Explore the vast range of titles available.

Opinion statement While the benefits of early palliative care are indisputable, most of the current evidence has emerged from resource-rich settings in urban areas of high-income countries, with an emphasis on solid tumors in outpatient settings; this model of palliative care integration is not currently scalable internationally. A shortage of specialist palliative care clinicians means that in order to meet the needs of all patients who require support at any point along their advanced cancer trajectory, palliative care must also be provided by family physicians and oncology clinicians who require training and mentorship. Models of care that facilitate the timely provision of seamless palliative care across all settings (inpatient, outpatient, and home-based care), with clear communication between clinicians, are crucial to the provision of patient-centred palliative care. The unique needs of patients with hematological malignancies must be further explored and existing models of palliative care provision modified to meet these needs. Finally, care must be provided in an equitable and culturally sensitive manner, recognizing the challenges associated with the delivery of high-quality palliative care to both patients in high-income countries who live in rural areas, as well as to those in low- and middle-income countries. A one-size-fits-all model will not suffice, and there is an urgent need to develop innovative context-specific models of palliative care integration worldwide, in order to provide the right care, in the right place, and at the right time.

Purpose Commonly used terms such as “supportive care,” “best supportive care,” “palliative care,” and “hospice care” were rarely and inconsistently defined in the palliative oncology literature. We conducted a systematic review of the literature to further identify concepts and definitions for these terms. Methods We searched MEDLINE, PsycInfo, EMBASE, and CINAHL for published peer-reviewed articles from 1948 to 2011 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. Dictionaries/textbooks were also searched. Results Nine of 32 “SC/BSC,” 25 of 182 “PC,” and 12 of 42 “HC” articles focused on providing a conceptual framework/definition. Common concepts for all three terms were symptom control and quality-of-life for patients with life-limiting illness. “SC” focused more on patients on active treatment compared to other categories (9/9 vs. 8/37) and less often involved interdisciplinary care (4/9 vs. 31/37). In contrast, “HC” focused more on volunteers (6/12 vs. 6/34), bereavement care (9/12 vs. 7/34), and community care (9/12 vs. 6/34). Both “PC” and “SC/BSC” were applicable earlier in the disease trajectory (16/34 vs. 0/9). We found 13, 24, and 17 different definitions for “SC/BSC,” “PC,” and “HC,” respectively. “SC/BSC” was the most variably defined, ranging from symptom management during cancer therapy to survivorship care. Dictionaries/textbooks showed similar findings. Conclusion We identified defining concepts for “SC/BSC,” “PC,” and “HC” and developed a preliminary conceptual framework unifying these terms along the continuum of care to help build consensus toward standardized definitions.

Opinion statement The specialty of palliative care has evolved over time to provide symptom management, psychosocial support, and care planning for patients with cancer throughout the disease continuum and in multiple care settings. This review examines the delivery and impact of palliative care in the outpatient, inpatient, and community-based settings. The article will discuss how these 3 palliative care settings can work together to optimize patient outcomes under a unifying model of palliative care “anywhere, anytime” and how to prioritize palliative care services when resources are limited. Many patients with advanced cancer receive care from each of the 3 branches of palliative care—outpatient, inpatient, and community-based settings—at some point along their disease trajectory. Early on, outpatient clinics provide longitudinal supportive care concurrent with active disease-modifying treatments. Telemedicine appointments can serve patients remotely to minimize their need to travel. When patients experience functional decline, community-based palliative care services can provide support and monitoring for patients at home. When patients develop acute symptomatic complications requiring admission, inpatient care consultation teams are essential for symptom management and goals-of-care discussions. For patients in severe distress, receiving care in a palliative care unit that provides intensive symptom control and facilitates complex discharge planning is ideal. Under a unifying model of palliative care designed to offer care “anywhere, anytime,” the 3 branches of palliative care could work in unison to support each other, minimize gaps in care, and optimize patient outcomes.

