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Background Cancer patients receiving immunotherapy often experience symptoms impacting their well-being. The present study aimed to develop and test the feasibility of a 12-week Technology-Enhanced Home Exercise and acupressure (TEHEplus) program to improve symptoms (fatigue, pain, sleep, anxiety, depression), social functioning, physical performance, and serum biomarkers (brain-derived neurotrophic factor, heat shock protein 90 levels.) Methods A two-phase design was employed. Phase 1 involved program development; Phase 2 was a pilot feasibility study. Participants with solid tumor cancers were recruited from cancer centers in Maryland and randomly assigned to four groups: Usual Care Control (UC), Technology-Enhanced Home Exercise (TEHE) alone, Acupressure alone (ACU), and TEHEplus. Feasibility was measured by enrollment duration, intervention adherence, and daily survey response rates. Outcomes were measured at baseline and program completion. Results In phase 1, four participants (age 56–82) provided feedback on online training, smartphone application, intervention duration, and outcome measures. In Phase 2, 40 participants (10 per group) were recruited over 12 months, with 43% ( n  = 17) completing all daily surveys. TEHEplus participants achieved 50% of exercise goals, and 78% adhered to the acupoint recommendations. TEHEplus participants showed significant improvements in fatigue ( p  = 0.02), pain inference ( p  = 0.30), and social functioning ( p  = 0.03); TEHE participants improved only in social functioning ( p  = 0.03). Conclusion TEHEplus is feasible and shows promise for symptom alleviation. Preliminary findings suggest potential benefits in symptom management and functional outcomes. However, further studies with larger and more diverse samples are warranted to explore its efficacy and generalizability.Further studies with larger, more diverse populations are needed to confirm its efficacy. TEHEplus may enhance symptom management and improve functional outcomes for cancer survivors undergoing immunotherapy. Trial registration ClinicalTrials.gov ID NCT03576274 Trial Registration Date: 06/07/2018.

Chemotherapy-induced neuropathy (CIN) significantly impacts cancer patients, leading to functional disability, diminished quality of life, and increased healthcare costs amid the ongoing opioid crisis. Auricular point acupressure (APA), a non-invasive and non-pharmacological alternative, has shown potential for alleviating the pain, numbness, and tingling associated with CIN. This study aims to assess the efficacy of APA for CIN symptoms and physical function and to examine the mechanisms underlying APA's effects on CIN. This is a three-arm randomized controlled clinical trial protocol. Patients aged 18 and older who are experiencing CIN are randomly assigned to one of the three groups: an APA group (in-person APA; mAPA), a sham control group (virtual APA; vAPA), and a wait-list usual care control group (UC). During the four-week program, participants in the mAPA receive an in-person APA treatment and training; the sham control participants (vAPA) receive a self-guided smartphone APA application with APA demonstration videos; and the UC participants will continue with the usual care and be re-randomized into one of the APA groups. The primary outcomes are changes in CIN symptoms and physical function. Secondary outcomes include evaluating pain sensory thresholds, motor and cognitive functioning, inflammatory signaling, brain connectivity, opioid use, and quality of life. The outcomes are measured at baseline, program completion (4 weeks), and at monthly follow-up for 3 months post-intervention. This study will provide evidence supporting the potential viability of APA as an intervention for CIN. ClinicalTrials.gov, ID NCT04920097 registered on 3 June 2021.

