PurposeThis multi-national cross-sectional study assessed socio-demographic and clinical determinants of satisfaction with cancer care in patients enrolled from hospital inpatient and outpatient settings.MethodsSix hundred ninety consecutive patients with any cancer type or stage including 558 outpatients were approached between October 2019 and October 2023 in 12 countries (20 cancer centres) from Asia, Europe, the Middle East and South America. Among them, 675 (98%) and 521 (93%) completed the EORTC PATSAT-C33 and the OUT-PATSAT7, respectively. Multi-level analyses were performed accounting for institutional differences in satisfaction with care.ResultsSelf-reported quality of life was positively related to all thirteen PATSAT-C33 and OUT-PATSAT7 satisfaction with care domains. Treatment toxicities and the absence of comorbidity predicted lower satisfaction with nine and ten care domains, respectively. Patients in day hospitals were significantly less satisfied with nurses’ availability, care coordination and health professionals’ information. Tumour site predicted satisfaction with care transition hospital-home. Not being married/with a partner and shorter travels to the hospital predicted less satisfaction with five and two care domains, respectively.ConclusionThis study illustrates the value of collecting patients’ feedback on their cancer care experience. It informs health policy, pointing out targets for improving satisfaction with cancer care across several institutions and cultures worldwide.Trial registrationClinicalTrials.gov under ID: NCT05989191, August 2, 2023Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10433-3.

PurposeCytoreductive surgery (CRS) with or without intraperitoneal hyperthermic chemotherapy (HIPEC) is a complex surgery aimed at removing peritoneal surface malignancy (PSM). PSM is prevalent in ovarian cancer, with up to 85% of patients experiencing non-specific symptoms leading to malnutrition. Studies have shown oncology patients display confusion about nutrition recommendations, although understudied in ovarian cancer. Experience-based co-design is a method of participatory research with key principles including empowerment and collaboration. This project aims to utilise experience-based co-design to understand nutrition challenges and develop nutrition resources for women undergoing CRS ± HIPEC for ovarian cancer. The secondary aim is to evaluate the experience-based co-design process to ensure it aligns with key principles of co-design.MethodsThis multi-centre study utilises experience-based co-design. Using maximum variation sampling, women with lived experience of CRS ± HIPEC for ovarian cancer, along with experienced oncology healthcare professionals will be invited to participate. Participants will be interviewed to identify key nutrition issues and information needs. Using thematic analysis, a patient journey map will be developed and key themes identified. A feedback session will be held for participants to identify priorities for service improvement and patient resource development based on key issues identified by patient journey mapping. These priorities will be addressed in co-design workshops with participants with lived experience and clinicians to develop patient information resources. Resources and experience-based co-design processes will be evaluated at the completion of the workshops.ConclusionsThis study will deliver new insights into the nutrition challenges and information needs identified by people undergoing CRS ± HIPEC for ovarian cancer within a co-design approach.

IntroductionTreatment for childhood acute lymphoblastic leukemia (ALL) can result in hepatotoxicity. Despite being a common complication of ALL therapy, mechanisms and biomarkers of treatment-associated hepatotoxicity (TAH) are not well described.MethodsWe conducted lipidomic profiling to identify plasma lipids associated with TAH in children receiving ALL therapy utilizing a nested case–control framework. TAH was defined as (1) transaminitis: ALT/AST ≥ CTCAE grade 3, and/or (2) conjugated hyperbilirubinemia: > 3.0 mg/dL during induction therapy or > 2.0 mg/dL post induction. A total of 90 patients (45 matched pairs) treated at Texas Children’s Hospital between 2012 and 2021 were selected for lipidomic profiling, with controls matched to cases based on the availability of samples collected at similar time points in therapy. Lipidomic profiling quantified 1056 lipids, with 751 retained after quality control. Associations with TAH were evaluated using multivariable conditional logistic regression controlling for age, diagnostic BMI z-score, race/ethnicity, and induction intensity.ResultsThe cohort was 55% male, 50% Hispanic, with a mean diagnostic age of 5 years. We identified 110 lipids nominally associated with TAH post-sample collection (p < 0.05). Lipid classes phosphatidylcholines (PCs; Holm-p = 5 × 10−6) and sphingomyelins (SMs; Holm-p = 0.0009) were significantly enriched in cases.DiscussionWe identified plasma lipid profiles, characterized by elevated PCs and SMs with reduced triglycerides, associated with the incidence of TAH in children with ALL. Similar patterns have been linked to metabolic liver disease in adults and children. These findings suggest lipid dysregulation may contribute to TAH susceptibility and highlight candidate biomarkers for future validation in larger cohorts.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10414-6.

