Impact of baseline glucocorticoids (GCs) on cardiotoxic events and myocardial damage related to immune checkpoint inhibitors: a retrospective clinical research

BACKGROUND

Immune checkpoint inhibitors (ICIs)-associated cardiotoxic events (CEs) are of increasing concern. Existing research about glucocorticoids (GCs) on immunotherapy focused on ICIs' efficacy and patients' outcome. The influence of GCs on ICIs-associated CEs and myocardial damage (MD) remains unknown.

RESEARCH DESIGN AND METHODS

This single-center retrospective study included patients treated with ICIs from 2018 to 2022, with follow-up period ending on 30 June 2023. The incidence, risk factors of ICIs-associated CEs, especially MD were described. Additionally, the impact of baseline GCs was assessed by propensity score matching (PSM) to mitigate intergroup differences and ensure comparability.

RESULTS

Among 1018 patients, 204 (20.04%) experienced ICIs-associated CEs, including 71 (6.97%) with MD. The mean follow-up time was 40.39 (95% CI 38.47-42.31) weeks. The median time to onset of MD was the shortest at 12.57 weeks (IQR 5.29-25.14). Tumor type, co-medication with platinum and angiogenesis inhibitors may be influential factors of MD. After PSM, the relative risks of CEs (OR 0.4625,95%CI 0.2514-0.7235, p = 0.0020) and MD (OR 0.3254, 95% CI 0.1190-0.8898, p = 0.0378) in GCs1 ≥ 20 mg group were both significantly lower than those in GCs1 < 20 mg.

CONCLUSION

GCs ≥ 20 mg during the first ICIs treatment cycle is significantly associated with the reduced risks of both ICIs-associated CEs and MD.

Understanding quality of life in Danish women with metastatic breast cancer undergoing multiple treatments

BACKGROUND

Women with metastatic breast cancer (mBC) may experience several symptoms exacerbated by successive treatments. There is however, a lack of knowledge of the most important symptoms and how these may affect daily life function. This study aims to elucidate the quality of life (QoL), including both symptoms and daily life functions, among mBC women undergoing varied treatments.

METHODOLOGY

We conducted a cross-sectional electronic questionnaire study enrolling mBC women (≥ stage III) receiving medical cancer treatment through September-December 2023. QoL, symptoms, and daily life function were measured using the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (QLQ-C30) and the breast cancer module (BR45). Health-related quality of life (HRQoL), defined by the EORTC, covers the subjective perceptions of the positive and negative aspects of cancer patients' symptoms, including physical, emotional, social, and cognitive functions. We examined associations between QoL, treatment line and therapy types, and estimated odds ratios (ORs) and confidence intervals (CIs).

RESULTS

Of 359 eligible participants, 111 responded (30.9%). At study commencement, 90.9% of the participants received at least one type of systemic treatment, with 16.2% undergoing chemotherapy, 61.3% anti-hormonal treatment, and 66.6% targeted cancer treatment. QLQ-C30 sum scores were highest in women receiving anti-hormonal treatment (80.7, interquartile range [IQR]: 17.6), followed by targeted cancer treatment (78.8, IQR: 18.4), and lowest with chemotherapy (77.1, IQR: 24.8). Quality of life decreased with subsequent treatment lines (first line: 80.3, IQR: 20.7, fourth line: 67.4, IQR: 11.3). No significant differences were found in the functions or in the individual symptoms according to monotherapy type.

INTERPRETATION

Women with mBC experience a substantial symptom burden and reduced functioning, and their QoL differs with successive lines of treatment. This underlines that women living with mBC need support and effective symptom management to maintain QoL.

Digital Health Interventions to Improve Mental Health in Patients With Cancer: Umbrella Review

BACKGROUND

Mental health plays a key role across the cancer care continuum, from prognosis and active treatment to survivorship and palliative care. Digital health technologies offer an appealing, cost-effective tool to address psychological needs.

OBJECTIVE

This umbrella review aims to summarize and evaluate the available evidence on the efficacy of digital health interventions for improving mental health and psychosocial outcomes for populations with cancer.

