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Background Older adults make up half of those with cancer and are prone to mood disorders, such as depression and severe anxiety, resulting in negative repercussions on their health-related quality-of-life (HRQOL). Educational interventions have been shown to reduce adverse psychological outcomes. We examined the effect of educational interventions on the severity of psychological outcomes in older adults with cancer (OAC) in the community. Method This PRISMA-adherent systematic review involved a search of PubMed, MedLine, Embase and PsycINFO for randomised controlled trials (RCTs) that evaluated educational interventions impacting the severity of depression, anxiety and HRQOL in OAC. Random effects meta-analyses and meta-regressions were used for the primary analysis. Results Fifteen RCTs were included. Meta-analyses showed a statistically insignificant decrease in the severity of depression (SMD = −0.30, 95%CI: −0.69; 0.09), anxiety (SMD = −0.30, 95%CI: −0.73; 0.13) and improvement in overall HRQOL scores (SMD = 0.44, 95%CI: −0.16; 1.04). However, subgroup analyses revealed that these interventions were particularly effective in reducing the severity of depression and anxiety in specific groups, such as OAC aged 60–65, those with early-stage cancer, those with lung cancer and those treated with chemotherapy. A systematic review found that having attained a higher education and income level increased the efficacy of interventions in decreasing the severity of adverse psychological outcomes. Conclusion Although overall meta-analyses were statistically insignificant, subgroup meta-analyses highlighted a few specific subgroups that the educational interventions were effective for. Future interventions can be implemented to target these vulnerable groups. [ABSTRACT FROM AUTHOR]

Simple Summary: Low molecular weight heparin (LMWH) has been the standard of care for venous thromboembolism (VTE) but new guidelines approved using non-vitamin K antagonist oral anticoagulants (NOAC). By conducting an individual patient data meta-analysis of randomised controlled trials (RCTs) comparing the outcomes of NOAC versus LMWH in cancer patients, we aim to determine an ideal strategy for the prophylaxis of VTE and prevention of VTE recurrence. Our study further addresses the conflicting evidence in the literature with an individual patient data meta-analysis. However, other studies are required to balance the risk of recurrent VTE and bleeding among different cancer subgroups. Emerging data highlight the need for individualised antithrombotic strategies to achieve optimal management of cancer patients. Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in cancer patients. Low molecular weight heparin (LMWH) has been the standard of care but new guidelines have approved the use of non-vitamin K antagonist oral anticoagulants (NOAC). By conducting an individual patient data (IPD) meta-analysis of randomised controlled trials (RCTs) comparing the outcomes of NOAC versus LMWH in cancer patients, we aim to determine an ideal strategy for the prophylaxis of VTE and prevention of VTE recurrence. Three databases were searched from inception until 19 October 2022. IPD was reconstructed from Kaplan–Meier curves. Shared frailty, stratified Cox and Royston–Parmar models were fit to compare the outcomes of venous thromboembolism recurrence and major bleeding. For studies without Kaplan–Meier curves, aggregate data meta-analysis was conducted using random-effects models. Eleven RCTs involving 4844 patients were included. Aggregate data meta-analysis showed that administering NOACs led to a significantly lower risk of recurrent VTE (RR = 0.65; 95%CI: 0.50–0.84) and deep vein thrombosis (DVT) (RR = 0.60; 95%CI: 0.40–0.90). In the IPD meta-analysis, NOAC when compared with LMWH has an HR of 0.65 (95%CI: 0.49–0.86) for VTE recurrence. Stratified Cox and Royston–Parmar models demonstrated similar results. In reducing risks of recurrent VTE and DVT among cancer patients, NOACs are superior to LMWHs without increased major bleeding. [ABSTRACT FROM AUTHOR]

