Quality of life research within the EORTC-the EORTC QLQ-C30. European Organisation for Research and Treatment of Cancer

Network analysis of quality of life among young and middle-aged Korean cancer survivors

Objective

This study aimed to identify and compare the network structure of quality of life factors among cancer survivors to inform tailored interventions.

Methods

A cross-sectional study was conducted using data from 330 cancer survivors aged 18-64 years, drawn from the 2019-2021 Korea National Health and Nutrition Examination Survey (KNHANES). Participants were categorized into two groups: cancer survivors with current cancer and those without. Network analysis using the EBICglasso algorithm was performed to assess eight quality of life (QoL) components measured by the Health-related Quality of Life Instrument with 8 Items (HINT-8) scale: climbing stairs, pain, vitality, work ability, depression, memory, sleep quality, and happiness.

Results

The network analysis revealed distinct patterns between the two groups. Among survivors with current cancer, depression, work ability, and vitality were the most central QoL components, suggesting a need for targeted psychological and occupational support. In contrast, survivors without current cancer exhibited a network where work ability, pain, and climbing stairs (physical function) played a dominant role, emphasizing the importance of pain management and functional rehabilitation. Work ability emerged as a critical determinant in both groups, indicating its sustained impact throughout the survivorship continuum. Additionally, the network structure in survivors without current cancer showed greater interconnectedness, reflecting the complex interplay of long-term survivorship challenges.

Conclusions

The study highlights the need for personalized, stage-specific interventions in cancer survivorship. Work remained central in both groups, emphasizing its ongoing impact on quality of life throughout the survivorship journey. While psychological support is crucial to cancer survivors with current cancer due to the centrality of depression, long-term pain management becomes increasingly important post-treatment. These findings provide valuable insights for nursing practice, suggesting that tailored interventions addressing work-related challenges, psychological distress, and chronic symptom management could improve quality of life and facilitate survivors' reintegration into daily life.

Quality of Life and Functionality of Head and Neck Cancer Patients Are Diminished As a Function of Sarcopenia and Obesity

BackgroundHealth-related quality of life (QoL) is a measure that allows us to know the patient's perception of well-being and how it is affected by their disease and treatments. In cancer patients, sarcopenia has been associated with low scores on various instruments used to assess the QoL; however, little information is available on the effects of sarcopenia and sarcopenic obesity on the QoL of patients with head and neck cancer (H&NC).MethodsIn this cross-sectional study with 71 H&NC patients aged between 40 and 80 years, we describe the scores on the instruments EORTC QLQ C-30 and EORTC QLQ-H&N35 according to the sarcopenia phenotype (NSG, nonsarcopenic group; SG, sarcopenic group; and SOG, sarcopenic obesity group), hand-grip strength, gait speed, total lymphocyte count, albumin, cholesterol and C-reactive protein, and the relationships between these variables.ResultsThe prevalence of sarcopenia and sarcopenic obesity was 48% and 28%, respectively. The QoL analysis showed that NSG had higher scores on the physical functioning scale [NSG 93 (83-100); SG 73 (52-88); SOG 83 (53-93), P = .009] and lower scores on the fatigue scale [NSG 11 (0-22); S 39 (30-67); SOG 44 (14-56); P = .004]. The NSG had a higher hand-grip strength (31.1 kg) than SG (24.1 kg, P = .007) and SOG (26.3 kg, P = .001), and a lower C-reactive protein. The SG and SOG showed no differences between them.ConclusionsPatients with sarcopenia or sarcopenic obesity have lower physical performance and a higher level of fatigue than nonsarcopenic patients. This loss of function can maintain or worsen sarcopenia due to the patient's self-restraint in physical exertion that encourages an increase in muscle tissue.

Assessing Patient-Reported Outcomes: A Mixed Methods Qualitative Comparison Between Obturator and Surgically Reconstructed Maxillectomy Patients

OBJECTIVES

Cancers of the maxillary region are often treated surgically with a maxillectomy followed by rehabilitation involving surgical reconstruction or obturator insertion to improve functional outcomes. However, there is a lack of consensus regarding the specific indications for either rehabilitation method. The objective of this study was to identify unique functional domains for maxillectomy patients who underwent surgical reconstruction or obturator insertion post-op to provide standardized data that can inform selection of either method.

METHODS

This mixed-methods qualitative research was conducted from January 2020 to June 2022 at London Health Sciences Centre, a tertiary care center in London, Ontario, Canada. Phase I included open-ended patient interviews through grounded theory, while phase II incorporated focus groups through the Delphi technique. Phase I identified functional domains of interest, which were further refined based on importance to patients in phase II. Inclusion criteria consisted of adults, 18 years or older who underwent maxillectomy surgery for head and neck cancer.

RESULTS

A total of 22 patients were included in phase I and 8 patients were included in phase II. The top 4 functional domains that affected patients regardless of rehabilitation method were eating difficulties, speaking difficulties, social discomfort with public eating, and numbness. The top 4 unique functional domains identified for the surgical group were dry mouth, trismus, chewing difficulties, and eye-related symptoms. The top 4 unique functional domains for the obturator group were obturator discomfort, nasal regurgitation, weight loss, and voice changes.

CONCLUSIONS

This study identified functional domains affecting maxillectomy patients, which can be used to inform decisions regarding selection of rehabilitation method in clinical practice. This data can also in the future to create the first patient-reported outcomes instrument for this patient population.

From pelvic radiation to social isolation: a qualitative study of survivors' experiences of chronic bowel symptoms after pelvic radiotherapy

PURPOSE

We explored survivors' experiences of chronic bowel symptoms following pelvic radiotherapy, strategies employed in living with these symptoms, effects on daily activities, and roles at home and in the workplace.

METHODS

Semi-structured interviews were conducted with 28 individuals (10 gynaecological, 14 prostate, four anal/rectal cancer survivors) who had completed pelvic radiotherapy at least six months prior to data collection and who had experience of bowel symptoms during this post-treatment period. Reflexive thematic analysis was undertaken.

RESULTS

We propose four themes describing a process leading from experience of symptoms to withdrawal from activities and roles. These are (1) losing control (the experience of unintended anal leakage or discharge); (2) experiencing embarrassment and fear (the experience of embarrassment or fear of embarrassment as a result of discharge becoming public); (3) managing and reacting (acting to reduce the likelihood of discharge or to prevent this becoming public); and (4) restriction and withdrawal (avoiding specific activities or situations so as to reduce or remove the risk of embarrassment). Returning to the workplace presented additional challenges across these themes.

CONCLUSIONS

Impacts of chronic bowel symptoms can be severe. Survivors employ a variety of methods and strategies in living with their symptoms. Some of these support continued role fulfilment but some constitute a withdrawal from pre-treatment roles. Current healthcare provision and statutory protections fail to fully meet needs following pelvic radiotherapy.

IMPLICATIONS FOR CANCER SURVIVORS

There is a need to develop and implement evidence-based services and supported self-management programmes for survivors experiencing chronic bowel problems post-radiotherapy.

Yoga for fatigue in people with cancer

BACKGROUND

Cancer-related fatigue (CRF) is one of the most prevalent symptoms in individuals with cancer. Various types of exercise have shown beneficial effects. While previous systematic reviews suggest exercise may improve CRF and quality of life, evidence specifically about yoga's impact, as well as evidence on long-term effects, is limited. Previous syntheses offer promising but inconclusive findings on yoga's effectiveness. This review is one of a suite of five reviews exploring exercise for cancer-related fatigue.

OBJECTIVES

To assess the effects of yoga versus no yoga on cancer-related fatigue in people with cancer: • before, during, and after anticancer treatment; • in the short, medium, and long term; • and effects on quality of life (QoL), adverse events, depression, and anxiety.

SEARCH METHODS

We used CENTRAL, MEDLINE, Embase, five other databases and two trials registers, together with reference checking, citation searching and contact with study authors to identify studies that are included in the review. The latest search date was October 2023.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing yoga to no yoga. We included studies in adults (aged 18 and older) with any type of cancer and anticancer therapy who received yoga before, during, or after anticancer therapy. We included trials evaluating at least one of the main outcomes (CRF or QoL). Yoga had to last for at least five sessions, and involve face-to-face instruction. We excluded trials with fewer than 20 participants randomised per group.

DATA COLLECTION AND ANALYSIS

The outcomes of interest in this review are cancer-related fatigue (CRF), quality of life (QoL), adverse events, depression, and anxiety. We used standard methods expected by Cochrane. For analyses, we pooled results within the same period of outcome assessment (i.e. short, medium, and long term), and employed a random-effects model. We assessed risk of bias with the Cochrane risk of bias (RoB) 1 tool, and used GRADE to assess the certainty of the evidence.

MAIN RESULTS

We included 21 RCTs with 2041 people with cancer who received yoga during (13 studies) or after (eight studies) anticancer therapy; none examined yoga initiated before therapy. Here we present results on CRF and QoL; findings on adverse events, depression, and anxiety are in the full review. Yoga during anticancer therapy The evidence is very uncertain about the effect of yoga compared to no yoga on: short-term CRF (standardised mean difference (SMD) 0.07, 95% confidence interval (CI) -0.18 to 0.32; mean difference (MD) on Brief Fatigue Inventory (BFI; lower values mean better outcome) of 0.16, 95% CI -0.41 to 0.71; 3 studies, 253 participants); medium-term CRF (MD on Multidimensional Fatigue Inventory (MFI; lower values mean better outcome) of -1.30, 95% CI -3.50 to 0.90; 1 study, 67 participants); and long-term CRF (MD 0.09 on BFI, 95% CI 1.16 to 0.98; 2 studies, 155 participants) (all very low-certainty evidence). Yoga may have a small beneficial effect or no effect compared to no yoga on short-term QoL (SMD 0.25, 95% CI 0.04 to 0.45; MD on Quality of Life Questionnaire-C30 (QLQ-C30; higher values mean better outcome) of 5.28, 95% CI 0.84 to 9.56; 4 studies, 374 participants) and medium-term QoL (MD on QLQ-C30 of 7.63, 95% CI 6.71 to 21.97; 2 studies, 151 participants), but the evidence is very uncertain (all very low-certainty evidence). None of the included studies reported long-term QoL. Yoga after anticancer therapy Yoga probably has a beneficial effect compared to no yoga on short-term CRF (SMD -0.26, 95% CI -0.42 to -0.09; MD 2.55, 95% CI 0.88 to 4.12; higher values mean better outcome; 5 studies, 602 participants; moderate-certainty evidence). Yoga might have a beneficial effect or no effect compared to no yoga on medium-term CRF, but the evidence is very uncertain (MD 3.02, 95% CI -1.48 to 7.52; 1 study, 54 participants (higher values mean better outcome; very low-certainty evidence). None of the included studies reported long-term CRF. Yoga may have a small beneficial effect or no effect compared to no yoga on short-term QoL (SMD 0.19, 95% CI -0.09 to 0.47; MD -3.27, 95% CI -8.08 to 1.55; higher values mean better outcome; 4 studies, 275 participants) and medium term QoL (MD 7.06, 95% CI -1.38 to 15.50; 1 study, 54 participants; higher values mean better outcome), but the evidence is very uncertain (all very low-certainty evidence). None of the included studies reported long-term QoL. A key limitation of the review was the included studies' methodological constraints: participants' awareness of treatment assignments (yoga or control) potentially introduced bias. Additionally, sample sizes were too small to determine medium- and long-term effects conclusively. Further research is needed to evaluate the sustainability of yoga's impact on cancer-related fatigue, quality of life, and adverse events.

