The European MyPath project aims to implement and evaluate electronic Patient-Reported Outcome Measures (ePROMs) in oncology. Nine oncology centres prepared the integration of an ePROMs tool into their local Electronic Health Records (EHRs), offering insight into the technological and organizational conditions required for successful adoption. Our findings highlight that multi-site integration of ePROMs into EHRs proved more complex and resource-intensive than anticipated, requiring adaptive approaches, with no one-size-fits-all solution.

Patient-centered care (PCC) improves quality of life, symptom management and healthcare outcomes in oncology. However, integration into routine cancer care remains limited. Digital solutions using patient-reported outcome measures (PROMs) offer a potential mechanism to operationalize PCC. This study explored healthcare professionals’ (HCPs) pre-implementation perspectives on using digital PROMs to support PCC in Norwegian oncology outpatient clinics, informing the design and implementation strategies of the European MyPath digital solution. Semi-structured interviews (n = 29) and three focus groups (n = 16) were conducted with varied HCPs across four Norwegian hospitals. Interviews explored perceptions of PCC, experiences with PROMs, and requirements for digital implementation. Data were analyzed using thematic analysis, combining inductive and deductive coding guided by the TPOM framework. Four themes emerged: (1) balancing PCC with disease-centered practices, (2) integrating PCC into daily routines, (3) customization and patient acceptance of digital tools, and (4) combining patient-reported data with clinical autonomy. HCPs viewed digital PROMs as promising for facilitating PCC but emphasized that successful implementation requires workflow alignment, adaptable digital solutions, and strong stakeholder engagement. Concerns included patient digital literacy, workload implications, and overreliance on PROMs at the expense of direct patient interaction. Our findings highlight a tension between HCPs’ needs for technical functionality and workflow alignment, and the support required to adapt their practice to fully realize PCC through digital tools. Integrating PCC successfully requires organizational, cultural, and workflow adaptations, alongside active HCP engagement in design and implementation. These changes are essential to reposition PCC as an integral rather than competing component of high-quality cancer care. Cancer treatment often focuses primarily on treating the tumor, while the emotional, physical, and psychological impacts on patients are overlooked. These factors can significantly affect patients' quality of life during and after treatment. The study addresses the challenge of integrating patient-centered care into cancer treatment, an approach that considers patients' overall well-being, not just their cancer. This study is part of the European Union-funded project MyPath, that aims to develop a digital tool supporting more patient-centered cancer care in Europe. Understanding the perspectives of healthcare providers is essential in ensuring that the tool fits with real-world clinical settings. The main point of this study is to explore how healthcare providers view patient-centered care and the role of digital tools in improving quality of life through better symptom management. The results show that healthcare providers recognize the importance of enhancing quality of life and believe that digital tools could support a more patient-centered approach to care. However, they tend to view patient-centered care as more relevant to end-of-life or palliative care, rather than active cancer treatment. This suggests that while digital tools hold potential to improve quality of life, a shift in mindset and hospital cultures is needed to make patient-centered care an equal part of cancer treatment, rather than a competing focus.

Digital Patient Reported Outcome Measures (PROMs) can help to promote patient-centred care (PCC). However, they are currently not routinely used, potentially compromising patient outcomes. In this work we sought to (i) explore existing processes, patient and healthcare professionals’ (HCP) perceptions of current gaps in PCC and (ii) their views on how a PROMs-based digital system could help to address these gaps in four European oncology outpatient clinics. We conducted a qualitative multi-site case study including healthcare staff (organisational leaders, managers and HCPs), patients being treated for cancer and caregivers in four outpatient clinics in Brussels (Belgium), Edinburgh (United Kingdom), Oslo (Norway), and Valencia (Spain). Data were collected through a series of semi-structured interviews to explore existing work practices, needs and attitudes. We also conducted non-participant observations of staff meetings and clinic activities to explore existing processes. Data were analysed through a mixture of inductive and deductive approaches drawing on the Technology, People, Organizations, and Macroenvironmental (TPOM) factors framework. We conducted 99 interviews with HCPs, patients and caregivers and 30 observations across the four sites. PCC was regarded as important across all sites. We observed limited existing efforts on systematically recording psychosocial needs of patients. Participants reported concerns that a new digital system to record PROMs may result in increased workloads for clinical staff and adversely impact patient-clinician relationships. Attitudes were influenced by previous experience with digital systems. Organisational leadership and support were viewed as crucial in facilitating adoption, including efforts to train and engage clinical and patient users, making available sufficient resources, and including end-users in system design. While digital PROMs have the potential to enhance PCC in cancer, their routine use is often hindered by sociotechnical challenges. This issue persists across different countries. Success in developing and implementing digital PROMs will require tailored system design and implementation strategies being cognisant of various stakeholder needs. This may include supplementing technological aspects of interventions with educational strategies, supporting local adaptations of designs, and aligning with clinician and organisational drivers for implementation.