Simple Summary: Anthracyclines form the backbone of many systemic chemotherapy regimens with great response rates for cancers. Yet, their established dose-limiting cardiotoxic effects can also lead to a reduction in cardiac function and an increased risk of heart failure. This PRISMA-adherent systematic review and meta-analysis of randomised-controlled trials aims to evaluate the progression of cardiac dysfunction and levels of natriuretic peptides, and risk of heart failure in cancer patients receiving anthracyclines. Our review included cohorts which followed patients over two years from the administration of anthracyclines and demonstrated that there were no significant declines compared to after six months. This period would be the most crucial for concurrent cardioprotection to prevent adverse remodelling. We also found the risk of developing significant declines in LVEF occurred in approximately one in six. The confounding effect of receiving concomitant trastuzumab and baseline LVEF was also negligible. Background: Anthracyclines form the backbone of many systemic chemotherapy regimens but are accompanied by dose-limiting cardiotoxicity. We elucidate the progression and severity of cardiac function over time, in the absence of cardioprotection, which less is known about. Methods: This PRISMA-guideline-adherent review was registered on PROSPERO (CRD42022373496). Results: 26 studies met the eligibility criteria including a total of 910 patients. The overall reduction in post-anthracycline pooled mean left ventricular ejection fraction (LVEF) in placebo arms of the included randomised-controlled trials was 4.5% (95% CI, 2.6 to 6.4). The trend in LVEF showed a progressive decline until approximately 180 days, after which there was no significant change. Those receiving a cumulative anthracycline dose of 300 mg/m2 experienced a more profound reduction. The overall pooled risk of a 10% absolute decline in LVEF from baseline, or a decline to an LVEF below 50%, was 17% (95% CI: 11 to 24; I2 = 71%). Sensitivity analyses of baseline LVEF and trastuzumab treatment status did not yield significant differences. Conclusion: While the mean LVEF decline in patients without cardioprotective therapy was clinically small, a vulnerable subset experienced significant impairment. Further research to best identify those who benefit most from cardioprotective therapies when receiving anthracyclines is required. [ABSTRACT FROM AUTHOR]

Patients with cancer have an increased risk of severe disease and mortality from COVID-19, as the disease and antineoplastic therapy cause reduced vaccine immunogenicity. Booster doses have been proposed to enhance protection, and efficacy data are emerging from several studies. To evaluate the proportion of COVID-19 primary vaccination non-responders with cancer who seroconvert after a booster dose. PubMed, EMBASE, CENTRAL and medRxiv were searched from 1st January 2021 to 10th March 2022. Quality was assessed using the Joanna Briggs Institute Critical Appraisal checklist. After the eligibility assessment, 22 studies were included in this systematic review and 17 for meta-analysis of seroconversion in non-responders, pooling a total of 849 patients with haematological cancer and 82 patients with solid cancer. Haematological cancer non-responders exhibited lower seroconversion at 44% (95% CI 36–53%) than solid cancer at 80% (95% CI 69–87%). Individual patient data meta-analysis found the odds of having a meaningful rise in antibody titres to be significantly associated with increased duration between the second and third dose (OR 1.02, 95% CI 1.00–1.03, P ≤ 0.05), age of patient (OR 0.960, 95% CI 0.934–0.987, P ≤ 0.05) and cancer type. With patients with haematological cancer as a reference, patients with lung cancer had 16.8 times the odds of achieving a meaningful increase in antibody titres (OR 16.8, 95% CI 2.95–318, P ≤ 0.05) and gastrointestinal cancer patients had 25.4 times the odds of achieving a meaningful increase in antibody titres (OR 25.4, 95% CI 5.26–492.21, P ≤ 0.05). administration of a COVID-19 vaccine booster dose is effective in improving seroconversion and antibody levels. Patients with haematological cancer consistently demonstrate poorer response to booster vaccines than patients with solid cancer. • 80% of patients with previously non-seroconverted solid cancer do so after a third dose. • Less than half of patients with haematological cancer seroconvert after a third dose. • After the third dose, antibody titres rose up to 30-fold across studies. • Individual patient data (IPD) revealed that gastrointestinal (GI) and lung cancers performed best among patients with solid cancer. • More days between second and third doses increased the odds of a 2x rise in titres. [ABSTRACT FROM AUTHOR]