METHODS

Literature searches were conducted in Embase, PsycINFO, PubMed, CINAHL, the Cochrane Library, and Web of Science from their inception to February 4, 2024. Systematic reviews (with or without meta-analysis) investigating the efficacy of digital health interventions for psychosocial variables in patients with cancer were included. Quality was assessed using the Assessing the Methodological Quality of Systematic Reviews-2 tool.

RESULTS

In total, 78 systematic reviews were included in this review. Among diverse delivery modalities and types of digital interventions, websites and smartphone apps were the most commonly used. Depression was the most frequently addressed, followed by quality of life, anxiety, fatigue, and distress. The qualities of the reviews ranged from critically low to high. Generally, despite great heterogeneity in the strength and credibility of the evidence, digital health interventions were shown to be effective for mental health in patients with cancer.

CONCLUSIONS

Taken together, digital health interventions show benefits for patients with cancer in improving mental health. Various gaps were identified, such as little research specifically focusing on older adult patients with cancer, a scarcity of reporting high-precision emotion management, and insufficient attention to other certain mood indicators. Further exploration of studies with standardized and rigorous approaches is required to inform practice.

TRIAL REGISTRATION

PROSPERO CRD42024565084; https://tinyurl.com/4cbxjeh9.

Social support in a large general population sample over the course of six years

Social support is an important resource that is assumed to buffer the effect of stressful events on health. The aims of this study were to test psychometric properties of the ENRICHD Social Support Instrument (ESSI), to investigate the impact of several sociodemographic and behavioral variables on social support, and to analyze changes in social support over a 6-year period. A sample of 9,681 people from the general population was examined at baseline, 4,987 of whom were surveyed at a follow-up examination six years later using the ESSI and several other questionnaires. The psychometric properties of the ESSI were good (Cronbach's α = 0.91) and measurement invariance across gender and age could be established. High socioeconomic status, sharing a household with others, and employment resulted in high levels of social support. Tobacco smokers and alcohol drinkers reported having less social support than nonsmokers and non-drinkers. During the 6-year period, the mean level of social support remained nearly unchanged (d = 0.01). The data provide a framework for the interpretation and comparison of social support with other clinical and nonclinical populations. Public health initiatives should aim to prevent social isolation to improve public health.

Experiences of intimate partner violence among female cancer patients: a meta-synthesis of qualitative research

OBJECTIVES

This research systematically synthesized qualitative studies on intimate partner violence experiences among female cancer patients, aiming to inform the development of relevant psychosocial interventions.

METHODS

PubMed, Embase, Web of Science, Scopus, Medline, The Cochrane Library, CINAHL, CNKI, Wanfang, VIP, and Sinomed databases were searched for qualitative studies on intimate partner violence among female cancer patients. The search time frame was from the establishment of the database to April 8 2024. The quality of included studies was assessed using the list of qualitative studies in the Joanna Briggs Institute (JBI) Reviewer Manual. Meta-synthesis was integrated according to the meta-aggregation method proposed by the JBI and reported in accordance with the guidelines for Enhancing Transparency in Reporting Qualitative Research Synthesis (ENTREQ).

RESULTS

This study incorporated literature from seven sources, extracting 24 primary findings into 10 categories. These categories were further synthesized into four overarching results: cancer patients experienced multiple forms of violence; the multiple impacts of violence on cancer patients; patients' different ways of coping with violence; and multiple needs of cancer patients.

CONCLUSIONS

Intimate partner violence has emerged as a major, preventable global health issue, particularly affecting female cancer patients and significantly impacting their physical and mental health. Healthcare professionals must vigilantly monitor and address the psychological aspects of these patients, offering psychological counseling and treatment promptly as required.

Mixed methods scoping review of patients' experiences of urgent and emergency cancer care

BACKGROUND

Patients with oncological emergencies require immediate specialist cancer care to ensure optimum outcomes. This is often a stressful, time-sensitive situation for patients and their families who describe having to navigate complex care pathways to access urgent treatment. Acute oncology was established as a subspecialty in the UK in 2009, with the goal to streamline emergency cancer care. Patient experiences of urgent care in acute oncology contexts have not specifically been explored; hence, it is unknown whether patient experiences of emergency cancer care have improved. This may be due to lack of a patient-reported experience measure for this purpose.

