The safety and feasibility of same-day discharge for the management of patients undergoing pulmonary lobectomy

OBJECTIVES

Is same-day discharge mode safe and feasible for thoracoscopic lobectomy? This study assesses the safety and feasibility of same-day discharge for patients undergoing thoracoscopic lobectomy.

METHODS

We conducted a prospective cohort study from January to December 2022, all patients undergoing thoracoscopic lobectomy were screened for eligibility, and participating eligible patients were separated into a same-day discharge lobectomy (SDDL) group and an inpatient lobectomy (InpL) group based upon length of stay. All discharged patients underwent 30-day postoperative follow-up performed by a team of medical professionals. In addition, eligible patients that underwent thoracoscopic lobectomy from January to December 2021 were included in the historical lobectomy (HisL) group.

RESULTS

Of the 52 patients that met the eligibility criteria for same-day discharge, 17 were discharged within 24 h after surgery. In the SDDL group, of whom 1 (5.9%) underwent emergency treatment and readmission within 30 days after surgery due to a pulmonary infection, no patients experienced complications such as reoperation, air leakage, atelectasis, chylothorax, or blood transfusion events during the follow-up period. No differences in overall postoperative complication rates were detected between the SDDL and InpL groups (P>0.05), there was a non-significantly higher rate of readmission and emergency visits in the SDDL group relative to the other two groups (P>0.05).

CONCLUSIONS

These results emphasize the safety and feasibility of same-day discharge for patients undergoing thoracoscopic lobectomy, it may further revolutionize the general approach to the hospitalization of thoracoscopic lobectomy patients.

Coping strategies and psychological distress in postoperative recovery: A repeated-measures study in women undergoing breast-conserving surgery

Objective

Breast-conserving surgery (BCS) is the standard treatment for early-stage breast cancer, yet patients often experience significant psychological distress and physical symptoms during recovery. This study aimed to explore the relationships between antecedents, physical symptoms (pain and nausea), psychological distress, and coping strategies utilized by women recovering from BCS to improve management of postoperative challenges.

Methods

This repeated-measures descriptive study involved 75 women who underwent BCS with sentinel lymph node biopsy at a National Cancer Institute-designated center. Participants completed the National Comprehensive Cancer Network (NCCN) Distress Thermometer and Ways of Coping Instrument on Postoperative Day 1 (POD1) and POD14. Bivariate analyses, multiple linear regression, and structural equation modeling were conducted to evaluate associations between antecedents, coping strategies, and distress. Open-ended responses were qualitatively analyzed for thematic content.

Results

Seeking social support (POD1 mean ​= ​1.25; POD14 mean ​= ​1.20) and planful problem-solving (POD1 mean ​= ​1.19; POD14 mean ​= ​1.04) were the most frequently used coping strategies, while accepting responsibility and confrontive coping were least utilized. Overall coping strategy use decreased between POD1 and POD14, likely reflecting recovery adaptation. Significant predictors of distress included escape-avoidance coping (β ​= ​0.415, P ​< ​0.001), social support (β ​= ​0.270, P ​= ​0.02), history of nausea (β ​= ​0.517, P ​< ​0.001), and age (β ​= ​0.293, P ​= ​0.007). Coping strategies did not mediate the relationship between antecedents and distress.

Conclusions

Adaptive coping strategies such as social support and planful problem-solving play a critical role in mitigating distress during BCS recovery. Interventions should emphasize fostering these strategies and addressing high-risk groups, such as younger patients and those with a history of nausea. Despite limitations, this study underscores the importance of supporting adaptive coping to improve postoperative outcomes and provides a basis for future research.

Correlation between cancer cachexia and psychosocial impact in older patients with advanced lung cancer undergoing chemotherapy

Objective

This study aimed to evaluate the association of cancer cachexia with psychosocial impact, nutrition impact symptoms (NIS), and geriatric assessment in older patients newly diagnosed with advanced lung cancer undergoing chemotherapy.

Methods

Older patients with advanced lung cancer scheduled to receive first-line chemotherapy between August 2021 and February 2022 were enrolled. Cachexia was diagnosed according to the International Consensus. NIS and psychosocial impacts were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ) C30, CAX24, and the Eating-Related Distress Questionnaire (ERD). Non-parametric tests evaluated the association between cachexia and its impacts. Patients with cachexia who consented to be interviewed were asked about their experiences with diet and weight changes. Three authors reviewed the interview data to ensure the analysis's veracity.

Results

Twenty-one of the 31 participants (68%) had cachexia at baseline. The cachexia group showed significantly greater severity of Food Aversion (P ​= ​0.035), Eating and Weight Loss Worry (P ​< ​0.001), and Loss of Control (P ​= ​0.005) compared to the non-cachexia group. There were no significant differences in the ERD and geriatric assessment (all P ​> ​0.05). The interview revealed that patients with cachexia perceived diet and weight changes early on and tried to manage their symptoms by themselves.

Conclusions

Cancer cachexia showed an association with NIS and psychosocial impacts. Older patients with advanced lung cancer scheduled to receive first-line chemotherapy should undergo a comprehensive assessment of cancer cachexia, including its potential physical and psychological impacts.

Trial registration

The trial registration number was UMIN 000053843.

The coping experiences in patients with hepatocellular carcinoma and their spouses following postoperative recurrence: A dyadic qualitative study

Objective

Dyadic coping practices can vary depending on cultural contexts, socioeconomic factors, and the stages of the cancer journey. This study aimed to explore the dyadic coping experiences of hepatocellular carcinoma (HCC) patients and their spouses following postoperative recurrence in the Chinese cultural context, where cancer recurrence is frequently seen as a death sentence, and family-centered care is prioritized.

Methods

A descriptive qualitative research design was used, involving face-to-face, in-depth semi-structured interviews with 13 pairs of hepatocellular carcinoma patients and their spouses at a tertiary cancer hospital from July to October 2023. The interview guide was designed based on the Actor-Partner Interdependence Model (APIM) framework. Data were analyzed using thematic analysis, and the study adhered to the COnsolidated criteria for REporting Qualitative research (COREQ) checklist.

Results

Three themes were identified: (1) active coping strategies, (2) negative coping tendencies, and (3) the need for systematic coping support. The majority of couples perceived hepatocellular carcinoma recurrence as a death sentence, which prompted them-especially the spouses-to adopt proactive strategies, such as striving to seek advanced treatments and concealing unfavorable information. In contrast, patients, particularly those with a hereditary hepatocellular carcinoma background, often exhibited passivity, withdrawal, and contemplation of treatment abandonment. Spouses frequently felt overwhelmed and unable to alleviate their partners' anxiety about recurrence and death, particularly in the absence of support from health care professionals. They expressed a strong need for professional guidance and targeted interventions to address end-of-life concerns, emphasizing the need for increased financial support, empowerment through knowledge, and access to peer support networks.

Conclusions

This research emphasizes the importance of recognizing the interdependent coping experiences of recurrent HCC patients and their spouses. Health care professionals are encouraged to implement culturally sensitive, dyadic interventions that foster collaborative coping, address death-related anxiety, and empower couples in managing recurrence together, thereby enhancing their coping strategies and confidence.

Shared-care management standards of palliative care in Chinese adults: A Delphi study

Objective

Shared-care management (SCM) in palliative care is a collaborative model where shared care teams work in partnership with patients' original health care providers, employing multimodal strategies including consultations and coordinated referrals to enhance quality of care for patients. The evidence regarding its implementation remains fragmented and lacks detailed explanations, which impedes its application in clinical practice. This study aimed to develop a SCM standard of palliative care in adults in mainland regions of China.

Methods

Initial standard framework identification was achieved via literature evidence summary. From April to August 2024, two rounds of Delphi method was conducted with the purposes of modifying the standard. To establish consensus, items with a mean importance score > 3.50 and the coefficient of variation of item scores < 0.25 were retained.

Results

The first round involved 35 experts, with a follow-up participation of 33 in the second round. The Kendall concordance coefficients of the two rounds of experts consultation were 0.128 and 0.134, respectively (all P ​< ​0.001), indicating consensus among the experts. At the end of the second round, the average importance score of each item was 4.73-5.00. A total of 8 modules including SCM team, applicable population, process of SCM, contents of SCM, start time, precautions, effectiveness evaluation and quality control, and the corresponding 22 items were finally identified in this standard.

Conclusions

The establishment of the standard in this study provides a critical framework that can be adopted by health care institutions to ensure that SCM services are delivered uniformly and effectively in mainland regions of China.

Development and psychometric testing of a self-management scale for cancer survivors with radiotherapy/chemotherapy-induced oral mucositis in China

Objective

This study aims to develop and validate a self-management scale for radiotherapy/chemotherapy-induced oral mucositis (SMS-RIOM/CIOM) in cancer survivors, addressing the need for a comprehensive tool to assess self-management capabilities.

Methods

This study employed a two-phase process: (1) initial scale development through literature review, semi-structured interviews, and expert consultations, and (2) psychometric testing with 420 cancer survivors from five wards of Zibo Hospital. The psychometric evaluation included item analysis, content validity testing, reliability assessments, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).

Results

The finalized SMS-RIOM/CIOM consists of 15 items across four dimensions: medication management, oral pain management, disease monitoring, and daily life management. EFA explained 77.322% of the total variance, while CFA demonstrated an excellent model fit (χ²/df=1.909, RMSEA=0.064, RMR=0.052, GFI=0.911, CFI=0.964, NFI=0.928, TLI=0.955, IFI=0.964). Reliability metrics were robust, including Cronbach's alpha of 0.902, split-half reliability of 0.849, test-retest reliability of 0.862, and a scale content validity index of 0.910.

Conclusions

The SMS-RIOM/CIOM is a reliable and valid tool for assessing self-management in cancer survivors with RIOM/CIOM. It provides valuable insights for clinical practice, enabling targeted interventions to improve self-management and enhance the quality of life for cancer survivors. Further research is recommended to validate its application across diverse populations and healthcare settings.

