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Stages of cachexia. Reprinted from The Lancet Oncology, Volume 12, Fearon K, et al., “Definition and classification of cancer cachexia: an international consensus,” pages 489–95, ©2011, with permission from Elsevier
Source publication
Purpose of Review
Over the past two decades, advances have been made in understanding the pathophysiology of cancer-associated weight loss, termed “cachexia.” To date, there is no proven effective intervention to completely reverse cachexia and there are no approved drug therapies to treat it. This paper will review relevant literature in relation...
Citations
... 7 Recent research into clinical communication with TYACs has offered some insights into the complexities of communication with this specialist patient group. [8][9][10][11][12] Yet one area that has received less attention is triadic communication. Triadic communication refers to the presence of a third party, such as a parent, carer or companion in clinical encounters 13 and the presence of such a person was found to occur in 87% of TYACs' consultations. ...
Objectives
Clinical communication needs of teenagers and young adults with cancer (TYACs) are increasingly recognised to differ significantly from younger children and older adults. We sought to understand who is present with TYACs, TYACs’ experiences of triadic communication and its impact. We generated three research questions to focus this review: (1) Who is present with TYACs in healthcare consultations/communication?, (2) What are TYACs’ experiences of communication with the supporter present? and (3) What is the impact of a TYAC’s supporter being present in the communication?
Design
Systematic review with narrative synthesis.
Data sources
The search was conducted across six databases: Medline, CINAHL, Embase, PsycINFO, Web of Science and AMED for all publications up to December 2023.
Eligibility criteria for selecting studies
Included papers were empirical research published after 2005; participants had malignant disease, diagnosed aged 13–24 years (for over 50% of participants); the research addressed any area of clinical communication.
Data extraction and synthesis
Three independent reviewers undertook full-text screening. A review-specific data extraction form was used to record participant characteristics and methods from each included paper and results relevant to the three review questions.
Results
A total of 8480 studies were identified in the search, of which 36 fulfilled the inclusion criteria. We found that mothers were the most common supporter present in clinical communication encounters. TYACs’ experiences of triadic communication are paradoxical in nature—the supporter can help or hinder the involvement of the young person in care-related communication. Overall, young people are not included in clinical communication and decisions at their preferred level.
Conclusion
Triadic communication in TYACs’ care is common, complex and dynamic. Due to the degree of challenge and nuances raised, healthcare professionals need further training on effective triadic communication.
PROSPERO registration number
CRD42022374528.
... Another cancerassociated side effect is cachexia (muscle mass loss), which not only reduces functionality and tolerance to anticancer therapies [12][13][14] but also has a high impact on patients' psychosocial environments, such as leading to a negative body image or problems with self-esteem [15]. However, the impacts of these side effects in this population in the long term have not been well studied [16]. ...
Exercise intervention features to improve physical activity levels in young adults with a cancer diagnosis: A systematic review.
Objective: To identify the different interventions focused on increasing Physical Activity (PA) levels in Young Adults with cancer (YAwC), as well as the features and benefits of the existing exercise interventions for this population.
Design: Systematic review.
Methods: Selected studies were identified from searches in the PubMed and Web of Science databases. In the search, different filters were used, such as Randomized Control Trials (RCTs), Randomized Trials (RTs), human trials and trials with adults aged 18 to 44 years, Control Trials (CTs) and trials written in English.
Results: A total of thirty-one articles met the inclusion criteria, five of which included theoretical- based interventions. The other six studies used an exercise intervention, and only one study performed a mixed program. The findings of these studies showed that different modalities of exercise interventions increased the level of PA. The main characteristics of these programs were that they included exercise and behavioral interventions, with duration of 12 weeks (2 to 4 days per week), a range of intensity between 55% and 70% of the Maximum Heart Rate (MHR), and supervised sessions.
Conclusion: The results of this review support that these specific programs for YAwC not only improve their levels of PA, healthy parameters, and lifestyle but also improve their family, economic and social environments.
... 3 The AYAs population is unique in terms of cancer risks and psychological needs. 4 Cancer is 1 of the leading causes of disease-related death in these age groups. 5 The most common types of cancer among these age groups include brain and other central nervous system tumors, breast, cervical, colorectal, leukemia, lymphoma, melanoma, sarcoma, testicular, and thyroid. 1 The importance of addressing the needs of AYAs helps educational programs focus on their developmental stage and learning abilities. ...
The Youth and Young Adults Cancer Knowledge Attitudes and Practices (C-KAP) exploratory study in 2 rural underserved areas in a border community. C-KAP is an interdisciplinary research pilot project led by university scholars in psychology and social work in partnership with community partners. The exploratory cross-sectional mix-method study recruited 141 (n =141) youth and young adults (ages 18-39). This study was informed on empirical research and a bilingual online questionnaire was field-tested, and data was collected via QuestionPro Software. Quantitative analysis was conducted using SPSS version 27. Descriptive statistics and frequency analysis were used for demographics and basic statistics. Chi square tests and Fisher’s exact tests between variables were ran to find statistically significant associations. For the qualitative data, independent coders conducted recurrent content analysis to identify themes. Salient themes include knowledge about cancer types; access to health care; prevention; and the perceived impact of COVID-19 pandemic. Findings highlight a lack of knowledge and orientation on cancer in youth and young adults suggesting the need for community tailored education and screening interventions. Other findings reflect gender differences in knowledge and practices, which indicates that a gender-specific lens is needed when delivering education.