Purpose: The study aimed to (1) examine the feasibility of providing a training course on auricular point acupressure (APA) for clinical oncology nurses to integrate APA into real-world nursing care settings, and (2) examine the effectiveness of APA on cancer-related pain (CRP) under usual inpatient oncology ward conditions. Methods: This was a 2-phase feasibility study. Phase 1, an in-person, 8 hour training program was provided to oncology nurses. Phase 2, a prospective and feasibility study was conducted to evaluate the integration of APA into nursing care activities to manage CRP. Oncology patients were included if their pain was rated at ≥4 on a 0 to 10 numeric rating scale in the past 24 hours. Patients received 1 APA treatment administered by the nurses and were instructed to stimulate the points for 3 days. Study outcomes (pain intensity, fatigue, and sleep disturbance), pain medication use, and APA practice were measured by a phone survey daily. Results: Ten oncology nurses received APA training in phase 1. APA had been added to the hospital’s electronic health records (EHRs) as a pain treatment. In phase 2, 33 oncology patients received APA treatment with a 100% adherence rate (pressing the seeds 3 times per day, 3 minutes per time based on the suggestion). The side effects of APA were minimal (~8%-12% felt tenderness on the ear). After 3 days of APA, patients reported 38% pain relief, 39% less fatigue, and 45% improvement in sleep disturbance; 24% reduced any type of pain medication use and 19% reduced opioid use (10 mg opioids using milligram morphine equivalent). The major barrier to integrating APA into routine nursing practice was time management (how to include APA in a daily workflow). Conclusion: It is feasible to provide 8-hour training to oncology nurses for mastering APA skill and then integrating APA into their daily nursing care for patients with CRP. Based on the promising findings (decreased pain, improved fatigue and sleep disturbance, and less opioid use), the next step is to conduct a randomized clinical trial with a larger sample to confirm the efficacy of APA for oncology nurses to treat CRP in real-world practice. ClinicalTrial.gov identifier number: NCT04040140.

Background/Objectives: Many cancer survivors continue to experience persistent symptoms such as pain, fatigue, and depression. Exercise and increasing physical activity (PA) are recommended as methods that can help alleviate these symptoms. However, maintaining regular exercise can be difficult due to the challenge of maintaining motivation. This secondary analysis uses data from a randomized controlled pilot study that examines the feasibility of the technology-enhanced combined exercise and other nonpharmacological interventions, such as the TEHEplus program, in managing symptoms. The program used mobile technologies and sent weekly physical performance reports to maintain engagement. In this study, we aimed to examine the impact of weekly physical performance reports on daily symptoms and PA and explored characteristics as moderators. Methods: This secondary analysis included participants who completed the 12-week TEHEplus program. Daily data of steps (PA), sleep duration, and symptoms (rated on a 4-point scale) were collected for 84 days. Mixed-effects and lagged regression models were used to assess the impact of weekly physical performance reports and the moderating effects of baseline characteristics. Results: Seventy-seven survivors of solid tumor cancer (mean age, 59.79, SD = 12.17) were analyzed. During this 84-day period, participants reported a reduction in low energy (B = −0.003, p = 0.004). Step counts increased by an average of 141 steps immediately after each weekly report (B = 140.857, p = 0.027). An increase of 5000 steps on the prior day was related to decreasing pain (B = −0.047, p < 0.001) and fatigue/low energy (B = −0.082, p < 0.001). Two additional hours of prior-night sleep worsened pain (B = 0.029, p = 0.001) and fatigue/low energy (B = 0.027, p = 0.002). Gender, employment, race, caregiver, and type of treatments moderate the relationship between daily PA, sleep (B = −0.131~0.078, ps < 0.05). Conclusions: Weekly physical performance reports promoted PA, which possibly led to self-reported improvement of symptoms. Higher PA was associated with better self-report symptoms, but longer sleep duration was associated with worsened symptoms, suggesting the need for future studies. The moderating effects suggested that tailoring interventions to individual profiles may enhance the program’s effectiveness.

