Enhanced supportive care for advanced cancer patients: study protocol for a randomized controlled trial.

BACKGROUND: Early palliative care along with standard cancer treatments is recommended in current clinical guidelines to improve the quality of life and survival of cancer patients. This study protocol aims to evaluate the effect of "Enhanced Supportive Care", an early primary palliative care provided by nurses. METHODS: A randomized controlled trial (RCT) will be conducted including advanced cancer patients scheduled for first-line palliative chemotherapy (N=360) and their caregivers in South Korea. Participants will be randomly assigned to the intervention or control group in a 1:1 ratio. Participants in the intervention group will receive the "Enhanced Supportive Care", which provides five sessions of symptom management and coping enhancement counseling by nurses. The control group will receive symptom monitoring five times. The primary endpoints are symptoms, coping, and quality of life (QoL) at 3 months. Secondary endpoints are symptoms, coping, and QoL at 6 months, depression and self-efficacy for coping with cancer at 3 and 6 months, symptom and depression change from baseline to 3 months, survival at 6 and 12 months among patients, and depression among caregivers at 3 and 6 months. DISCUSSION: This RCT will evaluate the effects of "Enhanced Supportive Care" on symptoms, depression, coping, self-efficacy for coping with cancer, QoL and survival of patients, as well as depression of caregivers. It will provide evidence of a strategy to implement early primary palliative care provided by nurses, which may consequently improve cancer care for newly diagnosed patients with advanced stage cancer. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04407013. Registered on May 29, 2020, https://www. CLINICALTRIALS: gov/ct2/show/study/NCT04407013 . The protocol version is ESC 1.0.

Combined Skin Moisturization of Liposomal Serine Incorporated in Hydrogels Prepared with Carbopol ETD 2020, Rhesperse RM 100 and Hyaluronic Acid.

We investigated the combined moisturizing effect of liposomal serine and a cosmeceutical base selected in this study. Serine is a major amino acid consisting of natural moisturizing factors and keratin, and the hydroxyl group of serine can actively interact with water molecules. Therefore, we hypothesized that serine efficiently delivered to the stratum corneum (SC) of the skin would enhance the moisturizing capability of the skin. We prepared four different cosmeceutical bases (hydrogel, oil-in-water (O/W) essence, O/W cream, and water-in-oil (W/O) cream); their moisturizing abilities were then assessed using a Corneometer®. The hydrogel was selected as the optimum base for skin moisturization based on the area under the moisture content change-time curves (AUMCC) values used as a parameter for the water hold capacity of the skin. Liposomal serine prepared by a reverse-phase evaporation method was then incorporated in the hydrogel. The liposomal serine-incorporated hydrogel (serine level=1%) showed an approximately 1.62~1.77 times greater moisturizing effect on the skin than those of hydrogel, hydrogel with serine (1%), and hydrogel with blank liposome. However, the AUMCC values were not dependent on the level of serine in liposomal serine-loaded hydrogels. Together, the delivery of serine to the SC of the skin is a promising strategy for moisturizing the skin. This study is expected to be an important step in developing highly effective moisturizing cosmeceutical products.

Chemotherapy-related cardiotoxicity and its symptoms in patients with breast cancer: a scoping review.

