Symptom Management In Cancer Patients Research Articles

Development of the Telephone Triage Guidelines and Computerized Application for Symptom Management in Cancer Patients

Development of the Telephone Triage Guidelines and Computerized Application for Symptom Management in Cancer Patients

CN74 The effect of nursing senior's self-efficacy on symptom management in cancer patients on clinical decision-making skills

CN74 The effect of nursing senior's self-efficacy on symptom management in cancer patients on clinical decision-making skills

The effectiveness of symptom management interventions based on electronic patient-reported outcomes (ePROs) for symptom burden, quality of life, and overall survival among patients with cancer: A meta-analysis of randomized controlled trials

ObjectiveTo explore the effectiveness of ePRO-based symptom management interventions on symptom burden, quality of life, and overall survival among patients with cancer for the first time and to explore the effects of different types of these interventions. BackgroundSince advances in screening and treatment have transformed cancer into a chronic illness rather than a fatal disease, symptom management has become increasingly critical in oncology nursing. In recent decades, ePROs have been increasingly used in the symptom management of cancer patients to improve their symptom burden, quality of life and overall survival, but the existing findings are still inconsistent and equivocal. MethodsA literature search was conducted in PubMed, Web-of-Science, CENTRAL, and CINAHL-Plus-with-Full-Text from inception to January 31, 2023. The quality of methodology and evidence were evaluated by the revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation framework. All data were analyzed using R within the RStudio platform, and the effects of interventions were determined by calculating SMD, HR and 95 %CI. Subgroup analysis, sensitivity analysis and cumulative meta-analysis were performed, and statistical heterogeneity was examined by I2 statistic, P value, and Egger's or arcsine test. Statistical significance was defined as a two-tailed P value <0.05. ResultsA total of 23 randomized controlled trials with 7231 patients were included. The results indicated that ePRO-based symptom management interventions could improve the symptom burden (SMD = −0.19, 95 % CI [−0.33, −0.05], P < 0.01), quality of life (SMD = 0.16, 95 % CI [0.06, 0.25], P < 0.01) and overall survival (HR = 0.84, 95 % CI [0.73, 0.97], P = 0.02) of cancer patients. Subgroup analysis showed that targeted interventions for patients undergoing specific treatments were effective in relieving the symptom burden and enhancing quality of life. Short-term (≤3 months) interventions or reporting via telephone call contributed to alleviating the symptom burden, while quality of life improved when the intervention was more than three months in duration or not reported by telephone call. The pooled results of symptom burden and quality of life were stable, and the beneficial trends of all three outcomes were steady. The overall quality of methodology and evidence was moderate. ConclusionsWe found that ePRO-based symptom management interventions are conducive to improving symptom burden, quality of life, and overall survival of cancer patients. In addition to encouraging the integration of ePRO-based interventions into routine oncology care, interventions with tailored plans, proper intensity and multidimensional supports need to be developed in the future to optimize the symptom management of cancer patients. RegistrationCRD42023393330.

Latest Findings in Key Research Areas of Precision Nursing for Chronic Diseases in Older Adults

The advent of the era of biomedical big data has helped promote the development of precision nursing. Precision nursing for chronic diseases in older adults is an interdisciplinary research field in which accurate individualized data are utilized to carry out early screening and health management of older adult populations at high risk for chronic diseases and early intervention of diseases, which plays an important role in improving the prognosis of diseases and the health level of the older adult population. Herein, we introduced the concept of precision nursing, and discussed the latest research findings in the key areas of precision nursing for chronic diseases in older adults, including precision symptom management in cancer patients and precision nursing in older patients with multimorbidity. At present, research concerning precise symptom management of cancer patients is mainly focused on prediction modelling for risks of symptoms, longitudinal change trajectories, core symptom identification, etc. Investigations in the precise nursing of cancer patients are conducted in the following areas, risk prediction, the timing of interventions, and intervention targets. Research on precision nursing for multimorbidity is mainly focused on assessment of chronic disease multimorbidity, multimorbidity pattern recognition, and health management of multimorbidity. We also discussed potential opportunities and challenges of precision nursing in the future, in order to provide a scientific basis for the improving the practice and theories of precision nursing. In the future, precision nursing will play an ever more important role in uncovering pathogenic information, the diagnosis and treatment of diseases, the health of the research population, and the promotion of medical research.

