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15 pages, 2057 KiB

Open AccessEditor’s ChoiceArticle

Immunotherapy-Related Oral Adverse Effects: Immediate Sequelae, Chronicity and Secondary Cancer

by Sharon Elad, Noam Yarom and Yehuda Zadik

Cancers 2023, 15(19), 4781; https://doi.org/10.3390/cancers15194781 - 28 Sep 2023

Cited by 8 | Viewed by 2456

Abstract

(1) Background: Immunotherapy-related adverse effects (irAEs) have been reported to manifest in oral tissues, mainly as lichenoid and non-lichenoid lesions and salivary gland dysfunction; however, the characterization of oral irAEs and their clinical impact is limited. (2) Methods: This is a retrospective clinical [...] Read more.

(1) Background: Immunotherapy-related adverse effects (irAEs) have been reported to manifest in oral tissues, mainly as lichenoid and non-lichenoid lesions and salivary gland dysfunction; however, the characterization of oral irAEs and their clinical impact is limited. (2) Methods: This is a retrospective clinical chart review of 14 patients with oral irAEs, describing the impact of the oral irAEs in terms of the immediate effect, treatment, chronicity of the irAEs and the development of oral cancer. (3) Results: Common symptoms were pain and dry mouth, causing no-to-severe pain and/or dry mouth sensation. The immediate sequala ranged from sensitivity to certain foods up to elimination of oral intake. Treatment included conventional palliation techniques with or without systemic steroids. Discontinuation of the immunotherapy agents was required in 6 patients. Innovative treatment modalities included photobiomodulation for oral mucosal pain relief, and salivary gland intraductal irrigations for relief of salivary gland hypofunction. Late sequala included the development of proliferative leukoplakia and oral cancer. (4) Conclusions: Patients treated with immunotherapy may develop debilitating oral irAEs. They should be followed for oral involvement so treatment may be initiated when the symptoms are mild to avoid discontinuation of the immunotherapy. Patients that develop oral lichenoid lesions should receive long-term follow-up, as they may have higher risk for oral cancer. Full article

(This article belongs to the Special Issue Supportive Care for Patients with Cancer)

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15 pages, 1731 KiB

Open AccessArticle

International e-Delphi Consensus Recommendations for the Assessment and Diagnosis of Circadian rest–Activity Rhythm Disorders (CARDs) in Patients with Cancer

by Craig Gouldthorpe, Sonia Ancoli-Israel, Elizabeth Cash, Pasquale Innominato, Gunnhild Jakobsen, Francis Lévi, Christine Miaskowski, Arti Parganiha, Atanu Kumar Pati, Deidre Pereira, Victoria Revell, Jamie M. Zeitzer and Andrew Davies

Cancers 2023, 15(15), 3784; https://doi.org/10.3390/cancers15153784 - 26 Jul 2023

Cited by 1 | Viewed by 2817

Abstract

Purpose: Circadian rest–Activity Rhythm Disorders (CARDs) are common in patients with cancer, particularly in advanced disease. CARDs are associated with increased symptom burden, poorer quality of life, and shorter survival. Research and reporting practices lack standardization, and formal diagnostic criteria do not exist. [...] Read more.

Purpose: Circadian rest–Activity Rhythm Disorders (CARDs) are common in patients with cancer, particularly in advanced disease. CARDs are associated with increased symptom burden, poorer quality of life, and shorter survival. Research and reporting practices lack standardization, and formal diagnostic criteria do not exist. This electronic Delphi (e-Delphi) study aimed to formulate international recommendations for the assessment and diagnosis of CARDs in patients with cancer. Methods: An international e-Delphi was performed using an online platform (Welphi). Round 1 developed statements regarding circadian rest–activity rhythms, diagnostic criteria, and assessment techniques. Rounds 2 and 3 involved participants rating their level of agreement with the statements and providing comments until consensus (defined internally as 67%) and stability between rounds were achieved. Recommendations were then created and distributed to participants for comments before being finalized. Results: Sixteen participants from nine different clinical specialties and seven different countries, with 5–35 years of relevant research experience, were recruited, and thirteen participants completed all three rounds. Of the 164 generated statements, 66% achieved consensus, and responses were stable between the final two rounds. Conclusions: The e-Delphi resulted in international recommendations for assessing and diagnosing CARDs in patients with cancer. These recommendations should ensure standardized research and reporting practices in future studies. Full article

