Factors associated with family decision-making self-efficacy among family members of patients with advanced cancer in mainland China.

OBJECTIVES: In Chinese culture, family members are the main decision maker on end-of-life (EoL) issues for patients with advanced cancer. Yet little is known about Chinese families' confidence in making EoL decisions and its associated factors. This study aims to investigate the status and associated factors of Chinese family members' confidence in making EoL decisions for patients with advanced cancer. METHODS: This cross-sectional study used a convenience sample of 147 family members of patients with stage III or stage IV cancer from a tertiary cancer center in Guangzhou, China. The questionnaires included demographic information of patients and their family members, patients' EoL preferences, and the Chinese version of the Family Decision-Making Self-Efficacy (FDMSE) Scale. RESULTS: A total of145 family members (98.64%) completed the questionnaires. The average score of FDMSE was 3.92 ± 0.53. A multiple regression analysis showed that the factors associated with FDMSE included patients' duration of disease, health insurance, participation in EoL decision-making, the expression of unfilled wishes, and family members' employment status. SIGNIFICANCE OF RESULTS: Chinese family members were not confident enough in making EoL decisions for patients with advanced cancer. It is recommended to develop cultural-tailored advanced care planning models to clarify patient preferences and to enhance the family members' self-efficacy in making EoL decisions with or for patients with advanced cancer.

Comparison of the effects of Valsalva maneuver, EMLA cream, and the combination of both in relieving pain of needle insertion on totally implantable access port: A randomized controlled study.

BACKGROUND: Totally implantable access port (TIAP) is a subcutaneously implanted, long-term infusion device that is widely used in oncology patients. However, multiple needle insertions into TIAP may lead to pain, anxiety, and dread in patients. This study aimed to compare the effectiveness of Valsalva maneuver, eutectic mixture of local anesthetics (EMLA) cream, and the combination of both in relieving pain of cannulations on TIAP. METHODS: This was a prospective randomized controlled study. We included 223 patients treated with antineoplastic drugs and randomized them into four groups: EMLA Group (Group E), control Group (Group C), Valsalva maneuver Group (Group V), and EMLA cream combing with Valsalva maneuver Group (Group EV). Each group was given the corresponding intervention before non-coring needle insertion. The data on pain scores and overall comfort were collected by numerical pain rating scale (NPRS) and visual analog scale (VAS). RESULTS: Group E and Group EV experienced the least amount of pain scores in needle insertion, which was significantly lower than Group V and Group C (p < 0.05). Meanwhile, Group E and Group EV obtained the highest comfort level, which was significantly higher than group C (p < 0.05). Fifteen patients developed localized skin erythema after the application of medical Vaseline or EMLA cream and subsided within half an hour after rubbing. CONCLUSION: EMLA cream is a safe and effective way to alleviate pain during non-coring needle insertion in TIAP and enhance the overall comfort of patients. We recommend applying EMLA cream 1 h before needle insertion of TIAP, especially in patients having needle phobia or high pain scores from previous non-coring needle insertion.

Construction of a comprehensive nutritional index and comparison of its prognostic performance with the PNI and NRI for survival in older patients with nasopharyngeal carcinoma: a retrospective study.

OBJECTIVES: To explore the relationship between the Comprehensive Nutritional Index (CNI) and survival in older patients with nasopharyngeal carcinoma (NPC) and to compare the prognostic performance of three nutritional indicators (CNI, Prognostic Nutritional Index (PNI), and Nutritional Risk Index (NRI)) for overall survival (OS). METHODS: This retrospective study involved 309 older NPC patients in Guangzhou (China) from November 2006 to November 2017. The CNI comprised five parameters: the body mass index (BMI), usual body weight percentage (UBW%), hemoglobin (Hb) level, albumin level, and total lymphocyte count (TLC). All single nutritional indicators were evaluated before and immediately after treatment. The principal component analysis (PCA) was used for calculation of the CNI by single nutritional indicators after treatment. The cutoff point for the CNI was evaluated and logistic regression used to explore the risk factors for the CNI. Univariable, multivariable Cox regression, and Kaplan-Meier methods were applied for OS and disease-free survival (DFS) analyses. Cox proportional hazards models were used to compare the prognostic value of the CNI, PNI, and NRI for OS. RESULTS: All single nutritional indicators decreased significantly after treatment (P < 0.05). The CNI cutoff point for mortality was 0.027, and the logistic regression indicated more complex treatments or higher cancer stage for NPC was associated with a low CNI (HR = 0.179; 95% CI: 0.037-0.856; 0.545, 0.367-0.811, respectively). In multivariable Cox regression, the CNI remained an independent prognostic factor of OS and DFS (HR = 0.468, 95% CI: 0.263-0.832; 0.527, 0.284-0.977, respectively). Kaplan-Meier curves showed that a low CNI was associated with worse OS and DFS (P = 0.001 and 0.013, respectively). The prognostic predictive performance of the CNI was superior to that of the PNI or NRI. CONCLUSIONS: The CNI can be recommended as an appropriate indicator reflecting the integrated nutritional status of older NPC patients. A low CNI predicted a poor survival outcome and the prognostic performance of CNI was superior to PNI or NRI.