OBJECTIVES:Clinical guidelines, including the WHO analgesic ladder, advocate paracetamol in conjunction with strong opioids for moderate to severe cancer pain despite a lack of evidence for its efficacy in this setting.This pilot study aimed to evaluate the feasibility of a larger randomised controlled trial (RCT) with the aim of establishing whether paracetamol combined with strong opioids provides superior analgesia for cancer-related pain over strong opioids alone. METHODS:Adult patients with incurable cancer taking regular paracetamol and strong opioids with an average pain score 2-8 on a Numeric Rating Scale (NRS 0-10) in the past 24 hours were randomised to receive either paracetamol or placebo for 13 days, with assessments at day 7 and 14. Outcomes were recruitment, retention, appropriateness of study design, patient acceptability and early signals of pain outcome. RESULTS:Thirty-four participants were recruited and 28 randomised at 12 months. After 7 months, the intervention phase was reduced to 7 days to improve recruitment and mitigate attrition. Retention was high but the clinical team assessed 7 days in the study as adequate and less burdensome for the patients. Average pain (NRS) on day 7 (change from baseline) was similar in the placebo group (-0.27) versus the paracetamol group (-0.46). Groups difference: -0.19, 95% CI -1.1 to 0.7, (p=0.67). Patient recruitment was slow. Due to this, the study did not progress to a definitive RCT. CONCLUSION:This pilot study demonstrates feasibility of the withdrawal design but signalled the need for a different recruitment strategy and a shorter study. Notably, there were no adverse pain outcomes, as NRS scores and opioid requirements didn't increase. TRIAL REGISTRATION NUMBER:NCT02706769.

BACKGROUND & AIMS:Malnutrition is common in oncology and is associated with poorer treatment tolerance and outcomes yet remains under-recognised in outpatient care. This quality improvement project compared the diagnostic accuracy of the Malnutrition Universal Screening Tool (MUST) and the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) for detecting malnutrition in oncology outpatients. METHODS:Adult patients attending a regional oncology day therapies unit for systemic anti-cancer therapy between 631 January 2025 were invited to complete a patient questionnaire incorporating PG-SGA SF items. Dietitians calculated PG-SGA SF and MUST scores. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), 95% confidence intervals, and Youden's Index were calculated for MUST cut-offs (≥1, ≥2) and PG-SGA SF cut-offs (≥2-≥9). Differences in classification distributions between tools were assessed using Fisher's Exact Test and McNemar's tests. RESULTS:Of 189 patients who returned questionnaires, 140 were included in the final analysis. Median age was 63 years; 77.1% were female and 58.6% had metastatic disease. GLIM criteria classified 46/140 (32.9%) patients as malnourished. MUST ≥1 demonstrated sensitivity 71.7% and specificity 88.3% (PPV 75.0%, NPV 86.5%), yielding the highest Youden's Index (0.600). MUST ≥2 showed very high specificity (98.9%) but poor sensitivity (21.7%). PG-SGA SF ≥ 2 achieved the highest sensitivity (89.1%) but low specificity (48.9%), while PG-SGA SF ≥ 4 provided the most balanced performance (sensitivity 76.1%, specificity 68.1%; Youden's Index 0.442). Overall classification distributions differed significantly between MUST and PG-SGA SF (Fisher's Exact Test, p = 0.0001) CONCLUSIONS: In this outpatient oncology cohort, MUST ≥1 demonstrated the best overall discrimination for detecting GLIM-defined malnutrition, while PG-SGA SF identified a greater proportion of patients at potential nutritional risk at lower cut-offs. PG-SGA SF thresholds around ≥4-6 may represent a pragmatic balance between sensitivity and specificity for routine outpatient screening. Limited agreement between tools indicates that they capture different dimensions of nutritional compromise, with the PG-SGA SF incorporating patient-reported symptoms and functional status that may identify risk not detected by weight-based screening alone. These aspects should be considered when selecting malnutrition screening tools and cut-off thresholds within oncology outpatient services.