METHODS

A mixed methods scoping review was conducted from 2010 to April 2024, with the aim of identifying core aspects of the care experience important to patients with cancer during an acute oncological episode, based on published research evidence. Qualitative, quantitative, and mixed methods articles were sourced and screened in accordance with Joanna Briggs Institute scoping review guidance. Core domains of patient experience were collated and summarised using mixed methods evidence synthesis.

RESULTS

Fifteen articles reporting on 14 unique studies were included. Issues important to patient experiences of emergency cancer care were described by patients, healthcare professional, and carer proxies. Studies captured experiences of various care delivery models including telehealth, in-person presentation to an Emergency Department, and acute oncology services. Six core domains of patient experience arose from the synthesis: managing emotional distress, being treated with compassion and respect, deciding when to seek help, hospital environment, quality of care and communication, and discharge planning.

CONCLUSIONS

This is the first review to identify existing literature on patient experiences of emergency cancer care, highlighting core domains of patient experience impactful for patients and their families. Patients' decisions about when to seek help and the impact of discussing palliative care needs during an emergency were more specific to emergency cancer care, compared to issues like the hospital environment, which can be important throughout a patient's cancer care journey. Results will help inform development of a patient-reported experience measure to allow healthcare providers to evaluate and continuously improve specialist urgent and emergency cancer care services.

A Case of Severe Early Childhood Caries Occurring in a Childhood Cancer Patient

BACKGROUND/OBJECTIVES

Childhood cancer is the leading cause of death among children, although medical advances are improving the prognosis. During cancer treatment, nausea or vomiting may occur and eating habits may become irregular; therefore, it is important to prevent the development of oral diseases. We encountered a childhood cancer patient with rapidly progressive multiple dental caries, and this report describes the progress.

METHODS

A boy aged 2 years 9 months was referred for perioperative oral management. No caries were detected in the oral cavity at the initial visit.

RESULTS

As the patient had difficulty eating because of nausea and vomiting during cancer treatment, he began to consume probiotic drinks frequently. At 8-month follow-up, dental caries localized to the primary molars was detected. However, caries had occurred in all erupted teeth by 9 months later, confirming the diagnosis of severe early childhood caries. Dental treatment and long-term oral management contributed to good oral health except for dental abnormalities caused by chemotherapy.

CONCLUSIONS

Childhood cancer patients, particularly at an early age, are at risk of rapid deterioration of oral disease even over a short time period. It is important to cooperate with medical or dental professionals from other hospitals to provide dietary and oral health instruction and continue long-term oral management to improve patients' quality of life.

Effectiveness of Dyadic Interventions on Quality of Life for Cancer Patients and Family Caregivers: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

BACKGROUND

Increases in cancer survivorship negatively impact patients and family caregivers, decreasing quality of life. Previous dyadic interventions involved them as a unit and focused on their outcomes, but inconsistent results existed in influencing quality of life.

OBJECTIVES

To assess dyadic intervention effect on quality of life for cancer patients and family caregivers across different cancer types and intervention durations.

DESIGN

A systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

METHODS

Six databases were searched from establishment until 14 January 2024. Two authors independently performed the search process, literature screening, and data extraction. The ROB version 2 and GRADE were respectively used to check the methodology and evidence quality. The data were analysed via RStudio, and intervention effects were estimated with 95% CIs and SMDs. The statistical heterogeneity was explored through the I2 statistic, P values, and Egger's test, and differences in overall effects were deemed statistically significant, having a P value < 0.05. Subgroup analysis was also conducted.

RESULTS

13 RCTs with 1625 participants, published from 2005 to 2021, were included. The results demonstrated that dyadic interventions enhanced quality of life for both cancer patients and family caregivers. Subgroup analysis suggested that family-centred interventions for patients with specific cancer types, which lasted for a long period (> 6 weeks), enhanced quality of life for cancer patients and family caregivers. The evidence and methodology were of a moderate quality.

CONCLUSIONS

Nurses are important practitioners of culture-oriented dyadic interventions. Long-term (> 6 weeks) and family-centred dyadic interventions for patients with a specific cancer type can enhance cancer patients' and family caregivers' quality of life, along with digital intelligence approaches to promote mutual communication and strengthen family relationships, thereby optimising oncology clinical nursing and enhancing the quality of life, health, and welfare of the entire family.

