Navigating emotional challenges: A journey with patients undergoing chemotherapy.

A recent article reported that cancer patients with subthreshold depression are more likely to develop major depression within a year. Multivariate regression analysis revealed that regular exercise was a protective factor against cancer-related fatigue, whereas advanced age, radiotherapy, pain, and low hemoglobin were risk factors for cancer-related fatigue. A limitation of this study was the lack of methodological details about leukemia patients receiving depressive treatment at a specific hospital. Professional assessment, behavioral modification plans, communication, destressing techniques, and educational plans may help chemotherapy patients manage emotional issues and reduce anxiety. Furthermore, these strategies can inspire patients to create, facilitate their treatment, and help them to remain healthy.

Effects of a reminiscence therapy-involved program on anxiety, depression, and the quality of life in cancer patients: a meta-analysis of randomized controlled trials.

Objective: Reminiscence therapy is increasingly being utilized for cancer patients to address psychological pressure and enhance their quality of life. This meta-analysis aimed to comprehensively evaluate the effect of a reminiscence therapy-involved program (RTIP) on anxiety, depression, and quality of life in cancer patients. Methods: A systematic literature search was conducted in the Web of Science, PubMed, Embase, and Cochrane Library databases until December 2023 to screen randomized control trials (RCTs) comparing the effect of RTIP and control care. Results: A total of 16 RCTs published from 2013 to 2023 were included, with 1,963 cancer patients undergoing RTIP with or without control care (RTIP group, N = 984) or control care (control group, N = 979). The results showed the the anxiety score [standardized mean differences (SMD) = -0.539; 95% confidence interval (CI) = -0.700, -0.378; P < 0.001], anxiety rate [relative risk (RR) = 0.736; 95% CI: 0.627, 0.865; P < 0.001], depression score (SMD = -0.664; 95% CI: -0.967, -0.361; P < 0.001), and depression rate (RR = 0.632; 95% CI = 0.532, 0.750; P < 0.001) were significantly reduced in the RTIP group compared to the control group. Furthermore, overall quality of life was increased in the RTIP group than in the control group (SMD = 0.501; 95% CI: 0.314, 0.689; P < 0.001). In digestive system cancer patients, anxiety/depression scores and rates were reduced, and the overall quality of life was elevated in the RTIP group in comparison with the control group (all P < 0.050). The quality of evidence was generally high, with a low risk of bias in most studies and no publication bias in any outcomes (all P > 0.050). Conclusion: RTIP attenuates anxiety and depression and improves the quality of life in cancer patients, benefitting their overall health condition. Systematic Review Registration: This meta-analysis was registered at PROSPERO with registration number CRD42024563266.

Cost-effectiveness of expanding national health insurance coverage for composite resin restorations in cancer patients in South Korea.

OBJECTIVES: Cancer patients often have compromised oral health, making them vulnerable to severe dental caries and restoration failures. Due to the nature of cervical or anterior caries in cancer patients, the use of adequate restorative materials is important. However, public dental insurance coverage for composite treatments varies among countries and only glass ionomer cements (GICs) are covered in all age groups in South Korea. This study examined the cost-effectiveness of expanding national health insurance coverage to include resin composite (RC) restorations as compared with GIC in cancer patients. METHODS: Data from cancer patients who received direct restoration using GIC were identified from the National Health Screening Cohort. The relative effect of RC compared to GIC was determined through a meta-analysis, which was then utilized in calculating corresponding transition probabilities within a multi-state model. A Markov-chain Monte Carlo microsimulation was performed to estimate useful life-years and total treatment costs at the tooth level. The incremental cost-effectiveness ratio (ICER) of RC versus GIC was calculated, considering scenarios with and without expanded national health insurance coverage. The robustness of the results was confirmed through various sensitivity analyses. RESULTS: Between the two materials, RC resulted in a 0.4-year longer useful life. From a limited societal perspective, it cost $9.6 less with expanded coverage but $24.3 more without expansion, resulting in an ICER of -$25.2 and $63.9 per tooth-year, respectively. From a patient's perspective, the ICER values were -$72.7 versus $138.8 per tooth-year, respectively, translating into $200 more in savings with the expansion. Various sensitivity analyses consistently demonstrated a smaller ICER when insurance coverage was expanded. CONCLUSIONS: The expansion of national health insurance coverage to include RC restorations for cancer patients appears to be clearly cost-effective. This emphasizes the need for further policy considerations to ensure access to dental care for cancer patients. CLINICAL SIGNIFICANCE: Timely management of dental caries is crucial for cancer patients, as untreated caries can escalate into severe oral conditions, negatively impacting treatment outcomes and increasing care costs. Expanding a national health insurance coverage for cancer patients in the treatment of early dental lesions is necessary to prevent advanced dental diseases.