ABSTRACT Background Cachexia, a complex multifactorial syndrome characterized by loss of skeletal muscle mass, is common in cancer and impacts treatment response, quality of life (QoL) and survival. No effective therapy is currently available. This report summarizes findings from the literature on the relationship between cachexia and physical function, activities of daily living and health‐related QoL in patients with solid tumours. Methods We conducted a systematic literature review by searching Embase, MEDLINE and Cochrane Library publications from 2018–2023 for relevant studies. After screening and data extraction, a narrative synthesis was performed to identify QoL and functional outcomes in relation to cachexia. Results Forty publications representing 37 unique studies and 52 053 patients were identified, with 35 (94.6%) observational studies and two (5.4%) post hoc analyses of randomized trials ranging in sample size from 38 to approximately 17 000 patients. Mean/median patient age ranged from 45 to 79.6 years. Across the 40 publications, 11 different definitions of cachexia or body weight loss were used (with the most common, the Fearon et al. 2011 International Consensus criteria, used in 18 publications [45.0%]), revealing an overall lack of consensus on the most suitable diagnostic criteria for cachexia. Nineteen outcome types were reported, including physical function measures in 31 studies (77.5%), health‐related QoL in 24 studies (60.0%), performance status in 16 studies (40.0%), pain and fatigue in 15 studies (37.5%) each, depression or anxiety in nine studies (22.5%) and activities of daily living in six studies (15.0%). Eleven outcome types were exclusively evaluated in univariate analysis; eight were evaluated in multivariate analysis. Many studies identified statistically significantly worse physical function, activities of daily living or health‐related QoL in patients with cachexia or body weight loss compared with patients without these conditions. Of studies assessing physical function measures, 80.6% (25/31) identified a statistically significant association with cachexia or body weight loss in at least one outcome; for studies assessing health‐related QoL, this was 91.7% (22/24); for performance status, 87.5% (14/16); for pain, 78.6% (11/14); for fatigue, 73.3% (11/15); for depression or anxiety, 55.6% (5/9); and for activities of daily living, 100% (6/6). Conclusions This systematic literature review provides insights into functional outcomes and health‐related QoL in predominantly real‐world populations with cancer cachexia and can inform selection of cachexia clinical trial endpoints that reflect clinical benefits to patients. However, the wide range of methods, physical function metrics and patient‐reported outcomes instruments used across studies support a call for standardization.

BACKGROUND:Cancer-associated malnutrition is highly prevalent and linked to adverse outcomes. However, studies evaluating malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria with inclusion of computed tomography (CT)-derived muscle mass are limited, particularly in Caucasian oncology populations. Moreover, the prevalence of GLIM-defined malnutrition and its association with overall survival across different treatment intents remains insufficiently characterized. OBJECTIVE:This study investigates whether incorporating CT-derived body composition assessment into the GLIM criteria improves the detection of malnutrition in oncology patients and evaluates its association with overall survival across different treatment intent groups. DESIGN:Secondary analysis of data from 2 observational, prospective studies in Ireland and the United Kingdom that both examined the effect of nutritional and inflammatory status on survival in patients. GLIM phenotypic and etiologic criteria were retrospectively applied using data available from these studies. Reduced muscle mass was derived from CT. PARTICIPANTS/SETTING:Data were available for 1405 patients enrolled between 2011 and 2016; 1118 had evaluable CT scans. Treatment intent included curative (n = 428), palliative active treatment (n = 873), and supportive care (n = 104). MAIN OUTCOME:Prevalence of GLIM-diagnosed malnutrition incorporating CT muscle assessment and its association with overall survival (months) by treatment intent. Survival analysis was carried out using Kaplan-Meier curves and Cox regression. STATISTICAL ANALYSIS:Descriptive statistics characterized clinical characteristics and nutritional status. Analyses were conducted in SPSS, and statistical significance was considered at P < .05. RESULTS:GLIM-malnutrition was identified in 40.4% (22.6% moderate; 17.8% severe). Among those with CT scans, 42.2% had low muscle mass, and only 24.8% had experienced >5% weight loss. CT analysis identified GLIM malnutrition in 22.8% of patients missed by weight/body mass index (BMI) criteria. Median follow-up was 102.4 months. Median survival was 30.4 months for well-nourished patients vs 13.5 months (moderate) and 6.4 months (severe) for malnourished patients (P < .001). Adjusted hazard ratios for death were 1.379 (moderate malnutrition) and 1.799 (severe malnutrition) (P < .001). CONCLUSION:GLIM-diagnosed malnutrition, particularly when incorporating CT-derived muscle mass, is common and strongly predicts poor survival across treatment intents. CT-based assessment identifies patients with muscle wasting who may be missed by conventional criteria, supporting its integration into GLIM phenotyping.

