BackgroundImmune checkpoint inhibitors (ICIs) have transformed cancer treatment, driving increased research into immune-related adverse events (irAEs), including pain. ICI-induced pain differs from traditional cancer pain or pain caused by chemotherapy or radiotherapy in its mechanisms, manifestations, and management. It often necessitates ICI dose reduction, potentially compromising efficacy, and requires careful balancing of immunosuppression and analgesia. Although glucocorticoids are first line for inflammatory pain, their long-term or high-dose use can attenuate ICI effectiveness, increase infection risk, and lead to pain recurrence after withdrawal—making “steroid-sparing strategies” a central clinical challenge. However, bibliometric studies in this area remain scarce. This analysis of 484 publications examines research trends, advances, characteristics, and management challenges of the pain spectrum in ICI-related irAEs.MethodsA systematic literature search was performed in the Web of Science Core Collection (WoSCC), yielding 484 relevant papers. Visualization and analysis were conducted using VOSviewer and CiteSpace. Collaboration networks, keyword co-occurrence, citation relationships, and citation burst detection were analyzed to identify research structures and current focal points.ResultsOncology forms the core discipline, with U.S. institutions playing a leading role. International collaboration is vital for advancing the field. Current research focuses on characterizing pain phenotypes across different ICIs and elucidating their potential immunological mechanisms. A major clinical challenge lies in early identification and differentiation of ICI-related pain from tumor- or treatment-related pain. Equally important is balancing rapid irAE control with avoiding the negative impact of prolonged steroid use on pain outcomes. Developing “steroid-sparing strategies” and establishing predictive biomarker systems are essential for achieving precision pain management.ConclusionThis bibliometric study maps the knowledge landscape and developmental trends of pain in ICI-related adverse events, underscores the need for interdisciplinary collaboration, and highlights future directions for overcoming clinical challenges and advancing individualized, precision-based treatment strategies.Supplementary informationThe online version contains supplementary material available at 10.1007/s00520-026-10440-4.

PurposeThe interpretation of patient-reported outcomes (PROs) in oncology research lacks a shared understanding of clinical relevance among interest groups. Terms like minimal important differences and clinically meaningful change aim to aid interpretation but remain inconsistently conceptualized. This study explores interest-holders’ perspectives to support setting-specific definitions of clinical relevance in PRO research.MethodsAn online survey was distributed via international networks to multi-professional interest-holders. Responses to an open-ended question regarding participants’ understanding of clinical relevance were analyzed using qualitative content analysis to identify recurring themes and patterns within the quotes.ResultsThe survey included 92 participants: clinical practitioners (38.5%), academic researchers (47.3%), industry researchers (8.8%), and patients/patient representatives (rep.) (5.5%). Five clusters emerged reflecting facets of clinical relevance: (a) patient value (e.g., impact on well-being), (b) practical implications (e.g., treatment changes), (c) external criteria (e.g., physiological changes), (d) statistical approaches (e.g., 10% difference), and (e) proxy value (e.g., physician’s perspective). Practitioners primarily focused on patient value (55.6%), while academic researchers showed a similar distribution but with greater variance across clusters. In contrast, industry researchers more frequently emphasized external criteria (20.0%) and proxy value (20.0%) compared to other groups. Patient value and statistical approaches were not mentioned by the same participants, nor were external criteria and practical implications.ConclusionConceptual understanding of clinical relevance varies by professional background, highlighting its multifaceted nature. These findings, identifying distinct conceptual clusters across interest groups, provide a foundation for developing harmonized, context-specific definitions of clinical relevance in PRO research.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10387-6.

PurposeThe aim of this study was to study the effect of transcranial stimulation with photobiomodulation (tPBM) in patients suffering from chemobrain.MethodPatients referred to a consultation dedicated to the management of post-chemotherapy cognitive impairment were included. The FACT-Cog (overall score and subscale) French version was used to assess perceived cognitive impairment and impact on quality of life for each patient before and at the end of tPBM treatment. All patients included were treated for chemobrain using transcranial stimulation by PBM for a minimum of 10 weeks (10 sessions, 1 session per week). The PBM consisted of transcranial stimulation delivered using a Vielight Neuro Duo 4® PBM device (in Gamma mode) for 20 min. Differences between pre- and post-treatment proportions were assessed with the McNemar test for paired data. Differences between FACT-Cog scores (total score and subscale) were assessed by the Wilcoxon signed-rank test.ResultsThirty-one women were included (mean age 52.1 ± 9.0 years). Mean total FACT-Cog score prior to tPBM was 63.3 ± 19.8. After the course of tPBM sessions, the mean total FACT-Cog score was 101.2 ± 20.1 (p < 0.001). Twenty-nine patients improved cognitive performance and, in 9 patients (29.0%), the FACT-Cog score had normalized. There was no significant difference between the proportion with anxiety or depression before vs after tPBM (p = 0.22 for anxiety, p = 0.62 for depression).ConclusionTranscranial stimulation by PBM shows therapeutic perspectives for the management of chemobrain.

