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Objective: To summarize the incidence of postoperative delirium among cancer patients undergoing head and neck surgery and determine the differential incidence rates among patients undergoing different types of head and neck surgeries. Data Sources: The databases of PubMed, Cochrane Library, Web of Science, EMBASE, and CINAHL were searched from inception till February 2023. Keywords based on the condition (delirium), context (postoperative), and population (head and neck cancer) were used as search terms. Review Methods: The PRISMA and MOOSE reporting guidelines were followed. The Joanna Briggs Institute critical appraisal checklists for cohort studies, case‐control studies, and randomized controlled trials were used to evaluate the methodological quality. Data were pooled using a random‐effects model, and the incidence with 95% confidence intervals was evaluated using the exact binomial method and Freeman‐Tukey double arcsine transformation of proportions. I2 was used to indicate heterogeneity. Predefined subgroup analysis and Meta‐regression, was performed to identify the factors affecting heterogeneity. Results: The summary incidence of postoperative delirium was 18.95% [95% confidence interval, 14.36%‐24.00%] with between‐study heterogeneity (I2 = 95.46%). The incidence of postoperative delirium in patients who underwent free flap reconstruction was 22.13%, which was higher than those of other types of surgeries. Meta‐regression revealed that conducted in sample size (P =.007) of the included studies was the factors affecting heterogeneity. Conclusions: The evidence on postoperative delirium incidence provided by the current Meta‐analysis enables effective treatment planning. [ABSTRACT FROM AUTHOR]

To evaluate the feasibility and potential effects of qigong Baduanjin for reversing frailty status among older cancer survivors. Twenty-eight older cancer survivors screened as pre-frail or frail were recruited. They were randomly assigned (1:1) to receive a sixteen-week Baduanjin intervention or an active control condition (light flexibility exercise). Frailty status (primary outcome) and secondary outcomes (physical performance, activities of daily living performance, psychological well-being, and health-related quality of life) were measured by physical performance tests and questionnaires. Qualitative interviews were conducted to explore participants' perspectives on the intervention. Twenty-one participants (75%) completed the study, with reasons of withdrawal mainly relating to the COVID-19 pandemic. Attendance at Baduanjin sessions and adherence to self-practice were satisfactory, with all retained participants attending all sessions and 81.8% practicing Baduanjin for more than 90 min per week. Qualitative findings demonstrated that participants accepted Baduanjin. The proportion of improvement in frailty status at post-intervention appeared to be higher in the intervention group (26.7%; 95% confidence interval [CI], 10.1% to 54.0%) than the control group (15.4%; 95% CI, 3.7% to 46.0%); yet the difference was not statistically significant (p = 0.461). Baduanjin qigong appears to be feasible and acceptable among older cancer survivors. To confirm the intervention effect, an adequately powered trial is warranted. ClinicalTrials.gov, NCT04694066. Retrospectively registered 5 January 2021, https://clinicaltrials.gov/ct2/show/NCT04694066. [ABSTRACT FROM AUTHOR]

The authors sought to 1) review the literature on the remote care model that uses remote patient monitoring software (RPMS) as key mechanisms in oncology care for symptom tracking and health information provision and (2) compare the remote care model to standard care in terms of health-related quality of life, symptom burden, health management self-efficacy, anxiety, and depression. The search was conducted on March 23, 2022, in the Cochrane Library, MEDLINE/PubMed, PsycINFO, and CINAHL databases. The primary strategies for applying digital technology in remote care models are patient-reported outcomes (PRO) tracking and health information delivery. Common PRO measurements applied in the RPMS include quality of life, symptom burden, self-efficacy, anxiety, and depression. Nine randomized controlled trials testing seven RPMS interventions were examined. Compared to standard care, remote patient monitoring via RPMS was related to greater quality of life and lower physical symptom burden during cancer therapy. The RPMS incorporated into routine clinical care with nurses providing remote monitoring performed better on PRO than that not integrated. The RPMS-based remote care model improves patient outcomes during cancer treatment, and it is not inferior to standard care until the RPMS function is more integrated with existing clinical care. Nurses are well-positioned to engage patients in self-care skills via RPMS and can play a vital role in integrating such a model of remote patient care into routine care practices. [ABSTRACT FROM AUTHOR]

