A study on the changes of white matter microstructure in breast cancer patients undergoing chemotherapy based on DTI technology

BackgroundBreast cancer is a prevalent cancer affecting women globally, with incidence rates rising rapidly.PurposeTo examine the diffusion tensor imaging (DTI) data of patients with breast cancer before and after chemotherapy through tract-based spatial statistical analysis (TBSS).Material and MethodsCognitive and neuropsychological tests and whole-brain DTI were administered to patients with breast cancer who did not receive postoperative chemotherapy (C-) or received postoperative chemotherapy (C+) and healthy controls (HCs). Structural differences across groups were compared through fractional anisotropy (FA), mean diffusivity rate (MD), radial diffusivity tensor (RD), and axial diffusivity tensor (AD). Spearman's correlation analysis was employed to explore the association of FA, MD, RD, and AD values in different brain regions with the results of cognitive and neuropsychological tests, as well as the relationship between DTI parameters and cognitive performance as measured by the Montreal Cognitive Assessment (MoCA) scores.ResultsCompared with the C- group, the C + group exhibited significant reduced FA values and increased MD and RD values in the genu of the corpus callosum, bilateral anterior and superior corona radiata, left posterior thalamic radiation, left external capsule, and bilateral superior longitudinal fasciculus. Spearman's correlation analysis showed a notable association between reduced FA values in specific regions and decreased cognitive performance, as measured by MoCA scores.ConclusionThese findings suggest that the alterations in white matter microstructure induced by breast cancer chemotherapy may contribute to cognitive decline. Further research is warranted to strengthen evidence for this relationship.

Predicting the effect of ethical climate and spiritual well-being of nurses on respecting the patients' privacy in intensive care units: an analytical study

BACKGROUND

Ethical climate, observance of patients' privacy and nurses' spiritual well-being are of great importance in intensive care units (ICU). In addition, it is essential to identify spiritual and ethical predictors of patients' privacy. Thus, this study aimed to determine the predictive effects of ethical climate and nurses' spiritual well-being on patients' privacy in ICU.

METHODS

In this analytical cross-sectional study, 250 out of 500 ICU nurses were recruited using proportionate allocation stratified sampling. Data were collected using a demographic characteristics form, Patient Privacy Scale, Hospital Ethical Climate Survey, and Spiritual Well-Being Scale. The data were analyzed using Pearson correlation coefficient and hierarchical linear regression analysis.

RESULTS

The results showed that patients' privacy was associated with the hospital's ethical climate and nurses' spiritual well-being (P < 0.001). The hierarchical linear regression analysis indicated that, in step 1, patients (β = 0.22, P = 0.03) and managers' (β = 0.41, P < 0.001) subscales of ethical climate had a significant proportion of the variance of patients' privacy. In step 2, patients (β = 0.25, P = 0.01), managers' (β = 0.34, P < 0.001) subscales of ethical climate, and nurses' spiritual well-being (β = 0.17, P = 0.01) had a significant proportion of the variance of patients' privacy. According to step 2, these variables explained 40% of the changes in patients' privacy.

CONCLUSION

The results of the present study showed that the ethical climate and nurses' spiritual well-being were the predictors of patients' privacy. Given that 40% of the variance of the patients' privacy was recognized by these variables, it is suggested that further research should be conducted to determine other predictors.

Latent class analysis of death coping ability among palliative care nurses and its association with their emotional labor

OBJECTIVE

Death coping ability is a critical professional skill for palliative care nurses. This study aimed to identify subgroups of death coping ability among Chinese palliative care nurses based on their assessments using the Death Coping Ability Scale, and to analyze the relationship between these subgroups and their emotional labor.

METHOD

Convenient sampling was employed to survey 868 palliative care nurses from medical institutions in Beijing, Jiangsu Province, Anhui Province, and Hunan Province. Data was collected using a general information questionnaire, the Chinese version of the Death Coping Ability Scale, and the Emotional Labor Scale. Latent profile analysis was conducted to categorize the nurses' death coping abilities, and differences in emotional labor among these categories were compared.

RESULTS

The death coping ability of palliative care nurses was categorized into three groups: "low death coping ability group" (11.5%), "medium death coping ability group" (52.0%), and "high death coping ability group" (36.5%). Factors influencing these categories included specialization in palliative care, opportunities for interaction with the bereaved, participation in grief counseling training, and personal bereavement experiences, all statistically significant (p < 0.05). Notably, there were significant differences in emotional labor scores among the three groups (F = 33.006, p < 0.001).

CONCLUSIONS

The death coping ability of palliative care nurses can be classified into three distinct categories, each associated with different levels of emotional labor. Nursing managers should recognize these differences and implement targeted, personalized interventions to enhance the death coping abilities of palliative care nurses.

Losses Related to Breast Cancer Diagnosis: The Impact on Grief and Depression Symptomatology Within the Context of Hispanic/Latina Patients with Breast Cancer

Objective: The present study explored the association between the losses incurred due to breast cancer diagnosis, symptoms of depression, PANIC/GRIEF, and contextual factors within the context of Hispanic/Latina (H/L) patients diagnosed with breast cancer (BC). Methods: This study was a cross-sectional study of adult H/L BC patients (n = 129). The participants were H/L women diagnosed with breast cancer (stages 0-4) in the past five years. Sociodemographic variables were assessed, as well as depression symptoms (Patient Health Questionnaire-9; Spanish version), grief (The Affective Neuroscience Personality Scales, Grief subscale; Spanish version), and general losses (Grief diagnostic instrument for general practice, loss categories section). Results: The mean age for the sample was 55.37 (SD = 11.57). The most frequent non-death-related losses were loss of liberty (f = 63, p = 48.8%), followed by fear of own death (f = 67, p = 51.9%) and loss of quality of life (f = 65, p = 50.4%). A higher mean rank was observed in depressive symptomatology scores for those who experienced loss of liberty (U = 73.91, p < 0.008), quality of life (U = 77.30, p < 0.001), and fear of their own death (U = 74.88, p < 0.002). The results indicate a significant positive relationship between the number of reported losses and depressive symptomatology (r = 0.340, p < 0.001). In terms of contextual factors, the participants who reported their income not being enough to cover their expenses reported a greater number of losses related to diagnosis (U = 74.67, p < 0.001) and more depressive symptomatology (U = 69.84, p = 0.041). Moreover, a relationship was observed between grief and academic levels (r = -0.234, p = 0.008). Likewise, a relationship was observed between age and the number of losses (r = -0.461, p < 0.001). Conclusions: Our results provide new evidence on how primary non-death-related losses due to a breast cancer diagnosis impact the mental health of H/L BC patients.

Dyadic effects of locus of control and coping style on posttraumatic growth in patients with gynecological cancer and their spouses: an actor‒partner interdependence modeling approach

OBJECTIVE

This study aimed to examine the dyadic effects of locus of control and coping style on the posttraumatic growth(PTG) of gynecological cancer patients and their spouses via the actor-partner interdependence model (APIM).

METHODS

This was a prospective cross-sectional survey study. A convenience sampling method was used to select participants. The Demographic and Cancer-related Information Questionnaire, Internality, Powerful others and Chance Scale, Simplified Coping Style Questionnaire and Chinese-Posttraumatic Growth Inventory Scale were utilized for the survey. An actor‒partner interdependence model was constructed to examine the impact of locus of control and coping style on PTG for both patients and their spouses.

RESULTS

The date of 400 individuals(200 couples) were analyzed. The PTG scores for patients and their husbands were 61.66 ± 12.82 and 57.77 ± 12.03, respectively. Both partners' PTG was influenced by internal locus of control and positive coping style (P < 0.01). Each partner's internal locus of control and positive coping style could predict their own PTG, with a significant actor effect (P < 0.05). The spouse's internal locus of control could predict the patient's PTG, whereas the patient's positive coping style could predict the spouse's PTG, indicating significant partner effects (P < 0.05).

CONCLUSIONS

The PTG of gynecological cancer patients and their spouses is moderate. The locus of control and coping style of both partners have an interactive effect on their own PTG. To promote PTG for both partners, healthcare professionals should intervene simultaneously with patients and their spouses, incorporating positive psychological intervention methods.

Emergency palliative cancer care: anxiety and midazolam

BACKGROUND AND OBJECTIVE

Cancer patients treated with palliative intent often report anxiety. Anxiety is associated with dyspnoea, cancer pain, and reduced quality of life. Limited knowledge on variability and treatment effects warranted exploring factors associated with improvement in anxiety for hospitalised palliative cancer patients.

METHODS

This study is a cross-sectional secondary analysis. All patients admitted to an acute palliative care unit for one year were assessed and 164 patients satisfied the study inclusion criteria. The patients reported self-registered symptom intensities using the 11-point numeric rating scale. Demographic variables, patient reports, and medical management were analysed for associations with anxiety.

RESULTS

At admission, 37.8% of the patients reported moderate or severe anxiety, and of these 43.6% used benzodiazepines. The corresponding numbers for benzodiazepine use were 35.1% and 24.4% for patients with mild and no anxiety, respectively. Of all patients, 26.8% reported improved anxiety during their hospital stay. More patients with moderate or severe anxiety at admission reported improved anxiety during hospitalisation (50.0%) compared to the corresponding patients with mild anxiety (22.8%). Patients with moderate or severe anxiety reported less improvement in pain compared to patients with mild anxiety. Improved dyspnoea was the only factor statistically associated with improvement in anxiety, both for patients reporting mild anxiety and moderate and severe anxiety. Thirty-seven-point-1% of patients with moderate or severe anxiety at admission received no benzodiazepine treatment during the hospital stay. Patients receiving midazolam had more anxiety at admission, were younger, and had poorer performance status. Median dose and interquartile range [IQR] of midazolam in these patients were 2 mg/24 h [IQR: 2.0-6.0].

