Search

Poor-quality medicines (substandard or counterfeit) can lead to treatment failure. There is a vast global imbalance in cancer treatment outcomes due to the difficulty of accessing quality chemotherapeutic products. Early diagnosis of cancer brings more hope for curative treatment of cancer and increases the demand for chemotherapeutic products. Consequently, it creates opportunities for unethical manufacturers and suppliers to develop substandard and/or counterfeit products. An ongoing review of cost-effective analytical methods is therefore paramount to tracking and tracing poor chemotherapeutic pharmaceutical products. Low- and middle-income country (LMIC) regulators lack safety equipment and standard operating procedures to handle chemotherapeutic products safely in the drug analysis laboratory and have limited capacity to perform post-marketing surveillance on these products. This review aimed to provide a compressive review of the Chemotherapeutic Paper Analytical Device (ChemoPAD). ChemoPAD is an important tool for quality screening of commonly used chemotherapeutic products in LMIC settings. It is an efficient, fast, simple, accessible, cost-effective, and transferable analytical method for verifying substandard and/or counterfeit chemotherapeutic products. Designed as a complete paper-based laboratory the size of a playing card, the ChemoPAD provides a promising solution for healthcare providers, patients, and other parties involved in post-marketing surveillance of chemotherapeutic products. Thus, in the near future, scientists could probably witness the use of the ChemoPAD technology platform to trace and track substandard and/or counterfeit chemotherapeutic products. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with breast cancer frequently complaint from insomnia difficulties that can affect quality of life and cancer progression. Such difficulties may result from rest-activity (i.e., 24 h alternation of sleep and wake) rhythm alterations consistently reported in this pathology. Currently proposed approaches to counter insomnia difficulties in patients with breast cancer have positive effects only on sleep complaints and well-being. Moreover, such approaches may be difficult to implement shortly after chemotherapy. Innovatively, vestibular stimulation would be particularly suited to tackling insomnia symptoms in patients with breast cancer. Indeed, recent reports have shown that vestibular stimulation could improve rest-activity rhythm and sleep in healthy volunteers. This perspective paper aims to support the evidence of using vestibular stimulation to improve rest-activity rhythms and reduce insomnia symptoms in patients with BC, with beneficial effects on quality of life and, potentially, survival. 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. [ABSTRACT FROM AUTHOR]

Isolated limb perfusion (ILP) is a well-established surgical procedure for the administration of high dose chemotherapy to a limb for the treatment of advanced extremity malignancy. Although the technique of ILP was first described over 60 years ago, ILP is utilised in relatively few specialist centres, co-located with tertiary or quaternary cancer centres. The combination of high dose cytotoxic chemotherapy and the cytokine tumour necrosis factor alpha (TNFα), mandates leakage monitoring to prevent potentially serious systemic toxicity. Since the procedure is performed at relatively few specialist centres, an ILP working group was formed with the aim of producing technical consensus guidelines for the procedure to streamline practice and to provide guidance for new centres commencing the technique. Between October 2021 and October 2023 a series of face to face online and hybrid meetings were held in which a modified Delphi process was used to develop a unified consensus document. After each meeting the document was modified and recirculated and then rediscussed at subsequent meeting until a greater than 90% consensus was achieved in all recommendations. The completed consensus document comprised 23 topics in which greater than 90% consensus was achieved, with 83% of recommendations having 100% consensus across all members of the working group. The consensus recommendations covered all areas of the surgical procedure including pre-operative assessment, drug dosing and administration, perfusion parameters, hyperthermia, leakage monitoring and theatre logistics, practical surgical strategies and also post-operative care, response evaluation and staff training. We present the first joint expert-based consensus statement with respect to the technical aspects of ILP that can serve as a reference point for both existing and new centres in providing ILP. [ABSTRACT FROM AUTHOR]

Malnutrition in cancer patients – in both prevalence and degree – depends primarily on tumor stage and site. Preoperative malnutrition in surgical patients is a frequent problem and is associated with prolonged hospital stay, a higher rate of postoperative complications, higher re-admission rates, and a higher incidence of postoperative death. Given the focus on the cancer and its cure, nutrition is often neglected or under-evaluated, and this despite the availability of international guidelines for nutritional care in cancer patients and the evidence that nutritional deterioration negatively affects survival. Inadequate nutritional support for cancer patients should be considered ethically unacceptable; prompt nutritional support must be guaranteed to all cancer patients, as it can have many clinical and economic advantages. Patients undergoing multimodal oncological care are at particular risk of progressive nutritional decline, and it is essential to minimize the nutritional/metabolic impact of oncological treatments and to manage each surgical episode within the context of an enhanced recovery pathway. In Europe, enhanced recovery after surgery (ERAS) and routine nutritional assessment are only partially implemented because of insufficient awareness among health professionals of nutritional problems, a lack of structured collaboration between surgeons and clinical nutrition specialists, old dogmas, and the absence of dedicated resources. Collaboration between opinion leaders dedicated to ERAS from both the European Society of Surgical Oncology (ESSO) and the ERAS Society was born with the aim of promoting nutritional assessment and perioperative nutrition with and without an enhanced recovery program. The goal will be to improve awareness in the surgical oncology community and at institutional level to modify current clinical practice and identify optimal treatment options. [ABSTRACT FROM AUTHOR]

Purpose UNC Medical Center converted to an electronic health record (EHR) in 2014. This conversion allowed for the transition of paper chemotherapy orders to be managed electronically. This article describes the process for converting inpatient paper chemotherapy orders into the new EHR in a safe and effective manner. Summary A collaborative interdisciplinary approach to the EHR transition enabled our organization to move from using paper chemotherapy orders to fully electronic chemotherapy treatment plans in both ambulatory and acute care areas. Active chemotherapy orders for acute care inpatients were reviewed and transcribed by two oncology pharmacists in the cancer hospital prior to being signed by an attending physician. The newly input orders were independently verified by two pharmacists in the cancer hospital inpatient pharmacy. Nurse review of the signed and verified treatment plans, along with reconciliation of the medication administration record ensured a safe transition to the new EHR workflow. Providers benefit from the ability to review treatment plans remotely, track changes, and include supportive medications in one consolidated location. The coordinated team effort allowed for a smooth transition with minimal interruptions to patient care. Conclusion The pharmacist-led, multidisciplinary conversion to electronic chemotherapy orders was safe, accurate, and occurred ahead of schedule for the EHR go-live. Advance communication and planning around scheduled inpatient admissions helped to minimize the impact of the transition from paper to electronic treatment plans. Both pharmacist and physician engagement were necessary to ensure a smooth transition for active inpatient treatment plans. [ABSTRACT FROM AUTHOR]

