Chemotherapy In Cancer Patients Research Articles

Electrical acupoint stimulation for the treatment of chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis

BackgroundChemotherapy-induced nausea and vomiting (CINV) is the most common adverse effect of chemotherapy and affects the continuation of chemotherapy in cancer patients. Electrical acupoint stimulation (EAS), which includes electroacupuncture and transcutaneous electrical stimulation(TES), has been used to treat CINV. This meta-analysis aimed to evaluate the efficacy of EAS in the treatment of CINV. MethodsRandomized controlled trials (RCTs) of EAS for CINV retrieved form five key databases. Two researchers independently performed article screening, data extraction and data integration. The Cochrane Collaboration’s tool for assessing risk of bias was used to assesse the methodological quality according to Cochrane Handbook for Systematic Reviews of Interventions. RevMan 5.4 was used to perform analyses. Results10 RCTs with a total of 950 participants were included. The results showed that there was no significant difference between EAS compared to sham EAS in terms of increasing the rate of complete control of CINV and decreasing the overall incidence of CINV [RR=1.26, 95% CI (0.96, 1.66), P =0.95; RR=1.16, 95% CI (0.97, 1.40), p=0.71]. In terms of CINV severity, EAS reduced the occurrence of moderate-to-severe CINV [RR=0.60, 95% CI (0.38, 0.94), P=0.03; RR=0.50, 95% CI (0.33, 0.76), P =0.001]. ConclusionEAS could improve moderate-to-severe CINV. However, EAS did not show a significant difference in reducing overall incidence and improving complete control rates compared with sham EAS. Due to limitations in the quality of the included articles, the available studies are insufficient to have sufficient evidence to confirm the efficacy of EAS for CINV. Validation with rigorously designed, large-sample, high-quality clinical trial studies may also be needed.

Symptom cluster study undergoing chemotherapy in breast cancer patients: latent class analysis and contemporaneous network analysis

PurposeThis study aims to explore the subgroups and networks of symptom clusters in breast cancer patients undergoing chemotherapy, and to provide effective interventions for the core symptoms. Patients and methodsA cross-sectional survey was conducted at four comprehensive hospitals in Foshan City, China, from August to November 2023. A total of 292 participants completed the Social Determinants of Health Questionnaire, the Numerical Rating Scale (NRS), the Pittsburgh Sleep Quality Index (PSQI), the Chinese version of the Cancer Fatigue Scale (CFS), and the Hospital Anxiety and Depression Scale (HADS). Latent class analysis (LCA) was utilized to distinguish subgroups, and network analysis was utilized to identify core symptoms among different subgroups. ResultsBreast cancer patients undergoing chemotherapy exhibit symptoms were divided into two subgroups: the High Burden Group of Symptoms (72.3%, Class 1) and the Low Burden Group of Symptoms (27.7%, Class 2). Education attainment, work status, family monthly income per capita, and daily sleep duration (hours) were associated with subgroup membership. “Panic feelings” (# HADS-A11) were the core symptom in both the full sample and Class 2, while “tension or pain” (# HADS-A1) was the core symptom in Class 1. ConclusionThe core symptoms of fear, enjoyment, nervousness, and pain varied across subgroups of patients and could inform the current strategies for symptom management in breast cancer chemotherapy patients.

Factors influencing self-regulatory fatigue in patients undergoing chemotherapy for gynecologic cancer: a cross-sectional study.