CONCLUSION

Improved dyspnoea was associated with reduced anxiety; however, the use of benzodiazepines was not.

Psychological distress and coping strategies among caregivers of children with cancer: a cross-sectional study

Background

Caregivers of children with cancer often experience significant psychological distress exacerbated by financial constraints and role modifications. This study aimed to assess the prevalence of anxiety and depression among caregivers of children receiving cancer treatment and to examine their coping mechanisms.

Methods

This cross-sectional study included 124 caregivers of children receiving chemotherapy at a tertiary care facility in Northern India. Inclusion criteria included caregivers more than 18 years of age, engaged in child care for at least 3 months, accompanying them for chemotherapy and understanding Hindi or English. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. The coping strategies were evaluated using a Brief Coping Orientation to the Problem-Experienced inventory.

Results

The mean age of the caregivers was 34.50 ± 7.60 years, with the majority being male (62.1%). Over one-third of the caregivers (37.9%) reported abnormal anxiety levels, while 44.4% exhibited borderline depression. A significant moderate positive correlation was found between anxiety and depression (r = 0.676, p < 0.001). The most commonly used coping mechanisms are active coping and self-distraction. Multiple regression analysis revealed self-blame, acceptance and planning as significant coping strategies for anxiety, while self-blame, planning and religion were significant for depression.

Conclusion

A substantial proportion of the caregivers experienced anxiety and depression. Emotion-focused and problem-focused coping strategies were the most frequently employed. These findings highlight the need for psychosocial support and interventions to foster healthier coping skills among caregivers of children with cancer.

Comparison of health-related quality of life trajectories in older breast cancer survivors and noncancerous controls over 10 years: A SEER-MHOS analysis

PURPOSE

This study analyzed the long-term effects of cancer on the health-related quality of life (HRQOL) of older breast cancer survivors for 10 years, including a control group to distinguish between the impacts of cancer treatment and aging.

METHODS

The SEER-MHOS data resource was used in the analysis. Cases were 674 older women diagnosed with breast cancer in 1998-2015 at age 65 and older and participated in Medicare Health Outcomes Survey within 24 months before their cancer diagnosis and at least once within 10 years of post-diagnosis. Propensity score-matched controls (n = 674) were randomly selected from noncancer cohorts. Participants reported their HRQOL using SF-36/VR-12. Repeated measures two-way analysis of variance was used to assess the effects of time, group, and the interaction between time and group on long-term HRQOL trajectory up to 10 years of follow-up.

RESULTS

At baseline, cases fared worse than controls in all HRQOL domains. Over time, physical component summary, physical functioning, general health, role limitation due to physical health, bodily pain, social functioning, and vitality worsened (Ptime < 0.05) with significant differences between the groups at some points (Pgroup < 0.05), while mental component summary, mental health, and role limitation due to emotional problems remained relatively constant (Ptime ≥ 0.05). Cases had consistently lower general health than controls with a greater gap at the end of observation.

CONCLUSIONS

Both cases and controls experienced physical HRQOL deterioration, but relatively stable mental HRQOL over 10 years.

IMPLICATIONS FOR CANCER SURVIVORS

Early interventions focusing on physical health are warranted to maintain HRQOL among older women diagnosed with breast cancer.

Assessment of perioperative anxiety levels at three time-points during hospital stay in patients undergoing elective surgery

BACKGROUND

Perioperative anxiety is associated with complications during and after surgery, resulting in prolonged hospital stays, and long-term physical and cognitive decline. A prospective observational study was conducted to assess anxiety levels at three time-points and identify sociodemographic factors influencing it.

METHODOLOGY

Three assessments were conducted on 105 patients (18-65 years) undergoing elective surgery after informed consent: A1 (day before surgery) using the State-Trait Anxiety Inventory (STAI-Trait) form, STAI-State form, and demographic data collection; A2 (on the day of surgery) with the STAI-S2 form; and A3 (24 h post-surgery) with the STAI-S3 form and a questionnaire on information requirements and pain.

RESULTS

Average state anxiety scores were S2 (18.06) > S1 (17.55) > S3 (16.38). The primary concerns were fear of feeling pain after surgery (41%), fear of the results of the surgery(33.3%), and concerns about family (32.40%). Unmarried individuals had significantly higher anxiety scores than married individuals in S1 (20.80 vs. 16.79, p - 0.009) and S2 (23.10 vs. 16.87, p - 0.001). Females consistently scored higher than males, with a significant difference in S2 (19.51 vs. 16.79, p - 0.05). Patients with a medical history showed the highest anxiety in S3 (18 vs. 15.67, p - 0.037). Skilled workers displayed the highest anxiety levels in S1 (20.20) and S2 (22.40, p - 0.044) as compared to other groups, while professionals showed the highest anxiety in S3 (18.05). Females (33%), rurals (29%), and ≤ 8th-grade education group (54.5%) were significantly more likely to report receiving inadequate information about surgery compared to males (12.5%, p - 0.018), urbans (13%, p - 0.036), and higher education group (18%, p - 0.022). Younger individuals of < 30 years (47%) were more likely to feel that more information about surgery would have relaxed them compared to 41-50 age group (7.14%, p - 0.016).

CONCLUSION

The anxiety levels fluctuated over three time-points and were influenced by demographic, cultural, and psychological factors. Therefore, anxiety should be identified both preoperatively and postoperatively through an individualized approach. Additionally, a significant proportion of the population still requires more information, and the diverse informational needs across the groups underscore the necessity for individualized interviews to ascertain specific information requirements, thereby preventing any paradoxical increase in anxiety due to inappropriate information delivery.

Evaluation of a Simulation Program for Providing Telenursing Training to Nursing Students: Cohort Study

Background

Telenursing has become prevalent in providing care to diverse populations experiencing different health conditions both in Israel and globally. The nurse-patient relationship aims to improve the condition of individuals requiring health services.

objectives

This study aims to evaluate nursing graduates' skills and knowledge regarding remote nursing care prior to and following a simulation-based telenursing training program in an undergraduate nursing degree.

Methods

A cohort study assessed 114 third-year nursing students using comprehensive evaluation measures of knowledge, skills, attitudes, self-efficacy, and clinical skills regarding remote nursing care. Assessments were conducted at 2 critical time points: prior to and following a structured simulation-based training intervention.

Results

Participant demographics revealed a predominantly female sample (101/114, 88.6%), aged 20-50 years (mean 25.68, SD 4.59 years), with moderate to advanced computer and internet proficiency. Notably, 91.2% (104/114) had no telenursing exposure, yet 75.4% (86/114) expressed training interest. Statistical analyses demonstrated significant improvements across all measured variables, characterized by moderate to high effect sizes. Key findings included substantial increases in telenursing awareness, knowledge, skills, attitudes and self-efficacy; significant reduction in perceived barriers to remote care delivery; and complex interrelation dynamics between variables. A multivariate analysis revealed nuanced correlations: higher awareness and knowledge were consistently associated with more positive attitudes and increased self-efficacy. Positive attitudes correlated with enhanced self-efficacy and reduced perceived barriers. Change score analyses further indicated that increased awareness and knowledge facilitated more positive attitudinal shifts, while heightened awareness and positive attitudes corresponded with decreased implementation barriers.

Conclusions

The study underscores the critical importance of integrating targeted telenursing training into nursing education. By providing comprehensive preparation, educational programs can equip students to deliver optimal remote care services. The COVID-19 pandemic has definitively demonstrated that remote nursing will be central to future health care delivery, emphasizing the urgent need to prepare nursing students for this emerging health care paradigm.

Self-disclosure and reproductive concerns among breast cancer female patients: the chain mediation model of couples' cancer-related communication problems and relationship intimacy

PURPOSE

Reproductive concerns are prevalent in the female breast cancer patient population and increase existential distress. Although self-disclosure significantly correlated reproductive concerns, the exact mechanism of action is unknown. Based on previous theoretical studies on couples' cancer-related communication problems and intimacy in couples, this study constructed a chain mediation model to investigate whether the two variables mediate the relationship between self-disclosure and reproductive concerns.

METHODS

A cross-sectional survey was conducted from August 2023 to July 2024 at Jiangxi Cancer Hospital. A total of 280 female breast cancer patients completed the Distress Disclosure Index, Couples' Cancer-Related Communication Problems Scale, Quality Relationship Index, and Reproductive Concerns After Cancer Scale. Data description and Pearson's correlation analysis were performed through SPSS 26.0 software. Serial mediation effect analysis and testing were performed through Hayes' Process 4.1 program.

RESULTS

Self-disclosure was found to be negatively associated with reproductive concerns and couples' cancer-related communication problems, but positively associated with intimacy. After controlling for sociodemographic variables, including age, matrimonial, number of children, and hormone receptor, the direct effect of self-disclosure on reproductive concerns was significant (Effect =  - 0.320; 95% CI, - 0.465 to - 0.178). In addition, three other indirect pathways of action were also significant: (1) through couples' cancer-related communication problems (Effect =  - 0.113; 95% CI, - 0.181 to - 0.045), (2) through intimate relationships (Effect =  - 0.110, 95% CI - 0.187 to - 0.043), and (3) through the chain-mediated effects of couples' cancer-related communication problems and intimacy (Effect =  - 0.025; 95% CI, - 0.054 to - 0.007). The total indirect effect of the three pathways of action was 43.66%.