Simple Summary: Canine lymphoma is a common cancer of one of the white blood cells that is commonly treated with chemotherapy. Many papers have been published about this disease and treatment, but few comprehensive reviews of the outcomes reported after chemotherapy, and the prognostic factors that influence the outcomes, have been published. Knowledge of the potential outcomes for this disease is important for veterinarians as they guide dog owners in the decision making about treatment options. This review evaluated the papers published on this topic and found that there is a wide variation in outcomes reported, as well as the factors that influence the outlook. Additionally, while individual papers have shown a much better survival, over the last 40 years, the overall improvement in outcome has been modest at best. The use of uniform reporting in the studies is needed, and novel approaches are likely needed to significantly improve the outlook for dogs with this disease. While canine lymphoma is a relatively common and important disease seen by veterinarians, there are limited comprehensive reviews of the literature regarding the remission and survival times following chemotherapy, and the associated prognostic factors. This comprehensive thematic review covers the available veterinary literature covering treatment outcomes and identified prognostic factors. A lack of standardised approaches to evaluate and report the outcomes was identified, including factors that would alter the duration of responses by weeks, or occasionally months. After publication of the suggested reporting criteria, this has improved but is still not uniformly applied. The prognostic factors included for evaluation varied from as few as three to seventeen, with over 50 studies using only univariate analysis. Individual papers reported much longer outcomes than others, but assessing the outcomes overall, there has been minimal change over the last 40 years. This supports the belief that novel approaches for lymphoma therapy will be required to substantively improve outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Patients with cancer may have many complications involving their psychosomatic systems, such as sleep disturbance, depression, and anxiety. Thus, many research studies were conducted to reduce these complications. Zolpidem, as a short-term non-benzodiazepine treatment of insomnia, and melatonin as a chronobiological functionregulatory hormone, are commonly used for improving sleep quality. This randomized clinical trial aims to compare the effects of zolpidem and melatonin on sleep quality, depression, and anxiety in patients with colorectal cancer. Methods: In this single-blinded trial, 90 patients with colorectal cancer undergoing chemotherapy who had obtained a score of 5 or higher on the Pittsburgh Sleep Quality Index (PSQI) were randomly divided into two groups (n=45). One group was treated with 10 mg zolpidem at bedtime, and the other group received 6 mg melatonin at bedtime for 30 days. PSQI on weeks 0, 4, 8, Groningen sleep quality scale, Hamilton rating scale for depression, and Hamilton anxiety rating scale questionnaires were performed to assess patients on weeks 0, 4, and 8. The outcome was then analyzed, and P=0.05 was considered statistically significant. Results: Both zolpidem and melatonin had significant impacts on sleep quality in week 4 (P<0.05). After stopping the treatments, the conditions were noticeably reversed on week 8 (P<0.05). Zolpidem and melatonin were relatively similar in affecting sleep duration, latency, efficiency, and disturbance. None of the two study medications had any considerable influence on anxiety and depression. Conclusion: Melatonin and zolpidem are promising agents for treating sleep complications and, to some extent, depression, and anxiety in cancer patients, according to the present study. However, further clinical trials are recommended to confirm the results of this study. [ABSTRACT FROM AUTHOR]

Background: With the growing global problem of antibiotic resistance it is crucial that clinicians use antibiotics wisely, which largely means following the principles of antimicrobial stewardship (AMS). Treatment of various types of wounds is one of the more common reasons for prescribing antibiotics. Objectives: This guidance document is aimed at providing clinicians an understanding of: the basic principles of why AMS is important in caring for patients with infected wounds; who should be involved in AMS; and how to conduct AMS for patients with infected wounds. Methods: We assembled a group of experts in infectious diseases/clinical microbiology (from the British Society for Antimicrobial Chemotherapy) and wound management (from the European Wound Management Association) who, after thoroughly reviewing the available literature and holding teleconferences, jointly produced this guidance document. Results: All open wounds will be colonised with bacteria, but antibiotic therapy is only required for those that are clinically infected. Therapy is usually empirical to start, but definitive therapy should be based on results of appropriately collected specimens for culture. When prescribed, it should be as narrowly focused, and administered for the shortest duration, as possible. AMS teams should be interdisciplinary, especially including specialists in infection and pharmacy, with input from administrative personnel, the treating clinicians and their patients. Conclusion: Available evidence is limited, but suggests that applying principles of AMS to the care of patients with wounds should help to reduce the unnecessary use of systemic or topical antibiotic therapy and ensure the safest and most clinically effective therapy for infected wounds. [ABSTRACT FROM AUTHOR]

In vitro models for screening new cancer chemotherapeutics often rely on two-dimensional cultures to predict therapeutic potential. Unfortunately, the predictive power of these models is limited, as they fail to recapitulate the complex three-dimensional environments in tumors that promote a chemoresistant phenotype. In this study, we describe the preparation and characterization of paper-based cultures (PBCs) engineered to assess chemotherapeutic effectiveness in three dimensional, diffusion-limited environments. Similar environments are found in poorly vascularized tumors. Monotonic gradients develop across these cultures, which are assembled by stacking cell-laden paper scaffolds to yield thick tissue-like structures, and provide distinct chemical environments for each scaffold. After prolonged incubation, the scaffolds can simply be peeled apart and analyzed. Through fluorescence imaging, we determined that viable and proliferative cell populations were most abundant in scaffolds close to the nutrient-rich medium. By adjusting the cell density, we modulated the spatiotemporal evolution of oxygen gradients across the cultures and correlated these environmental changes with cellular sensitivity to SN-38 exposure. From these results, we showed that differences in the oxygen gradients produced cellular populations with significantly different chemosensitivities. Through this work, we highlight PBCs ability to serve as an analytical model capable of determining chemotherapeutic effectiveness under a range of chemical environments. [ABSTRACT FROM AUTHOR]

Chordomas are rare, malignant bone tumors of the skull-base and axial skeleton. Until recently, there was no consensus among experts regarding appropriate clinical management of chordoma, resulting in inconsistent care and suboptimal outcomes for many patients. To address this shortcoming, the European Society of Medical Oncology (ESMO) and the Chordoma Foundation, the global chordoma patient advocacy group, convened a multi-disciplinary group of chordoma specialists to define by consensus evidence-based best practices for the optimal approach to chordoma. In January 2015, the first recommendations of this group were published, covering the management of primary and metastatic chordomas. Additional evidence and further discussion were needed to develop recommendations about the management of local-regional failures. Thus, ESMO and CF convened a second consensus group meeting in November 2015 to address the treatment of locally relapsed chordoma. This meeting involved over 60 specialists from Europe, the United States and Japan with expertise in treatment of patients with chordoma. The consensus achieved during that meeting is the subject of the present publication and complements the recommendations of the first position paper. [ABSTRACT FROM AUTHOR]

