Leorey N. Saligan

Background: Precision health is transforming the landscape of palliative care by enabling more individualized approaches to symptom assessment and management. Symptoms remain the primary focus of palliative care; however, traditional approaches rely largely on subjective self-report and often fail to capture the biological mechanisms underlying symptom variability and clustering. Objective: This paper examines how integrating symptom science with precision health approaches, including multi-omics, digital health technologies, and systems biology, can enhance symptom characterization and inform individualized palliative care interventions. Methods: This perspective paper focuses translational and clinical evidence, including exemplars from the authors’ program of research utilizing genomic, metabolomic, inflammatory, and extracellular vesicle biomarkers to characterize psychoneurological symptom clusters in individuals with serious illness. Supporting literature on digital health integration and ethical considerations in palliative care was also reviewed. Results: Emerging evidence demonstrates that multi-omic approaches may help identify biological mechanisms underlying symptom heterogeneity and clustering, enabling more precise phenotyping and informing the development of targeted interventions. Genotype–phenotype associations, such as those involving the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism, and biomarker-informed symptom clusters, highlight opportunities for the future development of mechanism-based symptom management strategies. Digital health interventions, including remote symptom monitoring and telehealth, have demonstrated improvements in symptom burden, quality of life, and care coordination although cost-effectiveness may vary across technologies, settings, and healthcare systems. However, variability in biological pathways and challenges related to implementation, equity, and access underscore the need for thoughtful integration. Innovation: This paper is innovative in its integration of multi-omic symptom science with precision health frameworks to advance a mechanism-informed model of palliative care. It uniquely bridges biological, technological, and clinical domains to move beyond symptom description toward biologically grounded, individualized symptom management, while explicitly preserving the “high-tech, high-touch” ethos central to palliative care. Conclusion: Integrating precision health strategies with symptom science offers a transformative opportunity to advance palliative care through individualized, mechanism-informed symptom management. A “high-tech, high-touch” approach is essential to ensure that technological innovation enhances, rather than replaces, the compassionate, person-centered care that defines palliative practice. Future directions should prioritize scalable models, non-invasive biomarkers, and equitable implementation across diverse populations.

Purpose: The purpose of this study was to address the relationship between social determinants of health (both individual and neighborhood levels) to understand more fully how social conditions are associated with physical functioning among breast cancer survivors (BCS). Methods: We conducted a secondary analysis of a national sample of breast cancer survivors recruited via Institutional Review Board–approved social media (i.e., Facebook) and online cancer-affiliated resource sites (e.g., Pink Ribbon Connection, Dr. Susan Love Foundation). BCS provided their address and demographic factors and completed the physical functioning survey (PF-10). Neighborhood social determinants of health (SDOH) included Yost National Rank Index and neighborhood factors (walkability and rural vs. urban status) using Geocoding. Descriptive statistics and linear regression models were used. Results: BCS who were older ( p = 0.038) and single ( p = 0.008) had poor physical functioning. Socioeconomic factors including higher education ( p = 0.001), higher income ( p = 0.034), and higher neighborhood socioeconomic status (Yost Index, p = 0.016) were associated with greater physical functioning. Neighborhood factors (walkability and rural vs. urban) were not associated with physical functioning in BCS. Conclusion: Physical functioning of BCS was linked to age, social network (marital status), and socioeconomic status. Future interventional research is needed that accounts for individual and socioeconomic factors to mitigate their effects on the physical functioning of BCS.

Objective . Numerous studies examine the link between health and sleep-wake patterns to understand etiology, establish preventive algorithms, or develop therapeutics. The use of actigraphy to measure physical activity (PA) and sleep is increasing, partly because of its non-invasive nature and its ability to continuously monitor PA and sleep in free-living settings. There are several actigraphy data cleaning and pre-processing methods, but there is no consensus on how to define PA metrics or standardized cleaning procedures to enable comparison across research studies. This scoping review examined existing literature on cleaning and pre-processing of actigraphy data. Approach. The PubMed (US National Library of Medicine), Scopus (Elsevier), and Web of Science: Core Collection (Clarivate Analytics) databases were searched for original studies published in English from 2017–2024. Using Covidence, two reviewers independently screened each article and collected data. Results. A total of 102 studies were included for the final analysis. Our results showed substantial heterogeneity in actigraphy devices, data cleaning and pre-processing methods, with some studies using their own algorithmic approaches to generate PA and sleep variables. While some studies used well-established algorithms like Freedson or Cole–Kripke, a large proportion either developed custom methods or did not report sufficient detail to allow replication. This variability highlights the urgent need for standardized reporting and consensus-based protocols in actigraphy data cleaning and pre-processing to allow replication and comparison of findings across studies. Significance. This scoping review is the first to differentiate, in a standardized way, between cleaning and pre-processing practices in actigraphy research and to quantify reporting practices across multiple device types and data processing strategies. Our findings show a critical gap in standardized reporting and offer actionable guidance for both high- and low-resource research settings.

