Background: A variety of nonpharmacological interventions that improve the quality of life of patients with advanced cancer have been difficult for medical staff to select through randomized controlled trials or traditional meta-analyses. Thus, a network meta-analysis is necessary. Objective: This study used network meta-analysis to analyze the effect of 13 different nonpharmacological interventions on improving the living quality of patients with advanced cancer. Methods: Five English databases were searched up to January 2019. The search strategy only included terms relating to or describing the intervention. Results: The study included 13 different nonpharmacological interventions. The overall efficacy was summarized through a holistic study of quality of life. The study found that the combined effect sizes of 13 nonpharmacological interventions crossed the invalid line (weighted mean difference, -13 [95% confidence interval, -33 to 8.5] to 1.7 [95% confidence interval, -18 to 22]), indicating that none of the intervention was significantly different from each other. By evaluating the heterogeneity of this outcome, no significant evidence of heterogeneity ( P > .05) was observed. Probability ranking according to the surface under the cumulative ranking curve showed that there was a great possibility for the CanWalk intervention and structured multidisciplinary intervention to improve outcomes for cancer patients. Conclusions: Thirteen nonpharmacological interventions did not significantly impact quality of life. Regarding the probability rank, CanWalk intervention may be the most promising way that advanced cancer patients can help themselves to a better life. Because of the limitations of the current studies, the conclusion needs further evidence. Implications for practice: Nurses should consider recommending moderate physical activity for patients with advanced cancer.

PURPOSE: This review aims to critically evaluate the efficacy of web or mobile-based (WMB) interventions impacting emotional symptoms in patients with advanced cancer. METHOD: Articles published from 1991 to 2019 were identified using PubMed, PsycINFO, CINAHL, and Scopus. Only interventions involving adults with advanced cancer using a WMB intervention to manage emotional symptoms were included. Risk of bias was assessed using ROBINS-I and ROB2 tools. Studies that reported mean symptom scores were pooled using a random-effects model, and standardized mean difference (SMD) and 95% CIs were calculated. RESULTS: Twenty-three of the 1177 screened studies met the inclusion criteria, and a total sample of 2558 patients were included. The sample was 57% female, and 33% had advanced cancer with mean age of 57.15 years. Thirteen studies evaluated anxiety, nineteen evaluated depression, and eleven evaluated distress. Intervention components included general information, tracking, communication, multimedia choice, interactive online activities, tailoring/feedback, symptom management support content, and self-monitoring. Overall pooled results showed that WMB interventions' effects on decreasing anxiety (SMD - 0.20, - 0.45 to 0.05, I2 = 72%), depression (SMD - 0.10, - 0.30 to 0.11, I2 = 73%), and distress (SMD - 0.20, - 0.47 to 0.06, I2 = 60%) were not significant for randomized controlled trials (RCTs). In contrast, WMB interventions significantly decreased symptoms of anxiety (p = .002) in a sub-group analysis of non-RCTs. CONCLUSION: This meta-analysis demonstrated that WMB interventions were not efficacious in alleviating emotional symptoms in adults with advanced cancer. Considering the diversity of interventions, the efficacy of WMB interventions and its impacts on emotional symptoms should be further explored.

BACKGROUND: Rehabilitation and palliative care may play an important role in addressing the problems and needs perceived by socioeconomically disadvantaged patients with advanced cancer. However, no study has synthesized existing research on rehabilitation and palliative care for socioeconomically disadvantaged patients with advanced cancer. The study aimed to map existing research of rehabilitation and palliative care for patients with advanced cancer who are socioeconomically disadvantaged. MATERIAL AND METHODS: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A systematic literature search was performed in CINAHL, PubMed and EMBASE. Two reviewers independently assessed abstracts and full-text articles for eligibility and performed data extraction. Both qualitative and quantitative studies published between 2010 and 2019 were included if they addressed rehabilitation or palliative care for socioeconomically disadvantaged (adults ≥18 years) patients with advanced cancer. Socioeconomic disadvantage is defined by socioeconomic position (income, educational level and occupational status). RESULTS: In total, 11 studies were included in this scoping review (138,152 patients and 45 healthcare providers) of which 10 were quantitative studies and 1 was a qualitative study. All included studies investigated the use of and preferences for palliative care, and none focused on rehabilitation. Two studies explored health professionals' perspectives on the delivery of palliative care. CONCLUSION: Existing research within this research field is sparse. Future research should focus more on how best to reach and support socioeconomically disadvantaged people with advanced cancer in community-based rehabilitation and palliative care.

