Symptoms and experiences of frailty in lung cancer patients with chemotherapy: A mixed-method approach

The Association Between Vulnerability and Taste Changes in Older Cancer Patients Undergoing Chemotherapy

This study aimed to examine the association between taste changes and vulnerability in elderly cancer patients undergoing chemotherapy. A cross-sectional study was conducted among older cancer patients undergoing chemotherapy in Wuxi, China. The Chemotherapy-induced Taste Alteration Scale (CiTAS) was used to measure taste alteration. The Vulnerable Elders Survey (VES) was used to measure vulnerability status. The univariate, correlation, and hierarchical regression analyses were applied to assess the association between taste changes and vulnerability. Of 200 older cancer patients, 123 (61.5%) participants were non-vulnerable. The univariate analysis revealed significant distribution differences of vulnerability in education level, smell abnormalities, drinking history, chemotherapy cycle, and taste changes. The level of taste changes was positively correlated with vulnerability (r = 0.401, p < 0.01). Results of the regression analysis indicated that vulnerability in older cancer patients was significantly associated with higher odds of "phantogeusia and parageusia" (OR = 4.505, p < 0.001). Taste changes may be an important influencing factor of vulnerability in older cancer patients.

Relationship between quality of life before treatment and survival in patients with hematological malignancies: A meta-analysis

This meta-analysis aimed to investigate the impact of pretreatment quality of life (QoL) on overall survival (OS) in patients with hematological malignancies. The observational studies with relationship between QoL and OS in patients undergoing either hematopoietic stem cell transplantation (HSCT) or chemotherapy were collected. Stratification by treatment was performed to examine the association between QoL and OS. Six articles were included in the analysis. Overall, significant associations with OS were observed for global QoL (hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 1.01-1.08), physical QoL (HR = 1.06, 95% CI:1.02-1.10), and social QoL (HR = 1.02, 95% CI: 1.00-1.03). When stratified by treatment, HSCT showed significant associations between OS and both global QoL (HR = 1.05, 95% CI:1.00-1.11) and physical QoL (HR = 1.03, 95% CI:1.00-1.06). For chemotherapy, significant associations were also observed between OS and global QoL (HR = 1.04, 95% CI:1.00-1.09), physical QoL (HR = 1.08, 95% CI:1.00-1.17), role QoL (HR = 1.02, 95% CI:1.00-1.04), and social QoL (HR = 1.02, 95% CI:1.00-1.04). No significant associations were observed regarding emotional QoL, which was only analyzed in HSCT. The factors influencing OS may vary depending on the treatment, emphasizing the importance of recognizing QoL from the pretreatment stage.

The relationship between frailty and depression in Chinese elderly prostate cancer patients following radical surgery: the mediating effect of sleep disturbances

OBJECTIVE

Depression is an important factor affecting long-term outcomes in prostate cancer patients. Frailty and sleep quality are associated with depressive symptoms, but the pathways through which frailty and sleep quality affect depression remain unclear. The aim of this study was to investigate the relationship between frailty and depression in older Chinese patients after radical prostate cancer surgery and to explore whether sleep disturbances mediate the effect of frailty on depression.

METHODS

A cross-sectional study was conducted with 277 elderly prostate cancer patients who underwent radical prostatectomy at a tertiary oncology center in Southern China (January 2022-March 2024). Inclusion criteria required ≥ 3 months postoperative recovery. Standardized instruments were administered: FRAIL Scale for frailty assessment, Pittsburgh Sleep Quality Index (PSQI) for sleep evaluation, and PHQ-9 for depression screening, supplemented by demographic questionnaires.

RESULTS

Clinically relevant depressive symptoms (PHQ-9 ≥ 5) were identified in 18.4% (n = 51). Depression scores showed positive correlations with frailty (r = 0.521, p < 0.01) and negative correlations with sleep quality (r = -0.521, p < 0.01). Mediation analysis revealed frailty directly predicted depression (β = 0.349, p < 0.001) and indirectly through sleep impairment (β = 0.119, p < 0.001), with the indirect pathway accounting for 25.43% of the total effect (95% CI:0.059-0.191).