Background: Cancer-related health outcomes are shaped by the interplay of aging, complex treatment exposures, and individual psychological characteristics. Mitochondrial dysfunction has been implicated as an underlying biological process affecting cancer-related outcomes. This secondary, exploratory pilot analysis aimed to examine age- and treatment-related differences in fatigue, coping self-efficacy, resilience, and skeletal muscle mitochondrial oxidative capacity, measured via phosphorus-31 magnetic resonance spectroscopy (31P-MRS). Methods: Eleven cancer survivors (mean age 53.3 ± 12.7 years) were recruited from a larger symptom management trial. Participants underwent 31P-MRS to assess mitochondrial function via phosphocreatine recovery time constant (τPCr). Patient-reported outcome measures and physical function assessments were collected. Group comparisons and correlation analyses were conducted to evaluate differences and associations based on age (<65 vs. ≥65 years) and treatment. Because treatment categories were not mutually exclusive and the time since last treatment was not collected, treatment-related comparisons are descriptive only. Given the small available sample size, we conducted this study as exploratory and hypothesis-generating. Results: Older survivors (≥65) had longer τPCr (59.5 vs. 50.1 s), weaker grip strength, higher fatigue, and lower physical performance compared to younger participants, although differences were not statistically significant. Treatment-related patterns were descriptive; participants receiving multiple treatments had shorter τPCr but lower muscular strength, while immunotherapy recipients reported higher fatigue and lower physical activity. Among younger participants, a negative correlation was observed between τPCr and fatigue (ρ = −0.71), and positive correlations were observed with resilience (ρ = 0.61) and coping self-efficacy (ρ = 0.74), reflecting a pattern that warrants cautious interpretation in this small sample. Conclusions: These preliminary results suggest age- and treatment-related differences in fatigue, physical performance, psychological factors, and skeletal muscle mitochondrial bioenergetics. These signals warrant further testing in larger, adequately powered cohorts to clarify mechanisms and inform the development of personalized survivorship care strategies.

Background Fatigue, a prevalent symptom of chronic illness, impacts quality of life. This proof-of-concept, randomized, double-blind, crossover trial assessed the anti-fatigue effects of ketamine (0.5 mg/kg) versus midazolam (0.045 mg/kg), the active comparator. Methods Ten participants, who were cancer survivors, with fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome, or systemic lupus erythematosus, were randomized into Arm 1 (n = 4, Period 1: ketamine to Period 2: midazolam) or Arm 2 (n = 6, Period 1: midazolam to Period 2: ketamine). Results The two periods were separately analyzed because of carryover effects with baseline fatigue scores, assessed by the fatigue visual analog scale (VAS), between the study periods (p = 0.03). Looking at changes in fatigue VAS scores from baseline (pre-infusion) to 3 days post-infusion, the ketamine group had a 21.0% decrease in Period 1 and 10.9% in Period 2, while the midazolam group showed a 17.7% decrease in Period 1 and 12.6% in Period 2. We did not observe a statistically significant difference in both periods. The largest fatigue score reduction for the ketamine group was at 1 day post-infusion, at − 38.7% in Period 1. Conclusion Despite no statistical significance, a reduction in real-time fatigue scores was observed, which exceeded the 20% efficacy threshold, the primary outcome, in the ketamine arm from pre-infusion to 3 days post-infusion. The carryover effects and the peak reduction in fatigue at 24 hours after ketamine administration suggest that future trials may need to consider a study design without cross-over and an optimal active placebo alternative.

Opinion Statement Symptom management remains a critical priority in oncology, particularly as many survivors continue to experience fatigue, pain, sleep disturbance, neuropathy, and psychological distress despite advances in treatment. Conventional pharmacologic options often provide only partial relief and may be limited by side effects. Acupuncture and acupressure have emerged as promising non-pharmacologic approaches, but the supporting evidence is drawn from a broad and heterogeneous literature. In this opinion paper, we provide a preliminary overview of the current review-level evidence to highlight general trends and evolving areas of promise, while emphasizing the need for further sham-controlled studies to clarify effectiveness and guide integration of acupuncture and acupressure into supportive oncology.