Digital tools facilitate the timely collection of patient-reported outcome and experience measures (ePROMs/PREMs), but there is no consistent reporting on the technical and content adaptations made essential to implementing these digital tools in a specific context. Adaptations made to ePROMs/ePREMs can improve data quality, clinical management, and patient outcomes. We explored how studies report on adaptations and the reasons and types of these during an implementation process of ePROMs/ePREMs systems in routine cancer care. We conducted a systematic scoping review. We searched PubMed, Embase, PsychINFO, and CINAHL (inception—May 5, 2023), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Guided by the Population, Concept, and Context (PCC) framework, data were extracted and summarised in tables in four dimensions: context, content, evaluation, and training. The systematic search found n = 5597 publications, and n = 20 were included (85

INTRODUCTION:In the UK National Health Service (NHS), most people with cancer are cared for at oncology outpatient services, where there are no standardised procedures for managing pain. As a result, patients with cancer may receive inadequate care for pain. The Cancer Pain-assessment Toolkit for Use in RoutinE oncology outpatient services aims to assess the feasibility of conducting a multicentre cluster-randomised trial of a systematic pain assessment and management programme integrated within routine care at UK NHS oncology outpatient services. This protocol describes an embedded process evaluation that aims to evaluate the acceptability, fidelity and implementation of the intervention and trial procedures. METHODS AND ANALYSIS:A combination of methods will be used in the process evaluation. Quantitative data on fidelity and intervention implementation will be collected using case report forms completed at sites, capturing details on training, intervention delivery and adherence. Qualitative data on acceptability and trial experience will be collected through semistructured interviews with intervention recipients (participants), intervention deliverers (healthcare professionals), research nurses and intervention champions. Researcher fieldnotes will also document trial acceptability throughout the trial. Quantitative data will be summarised descriptively. Qualitative data will be analysed using thematic analysis, guided by the framework of acceptability. ETHICS AND DISSEMINATION:The trial received ethical approval from South Yorkshire Research Ethics Committee and Health Research Authority (21/HRA/5245). Site-specific approvals were obtained from the research and innovation offices at Leeds Teaching Hospital and Hull Teaching Hospital. Trial findings will be disseminated through peer-reviewed publications and via participating sites. TRIAL REGISTRATION NUMBER:ISRCTN86926298.

BACKGROUND:In 2018, the Lancet Commission on Global Access to Palliative Care and Pain Relief introduced the concept of serious health-related suffering (SHS) to quantify the need for palliative care and proposed an essential package of palliative care and pain relief (PCPR) to address it. However, this package did not account for complex and specialized needs, and its global implementation has been limited. OBJECTIVES:We conducted a multistage, modified Delphi study to update and expand the initial Essential Package for children and adults METHODS: Two international panels -adult and pediatric- representing diverse geographical regions and income levels participated in two Delphi rounds. External validation was conducted by global experts in palliative care. RESULTS:Retention rates for the Delphi rounds were 79.5% for adults and 64.0% for children. Consensus was achieved on the updated Essential Packages for both adults and children, with minor modifications. Expanded Packages were developed, including additional medications, equipment, and human resources to address broader needs. The study also revealed persistent inequities in medicine availability, particularly in low- and middle-income countries, and limited awareness of the Lancet Commission's Essential Package among health professionals. CONCLUSION:These globally validated Essential and Expanded Packages for adults and children offer a practical adaptable framework to guide national health strategies, strengthen palliative care services, and reduce SHS. Their adoption can meaningfully contribute to achieving Universal Health Coverage.

