Marie Mclaughlin

Patients with cancer usually report limitations of their functional capacity, which may range from subclinical impairment of cardiopulmonary exercise reserve to poor quality of life with physical, cognitive, or psychosocial consequences. Exercise training is a potent multi-targeted approach to control pre-existing and new risk factors. Preliminary evidence shows that it is associated with a lower risk of cancer therapy-related cardiotoxicity and increased self-reported well-being in patients with cancer. Current evidence demonstrates that supervised exercise therapy, including high-intensity interval training, is safe and well-tolerated and reduces risk in subjects with cancer in the pre-, active-, and post-treatment settings. The present consensus document will discuss the role of exercise training in cardio-oncology, focusing on patients with cardiovascular diseases induced by cancer treatment and on those who received cardiotoxic therapies.

Background: Globally, around 400 million people are estimated to be affected by long COVID, yet treatment options remain scarce. A systematic review published in 2025 indicated that non-invasive brain stimulation may help reduce some long COVID symptoms. If repetitive transcranial magnetic stimulation (rTMS) has therapeutic potential for these patients, then a clear synthesis of the evidence is necessary to determine efficacy and potential for implementation. Methodology: This systematic review and narrative synthesis was conducted in accordance with PRISMA guidelines. The search, completed on the 4th of December 2025, covered four databases and grey literature. Studies were included if they examined long COVID and rTMS. Findings: A meta-analysis was not possible due to insufficient reported data across studies. Instead, a structured narrative synthesis was conducted on four included studies. The structured narrative synthesis of four studies indicates that rTMS is feasible and is associated with reported improvements in fatigue, mood, and cognitive symptoms in individuals with long COVID. However, all included evidence is based on uncontrolled case series and retrospective analyses, meaning no causal conclusions can be drawn and findings should be interpreted as exploratory. Conclusions: Taken together, the evidence remains preliminary and highlights the need for well-designed randomised controlled trials to assess efficacy.

In a 6-month pragmatic randomised controlled trial (RCT; ISRCTN16033549), we compared a just-in-time intervention to support energy management in adults with long COVID (LC) to standard care. Participants received either the ‘Pace Me’ app and a wearable activity tracker (intervention) or an app only with data entry screens (control). The intervention group received just-in-time messages on energy management when they reached 50%, 75%, and 100% of their daily ‘activity allowance’. The primary outcome was post-exertional malaise (PEM) measured by the DePaul Symptom Questionnaire-PEM (DSQ-PEM). Of 369 participants assessed for eligibility, 250 participants were randomised 1:1, and 77 controls and 84 intervention participants were included in the final per-protocol analysis. There was no time by group interaction for the DSQ-PEM. The intervention group value was 48 (95% CI 44-53) at baseline and 46 (95% CI 41-51) post-intervention (arbitrary units). The control group value was 47 (95% CI 42-52) at baseline and 44 (95% CI 39-49) at follow-up (interaction effect p = 0.614, η²p = 0.002; trivial). No individual question exhibited an interaction effect (p > 0.05). Although the intervention had minimal effect compared to control, the substantial recovery rates previously reported in LC, coupled with our wide inclusion criteria may have masked intervention effects. Therefore, future studies should consider this energy management framework in conditions without such recovery rates, such as CFS.