CONCLUSIONS

Self-disclosure not only directly affects reproductive concerns in female breast cancer patients, but also indirectly through couples' cancer-related communication problems and intimacy, as well as sequential mediation of the two. Interventions targeting the above factors can help promote self-disclosure in female breast cancer patients, reduce couples' cancer-related communication problems, and improve intimacy, thereby alleviating reproductive concerns after cancer.

Impact of wearing external breast prosthesis on body posture of patients after unilateral mastectomy: a randomized controlled trial

Introduction

Unilateral mastectomy induces postural alterations; however, the resolution of this issue in clinical settings remains unknown. This study aimed to explore the effects of wearing external breast prosthesis on the posture of patients after unilateral mastectomy.

Methods

A total of 240 patients who underwent unilateral mastectomy for breast cancer in our hospital's breast surgery department from September 2020 to March 2021 were selected, and they were registered and randomized in a 1:1 ratio to receive one of two treatments: (1) the intervention group wearing a external breast prosthesis (similar in weight to the breast) and (2) the control group wearing a cotton breast prosthesis (almost no weight). The generalized estimating equation method was used to analyze the impact of wearing external breast prosthesis on the patients' body posture 3 and 6 months after the intervention.

Results

Statistically significant differences were observed between the two groups regarding forward head posture, shoulder asymmetry, scapular tilt, and neck tilt (P < 0.05). However, the two groups had no significant differences in scapular adduction/abduction, pelvic tilt, and trunk inclination (P > 0.05). Over time, all degrees of deviation in postural abnormalities exhibited an upward trend, with postural abnormalities becoming increasingly serious.

Discussion

External breast prosthesis can improve postural abnormalities in patients with forward head posture, shoulder asymmetry, and scapular and neck tilts. However, there was no significant improvement in the short-term body posture of the patients concerning scapular adduction/abduction, pelvic tilt, or trunk inclination, indicating that further research is required to understand the effects of wearing external breast prosthesis on patients' body posture.

China clinical trial registry

https://www.chictr.org.cn/showproj.html?proj=56939, identifier ChiCTR2000040897.

Pain and Suffering: The Experience of Patients With Terminal Cancer

PURPOSE/OBJECTIVES

Analyze the meaning of pain and suffering experienced by patients with end-stage cancer from a systemic perspective.

DESIGN

Qualitative study based on General Systems Theory.

SAMPLE/PARTICIPANTS

Ten patients with terminal stage cancer were interviewed.

METHODS

Semi-structured interviews were conducted to understand the reasons for pain and suffering. From a systemic perspective, relationships and interrelationships between different categories, systems, and subsystems were established.

FINDINGS

More than a third of the patients identified the spiritual factor as the primary cause of their pain and suffering, above other factors (psychological, economic). They emphasized the importance of faith, religion, and beliefs during their illness.

IMPLICATIONS FOR PROVIDERS

Including training on aspects of spiritual care in the academic curricula of health professionals would enhance the quality of care for patients at the end of their lives.

From compassion to burnout: emotional labor in oncology nursing - a qualitative study

INTRODUCTION

Cancer incidents are increasingly rising. The quality of care received by cancer patients and the guarantee of their satisfaction are no longer limited to clinical services. Oncology nurses can offer an important role in enhancing the level of patient satisfaction through emotional labor in this regard.

OBJECTIVE

It aims to explore oncology nurses' perceptions regarding the concept of emotional labor and the individual and organizational consequences of emotional labor.

MATERIALS AND METHODS

The present qualitative research was carried out based on a phenomenological approach. We sampled 18 oncology nurses working at Mashhad hospitals in the year 2024 through semi-structured interviews. Our interview questions were composed of seven open, semi-structured, and in-depth questions. Data analysis was done through conventional content analysis using MAXQDA software.

RESULTS

The results of this study revealed three main concepts of emotional labor based on the definitions provided by oncology nurses: individual effects, organizational outcomes, and relationships with patients.

CONCLUSION

Emotional labor is pivotal to enforcing good quality in healthcare services, patient satisfaction and nursing relations between the patients and their families. It plays a very important role in ensuring better treatment processes.

Fatigue of palliative care nursing staff and selected sociodemographic, occupational and cognitive predictors: a cross-sectional study

OBJECTIVES

The aim of the study is to assess total fatigue levels among nursing staff who provide palliative care services, as well as to identify significant sociodemographic, occupational and cognitive predictors of self-perceived fatigue.

MATERIAL AND METHODS

This cross-sectional study was carried out on a study group of 424 nurses that provide health care services in the palliative care units in Poland. The following scales were employed in the study: Fatigue Assessment Scale, Utrecht Work Engagement Scale, the Multidimensional Scale of Perceived Social Support, Perceived Stress at Work and Professional Quality of Life Scale.

RESULTS

The average total fatigue level in the study group was 20.78 (SD = 5.41). There was a positive relationship between gender, age, place of residence, marital status, education, perception of social support, occupational stress, and professional quality of life and perceived fatigue. In turn, there was a negative relationship between years of service and perception of social support in the "others" category and perceived fatigue.

CONCLUSIONS

The study's results show a significant relationship between perceived fatigue and sociodemographic, occupational and cognitive variables. Int J Occup Med Environ Health. 2025;38(1):41-56.

Multilevel Targets for Promoting Pediatric HPV Vaccination: A Systematic Review of Parent-Centered, Provider-Centered, and Practice-Centered Interventions in HIC and LMIC Settings

BACKGROUND/OBJECTIVES

Human papillomavirus (HPV) is a predominant cause of cervical cancer globally in women. HPV-related cancers in men are also on the rise. Immunization against HPV infection is a highly effective preventative against these cancers. However, HPV vaccine programs are not easily implemented globally. The objective of this systematic review was to identify multilevel strategies associated with improved pediatric HPV vaccination in high-income countries (HICs) and low- and middle-income countries (LMICs) that target parent, provider, and practice points of interventions.

METHODS

Through a systematic search of electronic databases, we identified 159 peer-reviewed articles published between the years 2011 and 2023.

RESULTS

Ninety-five percent of the included studies were conducted in HICs. Just eight studies were set in LMICs. A variety of HPV vaccination outcomes were assessed including uptake, initiation of the series, continuation of the series, missed opportunities, time, and refusal. Eighty percent of studies reported improved pediatric HPV vaccination, including a third of studies with mixed findings. Parent-centered strategies included education programs and reminder/recall procedures. Provider-centered strategies also included education programs and training in communication. Practice-centered strategies included vaccine access programs, vaccine bundling protocols, provider prompts, standing orders, vaccine messaging, and lowering the initiation age to 9 years. Multilevel, multi-component programs were highly effective.

CONCLUSIONS

Multilevel strategies can be adopted in a variety of settings to promote HPV vaccination among youth globally. However, this research is disproportionately conducted in high resource environments. Further work is needed in LMIC settings as more countries begin to adopt HPV immunization programs.

Factors contributing to sexual dissatisfaction in women with breast cancer: The specific role of conjugal relationship quality

PURPOSE

The purpose of this study was (1) to investigate the personal, interpersonal, social, and cultural factors related to sexual dissatisfaction in women with breast cancer and (2) to explore these differences regarding surgery (lumpectomy vs. mastectomy).

METHODS

This cross-sectional study included women diagnosed with breast cancer (n = 87). Women were invited to complete questionnaires assessing sexual satisfaction, relationship satisfaction, conjugal support, quality of life, subjective health, anxiodepressive symptomatology, body image, self-esteem, and religiosity. Partial least squares path modeling (PLS‒PM) was used.

RESULTS

No direct links were observed between resources (intraindividual and social) and sexual dissatisfaction (SD) or between vulnerability (physical and emotional) and SD. The quality of the conjugal relationship acted as a mediator between these different variables. Intraindividual resources are influenced directly by physical and emotional vulnerability. Age influenced only SD in women who had undergone a lumpectomy compared with those who had undergone a mastectomy. Finally, religiosity and the length of the couple relationship had no influence on SD.

CONCLUSION

The results highlight the importance of considering different levels of variables when considering SD in women with breast cancer, particularly the role of the conjugal relationship. Hence, these results encourage the need to promote conjugal relationship quality to improve sexual satisfaction.

Evaluation of chemotherapy-induced nausea and vomiting in low, moderate, and highly emetogenic schemes between sexes

PURPOSE

Sex influences chemotherapy-induced nausea and vomiting (CINV). However, in clinical practice, males and females receive the same antiemetic prophylaxis. We compared CINV between sexes in patients with different emetic risk schemes and evaluated the predisposing factors and main adverse effects caused by antiemetics.

METHODS

Prospective observational study conducted in a tertiary-care hospital from February 2023 to May 2024 in patients starting chemotherapy or a new treatment line. CINV was evaluated using MASCC antiemetic tool, in acute (< 24 h) and delayed phases (24-120 h). Results were analyzed using χ2 test or Fisher's exact test. The primary endpoint was complete response (CR) rate, defined as no CINV and no use of rescue medication. Univariate and multivariate logistic regressions were used to identify patient-related risk factors associated with non-CR.

