BackgroundCaregivers to a person diagnosed with a glioblastoma often face significant responsibilities, balancing the demands of care with the complexities of the disease and treatment trajectory, while also coping with concerns and uncertainty of the future. Caregivers report unmet needs of information and support throughout the patient’s disease and treatment trajectory, and they may benefit from targeted supportive care interventions. ObjectiveThe aim of this study is to develop, test, and evaluate the feasibility of a supportive group intervention among caregivers to patients diagnosed with a glioblastoma. MethodsThe study consists of 3 phases with ongoing patient and public involvement (PPI). In the first phase, a systematic review will be carried out exploring the outcome of supportive group interventions for caregivers to patients diagnosed with a primary brain tumor. In the second phase, the design and development of the intervention will be conducted in cooperation with a panel of caregivers using PPI process. The third phase will include the feasibility and evaluation of the intervention. The study will be guided by the British Medical Research Council’s framework for developing complex interventions. The feasibility of the intervention will be tested in reference to relevant parameters. Quantitative data in terms of questionnaires will be analyzed using descriptive statistics, and qualitative evaluation interviews will be analyzed using thematic analysis. ResultsA national panel of caregivers (N=10) has been established, and the final design of the intervention is currently developed through an ongoing PPI process. A total of 3 hospitals in Denmark have committed to participating in the recruitment for the feasibility study. Recruitment began in April 2025, and the SUGRI (Supportive Group Intervention for caregivers to patients diagnosed with a glioblastoma) intervention will undergo a feasibility assessment in a multicenter study starting in August 2025, with the final evaluation planned for April 2026. ConclusionsThis study is expected to provide necessary insights to guide caregiver initiatives, ultimately improving support for caregivers within the neuro-oncology field. A supportive group intervention offered to the caregivers has the potential to address specific caregiver needs and strengthen their supportive network. Providing caregivers with support may enhance their perceived support, strengthen family functioning, and provide them with strategies to manage caregiving challenges, ultimately benefiting both caregivers and patients. Trial RegistrationClinicalTrials.gov NCT06869577; https://clinicaltrials.gov/study/NCT06869577 International Registered Report Identifier (IRRID)PRR1-10.2196/81948

Radiologic complete response vs pathologic complete response

INTRODUCTION:Sarcopenia, defined by reduced muscle strength, mass, and performance, presents a significant challenge in cancer care due to its impact on treatment outcomes, quality of life, and survival. This study aimed to assess its prevalence in newly diagnosed lymphoma patients. METHODS:Adults planned for first-line anthracycline-based chemotherapy were enrolled and screened for sarcopenia before treatment. Sarcopenia was defined by the European guidelines (EWGSOP2) using low muscle strength (hand-grip), low muscle mass (DXA), and low physical performance (gait speed). RESULTS:Sixty-nine patients (mean age 57, 19 women) were included. Six patients (9%) had low hand-grip strength, 15 (22%) had low muscle mass, and 4 (6%) demonstrated low gait speed. Two patients met the criteria for sarcopenia, with one having severe sarcopenia. CONCLUSION:Sarcopenia prevalence was 3%, but 22% had low muscle mass, suggesting muscle strength alone may not be an optimal screening tool for lymphoma patients.

Methods on tumour infiltrating lymphocytes

Purpose Chronic hematological malignancies progress slowly, potentially manifesting symptoms spanning months to years. HM-PRO is developed as a comprehensive clinical tool for assessing symptoms in hematology. The aim was to investigate the effect of a nurse-led systematic approach to symptom identification and management using HM-PRO in outpatient care in patients with chronic hematological malignancies. Methods This is a randomized trial including 94 patients to investigate an intervention comprising (1) HM-PRO data collection, (2) HM-PRO assessment guided by an algorithm, and (3) nurse-led tailored symptom management. The control arm received standard follow-up care. The primary outcome was change in QoL. Secondary outcomes were change in prevalence of physical and psychological symptoms. Results A statistically significant difference in QoL change scores over time favored the intervention (diff. 10.3; p = .04). For secondary endpoints, a significant between group difference in change over time for severity scores was observed in fatigue (diff. - 13.6; p = .003), overall symptom burden (diff. - 0.7 points; p = .029), emotional functioning (diff. 10.0; p < .0001), and anxiety (diff. - 2.5; p = .001). Conclusion A 12-month nurse-led symptom management intervention within hematology significantly improved QoL, emotional functioning, fatigue, anxiety, and overall symptom burden over time. This is the first randomized trial investigating nurse-led clinical application of the HM-PRO questionnaire providing knowledge on the efficacy of systematic symptom management in clinical practice. This study highlights both the pivotal role of nurses and multidisciplinary support and the inherent value of tailored symptom management.

