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Background and objective: Melanoma brain metastasis (MBM) generally portends a dismal prognosis. Simultaneous use of radiotherapy (RT) and immune checkpoint inhibitor (ICI) therapy demonstrated tremendous promise and emerged as the new standard. This meta-analysis was conducted to evaluate survival outcomes and toxicities of this combination in patients with MBM. Data analyses were performed using Comprehensive Meta-Analysis software (version 2) and IBM SPSS software (version 27). Methods: A systematic literature search of PubMed, EMBASE, and the Cochrane Library (via Wiley) was conducted using PICOS/PRISMA selection protocol and included studies to evaluate survival and safety-associated outcomes of ICI + RT for the treatment of MBM. Results: A total 44 studies involving 2498 patients were reviewed. The pooled effect size (ES) for overall survival (OS) to compare the ICI + RT arm and ICI alone arm (HR: 0.693 [0.526–0.913, p = .001]), and compare the ICI + RT arm and brain RT alone (HR: 0.595 [0.489–0.723, p < .001)] indicated better survival outcomes in ICI + RT versus RT alone and ICI alone arms. Comparing central nervous system toxicity in the ICI + RT arm and RT alone arm, the pooled ES Grade ≥ 3 neurologic adverse events (NAEs) risk ratio ([RR] = 1.425; 95% confidence interval [CI]: 0.485–4.183; p = .519) indicated that ICI + RT nonsignificantly increased Grade 3–4 NAEs. Comparing Grade ≥ 3 radiation necrosis in the ICI + RT arm and RT alone arm, the pooled ES RR (RR = 2.73; 95% CI: 0.59–12.59; p = .199) indicated that ICI + RT nonsignificantly increased Grade ≥ 3 radiation necrosis. Conclusion: Concurrent administration of RT and ICI evinced favorable OS outcomes and acceptable safety profile in MBM patients. Planned prospective trials are required to demonstrate the issue.

Background: One of the most important complications of cancer treatment is mucositis, whose prevention is essential because, in some cases, the presence of mucositis leads to the cessation of the treatment and the progression of cancer. Objectives: This study aimed to examine the effect of self-care training on the severity of oral mucositis in patients with breast cancer who underwent chemotherapy in 2020. Methods: The present study was conducted using a quasi-experimental design with two groups of 74 patients with breast cancer in selected hospitals of Zahedan University of Medical Sciences in the southeast of Iran in 2020. The patients were selected using convenience sampling and randomly assigned to the control and intervention groups. Considering the inclusion criteria, an oral assessment was performed on the patients at the beginning of the study using standard tools. Then, the patients in the intervention group received individual training in the first four weeks of the study. Oral mucositis was assessed for the patients in both groups during weeks 2, 4, 6, and 8 after the intervention. The patients in the control group did not receive any special training. The collected data were analyzed using SPSS software and the chi-square test and independent samples t-test. The generalized estimating equation (GEE) was used to compare the two groups and to examine the effective variables and time-group interaction. Results: The results of the chi-square test indicated no significant intergroup difference after four training sessions in terms of the presence of mucositis in weeks 2, 4, and 6 (P = 0.6 in the second week, P = 0.18 in the fourth week, and P = 0.16 in the sixth week). However, the chi-square test indicated a statistically significant difference between the two groups at the end of the eighth week (χ2 = 12.67; P = 0.005). In addition, the odds ratios for the severity of mucositis in patients using the GEE test showed that the only variable that played a significant role in preventing mucositis was the self-care intervention (OR = 0.02; P = 0.03). Other variables, such as smoking (OR = 0.2; P = 0.04), BMI (OR = 6.6; P = 0.08), and age (OR = 0.9; P = 0.3) had no effect on the possibility of developing mucositis. Conclusions: Self-care training with an emphasis on personal health and especially oral health to cancer patients can be effective in preventing mucositis. Therefore, medical staff should focus on oral health self-care training as a priority in training programs.

BACKGROUNDFatigue is one of the most common cancer-related problems. Fatigue-reduction nondrug methods include energy conservation strategies and improving self-caring efficacy. The aim of the present study was to determine the effect of energy conservation strategies training on fatigue and caring self-efficacy in cancer patients. METHODSIt was a single-blind clinical trial study performed on 80 breast cancer patients in educational hospitals in Zahedan (Iran) selected by simple random sampling. After randomly assigning patients to two groups (control and intervention), before the intervention, multidimensional fatigue inventory (MFI) and strategies used by people to promote health (SUPPH) were completed by patients in both groups. The control group received no special care except routine care. The intervention consisted of energy conservation strategies that was performed in the experimental group within 3 individual sessions once a week. Following all 3 training sessions, follow-up was performed for 6 weeks and the questionnaires were then administered to the control and intervention groups and the post-test was given. RESULTSMost of the participants in the two groups were educated less than high school diploma, were housewives, and in stage II of the diseases. The results showed that fatigue was significantly lower in the intervention group than the control group after the intervention (p= 0.01). The results also showed a significant improvement in the level of caring self-efficacy in the intervention group compared to the control group (p= 0.02). CONCLUSIONSThe results indicate that educational intervention can be used as an effective strategy and a complementary therapy along with other therapies to reduce fatigue in patients with breast cancer.

Background: The nature of breast cancer (BC) and its treatment is such that it leads to physical and psychological complications. Objectives: The present study aimed to determine the effect of supportive educational intervention on the perceived stress and severity of chemotherapy-related neuropathy in BC patients. Methods: This quasi-experimental study was carried out on 60 women suffering from BC in Zahedan, Iran, in 2020. The patients were selected using the convenience sampling method and randomly assigned into two groups of intervention and control. The patients in the intervention group received four 45-minute sessions about the common problems of BC on a weekly and individual basis. The control group received only routine ward care. Data collection tools were the Perceived Stress Scale (PSS) developed by Cohen and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale. Data were collected before the intervention and six weeks after the intervention. Data analysis was performed using SPSS 22 software. Results: The results of independent t-test showed that the mean and standard deviation of perceived stress score in the intervention group decreased from 56.8 ± 5.92 to 50.36 ± 3.89 (P < 0.001), and in the control group decreased from 55.6 ± 3.65 to 54.8 ± 3.53 (P = 0.258). The mean and standard deviation of neuropathy severity score in the intervention group decreased from 12.90 ± 1.66 to 8.43 ± 2.16 (P < 0.001), and in the control group increased from 12.56 ± 2.28 to 13.03 ± 1.93 (P = 0.276). The independent t-test showed that after implementing the supportive educational intervention, there was a significant difference between the two groups in terms of mean and standard deviation of neuropathy severity score (P < 0.001). Conclusions: According to our results, supportive educational intervention reduced the perceived stress and severity of neuropathy. Thus, it is necessary to include these supportive interventions in educational and care programs to improve patients’ psychological status and reduce stress and neuropathy.