Search Results (205)

Background/Objectives: This study evaluates the effects of a personalized exercise program on symptoms (pain, fatigue, sleep, cognitive function, physical function), resilience, and health-related quality of life (HRQOL) and compares the effectiveness of in-person versus telehealth delivery. Methods: A secondary data analysis was conducted on two 12-week randomized control pilot studies for solid tumor cancer survivors. One study involved in-person home visits with telephone follow-ups. The second utilized weekly exercise recommendations via a smartphone app. Both studies had control participants who received the standard care. Symptoms, resilience, and HRQOL were measured at baseline and after 12 weeks. Paired t-tests were conducted for intervention effects and ANCOVA for group differences, adjusting for age and education. Results: The analysis included 75 program completers: 15 in-person (iHBE), 38 telehealth (TEHE), and 22 who received standard care. Those receiving exercise interventions reported improvements in physical (t = 3.0, p < 0.01) and mental fatigability (t = 3.1, p < 0.01) at program completion compared to baseline. Comparing the mean changes between participants receiving exercise interventions in-person and via telehealth, there were no significant differences between the two delivery methods except perceived visuo-perceptual cognitive difficulty (F = 3.55, p = 0.027), where telehealth showed a slight advantage. Conclusions: The study provides initial evidence of the effectiveness of a telehealth personalized exercise on fatigability and cognitive difficulty, suggesting it is a potential viable alternative to in-person intervention. Further research with a larger cohort is essential to ascertain the effects of these interventional modalities on cancer-related health outcomes. Full article

Background: Advanced home care is becoming increasingly common for cancer patients and serves as a viable alternative to inpatient hospital care. The transition to home care is driven by both the rising costs of healthcare and evidence indicating better quality of care. This study aims to compare the costs of hospital-at-home treatment and in-hospital care for patients undergoing allo-HSCT. Methods: The cost analysis was conducted as a case–control study comparing the costs of allo-HSCT at home (HaH) to the costs of allo-HSCT for patients receiving in-hospital care (INH). The cost evaluation was conducted from the hospital’s perspective, which means that costs incurred outside the hospital setting were not included. Post-procedural costs for the first year after allo-HSCT included all readmissions and outpatient visits at Oslo University Hospital. Results: The cost for the peritransplant period could be reduced by up to 33% by treating allo-HSCT recipients at home instead of in the hospital. During the study period, 24% of the allo-HSCT recipients were treated at home, but our data from 2021 and 2022 indicate that at least a third of the patients scheduled for allo-HSCT are candidates for HaH. Conclusions: The findings demonstrate that patients in advanced home care experience significantly lower total costs compared to those receiving in-hospital treatment. Full article

Background/Objectives: The COVID-19 pandemic exposed critical vulnerabilities in healthcare systems, especially in ensuring continuity of care for patients with chronic diseases. Rehabilitation services, essential for recovery following SARS-CoV-2 infection, were among the most disrupted. This exploratory study aimed to assess Romanian patients’ perceptions of the accessibility and quality of post-COVID-19 rehabilitation services, focusing on individuals with chronic conditions. Methods: This exploratory cross-sectional study was conducted over a 12-month period in 2024. Data were collected from 76 adult patients diagnosed with at least one chronic condition (hypertension, diabetes mellitus, ischemic heart disease, cancer, or chronic obstructive pulmonary disease) and with confirmed prior SARS-CoV-2 infection. Most participants were recruited during outpatient specialty consultations, with a smaller number included from hospital settings, all located in Bucharest. A structured questionnaire was administered by the principal investigator after obtaining informed consent. Quantitative data were analyzed using non-parametric methods following confirmation of non-normal distribution via the Shapiro–Wilk test (p < 0.05). Satisfaction scores were reported as medians with interquartile ranges (IQR), and group comparisons were performed using the Mann–Whitney U test. A mixed-methods approach was employed, including thematic analysis of open-ended responses. Results: Patient satisfaction with rehabilitation services was consistently low. The median satisfaction scores [IQR] were accessibility 1.0 [0.0–2.0], quality of services 0.0 [0.0–4.0], staff empathy 0.0 [0.0–5.0], and perceived effectiveness 0.0 [0.0–5.0]. The median score for perceived difficulties in access was 1.0 [1.0–2.0], indicating widespread barriers. No statistically significant differences were observed between urban and rural participants or across chronic disease categories. Thematic analysis (n = 65) revealed key concerns including lack of publicly funded services, cost barriers, limited physician referral, service scarcity in rural areas, and demand for home-based rehabilitation options. Conclusions: Romanian patients with chronic illnesses and previous SARS-CoV-2 infection continue to face substantial barriers in accessing post-COVID-19 rehabilitation services. These findings highlight the need for more equitable and integrated recovery programs, especially for vulnerable populations in underserved settings. Full article