A higher dietary alpha-linolenic acid intake is associated with lower colorectal cancer risk based on MUC4 rs2246901 variant among Korean adults.

Alpha-linolenic acid (C18:3n-3 [ALA]) intake may have a beneficial effect in reducing cancer risk; however, its association with colorectal cancer (CRC) risk remains conflicted. Additionally, ALA was emphasized as being associated with mucins, an important glycoproteins family within the intestine. Thus, we hypothesized that a higher dietary ALA intake may reduce the risk of CRC and this preventive effect has an interaction with mucin 4 (MUC4) rs2246901. We conducted a case-control study at the National Cancer Center in Korea, involving 1039 cases and 1982 controls, aiming to determine the interaction of the MUC4 rs2246901 polymorphism and ALA intake in CRC risk. Dietary ALA intake was collected via semiquantitative food frequency questionnaire (SQFFQ), categorizing by 4 quartiles. We evaluated the odds ratios (ORs) and 95% confidence intervals (CIs) through unconditional logistic regression models. Higher dietary ALA intake was found to be inversely associated with CRC risk (adjusted OR = 0.58; 95% CI, 0.45-0.75, P for trend < .001). No significant association between MUC4 rs2246901 polymorphism and CRC risk was found. In a recessive model, MUC4 rs2246901 seemed to modify this association; participants with at least 1 major allele and higher ALA intake had a significantly lower CRC risk than those who had a lower intake (adjusted OR = 0.56; 95% CI, 0.43-0.72; P interaction = .047). A higher dietary ALA was proposed as a potential protective nutrient against CRC. Moreover, this association might be influenced by presence of the MUC4 rs2246901 polymorphism.

miR-17-5p/STAT3/H19: A novel regulatory axis tuning ULBP2 expression in young breast cancer patients.

BACKGROUND AND AIM: UL-16 binding protein 2 (ULBP2) is a highly altered ligand for the activating receptor, NKG2D in breast cancer (BC). However, the mechanism behind its de-regulation in BC patients remains to be explored. The sophisticated crosstalk between miR-17-5p, the lncRNA H19, and STAT3 as a possible upstream regulatory loop for ULBP2 in young BC patients and cell lines remains as an unexplored area. Therefore, this study aimed at unravelling the ncRNA circuit regulating ULBP2 in young BC patients and cell lines. PATIENTS AND METHODS: A total of 30 BC patients were recruited for this study. The expression levels of miR-17-5p, lncRNA H19, and STAT3 were examined in 30 BC tissues compared to their normal counterparts. In addition, the expression signatures of those transcripts were compared in young (<40 years) and old BC (≥40 years) patients. miR-17-5p oligonucleotides, STAT3 and H19 siRNAs were transfected in MDA-MB-231 cells using HiPerfect® Transfection Reagent. miR-17-5p and the transcripts of the target genes quantified using RT-qPCR. Their relative expression was calculated using the 2-ΔΔCT method. RESULTS: Through acting as a ceRNA circuit that antagonizes the function of miR-17-5p, H19 prevented the miR-17-5p-induced downregulation of STAT3; this mechanism further contributes to the pathogenesis of BC. Ectopic expression of miR-17-5p in MDA-MB-231 cells displayed its prominent role as an indirect potential activator of NK cells by significantly repressing the expression levels of the oncogenic mediator STAT3 and the oncogenic lncRNA H19 and inducing ULBP2 expression level by 3 folds in TNBC cell lines compared to mock cells. Furthermore, knocking down of STAT3 repressed the lncRNA H19 and increased ULBP2 expression levels, whereas siRNAs against H19 increased the expression levels of ULBP2. CONCLUSION: This study highlighted the crosstalk between the novel regulatory network composed of miR-17-5p, H19 and STAT3, and their impact on ULBP2 in BC. Moreover, this study underscored the potential role of miR-17-5p in counteracting the immune evasion tactics, particularly the shedding of ULBP2 in young BC patients, through the modulation of the STAT3/H19/ULBP2 regulatory axis. Thus, targeting this novel regulatory network could potentially enhance our understanding and advance the future application of the innate system-mediated immunotherapy in BC.