Health-related quality of life, anxiety, depression and psychological distress

Tumour infiltrating lymphocytes and Residual Cancer Burden

This study aimed to investigate the feasibility of nurse-led consultations based on ePRO for women with endometrial or ovarian cancer receiving chemotherapy. This was a prospective single-cohort feasibility study. The patients responded to weekly ePRO using the Elekta Kaiku platform, which was adapted to Danish. At selected time points during chemotherapy, nurses conducted nurse-led consultations replacing physicians. The primary outcome was the patient completion rate of ePRO reporting in the Elekta Kaiku platform. Secondary outcomes included assessing safety, acceptability, practicability, usability, patient satisfaction with ePRO, and patient symptom burden. Twenty patients were included, with a mean age of 59 years. A total of 320 ePRO reports were received, equivalent to an ePRO response of 18 times per patient during six cycles of chemotherapy. The results showed a high weekly completion rate (87

Tumour size and radiologic complete response by magnetic resonance imaging

PURPOSE:Preclinical studies have indicated that physical exercise may enhance chemotherapy efficacy. However, clinical trials are needed to investigate these findings. We hypothesized that an exercise program during neoadjuvant chemotherapy would improve tumor response in patients with breast cancer. PATIENTS AND METHODS:Neo-train was a randomized controlled trial allocating patients with breast cancer to the usual care control (CON) group or the exercise (EX) group that received supervised high-intensity interval training and progressive resistance training 3 times weekly during 18 to 24 weeks of neoadjuvant chemotherapy. The two groups were compared on tumor size, assessed using magnetic resonance imaging as primary outcome, and secondary clinical/pathologic, biological, physical, and patient-reported outcomes. RESULTS:From 2021 to 2023, 102 participants were randomly assigned to the EX (n = 50) or CON (n = 52) group. We found no between-group differences in median tumor size change from baseline to presurgery (EX vs. CON -3.0 mm [95% confidence interval (CI), -8.0 to 14.0]), the proportion with radiologic complete response [EX 65% vs. CON 56%; odds ratio 1.16 (95% CI, 0.39-3.91)], or pathologic complete response [EX 59% vs. CON 56%; odds ratio 1.03 (95% CI, 0.43-2.46)]. The exercise program was associated with higher relative dose intensity, fewer dose delays, shorter hospital stays, and increased cardiorespiratory fitness, muscle strength, and level of physical activity. We found no differences in tumor-infiltrating lymphocytes, body composition, health-related quality of life, anxiety, depression, psychological distress, or participation in rehabilitation between groups. CONCLUSIONS:Although the exercise program did not affect tumor size, the positive effects on chemotherapy completion and shorter hospitalizations suggest improved treatment tolerance.

Cardiorespiratory fitness, muscle strength and body composition

Background: Non -pharmacological interventions have the potential to enhance health -related quality of life (HRQoL) through symptom management. This systematic review aims to identify, collate, and assess randomized controlled trials investigating the effect of non -pharmacological interventions on symptoms and HRQoL within hematology. Methods: MEDLINE/PUBMED, EMBASE, CINAHL, PSYCINFO and COCHRANE were searched up to April 2021. Outcomes were changes in symptoms and HRQoL. Results: Sixty-five studies were categorized into five intervention types: Mind/body (n =9), Web -based (n =9), Music/art (n =6), Consultation -based (n =4), and Physical activity (n =37). We found significantly reduced fatigue (n =12 studies), anxiety (n =8) and depression (n =7), with 11 studies showing significant improvements in HRQoL. Conclusions: The evidence for non -pharmacological interventions shows substantial variation in efficacy and methodological quality. While specific symptoms and HRQoL outcomes significantly favored the intervention, no particular intervention can be emphasized as more favorable, given the inability to conduct a meta -analysis.