BackgroundSurgical resections of foregut malignancy are generally procedures with substantial morbidity and mortality. The use of exercise therapy has resulted in improvements in outcomes in many parts of the cancer treatment pathway and thus has become a standard addition to oncology and surgical oncology paradigms including during chemotherapy and as prehabilitation and rehabilitation for surgery. Guided in-hospital interval training as post-surgical therapy has not been evaluated as a treatment tool. If safe and acceptable to patients, this has the potential to improve surgical outcomes.MethodsTwenty-one subjects were enrolled in a prospective single-arm trial of guided in-hospital, immediately postoperative moderate- (+) intensity interval training while recovering from a resection of foregut malignancy. A specific exercise program was designed for the postoperative setting and administered, aimed at achieving maximal intensity training during surgical recovery in the hospital environment. We hypothesized that this intervention would be safe, acceptable to patients, and would not negatively influence health-related quality of life. This was assessed by compliance with exercise sessions, the incidence of training-related complications, and the EORTC QLQ-30 and Hospital Anxiety and Depression scores.ResultsTwenty-one patients were enrolled in this study (7 esophagectomies, 10 laparotomies, 4 laparoscopies). Participation in the program was high with 90.5% of subjects completing greater than 25% of all possible sessions and 71.4% of patients completing greater than 50% of possible sessions. There was no intervention-related adverse event. There was no reduction in emotional quality of life measures on discharge.ConclusionsAdministering a postoperative moderate- (+) intensity interval training program following recovery from major foregut surgery is acceptable to patients with high rates of participation. It is safe and does not result in a reduction in emotional health related quality of life.Supplementary informationThe online version contains supplementary material available at 10.1007/s00520-026-10453-z.

PurposeThis study examined the long-term effects of standard care lymphoedema treatment, delivered by cancer support centres in community-based settings, on quality of life and self-reported symptom severity among individuals with cancer-related lymphoedema (CRL).MethodsA single-group pre-post pragmatic study design was adopted. Survivors of cancer referred to community-based cancer support centres were recruited. Participants received a minimum of 3 standard care lymphoedema treatment sessions at the centres with a certified lymphoedema clinician at baseline (T1), 1 month (T2) and 6 months (T3), where core treatment strategies included lymphoedema education to enable self-management, skin care and weight management. Assessments of quality of life and symptom severity were conducted at each visit using limb specific versions of the Lymphoedema Quality of Life (LYMQoL) questionnaire (i.e. arm LYMQoL, leg LYMQoL) as applicable for each person, and a researcher-developed tool of self-reported symptom severity.ResultsOne-hundred and twenty survivors of cancer were recruited (mean age (± SD) 59 (± 12y); 90% female). Forty participants (33%) completed the T3 assessment. Linear mixed-model analyses demonstrated significant improvements in arm-CRL QoL (n = 78) and leg-CRL QoL (n = 18) from T1 to T3 (p < 0.05), with small (Cohen’s d = 0.24) and large (Cohen’s d = 0.85) effect sizes respectively. All 7 self-reported symptom ratings, including pain, swelling and functional restriction, improved from T1–T3.ConclusionStandard care lymphoedema treatment, when delivered in community-based cancer support centres, was associated with improvements in QoL and self-reported symptoms among survivors of cancer with arm and leg lymphoedema at 6 months.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10432-4.