Nutrition and Selected Lifestyle Elements as a Tertiary Prevention in Colorectal Cancer Patients.

BACKGROUND: Nutrition and lifestyle elements can significantly support the therapeutic process in colorectal cancer (CRC) patients, which is the basis for tertiary prevention. The study aimed to assess the nutritional strategies and lifestyle of CRC patients and to determine differences in these behaviors depending on gender and age. METHODS: The study group included 202 CRC patients. The research was carried out in two hospitals and using the snowball method. The research tool was an original questionnaire. Data were processed in statistical programs. p < 0.05 was considered statistically significant. RESULTS: Patients reported many behavioral-nutritional side effects. Half of them did not use a therapeutic diet (n = 101; 50.0%). The majority of patients declared that they ate three meals a day (57.4%). Fruits and vegetables were mainly eaten raw (69.3%). Almost a quarter of patients were not physically active at all (22.3%). Men chose to fry meat significantly more often than women (27.7% vs. 19.3%) (p = 0.003). The elderly consumed fast food significantly less often than middle-aged (88.5% vs. 72.3%) (p = 0.03). CONCLUSIONS: Patients showed both pro- and anti-health activities. The findings revealed several noteworthy disparities in dietary habits and lifestyle choices based on gender and age, indicating that these factors can significantly influence the health management of CRC patients. The patients' behaviors should be constantly monitored and intensified, especially through regular consultations and educational meetings with an oncology dietitian for nutritional tertiary prevention of chronic disease.

Exploring psychological help-seeking behaviors and stigma perception among cancer patients: a study on their impact on psychosocial adjustment.

OBJECTIVE: The study investigates the relationships between psychological help-seeking behaviors, stigma perception, and psychosocial adjustment among cancer patients. Understanding these dynamics is crucial for enhancing the mental health and overall well-being of individuals battling cancer. METHODS: This descriptive cross-sectional study involved 387 cancer patients, with data collected through structured questionnaires assessing attitudes toward seeking psychological help (ATSPPH-SF), stigma perception (SSRPH), and psychosocial adjustment (PAIS-SR). Statistical analyses, including correlation and hierarchical regression models, were conducted to explore the associations between these variables. RESULTS: The findings revealed a significant inverse relationship between perceived stigma and help-seeking behaviors, indicating that higher stigma is associated with reduced likelihood of seeking psychological support. Additionally, patients who were more reluctant to seek help demonstrated poorer psychosocial adjustment. Factors such as age, education level, marital status, and treatment status also played significant roles in influencing these outcomes. CONCLUSION: The study underscores the need for targeted interventions to reduce stigma and encourage help-seeking among cancer patients to improve their psychosocial adjustment and quality of life. Integrating mental health services into oncology care and addressing the stigma associated with psychological support are essential steps in enhancing patient outcomes.