To understand the current status of self-regulatory fatigue among gynecologic cancer chemotherapy patients and explore influencing factors. Using convenient sampling, a total of 232 gynecological cancer chemotherapy patients from two tertiary hospitals in Zhengzhou, Henan, China, were selected as study subjects from February 2023 to April 2023. General information questionnaire, Self-Regulatory Fatigue Scale (SRF-S), Strategies Used by People to Promote Health (SUPPH) Scale, Connor-Davidson resilience scale (CD-RISC) and Perceived Social Support Scale (PSSS) were employed for data collection. The data were analyzed using SPSS 26.0 software. Chi-square test and binary logistic regression were executed to explore the correlates of self-regulatory fatigue, the significance level (α) was set at 0.05. The self-regulatory fatigue score of the 232 patients was 44 (36, 56). Binary logistic regression analyses revealed significant associations, demonstrating that residing in urban areas (OR=0.241, P=0.015), having no comorbidities (OR=0.158, P=0.015), increased perceived social support (OR=0.937, P=0.001), strong self-efficacy (OR=0.959, P=0.021), and heightened psychological resilience (OR=0.895, P<0.001) acted as protective factors against self-regulatory fatigue (P < 0.05). Patients residing in rural areas, having more than two comorbidities, lower self-efficacy and psychological resilience levels, and lower perceived social support are indicative of higher levels of self-regulatory fatigue. Identifying these influencing factors can provide references and support for developing individualized support and intervention measures to improve patients' physical and mental well-being.

Implementation of personalized multidisciplinary neuropathy management program for chemotherapy-induced peripheral neuropathy symptoms in breast cancer patients

Objective To construct a personalized multidisciplinary neurotoxicity management program for chemotherapy-induced peripheral neuropathy (CIPN) symptoms in breast cancer patients and evaluate its application effects. Methods A retrospective analysis was conducted on clinical data of 133 breast cancer chemotherapy patients admitted to our hospital from January 2022 to January 2024. Based on the nursing protocols received, patients were divided into a control group (n = 66) and an intervention group (n = 67). The control group received conventional nursing interventions, while the intervention group received personalized nursing interventions in addition to the control group interventions. The nursing programs were carried out during chemotherapy. A comparison was made between the two groups before chemotherapy and 3 months after chemotherapy in terms of the degree of neuropathy, cancer-related fatigue, negative emotional status, and symptom management knowledge, attitudes, and practices (KAP). Results The intervention group showed significantly lower neuropathy severity (FACT/GOG-Ntx), cancer-related fatigue (CFS), and negative emotions (PHQ-9, GAD-7) scores after chemotherapy compared to the control group (p < 0.05). Additionally, the intervention group exhibited higher scores for symptom management knowledge, beliefs, and behaviors (p < 0.05). Conclusion Personalized multidisciplinary neurotoxicity management program significantly improved neuropathy severity, reduced cancer-related fatigue and negative emotions, and enhanced symptom management knowledge, attitudes, and practices among breast cancer patients undergoing chemotherapy.

The associates of anxiety among lung cancer patients: Dehydroepiandrosterone (DHEA) as a potential biomarker

ObjectiveAnxiety is a prevalent comorbidity in lung cancer (LC) patients associated with a decline in quality of life. Dehydroepiandrosterone (DHEA), a neuroactive steroid, levels rise in response to stress. Prior research on the association between DHEA and anxiety has yielded contradictory results and no study has investigated this association in LC patients.MethodsA total of 213 patients with LC were recruited from a general hospital. Data on demographic and cancer-related variables were collected. Using the Chinese version of the Hospital Anxiety and Depression Scale (HADS), the degree of anxiety was determined. Cortisol, DHEA, and Dehydroepiandrosterone sulfate (DHEA-S) levels in saliva were measured. Adjusting for confounding variables, a multivariate regression analysis was conducted.Results147 men and 66 women comprised our group with an average age of 63.75 years. After accounting for demographic and treatment-related factors, anxiety levels were significantly correlated with, post-traumatic stress symptoms (PTSSs) (β = 0.332, p < 0.001) and fatigue (β = 0.247, p = 0.02). Association between anxiety and three factors, including DHEA, PTSSs, and fatigue, was observed in patients with advanced cancer stages (III and IV) (DHEA β = 0.319, p = 0.004; PTSS β = 0.396, p = 0.001; fatigue β = 0.289, p = 0.027) and those undergoing chemotherapy (DHEA β = 0.346, p = 0.001; PTSS β = 0.407, p = 0.001; fatigue β = 0.326, p = 0.011).ConclusionsThe association between anxiety and DHEA remained positive in advanced cancer stages and chemotherapy patients. Further study is necessary to determine whether DHEA is a potential biomarker of anxiety in LC patients.