RELEVANCE TO CLINICAL PRACTICE

Dyadic interventions emphasising the involvement of both cancer patients and family caregivers should be considered and tailored by professionals and oncology nurses to establish harmonious family relationships, improve family coping techniques and decision-making to enhance the whole family's quality of life and well-being according to their cultural contexts, and promote more efficient, targeted, and economical oncology care.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution because all the involved participants were from existing studies, and the design, conduction, analysis, and interpretation of the data were completed by the authors in this article.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews: CRD42024519432; https://www.crd.york.ac.uk/PROSPERO/#recordDetails.

Relationship between disease perception and feelings of powerlessness in lymphoma patients: the mediating effect of social support and level of hope

Objectives

Lymphoma patients often experience significant physical and psychological stress, with feelings of powerlessness negatively impacting their health. While social support and hope are crucial for improving mood and coping with disease, their mechanisms in relation to disease perception and powerlessness remain unclear. This study aimed to examine the relationship between disease perception and feelings of powerlessness in lymphoma patients, focusing on the mediating roles of social support and hope.

Methods

For a cross-sectional design, 311 lymphoma patients were surveyed using the Brief illness perception questionnaire, Powerlessness assessment tool, Social Support Rating Scale, and Herth's Hope Scale, and were statistically analyzed using the software SPSS 27.0 and PROCESS version 4.1.

Results

A correlation was found between the disease perception, social support, hope level, and feeling of powerlessness of lymphoma patients (P < 0.01). There was a positive correlation between perceptions of illness and powerlessness (β= 0.291, P<0.001), and disease perception could influence powerlessness through three indirect pathways: the separate mediating effect of social support [β= 0.057, 95%CI (0.029~0.091)], the separate mediating effect of level of hope [β= 0.07, 95%CI (0.034~ 0.107)], and the chain mediating effect of social support and hope level [β= 0.019, 95%CI (0.008~0.033)]. Social support and level of hope played a partial medium mediating effect in the effect of perceived disease on feelings of powerlessness, accounting for 13.04% and 16.02% of the total effect, respectively, and the chained mediating effect of both accounted for 4.35% of the total effect.

Conclusions

Disease perception and powerlessness were positively correlated in lymphoma patients, and in addition, social support and level of hope mediated the relationship. This conclusion provides a theoretical basis and guidance for nursing interventions to reduce powerlessness in lymphoma patients.

Global prevalence and determinant factors of pain, depression, and anxiety among cancer patients: an umbrella review of systematic reviews and meta-analyses

INTRODUCTION

Depression and anxiety are prevalent psychological disorders that significantly affect physical, emotional, and social well-being, reducing quality of life and increasing medical costs. These issues are especially challenging for cancer survivors, complicating treatment management, affecting adherence, and potentially impacting survival rates. Thus, this umbrella review aimed to evaluate the global prevalence of pain, depression, and anxiety, as well as their determinants among cancer patients.

METHOD

An exhaustive umbrella review was conducted to systematically assess the prevalence and determinants of pain, depression, and anxiety among cancer survivors worldwide by analyzing systematic reviews and meta-analyses. The review involved a thorough search of multiple databases and included studies published in English up to July 2024 that reported on these symptoms. The process involved screening and selecting studies based on specific criteria, assessing the risk of bias using the AMSTAR tool, and analyzing data with statistical methods to determine overall prevalence and identify predictors. This comprehensive approach aimed to provide a detailed understanding of these psychological issues in cancer survivors and guide future research and interventions.

RESULT

The global summary prevalence of depression among cancer survivors was 33.16% (95% CI 27.59-38.74), while anxiety had a prevalence of 30.55% (95% CI 24.04-37.06). Pain prevalence after treatment was 39.77% (95% CI 31.84-47.70). Before treatment, 65.22% (95% CI 62.86-67.57) of cancer patients reported pain, which persisted in 51.34% (95% CI 40.01-62.67) during treatment. The analysis also found that during the COVID-19 pandemic, depression and anxiety rates among cancer patients were at their highest, with prevalences of 43.25% (95% CI 41.25-45.26) and 52.93% (95% CI 50.91-54.96), respectively.

CONCLUSION

The umbrella review found that depression and anxiety prevalence among cancer survivors was 33.16% and 30.55%, respectively, with significantly higher rates during COVID-19 at 43.25% and 52.93%. Key factors contributing to depression included poor social support, advanced cancer stage, and inadequate sleep, while anxiety was significantly linked to advanced cancer stage and poor sleep quality.