Background/Objectives: The place where a person dies serves as an indicator of end-of-life care quality. This study aims to identify the congruence of place of death (POD) and the reasons behind decision-making among terminally ill cancer patients in East Asia. Methods: We conducted a prospective multicenter cohort study in palliative care units in Japan, Korea, and Taiwan. Data were collected by the responsible physicians during routine clinical practice. Sankey diagrams were applied to present changes in reasons for POD incongruence. Results: A total of 2638 participants from 37 palliative care units in the three countries were enrolled, and most of them died at PCUs (Japan: 95.7%, Korea: 94%, Taiwan: 82%, p < 0.05). The congruence rate of the preferred and actual POD among PCU inpatients ranged from 70% to 80%. Availability of end-of-life care is the most common reason for preferred and eventual PCU death (78.6%, 72.2%, and 52.1%, respectively, p < 0.05). However, 13–22% of patients admitted to PCUs still preferred to die at home, for which traditional culture (20.2%, 40.8%, and 82%, respectively, p < 0.05) or family influence (44.4%, 38.8%, and 51.7%, respectively, p > 0.05) are the main reasons. Cultural and environmental factors, such as influences from family members’ preferences in the three countries or the ownership of housing/housing settings in Japan, are the main challenges in achieving POD congruence. Conclusions: Culturally inclusive strategies in clinical practice and policy implementation for identifying the preferred POD, enhancing communication among stakeholders, and facilitating transitional support may improve the quality of goal-concordant care. Full article

Background: In Italy, public health investments have not kept pace with the rising demand for cancer care. Hospitalization costs are increasing, and length of stay (LOS) remains a critical metric for hospital efficiency and care quality. Methods: An ecological study analyzed hospital discharge records of patients admitted to “Policlinico Tor Vergata” (Rome, Italy) in 2022. Associations between cancer types and key variables influencing inpatient care were analyzed using logistic regression models (AOR; 95% CI), along with discharge patterns. Results: Among 14,451 ordinary hospitalizations, cancer diagnoses accounted for 16.4%, with blood cancers as the largest subgroup (20.1%). LOS outliers (5%) contributed to 11,342 excess hospitalization days. Blood cancers were associated with prolonged LOS (2.031; 1.499–2.753), while blood (2.368; 1.911–2.933), gastric (2.216; 1.603–3.062), and bladder cancers (2.661; 2.133–3.319) had a higher infection risk. Patients with bladder cancers were more likely to be ≥65 years old (2.661; 2.133–3.319). Secondary diagnoses were more likely to occur in gastric cancer types (1.637; 1.486–1.802). A discharge analysis revealed that 46.8% of cancer patients were discharged home without activation of home care services, and only 0.2% received home care activation. Cancer patients were more likely to be discharged home (2.150; 1.911–2.418) while awaiting completion of diagnostic or therapeutic processes. Conclusions: Our findings highlight the significant variability in hospitalization patterns across cancer types and the inadequacy of current discharge planning processes. The burden of prolonged LOS highlights the unsustainability of current care models. An urgent transition toward integrated, community-based simultaneous care models is needed to reduce healthcare costs, prevent prolonged hospitalizations, and improve outcomes, particularly for vulnerable elderly patients. Full article