RESULTS

A total of 176 completed questionnaires (CQ): 94 for males and 82 for females were collected. The proportion of males who remained emesis-free was superior to females in the acute phase (100% versus 92.7%, p = 0.009). Likewise, a higher proportion of males remained nausea-free in the acute (91.5% versus 79.3%, p = 0.021) and delayed phase (90.4% versus 79.3%, p = 0.037). In females, young age (< 60 years) and previous nausea and vomiting during pregnancy may contribute to non-CR. A high proportion of patients reported adverse events like constipation and insomnia. Females suffered more constipation than males (52.4% versus 37.2%, p = 0.043).

CONCLUSION

Females experienced more CINV than males, with the consequences that entail. Antiemetic prophylaxis should be personalized, considering sex and age and not only the chemotherapy emetic potential.

Woman with cancer: cross-sectional analysis of health-related quality of life and social support

OBJECTIVE

To verify the correlation between perceived social support and health-related quality of life among women diagnosed with cancer.

METHOD

Analytical cross-sectional study conducted in 2019 with a sample of 119 women diagnosed with cancer treated at a reference hospital for oncological treatment in the southern region of Minas Gerais. Data collection was carried out through interviews and medical record analysis. The Medical Outcomes Study social support scale and the European Organization for Research and Treatment of Cancer quality of life questionnaire were used. Statistical analysis was performed using Spearman's correlation test.

RESULTS

There was a positive correlation between all types of social support and the emotional and social functions of quality of life. Emotional/information, affective, and positive social interaction supports were positively correlated with global health status and negatively correlated with appetite loss.

CONCLUSION

Higher social support scores were correlated with a better quality of life among the women with cancer assessed. By identifying the specific types of social support that can improve certain dimensions of quality of life, nursing professionals will be able to plan and implement interventions more effectively.

Knowledge, attitudes, and practices of gastric cancer patients toward nutritional therapy

Background

To investigate the knowledge, attitude, and practice (KAP) of patients with gastric cancer (GC) toward nutritional therapy.

Methods

This cross-sectional study was conducted from January to March 2024 at the Affiliated Hospital of Jiangnan University (Wuxi, China) and enrolled patients with GC. Questionnaires (Cronbach's α = 0.923) were used to collect data on demographics and KAP dimensions. Scores >75% were considered good. Multivariable analyses were performed to examine the factors associated with KAP. A structural equation modeling (SEM) analysis was performed to examine the relationships among KAP dimensions.

Results

The analysis included 486 valid questionnaires. The median knowledge, attitude, and practice scores were 6.0 (0-16; 37.5%), 26.0 (7-35; 74.3%), and 28.7 (8-40; 71.7%) indicating poor KAP. Only agricultural, forestry, animal husbandry, fishery, and water conservancy production personnel (OR = 0.09, 95%CI: 0.02-0.49, p = 0.006) were independently associated with knowledge. Knowledge (OR = 1.11, 95%CI: 1.05-1.18, p < 0.001) and a monthly income of 10,000-20,000 (OR = 3.85, 95%CI: 1.23-12.06, p = 0.021) were independently associated with attitude. Knowledge (OR = 1.22, 95%CI: 1.15-1.30, p < 0.001), attitude (OR = 1.21, 95%CI: 1.11-1.32, p < 0.001), personnel other than leading cadres of state organs and enterprises (all OR < 1 and all p < 0.05), and a monthly income of 10,000-20,000 yuan (OR = 3.02, 95%CI: 1.15-7.96, p = 0.025) were independently associated with practice. Knowledge had a direct positive influence on attitude (β = 0.350, p < 0.001) and practice (β = 0.460, p < 0.001) and an indirect positive influence on practice (β = 0.146, p < 0.001). Attitude had a direct positive influence on practice (β = 0.417, p < 0.001).

Conclusion

Patients with GC in Wuxi partly had poor KAP toward nutritional support.

Power asymmetry and embarrassment in shared decision-making: predicting participation preference and decisional conflict

BACKGROUND

Shared decision-making (SDM) is the gold standard for patient-clinician interaction, yet many patients are not actively involved in medical consultations and hesitate to engage in decisions on their health. Despite considerable efforts to improve implementation, research on barriers to SDM within the patient-clinician relationship and interaction is scant. To identify potential barriers to urological patients' participation in decision-making, we developed two novel scales assessing power asymmetry (PA-ME) and embarrassment in medical encounters (EmMed). The present study validates both scales in a large sample comprising urological patients and non-clinical participants. It further examines the effects of both factors on participation preferences and decisional conflict among patients.

METHODS

Data were collected from 107 urological patients at a university hospital for Urology and Urosurgery in Germany. Patients completed self-report questionnaires before and after their clinical appointments. In addition, 250 non-clinical participants provided data via an online study. All participants rated perceived power asymmetry in the patient-clinician relationship and their experience of embarrassment in medical contexts using the PA-ME and EmMed scales. Urological patients further indicated their participation preference in decisions regarding both general and urological care prior to the consultation. Afterward, they assessed the level of perceived decisional conflict.

RESULTS

Factor analyses yielded power asymmetry and medical embarrassment as unidimensional constructs. Both questionnaires have good (PA-ME; α = 0.88), respectively excellent (EmMed; α = 0.95), internal consistency. Among urological patients, higher levels of perceived power asymmetry predicted lower generic participation preference (β = - 0.98, p <.001, adjusted R2 = 0.14) and higher decisional conflict (β = 0.25, p <.01, adjusted R2 = 0.07). While, in patients, embarrassment was not linked to generic participation preference before the consultation (p ≥.5), it resulted in higher decisional conflict after the consultation (β = 0.39, p <.001, adjusted R2 = 0.14). Neither power asymmetry nor embarrassment were specifically associated with participation preference regarding urological care (p ≥.273).

CONCLUSIONS

Given their promising psychometric properties, the new instruments are recommended for routine assessment of power asymmetry and embarrassment among patients. Addressing these factors may be helpful to reduce decisional conflict and increase participation preferences. Both factors are prerequisites for a successful SDM-process and active patient engagement in health-related decisions.

Restore intestinal steady-state: new advances in the clinical management of chemotherapy-associated diarrhea and constipation

Chemotherapy remains the primary therapeutic strategy for most tumors, particularly those at advanced stages with distant metastases and resistance to molecularly targeted therapy or immunotherapy. There are many manifestations of chemotherapy-induced gastrointestinal toxicity (CIGT), including chemotherapy-induced diarrhea (CID) and chemotherapy-induced constipation (CIC). Although the World Health Organisation and the International Association Against Cancer have different grading criteria and strategies for the prevention and treatment of CIGT, there are still many unanswered questions that need to be clarified. This review critically describes pathological mechanisms and clinical research, analyzing the variability in diagnostic criteria and the absence of standardization in grading severity. We identify a critical gap in understanding the molecular underpinnings of CID and CIC and suggest targeted areas for future research, including developing personalized treatment approaches based on genetic profiling. The findings suggest a comprehensive treatment approach combining pharmacological and non-pharmacological strategies to enhance life quality and treatment adherence. This review will offer a comprehensive bird-eye of pathophysiological mechanisms, clinical manifestations, and therapeutic strategies of CIGT, thereby enriching accessible references to clinicians, and helping them to prevent and control CID and CIC.

Experiences, Challenges, and Needs of People Living with HIV in Hunan Province, China: A Qualitative Study

Background

Globally, the human immunodeficiency virus (HIV) epidemic continues to pose significant challenges. In China, the differentiated services delivery (DSD) model has been implemented to improve healthcare for people living with HIV (PLHIV). However, challenges persist in fully implementing and scaling up the DSD model. Given the knowledge gaps and the need for better strategies to support this vulnerable population, our study aimed to explore the experiences, challenges, and needs of PLHIV to inform the development of patient-centered healthcare services.

Methods

We employed a qualitative design to interview 20 PLHIV from July 27 to October 13, 2024, in the Infectious Disease Ward at the Second People's Hospital in Chenzhou, Hunan Province. Individual face-to-face in-depth interviews were conducted to collect data. Colaizzi's seven-step analysis method and NVivo 14 was used to analyze the transcripts.

Results

The participants, aged 23 to 83 years, had been living with HIV for durations ranging from one month to 19 years. The interview data revealed four themes: (1) the physiological dimension: multi-organ physical symptoms, increased physical vulnerability, and a desire for healthcare guidance; (2) the psychological dimension: emotional distress, inadequate HIV-related knowledge, considerable stigma and discrimination, and a desire for respect and dignity; (3) the societal dimension: huge economic burden, fragile social networks, and a desire for social support; and (4) the spiritual dimension: mixed feelings about death, negative expectations of the future, seeking solace in faith, and a desire for a "good" death.

Conclusion

PLHIV in this study have undergone complex journeys across physical, psychological, societal, and spiritual dimensions, expressing urgent needs for support from various stakeholders. Our findings highlight the urgency of implementing patient-centered care, enhancing psychological support, reducing discrimination, and providing robust social and spiritual care through stakeholder collaboration to optimize the DSD model and resource allocation.

Factors influencing clinical decision-making and health-related quality of life changes in colorectal cancer patients receiving targeted therapy: a multicenter study in China

OBJECTIVES

The aim of this paper is to assess the current clinical application of targeted therapy in colorectal cancer (CRC), identify factors influencing patients' acceptance of targeted therapy, and evaluate its impact of targeted therapy on patients' health-related quality of life (HRQoL).