(This article belongs to the Special Issue Supportive Care for Patients with Cancer)

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11 pages, 276 KiB

Open AccessArticle

Differential Impact of a Multicomponent Goals-of-Care Program in Patients with Hematologic and Solid Malignancies

by David Hui, Sairah Ahmed, Nico Nortje, Marina George, Clark R. Andersen, Kaycee Wilson, Diana Urbauer, Christopher Flowers and Eduardo Bruera

Cancers 2023, 15(5), 1507; https://doi.org/10.3390/cancers15051507 - 28 Feb 2023

Cited by 5 | Viewed by 1802

Abstract

We recently reported that an interdisciplinary multicomponent goals-of-care (myGOC) program was associated with an improvement in goals-of-care (GOC) documentation and hospital outcomes; however, it is unclear if the benefit was uniform between patients with hematologic malignancies and solid tumors. In this retrospective cohort [...] Read more.

We recently reported that an interdisciplinary multicomponent goals-of-care (myGOC) program was associated with an improvement in goals-of-care (GOC) documentation and hospital outcomes; however, it is unclear if the benefit was uniform between patients with hematologic malignancies and solid tumors. In this retrospective cohort study, we compared the change in hospital outcomes and GOC documentation before and after myGOC program implementation between patients with hematologic malignancies and solid tumors. We examined the change in outcomes in consecutive medical inpatients before (May 2019–December 2019) and after (May 2020–December 2020) implementation of the myGOC program. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included GOC documentation. In total, 5036 (43.4%) patients with hematologic malignancies and 6563 (56.6%) with solid tumors were included. Patients with hematologic malignancies had no significant change in ICU mortality between 2019 and 2020 (26.4% vs. 28.3%), while patients with solid tumors had a significant reduction (32.6% vs. 18.8%) with a significant between-group difference (OR 2.29, 95% CI 1.35, 3.88; p = 0.004). GOC documentation improved significantly in both groups, with greater changes observed in the hematologic group. Despite greater GOC documentation in the hematologic group, ICU mortality only improved in patients with solid tumors. Full article

(This article belongs to the Special Issue Supportive Care for Patients with Cancer)

11 pages, 288 KiB

Open AccessArticle

“OPERATION PHALCO”—Adapted Physical Activity for Breast Cancer Survivors: Is It Time for a Multidisciplinary Approach?

by Arianna Murri, Daniela Vitucci, Eliana Tranchita, Elisa Grazioli, Stefania Gori, Alessandra Modena, Monica Turazza, Roberto Filippini, Silvia Galeazzi, Matteo Verzè, Patrizia Frittelli, Domenico Cristiano Corsi, Fabrizio Nicolis, Attilio Parisi and Claudia Cerulli

Cancers 2023, 15(1), 34; https://doi.org/10.3390/cancers15010034 - 21 Dec 2022

Cited by 10 | Viewed by 1832

Abstract

The international literature emphasizes the importance of physical activity (PA) in the first steps after cancer surgery. The regular practice of physical exercise causes positive adaptations on several functional capacities, with positive consequences on patients’ quality of life. This project aims to evaluate [...] Read more.