OBJECTIVES:To compare costs and health consequences and to assess the cost-effectiveness of using low-dose oral long-acting morphine in people with chronic breathlessness. DESIGN:Within-trial planned cost-consequences and cost-effectiveness analysis of data from a multisite, parallel-group, double-blind, randomised, placebo-controlled trial of low-dose, long-acting morphine. SETTING:11 hospital outpatients across the UK. PARTICIPANTS:Consenting adults with chronic breathlessness due to long-term cardiorespiratory conditions. INTERVENTION:5-10 mg two times a day oral long-acting morphine with a blinded laxative for 56 days. PRIMARY OUTCOME MEASURES:Mean and SD of healthcare resource use (HRU) by trial arm; mean differences and 95% CI of costs between trial arms. SECONDARY OUTCOME MEASURES:Mean differences in 28- and 56-day quality-adjusted life years (QALYs based on EuroQol five-dimension five-level score), Short Form-six dimensional scores and ICEpop CAPability-Supportive Care Measure scores; cost-utility of long-acting morphine for chronic breathlessness. RESULTS:143 participants (75 morphine and 67 placebo) were randomised; 140 (90% power, males 66%, mean age 70.5 (SD 9.4)) formed the modified intention-to-treat population (participants receiving at least one dose of study medication). There were more inpatient and fewer outpatient services used by the morphine group versus the placebo. In the base-case analysis at 56 days, long-acting morphine was associated with similar mean per-patient costs and QALYs. There was an increase of £24 (95% CI -£395 to £552) and 0.002 (95% CI -0.004 to 0.008) QALYs. Hospitalisations were the main driver of cost differences. The corresponding incremental cost-effectiveness ratio was £12 000/QALY, with a probability of cost-effectiveness of 54% at a £20 000 willingness-to-pay threshold. In the scenario analysis that excluded costs of adverse events considered unrelated to long-acting morphine by site investigators and researchers, the probability of cost-effectiveness increased to 73%. CONCLUSION:Oral morphine for chronic breathlessness is likely to be a cost-effective intervention provided adverse events are minimised, but the effect on outcome is small and cautious interpretation is warranted. TRIAL REGISTRATION NUMBER:ISRCTN87329095.

Globally, healthcare systems are grappling with economic and human resource struggles. The ageing of the population and the rising prevalence of cancer are some of the main drivers of healthcare expenditure. If these challenges are not properly managed, the quality of the cancer care provided can deteriorate. Moreover, people with cancer struggle with physical, psychological, and social problems that are not routinely addressed despite overwhelming evidence of the benefits of the systematic assessment and management of symptoms. Based on the evidence that the delivery of patient-centred care (PCC) with active anticancer treatment improves most clinical outcomes and satisfaction with care, international consensus and guidelines revisions recommend the delivery of PCC as an integral part of anticancer treatment. Unfortunately, PCC is not implemented routinely, and patients do not receive the care they need. Funded by the EU, the MyPath project aims to assess whether PCC can be integrated into clinical practice using patient-centred care pathways supported by health information technology. At the core of the project is implementation science. Understanding what is required to successfully implement PCC will facilitate the uptake of evidence-based medicine across the continuum of routine cancer care, from active treatment to palliative care, to ensure that patients receive the care they need, when they need it. The purpose of this article is to present the methodology to be used in the MyPath project to implement PCC routinely. This study will be performed in nine European cancer centres. After its completion, we will assess if the proposed solution is successfully implemented.

OBJECTIVES:Standardising pain assessment in oncology outpatient services (OOS) leads to improvements in patients' pain and quality of life. The Edinburgh Pain Assessment Tool (EPAT) is a standardised cancer pain management tool that has been implemented on inpatient oncology wards (the original setting). Routine use of EPAT reduced post-surgical pain in cancer patients (the original scenario) and led to more appropriate analgesic prescribing. We describe here a case study of adapting the EPAT intervention for use in tertiary OOS in the United Kingdom (UK) National Health Services (NHS), using the ADAPT guidelines. METHODS:The adaptation process followed Moore et al.'s ADAPT guidance: Step 1: We assessed rationale for adapting EPAT by reviewing existing literature of pain management in OOS. Step 2: Semi-structured interviews with 20-healthcare professionals (HCPs) to understand current practice and how the intervention might fit the new context (OOS). Step 3: Identified the 'core' and 'peripheral' components of EPAT, undertook four co-design workshops with 7-HCPs to reconfigure EPAT to fit OOS (adapted version is referred to as EPAT+). Four HCPs trialled the EPAT+ intervention in practice to refine the intervention. RESULTS:Combining qualitative data from interviews with feedback from the co-design workshops and preliminary testing the prototype intervention highlighted several key adaptation goals for EPAT+. These included: (1) reduce length/time to complete EPAT+ due to time constraints in outpatient appointments, (2) the importance of pain re-assessment and using EPAT to facilitate patients to self-monitor their pain at home, and (3) the creation of new peripheral components to support communication with primary care providers. CONCLUSIONS:Using a theoretical driven conceptual guidance provided important learning on how to adapt an existing cancer pain management tool to a new setting (OOS). The result is a novel complex theory- and evidence-based intervention that will be formally tested in a cluster randomised pilot trial.