Bacterial co-infections in cancer patients with COVID-19: predictors and antimicrobial resistance trends.

INTRODUCTION: Within the context of the coronavirus disease 2019 (COVID-19) pandemic, this study investigated the multifaceted challenges of bacterial infections in cancer patients with COVID-19. It focuses on clinical predictors, resistance patterns, and microbiological characteristics. METHODOLOGY: Over 18 months, 112 adult cancer patients with coronavirus infection confirmed by reverse transcription polymerase chain reaction (RT-PCR) were enrolled. Bloodstream and respiratory samples were evaluated for bacterial infection using the Phoenix automation system for definitive species identification. In vitro susceptibility testing followed the Clinical Laboratory Standards Institute (CLSI) M100-Ed30 guidelines. RESULTS: Bacterial infections affected 25.0% of patients, encompassing bacteremia (21.4%) and respiratory tract infections (8.0%). Multivariable analysis identified hypertension, age < 60, and critical COVID-19 as significant predictors for bacterial infections (p-values = 0.024, 0.029, and 0.039, respectively). Most patients received antimicrobial therapy (93.8%), including last-resort carbapenems (52.7%) and colistin (8.9%). Thirty-three bacterial isolates were identified, with secondary infections doubling co-infection rates. Escherichia coli, Klebsiella species, and Staphylococcus aureus were the most common co-infecting species, while Klebsiella, Acinetobacter, and Pseudomonas species were more frequently associated with secondary infections. Alarmingly, 84.8% of isolates displayed high resistance patterns. All isolated S. aureus species were methicillin-resistant, and 62.5% of Gram-negative bacteria were exclusively sensitive to colistin. CONCLUSIONS: The dominance of highly transmissible hospital-acquired bacterial species, with increased resistance and extensive antibiotic use in COVID-19 patients, necessitates strict infection control and antimicrobial stewardship. Developing customized antimicrobial strategies for cancer patients with COVID-19 is crucial to managing bacterial infections effectively and improving patient outcomes.

The association of compassion with dignity and symptoms in end-of-life cancer patients.

OBJECTIVES: Compassion is essential in palliative care; however, there is a lack of evidence of the association between this construct and patients' dignity-related distress. The present study aimed to investigate the association between end-of-life cancer patients' sense of dignity, the level of compassion of the healthcare professionals (HCPs) noticed and perceived by the patients, and levels of compassion that HCPs felt they had toward patients, investigating through specific attitudes and behaviors. Furthermore, the relationship between compassion and patients' physical and psychological symptoms, such as levels of anxiety and depression, was also investigated. METHODS: The study was cross-sectional. The sample consisted of 105 end-of-life cancer patients and 40 HCPs. Patients had a Karnofsky Performance Status of 50 or lower and a life expectancy of less than 4 months. For each patient, sociodemographic data were collected, and a set of rating scales assessing compassion, dignity as well as physical and psychological symptoms were administered. RESULTS: The results showed significant negative associations between patients' perception of compassion and dignity-related distress as well as significant negative associations between patients' perception of compassion and patients' symptoms. SIGNIFICANCE OF RESULTS: Compassion seems to be involved in diminishing dignity-related distress and alleviating physical and psychological symptoms. Other studies are needed to understand whether patients' symptoms or whether specific HCPs' conditions influence compassion. Exploring compassion and at the end-of-life could encourage a dignity-conserving care.

Radiotherapy is recommended for hormone receptor-negative older breast cancer patients after breast conserving surgery.