BACKGROUND: Chemotherapy-related cardiotoxicity is a significant concern because it is a major cause of morbidity. This study aimed to provide in-depth information on the symptoms of chemotherapy-related cardiotoxicity (CRCT) by exploring literature that concurrently reports the types and symptoms of CRCT in patients with breast cancer. METHODS: A scoping review was performed according to an a priori protocol using the Joanna Briggs Institute's guidelines. The participants were patients with breast cancer. The concept was the literature of specifically reported symptoms directly matched with CRCT and the literature, in English, from 2010, and the context was open. The search strategy included four keywords: "breast cancer," "chemotherapy," "cardiotoxicity," and "symptoms." All types of research designs were included; however, studies involving patients with other cancer types, animal subjects, and symptoms not directly related to CRCT were excluded. Data were extracted and presented including tables and figures. RESULTS: A total of 29 articles were included in the study, consisting of 23 case reports, 4 retrospective studies, and 2 prospective studies. There were no restrictions on the participants' sex; however, all of them were women, except for one case report. The most used chemotherapy regimens were trastuzumab, capecitabine, and doxorubicin or epirubicin. The primary CRCT identified were myocardial dysfunction and heart failure, followed by coronary artery disease, pulmonary hypertension, and other conditions. Major tests used to diagnose CRCT include echocardiography, electrocardiography, serum cardiac enzymes, coronary angiography, computed tomography, and magnetic resonance imaging. In all case reports, CRCT was diagnosed through an incidental checkup according to the patient's symptom presentation; however, only 10 of these studies showed a baseline checkup before chemotherapy. The five most common CRCT symptoms were dyspnea, chest pain, peripheral edema, fatigue, and palpitations, which were assessed by patient-reported symptom presentation rather than using a symptom assessment tool. Dyspnea with trastuzumab treatment and chest pain with capecitabine treatment were particularly characteristic. The time for first symptom onset after chemotherapy ranged from 1 hour to 300 days, with anthracycline-based regimens requiring 3-55 days, trastuzumab requiring 60-300 days, and capecitabine requiring 1-7 days. CONCLUSIONS: This scoping review allowed data mapping according to the study design and chemotherapy regimens. Cardiac assessments for CRCT diagnosis were performed according to the patient's symptoms. There were approximately five types of typical CRCT symptoms, and the timing of symptom occurrence varied. Therefore, developing and applying a CRCT-specific and user-friendly symptom assessment tool are expected to help healthcare providers and patients manage CRCT symptoms effectively.

Symptom network and quality of life of breast cancer patients receiving multimodal cancer treatment: Cross-sectional study.

PURPOSE: Breast cancer patients experience symptoms and side effects from multimodal treatments, which often include menopausal symptoms resulting from cytotoxic chemotherapy or estrogen suppression therapy. This study aimed to explore the symptom network and clusters and its relationship to quality of life (QoL) in breast cancer patients who receive multimodal cancer treatment and experience treatment-related menopausal symptoms. METHODS: A correlational study was conducted. Breast cancer patients receiving multimodal cancer treatment and experiencing treatment-related menopausal symptoms were included while they were receiving radiation therapy (N = 250). Symptoms, functions and QoL were assessed using the EORTC QLQ-C30 and BR45. Network analysis, principal component analysis, exploratory factor analysis, and multiple linear regression analysis were conducted. RESULTS: Fatigue was the most central symptom in the symptom-only network as well as in the network consisting of symptoms and QoL. Fatigue, systemic therapy side effects, appetite loss, and cognitive symptoms demonstrated significant associations with QoL. The cancer and treatment related symptom cluster consisted of fatigue, cognitive symptoms, emotional symptoms and systemic therapy side effects. Breast cancer therapy-specific symptoms, such as arm symptoms, skin mucosis symptoms, and breast symptoms, formed a cluster with pain. CONCLUSION: Fatigue was the most central symptom in breast cancer patients receiving multimodal cancer treatment and experiencing menopausal symptoms. Evaluation of fatigue and providing interventions to manage fatigue would contribute to improvement of QoL of breast cancer patients receiving multimodal cancer treatments. Future network analysis and symptom cluster studies should specify the population of interest and the treatment phase using comprehensive symptom evaluation tools.

The needs for digital health and eHeath literacy of cancer patients, caregivers, and healthcare providers: A multicenter, descriptive correlational study.

