Cancers

Research

13 pages, 654 KiB

Open AccessArticle

Relationships among Inflammatory Biomarkers and Objectively Assessed Physical Activity and Sleep during and after Chemotherapy for Gynecologic Malignancies

by Danielle B. Tometich, Aasha I. Hoogland, Brent J. Small, Michelle C. Janelsins, Crystal Bryant, Yvelise Rodriguez, Brian D. Gonzalez, Xiaoyin Li, Hailey W. Bulls, Brian W. James, Bianca Arboleda, Claudia Colon-Echevarria, Mary K. Townsend, Shelley S. Tworoger, Paulo Rodriguez, Laura B. Oswald, Julienne E. Bower, Sachin M. Apte, Robert M. Wenham, Hye Sook Chon, Mian M. Shahzad and Heather S. L. Jim Show full author list Hide full author list

Cancers 2023, 15(15), 3882; https://doi.org/10.3390/cancers15153882 - 30 Jul 2023

Viewed by 1056

Abstract

Little is known regarding associations between inflammatory biomarkers and objectively measured physical activity and sleep during and after chemotherapy for gynecologic cancer; thus, we conducted a longitudinal study to address this gap. Women with gynecologic cancer (patients) and non-cancer controls (controls) completed assessments [...] Read more.

Little is known regarding associations between inflammatory biomarkers and objectively measured physical activity and sleep during and after chemotherapy for gynecologic cancer; thus, we conducted a longitudinal study to address this gap. Women with gynecologic cancer (patients) and non-cancer controls (controls) completed assessments before chemotherapy cycles 1, 3, and 6 (controls assessed contemporaneously), as well as at 6- and 12-month follow-ups. Physical activity and sleep were measured using wrist-worn actigraphs and sleep diaries, and blood was drawn to quantify circulating levels of inflammatory markers. Linear and quadratic random-effects mixed models and random-effects fluctuation mixed models were used to examine physical activity and sleep over time, as well as the associations with inflammatory biomarkers. On average, patients (n = 97) and controls (n = 104) were 62 and 58 years old, respectively. Compared to controls, patients were less active, more sedentary, had more time awake after sleep onset, and had lower sleep efficiency (p-values < 0.05). Across groups, higher levels of TNF-α were associated with more sedentary time and less efficient sleep (p-values ≤ 0.05). Higher levels of IL-1β, TNF-α, and IL-6 were associated with lower levels of light physical activity (p-values < 0.05). Associations between inflammatory biomarkers, physical activity, and sleep did not differ between patients and controls. Given these results, we speculate that inflammation may contribute to less physical activity and more sleep problems that persist even 12 months after completing chemotherapy. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment)

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16 pages, 1494 KiB

Open AccessArticle

Relationships among Inflammatory Biomarkers and Self-Reported Treatment-Related Symptoms in Patients Treated with Chemotherapy for Gynecologic Cancer: A Controlled Comparison

by Aasha I. Hoogland, Brent J. Small, Laura B. Oswald, Crystal Bryant, Yvelise Rodriguez, Brian D. Gonzalez, Xiaoyin Li, Michelle C. Janelsins, Hailey W. Bulls, Brian W. James, Bianca Arboleda, Claudia Colon-Echevarria, Mary K. Townsend, Shelley S. Tworoger, Paulo C. Rodriguez, Julienne E. Bower, Sachin M. Apte, Robert M. Wenham and Heather S. L. Jim

Cancers 2023, 15(13), 3407; https://doi.org/10.3390/cancers15133407 - 29 Jun 2023

Cited by 1 | Viewed by 1661

Abstract

Previous research suggests that inflammation triggers cancer-treatment-related symptoms (i.e., fatigue, depression, and disruptions in sleep and physical activity), but evidence is mixed. This study examined relationships between inflammatory biomarkers and symptoms in patients with gynecologic cancer compared to age-matched women with no cancer [...] Read more.