PurposeTaste dysfunction is a common but underrecognized complication in patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT). Taste dysfunction can adversely affect oral intake, nutritional status, and overall quality of life. This study aimed to comprehensively evaluate taste function in allo-HCT recipients using both objective and subjective measures and to identify clinical factors associated with taste disturbances.MethodsWe conducted a prospective observational study of 21 adult allo-HCT recipients. Taste function was assessed at two time points (pre-conditioning and pre-discharge) using the whole-mouth taste testing method for the five basic tastes and the Chemotherapy-induced Taste Alteration Scale (CiTAS). All 21 patients completed the CiTAS, and 19 patients underwent whole-mouth taste testing.ResultsMost patients exhibited objective taste dysfunction before transplantation, particularly for sweet, salty, sour, and bitter taste qualities. The objective taste thresholds remained stable post-transplantation, but the subjective CiTAS scores worsened for basic taste, general alterations, and discomfort. There was a trend (p = 0.057) for objective umami taste to be better preserved in patients with gastrointestinal graft-versus-host disease (GI-GVHD). Oral mucositis was associated with higher phantogeusia/parageusia scores, while high malnutrition risk or weight loss correlated with lower subjective symptom scores.ConclusionThe discrepancy between subjective and objective assessments of taste dysfunction highlights that taste perception is regulated by multifactorial and complex mechanisms. Intensive supportive care, which is often provided to severely ill patients, may offer psychological reassurance that indirectly improves self-reported taste symptoms. Whether umami sensitivity is influenced by systemic factors such as GI-GVHD requires further study.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10403-9.

PurposeWe aimed to understand patients’ initial experiences with targeted oral anticancer agents (OAAs). We investigated symptoms experienced and how symptom severity affected patient confidence to manage and seek care for symptoms and OAA adherence.MethodsWe conducted a longitudinal prospective cohort study of patients during the first 8 weeks of targeted OAA treatment at an NCI-designated cancer center. Participants completed patient-reported outcome measures (PROMs) online at three timepoints. Descriptive statistics quantified demographics, cancer characteristics, symptom severity, confidence, and OAA adherence. Logistic regression was used to estimate confidence and adherence by each symptom at each timepoint. Mixed effects logistic regressions accounted for repeated measures and time effects on outcomes.ResultsParticipants (n = 59) reported severe symptoms at all timepoints. Tiredness and drowsiness were most frequently reported as severe. Participants’ confidence increased from timepoint 1 to 3. Most participants reported high confidence (61–86%) and excellent adherence (75–80%) across all timepoints, but 20–25% had less than excellent OAA adherence. High confidence to manage symptoms was positively associated with older age. Confidence to manage symptoms was inversely related to the severity of depression, tiredness, drowsiness, constipation, and tingling/numbness.ConclusionConfidence to manage symptoms increased with time on OAAs, but severe symptoms persisted. Although self-reported OAA adherence was high, a notable number of participants reported suboptimal adherence. Relationships between confidence, symptom severity, and adherence should be identified in clinical settings to evaluate patients who may need extra clinical support during OAA treatment.

PurposeThis study aims to assess for indications of stigma and attitudes toward cannabis among cancer survivors (CS) who use or consider the use of cannabis.MethodsThis study employed a convergent, parallel mixed methods design utilizing focus group and questionnaire data to assess the presence of stigma among a sample of CS (n = 23) who use (n = 10) and do not use (n = 13) cannabis to manage symptoms. CS were recruited from a multi-site observational study in the Northeast U.S. region that assesses cannabis use among oncology patients.ResultsA total of 23 CS participated in this study. In general, this sample appeared to have positive attitudes towards cannabis, as indicated by quantitative results, and most CS felt accepting or neutral about other CS using cannabis, irrespective of whether they used or not. Most CS did not indicate experiences of stigma for cannabis use, did not feel judged by their medical providers, and indicated a feeling of empowerment to do whatever was needed to feel better. However, several CS reported intentional nondisclosure to their providers. Many CS discussed the presence of opioid-related stigma, both perceived from society and internalized, which appeared to play an important role in their symptom-management decision-making.ConclusionsFindings from this study suggest that while cannabis stigma may not be commonplace for CS, some do experience it. Further, opioid stigma appears to be perceived and intertwined in the decision-making processes for CS in this sample.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10523-2.

PurposeHematopoietic stem cell transplantation (HSCT) is a physically and psychosocially complex process for patients and their families, and nurses play a key role in coordinating patient care. This study aimed to explore nurses’ perspectives on caregiver engagement in the care of patients undergoing hematopoietic stem cell transplantation.MethodsA qualitative descriptive design with purposive sampling was used. Data were collected through semi-structured interviews with eleven nurses working in a bone marrow transplantation unit in Ankara. The data were analyzed using thematic analysis.ResultsFive main themes and ten sub-themes were identified. The main themes were 1) Nurses’ expectations and caregiver involvement, 2) Impact of caregiver’s engagement, 3) Caregiver strain and challenges, 4) Support needs of caregivers, and 5) Nurses’ role in supporting caregivers.ConclusionsNurses perceived that caregiver engagement positively improves patient outcomes but also noted that this placed a significant burden on caregivers. Nurses play a pivotal role in addressing the challenges and supporting caregivers through emotional support, education, and advocacy. Targeted interventions, such as education, psychological support, and enhanced communication, are crucial for supporting caregivers effectively and improving the well-being of both caregivers and patients.Supplementary informationThe online version contains supplementary material available at 10.1007/s00520-026-10424-4.

