Undergoing Cancer Treatment Research Articles

Management of odontogenic foci of infection (dental caries, periodontal disease and odontogenic infections) in the oral functional management of patients receiving cancer treatments: Guidelines based on a systematic review

AbstractIn cancer treatment, perioperative oral functional management is used as a part of supportive care. Its main objectives are as follows: (1) preventing and reducing adverse events, (2) maintaining or improving nutritional status, (3) improving cancer treatment outcomes, (4) maintaining or improving quality of life, (5) providing high quality medical care through comprehensive oral care, (6) controlling odontogenic foci of infection, and (7) maintaining or improving oral function. A literature search was conducted using the electronic databases of Medical Journal and PubMed. Electronic database searches were performed using various combinations of the following key words: cancer, surgery, treatment, chemotherapy, radiotherapy and dental disease, oral care, oral management, dental intervention, oral health, dental care, and dental management. The selection of literature for inclusion in the review was restricted to dental management of patients receiving cancer treatment. In the course of the literature review, hand searches were also added as needed. The guideline was developed by summarizing the results of the review. Based on a review of the literature on the management of dental foci of infection in the oral functional management of patients undergoing cancer treatment, a guideline was developed by summarizing the results of the review. This report is a secondary publication of our previous review report “J. Stomatol. Soc. 70(4): 279–289. Dec 2021.”

Financial burden of men with localized prostate cancer: a process paper.

Many individuals undergoing cancer treatment experience substantial financial hardship, often referred to as financial toxicity (FT). Those undergoing prostate cancer treatment may experience FT and its impact can exacerbate disparate health outcomes. Localized prostate cancer treatment options include: radiation, surgery, and/or active surveillance. Quality of life tradeoffs and costs differ between treatment options. In this project, our aim was to quantify direct healthcare costs to support patients and clinicians as they discuss prostate cancer treatment options. We provide the transparent steps to estimate healthcare costs associated with treatment for localized prostate cancer among the privately insured population using a large claims dataset. To quantify the costs associated with their prostate cancer treatment, we used data from the Truven Health Analytics MarketScan Commercial Claims and Encounters, including MarketScan Medicaid, and peer reviewed literature. Strategies to estimate costs included: (1) identifying the problem, (2) engaging a multidisciplinary team, (3) reviewing the literature and identifying the database, (4) identifying outcomes, (5) defining the cohort, and (6) designing the analytic plan. The costs consist of patient, clinician, and system/facility costs, at 1-year, 3-years, and 5-years following diagnosis. We outline our specific strategies to estimate costs, including: defining complex research questions, defining the study population, defining initial prostate cancer treatment, linking facility and provider level related costs, and developing a shared understanding of definitions on our research team. Analyses are underway. We plan to include these costs in a prostate cancer patient decision aid alongside other clinical tradeoffs.

ACOG Committee Opinion No. 817: Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment: Correction.

ACOG Committee Opinion No. 817: Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment: Correction.

The Role of Biotics as a Therapeutic Strategy for Oral Mucositis - A Systematic Review

ObjectivesOral mucositis (OM) is an acute and highly prevalent side effect of cancer treatments. Currently, there is no effective strategy for its prevention or treatment. This systematic review aimed to assess the effectiveness of biotics used as a therapeutic strategy for the management of OM.Materials and MethodsThe PRISMA checklist was followed and PubMed, Web of Science, and Scopus were screened for clinical and pre-clinical studies assessing the potential effects of biotics in OM. Inclusion criteria included in vivo studies related to oral mucositis evaluating the effect of biotics, and written in Portuguese, English, French, Spanish, or Dutch. The following exclusion criteria were used: systematic reviews and meta-analyses, reviews, case reports, opinion papers or comments, conference papers, letters without results, articles not related to oral therapy-induced mucositis or biotics, or in vitro articles that do not simulate oral mucositis.ResultsFrom a total of 1250 articles retrieved, 9 were included in this systematic review. Four clinical studies reported a reduction in oral mucositis occurrence with Lactobacillus species (Lactobacillus casei and Lactobacillus brevis CD2) and Bacillus clausii UBBC07. In pre-clinical studies, Lactococcus lactis genetically modified and Lactobacillus reuteri reduced the severity of OM and Streptococcus salivarius K12 also decreased the size of the ulcers.ConclusionThe findings of this systematic review suggest that probiotic supplementation may potentially reduce the incidence of therapy-induced OM and decrease its severity in patients undergoing cancer treatment. However, the available evidence is marred by significant heterogeneity across studies.

