European Journal of Cancer Care

Background. A timely diagnosis of cancer is important for patient outcomes. The delay in the patient interval (time from symptom interpretation to seeking help) is often the longest throughout the cancer patient pathway. Factors extending this interval include vague symptom profiles increasing the difficulty of symptom appraisal and individual demographics influencing help-seeking behaviours. An underexplored and potential source of delay in cancer diagnosis is associated with managing symptoms using self-care activities prior to presentation to healthcare. Methods. This study aimed to characterise the use of self-care activities in the context of managing nonspecific symptoms, prior to cancer diagnosis and their effect on the length of the patient interval. Eligible publications were identified using a rapid systematic review, and their qualitative self-care data were extracted and analysed using thematic synthesis. Results. Forty-five qualitative research papers between 2009 and 2024 were included in the final review. Self-care was used as part of an iterative process, often resulting in delayed presentation to healthcare, if methods were effective in managing nonspecific symptoms. Across the literature, varying types of self-care activities were reported across all cancers with nonspecific symptoms, including the use of over-the-counter or alternative medications, lifestyle changes, and watchful waiting. The individual’s decision to self-care was either prompted externally by a healthcare professional (HCP) (e.g., community pharmacists) or prompted by the individual depending on the availability of home remedies and medication. Patients used self-care when there was a low perceived need to seek healthcare, to determine whether healthcare was required, or to avoid the use of healthcare. However, across the literature, there is limited evidence to understand the variation by cancer type, symptoms, and individual characteristics. Conclusions. The findings of this rapid review demonstrate that self-care activities could hinder prompt help-seeking and delay cancer diagnosis among people who are experiencing nonspecific cancer symptoms. However, more evidence is needed to understand which individual factors facilitate the adoption of self-care behaviours over prompt help-seeking for nonspecific cancer symptoms.

Background. During the COVID-19 pandemic, people affected by cancer were in need of information about the virus and about the (self-) management of cancer symptoms and treatment. It is important to understand how patients with cancer navigated through the pandemic and to explore their experience relating to their supportive care needs. Aim. This study aimed to describe the experience of Swiss oncological patients during the COVID-19 pandemic with additional supportive cancer care. Methods. A single-center study was conducted in 2021. Patients with melanoma, breast, lung, or colon cancer who received active systemic anticancer treatment at the time of the COVID-19 pandemic and who were additionally seeing either oncology clinical nurse specialists, integrative medicine physicians, or both were included. We conducted semistructured interviews alongside the patient-reported quantitative assessment of distress and resilience. Thematic analysis was performed for the qualitative data and descriptive statistics for the quantitative data. Results. Eighteen patients with cancer were interviewed. Patients seeing an integrative medicine physician highlighted that they positively felt being addressed as a whole person during the consultations. The oncology clinical nurse specialists were perceived as the first point of contact for the patients and had more time during the pandemic compared to what the patients normally received. In general, patients did not experience delays or disruptions in their cancer treatment. As immunosuppressed and fatigued patients with cancer, they felt supported by the restrictions and hygienic measures. Access to vaccination reassured patients against the risk of infection. These results were reflected in the quantitative data, as we found moderate distress levels (M = 4.1; SD = 2.5) and high resilience scores (M = 7.5; SD = 0.9) in this patient population. Conclusion. During the COVID-19 pandemic, patients with cancer felt particularly supported by integrative medicine and cancer nurse consultations. Secured resources for nursing consultations and integrative medicine services can help to address the supportive care needs of patients with cancer.