12060 Background: Growth differentiation factor-15 (GDF-15) is an emerging therapeutic target in cancer cachexia. However, the association of circulating GDF-15 with the cancer cachexia phenotype remains poorly characterized. Methods: Serum GDF-15 was measured using the Roche Elecsys GDF-15 assay at screening in a phase 2, randomized trial of ponsegromab (an investigational anti-GDF-15 monoclonal antibody) in patients with cancer cachexia, and an elevated serum GDF-15 (≥ 1500 pg/mL) (NCT05546476). Cachexia was defined by international consensus criteria and sarcopenia by standardized sex-specific cut-off values for lumbar skeletal muscle index. Cross-sectional associations of GDF-15 with various demographic and clinical parameters were explored post-hoc using summary statistics and Pearson’s correlation (with GDF-15 on the log 10 scale). Results: A total of 187 patients were enrolled in this study with a median (IQR) age of 67 (60-74) years and 37% were female. Baseline median GDF-15 values were higher among patients with cachexia and colorectal and pancreatic cancers, compared to NSCLC. GDF-15 elevation was higher in patients with stage IV disease, sarcopenia, and worse performance status (Table). Higher GDF-15 levels were associated with lower serum albumin (r = -0.31 [95% CI: -0.44, -0.177]) and pre-albumin (r = -0.17 [95% CI: -0.31, -0.03]). No significant associations were observed between GDF-15 levels and appetite or fatigue assessments. Conclusions: Among patients with cancer cachexia, GDF-15 elevation was more pronounced in those with more advanced cancer, sarcopenia, and worse performance status. In addition, GDF-15 levels were negatively correlated with markers of nutritional status. Clinical trial information: NCT05546476 . Demographic or Clinical Characteristic n Median (IQR) serum GDF-15, pg/ml Age, years- 18-44- 45-64- ≥65 670111 2718 (2461, 8117)4197 (2366, 9425)3849 (2310, 7125) Type of cancer- NSCLC- Pancreatic- Colorectal 745954 2701 (2114, 4094)4714 (2408, 9561)6468 (4106, 10052) Interval from cancer diagnosis- <1 year- ≥1 year 9691 4259 (2447, 8919)3781 (2259, 6997) Stage of cancer- I/II- III- IV 1634137 3551 (2264, 6320)3232 (2461, 5704)4365 (2387, 8117) Body mass index (BMI), kg/m2- <20- ≥20 9988 3254 (2220, 6801)5052 (2712, 8749) % weight loss in 6 months prior to screening- < 10%- ≥ 10% 9988 3849 (2290, 7677)4118 (2381, 7595) Sarcopenia status- Yes- No 14440 4259 (2402, 7672)2928 (2136, 8052) ECOG Performance Status- 0- 1- 2/3 3312331 2842 (2408, 5673)4094 (2366, 8623)5119 (2272, 7667) Systemic anticancer therapy- Platinum-based therapy- Antimetabolite agents- Biological agents- Antimicrotubule agents- PD-1 or PD-L1 inhibitors 68100407330 5760 (3053, 10008)5914 (2847, 10768)5744 (3317, 9644)4891 (2762, 9425)2744 (2149, 4787)