CONCLUSION

Elderly prostate cancer survivors exhibit heightened post-prostatectomy depression risks. Frailty acts as a dual-pathway predictor-directly exacerbating depressive symptoms and indirectly via sleep deterioration. These findings advocate for multidimensional interventions targeting frailty management and sleep optimization to improve mental health outcomes in this vulnerable cohort.

Global research and emerging trends in depression in lung cancer: a bibliometric and visualized study from 2014 to 2024

Background

The impact of depression on the physical and psychological well-being of lung cancer patients has raised significant concerns. This study explored lung cancer-related depression research from a bibliometric perspective.

Methods

Articles and reviews on depression in lung cancer published from 2014 to 2024 in the Web of Science Core Collection were retrieved and identified. The information extracted included "Full Record and Cited References". Bibliometric analysis was conducted using CiteSpace and Excel to examine relevant publications in terms of country, institution, authorship, journal, citations, and keywords.

Results

A total of 761 publications on depression in lung cancer were identified for analysis, contributed by 4,667 authors from 305 institutions and 58 countries. The annual publication count has steadily increased, culminating in a peak in 2024. China (275 papers), Harvard University (58 publications), and Joseph A. Greer (25 publications) were the most productive and influential country, institution, and author, respectively. Jennifer S. Temel emerges as a highly influential author, securing the second position in terms of both publication count and citation impact. The journal with the highest number of publications is Supportive care in cancer, while the Journal of Clinical Oncology has garnered the most citations. Reference and keyword analysis indicated that the research hotspots mainly included 1) Epidemiology of lung cancer-related depression; 2) The deleterious impact of depression on lung cancer patients, particularly with regards to their quality of life; 3) Association between inflammation and depression in lung cancer; 4) Treatment.

Conclusions

Our study employed bibliometric analysis to identify prevalent focal areas and emerging trends in the field of research on lung cancer-related depression. Our study found that numerous unanswered questions persist, including the intricate relationship between lung cancer and depression, the profound impact of depression on lung cancer patients, and the interplay between inflammation and depression in this specific population. Furthermore, a current challenge in clinical practice involves the development of secure and more efficacious treatment strategies for individuals with lung cancer-related depression. These findings provide valuable guidance for scholars seeking to explore new avenues of investigation.

Quality of Life and Factors Associated with Quality of Life among Patients with Lung Cancer in Northeastern Thailand

BACKGROUND

Lung cancer is a leading cause of global morbidity and mortality, severely affecting patients' quality of life (QoL). Understanding the factors associated with QoL in these patients is crucial for improving treatment and care. This study aimed to assess QoL among lung cancer patients and identify the factors influencing it.

METHODS

This cross-sectional analytic study included 130 patients diagnosed with lung cancer at a tertiary facility in Northeastern Thailand. QoL was evaluated using the FACT-L interview, covering subscales such as physical, social/family, emotional, and functional well-being, as well as a lung cancer subscale, and the FACT-L Trial Outcome Index (TOI) and FACT-G. Descriptive statistics and multiple logistic regression were used for data analysis.

RESULTS

The majority of subjects had low overall QoL (52.31%; Mean ± SD: 45.24 ± 11.33), low FACT-L TOI (83.08%; 21.05 ± 9.21), and low FACT-G (57.69%; 35.72 ± 8.70). Subscale analysis revealed low levels of physical well-being (85.38%; 6.56 ± 3.54), emotional well-being (85.38%; 6.15 ± 3.67), and functional well-being (96.15%; 4.97 ± 3.82). However, about half of the subjects reported moderate social/family well-being (50.77%; 18.04 ± 4.17) and lung cancer subscale scores (56.15%; 9.51 ± 4.31). Multivariate analysis identified factors significantly associated with higher QoL, including age (AOR = 1.05, 95% CI: 1.01-1.10), absence of comorbidities (AOR = 3.95, 95% CI: 1.60-9.74), and absence of lymph node invasion (AOR = 4.42, 95% CI: 1.26-15.56). Conversely, sleep problems (AOR = 0.26, 95% CI: 0.08-0.81), local metastasis (AOR = 0.25, 95% CI: 0.09-0.72), and undergoing radiotherapy (AOR = 0.25, 95% CI: 0.07-0.98) were associated with lower QoL.