METHODS

This study was based on a national multi-center survey. From March 2020 to March 2021, involved 19 tertiary hospitals across seven regions in China through multi-stage stratified sampling. CRC patients who underwent genetic testing participated. Data on demographic and clinical characteristics, disease knowledge, medical service utilization, medical expenditure, and HRQoL before and after treatment were collected through face-to-face interviews. Logistic regression identified factors affecting therapy acceptance, while the HRQoL changes in pre-and post-treatment were compared by the Mann-Whitney U test.

RESULTS

Among 1,468 eligible patients, 79.7% were aged 50+, 60% male, and 31.5% retired. Secondary education was the most common level (30.3%). A total of 62.7% of patients received targeted therapy. Multivariable analysis showed that metastasis at diagnosis, out-of-pocket expenses, and reimbursement ratio were positively associated with targeted therapy (P < 0.05), while initial diagnosis stage, region, and genetic testing reimbursement were negatively associated (P < 0.05). Post-therapy, patients' quality of life declined significantly (P < 0.001), especially in fatigue and financial burden.

CONCLUSIONS

Our study revealed multiple factors influencing CRC patients' acceptance of targeted therapy and found that targeted therapy may adversely affect HRQoL. These findings emphasize the necessity of implementing more comprehensive patient management strategies to optimize the clinical application of targeted therapy and improve patients' quality of life.

Deciphering the anti-neoplastic potential of Allium ascalonicum in averting the proliferation and epithelial-mesenchymal transition of triple-negative breast cancer through virtual docking and In Vitro approaches

BACKGROUND

Universally, Allium ascalonicum (Shallots) is a well-known flavouring agent in many cuisines. Though, it's been proved for its health benefits due to the presence of alkaloids, flavonoids, terpenoids, phenols and coumarins, its role as an anti-neoplastic agent still requires comprehensive investigation. In our study, we have investigated the presence of potential anti-neoplastic phytocompounds, anti-inflammatory, cytotoxicity and anti-metastatic activity of Shallots against Triple-Negative Breast Cancer cell line, MDA-MB-231.

METHODS

Phytocompounds of aqueous Allium ascalonicum extract (AAE) derived from GC-MS and LC-MS analysis were docked with an inflammatory marker, Interleukin-18 (IL-18); anti-apoptotic proteins, B-cell Lymphoma-2 (BCL-2) and Myeloid Cell Leukemia-1 (MCL-1); and metastatic marker, Vimentin using PyRx (Version 0.9.9). Subsequently, the anti-inflammatory property of AAE was determined using Bovine Serum Albumin (BSA) Denaturation Assay and the chemotherapeutic potential of AAE was determined using 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide (MTT) assay on MDA-MB-231 and HEK293T cell lines. Additionally, to determine the synergistic effect of Doxorubicin Hydrochloride (Standard) and AAE, MTT assay was performed on MDA-MB-231 cell lines treated with the combination therapy. Furthermore, the anti-metastatic property of AAE was determined using cell migration and clonogenic assays. Finally, Dual Acridine Orange/Ethidium Bromide fluorescence staining method was used to determine if AAE has the ability to induce apoptosis and necrosis in MDA-MB-231 cells.

RESULTS

Molecular docking results using the compounds obtained from LC-MS and GC-MS with the target proteins revealed promising anti-neoplastic bioactive compounds. BSA Denaturation assay proved that AAE has anti-inflammatory property, with the highest, 85.78% observed at 2 mg/ml of AAE. Moreover, MTT assay proved that AAE exhibited cytotoxic effect on MDA-MB-231 in a dose-dependent manner, with an IC50 observed at 1.23 mg/ml (**p ≤ 0.005) and non-toxic to HEK293T cells. Combination therapy of the standard with AAE reduced the IC50 of the standard by 65.5%. Consecutively, the anti-metastatic property of AAE was proved using cell migration and clonogenic assays, suggesting suppression of epithelial-mesenchymal transition. Finally, Dual Acridine Orange/Ethidium Bromide fluorescence staining method displayed that, AAE has the ability to induce apoptosis and necrosis in TNBC cells.

CONCLUSION

The outcomes from in vitro assays corroborated with the molecular docking results and hence, on authenticating the potentiality of AAE's anti-neoplastic effect via. in vivo models, pre-clinical and clinical trials, Allium ascalonicum can be articulated to a prospective anti-neoplastic drug for treating TNBC.

Cancer nursing research priorities: findings from a cancer nurses' consultation in Europe

BACKGROUND

Nurses are well positioned to identify the most critical issues in patient care and to determine priorities for investigation. Involving nurses in developing research priorities may increase their engagement in research and enhance the development high-quality nursing practice.

AIM

This study aimed to scope the potential topics for future cancer nursing research in Europe from the perspective of cancer nurses.

METHODS

It was the second phase of a three-phase mixed methods study comprising: a rapid review; a consultation with European cancer nurses; and a subsequent Delphi study incorporating the findings from the first two phases. The consultation involved 73 cancer nurses from the European Oncology Nursing Society.

FINDINGS

The analysis identified 73 research priority topics, which were developed into eight main themes.

CONCLUSION

The study's findings show that the research priorities identified by cancer nurses are in accord with many of the topics highlighted by the European Union Commission, the World Health Organization, and cancer and nursing organisations with regard to cancer care and nursing practice.

Attitudes toward palliative care among cancer patients: a multi-method study

Background

Palliative care plays a crucial role in improving the quality of life for cancer patients, particularly those in advanced stages of the disease. Despite its proven benefits, attitudes toward palliative care vary widely among patients due to cultural beliefs, personal values, and awareness of available services. Understanding cancer patients' perspectives on palliative care is essential for enhancing end-of-life care strategies and ensuring that interventions align with their preferences. However, limited research has explored patients' attitudes toward palliative care in China, highlighting the need for further investigation.

Objectives

To explore the current status of cancer patients' palliative care attitudes, identify subgroups of attitudes and examine influencing factors for different subgroups; and understand the cancer patients' perceptions of palliative care.

Methods

A multi-method design was used. 541 cancer patients participated from March to June 2024. A latent profile analysis (LPA) was conducted to identify subgroups. The differences between the variables including sociodemographic characteristics and subgroups were explored, and participants also responded to open-ended questions about what perceptions on palliative care, and content analysis identified themes most frequently reported.

Results

Palliative care attitudes among cancer patients were low. Four different subgroups of palliative care attitudes and three themes about perspectives were confirmed. Education status, occupational status, primary caregivers, type of insurance, cancer stage, anxiety, and level of palliative care knowledge were significant factors affecting different groups (p < 0.05).

Conclusion

Majority of cancer patients had poor attitudes toward palliative care, confirming the major factors and perspectives of palliative care. These results emphasize the importance that should be given to the dissemination of knowledge and education about palliative care for cancer patients, and to improve the acceptance and recognition in order to promote palliative care practice.

Role of AI in empowering and redefining the oncology care landscape: perspective from a developing nation

Early diagnosis and accurate prognosis play a pivotal role in the clinical management of cancer and in preventing cancer-related mortalities. The burgeoning population of Asia in general and South Asian countries like India in particular pose significant challenges to the healthcare system. Regrettably, the demand for healthcare services in India far exceeds the available resources, resulting in overcrowded hospitals, prolonged wait times, and inadequate facilities. The scarcity of trained manpower in rural settings, lack of awareness and low penetrance of screening programs further compounded the problem. Artificial Intelligence (AI), driven by advancements in machine learning, deep learning, and natural language processing, can profoundly transform the underlying shortcomings in the healthcare industry, more for populous nations like India. With about 1.4 million cancer cases reported annually and 0.9 million deaths, India has a significant cancer burden that surpassed several nations. Further, India's diverse and large ethnic population is a data goldmine for healthcare research. Under these circumstances, AI-assisted technology, coupled with digital health solutions, could support effective oncology care and reduce the economic burden of GDP loss in terms of years of potential productive life lost (YPPLL) due to India's stupendous cancer burden. This review explores different aspects of cancer management, such as prevention, diagnosis, precision treatment, prognosis, and drug discovery, where AI has demonstrated promising clinical results. By harnessing the capabilities of AI in oncology research, healthcare professionals can enhance their ability to diagnose cancers at earlier stages, leading to more effective treatments and improved patient outcomes. With continued research and development, AI and digital health can play a transformative role in mitigating the challenges posed by the growing population and advancing the fight against cancer in India. Moreover, AI-driven technologies can assist in tailoring personalized treatment plans, optimizing therapeutic strategies, and supporting oncologists in making well-informed decisions. However, it is essential to ensure responsible implementation and address potential ethical and privacy concerns associated with using AI in healthcare.

Stigma, colorectal cancer knowledge and self-efficacy among colorectal cancer survivors: A cross-sectional study based on random forest analysis

PURPOSE

To assess the stigma levels among colorectal cancer (CRC) survivors, identify determinants, examine correlations with CRC knowledge and self-efficacy, and quantify the relative influence of various contributing factors.

METHODS

In total, 301 CRC survivors were enrolled from a tertiary oncology center in southern China. The participants completed the Social Impact Scale (SIS), Bowel Cancer Awareness Measure (Bowel CAM), General Self-Efficacy Scale (GSES), and a demographic and disease-related questionnaire. The analytical framework included multiple linear regression to identify the factors influencing stigma, LASSO regression for variable refinement, and random forest modeling to construct hierarchies of factor importance.