Background The Patient Cloud ePRO app was adopted by the National Cancer Institute National Clinical Trials Network (NCTN) to facilitate capturing electronic patient-reported (ePRO) outcome data, but use has been low. The study objectives were to test whether a patient-targeted ePRO educational resource (ePRO-E) would increase ePRO intent (number of users) and improve data quality (high quality: ≥80% of the required surveys submitted) within an ongoing NCTN study. Methods The ePRO-E intervention, a patient-targeted educational resource (written material and 6-minute animated YouTube video), was designed to address ePRO barriers. ePRO intent and data quality were compared between 2 groups (N  =   69): a historical control group and a prospectively recruited intervention group exposed to ePRO-E. Covariates included technology attitudes, age, sex, education, socioeconomic status, and comorbidity. Results Intervention group ePRO intent (78.8%) was statistically significantly higher than historical control group intent (47.1%) (P  =  .03). Patients choosing ePRO versus paper surveys had more positive and higher technology attitudes scores (P  =  .03). The odds of choosing ePRO were 4.7 times higher (95% Confidence Interval [CI] = 1.2 to 17.8) (P  =  .02) among intervention group patients and 5.2 times higher (95% CI = 1.3 to 21.6) (P = .02) among patients with high technology attitudes scores, after controlling for covariates. However, the 80% submission rate (percentage submitting ≥80% of required surveys) in the ePRO group (30.6%) was statistically significantly lower than in the paper group (57.9%) (P  =  .05). Conclusions ePRO-E exposure increased ePRO intent. High technology attitudes scores were associated with ePRO selection. Since the ePRO survey submission rate was low, additional strategies are needed to promote high-quality data submission. [ABSTRACT FROM AUTHOR]

PURPOSE Our institution participated in the Oncology Care Model, which required us to include many of the 13 elements of the National Academy of Medicine (NAM) care plan into care pathways for our patients. We optimized our existing chemotherapy consent process to meet this need and maximized completion. METHODS Our multidisciplinary committee developed a three-phase Plan-Do-Study-Act process in our breast cancer clinic: (1) update and educate providers on our paper chemotherapy form with multiple components of the NAM care plan including prognosis and treatment effects on quality of life; (2) piloted an electronic chemotherapy consent form to decrease the administrative burden; and (3) autopopulated fields within the electronic consent. We assessed feedback after cycle 1 and created a Pareto chart. The outcome measure was percent completion of chemotherapy consent documents. RESULTS Baseline monthly random chart audit of 40 patients revealed 20% of paper chemotherapy consent forms were completed in their entirety among patients. When we re-educated clinicians about the new paper consent containing the NAM elements, compliance rose to nearly 30%. A Pareto chart confirmed that content redundancy and wordiness were leading to under-completion. After creating and piloting the electronic consent, compliance increased to 90%. Finally, autopopulation with drop-down selections increased and sustained completion to 100%. CONCLUSION Incorporating regulatory requirements into an existing workflow using Plan-Do-Study-Act methodology can reduce administrative burden on clinicians. Additional use of innovative technology can further increase clinician compliance with regulatory requirements while delivering high-value quality care to patients with cancer. [ABSTRACT FROM AUTHOR]

Purpose: Hematology-oncology patients undergoing chemotherapy and hematopoietic stem cell transplantation (HSCT) recipients are at risk for oral complications which may cause significant morbidity and a potential risk of mortality. This emphasizes the importance of basic oral care prior to, during and following chemotherapy/HSCT. While scientific evidence is available to support some of the clinical practices used to manage the oral complications, expert opinion is needed to shape the current optimal protocols. Methods: This position paper was developed by members of the Oral Care Study Group, Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT) in attempt to provide guidance to the health care providers managing these patient populations. Results: The protocol on basic oral care outlined in this position paper is presented based on the following principles: prevention of infections, pain control, maintaining oral function, the interplay with managing oral complications of cancer treatment and improving quality of life. Conclusion: Using these fundamental elements, we developed a protocol to assist the health care provider and present a practical approach for basic oral care. Research is warranted to provide robust scientific evidence and to enhance this clinical protocol. [ABSTRACT FROM AUTHOR]

Given the high incidence of NSCLC in the elderly, EORTC Elderly Task Force and Lung Cancer Group, and International Society of Geriatric Oncology has published in 2010 an expert's opinion paper providing recommendations for the management of elderly NSCLC patients. Since that time we believe that important data is published that require the update of our recommendations.Non-small-cell lung cancer (NSCLC) is a very common disease in the elderly population and its incidence in this particular population is expected to increase further, because of the ageing of the Western population. Despite this, limited data are available for the treatment of these patients and, therefore, the development of evidence-based treatment recommendations is challenging. In 2010, European Organization for Research and Treatment of Cancer (EORTC) took an initiative in collaboration with International Society of Geriatric Oncology (SIOG) and created an experts panel that provided an experts' opinion consensus paper for the management of elderly NSCLC patients. Since this publication, important new data are available and EORTC and SIOG recommended to update the 2010 recommendations. Besides recommendations for surgery, adjuvant chemotherapy and radiotherapy, treatment of locally advanced and metastatic disease, recommendations were expanded, to include data on patient preferences and geriatric assessment. [ABSTRACT FROM AUTHOR]

The Transplant Infectious Disease journal has expanded its focus to include a wider range of infections in immunocompromised hosts. They have published a special edition on infections in hematopoietic stem cell transplant recipients, CAR-T recipients, and patients undergoing chemotherapy for cancer. The journal conducts clinico-pathologic conferences and expresses gratitude to reviewers. They also announce the Francisco Marty Transplant Infectious Disease Editorial Fellowship and plan to open up opportunities for submitting papers previously peer-reviewed by other high-caliber journals. The document provides a list of reviewers who have provided reviews for papers submitted to the Journal. [Extracted from the article]

Compared with intravenous (i.v.) chemotherapy, oral administration is convenient, requires fewer healthcare resources, is generally preferred by patients, and may be appropriate in older people with breast, colorectal and lung cancers. The effects of organ dysfunction on drug metabolism and drug interactions in patients with multiple comorbidities must be considered but are not specific to oral chemotherapy. Single-agent oral chemotherapy with capecitabine or vinorelbine is active in older patients with advanced or metastatic breast cancer. Choice of treatment is based mainly on different safety profiles. In the adjuvant treatment of colorectal cancer (CRC), single-agent oral capecitabine is an effective alternative to i.v. fluorouracil (5-FU) regimens. In metastatic CRC, oral, single-agent capecitabine has recently shown encouraging median overall survival in combination with bevacizumab. In non-small cell lung cancer, fit older patients, like their younger counterparts, benefit from platinum-based doublets, with carboplatin preferred to cisplatin. Single agent vinorelbine is an option for those less suited to combination chemotherapy, and oral may be an alternative to i.v. administration. For elderly cancer patients in general, metronomic chemotherapy combines good tolerability with acceptable activity. [ABSTRACT FROM AUTHOR]