CONCLUSIONS

These findings suggest that lung cancer patients with sleep problems, local metastasis, or undergoing radiotherapy should receive intensive palliative care to improve their QoL during the end of life stage.

Therapy-Related Symptoms and Sense of Coherence: The Mediating Role of Social Support and Hope in Lung Cancer Patients Undergoing Chemotherapy

Aim

To investigate the current status of the sense of coherence in lung cancer patients undergoing chemotherapy and explore the mediating role of social support and hope in the relationship between therapy-related symptoms and sense of coherence.

Methods

We conducted a cross-sectional study to investigate lung cancer chemotherapy patients aged 18 years or older who completed at least two cycles of chemotherapy. Patients were recruited from the First Affiliated Hospital of Guangzhou Medical University's chemotherapy day ward from May to December 2023. Patients were required to complete a questionnaire that included the Sense of Coherence Scale, the Perceived Social Support Scale, the Herth Hope Index, and the Therapy-related Symptoms Checklist. The structural equation model was used to test the mediating role of social support and hope between therapy-related symptoms and the sense of coherence.

Results

A total of 241 patients were included. The scores of the sense of coherence, hope level, therapy-related symptoms, and social support were 68.79 ± 11.24, 38.94 ± 4.25, 11.53 ± 8.15, and 69.49 ± 8.15, respectively. Sense of coherence, social support, hope, and therapy-related symptoms were significantly related (P<0.01). Therapy-related symptoms had a direct negative influence on the sense of coherence [B=-0.144, 95% CI (-0.209, -0.070)]. Meanwhile, therapy-related symptoms influenced the sense of coherence via three pathways: independent mediation of social support [B=-0.021, 95% CI (-0.065, -0.002)], independent mediation of hope [B=-0.022, 95% CI (-0.057, -0.000)], and chain mediation of social support and hope [B=-0.012, 95% CI (-0.035, -0.002)].

Conclusion

Lung cancer patients undergoing chemotherapy experience a medium sense of coherence. This study's findings indicate that the relationship between therapy-related symptoms and sense of coherence is affected by the independent mediating effect of social support and hope and the chain mediating effect of social support and hope. Therefore, reducing the burden of their therapy-related symptoms, providing them with social support, and fostering their hope can enhance patients' sense of coherence and improve their quality of life.

Heterogeneity of pain-fatigue-sleep disturbance symptom clusters in lung cancer patients after chemotherapy: a latent profile analysis

PURPOSE

Pain-fatigue-sleep disturbance symptom cluster (PFS) was common in patients with lung cancer and seriously affected the life quality of patients. However, the heterogeneity and subgroups of PFS were unclear in lung cancer patients after chemotherapy. This study was conducted to identify distinct subgroups of PFS in patients with lung cancer after chemotherapy, and explore the differences and risk factors of PFS subgroups.

METHODS

Lung cancer patients after chemotherapy were recruited. Data were collected using the Chinese version of the Brief Pain Inventory, the Cancer Fatigue Scale, and the Pittsburgh Sleep Quality Index. The latent profile analysis (LPA) was used to identify the subgroups of PFS. Univariate analysis was used to identify the differences among all subgroups. Logistic regression and restricted cubic splines were used to investigate predictors of the PFS subgroups.