Effectiveness of Virtual Reality in Symptom Management of Cancer Patients: A Systematic Review and Meta-Analysis.

Although the survival rate of cancer patients has been increasing, such patients often experience severe physical and psychological burdens due to the effects of the disease and therapy. Multiple virtual reality (VR)-based interventions have been used to help improve physical and psychological symptoms and quality of life in cancer patients. This study aimed to assess the effects of VR-based interventions on anxiety, pain, depression, fear, distress, and quality of life in cancer patients. We conducted systematic searches in the PubMed, Web of Science, CINAHL, EMBASE, Cochrane Library, Scopus and APA PsycINFO databases from their inception to August 16, 2022. Two reviewers independently selected studies and extracted articles that met strict inclusion and exclusion criteria. Quality assessments of the included studies were performed according to the Cochrane risk assessment tool, and data analysis was performed using RevMan 5.4 software. A total of 12 studies including 425 participants in the intervention group and 400 participants in the control group were selected for the final analysis. The results showed a significant difference between the VR and control groups for anxiety (standard mean difference [SMD] =-0.83, 95% CI -1.25 to -0.42, P < 0.001), SMD=pain (SMD =-0.86, 95% CI -1.36 to -0.35, P < 0.001), depression (SMD=-0.46, 95% CI -0.74 to -0.18, P=0.001), fear (MD=-0.82, 95% CI -1.60 to -0.03, P=0.04), and distress (SMD=-1.16, 95% CI -1.96 to -0.37, P=0.004). However, no significant difference was observed in quality of life (SMD=1.01, 95% CI -0.67 to 2.70, P=0.24). VR interventions were effective in improving physical and psychological symptoms in cancer patients. Due to the limited number of studies, small sample sizes, and moderate to high heterogeneity, these results should be interpreted with caution. More rigorous, comprehensive and high-quality randomized controlled trials (RCTs) are needed to validate the results of this study. PROSPERO International Prospective Register of Systematic Reviews CRD42022304931;https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=304931.

23 (PB-023) Poster Spotlight - The effect of behavioral graded activity on physical activity level, health-related quality of life, and symptom management in cancer patients and survivors: systematic review and meta-analysis

Background: In past years, behavioral graded activity (BGA) has demonstrated positive effects on debilitating symptoms, physical functioning, and pain in chronic pain populations, and appears foremost in cognitive behavioral therapy or other psychological informed practices (PIP). Up to now, no systematic review has been published about the effect of BGA on different biopsychosocial outcomes within cancer populations. Therefore, this systematic review and meta-analysis determined the effectiveness of PIP with BGA compared to (1) waitlists (WL), (2) usual care (UC), (3) PIP alone, or (4) BGA alone in cancer patients and survivors (CPaS).

Improving symptom assessment and management in the community through capacity building of primary palliative care: A study protocol of exploratory research.

Aim: To determine the effectiveness of capacity building program on palliative care (PC) in enhancing the capacity of the primary health care workers in need assessment and symptom management of cancer patients. Background: In India, less than one percent of people living with cancer have access to palliative care since most are from low- and middle-income groups. Accredited social health activist (ASHA) and primary health care workers are grassroots workers who are the first contact with family members and are seldom aware of PC in India. It is essential to train them to give practical and efficient care to needy people. Design: A quasi-experimental design with follow-up will be conducted using an evaluative approach. Methods: The study population consists of 1440 Primary Health Care Workers (staff nurses, ANMs, and ASHA workers) of three taluks of Udupi District, Karnataka State, India. Training on PC will be provided for ASHA workers for one day and ANM/Staff nurses for three days. After their training, they are expected to demonstrate the gain in knowledge & skill in providing PC for cancer patients by identifying and implementing PC services using a mobile app at the primary healthcare level. Discussion: Palliative home care can give comfort and reduce patients' financial burden, and this training may help to improve the quality of life of needy patients. Impact: If this palliative care training program succeeds, it can be integrated into the healthcare continuum, making it an essential component of primary healthcare delivery to achieve universal health coverage. Moreover, home-based PC supports patients who want to die at home even though it reduces hospital stay costs. Trial registration: CTRI/2020/04/024792.