Identifying cell response to a chemotherapy drug treatment, in particular at the single cell level, is an important issue in patient management. This study aims at evaluating the effect of gemcitabine on single living cells using micro-Raman imaging. We used as a model the non-small lung cancer cell line, Calu-1, exposed to cytostatic doses (1 nM to 1 μM for 24 h and 48 h) of gemcitabine, an antitumor drug currently used in the treatment of lung cancer. Following drug treatment as a function of doses and incubation times, the Raman maps of single living cells were acquired. Cell biomolecules (DNA, RNA, and proteins) were chemically extracted and their spectral signatures used to evaluate their respective distribution in the cellular spectral information of control and treated cells. The quantification of these distributions reveals a significant effect of 100 nM gemcitabine at 48 h incubation (concomitant decrease of nucleic acids and increase of proteins). PCA analyses performed both on nuclear and extracted biomolecules spectra show a time-dependent effect of the drug. These promising results reveal that effects of subtoxic doses can be monitored at the single cell level highlighting the importance of such studies for clinical applications. [ABSTRACT FROM AUTHOR]

Identifying cell response to a chemotherapy drug treatment, in particular at the single cell level, is an important issue in patient management. This study aims at evaluating the effect of gemcitabine on single living cells using micro-Raman imaging. We used as a model the non-small lung cancer cell line, Calu-1, exposed to cytostatic doses (1 nM to 1 μM for 24 h and 48 h) of gemcitabine, an antitumor drug currently used in the treatment of lung cancer. Following drug treatment as a function of doses and incubation times, the Raman maps of single living cells were acquired. Cell biomolecules (DNA, RNA, and proteins) were chemically extracted and their spectral signatures used to evaluate their respective distribution in the cellular spectral information of control and treated cells. The quantification of these distributions reveals a significant effect of 100 nM gemcitabine at 48 h incubation (concomitant decrease of nucleic acids and increase of proteins). PCA analyses performed both on nuclear and extracted biomolecules spectra show a time-dependent effect of the drug. These promising results reveal that effects of subtoxic doses can be monitored at the single cell level highlighting the importance of such studies for clinical applications. [ABSTRACT FROM AUTHOR]

Introduction: Cancer is the second commonest explanation for death subsequent to heart diseases and it represented 8.8 million deaths worldwide during 2015. Quality of Life (QOL) is all about personal satisfaction, degree or the standard to which an individual, gathering of individuals or community people can appreciates the significant inclination and experience of life like physically, mentally, socially, etc. Aim: To identify the existing tools or instrument for QOL among chemotherapy patients. Materials and Methods: A systematic search of literature for QOL tool among chemotherapy patients was conducted. Electronic databases were looked: Pubmed, proquest, PsycINFC Scopus, Cumulative Index to Nursing and Allied Health Literature (CINHAL). Results: Researcher found 673 research papers from electronic data base: from that 353 articles were excluded bases on exclusion criteria. So total retrieved articles were 320 among all 51 duplicate articles, 88 No full text available, 58 not relevant and 47 abstracts were excluded. Final retrieved articles were 75; among them 38 full articles were excluded based on inclusion criteria. Finally, according to 38 studies, out of 14 investigations utilised European Organisation for the Research and Treatment of Cancer (EORTC QOL-C 30) survey, four studies used the Health Related Quality Of Life (HRQOL) tool, four studies used World Health Organisation Quality of Life-BREF (WHOQOL-BREF) is a self-report questionnaire which assesses 4 domains of quality of life (QOL): physical health, psychological health, social relationships, and environment, Twelve studies used self administered questionnaire, four studies used other method like face to face validity, Functional Assessment of Cancer Therapy (FACT) etc. The most-normally utilised instrument was a QOL tool for use in universal clinical preliminaries in oncology having a place with EORTC QOL C-30 survey, HRQOL tool and WHO BREF tool. Conclusion: In this review study variety of instruments has been used by the researcher that explores the QOL of chemotherapy patients. The significance of psychometric properties of the instruments and its effect on discoveries rising up out of various examinations, it appears to be fundamental that more thought be paid to the validity and reliability of tool before conducting the research studies. Literature suggested that the analysts contribute enough consideration regarding the choice of standard instruments and organise the instruments' validity and reliability of their outlook explores. Finding of study suggested that tools along with ideal psychometrics properties which were good with the socio-cultural setting of particular country. [ABSTRACT FROM AUTHOR]

Cancer treatment-induced bone loss (CTIBL) is one of the most important side effects of adjuvant antineoplastic treatment in hormone-dependent neoplasms. Chemotherapy, GnRH analogs and tamoxifen can induce marked bone loss in premenopausal women with early breast cancer. Aromatase inhibitors (AIs) are replacing tamoxifen as the preferred treatment for postmenopausal women. As a class effect, steroidal (exemestane) and non-steroidal (anastrozole and letrozole) AIs increase bone turnover and cause bone loss (4%–5% over 2 years). When compared to tamoxifen, the risk of getting a clinical fracture under AI treatment is increased by 35%–50%. In patients with prostate cancer, androgen deprivation therapy (ADT) increases bone turnover, reduces bone mass (4%–5% per year) and increases the fracture rate depending on the duration of therapy. Zoledronic acid can prevent accelerated bone loss induced by goserelin in premenopausal women, by letrozole in postmenopausal women and by ADT in men. More limited data indicate that weekly alendronate or risedronate could also be effective for preventing CTIBL. Initiation of therapy early, prior to the occurrence of severe osteoporosis, rather than after, may be more effective. Bisphosphonate treatment should be considered in osteoporotic but also in osteopenic patients if other risk factor(s) for fractures are present. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to understand the knowledge structure and trends in research on cancer-related cognitive impairment (CRCI) in patients with non-central nervous system (non-CNS) cancer through text network analysis and topic modeling. Methods: From 2011 to 2021, studies on CRCI in patients with non-CNS cancer registered in databases including Ovid-MEDLINE, EMBASE, Cochrane, CINAHL, CENTRAL, and PsycInfo, were extracted and cleaned into words using Python's natural language toolkit package. Text network analysis was performed using the NetworkX library, and topic modeling analysis based on the latent Dirichlet allocation algorithm was carried out using the Gensim library. Results: In total, 24,030 keywords were extracted from the abstracts of 490 selected papers, of which "chemotherapy," "breast cancer," and "quality of life" showed high frequency and centrality. As a result of the topic modeling analysis, four subject groups were derived, including cognitive impairment due to chemotherapy, breast cancer and cognitive impairment, factors related to cognitive impairment, and symptom experience. Conclusion: These findings will help cancer researchers to understand the trends and insights of research on CRCI in patients with non-CNS cancer and suggest important areas and directions for future studies. [ABSTRACT FROM AUTHOR]