Opinion statement Fatigue is a common and distressing symptom experienced by patients with cancer. It is most common in patients with locally advanced or metastatic incurable disease. It can have profound effects on quality-of-life and physical functioning. In addition to general supportive measures (directed at tackling contributory conditions and comorbidities), a variety of specific interventions have been developed which can be broadly categorised as physical therapies, psychological therapies or medication. There is some evidence that each of these approaches can have benefits in patients with earlier stage disease, those undergoing active treatment and in cancer survivors. The best evidence is for aerobic exercise, yoga, cognitive-behavioural therapy (CBT) and psycho-educational interventions. Less strong evidence supports the use of medications such as methylphenidate or ginseng. In patients with advanced disease, it is likely that the mechanisms of fatigue or the factors contributing to fatigue maintenance may be different. Relatively fewer studies have been undertaken in this group and the evidence is correspondingly weaker. The authors recommend the cautious use of aerobic exercise (e.g. walking) in those who are still mobile. The authors advise considering the use of psycho-educational approaches or CBT in those patients who are able to engage in such forms of therapy. In patients near the end-of-life, the authors advise use of dexamethasone (short-term use) and other pharmacological treatments only on the basis of a clinical trial.

Background Chemotherapy-induced alopecia is a common consequence of cancer treatment with a high psychological impact on patients and can be prevented by scalp cooling (SC). With this multi-center patient series, we examined the results for multiple currently used chemotherapy regimens to offer an audit into the real-world determinants of SC efficacy. Materials and methods The Dutch Scalp Cooling Registry collected data on 7424 scalp-cooled patients in 68 Dutch hospitals. Nurses and patients completed questionnaires on patient characteristics, chemotherapy, and SC protocol. Patient-reported primary outcomes at the start of the final SC session included head cover (HC) (eg, wig/scarf) use (yes/no) as a surrogate for patient satisfaction with SC and WHO score for alopecia (0 = no hair loss up to 3 = total alopecia) as a measure of scalp cooling success. Exhaustive logistic regression analysis stratified by chemotherapy regimen was implemented to examine characteristics and interactions associated with the SC result. Results Overall, over half of patients (n = 4191, 56%) did not wear a HC and 53% (n = 3784/7183) reported minimal hair loss (WHO score 0/1) at the start of their final treatment. Outcomes were drug and dose dependent. Besides the chemotherapy regimen, this study did not identify any patient characteristic or lifestyle factor as a generic determinant influencing SC success. For non-gender specific cancers, gender played no statistically significant role in HC use nor WHO score. Conclusions Scalp cooling is effective for the majority of patients. The robust model for evaluating the drug and dose-specific determinants of SC efficacy revealed no indications for changes in daily practice, suggesting factors currently being overlooked. As no correlation was identified between the determinants explaining HC use and WHO score outcomes, new methods for evaluation are warranted. Chemotherapy-induced alopecia is a common consequence of cancer treatment with a high psychological impact on patients and can be prevented by scalp cooling. This study examined the results of chemotherapy regimens to offer an audit into the real-world determinants of scalp cooling efficacy.

Abstract Background Locally advanced rectal cancer (LARC) is treated with combined chemotherapy, radiation, and surgery to maximize the potential for cure. This multimodality treatment approach can result in substantial toxicity for patients, including life-altering changes in bowel, urinary, and sexual function as well as decrements in quality of life (QOL). We explored the lived experiences of patients and caregivers during multimodality treatment for LARC. Methods We conducted a qualitative study of patients undergoing multimodality treatment for LARC and their designated caregivers. Each participant completed an hour-long individual in-depth interview using a semistructured interview guide covering treatment experiences, coping strategies, and supportive care needs. We transcribed, coded, and analyzed interviews using a thematic analysis approach and constant comparison methods. Results We included 21 patients (median age 51 years, 11 women, 17 white, 10 post-surgical resection) and 10 caregivers (6 married/living with patients). We identified five themes among patients and caregivers: (1) the lengthy, complex, and unpredictable nature of multimodality therapy; (2) need to balance receiving detailed information with avoiding information overload; (3) the profound impact that multimodality therapy had on multiple QOL domains; (4) use of coping mechanisms to maintain control and preserve identity; and (5) desire for additional informational and supportive care resources. Conclusion Patients and caregivers face important challenges in navigating care for LARC due to the complicated and unpredictable nature of multimodality therapy. Findings from this study should inform the development of interventions to address the immense informational and supportive care needs of patients receiving multimodality treatment for LARC.