A randomized trial of negative pressure wound therapy technology combined with intermittent instillation in the treatment of neck anastomotic leakage after esophageal cancer surgery.

BACKGROUND: This study aimed to examine the effects of applying the negative pressure wound therapy (NPWT) combined with intermittent instillation (NPWTi) in patients with cervical anastomotic leakage (AL) after esophageal cancer surgery. METHODS: From July 2019 to June 2021, 64 patients undergoing AL after esophageal cancer surgery were selected from our Hospital's Thoracic Department, and randomly allocated to the conventional nursing group (20 patients), the hospital central NPWTi group (23 patients), and the portable NPWTi group (21 patients). The hospital central NPWTi group was treated with central negative pressure combined with intermittent instillation, and the portable NPWTi group was treated with portable negative pressure combined with intermittent instillation. Indicators of fistula healing, healing days, treatment costs, comfort, and nursing satisfaction were examined in each group. RESULTS: The fistula healing rate, healing days, nursing satisfaction, and comfort level of the hospital central NPWTi group and the portable NPWTi group were better than those of the conventional nursing group (P<0.05). There was no difference in the fistula healing rates and healing days between the hospital central NPWTi group, and the portable NPWTi group (P>0.05). The treatment costs of the hospital central NPWTi group were lower than those of the portable NPWTi group (P<0.05). CONCLUSIONS: Negative pressure treatment technology combined with the intermittent instillation of the neck anastomotic fistula improved the fistula microenvironment, strengthened the sterilization effect, drained the leachate effectively, shortened the fistula healing time, improved the fistula cure rate, and increased patients' satisfaction with nursing. In relation to the negative pressure source, there was no difference in the therapeutic effects of hospital central NPWTi compared to the portable negative pressure meter, but the hospital central NPWTi treatment costs were lower and patients' acceptance of NPWT instillation was higher. Thus, central NPWT instillation treatment is worthy of promotion. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100052240.

Construction of a comprehensive nutritional index and its correlation with quality of life and survival in patients with nasopharyngeal carcinoma undergoing IMRT: A prospective study.

OBJECTIVES: The aim of this study was to investigate the relationship between a comprehensive nutritional index (CNI) and QoL in patients with NPC who undergo IMRT and to explore the relationship between CNI and survival. METHODS: 359 patients with newly diagnosed NPC were enrolled. QoL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 and Quality of Life Questionnaire Head and Neck Cancer Module at three time points: before, immediately after, and 3 months after IMRT. The CNI comprised five values including body mass index, usual body weight percentage, hemoglobin, albumin, and total lymphocyte count, and was evaluated before and immediately after IMRT. The correlation between the CNI and QoL and the effect of CNI on prognosis were analysed. RESULTS: QoL and CNI scores decreased remarkably after IMRT (P < 0.05). The CNI was quite low in patients with III-IV clinical tumor stage and those undergoing induction chemotherapy plus concurrent chemotherapy. After IMRT, lower CNI score correlated worse QoL (P < 0.05). The Kaplan-Meier curve indicated that patients with lower CNI had significantly poorer survival outcomes (P = 0.02). In multivariate analysis, CNI remained an independent prognostic factor of overall survival (P = 0.046). CONCLUSIONS: CNI can be recommended as an appropriate indicator reflecting the integrated nutrition status of NPC patients. Low CNI was associated with poor QoL and predicted a poor survival outcome. More interventions should be taken to improve the nutrition status of NPC patients to improve QoL and enhance survival outcomes.

Combining Manual Lymph Drainage with Physical Exercise after Modified Radical Mastectomy Effectively Prevents Upper Limb Lymphedema.