The international literature emphasizes the importance of physical activity (PA) in the first steps after cancer surgery. The regular practice of physical exercise causes positive adaptations on several functional capacities, with positive consequences on patients’ quality of life. This project aims to evaluate the effect of a post-operative training protocol, structured by taking into account both cancer-related issues and the presence of comorbidities, on functional capacities and quality of life of breast cancer survivors. Therefore, it was necessary to create a synergy between oncologists (referring physicians), sport medicine physicians (risk stratification and exercise prescription) and kinesiologists (trainers). Thirty-five post-surgery BC patients decided on a voluntary basis to attend an online Adapted PA (APA) protocol for 4 months, twice a week (APA Group) or Usual Care Group (UC Group). Functional capacity of the APA Group significantly increased, by 13.1% (p = 0.000), whereas perceived exertion decreased by 19.7% (p = 0.020). In the same group, the general health evaluated through the questionnaire EORTC-QLQ-C30 increased (p = 0.050). No differences were found in the UC Group. Operation Phalco, creating a network between oncologists, sports medicine physicians and kinesiologists, confirms the importance of structuring a post-operative path where APA should be included as early as possible in the cancer patient care. Full article

(This article belongs to the Special Issue Supportive Care for Patients with Cancer)

12 pages, 1158 KiB

Open AccessArticle

Real-World Use of Granulocyte-Colony Stimulating Factor in Patients with Breast Cancer from Alberta, Canada

by Philip Q. Ding, Brandt J. Newcomer and Winson Y. Cheung

Cancers 2022, 14(24), 6197; https://doi.org/10.3390/cancers14246197 - 15 Dec 2022

Cited by 2 | Viewed by 1757

Abstract

Background: There are limited published data in the Canadian healthcare system on the use of granulocyte colony-stimulating factor (G-CSF) among patients with breast cancer. This study characterized real-world G-CSF use during the period surrounding the introduction of filgrastim biosimilar. Methods: Electronic medical records [...] Read more.

Background: There are limited published data in the Canadian healthcare system on the use of granulocyte colony-stimulating factor (G-CSF) among patients with breast cancer. This study characterized real-world G-CSF use during the period surrounding the introduction of filgrastim biosimilar. Methods: Electronic medical records were reviewed retrospectively for patients with breast cancer who received moderately or highly myelosuppressive (neo)adjuvant chemotherapy from 2008 to 2019 in Alberta, Canada. Trends in G-CSF usage were plotted to elucidate temporal variations and multivariable regression models were constructed to identify clinical factors associated with G-CSF use. Results: We included 6662 patients in our analyses. G-CSF was used in 57.1% of patients during their treatment trajectory. Among the 3801 patients who were treated with G-CSF, the majority received pegfilgrastim only (91.5%; n = 3477) versus filgrastim only (5.7%; n = 217). G-CSF use increased linearly more than two-fold over the 11-year study period. Predictors of G-CSF use included younger age, south zone of residence, higher neighborhood education, inferior disease stage, highly neutropenic risk chemotherapy, and more recent chemotherapy initiation. Conclusions: Despite increasing G-CSF usage over time, an appreciable proportion of patients for whom G-CSF prophylaxis is recommended did not receive it. G-CSF use could be further optimized to align with supportive care clinical guidelines and reduce the impact of neutropenia and its associated complications. Full article

(This article belongs to the Special Issue Supportive Care for Patients with Cancer)

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Review

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12 pages, 827 KiB

Open AccessReview

Features of Studies on Transition Interventions for Childhood Cancer Survivors: A Scoping Review

by Jun Ma, Xueling Xiao, Siqi Zhou, Can Gu, Fei Liu and Honghong Wang

Cancers 2024, 16(2), 272; https://doi.org/10.3390/cancers16020272 - 8 Jan 2024

Viewed by 1252

Abstract

Purpose: in this scoping review, previously reported data were described and synthesized to document transition interventions in CCSs, and the features of intervention components of the current transition studies for CCSs were summarized. Methods: A literature search was conducted in PubMed, Web of [...] Read more.