Remote monitoring technologies have transformed healthcare delivery by enabling the in-home management of chronic conditions, improving patient autonomy, and supporting clinical oversight. Passive sensing, a subset of remote monitoring, facilitates unobtrusive, real-time data collection without active user engagement. Leveraging devices such as smartphones, wearables, and smart home sensors, these technologies offer advantages over traditional self-reports and intermittent evaluations by capturing behavioural, physiological, and environmental metrics. This systematic review evaluates the clinical utility of passive sensing technologies used in remote monitoring, with a specific emphasis on their impact on clinical outcomes and feasibility in real-world healthcare settings. A PRISMA-guided search identified 26 studies addressing conditions such as Parkinson’s disease, dementia, cancer, cardiopulmonary disorders, and musculoskeletal issues. Findings demonstrated significant correlations between sensor-derived metrics and clinical assessments, validating their potential as digital biomarkers. These technologies demonstrated feasibility and ecological validity in capturing continuous, real-world health data and offer a unified framework for enhancing patient care through three main applications: monitoring chronic disease progression, detecting acute health deterioration, and supporting therapeutic interventions. For example, these technologies successfully identified gait speed changes in Parkinson’s disease, tracked symptom fluctuations in cancer patients, and provided real-time alerts for acute events such as heart failure decompensation. Challenges included long-term adherence, scalability, data integration, security, and ownership. Future research should prioritise validation across diverse settings, long-term impact assessment, and integration into clinical workflows to maximise their utility. Full article

Objective: This narrative review aims to synthesize qualitative research on the experiences of patients, families, and healthcare professionals during the transition of advanced cancer patients from hospital to community care. Methods: A systematic search of qualitative studies published between 2010 and 2023 was conducted. Thirteen studies were selected for their relevance to the transition from hospital to community care. The studies were thematically analysed to identify recurring patterns and significant findings. Results: The analysis revealed six key themes: (1) planning and managing transitions, (2) communication between actors involved in the process of transition, (3) constraints on health systems, (4) family, as a unit of care, (5) needs of patients and families in the process of transition to community care, and (6) emotions and feelings of actors involved in the transition. This review highlighted that transitions are often poorly managed, with inadequate communication, which contributes to anxiety, a sense of loss, and disruption in care continuity. Conclusions: This review emphasizes the importance of better planning, communication, and support during transitions from hospital to community care. A coordinated approach addressing the holistic needs of patients and families, including emotional support and clear communication, is essential for smoother, more effective transitions. Full article

Background: Healthcare total spending accelerated during the COVID-19 pandemic. Understanding broad high- and low-cost healthcare utilization while the healthcare system is under stress can help identify strategies and gaps to improve the future quality of care while reducing high-cost care and maximizing low-cost care. Methods: This was a population-based cross-sectional study with 56,141 individuals in the U.S. using 2020–2021 Medical Expenditure Panel Survey (MEPS) data sources. We applied a Poisson regression approach to test differences among patients with/without cancer/COVID-19 in healthcare utilization outcomes, including emergency department (ED) visits, inpatient discharge, inpatient nights of stay, outpatient visits, and home provider days. Results: Outpatient visits were affected by both cancer and COVID-19 diagnoses (86% to 109% higher for individuals with cancer and/or COVID-19, p < 0.001). COVID-19 patients with/without cancer had statistically significant increases in high-cost care, including (1) ED visits (151% to 245% higher, p < 0.001), (2) number of inpatient visits (94% to 170%, p < 0.001, p < 0.001), and (3) inpatient nights of stay (259% to 268% higher, p < 0.001). There were no statistically significant differences in home-based utilization when compared to individuals without cancer and without COVID-19. Conclusions: Improving and adopting innovative low-cost home-based care utilization are critical to reduce future healthcare spending and strengthen pandemic preparedness. Full article

