Introduction Cancer is a major health problem and a devastating disease. People living with cancer experience a variety of signs and symptoms. Cancer patients undergo physical, psychological, social, and financial implications due to the disease and its treatment. Cancer harshly affects the individual\'s health and deteriorates the quality of life (QoL). This study assesses the QoL determinants among various cancer patient groups in western Maharashtra, India. Materials and methods This hospital-based cross-sectional study was conducted in the oncology center, Krishna Vishwa Vidyapeeth, Karad, India. The study consisted of 270 cancer patients selected by purposive sampling technique. The data regarding the QoL was collected using a structured and validated questionnaire consisting of 50 questions elicited through one-to-one interviews. Data were analyzed using statistical software. Results Of 270 cancer patients, 135 (50%) were males and 135 (50%) were females aged between 22 and 66 years. Maximum patients (N = 89, 32.9%) were in the age group of 41-50 years, and the majority of patients (N = 34, 12.6%) suffered from breast cancer. The QoL among our patients was very low in 104 (38.5%) and 127 (47.0%), average in 36 (13.3%), and high only in 3 (1.1%) patients. Conclusion QoL among cancer patients was influenced by their symptoms, treatment, and the financial strain they experienced. There is a need to develop interventions to effectively manage symptoms that will help patients gain a greater sense of control over their illness and treatment, thereby improving their QoL.

BACKGROUND: In recent years, there has been a significant increase in the survival rates of cancer patients. However, this has also led to an increase in side effects, such as dyspnoea, which can negatively impact of patients. We propose a programme for re-educating effort. The main objective is to test the effectiveness of this programme in improving respiratory symptoms and functionality in cancer patients.
METHODS: Experimental, prospective, longitudinal, randomised study with a parallel fixed-assignment scheme (CG-IG). The patients were selected from the Medical Oncology Service of the University Hospital Complex of Salamanca (CAUSA), Spain. Two parallel intervention programmes were designed for the two study groups (Conventional Clinical Practice-Effort Re-education Programme). Primary variables: dyspnoea (MRC), functionality (Barthel); secondary variables: physical performance (SPPB) and functional capacity (ECOG) and the socio-demographic variables (age, sex, anatomopathological diagnosis, and number of treatment lines).
RESULTS: The study sample consisted of 182 patients, with 12 excluded, resulting in a final sample size of n = 170. Sex distribution (CG: 52.9% male and 47.1% female; IG: 49.4% male and 50.6% female). The primary oncological diagnosis was lung cancer, and the most frequent tumour stages were III and IV. Statistically significant differences were found between the IG and CG scores (p < 0.001, d = 0.887, 95% CI) and between the IG and CG scores (p = 0.004, d = 0.358, 95% CI), indicating that the IG performed better.
CONCLUSIONS: The results of this study support the beneficial effects of an exercise re-education programme, carried out by an interdisciplinary team in improving the autonomy of oncology patients with dyspnoea.
BACKGROUND: The clinical trial was registered in ClinicalTrials.gov (NCT04186754). (03 September 2019).

UNASSIGNED: This study explores the impact of emotional health on cancer patients, acknowledging the controversies and lack of high-quality data in the field, particularly for rare cancers and younger patients. It highlights the significant prevalence of depression and anxiety among cancer patients, the inadequacies in addressing mental health during and after treatment, and the inconsistencies in prevalence rates due to varying study methodologies. This study unravels the importance of data regarding mental health status in a clinical dataset to accompany the biological sample to be included in a biobank.
UNASSIGNED: The study utilized a questionnaire to evaluate the opinions of cancer patients, clinicians, and researchers regarding the inclusion of mental health data in clinical datasets accompanying biological samples in biobanks. The study involved 120 participants (40 from each group), and the data were analyzed using statistical methods.
UNASSIGNED: The study found significant differences in the perceived importance of including mental health information among the three groups. Patients showed a higher tendency (87.9%) to consider mental health questions relevant compared to researchers (72.08%) and clinicians (62.08%). The first four questions regarding emotional well-being received the highest positive responses, particularly from patients (94.3%). The findings underline the importance of addressing the mental health of cancer patients, which is often overlooked. The study emphasizes the necessity for integrating mental health data in biobanks and increasing psychological support for cancer patients.
UNASSIGNED: There are clear differences in how patients, researchers, and clinicians value emotional and psychological aspects. The study underscores the need for better education on modern medical practices and the benefits of comprehensive patient care, including mental health considerations.