OBJECTIVE: Upper limb lymphedema is a common complication after radical mastectomy in patients with breast cancer. In this study, we examined the efficacy of self-manual lymph drainage (MLD) after modified radical mastectomy for the prevention of upper limb lymphedema, scar formation, or shoulder joint dysfunction in breast cancer patients. METHODS: Breast cancer patients scheduled for modified radical mastectomy were randomly apportioned to undergo physical exercise only (PE group, the control; n = 500) or self-MLD as well as exercise (MLD group; n = 500) after surgery. In the PE group, patients started to undertake remedial exercises and progressive weight training after recovery from anesthesia. In the MLD group, in addition to receiving the same treatments as in the PE group, the patients were trained to perform self-MLD on the surgical incision for 10 min/session, 3 sessions/day, beginning after suture removal and incision closure (10 to 30 days after the surgery). Scar formation was evaluated at one week, and 1, 3, 6, and 12 months after the surgery, respectively. Upper limb circumference and shoulder abduction were measured 24 h before surgery, and at one week, and 1, 3, 6 and 12 months after the surgery. RESULTS: Compared to those in the PE group, patients in MLD group experienced significant improvements in scar contracture, shoulder abduction, and upper limb circumference. CONCLUSIONS: Self-MLD, in combination with physical exercise, is beneficial for breast cancer patients in preventing postmastectomy scar formation, upper limb lymphedema, and shoulder joint dysfunction.

The prevalence and correlates of symptom distress and quality of life in Chinese oesophageal cancer patients undergoing chemotherapy after radical oesophagectomy.

PURPOSE: The current study was designed to describe the symptom distress and quality of life (QoL) in Chinese oesophageal cancer patients undergoing chemotherapy after radical oesophagectomy and to identify the factors that influenced symptom distress and the relationship between symptom distress and QoL. METHODS: The sample consisted of 102 oesophageal cancer patients undergoing chemotherapy after radical oesophagectomy. The patients completed the Chinese versions of the M.D. Anderson Symptom Inventory (MDASI, an instrument that measures symptom distress), the Hospital Anxiety and Depression Scale (HADS), the Medical Coping Modes Questionnaire (MCMQ) and the Functional Assessment of Cancer Treatment-General (FACT-G, an instrument that measures QoL). RESULTS: The symptoms and symptom interference scores of the patients in the current research were 3.62 (SD 1.66) and 2.94 (SD 1.76), respectively. Occupation after illness, anxiety, types of surgery, whether chemotherapy was on schedule and confrontation coping strategies were factors that influenced symptom distress. There was a negative relationship between symptom distress and QoL scores. CONCLUSION: Oesophageal cancer patients receiving chemotherapy suffer many limitations due to symptom distress and disruptions in their QoL. Oesophageal cancer patients should be assessed regularly and should be supported on an ongoing basis.

A randomised, controlled trial comparing the long-term effects of peripherally inserted central catheter placement in chemotherapy patients using B-mode ultrasound with modified Seldinger technique versus blind puncture.

OBJECTIVE: To compare the effects of peripherally inserted central venous catheter (PICC) placement using B-mode ultrasound with the modified Seldinger technique (BUMST) versus the blind puncture. METHODS: One hundred chemotherapy patients were recruited to participate in a randomised, controlled trial in Guangzhou, China. Fifty were assigned to the experimental group (using BUMST), and 50 were assigned to the control group (blind puncture). Demographic and background data, data related to PICC placement, complications after PICC placement, the patients' degree of comfort (determined via a questionnaire), and patients' costs for PICC maintenance were collected to compare the effects of the two methods. T-tests and chi-square tests were used to analyse the data; p < 0.05 was accepted as statistically significant. RESULTS: Nighty-eight of the 100 PICCs were successfully inserted (50 in the experimental group and 48 in the control group). Compared with the control group, the experimental group had a lower rate of unplanned catheter removal (4.0% vs. 18.7%; p = 0.02), a lower incidence of mechanical phlebitis (0% vs. 22.9%; p < 0.001), a lower incidence of venous thrombosis (0% vs. 8.3%; p = 0.037), and a higher incidence of catheter migration (32% vs. 2.1%; p < 0.001). Compared with the control group, the experimental group experienced significantly less severe contact dermatitis (p = 0.038), had improved comfort at 1 week, 1 month, 2 months, and 3 months after PICC placement (p < 0.001), and had lower costs for PICC maintenance at 2 months, 3 months and when the catheter was removed (p < 0.05). CONCLUSIONS: Using B-mode ultrasound with MST for PICC placement reduced complications and patients' costs for PICC maintenance and improved patients' degree of comfort; thus, this procedure should be more widely used. The clinical trial registration number: ChiCTR-TRC-12002749.