Simple Summary: Gastric cancer is a common cancer worldwide, with a growing incidence. The standard treatment for early-stage and resectable tumors involves surgery combined with perioperative chemotherapy. High relapse rates significantly compromise prognosis, highlighting the need for new strategies in the perioperative setting. This paper offers a thorough review of the latest evidence regarding perioperative treatment for gastric cancer. It integrates new agents such as targeted therapies, immunotherapy, antibody–drug conjugates, and multimodal strategies, and presents future perspectives in this field. Gastric cancer is the fifth most common cancer worldwide and its incidence is rising. Surgery is the only curative strategy and its association with perioperative chemotherapy is now standard treatment for most resectable tumors. Despite treatment advances, disease relapse is high, even in early stages, and continued improvement in curative treatment is imperative. With deeper knowledge of gastric cancer heterogeneity, molecular subtypes, and the tumor immune microenvironment, new standard treatment strategies may emerge in the near future. This paper provides a comprehensive review of the current treatment landscape in resectable gastric cancer and future perspectives for the next decade regarding new agents such as targeted therapies, immunotherapy, antibody–drug conjugates, and the combination of multiple treatment modalities. [ABSTRACT FROM AUTHOR]

Simple Summary: Treatment outcomes in chronic myeloid leukemia (CML) have improved in recent years because of the use of tyrosine kinase inhibitors. However, treatment responses to myeloid blast-phase CML (MBP-CML) are still unsatisfactory. In this paper, we summarize the biological mechanisms of progression to MBP and the most frequently used treatment regimens for MBP-CML. We also review why some patients develop resistance to tyrosine kinase inhibitors. Myeloid blast-phase chronic myeloid leukemia (MBP-CML) is a rare disease with a dismal prognosis. It is twice as common as lymphoid blast-phase CML, and its prognosis is poorer. Despite the success with tyrosine kinase inhibitors in the treatment of chronic-phase CML, the same does not hold true for MBP-CML. In addition to the Philadelphia chromosome, other chromosomal and molecular changes characterize rapid progression. Although some progress in elucidating the biology of MBP-CML has been made, there is need to discover more in order to develop more satisfactory treatment options. Currently, most common treatment options include tyrosine kinase inhibitors (TKIs) as monotherapy or in combination with acute myeloid leukemia-based intensive chemotherapy regimens. Some patients may develop resistance to TKIs via BCR-ABL1-dependent or BCR-ABL1-independent mechanisms. In this paper, we provide an overview of the biology of MBP-CML, the current treatment approaches, and mechanisms of resistance to TKIs. In order to improve treatment responses in these patients, more emphasis should be placed on understanding the biology of myeloid blastic transformation in CML and mechanisms of resistance to TKIs. Although patient numbers are small, randomized clinical trials should be considered. [ABSTRACT FROM AUTHOR]

A solution approach is proposed for the interday problem of assigning chemotherapy sessions at a network of treatment centres with the goal of increasing the cost-efficiency of system-wide capacity use. This network-based scheduling procedure is subject to the condition that both the first and last sessions of a patient's treatment protocol are administered at the same centre the patient is referred to by their oncologist. All intermediate sessions may be administered at other centres. It provides a systematic way of identifying effective multi-appointment scheduling policies that exploit the total capacity of a networked system, allowing patients to be treated at centres other than their home centre. The problem is modelled as a Markov decision process which is then solved approximately using techniques of approximate dynamic programming. The benefits of the approach are evaluated and compared through simulation with the existing manual scheduling procedures at two treatment centres in Santiago, Chile. The results suggest that the approach would obtain a 20% reduction in operating costs for the whole system and cut existing first-session waiting times by half. A key conclusion, however, is that a network-based scheduling procedure brings no real benefits if it is not implemented in conjunction with a proactive assignment policy like the one proposed in this paper. [ABSTRACT FROM AUTHOR]

Introduction: Prior to implementing a new computerized prescription order entry (CPOE) application, the potential risks associated with this system were assessed and compared to those of paper-based prescriptions. The goal of this study is to identify the vulnerabilities of the CPOE process in order to adapt its design and prevent these potential risks. Methods and materials: Failure mode and effects analysis (FMEA) was used as a prospective risk-management technique to evaluate the chemotherapy medication process in a university hospital oncology clinic. A multidisciplinary team assessed the process and compared the critical steps of a newly developed CPOE application versus paper-based prescriptions. The potential severity, occurrence and detectability were assessed prior to the implementation of the CPOE application in the clinical setting. Results: The FMEA led to the identification of 24 process steps that could theoretically be vulnerable, therefore called failure modes. These failure modes were grouped into four categories of potential risk factors: prescription writing, patient scheduling, treatment dispensing and patient follow-up. Criticality scores were calculated and compared for both strategies. Three failure modes were prioritized and led to modification of the CPOE design. Overall, the CPOE pathway showed a potential risk reduction of 51% compared to paper-based prescriptions. Conclusion: FMEA was found to be a useful approach to identify potential risks in the chemotherapy medication process using either CPOE or paper-based prescriptions. The e-prescription mode was estimated to result in less risk than the traditional paper mode. [ABSTRACT FROM AUTHOR]