RESULTS

Participants demonstrated moderate levels across all measures: stigma (54.63 ± 8.37), CRC knowledge (8.25 ± 4.74), and self-efficacy (26.81 ± 5.95). Multiple linear regression identified type of medical insurance, support from peers, unwillingness to accept colonoscopy, CRC knowledge, and self-efficacy as significant factors influencing stigma. Random forest analysis ranked factor importance by Gini index: self-efficacy (4366.41), support from peers (1618.03), CRC knowledge (1029.04), type of medical insurance (886.66), and unwillingness to accept colonoscopy (750.16).

CONCLUSIONS

Healthcare providers should pay more attention to stigma among CRC patients. Effective stigma reduction necessitates culturally-sensitive psychosocial interventions, including enhancing patients' confidence in managing their disease, strengthening professional-driven online popularization of science campaigns, and facilitating social support networks.

Breast cancer beliefs and screening behaviors among South Asian immigrant women living in the United States

BACKGROUND

Breast cancer incidence is increasing among South Asian women in the United States (US). This qualitative study explored breast cancer beliefs, behaviors, and experiences among South Asian immigrant women in New Jersey (NJ).

METHODS

We conducted four online focus groups with South Asian women from NJ, aged ≥ 25 years with no prior history of cancer, in English, between June 2021 and July 2022. Thematic content analysis was guided by the Social Contextual Framework.

RESULTS

We recruited 22 participants, average age 52 (standard deviation (SD) = 8.4) years, all born in South Asia, and living in the US for an average of 26 (SD = 11.7) years. Low perceived individual risk of breast cancer was influenced by no family history and healthy lifestyles. Despite diet changes since immigrating and misconceptions held by some, women understood the benefits of mammography. Interpersonal and cultural barriers included family responsibilities and norms deprioritizing women's health and health-seeking behaviors. Access to care may be limited by structural factors including immigration status, insurance, and language barriers. Social norms regarding stigma, modesty, and self-disclosure may vary by generation and context.

CONCLUSIONS

Despite low perceived breast cancer risk and some cultural and structural barriers to screening, South Asian immigrant women generally understood mammography's early detection benefits. Culturally appropriate interventions leveraging family ties and social networks are needed to dispel misconceptions, promote health-seeking behaviors, and address structural barriers.

Somatic acupressure for the management of the fatigue-sleep disturbance-depression symptom cluster in breast cancer survivors: a study protocol for a phase III randomised controlled trial

INTRODUCTION

The fatigue-sleep disturbance-depression symptom cluster (FSDSC) is commonly experienced by breast cancer (BC) survivors, leading to a deteriorated quality of life (QoL). Somatic acupressure (SA) has been recommended as a promising non-pharmacological intervention for cancer-related fatigue (the core symptom of the FSDSC) in the guidelines, showing its encouraging role in relieving cancer-related sleep disorders, fatigue and depression. This phase III randomised controlled trial (RCT) is designed to evaluate the effects, safety and cost-effectiveness of SA for managing the FSDSC in BC survivors.

METHODS

This phase III RCT will be a partial-blinded, sham-controlled, three-arm, parallel clinical trial, involving a 7-week SA intervention period and a 12-week follow-up period. 108 BC survivors will be randomly allocated in a ratio of 1:1:1 to either a true SA group (self-administered acupressure plus usual care), a sham SA group (self-administered light acupressure at non-acupoints plus usual care) or a usual care group. The primary outcomes will be the effectiveness of SA on the FSDSC at both the individual symptom level and cluster symptom level. Each individual symptom will be specifically measured by the Brief Fatigue Inventory (fatigue), the Pittsburgh Sleep Quality Index (sleep disturbance) and the Hospital Anxiety and Depression Scale-Depression (depression). The cluster symptom level will be measured by using an FSDSC composite score, an averaging score of three separated 0-10 numeric rating scales for fatigue, depression and sleep disturbance. The secondary outcomes will include QoL (measured by the Functional Assessment of Cancer Therapy-Breast), adverse events and cost-effectiveness. Outcomes will be assessed at baseline (week 0), immediately after intervention (week 7) and follow-up (week 19). All outcomes will be analysed based on the intention-to-treat principle using the Statistical Package for Social Science (SPSS 25) software.

ETHICS AND DISSEMINATION

Ethical approvals of this study have been granted by the Human Research Ethics Committee at Charles Darwin University (H22110) and the Clinical Trial Ethics Committee at the Affiliated Hospital of Zunyi Medical University (KLL-2023-594), and the Second Affiliated Hospital of Zunyi Medical University (KYLL-2023-058). Findings from this trial will be published in peer-reviewed journals and presented at professional conferences.

TRIAL REGISTRATION NUMBER

NCT06412107.

The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial

INTRODUCTION

Transsphenoidal endoscopic pituitary (TEP) tumor resection is performed through the nose via the sphenoid sinus to remove tumors from the pituitary gland. Also, enhanced recovery after surgery (ERAS) was adapted to reduce physical and physiological traumatic stress response of surgical patients.

METHODS

A total of 174 patients who underwent TEP tumor resection in our department from August 2021 to June 2022 were randomly divided into non-ERAS group and ERAS group. The main primary observational indicator was postoperative self-care ability parameters such as early urethral catheters' removal and postoperative food intake. Also, secondary indicators such as postoperative complications, average length of hospital stay (LOS), and total hospital cost were compared.

RESULTS

The overall self-care ability of the ERAS group was higher than that of the non-ERAS group 24 h after surgery (35 points vs 20 points, p < 0.001). Also, food intake on the first day after surgery was higher than that of the non-ERAS group (p < 0.001). Furthermore, the average LOS in the ERAS group was lower than that of the non-ERAS group (4 days vs 7 days, p < 0.01). Additionally, the average hospitalization cost in the ERAS group was lower than that of the non-ERAS group (32, 886 RMB vs 48, 125 RMB, p < 0.001).

CONCLUSION

ERAS nursing strategy promoted early recovery of self-care, shorten the average LOS, and reduce hospitalization costs without increasing the incidence of postoperative complications.

Sex-related differences in eating-related distress experienced by patients with advanced cancer

BACKGROUND

Sex-related differences in eating-related distress (ERD) experienced by cancer patients have not previously been clarified.

METHODS

We conducted a multicenter survey among advanced cancer patients referred to palliative care. Data on patient characteristics were collected from the electronic medical records, and data on measurement outcomes were obtained from a questionnaire. Patients were categorized into male and female groups. We measured ERD using the Questionnaire for Eating-Related Distress among Patients with advanced cancer (QERD-P). The QERD-P comprises 3 items in each of the 7 factors, for a total of 21 items, and each item is rated on a 7-point Likert scale. High scores indicate worse distress. Comparisons were calculated using the Mann-Whitney U test. To assess associations between sexes and ERD, multivariate logistic regression analysis was performed.

RESULTS

A total of 192 patients were enrolled and divided into the male (n = 92) and female (n = 100) groups. The total score of the QERD-P was significantly higher in the male group (p = 0.018). The subtotal scores of "reasons why I cannot eat," "insufficient information," and "arguments with my family" were significantly higher in the male group (p = 0.035, 0.032, and 0.003, respectively). The male group had significantly higher risks for ERD associated with "arguments with my family" and "time with my family" (odds ratio [OR] 2.69, 95% confidence interval [CI] 1.38-5.24; OR 2.28, 95% CI 1.15-4.53).

CONCLUSIONS

Males had significantly worse ERD and were at higher risk of ERD in family relationships than females.

Low-molecular-weight polyphenol promotes cell sensitivity to cisplatin and alleviates cancer-related muscle atrophy via NF-κB suppression in oral squamous cell carcinoma

OBJECTIVE

Drug resistance and subsequent adverse effects, such as cancer cachexia, limit the clinical use of cisplatin. Oligonol® (Olg), a low-molecular-weight polyphenol, exhibits NF-κB inhibitory properties. NF-κB activation has been implicated in cisplatin resistance of cancer cells and skeletal muscle wasting. Therefore, we hypothesized that combined cisplatin and Olg could overcome chemoresistance and reduce muscle atrophy.

METHODS

To investigate the efficiency of Olg, oral squamous cell carcinoma (OSCC) cells were used for chemosensitivity, and human skeletal muscle myoblast (HSkMC) was used for muscle atrophy. HSkMCs treated with OSCC cell-derived conditioned medium were used to examine the role of Olg in muscle atrophy mediated by the tumor inflammatory microenvironment.

RESULTS

Olg exerted little effect on the viability of OSCC cells by promoting apoptotic cell death. However, it exhibited excellent capability to enhance the sensitivity of OSCC cells to cisplatin and overcome the acquired cisplatin resistance of OSCC. We revealed that NF-κB signaling contributes to cisplatin resistance in OSCC cells, whereas Olg enhances cell sensitivity to cisplatin by NF-κB suppression. Conversely, Olg contributes to a positive protein turnover and alleviates cisplatin-induced muscle atrophy by regulating Akt/mTOR/p70S6K and NF-κB/MuRF1 pathway. Olg represses TNF-α and interleukin 6 driven from OSCC cells and alleviates muscle atrophy mediated by the tumor inflammatory microenvironment.

CONCLUSIONS

Olg enhanced cisplatin chemosensitivity and reduced its adverse effects on skeletal muscle, suggesting its potential as a chemosensitizing agent for cisplatin. Further animal and clinical studies are required to validate these findings.

Identifying potential medical aid beneficiaries using machine learning: A Korean Nationwide cohort study

OBJECTIVE

To identify potential medical aid beneficiaries using demographic and medical history of individuals and analyzing important features qualitatively.

