of pharmacologic and lifestyle interventions in cancer. This state-of-the-art review article appraises recent evidence for a lifestyle medicine approach, beyond diet and exercise, to optimize survivorship and quality of life for patients with gynecologic cancers and introduces the 8-week web-based comprehensive HEAL-GYN program.

Association of difficulties in daily physical activities and handgrip strength with cancer diagnoses in 65,980 European older adults

BACKGROUND

People with cancer usually report physical deconditioning, which can limit daily activities.

AIMS

Our aim was to analyze associations between daily physical activities and handgrip strength with cancer diagnoses among European older adults.

METHODS

We used data from SHARE (a representative survey of individuals aged 50 years or older) wave 7, residing in 27 European countries and Israel. Participants self-reported difficulties in daily physical activities and cancer diagnoses, and handgrip strength was objectively assessed using a handheld dynamometer. Data were analyzed using binary logistic regression.

RESULTS

Overall, 65,980 participants (average age 67.6 years (SD = 9.4)) were analyzed. Having difficulties in any daily physical activity was significantly associated with higher odds of cancer diagnoses. Lower handgrip strength was significantly associated with cancer diagnoses among participants included in the first (adjusted odds ratio (AOR) = 1.27 [95%CI = 1.11-1.45]) and the second third (AOR = 1.15 [95%CI = 1.03-1.28]) when compared with participants from the last third in the final adjusted model.

DISCUSSION

Having difficulties in daily physical activities as well as lower levels of handgrip strength is positively associated with cancer diagnoses.

CONCLUSION

Adults with difficulties lifting or carrying weights over 5 kilos or having difficulties in two or more activities showed critical associations with cancer diagnosis.

The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review

PURPOSE

To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors.

METHODS

A systematic review of electronic databases (CINAHL Plus, Cochrane Library: Database of Systematic Reviews, Embase, National Health Service's Health Technology Assessment, PubMed, Scopus, Web of Science) was conducted in December 2019 and updated in April 2021.

RESULTS

Searches identified 3,499 unique studies. Sixty-eight studies met inclusion criteria. There were 81 unique interventions across included studies. Interventions were primarily delivered post-treatment and lasted an average of 16.5 weeks (SD = 13.1). They were most frequently delivered using telephone calls (59%), administered delivered by nursing professionals (35%), and delivered in a one-on-one format (88%). Risk of bias of included studies was primarily moderate to high. Included studies captured 55 measures of disability. Only 54% of reported outcomes had data that allowed calculation of effect sizes ranging -3.58 to 15.66.

CONCLUSIONS

The analyses suggest small effects of telehealth-based cancer interventions on disability, though the heterogeneity seen in the measurement of disability makes it hard to draw firm conclusions. Further research using more diverse samples, common measures of disability, and pragmatic study designs is needed to advance telehealth in cancer rehabilitation.

IMPLICATIONS FOR CANCER SURVIVORS

Telehealth-based cancer rehabilitation interventions have the potential to increase access to care designed to reduce disability across the cancer care continuum.