Introduction Identifying and managing unmet supportive care needs is a vital aspect of providing comprehensive healthcare to cancer patients. Planning and redesigning services can be informed by assessment of unmet supportive care need. Objectives This study aimed to assess unmet supportive care needs and associated factors among cancer patients in Ethiopia. Methods A cross-sectional study design was conducted among 260 cancer patients. The sample size was obtained using a simple random sampling method. The collected data were entered and cleaned using EpiData 4.6 and exported to SPSS version 25 for analysis. Binary and multiple logistic regression analyses were performed to identify factors associated with the outcome variable. In the multivariate analysis, adjusted odds ratio (AOR) with 95% confidence interval (CI) were used as measures of association, and a p -value of less than 0.05 was considered statistically significant for unmet supportive care needs. Results A total of 260 individuals were initially approached to participate, yielding a response rate of 93.1%. One hundred eleven participants (45.9%) reported at least one unmet supportive care needs. The most prevalent unmet supportive care needs were physical needs (61.6%) and health system needs (62.4%). Logistic regression analysis revealed age, sex, educational level, and stage of cancer diagnosis were significantly associated with unmet supportive care needs. Conclusion The study highlights a high prevalence of unmet supportive care needs among cancer patients, primarily related to physical needs. The findings suggest potential opportunities for intervention in addressing physical needs. Age, sex, educational level, and stage of cancer at diagnosis were significantly associated with unmet supportive care need. Addressing these factors through tailored interventions can improve patient outcomes and guide policy decisions aimed at reducing unmet cancer support services.

Abstract Background Iron deficiency (ID) is very common in patients with solid tumors and may cause symptoms such as fatigue. However, its impact on clinical outcomes is poorly described. The aim of this prospective monocentric cohort study was to evaluate the evolution of quality of life (QoL) of these patients after iron supplementation. Methods We included patients treated for a solid tumor, which were diagnosed with a functional (ferritin <800 ng/mL) or absolute (ferritin <300 ng/mL) ID (transferrin saturation coefficient <20%). The primary endpoint was patients’ QoL evolution between baseline and intermediate visit, 15-30 days after initial intravenous iron supplementation, assessed by the Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale. Secondary endpoints were the same assessment between baseline, intermediate, and final visit at 6 months and the evolution of functional capacities. Results From 02/2014 to 12/2016, 248 patients were enrolled, of whom 186 were included in the analyses, including 140/186 (75.3%) with absolute ID. Anemia was detected in 141/174 (81.0%) patients at baseline. The FACT-An scores improved significantly between inclusion and intermediate visit (P = .001) and also between the 3 times of evaluation (P < .001). The most improved dimensions were those assessing physical, emotional well-being, and fatigue. Patients who performed the functional tests in all 3 phases had a significant improvement in performance on the majority of tests. Conclusion The supplementation of ID was associated with an improvement of the QoL and functional capacities in patients with cancer. A randomized control trial is necessary to confirm our results. Our findings underline the importance of supportive care, including screening for ID, in oncology. Clinical trial registration number NCT03625661. Iron deficiency is common in patients with solid tumors and may cause fatigue. This article evaluates changes in the quality of life of these patients after iron supplementation.

Head and neck cancer (HNC) survivors experience a significant financial burden (FB) after treatment, even in Germany with a statutory health insurance. The financial toxicity of cancer can cause higher morbidity and mortality rates but may also impair quality of life (QoL). Our investigation aims to elucidate the impact of HNC-related FB on QoL potentially facilitating better understanding of their interplay. Of n  = 209 consecutive HNC patients attending our university hospital’s cancer aftercare program between August 2022 and March 2023, n  = 200 patients completed the EORTC QLQ-Q30 questionnaire, and we analyzed the QoL scale data based on their self-reported FB. Parametric and non-parametric analyses were used to assess the impact of FB and independent predictors on QoL and QoL scales, and causal diagrams were used to visualize their causal relationship. HNC patients reported significant impaired QoL in consequence of FB. Significant detrimental effects of FB were observed on role functioning (RF; p  = 0.0011), emotional functioning (EF; p  = 0.0039), cognitive functioning (CF; p  = 0.0149), and social functioning (SF; p  = 0.0011). Advanced stage, advanced T category, and suffering from larynx/hypopharynx cancer demonstrated a significant quantitative interaction with FB increasing the risk for impaired QoL with respect to RF, EF, CF, and SF. HNC survivors suffer from significant impaired QoL and FB after treatment. In general, FB impairs particular QoL scales, and these QoL scales are differentially affected by particular tumor characteristics together with FB jointly impairing QoL of HNC survivors.