Purpose: in this scoping review, previously reported data were described and synthesized to document transition interventions in CCSs, and the features of intervention components of the current transition studies for CCSs were summarized. Methods: A literature search was conducted in PubMed, Web of Science, EMBASE, PsycINFO, CINAHL, Ovid, and the Cochrane Library following the PRISMA-ScR statement. All original studies (n = 9) investigating transition interventions in CCSs were included. Results: The current studies identified essential elements for transition programs, such as delivering knowledge, developing skills for coordination of care, and addressing psychosocial needs. However, the current transition interventions were generally in their infancy, and major deficits were found, including poorly reported intervention components and procedures, a limited number of relevant validated outcomes, and a failure to incorporate conceptual frameworks and international consensus statements. Conclusions: This scoping review mapped current evidence of transition interventions for CCSs and highlighted the paucity of data in this area. More high-quality and well-reported randomized controlled trials are needed for the enrichment and standardization of future transition interventions. Full article

(This article belongs to the Special Issue Supportive Care for Patients with Cancer)

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22 pages, 720 KiB

Open AccessReview

The Association between the Gut Microbiome and Development and Progression of Cancer Treatment Adverse Effects

by Amanda S. Maddern, Janet K. Coller, Joanne M. Bowen and Rachel J. Gibson

Cancers 2023, 15(17), 4301; https://doi.org/10.3390/cancers15174301 - 28 Aug 2023

Cited by 3 | Viewed by 1819

Abstract

Adverse effects are a common consequence of cytotoxic cancer treatments. Over the last two decades there have been significant advances in exploring the relationship between the gut microbiome and these adverse effects. Changes in the gut microbiome were shown in multiple clinical studies [...] Read more.

Adverse effects are a common consequence of cytotoxic cancer treatments. Over the last two decades there have been significant advances in exploring the relationship between the gut microbiome and these adverse effects. Changes in the gut microbiome were shown in multiple clinical studies to be associated with the development of acute gastrointestinal adverse effects, including diarrhoea and mucositis. However, more recent studies showed that changes in the gut microbiome may also be associated with the long-term development of psychoneurological changes, cancer cachexia, and fatigue. Therefore, the aim of this review was to examine the literature to identify potential contributions and associations of the gut microbiome with the wide range of adverse effects from cytotoxic cancer treatments. Full article

(This article belongs to the Special Issue Supportive Care for Patients with Cancer)

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15 pages, 1439 KiB

Open AccessReview

Delivering Palliative and Supportive Care for Older Adults with Cancer: Interactions between Palliative Medicine and Geriatrics

by Alicia Castelo-Loureiro, Andrea Perez-de-Acha, Ana Cristina Torres-Perez, Vanessa Cunha, Paola García-Valdés, Paula Cárdenas-Reyes and Enrique Soto-Perez-de-Celis

Cancers 2023, 15(15), 3858; https://doi.org/10.3390/cancers15153858 - 29 Jul 2023

Cited by 7 | Viewed by 3156

Abstract

The world’s population is aging rapidly, with projections indicating that by 2050 one in six people will be aged ≥65 years. As a result, the number of cancer cases in older people is expected to increase significantly. Palliative care is an essential component [...] Read more.

The world’s population is aging rapidly, with projections indicating that by 2050 one in six people will be aged ≥65 years. As a result, the number of cancer cases in older people is expected to increase significantly. Palliative care is an essential component of cancer care with a direct impact on quality of life. However, older adults with cancer often suffer from multiple comorbidities, cognitive impairment, and frailty, posing unique challenges in the delivery of palliative care. The complex healthcare needs of older patients with cancer therefore require a comprehensive assessment, including a geriatric evaluation. Collaboration between geriatrics and palliative care can offer a solution to the challenges faced by older people with cancer, since this is a population with overlapping concerns for both disciplines. This review highlights the importance of palliative care for older adults with cancer and the benefits of a multidisciplinary approach. It also addresses the coordination of palliative care and geriatrics for specific symptom management and decision making. Full article

(This article belongs to the Special Issue Supportive Care for Patients with Cancer)