Background/Objectives: Brain-derived neurotrophic factor (BDNF) has been investigated as a potential mechanistic marker or therapeutic target to manage symptoms such as fatigue, pain, depression, and sleep disturbances. However, the variability in BDNF response to exercise or physical activity (exercise/PA) and its clinical relevance in symptom management remains unclear. This scoping review assesses existing studies exploring the relationships between exercise/PA, symptoms, and BDNF levels, specifically focusing on fatigue, pain, depression, and sleep disturbances in adults. Methods: Relevant studies indexed in PubMed and CINAHL were identified. Using systematic review software, two reviewers independently screened and evaluated full texts, based on the following criteria: human studies reporting BDNF levels in adults, using exercise/PA interventions, assessing symptoms (pain, fatigue, depression, and/or sleep disturbance) as outcomes, and published in English. Results: Of 950 records, 35 records met the inclusion criteria. While exercise/PA is broadly supported for managing symptoms, 74.3% (n = 26) of studies reported increased BDNF levels, and only 40% (n = 14) showed significant increases following exercise/PA. Only 14% (n = 5) of studies demonstrated a significant relationship between changes in BDNF and symptoms. No significant differences in BDNF levels and symptoms were observed between different types of exercise (e.g., aerobic vs. strength vs. flexibility/stretching) and PA. Conclusions: The current literature provides insufficient evidence to confirm BDNF as a marker for exercise/PA effectiveness on symptoms. Further clinical investigations are needed to validate its potential as a therapeutic target.

Background/Objectives: This study evaluates the effects of a personalized exercise program on symptoms (pain, fatigue, sleep, cognitive function, physical function), resilience, and health-related quality of life (HRQOL) and compares the effectiveness of in-person versus telehealth delivery. Methods: A secondary data analysis was conducted on two 12-week randomized control pilot studies for solid tumor cancer survivors. One study involved in-person home visits with telephone follow-ups. The second utilized weekly exercise recommendations via a smartphone app. Both studies had control participants who received the standard care. Symptoms, resilience, and HRQOL were measured at baseline and after 12 weeks. Paired t-tests were conducted for intervention effects and ANCOVA for group differences, adjusting for age and education. Results: The analysis included 75 program completers: 15 in-person (iHBE), 38 telehealth (TEHE), and 22 who received standard care. Those receiving exercise interventions reported improvements in physical (t = 3.0, p < 0.01) and mental fatigability (t = 3.1, p < 0.01) at program completion compared to baseline. Comparing the mean changes between participants receiving exercise interventions in-person and via telehealth, there were no significant differences between the two delivery methods except perceived visuo-perceptual cognitive difficulty (F = 3.55, p = 0.027), where telehealth showed a slight advantage. Conclusions: The study provides initial evidence of the effectiveness of a telehealth personalized exercise on fatigability and cognitive difficulty, suggesting it is a potential viable alternative to in-person intervention. Further research with a larger cohort is essential to ascertain the effects of these interventional modalities on cancer-related health outcomes.

Physical impairments following cancer treatment have been linked with the toxic effects of these treatments on muscle mass and strength, through their deleterious effects on skeletal muscle mitochondrial oxidative capacity. Accordingly, we designed the present study to explore relationships of skeletal muscle mitochondrial oxidative capacity with physical performance and perceived cancer-related psychosocial experiences of cancer survivors. We assessed skeletal muscle mitochondrial oxidative capacity using in vivo phosphorus-31 magnetic resonance spectroscopy ( 31 P MRS), measuring the postexercise phosphocreatine resynthesis time constant, τPCr, in 11 post-chemotherapy participants aged 34–70 years. During the MRS procedure, participants performed rapid ballistic knee extension exercise to deplete phosphocreatine (PCr); hence, measuring the primary study outcome, which was the recovery rate of PCr (τPCr). Patient-reported outcomes of psychosocial symptoms and well-being were assessed using the Patient-Reported Outcomes Measurement Information System and the 36-Item Short Form health survey (SF-36). Rapid bioenergetic recovery, reflected through a smaller value of τPCr was associated with worse depression ( rho ρ = − 0.69, p  = 0.018, and Cohen’s d = − 1.104), anxiety (ρ = − 0.61, p  = .046, d = − 0.677), and overall mental health (ρ = 0.74, p  = 0.010, d = 2.198) scores, but better resilience (ρ = 0.65, p  = 0.029), and coping-self efficacy (ρ = 0.63, p  = 0.04) scores. This is the first study to link skeletal muscle mitochondrial oxidative capacity with subjective reports of cancer-related behavioral toxicities. Further investigations are warranted to confirm these findings probing into the role of disease status and personal attributes in these preliminary results.