A Prospective Observational Study on Neurotoxicity of Chemotherapy - A Critical Analysis

Background: Cancer treatment frequently depends on the intricate and potent effects that are acknowledged for their potential to save lives. Chemotherapy can have adverse effects on both the central and peripheral nervous systems, posing significant challenges. Objective: • To assess the causative agent, development, and timing of occurrence. • To improve management of neurological complications. • To discriminate the iatrogenic effects of cancer therapy and neurological progression. Method: A prospective observational study was conducted in a hospital setting, focusing on the neurotoxic effects of chemotherapy in cancer patients over a span of six months. The research involved participants from both the oncology in-patient and daycare departments. After obtaining informed consent, individuals in the study population were interviewed to gather information about any neurological symptoms they encountered following their chemotherapy sessions. Results and discussion: Within our study population, a predominant 67% comprised female patients, while male patients constituted 33%. Of the total participants, 66% reported experiencing neurological symptoms. Among these symptoms, the majority of patients encountered sensations such as tingling, numbness, and a burning sensation. Other reported symptoms included headaches, distal weakness, myalgia, seizures, and ataxia. Conclusion: In this current study, 66% of the study population encountered neurological side effects. Generally, the presence of comorbidities, vitamin deficiencies, and advanced age can significantly contribute to the development of peripheral neuropathy. Depending on the severity of neuropathy, recommendations for interventions include the prescription of vitamin supplements, calcium supplements, duloxetine, and pregabalin.

Predictive model for pancreatic steatosis after neoadjuvant chemotherapy in breast cancer: Construction and ultrasound validation

ObjectiveTo develop and verify a nomogram model for predicting occurrence of pancreatic steatosis (PS) after chemotherapy in breast cancer patients. MethodsA total of 215 breast cancer (BC) patients who underwent neoadjuvant chemotherapy in the hospital from February 2018 to November 2018 were prospectively collected for imaging and clinical data. Subjects were randomly divided into a training set (172 cases) and a validation set (43 cases) according to a random number table in a 4:1 ratio, and independent risk factors associated with PS were screened and modeled in a nomogram model after using single-factor and multifactorial logistic regression analyses on the training set. The model's performance was evaluated through various analyses, including subject operating characteristic curve(ROC), calibration curves, decision curve (DCA), and clinical impact curve (CIC), assessing its predictive performance, precision, and practical value in a clinical setting. ResultsThe results of univariate and multifactorial binary logistic regression analyses showed that age, triglycerides, and whether or not neoadjuvant chemotherapy was an independent risk factor for the development of PS, and these three independent risk factors were used to further construct a nomogram model. The model demonstrated strong predictive efficacy with an area under the ROC curve of 0.817 (95% CI = 0.753–0.880) in the training set and 0.762 (95% CI = 0.615–0.901) in the validation set. Calibration curve analysis confirmed accurate prediction of PS, and both DCA and CIC confirmed the model's clinical utility and validity. ConclusionThe nomogram model developed in this study shows strong prediction effect, discriminatory power, and clinical applicability, serving as an intuitive and visual tool for assessing the risk of PS in breast cancer chemotherapy patients.

Ayurveda &amp; Bioactives as Adjuvant for Dna Modulation in Cancer Treatment &amp; Adverse Drug Reaction [ADR] – A Glimpse of Traditional Indian Nanotechnology

Bioactives such as Curcumin and Quercetin and herbs such as “Tulsi”/ Holy basil [_Occimum sanctum_ L.] can provide relief from Adverse drug reaction [ADR] caused by chemotherapy in cancer patients. About 50% patients face moderate ADR issues such as nausea, vomiting, headache, and fewer [20-30%] serious ones [hair loss, loss of fertility and immunity]. The growing recurrence or resistance of cancers to chemotherapy and antimicrobial resistance [AMR] are other emerging challenges in addressing the global cancer burden, among the top causes of death. Two targets of herbal/ bioactive actions include topoisomerase that affects cell replication and telomere length and it may reduce resistance/ recurrence also. Patients with special conditions the old, children and less developed countries with low health budgets can especially develop from it.