In this study, the necessity of radiotherapy (RT) for hormone receptor-negative older breast cancer patients after breast-conserving surgery (BCS) was investigated. The data of hormone receptor-negative invasive breast cancer patients who underwent BCS were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. All patients were separated into two groups, namely, the RT group and the no radiotherapy (No RT) group. The 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) rates were compared between the No RT and RT groups after propensity score matching (PSM). The nomograms for predicting the survival of patients were constructed from variables identified by univariate or multivariate Cox regression analysis. A total of 2504 patients were enrolled in the training cohort, and 630 patients were included in the validation cohort. After PSM, 738 patients were enrolled in the No RT group and RT group. We noted that RT can improve survival in hormone receptor-negative older breast cancer patients who undergo BCS. Based on the results of multivariate Cox analysis, age, race, tumour grade, receipt of RT and chemotherapy, pathological T stage, N status, M status and HER2 status were linked to OS and CSS for these patients, and nomograms for predicting OS and CSS were constructed and validated. Moreover, RT improved OS and CSS in hormone receptor-negative older breast cancer patients who underwent BCS. In addition, the proposed nomograms more accurately predicted OS and CSS for hormone receptor-negative older breast cancer patients after BCS.

Prevalence of Anxiety, Depression, and Distress and Their Association With Problems Encountered by Advanced Cancer Patients in a Tertiary Hospital in Saudi Arabia.

BACKGROUND: Patients with advanced cancer often suffer from significant psychological distress, anxiety, and depression, which can profoundly influence their quality of life. This study aimed to evaluate the prevalence and severity of these psychological factors in advanced cancer patients. Additionally, it sought to identify related psychosocial, practical, emotional, and physical problems and their association with the psychological factors. Furthermore, this study provides interventions and strategies to help mitigate the psychological burden experienced by these patients. METHODS: A cross-sectional survey involving 180 patients with advanced cancer was conducted at a tertiary hospital in Saudi Arabia. Participants were assessed using the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS). Data analysis included descriptive statistics, chi-square tests for categorical variables, and multivariate regression to explore the factors associated with distress, anxiety, and depression. RESULTS: The prevalence of distress, anxiety, and depression among patients was 40.6%, 46.1%, and 52.2%, respectively. Patients who experienced 'changes in urination' which is an item in DT had a 2.86 times higher risk of developing distress. Patients experiencing sadness (item in DT) and fatigue (item in DT) were at a 3.91 and 2.29 times higher risk of developing anxiety, respectively. Practical problems, such as childcare and treatment decisions, emotional problems, and physical problems, such as appearance, bathing/dressing, and eating difficulties, were significantly associated with distress. There was no significant association between patients' demographics and psychological factors. CONCLUSION: The findings underscore the complex interplay of psychosocial, practical, emotional, and physical problems faced by advanced cancer patients receiving palliative care. These patients exhibit a high percentage of distress, anxiety, and depression. Addressing these multifaceted problems through targeted psychological and social interventions can significantly enhance the overall care and quality of life for this vulnerable population. This study advocates routine psychological screenings and tailored interventions to mitigate the psychological burden in this group.

Predictors of forgiveness in cancer patients after treatment.

BACKGROUND: The aim of the present study was to investigate the level of forgiveness in the context of emotional experience and existential aspects of the life of cancer patients after treatment. PARTICIPANTS AND PROCEDURE: One hundred and twenty-eight cancer patients aged 22-83 years completed methods administered to measure forgiveness (Heartland Forgiveness Scale), hope (Adult Dispositional Hope Scale), positive and negative affect (Positive and Negative Affect Schedule), anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and gratitude (Gratitude Questionnaire GQ-6) and questions measuring the perceived importance of the spiritual aspect of life and the practice of religious faith. RESULTS: Levels of forgiveness were related to levels of hope, gratitude, positive and negative affect, depression, anxiety, and rating of the importance of the spiritual aspect of life. Using a regression model, the rate of forgiveness was significantly predicted by gratitude and anxiety. CONCLUSIONS: It was concluded that gratitude and anxiety could explain 35.4% of the variance in forgiveness.

Research progress on predictive models for malnutrition in cancer patients.