AUTHORS' CONCLUSIONS

Our review provides uncertain evidence of the beneficial effects of yoga initiated during or after anticancer therapy compared to no yoga for people with cancer. Although there are indications supporting the use of yoga to address CRF, the uncertainty of the evidence underscores the need for caution in its implementation. Future RCTs should employ rigorous methodologies, enrol sufficient participants, and use appropriate controls.

Health-related quality of life in patients with aggressive non-Hodgkin lymphoma: results from the PETAL trial

When different therapies provide similar cure rates, health-related quality of life (HRQoL) may become crucial for the choice of treatment. In the Positron Emission Tomography-guided Therapy of Aggressive non-Hodgkin Lymphomas (PETAL) trial, we compared six cycles of R-CHOP with or without two extra doses of rituximab in prognostically favorable interim PET (iPET)-negative patients, while eight cycles of R-CHOP were compared with two R-CHOP cycles followed by six cycles of a more intensive protocol in prognostically unfavorable iPET-positive patients. As reported previously, treatment intensification did not improve outcome. HRQoL was assessed using the EORTC QLQ-C30 questionnaire. Pretreatment questionnaires were obtained from 558 out of the 862 participants (64.7%). Pretreatment HRQoL was significantly worse than in the general population. It was associated with age, gender, B symptoms, International Prognostic Index (IPI) and total metabolic tumor volume (TMTV). Physical and cognitive functioning predicted survival independent of IPI or TMTV. During treatment, some domains remained stable (e.g., cognitive functioning, nausea/vomiting), while others improved (e.g., emotional functioning, pain) or deteriorated (e.g., physical functioning, role functioning, fatigue). At the end of treatment, HRQoL was better in patients with controlled disease than in patients with progressive disease and better for iPET-negative patients than for iPET-positive patients. During follow-up, all HRQoL domains returned to levels similar to those reported for the general population. Differences between randomized treatment arms were not observed. The longitudinal data need to be interpreted with caution, because decreasing participation resulted in a selection of patients with increasingly good outcomes. ClinicalTrials.gov no. NCT00554164 (registered 11/5/2007).

Neuromodulation through brain stimulation-assisted cognitive training in patients with post-chemotherapy subjective cognitive impairment (Neuromod-PCSCI) after breast cancer: study protocol for a double-blinded randomised controlled trial

INTRODUCTION

Breast cancer is the most common form of cancer in women. A considerable number of women with breast cancer who have been treated with chemotherapy subsequently develop neurological symptoms such as concentration and memory difficulties (also known as 'chemobrain'). Currently, there are no validated therapeutic approaches available to treat these symptoms. Cognitive training holds the potential to counteract cognitive impairment. Combining cognitive training with concurrent transcranial direct current stimulation (tDCS) could enhance and maintain the effects of this training, potentially providing a new approach to treat post-chemotherapy subjective cognitive impairment (PCSCI). With this study, we aim to investigate the effects of multi-session tDCS over the left dorsolateral prefrontal cortex in combination with cognitive training on cognition and quality of life in women with PCSCI.

METHODS AND ANALYSIS

The Neuromod-PCSCI trial is a monocentric, randomised, double-blind, placebo-controlled study. Fifty-two women with PCSCI after breast cancer therapy will receive a 3-week tDCS-assisted cognitive training with anodal tDCS over the left dorsolateral prefrontal cortex (target intervention), compared with cognitive training plus sham tDCS (control intervention). Cognitive training will consist of a letter updating task. Primary outcome will be the performance in an untrained task (n-back task) after training. In addition, feasibility, safety and tolerability, as well as quality of life and performance in additional untrained tasks will be investigated. A follow-up visit will be performed 1 month after intervention to assess possible long-term effects. In an exploratory approach, structural and functional MRI will be acquired before the intervention and at post-intervention to identify possible neural predictors for successful intervention.

ETHICS AND DISSEMINATION

Ethical approval was granted by the ethics committee of the University Medicine Greifswald (BB236/20). Results will be available through publications in peer-reviewed journals and presentations at national and international conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov; NCT04817566, registered on 26 March 2021.

DeintensiF: Standard versus individualized deintensified follow-up after curative treatment in head and neck cancer: protocol of a randomized pilot study

BACKGROUND

Around 70% of head and neck cancer (HNC) cases are diagnosed in an advanced stage. Improvements in treatment have led to a cure rate of up to 80-90% for early-stage and 40-50% for advanced-stage disease. However, routine follow-up involves social and financial burdens, including frequent imaging associated with radiation exposure and costs. Currently, there is no consensus on the follow-up strategy after HNC treatment, and no conclusive evidence shows a survival advantage for routine follow-up over symptom-driven self-referrals. The DeintensiF study aims to provide robust evidence, comparing standard follow-up with a tailored deintensified approach. Additionally, it seeks to explore whether early detection of recurrence/second primary malignancy in asymptomatic patients impacts survival and quality of life. The pilot phase aims to assess feasibility of patients' recruitment and adherence to the assigned follow-up strategy and patient-reported outcomes (PROs) questionnaire in the first 2 years.

METHODS

This randomized-controlled, multicenter, open-label, pilot study has the goal to randomize a minimum of 16 patients across three Swiss sites into two arms within 1 year. The Experimental Arm A: scheduled clinical exams every 6 months and monthly PRO with evaluation and possibility to alert for open urgent appointments; and the Control Arm B: regular visits every 3 months for the first 2 years and less frequent thereafter plus multiple scheduled imaging appointments for head and neck magnet resonance imaging (MRI) and computed tomography (CT) with contrast and chest CT scans. Patients' motivation for participation or not will be explored by additional questionnaire before randomization. The primary objective during the pilot phase is to evaluate the feasibility of recruiting and randomizing patients with complete remission 6 months after treatment of head and neck squamous cell carcinoma to a deintensified and to a conventional follow-up. The secondary objective is to assess adherence to the two different follow-up strategies.

DISCUSSION

If feasible, the DeintensiF pilot study will expand from the recruited patients (detailed in the "Methods" section) to a larger cohort of advanced HNC cases in the main trial, integrating electronic PRO tailored follow-up care. This approach aims to reshape follow-up practices, enhancing patient-centered strategies and outcomes in head and neck oncology.

TRIAL-REGISTRATION

ClinicalTrials.gov (NCT05388136); Swiss National Clinical Trial Portal (SNCTP000005198).

Psychosocial interventions and health-related quality of life in adults with incurable cancer: systematic review

OBJECTIVES

This study aimed to assess the effects of psychosocial interventions in improving health-related quality of life (HRQoL) in adult patients with incurable cancer.

METHODS

A systematic search was performed in the MEDLINE, PsycINFO, CINAHL, Scopus and Medic databases to identify randomised controlled trials, quasi-experimental studies and cohort studies from 2004 to March 2024 aiming to influence HRQoL or psychosocial well-being.

RESULTS

The systematic search yielded 635 articles. After the removal of duplicates, screening of titles and abstracts, assessment of eligibility and screening of the reference list of included studies, 17 studies were included in the review, and a narrative synthesis was conducted. The delivery of psychosocial interventions varied considerably. They were most often structured, individual, performed in person or remotely, and applied multiple combined methods. Professionals delivering the intervention most often had a background in psychology, nursing or social work. The most frequent outcomes were quality of life, depression and anxiety, measured using multiple different tools. Of the studies, 35% reported significant sustainable improvements. The results favoured individual intervention and the multiple-method approach.

CONCLUSIONS

The interventions presented as psychosocial interventions have their own characteristics and nature, but evidence of their efficacy is limited. There is an apparent need for research and discussion regarding the definitions, differences and relationships between psychosocial, psychological, social and spiritual interventions in cancer care.

Prevalence and impact of financial toxicity in older patients with cancer: a prospective observational study in India

PURPOSE

We aimed to assess the prevalence of financial toxicity in older Indian patients with cancer and evaluate the association with quality of life (QoL), distress, vulnerabilities in the geriatric assessment, and factors impacting financial toxicity.

METHODS

This was a prospective observational study at the Tata Memorial Center (Mumbai, India) in patients aged 60 years and over, planned for cancer-directed therapy. We used the COST-FACIT and CFPB Financial Well-Being Scales to assess financial toxicity. QoL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 questionnaire, and distress with the NCCN distress thermometer.

RESULTS

Between June 2022 and September 2023, we enrolled 953 patients. The median age was 66 (IQR 63-72) years; 277 patients (29.1%) were over 70 years old, 737 (77.3%) were male, and 135 (14.2%) had health insurance. Therapy was planned with palliative intent in 607 (63.7%) patients. The prevalence of financial toxicity was 73.7% as per the COST-FACIT scale (n = 703), and 66% as per the CFPB (n = 629). Higher financial toxicity on the COST-FACIT scale was associated with poor financial well-being on the CFPB scale. Financial toxicity was associated with poor QoL and higher distress. Factors associated with significantly greater financial toxicity included history of tobacco chewing, monthly family income less than ₹50,000, lack of health insurance, illiteracy, depression, and cognitive impairment.

CONCLUSIONS

Identifying the factors contributing to financial toxicity will help make the cancer treatment journey smoother, more accessible and improve compliance to therapy for older patients.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: CTRI/2020/04/024675.

Correlations of resilience with coping styles and quality of life in patients with malignancies

BACKGROUND

Resilience is an individual's ability and psychological rebound capacity to adapt well after experiencing adversity, trauma, etc. Patients with strong resilience can face illnesses actively.

AIM

To determine the association of resilience with coping styles and quality of life in patients with malignancies.

METHODS

This study included patients with malignant tumors who were hospitalized at Fuyang Hospital Affiliated to Anhui Medical University from March 2022 to March 2024. The Connor-Davidson Resilience Scale, Medical Coping Modes Questionnaire, Social Support Rating Scale, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 were utilized to assess patients' resilience, coping styles, social support, and quality of life, respectively. Pearson correlation analysis was conducted to assess the correlations.

RESULTS

A total of 175 patients with malignant tumors demonstrated no marked difference in terms of age, education level, employment status, monthly household income, and disease staging (P < 0.05). Further, patients with malignancies demonstrated scores of 17.49 ± 1.20, 17.27 ± 1.46, and 11.19 ± 1.29 points in terms of coping styles in confrontation, avoidance, and resignation dimensions, respectively. Subjective support, objective support, and support utilization scores in terms of social support were 10.67 ± 1.80, 11.26 ± 2.08, and 9.24 ± 1.14 points, respectively. The total resilience score and tenacity, self-improvement, and optimism dimension scores were positively correlated with the confrontation coping style score, whereas the total resilience score and tenacity and self-improvement scores were negatively associated with avoidance and resignation coping style scores (P < 0.05). The total resilience score and the tenacity dimension score were positively associated with physical, role, cognitive, emotional, and social functions, as well as global health status (P < 0.05), and were inversely related to fatigue, insomnia, and economic difficulties (P < 0.05).

CONCLUSION

The resilience of patients with malignancies is positively associated with the confrontation dimension in the coping style, the total and various social support domain scores, and the overall quality of life. Clinical medical staff need to pay attention to the effect of medical coping styles and social support on the resilience level of patients with malignancies to further improve their quality of life.

The impact of treatment for muscle-invasive bladder cancer on health-related quality of life

OBJECTIVES

To evaluate the impact of treatment for localised muscle-invasive bladder cancer (MIBC) during the first 2 years after diagnosis.