CLINICAL TRIAL NUMBER

Not applicable.

Illness cognition, illness perception and related factors in patients with lymphangioleiomyomatosis

PURPOSE

To explore the self-perceived illness cognition and perception status, as well as the relevant factors among lymphangioleiomyomatosis (LAM) patients.

METHODS

A web-based questionnaire survey was conducted in September 2023. A total of 121 LAM patients participated (including 16 patients with TSC-LAM), and the survey collected general demographic information, responses to a disease cognition questionnaire, and a simplified disease perception questionnaire.

RESULTS

LAM patients have a higher level of negative illness cognition and a lower level of positive illness cognition, specifically characterized by helplessness (15.74 ± 4.68 points), acceptance (16.00 ± 3.28 points), and perceived benefits (16.92 ± 3.86 points). Single-factor analysis of variance found significant correlations between cultural level, age, family average monthly income, use of rapamycin, use of home oxygen therapy, hospitalization frequency, disease duration, severity of respiratory distress, activity limitation, and the helplessness score of LAM patients (p ≤ 0.05); the number of children was significantly associated with acceptance scores of LAM patients (p ≤ 0.05); and whether surgery had been performed was significantly associated with acceptance and perceived benefits scores of LAM patients (p ≤ 0.05). Disease duration and activity limitation entered the regression equation for helplessness dimension, while whether surgery had been performed entered the regression equation for perceived benefits dimension, but no factor entered the regression equation for acceptance dimension. Applying the same analysis to disease perception, we found that the average score of the Illness Perception Questionnaire was 45.43 ± 8.97, with lower scores in the reverse-scored items of individual control, treatment, and understanding.

CONCLUSIONS

LAM patients exhibit higher levels of helplessness, particularly among those with longer disease duration and greater activity limitations, leading to a more negative perception of the disease. Additionally, patients who have undergone surgical procedures tend to perceive fewer benefits. Furthermore, there is a significant correlation between illness perception and factors such as rapamycin usage, home oxygen therapy, disease duration and activity limitations caused by LAM. This indicates that clinical healthcare providers should pay more attention to LAM patients and their associated groups, providing both informational and psychological support.

Effects of virtual counseling on the care burden and quality of life of family caregivers for leukemia patients: a randomized controlled trial study

BACKGROUND

Leukemia patients' caregivers often face care burden and low quality of life. Continuous virtual counseling can help to management these problems. This study examines effects of virtual counseling on the care burden and quality of life of family caregivers for leukemia patients.

METHOD

The study employed a randomized controlled trial pretest-posttest design with a control group, involving 90 family caregivers of leukemia patients at Iranian oncology clinics in 2021. Two oncology clinics were randomly assigned as experimental (45 participants) and control groups (45 participants). Participants were recruited using a convenience sampling method, adhering to pre-defined inclusion criteria. Data collection was facilitated using Novak and Guest's Caregiver Burden Inventory and the Caregiver Quality of Life Index-Cancer, administered at baseline, one month, and two months post-intervention. The experimental group engaged in six weeks of continuous virtual counseling, with sessions lasting 45-60 min each week. In contrast, the control group received standard hospital care.

RESULTS

The average ages of the experimental and control groups were 34.29 and 32.33 years, respectively. In the experimental group, 51.1% were men, and 68.88% were spouses of patients. In the control group, 62.2% were women, and 44.45% were spouses of patients. Two months following the intervention, the experimental group demonstrated significant improvement in average scores for both care burden (experimental group: baseline: 90.11 ± 11.34, post-test 1: 73.78 ± 11.58, post-test 2: 52.91 ± 13.57; control group: baseline: 86.38 ± 9.81, post-test 1: 90.93 ± 14.54, post-test 2: 97.40 ± 15.03; a large significant interaction effect for time*group (η2 = 0.653, p < 0.001), and quality of life (baseline: 65.18 ± 8.36, post-test 1: 73.76 ± 6.53, post-test 2: 89.07 ± 9.43; control group: baseline: 61.82 ± 11.68, post-test 1: 51.96 ± 11.22, post-test 2: 44.24 ± 13.63; a large significant interaction effect for time*group (η2 = 0.651, p < 0.001).