Cannabis use among adults undergoing cancer treatment.

Little is known about the risks and benefits of cannabis use in the context of cancer care. This study characterized the prevalence, reasons for use, and perceived benefits of cannabis and compared symptoms and perceived risks between those who reported past 30-day cannabis use and those who did not. Adults undergoing cancer treatment at a National Cancer Institute-designated cancer center completed measures of sociodemographic characteristics, cannabis use, use modalities, reasons for use, perceived harms/benefits of use, physical and psychological symptoms, and other substance/medication use. Analyses compared patients who used or did not use cannabis in the past 30 days. Participants (N=267) were 58 years old on average, primarily female (70%), and predominantly White (88%). Over a quarter of respondents (26%) reported past 30-day cannabis use, and among those, 4.5% screened positive for cannabis use disorder. Participants who used cannabis most often used edibles (65%) or smoked cannabis (51%), and they were younger and more likely to be male, Black, and disabled, and to have lower income and Medicaid insurance than participants who did not use cannabis. Those who used cannabis reported more severe symptoms and perceived cannabis as less harmful than those who did not use cannabis. The most common medical reasons for cannabis use were pain, cancer, sleep problems, anxiety, nausea/vomiting, and poor appetite. Participants reported the greatest cannabis-related symptom relief from sleep problems, nausea/vomiting, headaches, pain, muscle spasms, and anxiety. Patients with cancer who used cannabis perceived benefits for many symptoms, although they showed worse overall symptomatology. Among adults undergoing cancer treatment, 26% reported cannabis use in the past 30 days. Those who used cannabis were more likely to be male and disabled and to have lower income and Medicaid insurance than those who did not use cannabis. Participants most commonly reported using cannabis for pain, cancer, sleep, anxiety, and nausea/vomiting and reported the greatest perceived benefits for sleep, nausea/vomiting, headaches, pain, muscle spasms, and anxiety, yet participants who used cannabis also reported feeling worse physically and psychologically compared to those who did not use cannabis. Participants who used cannabis were more likely to report that cannabis was less risky to their health than alcohol, smoking, and opioids than those who did not use cannabis.

Effect of Multimodal Intervention on Cancer-Related Fatigue and Quality of Life among Patients Undergoing Cancer Treatment—Pilot Study (Part 1)

Abstract Background Cancer-related fatigue (CRF) is the most common and devastating problem in cancer patients even after successful treatment. CRF has a severe impact on daily activities, social relationships, reintegration, and overall quality of life (QOL). Objective This study was done to evaluate the effect of multimodal intervention (MMI) on CRF and QOL among cancer patients undergoing cancer treatment. Materials and Methods One group before-and-after study (pre-experimental design) was conducted among cancer patients undergoing cancer treatment who met inclusion criteria and were selected using a purposive sampling technique, in selected hospitals. MMI consisted of exercise program, acupressure, and home care management guide. Pre-test CRF and QOL were assessed on first day using a FACIT-F scale (Functional Assessment of Chronic Illness Therapy: Fatigue) and Functional Assessment of Cancer Therapy: Fatigue (FACT-G) Version 4, respectively. Post- test for CRF was further determined after 7 days, 21 days, and 3months and QOL was determined after 21 days and 3 months. Statistical Analysis Demographic and clinical characteristics of the participants are presented as frequency and percentage. Comparison of pre- test and post-test means of CRF and QOL is done by repeated measures analysis of variance (ANOVA). Correlation between fatigue and QOL of cancer patients was found by using Pearson correlation test. Results The mean pre-test fatigue score of the cancer patients (pre-test mean= 25.21) was lower than their mean post-test fatigue scores (post-test 1 =25.83, post-test 2 = 28.28, and post-test 3 = 34.72). There was a significant difference in CRF and QOL scores between before and after the MMI. In the repeated measures ANOVA, p-value is less than 0.05 (level of significance p < 0.05). Conclusion Regardless of mechanism of occurrence of fatigue, most patients living with cancer suffer with persistent CRF. Yet it is often not assessed, has limited treatment options, there is a need to assess the state of fatigue in cancer patients. They do need intervention to reduce the fatigue and to improve the QOL. Nonpharmacological therapies are the best strategies to manage the fatigue among cancer patients without any safety issue.