Disease-related malnutrition is a prevalent issue among cancer patients, affecting approximately 40-80% of those undergoing treatment. This condition is associated with numerous adverse outcomes, including extended hospitalization, increased morbidity and mortality, delayed wound healing, compromised muscle function and reduced overall quality of life. Moreover, malnutrition significantly impedes patients' tolerance of various cancer therapies, such as surgery, chemotherapy, and radiotherapy, resulting in increased adverse effects, treatment delays, postoperative complications, and higher referral rates. At present, numerous countries and regions have developed objective assessment models to predict the risk of malnutrition in cancer patients. As advanced technologies like artificial intelligence emerge, new modeling techniques offer potential advantages in accuracy over traditional methods. This article aims to provide an exhaustive overview of recently developed models for predicting malnutrition risk in cancer patients, offering valuable guidance for healthcare professionals during clinical decision-making and serving as a reference for the development of more efficient risk prediction models in the future.

Impact of assessing the emotional health status in the management of cancer patients.

Background and aims: This study explores the impact of emotional health on cancer patients, acknowledging the controversies and lack of high-quality data in the field, particularly for rare cancers and younger patients. It highlights the significant prevalence of depression and anxiety among cancer patients, the inadequacies in addressing mental health during and after treatment, and the inconsistencies in prevalence rates due to varying study methodologies. This study unravels the importance of data regarding mental health status in a clinical dataset to accompany the biological sample to be included in a biobank. Methods: The study utilized a questionnaire to evaluate the opinions of cancer patients, clinicians, and researchers regarding the inclusion of mental health data in clinical datasets accompanying biological samples in biobanks. The study involved 120 participants (40 from each group), and the data were analyzed using statistical methods. Results: The study found significant differences in the perceived importance of including mental health information among the three groups. Patients showed a higher tendency (87.9%) to consider mental health questions relevant compared to researchers (72.08%) and clinicians (62.08%). The first four questions regarding emotional well-being received the highest positive responses, particularly from patients (94.3%). The findings underline the importance of addressing the mental health of cancer patients, which is often overlooked. The study emphasizes the necessity for integrating mental health data in biobanks and increasing psychological support for cancer patients. Conclusions: There are clear differences in how patients, researchers, and clinicians value emotional and psychological aspects. The study underscores the need for better education on modern medical practices and the benefits of comprehensive patient care, including mental health considerations.

Examining posttraumatic growth among Turkish family caregivers of cancer patients.

Cancer is a deadly disease that affects millions of people worldwide and is a source of great difficulty, stress, and trauma not only for patients but also for their caregivers. The physical and emotional suffering that patients experience by patients can lead their caregivers to cope with constant anxiety, sadness, and uncertainty. Moreover, during the cancer treatment process, caregivers must make a great effort to meet the needs of patients and support them. This situation may negatively affect the quality of life and psychological health of cancer patients' caregivers and may lead them to experience trauma. The aim of this cross-sectional study was to examine posttraumatic growth's relationship with age, the transformative power of suffering, and hope in family caregivers of cancer patients. Participants consisted of 314 Turkish family caregivers of cancer patients (73.2% women; Mage = 39.89 years) selected by using convenience sampling method. Participants answered a data collection tool consisting of a demographic information form, the Posttraumatic Growth Inventory, Trait Hope Scale, and Transformative Power of Suffering Scale. Data were analyzed using descriptive statistics, the Pearson product-moment correlation coefficient analysis, simple mediation analysis, and moderated mediation analysis. The results of this study revealed that hope mediated the association between the transformative power of suffering and posttraumatic growth in family caregivers of cancer patients, whereas age moderated this relationship. Psychosocial support programs for cancer caregivers could benefit from incorporating interventions that explore the transformative potential of suffering and cultivate hope. Tailoring these interventions to address the specific needs of different age groups may enhance their effectiveness. Future researchers should investigate the factors associated with posttraumatic growth in caregivers across diverse cultures, age ranges, and cancer diagnoses.