CONCLUSION

The findings of this study suggest that virtual counseling can be a positive influence in reducing care burden and improving the quality of life for caregivers of leukemia patients. These results highlight the potential value of incorporating virtual counseling strategies into the caregiving support programs for nurses.

TRIAL REGISTRATION

Current controlled trials IRCT20211227053551N7) on February 9, 2025, as well as Retrospectively registered.

Return-to-Work Support Needs and Influencing Factors Among Korean Young Adult Cancer Survivors: A Cross-Sectional Study

OBJECTIVES

To investigate the need for return-to-work (RTW) support among young adult cancer survivors and identify influencing factors.

SAMPLE & SETTING

This cross-sectional study included 134 Korean young adult cancer survivors, recruited in two days in April 2022 through an online survey.

METHODS & VARIABLES

The study measured the need for RTW support, cancer stigma, cancer fatigue, and social support. Analyses included descriptive statistics, Pearson's correlation, and stepwise multiple linear regression.

RESULTS

The factors significantly influencing the need for RTW support were cancer type (p < 0.001), occurrence of metastasis or recurrence (p = 0.004), number of cancer treatment types being received (p = 0.007), and cancer fatigue (p = 0.012). These variables explained about 26% of the variance.

IMPLICATIONS FOR NURSING

This study offers important need-oriented information and highlights the need for proactive management of cancer-related fatigue to provide RTW support for young adult cancer survivors.

Feasibility and preliminary effects of a socio-spiritual intervention for adults with cancer and their family caregivers: a pilot randomised controlled trial

Background

Despite significant psychosocial-spiritual needs adversely affecting the health-related quality of life (HRQoL) of adults living with cancer and their family caregivers in sub-Saharan Africa, there is a dearth of culturally tailored interventions to address these needs. This study evaluates the feasibility of a socio-spiritual intervention designed for adults with cancer and their family caregivers in sub-Saharan Africa, and preliminarily examines its impact on family/social support, spiritual needs, information needs, health literacy and HRQoL.

Methods

This study employed a single-site randomised controlled trial design. Eighty-eight dyads were randomly assigned to either a socio-spiritual intervention (n = 44 dyads) or usual care (n = 44 dyads). The intervention group participated in a 4-week face-to-face training programme with usual care, whereas the control group received only usual care over the same period.

Result

A total of 82 dyads completed the study (40 dyads in the intervention group and 42 dyads in the control group). The eligibility and acceptance rates were >85%, retention was >90% and treatment fidelity was high (between 88.5% and 94.6%). In terms of intervention effects, the intervention was helpful in reducing needs and improving HRQoL of adults with cancer (F (13, 65) = 24.50, p < 0.001; Wilks' Lambda = 0.17) and their family caregivers (F (13, 65) = 14.27, p < 0.001; Wilks' Lambda = 0.26).

Conclusion

This pilot study established the feasibility of a face-to-face training programme for adults with cancer and their families, as well as its potential for improving HRQoL of this population.This study's findings imply that by supporting individuals with cancer and their family caregivers as a unit of care, both individual needs and components of HRQoL can be maintained or even improved. In current practice in Nigeria, only patients' needs are routinely addressed; caregivers often are left on their own to obtain information and support to deliver complex care in the home.

Evaluation of psychological status in early-stage breast cancer outpatients: a cross-sectional study utilizing the Kessler 10 Scale

OBJECTIVE

To evaluate the psychological status of early-stage breast cancer outpatients using the Kessler 10 Scale (K10) and to determine the feasibility of employing the K10 scale for psychological assessment in outpatient settings.

METHODS

This cross-sectional study surveyed 250 patients at the Breast Surgery Outpatient Clinic of our hospital, from February to March 2023, using the Kessler 10 Scale (K10) questionnaire.

RESULTS

A total of 120 breast cancer (BC) patients and 120 non-breast cancer (non-BC) patients completed the questionnaire. The K10 scores were significantly higher in BC patients compared to non-BC patients (15 [12.25, 20] vs. 13.5 [11.25, 17], P = 0.006). Among BC patients, those receiving postoperative endocrine therapy had significantly higher K10 scores than those not (19 [14, 22] vs. 15 [12, 20], P = 0.04). However, the type of surgery did not significantly impact the psychological status of BC patients (P = 0.57).