Disease-related malnutrition is a prevalent issue among cancer patients, affecting approximately 40-80% of those undergoing treatment. This condition is associated with numerous adverse outcomes, including extended hospitalization, increased morbidity and mortality, delayed wound healing, compromised muscle function and reduced overall quality of life. Moreover, malnutrition significantly impedes patients\' tolerance of various cancer therapies, such as surgery, chemotherapy, and radiotherapy, resulting in increased adverse effects, treatment delays, postoperative complications, and higher referral rates. At present, numerous countries and regions have developed objective assessment models to predict the risk of malnutrition in cancer patients. As advanced technologies like artificial intelligence emerge, new modeling techniques offer potential advantages in accuracy over traditional methods. This article aims to provide an exhaustive overview of recently developed models for predicting malnutrition risk in cancer patients, offering valuable guidance for healthcare professionals during clinical decision-making and serving as a reference for the development of more efficient risk prediction models in the future.

BACKGROUND: Patients with advanced cancer often suffer from significant psychological distress, anxiety, and depression, which can profoundly influence their quality of life. This study aimed to evaluate the prevalence and severity of these psychological factors in advanced cancer patients. Additionally, it sought to identify related psychosocial, practical, emotional, and physical problems and their association with the psychological factors. Furthermore, this study provides interventions and strategies to help mitigate the psychological burden experienced by these patients.
METHODS: A cross-sectional survey involving 180 patients with advanced cancer was conducted at a tertiary hospital in Saudi Arabia. Participants were assessed using the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS). Data analysis included descriptive statistics, chi-square tests for categorical variables, and multivariate regression to explore the factors associated with distress, anxiety, and depression.
RESULTS: The prevalence of distress, anxiety, and depression among patients was 40.6%, 46.1%, and 52.2%, respectively. Patients who experienced \'changes in urination\' which is an item in DT had a 2.86 times higher risk of developing distress. Patients experiencing sadness (item in DT) and fatigue (item in DT) were at a 3.91 and 2.29 times higher risk of developing anxiety, respectively. Practical problems, such as childcare and treatment decisions, emotional problems, and physical problems, such as appearance, bathing/dressing, and eating difficulties, were significantly associated with distress. There was no significant association between patients\' demographics and psychological factors.
CONCLUSIONS: The findings underscore the complex interplay of psychosocial, practical, emotional, and physical problems faced by advanced cancer patients receiving palliative care. These patients exhibit a high percentage of distress, anxiety, and depression. Addressing these multifaceted problems through targeted psychological and social interventions can significantly enhance the overall care and quality of life for this vulnerable population. This study advocates routine psychological screenings and tailored interventions to mitigate the psychological burden in this group.