RESULTS

Based on LPA, 512 participants were divided into four subgroups (Class 1: low pain-fatigue-sleep disturbance; Class 2: moderate pain-moderate fatigue-low sleep disturbance, Class 3: low pain-high fatigue-high sleep disturbance, and Class 4: high pain-fatigue-sleep disturbance). The univariate analysis showed that gender, body mass index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status, leukocyte, neutrophils, platelet, C-reactive protein, stress, anxiety, depression, and social support were associated with PFS. The logistic regression analysis revealed that patients in Class 2 and Class 3 were more likely to experience great stress than those in Class 1. Additionally, compared to Class 1, females, lower BMI, stress, anxiety, and depression were independent predictors of Class 4.

CONCLUSION

This study successfully identified subgroups of PFS in patients with lung cancer after chemotherapy. Based on the results of this study, medical workers can identify patients with high risks for PFS and conduct more targeted interventions to improve symptom management.

Systematic review of associations between anxiety, depression, and functional/biological aging among cancer survivors

BACKGROUND

Evidence suggests a mind-body component to aging through which psychological distress from anxiety and depression drives molecular changes that promote early decline (ie, accelerated aging). Cancer survivors experience particularly high rates of anxiety and depression. Some survivors also have accelerated aging, though the relationships between anxiety and depression and aging are not clear. A synthesis of evidence is needed to understand the state of the science and impending priorities.

METHODS

PubMed, Embase, CINAHL, Web of Science, and PsycNet databases were searched for studies that measured associations between depression, anxiety, and nonchronological aging in cancer survivors (2012-2022). Data were methodologically evaluated.

RESULTS

Survivorship studies were included if they were peer reviewed, published in English from 2012 to 2022, and measured associations between anxiety and depression and aging. In total, 51 studies were included. Just over half were cross-sectional (53%). Foci included functional (n = 35 [69%]) and biological (n = 16 [31%]). Functional aging measures included frailty, sarcopenia, geriatric assessment, and cognition. Biological aging measures included telomere length, telomerase, age-related inflammatory blood-based biomarkers, renal insufficiency, anemia, and DNA methylation. We tested 223 associations. Associations between anxiety, depression, and aging were generally positive, though with varying strengths. Most compelling were associations between functional aging and depression. There were concerns for selection and measurement biases.

CONCLUSIONS

Findings suggest positive associations between anxiety, depression, and aging among cancer survivors. Future work is needed to clarify temporality, develop a consensus on the measurement of aging, and diversify cohorts.

Anxiety and Depression in Advanced and Metastatic Lung Cancer Patients-Correlations with Performance Status and Type of Treatment

Background and Objectives: The treatment of advanced and metastatic lung cancer is multimodal, and it is coordinated by a multidisciplinary team. Anxiety and depression occur frequently in patients with lung cancer, creating considerable discomfort in therapeutic management. At the same time, these psychoemotional symptoms affect the patients' quality of life. Objective: This research seeks to identify correlations both between anxiety and depression and the patients' performance statuses, as well as between anxiety and depression and the type of treatment: radiotherapy, chemotherapy, tyrosine kinase inhibitors (TKI), immunotherapy and palliative care. Materials and Methods: The study evaluated 105 patients with lung cancer from two oncologic centers. Patients were assessed for anxiety and depression using the questionnaire Hospital Anxiety and Depression Scale (HADS). The HADS is a self-report rating scale of 14 items. It measures anxiety and depression, and has two subscales. There are seven items for each subscale. There are 4-point Likert scale ranging from 0 to 3. For each subscale, the score is the sum of the seven items, ranging from 0 to 21. Results: The most powerful correlation with statistical significance was observed between the IT type of treatment (immunotherapy) and the normal level of anxiety, PC = 0.82 (p < 0.001) as well as the normal level of depression. Palliative treatment was correlated with anxiety and depression, both borderline and abnormal. For ECOG 3-4 performance status and abnormal anxiety, respectively, abnormal depression was significantly associated. Also, continuous hospitalization was associated with abnormal anxiety and depression. Conclusions: Early assessments of anxiety and depression are necessary in patients with advanced and metastatic lung cancer, with unfavorable performance status, who have been admitted to continuous hospitalization, and who require palliative care.