Context: Chemotherapy errors are considered the second most common cause of fatal medication errors (ME). Currently, computerized provider order entry (CPOE) is increasingly used to prevent or decrease ME and improve the safety of the medication process. Objectives: This study was conducted to systematically review the impacts of CPOE on the incidence of chemotherapy ME, the severity of errors, and adverse drug events (ADEs) in cancer care units. Data Sources: The literature search was conducted, using 5 databases of PubMed, EMBASE, Scopus, Web of Science, and ScienceDirect between 2000 and 2020. Search terms included keywords and MESH terms related to CPOE, ME, chemotherapy, and cancer care unit. Study Selection: Articles were included in this research if they investigated the CPOE system, reported ME, and were carried out in the oncology department. Non-English papers, duplications, review studies, and conference papers were excluded. Data Extraction: The selected papers were read repeatedly and related papers were extracted. All eligible articles were qualitatively evaluated with a tool provided by Downs. The extracted information included the author's name, year of publication, study location, type of study, study objectives, and main findings. Results: A total of 829 studies were retrieved. Fourteen articles met the inclusion criteria. Ten studies (71%) reported the impact of CPOE on chemotherapy ME in comparison with the paper-based ordering method. In 4 studies (29%), researchers developed a CPOE for the oncology department, and the system was, then, assessed concerning user experience, safety challenges as well as the effects of CPOE on ME. Nine articles (64%) reported the impact of the CPOE system on ME only in the prescribing phase, and 5 studies (36%) examined ME in all phases of the chemotherapy process. Five studies (36%) reported the impact of the CPOE system on ADEs and the severity of errors. Conclusions: Implementing CPOE is associated with a significant reduction in ME in all phases of the chemotherapy process. However, the CPOE does not prevent all MEs and may cause new errors. The rigorous analysis of the chemotherapy process and considering the designing principles could help develop the CPOE systems and minimize ME. [ABSTRACT FROM AUTHOR]

Melanoma cells have a poor ability to mediate oxidative stress, which may be attributed to constitutive abnormalities in their melanosomes. We hypothesize that disorganization of the melanosomes will allow chemical targeting of the melanin within. Chemical studies show that under oxidative conditions, synthetic melanins demonstrate increased metal affinity and a susceptibility to redox cycling with oxygen to form reactive oxygen species. The electron paramagnetic resonance (EPR)-active 5,5'-dimethyl-pyrollidine N-oxide spin adduct was used to show that binding of divalent Zn or Cu to melanin induces a pro-oxidant response under oxygen, generating superoxide and hydroxyl radicals. A similar pro-oxidant behaviour is seen in melanoma cell lines under external peroxide stress. Melanoma cultures grown under 95% O2/5% CO2 atmospheres show markedly reduced viability as compared with normal melanocytes. Cu- and Zn-dithiocarbamate complexes, which induce passive uptake of the metal ions into cells, show significant antimelanoma activity. The antimelanoma effect of metal- and oxygen-induced stress appears additive rather than synergistic; both treatments are shown to be significantly less toxic to melanocytes.

This article discusses a JSGS paper published in the Annals of Gastroenterological Surgery. The paper focuses on the clinicopathological analysis of 460 cases of carcinoma of the ampulla of Vater (CAV) and identifies six prognostic factors. The study also explores the therapeutic strategy for CAV and suggests that preoperative chemotherapy may be the most effective treatment for aggressive CAV. The article also includes three other papers on preoperative chemotherapy in gastric cancer, colorectal cancer, and colon cancer, highlighting the potential benefits and challenges of this treatment approach. [Extracted from the article]

We review the current status of prevention trials in the management of cervical intraepithelial neoplasia (CIN) and cervical cancer. Two large, randomized controlled trials have shown that folic acid is inactive in reversing low to moderate grade CIN. A large randomized trial of locally applied beta-trans retinoic acid showed that the agent was effective in reversing moderate but not severe CIN. Results from a pilot trial involving 30 patients with CIN I (mild dysplasia) and CIN II (moderate dysplasia) indicate that beta-carotene can suppress CIN; a large ongoing randomized trial will answer the question more definitively.

Chemotherapy is one of the most effective treatments for cancer, but the efficacy of standard chemotherapy regimens is often limited by toxicities and the individual heterogeneity of cancers. Precise dosing is an important tool to improve efficacy and reduce significant differences in toxicity. However, most of the existing studies on chemotherapy optimization fail to fully consider the toxic side effects, drug resistance, and drug combinations, and thus the chemotherapy regimens obtained may face difficulty in achieving the expected efficacy and also affect the subsequent treatment. Therefore, this paper establishes a tumor growth model for the combination chemotherapy of cell cycle-specific and non-cycle-specific drugs and includes the factors of acquired drug resistance and toxic side effects, proposing an improved multi-objective Squirrel Search Algorithm, the TA-MOSSA, to solve the problem of accurate chemotherapy drug optimization. In this paper, experiments were conducted to analyze the efficacy of chemotherapy dosing regimens obtained by the TA-MOSSA based on the tumor growth model, and the results show that the TA-MOSSA can provide effective chemotherapy regimens for patients who take different treatment approaches. [ABSTRACT FROM AUTHOR]

BACKGROUND: The scientific revolution in the treatment of many illnesses has been significantly aided by stem cells. This paper presents an optimal control on a mathematical model of chemotherapy and stem cell therapy for cancer treatment. OBJECTIVE: To develop effective hybrid techniques that combine the optimal control theory (OCT) with the evolutionary algorithm and multi-objective swarm algorithm. The developed technique is aimed to reduce the number of cancerous cells while utilizing the minimum necessary chemotherapy medications and minimizing toxicity to protect patients' health. METHODS: Two hybrid techniques are proposed in this paper. Both techniques combined OCT with the evolutionary algorithm and multi-objective swarm algorithm which included MOEA/D, MOPSO, SPEA II and PESA II. This study evaluates the performance of two hybrid techniques in terms of reducing cancer cells and drug concentrations, as well as computational time consumption. RESULTS: In both techniques, MOEA/D emerges as the most effective algorithm due to its superior capability in minimizing tumour size and cancer drug concentration. CONCLUSION: This study highlights the importance of integrating OCT and evolutionary algorithms as a robust approach for optimizing cancer chemotherapy treatment. [ABSTRACT FROM AUTHOR]

The rapid development of antibiotic resistance in K. pneumonia has led to a major concern. In order to analyze the hotspots and develop trends in this field through visual the analysis, this study used CiteSpace software to summarize the available data in the literature to provide insights. A total of 9366 research articles were retrieved from the Web of Science Core Collection, and the number of published papers is increasing year by year. The country with the most articles was the USA, followed by China and India. The institution with the highest number of publications was LERU. The author with the highest number of articles was Li. The journal with the highest citation rate was Antimicrobial Agents and Chemotherapy. In addition, based on keyword coword analysis and cited literature prominence analysis by CiteSpace, the current research focus in the field was therapy, CRKP, and resistance genes. This paper provides a new quantitative visualization way for the development of the field in the recent ten years. The results show global trends that researchers can use to determine future directions. [ABSTRACT FROM AUTHOR]

