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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: closed (30 June 2024) | Viewed by 17837

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Special Issue Editors

Prof. Dr. Thomas Licht

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Ludwig Boltzmann Institute for Rehabilitation Research, Kurbadstraße 14, 1100 Vienna, Austria
Interests: cancer rehabilitation; supportive care of cancer; outcome research; psycho-oncology
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Richard Crevenna

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Guest Editor

Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
Interests: side effects management; supportive care & cancer rehabilitation; prehabilitation; exercise
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The continuing improvement of early detection and screening measures, as well as advancements in treatments, coupled with a progressively aging population, has resulted in increased numbers of cancer survivors. This, in turn, has led to increased interest in and emphasis on assessing the health-related quality of life (HRQoL) o this population. Clinical trials and comparative effectiveness studies are being designed accordingly, including long-term follow-up to assess late effects of treatment and HRQoL in addition to the more traditional assessments of cancer outcomes, such as survival or other clinical parameters.

In light of this, we have proposed a Special Issue of Cancers dedicated to exploring the recent developments in HRQoL in the context of cancer survivorship. We welcome submissions focusing on clinical trials and other studies assessing long-term HRQoL trajectories; methodological papers, including both qualitative and quantitative research into HRQoL in cancer survivorship, are also of interest.

In recognition of the many demands on researchers and clinicians’ time, we have proposed a six-month window between acceptance of inclusion into the Special Issue and submission of a final draft of the manuscript for peer review.

Please notify us of your interest and proposed title by 30 September 2023. You will be notified of our decision to accept by 31 October 2023. Final manuscripts should be submitted by 31 March 2024 for publication on 31 July 2024.

I look forward to hearing from you.

Kind regards,
Prof. Dr. Thomas Licht
Prof. Dr. Richard Crevenna
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cancer survivors
oncology
psycho-oncology
health-related quality of life
patient-reported outcome measures
self-report

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Published Papers (10 papers)

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19 pages, 1186 KiB

Open AccessArticle

Investigating Physical, Social, Emotional, and Health Frailties of Cancer Survivors after Cancer Treatment: The Urgent Call for Tailored Multidisciplinary Survivorship Plans in Italy

by Stefania Moramarco, Luigi De Angelis, Laura Bernardini, Lorenza Marconi, Gaia Piunno, Simonetta Siciliano, Andrea Malizia, Ersilia Buonomo, Alessia Pesaresi, Angela Andreoli, Barbara Capotondi, Mario Roselli, Leonardo Palombi and Francesco Torino

Cancers 2024, 16(17), 3080; https://doi.org/10.3390/cancers16173080 - 4 Sep 2024

Viewed by 1043

Abstract

Background: Understanding the specific needs of cancer survivors is essential for healthcare policy. In Italy, dedicated studies are lacking, so we aimed to investigate the physical, mental, social, and health difficulties encountered by these patients. Methods: We conducted a cross-sectional study on breast or colorectal cancer survivors (people 5+ years free from it and its treatments) using an ad hoc survey including validated questionnaires (Grauer–Palombi, SF-36, PREDIMED). Participants were recruited within the Oncology Unit of the “Policlinico Tor Vergata”, Italy. Results: A total of 62 patients (80.6% females; years range: 37–87) agreed to be interviewed. A profile of cancer survivors was drafted: an overaged person with multiple co-morbidities, not well-nourished, adhering to the Mediterranean diet, reporting critical conditions as for physical and functional status. The mean number of co-morbidities was 3.6 ± 2.4 SD, with a statistically significant difference between age groups (under and over 65). Compared to the general population, the sample showed more frailties, especially when >65. The risk of having multimorbidity (four or more co-morbidities) significantly increased in those over 65 (OR: 4.72; CI: 1.43–15.59). Conclusion: There is an urgent need for survivorship care planning for the patient-centered continuum of care. Assessing and monitoring their specific needs will help propose appropriate and tailored responses. Full article

(This article belongs to the Special Issue Latest Advancements in Health-Related Quality of Life Research in Cancer Survivorship)