PATIENTS AND METHODS

A prospective cohort study was conducted including patients diagnosed with non-metastatic (cM0) MIBC between November 2017 and November 2019 in the Netherlands. Health-related quality of life (HRQoL) was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) as well as the MIBC-specific QLQ-BLM30 module. Questionnaires were administered at baseline (pre-treatment) and at 6, 12 and 24 months after diagnosis. Patients were grouped by treatment: neoadjuvant chemotherapy (NAC) and radical cystectomy (RC), upfront RC, chemoradiation, and radiotherapy. Linear mixed models were used to assess HRQoL changes over time per treatment group.

RESULTS

A total of 518 patients participated in quality of life measurements (46% response rate). After excluding 14 patients who did not complete the EORTC QLQ-C30 and 114 for baseline completion after start of treatment, a total of 390 patients were included of whom 105 underwent NAC and RC, 148 underwent upfront RC, 58 underwent chemoradiation, and 79 underwent radiotherapy alone. Over time, clinically relevant improvements in emotional functioning and future perspective were observed across all treatment groups. However, a temporary worsening in physical functioning was observed at 6 months. Patients treated with RC (with or without NAC) experienced persistent deteriorations in body image and sexual functioning up to at least 2 years after diagnosis, although urostomy-related outcomes improved. Patients undergoing chemoradiation showed improvements in urinary symptoms, while those receiving radiotherapy reported significant worsening of dyspnoea over time.

CONCLUSION

In this largest population-based study to date on HRQoL in MIBC, HRQoL largely recovered to baseline levels during the first 2 years after diagnosis. However, persistent deteriorations in physical and cognitive functioning, body image, and sexual function were observed, particularly in patients treated with RC (with or without NAC).

Vaccines for preventing infections in adults with solid tumours

BACKGROUND

Infections are one of the most frequent complications seen in adults with cancer, often arising from the underlying condition or as a result of immunosuppressive treatments. Certain infections (e.g. influenza, pneumococcal disease, and meningococcal disease) may be prevented through vaccination. However, adults with solid tumours may elicit varying immune responses compared to healthy individuals.

OBJECTIVES

To assess the benefits and risks of vaccines for the prevention of infectious diseases in adults with solid tumours.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, two further databases, and two study registries from inception to 2 December 2024 for randomised controlled trials (RCTs) and controlled non-randomised studies of interventions (NRSIs).

SELECTION CRITERIA

We included RCTs evaluating vaccines against the following infectious diseases in adults (≥ 18 years of age) with any diagnosis of solid tumour cancer compared to placebo or no vaccine: pneumococcal disease, Haemophilus influenzae type b disease, meningococcal disease, pertussis, hepatitis B, tetanus, polio, diphtheria, influenza, herpes zoster, and COVID-19. In cases where RCTs were unavailable, we included prospective controlled NRSIs. We excluded live-attenuated vaccines.

DATA COLLECTION AND ANALYSIS

We followed standard Cochrane methodology. Two review authors independently screened search results, extracted data, and assessed the risk of bias (RoB) in the included studies using the Cochrane RoB 2 tool for RCTs and ROBINS-I for NRSIs. We rated the certainty in the evidence using the GRADE approach for the following prioritised outcomes: incidence of infection concerned, all-cause mortality, quality of life, adverse events (AEs) of any grade, serious adverse events (SAEs), localised events at the injection site, and systemic events.

MAIN RESULTS

We included 10 studies (five RCTs and five NRSIs) involving 81,823 adults with solid tumours receiving vaccines to prevent infections with herpes zoster, influenza, or COVID-19. Six studies included participants with varied solid tumours, while two focused on neck and oesophageal cancer or lung cancer. We assessed the RCTs to be at low or moderate risk of bias, whereas most NRSIs were at critical risk of bias due to concerns about confounding. We identified two ongoing studies: one RCT evaluating an influenza vaccine, and one NRSI evaluating COVID-19 vaccines. Twelve studies are awaiting assessment. We did not identify RCTs or NRSIs of vaccines for preventing pneumococcal disease, Haemophilus influenzae type b disease, meningococcal disease, pertussis, hepatitis B, tetanus, polio, or diphtheria compared to placebo or no vaccine. The results from the RCTs are presented below. The results from the NRSIs are detailed in the main text of the review. No study reported quality of life. Vaccines for preventing herpes zoster compared to placebo or no vaccine Three RCTs (3054 participants) evaluated vaccines to prevent herpes zoster. Herpes zoster vaccines decrease the incidence of herpes zoster up to 29.4 months after the final dose (RR 0.37, 95% CI 0.23 to 0.59; 1 RCT, 2678 participants; high-certainty evidence). Herpes zoster vaccines probably make little or no difference to all-cause mortality up to 28 days after the final dose (RR 1.17, 95% CI 0.91 to 1.50; 2 RCTs, 2744 participants; moderate-certainty evidence); make little or no difference to any-grade AEs up to 30 days after final dose (RR 1.02, 95% CI 0.98 to 1.05; 3 RCTs, 2976 participants; high-certainty evidence), and probably make little or no difference in SAEs up to 30 days (RR 1.08, 95% CI 0.93 to 1.24; I² = 0%; 3 RCTs, 2976 participants; moderate-certainty evidence). Vaccines to prevent herpes zoster increase the number of participants with localised events at the injection site compared to placebo or no vaccine (RR 6.81, 95% CI 2.52 to 18.40; 3 RCTs, 2966 participants; high-certainty evidence) and may make little or no difference to the number of participants with systemic events up to 30 days after final dose (RR 1.08, 95% CI 0.77 to 1.50; 3 RCTs, 2966 participants; low-certainty evidence). Vaccines for preventing influenza compared to placebo or no vaccine One RCT (75 participants) evaluated vaccines to prevent influenza. We are uncertain about the effects of influenza vaccines administered prior to surgery on all-cause mortality (RR 1.00, 95% CI 0.07 to 15.33; 1 RCT, 66 participants; very low-certainty evidence), any-grade AEs (RR 1.17, 95% CI 0.89 to 1.54; 1 RCT, 75 participants; very low-certainty evidence), and SAEs (RR 1.46, 95% CI 0.76 to 2.83; 1 RCT, 75 participants; very low-certainty evidence) up to 15 days post-surgery. The RCT did not report the incidence of influenza, localised events at the injection site, or systemic events. Vaccines for preventing COVID-19 compared to placebo or no vaccine One RCT (2256 participants) evaluated vaccines to prevent COVID-19. Participants may have been exposed to the SARS-CoV-2 variants alpha, beta, and gamma. Vaccines to prevent COVID-19 probably decrease the incidence of COVID-19 in participants without previous COVID-19 infection up to six months after the second dose (RR 0.08, 95% CI 0.02 to 0.25; 1 RCT, 2100 participants; moderate-certainty evidence). The COVID-19 vaccines probably increase any-grade AEs (RR 1.99, 95% CI 1.71 to 2.30; 1 RCT, 2328 participants; moderate-certainty evidence). They may have little or no effect on SAEs up to 6 months after the second dose (RR 1.43, 95% CI 0.80 to 2.54; 1 RCT, 2328 participants; low-certainty evidence). The RCT did not report localised events at the injection site or systemic events.

AUTHORS' CONCLUSIONS

In adults with solid tumours, herpes zoster vaccines reduced the incidence of herpes zoster (high-certainty evidence), although localised events at the injection site were more likely to occur (high-certainty evidence). The evidence is very uncertain about the effects of influenza vaccines on all-cause mortality, any-grade AEs, and SAEs (very low-certainty evidence); the incidence of influenza was not measured in the studies. COVID-19 vaccines probably decrease the incidence of COVID-19 in those without prior infection (moderate-certainty evidence) but probably increase any-grade AEs (moderate-certainty evidence). We found no RCTs or NRSIs investigating vaccines for preventing pneumococcal disease, Haemophilus influenzae type b disease, meningococcal disease, pertussis, hepatitis B, tetanus, polio, diphtheria compared to placebo or no vaccine, in adults with solid tumours. Additional research, preferably of RCT design, is necessary to resolve uncertainties.

Quality of life in older patients with cancer and related unmet needs: a scoping review

BACKGROUND

Older patients form the largest group of cancer patients yet remain underrepresented in clinical research. This scoping review aims to synthesize findings on quality of life (QoL) in older adults with cancer, comparing them to younger counterparts and older individuals without cancer, and identifying associated factors.

METHODS

PubMed and PsychINFO databases were searched for articles published until January 2024. Studies were included with exclusively older adults with cancer (≥ 65 years), age-mixed samples (mean/median ≥ 70 years), or that report results separately for older and younger adults with cancer. Out of 6, 397 identified studies, 87 met the inclusion criteria.

RESULTS

Most studies were cross-sectional, conducted in 14 countries with a mean age of 74.2 years. Physical QoL (PQoL) demonstrates an age-related decline, primarily influenced by comorbidity burden, physical activity, and lifestyle. In contrast, mental QoL (MQoL) remained stable or increased with advancing age, reflecting resilience and effective coping by older patients. While cognitive and role functioning tended to show stable or declining values with age, findings regarding social functioning were mixed. Socioeconomic factors, e.g. education, income, or marital status, mainly impacted MQoL, as well as other QoL domains. Symptom management and social support represent unmet needs that contribute to QoL impairments. Older adults with cancer underreport symptoms they perceive as normal for their age, experience ageism in healthcare, and reduced social participation.

INTERPRETATION

Comprehensive, multidisciplinary cancer care is essential for older adults with cancer, focusing on the prevention of functional health decline, geriatric assessment, socioeconomic health disparities, and enhancing symptom management.

Does adjuvant chemotherapy result in poorer health-related quality of life among colorectal cancer patients? A longitudinal multisite observational study in Singapore

BACKGROUND

Research on health-related quality of life (HRQOL) using minimally important differences for cancer care in Asian settings are sparse. This study aimed to describe functional HRQOL trajectories among Colorectal Cancer (CRC) patients undergoing adjuvant chemotherapy (AC) compared to those who did not (No AC), evaluate if AC was associated with change in HRQOL prospectively, and examine QOL differences between elderly and non-elderly CRC patients requiring AC.

METHODS

CRC patients diagnosed between February 2018 to August 2021 were recruited from three Singapore public hospitals. Participants completed the EORTC QLQ-C30 over seven timepoints (diagnosis, predischarge, 1-, 3-, 6-, 9-, 12-months post-surgery). Clinical characteristics were collected from electronic medical records.

RESULTS

The sample comprised 251 participants (102 in AC group; 40.64%). Clinically relevant deteriorations in functional HRQOL were observed in both groups between baseline and predischarge. These returned to baseline by 12-month. AC was associated with poorer physical (β = -35.34, p < 0.05) and role functioning (β = -71.17, p < 0.05) over time. Being elderly was associated with poorer physical functioning (β = -0.44, p < 0.05) over time. However, the non-elderly AC subgroup tended to experience poorer HRQOL in general compared to elderly.

CONCLUSIONS

Functional recovery remains a challenge for CRC patients in general. However, non-elderly AC patients may experience more severe impacts to role and social functioning.