Cancer patients receiving immunotherapy often experience symptoms impacting their well-being. The present study aimed to develop and test the feasibility of a 12-week Technology-Enhanced Home Exercise and acupressure (TEHEplus) program to improve symptoms (fatigue, pain, sleep, anxiety, depression), social functioning, physical performance, and serum biomarkers (brain-derived neurotrophic factor, heat shock protein 90 levels.) A two-phase design was employed. Phase 1 involved program development; Phase 2 was a pilot feasibility study. Participants with solid tumor cancers were recruited from cancer centers in Maryland and randomly assigned to four groups: Usual Care Control (UC), Technology-Enhanced Home Exercise (TEHE) alone, Acupressure alone (ACU), and TEHEplus. Feasibility was measured by enrollment duration, intervention adherence, and daily survey response rates. Outcomes were measured at baseline and program completion. In phase 1, four participants (age 56–82) provided feedback on online training, smartphone application, intervention duration, and outcome measures. In Phase 2, 40 participants (10 per group) were recruited over 12 months, with 43% (n = 17) completing all daily surveys. TEHEplus participants achieved 50% of exercise goals, and 78% adhered to the acupoint recommendations. TEHEplus participants showed significant improvements in fatigue (p = 0.02), pain inference (p = 0.30), and social functioning (p = 0.03); TEHE participants improved only in social functioning (p = 0.03). TEHEplus is feasible and shows promise for symptom alleviation. Preliminary findings suggest potential benefits in symptom management and functional outcomes. However, further studies with larger and more diverse samples are warranted to explore its efficacy and generalizability.Further studies with larger, more diverse populations are needed to confirm its efficacy. TEHEplus may enhance symptom management and improve functional outcomes for cancer survivors undergoing immunotherapy. ClinicalTrials.gov ID NCT03576274 Trial Registration Date: 06/07/2018.

Context: Bodily pain and cognitive concerns are both prevalent and share similar underlying mechanisms. A few studies have suggested that pain and cognitive concerns may be linked through substance use coping; however, this relationship remains unclear, particularly among breast cancer survivors (BCS). Gaining a clearer understanding of this relationship is critical, as it could inform survivorship care plans for BCS. Objectives: This study aims to investigate whether bodily pain is related to cognitive concerns among BCS and to further explore whether this relationship is mediated by substance use coping. Methods: This study is a sub‐analysis of data obtained from a larger cross‐sectional study. Bodily pain was assessed using the Short‐Form Health Survey, and cognitive concerns were measured using the Patient‐Reported Outcomes Measurement Information System. Substance use coping was assessed using two items from the Brief Coping Orientation to Problems Experienced Inventory. Path analysis was used to examine the relationships among bodily pain, substance use coping, and cognitive concerns. Results: Higher levels of bodily pain and higher use of substance use coping were associated with greater cognitive concerns. Although the relationship was weakly related, we found that bodily pain was associated with substance use coping, and that substance use coping mediated the association between bodily pain and cognitive concerns. Conclusion: These findings highlight the importance of regular pain assessments to help prevent future behavioral and cognitive consequences. Moreover, efforts to screen for and manage both pain and substance use may ultimately help prevent cognitive problems during survivorship.

Agricultural workers in the United States (U.S.) are exposed to occupational heat stress, increasing their risk of adverse kidney outcomes. The aim of this integrative review was to explore the relationship between occupational heat stress and kidney health among U.S. agricultural workers. PubMed, EMBASE, Scopus, and Google Scholar were searched for original research articles on this relationship among U.S. agricultural workers. Studies were screened and reviewed by two independent reviewers in three phases: title and abstract screening, full text screening, and data extraction. The search yielded 278 articles; 14 were included in the final analysis. Heat stress was commonly measured using core body temperature changes, heat index, and wet-bulb globe temperature. Acute kidney injury (AKI) incidence following a single work shift was up to 43%. Occupational heat stress and piece-rate compensation increased the odds for developing AKI. The use of cooling bandanas and water mixed with electrolytes are promising interventions for mitigating the effect of heat stress on kidney health outcomes. The results confirm that occupational heat stress influences kidney health for U.S. agricultural workers. The mechanisms of this relationship have not been fully elucidated. More studies exploring heat protection interventions are needed.