Development, validation, and clinical utility of risk prediction models for cancer-associated venous thromboembolism: A retrospective and prospective cohort study

Objectives

This study aims to develop cancer-associated venous thromboembolism (CA-VTE) risk prediction models using survival machine learning (ML) algorithms.

Methods

This study employed a double-cohort study design (retrospective and prospective). The retrospective cohort (n ​= ​1036) was used as training set (70.0%, n ​= ​725) and internal validation set (30.0%, n ​= ​311); while the prospective cohort (n ​= ​321) was used as external validation set. Seven survival ML algorithms, including COX regression, classification, regression and survival tree, random survival forest, gradient boosting survival machine tree, extreme gradient boosting survival tree, survival support vector analysis, and survival artificial neural network, were applied to train CA-VTE models.

Results

Univariate analysis and LASSO-COX regression both selected five predictors: age, previous VTE history, ICU/CCU, CCI, and D-dimer. The seven survival ML models (C-index: 0.709-0.760; Brier Score: 0.212-0.243) all outperformed Khorana Score (C-index: 0.632; Brier Score: 0.260) in external validation set. Among all models, the COX_DD model (COX regression ​+ ​D-dimer) performed best. However, ML models and Khorana Score predicted CA-VTE risk on ≥ 7 days of hospitalization with an increase in Brier Score ≥ 0.25, showing poor calibration.

Conclusions

In this study, the CA-VTE risk prediction models developed in seven survival ML algorithms outperformed Khorana Score. Combining with D-dimer can improve model performance. Applying the nomogram based on the optimal COX_DD model allows oncology nurse to reassess CA-VTE risk once a week. The prediction models developed using survival ML algorithms in this study may contribute to the dynamic and accurate risk assessment of CA-VTE for cancer survivors.

Health-related quality of life and related factors among esophageal cancer survivors after esophagectomy in the 6-month postoperative period: A multicenter cross-sectional study in north China

Objective

Esophagectomy is a primary curable treatment and a highly challenging procedure for esophageal cancer (EC) survivors. EC survivors experience various unmet needs. This study is aimed to assess unmet needs, health-related quality of life (HRQOL), and psychological distress of postoperative EC survivors.

Methods

A multicenter cross-sectional study was conducted between December 2023 and March 2024 across 28 hospitals in northern China. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Hospital Anxiety and Depression Scale, and Supportive Care Need Survey - Short Form 34 were utilized to assess the HRQOL, anxiety, depression, and unmet needs.

Results

A total of 357 postoperative EC survivors were recruited, with a mean age of 63.42 years. Approximately 14.6% exhibited borderline anxiety, and 17.9% showed borderline depression. Unmet needs were highest in health information and patient care domains. HRQOL was lower in global health, social, and physical functions post-surgery. Fatigue, appetite loss, insomnia, and financial difficulties were common. Dysphagia, dry mouth, reflux, and choking negatively impacted HRQOL. Multivariable regression analysis indicated that anxiety and depression levels were higher, and HRQOL was lower in those one week to six months post-surgery compared to one-week post-surgery.

Conclusions

EC survivors experience significant psychological distress and reduced HRQOL up to six months post-surgery. Dysphagia and unmet needs are prevalent. Compared to immediate post-surgery, EC survivors experienced higher levels of anxiety and depression, and lower level of HRQOL in six months. Future research should focus on developing individualized care strategies to provide optimal support.

Self-care and associated factors of patients with permanent colostomies: A structural equation model

Objective

To investigate the structural relationships between eHealth literacy, health-promoting behaviors, depression, disease stigma, self-efficacy and self-care in Chinese patients with permanent colostomies.

Methods

A cross-sectional multi-stage random sampling study was conducted between October 2022 and July 2023. The study involved 280 participants with permanent colostomies recruited from four general hospitals in Yancheng City, China. Data were collected using a questionnaire package to assess model variables, including health-promoting behaviors, eHealth literacy, depression, disease stigma, self-efficacy and self-care. Structural equation modeling was employed to analyze the data.

Results

The model explained 81.8% of the total variance. Health-promoting behaviors (β ​= ​0.41, P ​< ​0.001), eHealth literacy (β ​= ​0.16, P ​< ​0.001), and depression (β ​= ​-0.17, P ​< ​0.001) influenced self-care directly. On the other hand, health-promoting behaviors, depression and disease stigma influenced self-care indirectly through self-efficacy mediation. The total, direct, and indirect effects of health-promoting behaviors and depression on self-care were 0.53 and -0.26, 0.41 and -0.17, and 0.12 and 0.09, respectively, in patients with colostomies.

Conclusions

This study highlights the importance of improving health-promoting behaviors, eHealth literacy, and self-efficacy in patients with colostomies. The study also suggests that reducing depression and disease stigma could enhance patients' self-care. Health care professionals can leverage these findings to develop appropriate programs to improve patients' self-care.

Disparities in cancer-related financial toxicity across economically diverse provinces in China: A multi-center cross-sectional study

Objective

China's diverse economic landscape across its regions may contribute to disparities in cancer-related financial toxicity (FT), but empirical evidence is lacking. This study examined regional disparities in cancer-related FT across economically diverse provinces in China.

Methods

A cross-sectional study was conducted among adult patients with cancer from six tertiary and six secondary hospitals across three Chinese provinces with varying economic statuses (high-, middle-, and low-income). FT was assessed using the COmprehensive Score for financial Toxicity (COST). Hierarchical regression analysis was employed to compare FT among participants from different economic regions, controlling for 13 patient-level sociodemographic and clinical risk factors.

Results

From February to October 2022, 1208 participants completed the survey (response rate ​= ​97.3%). Mean COST scores were 21.99 ​± ​6.37 (high-income), 20.38 ​± ​8.01 (middle-income), and 19.20 ​± ​5.14 (low-income), showing significant differences (P ​< ​0.001), with lower scores indicating more severe FT. After adjusting for covariates, regional economic level was significantly associated with FT, with more severe FT in middle- (B: -1.515; 95% CI: -2.250, -0.780) and low-income regions (B: -2.159; 95% CI: -2.899, -1.418) than in high-income regions.

Conclusions

This study reveals significant disparities in cancer-related FT across economically diverse provinces in China. The findings underscore the need for targeted policies and interventions to improve health equity in cancer care, with a focus on not neglecting middle-income regions. Oncology nurses are expected to enhance awareness of FT management, voice the needs of patients, and advocate for policy reforms to address these disparities.

Effectiveness of health promotion interventions to increase faecal occult blood test uptake rates among older adults with an average-risk of colorectal cancer: A systematic review and meta-analysis

Objective

This review aims to examine the effectiveness of interventions in increasing faecal occult blood test (FOBT) uptake rates among older adults with an average-risk of colorectal cancer (CRC) and to identify essential components of such interventions based on current evidence.

Methods

Five databases were included in a systematic literature search for studies reporting randomized controlled trials (RCT) and interventions aimed at increasing FOBT uptake rates among average-risk individuals aged 50-75. Review Manager 5.4.1 was used for conducting meta-analyses and subgroup analyses.

Results

A meta-analysis of the 20 included studies demonstrated that health promotion interventions led to significant increases in FOBT uptake rates (odds ratio [OR] ​= ​1.55, 95% confidence interval (CI) ​= ​1.30-1.85; I 2 ​= ​95%). Provision of information, mailing of FOBT outreach, and reminders were identified as core components of promotion interventions to increase FOBT uptake rates. Among the different significant reminder strategies, a digital message (via text) plus telephone calls (automated and navigator-initiated) had a larger effect size than a telephone call alone. In addition, there was no significant evidence that financial incentives were associated with FOBT uptake. Most studies included a diverse mixture of components, but only a few studies utilized theoretical framework-based interventions.

Conclusions

Future studies with rigorous methodologies are warranted to examine the effectiveness and understand the mechanisms of theoretical framework-based multi-component educational programmes aimed at increasing FOBT uptake rates.

Systematic review registration

PROSPERO CRD42024520859.

Network analysis of quality of life among young and middle-aged Korean cancer survivors

Objective

This study aimed to identify and compare the network structure of quality of life factors among cancer survivors to inform tailored interventions.

Methods

A cross-sectional study was conducted using data from 330 cancer survivors aged 18-64 years, drawn from the 2019-2021 Korea National Health and Nutrition Examination Survey (KNHANES). Participants were categorized into two groups: cancer survivors with current cancer and those without. Network analysis using the EBICglasso algorithm was performed to assess eight quality of life (QoL) components measured by the Health-related Quality of Life Instrument with 8 Items (HINT-8) scale: climbing stairs, pain, vitality, work ability, depression, memory, sleep quality, and happiness.

Results

The network analysis revealed distinct patterns between the two groups. Among survivors with current cancer, depression, work ability, and vitality were the most central QoL components, suggesting a need for targeted psychological and occupational support. In contrast, survivors without current cancer exhibited a network where work ability, pain, and climbing stairs (physical function) played a dominant role, emphasizing the importance of pain management and functional rehabilitation. Work ability emerged as a critical determinant in both groups, indicating its sustained impact throughout the survivorship continuum. Additionally, the network structure in survivors without current cancer showed greater interconnectedness, reflecting the complex interplay of long-term survivorship challenges.

Conclusions

The study highlights the need for personalized, stage-specific interventions in cancer survivorship. Work remained central in both groups, emphasizing its ongoing impact on quality of life throughout the survivorship journey. While psychological support is crucial to cancer survivors with current cancer due to the centrality of depression, long-term pain management becomes increasingly important post-treatment. These findings provide valuable insights for nursing practice, suggesting that tailored interventions addressing work-related challenges, psychological distress, and chronic symptom management could improve quality of life and facilitate survivors' reintegration into daily life.

