The management strategies of cancer-associated anorexia: a critical appraisal of systematic reviews

Abstract Background Cancer-related anorexia remains one of the most prevalent and troublesome clinical problems experienced by patients with cancer during and after therapy. To ensure high-quality care, systematic reviews (SRs) are seen as the best guide. Considering the methodology quality of SRs varies, we undertook a comprehensive overview, and critical appraisal of pertinent SRs. Methods Eight databases (between the inception of each database and September 1, 2017) were searched for SRs on the management of cancer-related anorexia. Two researchers evaluated the methodological quality of each SR by using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) checklist. Characteristics of the “high quality” SRs were abstracted, included information on relevant studies numbers, study design, population, intervention, control, outcome and result. Results Eighteen SRs met the inclusion criteria. The R-AMSTAR scores of methodological quality ranged from 18 to 41 out of 44, with an average score of 30. Totally eight SRs scored ≥31 points, which showed high methodological quality, and would be used for data extraction to make summaries. Anamorelin had some positive effects to relieve cancer anorexia-cachexia syndrome (CACS) and improve the quality of life (QoL). Megestrol Acetate (MA) could improve appetite, and was associated with slight weight gain for CACS. Oral nutritional interventions were effective in increasing nutritional intake and improving some aspects of QoL in patients with cancer who were malnourished or at nutritional risk. The use of thalidomide, Eicosapentaenoic Acid, and minerals, vitamins, proteins, or other supplements for the treatment of cachexia in cancer were uncertain, and there was inadequate evidence to recommend it to clinical practices, the same situation in Chinese Herb Medicine and acupuncture (acupuncture and related therapies were effective in improving QoL) for treating anorexia in cancer patients, warranting further RCTs in these areas. Conclusions Anamorelin, MA, oral nutrition interventions, and acupuncture could be considered to be applied in patients with cancer-related anorexia. Future RCTs and SRs with high quality on the pharmaceutical or non-pharmaceutical interventions of anorexia in cancer patients are warranted

Perspectives of Chinese Cancer Patients towards Disclosure of Cancer Diagnosis to Their Minor Children

Background: One of the issues that cancer patients with minor or adolescent children face is whether to inform children about their cancer diagnosis. Their perspectives towards this issue are under-explored in China. Objective: To explore Chinese cancer parents’ perspectives towards informing children of their diseases. Methods: Eighteen cancer patients with children under-18 were recruited using purposive sampling. Semi-structured, face-to-face, in-depth interviews were conducted using a phenomenological approach. Data were analyzed using Colaizzi’s approach. Results: Six main themes with 2-6 sub-themes emerged: a) Inappropriate to disclose the true diagnosis to children; b) Appropriate to disclose the true diagnosis to children; c) Communication content between cancer patients and their children in regard to cancer; d)Attitude on ways of disclosing cancer diagnosis to children; e) Reflections on parenting style; and f) Unmet needs for information and support. Conclusions: Perspectives of Chinese cancer parents towards truthfully disclosing their diagnosis vary, but all are for the purpose of protecting children. Study findings indicate that Chinese cancer parents have culture-specific considerations, such as concepts of death and filial piety, which differ from studies in western countries. Meanwhile, there are barriers between cancer parents and children in communicating about the illness and unmet needs for information and support.</p

Risk factors of breast cancer-related lymphoedema: protocol of an umbrella review

Introduction Breast cancer-related lymphoedema (BCRL) is a progressive and debilitating complication post-breast cancer treatment. Identifying potential risk factors facilitates the prevention and management of BCRL. Multiple systematic reviews have been conducted to address the variables correlated with the occurrence of BCRL. This study aims to identify and examine factors predicting the development of BCRL, to clarify the predicting mechanism of these factors, as well to determine the credibility of risk factors for BCRL.Methods and analysis This umbrella review will be conducted with the methodological guidance of the Joanna Briggs Institute and the Cochrane handbook. A comprehensive systematic search will be performed in ten databases: PubMed, Embase, CINAHL, Web of Science, Scopus, CNKI, SinoMed, Wangfang database, the JBI Database of Systematic Reviews, Cochrane Database of Systematic Reviews. The search for unpublished studies will include ProQuest and the PROSPERO register. Reference lists will also be hand searched. Two reviewers will independently screen the studies, extract data and assess the methodological quality using the Methodological Quality of Systematic Reviews-2 and the Risk of Bias in Systematic Reviews. The degree of overlap between included reviews will be assessed by calculating the Corrected Covered Area. The credibility of the associations between risk factors and lymphoedema will be graded into four classes: convincing, highly suggestive, suggestive and weak, referring to the classification system of recent umbrella reviews. A descriptive, narrative synthesis and suggestions for clinical practice and future research will be made based on included systematic reviews, considering the quality of the evidence.Ethics and dissemination Ethical approval is not required for this umbrella review. We will seek to submit the results for publication in a peer-reviewed journal or present it at conferences.PROSPERO registration number CRD42022375710