Abstract Context Patients with advanced-stage cancer often suffer many physical and psychological symptoms. Exercise has been shown to improve quality of life (QoL), decrease cancer-related symptoms, and maintain or improve functional status in cancer survivors or patients with early stage cancer. However, the effect of exercise on these outcomes in patients with advanced-stage cancer is unclear. Objectives This meta-analysis aimed to assess the effectiveness of exercise interventions for patients with advanced-stage cancer in improving cancer-related symptoms and functional status outcomes. Methods We conducted a comprehensive literature search in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science from their inception to February 3, 2019, to include randomized controlled trials (RCTs) comparing exercise and usual care for improving outcomes in patients with advanced-stage cancer. Two reviewers independently screened the studies, extracted data of interest, and assessed the risk of bias of individual RCTs using the Cochrane Handbook, Version 5.1.0. Results About 15 RCTs enrolling 1208 patients were included. Compared with usual care, exercise showed a significant improvement in QoL (standardized mean difference [SMD] 0.22; 95% CI 0.06–0.38; P = 0.009), fatigue (SMD −0.25; 95% CI −0.45 to −0.04; P = 0.02), insomnia (SMD −0.36; 95% CI −0.56 to −0.17; P = 0.0002), physical function (SMD 0.22; 95% CI 0.05–0.38; P = 0.009), social function (SMD 0.18; 95% CI 0.02–0.34; P = 0.03), and dyspnea reduction (SMD −0.18; 95% CI −0.34 to −0.01; P = 0.03). Conclusion Exercise serves as an effective intervention to improve QoL and alleviate fatigue, insomnia, dyspnea, and physical and social functions for patients with advanced-stage cancer.

BACKGROUND: Telehealth approaches are increasingly being used to support patients with advanced diseases, including cancer. Evidence suggests that telehealth is acceptable to most patients; however, the extent of and factors influencing patient engagement remain unclear. OBJECTIVE: The aim of this review is to characterize the extent of engagement with telehealth interventions in patients with advanced, incurable cancer reported in the international literature. METHODS: This systematic review was registered with PROSPERO (International Prospective Register of Systematic Reviews) and is reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. A comprehensive search of databases was undertaken for telehealth interventions (communication between a patient with advanced cancer and their health professional via telehealth technologies), including MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Sociological Abstracts, and Web of Science, from the inception of each electronic database up until December 31, 2020. A narrative synthesis was conducted to outline the design, population, and context of the studies. A conceptual framework of digital engagement comprising quantitative behavioral measures (frequency, amount, duration, and depth of use) framed the analysis of engagement with telehealth approaches. Frequency data were transformed to a percentage (actual patient engagement as a proportion of intended engagement), and the interventions were characterized by intensity (high, medium, and low intended engagement) and mode of delivery for standardized comparisons across studies. RESULTS: Of the 19,676 identified papers, 40 (0.2%) papers covering 39 different studies were eligible for inclusion, dominated by US studies (22/39, 56%), with most being research studies (26/39, 67%). The most commonly reported measure of engagement was frequency (36/39, 92%), with substantial heterogeneity in the way in which it was measured. A standardized percentage of actual patient engagement was derived from 17 studies (17/39, 44%; n=1255), ranging from 51% to 100% with a weighted average of 75.4% (SD 15.8%). A directly proportional relationship was found between intervention intensity and actual patient engagement. Higher engagement occurred when a tablet, computer, or smartphone app was the mode of delivery. CONCLUSIONS: Understanding engagement for people with advanced cancer can guide the development of telehealth approaches from their design to monitoring as part of routine care. With increasing telehealth use, the development of meaningful and context- and condition-appropriate measures of telehealth engagement is needed to address the current heterogeneity in reporting while improving the understanding of optimal implementation of telehealth for oncology and palliative care.