Symptom monitoring with electronic patient-reported outcomes during cancer treatment: final results of the PRO-TECT cluster-randomized trial

Symptoms are often underdetected during cancer treatment. To determine if symptom monitoring with electronic patient-reported outcomes (PROs) improves clinical outcomes, we conducted a cluster-randomized trial in which 52 oncology practices were assigned to PRO or usual care. At PRO practices, patients with metastatic cancer were invited to complete weekly symptom surveys. Severe or worsening symptoms generated alerts to the care team. The primary outcome was overall survival, and secondary outcomes included emergency visits, time to deterioration of physical function, symptoms, health-related quality of life (HRQL) and patient satisfaction with PRO. Among 1,191 enrolled patients, there was no difference in survival (hazard ratio (HR) 0.99 (95% confidence interval (CI), 0.83-1.17); P = 0.86). Time to first emergency visit was significantly prolonged with PRO compared to usual care (HR 0.84 ((95% CI, 0.71-0.98); P = 0.03), with a 6.1% reduction in the cumulative incidence of emergency visits and fewer mean visits at 12 months with PRO (1.02 versus 1.30; P < 0.001). Benefits also significantly favored PRO for delayed deterioration of physical function (median 12.6 versus 8.5 months, HR 0.73; P = 0.002), symptoms (12.7 versus 9.9, HR 0.69; P < 0.001) and HRQL (15.6 versus 12.2, HR 0.72; P = 0.001), which remained significant when considering deaths in analyses. Most patients felt that PRO improved discussions with the care team (77.0% (188/244)), made them feel more in control of their care (84.0% (205/244)) and would recommend it to other patients (91.4% (223/244)). Patients completed 91.5% (20,565/22,486) of expected weekly symptom surveys. These findings demonstrate that symptom monitoring with PRO meaningfully improves clinical outcomes, the patient experience and utilization of services and should be included as a standard part of quality cancer clinical care. Future studies of PRO in clinical care should focus on these outcomes rather than mortality as primary endpoints. ClinicalTrials.gov registration: NCT03249090.

Implementing a group-based online mental well-being program for women living with and beyond breast cancer - A mixed methods study

PURPOSE

There is a gap in available mental well-being services in Australia for women diagnosed with breast cancer. This pilot mixed-methods uncontrolled study aimed to assess the feasibility of an online mental health and well-being intervention, the Be Well Plan (BWP), which enables participants to create a personalized, flexible well-being strategy.

METHODS

Women diagnosed with stages I-IV breast cancer were recruited into 4 asynchronous groups to participate in the BWP, a 5-week facilitator-led group-based mental health and well-being program. Psychological measures used at baseline and post-intervention included: the Warwick Edinburgh Mental Well-Being Scale, Brief Resilience Scale, Self-compassion Scale, 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder scale, and EORC QLQ-C30. Multivariate analysis of variance and effect sizes were calculated on pre- and post-psychological measures, followed by qualitative content analysis on post-completion interviews with participants.

RESULTS

Nineteen women (mean age 45.7, standard deviation = 7.74) were included in the study. Large effect sizes were reported for mental well-being, depressive symptoms, and anxiety (partial ω2 = 0.28, 0.21, and 0.20, respectively). Self-compassion, resilience, and quality of life results were not statistically significant. Qualitative content analysis provided insight into experiences with Program Delivery Experience, Application of the BWP, Mental Health Improvements, Supporter Involvement, Adopted Interventions, and Recruitment. Participants reported benefits in mindfulness, grounding techniques, and physical activities.

CONCLUSION

The BWP has the potential to be an effective intervention to support the mental health and well-being of breast cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

This study highlights flexible interventions that accommodate the diverse needs of breast cancer survivors to improve mental well-being and alleviate psychological distress.

How family support alleviates death anxiety in breast cancer patients: the mediating role of meaning in life

Previous studies have predominantly focused on the relationship between death anxiety and quality of life in breast cancer patients, with limited exploration on how to alleviate their death anxiety. To address this gap, we recruited 533 breast cancer patients and utilized structural equation modeling and Process Model 4 to analyze the internal mechanisms and boundary conditions between family support and death anxiety. The study results indicated that family support significantly negatively impacts death anxiety in breast cancer patients; similarly, meaning in life also significantly negatively impacts death anxiety. More importantly, we found that meaning in life plays a full mediating role between family support and death anxiety. This study suggests that by enhancing family support levels and strengthening patients' perception of meaning in life, we can significantly improve the psychological health status of breast cancer patients, thereby potentially improving their quality of life.

Quality of life of women with recurrent vulvar cancer treated with electrochemotherapy

BACKGROUND

The quality of life of patients undergoing oncologic treatment has become an important issue in recent years. Owing to potential mutilation following surgery for vulvar cancer, more conservative approaches have evolved with the integration of new local ablative therapies, such as electrochemotherapy. The aim of this study was to determine the quality of life of women with vulvar cancer recurrence treated with electrochemotherapy for nonpalliative purposes.

PATIENTS AND METHODS

Eleven patients with vulvar cancer recurrence were treated with electrochemotherapy from July 2020 to December 2023. Patients completed different questionnaires: the EuroQol - 5 Dimension (EQ-5D), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Vulva Cancer 34 (EORTC QLQ-VU34) and visual analog pain scale (VAS) before and one, three and six months after electrochemotherapy. As a control group, fifteen patients with vulvar cancer recurrence treated with wide local excision completed the EORTC QLQ-C30 and VAS questionnaires before surgery and three and six months after surgery.

RESULTS

No significant differences in EQ-5D scores were found between quality of life before electrochemotherapy and at each follow-up visit. A comparison of the EORTC QLQ-C30 scores between the electrochemotherapy and surgery groups showed a significant difference in physical functioning, fatigue, insomnia, and global health status three months after the procedure and in role, cognitive, social functioning and appetite loss six months after the procedure, all of which were in favor of the electrochemotherapy group. The EORTC QLQ-VU34 questionnaire showed improvements in urinary symptoms and symptoms related to scarring and mutilation of the external genitalia in the electrochemotherapy group. The VAS score did not differ significantly between the electrochemotherapy and surgical groups.

CONCLUSIONS

The study showed that the quality of life after treatment with electrochemotherapy is better in some segments than after surgical treatment.

Research on preventing low anterior resection syndrome following sphincter-preserving surgery for rectal cancer through high-risk screening and pelvic floor biofeedback therapy

PURPOSE

This study aims to evaluate the effectiveness of high-risk screening combined with pelvic floor biofeedback therapy in preventing low anterior resection syndrome (LARS) after sphincter-preserving surgery (SPS) for rectal cancer.

METHODS

Forty-three patients who underwent SPS for rectal cancer at Jiangxi Cancer Hospital from January to December 2022 were assigned to the standard care group and received standard care plus pelvic floor biofeedback therapy. Forty-nine patients treated from January to December 2023 were designated as the high-risk screening group and received high-risk screening for LARS in addition to the standard care group's treatment protocol. LARS scores and incidence rates at 1, 3, and 6 months postoperatively, anorectal pressure values, quality of life scores at 3 and 9 months, and treatment adherence were compared between the two groups.

RESULTS

The high-risk screening group showed significantly lower LARS scores and incidence rates at all postoperative intervals compared to the standard care group. Additionally, the high-risk screening group demonstrated better anorectal pressure and quality of life scores and achieved higher treatment adherence, with statistically significant differences between groups (p < 0.05).

CONCLUSIONS

High-risk screening combined with targeted pelvic floor biofeedback therapy following SPS for rectal cancer can effectively prevent LARS and improve postoperative recovery quality.

Longitudinal study on quality of life following cervical cancer treatment in Botswana

PURPOSE

This study longitudinally assessed the quality of life (QoL) in patients who completed chemoradiation (CRT) for cervical cancer in Botswana and compared the QoL for those living with and without HIV infection.

METHODS

Patients with cervical cancer recommended for curative CRT were enrolled from August 2016 to February 2020. The European Organisation for Research and Treatment of Cancer Core Quality-of-Life (QLQ-C30) and cervical cancer-specific (QLQ-Cx24) questionnaires, translated into Setswana, were used to assess the QoL of patients prior to treatment (baseline), at the end of treatment (EOT) and in 3 month intervals post-treatment for 2 years, and statistical analyses were performed.

RESULTS

A total of 294 women (median age: 46 years) were enrolled and followed up for an average of 16.4 months. Of women with recorded staging, most had FIGO stage III/IV disease (64.4%). Women living with HIV (WLWH; 74.1%) presented at earlier ages than those without HIV (44.8 years vs 54.7 years, p<0.001). The QoL for all domains did not differ by HIV status at baseline, EOT or 24 month follow-up. Per QLQ-C30, the mean global health status score (72.21 vs 78.37; p<0.01) and the symptom (12.70 vs 7.63; p=0.04) and functional scales (88.34 vs 91.85; p<0.01) improved significantly from the EOT to the 24 month follow-up for all patients; however, using the QLQ-Cx24 survey, no significant differences in the symptom burden (12.53 vs 13.67; p=0.6) or functional status (91.23 vs 89.90; p=0.53) were found between these two time points.

CONCLUSION

The QoL increased significantly for all patients undergoing CRT, underscoring the value of pursuing curative CRT, regardless of the HIV status.

Using prior information to individualize start item selection when assessing physical functioning with the EORTC CAT Core

BACKGROUND

Computerized adaptive test (CAT) provides individualized measurement, using the patient's previous responses to select the next most informative item. However, the first item, the start item, is usually not individualized as no score estimate is available a priori. The European Organisation for Research and Treatment of Cancer (EORTC) CAT Core covers 15 health-related quality of life domains. Scores for one domain may be used to obtain initial score estimates for another domain. We assessed the potential for using such cross-domain information to individualize start item selection for the EORTC CAT Core physical functioning.

METHODS

The potential for predicting physical functioning (PF) scores from each of the 14 other domains using linear regression was assessed in an international, mixed sample comprising 10,084 cancer patient assessments. Using Monte Carlo CAT simulations, the impact of individually selected PF start items vs. fixed start item for CAT measurement precision was assessed.

RESULTS

Depending on the domain predicting PF, the correlation of predicted and observed PF scores ranged 0.25-0.71 and the predicted PF scores were within 1SD of the observed PF scores for 57-85% of the patients. The CAT simulations showed that individually selected start items improved measurement precision for the initial steps of CATs. The application of individual start items had trivial or no impact on measurement precision when the CAT asked three or more items.

CONCLUSIONS

Simple linear regression may provide useful cross-domain predictions. Using individualized start items may increase measurement precision of the EORTC CAT Core for the initial steps of CAT which may be of relevance for short CATs.

Top Ten Tips Palliative Care Clinicians Should Know About Diagnosing, Categorizing, and Addressing Fatigue

Fatigue is a multifactorial symptom that is commonly faced by patients with cancer, chronic disease, and other serious illnesses. Fatigue causes suffering across biopsychosocial domains and affects patients and their loved ones. In this article, a consortium of professionals across cancer care, physical therapy, exercise, pharmacy, psychiatry, and palliative medicine offers tips and insights on evaluating, categorizing, and addressing fatigue in the setting of serious illness. The comprehensive approach to managing fatigue underscores the importance of collaborative efforts characteristic of interdisciplinary palliative care. Prioritizing screening, diagnosing, and treating fatigue is crucial for enhancing patients' and families' overall quality of life.

Mapping and comparing the quality of life outcomes in childhood and adolescent and young adult cancer survivors: an umbrella review and future directions

BACKGROUND

A cancer diagnosis early in life can leave a legacy in terms of compromised Quality of Life (QoL). There is a lack of clarity regarding the impact on QoL according to age at diagnosis, with childhood cancer survivors (CCS) and adolescents and young adult cancer survivors (AYACS) often combined. As part of an EORTC Quality of Life Group study, this umbrella review aims to (1) identify the QoL outcomes reported in the literature for both CCS and AYACS, and (2) investigate the similarities and differences in QoL challenges between both groups.

METHODS

A systematic literature search of systematic reviews and meta-analyses was conducted in December 2023 using PubMed, PsychInfo, and CINAHL. Methodological quality was evaluated using the AMSTAR tool.