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14 pages, 272 KiB

Open AccessArticle

Mental Health Challenges in Cancer Patients: A Cross-Sectional Analysis of Depression and Anxiety

by Walid Shalata, Itamar Gothelf, Tomer Bernstine, Regina Michlin, Lena Tourkey, Sondos Shalata and Alexander Yakobson

Cancers 2024, 16(16), 2827; https://doi.org/10.3390/cancers16162827 - 12 Aug 2024

Cited by 1 | Viewed by 2616

Abstract

Advancements in cancer treatment and early detection have extended survival rates, transforming many cancers into chronic conditions. However, cancer diagnosis and treatment can trigger significant psychological distress, including depression and anxiety, impacting patient outcomes and care. This study aimed to examine the prevalence of and identify the risk factors for depression and anxiety among cancer patients. A cross-sectional study was conducted, including patients under the care of the oncology department at a tertiary medical center between June 2021 and October 2023. Depression and anxiety were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) short forms. Logistic regression analysis identified risk factors for depression and anxiety. The study population included 159 patients, with 40.3% reporting worsening mental health, but only about half of them received therapy. Among the study participants, 22.6% experienced symptoms of depression and 30.2% experienced symptoms of anxiety. Single-cancer patients and those with metastases were at increased risk for depression, while those with a disease duration of more than a year and patients with female-specific cancer were more likely to experience anxiety. Given the high prevalence of mental health deterioration in cancer patients, closer monitoring and validated assessment tools are essential to improve depression and anxiety diagnosis and facilitate early interventions. Full article

(This article belongs to the Special Issue Latest Advancements in Health-Related Quality of Life Research in Cancer Survivorship)

17 pages, 600 KiB

Open AccessArticle

Qualitative Classification of Late Systemic Symptoms in Head and Neck Cancer Survivors

by Poppy Schoenberg, Elizabeth Wulff-Burchfield, David Schlundt, Kemberlee Bonnet, Mary Dietrich and Barbara Murphy

Cancers 2024, 16(11), 2106; https://doi.org/10.3390/cancers16112106 - 31 May 2024

Viewed by 916

Abstract

Improved rates of cancer control have increased the head and neck cancer survivor population. Cancer survivorship clinics are not widely available in the USA, and longitudinal supportive care for patients undergoing multimodal therapy has not advanced at a pace commensurate with improvements in cancer control. Consequently, a large head and neck cancer survivor population whose quality of life may be chronically and/or permanently diminished presently exists. This lack of awareness perpetuates under-recognition and under-investigation, leaving survivors’ (mostly detrimental) experiences largely uncharted. We conducted a qualitative exploration of survivors’ experiences, aiming to unpack the profound impact of late systemic symptoms on daily life, encompassing work, relationships, and self-identity in the head and neck cancer survivor community. The study included 15 remitted head and neck survivors, ≥12 months from their final treatment, who participated in semi-structured interviews conducted by a medical oncologist. Data analysis comprised qualitative thematic analysis, specifically inductive hierarchical linear modeling, enriched by a deductive approach of anecdotal clinical reporting. Results highlighted that 43.36% of all quotation material discussed in the interviews pertained to chronic emotion disturbance with significant implications for other domains of life. A central symptom cluster comprised impairments in mood/emotions, daily activity, and significant fatigue. Dysfunction in sleep, other medical conditions, and cognitive deficits comprised a secondary cluster. Physical dysfunctionality, encompassing pain, appetite, and eating, and alterations in experienced body temperature, constituted a tertiary cluster, and perhaps were surprisingly the least discussed symptom burden among head and neck cancer survivors. Symptoms causing heightened long-term survivor burden may be considered epiphenomenal to central physical dysfunctionality, albeit being presently the least represented in cancer survivor care programs. Moving forward, the development of targeted and multi-dimensional treatment programs that encompass physical, psychosocial, and spiritual domains are needed to increase clinical specificity and effective holistic long-term solutions that will foster a more compassionate and informed future of care for the cancer survivorship community. Full article

(This article belongs to the Special Issue Latest Advancements in Health-Related Quality of Life Research in Cancer Survivorship)