Assessing Efficacy and Use Patterns of Medical Cannabis for Symptom Management in Elderly Cancer Patients.

Our study sought to further characterize patterns of medical cannabis use in elderly cancer patients. Furthermore, we sought to assess efficacy of medical cannabis for the treatment of pain, nausea, anorexia, insomnia and anxiety in elderly cancer patients. Medical cannabis use is growing for symptom management in cancer patients, but limited data exists on the safety or efficacy of use in elderly patients. A retrospective chart review assessing changes in numerical symptom scores reported at clinic visits before and after medical cannabis initiation. There was no statistically significant difference in pain, nausea, appetite, insomnia or anxiety scores reported before and after initiation of medical cannabis. Oil was the most common form used, followed by vape, and the most common ratios used were high tetrahydrocannabinol (THC) to cannabidiol (CBD) and equal parts THC/CBD products. This study did not find a statistically significant change in symptom scores with medical cannabis use, although further study is warranted given the limitations of the present study. Elderly patients most commonly are using equal parts THC/CBD or high THC ratio products initially.

Abstract P4-10-22: Patient reported symptoms and functional status in breast cancer

Abstract Background: To improve symptom management in cancer patients, the province of Ontario (Canada) implemented the collection of the Edmonton Symptom Assessment System (ESAS) and Patient-Reported Functional Status (PRFS) tool at cancer centre outpatient visits. ESAS measures 9 symptoms on a scale from 0 (no symptoms) to 10 (worst possible symptom); scores &amp;gt; 4 (moderate to severe) require intervention. The PRFS tool is a version of the Eastern Cooperative Oncology Group performance status tool designed to be completed by the patient; scores range from 0 (“normal with no limitation”) to 4 (“pretty much bedridden, rarely out of bed”). Our main objective was to describe the symptom burden and functional status of breast cancer (BC) patients.Methods: This cross-sectional study included women with stage I-IV BC who completed the ESAS and the PRFS tool during outpatient clinic visits at 2 Toronto academic centres. ESAS and PRFS scores were described for 3 participant groups: women diagnosed with early-stage BC (ESBC= stages I-III) in the year prior to enrolment; women with ESBC diagnosed &amp;gt; 1 year prior to enrolment; and women with metastatic BC. Multivariable logistic regression models were used to identify factors associated with ESAS scores &amp;gt; 4 for each ESAS symptom. Covariates included age, comorbidity, BC subtype, disease group, previous surgery, and current systemic therapy. Results: Of 381 women, 107 (28%) were diagnosed with ESBC ≤ 1 year prior to enrolment; 171 (45%) were diagnosed with ESBC &amp;gt; 1 year prior to enrolment; 103 (27%) had metastatic BC. Mean age was 57 (SD17) years. For ESBC, tiredness had the highest incidence of moderate to severe scores, followed by impaired well-being and anxiety (Table 1). For metastatic BC, impaired well-being had the highest incidence of moderate to severe symptoms, followed by tiredness and anxiety. More than 20% of metastatic BC patients had scores &amp;gt; 4 for pain, drowsiness, shortness of breath and depression. Most reported PRFS scores of 0 (“Normal with no limitations”) or 1 (“Not my normal self, but able to be up and about with fairly normal activities”), but 17% of metastatic BC patients reported a PRFS of 2 (“Not feeling up to most things, but in bed or chair less than half the day”). A comorbidity score ≥1 was associated with moderate to severe depression (OR 2.0; 95%CI 1.1-3.7), lack of appetite (OR 3.1; 95%CI 1.4-6.6), shortness of breath (OR 2.6; 95%CI 1.3-5.2), tiredness (OR 2.0; 95%CI 1.2-3.3) and impaired well-being (OR 2.0; 95%CI 1.2-3.4). Metastatic BC was associated with moderate to severe scores for anxiety (OR 2.3; 95%CI 1.2-4.5), pain (OR 3.0; 95%CI 1.4-6.4) and impaired well-being (OR 2.1; 95%CI 1.1-4.0). Conclusion: A high prevalence of symptom scores &amp;gt; 4 was found both in ESBC and metastatic BC, highlighting the need of symptom screening for all BC patients. Particular attention should be paid to patients with comorbidity scores ≥ 1, who have increased odds of presenting higher symptom scores. Table 1.