ObjectiveCancer-related pain remains a major challenge in inpatient oncology care, affecting a large proportion of patients with advanced malignancies. This retrospective cohort study was aimed at evaluating whether implementation of a standardized painless ward model was associated with improved cancer pain control and hospitalization outcomes compared with conventional ward-based care.MethodsThis single-center retrospective cohort study included 848 hospitalized patients with pathologically confirmed malignancies and cancer-related pain. Patients admitted before painless ward implementation (general ward, January 2021–December 2022; n = 422) were compared with those admitted after implementation (painless ward, January 2023–December 2024; n = 426). Baseline pain intensity was assessed at admission using the Numerical Rating Scale (NRS). Pain reassessment was performed by trained oncology nursing staff at least once daily and every 4 h when NRS > 4, with physician reassessment when clinically indicated. Pain outcomes at discharge, change in pain intensity during hospitalization (ΔNRS), length of stay (LOS), and prolonged hospitalization (LOS > 10 days) were evaluated. Multivariable linear regression analyses were performed to adjust for baseline pain and demographic factors.ResultsPatients managed in the painless ward experienced a greater reduction in pain intensity during hospitalization compared with those in the general ward, with a lower prevalence of severe pain (NRS ≥ 7: 15.5% vs. 24.4%) and a lower mean NRS score (3.70 ± 2.27 vs. 4.35 ± 2.62; P < 0.01). Gender- and age-related differences in pain severity observed under conventional care were not observed following painless ward implementation. The painless ward was also associated with a shorter mean LOS (10.15 ± 7.53 vs. 11.72 ± 7.49 days) and a lower proportion of prolonged hospitalization (36.6% vs. 48.1%). Baseline pain severity at admission was higher in the painless ward group (mean NRS 7.39 ± 1.86) than in the general ward group (6.11 ± 2.33; P < 0.001). Despite this, patients managed in the painless ward experienced a greater reduction in pain intensity during hospitalization (mean ΔNRS −3.69 ± 1.30 vs. −1.76 ± 0.68; P < 0.001). After adjustment for baseline NRS, age, and gender, admission to the painless ward remained independently associated with greater pain reduction (β = −2.00, 95% CI −2.14 to −1.85; P < 0.001). The painless ward was also associated with a shorter mean LOS and a lower proportion of prolonged hospitalization.ConclusionThis real-world study suggests that implementation of a standardized painless ward model is associated with better inpatient cancer pain control, shorter hospitalization duration, and attenuation of demographic differences in pain severity. These findings should be interpreted as associative and warrant confirmation in prospective studies.

PurposeFor those with a life-limiting illness, advance care planning (ACP) is essential for patient-centered care. However, there is limited research available on the timing and impact of ACP on patients with brain tumors, particularly with glioblastoma. The primary aim of this study was to determine if there is a relationship between advance directive (AD) documentation, a part of ACP, and depression, performance status scores, or demographics of patients with glioblastoma.MethodsThe sample consisted of 146 patients with glioblastoma, 98 of whom had documented AD, defined as within the 14 days prior to diagnosis or during their disease course, at a single comprehensive cancer center. Demographic characteristics, depression scores, performance status scores, and AD documentation were extracted from electronic medical records over repeated clinical time points. Logistic regression, mixed model, and generalized estimating equations models were used to assess relationships between patient variables and documentation of AD.ResultsNo statistically significant difference in depression scores was found between those with and without documented AD. There was a statistically significant difference in performance status, such that those with worse performance status were more likely to have a documented AD. Patients who were female, older, and not married were more likely to have documented AD.ConclusionIn our sample, AD was more likely to be established for patients with advanced disease and specific demographic factors, whereas depression scores did not predict presence or absence of AD. This may indicate that patients with decreased performance status may be more receptive to completing AD than those with better performance status. Alternatively, it could reflect that providers are more likely to approach the subject as their health deteriorates. Patients preparing for neurosurgical intervention might be more receptive to AD completion and ACP discussion than patients in other phases of care. We offer recommendations to promote a more proactive approach to AD so that more patients are prepared by the time their performance status starts to decline.Supplementary informationThe online version contains supplementary material available at 10.1007/s00520-026-10492-6.