Previous research suggests that inflammation triggers cancer-treatment-related symptoms (i.e., fatigue, depression, and disruptions in sleep and physical activity), but evidence is mixed. This study examined relationships between inflammatory biomarkers and symptoms in patients with gynecologic cancer compared to age-matched women with no cancer history (i.e., controls). Patients (n = 121) completed assessments before chemotherapy cycles 1, 3, and 6, and 6 and 12 months later. Controls (n = 105) completed assessments at similar timepoints. Changes in inflammation and symptomatology were evaluated using random-effects mixed models, and cross-sectional differences between patients and controls in inflammatory biomarkers and symptoms were evaluated using least squares means. Associations among inflammatory biomarkers and symptoms were evaluated using random-effects fluctuation mixed models. The results indicated that compared to controls, patients typically have higher inflammatory biomarkers (i.e., TNF-alpha, TNFR1, TNFR2, CRP, IL-1ra) and worse fatigue, depression, and sleep (ps < 0.05). Patients reported lower levels of baseline physical activity (p = 0.02) that became more similar to controls over time. Significant associations were observed between CRP, depression, and physical activity (ps < 0.05), but not between inflammation and other symptoms. The results suggest that inflammation may not play a significant role in fatigue or sleep disturbance among gynecologic cancer patients but may contribute to depression and physical inactivity. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment)

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10 pages, 266 KiB

Open AccessArticle

Fear of Cancer Recurrence in Patients with Sarcoma in the United Kingdom

by Anika Petrella, Lesley Storey, Nicholas J. Hulbert-Williams, Lorna A. Fern, Maria Lawal, Craig Gerrand, Rachael Windsor, Julie Woodford, Jennie Bradley, Hatty O’Sullivan, Mary Wells and Rachel M. Taylor

Cancers 2023, 15(3), 956; https://doi.org/10.3390/cancers15030956 - 02 Feb 2023

Cited by 5 | Viewed by 1923

Abstract

Fear of cancer recurrence (FCR) is a persistent concern among those living with cancer and is associated with a variety of negative psychosocial outcomes. However, people with sarcoma have been underrepresented within this area of research. We aimed to determine the prevalence of [...] Read more.

Fear of cancer recurrence (FCR) is a persistent concern among those living with cancer and is associated with a variety of negative psychosocial outcomes. However, people with sarcoma have been underrepresented within this area of research. We aimed to determine the prevalence of FCR experienced by people with sarcoma in the United Kingdom and explore factors that may predict FCR, such as the perceived impact of cancer and psychological flexibility. Participants (n = 229) with soft tissue (n = 167), bone (n = 25), and gastrointestinal stromal tumours (n = 33) completed an online survey including the self-reported measures of FCR, the perceived physical and psychological impact of cancer and psychological flexibility, and demographic information. Data were analysed using ANOVA and multiple regression modelling. Mean FCR scores (M = 91.4; SD = 26.5) were higher than those reported in meta-analytic data inclusive of all cancer types (M = 65.2; SD = 28.2). Interest in receiving support for FCR was also high (70%). Significant factors associated with FCR included cognitive and emotional distress and psychological flexibility, but not perceptions of the physical impact of cancer (R² = 0.56). The negative association between psychological flexibility and FCR suggests the potential benefit of intervention approaches which foster psychological flexibility, such as acceptance and commitment therapy. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment)

10 pages, 772 KiB

Open AccessArticle

Impact of Immune-Related Adverse Events on Immune Checkpoint Inhibitors Treated Cancer Patients’ Survival: Single Center Experience and Literature Review

by Raquel Romão, Ana S. Mendes, Ridhi Ranchor, Maria João Ramos, João Coelho, Rita Carrilho Pichel, Sérgio Xavier Azevedo, Paula Fidalgo and António Araújo

Cancers 2023, 15(3), 888; https://doi.org/10.3390/cancers15030888 - 31 Jan 2023

Cited by 4 | Viewed by 1472

Abstract

Immune-related adverse events have emerged as a new challenge and its correlation with survival remains unclear. The goal of our study was to investigate the effect of irAE on survival outcomes in solid tumor patients receiving ICI treatment. This was a retrospective, single-center [...] Read more.