Background/Aims Borderline resectable pancreatic cancer, an intermediate stage between a completely resectable state and an unresectable state, requires a multidisciplinary treatment approach. This study aimed to elucidate the main characteristics and recent research trends regarding borderline resectable pancreatic cancer to gain further insights into them. Methods Data from published papers about borderline resectable pancreatic cancer were collected from Web of Science (2014-2023) for analysis. This study included 355 papers; data on major countries, publishing organizations, and keywords were collected and analyzed. Furthermore, R studio and VOSviewer were used to qualitatively and quantitatively analyze keywords. Results Publication of papers on borderline resectable pancreatic cancer increased annually by 12.8%, with the United States and Japan being the main publishing countries. In 2014, keywords related to surgery and chemotherapy were dominant; however, a shift toward more integrative approaches, such as neoadjuvant therapy, was observed over time. Conclusion This study demonstrates rapidly evolving trends and paradigm changes in the research and management of borderline resectable pancreatic cancer. Thus, the results of this study are expected to contribute to establishing future research strategies and improving patient treatment outcomes. [ABSTRACT FROM AUTHOR]

Fenamates as classical nonsteroidal anti‐inflammatory agents are widely used for relieving pain. Preclinical studies and epidemiological data highlight their chemo‐preventive and chemotherapeutic potential for cancer. However, comprehensive reviews of fenamates in cancer are limited. To accelerate the repurposing of fenamates, this review summarizes the results of fenamates alone or in combination with existing chemotherapeutic agents. This paper also explores targets of fenamates in cancer therapy, including COX, AKR family, AR, gap junction, FTO, TEAD, DHODH, TAS2R14, ion channels, and DNA. Besides, this paper discusses other mechanisms, such as regulating Wnt/β‐catenin, TGF‐β, p38 MAPK, and NF‐κB pathway, and the regulation of the expressions of Sp, EGR‐1, NAG‐1, ATF‐3, ErbB2, AR, as well as the modulation of the tumor immune microenvironment. Furthermore, this paper outlined the structural modifications of fenamates, highlighting their potential as promising leads for anticancer drugs. [ABSTRACT FROM AUTHOR]

Background: Cancer-treatment toxicity is common and symptoms must be identified quickly and accurately. Since symptom reporting during consultations is hampered by time constraints and patient/oncologist biases, patient-reported outcome-measure (PROM) questionnaires are useful. A strong shift to at-home cancer treatment has led to growing interest in remote symptom monitoring via electronic-PROMs (ePROMs). However, because PROMs are generally designed for medical-staff use, ePROMs must be adapted to patient comprehension/abilities. Here, to meet the oncological-healthcare needs of our region, we developed QuestOnco, a mobile-phone ePROM application. It is based on the symptom descriptions and severity grades of the PRO-CTCAE PROM and is designed for real-time on-demand reporting of 34 common or life-threatening cancer-treatment symptoms. This study describes the development of QuestOnco and its content validation relative to two comparators: PRO-CTCAE and the medical records. Methods: The cohort study was conducted in a tertiary-care hospital in 2021 and consisted of two stages. Stage I assessed the comprehensibility of QuestOnco for patients: 24 cancer-therapy patients were asked to try the application for 30 min and then underwent semi-structured cognitive interviews. Stage II tested QuestOnco-content validity against the comparators: patients starting a ~ 6-week cancer-therapy cycle were asked to use QuestOnco in an on-demand fashion and to complete weekly paper PRO-CTCAEs. Total QuestOnco, PRO-CTCAE, and medical-record symptom reports were compared in terms of symptom and symptom-severity frequencies. Severity concordance of each reported symptom was assessed by Kendall's tau-b rank-correlation coefficients. Results: In the second round of 12 Stage-I patients (total Stage-I enrollment rate = 100%), 0% reported comprehension difficulties. 110 patients were recruited for Stage II (enrollment rate = 23%). QuestOnco, PRO-CTCAE, and the medical records detected 85%, 100%, and 62% of the target symptoms at least once, respectively, and reported grade-1, -2, -3, and -4 toxicities with similar frequencies (56–67%, 23–32%, 6–10%, and 2–3%, respectively). Overall symptom-severity concordance was moderate with PRO-CTCAE (tau-b = + 0.21, range = -0.03 to + 0.38) and strong with the medical records (tau-b = + 0.33, range = -0.01 to + 0.61). Few remarkable discrepancies were observed. Conclusions: The QuestOnco application was well-understood by patients and demonstrated good content validity compared to its parent PROM and the medical records. Trial registration: ClinicalTrials.gov No. NCT04915274. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to consolidate the most robust evidence on nutritional strategies for patients undergoing chemotherapy, offering evidence‐based guidance for clinical practice. The review highlights critical evidence gaps in nutritional therapy for advanced gastric cancer (AGC) patients undergoing systemic therapy, integrating findings from both prospective and retrospective studies. Method: According to the "6S" evidence resource pyramid model, clinical decision‐making tools, guidelines, expert consensus, and systematic reviews on nutritional management for chemotherapy patients were systematically retrieved from national and international databases. The methodological quality of the selected literature was evaluated using AGREE II for guidelines, the JBI Evidence‐Based Healthcare Center's standards for systematic reviews, and expert consensus developed by evidence‐based practice experts. Results: A total of 47 articles were analyzed, consisting of 12 guidelines, 12 expert consensus statements, and 23 systematic reviews. The findings were categorized into five dimensions: interdisciplinary collaboration, nutritional screening and assessment, nutritional requirements, nutritional therapy, and discharge and follow‐up, resulting in the identification of 62 pieces of relevant evidence. Conclusions: The study provides comprehensive, evidence‐based recommendations for nutritional management in chemotherapy patients. Application of the evidence should be adapted to specific clinical scenarios, patient conditions, preferences, and expert judgment to ensure both feasibility and relevance in clinical practice. Contributions: This review consolidates diverse nutritional management strategies into a unified framework, addressing evidence gaps in AGC under systemic therapy. Integrating prospective and retrospective studies with interdisciplinary insights provides evidence‐based recommendations to enhance patient care through personalized and standardized approaches. [ABSTRACT FROM AUTHOR]

Simple Summary: Acute myeloid leukemias (AML), mimicking acute promyelocytic leukemia (APL) features but lacking the canonical t(15;17) translocation, are rare but challenging entities, both on a diagnostic and clinical plan. From the first report, in the early 1990s, of an APL-like AML characterized by the t(11;17) translocation, several cases have been described, with significant heterogeneity in terms of presentation, sensitivity to treatments, and prognosis. In this review, we aim to describe APL-like entities reported to-date and discuss their biological background and clinical implications. Acute promyelocytic leukemia (APL) is a rare type of AML, characterized by the t(15;17) translocation and accounting for 8–15% of cases. The introduction of target therapies, such as all-trans retinoic acid (ATRA) and arsenic trioxide (ATO), radically changed the management of APL, making it the most curable AML subtype. However, a small percentage (estimated to be 2%) of AML presenting with APL-like morphology and/or immunophenotype lacks t(15;17). This rare APL-like AML group, whose first case was described in the early 1990s, now includes over 40 entities. These diseases present great heterogeneity in terms of genetic lesions, clinical presentation, sensitivity to targeted agents and chemotherapy, and prognosis. Furthermore, the diagnosis is very challenging. Thus, in this paper, we aim to comprehensively review the literature reports and studies addressing APL-like entities, investigate the biological mechanisms of leukemogenesis, evaluate the clinical characteristics, and discuss future lines of research and possible clinical approaches. [ABSTRACT FROM AUTHOR]

