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Cancer is a major social, public health and economic problem worldwide, causing physical and psychological distress to patients. The emerging telemedicine model in healthcare delivery has garnered significant interest because of its potential effectiveness.
To assess the effects of telemedicine on distress, physical function, and self-efficacy in cancer patients.
This meta-analysis was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 checklist.
Six databases were searched for relevant studies published from inception to October 2024. The literature search and data collection were conducted by two separate researchers. The quality of the methodologies in the studies included was evaluated using the Cochrane Risk of Bias Tool. Data analysis was conducted using Review Manager (version 5.4).
Compared with the control group, patients who received telemedicine experienced significant reductions in distress (SMD = −0.44, 95% CI: −0.62 to −0.25, p < 0.00001, I 2 = 46%) and significant increases in physical function (SMD = 0.11, 95% CI: 0.01–0.22, p = 0.04, I 2 = 0%) and self-efficacy (SMD = 0.46, 95% CI: 0.23–0.69, p < 0.0001, I 2 = 0%).
Telemedicine can effectively enhance the psychological health and physiological function of cancer patients, as well as their self-efficacy, suggesting a sustainable approach to the clinical care of cancer patients. Future studies are needed to further investigate the effectiveness of telemedicine interventions in different types of cancer patients and in different cultural contexts and to conduct long-term follow-up studies to evaluate their long-term effectiveness and cost-effectiveness.
This systematic review and meta-analysis provides evidence to offer effective and sustainable telemedicine care among cancer patients.
No patient or public contribution.
This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (Registration number: CRD42024604929) under the title ‘The effectiveness of death education on death anxiety, depression and quality of life in patients with advanced cancer: A meta-analysis of randomised controlled trials’. The full study protocol could be obtained at https://www.crd.york.ac.uk/PROSPERO/view/CRD42024604929
Patients with advanced cancer can suffer from serious distress like death anxiety and depression, in addition to facing a reduced quality of life. Death education interventions have been shown to improve these outcomes, but their effectiveness remains unclear, especially in the advanced stages.
This meta-analysis aimed to examine the efficacy of death education interventions on death anxiety, depression, and quality of life in advanced cancer sufferers, and to explore the influence of the intervention site, duration, the age of participants, and dyadic relationships with caregivers on the effectiveness of these interventions.
A meta-analysis of randomized controlled trials was performed.
A systematic search of 10 electronic databases identified 19 eligible RCTs with 1531 participants. Data were extracted and analyzed via Review Manager 5.4. Subgroup analyses were performed on the basis of the intervention site, duration, age of participants, and presence of caregivers.
In comparison to the control intervention, the death education intervention notably alleviated death anxiety (SMD = −2.11, 95% CI: −5.91 to −0.89, p = 0.008) and depression (SMD = −0.45, 95% CI: −0.72 to −0.18, p = 0.001). Quality of life (SMD = 0.86, 95% CI: 0.39–1.33, p = 0.0003) was also significantly improved. Subgroup analyses revealed that interventions with longer durations, conducted in professional settings, and targeting younger patients were more likely to be effective in reducing depression and enhancing the quality of life. Interventions without family companionship were more effective in improving depression, while interventions with family companionship were more effective in improving quality of life.
Death education interventions are effective at improving death anxiety, depression, and quality of life in patients with advanced cancer. Tailoring interventions to individual features and cultural backgrounds is crucial to achieving the best effect.
Death education is an effective and important intervention measure that can help patients with advanced cancer better cope with death anxiety and depressive emotions and improve their quality of life. Clinical medical workers should select appropriate death education programs based on the specific conditions of patients and provide necessary support and guidance.
CRD42024565376
Although cancer is a worldwide public health problem, it can be detected early and prevented through cancer screening. However, not all individuals are motivated to undergo cancer screening. Current studies have revealed that decision aids can impact decision-related outcomes among individuals at risk of cancer. However, their efficacy on decision knowledge and decision conflict remains unclear.
The purpose of this meta-analysis was to appraise the efficacy of decision aids on decision knowledge and conflict among people at risk of cancer.
Nine electronic databases were utilized to search the literature until October 31, 2024. The Cochrane Risk of Bias Tool 2.0 and the Grading of Recommendations Assessment, Development, and Evaluation approach were used to evaluate the certainty of evidence. The data were analyzed using Stata 16.0.
Thirteen relevant studies with 2971 participants published between 2002 and 2023. The pooled results showed that decision aids significantly improved decision knowledge (SMD = 0.45, 95% CI [0.19–0.72], p = 0.00) and decreased decision conflict (SMD = −0.47, 95% CI [−0.73 to −0.21], p = 0.00). Subgroup analyses revealed that the framework, format, population, and duration of decision aids can influence their effects on decision knowledge and decision conflict among people at risk of cancer.