Return-to-work intervention while undergoing cancer treatment: Female cancer survivors' experiences.

This qualitative study followed participants enrolled in a return to work (RTW) intervention, aiming to address individual physical, psychological and work-related challenges. To explore cancer survivors' experiences of receiving a tailored RTW intervention initiated parallel with chemotherapy and/or radiotherapy. Two semi-structured interviews of eight female cancer survivors in treatment for breast cancer (n = 7) or ovaria cancer (n = 1) were conducted prior or close to their RTW and 3-5 months later. Inspired by Margrit Schreier's inductive analysis coding and identification of themes guided the analysis. Participants expressed satisfaction with the RTW intervention, which helped them to cope during the RTW process. Three themes with corresponding subthemes dominated the participants' experience of the RTW intervention. 1) Social workers made participants feel individually coached, 2) Collaboration with social workers helped over time to manage RTW, and 3) Social workers supported participants to conduct and adjust the RTW plan. This study shows how the interaction with social workers were based on mutual trust and sense of being cared for, which seems to have a positive impact on how participants managed their RTW. Future research needs to address the long-term challenges in cancer survivors' RTW.

Vibration Therapy for Cancer-Related Bone Diseases

Patients undergoing cancer treatments and/or suffering from metastatic bone lesions experience various skeletal-related events (SREs), substantially reducing functional independence and quality of life. Therefore, researchers are working towards developing new interventions by harnessing the bone’s innate anabolic response to mechanical stimulations. Whole body vibration (WBV) has recently gained interest due to its nature of being safe, effective, and easy to perform. In this review, we will summarize the most cutting-edge vibration studies of cancer models and bone-cancer cell interactions. We will also discuss various parameters, including age, vibration settings, and differences between bone sites, which may affect vibration efficacy. Studies have shown that WBV improves bone mineral density (BMD) and bone volume in patients and mice with cancer. WBV also reduces tumor burden and normalizes bone vasculature in mice. At the cellular level, vibration promotes interactions between bone cells and cancer cells, which reduce osteoclastogenesis and inhibit cancer metastatic potential. Hence, WBV could potentially serve as a new intervention or adjuvant treatment to attenuate cancer progression while preserving bone health.

Oncology literacy: Educational book for children, families and health professionals.

e24208 Background: With the progress of technology, not only the range of treatments and procedures increases, but also the amount of information and the complexity of the language. Appropriate materials are needed especially when stakeholders have different specificities, but need to speak the same language to understand each other and facilitate engagement in treatment. The aim of this study was to evaluate Beabook, an educational book designed for children with cancer, their family members and health professionals. Methods: The educational book, which has more than 150 terms from the oncology environment and is in more than 200 hospitals and institutions in Brazil, was scored using SAM - Suitability Assessment of Materials, a grading scale to evaluate suitability of health information materials based on categories: content, literacy demand, graphics, layout and typography, learning stimulation and motivation, and cultural appropriateness. Results: The book was analyzed by 61 participants, including children (n = 12) undergoing cancer treatment, remission, palliative care and cured, validating with a score of 26 (maximum scale score - 100%), family members (n = 20): mothers, fathers, siblings, uncles, with a score of 25.6 (98.4%) and health professionals (n = 29): doctors, nurses, psychologists, nutritionists, physiotherapists among others, with score of 25.4 (97.6%), resulting in a final score of 25.6 (98.6%), which represents material above expectations, fully adequate. Conclusions: An educational book suitable for different groups with different perspectives is of great importance in an environment where information is often omitted with the intention of protecting children, ludic communication is confused with fanciful stories and professionals do not have support materials to learn to communicate with patients and families. Studies prove that a unified, standardized and adequate language between stakeholders increases engagement and empowerment, being important mainly in the health area, where helping in the diagnosis and treatment does not imply only in the provision of clinical resources but in the guidance and sharing of information that demystify and build new representations.