Immune-related adverse events have emerged as a new challenge and its correlation with survival remains unclear. The goal of our study was to investigate the effect of irAE on survival outcomes in solid tumor patients receiving ICI treatment. This was a retrospective, single-center study at a university hospital involving patients with malignancy who received immune checkpoint inhibitors. Chart review was performed on each patient, noting any irAE, including new events or worsening of previous autoimmune condition after starting treatment with ICI. A total of 155 patients were included, 118 (76.1%) were male, with median age of 64 years. Median follow up time was 36 months. Seventy patients (45.2%) had at least one irAE. Of all irAE, nine (8.1%) were classified as grade 3 or higher according to the CTCAE version 5.0. There was one death secondary to pneumonitis. Median ICI cycles until first irAE onset was 4 (range: 2–99). The objective response rate was higher for patients who developed irAE (18.7% vs. 9.0%; p = 0.001), as was median overall survival (18 months (95% CI, 8.67–27.32) vs. 10 (95% CI, 3.48–16.52) months; p < 0.016) and progression free survival (10 months (95% CI, 5.44–14.56) vs. 3 months (95% CI, 1.94–4.05); p = 0.000). The risk of death in patients with irAE was 33% lower when compared to patients without such events (hazard ratio (HR): 0.67; 95% CI, 0.46–0.99; p = 0.043). Development of irAE predicted better outcomes, including OS in patients with advanced solid tumors treated with ICI. Further prospective studies are needed to explore and validate this prognostic value. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment)

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14 pages, 1905 KiB

Open AccessArticle

Outcomes Following Autologous Fat Grafting in Patients with Sequelae of Head and Neck Cancer Treatment

by Jorge Masià-Gridilla, Javier Gutiérrez-Santamaría, Iago Álvarez-Sáez, Jorge Pamias-Romero, Manel Saez-Barba and Coro Bescós-Atin

Cancers 2023, 15(3), 800; https://doi.org/10.3390/cancers15030800 - 28 Jan 2023

Cited by 1 | Viewed by 1474

Abstract

A single-center retrospective study was designed to assess the outcomes of autologous fat grafting for improving surgery- and radiotherapy-related sequelae in 40 patients with head and neck cancer. All patients underwent surgical resection of primary tumors and radiotherapy (50–70 Gy) and were followed [...] Read more.

A single-center retrospective study was designed to assess the outcomes of autologous fat grafting for improving surgery- and radiotherapy-related sequelae in 40 patients with head and neck cancer. All patients underwent surgical resection of primary tumors and radiotherapy (50–70 Gy) and were followed over 12 months after fat grafting. Eligibility for fat grafting procedures included complete remission after at least 3 years of oncological treatment. The cervical and paramandibular regions were the most frequently treated areas. Injected fat volumes ranged between 7.5 and 120 mL (mean: 23 mL). Esthetic improvement was obtained in 77.5% of patients, being significant in 17.5%, and functional improvement in 89.2%, being significant in 29.7% of patients. Minor complications occurred in three patients. There was a high degree of satisfaction regarding esthetic improvement, global satisfaction, and 92.5% of patients would recommend the procedure. This study confirms the benefits of fat grafting as a volumetric correction reconstructive strategy with successful cosmetic and functional outcomes in patients suffering from sequelae after head and neck cancer treatment. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment)

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Graphical abstract

12 pages, 468 KiB

Open AccessArticle

Cancer-Related Symptom Management Intervention for Southwest American Indians

by Felicia S. Hodge, Tracy Line-Itty and Rachel H. A. Arbing

Cancers 2022, 14(19), 4771; https://doi.org/10.3390/cancers14194771 - 29 Sep 2022

Viewed by 1183

Abstract

There is limited literature related to culturally embedded meanings of cancer and related symptoms among American Indians. A culturally appropriate intervention to improve management of cancer-related symptoms, including pain, depression, fatigue and loss of function, was tested. Two-hundred and twenty-two adult American Indians [...] Read more.