This meta-analysis illuminates that decision aids are effective for improving decision knowledge and diminishing decision conflict among people at risk of cancer. The framework, format, population, and duration should be considered when developing decision aids. Our findings may suggest future directions for assisting people at risk of cancer in making informed decisions about cancer screening. Additional trustworthy research is required to verify these findings.
Increases in cancer survivorship negatively impact patients and family caregivers, decreasing quality of life. Previous dyadic interventions involved them as a unit and focused on their outcomes, but inconsistent results existed in influencing quality of life.
To assess dyadic intervention effect on quality of life for cancer patients and family caregivers across different cancer types and intervention durations.
A systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
Six databases were searched from establishment until 14 January 2024. Two authors independently performed the search process, literature screening, and data extraction. The ROB version 2 and GRADE were respectively used to check the methodology and evidence quality. The data were analysed via RStudio, and intervention effects were estimated with 95% CIs and SMDs. The statistical heterogeneity was explored through the I2 statistic, P values, and Egger's test, and differences in overall effects were deemed statistically significant, having a P value < 0.05. Subgroup analysis was also conducted.
13 RCTs with 1625 participants, published from 2005 to 2021, were included. The results demonstrated that dyadic interventions enhanced quality of life for both cancer patients and family caregivers. Subgroup analysis suggested that family-centred interventions for patients with specific cancer types, which lasted for a long period (> 6 weeks), enhanced quality of life for cancer patients and family caregivers. The evidence and methodology were of a moderate quality.
Nurses are important practitioners of culture-oriented dyadic interventions. Long-term (> 6 weeks) and family-centred dyadic interventions for patients with a specific cancer type can enhance cancer patients' and family caregivers' quality of life, along with digital intelligence approaches to promote mutual communication and strengthen family relationships, thereby optimising oncology clinical nursing and enhancing the quality of life, health, and welfare of the entire family.
Dyadic interventions emphasising the involvement of both cancer patients and family caregivers should be considered and tailored by professionals and oncology nurses to establish harmonious family relationships, improve family coping techniques and decision-making to enhance the whole family's quality of life and well-being according to their cultural contexts, and promote more efficient, targeted, and economical oncology care.
No Patient or Public Contribution because all the involved participants were from existing studies, and the design, conduction, analysis, and interpretation of the data were completed by the authors in this article.
International Prospective Register of Systematic Reviews: CRD42024519432; https://www.crd.york.ac.uk/PROSPERO/#recordDetails
The diagnosis of pediatric cancer is a major shock to family caregivers, and posttraumatic stress symptoms (PTSSs) emerge as the most prevalent adverse psychological outcomes. However, not all family caregivers have sufficient resilience to cope with these challenges; thus, supportive care interventions are necessary. These interventions, which include psychosocial support, education, and other forms of assistance, are designed to enhance the well-being of those affected by disease. In the past few years, more research has been delving into supportive care interventions for family caregivers of cancer-affected children, yet there is still a variance in the results.
To investigate the impacts of supportive care interventions on PTSSs and resilience in family caregivers of cancer-affected children, also focusing on the impacts of prerecruitment time to diagnosis, duration, type of intervention, and recruitment area on the outcomes.
Nine databases (Cochrane Library, Ovid MEDLINE, CINAHL Plus with Full Text, Embase, CNKI, Sinomed, WANFANG, VIP, and Web of Science) were searched from their inception to February 21, 2024. The revised Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method were used to evaluate the quality of evidence. To gauge the effectiveness of the interventions, we computed the standard mean difference (SMD) and the 95% confidence interval (CI) utilizing StataCorp (version 16.0). Sensitivity analysis and Egger's test were also conducted.
Supportive care interventions significantly improved the PTSSs (SMD = −0.86, 95% CI [−1.39, −0.33], p < 0.01, I 2 = 94.95%) and resilience (SMD = 0.85, 95% CI [0.26, 1.44], p < 0.01, I 2 = 88.3%) among family caregivers of cancer-affected children. Subgroup analyses revealed that early interventions for family caregivers after the diagnosis of children and the short-term interventions were associated with improvements in their PTSS and resilience. Moreover, cognitive behavioral interventions were the most common type of interventions and were effective in supporting family caregivers. Additionally, supportive care interventions did not improve PTSSs among family caregivers in middle-income countries.