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16 pages, 707 KiB

Open AccessArticle

Internal Responsiveness of EQ-5D-5L and EORTC QLQ-C30 in Dutch Breast Cancer Patients during the First Year Post-Surgery: A Longitudinal Cohort Study

by Noëlle J. M. C. Vrancken Peeters, Janine A. van Til, Anouk S. Huberts, Sabine Siesling, Olga Husson and Linetta B. Koppert

Cancers 2024, 16(11), 1952; https://doi.org/10.3390/cancers16111952 - 21 May 2024

Viewed by 1351

Abstract

The EuroQoL 5-Dimension 5-Level questionnaire (EQ-5D-5L) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) are commonly used Patient-Reported Outcome Measures (PROMs) for breast cancer. This study assesses and compares the internal responsiveness of the EQ-5D-5L and EORTC QLQ-C30 in Dutch breast cancer patients during the first year post-surgery. Women diagnosed with breast cancer who completed the EQ-5D-5L and EORTC QLQ-C30 pre-operatively (T0), 6 months (T6), and 12 months post-surgery (T12) were included. Mean differences of the EQ-5D-5L and EORTC QLQ-C30 between baseline and 6 months (delta 1) and between baseline and 12 months post-surgery (delta 2) were calculated and compared against the respective minimal clinically important differences (MCIDs) of 0.08 and 5. Internal responsiveness was assessed using effect sizes (ES) and standardized response means (SRM) for both deltas. In total, 333 breast cancer patients were included. Delta 1 and delta 2 for the EQ-5D-5L index and most scales of the EORTC QLQ-C30 were below the MCID. The internal responsiveness for both PROMs was small (ES and SRM < 0.5), with greater internal responsiveness for delta 1 compared to delta 2. The EQ-5D-5L index showed greater internal responsiveness than the EORTC QLQ-C30 Global Quality of Life scale and summary score. These findings are valuable for the interpretation of both PROMs in Dutch breast cancer research and clinical care. Full article

(This article belongs to the Special Issue Latest Advancements in Health-Related Quality of Life Research in Cancer Survivorship)

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16 pages, 2770 KiB

Open AccessArticle

The Use of Natural Language Processing Elements for Computer-Aided Diagnostics and Monitoring of Body Image Perception in Enterally Fed Patients with Head and Neck or Upper Gastrointestinal Tract Cancers

by Agnieszka Różańska, Elwira Gliwska, Klaudia Barańska, Stella Maćkowska, Adrianna Sobol and Dominik Spinczyk

Cancers 2024, 16(7), 1353; https://doi.org/10.3390/cancers16071353 - 29 Mar 2024

Viewed by 1102

Abstract

Background: Psycho-oncology care has emerged as a significant concern in contemporary oncology practice, given its profound impact on patient psychological well-being. Patients undergoing treatment for head–neck or upper gastrointestinal tract cancers often experience complex emotional and psychological challenges, necessitating specialized support and intervention. Traditional approaches to psycho-oncological care may be limited in their ability to comprehensively assess and address patients’ needs. Therefore, exploring innovative methodologies, such as leveraging natural language processing (NLP) elements, is crucial to enhancing the effectiveness of psycho-oncological interventions. Methods: In this study, we developed a method utilizing natural language processing (NLP) elements to augment psycho-oncological care for patients with head–neck or upper gastrointestinal tract cancers. The method aimed to facilitate vocabulary, sentiment, and intensity analysis of five basic emotions (happiness, sadness, anger, disgust, and fear), as well as to explore potential areas of difficulty such as body image, pain, and self-esteem. We conducted research involving 50 patients across three treatment stages. Results: Our method facilitated the identification of characteristic features at each treatment stage, aiding in the tailoring of appropriate therapies to individual patient needs. The results offer insights valuable to psychologists and psychiatrists for expedited diagnosis and intervention, potentially influencing therapy outcomes. Additionally, the data may inform treatment decisions by addressing patient-specific concerns. Furthermore, our method holds promise for optimizing the allocation of psychological care resources, particularly at the initial stages of patient contact. Limitations: The main problem in the research was the fairly wide age range of participants, which explains the potential diversity of vocabulary. Conclusion: In conclusion, our study demonstrates the potential utility of integrating natural language processing (NLP) elements into psycho-oncological care for patients with head–neck or upper gastrointestinal tract cancers. The developed method offers a novel approach to comprehensively assessing patients’ emotional states and areas of difficulty, thereby facilitating tailored interventions and treatment planning. These findings underscore the importance of continued research and innovation in psycho-oncology to enhance patient care and outcomes. Full article