Barriers to offering female fertility preservation to pediatric and young adult oncology patients: A national survey of pediatric hematology oncology providers in the United States and Canada.

e24088 Background: The American Society of Clinical Oncology (ASCO) recently updated its guidelines on fertility preservation based on similar rates of pregnancy from oocyte and embryo preservation. However, fertility preservation in female pediatric and young adults undergoing cancer treatment remains a challenge due to barriers in communication, lack of awareness and resources. Methods: A survey created using SurveyMonkey was sent electronically to all physicians who were Children’s Oncology Group (COG) members (2190), weekly for 4 weeks. Results: 304 physicians (13.8%) responded to the survey. While most providers discuss the possibility of infertility with all female patients (83%), only 43% offer fertility preservation irrespective of age. Cancer diagnosis is a key factor in the decision to offer fertility preservation to patients (63%). Ewing sarcoma (75%), osteosarcoma (69%), and bone marrow transplant candidacy (70%) are the most common diagnoses associated with physician offering of fertility preservation. It is typically offered prior to the first round of chemotherapy (53%). Seventy-five percent of providers report that insufficient time before starting chemotherapy is a major barrier to offering fertility preservation. Severity of patient illness (58%), insurance issues and high cost (19%), provider belief that it is not necessary in every patient (25%), and lack of data supporting female fertility preservation and experimental methods (16%) are other barriers which impact the decision to offer fertility preservation. Ovarian suppression (77%), cryopreservation (egg freezing) (85%), and ovarian tissue freezing (66%) are the most discussed fertility preservation options with only one out of four providers discussing freezing embryos. Only one out of five providers check Anti-Mullerian hormone (AMH) levels prior to starting cancer treatment; however, two out of five check AMH levels after completion of therapy. Most providers do not check AMH levels. Conclusions: Despite high risk for infertility among female cancer patients due to treatment and several advances that have been made in the field, the practice of offering fertility preservation is not universal due to various barriers at the physician and institutional level. Physician education and familiarity with ASCO’s newer guidelines is one way to promote a healthier dialogue and informed decision making. We also conclude that detailed guidelines and monitoring practices for diminished ovarian reserve are lacking and need further thought.[Table: see text]

Correlation between step count and clinical outcomes for patients with cancer during treatment: A feasibility study.

e18804 Background: Step count, as measured by a wearable accelerometer, has been shown to have a relationship to premature death, cardiovascular events, functional decline, longer stay, and higher rehospitalization rates. However, few cancer studies or trials have incorporated accelerometers to measure response to active treatment. We developed the DigiBioMarC™ smartphone application for cancer patients to enable participation in decentralized clinical trials and remote cancer care by collecting informed consent, ePROs and accelerometer data using an Apple Watch. This analysis assessed whether daily step data were associated with participants clinical events. Methods: We tested the feasibility of the DigiBioMarC application along with the Apple Watch for approximately 4 weeks with 50 cancer patients undergoing IV chemotherapy or immunotherapy recruited in a fully decentralized study through Kaiser Permanente Northern California. Participants used the app for at least 28 days and were provided with an Apple Watch if they did not already have one. Data pre-processing was performed to identify periods of missing data and non-wear time. Step count was calculated for each calendar day and days that included at least ten hours of wear time while awake were considered sufficient and included in the analysis. Specific clinical events were collected from the patients’ electronic health records (EHR) up to six months following the study. Results: Thirteen participants experienced at least one clinical event, and there were 5 deaths. Using Cox regression, patients with more sufficient days were less likely to die during follow up (p = 0.122) than patients with fewer sufficient days. On sufficient days, median daily steps < = 2,510 were associated with one or more adverse clinical events, while daily steps > 2,510 were associated with no clinical events and had a longer time to adverse clinical event (p = 0.068) compared to those with less than or equal to 2,510 median daily steps on sufficient days. Daily median step count on sufficient days predicted clinical event occurrence with an accuracy of 0.833. Conclusions: Findings from this feasibility study support the hypothesis that daily stepping behavior is a valid real-world digital measure to predict clinical events in patients undergoing cancer treatment. Although the predictive models did not reach statistical significance (p < 0.05), this is likely due to the low frequency of clinical events in the dataset. These findings indicate that future investigations with larger sample sizes are warranted as this may be a beneficial tool for decentralized trials or care when patients have longer periods of time between clinical visits. In patients undergoing cancer treatment, real-world based step data extracted from wearables can provide early indication of poor or declining health.

