Xavier Bonfill

Introduction: Breast cancer-related lymphedema (BCRL) is a disabling complication, and the effectiveness of exercise as treatment remains uncertain. Objective: We aimed to evaluate the effectiveness and safety of exercise in women with BCRL. Methods: A comprehensive search was conducted in MEDLINE, Embase, Cochrane Library, PEDro, and LILACS from database inception to March 2025, collating systematic reviews (SRs) of randomized controlled trials (RCTs) evaluating exercise, alone or combined with physiotherapy, in women with BCRL. Risk of bias was assessed using ROBIS and RoB 2, certainty of evidence (CoE) using GRADE, and overlap using GROOVE. Results: Of 2023 records, 9 SRs including 170 primary studies were included; after overlap management, eligible RCT data were synthesized by comparison and outcome. Supervised weightlifting probably reduced the risk of a ≥5% long-term increase in lymphedema volume (RR: 0.13; 95% CI: 0.07–0.25; moderate CoE), but evidence is very uncertain regarding ≥5% volume reduction (RR: 0.85; 95% CI: 0.44–1.66; very low CoE). Aquatic exercise may improve shoulder flexion (MD: 8.73 degrees; 95% CI: 3.55–13.91; low CoE) and shoulder abduction (MD: 6.87 degrees; 95% CI: 2.50–11.24; low CoE) compared with Pilates. No adverse events were reported, although they were not systematically defined or reported. Conclusions: Supervised weightlifting probably prevents increases in lymphedema volume, and aquatic exercise may improve shoulder mobility; however, the evidence remains uncertain, and the absence of adverse events does not confirm safety. Registration: PROSPERO (CRD42022334433).

Introduction: Breast cancer-related lymphedema (BCRL) affects quality of life (QoL) and increases healthcare costs. Resistance training (RT) is proposed as a preventive strategy, although its safety and effectiveness remain uncertain. Objective: To evaluate the effectiveness and safety of RT in preventing BCRL in women at risk. Methods: MEDLINE, Embase, CENTRAL, PEDro, and LILACS databases were searched from their inception to January 2025, along with the gray literature, trial registries, and preprints. Risk of bias was assessed using RoB 2, and certainty of the evidence (CoE) was assessed using GRADE. Primary outcomes were the occurrence of lymphedema and overall QoL; secondary outcomes included pain, upper limb function, range of motion (ROM), grip strength, and adverse events. Results: Eight RCTs (n = 1131) were included. The effects of RT on lymphedema and arm volume are very uncertain (very low CoE). For QoL, pain, ROM, and grip strength, the findings were inconsistent and uncertain (low to very low CoE). Adverse events were mild and transient, with no serious complications. Conclusion: RT is probably safe in women at risk of developing BCRL. Its preventive effectiveness is highly uncertain. Well-designed RCTs with standardized diagnostic criteria, patient-centered outcomes, and long-term follow-up are needed to establish their role in BCRL prevention with greater certainty. Ethics and dissemination: This study did not require ethical approval. The results will be disseminated through publications in peer-reviewed journals and academic presentations. Registration: PROSPERO (CRD42023455720).

Overlap of primary studies among multiple systematic reviews (SRs) is a major challenge when conducting overviews. The corrected covered area (CCA) is a metric computed from a matrix of evidence that quantifies overlap. Therefore, the assumptions used to generate the matrix may significantly affect the CCA. We aim to explore how these varying assumptions influence CCA calculations. We searched two databases for intervention-focused overviews published during 2023. Two reviewers conducted study selection and data extraction. We extracted overview characteristics and methods to handle overlap. For seven sampled overviews, we calculated overall and pairwise CCA across 16 scenarios, representing four matrix-construction assumptions. Of 193 included overviews, only 23 (11.9%) adhered to an overview-specific reporting guideline (e.g. PRIOR). Eighty-five (44.0%) did not address overlap; 14 (7.3%) only mentioned it in the discussion; and 94 (48.7%) incorporated it into methods or results (38 using CCA). Among the seven sampled overviews, CCA values varied depending on matrix-construction assumptions, ranging from 1.2% to 13.5% with the overall method and 0.0% to 15.7% with the pairwise method. CCA values may vary depending on the assumptions made during matrix construction, including scope, treatment of structural missingness, and handling of publication threads. This variability calls into question the uncritical use of current CCA thresholds and underscores the need for overview authors to report both overall and pairwise CCA calculations. Our preliminary guidance for transparently reporting matrix-construction assumptions may improve the accuracy and reproducibility of CCA assessments.