RESULTS

Overall, 1457 articles were assessed, and 39 systematic reviews and meta-analyses met the inclusion criteria. QoL outcomes were categorized into eight QoL domains, all of which were reported in both groups of young survivors. However, reviews on CCS often focused on outcomes relating to emotional functioning, cognitive difficulties, social challenges, school functioning, body image and overall happiness, whereas AYACS reviews had a greater focus on depressive symptoms, outcomes related to sexual health and reproductive health, employment, financial difficulties, self-image and identity and the impact of cancer.

CONCLUSION

This umbrella review comprehensively explores QoL outcomes among CCS and AYACS, revealing both shared and distinct challenges. Future research should focus on developing tailored questionnaires, emphasizing transition periods and incorporating a life perspective to capture unique developmental tasks of young survivors.

SOHO State of the Art Updates and Next Questions | Measuring Patient-Reported Outcomes (PROs) and Treatment Tolerability in Patients With Hematologic Malignancies

There has been a rapid expansion of novel therapeutics for hematologic malignancies, including monoclonal antibodies, small molecules, and cellular therapies, which confer different treatment-related toxicities and symptomatic adverse events (AEs) than traditional cytotoxic chemotherapies. Given that patients with blood cancers are living longer with these newer treatments, with some therapies requiring indefinite or time-intensive administration, consideration of patient-reported tolerability and effects on health-related quality of life (HRQoL) are increasingly relevant. Historically, clinical trials have focused on the efficacy and safety of therapies. While related to safety and not intended to replace it, "treatment tolerability" is a distinct construct defined as the extent to which symptomatic and nonsymptomatic AEs impact a patient's ability and desire to continue with current treatment dosing, which also encompasses how patients feel and function while undergoing anticancer therapies. Assessment of tolerability requires the systematic and rigorous measurement of patient-reported outcomes (PROs). In this review, we discuss the introduction of patient-reported outcomes measures (PROMs) into hematology clinical trials and how PROs inform the measurement of treatment tolerability, including symptomatic adverse events, physical and role functioning, and overall side effect burden. Selected PROMs for measurement of these core tolerability domains are outlined, with a focus on novel analytic tools that have been developed for the longitudinal analysis of tolerability data. Further, we outline ongoing studies to accelerate integration of PROs throughout the cancer care spectrum, from early-stage drug development to routine clinical care, with the goal of improving both HRQoL and survival.

Quality of Life in Patients with Locally Advanced Pancreatic Cancer During Stereotactic Radiotherapy Combined with Heat-Killed Mycobacterium Obuense Vaccination

Background: New treatment options for patients with locally advanced pancreatic cancer (LAPC) have proven to be safe but, in addition, may have an effect on the patient's quality of life. Objectives: To evaluate the effect of stereotactic body radiotherapy (SBRT) combined with intradermal heat-killed mycobacterium obuense (IMM-101) vaccination on health-related quality of life (HRQoL), pain, and sleep, in patients with LAPC. Design: Prospective cohort study. Setting/Participants: In total, 42 Dutch patients with LAPC were included after completion of at least four cycles of (m) leucovorin calcium (folinic acid), fluorouracil, irinotecan hydrochloride, and oxaliplatin (FOLFIRINOX). Measurements: Quality of life was assessed with the EORTC QLQ-C30. Patients completed the Richard Campbell Sleep Questionnaire (RCSQ) for five consecutive nights and wore simultaneously a GENEActiv tri-axial accelerometer, which registered sleep duration and sleep efficiency. The Numeric Rating Scale was used to assess pain intensity during treatment. Data were collected at the baseline visit [i.e., at inclusion in the study after (m)FOLFIRINOX treatment] and at week 8 (i.e., 6 weeks after start date of SBRT and after four IMM-101 vaccinations). Results: Univariable linear mixed model analysis revealed significant improvement for EORTC QLQ-C30 items "cognitive functioning" and "emotional functioning." Outcomes on RCSQ subscales and "RCSQ total score" did not significantly change. In the multivariable model, with "Global HRQoL scale" and "RCSQ total score" as outcomes, we did not find a significant change during treatment. Conclusion: In this prospective cohort study, we found that SBRT combined with IMM-101, in patients with LAPC, is well tolerated and does not negatively affect HRQoL, sleep quality, and pain.

Handling missing values in patient-reported outcome data in the presence of intercurrent events

INTRODUCTION

As patient-reported outcomes (PROs) are increasingly used in the evaluation of medical treatments, it is important that PROs are carefully analyzed and interpreted. This may be challenging due to substantial missing values. The missingness in PROs is often closely related to patients' disease status. In that case, using observed information about intercurrent events (ICEs) such as disease progression and death will improve the handling of missing PRO data. Therefore, the aim of this study was to develop imputation models for repeated PRO measurements that leverage information about ICEs.

METHODS

We assumed a setting in which missing PRO measurements are missing at random given observed measurements, as well as the occurrence and timing of ICEs, and potentially other (baseline or time-varying) covariates. We then showed how these missingness assumptions can be translated into concrete imputation models that also account for a longitudinal data structure. The resulting models were applied to impute anonymized PRO data from a single-arm clinical trial in patients with advanced lung cancer.

RESULTS

In our trial example, accounting for death and other ICEs in the imputation of missing data led to lower estimated mean health-related quality of life (while alive) compared to an available case analysis and a naive linear mixed model imputation.

CONCLUSION

Information about the timing and occurrence of ICEs contribute to a more plausible handling of missing PRO data. To account for ICE information when handling missing PROs, the missing data model should be separated from the analysis model.

Double burden: financial toxicity in patients with advanced soft tissue sarcoma at the start of first-line palliative chemotherapy: baseline data from the HOLISTIC study

PURPOSE

The HOLISTIC study assessed health-related quality of life (HRQoL) in advanced soft tissue sarcoma (STS) patients receiving first-line palliative chemotherapy. The secondary objective discussed here is to evaluate baseline self-reported financial difficulties and associated sociodemographic factors and global health status (GHS), compare financial toxicity between patients in the United Kingdom (UK) and the Netherlands (NL), and evaluate the consequences of financial toxicity.

METHODS

This prospective study included 72 UK and 65 NL patients. Financial toxicity was evaluated by the financial difficulties scale of the EORTC QLQ-C30. Associated factors (i.e., country, gender, educational level, relationship status, employment changes, income, age, time since diagnosis, and GHS) were analyzed using descriptive analysis, Chi-square tests, and univariate and multivariate logistic regression.

RESULTS

Median participant age was 62 (range: 27-79) years, and gender distribution was equal. 58% of UK and 48% of NL patients had no income or a monthly income ≤ £/€ 2000 (p = 0.417). Self-reported additional costs for medication (31% vs. 9%, p < 0.001) and parking (75% vs. 41%, p < 0.001) were more prevalent among Dutch than UK patients. Travel expenses were similar: 68% in NL and 66% in UK. Univariate analysis showed an increased risk of financial toxicity in UK patients (40% vs. 22% [NL], p = 0.023), single patients (52% vs. 27% [with partner], p = 0.014), and those with a change in employment status (46% vs. 24% [no change], p = 0.019). In UK patients, multivariate analysis indicated lower odds for financial toxicity for patients with a high income (OR 0.207, p = 0.031) and higher odds for patients with a worse GHS (OR 5.171, p = 0.012), whereas in NL, higher odds were seen for male (OR 13.286, p = 0.027) and single (OR 41.735, p = 0.007) patients.

CONCLUSION

Financial toxicity was common among advanced STS already at the start of palliative chemotherapy, influenced by factors such as residence country, income, relationship status, gender, and GHS. Timely interventions are needed to address financial challenges in this population.

Cancer-specific utility instrument for health economic evaluations: A synopsis of the EORTC QLU-C10D user manual and current validity evidence

The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Utility - Core 10 Dimensions (QLU-C10D) adds a preference-based scoring algorithm to the EORTC measurement portfolio. It is built on the most widely used health-related quality of life (HRQoL) measure in oncology, the EORTC Quality of Life Questionnaire - Core 30 (QLQ-C30), allowing for the calculation of both HRQoL profiles and health utilities. This is an important advancement for integrating cancer-specific values into health economic evaluations and decision making, offering greater content validity and statistical power than some generic measures. This article presents an outline of the EORTC QLU-C10D User Manual to inform health-technology bodies, academic researchers, and industry, on the why and how of using this instrument for utility measurement. It covers basic concepts, proper use of the tool, including administration and scoring. Further, we summarise the presently published valuation studies, country-specific value sets, and body of evidence about psychometric properties. Current methodological questions are discussed, including mapping between utility measures and adaptions of generic measures for use in cancer populations. Taking into account empirical studies on psychometric properties, like content and construct validity, and comparisons with generic measures, we argue that the QLU-C10D is a reliable and valid instrument for cancer populations. Without imposing additional patient and administrative burden it has the potential to support health economic decisions in cancer by providing high-quality cancer-specific utility scores, to complement the more detailed HRQoL information from the QLQ-C30.

Understanding quality of life in Danish women with metastatic breast cancer undergoing multiple treatments

BACKGROUND

Women with metastatic breast cancer (mBC) may experience several symptoms exacerbated by successive treatments. There is however, a lack of knowledge of the most important symptoms and how these may affect daily life function. This study aims to elucidate the quality of life (QoL), including both symptoms and daily life functions, among mBC women undergoing varied treatments.

METHODOLOGY

We conducted a cross-sectional electronic questionnaire study enrolling mBC women (≥ stage III) receiving medical cancer treatment through September-December 2023. QoL, symptoms, and daily life function were measured using the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (QLQ-C30) and the breast cancer module (BR45). Health-related quality of life (HRQoL), defined by the EORTC, covers the subjective perceptions of the positive and negative aspects of cancer patients' symptoms, including physical, emotional, social, and cognitive functions. We examined associations between QoL, treatment line and therapy types, and estimated odds ratios (ORs) and confidence intervals (CIs).

RESULTS

Of 359 eligible participants, 111 responded (30.9%). At study commencement, 90.9% of the participants received at least one type of systemic treatment, with 16.2% undergoing chemotherapy, 61.3% anti-hormonal treatment, and 66.6% targeted cancer treatment. QLQ-C30 sum scores were highest in women receiving anti-hormonal treatment (80.7, interquartile range [IQR]: 17.6), followed by targeted cancer treatment (78.8, IQR: 18.4), and lowest with chemotherapy (77.1, IQR: 24.8). Quality of life decreased with subsequent treatment lines (first line: 80.3, IQR: 20.7, fourth line: 67.4, IQR: 11.3). No significant differences were found in the functions or in the individual symptoms according to monotherapy type.

INTERPRETATION

Women with mBC experience a substantial symptom burden and reduced functioning, and their QoL differs with successive lines of treatment. This underlines that women living with mBC need support and effective symptom management to maintain QoL.

Patient-relevance of outcome measures in breast cancer clinical trials: a cross-sectional comparative analysis of patient preferences and trials conducted between 2014 and 2024

BACKGROUND

Worldwide, many clinical trials are performed using clinical outcomes and surrogate outcomes as endpoints. Surrogate outcomes are used, for instance, if there is not enough follow-up time to measure the outcome of interest. Surrogate outcomes might not be patient-relevant, however. This study assesses to what extent patient-relevant outcomes are measured in clinical trials for breast cancer drugs.

RESEARCH DESIGN AND METHODS

A cross-sectional comparative analysis was conducted in which patient preferences for outcomes derived from the literature were compared to outcomes measured in phase III breast cancer trials conducted between 2014 and 2024.