BACKGROUND: Breast cancer is one of the most common diseases globally that may have side effects on liver and renal function. Pharmacological treatments to reduce adverse liver and renal effects are still limited. It has been proposed that silymarin may possess hepatoprotective and anti-inflammatory properties. The present trial aims to assess the hepatorenal protective efficacy of silymarin supplementation in cancer patients receiving chemotherapy in an outpatient setting.
METHODS: This is a randomized, placebo-controlled clinical trial that recruited female breast cancer patients. Participants were randomly assigned to one placebo group and two intervention groups. The control group received 140 mg of placebo daily, while the two intervention groups received 140 mg silymarin daily. Follow-up assessments were conducted at baseline, 3 weeks, and 6 weeks. At the beginning of the study, the patients were subjected to a computed tomography (CT) scan, and the liver and renal parameters such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), bilirubin, Blood urea nitrogen (BUN) and Creatinine (Cr) were examined through laboratory tests.
RESULTS: Despite two deaths and three dropouts, 100 patients completed the study. Silymarin showed significant effects on liver enzymes in the levels of ALP and bilirubin (P < 0.05), with no significant impact on renal function in the levels of Blood urea nitrogen (BUN) and Creatinine (Cr) (P > 0.05). The medication was well-tolerated, with minimal reported side effects (P > 0.05).
CONCLUSIONS: The study suggests that silymarin may have hepato-renal protective potential in breast cancer patients and improve patient tolerance to chemotherapy. The data presented on the efficacy and safety of silymarin may provide stronger foundation for further trials and for a possible use in clinical practice.
UNASSIGNED: Registration Number: IRCT20201123049474N2, First Trial Registration: 16/08/2021, Access: https://www.irct.behdasht.gov.ir/trial/57641.

BACKGROUND: In oncology, the suffering of patients and the burnout of health professionals are key issues. Mindfulness meditation is a holistic approach that can help to improve well-being. While numerous studies have shown the benefits of meditation for both patients and health professionals, the added value of offering shared meditation to groups of patients, health professionals and third persons has not been assessed. Beyond strengthening the relationship between carers and patients, opening up meditation sessions to third parties (neither carers nor patients) enables patients to escape the stigma of their illness. We previously conducted a pilot study that validated the feasibility and the relevance of shared meditation with a specifically designed programme.
METHODS: IMPLIC-2 is a two-arm randomised study designed to assess the added value of this meditation programme (optimised following the pilot study), particularly for cancer patients (our target population). People motivated to follow the programme, without previous regular practice of meditation and able to participate in the sessions are eligible. The study will include 96 participants: 16 health professionals, 16 third persons and 64 patients. The latter will be randomized in two arms: the experimental arm (\"Shared\" meditation) consisting of 4 mixed groups of 8 patients, 4 health professionals and 4 third parties, and the control arm (\"Patient\" meditation) consisting of 2 groups of 16 patients. Validated questionnaires will be used to measure the effects of the programme, notably in terms of quality of life, perceived stress, feelings of self-efficacy, qualities of mindfulness and self-compassion, and carers\' burn-out. Participants\' perception of a change in their quality of life and satisfaction will be measured at the end of the programme. A complementary qualitative focus-group approach will be used to optimise implementation of the programme beyond the study.
CONCLUSIONS: The well-being of oncology patients would be improved. Dealing with overworked carers would have a beneficial impact on the way they interact with patients. In addition, encounters between the three types of population will allow otherness to be viewed differently and alleviate suffering by promoting collective humanity.
BACKGROUND: NCT06041607, registered: 09/18/2023.
METHODS: Version n°1.2 dated from 08/29/2023.

OBJECTIVE: Clinical notes contain unstructured representations of patient histories, including the relationships between medical problems and prescription drugs. To investigate the relationship between cancer drugs and their associated symptom burden, we extract structured, semantic representations of medical problem and drug information from the clinical narratives of oncology notes.
METHODS: We present Clinical concept Annotations for Cancer Events and Relations (CACER), a novel corpus with fine-grained annotations for over 48 000 medical problems and drug events and 10 000 drug-problem and problem-problem relations. Leveraging CACER, we develop and evaluate transformer-based information extraction models such as Bidirectional Encoder Representations from Transformers (BERT), Fine-tuned Language Net Text-To-Text Transfer Transformer (Flan-T5), Large Language Model Meta AI (Llama3), and Generative Pre-trained Transformers-4 (GPT-4) using fine-tuning and in-context learning (ICL).
RESULTS: In event extraction, the fine-tuned BERT and Llama3 models achieved the highest performance at 88.2-88.0 F1, which is comparable to the inter-annotator agreement (IAA) of 88.4 F1. In relation extraction, the fine-tuned BERT, Flan-T5, and Llama3 achieved the highest performance at 61.8-65.3 F1. GPT-4 with ICL achieved the worst performance across both tasks.
CONCLUSIONS: The fine-tuned models significantly outperformed GPT-4 in ICL, highlighting the importance of annotated training data and model optimization. Furthermore, the BERT models performed similarly to Llama3. For our task, large language models offer no performance advantage over the smaller BERT models.
CONCLUSIONS: We introduce CACER, a novel corpus with fine-grained annotations for medical problems, drugs, and their relationships in clinical narratives of oncology notes. State-of-the-art transformer models achieved performance comparable to IAA for several extraction tasks.