Peritoneal carcinomatosis is a common presentation found in advanced-stage gastrointestinal (GI) and gynecological cancers. Combined cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with significant survival benefits for select patients. CRS/HIPEC is not currently provided in Newfoundland and Labrador (NL). The Canadian HIPEC Collaborative Group recommends that centres complete a minimum of one case monthly to maintain competency and achieve good outcomes. Thus, we aimed to demonstrate that the annual patient volume in NL justifies the feasibility of implementing a combined surgical and gynecological oncology CRS/HIPEC program. Methods: A retrospective chart review of the NL Cancer Care Registry identified patients with stage IV colorectal, appendiceal, or gastric cancer and stage III to IV epithelial ovarian cancer over a 1-year period (1 January 2020–31 December 2020) to identify the number of patients meeting the criteria for CRS/HIPEC and/or those referred out of province to receive the treatment. The results are presented as proportions and percentages. Results: Thirty-one patients were eligible to receive CRS/HIPEC during the study period (11 GI, 20 gynecological). Of the GI patients, 63% were referred out of province for the procedure. Gynecological patients underwent CRS and systemic therapy +/− outpatient intraperitoneal chemotherapy in NL. Conclusions: Allowing patients to receive this standard of care treatment near home reduces financial, social, and emotional stressors. Our results confirm a sufficient patient volume to support a combined CRS/HIPEC program in NL. The implementation of this program will require multidisciplinary collaboration, specialized training, equipment, and protocol development. Full article

Background/objectives: Depression is a common complication of cancer and is associated with distress and reduced participation in medical care. The prevalence is still uncertain in advanced cancer due to methodological problems. Our aim was to study depression in the last year of life and related variables. Methods: We used an administrative database and analyzed clinically verified diagnoses of depression during the last year of life for 27,343 persons (nursing home residents excluded) and related the data to age, sex, socioeconomic status on an area level (Mosaic system), and frailty risk as calculated by the Hospital Frailty Risk Score (HFRS). T-tests, chi-2 tests, and binary logistic regression models were used. Results: During the last year of life, a clinical diagnosis of depression was found in 1168/27,343 (4.3%) cases and more frequently seen in women (4.8% vs. 3.8%, p = 0.001), in the elderly aged 80 years or more, p = 0.03, and especially in persons with a frailty risk according to the HFRS, with rates of 3.3%, 5.3% and 7.8% in the low-risk, intermediate and high-risk groups, respectively (p < 0.001), whereas no differences were found based on socioeconomic status. In a multiple logistic regression model, being female (aOR 1.30, 95% CI 1.16–1.46) or having an intermediate (1.66, 1.46–1.88) or high frailty risk (2.57, 2.10–3.14) retained the predictive value (p < 0.001, respectively). Conclusions: Depression is more common in women and, above all, in people with multimorbidity. Depression affects the amount of health care needed, including the need for psychiatric care. Therefore, it should be included in clinical decision-making, especially as depression is associated with poorer prognosis in cancer. Full article

This pilot study aimed to assess the feasibility and preliminary effects of a supervised, home-based exercise program in patients recovering from laparoscopic colorectal cancer surgery. A total of 23 patients were included, with 13 participating in the exercise intervention and 10 receiving standard postoperative care. The exercise group (intervention group) followed a two-month structured program, while the control group received no structured exercise. Feasibility was demonstrated by 98% adherence in the intervention group and no reported adverse events. At T1, the intervention group showed significant improvements in role function, cognitive function, and reduced fatigue compared to the control group. At T2, a significant difference was observed in physical function. Functional capacity, assessed by the Six-Minute Walk Test, was significantly better in the intervention group at T1, T2, and T3, as was physical performance measured by the Short Physical Performance Battery (SPPB) at T1, T2, and T3. No significant differences were observed between the groups in anxiety, depression, sleep quality, or body composition parameters. This study highlights the feasibility of a supervised home-based exercise program in the early postoperative phase, demonstrating positive effects on Quality of Life, functional recovery, and fatigue in colorectal cancer patients. Full article

Recent advancements in wearable devices have significantly enhanced remote patient monitoring, enabling healthcare professionals to evaluate conditions within home settings. While electronic health records (EHRs) offer extensive clinical data, they often lack crucial contextual information about patients’ daily lives and symptoms. By integrating continuous self-reported outcomes related to vulnerability, anxiety, and depression from older adult cancer survivors with objective data from wearables, we can develop personalised risk models that address time-varying risk factors in cancer care. Our study combines real-world data from wearable devices with self-reported information, employing process mining techniques to analyse dynamic risk models for vulnerability and anxiety. Unlike traditional static assessments, this approach recognises that risk factors evolve. Collaborating with healthcare professionals, we analysed data from the LifeChamps study to create two dynamic risk models. This collaborative effort revealed how activity and sleep patterns influence self-reported vulnerability and anxiety among participants. It underscored the potential of wearable sensors and artificial intelligence techniques for deeper analysis and understanding, making us all part of a larger effort in cancer care. Overall, patients with prolonged sedentary activity had a higher risk of vulnerability, while those with highly dynamic sleep patterns were more likely to report anxiety and depression. Prostate-metastatic patients showed an increased risk of vulnerability compared to other cancer types. Full article