Exploring Malnutrition Risk in Cancer Chemotherapy Patients: An Assessment of Associated Factors in a Tertiary Care Cancer Center

Objectives: This study aimed to assess the risk of malnutrition in cancer chemotherapy patients and identify the associated factors. Materials and Methods: It is a cross-sectional study. Purposive sampling was used to collect data from a tertiary care cancer centre. The study collected data from 101 participants and used a malnutrition screening tool (MST) to assess the risk of malnutrition. Results: The majority of participants in the study were female (61.4%) and in the 3rd or 4th stage of cancer (57.4% and 41.6%, respectively). Of the participants, 63.4% experienced weight loss without trying chemotherapy, and 60.4% were at risk for malnutrition. Cancer stage was associated with malnutrition risk, but other clinical variables were not. Conclusion: Malnutrition is a significant issue among cancer chemotherapy patients in the study’s population. The findings of this study can be used to develop interventions to prevent and manage malnutrition in patients with cancer and improve the effectiveness of cancer treatment in the Indian population.

Safety and efficacy of pre-emptive antifungal therapy versus empirical therapy in patients with febrile neutropenia – A meta-analysis

Febrile neutropenia is a life-threatening complication usually seen in cancer chemotherapy patients. Bacterial agents are the most common etiology of sepsis in febrile neutropenia and warrants empirical antibiotic treatment. However, the efficacy of pre-emptive therapy over empirical therapy is debatable. The objectives of this study were to evaluate the efficacy (difference in mortality rate) of pre-emptive antifungal therapy in patients with febrile neutropenia compared to empirical antifungal therapy and to evaluate the safety (antifungal exposure, adverse effects, and duration of hospital stay) of pre-emptive antifungal therapy. The data source used for the study is only PubMed. Only full-text articles in English language since the year 2000 were included. Unpublished studies will not be sought. Searches will be re-run before analysis. Data extraction was guided by a predetermined checklist. Using RevMan 5 software, the effect of intervention is null (95% CI 0.66–1.91, P = 0.57)]. An insignificant Q statistic (P &gt; 0.66) indicates the absence of heterogeneity (I2 = 0%) as there is not much difference in the mortality rates between two groups. Data analyses were performed from June 2023 to August 2023. The primary outcome is an insignificant Q statistic (P &gt; 0.66) indicates the absence of heterogeneity (I2 = 0%) as there is not much difference in the mortality rates between two groups. Hence, pre-emptive therapy can be considered in place of empirical therapy to avoid over treatment with antifungal agents in patients with febrile neutropenia. A meta-analysis of five eligible comparative studies involving 588 subjects who had pre-emptive antifungal therapy and 587 subjects who had empirical therapy signifies the effect of intervention is null (95% CI 0.66–1.91, P = 0.57). An insignificant Q statistic (P &gt; 0.66) indicates the absence of heterogeneity (I2 = 0%) as there is not much difference in the mortality rates between two groups. Hence, pre-emptive therapy can be considered in place of empirical therapy to avoid over treatment with antifungal agents in patients with febrile neutropenia. This systematic review and meta-analysis demonstrated that pre-emptive therapy can be considered in place of empirical therapy to avoid over treatment with antifungal agents in patients with febrile neutropenia. Trial Registration: PROSPERO receipt number-443707.

Investigation into quality of life of patient receiving chemotherapeutic regimen in selected hospital in South East Nigeria: A pilot study

In 2008 approximately 12.7million cancers were diagnosed and 7.6million people died due to cancer worldwide. People living with cancer experience a variety of reactions as such quality of life and chemotherapy for cancer patients and its associated side effects are topical issues in oncology practice. A survey was conducted among 264 breast cancer patients selected by Purposive sampling technique, the instrument for the study was (EORTC QLQ - C30 &amp; BR 23). This instrument was used to determine the quality of life of cancer patients and breast cancer in particular. It has a total of 53 items. The first 30 items (i.e. EORTC QLQ - C30), bothers on patients perception of health, the last 23 items which are numbered 31 – 53 (i.e. BR 23). QOL of breast cancer patients using EORTC QLQE30-BR23, revealed that they have trouble taking a long walk, they have you had pains, they need to rest with a mean of 1.9, 2.7 and 2.8 respectively. Also, 15.9% of the respondents had an excellent quality of life in the past week, 78.0% have good quality of life in the past week, it also further revealed that 14.8% had an overall excellent quality of life during the past week. Also, findings revealed that most of the respondents 57.95% had a very bad/poor QOL. Furthermore, findings further revealed that the patients’ perception of overall health past weeks was good, 206(78.03%). Cancer patients experienced many adverse reactions that affected their QOL. There is a need to develop strategies for managing their adverse event resulting from interventions for cancer, thus improving the patient quality of life.