There is limited literature related to culturally embedded meanings of cancer and related symptoms among American Indians. A culturally appropriate intervention to improve management of cancer-related symptoms, including pain, depression, fatigue and loss of function, was tested. Two-hundred and twenty-two adult American Indians with cancer were recruited from eight Southwest sites for a randomized clinical trial. The intervention group received tailored education, a toolkit with a video, and participated in discussion sessions on cancer symptom management; the control group received information on dental care. Pre- and post-test questionnaires were administered to control and intervention groups. Measures included socio-demographics, cancer-related symptom management knowledge and behavior, and quality of life measures. Male cancer survivors reported poorer self-assessed health status and lower scores on quality-of-life indicators as compared to female cancer survivors. Significant improvement was reported in symptom management knowledge scores following the intervention: management of pain (p = 0.003), depression (p = 0.004), fatigue (p = 0.0001), and loss of function (p = 0.0001). This study is one of the first to demonstrate a change in physical symptom self-management skills, suggesting culturally appropriate education and interventions can successfully enhance cancer-related symptom management knowledge and practice. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment)

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21 pages, 1551 KiB

Open AccessArticle

Unraveling Desmoid-Type Fibromatosis-Specific Health-Related Quality of Life: Who Is at Risk for Poor Outcomes

by Anne-Rose W. Schut, Emma Lidington, Milea J. M. Timbergen, Eugenie Younger, Winette T. A. van der Graaf, Winan J. van Houdt, Johannes J. Bonenkamp, Robin L. Jones, Dirk. J. Grünhagen, Stefan Sleijfer, Cornelis Verhoef, Spyridon Gennatas and Olga Husson

Cancers 2022, 14(12), 2979; https://doi.org/10.3390/cancers14122979 - 16 Jun 2022

Cited by 5 | Viewed by 1373

Abstract

Desmoid-type fibromatosis (DTF) is a rare, soft-tissue tumour. These tumours do not metastasize, but their local aggressive tumour growth and unpredictable behaviour can have a significant impact on health-related quality of life (HRQoL). Little is known about which DTF patients are particularly affected [...] Read more.

Desmoid-type fibromatosis (DTF) is a rare, soft-tissue tumour. These tumours do not metastasize, but their local aggressive tumour growth and unpredictable behaviour can have a significant impact on health-related quality of life (HRQoL). Little is known about which DTF patients are particularly affected by an impaired HRQoL. The objectives of this study were to assess HRQoL among different groups of DTF patients and to investigate which socio-demographic and clinical characteristics were associated with DTF-specific HRQoL. A cross-sectional study was conducted among DTF patients from the United Kingdom and the Netherlands. HRQoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), accompanied by the DTF-QoL to assess DTF-specific HRQoL. The scores were compared amongst subgroups, based on the socio-demographic and clinical characteristics of DTF patients. Multiple linear regression analyses with a backward elimination were conducted to identify the factors associated with DTF-specific HRQoL. A total of 235 DTF patients completed the questionnaires. Female patients, patients with more than two comorbidities, or patients who received treatment other than only active surveillance (AS) or surgery scored significantly worse on the subscales of both the EORTC QLQ-C30 and DTF-QoL. Patients that were ≥ 40 years scored significantly worse on the physical functioning scale of the EORTC QLQ-C30, while younger patients (18–39 years) scored significantly worse on several DTF-QoL subscales. Differences in the DTF-QoL subscales were found for tumour location, time since diagnosis and the presence of recurrent disease. Furthermore, treatments other than AS or surgery only, female sex, younger age and the presence of comorbidities were most frequently associated with worse scores on the DTF-QoL subscales. This study showed that (DTF-specific) HRQoL differs between groups of DTF patients. Awareness of these HRQoL differences could help to provide better, personalised care that is tailored to the needs of a specific subgroup. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment)

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Review

Jump to: Research, Other

11 pages, 1409 KiB

Open AccessReview

Best Supportive Care of the Patient with Oesophageal Cancer

by Rita Carrilho Pichel, Alexandra Araújo, Vital Da Silva Domingues, Jorge Nunes Santos, Elga Freire, Ana Sofia Mendes, Raquel Romão and António Araújo

Cancers 2022, 14(24), 6268; https://doi.org/10.3390/cancers14246268 - 19 Dec 2022

Cited by 2 | Viewed by 1903

Abstract

Background: Oesophageal cancer patients have poor survival, and most are unfit for curative or systemic palliative treatment. This article aims to review the best supportive care for oesophageal cancer, focusing on the management of its most frequent or distinctive symptoms and complications. Methods: [...] Read more.