(This article belongs to the Special Issue Latest Advancements in Health-Related Quality of Life Research in Cancer Survivorship)

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13 pages, 915 KiB

Open AccessArticle

Longitudinal Assessment of Quality of Life in Nasopharyngeal Cancer Patients Treated with Intensity-Modulated Proton Therapy and Volumetric Modulated Arc Therapy at Different Time Points

by Kuan-Cho Liao, Yu-Jie Huang, Wen-Ling Tsai, Chien-Hung Lee and Fu-Min Fang

Cancers 2024, 16(6), 1217; https://doi.org/10.3390/cancers16061217 - 20 Mar 2024

Cited by 2 | Viewed by 1439

Abstract

Purpose: This retrospective cohort study aims to compare the quality of life (QoL) in patients with nasopharyngeal cancer (NPC) treated with intensity-modulated proton therapy (IMPT) versus volumetric modulated arc therapy (VMAT) at different time points. Materials and Methods: We conducted a longitudinal assessment of QoL on 287 newly diagnosed NPC patients (IMPT: 41 and VMAT: 246). We collected outcomes of global QoL, functional QoL, C30 symptoms, and HN35 symptoms from EORTC QLQ-C30 and QLQ-HN35 questionnaires at pre-radiotherapy, during radiotherapy (around 40 Gy), 3 months post radiotherapy, and 12-months post radiotherapy (RT). The generalized estimating equation was utilized to interpret the group effect, originating from inherent group differences; time effect, attributed to RT effects over time; and interaction of the group and time effect. Results: IMPT demonstrated superior mean dose reductions in 12 of the 16 organs at risk compared to VMAT, including a significant (>50%) reduction in the oral cavity and larynx. Both groups exhibited improved scores of global QoL, functional QoL, and C30 symptoms at 12 months post RT compared to the pre-RT status. Regarding global QoL and C30 symptoms, there was no interaction effect of group over time. In contrast, significant interaction effects were observed on functional QoL (p = 0.040) and HN35 symptoms (p = 0.004) during RT, where IMPT created an average of 7.5 points higher functional QoL and 10.7 points lower HN35 symptoms than VMAT. Conclusions: Compared to VMAT, dose reduction attributed to IMPT could translate into better functional QoL and HN35 symptoms, but the effect is time dependent and exclusively observed during the RT phase. Full article

(This article belongs to the Special Issue Latest Advancements in Health-Related Quality of Life Research in Cancer Survivorship)

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20 pages, 2794 KiB

Open AccessArticle

Role of Nutraceuticals in Counteracting Inflammation in In Vitro Macrophages Obtained from Childhood Cancer Survivors

by Alessandra Di Paola, Maria Maddalena Marrapodi, Elvira Pota, Rosa Colucci Cante, Deeksha Rana, Giulia Giliberti, Giuseppe Di Feo, Shakeel Ahmed, Domenico Roberti, Roberto Nigro, Francesca Rossi and Maura Argenziano

