Quantifying chemotherapy-induced cognitive impairment in gastrointestinal cancer patients: A scoping review of methodological concerns in the literature.

PURPOSE: Chemotherapy is one of the common treatments in cancer management. However, chemotherapy-induced cognitive impairment (CICI) is one notable side effect that can greatly impact a patient's quality of life. Literature on CICI in gastrointestinal (GI) cancers are few and inconsistent. This review aims to identify the methodological differences in such studies. METHODS: A systematic search was performed in four electronic databases. All peer-reviewed primary literature published in English that evaluated cognitive-related functioning scores related to chemotherapy in GI cancer patients were included. Information about each study such as CICI findings, study limitations, methodology, and sample characteristics was extracted and synthesized. RESULTS: A total of 19 studies were included. Evidence of CICI was found in 50.0% (8 of 16) and 62.5% (5 of 8) studies that used objective and subjective measures, respectively. Methodological differences such as groups used for comparison, instruments used, and assessment from the length of time since chemotherapy were highlighted between studies that did and did not find evidence of CICI. CONCLUSIONS: This review suggests that the mixed findings can be attributed to the heterogeneous methodologies adopted in the evaluation of CICI in this field. IMPLICATIONS FOR CANCER SURVIVORS: Further studies are necessary to establish the presence and chronicity of CICI, and in which groups of patients to facilitate targeted interventions and treatments.

Preoperative Quality of Life and Mental Health Can Predict Postoperative Outcomes and Quality of Life after Colorectal Cancer Surgery.

Background and Objectives: It remains unclear which domains of preoperative health-related quality of life (HRQOL) and mental health are predictive of postoperative clinical and patient-reported outcomes in colorectal cancer (CRC) patients. Materials and Methods: A prospective cohort of 78 CRC patients undergoing elective curative surgery was recruited. The EORTC QLQ-C30 and HADS questionnaires were administered preoperatively and one month after surgery. Results: Preoperative cognitive functioning scores (95% CI 0.131-1.158, p = 0.015) and low anterior resection (95% CI 14.861-63.260, p = 0.002) independently predicted poorer 1-month postoperative global QOL. When postoperative complications were represented using the comprehensive complication index (CCI), poorer preoperative physical function scores were associated with higher CCI scores (B = -0.277, p = 0.014). Preoperative social function score (OR = 0.925, 95% CI 0.87 to 0.99; p = 0.019) was an independent predictor for 30-day readmission, while physical functioning score (OR = -0.620, 95% CI -1.073--0.167, p = 0.008) was inversely related to the length of hospitalization. The overall regressions for 1-month postoperative global QOL (R2: 0.546, F: 1.961, p = 0.023) and 30-day readmission (R2: 0.322, χ2: 13.129, p < 0.001) were statistically significant. Conclusions: Various QLQ-C30 domains were found to be predictive of postoperative outcomes, including complications, readmission, and length of hospitalization. Preoperative cognitive dysfunction and low AR were independent predictors of poorer postoperative global QOL. Future research should seek to examine the efficacy of targeting specific baseline QOL domains in improving clinical as well as patient-reported outcomes after CRC surgery.

Psychosocial Health Factors Among Men Reporting Recent Sexual Assault.

AIM: The aim of this study was to describe psychosocial health factors in a community sample of men who sought care for sexual assault in the previous 3 months and who were recruited using Internet-based methods. METHODS: The cross-sectional survey assessed factors related to HIV postexposure prophylaxis (PEP) uptake and adherence postsexual assault: HIV risk perception, HIV PEP self-efficacy, mental health symptoms, social responses to sexual assault disclosure, PEP costs, negative health habits, and social support. RESULTS: There were 69 men in the sample. Participants reported high levels of perceived social support. A high proportion reported symptoms of depression ( n = 44, 64%) and posttraumatic stress disorder ( n = 48, 70%) consistent with cutoffs for clinical diagnoses. Just over a quarter of participants reported past 30-day illicit substance use ( n = 20, 29%), and 45 people (65%) reported weekly binge drinking (six or more drinks on one occasion). POTENTIAL IMPACT OF THIS WORK ON HEALTH EQUITY AND FORENSIC NURSING: Men are underrepresented in sexual assault research and clinical care. We highlight similarities and differences between our sample and prior clinical samples and also outline needs for future research and interventions. CONCLUSIONS: Men in our sample were highly fearful of acquiring HIV, initiated HIV PEP, and completed or were actively taking HIV PEP at the time of data collection despite high rates of mental health symptoms and physical side effects. These findings suggest that forensic nurses need not only to be prepared to provide comprehensive counseling and care to patients about HIV risk and prevention options but also to address the unique follow-up needs of this population.