Latent profile analysis of self-management and its association with quality of life differences in patients with cancer treated with immune checkpoint inhibitors

Objective

This study aimed to explore latent profiles of self-management ability in patients with cancer treated with immune checkpoint inhibitors, analyze each subgroup's characteristics, and determine the relationship between self-management and quality of life.

Methods

This cross-sectional study included 393 patients treated with immune checkpoint inhibitors. The participants completed questionnaires containing sociodemographic information, the Functional Assessment of Cancer Therapy-Immune Checkpoint Modulator (FACT-ICM), the Cancer Patient Self-management Evaluation Scale, and the Medical Coping Modes Questionnaire. Latent profile analysis was used to examine potential latent groups of self-management. Multivariate logistic regression was used to analyze the sociodemographic variables in each profile. Kruskal-Wallis H-rank sum test was used to explore the relationships between self-management profiles and quality of life.

Results

The self-management abilities of the patients treated with immune checkpoint inhibitors were grouped into three latent profiles: "low self-management" (16.8%), "average self-management-avoidance of information" (44.3%), and "high self-management" (38.9%). The coping modes, educational levels, medical insurances, age, monthly family income per capita, and communication styles with health care professionals post-discharge significantly influenced the distribution of self-management. There were significant differences in the FACT-ICM scores across all three groups, except for the emotional well-being dimension.

Conclusions

The patients with cancer treated with immune checkpoint inhibitors exhibit three distinct self-management profiles. To enhance patients' quality of life, healthcare professionals should develop targeted self-management strategies focusing on information management and communication between patients and healthcare providers.

Symptoms associated with concurrent chemoradiotherapy in patients with cervical cancer: Application of latent profile analysis and network analysis

Objective

This study aims to explore symptom subgroups and influencing factors among patients undergoing concurrent chemoradiotherapy (CCRT) for cervical cancer, to construct a symptom network, and to identify core symptoms within the overall sample and its various subgroups.

Methods

A cross-sectional survey was conducted with 378 patients undergoing CCRT for cervical cancer from June 2023 to May 2024 at a tertiary hospital in Anhui Province. Participants completed the General Information Questionnaire, the Symptom Assessment Scale for Patients Undergoing CCRT for Intermediate and Advanced Cervical Cancer, and the Dyadic Coping Inventory. Latent profile analysis (LPA) identified symptom subgroups, while multivariate logistic regression examined influences on these subgroups. Symptom networks were developed using R language to analyze centrality indices and identify core symptoms.

Results

Patients were classified into three subgroups: low symptom burden (n ​= ​200, 52.91%), moderate symptom burden with prominent intestinal response (n ​= ​75, 19.84%), and high symptom burden (n ​= ​103, 27.25%). Multivariate logistic regression indicated that age, tumor stage, chemotherapy frequency, and dyadic coping (DC) were predictive of subgroup membership (P ​< ​0.05). Network analysis revealed sadness (r s  ​= ​1.320) as the core symptom for the overall sample, nausea (r s  ​= ​0.801) for the low symptom burden group, and vomiting (r s  ​= ​0.705, 0.796) for both the moderate symptom burden with intestinal response prominence group and the high symptom burden group.

Conclusions

Three symptom subgroups exist among patients undergoing CCRT for cervical cancer, with sadness, nausea, and vomiting identified as core symptoms. Health care professionals should provide individualized symptom management tailored to these subgroups.

The development and preliminary evaluation of a financial navigation program among patients with breast cancer in China

Objective

This study aims to develop a financial navigation program among patients with breast cancer in China and assess its feasibility, acceptability, and preliminary effects on cost-related health literacy and financial toxicity (FT).

Methods

The Medical Research Council (MRC) framework were adopted to guide the development of the financial navigation program, providing a structured approach to complex intervention development and evaluation. It consisted of three phases: evidence identification via a scoping review, intervention content modeling through qualitative study analysis, and outcome mapping based on social stress theory. The feasibility, acceptability and primary effectiveness were examined in a single-center, assessor-blinded pilot randomized controlled trial with 26 recruited patients.

Results

The financial navigation program consists of needs assessment, cost-related health education, resource/service referral and personalized counseling. The consent rate and a 1-month attrition rate for the feasibility study of the intervention were 55.9% and 7.7%, respectively. Most (91.7%) participants were satisfied with the program and perceived benefits. The intervention significantly improved cost-related health literacy, although no statistically significant between-group difference in FT was observed.

Conclusions

The MRC framework serves as a useful scientific basis for developing financial navigation program with a culturally sensitive approach. The financial navigation program was feasible, acceptable, effective in improving cost-related health literacy and has the potential to enhance FT among patients with breast cancer in China.

Trial registration

ClinicalTrials.gov Identifier NCT06355440.

Psychometric validation of the Chinese version of the Edmonton-33 scale in patients with head and neck cancer

Objective

This study aimed to translate the Edmonton-33 scale (E-33) into Chinese and evaluate its reliability and validity in patients with head and neck cancer (HNC).

Methods

In Phase 1, the E-33 was translated from English to Chinese using the Brislin double-back translation method. Content validity was evaluated by a panel of experts, and a pilot test was conducted with a small sample of HNC patients. In Phase 2, a cohort of 510 patients from Henan and Hubei provinces was recruited. Psychometric properties were assessed through item analysis; and reliability testing (including Cronbach's alpha, test-retest reliability, and split-half reliability), as well as construct validity (using exploratory and confirmatory factor analysis).

Results

The item-level content validity index (I-CVI) ranged from 0.833 to 1.000, and the scale-level content validity index (S-CVI/Ave) was 0.965. The Cronbach's alpha, the test-retest reliability coefficient, and the split-half reliability values were 0.922, 0.973, and 0.971, respectively. Four main factors were identified using exploratory factor analysis, explaining 77.07% of the total variance. Confirmatory factor analysis showed good fit indices: χ2/df ​= ​1.626, RMSEA ​= ​0.048, NFI ​= ​0.936, RFI ​= ​0.930, IFI ​= ​0.974, TLI ​= ​0.972, and CFI ​= ​0.974.

Conclusions

The Chinese version of the Edmonton-33 scale (CE-33) demonstrated high reliability and validity, suggesting its potential as a valuable self-report tool for assessing functional outcomes in Chinese-speaking HNC patients.

Home-based symptom management for patients with malignant lymphoma undergoing intermittent chemotherapy: A prospective observational study using network analysis

Objective

This study aimed to explore the symptom burden of patients with malignant lymphoma at home during the intermittent periods of chemotherapy and identify core symptoms using network analysis.

Methods

A prospective observational study was conducted, recruiting 208 patients from December 2019 to December 2020. Symptom burden was assessed using the MD Anderson Symptom Inventory-Chinese version (MDASI-C) at three time points during the first to third chemotherapy cycles (T1-T3). Symptom networks were constructed for each time point, and centrality indices were analyzed to identify core and bridge symptoms. Network comparison tests (NCT) were used to examine changes in symptom interconnectivity over time.

Results

A total of 208 participants were included in the data analysis. Fatigue and vomiting were the most prevalent and severe symptoms reported at all time points, respectively. In the presented symptom network, lack of appetite (r s  ​= ​1.13), sadness (r s  ​= ​1.20), and nausea (r s  ​= ​1.13) were the core symptoms of T1, T2, and T3, respectively. Lack of appetite (r b  ​= ​21, r c  ​= ​0.01), distress (r b  ​= ​25, r c  ​= ​0.01), and dry mouth (r b  ​= ​11, r c  ​= ​0.01) were identified as bridge symptoms at T1, T2, and T3, respectively. NCT results indicated no statistical differences in the global symptom network strength and overall edge weight among the three time points, while sadness exhibited higher betweenness and closeness in the network of T2 (T1 vs. T2, P c  ​= ​0.03, P b  ​= ​0.03; T2 vs. T3, P c  ​= ​0.01, P b  ​= ​0.03).

Conclusions

The findings highlight lack of appetite, sadness, and nausea as critical targets for symptom management in patients with malignant lymphoma undergoing intermittent chemotherapy. Caregivers and healthcare providers should focus on these symptoms to improve home-based symptom management and enhance patient well-being.

Impact of informed consent quality on illness uncertainty among patients with cancer in clinical trials: A cross-sectional study

Objective

This study aimed to examine the level of illness uncertainty and the quality of informed consent among patients with cancer participating in clinical trials and explore their interrelationship.

Methods

A cross-sectional study was conducted with 265 patients with cancer recruited from a tertiary hospital in Beijing, China, from April to November 2023. Participants completed a questionnaire encompassing demographic details, the Mishel Uncertainty in Illness Scale, and the Quality of Informed Consent Questionnaire. Descriptive statistics, correlation analyses, and multiple regression analyses were performed to assess the data.

Results

The mean illness uncertainty score was 40.63 ​± ​10.12, reflecting a moderately low level of uncertainty, with "Ambiguity" scoring the highest among its dimensions. The mean score for informed consent quality was 3.30 ​± ​1.20, indicating a moderate level of understanding, with notable gaps in elements such as alternatives and confidentiality. A significant negative correlation was found between the "Foreseeable risks or discomforts" element of informed consent and overall illness uncertainty (P ​< ​0.05). Regression analysis revealed that factors such as clinical trial phase, primary caregiver relationship, and health insurance model significantly influenced illness uncertainty and its dimensions.

Conclusions

Enhancing the quality of informed consent can effectively reduce illness uncertainty among patients with cancer in clinical trials. Greater emphasis should be placed on clear communication of risks and discomforts and patient-centered interventions to mitigate psychological stress.