... [23] Merely, the assessment of weight loss and its reversal by conventional nourishment alone cannot appreciate the multi-dimensional syndrome of cachexia associated with oral cancer. [48] A study conducted by Maier et al. in a group of 100 oral cancer patients with signs of cachexia revealed that there was a significantly increased incidence of grossly decayed teeth and tartar of more than 3 mm observed in 40.9% of the patients. The study concluded that the significantly worse oral hygiene and dental status in such patients may be attributed to many factors such as reduced salivary secretion, lower social strata often neglecting the dental check-ups, and seldom brushing habits due to tumor pain. ...
... [28] In spite of ample time and investment into this field of research, there are no standardized guidelines for assessing, classifying, or treating the oral cancer cachexic patients. [48] Conclusions Lack of awareness and ignorance of the patients about the oral complications of cancer therapy may also direct effect deteriorating their nutritional status. Nurses being the patient's primary caregiver and their first point of contact can play an important role in detecting oral complications of patients undergoing cancer therapy. ...
Oral cancer, a part of head-and-neck cancer (HNC), is associated with a high risk of cancer-associated weight loss causing cachexia which is still an understudied illness. Cachexia is a host-phagocytic syndrome caused by the multiple factors, resulting in the severity of heterogenic fashion. For the current review, a bibliographic search was done in PubMed and other databases for the English articles published from the year 1980 to 2021. Recent studies have revealed that cachexia associated with 35%-60% of all the oral cancer patients is either due to the implication of the tumor or obstruction of food intake for which a strong need for nutritional assistance and hydration is desired. The health of cancer individuals undergoing chemotherapy or bone marrow transplant is negatively affected by poor oral health and reduced dentition status. The impact of a deficient oral condition is not clearly understood to date, possibly due to the limited number of studies and a lack of widely accepted clinical trials to prevent cachexia. The masticatory function of such patients is drastically affected thus contributing to the decreased nutritional status causing wasting of tissues. The aim of this article is to provide substantial evidence that poor oral hygiene with an altered dentition status negatively influences the energy balance of oral cancer patients who experience wasting.
... Significant differences exist in disease-relevant systems between young and aged animals, and these differences may affect the outcome of studies investigating basic disease biology [24,25]. Moreover, the impact of cancer cachexia is likely to be distinct regarding age, given the challenges of each specific development stage [26]. To our knowledge, no study so far has compared the metabolic muscle changes at different ages in cachectic tumour-bearing hosts, showing these metabolic differences concerning the stage of life. ...
Cancer cachexia is a severe wasting condition that needs further study to find ways to minimise the effects of damage and poor prognosis. Skeletal muscle is the most impacted tissue in cancer cachexia; thus, elucidation of its metabolic alterations could provide a direct clue for biomarker research and be applied to detect this syndrome earlier. In addition, concerning the significant changes in the host metabolism across life, this study aimed to compare the metabolic muscle changes in cachectic tumour-bearing hosts at different ages. We performed 1H-NMR metabolomics in the gastrocnemius muscle in weanling and young adult Walker-256 tumour-bearing rats at different stages of tumour evolution (initial, intermediate, and advanced). Among the 49 metabolites identified, 24 were significantly affected throughout tumour evolution and 21 were significantly affected regarding animal age. The altered metabolites were mainly related to increased amino acid levels and changed energetic metabolism in the skeletal muscle, suggesting an expressive catabolic process and diverted energy production, especially in advanced tumour stages in both groups. Moreover, these changes were more severe in weanling hosts throughout tumour evolution, suggesting the distinct impact of cancer cachexia regarding the host’s age, highlighting the need to adopting the right animal age when studying cancer cachexia.
... Cachexia is a common sequela of cancer, which is manifested by weight loss and muscle atrophy. It has a negative effect on the exercise capacity in children undergoing treatment for cancer [29,30]. This reduces the exercise capacity level, which is still insufficient in the group of childhood cancer survivors. ...
The aim of the study was to assess the exercise capacity (VO2peak) of children undergoing leukemia treatment and to compare the results with healthy children. Furthermore, we assessed the influence of treatment methods on the level of exercise capacity and the increase in sedentary behaviors. The study comprised 21 children (12 boys and 9 girls) undergoing treatment for acute lymphoblastic leukemia (ALL) (n = 13) and acute myeloid leukemia (AML) (n = 8). The subjects were aged 7–13 years (mean age 10.7, SD 2.0 years). Cardiorespiratory fitness was assessed by using the ergospirometry test. Progressive Godfrey protocol was performed. The level of physical activity was assessed by using the questions from the Health Behavior in School-Aged Children (HBSC 2018) questionnaire. The study results showed that children undergoing leukemia treatment were characterized by a reduced level of exercise capacity. The measured value of VO2peak in the group of treated children was, on average, 22.16 mL·kg−1·min−1. The mean values of VO2peak predicted for this age group were 45.48 mL·kg−1·min−1 (SD, 3.8). The measured value of VO2peak in the study group with the division into age groups was, on average, 21.21 mL·kg−1·min−1 in the group of children aged 7–10 years. In the group of children aged 11–13 years, this parameter was 22.64 mL·kg−1·min−1. Lack of physical activity and failure to meet the standards for the minimum level of weekly physical activity (MVPA index—moderate-to-vigorous physical activity) probably contribute to the deterioration in exercise capacity level of cancer-treated children.