RESULTS

Patients prefer outcomes addressing survival benefits, treatment effectiveness, adverse events and health-related quality of life. Minor improvements in survival benefits are greatly valued. The majority of patients are willing to accept some side effects for a positive outcome. The primary outcome used most frequently in trials is progression-free survival. The most common secondary outcomes are adverse events, mortality, overall response rate, and health-related quality of life.

CONCLUSION

Phase III trial outcomes appear to align largely with breast cancer patients' preferences. Nevertheless, patients and trial designers emphasize different outcomes. Improvement is therefore needed to enhance the relevance of trial data for patients.

Cardiovascular training for fatigue in people with cancer

RATIONALE

Cancer-related fatigue (CRF) is the most prevalent and severe symptom among people with cancer. It can be attributed to the cancer itself or to anticancer therapies. CRF affects the individual physically and mentally, and cannot be alleviated by rest. Studies show a positive effect of exercise on CRF.

OBJECTIVES

To evaluate the effects of cardiovascular training on cancer-related fatigue (CRF), quality of life (QoL), adverse events, anxiety, and depression in people with cancer, with regard to their stage of anticancer therapy (before, during, or after), up to 12 weeks, up to six months, or longer, postintervention.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and World Health Organization ICTRP to identify studies that are included in the review. The latest search date was October 2023.

ELIGIBILITY CRITERIA

We included randomised controlled trials (RCTs) evaluating cardiovascular training for CRF or QoL, or both, in people with cancer. Trials were eligible if training was structured, included at least five sessions, and instruction was face-to-face (via video tools or in person). We excluded studies with fewer than 20 randomised participants per group and where only an abstract was available.

OUTCOMES

Our critical outcomes were: short-, medium-, long-term CRF and QoL. Important outcomes were adverse events, and short-, medium-, long-term anxiety and depression.

RISK OF BIAS

We used the Cochrane RoB 1 tool to assess bias in RCTs.

SYNTHESIS METHODS

We used standard Cochrane methodology. We synthesised results for each outcome using meta-analysis where possible (inverse variance or Mantel-Haenszel; random-effects model). We pooled data for the respective assessment periods above. We used GRADE to assess certainty of evidence for each outcome.

INCLUDED STUDIES

We included 23 RCTs with 2135 participants, of whom 96.6% originated from high-income countries; 1101 participants were randomised to cardiovascular training and 1034 to no training. Studies included mostly females who were diagnosed with breast cancer. We also identified 36 ongoing and 12 completed studies that have not yet published (awaiting assessment). We only present findings on CRF, QoL and adverse events. For details regarding anxiety and depression, see full text.

SYNTHESIS OF RESULTS

Cardiovascular training before anticancer therapy versus no training for people with cancer We identified no studies for inclusion in this comparison. Cardiovascular training during anticancer therapy versus no training for people with cancer We included 10 studies (1026 participants); eight studies contributed data to quantitative analyses (860 participants). Cardiovascular training probably reduces short-term CRF slightly (mean difference (MD) 2.85, 95% confidence interval (CI) 1.16 to 4.55, on the Functional Assessment of Cancer Therapy - Fatigue (FACT-F), scale 0 to 52, higher values mean better outcome; minimally important difference (MID) 3; 6 studies, 593 participants) and probably results in little to no difference in short-term QoL (MD 3.56, 95% CI 0.21 to 6.90, on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ C-30), scale 0 to 100, higher values mean better outcome, MID 10; 6 studies, 612 participants) (both moderate-certainty evidence). We are uncertain about the effects on medium-term CRF (MD 2.67, 95% CI -2.58 to 7.92, on FACT-F; MID 3; 1 study, 62 participants), long-term CRF (MD 0.41, 95% CI -2.24 to 3.05, on FACT-F; MID 3; 2 studies, 230 participants), medium-term QoL (MD 6.79, 95% CI -4.39 to 17.97, on EORTC QLQ C-30; MID 10; 1 study, 62 participants), and long-term QoL (MD 1.51, 95% CI -3.40 to 6.42, on EORTC QLQ C-30; MID 10; 2 studies, 230 participants) (all very low-certainty evidence). For adverse events (any grade and follow-up), we did not perform meta-analysis due to heterogeneous definitions, reporting, and measurement (9 RCTs, 955 participants; very low-certainty evidence). Cardiovascular training after anticancer therapy versus no training for people with cancer We included 13 studies (1109 participants); nine studies contributed data to quantitative analyses (756 participants). We are uncertain about the effects of cardiovascular training on short-term CRF (MD 3.62, 95% CI 0 to 7.13, on FACT-F; MID 3; 6 studies, 497 participants), long-term CRF (MD -0.80, 95% CI -1.72 to 0.13, on the Fatigue Symptom Inventory (FSI), scale 1 to 10, higher values mean worse outcome; MID 1; 2 studies, 262 participants), short-term QoL (MD 3.70, 95% CI -0.14 to 7.41, on the Functional Assessment of Cancer Therapy - General (FACT-G), scale 0 to 108, higher values mean better outcome; MID 4; 8 studies, 642 participants), long-term QoL (MD 3.10, 95% CI -1.12 to 7.32, on FACT-G; MID 4; 1 study, 201 participants), and adverse events (risk ratio (RR) 2.71, 95% CI 0.58 to 12.67; 1 study, 50 participants) (all very low-certainty evidence). There were no data for medium-term CRF and QoL.

AUTHORS' CONCLUSIONS

Moderate-certainty evidence shows that cardiovascular training by people with cancer during their anticancer therapy slightly reduces short-term CRF and results in little to no difference in short-term QoL. We do not know whether cardiovascular training increases or decreases medium-term CRF/QoL, and long-term CRF/QoL. There is very low-certainty evidence (due to heterogeneous definitions, reporting and measurement) evaluating whether the training increases or decreases adverse events. In people with cancer who perform cardiovascular training after anticancer therapy, we are uncertain about the effects on short-term CRF/QoL, long-term CRF/QoL, and adverse events. We identified a lack of evidence concerning cardiovascular training before anticancer therapy and on safety outcomes. The 36 ongoing and 12 completed, but unpublished, studies could help close this gap, and could contribute to improving the effect estimates and certainty.

FUNDING

This Cochrane review was funded by the Federal Ministry of Education and Research of Germany, grant number: FKZ 01KG2017.

REGISTRATION

Protocol available via DOI: 10.1002/14651858.CD015211.

A rapid state-of the-art review of client-reported outcomes measures used to assess dogs' clinical signs and quality of life during chemotherapy

BACKGROUND

Quality of life is an essential component of decision-making in veterinary oncology. Poor management of adverse events during chemotherapy can impair dogs' quality of life and be life-threatening. Consequently, client-reported outcome measures (CROMs) are being proposed to help assess both clinical signs and quality of life. The purpose of this rapid review was to: (1) identify existing CROMs that have been used to assess dogs' clinical signs and quality of life during chemotherapy; and (2) evaluate their methodological development to inform adaptation or development of a CROM for use in routine clinical practice, including remote monitoring. Databases (Scopus, Web of Science, PUBMED/MEDLINE) were searched for CROMs (questionnaires) completed by a non-expert family member about their companion dog. CROM content (domains measured) and scale quality were appraised.

RESULTS

Ten CROMs were identified and three were variations of the same tool. Content of the CROMs varied considerably (range 3-17 domains) with gastrointestinal being the most frequently measured clinical sign cluster (9/10 studies), followed by mobility/ambulatory activity (7/10) and global quality of life (6/10). No CROMs adhered to quality standards for the development of questionnaires and most failed to include qualitative design methods and basic psychometric assessment to ensure reliability and validity (such as internal consistency, test-retest reliability or factor analysis).

CONCLUSION

The validity and reliability of existing chemotherapy CROMs for dogs remains under-tested. Although CROMs combined with remote digital monitoring have the potential to enhance patient care, as has been demonstrated with physician-based oncology, there is a need to apply quality standards to ensure optimal validation. Interdisciplinary collaborations would likely improve CROM quality and clinical utility thereby allowing veterinary healthcare professionals to better support their patients.

Effects of nurse-led symptom management in chronic myeloid malignancies: a randomized trial

PURPOSE

Chronic hematological malignancies progress slowly, potentially manifesting symptoms spanning months to years. HM-PRO is developed as a comprehensive clinical tool for assessing symptoms in hematology. The aim was to investigate the effect of a nurse-led systematic approach to symptom identification and management using HM-PRO in outpatient care in patients with chronic hematological malignancies.

METHODS

This is a randomized trial including 94 patients to investigate an intervention comprising (1) HM-PRO data collection, (2) HM-PRO assessment guided by an algorithm, and (3) nurse-led tailored symptom management. The control arm received standard follow-up care. The primary outcome was change in QoL. Secondary outcomes were change in prevalence of physical and psychological symptoms.

RESULTS

A statistically significant difference in QoL change scores over time favored the intervention (diff. 10.3; p = .04). For secondary endpoints, a significant between group difference in change over time for severity scores was observed in fatigue (diff. - 13.6; p = .003), overall symptom burden (diff. - 0.7 points; p = .029), emotional functioning (diff. 10.0; p < .0001), and anxiety (diff. - 2.5; p = .001).

CONCLUSION

A 12-month nurse-led symptom management intervention within hematology significantly improved QoL, emotional functioning, fatigue, anxiety, and overall symptom burden over time. This is the first randomized trial investigating nurse-led clinical application of the HM-PRO questionnaire providing knowledge on the efficacy of systematic symptom management in clinical practice. This study highlights both the pivotal role of nurses and multidisciplinary support and the inherent value of tailored symptom management.

TRIAL REGISTRATION

Clinical trial registration number: NCT04757545 (02/12/2021).

The effect of insomnia treatment on work productivity and related costs among cancer survivors with insomnia and comorbid perceived cognitive impairments: A secondary analysis of a randomized controlled trial

PURPOSE

This secondary analysis of a randomized clinical trial aimed to understand the cost-effectiveness of cognitive behavioral therapy for insomnia (CBT-I) in improving absenteeism (i.e., time away from work) and presenteeism (i.e., unproductivity while at work) among cancer survivors.

METHODS

A total of 55 currently employed mixed cancer survivors who met DSM-5 criteria for insomnia disorder and self-reported cognitive impairments were randomized to receive seven weekly, individual CBT-I sessions immediately or after a waiting period. Participants completed the Work Productivity and Activity Impairment Questionnaire (WPAI). Information from participants and the Labour Force Survey (LFS) were used to calculate costs. Education-adjusted mixed-effects models using intention-to-treat principles assessed immediate and longer-term effects of treatment on work productivity.

RESULTS

While CBT-I was not associated with significant improvements in absenteeism, the treatment group reported a 23.5-point reduction in presenteeism post-treatment, compared to a 0.45-point decrease in the waitlist control group. Improvements in presenteeism were maintained at 6-month follow-up. The mean cost of total work productivity loss was CAD627.59 per person per week before beginning CBT-I. Treatment resulted in a 48.4%, 44.6%, and 30.5% reduction in lost productivity immediately, 3 and 6 months post-treatment, respectively. Total cost savings for the first year after treatment, adjusting for treatment costs, were estimated at CAD 9478.82.

CONCLUSIONS

Intervening upon late and long-term effects of cancer treatment (e.g., sleep, fatigue, cognitive impairment) through CBT-I produces meaningful and durable improvements in work productivity, particularly presenteeism.

IMPLICATIONS FOR CANCER SURVIVORS

With appropriate treatment, survivors can address side effects and increase productivity, but additional work is needed to improve access to and coverage for evidence-based interventions.