OBJECTIVE: Cancer patients undergoing chemotherapy continue to experience significant fatigue, which affects their quality of life. The present study aims to evaluate the combined effect of comprehensive physical exercise, pranayama (regulated breathing practices of yoga), and dietary support intervention on fatigue in cancer patients undergoing chemotherapy.
METHODS: Non-advanced adult cancer patients undergoing chemotherapy (N = 52) were randomized into the intervention group (N = 26) or control group (N = 26). Fatigue assessment was done using the Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue Scale (version 4) at baseline and after 3 months. The intervention group participants practiced physical exercise, slow-paced pranayama and supplemented their diet with an intake of 100 g of millet protein powder (MPP), commonly known as \"Sattu\" in India. The control group received standard medical care.
RESULTS: A total of 39 patients (N = 13 in the intervention and N = 26 in the control group) were included in the statistical analysis. Within the intervention group, a statistically significant reduction in fatigue (p = 0.002) with a large effect size (d = 2.1) was observed. There was no statistically significant reduction in fatigue within the control group (p = 0.36). The group comparison showed a statistically significant reduction in post-scores of fatigue (p < 0.0001) in the intervention group as compared to the control group with a moderate effect size (R = 0.1). No unintended adverse effects related to the intervention were observed.
CONCLUSIONS: The results suggest the potential role of integrated physical exercise, pranayama, and dietary support in reducing fatigue in cancer patients undergoing chemotherapy. Further validation with a larger sample size is required.
BACKGROUND: CTRI/2022/04/041717 [Registered prospectively on 07/04/2022].

Thrombotic microangiopathy (TMA) encompasses a range of disorders characterized by blood clotting in small blood vessels, leading to organ damage. It can manifest as various syndromes, including thrombotic thrombocytopenic purpura (TTP), hemolytic-uremic syndrome (HUS), and others, each with distinct causes and pathophysiology. Thrombo-inflammation plays a significant role in TMA pathogenesis: inflammatory mediators induce endothelial injury and activation of platelet and coagulation cascade, contributing to microvascular thrombosis. Primary TMA, such as TTP, is primarily caused by deficient ADAMTS13 metalloproteinase activity, either due to antibody-mediated inhibition or intrinsic enzyme synthesis defects. In cancer patients, a significant reduction in ADAMTS13 levels and a corresponding increase in VWF levels is observed. Chemotherapy further decreased ADAMTS13 levels and increased VWF levels, leading to an elevated VWF/ADAMTS13 ratio and increased thrombotic risk. Drug-induced TMA (DITMA) can result from immune-mediated or non-immune-mediated mechanisms. Severe cases of COVID-19 may lead to a convergence of syndromes, including disseminated intravascular coagulation (DIC), systemic inflammatory response syndrome (SIRS), and TMA. Treatment of TMA involves identifying the underlying cause, implementing therapies to inhibit complement activation, and providing supportive care to manage complications. Plasmapheresis may be beneficial in conditions like TTP. Prompt diagnosis and treatment are crucial to prevent serious complications and improve outcomes.