How social support influences learned helplessness in lung cancer patients: the chain mediation role of individual resilience and self-efficacy

Background

Social support, which is a crucial external resource for cancer patients, was demonstrated to be a positive predictor of learned helplessness (LH). But it is far from clear whether and how social support decreases the LH in cancer patients. The purpose of present study is to detect the association between social support and LH and the role of individual resilience and self-efficacy in mediating this relationship.

Methods

The convenience sampling method was utilized. From August 2022 to February 2024, a total of 537 lung cancer patients (M age = 60.25 years, SDage = 9.85 years) from five tertiary hospitals in one municipalities (Chongqing), and two provinces (Sichuan and Yunnan) were recruited, among which 389 were males and 148 were females. LH, social support, individual resilience, and self-efficacy were assessed by using standard scales. A structural equation model was constructed employing AMOS 23.0 to examine the interrelationships among social support, individual resilience, self-efficacy, and LH of lung cancer patients.

Results

A total of 537 lung cancer patients were finally included. Social support, individual resilience, and self-efficacy were positively related to LH (r = -0.299 to -0.451, p < 0.01). The mediation model revealed that the direct effect of social support on LH was significant (β = -0.407, p < 0.001). Besides, social support could also affect LH through three pathways: (1) the mediating effect of individual resilience (β = -0.075, p < 0.001); (2) the mediating effect of self-efficacy (β = -0.060, p < 0.05); (3) the chain mediating effect of individual resilience and self-efficacy (β = -0.011, p < 0.05).

Conclusion

The results indicate that social support alleviates lung cancer patients' LH, and that individual resilience and self-efficacy mediate the correlation between social support and LH. Besides providing adequate social support, intervention strategies built on individual resilience and self-efficacy should be applied to reduce LH in lung cancer patients.

Associations of frailty with symptoms, and HRQOL in older cancer survivors after cancer treatments: a systematic review and meta-analyses

PURPOSE

Frailty in older adult cancer survivors after cancer treatments is associated with various health outcomes. However, there is less agreement on how frailty affects symptoms and health-related quality of life (HRQOL). This systematic review and meta-analysis aimed to evaluate the current literature on frailty, symptoms, and HRQOL, as well as the associations of frailty with these factors in older adult cancer survivors with chemotherapy.

METHODS

A review was conducted on peer-reviewed publications from 2008 to 2023, using seven electronic databases. Meta-analyses were performed using random effects models to determine pooled effect estimates for frailty prevalence, symptom severity, and HRQOL scores.

RESULTS

A total of 26 studies involving older cancer survivors were included in the analysis. Most of these studies were conducted in Western countries and focused on White survivors, particularly those with breast cancer. The mean pooled prevalence of frailty was 43.5%. Among frail survivors, the most common symptoms reported after cancer treatments were pain (36.4%), neuropathy (34.1%), and fatigue (21.3%). Frailty was associated with higher pooled mean symptom severity (B = 1.23, p = 0.046) and lower functional HRQOL (B = - 0.31, p = 0.051, with marginal significance) after cancer treatments.

CONCLUSION

Frail older cancer survivors are at high risk of adverse symptoms and poor HRQOL after cancer treatment. Further research on screening for frailty is needed to prevent older adults from developing worse symptoms burden and maintain HRQOL. It is also essential to understand the mechanisms of the associations between frailty, symptoms and HRQOL in this population.

Making meaning of everyday life in the context of lung cancer treatment-a qualitative study of outpatients' perspectives

BACKGROUND

The increasing survival after a lung cancer diagnosis implies that patients live longer with the disease, which means that symptoms and side effects of the treatment become part of everyday life.