Older patients receiving antineoplastic treatment face challenges such as frailty and reduced physical capacity and function. This systematic review and meta-analysis aimed to evaluate the effects of exercise interventions on physical function outcomes, health-related quality of life (QoL), and symptom burden in older patients above 65 years with hematological malignancies undergoing antineoplastic treatment. This review adheres to Cochrane guidelines, with the literature searches last updated on 27 March 2024, including studies with patients above 18 years. Screening of identified studies, data extraction, risk of bias, and GRADE assessments were performed independently by two authors. Meta-analyses evaluated the impact of exercise, considering advancing age. Forty-nine studies contributed data to the meta-analyses. Five studies included patients with a mean age above 60 years, and none included only patients above 60. Exercise interventions had moderate to small positive effects on QoL global (SMD 0.34, 95% CI [0.04–0.64]) and physical function (SMD 0.29, 95% CI [0.12–0.45]). Age did not explain the variability in exercise effects, except for physical function (slope 0.0401, 95% CI [0.0118–0.0683]) and pain (slope 0.0472, 95% CI [0.01–0.09]), which favored younger patients. Exercise interventions improve physical function and QoL and reduce symptoms in adults with hematological malignancies undergoing antineoplastic treatment; however, the influence of age remains inconclusive.

Non-pharmacological interventions have the potential to enhance health-related quality of life (HRQoL) through symptom management. This systematic review aims to identify, collate, and assess randomized controlled trials investigating the effect of non-pharmacological interventions on symptoms and HRQoL within hematology.MEDLINE/PUBMED, EMBASE, CINAHL, PSYCINFO and COCHRANE were searched up to April 2021. Outcomes were changes in symptoms and HRQoL.Sixty-five studies were categorized into five intervention types: Mind/body (n=9), Web-based (n=9), Music/art (n=6), Consultation-based (n=4), and Physical activity (n=37). We found significantly reduced fatigue (n=12 studies), anxiety (n=8) and depression (n=7), with 11 studies showing significant improvements in HRQoL.The evidence for non-pharmacological interventions shows substantial variation in efficacy and methodological quality. While specific symptoms and HRQoL outcomes significantly favored the intervention, no particular intervention can be emphasized as more favorable, given the inability to conduct a meta-analysis.

Background Depressive symptoms are common in patients with diffuse glioma, potentially reducing their quality of life. Understanding baseline factors associated with the development of depressive symptoms is important for psychoeducation and early intervention. This study investigates the associations of baseline patient- and tumor-related characteristics and depressive symptoms 1 year after surgery.Methods We combined retrospective longitudinal datasets from Amsterdam UMC and Rigshospitalet Copenhagen. Several characteristics of patients and tumors were retrieved, in particular items of their mood and functioning status. Depression instruments were harmonized to the Patient-Reported Outcomes Measurement Information System Depression scale through previously developed item response theory. Functioning items were harmonized to the International Classification of Functioning, Disability, and Health (ICF) domains using linking methods published previously. We analyzed the associations of 25 baseline factors with depressive symptoms one year after surgery by multivariable stepwise backward linear regression models and verified model robustness using best subset selection.Results We included 118 patients with diffuse glioma with a mean age of 48 years and a glioblastoma in 29%. Baseline depressive symptoms, lower ICF energy, and impaired ICF language functioning were associated with more depressive symptoms at follow-up in the multivariable model (R-squared: 0.379).Conclusions We identified 3 key baseline factors associated with depressive symptoms one year after surgery. Clinically, our findings contribute to the comprehension of predictive factors for depressive symptoms, aiding healthcare providers and patients in understanding and possibly allowing for early intervention.