- Prevalence of ESAS scores ≥ 4 and PRFS scores for each disease group.ESAS SymptomsPercent with ESAS scores ≥ 4 (moderate to severe)Early-Stage Breast Cancer – 1st year (N=107)Early-Stage Breast Cancer – &amp;gt; 1st year (N=171)Metastatic Breast Cancer (N=103)Total (N=381)Pain12.1%14.7%30.1%18.2%Tiredness25.2%30.1%39.8%31.3%Drowsiness1.8%12.9%25.2%16.6%Nausea9.4%3.5%7.8%4.2%Lack of Appetite10.3%7.1%13.6%9.5%Shortness of Breath14%7.6%22.3%12.4%Depression17.7%14.6%22.6%16.5%Anxiety24.3%17.2%35.3%21.3%Well-being1.8%25.7%44.1%30.3%PRFS scoresPercent with PRFS ScoreNormal with no limitations (0)30.8%49.7%28.2%38.6%Not my normal self, but able to be up and about with fairly normal activities (1)52.3%42.1%50.5%47.2%Not feeling up to most things, but in bed or chair less than half the day (2)12.2%4.7%16.5%10%Able to do little activity and spend most of the day in bed or chair (3)3.7%2.3%4.9%3.4%Pretty much bedridden, rarely out of bed (4)---- Citation Format: Sofia Torres, Ahmed Bayoumi, Geoffrey Liu, Ana Beatriz Kinupe Abrahao, Nicholas Mitsakakis, Murray Krahn, Maureen Trudeau. Patient reported symptoms and functional status in breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-22.

Research progress of yoga in symptom management of cancer patients

Research progress of yoga in symptom management of cancer patients

1457P The end-of-life experiences for cancer patients with COVID-19 across the two peak pandemic waves

The COVID-19 (C-19) pandemic has seen much research scrutinising the impact of C-19 on cancer patients, focusing on understanding the impact of a cancer diagnosis and anti-cancer treatments on mortality. Yet there is paucity of work regarding the end-of-life care (EOLC) for cancer patients dying with C-19. Retrospective record review of all non-ventilated patients who died in a tertiary referral UK cancer centre with known or suspected C-19 across the 2 peak pandemic waves from 25/03/20 – 01/05/20 and 05/12/20 – 01/03/21. Demographics and risk factors for severe C-19 were described. EOLC assessment considered palliative care (PC) needs, medications prescribed and advance care plans including Treatment Escalation Plans (TEP) and Do Not Attempt Resuscitation (DNAR) orders. 34 patients were included. Most patients were female (18) and White British (19), mean age was 69 (45-82). 8 patients had recognised cardiovascular risk factors; 11 patients had no comorbidities additional to cancer. 26 patient had metastatic disease, 30 were receiving palliative treatment. Most patients were referred to PC for symptom control (20), 8 were referred for EOLC. All patients had DNAR orders and TEPs. The median number of PC reviews was 5 (range 1-24). Integrated Palliative Outcome Scale (IPOS) (a holistic assessment tool used in clinical care) scores on first assessment (n=24) recorded the main symptoms as weakness, lacking peace and anxiety. Family anxiety was the highest scoring aspect. Medical management at the end-of-life was, however, generally uncomplicated; total opioid (oral morphine equivalent) and benzodiazepine doses administered in last 24 hours before death were relatively low, median dose (range) 30mg (5-180 mg) and 10mg (0-30mg) respectively. With prompt recognition and access to standard EOLC, the symptom management of cancer patients dying from C-19 is relatively uncomplicated. As a transmissible disease, associated with social anxiety and restrictions, death from C-19 is, however, undeniably complicated. Timely acknowledgment of the vulnerability of patients with advanced cancer and C-19 is essential to facilitate early communication about patients’ priorities and wishes, and enhance family support.