Effects of the coronavirus disease 2019 pandemic on anxiety and spirituality in patients with cancer undergoing chemotherapy: A cross-sectional study.

e24200 Background: The objective of this study was to evaluate anxiety and spirituality levels in oncology patients during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This short-term cross-sectional study applied a previously validated General Anxiety Disorder-7 (GAD7) scale and spirituality inventory to 230 patients undergoing antineoplastic chemotherapy during the second wave of COVID-19 in Brazil. The means ± SD of the scales were calculated and correlated (Spearman's rho). After categorization, chi-square and multinomial regression models were used to identify risk factors (p < 0.05). Results: The levels of anxiety (6.16±5.11) and spirituality (17.22±2.66) were moderately and inversely correlated (p = 0.001, r = -0.212). Women (p = 0.025), fatigue (p = 0.048), and insomnia (p = 0.001) were associated with an increased incidence of anxiety; however, spirituality was associated with a reduced incidence of fatigue (p = 0.032). Death of family or friends due to COVID-19 increased the risk of high levels of anxiety (p < 0.05), while in multivariate analysis, insomnia (p = 0.030) and sleep difficulty (p = 0.031) were also directly associated with anxiety and spirituality reduced the interruption of chemotherapy during the COVID-19 pandemic (p = 0.036). Conclusions: Fear of the COVID-19 pandemic altered the psychoemotional environment of patients undergoing chemotherapy, resulting in increased levels of anxiety. However, spirituality was an important coping strategy in patients undergoing cancer treatment.

ADESÃO AO TRATAMENTO ONCOLÓGICO: perscrutando sujeitos que vivenciam este processo

Cancer is an important public health problem, which conditions the recovery of health to the adherence to treatment demonstrated by the subjects affected by the disease. This study sought to understand which factors facilitate and hinder adherence to cancer treatment and what are the possible interventions. This is a qualitative research with documental design, in which statements of subjects undergoing cancer treatment published in social networks were collected and grouped. The methodology of data analysis was guided by Content Analysis, and from the exploration of the statements, five thematic categories were identified: the subject and his internal world; the impacts on quality of life; subject, family and health team; health system and its conditioning factors; protective resources. The results indicated that adherence to treatment is a multifactorial phenomenon, which requires a broad and empathetic look at the construction of policies and health care. It is essential that health practices recognize the subjectivity of individuals affected by cancer. And thus, understand their difficulties in adherence as part of the process of adaptation to this condition and rethink interventions that help in this process.

Warts in pediatric oncology patients: A single-institution retrospective study.

Pediatric oncology patients undergoing cancer treatment can often have numerous and recalcitrant cutaneous warts due to their underlying immunosuppression. There are little published data on the optimal management of warts in pediatric oncology patients undergoing active cancer treatment compared to patients having completed treatment. Our objective was to analyze the clinical course of warts treated within this patient population at Boston Children's Hospital over a 10-year period. This was a single-institution retrospective study of 72 pediatric oncology patients from 1 September 2011 to 1 September 2021 who were treated for warts at Boston Children's Hospital. All patients had a diagnosis of cutaneous warts with at least one follow-up visit and were receiving active treatment for cancer either during or after concurrent treatment of their warts. We examined the modality and effectiveness of wart treatments while both on and offactive treatment of their cancer. The median age was 12 years (range 4-18). Fifty-four percent of patients were documented to have plantar warts. Sixty percent of patients with a documented number of warts had more than five warts at presentation. For cases in which outcomes were specified, treatment resulted in complete resolution of warts in only 24.0% of patients undergoing active cancer treatment compared to 63.3% of patients not on active treatment. Warts persisted or worsened in 56.0% of patients undergoing active cancer treatment compared to only 13.4% of patients not on active treatment. These data may help guide clinicians in evaluating and treating warts in pediatric oncology patients.

Effects of Active Video Games in Patients With Cancer: Systematic Review.