PurposeIntegrative complementary medicine (ICM) combines complementary therapies with conventional supportive and palliative care to address quality of life (QoL). Diabetes mellitus (DM) is prevalent among patients with cancer and has been associated with worse health-related QoL. We examined the impact of an ICM program on QoL-related concerns among patients being treated for cancer, with vs. without DM.MethodsThis prospective, controlled and pragmatic study examined a 6-week ICM program, comparing DM to non-DM patients using the ESAS (Edmonton Symptom Assessment Scale) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) tools. The threshold for statistical significance was established at a P-value of less than 0.05.ResultsOf 671 patients, 135 (20%) had DM, with similar baseline QoL-related concerns (pain, fatigue, gastrointestinal and emotional concerns) in both groups. DM patients (vs. non-DM) responded significantly less on drowsiness on ESAS (P = 0.047); and emotional functioning on EORTC (P = 0.017). Compared to baseline, the non-DM group showed significant improvement in fatigue and sleep quality (on ESAS and EORTC; P < 0.001), while the DM group did not show any improvement for these concerns.ConclusionPatients with cancer and DM showed a less significant response to ICM treatments when compared to non-DM patients, emphasizing the need for identifying this sub-population of patients while creating specialized ICM programs tailored to their needs. Future research should focus on exploring the impact of ICM programs on patients with both DM and cancer.Trial registrationClinicalTrials.gov NCT01860365, 2013-05-21.

PurposeCyclophosphamide is a commonly used chemotherapeutic agent in hematopoietic stem cell transplantation (HSCT), but its use can lead to adverse effects such as hemorrhagic cystitis (HC) and electrolyte disturbances, including hyponatremia. While standard hydration protocols are used to mitigate these risks, the optimal regimen remains unclear. This study explores the impact of a restrictive hydration regimen on HC incidence and electrolyte imbalances in patients undergoing high-dose cyclophosphamide treatment as part of HSCT conditioning.MethodsA retrospective cohort study was conducted at Amsterdam UMC, including patients who received high-dose cyclophosphamide as part of HSCT between 2016 and 2024. Patients were grouped based on hydration protocols: an original regimen (5 L of NaCl 0.45%/dextrose 2.5% per day) and a new restrictive regimen (1.5 L/m2/day of 0.65% NaCl). The primary endpoint was the incidence of HC, while secondary endpoints included sodium and potassium changes, fluid overload (measured by furosemide use), and clinical outcomes.ResultsHC occurred in 10/386 (2.6%) patients in the original protocol and 1/69 (1.4%) in the restrictive protocol (odds ratio [95% confidence interval]: 0.55 [0.03–2.96], p = 0.57). Clinically relevant hyponatremia was less common with the restrictive regimen (1.4%) than with the original protocol (4.4%), though the difference was not significant (p = 0.27). On the other hand, patients receiving the restrictive regimen showed more clinically relevant hypokalemia (8.7% vs 5.9%, p = 0.28). Fluid overload, as indicated by furosemide use, was lower in the restrictive group albeit not statistically significant.ConclusionIn this retrospective single-center cohort, we did not observe a higher incidence of HC or electrolyte imbalances with a restrictive hydration regimen compared to the original regimen.

PurposeDetermine the acceptability of a community-based, practical Geriatric Assessment (GA) intervention among community health workers (Promotoras) and cancer survivor key informants. Promotora-delivered health assessment, education, and social support models of care are feasible and effective in chronic disease management, but more evidence is needed in the cancer survivorship context. Promotoras function as a bridge, connecting community-based services with populations with historically limited healthcare engagement.MethodsDescriptive qualitative design. We held focus groups with promotora key informants and interviews with older cancer survivor consultants, between January and February 2024. Researchers developed a semi-structured interview guide, informed by conceptual models and an implementation framework, to facilitate perceptions of promotora-guided interventions, GA, and cancer survivorship. Researchers performed content analysis with deductive and inductive techniques on transcribed interviews.ResultsAcceptability of the GA intervention was described by promotoras and cancer survivor consultants within three distinct categories: The GA intervention employs a motivator to help address survivorship complexities; the GA intervention plans for impaired ADLs and IADLs in survivorship; the GA intervention integrates promotoras with clinical oncology care.ConclusionThe proposed implementation of a practical GA intervention by promotoras was deemed acceptable. The findings provided essential contextual data to ensure that the pilot, practical GA study can establish feasibility and preliminary efficacy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10473-9.