Background:
Epilepsy is one of the most common and severe chronic neurological disorders and is associated with psychosocial problems. Several qualitative studies have investigated the experiences of adolescents and young adults with epilepsy. However, the findings were conflicting to some extent. This study examined and synthesized qualitative research data to understand the experiences of adolescents and young adults living with epilepsy, improving the development of targeted interventions and enhancing these experiences.
Objective:
To synthesize qualitative evidence about the experiences of adolescents and young adults suffering from epilepsy.
Methods:
This systematic review and qualitative evidence synthesis used the Joanna Briggs methodology for qualitative systematic reviews [1]. PubMed, PsychINFO, EMBASE, and Web of Science were searched for studies indexed until March 2022. Qualitative data were extracted, analyzed, and aggregated using meta-synthesis.
Results:
Seventeen studies were included in the review. Three distinct themes were identified: "impact of epilepsy," "emotions associated with epilepsy," and "self-management of epilepsy." The results show that adolescents and young adults with epilepsy develop different strategies to manage epilepsy and associated problems.
Conclusion:
The results improved our understanding of the experiences of adolescents and young adults suffering from epilepsy. Several approaches are encouraged to improve these experiences and the quality of life, including granting more autonomy to affected children, providing individualized care and advice, improving public awareness of epilepsy to avoid stigma, and strengthening legal frameworks to safeguard the rights of affected people.
Significant loss of muscle mass may occur in cachexia and sarcopenia, which are major causes of mortality and disability. Cachexia represents a complex multi-organ syndrome associated with cancer and chronic diseases. It is often characterized by body weight loss, inflammation, and muscle and adipose wasting. Progressive muscle loss is also a hallmark of healthy aging, which is emerging worldwide as a main demographic trend. A great challenge for the health care systems is the age-related decline in functionality which threatens the independence and quality of life of elderly people. This biological decline can also be associated with functional muscle loss, known as sarcopenia. Previous studies have shown that microRNAs (miRNAs) play pivotal roles in the development and progression of muscle wasting in both cachexia and sarcopenia. These small non-coding RNAs, often carried in extracellular vesicles, inhibit translation by targeting messenger RNAs, therefore representing potent epigenetic modulators. The molecular mechanisms behind cachexia and sarcopenia, including the expression of specific miRNAs, share common and distinctive trends. The aim of the present review is to compile recent evidence about shared and divergent epigenetic mechanisms, particularly focusing on miRNAs, between cachexia and sarcopenia to understand a facet in the underlying muscle wasting associated with these morbidities and disclose potential therapeutic interventions.
The health of babies, children and young people is fundamentally different from that of adults, so their healthcare must reflect their unique needs and engage their parents, family members and communities. Paediatric Nursing in Australia and New Zealand introduces nursing students to the care of infants, children, young people and their families in a range of clinical and community settings across Australasia. This third edition includes New Zealand content and an increased focus on families. New chapters cover health services available for Aboriginal, Torres Strait Islander and Māori children, the transition to parenthood for new families, children's sleep patterns and behaviour, and paediatric health in school settings. Case studies and reflective questions encourage students to develop critical thinking and problem-solving skills. Written by an expert team, Paediatric Nursing in Australia and New Zealand equips future nurses with the knowledge and skills to provide evidence-based care to babies, children and their families.
Background
Adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) are more likely to have chemotherapy‐related complications than children. In addition, several reports have shown that infections account for most of the therapy‐related mortality during cancer treatment in AYAs. Thus, we hypothesized that chemotherapy‐induced myelosuppression is more severe in AYAs than in children, and the state of neutropenia was compared between children and AYAs using the D‐index, a numerical value calculated from the duration and depth of neutropenia.
Procedure
This study retrospectively analyzed 95 patients newly diagnosed with ALL at our institution between 2007 and 2019. Of these, 81 were children (<15 years old) and 14 were AYAs (≥15 years old). The D‐index and duration of neutropenia during induction chemotherapy for ALL were compared between children and AYAs.
Results
The median D‐index of children was significantly higher than that of AYAs (8187 vs 6446, respectively, P = .017). Moreover, the median duration of neutropenia was also significantly longer in children than in AYAs (24.0 days vs 11.5 days, respectively, P = .007).
Conclusion
Contrary to our expectations, myelosuppressive toxicity during induction chemotherapy for ALL was more severe in children than in AYAs.