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Other

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16 pages, 1375 KiB

Open AccessSystematic Review

Oral Mucositis Management in Children under Cancer Treatment: A Systematic Review

by Ricardo Braguês, Maria Francisca Marvão, Patrícia Correia and Raquel M. Silva

Cancers 2024, 16(8), 1548; https://doi.org/10.3390/cancers16081548 - 18 Apr 2024

Cited by 1 | Viewed by 2666

Abstract

Children undergoing antineoplastic treatment often present severe side effects due to the dosage and duration of treatments, with oral mucositis emerging as one of the most prevalent and painful inflammatory conditions. There is a growing body of evidence on therapeutic interventions such as [...] Read more.

Children undergoing antineoplastic treatment often present severe side effects due to the dosage and duration of treatments, with oral mucositis emerging as one of the most prevalent and painful inflammatory conditions. There is a growing body of evidence on therapeutic interventions such as cryotherapy, low-level laser therapy, and natural compounds for this condition. The aim of this systematic review was to identify and compare therapies for the management of cancer treatment-induced oral mucositis in pediatric patients. From 2655 articles obtained in initial searches, 39 articles were considered in this systematic review, after applying inclusion/exclusion criteria. Low-level laser therapy, palifermin, honey, and zinc demonstrated reductions in oral mucositis incidence, duration, severity, and pain reported by the patient. Although there are several therapies in place for the prevention and treatment of oral mucositis in children, evidence of their efficacy is still inconclusive to establish accurate clinical protocols. Full article

(This article belongs to the Special Issue Supportive Care for Patients with Cancer)

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Graphical abstract

15 pages, 343 KiB

Open AccessPerspective

Supportive Care in Pediatric Oncology: Opportunities and Future Directions

by Jason L. Freedman, Dori M. Beeler, Alison Bowers, Natalie Bradford, Yin Ting Cheung, Maya Davies, L. Lee Dupuis, Caitlin W. Elgarten, Torri M. Jones, Tracey Jubelirer, Tamara P. Miller, Priya Patel, Charles A. Phillips, Hannah R. Wardill and Andrea D. Orsey

Cancers 2023, 15(23), 5549; https://doi.org/10.3390/cancers15235549 - 23 Nov 2023

Cited by 7 | Viewed by 2761

Abstract

The optimization of outcomes for pediatric cancer patients relies on the successful advancement of supportive care to ease the treatment burden and mitigate the long-term impacts of cancer therapy. Advancing pediatric supportive care requires research prioritization as well as the development and implementation [...] Read more.

The optimization of outcomes for pediatric cancer patients relies on the successful advancement of supportive care to ease the treatment burden and mitigate the long-term impacts of cancer therapy. Advancing pediatric supportive care requires research prioritization as well as the development and implementation of innovations. Like the prevailing theme throughout pediatric oncology, there is a clear need for personalized or precision approaches that are consistent, evidence-based, and guided by clinical practice guidelines. By incorporating technology and datasets, we can address questions which may not be feasible to explore in clinical trials. Now is the time to listen to patients’ voices by using patient-reported outcomes (PROs) to ensure that their contributions and experiences inform clinical care plans. Furthermore, while the extrapolation of knowledge and approaches from adult populations may suffice in the absence of pediatric-specific evidence, there is a critical need to specifically understand and implement elements of general and developmental pediatrics like growth, nutrition, development, and physical activity into care. Increased research funding for pediatric supportive care is critical to address resource availability, equity, and disparities across the globe. Our patients deserve to enjoy healthy, productive lives with optimized and enriched supportive care that spans the spectrum from diagnosis to survivorship. Full article

(This article belongs to the Special Issue Supportive Care for Patients with Cancer)

13 pages, 749 KiB

Open AccessPerspective

Supportive Care: The “Keystone” of Modern Oncology Practice

by Florian Scotté, Amy Taylor and Andrew Davies

Cancers 2023, 15(15), 3860; https://doi.org/10.3390/cancers15153860 - 29 Jul 2023

Cited by 23 | Viewed by 4835

Abstract

The Multinational Association of Supportive Care in Cancer (MASCC) defines supportive care as “the prevention and management of the adverse effects of cancer and its treatment. This includes management of physical and psychological symptoms and side effects across the continuum of the cancer [...] Read more.