Formulation Development and Evaluation of Sustained Release Rectal Suppository of Domperidone Maleate

The aim of present research was formulation development and evaluation of sustained release rectal suppository of domperidone maleate. By using Hot fusion method in that combination of PEG 4000 and poloxamer 188 was used as polymer and HPMC K4M was used for sustained released effect and surfactant was utilized for increasing bioavailability. The formulation was optimized based on Design expert software and Central Composite Design was used for study. Fourier transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC) were performed to check any interaction between drug and excipients. The hardness, weight variation, friability, micro melting range test, disintegration time, dissolution studies and uniformity content of formulated batches were evaluated. All the results were within the acceptable pharmacopeial limits and were evaluated statistically by using one way ANOVA test for quadratic model. From the result, S7 batch was observed optimized formulation because upto 8 hrs 90.82% drug was released. kinetic studies of the drug release for optimized formulation follows zero order kinetics. This study was concluded that rectal route was more beneficial than oral route because it avoids first pass metabolism and enhance bioavailability of Domperidone maleate. The prepared Domperidone maleate suppository will be used for emesis caused due to chemotherapy in cancer patient and effective in the treatment of nausea and vomiting induced by drugs, migration and radiation sickness.

Symptomatic adverse events of chemotherapy in breast cancer patients:Using CTCAE, PRO-CTCAE, and EORTC QLQ-C30.

The Common Terminology Criteria for Adverse Events (CTCAE) is used as a tool to evaluate the adverse events (AE) of chemotherapy in cancer patients. Since CTCAE by medical providers underestimates AE more than patient-reported outcomes (PRO), the National Cancer Institute developed PRO-CTCAE. The present study investigated differences between symptoms detected using CTCAE by medical providers and PRO-CTCAE by breast cancer patients. Patients received chemotherapy comprising epirubicin and cyclophosphamide pre- or postoperatively. AE were evaluated using 4 questionnaires:PRO-CTCAE, CTCAE, the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC-QLQ-30), and Hospital Anxiety and Depression Scale (HADS) after 1, 2, and 3 courses of chemotherapy. Forty-two patients were registered. Regarding the recognition of psychological symptoms, such as fatigue, anxiety, and discouragement, and subjective symptoms, including heart palpitations and shortness of breath, PRO using PRO-CTCAE was significantly higher than medical provider-recognized outcomes using CTCAE. Concerning the recognition of regimen-specific symptoms, such as vomiting, nausea, and decreased appetite, medical provider- recognized outcomes were the same or higher than PRO. In QLQ-C30, the physical and role functions, fatigue and dyspnea significantly worsened after 2 and 3 courses of chemotherapy. J. Med. Invest. 71 : 82-91, February, 2024.

Kiosk 5R-TB-07 - Hybrid PET-MR Imaging to Assess Acute Cardiovascular Changes in Response to Thoracic Radiotherapy and Chemotherapy in Cancer Patients

Kiosk 5R-TB-07 - Hybrid PET-MR Imaging to Assess Acute Cardiovascular Changes in Response to Thoracic Radiotherapy and Chemotherapy in Cancer Patients

Effect of aromatherapy with rose essential oil on the nausea and vomiting in chemotherapy patients: a randomized controlled trial.