Objective: Cancer chemotherapy for the discovery of new antineoplastic drugs is one of the updated areas of medical and pharmaceutical research. Methods: In the current project, a novel series of 1,3-thiazole derivatives were synthesized and their corresponding anticancer activity was evaluated by MTT assay using three cancer cell lines. A2780 (ovarian cancer), PC3 (prostatic carcinoma), and MCF-7 (breast cancer) were utilized for this purpose. Subsequently, Caspase-3 activation, mitochondrial membrane potential (MMP), and generation of reactive oxygen species (ROS) were also explored for some selected active compounds. Results and Discussion: Fortunately, tested compounds were so active against MCF-7 cells compared to other cell lines. Compounds (VI), (VII), (VIII), (IX), and (XII) enhanced Caspases-3 activity in the MCF-7 cell line that 3-Cl analog (VII) was illustrated as the most cytotoxic index against MCF-7 cells. This is while that among the above analogs (VI–IX), and (XII), just and just, 2-F derivative (IV) revealingly reduced the mitochondrial membrane potential (MMP). The current compounds demonstrated better anticancer activity compared to the other thiazole derivatives. Generally, derivatives bearing electron-withdrawing as well as electron-donating groups are active toward cancerous cell lines. Conclusions: The novel 1,3-thiazole derivatives presented in the current paper could be suggested as potential anticancer agents, especially against breast cancer. [ABSTRACT FROM AUTHOR]

The typical treatment for tumor involves a combination of radiation therapy and chemotherapy. In this study, we explore a mathematical model based on proliferation and diffusion, considering the impacts of both radiotherapeutic and chemotherapeutic treatments. The mathematical model is formulated as a system of partial differential equations, accompanied by initial, boundary, and free boundary conditions. Existence and uniqueness of this mathematical problem are obtained by developing an iteration algorithm in this paper. [ABSTRACT FROM AUTHOR]

Cancer remains one of the leading causes of death worldwide. Despite advances in medical treatments, current therapeutic strategies, including radiotherapy, chemotherapy, targeted therapy, and surgical resection, have not significantly reduced the global incidence and mortality rates of cancer. Oncologists face considerable challenges in devising effective treatment plans due to the adverse side effects associated with standard therapies. Therefore, there is an urgent need for more effective and well-tolerated cancer treatments. Curcumin, a naturally occurring compound, has garnered significant attention for its diverse biological properties. Both preclinical studies and clinical trials have highlighted curcumin's potential in cancer treatment, demonstrating its ability to inhibit the proliferation of various cancer cell types through multiple cellular and molecular pathways. This paper examines the antineoplastic properties, and the therapeutic mechanisms including cell signalling pathways targeted by curcumin that are implicated in cancer development and explores the challenges in advancing curcumin as a viable anticancer therapy. [ABSTRACT FROM AUTHOR]

Background: Irinotecan is a standard chemotherapeutic agent in small cell lung cancer (SCLC), however, as a common adverse reaction, diarrhea limits the use of irinotecan. Shengjiang Xiexin decoction (SXD) has been used in various gastrointestinal diseases in China two thousand years ago. We designed this clinical trial to supply more evidences on the use of SXD as prophylaxis for irinotecan-induced diarrhea, especially for high-risk population predicted by gene testing of uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1). Methods: In this clinical trial, 120 patients with SCLC were recruited from six hospitals in China. They received two cycles of chemotherapy, meanwhile they were randomized to receive SXD or placebo for 14 days of oral administration in each cycle of chemotherapy. The primary outcome is the incidence of diarrhea. And secondary outcomes include the the degree of diarrhea and neutropenia, the number of chemotherapy cycles with diarrhea, first occurrence time and duration of diarrhea. To evaluate the effect of SXD on the intestine, a rat model with delayed-onset diarrhea induced by irinotecan was established, and the expression of inflammatory factors including IL-1β, IL-6 and TNF-α, anti-inflammatory factors including IL-10, TGF- β in jejunal tissue was detected by ELISA. Results: 101 patients (53 in SXD group, 48 in placebo group) completed the trial. The incidence of diarrhea in SXD group and placebo group were 26.42% (14/53) and 52.08% (25/48), respectively (P < 0.05), and the degree of diarrhea also had significant differences (P < 0.05). In UGT1A1 high-risk population, the incidence of diarrhea in two groups were 9.09% and 66.67% (P < 0.05), but there was no significant differences in UGT1A1 low-risk population. The incidence of neutropenia with degree 1–3 between two groups was 20.75% vs 20.83%, 13.21% vs 18.57%, 9.43% vs 20.83% (P < 0.05). No severe adverse events were reported in any group. And animal studies had shown SXD reduced content of IL-1β, IL-6, TNF-α, increased content of IL-10, TGF-β in jejunum tissue. Conclusions: SXD had a prophylactic effect in the diarrhea induced by irinotecan, especially for UGT1A1 high-risk population, and this effect from SXD appeared to be maintained the completion of chemotherapy schedule. The mechanism of action of SXD was related to the regulation of inflammatory factors. Trial registration Chinese Clinical Trial Register: ChiCTR1800018490. Registered on 20 September 2018. https://www.chictr.org.cn/showproj.html?proj=25250. The preliminary protocol of this clinical study has been published in the journal "Trials" in the form of protocol before this paper (Deng et al. in Trials 21:370, 2020). [ABSTRACT FROM AUTHOR]

Patients with serious illnesses often do not engage in discussions about end-of-life care decision-making, or do so reluctantly. These discussions can be useful in facilitating advance care planning and connecting patients to services such as palliative care that improve quality of life. Terror Management Theory, a social psychology theory stating that humans are motivated to resolve the discomfort surrounding their inevitable death, has been discussed in the psychology literature as an underlying basis of human decision-making and behavior. This paper explores how Terror Management Theory could be extended to seriously ill populations and applied to their healthcare decision-making processes and quality of care received. [ABSTRACT FROM AUTHOR]