Cancers 2024, 16(4), 714; https://doi.org/10.3390/cancers16040714 - 8 Feb 2024

Cited by 1 | Viewed by 1351

Abstract

The advancement of anti-cancer therapies has markedly improved the survival rate of children with cancer, making them long-term childhood cancer survivors (CCS). Nevertheless, these treatments cause a low-grade inflammatory state, determining inflamm-aging and, thus, favoring the early onset of chronic diseases normally associated with old age. Identification of novel and safer therapeutic strategies is needed to counteract and prevent inflamm-aging. Macrophages are cells involved in immune and inflammatory responses, with a pivotal role in iron metabolism, which is related to inflammation. We obtained macrophages from CCS patients and evaluated their phenotype markers, inflammatory states, and iron metabolism by Western blotting, ELISA, and iron assays. We observed a strong increase in classically activated phenotype markers (M1) and iron metabolism alteration in CCS, with an increase in intracellular iron concentration and inflammatory markers. These results suggest that the prevalence of M1 macrophages and alteration of iron metabolism could be involved in the worsening of inflammation in CCS. Therefore, we propose macrophages and iron metabolism as novel therapeutic targets to counteract inflamm-aging. To avoid toxic regimens, we tested some nutraceuticals (resveratrol, curcumin, and oil-enriched lycopene), which are already known to exert anti-inflammatory properties. After their administration, we observed a macrophage switch towards the anti-inflammatory phenotype M2, as well as reductions in pro-inflammatory cytokines and the intracellular iron concentration. Therefore, we suggest—for the first time—that nutraceuticals reduce inflammation in CCS macrophages through a novel anti-inflammatory mechanism of action, modulating iron metabolism. Full article

(This article belongs to the Special Issue Latest Advancements in Health-Related Quality of Life Research in Cancer Survivorship)

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15 pages, 914 KiB

Open AccessArticle

Analysis of Health-Related Quality of Life Reporting in Phase III RCTs of Advanced Genitourinary Tumors

by Fabrizio Di Costanzo, Fabiana Napolitano, Fabio Salomone, Anna Rita Amato, Gennaro Alberico, Fortuna Migliaccio, Giovanna Pecoraro, Annachiara Marra, Felice Crocetto, Antonio Ruffo, Sarah Scagliarini, Sabrina Rossetti, Livio Puglia, Marilena Di Napoli, Roberto Bianco, Alberto Servetto and Luigi Formisano

Cancers 2023, 15(23), 5703; https://doi.org/10.3390/cancers15235703 - 4 Dec 2023

Cited by 1 | Viewed by 1459

Abstract

Background: As recommended in the European Society for Medical Oncology (ESMO) guidelines, assessment of health-related quality of life (HRQoL) should be a relevant endpoint in randomized controlled trials (RCTs) testing new anticancer therapies. However, previous publications by our group and others revealed a frequent underestimation and underreporting of HRQoL results in publication of RCTs in oncology. Herein, we systematically reviewed HRQoL reporting in RCTs testing new treatments in advanced prostate, kidney and urothelial cancers and published between 2010 and 2022. Methods: We searched PubMed RCTs testing novel therapies in genitourinary (GU) cancers and published in fifteen selected journals (Annals of Oncology, BMC Cancer, British Journal of Cancer, Cancer Discovery, Clinical Cancer Research, Clinical Genitourinary cancer, European Journal of Cancer, European Urology, European Urology Oncology, JAMA, JAMA Oncology, Journal of clinical Oncology, Lancet, Lancet Oncology and The New England Journal of Medicine). We excluded trials investigating exclusively best supportive care or behavioral intervention, as well as subgroup or post hoc analyses of previously published trials. For each RCT, we investigated whether HRQoL assessment was performed by protocol and if results were reported in the primary manuscript or in a secondary publication. Results: We found 85 eligible trials published between 2010 and 2022. Only 1/85 RCTs (1.2%) included HRQoL among primary endpoints. Of note, 25/85 (29.4%) RCTs did not include HRQoL among study endpoints. HRQoL results were non-disclosed in 56/85 (65.9%) primary publications. Only 18/85 (21.2%) publications fulfilled at least one item of the CONSORT-PRO checklist. Furthermore, 14/46 (30.4%) RCTs in prostate cancer, 12/25 (48%) in kidney cancer and 3/14 (21.4%) in urothelial cancer reported HRQoL data in primary publications. Next, HRQoL data were disclosed in primary manuscripts of 12/32 (37.5%), 5/13 (38.5%), 5/16 (31.3%) and 5/15 (33.3%) trials evaluating target therapies, chemotherapy, immunotherapy and new hormonal agents, respectively. Next, we found that HRQoL data were reported in 16/42 (38%) and in 13/43 (30.2%) positive and negative trials, respectively. Finally, the rate of RCTs reporting HRQoL results in primary or secondary publications was 55.3% (n = 47/85). Conclusions: Our analysis revealed a relevant underreporting of HRQoL in RCTs in advanced GU cancers. These results highlight the need to dedicate more attention to HRQoL in RCTs to fully assess the value of new anticancer treatments. Full article