Physical activity (PA) is now considered an adjuvant therapy in cancer treatment; nevertheless, multiple barriers could reduce PA engagement during treatment. Active video games (AVGs) lead to the achievement of mild- to moderate-intensity PA and represent a promising tool for regular movement and exercise. This paper aims to review the current literature and provide updated content on the physiological and psychological effects of AVG-based interventions in patients with cancer undergoing treatment. Four electronic databases were investigated. Studies reporting on AVG interventions delivered to patients undergoing treatment were included. A total of 21 articles (17 interventions) were identified for data extraction and quality assessment. A total of 362 patients with cancer participated in the studies (number of participants 3-70). The majority underwent treatment for breast, lung, prostate, hematologic, or oral or laryngeal cancer. The types and stages of cancer varied in all studies. Participants ranged in age from 3 to 93 years. Four studies included patients with pediatric cancer. The duration of interventions ranged from 2 to 16 weeks, with a minimum of 2 sessions per week and a maximum of 1 daily session. Sessions were supervised in 10 studies, and 7 included home-based interventions. AVG interventions improved endurance, quality of life, cancer-related fatigue, and self-efficacy. Effects were mixed on strength, physical function, and depression. AVGs did not affect activity level, body composition, or anxiety. Compared with standard physiotherapy, physiological effects were lower or similar, and psychological effects were higher or similar. Overall, our results suggest that AVGs can be recommended to patients undergoing cancer treatment, given the physiological and psychological benefits. When AVGs are proposed, supervision of the sessions should be considered as it can limit dropouts. In the future, it is important to develop AVGs that combine endurance and muscle strengthening, with the possibility of achieving moderate to high exercise intensity, depending on the physical abilities of the patients, as indicated in the World Health Organization's recommendations.

Beyond Medical Care: How Different National Models of Care Impact the Experience of Adolescent and Young Adult Cancer Patients.

Patient experience is positively associated with clinical effectiveness, quality care, and patient safety. This study examines the experience of care of adolescents and young adult (AYA) cancer patients from Australia and the United States, allowing a comparison of patient experiences in the context of different national models of cancer care delivery. Participants (n = 190) were aged 15-29 years and received cancer treatment from 2014 to 2019. Australians (n = 118) were recruited nationally by health care professionals. U.S. participants (n = 72) were recruited nationally via social media. The survey included demographic and disease variables, and questions regarding medical treatment, information and support provision, care coordination, and satisfaction across the treatment pathway. Sensitivity analyses examined the possible contribution of age and gender. Most patients from both countries were satisfied or very satisfied with their medical treatment (chemotherapy, radiotherapy, and surgery). There were significant differences between countries in the provision of fertility preservation services, age-appropriate communication, and psychosocial support. Our findings suggest when a national system of oversight with both state and federal funding is implemented, as is the case in Australia but not in the United States, significantly more AYAs with cancer receive age-appropriate information and support services, and improved access to specialist services such as fertility care. A national approach with government funding and centralized accountability appears to be associated with substantial benefits for the well-being of AYAs undergoing cancer treatment.

C8 INSTITUTIONAL VALIDATION OF THE JOINT ANMCO AND AIOM TUSCANY CLINICAL CARDIO–ONCOLOGY PATHWAY FOR THE CARDIOLOGY MANAGEMENT OF CANCER OUTPATIENTS

Abstract Background Given the relevance and the growing complexity of the management of cardio–oncology (CO) outpatients, a common care pathway has been recently proposed by ANMCO and AIOM Tuscany. Materials and methods: The proposal: 1) defined 3 categories of patients to be entered into the pathway (A: known cardiac disease needing active oncology treatment; B: undergoing cancer treatments with potential cardiac toxicity; C: experiencing cardiac toxicity and/or worsening of cardiovascular risk profile); 2) proposed two standard request forms for oncology (ONCO) and hematology (HEM); 3) set the minimum requirements for a cardio–oncology path; 4) indicated follow–up strategies during and after oncological treatments. Given the short observation interval we focused on points 1 and 2. Medical records of all cancer patients for whom a CO examination was required were analized to check if proposed forms have been used and if cases fulfilled into appropriate categories. Observation period was retrospectively set to 1 year starting from October 2022. Minimum appropriateness threshold for each process index was set to 80%. Results A total of 480 requests for a CO visit were retrospectively identified, 322 out of 480 (67%) from medical oncology and 158 out of 480 (33%) from hematology units. Appropriate request form was used in 95% of cases (456 out of 480) with no difference between ONCO and HEM units. All patients but 20 (460 out of 480, 95.8%) fulfilled (at least) one of the 3 pre–defined categories with no difference between ONCO and HEM units. Categories distribution was: A group 25%, B group 60%, and C group 15%. Patients from medical oncology were more likely to belong to A and B groups while cases from hematology to B and C groups. Conclusions Our data indicate that minimum thresholds were met for both index 1 and 2 (with values that are approaching to 100%) so supporting the use of the proposed clinical CO pathway.