Supportive care interventions have demonstrated efficacy in improving PTSSs and resilience among family caregivers of cancer-affected children. This research proved the imperative of providing prompt supportive care to family caregivers early after the pediatric cancer diagnosis. Additionally, it is also necessary to further study and explore the optimal way to combine different intervention components based on caregivers' need and to develop regionally adapted and culturally sensitive supportive care interventions to better improve health outcomes for family caregivers.
Cancer screening is a pivotal method for reducing mortality from disease, but the screening coverage is still lower than expected. Telehealth interventions demonstrated significant benefits in cancer care, yet there is currently no consensus on their impact on facilitating cancer screening or on the most effective remote technology.
A network meta-analysis was conducted to detect the impact of telehealth interventions on cancer screening and to identify the most effective teletechnologies.
Six English databases were searched from inception until July 2023 to yield relevant randomized controlled trials (RCTs). Two individual authors completed the literature selection, data extraction, and methodological evaluations using the Cochrane Risk of Bias tool. Traditional pairwise analysis and network meta-analysis were performed to identify the overall effects and compare different teletechnologies.
Thirty-four eligible RCTs involving 131,644 participants were enrolled. Overall, telehealth interventions showed statistically significant effects on the improvement of cancer screening. Subgroup analyses revealed that telehealth interventions were most effective for breast and cervical cancer screening, and rural populations also experienced benefits, but there was no improvement in screening for older adults. The network meta-analysis indicated that mobile applications, video plus telephone, and text message plus telephone were associated with more obvious improvements in screening than other teletechnologies.
Our study identified that telehealth interventions were effective for the completion of cancer screening and clarified the exact impact of telehealth on different cancer types, ages, and rural populations. Mobile applications, video plus telephone, and text message plus telephone are the three forms of teletechnologies most likely to improve cancer screening. More well-designed RCTs involving direct comparisons of different teletechnologies are needed in the future.
Telehealth interventions should be encouraged to facilitate cancer screening, and the selection of the optimal teletechnology based on the characteristics of the population is also necessary.
To assess the effectiveness of different nonpharmacological treatments for severe radiation-induced oral mucositis in patients with head and neck cancer.
Radiation-induced oral mucositis is highly prevalent in patients with head and neck cancer. Current medications for radiation-induced oral mucositis are limited in effectiveness and susceptible to side effects, and while there is an increasing adoption of nonpharmacological interventions, the optimal one remains unclear.
Systematic review and network meta-analysis based on the PRISMA-NMA guidelines.
Six databases were searched. Two authors independently performed the literature screening, data extraction and methodological quality assessment of the included studies. Traditional pairwise meta-analysis was performed by R Studio. A network meta-analysis was then conducted to assess the effects of nonpharmacological interventions for severe radiation-induced oral mucositis in patients with head and neck cancer.
Fifty-two studies involving seven types of nonpharmacological interventions were enrolled. The network meta-analysis indicated that natural plant-based therapies might be the most effective, health education interventions might be the second most effective, and honey might be the third most effective interventions for reducing the incidence of severe radiation-induced oral mucositis. For reducing the incidence of severe oral mucositis-related pain, the pairwise meta-analysis showed that only natural plant-based therapies and health education interventions were effective.
Nonpharmacological interventions are effective in the management of severe radiation-induced oral mucositis among patients with head and neck cancer.
Nonpharmacological interventions are a category of safe and effective adjunctive therapies that should be encouraged in clinical practice.
CRD42023400745.
Endoscopic submucosa dissection (ESD) has been applied extensively in the treatment of large intestine tumours due to its high total excision ratio. Nevertheless, there is a high incidence of adverse reactions in colon ESD, and the efficacy of prophylactic ESD following ESD in prevention of postoperative haemorrhage is still disputed. The purpose of this meta-analysis is to evaluate the effectiveness of prophylaxis of wound closure in large intestine ESD after operation. For eligibility, we looked through three databases: PubMed, Embase and Cochrane Library. Heterogenity was measured by means of a chi-square method of Q-statistic and an I2 test. Fixed or random effects models were used for data processing. Based on the retrieval policy, we found a total of 1286 papers, and then we collected nine papers to extract the data. Regarding postoperative haemorrhage, there was a significant reduction in the risk of wound haemorrhage in the wound closure group than in the control group (OR, 0.29; 95% CI, 0.19–0.44 p < 0.0001). No statistical significance was found in the incidence of perforation in the wound closure and the control group (OR, 0.45; 95% CI, 0.19–1.03 p = 0.06). There was a significant reduction in the incidence of postoperation fever among those in the wound closure group than in the control group (OR, 0.37; 95% CI, 0.15–0.93 p = 0.04). Preventive endoscopic closure decreased the rate of ESD in colon disease, but did not significantly decrease the rate of postoperation perforation and postoperative fever. Future research will be required to clarify the risk factors and classify high-risk individuals in order to formulate a cost-effective prevention strategy.