Development of a dyadic mindfulness self-compassion intervention for patients with lung cancer and their family caregivers: A multi-method study

Objective

Lung cancer and its prolonged treatment are profoundly unsettling for patients and their family caregivers, and developing dyadic measures to alleviate their negative affectivity is pivotal. This study aimed to develop a complex intervention to alleviate dyadic psychological stress among patients with lung cancer and their family caregivers.

Methods

A stepwise multi-method study was conducted following the Medical Research Council framework. Three phases were adopted, namely: (1) a preparation phase, a systematic review was conducted to identify the evidence base, (2) a development phase, empirical data from a quantitative study and a qualitative study were integrated to identify effective components, and (3) a modification phase, an online Delphi survey was carried out to refine the intervention.

Results

The dyadic Mindfulness Self-Compassion intervention developed in this study consists of six weekly sessions. The key components of the intervention include: (1) getting along with cancer (introductory session targets illness perception), (2) practising mindful awareness (core session for mindfulness), (3) defining dyadic relationships and introducing self-compassion (core session for self-compassion), (4) promoting dyadic communication (maintenance session targets communication skills), (5) promoting dyadic coping (maintenance session targets coping skills), and (6) a summary session reviewing the rewards and challenges of dyadic adaptation named embracing the future.

Conclusions

An evidence-based, theory-driven, and culturally appropriate dyadic Mindfulness Self-Compassion intervention was developed for patients with lung cancer and their family caregivers. Future studies are warranted to pilot and evaluate the usability, feasibility, acceptability, satisfaction, and effectiveness of this complex intervention.

Trial registration

ClinicalTrial.gov NCT04795700.

Experiences and barriers in downward referral decision-making for palliative care patient caregivers under China's three-tiered linkage model: A qualitative study

Objective

This study aimed to explore hospice caregivers' downward referral decision-making experiences and barriers under the triadic linkage model in China and to analyze the deeper social dynamics of hospice referral choices.

Methods

Semi-structured interviews were conducted with caregivers handling hospice referrals from two primary hospice agencies in Nanjing, China. The themes were analyzed and summarized using the Colaizzi 7-step analysis.

Results

Four themes and nine subthemes were extracted: multidimensional caregiver psychological experience (Dilemma and Guilt, Emotional Support and Psychological Adaptation), perceived disparities between referral organizations (convenience and affordability in the home community, perceived lack of primary health care resources), limitations of caregiver decision-making (cognitive comprehension bias, difficulty in information seeking, and passive acceptance of decision making), and limitations of health care referral support (lack of health care referral guidance, inadequate referral handoffs).

Conclusions

Feedback from caregivers of hospice-referred patients reveals many barriers to hospice referral decision making and referral implementation. Overcoming these barriers entails efforts to change the cognitive misunderstandings regarding hospice referrals from patients' perspective, clarify the distribution of responsibilities among hospice agencies, and provide information support and decision-making assistance. These measures must be employed to improve the implementation of hospice referral, realize the multiple benefits of hierarchical diagnosis and treatment, boost patients' satisfaction with the referrals, and ensure the rational and efficient distribution of hospice resources.

Development and validation of the symptom assessment scale for patients with nasopharyngeal cancer undergoing radiotherapy

Objective

This study aims to develop the Symptom Assessment Scale for Patients with Nasopharyngeal Cancer Undergoing Radiotherapy (SAS-NPC), based on the Symptom Experience Model.

Methods

In Phase 1, a content analysis of the literature and group discussions were conducted to construct an initial pool of 61 items. Following expert review by 16 specialists and cognitive interviews with 10 patients, the pool was refined to 56 items. In Phase 2, a convenience sampling method was used to recruit 625 patients with nasopharyngeal cancer (NPC) undergoing radiotherapy, who assessed and explored the scale items. Phase 3 focused on evaluating the scale's reliability and validity.

Results

The SAS-NPC consists of 7 dimensions and 33 items. Reliability analysis revealed a Cronbach's α coefficient of 0.928 for the total scale, a split-half reliability of 0.790, and a retest reliability of 0.828. Validity analysis showed content validity indices for each item ranging from 0.833 to 1.000, with an overall content validity index of 0.970 for the scale. Exploratory factor analysis (EFA) identified 7 common factors, which accounted for 74.505% of the total variance. Confirmatory factor analysis (CFA) demonstrated good overall model fit.

Conclusions

The SAS-NPC comprehensively captures acute and long-term symptoms associated with patients with NPC undergoing radiotherapy. The scale exhibits strong reliability and validity, making it an ideal tool for assessing NPC symptom burden and facilitating clinical symptom management.

Identifying the heterogeneity of self-advocacy in Chinese patients with breast cancer using latent profile analysis and symptom networks

Objective

This study aims to identify subgroups of self-advocacy in patients with breast cancer, assess the heterogeneity among different subgroups, and further delineate symptom networks within each subgroup.

Methods

A cross-sectional survey was conducted among 320 patients with breast cancer in Wuxi, China, from September 2023 to March 2024, who completed questionnaires about their demographic and clinical characteristics, the M.D. Anderson Symptom Inventory, and the Female Self Advocacy in Cancer Survivorship scale. Latent profile analysis was conducted to identify subgroups of self-advocacy. Multinomial logistic regression was employed to reveal the heterogeneity of each subgroup in demographics and clinical characteristics. Network analysis was performed to unveil the network structure of clinical symptoms within each subgroup.

Results

Three subgroups were identified: "Profile 1: low self-advocacy", "Profile 2: moderate self-advocacy", and "Profile 3: high self-advocacy". Compared with patients in Profile 3, those in Profile 1 and Profile 2 showed a higher tendency to have more severe symptoms. Network analysis further revealed that "lack of appetite" emerged as the core symptom in Profile 1, while the core symptom in Profile 2 and Profile 3 was "distress".

Conclusions

Patients in different subgroups manifest individualized self-advocacy. The severity of clinical symptoms might serve as an important risk factor for those with low levels of self-advocacy. Conducting symptom networks of diverse subgroups can facilitate tailored symptom management by focusing on core symptoms, thereby enhancing the effectiveness of interventions and improving patients' self-advocacy and overall quality of life.

Latent profile analysis of fear of cancer recurrence in patients with prostate cancer: Insights into risk factors and psychological interventions

Objective

To explore fear of cancer recurrence (FCR) profiles in prostate cancer survivors, identify heterogeneous subgroups, and examine influencing factors to provide a reference for improving mental well-being and overall quality of life.

Methods

A convenience sample of 389 patients completed a questionnaire that assessed general and disease-related data, including the Fear of Progression Questionnaire-Short Form, Perceived Social Support Scale, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. Statistical analysis involved latent profile analysis (LPA), Bolck-Croon-Hagenaars methods and multinomial logistic regression.

Results

Three FCR profiles were identified: "Adapted" (25.7%), "Struggling" (42.2%), and "Dysregulated" (32.1%). Compared to the Adapted group, factors associated with the Struggling group included age, social support, and employment status, while factors associated with the Dysregulated group included age, social support, and time since diagnosis. From Adapted to Dysregulated, physical, cognitive, emotional, and social function declined, while dyspnea, insomnia, and financial difficulties increased.

Conclusions

The psychological problems caused by the FCR in patients with prostate cancer seriously affect their physical, emotional, cognitive and social functions. Targeted intervention strategies should be developed for different categories of patients with prostate cancer to improve the FCR and promote the health-related quality of life.

Exploring the relationship between illness perception, self-transcendence, and demoralization in patients with lung cancer: A latent profile and mediation analysis

Objective

This study examined the heterogeneity of illness perceptions in patients with lung cancer and evaluated the mediating role of self-transcendence in the relation between illness perception and demoralization.

Methods

A convenience sample of 477 patients with lung cancer was selected from three tertiary hospitals in Wuhan, China, between January and June 2024. Participants completed the Brief Illness Perception Questionnaire, Self-Transcendence Scale, and Demoralization Scale. Data were analyzed using Mplus 8.3 and SPSS 25.0.

Results

Three latent illness perception profiles were identified among patients with lung cancer: low (27.25%), moderate (40.04%), and high (32.71%). Mediation analyses revealed a partial mediation effect in the relation between illness perception and demoralization in the low versus moderate (SE ​= ​1.56, 95% CI ​= ​14.71, 20.86) and high versus low illness perception groups (SE ​= ​1.71, 95% CI ​= ​35.44, 42.71).

Conclusions

Patients with lung cancer exhibited heterogeneous illness perceptions, and self-transcendence partially mediated the relation between illness perception and demoralization. Promoting self-transcendence may help mitigate the negative impact of illness perceptions on demoralization. Clinical interventions aimed at reducing negative illness perceptions and enhancing self-transcendence should be prioritized in the care of patients with lung cancer.

Upper limb symptoms in breast cancer survivors with lymphedema: A latent class analysis and network analysis

Objective

Breast cancer survivors (BCS) with lymphedema experience multiple symptoms in upper limbs that significantly impact their quality of life. The complexity of symptomology and the connection among these symptoms are unclear. This study aimed to identify upper limb symptom subgroups and symptom networks among BCS.

Methods

This secondary analysis included individuals with lymphedema (defined as an inter-limb circumference difference of ≥ 2 cm) from three cross-sectional studies among post-surgery BCS. Upper limb symptoms were assessed by the Breast Cancer and Lymphedema Symptom Experience Index. Descriptive analysis, latent class analysis, logistic regression analysis, and network analysis were performed.

Results

A total of 341 BCS with upper limb lymphedema were included. Swelling, heaviness and tightness were the most prevalent symptoms. Four distinct latent classes were identified: "Severe symptom" group (Class 1: 9.4%), "Movement-limitation and lymph-stasis" group (Class 2: 24.6%), "Lymph-stasis" group (Class 3: 37.5%), and "Mild symptom" group (Class 4: 28.4%). BCS with axillary lymph node dissection, radiotherapy, longer post-surgery duration, and without medical insurance were less likely to belong to the mild symptom group (P ​< ​0.001). Symptom network density decreased from Class 1 to 4. Core symptoms for each symptom network were tenderness, firmness, arm-swelling, and heaviness, respectively.