Gastroscopy after positive screening for faecal immunochemical tests and colonoscopy: A systematic review.

BACKGROUND: Colorectal cancer (CRC) screening using the faecal immunochemical test (FIT) kits based on the detection of occult blood in stool is widely advocated in numerous screening programs worldwide. However, CRC is not commonly diagnosed in positive cases. We undertook this review to determine if there is evidence to suggest the use of opportunistic oesophago-gastro-duodenoscopy (OGD) in patients without CRC. METHODS: A systematic review encompassing three electronic databases was performed. All peer-reviewed studies of FIT-positive patients who underwent either OGD and colonoscopy concurrently or OGD post-colonoscopy were included. Only studies from 2008 to 2022 using FIT kits were included to ensure studies not previously included in an earlier review were being analysed. A forward citation search of the included articles was also conducted to ensure no relevant articles were missed. RESULTS: A total of 2409 records were extracted. Only four studies fulfilled the selection criteria and were included. Although the rates of abnormal OGD results were relatively high in the four studies, only 3 of 605 (0.50%) patients had gastric cancer in the entire review sample. No other malignancies were identified in all four studies. Other notable pathologies such as gastric polyps and gastritis were also reported. CONCLUSIONS: There is little overall evidence to recommend UGI screening for all FIT-positive patients following a colonoscopy. However, there may be a role for clinicians to consider opportunistic OGD in this group of patients. Future research should examine patient populations from other sociocultural contexts including cost-effective analysis when considering changes in health guidelines on UGI screening.

Discharge within 24 hours following colonic surgery-a distant dream or near reality? A scoping review.

BACKGROUND: Enhanced recovery after surgery programs have improved patient outcomes following colorectal surgery. This has provided a platform for the consideration of ambulatory colectomies where patients are discharged within 24 hours after surgery. Although some studies have demonstrated its feasibility, the safety profile and patient eligibility criteria for discharge within 24 hours after surgery remain relatively ill-defined. This study provided a review of the patient selection criteria and postoperative outcomes shown in patients discharged within 24 hours after surgery. METHODS: Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were adhered to. A comprehensive search was performed on 3 electronic databases, and the relevant articles were identified. The primary outcome measures were postoperative morbidity and readmission rates. The different domains relevant to the selection of patients and perioperative care of patients discharged within 24 hours after surgery were also qualitatively assessed. RESULTS: Eight studies were included, which involved a total of 1,229 patients. The majority of selected patients underwent elective laparoscopic colonic surgeries. The patient characteristics, such as age, comorbidities, obesity, and psychosocial environment, were important considerations. A close follow-up with home-based medical services was ideal in patients discharged within 24 hours after surgery. The readmission rates ranged from 0.0% to 9.0%. Despite morbidity rates of up to 26.7%, the majority of them were minor and classified as Clavien-Dindo Grade I to II. CONCLUSION: The use of programs related to discharge within 24 hours after surgery in colorectal surgery is safe, feasible, and practical in a select group of patients within a well-designed clinical framework and pathway. Future studies should compare patient outcomes following discharge within 24 hours after surgery with conventional enhanced recovery after surgery protocols. In addition, patient and caregiver perceptions, quality of life, and cost-effectiveness analysis should also be performed.

Colorectal cancer patients advocating screening to their siblings: a randomized behavioral intervention.

BACKGROUND AND AIMS: Siblings of colorectal cancer (CRC) patients are at increased risk of developing CRC, but screening rates remain low. Through a randomized behavioral intervention, this study aimed to determine whether patients can advocate screening to their siblings using a tailored educational package. METHODS: CRC survivors were recruited and randomized into relaying either tailored materials (intervention group) or existing national screening guidelines (control group) to their siblings. Siblings could respond to the study team if they were interested in learning about CRC screening. Study outcomes were patient advocacy rates (number of patients who had successfully contacted at least 1 eligible sibling) between groups and the proportion of eligible siblings who responded. RESULTS: Between May 2017 and March 2021, 219 CRC patients were randomized to the intervention (n = 110) and control (n = 109) groups. Patient advocacy rates were high and did not differ significantly between groups. However, only 14.3% of eligible siblings (n = 85) responded to the study team. Siblings of patients from the intervention group were more likely to respond (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-3.0; P < .05). Moreover, after controlling for potential confounders, siblings aged ≥60 years were significantly less likely to respond (adjusted odds ratio, .3; 95% confidence interval, .1-.7; P < .01). CONCLUSIONS: CRC patients are willing advocates of screening, and siblings contacted by patients from the intervention group were also more likely to reach out to the study team. However, overall sibling response rates were low despite advocacy, suggesting that patient-led advocacy should at best be used as an adjunct to other, multipronged CRC screening promotion modalities.