Introduction: Randomized controlled trials (RCTs) are essential for evidence‐based nursing care. However, the quality of reporting and adherence to methodological standards in Latin American nursing journals remains unclear. This study evaluates the characteristics, reporting quality, and potential risk of bias of RCTs published in Latin American nursing journals. Objective: To assess the reporting compliance and risk of bias of RCTs published in Latin American nursing journals. Design: Meta‐research study. Methods: A comprehensive handsearch of 29 Latin American nursing journals was performed covering publications from 2000 to 2024. Identified RCTs were assessed for adherence to CONSORT reporting guidelines and evaluated for risk of bias. Outcomes were classified using the COMET taxonomy. A descriptive analysis was performed. Results: A total of 6377 references were screened, identifying 34 eligible RCTs, most published after 2018. The median CONSORT compliance was 19 reported items (IQR 16–22). High compliance (> 90%) was observed in abstract reporting items, study objectives, and participant selection criteria. However, critical methodological features such as randomization procedures, blinding, and protocol registration showed low adherence (< 40%). Risk of bias was mostly rated as having “some concerns”, largely due to insufficient reporting. According to the COMET taxonomy, the most frequently reported outcome domains were “Delivery of care” and “Physical functioning”. Conclusions: Reporting compliance and risk of bias of RCTs published in Latin American nursing journals presents significant gaps, particularly in key methodological domains. These shortcomings hinder transparency, reproducibility, and integration into evidence synthesis. Strengthening editorial policies and enforcing reporting standards could enhance the quality and reliability of published research in Latin American nursing journals.

Background: Breast cancer-related lymphedema (BCRL) is a common complication that impairs function and quality of life (QoL). The comparative effectiveness of physical therapy interventions (PTIs) remains unclear. This systematic review and network meta-analysis (NMA) was conducted to identify the most effective PTIs for BCRL management. Methods: A systematic search of Medline/PubMed, LILACS, CENTRAL, PEDro, and CINAHL was conducted up to July 2024. Eligible studies were randomized controlled trials (RCTs) involving women with BCRL, evaluating PTIs delivered alone or in combination. Primary outcomes were lymphedema volume, volume reduction, percentage reduction, QoL, and pain. Secondary outcomes included range of motion (ROM), grip strength, and adverse events. A frequentist NMA was performed, and certainty of evidence (CoE) was assessed using the GRADE approach. Results: Eighty-three RCTs were identified, of which twenty-six (1203 participants) were included in the NMA, assessing 23 PTIs. Based on moderate CoE, yoga was among the most effective interventions for improving QoL within 6 months compared to usual standard care (USC). The multimodal approach, with or without a home exercise program, showed intermediate benefits for external rotation and may also improve shoulder abduction (low to moderate CoE). No intervention demonstrated clear superiority over USC for other outcomes. Adverse events were reported with kinesiotaping and compression measures. Conclusions: The evidence supports yoga and multimodal programs as potential short-term strategies for improving QoL and shoulder mobility in women with BCRL. However, the predominance of low-to-very-low CoE underscores the need for individualized clinical decisions and future high-quality RCTs with standardized comparators, larger samples, and longer follow-up. The consistent use of standardized comparators will be crucial in improving network connectivity and enabling more robust and comprehensive comparisons across multiple interventions.