Cannabis use is associated with patient and clinical factors in a population-based sample of colorectal cancer survivors.

This study aimed to characterize patient and clinical factors associated with cannabis (marijuana) use among patients diagnosed with colorectal cancer (CRC). We identified CRC patients, diagnosed from 2016 to 2018, using the Seattle-Puget Sound Surveillance, Epidemiology, and End Results (SEER) cancer registry. CRC patients were recruited via mail and telephone, and participants completed a questionnaire eliciting information on medical history, demographics, and lifestyle factors, including cannabis use. Cancer stage was obtained from SEER registry data. Of 1,433 survey respondents, 339 (24%) were current cannabis users. Current cannabis use was associated with younger age at diagnosis, lower BMI, and a higher prevalence of cigarette smoking and alcohol consumption (p-value < 0.05). Cannabis use was also associated with lower quality of life scores (FACT-C) and advanced-stage cancer (p-value < 0.05). Cannabis use among CRC patients was common. Patients with more advanced disease were more likely to report cannabis use. Use also varied by some personal factors, consistent with patterns in the general population. Given the high prevalence of cannabis use among CRC patients, research is needed to determine the benefits and harms of cannabis use for symptom management in cancer patients.

Psychoeducational Nursing Intervention for Symptom Management in Cancer Patients: A Randomized Clinical Trial

Objective:The objective of this study was to assess the effects of a psychoeducational intervention upon symptom control and quality of life (QoL) among cancer patients.Methods:This was an open randomized clinical trial (RCT) conducted at the Cancer Institute of the State of São Paulo. The RCT comprised 107 outpatients in chemotherapy or radiation for malignant neoplasms. Participants were randomized to control group (usual treatment) or intervention group (IG) (psychoeducational intervention) with assessments at baseline and upon completion of the intervention. Sociodemographic information, clinical data, QoL, functionality, and symptoms were assessed. This trial is registered with the Brazilian Clinical Trials Registry number RBR-9337nv. A mixed-effects model was applied to compare the effects of the intervention between the groups.Results:The most frequent symptoms were fatigue (76.6%), insomnia (47.7%), pain (42.1%), and loss of appetite (37.4%). The symptom intensity analysis suggests that insomnia was the strongest symptom, followed by fatigue, loss of appetite, and pain. The IG experienced a significant improvement in terms of loss of appetite (P = 0.002) and a tendency toward less insomnia (P = 0.053).Conclusions:The intervention significantly reduced appetite loss in cancer patients. Despite no effects observed in global QoL or functionality, the intervention yielded a tendency to improve insomnia, and this outcome should be investigated in future studies.

Optimizing Health Information Technologies for Symptom Management in Cancer Patients and Survivors: Usability Evaluation.

BackgroundUnmanaged cancer symptoms and treatment-related side effects can compromise long-term clinical outcomes and health-related quality of life. Health information technologies such as web-based platforms offer the possibility to supplement existing care and optimize symptom management.ObjectiveThis paper describes the development and usability of a web-based symptom management platform for cancer patients and survivors that will be implemented within a large health system.MethodsA web-based symptom management platform was designed and evaluated via one-on-one usability testing sessions. The System Usability Scale (SUS), After Scenario Questionnaire (ASQ), and qualitative analysis of semistructured interviews were used to assess program usability.ResultsTen cancer survivors and five cancer center staff members participated in usability testing sessions. The mean score on the SUS was 86.6 (SD 14.0), indicating above average usability. The mean score on the ASQ was 2.5 (SD 2.1), indicating relatively high satisfaction with the usability of the program. Qualitative analyses identified valued features of the program and recommendations for further improvements.ConclusionsCancer survivors and oncology care providers reported high levels of acceptability and usability in the initial development of a web-based symptom management platform for cancer survivors. Future work will test the effectiveness of this web-based platform.