The hepatorenal protective effects of silymarin in cancer patients receiving chemotherapy: a randomized, placebo-controlled trial.

BACKGROUND: Breast cancer is one of the most common diseases globally that may have side effects on liver and renal function. Pharmacological treatments to reduce adverse liver and renal effects are still limited. It has been proposed that silymarin may possess hepatoprotective and anti-inflammatory properties. The present trial aims to assess the hepatorenal protective efficacy of silymarin supplementation in cancer patients receiving chemotherapy in an outpatient setting. METHOD: This is a randomized, placebo-controlled clinical trial that recruited female breast cancer patients. Participants were randomly assigned to one placebo group and two intervention groups. The control group received 140 mg of placebo daily, while the two intervention groups received 140 mg silymarin daily. Follow-up assessments were conducted at baseline, 3 weeks, and 6 weeks. At the beginning of the study, the patients were subjected to a computed tomography (CT) scan, and the liver and renal parameters such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), bilirubin, Blood urea nitrogen (BUN) and Creatinine (Cr) were examined through laboratory tests. RESULTS: Despite two deaths and three dropouts, 100 patients completed the study. Silymarin showed significant effects on liver enzymes in the levels of ALP and bilirubin (P < 0.05), with no significant impact on renal function in the levels of Blood urea nitrogen (BUN) and Creatinine (Cr) (P > 0.05). The medication was well-tolerated, with minimal reported side effects (P > 0.05). DISCUSSION: The study suggests that silymarin may have hepato-renal protective potential in breast cancer patients and improve patient tolerance to chemotherapy. The data presented on the efficacy and safety of silymarin may provide stronger foundation for further trials and for a possible use in clinical practice. TRIAL REGISTRATION INFORMATION: Registration Number: IRCT20201123049474N2, First Trial Registration: 16/08/2021, Access: https://www.irct.behdasht.gov.ir/trial/57641.

Impact of a multimodal effort re-education programme on functionality, physical performance, and functional capacity in cancer patients with dyspnoea: a randomised experimental study.

BACKGROUND: In recent years, there has been a significant increase in the survival rates of cancer patients. However, this has also led to an increase in side effects, such as dyspnoea, which can negatively impact of patients. We propose a programme for re-educating effort. The main objective is to test the effectiveness of this programme in improving respiratory symptoms and functionality in cancer patients. METHODOLOGY: Experimental, prospective, longitudinal, randomised study with a parallel fixed-assignment scheme (CG-IG). The patients were selected from the Medical Oncology Service of the University Hospital Complex of Salamanca (CAUSA), Spain. Two parallel intervention programmes were designed for the two study groups (Conventional Clinical Practice-Effort Re-education Programme). Primary variables: dyspnoea (MRC), functionality (Barthel); secondary variables: physical performance (SPPB) and functional capacity (ECOG) and the socio-demographic variables (age, sex, anatomopathological diagnosis, and number of treatment lines). RESULTS: The study sample consisted of 182 patients, with 12 excluded, resulting in a final sample size of n = 170. Sex distribution (CG: 52.9% male and 47.1% female; IG: 49.4% male and 50.6% female). The primary oncological diagnosis was lung cancer, and the most frequent tumour stages were III and IV. Statistically significant differences were found between the IG and CG scores (p < 0.001, d = 0.887, 95% CI) and between the IG and CG scores (p = 0.004, d = 0.358, 95% CI), indicating that the IG performed better. CONCLUSION: The results of this study support the beneficial effects of an exercise re-education programme, carried out by an interdisciplinary team in improving the autonomy of oncology patients with dyspnoea. TRIAL REGISTRATION: The clinical trial was registered in ClinicalTrials.gov (NCT04186754). (03 September 2019).

Comprehensive analysis of the prognostic value of pre-treatment nutritional indicators in elderly rectal cancer patients.