Supportive care needs among head and neck cancer patients in the recovery phase from 6 months to 2 years after treatment: which factors matter?

PURPOSE

To investigate which demographic, personal, clinical, physical, psychological, social, lifestyle, and cancer-related quality of life (QoL) factors are associated with (changes in) supportive care needs (SCNs) from 6 months to 2 years after treatment in head and neck cancer (HNC) patients.

METHODS

Data from the prospective NETherlands QUality of life and BIomedical Cohort (NET-QUBIC) study among HNC patients treated with curative intent was used. SCNs were measured using the Supportive Care Needs Survey 34-item Short-Form (SCNS-SF34) (6 months, 1 and 2 years after treatment) and the 11-item HNC-specific module (SCNS-HNC) (2 years). Multivariable linear mixed model analyses and linear regression analyses were used to study factors associated with changes in SCNs over time (SCNS-SF34) and the level of SCNs at 2 years follow-up (SCNS-SF34 and SCNS-HNC).

RESULTS

Data from 483 patients was used. SCNs in the physical and daily living (PDL), psychological (PSY), and health system, information, and patient support (HSIPS) domains decreased significantly over time. At 2 years follow-up, the highest SCNs were reported regarding lack of energy/tiredness (10.8%). Changes in SCNs and the absolute level of SCNs at 2 years were associated with personal and clinical factors and post-treatment (6 months) with psychological, lifestyle, and cancer-related QoL factors.

CONCLUSIONS

Personal, clinical, psychological, lifestyle, and cancer-related QoL factors were associated with SCNs. These results can be used to develop predictive models to personalize supportive care for HNC patients.

IMPLICATIONS FOR CANCER SURVIVORS

SCNs decrease over time, but a subgroup of patients still presents with SCNs 2 years after treatment.

The potential of experience sampling methods in palliative care

BACKGROUND

Experience sampling methods typically involve multiple self-report assessments per day over consecutive days. Unlike traditional patient-reported outcome measures or interviews, such methods offer the possibility to capture the temporal fluctuations of experiences in daily environments, making them valuable for studying the daily lives of people with advanced illness. Yet, their use in palliative care research is limited.

AIMS

To introduce experience sampling methods to the field of palliative care as a valuable tool for studying the everyday experiences of people with advanced illness, and to present the findings of an experience sampling methods pilot study with people with advanced breast or advanced lung cancer.

EVIDENCE USED TO SUPPORT THE INFORMATION PRESENTED

We draw on published health research using experience sampling methods. We present a newly developed experience sampling methods questionnaire (ESM-AC) and report pilot study findings on the feasibility and acceptability of experience sampling methods among people with advanced breast or lung cancer.

KEY LEARNING POINTS

Experience sampling methods hold potential to uncover the dynamics of everyday experiences of people with advanced illness. The methods offer considerable flexibility and options to answer a variety of research questions, but consideration is required regarding sampling protocols and participant burden. We showed appropriate feasibility and acceptable participant burden of the methods among people with advanced breast or advanced lung cancer.

Personalized treatment approaches in hepatocellular carcinoma

Personalized medicine is an emerging field that provides novel approaches to disease's early diagnosis, prevention, treatment, and prognosis based on the patient's criteria in gene expression, environmental factors, lifestyle, and diet. To date, hepatocellular carcinoma (HCC) is a significant global health burden, with an increasing incidence and significant death rates, despite advancements in surveillance, diagnosis, and therapeutic approaches. The majority of HCC lesions develop in patients with liver cirrhosis, carrying the risks of mortality associated with both the tumor burden and the cirrhosis. New therapeutic agents involving immune checkpoint inhibitors and targeted agents have been developed for sequential or concomitant application for advanced HCC but only a tiny percentage of patients benefit from each approach. Moreover, clinicians encounter difficulties determining the most appropriate regimen for each patient. This emphasizes the need for a personalized treatment approach. In other words, patients should no longer undergo treatment based on their tumor's histology but depending on the distinct molecular targets specific to their tumor biology. However, the utilization of precision medicine in managing HCC is still challenging. This review aims to discuss the role of personalized medicine in diagnosing, managing, and defining the prognosis of HCC. We also discuss the role of liquid biopsy and their clinical applications for immunotherapies in HCC. More clinical studies are still necessary to improve the precision of biomarkers used in the treatment decision for patients with HCC.

Transarterial Radioembolisation with Y90 Resin Microspheres and the Effect of Reimbursement Criteria in France: Final Results of the CIRT-FR Prospective Observational Study

PURPOSE

This analysis of the CIRSE Registry for SIR-Spheres Therapy in France, CIRT-FR, reports on real-world outcomes of transarterial radioembolisation (TARE) with Y90 resin microspheres for hepatocellular carcinoma (HCC) and colorectal cancer liver metastases (CRLM) patients in France, focusing on safety, effectiveness and health-related quality of life (HRQoL). Results on patients treated based on national reimbursement criteria are discussed here.

METHODS

Prospective, multicentre, observational study of HCC and CRLM patients treated between August 2017 and July 2020 with TARE Y90 resin microspheres. Patients were assigned to different analysis groups based on reimbursement recommendations. Follow-up period was at least 24 months with patient data collected every 3 months.

RESULTS

In total, 252 (193 HCC, 59 CRLM) patients of CIRT-FR were included in the analysis. No differences in effectiveness, safety and HRQoL were found between analysis groups based on reimbursement recommendations. Median overall survival for HCC and CRLM was 19.0 (95% CI, 16.1-22.4) and 10.8 (95% CI, 8.0-13.5) months, respectively. Serious procedure-related adverse events occurred in 13% of the patients. HRQoL generally remained stable, with some fluctuations in function scores and symptoms.

CONCLUSION

In our cohorts, patients performed similarly regarding clinical outcomes irrespective of their analysis group based on reimbursement recommendations. Our results suggest that instead of restrictive reimbursement criteria, more decision-making power in selecting suitable patient groups could be given to multidisciplinary tumour boards. Results confirm that TARE with Y90 resin microspheres is an effective and safe treatment for liver cancer, with maintained HRQoL in most patients.

A multimodal intervention program to improve sexual health and self-perceived quality of life in patients treated for cervical cancer: a randomized prospective study (PROVIDENCE trial)

BACKGROUND

Patients with cervical cancer treatment experience an impairment of sexual function and quality of life. This issue is usually underreported and undertreated, and evidence-based interventions are lacking. Prevention of sexual dysfunction is a crucial pillar in improving the quality of life of these patients. The primary objective of this trial is to evaluate the impact of a multimodal intervention, encompassing prevention of vaginal dysfunction and patient education, on sexual function and quality of life in cervical cancer survivors utilizing patient-reported outcome measurements.

METHODS

Multi-institutional, randomized clinical trial where patients will be randomized 1:2 at diagnosis of initial or locally advanced cervical cancer to control arm or intervention arm. After treatment, control arm patients will undergo standard follow-up by their referring physician. The multimodal intervention for patients in the intervention group includes application of vaginal estrogens plus hyaluronic-acid cream along with use of vaginal vibrator, systematic evaluation of the need of systemic hormone replacement therapy and treatment if needed, and access to online content about sexuality, nutrition, sports and lifestyle habits. Through 4 appointments (at diagnosis, 1, 6, and 12 months after treatment), sexual health, vaginal trophism and self-perceived quality of life of patients in both arms will be assessed with validated questionnaires as female sexual function index (FSFI), European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30, and Cx-24, Cervantes Scale, vaginal health index and vaginal thickness assessed by ultrasound. The major inclusion criteria will be patients aged ≥18 years with the International Federation of Gynecology and Obstetrics stage I-III cervical cancer treated with surgery and/or radiotherapy. The primary endpoint will be FSFI score 12 months after treatment, which will be compared between groups. Uni- and multivariate analysis will be performed to identify factors influencing sexual function recovery after treatment. The sample size will be of 120 eligible patients, who will be randomized to detect an improvement of 5.2 points in FSFI score. Complete accrual is estimated in March 2026. To date, the present study has no external funding.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT06031493.

Towards Personalized Radiotherapy in Pelvic Cancer: Patient-Related Risk Factors for Late Radiation Toxicity

Normal tissue reactions vary significantly among patients receiving the same radiation treatment regimen, reflecting the multifactorial etiology of late radiation toxicity. Predicting late radiation toxicity is crucial, as it aids in the initial decision-making process regarding the treatment modalities. For patients undergoing radiotherapy, anticipating late toxicity allows for planning adjustments to optimize individualized care. Various dosimetric parameters have been shown to influence the incidence of late toxicity, and the literature available on this topic is extensive. This narrative review examines patient-related determinants of late toxicity following external beam radiotherapy for pelvic tumors, with a focus on prostate and cervical cancer patients. In Part I, we address various methods for quantifying radiation toxicity, providing context for interpreting toxicity data. Part II examines the current insights into the clinical risk factors for late toxicity. While certain factors-such as previous abdominal surgery, smoking behavior, and severe acute toxicity-have consistently been reported, most of the others show inconsistent associations. In Part III, we explore the influence of genetic factors and discuss promising predictive assays. Single-nucleotide polymorphisms (SNPs) likely elevate the risk in specific combinations. Advances in artificial intelligence now allow for the identification of SNP patterns from large datasets, supporting the development of polygenic risk scores. These innovations hold promise for improving personalized treatment strategies and reducing the burden of late toxicity in cancer survivors.

Sexual Health and Quality of Life in Patients With Low-Risk Early-Stage Cervical Cancer: Results From GCIG/CCTG CX.5/SHAPE Trial Comparing Simple Versus Radical Hysterectomy

PURPOSE

Simple hysterectomy and pelvic node assessment (SHAPE) is a phase III randomized trial (ClinicalTrials.gov identifier: NCT01658930) reporting noninferiority of simple compared with radical hysterectomy for oncologic outcomes in low-risk cervical cancer. This study presents secondary outcomes of sexual health and quality of life (QOL) of the SHAPE trial.

METHODS

Participants were randomly assigned to receive either radical or simple hysterectomy. Sexual health was assessed up to 36 months postoperatively using the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised and QOL using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Cervical Cancer-Specific Module (QLQ-CX24) questionnaires.

RESULTS

Among participants with at least one QOL measure, clinical and pathologic characteristics were balanced and with no differences in preoperative baseline scores for sexual health or QOL between groups. FSFI total score met the cutoff for dysfunction up to 6 months (P = .02) in the radical hysterectomy group. Group differences favored simple hysterectomy for FSFI subscales: desire and arousal at 3 months (P ≤ .001) and pain and lubrication up to 12 months (P ≤ .018). Both groups met the cutoff for sexual distress but was higher in radical hysterectomy at 3 months (P = .018). For QLQ-CX24, symptom experience was significantly better up to 24 months (P = .031) and body image better at 3, 24, and 36 months (P ≤ .01) for simple hysterectomy. Sexual-vaginal functioning was significantly better up to 24 months (P ≤ .022) and more sexual activity up to 36 months (P = .024) in the simple hysterectomy arm. Global health status was significantly higher at 36 months for simple hysterectomy (P = .025).

CONCLUSION

Simple hysterectomy was associated with lower rates of sexual dysfunction than radical hysterectomy, with a lower proportion of women having sustained sexual-vaginal dysfunction. These results further support the benefit of surgical de-escalation for low-risk cervical cancer.

The effects of regular exercise on cognitive and cardiometabolic health in testicular cancer survivors subjected to platinum-based chemotherapy

BACKGROUND

Platinum-based chemotherapy provides curative treatment to more than 95% of patients with testicular germ cell tumor but it has negative cardiometabolic and neurological effects. Regular exercise can alleviate late chemotherapy-related toxicities. We examined the impact of a 6-month supervised aerobic-strength training on cognitive and cardiometabolic health and residual level of platinum in cancer survivors.