The Multinational Association of Supportive Care in Cancer (MASCC) defines supportive care as “the prevention and management of the adverse effects of cancer and its treatment. This includes management of physical and psychological symptoms and side effects across the continuum of the cancer journey from diagnosis through treatment to post-treatment care. Supportive care aims to improve the quality of rehabilitation, secondary cancer prevention, survivorship, and end-of-life care”. This article will provide an overview of modern supportive care in cancer, discussing its definition, its relationship with palliative care, models of care, “core” service elements (multi-professional/multidisciplinary involvement), the evidence that supportive care improves morbidity, quality of life, and mortality in various groups of patients with cancer, and the health economic benefits of supportive care. The article will also discuss the current and future challenges to providing optimal supportive care to all oncology patients. Full article

(This article belongs to the Special Issue Supportive Care for Patients with Cancer)

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14 pages, 1179 KiB

Open AccessPerspective

Oncology-Led Early Identification of Nutritional Risk: A Pragmatic, Evidence-Based Protocol (PRONTO)

by Maurizio Muscaritoli, Gil Bar-Sela, Nicolo Matteo Luca Battisti, Borislav Belev, Jorge Contreras-Martínez, Enrico Cortesi, Ione de Brito-Ashurst, Carla M. Prado, Paula Ravasco and Suayib Yalcin

Cancers 2023, 15(2), 380; https://doi.org/10.3390/cancers15020380 - 6 Jan 2023

Cited by 9 | Viewed by 6243

Abstract

Nutritional issues, including malnutrition, low muscle mass, sarcopenia (i.e., low muscle mass and strength), and cachexia (i.e., weight loss characterized by a continuous decline in skeletal muscle mass, with or without fat loss), are commonly experienced by patients with cancer at all stages [...] Read more.

Nutritional issues, including malnutrition, low muscle mass, sarcopenia (i.e., low muscle mass and strength), and cachexia (i.e., weight loss characterized by a continuous decline in skeletal muscle mass, with or without fat loss), are commonly experienced by patients with cancer at all stages of disease. Cancer cachexia may be associated with poor nutritional status and can compromise a patient’s ability to tolerate antineoplastic therapy, increase the likelihood of post-surgical complications, and impact long-term outcomes including survival, quality of life, and function. One of the primary nutritional problems these patients experience is malnutrition, of which muscle depletion represents a clinically relevant feature. There have been recent calls for nutritional screening, assessment, treatment, and monitoring as a consistent component of care for all patients diagnosed with cancer. To achieve this, there is a need for a standardized approach to enable oncologists to identify patients commencing and undergoing antineoplastic therapy who are or who may be at risk of malnutrition and/or muscle depletion. This approach should not replace existing tools used in the dietitian’s role, but rather give the oncologist a simple nutritional protocol for optimization of the patient care pathway where this is needed. Given the considerable time constraints in day-to-day oncology practice, any such approach must be simple and quick to implement so that oncologists can flag individual patients for further evaluation and follow-up with appropriate members of the multidisciplinary care team. To enable the rapid and routine identification of patients with or at risk of malnutrition and/or muscle depletion, an expert panel of nutrition specialists and practicing oncologists developed the PROtocol for NuTritional risk in Oncology (PRONTO). The protocol enables the rapid identification of patients with or at risk of malnutrition and/or muscle depletion and provides guidance on next steps. The protocol is adaptable to multiple settings and countries, which makes implementation feasible by oncologists and may optimize patient outcomes. We advise the use of this protocol in countries/clinical scenarios where a specialized approach to nutrition assessment and care is not available. Full article

(This article belongs to the Special Issue Supportive Care for Patients with Cancer)

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