Purpose. Consolidation with durvalumab is standard of care in the management of unresectable stage 3 non-small-cell lung cancer (NSCLC) postchemoradiation, and pneumonitis is an independent potential treatment complication of both treatment strategies. This study seeks to determine the timing of radiation pneumonitis (RP) by receipt of durvalumab. In addition, we reviewed the preventative strategies guided by pathophysiology of pneumonitis. Methods. We identified patients with unresectable Stage 3 NSCLC who developed grade ≥2 RP after chemoradiotherapy. Time-to-RP was defined from date of completion of radiotherapy to date of radiological diagnosis of RP and accompanying clinical symptoms. Early RP was defined as RP within 2 months of completion of radiotherapy. Differences in time-to-RP by receipt of durvalumab were evaluated using Wilcoxon rank-sum test. Differences in those who had early vs late RP by receipt of durvalumab was evaluated using Fisher’s exact test. Logistic regression was used to evaluate patient and treatment factors associated with early RP. Results. Of the 144 patients with Stage 3 NSCLC who had definitive chemoradiotherapy, 31 (22%) developed grade ≥2 RP and were included in the study. There was one patient with grade 5 RP. The median age of the cohort was 67 years (range 41–87). The mean lung dose, V5Gy, and V20Gy were 15.8Gy (SD = 1.56), 60.14% (SD 2.73), and 29.96% (SD 1.82), respectively. Twelve (39%) patients received durvalumab. The median time-to-RP was 3.4 months (range: 1.7–7.2) and 2.3 months (range: 0.6–9.6) in patients who had durvalumab and no durvalumab, respectively (). 83% (10/12) of patients who had durvalumab and 58% (11/19) of patients who did not have durvalumab had late RP (). No other patient and treatment factors were associated with early RP. Conclusion. Patients on durvalumab may have late-onset RP; therefore, further studies with larger cohort of patients and development of new predictive models that incorporate evolving management are needed should preventative strategies of RP be considered in routine clinical practice.

Objective. Matrix metalloproteinase-2 (MMP2) overexpression has been considered as a hallmark of tumor aggressiveness. The significant roles of MMP2 in other human disorders, such as cardiovascular diseases and dental caries, have also been demonstrated. Herein, we used in silico approaches to evaluate the binding affinity of selected cinnamic acids to the MMP2 catalytic domain. The obtained findings were subsequently juxtaposed with those attributed to oleandrin, utilized as a reference pharmaceutical agent. Methods. This research employed the AutoDock software to assess the affinity of 19 herbal compounds derived from cinnamic acid to the catalytic cleft of MMP2. The ligands attaining the most negative scores, as determined by the Gibbs free binding energy assessments, were accorded the highest rankings. The interactions between the MMP2 and cinnamic acids ranked highest were elucidated using the Discovery Studio Visualizer tool. Molecular dynamics simulations were performed to investigate the structural stability of MMP2 backbone atoms when forming complexes with both the top-ranked inhibitor from this study and a standard drug. Results. Eight cinnamic acids were indicated with values less than −10 kcal/mol. Cynarin emerged as the most potent inhibitor of the enzyme, with the score and inhibition constant value of −15.19 kcal/mol and 7.29 pM, respectively. The MMP2 backbone atoms achieve stability around the 20 ns mark, displaying a root mean square deviation of approximately 3.2 Å when influenced by the top-ranked cinnamic acid, the standard drug, or in their free form. Conclusion. The inhibition of MMP2 by cinnamic acids, particularly cynarin, holds promise as a valuable therapeutic strategy for various human disorders, encompassing cancer, cardiovascular conditions, and dental caries.

Objective. Lung cancer (LC) patients suffer from multiple cooccurring symptoms. Interventions that have the potential to impact more than one symptom within a symptom cluster should be identified. The aim of this review was to examine nonpharmacological interventions that were effective in the management of one or more of the following symptoms in LC patients: dyspnea, fatigue, physical functioning (PF), and role functioning (RF). Methods. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used for reporting this systematic review. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (using the PubMed interface), Embase (using the embase.com interface), and Web of Science were used as electronic databases. Randomized controlled studies were included if they assessed the effects of nonpharmacological interventions on dyspnea, fatigue, PF, and/or RF in patients with LC. Studies were evaluated with the Cochrane risk of bias tool, and relevant data were extracted and narratively summarized. Results and Conclusions. In total, 89 articles were included. Search results (until April 2023) show that most evidence was found for exercise interventions, followed by multicomponent, psychoeducational, diet, acupuncture, and other interventions. Studies that had an effect on multiple symptoms were observed to have the most frequent instances of positively affecting dyspnea, followed by PF, fatigue, and RF.

Women around the world are most frequently afflicted with breast cancer, and it is one of the most frequent causes of cancer death in females. Breast cancer is usually classified according to biomarker status, triple‐negative breast cancer (TNBC) represents a distinct subtype characterized by immunohistochemical findings that denote negativity for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (Her-2) on cancer tissue. It is more common in younger women than in other subtypes. As an invasive breast cancer subtype with a unique drug-resistant phenotype and metastatic burden, it has limited treatment options, and patients have a poor prognosis with high rates of local, distant recurrence and mortality, and there is still a lack of standardized treatment protocols for TNBC. In this review, we delve into the current treatment strategies for TNBC and explore the potential for new approaches and targets in the future. This trial is registered with NCT03997123.