PURPOSE: Digital health is an indispensable tool, but its use depends on the eHealth literacy (eHL) of end-users. This study aimed to understand the need for digital health and eHL among cancer patients, caregivers, and healthcare providers and to identify differences in digital health needs related to the eHL of cancer patients. METHODS: A multicenter, descriptive correlational study was conducted and included a total of 209 patients, 150 caregivers and 150 healthcare providers. Digital health needs were identified, and eHL was measured using the Korean version of the eHealth Literacy Scale. Differences in digital health needs in relation to the eHL of patients were analyzed. RESULTS: The most necessary digital health functions among cancer patients and caregivers were 'information and education on symptom management after cancer treatment' and 'education on coping methods for each type of cancer' (87.1-94.0%). Healthcare providers reported the need for a digital health function for 'medication information' and assisting in 'medical appointments' (96.7-98.0%). The preferred types of digital health were telemonitoring, mobile services, and telemedicine by telephone (81.3-90.5%). The mean eHL score of the cancer patients was 28.84 ± 6.75. Differences existed in the need for digital health functions and preferences for digital health types between cancer patients with high and low eHL. CONCLUSIONS: Cancer patients and caregivers expressed strong needs for digital health that provide information and education about symptom management and coping with cancer. Digital health interventions for cancer care need to be developed to reflect the identified needs and preferences and eHL of end-users.

Third-wave cognitive behavioral therapies for caregivers of cancer patients: a scoping review.

BACKGROUND: Cancer caregivers extend comprehensive support covering all aspects of patients' daily lives. It has been reported that a significant proportion of cancer caregivers experience emotional distress. As one way to solve this problem, third-wave cognitive behavioral therapies (CBT), which involves integrating acceptance and mindfulness into cognitive‒behavioral therapy, has been applied to improve caregiver outcomes. METHODS: A scoping review was conducted based on the scoping review guidelines proposed by the Jonna Briggs Institute (JBI). The population was caregivers of cancer patients, the concept was third-wave CBT, and the context remained open. English and Korean publications published from 2001 to June 2022 were identified from PubMed, Embase, CINAHL, PsycINFO, Cochrane, Korea Med, and RISS. RESULTS: A total of 12 studies were included in this scoping review. Mindfulness-Based Stress Reduction (MBSR) and Acceptance and Commitment Therapy (ACT) was the most frequently applied intervention (n = 3, each). Among the components of third-wave CBT, 'mindfulness' was identified in all the studies reviewed (n = 12). Dyadic interventions comprised the majority (n = 9). Interventions using digital technologies such as mobile application/web page (n = 3), telephone (n = 3), and FaceTime (n = 2) have increased since 2017. Depression was the most frequently evaluated outcome (n = 8), followed by anxiety and mindfulness (n = 6, each). CONCLUSIONS: The current review explored available third-wave CBT intervention studies for cancer caregivers and targeted outcomes. Most of the interventions were dyadic interventions and utilized mindfulness. Delivery methods were continuously updated with digital technologies. Further RCTs with robust research designs and a synthesis of the results of the trials would provide evidence about how to effectively apply third-wave CBTs for cancer caregivers.

Fear of cancer recurrence and its predictors and outcomes among cancer survivors: A descriptive correlational study.

PURPOSE: Fear of cancer recurrence (FCR) is a major issue in the context of survivorship. The identification of predictors and outcomes of FCR is a top research priority. The purpose of this study was to understand FCR as a process and to identify predictors and outcomes of FCR among Korean cancer survivors. METHODS: A descriptive correlational study was conducted on 240 cancer survivors who had completed cancer treatment and were then receiving regular follow-up care. The FCR, health behaviors, and quality of life (QoL) of participants were measured. The process of FCR was evaluated using mediation analysis, moderation analysis and path analysis. Predictors and outcomes of FCR were identified using t tests, chi-square tests, Spearman correlation analysis and multiple regression analysis. RESULTS: The clinical level of FCR (≥13) was experienced by 66.2% of cancer survivors. Female and breast cancer patients demonstrated higher FCR severity. FCR severity functioned as a mediator between triggers and both psychological distress and functioning impairments. FCR severity was not related to health behaviors. Significant but small variance in QoL was explained by FCR severity and functional status (p < .001). CONCLUSIONS: The process of FCR was explained in terms of FCR severity functioning as a mediator between triggers and both psychological distress and functioning impairments. The small but significant contribution of FCR severity to QoL indicated the significance of addressing FCR in survivorship care by screening and providing interventions for at-risk survivors.