Conclusions

This study identified four distinct categories of upper limb symptoms and influencing factors among individuals with breast cancer-related lymphedema (BCRL). Our findings suggest the need to consider individualized approaches to symptom management and support for BCRL, taking into account their specific symptom clusters and associated risk factors.

Network analysis of fatigue symptoms in Chinese patients with advanced cancer

Objective

This study was aimed at investigating the network structures of fatigue symptoms in patients with advanced cancer, with a focus on identifying the central symptom-an aspect crucial for targeted and effective fatigue symptom management.

Methods

In this cross-sectional study, patients with advanced cancer were recruited from the cancer treatment center of a tertiary hospital in China between January and December of 2022. Symptom occurrence and severity were assessed with the Cancer Fatigue Scale. Network analysis was conducted to explore the network structure and identify the core fatigue symptoms.

Results

The study included 416 patients with advanced cancer. Lack of energy (2.25 ​± ​1.24), lack of interest in anything (2.20 ​± ​1.22), and lack of self-encouragement (2.03 ​± ​1.25) were the most severe fatigue symptoms and belonged to the affective fatigue dimension. In the overall network, reluctance (r s  ​= ​5.622), a heavy and tired body (r s  ​= ​5.424), and tiring easily (r s  ​= ​5.319) had the highest strength values. All these core symptoms were classified within the physical fatigue dimension and remained stable before and after adjustment for covariates.

Conclusions

This study identified reluctance, a heavy and tired body, and tiring easily as the core fatigue symptoms in patients with advanced cancer, thus providing valuable insight to help clinical nurses formulate more effective symptom management strategies. Future interventions could assess the efficacy of targeting the central symptom cluster in alleviating other symptoms and patient burden.

Identifying core symptom clusters based on symptom distress levels in patients with maintenance hemodialysis: a cross-sectional network analysis

BACKGROUND

To explore the symptom clusters of patients undergoing maintenance hemodialysis and construct a symptom network to identify the core symptoms and core symptom clusters, to provide reference for precise symptom management.

METHODS

Conveniently selected 354 patients with maintenance hemodialysis were surveyed cross-sectionally using the general information questionnaire, the Dialysis Symptom Index and the Kidney Disease Questionnaire. Symptom clusters were extracted using exploratory factor analysis, and core symptom clusters were identified using hierarchical regression and network analysis.

RESULTS

The most common and severe symptoms were fatigue, dry skin and itching, and the most distressing symptoms were fatigue, itching and trouble falling asleep. Within the symptom network, worry (rs = 1.0) had the highest strength, trouble staying asleep(rc = 0.01) had the highest closeness, and fatigue had the highest betweenness (rb = 30) and bridge strength (rbs = 0.53). A total of four symptom clusters were extracted, namely psychological symptom cluster, sleep disorder symptom cluster, uremia-related symptom cluster, and neurological symptom cluster. Hierarchical regression results showed that the psychological symptom cluster had the greatest impact on patients' quality of life.

CONCLUSIONS

Fatigue was the most severe symptom and the bridge symptom, the uremia-related symptom cluster caused the greatest distress for patients, worry was the core symptom, and the psychological symptom cluster was identified as the core cluster. Clinical staff can provide effective symptom management and improve patient symptom burden by establishing intervention strategies centered on these results.

A cross-sectional study on knowledge, attitude and practice of osteoporosis prevention in patients with breast cancer undergoing endocrine therapy: A cross-sectional study

Objectives

This study aims to understand the current status of knowledge, health beliefs, and behavior related to osteoporosis prevention in patients with breast cancer during endocrine therapy and to analyze its influencing factors.

Methods

From December 2022 to June 2023, convenience sampling was used to investigate patients with breast cancer receiving endocrine therapy in a Class III Grade A hospital in Shanghai using the general information questionnaire, Osteoporosis-Related preventive Behavior Questionnaire, Osteoporosis Knowledge Questionnaire (OKT), and Osteoporosis Health Belief Scale (OHBS).

Results

Four hundred thirty-five questionnaires were distributed, and 403 valid questionnaires were collected, with an effective recovery rate of 92.6%. OKT failed in 282 cases (70.0%), and the standard score was (52.53 ​± ​12.01). The standard score of OHBS was (72.46 ​± ​5.79). The results of univariate analysis showed that age was negatively correlated with daily sunshine time. It was positively correlated with calcium/vitamin D supplementation and bone mineral density measurement. Multiple linear regression analysis showed that age and education level influenced OKT and OHBS scale scores (P ​< ​0.05). Pearson correlation analysis showed a significant positive correlation between OKT and OHBS (P ​< ​0.05).

Conclusions

Patients with breast cancer with endocrine therapy have poor knowledge of osteoporosis and low levels of health belief, and most of them have wrong prevention behaviors.

Artificial intelligence-assisted machine learning models for predicting lung cancer survival

Objective

This study aimed to evaluate the feasibility of large language model-Advanced Data Analysis (ADA) in developing and implementing machine learning models to predict survival outcomes for lung cancer patients, with a focus on its implications for nursing practice.

Methods

A retrospective study design was employed using a dataset of lung cancer patients. Data included sociodemographic, clinical, treatment-specific, and comorbidity variables. Large language model-ADA was used to build and evaluate three machine learning models. Model performance was validated, and results were presented using calibration plots.

Results

Of 737 patients, the survival rate of this cohort was 73.3%, with a mean age of 59.32 years. Calibration plots indicated robust model reliability across all models. The Random Forest model demonstrated the highest predictive accuracy among the models. Most critical features identified were preoperative white blood cells (2.2%), preoperative lung function of Forced Expiratory Volume in one second (2.1%), preoperative arterial oxygen saturation (1.9%), preoperative partial pressure of oxygen (1.7%), preoperative albumin (1.6%), preoperative preparation time (1.5%), age at admission (1.5%), preoperative partial pressure of carbon dioxide (1.5%), preoperative hospital stay days (1.5%), and postoperative total days of thoracic tube drainage (1.4%).

Conclusions

Large language model-ADA effectively facilitates the development of machine learning models for lung cancer survival prediction, enabling non-technical health care professionals to harness the power of advanced analytics. The findings underscore the importance of preoperative factors in predicting outcomes, while also highlighting the need for external validation across diverse settings.

Feasibility and preliminary efficacy of a systematic transaction model-guided dyadic coping nursing intervention for patients with breast cancer and their spousal caregivers: A pilot study

Objective

This study aimed to assess the feasibility, acceptability, and preliminary efficacy of a Systematic Transaction Model (STM)-guided dyadic coping nursing intervention for patients with breast cancer and their spouses.

Methods

A single-arm, pre-test/post-test pilot study was conducted at a tertiary hospital in Wuxi, China, recruiting 28 breast cancer patient-caregiver pairs. Each dyad participated in six hybrid intervention sessions. Paired t-tests were used to evaluate pre- and post-intervention changes, and effect sizes were calculated. Feasibility was assessed by recruitment and retention rates, acceptability via the Client Satisfaction Questionnaire-8 (CSQ-8), and preliminary efficacy through measures of body image, dyadic coping, post-traumatic growth, and marital satisfaction.

Results

All 28 dyads completed the intervention. Patients showed small-to-moderate improvements in body image, post-traumatic growth, dyadic coping, and marital satisfaction (d ​= ​0.4-0.5, P ​≤ ​0.022), with clinically meaningful changes observed in 39%-68% of patients. Spousal caregivers also demonstrated improvements in post-traumatic growth, dyadic coping, and marital satisfaction (d ​= ​0.3-0.6, P ​≤ ​0.033), with 36%-46% showing clinically important differences.

Conclusions

This pilot study supports the feasibility and initial efficacy of an STM-guided dyadic coping intervention, which may benefit breast cancer patients and their spouses as a unit. Further large-scale trials are recommended to validate these findings.

Trial registration

China Clinical Trial Registry (ChiCTR2400083416).

The role of a cardio-oncology clinical nurse specialist in the United Kingdom

Cardio-oncology is a growing subspeciality of cardiology that involves the prevention and early detection of cancer therapy-related cardiovascular toxicity (CTR-CVT). Cardiovascular complications can occur before, during and after cancer treatment, due to de novo cardiotoxicity or an exacerbation of a previous cardiac condition. Therefore, cancer patients undergoing cancer treatment need to be assessed before, during and after their cancer treatment. This article describes the development and progress of a specialised nursing role, known as a Clinical Nurse Specialist (CNS), at the Royal Brompton Hospital in London, United Kingdom (UK).

An ideal portrait of the professional competence of clinical research nurses: A qualitative study

Objective

This study aims to identify and define the ideal professional competencies of Clinical Research Nurses (CRNs) in China, focusing on the essential knowledge, skills, and personal attributes required for effective practice in clinical trials.

Methods

Interviews were conducted with CRNs, Nurse Managers (NMs), Principal Investigators (PIs), Sub-Investigators (SIs), Clinical Research Coordinators (CRCs), Clinical Research Associates (CRAs), and subjects. Thematic analysis was performed using Colaizzi's seven-step method to analyze interview data and identify key competencies.

Results

The study identified four primary themes that characterize the ideal CRN profile: (1) theoretical knowledge ability, (2) practical technical ability, (3) professional quality and ability, and (4) personal traits. A total of 21 specific indicators were delineated, reflecting the diverse expectations of various stakeholders in clinical trials.

Conclusions

The findings highlight the multifaceted nature of CRN competencies, emphasizing the importance of comprehensive training programs tailored to the needs of CRNs. This study provides a foundational framework for enhancing CRN training and professional development in China.