This article focuses on the study of lactating sows, where the main interest is the influence of temperature, measured throughout the day, on the lower quantiles of the daily feed intake. We outline a model framework and estimation methodology for quantile regression in scenarios with longitudinal data and functional covariates. The quantile regression model uses a time-varying regression coefficient function to quantify the association between covariates and the quantile level of interest, and it includes subject-specific intercepts to incorporate within-subject dependence. Estimation relies on spline representations of the unknown coefficient functions and can be carried out with existing software. We introduce bootstrap procedures for bias adjustment and computation of standard errors. Analysis of the lactation data indicates, among others, that the influence of temperature increases during the lactation period.Supplementary materials accompanying this paper appear on-line.

Background Patients who undergo treatment for hematologic malignancies may experience a decline in sexual health, alterations in sexual functioning, and reproductive capacity during survivorship. Aim This study investigated the prevalence of sexual dysfunction and factors influencing sexual activity and functioning in patients with hematologic malignancies, to identify potential targets for interventions in clinical practice. Methods This nationwide cross-sectional study included adult patients diagnosed with a hematologic malignant disease in Denmark in the period from January 20, 2013, to August 20, 2022. Eligible participants received electronic questionnaires through their officially assigned digital mailbox. Outcomes Outcomes included the Female Sexual Function Index, International Index of Erectile Function, Female Sexual Distress Scale-Revised, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Sexual Health, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Results A total of 362 patients, on average 5.7 +/- 3.4 years postdiagnosis, completed the questionnaires. Of these, 52.5% women and 73.2% men reported sexual dysfunction, with more women (40.9%) than men (34.1%) being sexually inactive. Across gender, this was significantly more prevalent in patients >65 years of age and in those with a low quality of life. In addition, for women a significant association with fatigue and sleep difficulties was observed. In total, 40.3% reported sexual-related personal distress, with the highest proportion among patients 40 to 65 years of age. Most patients (98.7%) with sexual dysfunction had not discussed sexual issues with their healthcare professional. Clinical implications It is hoped that knowledge from this study will help healthcare professionals in clinical practice and encourage them to proactively address and discuss sexual health issues with their patients, irrespective of age. Strengths and Limitations Sexually inactive participants may reduce the overall score of sexual function in the scoring of both the Female Sexual Function Index and International Index of Erectile Function. We therefore analyzed sexual function in a subgroup analysis in only those being sexually active to emphasize that level of dysfunction persists in sexually active participants. Conclusion Patients report a high prevalence of sexual dysfunction, sexual distress, and gender-specific sexual symptoms following diagnosis and treatment of a malignant hematologic disease, impacting their quality of life. Sexual Health in Patients With Hematologic Malignancies; NCT05222282;

Objective: To investigate the quality of life (QoL) and the impact of caregiving in family caregivers of hematological cancer patients and its association with patient symptom burden. Methods: A cross-sectional study including Danish patients (n = 375) and caregivers (n = 140). Caregivers completed scales for anxiety and depression using the Hospital Anxiety and Depression Scale, sleep quality using the Pittsburgh Sleep Quality Index, health related QoL using the 12 -item Short -Form Health Survey, and caregiver roles using the Caregiver Roles and Responsibilities Scale. Patients reported symptoms using the MD Anderson Symptom Inventory. Analysis of covariance was used to examine associations between patient symptom burden and caregivers ' QoL outcomes. Results: The results show that caregivers experience sleep difficulties, moderate anxiety, and reduced QoL. Patient symptom burden was significantly associated with caregiver anxiety (p = 0.009), and mental well-being (p = 0.002), while patient treatment status was a significant factor associated with caregiver anxiety (p = 0.016), depression (p = 0.009), emotional well-being (p = 0.002), and sleep (p = 0.01). Conclusion: Caregivers of patients with hematological cancers undergoing active treatment face a high symptom burden, which significantly impacts their QoL, including sleep, psychological well-being, and emotional health. Patients reported a high symptom burden, and patient symptom burden was significantly associated with caregiver QoL. Adequate patient and caregiver support is needed to promote their well-being and mitigate adverse health effects in caregivers, and this should be acknowledged in the context of caring for patients with hematological cancer.