This study aims to examine the feasibility of DNA methylation age as a biomarker for symptoms and resilience in cancer survivors with multiple chronic conditions (MCCs). We included ten participants from our parent study, an ongoing randomized control trial study. Participants’ symptoms and resilience were assessed, and peripheral blood was collected. DNA methylation age calculation was performed using DNAge® analysis. Data were analyzed using Spearman’s correlation analysis and the Mann–Whitney U test. Participants in the intervention group tended to have a decrease in DNA methylation age and age acceleration after completing an exercise program (mean difference = −0.83 ± 1.26). The change in DNA methylation age was significantly correlated with the change in resilience score (r = −0.897, p = 0.015). The preliminary results suggest that DNA methylation age can be a potential biomarker for improving resilience in cancer survivors with multiple chronic conditions. This finding is limited by the small sample size, and a larger study is needed.

Background Chronic low back pain (cLBP) is a major health problem and the most common pain condition among those aged 60 years or older in the US. Despite the development of pharmacological and nonpharmacological interventions, cLBP outcomes have not improved and disability rates continue to rise. This study aims to test auricular point acupressure (APA) as a non-invasive, nonpharmacological self-management strategy to manage cLBP and to address current shortcomings of cLBP treatment. Methods/design For this prospective randomized controlled study, participants will be randomly assigned to three groups: (1) APA group (active points related to cLBP), (2) Comparison group-1 (non-active points, unrelated to cLBP), and (3) Comparison group-2 (enhanced educational control, an educational booklet on cLBP will be given and the treatment used by participants for their cLBP will be recorded). The ecological momentary assessment smartphone app will be used to collect real-time cLBP outcomes and adherence to APA practice. Treatment and nonspecific psychological placebo effects will be measured via questionnaires for all participants. This proposed trial will evaluate the APA sustained effects for cLBP at 12-month follow-up. Monthly telephone follow-up will be used to collect study outcomes. Blood will be collected during study visits at baseline, post APA treatment, and follow-up study visits at 1, 3, 6, 9 and 12 months post completion of treatment for a total of seven assessments. Appointments will start between 9 and 11 am to control for circadian variation in cytokine levels. Discussion This study is expected to provide vital information on the efficacy, sustainability, and underlying mechanism of APA on cLBP necessary for APA to gain acceptance from both healthcare providers and patients, which would provide a strong impetus for including APA as part of cLBP management in clinical and home settings. Trial registration ClinicalTrials.gov, ID: NCT03589703 . Registered on 22 May 2018.

Purpose: The aims of this study were to explore prevalence of health-related problems and identify factors associated with health-related quality of life (HRQOL) among community-dwelling older adults (CDOAs) in rural Thailand. Methods: A total of 384 CDOAs with mean age of 71 years (SD = 7.6) were recruited. The Thai Ministry of Public Health’s comprehensive geriatric assessment (CGA) was used to measure the CDOAs’ health conditions in the primary care unit of community hospitals. HRQOL of the participants was assessed by using the EQ-5D questionnaire. Results: The results showed that the most common health-related problems were risk of glaucoma (89.6%) and hypertension (64.6%). The HRQOL were predicted by the incidence of falls (β = −0.076, P < .001), Timed Up and Go Test (β = −0.087, P < .001), and age (β = −0.667, P = .002). Discussion: This study highlighted the need to incorporate CGA in family practice, which included risk of falls assessment by measuring TUG test, fall prevention, and to provide resources for caring older adults at home which ultimately will improve CDOAs’ quality of life.