Adolescent childhood cancer survivors talking about cancer: A socioecological perspective

Objective

This study aimed (1) to investigate the communication patterns of adolescent childhood cancer survivors (ACCSs), including their motivations, methods, context, and outcomes and (2) to identify factors influencing their cancer-related communication (cancer communication) at each level of the socioecological model.

Methods

A qualitative descriptive research design was adopted to explore ACCSs' experiences of communicating about cancer and the factors influencing such experiences. Semi-structured interviews were conducted, and the collected data were analyzed using thematic analysis. This study was conducted according to the Standards for Reporting Qualitative Research.

Results

The ACCSs were motivated to engage in cancer-related communication by acquiring social support and an altruistic perspective. Although ACCSs rarely initiated cancer-related communication proactively, they communicated with close friends and family members about their cancer experiences. The motivation to communicate with friends shifted from sharing factual information, such as their daily lives in the hospital, to seeking emotional connections shaped by psychosocial development. Dissatisfaction with the limitations of school life and concerns about cancer were primarily discussed with parents. Furthermore, parents' perceptions of cancer and their explanations of the illness to their children appeared to influence the children's perceptions of their cancer experiences and their communication about cancer. Cancer-related communication among ACCSs was influenced by factors at multiple levels. Furthermore, institutional- and community-level factors affected individual and interpersonal factors.

Conclusions

A multilayered approach involving ACCSs, parents, educators, school peers, and the broader community is essential for enhancing communication about cancer within this population.

A narrative review of medical and surgical nurses' attitudes and perceptions when caring for patients with a secondary diagnosis of mental illness

BACKGROUND

Medical and surgical nurses are responsible for prioritising patient-centred and holistic care. It is necessary for nurses to possess the relevant knowledge and interpersonal skills to deliver culturally responsive, compassionate, safe, and effective care to patients who have comorbidities inclusive of mental health conditions. It is important to acknowledge reported experiences of mistreatment, and discrimination from patients with a secondary diagnosis of mental illness (SDMI). To counter poor nursing practice and disrupt discriminatory attitudes and perceptions of medical and surgical nurses it is necessary for nurse educators to embed anti-discriminatory and social justice pedagogy into pre-registration nurse education.

AIM

This review seeks to explore and identify the attitudes and perceptions of medical and surgical nurses when caring for patients with a secondary diagnosis of mental illness.

METHOD

This literature review used a systematised approach to retrieve evidence that assessed the attitudes and perceptions of nurses when caring for patients with a SDMI in medical and surgical ward environments. Five databases were searched (PubMed, Embase, Clinical Knowledge Network, Cochrane and PsycInfo) between 2011 and 2023. Thematic synthesis was conducted on studies that met the following inclusion criteria: a) nurses as research participants who have cared or currently care for patients with a SDMI, b) nurse's attitudes, perceptions, feelings, and experiences, and c) surgical and medical inpatient units. Studies were excluded if they were: a) systematic reviews; b) reviews; c) literature not in English and d) grey literature.

RESULTS

8 peer reviewed articles were included. Nurses' attitudes and perceptions were found to be stigmatising and discriminatory towards patients with a SDMI and negatively impacted their care. The themes from the retrieved evidence suggests that nurses commonly viewed patients with a SDMI as risky, unpredictable, fear inducing, and created feelings of futility and reduced professional satisfaction. Nurses felt unprepared when caring for this patient group. Several factors that negatively impacted nurses' preparedness included their previous education in mental health, personal experience with mental health issues, and social demographic variables.

CONCLUSION

Education reform in nursing is necessary to improve healthcare advocacy and safety for patients with a SDMI, cared for in medical and surgical nursing environments. This can only be achieved through a nursing workforce cognisant with human rights and social justice principles. Fair, just, and compassionate nursing responses to patient with a SDMI recognizes critical concepts of mental health recovery, hope and anti-discriminatory pedagogy in nurse education. Critical social justice approaches in curriculum provides nursing students with lessons to understand complex health issues, and national and global disparities in health that exist according to social, cultural, racial and political determinants of health and wellbeing. Recommendations to address these concepts include in-service mental health training focusing on clinical knowledge, clinical mentorship, anti-stigmatising training and simulation-based exercises based upon social justice principles in pre-registration nurse education curriculum.

Perception and sentiment analysis of palliative care in Chinese social media: Qualitative studies based on machine learning

BACKGROUND

Traditional Chinese culture makes death a sensitive and taboo topic, leading patients and family members to refuse to choose palliative care.

AIM

To explore the current situation of the public's perception and sentiment towards palliative care and reduce the barriers health-related persons face in providing professional services.

METHOD

The research steps include text acquisition, text cleaning, data standardization, K-Means clustering algorithm, and sentiment analysis algorithm.

RESULTS

This study had 9017 comments. The comments increased yearly from 2014 to 2023. K-Means clustering results showed patients' physical condition, disease knowledge, and nursing service. Boson NLP results showed 3264 negative comments, 3451 positive comments, and 2302 neutral objective comments. The dictionary method showed positive and negative emotions such as anger, disgust, fear, sad, surprise, good, and happy. Negative emotions were mainly in Physical and mental condition. Positive emotions were mainly in nursing service and unrelated to disease knowledge.

CONCLUSION

Healthcare professionals should pay attention to the adverse effects of public misperceptions and negative emotions. They provide appropriate measures to enhance positive emotions and perceptions and encourage patients to accept palliative care.

Trajectories of Child and Caregiver Positive Coping Following a Brief Emotion-Focused Family Therapy (EFFT) Intervention

Families play an influential role in promoting positive coping (PC) among youth, which has led to the development of family-based interventions, such as emotion-focused family therapy (EFFT). The present study examined trajectories of PC over 1 year following a 2-day virtual caregiver group EFFT intervention. Participants included 155 caregivers who attended the EFFT intervention. Caregivers completed measures on themselves and up to four children at six time points from pre-intervention to 12-month follow-up. Higher-order growth curve analysis modelled trajectories of PC for individuals nested within families. Participants exhibited an increase in PC over 12 months. Caregivers had higher initial PC levels than children and improved at a slower rate. Finally, participants in families with higher social support and lower family dysfunction had higher baseline PC. These variables did not predict change. Findings reveal that aspects of the family environment are related to PC, highlighting the importance of family-based interventions.

Comprehensive Evaluation of Cancer Treatment-Related Cardiac Dysfunction by Ultrasound Myocardial Strain: A Network Meta-Analysis

Anticancer treatment regimens are effective but may lead to cardiac dysfunction. The meaning of this statement is that myocardial strain can be a good indicator of cancer treatment-related cardiac dysfunction. We used Bayesian network meta-analysis to compare and rank these regimens to comprehensively evaluate their influence on the heart. We searched multiple databases to identify relevant studies. Global longitudinal strain (GLS), global radial strain, global circumferential strain, and other parameters were collected at baseline (T0), from baseline to 3 months of follow-up (T3), from 3 months to 6 months of follow-up (T6), and from 6 months to 12 months or longer of follow-up (T12). The weight mean differences (WMD) with 95% confidence intervals (CI) were used to express continuous variables. Direct and indirect comparison and ranking of different regimens based on the forest plots and the surface under the cumulative ranking area. A total of 4613 subjects were included in 33 studies. Anthracycline-based chemotherapy (ANT), trastuzumab, paclitaxel plus carboplatin or clofarabine, and radiotherapy (RT) were more likely to reduce GLS and global circumferential strain at T3 and T12. In particular, ANT+RT resulted in a more significant decrease in GLS than ANT alone at T12 (WMD 1.15; 95% CI, 0.05-2.26). Interestingly, cardioprotective treatment regimens, such as anthracycline plus bisoprolol plus angiotensin-converting enzyme inhibitors (ANT+BB+ACEIs) (WMD -2.79; 95% CI, -5.06 to -0.52), and ANT plus rosuvastatin (STATINs) (WMD -2.92; 95% CI, -5.54 to -0.29), were more likely to improve GLS than ANT at T12. The included anticancer regimens, especially ANT+RT, reduced GLS at T12, but their combination with cardioprotective drugs improved them. These results will help clinicians choose the best therapy regimens.

Effectiveness of peri-operative psychological interventions for the reduction of postsurgical pain intensity, depression, anxiety and pain catastrophising: A systematic review and meta-analysis

BACKGROUND

Evidence suggests that psychological interventions during the peri-operative period can help reduce the development of chronic postsurgical pain (CPSP); however, there is no evidence of their effects on other important pain-related variables.

OBJECTIVES

This systematic review and meta-analysis evaluated the effectiveness of peri-operative psychological interventions for the reduction of postsurgical pain intensity, depression, anxiety, stress and pain catastrophising.

STUDY DESIGN

Systematic review of randomised controlled trials (RCTs) with meta-analyses (registration number: CRD42023403384). The search for studies was carried out in Web of Science, PsychINFO, MEDLINE and CINAHL up to March 2023.

ELIGIBILITY CRITERIA

RCTs comparing peri-operative psychological interventions with usual care or nonpsychological control interventions in adult patients with any type of surgery. The main outcome was pain intensity reduction after surgery. Secondary outcomes included patient-reported depression, anxiety, stress and pain catastrophising after surgery.

RESULTS

Twenty-seven RCTs (psychological intervention: 1462 patients; control: 1528 patients) were included in the systematic review and 17 studies for the meta-analysis. Random-effect models were used to combine the effect sizes of the studies. Compared with usual care or control interventions, psychological interventions reduced pain intensity, d = -0.45 95% CI, (-0.77 to -0.13) and anxiety, d = -0.33 95% CI, (-0.54 to -0.11) after surgery. Moderator analyses revealed that psychological interventions delivered by a psychologist were more effective than those delivered by other professionals. CBT seemed the most beneficial for surgical patients. The findings in other moderator analyses were heterogeneous.