Background: Oesophageal cancer patients have poor survival, and most are unfit for curative or systemic palliative treatment. This article aims to review the best supportive care for oesophageal cancer, focusing on the management of its most frequent or distinctive symptoms and complications. Methods: Evidence-based review on palliative supportive care of oesophageal cancer, based on Pubmed search for relevant clinical practice guidelines, reviews and original articles, with additional records collected from related articles suggestions, references and societies recommendations. Results: We identified 1075 records, from which we screened 138 records that were related to oesophageal cancer supportive care, complemented with 48 additional records, finally including 60 records. This review summarizes the management of oesophageal cancer-related main problems, including dysphagia, malnutrition, pain, nausea and vomiting, fistula and bleeding. In recent years, several treatments have been developed, while optimal management is not yet standardized. Conclusion: This review contributes toward improving supportive care and decision making for oesophageal cancer patients, presenting updated summary recommendations for each of their main symptoms. A robust body of evidence is still lacking, and the best supportive care decisions should be individualized and shared. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment)

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12 pages, 550 KiB

Open AccessReview

Opioid-Induced Sexual Dysfunction in Cancer Patients

by Bartłomiej Salata, Agnieszka Kluczna and Tomasz Dzierżanowski

Cancers 2022, 14(16), 4046; https://doi.org/10.3390/cancers14164046 - 22 Aug 2022

Cited by 3 | Viewed by 2921

Abstract

Sexual dysfunction is common in patients with advanced cancer, although it is frequently belittled, and thus consistently underdiagnosed and untreated. Opioid analgesics remain fundamental and are widely used in cancer pain treatment. However, they affect sexual functions primarily due to their action on [...] Read more.

Sexual dysfunction is common in patients with advanced cancer, although it is frequently belittled, and thus consistently underdiagnosed and untreated. Opioid analgesics remain fundamental and are widely used in cancer pain treatment. However, they affect sexual functions primarily due to their action on the hypothalamus–pituitary–gonadal axis. Other mechanisms such as the impact on the central and peripheral nervous systems are also possible. The opioid-induced sexual dysfunction includes erectile dysfunction, lack of desire and arousal, orgasmic disorder, and lowered overall sexual satisfaction. Around half of the individuals taking opioids chronically may be affected by sexual dysfunction. The relative risk of sexual dysfunction in patients on chronic opioid therapy and opioid addicts increased two-fold in a large meta-analysis. Opioids differ in their potential to induce sexual dysfunctions. Partial agonists and short-acting opioids may likely cause sexual dysfunction to a lesser extent. Few pharmaceutical therapies proved effective: testosterone replacement therapy, PDE5 inhibitors, bupropion, trazodone, opioid antagonists, and plant-derived medicines such as Rosa damascena and ginseng. Non-pharmacological options, such as psychosexual or physical therapies, should also be considered. However, the evidence is scarce and projected primarily from non-cancer populations, including opioid addicts. Further research is necessary to explore the problem of sexuality in cancer patients and the role of opioids in inducing sexual dysfunction. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment)

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13 pages, 678 KiB

Open AccessReview

An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research

by Gunnhild Jakobsen, Kari Hanne Gjeilo, Marianne Jensen Hjermstad and Pål Klepstad

Cancers 2022, 14(16), 3933; https://doi.org/10.3390/cancers14163933 - 15 Aug 2022

Cited by 3 | Viewed by 4185

Abstract

Patients with advanced cancer experience multiple symptoms, with fluctuating intensity and severity during the disease. They use several medications, including opioids, which may affect sleep. Sleep disturbance is common in cancer patients, decreases the tolerability of other symptoms, and impairs quality of life. [...] Read more.