Purpose of the research Pain and sleep disturbance have been shown to have a profound influence on the outcomes of cancer treatment. This study sought to determine whether administering opioid analgesics or sleeping medication to cancer patients during their first admission to a hospital is associated with poor prognoses. Methods and sample We conducted a population-based retrospective cohort study by analyzing data obtained from the National Health Insurance Research Database in Taiwan. The study population comprised cancer patients whose first admission to a hospital for initial cancer treatment was in 2004. Key results We collected data on 2302 cancer patients. To analyze the effect of opioid analgesic and sleeping medication usage on cancer patient survival, we compared the 3-year survival rates among 4 groups of patients (no use, sleeping medications–only, opioid analgesics–only, both used). The 3-year Kaplan–Meier plots for these 4 groups show that the difference was statistically significant (log rank 48.244, p < 0.001). The longevity of cancer patients was the greatest among the no–use group, followed by the sleeping medications–only group, then the opioid analgesics–only group, and finally, the group in which both sleeping medications and opioid analgesics were used. Conclusions The use of opioid analgesics or sleeping medication was shown to be negatively correlated with the survival rate of cancer patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the influence of rest-activity rhythm on the survival of cancer patients. This study collected data related to cancer patients experiencing pain who had been hospitalized for treatment between August 2006 and October 2007. Data included the Karnofsky Performance Status Index as a representation of functional condition as well as the Brief Pain Inventory and the Pittsburgh Sleep Quality Index. Actigraphic methods were used to record the dichotomy index (I < O) of patients' rest-activity rhythms over periods of three consecutive days. Patients were closely followed until 31 July 2013. Results were analyzed using Kaplan-Meier survival analysis, log-rank testing and Cox proportional hazards regression analysis to evaluate whether alterations in the rest-activity rhythm affected the survival rate of the patients. Of the 68 hospitalized cancer patients experiencing pain at the time of admission, 51 subsequently died within the study period. A significant difference was observed in the survival curves between the regular I < O group and the disrupted I < O group (log rank = 7.942, p = 0.005). A multivariable proportional hazard model was used for analysis of overall survival, revealing that the risk of death within the study period among patients with disrupted I < O was 4.59 times higher than that of patients with regular I < O (95% CI: 1.92-10.96, p = 0.001). Among patients with poor performance status, the risk of death among patients with disrupted I < O was 8.68 times higher than that of patients with regular I < O (95% CI: 2.50-30.09, p = 0.001). Disruptions in rest-activity rhythm were negatively correlated with the survival of hospitalized cancer patients experiencing pain. Effects were particularly pronounced in cancer patients with poor performance status. [ABSTRACT FROM AUTHOR]

Abstract: Cancer patients often experience multiple symptoms concurrently, a phenomenon called symptom clustering. Different symptom clusters have been identified by various symptom assessment tools, as well as by different research methods, but no study has reported whether these identified symptom clusters can be replicated in a new sample. The severity of nine symptoms in 321 cancer patients was assessed using a Taiwanese version of the M.D. Anderson Symptom Inventory. The fit between these data and a model with three symptom factors (sickness, gastrointestinal, and emotional) was evaluated using confirmatory factor analysis. Most fitness indices demonstrated a satisfactory fit between the data and a prespecified three-factor model except one; the root mean square error of approximation was <0.06. A modified model with one symptom (lack of appetite) double loaded in the sickness and gastrointestinal factors demonstrated a significantly better fit between the data and the model. Higher scores in each of the three symptom factors were associated with poorer functional status. Metastatic disease and receiving both chemotherapy and radiation therapy were associated with higher scores in sickness and gastrointestinal factors, but not in the emotional factor. Only hospitalization affected patients'' scores in emotional factors. Our findings confirmed the prespecified structure of symptom clusters. A modified model showed a better fit. Patients'' complex symptom experience may be better represented by subscale scores based on meaningful clusters rather than on an overall score across all symptoms. [Copyright &y& Elsevier]

The purposes of this study were: 1) to compare performance status, mood states, and level of hope between patients with cancer pain and patients without cancer pain; and 2) to determine the relationships of pain intensity and pain interference with daily life to performance status, mood states, and level of hope. A total of 233 Taiwanese cancer patients with pain and 251 without pain participated. The self report instruments consisted of the Chinese version of the Profile of Mood States (POMS) short form, the Chinese version of the Herth Hope Index, the Brief Pain Inventory-Chinese version (BPI-C), the Chinese version of the Karnorfsy Performance Scale (KPS), and a demographic questionnaire. The major findings of this study were that cancer patients with pain reported significantly lower levels of performance status and higher levels of total mood disturbance than did cancer patients who did not experience pain after controlling for sex, disease stage, and recruitment site. In addition, patients with cancer pain experienced significantly more anger, fatigue, depression, confusion, and lethargy than did patients without pain after controlling for sex, disease stage, and recruitment site. Among patients with pain, pain intensity was significantly correlated with performance status and mood state, but not with level of hope. Pain interference with daily life was significantly correlated both with performance status, mood state, and level of hope. Pain intensity and pain interference were significantly correlated with each mood state as well as with total mood disturbance. This study has demonstrated the effect of cancer pain on patients'' physical, psychological, and spiritual life and has supported the multidimensional notion of the cancer pain experience in Taiwanese patients. [Copyright &y& Elsevier]