CONCLUSIONS

Moderate-quality evidence exists that peri-operative psychological interventions can significantly reduce pain intensity and anxiety postsurgery. However, results should be interpreted with caution because of the presence of a high risk of bias in many trials.

The Implementation of Enhanced Recovery After Spine Surgery in High and Low/Middle-income Countries: A Systematic Review and Meta-Analysis

In this review article, we explore the implementation and outcomes of enhanced recovery after spine surgery (spine ERAS) across different World Bank country-income levels. A systematic literature search was conducted through PubMed, Embase, Scopus, and CINAHL databases for articles on the implementation of spine ERAS in both adult and pediatric populations. Study characteristics, ERAS elements, and outcomes were analyzed and meta-analyses were performed for length of stay (LOS) and cost outcomes. The number of spine ERAS studies from low-middle-income countries (LMICs) increased since 2017, when the first spine ERAS implementation study was published. LMICs were more likely than high-income countries (HICs) to conduct studies on patients aged ≥18 years (odds ratio [OR], 6.00; 95% CI, 1.58-42.80), with sample sizes 51 to 100 (OR, 4.50; 95% CI, 1.21-22.90), and randomized controlled trials (OR, 7.25; 95% CI, 1.77-53.50). Preoperative optimization was more frequently implemented in LMICs than in HICs (OR, 2.14; 95% CI, 1.06-4.41), and operation time was more often studied in LMICs (OR 3.78; 95% CI, 1.77-8.35). Implementation of spine ERAS resulted in reductions in LOS in both LMIC (-2.06; 95% CI, -2.47 to -1.64 d) and HIC (-0.99; 95% CI, -1.28 to -0.70 d) hospitals. However, spine ERAS implementation did result in a significant reduction in costs. This review highlights the global landscape of ERAS implementation in spine surgery, demonstrating its effectiveness in reducing LOS across diverse settings. Further research with standardized reporting of ERAS elements and outcomes is warranted to explore the impact of spine ERAS on cost-effectiveness and other patient-centered outcomes.

Anticancer therapy-induced peripheral neuropathy in solid tumors: diagnosis, mechanisms, and treatment strategies

Anticancer therapy-induced peripheral neuropathy (PN) is a common adverse event during the diagnosis and treatment of solid tumors. The drug class, cumulative dose, and individual susceptibility affect the incidence and severity of PN. Owing to the lack of specific biomarkers and imaging tests, the diagnostic criteria for PN remain unclear. Moreover, the available and effective clinical treatment strategies are very limited, and most of the current drugs focus on symptom management rather than fundamental reversal of the disease course. The morbidity mechanisms of PN are diverse, including direct neurotoxicity, mitochondrial dysfunction, and disruption of axonal transport. Here, we summarize the diagnosis, mechanisms, and neuroprotective strategies of PN and discuss potential intervention treatments.

Application of enhanced recovery after surgery in perioperative care of infants and children with Hirschsprung disease

BACKGROUND

Enhanced recovery after surgery (ERAS) represents an innovative, protocol-driven perioperative care program designed to optimize patient outcomes. However, its application and efficacy in infants and children with Hirschsprung disease (HD) remain underexplored.

AIM

To delve into the impact of ERAS on perioperative recovery and the overall medical experience in HD infants and children.

METHODS

Thirty-eight infants and children with HD who received the Soave surgical procedure were enrolled in this case-control study. According to age- and sex-stratified single-blind randomized tables, 20 cases received ERAS treatment (ERAS group) and 18 cases received conventional treatment (control group). The two treatments were then compared in terms of perioperative recovery and medical experience.

RESULTS

Significant differences were observed in pain scores at awakening (4.2 ± 1.3 vs5.2 ± 1.2, t = 2.516, P = 0.017) and pain duration (85.69 ± 7.46 hours vs 67.00 ± 8.56 hours, t = 7.139, P < 0.001) between the ERAS and control group. The recovery of bowel movement was earlier in the ERAS group than in the control group (borborygmus time: 33.63 ± 9.83 hours vs 44.69 ± 16.85 hours, t = 2.501, P = 0.017; feeding time: 36.63 ± 9.55 hours vs 49.36 ± 16.99 hours, t = 2.884, P = 0.007; anal catheter indwelling time: 75.83 ± 13.80 hours vs 93.36 ± 20.65 hours, t = 3.104, P = 0.004), and fever duration (40.73 ± 14.42 hours vs 52.63 ± 18.69 hours, t = 2.211, P = 0.034). In the ERAS group, hospital stay was shorter (7.5 ± 0.9 days vs 8.3 ± 1.2 days) and the cost was lower (14203 ± 2381 yuan vs 16847 ± 3558 yuan). During the 1-month follow-up period, of the multiple postoperative complications observed, the occurrence of perianal dermatitis (P_Fisher = 0.016) and defecation dysfunction (P_Fisher = 0.027) were lower in the ERAS group than in the control group.

CONCLUSION

The ERAS protocol has the potential to profoundly enhance postoperative recovery and significantly elevate the overall comfort and quality of the medical experience, making it an indispensable approach that warrants widespread adoption. Continuous refinement through evidence-based practices is anticipated to further optimize its efficacy.

Optimizing bone marrow harvesting sites for enhanced mesenchymal stem cell yield and efficacy in knee osteoarthritis treatment

Knee osteoarthritis (OA) is a debilitating condition with limited long-term treatment options. The therapeutic potential of mesenchymal stem cells (MSCs), particularly those derived from bone marrow aspirate concentrate, has garnered attention for cartilage repair in OA. While the iliac crest is the traditional site for bone marrow harvesting (BMH), associated morbidity has prompted the exploration of alternative sites such as the proximal tibia, distal femur, and proximal humerus. This paper reviews the impact of different harvesting sites on mesenchymal stem cell (MSC) yield, viability, and regenerative potential, emphasizing their relevance in knee OA treatment. The iliac crest consistently offers the highest MSC yield, but alternative sites within the surgical field of knee procedures offer comparable MSC characteristics with reduced morbidity. The integration of harvesting techniques into existing knee surgeries, such as total knee arthroplasty, provides a less invasive approach while maintaining therapeutic efficacy. However, variability in MSC yield from these alternative sites underscores the need for further research to standardize techniques and optimize clinical outcomes. Future directions include large-scale comparative studies, advanced characterization of MSCs, and the development of personalized harvesting strategies. Ultimately, the findings suggest that optimizing the site of BMH can significantly influence the quality of MSC-based therapies for knee OA, enhancing their clinical utility and patient outcomes.

Experiences of cancer-related stigma in Africa: A scoping review

Cancer is a major health issue, particularly in low- and middle-income countries where 70% of cancer deaths occur. Stigma and barriers to screening and treatment lead to poor outcomes. We conducted structured searches of PubMed, Embase, MEDLINE, CINAHL, and CABI Global Health databases according to PRISMA-ScR guidelines. Searches used keywords related to (1) Africa, (2) cancer, and (3) stigma. We then screened to finalize a list of research manuscripts, dissertations, theses, and conference abstracts using quantitative, qualitative, or mixed methods to explore cancer stigma in Africa. This review focused on non-cervical cancers. Breast and cervical cancers have distinct stigma-related experiences due to awareness, screening, and sociocultural perceptions. Including cervical cancer risks dilutes the specificity and depth of findings. The review included 53 studies that linked stigma and cancer in Africa to physical symptoms, appearance changes, misconceptions, and emotional challenges, hindering care and worsening treatment outcomes. Cancer-related stigma negatively impacts screening and treatment engagement in Africa. The lack of intervention studies underscores the need for evidence-based strategies to reduce stigma. Future efforts should reduce barriers to cancer care, enhance public awareness, and implement policy changes to improve outcomes.

Palliative Care Knowledge, Attitudes, and Self-Competence of Nurses Working in Hospital Settings

ObjectiveWith the growing need to integrate palliative care into healthcare systems, nurses in hospital settings often provide care for patients with life-limiting conditions, many of whom lack formal education in palliative care. This study aimed to assess knowledge, attitude, and self-competence of nurses working in hospital settings regarding palliative care.MethodsThis study evaluated 129 hospital nurses in Colorado. It used the Palliative Care Quiz for Nursing, the Frommelt Attitude Toward Care of the Dying Scale, and the Palliative Care Nursing Self-Competency Scale to assess their knowledge, attitudes, and perceived self-competence.ResultsThe mean scores were knowledge, 11.69 (SD = 2.8); attitudes, 123.35 (SD = 11.44); and self-competence, 167.5 (SD = 31.5). The lowest scores were in psychosocial and spiritual care. Nurses generally feel competent; however, they often lack confidence in addressing patients' social and spiritual needs. They experienced unease when discussing death and exhibited paternalistic attitudes. Significant differences were found in educational background, nursing experience, personal caregiving experience, and practice setting. Positive correlations exist between attitudes, knowledge, and self-competence, indicating that greater knowledge and competence were associated with better attitudes toward end-of-life care.ConclusionsThis study highlights the need for educational interventions focusing on communication skills, pain management, psychological and spiritual care, and patient-centered care to improve nurses' competence in delivering high-quality palliative care in hospital settings.

VAS value set still has its own application value compare with TTO value set of EQ-5D-3L in Chinese population

OBJECTIVE

To develop a Chinese visual analogue scale (VAS) value set for Europe Quality of Life Questionnaire (EQ-5D-3L) and compare it with the time trade-off (TTO) value set which was constructed based on the same sample.

METHODS

An adapted Measurement and Valuation of Health (MVH) protocol was applied with VAS method. EQ-5D-3L was used in face-to-face interviews conducted by trained interviewers with participants selected via multi-stage stratified clustered random sample. Fifteen hypothetical health statuses (11 random states in MVH protocol, plus full health, severe problems for all dimensions, unconscious, and death) were assigned for assessment individually. Ordinary least square (OLS), general least square (GLS), and weighted least square (WLS) models were constructed. Five categories of indices, including quality of original data, distribution of rescaled values, goodness of fit of models, distribution of predicted values, and dimensions order were adopted to compare between Chinese VAS and TTO value sets.