AMTRA: a multicentered experience of a web-based monitoring and tailored toxicity management system for cancer patients.

Technology-based interventions are increasingly being introduced in routine clinical cancer care. There is a need for reliable systems to monitor treatment-related toxicity in a standardized manner. Such electronic tools bridge the gap in providing quality home-based monitoring. From July 2017 to December 2017, we performed a multicentered, non-randomized prospective cohort analysis with patients who were receiving routine chemotherapy for various solid tumors, using a web-based patient-reported toxicity registration, management, and intervention system called AMTRA (ambulatory Monitoring of cancer Therapy using an interactive Application) linked to the homecare nursing organization Remedus®. Twelve common toxicities plus pain and two biometrics could be registered daily or more frequently as required. These were processed centrally to generate tailored advice for lesser symptoms or a phone call from a dedicated nurse in case of severe or prolonged toxicity. A compliance tool to monitor oral therapies was incorporated in the system. One hundred sixty-eight patients (92%) were enrolled, with 31,514 registrations analyzed. One hundred eight patients reported severe toxicity (> 1461 registrations), resulting in 102 clinical interventions ranging from self-management advice, supplemental consultations to hospitalizations. Compliance to oral chemotherapy was high using AMTRA with a median of 98.7% (95 confidence interval (CI) [93.5-100.0%]). Seventy-nine percent of patients stated that the availability of AMTRA self-reports was useful in communication with the care provider, while 75% felt more in control while managing their treatment. The application of an interactive PRO-system in routine symptom management of cancer patients allowed standardized documentation of toxicities and recorded a high compliance with oral treatment. It allows for rapid interaction for toxicities and cancer-related symptoms experienced at home.

Impact of Opioid Use in Hematological Malignancies: Clinical, Immunological and Concomitant Aspects

Opioid agents play a unique role in pain and symptom management for cancer patients. Research shows that opiate use, especially when associated with underlying cancer, has significant effects on hematological parameters. These changes may lead to greater risk for immunosuppression, tumor growth and progression of metastatic processes. The aim of this review is to explore the effects of opiates on various metabolic and biological processes, as well as the hematopoietic system, especially in cancer patients. Our findings demonstrate that the tumor-promoting effects of opiates remain contradictory, as both growth-promoting and anti-tumor effects have been observed. However, available data suggest that opiates can facilitate the proliferation and migration of tumor cells, and understanding of this process on cancer treatment is tremendously important.

Research progress of mindfulness therapy in symptom management of cancer patients

This study summarizes the sources of mindfulness, intervention classification, mechanism of action, and application effects on cancer patients, and summarizes the effect of mindfulness therapy on improving fatigue symptoms, relieving psychological pain, improving sleep quality, and reducing pain in cancer patients, in order to provide evidence basis for the righteousness intervention of cancer patients in the future. Key words: Neoplasms; Mindfulness therapy; Symptom management; Research progress

1809P - Clinical characteristics are associated with acupuncture treatment response for xerostomia in cancer patients