Uso tópico de clareadores associados a hidratantes nos cuidados imediatos após peelings para tratamento de melasma: um estudo-piloto / Topical use of a blend of bleaches associated with moisturizers in immediate post-peeling care for melasma treatment

Introdução: melasma é uma dermatose de difícil controle e de características recidivantes, com diversas abordagens terapêuticas clínicas e intervencionistas. Objetivo: avaliar a segurança e a eficácia de um creme clareador no período imediatamente após peelings superficiais seriados. Métodos: cinco mulheres portadoras de melasma utilizaram creme contendo clareadores, hidratantes e calmantes durante o período de tratamento com peelings superficiais seriados. Foram avaliadas em D0, D7, D30, D37, D60, D67 e D90 por meio de: fotografias, registro da opinião do médico e paciente, descrição de eventos adversos, necessidade de interrupção do uso do produto assim como preenchimento do MELASQol. Resultados: houve melhora na hidratação, qualidade da pele e no clareamento, com pouco desconforto e redução significativa dos escores do MELASQol, com comprovação estatística. Conclusões: a utilização de tópico com propriedades clareadoras e calmantes é uma alternativa efetiva e segura para evitar a interrupção do tratamento de melasma durante o período da realização de peelings superficiais seriados

Introduction: Melasma is a recurrent and challenging dermatosis despite several clinical and interventional therapeutic approaches. Objective: This study aims to assess the safety and efficacy of using a bleaching cream in the period immediately after serial surface peels. Methods: Five women with melasma used a cream containing bleaches, moisturizers, and tranquilizers during the treatment period with serial surface peels. We assessed them in D0, D7, D30, D37, D60, D67, and D90 through photographs, record of the physician's and patient's opinion, description of adverse events, need to interrupt using the product, and the MELASQol questionnaire. Results: We observed improved hydration, skin quality, and bleaching, with little discomfort and a significant reduction in MELASQol scores, with statistical evidence. Conclusions: The use of a topic cream with bleaching and tranquilizing properties is an effective and safe alternative to avoid interruption of melasma treatment during the period of serial surface peels

Tratamento da poroqueratose actínica superficial disseminada com laser 1340-nm Nd: YAP / Treatment of disseminated superficial actinic porokeratosis with 1,340nm Nd:YAP laser

Este estudo demonstrou o resultado clínico e histológico do tratamento com laser fracionado não ablativo de paciente com poroqueratose actínica superficial disseminada. A paciente recebeu sete sessões de laser 1340-nm Nd:YAP, com intervalos de quatro a cinco semanas. Biópsias e fotos foram realizadas antes e após o tratamento, o qual foi bem tolerado e trouxe melhora do eritema e da textura das lesões. O seguimento foi de um ano. O exame anatomopatológico após o tratamento revelou pouca modificação da lamela cornoide.

This study demonstrated the clinical and histologic result of the treatment of one disseminated superficial actinic porokeratosis patient with non-ablative fractional laser. The patient was treated with seven sessions of 1340-nm Nd:YAP laser, with 4 or 5 week-intervals. Biopsies and photographs were performed before and after treatment, which was well tolerated and lead to improvement in the erythema and texture of the lesions. There was a 1-year follow-up. Histopathologic examination after treatment revealed little changes in the cornoid lamella.

One-pot reductive mono-N-alkylation of aniline and nitroarene derivatives using aldehydes.

One-pot reductive mono-N-alkylation of aniline and nitroarene derivatives using various aldehydes by Pd/C catalyst in aqueous 2-propanol solvent with ammonium formate as in situ hydrogen donor is illustrated. The reaction proceeded smoothly and selectively with excellent yield at room temperature. Our protocol presents a facile, economical, and environmentally benign alternative for reductive amination.