Cancer remains a growing global health burden, with many survivors experiencing significant psychological symptoms such as fatigue, pain, anxiety, and depression. Noninvasive brain stimulation techniques such as rTMS have gained attention for their potential to modulate neural circuits implicated in pain perception, mood regulation, and fatigue. This scoping review aims to explore the current application, safety, and effectiveness of Transcranial Magnetic Stimulation (TMS) as a potential intervention to alleviate cancer-related and treatment-induced psychological symptoms. This scoping review followed Arksey and O’Malley’s 5-stage framework and adhered to PRISMA-ScR guidelines. The review identified, selected, and charted data from eligible studies across 5 databases to explore the effects of repeated transcranial magnetic stimulation on individuals living with cancer. Between 2010 and 2025, 17 studies investigated rTMS in cancer populations, including single-arm trials, sham-controlled RCTs, case studies, and retrospective observational studies, with sample sizes ranging from 1 to 66 participants (total n=406). Participants were predominantly female (65.9%) and had diverse cancer types, stages, and treatment statuses, including completed treatment, active therapy, and palliative care. rTMS protocols varied in duration (5 d to 6 wk), session frequency, intensity (70% to 120% RMT), and coil placement, targeting motor cortex, dorsolateral prefrontal cortex, or frontoparietal networks. Safety outcomes were favorable, with no serious adverse events reported and only mild, transient side effects, though one case of postoperative seizure was noted. rTMS was generally feasible and well-tolerated, with participants reporting positive experiences and high adherence. Key efficacy findings included improvements in depression, anxiety, pain, quality of life, motor function, and chemotherapy-induced neuropathy, although follow-up periods and outcome measures were heterogeneous across studies. rTMS appears safe and promising for managing cancer-related symptoms, but larger, standardized, sham-controlled trials with long-term follow-up are needed to confirm its clinical value.

The cumulative global incidence of long COVID is around 400 million individuals, yet effective treatment options remain limited. A recent systematic review published in 2025 highlighted promising results for non-invasive brain stimulation in alleviating long COVID symptoms. Given the growing use of repetitive transcranial magnetic stimulation (rTMS) for people with long COVID, a focused meta-analysis on the therapeutic effectiveness of rTMS is warranted. To address this gap, this protocol outlines the planned procedures for a systematic review and meta-analysis. A comprehensive search will be conducted across CINAHL Ultimate, MEDLINE, ScienceDirect, and Scopus. Retrieved studies will be managed using Rayyan, with two independent reviewers screening titles and abstracts, followed by full-text review. Data extraction will follow PRISMA and Cochrane guidelines using a standardised form, with dual independent extraction and reconciliation of discrepancies. Risk of bias will be assessed using Cochrane RoB 2.0. Meta-analytical procedures will include calculation of standardised effect sizes (e.g., Hedges’ g), use of random-effects models, and assessment of heterogeneity via I², Cochran’s Q, and tau². Subgroup and moderator analyses will explore variations in rTMS protocols, participant characteristics, and symptom domains. Sensitivity analyses and meta-regression will be conducted where data permit. Results will be visualised using forest and funnel plots, and the GRADE framework will be used to assess the quality of evidence.

Objective: To synthesise quantitative evidence on the effectiveness of Transcranial Magnetic Stimulation (TMS) as an intervention for individuals with long COVID/post-COVID syndrome. Introduction: An estimated 65 million people worldwide meet the WHO’s criteria for post-COVID-19 condition, a multisystem disorder with persistent symptoms following SARS-CoV-2 infection. Despite its global impact, effective treatments are limited. A recent review highlighted early but promising results from non-invasive brain stimulation techniques, including transcranial magnetic stimulation (TMS), though the underlying mechanisms remain unclear. Given the expanding use of TMS in long COVID, a follow-up meta-analysis is needed to reflect recent developments. This review aims to evaluate the efficacy of TMS in treating post-COVID-19 symptoms. Inclusion criteria: This review will include studies that investigate interventions involving TMSin individuals diagnosed with long COVID or post-COVID syndrome, limited to those published in the English language. Studies will be excluded if they do not involve rTMS as a therapeutic intervention, do not involve TMS at all, focus on populations other than those with long COVID or post-COVID condition, are review articles or case studies, or are not published in English. Methods: A comprehensive search will be conducted in CINAHL Ultimate, MEDLINE, ScienceDirect, and Scopus using a strategy developed with the research team. Retrieved citations will be managed in Rayyan. Two independent reviewers will screen titles and abstracts, followed by full-text screening and data extraction by two other independent reviewers. All stages will follow predefined, pilot-tested inclusion and exclusion criteria. Discrepancies will be resolved by a third reviewer or team discussion. Intra-rater reliability at both screening stages will be assessed using Cohen’s Kappa. Study characteristics and findings will be presented using both narrative synthesis and tabular formats. Review registration: https://doi.org/10.17605/OSF.IO/RE235