PurposeNEPA, a fixed-antiemetic combination of netupitant and palonosetron, is available via two administration routes (oral and intravenous). A new oral suspension was developed to offer a more convenient option for patients. This study evaluated the bioequivalence between the oral capsule and the oral suspension.MethodsOpen-label, randomized, single-center phase I trial conducted according to a two-treatment, four-period, two-sequence replicative design. Two treatments were investigated for bioequivalence: a 10-mL oral suspension (Test [T]) and the hard capsule (Reference [R]), both containing 300 mg netupitant/0.5 mg palonosetron. Healthy individuals were randomized (1:1) to receive two doses of both Test and Reference formulations, in either T-R-T-R or R-T-R-T sequence. The primary objective was to demonstrate AUC0-t bioequivalence of netupitant and palonosetron after a single dose of Test and Reference formulations.ResultsIn total, 72 participants were included. The geometric mean plasma concentration–time profiles of netupitant and palonosetron were similar for the Test and Reference formulations. The AUC0-t geometric means of both analytes were similar for the Test and Reference formulations. The 90% confidence interval of the Test/Reference ratios for AUC0-t of netupitant and palonosetron were within the acceptance range for bioequivalence of 80–125%. The AUC0-t variability was moderate for netupitant and low for palonosetron. Both formulations were well tolerated.ConclusionThe NEPA oral suspension is pharmacokinetically bioequivalent to the capsule formulation in healthy individuals, with no new safety concerns. These findings support NEPA oral suspension as a potentially beneficial option for patients who prefer an oral suspension over a hard capsule and for those with swallowing difficulties.EUCT Number: 2023–504355-28–00 (25/08/2023).Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10345-2.

PurposeCognitive and psychological symptoms in neuropsychiatric disorders have been linked to blood cell parameters, including neutrophil-to-lymphocyte ratios (NLRs), systemic immune-inflammation indices (SIIs), and platelet-to-lymphocyte ratios (PLRs). It remains unclear whether cognitive impairments in haematological cancers are associated with biological vulnerabilities reflected in these parameters. We examined whether cognitive and psychological morbidity correlated with blood cell parameters before, during, and after chemotherapy in individuals with aggressive lymphoma.MethodsNeuropsychological testing and self-reported questionnaires were administered at diagnosis, mid-chemotherapy, and 6–8 weeks post-treatment (n = 30). Regression models assessed associations between cognition and blood cell parameters. Bootstrapped Pearson correlations examined relationships between NLRs, SIIs, PLRs, and psychological symptoms. To test specificity, similar analyses were conducted in healthy controls (n = 72).ResultsIn individuals with aggressive lymphoma, NLRs, SIIs, and PLRs correlated with impairments in inhibitory control, cognitive flexibility, delayed recall, and working memory across time points (p < 0.05). A disconnect emerged between these parameters and subjective self-reports. At diagnosis, lower NLRs, SIIs, and PLRs were associated with worse objective cognitive performance but better perceived cognition. Mid-chemotherapy, higher NLRs correlated with worse delayed recall but fewer reported depression and anxiety symptoms (p < 0.05). No significant associations were observed in healthy controls.ConclusionCognitive impairment was associated with blood cell parameters in individuals with aggressive lymphoma, indicating distinct biological patterns of dysfunction before, during, and after chemotherapy. The disconnect between objective neuropsychological performance and subjective self-reports reinforces the value of incorporating biomarkers into cognitive assessments in this population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10317-6.

PurposeBiannual ultrasound-based hepatocellular carcinoma (HCC) surveillance is standard practice for individuals with cirrhosis and subgroups with non-cirrhotic hepatitis B. While this practice improves cancer-related survival, the detection of false-positive results can lead to additional testing which poses both physical and psychosocial risks. Our study explored the psychosocial consequences of false-positive ultrasound results in participants undergoing HCC surveillance.MethodsWe performed a qualitative study with semi-structured interviews to understand the psychosocial impact of participants who received a false-positive ultrasound result during HCC surveillance until no new themes emerged. Key themes were analysed using the Framework Approach.ResultsTen participants with cirrhosis or non-cirrhotic hepatitis B were recruited. Most had a poor understanding of the role of ultrasound in HCC surveillance. Some participants experienced significant anxiety with existential concerns impacting family and work life. Others remained uninformed about the risk for HCC and did not experience significant psychosocial impacts. The lack of understanding about the role of surveillance and the potential for false positives contributed to unpredictable psychosocial consequences. Despite experiencing surveillance-related harm, all participants wished to continue regular surveillance.ConclusionOur findings highlight a need for improved health literacy about the purpose and potential harms of HCC surveillance. Optimising surveillance protocols to minimise false-positive findings may also further alleviate physical and psychosocial harm.