The present study aims to determine the effect of aromatherapy with rose essential oil on the rate of nausea and vomiting in chemotherapy patients. This randomized controlled trial included 66 cancer patients who were randomly divided: the rose essential oil aromatherapy group (n=33) and the control group (n=33). The sampling period ranged from November 2022 to March 2023. The state of nausea and vomiting was assessed using the Visual Analog Scale. The average scores of nausea and vomiting of both the second and third cycle in three time periods after chemotherapy (first, second, and third six hours) were significantly lower in the intervention group than the control group (P<0.001). Also, in the second cycle of chemotherapy, unlike the third cycle of chemotherapy, there was a significant interaction between group and time (ηp2=0.100, P=0.001, F (84.70, 1.37) = 6.91). In other words, the amount of difference between the mean scores of nausea and vomiting of the two control and intervention groups depended on the variable levels of time and vice versa. The results indicate the reducing effect of aromatherapy with rose essential oil on the severity of nausea and vomiting after chemotherapy in cancer patients. Therefore, it is recommended to be used in chemotherapy to reduce the severity of nausea and vomiting according to the patient's condition.

Development of Organoid-Based Cytotherapeutics for Taste Loss Induced By Anti-Cancer Chemotherapy and Radiotherapy

Introduction Ulcerative mucositis and taste loss are common side effects induced by cancer therapy, including chemotherapy and radiation therapy. These conditions cause significant oral pain and loss of taste, impacting food intake and physical health abnormalities such as malnutrition, as well as depression and mental health deterioration, which can affect prognosis. To address these challenges, an appropriate treatment for oral mucositis is required. While various types of oral mucositis treatments have been developed (e.g., patch, spray, ointment), most show indirect healing effects such as pain control and inflammation relief. Thus, a direct method for treating oral lesions should be developed. This research was supported by the Korean Fund for Regenerative Medi- cine (KFRM) grant funded by the Korea Government (the Ministry of Science and ICT, the Ministry of Health &amp; Welfare) (21C0712L1-11). Methods To compensate for the difficulty in supplying human tissue, we conducted preliminary experiments using mice to establish protocols for manufacturing human oral tissue-derived cell therapeutics. we devised an organoid-derived cell sheet transplantation. First, we generated organoids derived from oral mucosa and prepared a cell sheet using a temperature-responsive cell culture dish. The harvested cell sheet was transplanted to the lesion site to enable structural and functional recovery of the oral mucosa and gustatory organs. Results We have developed a cell-therapeutic platform based on regenerative medicine technology to recover oral lesions in cancer chemotherapy and radiotherapy patients. Specifically, we developed a method for producing autologous cell therapeutics. The oral mucosa tissue of a patient scheduled for anticancer treatment was collected, and epithelial cells were obtained from the tissue. Using these cells, we generated organoids with differentiated taste bud cells, and isolated cells from the organoids were seeded onto temperature-responsive cell culture dishes and cultured beyond confluence for the formation of a sheet. We performed immunostaining to detect various types of taste cells in the cell sheet. We also confirmed the success of cell sheet transplantation and the subsequent healing effect. Conclusion Improving the prognosis and acquiring the will to recover of cancer chemotherapy and radiotherapy patients through repairing taste function and rapid healing of lesions are crucial. We have developed a cell therapy technology that enables the structural and functional recovery of the oral mucosa and gustatory organs, providing a promising solution to treat the side effects of anti-cancer treatment. Our research provides an R&amp;D initiative for the treatment and prevention of intractable diseases by culturing, manufacturing, and transplanting living autologous cells.

Study to Assess the Effectiveness of Warm Water Foot Bath on Reducing Level of Fatigue and Insomnia among Chemotherapy Cancer Patients

Study to Assess the Effectiveness of Warm Water Foot Bath on Reducing Level of Fatigue and Insomnia among Chemotherapy Cancer Patients

Profile of Cytostatic Drug Use in Breast Cancer Patients (Mammae carcinoma) at Medan Hospital

Breast cancer is the most common type of cancer in the world (2,261,419 cases) and in Indonesia (65,858 cases). This research aims to determine the class and type of cytostatic drugs most frequently used in breast cancer chemotherapy patients from January to March 2023 at RSUP Haji Adam Malik Medan. This study used a descriptive survey method with a saturated sample of 176 medical records. Data collection was done retrospectively by gathering information from the electronic medical records of the patients. The research results show that the characteristics of the patients are as follows: the majority were female, totalling 176 patients (100%). The most common age group was 45-54 years, with 111 patients (63.1%), and the prescription of cytostatic drugs was highest in March, with 80 patients (36.9%). In conclusion, the most commonly used class of cytostatic drugs was antibiotics, with 146 cases (32.88%), and the most commonly used type of cytostatic drug was Doxorubicin, with 114 cases (25.68%). This indicates that the use of antibiotics is a significant part of breast cancer treatment, and it is important to pay attention to the safety and regularity of drug use to prevent drug resistance and the severity of the disease.