AIM

The study explored how older adults make meaning of everyday life when undergoing treatment for their lung cancer.

MATERIAL AND METHODS

A qualitative study using semi-structured interviews was conducted with 12 older adults with lung cancer undergoing various treatments. The analysis followed Giorgi's phenomenologic five-step method.

RESULTS

The analysis revealed three partly overlapping themes: meeting the health care system, losing identity, and struggling for meaning in everyday life. The patients appreciate clear and coherent communication at the oncology clinic. They had different needs for support from organised support groups, friends, communities, or relatives to make meaning of everyday life.

CONCLUSION

Creating meaning in everyday life is essential despite the disease and the treatments' side effects. Interpersonal relationships create meaningfulness in everyday life through a salutogenic perspective that makes everyday life comprehensible and manageable.

SIGNIFICANCE

The patients need an everyday life perspective on the disease and the side effects, which a salutogenic approach in the encounter with the health care system could support.

Diet Is Associated with Frailty in Lung Cancer: A Possible Role of Gut Microbiota

This study investigated the associations between diet and frailty in lung cancer patients and the potential role of the gut microbiota involved. We assessed dietary intake and frailty status in 231 lung cancer patients by 3-day, 24-h dietary recalls and Fried frailty criteria, respectively, and collected 50 fecal samples for next-generation sequencing. A total of 75 (32.5%) patients were frail, which might be related to significantly lower intake of energy, protein, carbohydrate, dietary fiber, niacin, leucine, some minerals, and a poorer dietary quality as indicated by the Chinese Healthy Eating Index (p < 0.05). Among these, carbohydrate (OR = 0.98; 95% CI 0.96-0.99; p = 0.010), calcium (OR = 0.99; 95% CI 0.99-1.00; p = 0.025), and selenium (OR = 1.03; 95% CI 1.00-1.06; p = 0.022) were all significantly associated with frailty. A multivariate logistic regression analysis showed that the mean risk of frailty was 0.94 times lower (95% CI 0.90-0.99; p = 0.009) among participants with higher CHEI scores. Additionally, the frail patients demonstrated significantly lower gut microbiota β diversity (p = 0.001) and higher relative abundance of Actinobacteriota (p = 0.033). Frailty in lung cancer patients might be associated with insufficient nutrients intake and a poor dietary quality through gut microbiota regulation.

Heterogeneity of vulnerability and taste changes in older cancer patients undergoing chemotherapy: a latent class analysis

PURPOSE

Taste changes and vulnerability are commonly co-occurring in oncology patients undergoing chemotherapy. However, few studies explored the association and the inter-individual variability of these two conditions. This study aimed to identify heterogeneous subtypes of vulnerability and taste changes in older cancer patients undergoing chemotherapy, and explore individuals' characteristics and risk factors.

METHODS

In this cross-sectional study, the latent class analysis (LCA) was conducted to identify the heterogeneous subgroups of patients with distinct vulnerability and taste change profiles. Differences in sociodemographic and clinical characteristics among the subpopulation were evaluated using parametric and nonparametric tests. Multinomial logistic regression was performed to investigate predictors of taste change-vulnerability subgroup classification.

RESULTS

Three subgroups of those older cancer survivors were identified from the LCA: Class 1 (27.5%)-"Moderate taste change and low vulnerability", Class 2 (29.0%)-"Low taste change and moderate vulnerability", Class 3 (43.5%)-"High taste change and high vulnerability". 98.9% of Class 3 reported taste changes and 54.0% reported vulnerability. Results from multinomial logistic regression indicated that patients in Class 3 were more likely to report experiencing mouth dryness and high blood pressure, and have received more than 3 cycles of chemotherapy.

CONCLUSION

The findings could provide new insights into the association between taste changes and vulnerability in older cancer adults receiving chemotherapy. Identifying different latent classes of taste changes and vulnerability would be helpful for developing interventions tailored to the heterogeneous survivors.