RESULTS

All 5,939 participants aged 15 and over were completely interviewed; 5,884 eligible participants were included in constructing models. Model 2 was the best for having 4 out of 7 indices of goodness of fit. Comparing with the TTO value set, Adjusted R-square of Model2 increased from 0.354 to 0.670;the mean absolute error decreased from 0.0838 to 0.0319; and the Pearson correlation coefficient between predicted and mean values increased from0.8989 to 0.9837. Model 2 gave uniformly lower values than Chinese TTO value set. VAS method had a higher responsive rate, less inconsistency, lower skewed values, and better goodness of fit values.

CONCLUSIONS

We recommend VAS value set, Model 2, as the reference of scoring algorithm when using EQ-5D-3L in large scale survey of Chinese population.

Exploring Social Isolation Among Patients With Colorectal Cancer and Their Spousal Caregivers in China: An Actor-Partner Interdependence Model

This cross-sectional study aimed to investigate dyadic effects of micro-level (physical [PCS]/mental [MCS] health) and meso-level (dyadic coping/social support) factors on both subjective and objective social isolation in patient-spousal caregiver dyads with colorectal cancer (CRC), with hypothesized actor-partner interdependence effects. Data from 220 patient-caregiver dyads with CRC collected using validated instruments (General Alienation Scale, Lubben Social Network Scale-6, Medical Outcomes Study 12-item Short-Form version 2, Dyadic Coping Inventory, and Perceived Social Support Scale) were analyzed using the Actor-Partner Interdependence Model. Findings substantiated dyadic interdependence between subjective/objective social isolation and variables within dyads across micro- and meso-levels. Both micro-level (PCS/MCS) and meso-level (dyadic coping/social support) factors demonstrated significant actor effects on both subjective and objective social isolation experienced by patients and their partners. Patients' both micro-level (PCS/MCS) and meso-level (dyadic coping/social support) factors negatively influenced their partners' subjective and objective social isolation. No partner effect was identified from variables associated with spousal caregivers on patients' social isolation. These findings suggest that interventions targeting these variables could be effectively designed for patient-spousal caregiver dyads with CRC to address social isolation.

Relationship between core symptoms, function, and quality of life in colorectal cancer patients: a network analysis

PURPOSE

To identify core symptoms in patients with colorectal cancer and investigate how these symptoms correlate with functional status and quality of life (QoL).

METHODS

This study included patients over 18 years of age who underwent therapeutic surgery for colorectal cancer with or without a stoma. The European Organization for Research and Treatment of Cancer - Quality of Life Questionnaire Core 30 (EORTC-QLQ C30) and Colorectal Cancer Module (EORTC-QLQ CR29) were used. Data analysis involved constructing networks using the qgraph package in R, identifying core symptoms based on strength centrality, and assessing centrality stability using the bootnet package.

RESULTS

The study included 511 patients: 321 without a stoma and 190 with a stoma. The QoL score for both groups were 55.06 and 55.09, showing no significant difference (p= 0.991). Fatigue and pain are common core symptoms in colorectal cancer surgery patients, whereas appetite loss (rs = 0.37) is specific to those without a stoma and body image concerns (rs = 1.06) are central issues for stoma patients. Notably, despite its prevalence and severity, anxiety was not a core symptom in either group of patients. In the QoL network, emotional functioning served as an intermediary link between QoL and core symptoms in patients without a stoma, whereas QoL was directly associated with core symptoms in patients with a stoma.

CONCLUSION

Improving quality of life requires distinct clinical pathways depending on whether the patient has a stoma, necessitating individualized symptom management strategies in the early postoperative period.

Analysis of Longitudinal Trajectory and Influencing Factors of Supportive Care Needs in Colorectal Cancer Patients With Enterostomy

AIMS

The aim of this study was to understand the dynamic changes in the needs of patients with enterostomy during the 3 months after discharge and its possible influencing factors.

DESIGN

A prospective observational design.

METHODS

This study investigated the supportive care needs of patients who underwent colorectal cancer surgery with colostomy in three Chinese hospitals from May 2023 to October 2023 during the 3 months following discharge from the hospital. The growth mix model was used to describe the needs trajectory and analyse the heterogeneity of the trajectory. Univariate analysis was used to find the factors that might affect the heterogeneity of needs trajectory of patients with enterostomy, and then logistic regression analysis was used to determine the influencing factors of the heterogeneity of needs trajectory of patients with enterostomy. The reporting of this study adhered to the STROBE checklist.

RESULTS

A total of 232 patients with enterostomy completed follow-up. There was heterogeneity in the developmental trajectories of supportive care needs of enterostomy patients and the trajectories of the five dimensions of supportive care needs. The heterogeneity factors affecting the trajectory of supportive care needs included the enterostomy patient's psychosocial adjustment score, type of enterostomy, and educational background and the heterogeneity factors affecting the five dimensions trajectory of supportive care needs include psychosocial adjustment score, tumour staging, type of enterostomy, smoking, chemotherapy and enterostomy self-care knowledge score.

CONCLUSIONS

The needs of patients with enterostomy within 3 months after discharge were dynamic. Identifying and meeting the unmet needs of patients with enterostomy was crucial to improving the health-related quality of life of patients with enterostomy.

PATIENT OR PUBLIC CONTRIBUTION

None.

RELEVANCE TO CLINICAL PRACTICE

The needs of patients with enterostomy were dynamic, with the needs of most patients with enterostomy decreasing within 3 months of discharge, but some patients with enterostomy continued to have high needs at 3 months after discharge, and clinical nurses were expected to pay special attention to these patients.

Comparing the effects of different non-pharmacological traditional Chinese medicine therapies on cancer survivors: A Bayesian Network Meta-analysis

OBJECTIVES

Several studies have demonstrated the positive impact of non-pharmacological Traditional Chinese Medicine (TCM) therapies on pain, fatigue, sleep quality, and quality of life in cancer survivors. However, no research has compared the effectiveness of these therapies. This study aims to compare various interventions and identify the most effective non-pharmacological TCM therapies to provide evidence-based recommendations for cancer survivors.

METHODS

A systematic search was conducted in PubMed, Embase, Web of Science, CNKI, and Wanfang Data. RCTs investigating the effects of Taichi, Qigong, acupuncture, acupressure, TCM emotional therapy, and mixed therapies as interventions for cancer survivors were screened was conducted. Data from the creation of the database to February 2025 were included. Two independent reviewers evaluated the study quality. A Bayesian Network Meta-analysis was conducted to carry out a random effects model.

RESULTS

Seventy-one RCTs involving 6473 patients were included in the analysis. Network meta-analysis showed significance for all five intervention therapies in pain control in cancer patients. The best efficacy was observed for acupressure (SMD=-1.1 [-1.55, -0.66]) and Taichi/Qigong (SMD=-1.08[-1.64, -0.53]), followed by TCM emotional therapy (SMD=-0.93 [-1.42, -0.44]) and acupuncture (SMD=-0.54 [-0.93, -0.15]), with the latter showing comparatively lower efficacy. None of the interventions demonstrated superior efficacy in improving fatigue compared to the control group. Mixed therapies (SMD=-1.36[-2.56, -0.28]) demonstrated the greatest effect in improving sleep quality. Taichi/Qigong (SMD=1.87 [0.96, 2.83]) demonstrated certain advantages in improving quality of life. However, acupuncture and TCM emotional therapy had no significant effect on sleep quality or overall quality of life.

CONCLUSION

The evidence from this study suggests that acupressure and Taichi/Qigong are recommended as the most effective therapies for pain relief and quality of life improvement, respectively. The efficacy of these therapies for fatigue remains inconclusive. However, due to the limited number of included studies and the high risk of bias, these results should be interpreted with caution. Future studies should include more rigorously designed high-quality randomized controlled trials to confirm their long-term efficacy and safety.

REGISTRATION

PROSPERO CRD42024601976.

To understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer: a systematic review of qualitative studies

PURPOSE

This study aimed to understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer.

METHODS

A qualitative systematic review has been reported according to PRISMA guidelines. A comprehensive search was conducted across multiple databases (APA PsycINFO, CINAHL, and Medline) and citation searches. Studies were screened according to pre-determined inclusion and exclusion criteria. Methodological quality was evaluated. Findings were extracted in relation to the context of interest of experiences, needs, and preferences of supportive care. Each finding was accompanied by a qualitative verbatim illustration representing the participant's voice.

RESULTS

4449 publications were screened, and 44 studies were included. Cancer populations represented in the included studies included lymphoma, leukaemia, brain cancer, sarcomas, and neuroblastoma. Two overarching synthesised findings were identified as (1) coping, caring relationships, communication, and impact of the clinical environment, and (2) experiences of isolation, fear of the unknown, restricted information, and changing self. Children and adolescents articulated that cancer care would be enhanced by developing a sense of control over their body and healthcare, being involved in communication and shared decision-making, and ensuring the clinical environment is age-appropriate. Many experienced a sense of disconnection from the rest of the world (including peers, school, and experiences of prejudice and bullying), and a lack of tailored support and information were identified as key unmet care needs that require further intervention.

CONCLUSIONS

Children and adolescent who are diagnosed with cancer are a unique and understudied group in oncological survivorship research, with the slowest progress in improvement of care over time. This review will facilitate the development of future interventions and promote the importance of tailored support for children and adolescents at all stages of the cancer journey.

IMPLICATIONS FOR CANCER SURVIVORS

Children and adolescents continue to experience a range of difficulties despite routine contact with cancer healthcare professionals. Children and adolescents should be carefully assessed about their individual circumstances and preferences for support given the clear implications from this review that "one size" does not fit all.