The use of radiotherapy, surgery and chemotherapy in the curative treatment of cancer: results from the FORTY (Favourable Outcomes from RadioTherapY) project.

Radiotherapy, surgery and chemotherapy play key roles in the curative treatment of cancer, alone and in combination. Quantifying their roles is essential for equipment provision and workforce planning. The estimate that 40% of cancer patients are cured by RT has been used extensively to inform and influence policy but is relatively old and warrants review. Patient, tumour and treatment event data was obtained for the 5 year period from 2009 to 2013, allowing a further 5 years for survival outcomes to be known. We analysed patient-level data on utilisation of surgery, radiotherapy, and chemotherapy in cancer patients in England. Data were sourced from Public Health England, using National Cancer Registrations, the National Radiotherapy Dataset (RTDS) and the Systemic Anti-Cancer Therapy Dataset (SACT). All tumour sites (excluding C44) and ages were included. We analysed three cohorts: all patients [n = 1,029,569], patients who survived 5 years or more [n = 537,970] and patients who survived <5 years [n = 491,599]. Overall cancer-specific 5-year survival was 52%, and in those patients, surgery was the most common curative treatment, with 80% receiving surgery, alone or in combination; radiotherapy was delivered to 39% and chemotherapy to 29%; 45% received two and 13% all three modalities. The high proportion receiving multi-modality treatment emphasises the importance of integrated, resourced, multidisciplinary cancer care. Radiotherapy was delivered to almost 40% of patients who survived 5 years which underlines its importance in cancer management. The results are essential in planning cancer services. They also inform the public health narrative.

Melatonin Restores Autophagic Flux by Activating the Sirt3/TFEB Signaling Pathway to Attenuate Doxorubicin-Induced Cardiomyopathy.

Doxorubicin (DOX) chemotherapy in cancer patients increases the risk of the occurrence of cardiac dysfunction and even results in congestive heart failure. Despite the great progress of pathology in DOX-induced cardiomyopathy, the underlying molecular mechanisms remain elusive. Here, we investigate the protective effects and the underlying mechanisms of melatonin in DOX-induced cardiomyopathy. Our results clearly show that oral administration of melatonin prevented the deterioration of cardiac function caused by DOX treatment, which was evaluated by left ventricular ejection fraction and fractional shortening as well as cardiac fibrosis. The ejection fraction and fractional shortening in the DOX group were 49.48% and 25.5%, respectively, while melatonin treatment increased the ejection fraction and fractional shortening to 60.33 and 31.39 in wild-type mice. Cardiac fibrosis in the DOX group was 3.97%, while melatonin reduced cardiac fibrosis to 1.95% in wild-type mice. Sirt3 is a mitochondrial deacetylase and shows protective effects in diverse cardiovascular diseases. Therefore, to test whether Sirt3 is a key factor in protection, Sirt3 knockout mice were used, and it was found that the protective effects of melatonin in DOX-induced cardiomyopathy were partly abolished. Further analysis revealed that Sirt3 and its downstream molecule TFEB were downregulated in response to DOX treatment, while melatonin administration was able to significantly enhance the expressions of Sirt3 and TFEB. Our in vitro study demonstrated that melatonin enhanced lysosomal function by increasing the Sirt3-mediated increase at the TFEB level, and the accumulation of autolysosomes induced by DOX treatment was attenuated. Thus, autophagic flux disrupted by DOX treatment was restored by melatonin supplementation. In summary, our results demonstrate that melatonin protects the heart against DOX injury by the restoration of autophagic flux via the activation of the Sirt3/TFEB signaling pathway.