We evaluated validity, reliability, and effect of user expertise of “HaemoCalc”, a mobile phone application for hematocrit (Hct) measurement from fingerpick blood samples, compared to a traditional Hawksley microhaematocrit reader (MHR). Experiment 1 examined the effect pitch angle during image capture exerted on the validity of Hct values. Twenty participants' samples were analyzed at 0°, 10°, and 20° directly over the sample, and 33° with a 10 cm setback. Analysis of variance (ANOVA) revealed a significant effect of angle on Hct values (p < 0.01). Measurements at 33° pitch differed from other angles and the MHR (p < 0.001, d = 2.31–3.06). Bland–Altman analysis showed good agreement at 0°, 10°, and 20° (mean differences: −0.4% to 1.0%) but poor agreement at 33° (mean difference: −4.4%, LOA: −0.7% to 8.4%). Experiment 2 assessed inter‐ and intra‐rater reliability of expert and novice users (n = 12). Participants performed three trials each. HaemoCalc and MHR showed excellent reliability (ICC = 0.95–1.00). No differences were observed between experts and novices (p = 1.000, d = 0.01–0.39). HaemoCalc is a valid and reliable tool for Hct measurement at small pitch angles and in expert and novice users. The HaemoCalc app offers scalability, repeatability, health and safety benefits, and potential applications in medical education and remote learning.

Background: Comorbid cancer and dementia, which share common risk factors and significantly burden the healthcare system, affect a growing number of individuals, especially the ageing population. As both conditions place a substantial burden on healthcare systems and may be underdiagnosed, there is an urgent need to explore effective management strategies, including the potential benefits of physical activity, which has shown promise in mitigating cognitive decline and improving physical function in both cancer and dementia populations. This scoping review aimed to explore the current knowledge of physical activity for individuals with comorbid cancer and dementia, identifying gaps in understanding and highlighting the need for future research in this area. Summary: This scoping review followed the 5-stage framework outlined by Arksey and O'Malley, with a focus on identifying the effects of physical activity on individuals with comorbid cancer and dementia. The review involved a comprehensive search across multiple databases, selecting relevant studies based on predefined criteria, and summarizing key findings to highlight research gaps and inform future studies. Out of 263 records identified from multiple databases, none were retained for full-text screening due to exclusions based on review articles, non-human participants, lack of comorbid cancer-dementia, and absence of a physical activity/exercise component. Key Messages: There is a significant gap in research on physical activity in individuals with comorbid cancer and dementia. Future studies are essential to explore the impact of exercise on the development and outcomes of these conditions, which could improve preventative strategies and care pathways for this growing population.

Background/Objectives: Advancements in breast cancer therapeutics, such as anthracyclines, are improving cancer survival rates but can have side effects that limit their use. Cardiotoxicity, defined as damage to the heart caused by cancer therapeutics, is characterised by a significant reduction in left ventricular ejection fraction (LVEF) and symptoms of cardiac dysfunction. Multiple oral supplements exist with antioxidant and anti-inflammatory properties that have the potential to lower cardiotoxicity risk and ameliorate the complications associated with left ventricular dysfunction. In this review, we evaluate the current status of using nutritional interventions to modulate cardiotoxicity. Methods: We used specific keywords to search for articles that met our predetermined inclusion and exclusion criteria to review the evidence and provide insights for future research. Results: Seven studies were identified as eligible for this review: six focused on oral supplementation strategies in breast cancer patients undergoing chemotherapy, and one focused on nutritional counselling and adherence to the Mediterranean diet in breast cancer survivors’ post-treatment. There was a significantly attenuated reduction in LVEF in five studies that monitored cardiometabolic health, and there were significant improvements in blood serum levels of cardiac biomarkers across all studies. Conclusions: Current evidence suggests that appropriate nutritional interventions, alongside chemotherapy, can modulate the risk of cardiotoxic side effects. This highlights the potential of oral antioxidant supplementation and Mediterranean diet counselling to decrease tertiary cancer therapy costs associated with cardiovascular complications.