Patients with advanced cancer experience multiple symptoms, with fluctuating intensity and severity during the disease. They use several medications, including opioids, which may affect sleep. Sleep disturbance is common in cancer patients, decreases the tolerability of other symptoms, and impairs quality of life. Despite its high prevalence and negative impact, poor sleep quality often remains unrecognized and undertreated. Given that sleep is an essential aspect of health-related quality of life, it is important to extend both the knowledge base and awareness among health care providers in this field to improve patient care. In this narrative review, we provide recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that contribute to insomnia. We also present direct implications for health care providers working in palliative care and for future research. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment)

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Other

Jump to: Research, Review

15 pages, 355 KiB

Open AccessPerspective

Tackling Insomnia Symptoms through Vestibular Stimulation in Patients with Breast Cancer: A Perspective Paper

by Joy Perrier, Melvin Galin, Pierre Denise, Bénédicte Giffard and Gaëlle Quarck

Cancers 2023, 15(11), 2904; https://doi.org/10.3390/cancers15112904 - 25 May 2023

Cited by 1 | Viewed by 1357

Abstract

Insomnia symptoms are common among patients with breast cancer (BC; 20–70%) and are predictors of cancer progression and quality of life. Studies have highlighted sleep structure modifications, including increased awakenings and reduced sleep efficiency and total sleep time. Such modifications may result from [...] Read more.

Insomnia symptoms are common among patients with breast cancer (BC; 20–70%) and are predictors of cancer progression and quality of life. Studies have highlighted sleep structure modifications, including increased awakenings and reduced sleep efficiency and total sleep time. Such modifications may result from circadian rhythm alterations consistently reported in this pathology and known as carcinogenic factors, including lower melatonin levels, a flattened diurnal cortisol pattern, and lower rest-activity rhythm amplitude and robustness. Cognitive behavioral therapy and physical activity are the most commonly used non-pharmacological interventions to counter insomnia difficulties in patients with BC. However, their effects on sleep structure remain unclear. Moreover, such approaches may be difficult to implement shortly after chemotherapy. Innovatively, vestibular stimulation would be particularly suited to tackling insomnia symptoms. Indeed, recent reports have shown that vestibular stimulation could resynchronize circadian rhythms and improve deep sleep in healthy volunteers. Moreover, vestibular dysfunction has been reported following chemotherapy. This perspective paper aims to support the evidence of using galvanic vestibular stimulation to resynchronize circadian rhythms and reduce insomnia symptoms in patients with BC, with beneficial effects on quality of life and, potentially, survival. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment)

12 pages, 947 KiB

Open AccessSystematic Review

The Effects of Patient-Reported Outcome Screening on the Survival of People with Cancer: A Systematic Review and Meta-Analysis

by Caterina Caminiti, Giuseppe Maglietta, Francesca Diodati, Matteo Puntoni, Barbara Marcomini, Silvia Lazzarelli, Carmine Pinto and Francesco Perrone

Cancers 2022, 14(21), 5470; https://doi.org/10.3390/cancers14215470 - 07 Nov 2022

Cited by 11 | Viewed by 1492

Abstract

This study examined the effects of the routine assessment of patient-reported outcomes (PROs) on the overall survival of adult patients with cancer. We included clinical trials and observational studies with a control group that compared PRO monitoring interventions in cancer clinical practice to [...] Read more.

This study examined the effects of the routine assessment of patient-reported outcomes (PROs) on the overall survival of adult patients with cancer. We included clinical trials and observational studies with a control group that compared PRO monitoring interventions in cancer clinical practice to usual care. The Cochrane risk-of-bias tools were used. In total, six studies were included in the systematic review: two randomized trials, one population-based retrospectively matched cohort study, two pre–post with historical control studies and one non-randomized controlled trial. Half were multicenter, two were conducted in Europe, three were conducted in the USA and was conducted in Canada. Two studies considered any type of cancer, two were restricted to lung cancer and two were restricted to advanced forms of cancer. PRO screening was electronic in four of the six studies. The meta-analysis included all six studies (intervention = 130.094; control = 129.903). The pooled mortality outcome at 1 year was RR = 0.77 (95%CI 0.76–0.78) as determined by the common effect model and RR = 0.82 (95%CI 0.60–1.12; p = 0.16) as determined by the random-effects model. Heterogeneity was statistically significant (I² = 73%; p < 0.01). The overall risk of bias was rated as moderate in five studies and serious in one study. This meta-analysis seemed to indicate the survival benefits of PRO screening. As routine PRO monitoring is often challenging, more robust evidence regarding the effects of PROs on mortality would support systematic applications. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment)

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