Effectiveness of fluconazole as antifungal prophylaxis in cancer patients undergoing chemotherapy, radiotherapy, or immunotherapy: systematic review and meta-analysis.

This review assessed the effectiveness of fluconazole as antifungal prophylaxis on the incidence of oral fungal diseases in patients undergoing cancer treatment. The secondary outcomes evaluated were the adverse effects, discontinuation of cancer therapy due to oral fungal infection, mortality by a fungal infection, and the mean duration of antifungal prophylaxis. Twelve databases and records were searched. The RoB 2 and ROBINS I tools were used to assess the risk of bias. The relative risk (RR), risk difference, and standard mean difference (SMD) were applied with 95% confidence intervals (CI). The certainty of the evidence was determined by GRADE. Twenty-four studies were included in this systematic review. In randomized controlled trials pooling, fluconazole was a protective factor for the primary outcome (RR = 0.30; CI: 0.16, 0.55; p < 0.01, vs placebo). Compared to other antifungals, fluconazole was only more effective than the subgroup of amphotericin B and nystatin (alone or in combination) (RR = 0.19; CI: 0.09, 0.43; p < 0.01). Fluconazole was also a protective factor in non-randomized trials pooling (RR = 0.19; CI: 0.05, 0.78; p = 0.02, vs untreated). The results showed no significant differences for the secondary outcomes. The certainty of the evidence was low and very low. In conclusion, prophylactic antifungals are necessary during cancer treatment, and fluconazole was shown to be more effective in reducing oral fungal diseases only compared with the subgroup assessing amphotericin B and nystatin, administered alone or in combination.

Analysis of etiological factors of nursing diagnosis of impaired comfort in children and adolescents with cancer.

To analyse the etiological factors of the nursing diagnosis of impaired comfort in children and adolescents with cancer. This cross-sectional study was carried out in the referral unit for the treatment of childhood cancer in a tertiary hospital located in northeastern Brazil. A total of 200 children and adolescents who were undergoing cancer treatment were included in this study. Data collection instruments and protocols were constructed with operational and conceptual definitions of clinical indicators and etiological factors for the nursing diagnosis of impaired comfort. A latent class model with adjusted random effects was used to determine impaired comfort and measures of sensitivity and specificity of clinical indicators. A univariate logistic regression analysis was performed for each etiological factor of impaired comfort. The analysis of etiological factors for the nursing diagnosis of impaired comfort in children and adolescents with cancer showed the high prevalence of four factors: noxious environmental stimuli, insufficient situational control, insufficient resources and insufficient environmental control. Illness-related symptoms, noxious environmental stimuli, and insufficient environmental control increased the chance of impaired comfort occurring. The etiological factors with the highest prevalence and most significant impact on the occurrence of impaired comfort were noxious environmental stimuli, insufficient situational control and illness-related symptoms. The results obtained in this investigation can support more accurate nursing diagnostic inference of impaired comfort in children and adolescents with cancer. Moreover, the results can inform direct interventions for the modifiable factors that trigger this phenomenon to avoid or minimize the signs and symptoms of the nursing diagnosis.

Informal and formal financial assistance to rural women during cancer treatment

IntroductionRural women with cancer are at heightened risk of financial toxicity. Financial assistance is an important, yet underexamined, aspect of how patients with cancer cope with financial toxicity. This study aims to examine the types of financial assistance rural women with cancer received during cancer treatment and how they described the impact of that assistance. Material and methodsUsing data from interviews with 36 rural women with cancer histories, this study used a qualitative descriptive design to explore the types of financial assistance participants received during cancer treatment. ResultsParticipants described two forms of financial assistance they received: informal and formal financial assistance. Informal financial assistance was provided by social networks and local communities and included cash support, community fundraisers, and in-kind donations. Formal financial assistance was provided by healthcare systems and charitable organizations and included resource navigation and cash grants. Both forms of financial assistance were helpful for many patients with cancer; however, not all participants who needed financial assistance received it. DiscussionInformal and formal financial assistance are significant forms of support for some rural women undergoing cancer treatment. However, such support is unequally distributed and may exacerbate existing inequalities. Financial assistance is not an adequate substitute for public policy that reduces the economic toll of cancer treatment on patients.