METHODS

This retrospective, national cohort, case-control study included data from the National Health Insurance Service (NHIS) in Korea between January 1, 2002 and December 31, 2019. Potential medical aid beneficiaries were classified using several machine learning models (linear models and tree-based models). Demographic data such as age, sex, region, insurance type, insurance fee, and medical history such as diagnosis, operation, statement, visits, and costs were collected. Those data were transformed into a one-dimensional vector for each individual, allowing machine learning models to learn. For feature importance calculation, we used the average gain across all splits for each feature.

RESULTS

274,635 individuals were finally included in the study population, and 62,501 were classified as potential medical aid beneficiaries. XGBoost successfully classified potential medical aid beneficiaries with an AUROC of around 0.891. Assuming predicting before two years, the performance was still significant with an AUROC of around 0.832. Economic variables, such as insurance fees and several costs, turned out to be the most important, but variables regarding medical status, such as the results of blood tests and history of chronic diseases, were also important.

CONCLUSION

Machine learning-based models successfully screened potential medical aid beneficiaries. Qualitative analysis of important features well reflected prior knowledge regarding public health. These findings can contribute to the soundness of healthcare finance and the improvement of public health.

"Detect Anemia Preoperatively": A Scoping Review of Recommendations

Background

Preoperative anemia significantly impacts patient outcomes, prompting increasing global implementation of patient blood management (PBM) measures. Timely diagnosis and differentiation of preoperative anemia are crucial components of PBM to maximize its effectiveness. Despite this, comprehensive implementation remains inconsistent. This scoping review aims to give an overview of recommendations regarding preoperative anemia management to detect gaps in knowledge and emerging ideas.

Methods

A scoping review, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, investigated preoperative anemia detection, focusing on patient population, timing, extent, and process of investigations. PubMed and ScienceDirect were searched for English and German articles published in the last 5 years, supplemented by manual selection. Pediatric and obstetric recommendations were excluded. Results were synthesized based on key questions.

Results

Four hundred sixty-five articles were screened, and 80 met the inclusion criteria, including 25 clinical practice guidelines. Most (n = 62) suggested "detect and correct" anemia without further specification. The rest advised conducting investigations early, ideally up to 30 days before major procedures with expected blood loss >500 mL. Recommended tests include blood counts, various iron parameters, folic acid/vitamin B12, inflammation markers, and renal, hepatic, and thyroid function tests. Ten articles described detailed algorithms. Other key recommendations included using reticulocyte hemoglobin, point-of-care Hb measurements, and automated laboratory algorithms. The underlying quality of scientific evidence is heterogeneous.

Conclusions

International recommendations on the detection of preoperative anemia are heterogeneous and often generic. Automated algorithms could make a significant contribution to practicability. While practice-oriented guidelines, especially by surgical societies, could promote standardized and efficient implementation, further research is needed to improve the quality of underlying scientific evidence.

Critical theory and cultural competency in medical QI projects: lessons from Pacific Islander communities

This reflection explores the transformative power of critical theory through a quality improvement (QI) project creating culturally relevant dietary resources for Pacific Islander communities in Washington State, USA. Food injustice and lack of food sovereignty are examined as manifestations of modern-day colonialism perpetuated by capitalist-driven social structures. The methodology employed critical reflection, defined as the process of examining assumptions and power relations that shape practice, central to critical theory. Iterative group discussions aimed to understand the impact of individual and collective assumptions, power dynamics, and oppression on the project's conceptualization, implementation, and evaluation.Specific recommendations are integrated into the discussion to aid those replicating similar protocols, emphasizing actionable steps such as engaging with the community at all project stages. The research team, composed of osteopathic medical students and a critical theory expert, engaged in reflexivity to understand how social locations and lived experiences influenced perceptions. Despite the goal of fostering cultural inclusivity, limitations in engaging the Pacific Islander community throughout the project lifecycle highlighted the need for cultural humility and participatory action methodology.This study underscores the importance of understanding the history and socio-political context of marginalized communities to avoid perpetuating colonial practices and trauma. It emphasizes the necessity for medical schools to incorporate sociological theories into curricula to promote compassionate, culturally appropriate care and research. By critically examining positionality and engaging in transformative learning, the group advocates for systemic changes towards a more equitable global healthcare system.Through critical reflection, the group has come to understand how lived experiences have shaped perceptions of oppression, which are entrenched within and perpetuated by social institutions. Actionable items from these reflections are presented to help future practitioners and educators apply cultural humility, community empowerment, and critical theory in QI projects.

Patient-Reported Barriers and Preferred Interventions to Improve Lung Cancer Screening Uptake

OBJECTIVE

Lung cancer screening (LCS) utilization remains low. We aimed at assessing LCS patient-reported barriers and preferred interventions to improve uptake.

METHODS

Between July and November 2023, an electronic 60-item survey was completed by consented patients aged 50 to 80 years who were due to receive LCS, and their eligibility for LCS was confirmed. The survey assessed patients' LCS perceptions and preferences to increase uptake. Regression analyses was performed to assess associated sociodemographic factors.

RESULTS

In all, 12,558 patients were contacted; 1,396 responded, 871 were interested, and 86 were eligible and enrolled (mean age: 62.4; 40% female; 79.1% White, 4.7% Asian, 2.3% Black). LCS was perceived as beneficial for early lung cancer detection by 91.9%, yet only 24.4% had undergone LCS previously. Of the respondents, 54.7% identified barriers to LCS with the most common being cost (23.3%) and lack of symptoms (23.3%). Current (versus former) smokers reported higher barrier scores (B coefficient: 7.06, 95% confidence interval [CI], 1.71-13.12) and lower self-efficacy scores (B coefficient: -5.15; 95% CI, -8.73 to -1.56). Patients with prior cancer screening had higher self-efficacy scores (B coefficient, 8.92; 95% CI, 1.95-15.88). Preferred interventions included patient reminders (63.3%), primary care provider notification about LCS eligibility (62.0%), and educational materials (60.8%). Patients with higher self-efficacy (odds ratio, 1.16; 95% CI, 1.06-1.27) were more likely to prefer reminders. Patients with personal cancer history were more likely to prefer primary care provider notification (odds ratio, 5.81; 95% CI, 1.15,29.22).

CONCLUSIONS

Our results underscore the LCS perceived benefits and barriers, as well as patient-preferred interventions to enhance screening participation.

Effectiveness of Nonpharmacologic Interventions for Chemotherapy-Induced Peripheral Neuropathy in Patients With Breast Cancer: A Systematic Review and Network Meta-analysis

BACKGROUND

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect in patients with breast cancer (BC) during treatment. Patients experiencing CIPN develop neuropathic symptoms, which could lead to the modification or discontinuation of chemotherapy. Nonpharmacological interventions can be simple and safe, but evidence of their effectiveness in patients with BC experiencing CIPN is currently insufficient.

OBJECTIVE

To compare and rank the effectiveness of nonpharmacologic interventions for CIPN in patients with BC.

METHODS

We conducted a systematic search of randomized controlled trials registered from database inception until October 2022 in 7 databases. We assessed studies that met the inclusion and exclusion criteria and evaluated the risk of bias. Network meta-analysis was conducted using Stata SE 17.0 (StataCorp, College Station, Texas).

RESULTS

A total of 13 studies involving 9 nonpharmacologic interventions and comprising 571 participants were included. The results of the network meta-analysis showed that cryotherapy (standard mean difference, -1.22; 95% confidence interval, -2.26 to -0.17) exerted significant effects versus usual care. Cryotherapy (surface under the cumulative ranking area [SUCRA]: 0.74) was associated with the highest likelihood of effectively alleviating CIPN in patients with BC, followed by exercise (SUCRA: 0.62) and self-acupressure (SUCRA: 0.59).

CONCLUSIONS

Cryotherapy was the most effective nonpharmacologic intervention for alleviating CIPN in patients with BC. Large-scale studies are required to verify the present findings.

IMPLICATIONS FOR PRACTICE

This study provides evidence regarding the effectiveness of nonpharmacologic interventions for CIPN. Physicians and nurses could incorporate cryotherapy into clinical practice to alleviate CIPN in patients with BC.

Quality-of-care indicators for oncology management: an analysis of Asia-Pacific healthcare and oncology indicators

Cancer is a major cause of morbidity and mortality, with variable outcomes seen in the Asia-Pacific region due to substantial differences in cancer care and management. Quality indicators are evidence-based, standardized measures of healthcare quality that help measure or quantify healthcare processes, outcomes, and organizational systems to help promote and provide equitable high-quality healthcare. A detailed list of quality indicators in medical, surgical, and palliative oncology was identified from literature reviews. This study, which was commissioned by the ESMO Asia Pacific Public Policy Committee, aims to report on the performance of healthcare and oncology quality indicators across 47 countries in the Asia-Pacific region.

Virtual 3D models, augmented reality systems and virtual laparoscopic simulations in complicated pancreatic surgeries: state of art, future perspectives, and challenges

Pancreatic surgery is considered one of the most challenging interventions by many surgeons, mainly due to retroperitoneal location and proximity to key and delicate vascular structures. These factors make pancreatic resection a demanding procedure, with successful rates far from optimal and frequent postoperative complications. Surgical planning is essential to improve patient outcomes, and in this regard, many technological advances made in the last few years have proven to be extremely useful in medical fields. This review aims to outline the potential and limitations of 3D digital and 3D printed models in pancreatic surgical planning, as well as the impact and challenges of novel technologies such as augmented/virtual reality systems or artificial intelligence to improve medical training and surgical outcomes.