Venous thromboembolism (VTE) is considered the most common and potentially life-threatening cardiovascular complication in cancer and the second leading cause of death after cancer progression itself. In recent years, the steadily increasing rate of cancer-associated thrombosis (CAT) seems mainly related to amelioration in imaging techniques and the placements of central venous catheters (CVCs). The pivotal role of CVCs in the switch from hospital to home care is offset by its high thrombotic burden. The peripherally inserted central catheter (PICC) offers advantages (convenience, fast access, and cost-effectiveness) in comparison to centrally inserted devices (PORT), but increased thrombotic risk is reported. The aim of this narrative review was to offer a comprehensive overview of the existing literature about PICC-related thrombosis (PICC-VTE) by analyzing the current knowledge and related gaps. We further discussed advancements in insertion techniques, underscored the role of the novel PICC-PORT lines, and provided a “head-to-head” comparison among major guidelines on primary thromboprophylaxis. Full article

Microfluidic biosensors integrate microfluidic and biosensing technologies to achieve the miniaturization, integration, and automation of disease diagnosis, and show great potential for application in the fields of cancer liquid biopsy, pathogenic bacteria detection, and POCT. This paper reviews the recent advances related to microfluidic biosensors in the field of laboratory medicine, focusing on their applications in the above three areas. In cancer liquid biopsy, microfluidic biosensors facilitate the isolation, enrichment, and detection of tumor markers such as CTCs, ctDNA, miRNA, exosomes, and so on, providing support for early diagnosis, precise treatment, and prognostic assessment. In terms of pathogenic bacteria detection, microfluidic biosensors can achieve the rapid, highly sensitive, and highly specific detection of a variety of pathogenic bacteria, helping disease prevention and control as well as public health safety. Pertaining to the realm of POCT, microfluidic biosensors bring the convenient detection of a variety of diseases, such as tumors, infectious diseases, and chronic diseases, to primary health care. Future microfluidic biosensor research will focus on enhancing detection throughput, lowering costs, innovating new recognition elements and signal transduction methods, integrating artificial intelligence, and broadening applications to include home health care, drug discovery, food safety, and so on. Full article

Background and Aims: Home parenteral nutrition (HPN) is essential in the management of chronic intestinal failure (CIF) and malignant bowel obstruction (MBO), particularly in cases where enteral feeding is not feasible. This review examines the evidence from 34 studies to evaluate the impact of HPN on survival and quality of life (QoL) in patients with MBO, CIF, and advanced cancer, as well as to identify clinical predictors of survival and address psychosocial challenges. Methods: A comprehensive review was conducted of 34 studies, focusing on the use of HPN in patients with MBO, CIF, and advanced cancer. Data were analyzed for survival outcomes, QoL metrics, and predictors of survival, including performance status, albumin levels, and the continuation of chemotherapy. The psychosocial aspects of HPN therapy were also assessed, particularly its influence on patient’s daily lives and mental health. Results: Key predictors of improved survival included good performance status, higher albumin levels, and the ability to continue chemotherapy. While HPN extended survival in many cases, its impact on QoL varied significantly. Psychosocial challenges, including lifestyle disruption and mental health strain, were common among long-term HPN patients, underscoring the need for comprehensive patient support. Conclusions: HPN can be a life-sustaining therapy for patients with CIF, MBO, and advanced cancer, but its success depends on careful patient selection and management. Identifying predictors of survival helps optimize outcomes, while addressing psychosocial challenges is crucial to minimizing the negative impact on QoL. This review highlights the need for a balanced approach to maximize the benefits of HPN. Full article