Nutritional status assessment has been deemed essential in treating elderly cancer patients. This study aims to investigate and compare the prognostic value and clinical utility of pre-treatment nutritional indicators in elderly rectal cancer (RC) patients. We retrospectively collected data from 361 elderly rectal cancer patients. The optimal cut-off values for pre-treatment nutritional indicators were calculated using ROC curve analysis. Univariate and multivariate Cox analyses were conducted to identify independent prognostic nutritional indicators. The predictive performance and clinical utility of these independent nutritional indicators was evaluated using time-dependent ROC. Multivariate analyses showed that body mass index (BMI), prognostic nutritional index (PNI), geriatric nutrition risk index (GNRI), and platelet-albumin ratio (PAR) independently predicted overall survival and progression-free survival in elderly RC patients (all p < 0.05), except for advanced lung cancer inflammation index (ALI). According to the nomogram model, the pre-treatment nutritional prognosis score was calculated and the patients were risk stratified. The KM curve showed that the survival of the high-risk group was significantly worse than that of the low-moderate risk group. Time-dependent ROC indicated that novel nutritional prognostic indicator (NNPI) had the best predictive ability compared with the independent prognostic nutritional indicator. Subgroup analysis also showed that NNPI had prognostic value across different clinical factors and had significant clinical utility. In elderly RC patients, BMI, PNI, GNRI, PAR, and NNPI serve as objective assessment tools for nutrition-related mortality risk. Identifying elderly patients at higher nutritional risk can guide early clinical nutritional interventions and improve patient outcomes.

Contraception use and changes in young women with newly diagnosed breast cancer.

OBJECTIVE: To evaluate contraception use and change among young women with early breast cancer. DESIGN: Secondary analysis of a cluster randomized trial. SETTING: Multi-institutional. PATIENT(S): Patients with newly diagnosed breast cancer age ≤45 years enrolled from 54 US oncology practices. INTERVENTION(S): Sites were randomly assigned to the Young Women's Intervention, an educational intervention for young women with newly diagnosed breast cancer and their oncologists addressing issues specific to this population, including contraception, or a contact-time control physical activity intervention. Participants completed surveys in follow-up, including a 3-month survey regarding contraceptive practices before and after diagnosis. MAIN OUTCOME MEASURE(S): Outcomes of interest included young women's contraceptive use and methods before breast cancer diagnosis and 3 months after study enrollment. Logistic regression models assessed factors associated with use of less than highly effective contraceptive methods categorized according to World Health Organization effectiveness tiers and changes in contraceptive methods. RESULT(S): Of 312 women included, 258 (83%) reported contraceptive use before breast cancer diagnosis, and 275 (88%) reported contraceptive use after diagnosis. Use of highly effective methods (e.g., vasectomy, non-hormonal intrauterine devices) increased from 39% before diagnosis to 52% after diagnosis. Use of moderately effective methods (e.g., hormonal methods) decreased from 22% before diagnosis to 3% after diagnosis. Use of less effective methods (e.g., condoms, withdrawal) increased from 22% before diagnosis to 34% after diagnosis. On multivariable analysis, factors associated with using less than highly effective contraception after diagnosis included desire for additional children (odds ratio [OR], 6.33; 95% confidence interval [CI], 3.76-10.66) and discussing contraception with a provider (OR, 1.96; 95% CI, 1.12-3.40). After breast cancer diagnosis, 207 patients (66%) reported no change in contraceptive methods. On multivariable analysis, factors associated with contraceptive method change after diagnosis included age <35 years (OR, 2.96; 95% CI, 1.57-5.58) and provider discussion (OR, 3.59; 95% CI, 1.91-6.78). There was no association in either analysis with study arm. CONCLUSION(S): Although most patients used contraception after breast cancer diagnosis, nearly half reported using less than highly effective contraceptive methods with higher failure rates, highlighting the need for early and improved contraceptive counseling for young women with breast cancer. CLINICAL TRIAL REGISTRATION NUMBER: NCT01647607.