Impact of Tumor Location on Predicting Early-Stage Breast Cancer Patient Survivability Using Explainable Machine Learning Models

PURPOSE

This study aims to investigate the impact of tumor quadrant location on the 5-year early-stage breast cancer survivability prediction using explainable machine learning (ML) models. By integrating these predictive models with Shapley Additive Explanations (SHAP), feature importance, and coefficient effect size, we aim to provide insights into the significant factors influencing patient outcomes.

METHODS

Data from 401 early-stage patients with breast cancer at the University of Missouri's Ellis Fischel Cancer Center were used, encompassing 20 variables related to demographics, tumor characteristics, and therapeutics. Six ML models, namely, Xtreme Gradient Boosting, Random Forest classifier, Logistic Regression, Decision Tree classifier (DT), Support Vector Machine classifier, and AdaBoost (ADB), were trained and evaluated using various performance metrics, including accuracy, sensitivity, specificity, F1-score, area under the receiver operating characteristic curve (AUC-ROC), and area under the precision-recall curve (AUC-PR). Feature importance, coefficient effect size, and SHAP values were used to interpret and visualize the importance of different features, particularly focusing on tumor quadrant variables.

RESULTS

The extreme gradient boosting model outperformed other models, achieving an AUC-ROC score of 0.98 and an AUC-PR score of 0.97. The analysis revealed that tumor quadrant variables, especially the upper outer and miscellaneous or overlapping sites, were among the top predictive features for breast cancer survivability. SHAP analysis further highlighted the significance of these tumor locations in influencing survival outcomes.

CONCLUSION

This study demonstrates the efficacy of explainable ML models in predicting 5-year early-stage breast cancer survivability and identifies tumor quadrant location as an independent prognostic factor. The use of SHAP values provides a clear interpretation of the model's predictions, offering valuable insights for clinicians to refine treatment protocols and improve patient outcomes.

A deep ensemble learning approach for squamous cell classification in cervical cancer

Cervical cancer, arising from the cells of the cervix, the lower segment of the uterus connected to the vagina-poses a significant health threat. The microscopic examination of cervical cells using Pap smear techniques plays a crucial role in identifying potential cancerous alterations. While developed nations demonstrate commendable efficiency in Pap smear acquisition, the process remains laborious and time-intensive. Conversely, in less developed regions, there is a pressing need for streamlined, computer-aided methodologies for the pre-analysis and treatment of cervical cancer. This study focuses on the classification of squamous cells into five distinct classes, providing a nuanced assessment of cervical cancer severity. Utilizing a dataset comprising over 4096 images from SimpakMed, available on Kaggle, we employed ensemble technique which included the Convolutional Neural Network (CNN), AlexNet, and SqueezeNet for image classification, achieving accuracies of 90.8%, 92%, and 91% respectively. Particularly noteworthy is the proposed ensemble technique, which surpasses individual model performances, achieving an impressive accuracy of 94%. This ensemble approach underscores the efficacy of our method in precise squamous cell classification and, consequently, in gauging the severity of cervical cancer. The results represent a promising advancement in the development of more efficient diagnostic tools for cervical cancer in resource-constrained settings.

Dysphagia development in heart failure patients: A scoping review

OBJECTIVE

Dysphagia significantly affects older adults, particularly those with heart failure (HF). This scoping review aimed to delineate the development of dysphagia and its contributing factors in patients with HF.

METHODS

We systematically searched MEDLINE, EMBASE, CINAHL, and CENTRAL databases up to September 2023, focusing on studies involving HF patients aged 60 and above, particularly those assessing post-hospitalization dysphagia.

RESULTS

Of 1,076 identified studies, nine were relevant. The prevalence of dysphagia at admission was 23.6 % (14.1 - 32.9), with 9.4 % (4.5 - 13.8) persisting until discharge. The evaluation of dysphagia primarily relies on oral intake assessments, highlighting several risk factors, including high inflammation, low energy intake, advanced age, low Barthel Index scores, poor oral health, antipsychotic usage, and low maximum tongue pressure. It is important to note potential author bias and overlap among study populations.

CONCLUSIONS

This review highlights the significant development of dysphagia in patients with HF, and the prevalence of newly developed dysphagia was 23.6 % (14.1 - 32.9). Key risk factors include older age, high inflammation, low activities of daily living, and sarcopenia, which is suggested as a pathogenic mechanism in dysphagia. Future research should focus on diverse samples, investigate the impact of sarcopenia and cachexia, and objectively assess swallowing function.

Mapping and comparing the quality of life outcomes in childhood and adolescent and young adult cancer survivors: an umbrella review and future directions

BACKGROUND

A cancer diagnosis early in life can leave a legacy in terms of compromised Quality of Life (QoL). There is a lack of clarity regarding the impact on QoL according to age at diagnosis, with childhood cancer survivors (CCS) and adolescents and young adult cancer survivors (AYACS) often combined. As part of an EORTC Quality of Life Group study, this umbrella review aims to (1) identify the QoL outcomes reported in the literature for both CCS and AYACS, and (2) investigate the similarities and differences in QoL challenges between both groups.

METHODS

A systematic literature search of systematic reviews and meta-analyses was conducted in December 2023 using PubMed, PsychInfo, and CINAHL. Methodological quality was evaluated using the AMSTAR tool.

RESULTS

Overall, 1457 articles were assessed, and 39 systematic reviews and meta-analyses met the inclusion criteria. QoL outcomes were categorized into eight QoL domains, all of which were reported in both groups of young survivors. However, reviews on CCS often focused on outcomes relating to emotional functioning, cognitive difficulties, social challenges, school functioning, body image and overall happiness, whereas AYACS reviews had a greater focus on depressive symptoms, outcomes related to sexual health and reproductive health, employment, financial difficulties, self-image and identity and the impact of cancer.

CONCLUSION

This umbrella review comprehensively explores QoL outcomes among CCS and AYACS, revealing both shared and distinct challenges. Future research should focus on developing tailored questionnaires, emphasizing transition periods and incorporating a life perspective to capture unique developmental tasks of young survivors.

Knowledge status of skin tear prevention and its demographic and occupational influencing factors: A National cross-sectional survey among nurses

AIM

A skin tear (ST) is a common skin injury that is often misdiagnosed or overlooked. This study examined the current state of nurses' ST knowledge and its influencing factors.

DESIGN

A national cross-sectional survey combined with a quantitative analysis was used to provide evidence of poor ST knowledge among nurses and its influencing factors.

METHODS

An electronic questionnaire survey was conducted among 1293 nurses from 32 hospitals in 18 provinces across China, including a General Information Questionnaire, ST Knowledge Assessment Instrument (OASES) and a Self-directed Learning Competence Scale for Nurses (SLCS-N).

RESULTS

The mean OASES score was 9.51 ± 3.15, with a score rate of 47.55%. Pearson's correlation analysis showed positive correlations, ranging from none to strong, between every dimension in the OASES and from strong to extremely strong between every dimension in the SLCS-N. Multivariate analysis revealed multiple independent factors influencing ST knowledge, such as hospital tier, specialized nurses in wound/ostomy/incontinence care, participation in training for wound/ostomy/incontinence management, willingness to undergo ST training, self-assessed grade in ST care and the degree of emphasis of managers.

CONCLUSION

ST knowledge status was generally poor among nurses nationwide. Managers should establish a comprehensive and specialized curriculum-based system, develop evidence-based standardized nursing processes, and provide tailored training programs to address nurses' unique characteristics and individualized needs, thereby enhancing their proficiency in ST-related knowledge and skills.

IMPACT

This study is the first to identify a poor level of ST knowledge among nurses nationwide, particularly in the four dimensions of risk assessment: prevention, treatment, classification, and observation. Based on the findings regarding demographic factors and ST experiences, an integrated management system and educational program should be implemented to improve nurses' awareness and knowledge in this field.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contributions.

Examining unmet needs in older adults with lung cancer: A systematic review and narrative synthesis

INTRODUCTION

Unmet needs in the older population with cancer are complex due to aging-related health conditions. A review of unmet needs in older people with cancer showed that needs varied among different cancer types. In lung cancer, a higher incidence of geriatric syndromes and comorbidities exist compared to other cancer cohorts, impacting treatment tolerance and completion. Consequently, it is crucial to identify and understand unmet needs to address supportive care needs beyond cancer diagnosis and treatment. This systematic review aims to synthesise the available literature to analyse the number and nature of unmet needs experienced by older patients with lung cancer.

MATERIALS AND METHODS

We performed a systematic search following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, which was registered in PROSPERO(CRD42022311105). We searched CINAHL, Medline, Embase, and Scopus electronic databases for published literature (January 2002 to November 2023) on unmet needs of patients ≥65 years diagnosed with lung cancer. We used a narrative synthesis approach to summarise the results and identify themes.

RESULTS

The search yielded 1356 articles, of which 35 met the inclusion criteria. A significant portion of older patients with lung cancer reported experiencing unmet needs, ranging from 78 % to100 %. Compared to other cancer streams, older patients with lung cancer experienced a higher burden of unmet needs, with a mean of seven unmet needs per person. Most studies identified psychological and physical/daily living domains as having the greatest prevalence and highest burden of unmet need.

DISCUSSION

Increased psychological distress and poorer quality of life correlated with increased unmet needs. Identifying and addressing unmet needs is critical for patient wellbeing and should be prioritised when developing models of care and tailored interventions for older people with lung cancer.