(This article belongs to the Special Issue Latest Advancements in Health-Related Quality of Life Research in Cancer Survivorship)

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24 pages, 1068 KiB

Open AccessArticle

“Is My Brain Ever Going to Work Fully Again?”: Challenges and Needs of Cancer Survivors with Persistent Cancer-Related Cognitive Impairment

by Darren Haywood, Evan Dauer, Frank D. Baughman, Blake J. Lawrence, Susan L. Rossell, Nicolas H. Hart and Moira O’Connor

Cancers 2023, 15(22), 5331; https://doi.org/10.3390/cancers15225331 - 8 Nov 2023

Cited by 8 | Viewed by 3526

Abstract

Many cancer survivors experience cognitive impairments that impact memory, concentration, speed of information processing, and decision making. These impairments, collectively known as cancer-related cognitive impairments (CRCIs), are a key domain of unmet needs and can significantly impact a cancer survivor’s identity and quality of life. However, there are no purpose-built, multi-domain, needs assessment tools specifically for CRCI. The development of such tools requires an in-depth understanding of cancer survivors’ CRCI-specific challenges and associated needs. This study explored the challenges and associated needs of cancer survivors with persistent CRCI. An in-depth qualitative design using semi-structured interviews with (a) cancer survivors with perceived CRCI (n = 32) and (b) oncology health professionals (n = 19) was utilised. A reflexive thematic analysis of the interviews resulted in five overarching themes: (1) executing regular activities, (2) relational difficulties, (3) occupational functioning, (4) psychological distress, and (5) social functioning, as well as an additional informational needs domain. Ultimately, CRCI was found to directly produce a range of challenges that negatively, and persistently, impact cancer survivors’ quality of life. Cancer survivors were also found to have a range of needs associated with these challenges. This research should be used to inform future challenges and needs assessment tools as well as treatment and supportive care priority areas directly relating to CRCI. Full article

(This article belongs to the Special Issue Latest Advancements in Health-Related Quality of Life Research in Cancer Survivorship)

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Review

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25 pages, 1080 KiB

Open AccessReview

Influence of Amino Acids and Exercise on Muscle Protein Turnover, Particularly in Cancer Cachexia

by Rashmita Pradhan, Walburga Dieterich, Anirudh Natarajan, Raphaela Schwappacher, Dejan Reljic, Hans J. Herrmann, Markus F. Neurath and Yurdagül Zopf

Cancers 2024, 16(10), 1921; https://doi.org/10.3390/cancers16101921 - 18 May 2024

Cited by 1 | Viewed by 2074

Abstract

Cancer cachexia is a multifaceted syndrome that impacts individuals with advanced cancer. It causes numerous pathological changes in cancer patients, such as inflammation and metabolic dysfunction, which further diminish their quality of life. Unfortunately, cancer cachexia also increases the risk of mortality in affected individuals, making it an important area of focus for cancer research and treatment. Several potential nutritional therapies are being tested in preclinical and clinical models for their efficacy in improving muscle metabolism in cancer patients. Despite promising results, no special nutritional therapies have yet been validated in clinical practice. Multiple studies provide evidence of the benefits of increasing muscle protein synthesis through an increased intake of amino acids or protein. There is also increasing evidence that exercise can reduce muscle atrophy by modulating protein synthesis. Therefore, the combination of protein intake and exercise may be more effective in improving cancer cachexia. This review provides an overview of the preclinical and clinical approaches for the use of amino acids with and without exercise therapy to improve muscle metabolism in cachexia. Full article

(This article belongs to the Special Issue Latest Advancements in Health-Related Quality of Life Research in Cancer Survivorship)

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