Abstract: Context: It is well known that insomnia is highly prevalent in cancer patients. Although various studies have used the Athens Insomnia Scale (AIS) for insomnia assessment, it has never been applied to cancer patients with insomnia. Objectives: The purpose of this study was to establish the reliability and validity of the Taiwanese AIS version (AIS-T) and evaluate the severity of insomnia among cancer patients in Taiwan. Methods: Using a cross-sectional research design, 195 cancer patients (n =195) were recruited from outpatient oncology clinics. Results: Cronbach’s alpha for internal consistency was 0.83, and the test-retest reliability was 0.94 over an interval of three days, based on a sample of 30 patients. Moreover, concurrent validity could be evaluated by significant correlations of the AIS-T with the Pittsburgh Sleep Quality Index-Taiwan form (PSQI-T) (r =0.82, P <0.001) and sleep efficiency measured by Actiwatch parameters (r =−0.54, P <0.001). Construct validity could be established by the Brief Fatigue Inventory-Taiwan form (r =0.56, P <0.001) and Medical Outcomes Study Short Form-36-Taiwanese version (physical component summary: r =−0.52, P <0.001; mental component summary: r =−0.53, P <0.001). The AIS-T could detect significant known-group validity from sleep quality (PSQI-T ≥5 or <5, respectively). The Actiwatch parameters are consistent with the results of the AIS-T, and both data sets indicate that patients experienced sleep disturbances. The prevalence of insomnia, as defined by the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th ed., was 22.56%; 49.2% subjects had significant insomnia at the score ≥6 at AIS-T. Conclusion: This study concludes that the AIS-T is a reliable and valid instrument for assessing insomnia among cancer patients in Taiwan. [Copyright &y& Elsevier]

Context: No study has examined the varying family experience of palliative sedation therapy (PST) for terminally ill patients in different settings.Objectives: To examine and compare family concerns about PST use and its effect on the grief suffered by terminally ill patients' families in palliative care units (PCUs) or intensive care units (ICUs).Methods: A total of 154 family members of such patients were recruited in Taiwan, of whom 143 completed the study, with 81 from the PCU and 62 from the ICU. Data were collected on their concerns regarding PST during recruitment. Grief levels were assessed at three days and one month after the patient's death with the Texas Revised Inventory of Grief.Results: Families' major concern about sedated patients in the PCU was that "there might be other ways to relieve symptoms" (90.2%), whereas families of ICU sedated patients gave the highest ratings to "feeling they still had something more to do" (93.55%), and "the patient's sleeping condition was not dignified" (93.55%). Family members recruited from the ICU tended to experience more grief than those from the PCU (P = 0.005 at Day 3 and < 0.001 at Month 1). PST use predicted higher levels of grief in family members recruited from the PCU (P < 0.001 at Day 3 and Month 1).Conclusion: Family experiences with the use of PST in terminally ill patients varied in different settings. Supportive care should address family concerns about PST use, and regular attention should be paid to the grief of individuals at higher risk. [ABSTRACT FROM AUTHOR]

The impact of cancer pain on the quality of life of lung cancer patients is obvious, but the relationship of cancer pain to uncertainty and level of hope in cancer patients is not clear and has been the subject of only a few studies. The purpose of this study is to look at the relationship of pain to uncertainty and hope in Taiwanese lung cancer patients. A cross-sectional and descriptive correlational design was used in this study. A convenience sample of lung cancer patients was recruited from chest medicine and oncology inpatient units at three teaching hospitals in the Taipei area of Taiwan. The research instruments included the Brief Pain Inventory-Chinese version (BPI-C), Mishel''s Uncertainty Illness Scale (MUIS), and the Herth Hope Index (HHI). Data were analyzed using descriptive statistics, Pearson''s correlation, and multiple regression. A total of 164 subjects were recruited, including 79 patients with cancer pain and 85 patients without cancer pain. The major findings were: 1) there were significant differences in level of uncertainty and level of hope between patients with cancer pain and those without. Patients with cancer pain reported higher levels of uncertainty and lower levels of hope than did patients without cancer pain; 2) pain severity was not significantly related to level of uncertainty; however, pain interference with daily life was positively correlated to level of uncertainty; 3) both pain severity and pain interference were negatively correlated with level of hope; and 4) after controlling for pain severity and pain interference, uncertainty was a significant predictor of level of hope. Important implications for future studies are discussed. [Copyright &y& Elsevier]