To examine the multidimensional properties of caregiver burden among family caregivers of patients with advanced cancer in a palliative context.
A sequential, explanatory, mixed-method study was performed.
Family caregivers of patients diagnosed with advanced cancer were recruited from a palliative care department of a third-level hospital in Sichuan Province, China. The Caregiver Burden Inventory, Social Support Rating Scale and Connor–Davidson Resilience Scale were used to collect quantitative data, and a total of 150 caregivers were recruited from January 2022 to September 2022. Qualitative data were collected through semi-structured interviews, and a total of 22 caregivers were interviewed from October 2022 to November 2022. Survey data were analysed using descriptive statistics, and the factors of caregiver burden were identified using the Mann–Whitney U test, Kruskal–Wallis H test and Spearman correlations. Interpretative phenomenological analysis was performed to analyse the interview data to initially explore the multidimensions of caregiver burden. The following-a-thread method and convergence coding matrix were used for triangulation to examine the multidimensional properties of caregiver burden.
The participants experienced a moderate level of caregiver burden (32.97 ± 13.09). Through triangulation, six meta-themes and nine meta-subthemes were identified as multidimensional properties of caregiver burden, including physical (too many caring tasks and poor health condition), emotional (strong negative emotions resulting from patients' suffering and insufficient and ineffective family communication), social (less social interaction and social role conflict) and economic burdens, factors that aggravate burden (prevention and control of COVID-19 and spousal relationship with patients) and factors that mitigate burden (social support).
Multiple dimensions of caregiver burden were experienced by family caregivers of patients with advanced cancer in the palliative context. Family-centred palliative care must be further developed.
It is important to develop family-centred palliative care. Therefore, the focus must be on developing a rational understanding of palliative care in public and a culture-oriented death education in palliative units.
This study adopted a mixed-method approach to comprehensively understand the phenomenon of and factors in caregiver burden in the Chinese palliative oncology context. Our findings suggest that family caregivers in palliative oncology experience a moderate level of caregiver burden, with dimensions including physical, emotional, social and economic burdens, among which emotional burden is the most prominent. The findings of this study provide policy makers and nurse practitioners with targets to be addressed in family-centred care in Chinese palliative units.
The results of this study are reported based on the guidelines of the Mixed-Methods Article Reporting Standards.
Eligible caregivers were invited to participate in the study and semi-structured interviews. Nurse managers of the palliative unit helped us access the patient-management system.
Current studies have revealed that acceptance and commitment therapy (ACT) can alleviate the adverse effects of cancer; however, its effectiveness on the psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer remains unclear.
The aims of this study were to identify the effectiveness of ACT on psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer, and to explore moderators.
PubMed, Embase, Web of Science, CENTRAL, PsycINFO, CINAHL, CNKI, VIP, and Wanfang electronic databases were searched from inception to September 29, 2022. The Cochrane Collaboration's risk-of-bias assessment tool II and the Grading of Recommendations Assessment, Development, and Evaluation approach were used to evaluate evidence certainty. The data were analyzed using R Studio. The study protocol was registered with PROSPERO (CRD42022361185).
The study included 19 relevant studies (1643 patients) published between 2012 and 2022. The pooled results showed that ACT significantly improved psychological flexibility (mean difference [MD] = −4.22, 95% CI [−7.86, −0.58], p = .02) and quality of life (Hedges' g = 0.94, 95% CI [0.59, 1.29], Z = 5.31, p < .01) but did not significantly improve fatigue (Hedges' g = −0.03, 95% CI [−0.24, 0.18], p = .75) or sleep disturbance (Hedges' g = −0.26, 95% CI [−0.82, 0.30], p = .37) in patients with cancer. Additional analyses revealed a 3-month sustainable effect on psychological flexibility (MD = −4.36, 95% CI [−8.67, −0.05], p < .05), and moderation analysis showed that intervention duration (β = −1.39, p < .01) and age (β = 0.15, p = .04) moderated the effects of ACT on psychological flexibility and sleep disturbance, respectively.
Acceptance and commitment therapy demonstrates effectiveness for psychological flexibility and quality of life of patients with cancer, but there is a lack of evidence regarding its effects on fatigue and sleep disturbance. In clinical practice, ACT should be designed in more detail and rounded to achieve better results.
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