Introduction The management of cancer care generates vast amounts of data, collected in the clinical registry; however, the interpretation of these unstandardized and heterogeneous records is often challenging. Artificial intelligence (AI) is emerging as a promising tool in healthcare, particularly in Oncology, where early diagnosis, complex therapies, long term follow-up and the impact on quality of life are paramount. This technology offers significant opportunities to support clinical decision-making and optimize the management of clinical data. Nevertheless, the literature describing how AI is concretely applied to support decision-making and administrative workflow in oncology remains scattered. Objective The aim is to identify evidence regarding the use of AI in Oncology, focusing on its role in supporting clinical decision-making and technical procedures across the entire cancer care continuum. Methods This scoping review will analyze primary studies published between 2020 and 2025. Eligibility criteria will be determined based on the PCC framework: Population (cancer patients), Concept (AI), and Context (clinical records). Studies focusing solely on population registries, those lacking identifiable AI use, as well as narrative reviews, will be excluded. Relevant literature will be identified through a systematic search in MEDLINE, EMBASE and CENTRAL. Additionally, forward citation tracking and review of existing systematic reviews will be conducted. Two independent reviewers will screen articles by titles and abstracts and consequently by full-text, using RAYYAN software. Data extraction will include the following items: cancer type, specific AI technique, the model or tool used, clinical utility, primary recipient (patient or health professional), stage of implementation, and reported outcomes or limitations. Quality assessment or bias evaluation will not be performed. Findings will be synthesized narratively and, where appropriate, represented graphically. Potential Results This research is expected to provide a comprehensive synthesis of AI applications in Oncology, highlighting the current role of this technology in enhancing the management of medical records and supporting clinical decision-making in the cancer care continuum. Expected outcomes include evidence of an upward trend in recent publications on the subject, a classification of techniques and models, a catalog of approved AI-based tools, distinctions between patient-oriented and healthcare professional support tools, and the identification of key limitations. Conclusion The findings of this review will enable clinicians and patients to gain insights into the current landscape of AI in Oncology, identify future research directions, and develop evidence-based strategies for the responsible integration of AI into cancer care. The goal is to position this technology as a supportive tool that complements, rather than replaces, healthcare professionals.

Purpose: To assess the efficacy and safety of non-chemotherapy anticancer drugs (immunotherapy or targeted therapy) compared to best supportive care (BSC) or placebo for the treatment of advanced gastric cancer (GC). Methods: Systematic review of randomized controlled trials (RCTs) searching (May 2022) MEDLINE, EMBASE, CENTRAL, Epistemonikos, ClinicalTrials.gov, and PROSPERO. Certainty of evidence was evaluated following GRADE. Results: Six RCTs included. Targeted therapies likely result in a slight increase in overall survival (OS) (HR 0.84, 95% CI 0.75, 0.93; moderate certainty) and progression-free survival (PFS) (HR 0.52, 95% CI 0.43, 0.62; moderate certainty). Toxicity had a slightly increased risk (RR 1.19, 95% CI 0.95, 1.48; low certainty). Immunotherapy also showed a likely improvement in PFS (HR 0.60, 95% CI 0.49, 0.73; moderate certainty), while toxicity showed a likely higher risk (RR 2.72, 95% CI 1.24, 5.94; moderate certainty). However, benefits in survival translated to time gains of slightly over a month for OS and less than a month for PFS. No data were reported on performance status (PS), hospital admissions, or quality of life (QoL). Conclusions: Our study suggests some survival benefits with low toxicity from these treatments, but gains are marginal. Uncertainties persist regarding their impact on QoL and outcomes for patients with poor PS. Caution is advised in treatment selection for advanced GC patients, who should actively participate in decision-making. Future research should include diverse patient populations and assess patient-centered outcomes with consistent comparator groups for BSC. Trial Registration: The study protocol was registered in OSF (https://doi.org/10.17605/OSF.IO/7CHX6) on 2022–04-01.