BackgroundXerostomia is a common symptom in cancer patients undergoing radiation to the head and neck region and/or those undergoing systemic chemotherapy. Acupuncture has been recognized as an effective integrative modality for managing xerostomia, but data about predicting treatment response to acupuncture are limited. We explored patient characteristics and treatment response among patients who received acupuncture for xerostomia. MethodsWe reviewed acupuncture records with a primary referral for xerostomia in an outpatient environment from March 2016 to April 2018. Treatment response was assessed using Edmonton Symptom Assessment Scale (ESAS; 0-10 scale) performed pre and post each acupuncture treatment. Bivariate associations between patient characteristics and treatment response were analyzed. ResultsA total of 781 acupuncture treatment records (139 patients) were identified. Majority were male (63%) and 59 (42%) with head and neck cancer. The median treatment response was 11% (IQR: 0-33) reduction in xerostomia score. BMI ≥ 35 and Charlson comorbidity index (CCI) <6 were associated with greater symptom reduction: BMI ≥ 35 (17% [IQR: 0%-100%]) vs BMI < 35 (10% [IQR: 0%-33%]), P=0.012; CCI < 6 (14% [IQR: 0%-33%]) vs CCI ≥ 6 (0% [IQR: 0%-25%]), P=0.003. Mental wellbeing (PROMIS Mental Health score) (P=0.024) positively correlated with greater reduction in xerostomia score. High severity of fatigue and sleep problems correlated with less symptom reduction (P=0.008 and P=0.006, respectively). Higher blood glucose level was associated with less reduction (P=0.002) in xerostomia score. ConclusionsUsing the current approach, acute pre-post treatment response of xerostomia to acupuncture was low. Features of patient clinical characteristics may be predictive of treatment response. More research is needed to further explore these associations and examine the impact of optimization of clinical conditions on acupuncture treatment response in symptom management for cancer patients. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Application of internet-delivered cognitive-behavioral therapy on symptom management in cancer patients: a Meta-analysis

Objective To assess the application effects of internet-delivered cognitive-behavioral therapy (ICBT) on symptom management in cancer patients. Methods All randomised controlled trials (RCTs) about applying ICBT in symptom management in cancer patients in the following databases were searched from the establishment date up until 20th August 2018: Web of Science, PubMed, Cochrane Library, Embase, CBMdisc, Chinese National Knowledge Infrastructure databases (CNKI) and Wanfang. After literature screening, data extraction and quality evaluation, RevMan 5.3 software was used for meta-analysis. Results Finally, 11 RCT studies were included, totaling 2329 subjects. The results showed that ICBT was beneficial to improve mental distress [SMD=5.02, 95%CI (0.80, 9.25) , P=0.02], sleep quality [SMD=0.35, 95%CI (0.02, 0.68) , P=0.04]and cancer-related fatigue [SMD=0.50, 95%CI (0.01, 0.99) , P=0.04]; but ICBT did not have depression relieving effects in cancer patients (P>0.05) . Conclusions ICBT is beneficial to reduce psychological pain, improve sleep quality and alleviate cancer-related fatigue in cancer patients, but it has no obvious advantage in alleviating depression. Future studies still need to focus on specific cancer types and validate them with multi-center, large-sample and long-term intervention studies. Key words: Meta-analysis; Internet-delivered cognitive-behavioral therapy; Mobile health; Symptom management; Cancer

Clinical Guidelines for Management of Gastrointestinal Symptoms in Cancer Patients: The Japanese Society of Palliative Medicine Recommendations.

Background: Gastrointestinal symptoms, including nausea, vomiting, bowel obstruction, ascites, constipation, and anorexia, are common and often refractory in advanced cancer patients. The palliation of gastrointestinal symptoms is important in improving the quality of life of cancer patients, as well as that of their families and caregivers. Currently published clinical guidelines for the management of gastrointestinal symptoms in cancer patients do not comprehensively cover the topics or are not based on a formal process for the development of clinical guidelines. Methods: The Japanese Society for Palliative Medicine (JSPM) developed comprehensive clinical guidelines for the management of gastrointestinal symptoms in cancer patients after a formal guideline development process. Results: This article summarizes the recommendations along with their rationale and a short summary of the development process of the JSPM gastrointestinal symptom management guidelines. We established 31 recommendations, all of which are based on the best available evidence and agreement of expert taskforce members. Discussion: Future clinical studies and continuous guideline updates are required to improve gastrointestinal symptom management in cancer patients.