METHODS

Twenty-eight middle-aged (42.1 ± 7.6 years) testicular germ cell tumor survivors subjected to platinum-based chemotherapy (1-8 cycles, 0-24 years ago) were recruited into exercise (n = 20) and control (n = 8) groups. Effects of 6-month exercise training on the whole-body and muscle metabolism, cognitive functions, cardiopulmonary fitness, residual plasma platinum, and plasma adiponectin were examined.

RESULTS

Exercise intervention improved cardiopulmonary fitness and cognitive functions, reduced residual plasma platinum, visceral adiposity and muscle lipids, improved glucose (glycosylated hemoglobin) and lipid (high-density lipoprotein cholesterol) metabolism, and enhanced dynamics of muscle post-exercise phosphocreatine recovery. Exercise-related decline in plasma platinum was paralleled by decline of muscle glycerophosphocholines and by the enhanced metabolic flexibility during low-intensity exercise, and predicted training-induced increase in cognitive functions.

CONCLUSIONS

The 6-month exercise intervention resulted in improved cognitive and cardiometabolic health in testicular germ cell tumor survivors, which was paralleled by reduced plasma platinum, providing evidence that structured supervised exercise brings multiple health benefits to testicular germ cell tumor survivors.

Lived experiences of dysphagia-related quality of life among esophageal cancer patients: a qualitative study

INTRODUCTION

Esophageal cancer impairs basic functions such as eating and drinking frequently resulting in difficulty swallowing (dysphagia) and other problems such as weight loss, pain, fatigue, and taste alterations. There is still a research gap in understanding the impact of dysphagia on quality of life, as patients continue to bear significant physical and psychological burdens despite advances in treatment. This study attempted to address this gap by examining the lived experiences of dysphagia-related quality of life among esophageal cancer patients.

METHODS

A phenomenological study was employed to analyze the data provided by 14 patients with esophageal cancer at the Oncology Center of the University of Gondar Comprehensive Specialized Hospital from March to April 2023. An interview guide was employed to carry out in-depth interviews with purposively selected patients. The interviews were audio-taped, translated, transcribed, and analysed using thematic analysis.

RESULTS

Three main themes emerged from the analysis of the participant interviews: physical challenges related to difficulty swallowing, altered dietary habits, and struggle to maintain weight; psychosocial strain, including emotional distress and social isolation; and reliance on assistance, encompassing both dependency and financial burden.

CONCLUSION AND RECOMMENDATIONS

This study underscores the significant physical, emotional, and social challenges experienced by esophageal cancer patients with dysphagia. To enhance support, healthcare providers should develop personalized care plans that address both the physical and emotional aspects of dysphagia, with sensitivity to cultural practices. Efforts should also be made to alleviate feelings of dependency and promote public awareness to reduce stigma and build a more supportive community.

Weather-Related Factors and Patient-Reported Outcomes (PROs) in Cancer Patients: Results from the ExPRO Study

OBJECTIVE

The ExPRO (External factors influencing patient reported outcomes of patients with malignant diseases) study explored associations between QoL data and environmental factors on the day of questionnaire completion: mean temperature, sunshine hours, season, and lunar phase.

METHODS

We undertook a cross-sectional analysis of baseline data in the prospective cohort study at two cancer centers in eastern Germany. From December 2020 to December 2021, cancer patients completed the EORTC QLQ-C30 questionnaire upon admission. Statistical analysis was performed to explore associations between QoL data and environmental factors, including temperature, sunshine hours, season, and lunar phases.

RESULTS

We received 5040 responses (54% male). QoL scores were highest at 25-30 °C and lowest at 5-10 °C (mean 61.3 vs. 52.6, p <0.001). Insomnia was highest at ≤0 °C and lowest at 25-30 °C (mean 39.3 vs. 29.5, p <0.001). QoL was highest with 8 hours of sunshine and lowest with 0 hours (mean 56.9 vs. 50.9, p = 0.003).

CONCLUSION

Higher temperatures, more sunshine, and summer seasons are associated with higher QoL in cancer patients, while lower temperatures and reduced sunlight are associated with poorer QoL. These findings highlight the need to consider environmental factors in PRO assessments.

Pretreatment Fatigue in Breast Cancer Patients: Comparison With Healthy Controls and Associations With Biopsychosocial Variables

OBJECTIVE

Cancer-related fatigue is one of the most common burdens of cancer patients. To date, most studies focused on fatigue during or after treatment. However, investigation of pretreatment fatigue is crucial to identify causal or risk factors other than cancer therapy and to enable timely fatigue management.

METHODS

Two hundred and thirty-two breast cancer patients (mean age = 55.6) and 41 healthy participants (mean age = 49.3) were recruited via the National Center for Tumor Diseases (NCT) Heidelberg. Patient-reported outcomes were assessed with the EORTC QLQ-FA12 for fatigue, the EORTC QLQ-C30 for functioning, the STAI for anxiety, the CESD-R for depression and the PSQI for sleep disturbance. Descriptive analyses and logistic regression models were performed using baseline data before start of cancer treatment. The thresholds of clinical importance (TCI) were applied to test for clinically relevant fatigue.

RESULTS

Compared to the healthy participants, patients scored significantly higher in physical, emotional, and total fatigue, in depression, in global health status and in all functioning scales except cognitive function (all p < 0.01). 48.7% of all patients reported clinically relevant fatigue. Being younger, being obese, having low education, or low social support was associated with a higher likelihood of clinically relevant fatigue before treatment. Higher depression and anxiety scores, poorer sleep quality and global health status, and impaired functioning seemed to get along with an increased likelihood of scoring above the TCI of fatigue (all p < 0.001).

CONCLUSIONS

Our study results suggest that fatigue screening, patient-centered fatigue education and psychosocial support may be needed already from the time of cancer diagnosis.

Navigating the Surgical Pathway for Frail, Older Adults Undergoing Colorectal Surgery

Adults ≥ 65 years of age comprise nearly 20% of the U.S. population and over half of surgical patients. Older adults, particularly when frail, may require additional preoperative evaluation and counseling, specialized hospital care, and may experience more noticeable physical and cognitive changes than younger or healthier patients. Surgeons can assess frailty and risk using several frailty measures, as data exist demonstrating worse perioperative outcomes among patients undergoing colorectal surgery. Prehabilitation programs have not been shown to improve surgical outcomes for colorectal surgery patients but may help maintain physical function or hasten recovery to baseline around the time of surgery, particularly for frail patients. Functional decline and delirium are common postoperatively in older adult patients, particularly those who are frail at baseline, and should be discussed with at-risk older adults. Primary care physicians and geriatricians can help with in-depth evaluation of frailty and geriatric syndromes. Special attention to the risks, outcomes, and care of older adults considering or undergoing colorectal surgery can help inform decision-making, which may facilitate goal-concordant care.

Geriatric Nutrition Risk Index is closely associated with sarcopenia and quality of life in gastric cancer patients: a cross-sectional study

Impaired nutritional status is closely related to the development of sarcopenia and poor quality of life (QoL) in cancer patients. This study aimed to investigate the association of Geriatric Nutritional Risk Index (GNRI) with sarcopenia and QoL in patients with gastric cancer (GC). Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia 2019 criteria. This cross-sectional study included a total of 311 patients with GC. Among them, 57 (18.3%) patients were diagnosed with sarcopenia. GNRI showed significant correlations with sarcopenia-related indicators including skeletal muscle index, handgrip strength, gait speed, and 5-time chair stand time (p < 0.001). A significant association was observed between GNRI and sarcopenia [odds ratio (OR) = 0.815, 95% confidence interval (CI): 0.760-0.874, p < 0.001] in the multivariate analysis. The optimal cutoff value of GNRI for predicting sarcopenia was 94.98, with a sensitivity of 75.4% and specificity of 73.2%. Patients with low GNRI exhibited significantly lower scores in terms of global health status and most functional scales. Furthermore, the majority of symptoms exhibited greater severity in patients with low GNRI. In conclusion, the present study revealed that GNRI was closely associated with sarcopenia and QoL, and could effectively predict sarcopenia in patients with GC.

Dose-Limiting Toxicities of Paclitaxel in Breast Cancer Patients: Studying Interactions Between Pharmacokinetics, Physical Activity, and Body Composition-A Protocol for an Observational Cohort Study

Background/Objectives: Paclitaxel (PTX), a commonly used chemotherapy for breast cancer (BC), is associated with dose-limiting toxicities (DLTs) such as peripheral neuropathy and neutropenia. These toxicities frequently lead to dose reductions, treatment delays, or therapy discontinuation, negatively affecting patients' quality of life and clinical outcomes. Current dosing strategies based on body surface area (BSA) fail to account for individual variations in body composition (skeletal muscle mass (SMM) and adipose tissue (AT) mass) and physical activity (PA), which can influence drug metabolism and toxicity. This study aims to explore the relationships between PTX pharmacokinetics, body composition, and PA to predict DLTs. Methods: This single-group observational cohort study will recruit 40 female BC patients undergoing PTX treatment. Data collection will include plasma PTX concentrations, body composition assessments (using dual X-ray absorptiometry and bioelectrical impedance analysis), PA measurements (via accelerometers), and questionnaires to assess BC-related health-related quality of life, chemotherapy-induced peripheral neuropathy, and neutropenia during the PTX schedule using validated questionnaires. Dose-limiting toxicities will be graded according to the Common Terminology Criteria for Adverse Events v5.0 (grade 3 or higher). This protocol is designed to develop a population-based PK-PD model that predicts the occurrence of chemotherapy-induced peripheral neuropathy and neutropenia in women with stage II or III BC undergoing PTX therapy, focusing on explanatory outcomes related to SMM, AT mass, and PA.

Concurrent Validity Between EQ-5D and HRQ-6D Measures in Patients with Different Primary Diagnoses

Background/Objectives: The HRQ-6D is a newly developed instrument to measure Health-related quality of life (HRQOL) and EQ-5D is the gold standard for measuring HRQOL. This study aims to test the concurrent validity between EQ-5D and HRQ-6D measures among patients with different primary diagnoses. Methods: This cross-sectional study uses two HRQOL measurement instruments, EQ-5D-3L and HRQ-6D. Data collection was performed between January 2023 and May 2023. All the necessary data for this study were collected from actual patients who presented with any one of the four different types of primary diagnoses: heart disease, cancer, depressive disorders, and end-stage renal disease (ESRD). They were recruited from the four specialist clinics that cater to the treatment of each of the four different types of primary diagnoses in a tertiary hospital. Results: There were 149 patients who participated in the study wherein 40 (26.8%) of them were ESRD patients, 39 (26.2%) of them were cancer patients, 38 (25.5%) of them were mentally depressed, and the remaining were patients with heart diseases. The domains in HRQ-6D, except for the perception of future health, are significantly associated with domains in EQ-5D-3L after having controlled for patients' primary diagnoses (i.e., p < 0.001). The HRQ-6D replaces the domain "Usual activities" with "Physical energy," and the association between these two domains is significant (p < 0.001). The correlation between the overall HRQ-6D and EQ-VAS scores is also significant (coefficient = 0.445, p < 0.001). Conclusions: The HRQ-6D is demonstrated to have concurrent validity with EQ-5D. Therefore, clinicians and researchers can use HRQ-6D to measure patient outcomes for interventional and observational studies. (Total word count = 265 words).