Purpose: This scoping review aims to deepen the understanding of end-of-life anticancer drug use in lung cancer patients, a disease marked by high mortality and symptom burden. Insight into unique end-of-life treatment patterns is crucial for improving the appropriateness of cancer care for these patients. Methods: Comprehensive searches were carried out in Medline and Embase to find articles on the utilization of anticancer drugs in the end of life of lung cancer patients. Results: We identified 68 publications, highlighting the methodological characteristics of studies including the timing of the research, disease condition, treatment regimen, type of treatment, and features of the treatment. We outlined the frequency of anticancer drug use throughout different end-of-life periods. Conclusion: This review provides a comprehensive overview of primary studies exploring end-of-life treatments in lung cancer patients. Methodological inconsistencies pose many challenges, revealing a notable proportion of patients experiencing potential overtreatment, warranting more standardized research methods for robust evaluations.

Background: Highlighting the identified gaps in evidence-based research concerning advanced esophageal cancer (EC) treatment and care, this review evaluates the efficacy and safety of anticancer drugs compared to supportive care for advanced EC patients, aiming to assess the appropriateness of usual treatments and identify the gaps that need to be filled with primary research. Methods: We searched (May 2022) MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Epistemonikos, and trial registries (ClinicalTrials.gov and PROSPERO) for randomised controlled trials (RCTs) comparing anticancer drugs (chemotherapy, immunotherapy, or biological/targeted therapy) with supportive care in advanced EC. The results were summarised using GRADE summary of finding tables. Results: We included 15 RCTs. Most studies did not have a special focus on EC, did not detail the treatment lines in all patients, and did not evaluate all outcomes. Anticancer drugs may result in a slight increase in overall survival (OS) (HR 0.78; 95% CI 0.71, 0.86; MD 0.83 months) and better progression-free survival (PFS) (HR 0.56 95% CI 0.49, 0.64, MD 0.68 months), but also may increase toxicity (RR 1.37; 95% CI 1.13, 1.65), without a significant improvement in quality of life. The certainty of evidence was low or very low due to indirectness of results and lack of specific focus on EC in some studies. Conclusion: RCTs on advanced EC lack specificity, detailed treatment line information, and evaluation of all relevant outcomes. Moreover, when they find any benefit, this is negligible. Therefore, the certainty to justify anticancer drug treatments instead of supportive care in advanced EC is low or very low, and this information should be actively shared with affected patients. More and better RCTs should be conducted to assess whether any old or new proposed treatment for advanced EC patients provides a better balance of benefits and harms than the supportive care. Systematic review registration: The study protocol was registered in OSF (https://doi.org/10.17605/OSF.IO/7CHX6) on 2022–03-29.

Purpose : This scoping review contributes to understanding the utilization of end-of-life anticancer drugs in gastrointestinal cancer patients, a topic posing significant public health challenges due to its prevalence, impact on morbidity and mortality, and associated healthcare costs. Insight into unique treatment patterns at the end of life is vital for enhancing the appropriateness of cancer care for these patients. Methods: Extensive searches were conducted in Medline and Embase to locate articles on the use of anticancer drugs in the end-of-life phase of gastrointestinal cancer patients. Results: We identified 30 publications and described treatment frequencies alongside methodological characteristics. On average, 7.0% and 13.2% of patients received anticancer drugs in the last two and four weeks of life, respectively, with 3.3% commencing new anticancer regimens in the final four weeks. Conclusion: This review offers a comprehensive overview of primary studies reporting end-of-life treatments in gastrointestinal cancer patients. However, methodological inconsistencies present significant challenges, highlighting a notable proportion of patients potentially experiencing overtreatment. Therefore, there is a pressing need for more standardized research methods to ensure robust evaluations and enhance the quality of care for these patients.