BACKGROUND:The Global Leadership Initiative on Malnutrition (GLIM) criteria provides a framework for assessing cachexia in cancer patients. However, the role of systemic inflammation in this framework needs further exploration. METHODS:This study analyzed a cohort of 388 advanced cancer patients from 18 oncological care settings. C-reactive protein (CRP), the modified Glasgow Prognostic Score (mGPS) and Neutrophil-to-Lymphocyte Ratio (NLR) were used to assess systemic inflammation. Associations between these inflammatory markers and Weight Loss (WL), Body Mass Index (BMI), Skeletal Muscle Index (SMI), and survival outcomes (OS) were evaluated using Chi-square and Kaplan-Meier survival analyses. RESULTS:CRP was significantly associated with ECOG-PS (p < 0.01), and WL (p < 0.05). mGPS was significantly associated with ECOG-PS (p < 0.001), WL (p < 0.001), and BMI (p < 0.05). NLR was significantly associated with ECOG-PS (p < 0.05), WL (p < 0.001), and BMI (p < 0.05). CRP (p < 0.001), mGPS (p < 0.001), NLR (p < 0.001), WL (p < 0.001), and SMI (p < 0.05) were significantly associated with OS, but not BMI (p = 0.23). Combining CRP, mGPS, NLR, with WL, BMI, and SMI significantly improved OS prediction. WL was significantly associated with OS in patients with NLR<3 (p < 0.05) but not in CRP≤10 mg/L or mGPS = 0. SMI was significantly associated with OS in patients with mGPS = 0 (p < 0.05). CONCLUSION:Systemic inflammation, as assessed by CRP, mGPS and NLR, significantly improves the relationship between phenotypic criteria and OS. These findings support the GLIM framework's inclusion of systemic inflammation as a critical factor. Given its strong predictive value, systemic inflammation should be prioritized in routine clinical assessments of cancer patients, with mGPS having greater prognostic value within the GLIM framework.

Each year in the UK approximately 367,000 people are diagnosed with cancer of whom half will experience moderate to severe chronic pain and a third are undertreated for their pain. Most people with cancer are cared for at oncology outpatient services where there are no standardised approaches for managing pain. As a result, cancer patients are at risk of receiving inadequate care for pain. There is a need for a standardised approach to pain management within oncology outpatient services. The aim of this pilot trial is to establish the feasibility of conducting a multi-centre clustered-randomised trial of an integrated standardised pain assessment and management programme integrated within routine care at oncology outpatient services in the United Kingdom National Health Service (NHS). We will conduct a two-arm pilot cluster randomised trial with nested process evaluation to evaluate the feasibility and acceptability of trial processes, establish fidelity of intervention implementation, estimate variability in outcomes and feasibility of future economic evaluation. Twelve outpatient services (clusters) from at least two NHS tertiary oncology referral centres (sites), in the North of England will be randomised (1:1) to deliver a pain management programme plus usual care or usual care alone and will recruit a total sample of 180 participants. Adults attending a participating outpatient service who self-report a score of ≥ 3 on the 0–10 Numerical Rating Scale (NRS) for worst pain in the past 72 h in any part of their body, and will be available for 1-week follow-up will be eligible. Participant self-reported questionnaires will be collected at baseline, 1-week, 1-month, and 2-months with medical record review at 1-month and 2-months. Progression to a future trial will be based on pre-defined criteria associated with eligibility and consent rates, follow-up and intervention delivery and acceptability. Little research has described optimal ways to implement a standardised pain assessment and management programme into oncology outpatient services. The strengths of the pilot trial are its sample size, number of clusters, and planned evaluation of trial processes and intervention fidelity to provide robust trial evidence to fully inform a future definitive phase III multi-centre cluster randomised trial within the UK NHS. The CAPTURE pilot trial is registered on the ISRCTN registry (86,926,298).

CONTEXT:Cancer pain affects up to 45% of patients, with more than 30% experiencing moderate to severe pain. Despite established guidelines, over 40% of patients receive inadequate pain management, severely impacting their quality of life. While effective pain assessment is essential, a standardized approach is lacking in both research and clinical practice. OBJECTIVES:MyPath, a European Union-funded project, aims to implement a patient-centered care (PCC) approach across nine European cancer centers by systematically assessing and managing common symptoms and psychosocial issues to improve PCC for cancer patients. The aim of the present article is to describe the development of the clinical content for the MyPath Pain Care Pathway (PCP), based on patient reported outcomes (PROs) and clinical assessment, designed to offer standardized multidimensional pain management. METHODS:Between September 2022 and August 2024, an international, multidisciplinary steering group developed a systematic method for assessing and diagnosing cancer pain using evidence-based guidelines. RESULTS:The MyPath PCP pain assessment includes five key components: pain etiology, location, intensity, flares, and treatment (including relief and dose-limiting side effects), in line with the ICD-11 classification. Data will be gathered through digitalized PROs and clinical consultation in the MyPath's digital solution, which will suggest individualized pain management strategies. The first version of the tool will be implemented in 2025, with further adaptations based on feedback from patients, caregivers, and healthcare professionals. CONCLUSIONS:The MyPath PCP represents a digital standardized pain assessment approach to improve the quality of pain management for cancer patients across clinical settings.