CONCLUSIONS

The Kessler 10 Scale (K10) is a practical tool for initial psychological screening in outpatient settings. BC patients demonstrate significantly higher levels of psychological distress compared to non-BC patients. Patients undergoing endocrine therapy as part of adjuvant treatment following surgery experience greater psychological distress compared to those not. These findings underscore the importance of early psychological monitoring and intervention for this population during outpatient visits.

Developing and implementing a nurse-delivered and a web-based dyadic psychoeducational program for people with advanced cancer and their family caregivers: sharing experiences from a three-arm international randomized controlled trial (DIAdIC)

Background

Each year millions are diagnosed with cancer, impacting both patients and caregivers. Few interventions target both patients and family caregivers together, despite their shared experiences. While dyadic psychoeducational programs are gaining attention, evidence on developing and implementing these in international trials is limited. The DIAdIC trial faced unique challenges requiring innovative solutions to maintain study integrity.

Objectives

To present our experiences with the development and implementation of two dyadic psychoeducational home-based programs, FOCUS+ and iFOCUS in the context of a randomized controlled trial (RCT) in six European countries.

Design

A case report detailing our experiences in the development and implementation of two dyadic psychoeducational home-based programs (one face-to-face and one web-based) across multiple countries, highlighting the challenges and mitigating strategies in an international context.

Methods

A chronological narrative describing experiences with the development and implementation of iFOCUS and FOCUS+.

Results

The FOCUS+ and iFOCUS programs were successfully developed for the European context through rigorous translation and adaptation processes. Despite recruitment challenges including COVID-19 restrictions and administrative hurdles, 431 patient-caregiver dyads were enrolled across 6 European countries. Quantitative and qualitative data assessed the outcomes of FOCUS+ and iFOCUS interventions, including the primary endpoints of emotional functioning and self-efficacy. Fidelity was evaluated using audio recordings, checklists, and user data. Challenges in trial management were addressed with flexible timelines and technical support.

Conclusion

The international DIAdIC trial developed and implemented two psychoeducational dyadic programs for patients with advanced cancer and their family caregivers. Based on our experiences we share several insights for future similar studies. These relate to the attention needed for context-specific adaptations when using existing interventions or programs, the translation of human-facilitated programs to standalone eHealth versions, the challenges of adopting a dyadic focus in the study, the pragmatic challenges of conducting an RCT and evaluating implementation and effects, and the technology used for study management.

Fatigue in hematological cancer changes across chemotherapy trajectory within the context of IL-6, not hemoglobin level: evidence from growth curve modeling

PURPOSE

The present study aimed to examine (a) how fatigue severity changes during the course of chemotherapy in patients with hematologic cancer and (b) whether cytokines (IL-1 alpha, IL-1 beta, IL-6) are associated with fatigue change after controlling for demographic and clinical factors (e.g., hemoglobin/hematocrit, medications, comorbid conditions).

METHODS

This observational cohort study used data from 148 hematological cancer patients four times: prior to chemotherapy, on the last day of chemotherapy, 1 week after the chemotherapy completion, and 1 month after baseline assessment. Latent growth curve modeling was used to examine the longitudinal association of fatigue severity with cytokines and hemoglobin.

RESULTS

A quadratic growth curve model fit the data well, indicating model tenability, and explained a large amount of variance in fatigue across measurement time points. Fatigue slightly increased toward the end of chemotherapy and decreased with time after chemotherapy completion. The influence of IL-6 on fatigue was significant at all time points except at the last assessment occasion (i.e., 1 month after the baseline assessment). The influence of IL-6 on fatigue was independent (unique) from the impact of hemoglobin level. Age and chemotherapy given for the first line of treatment significantly influenced the rate of fatigue change over time. Age also influenced the change pattern's shape.

CONCLUSIONS

Fatigue severity changes across the course of chemotherapy within the context of IL-6 activity, not the hemoglobin level. The influence of IL-6 may be limited during and shortly after chemotherapy. These findings inform the development of new symptom management strategies.

Reliability and validity of Persian version of the nurses' willingness to engage in palliative care scale

INTRODUCTION

Nurses play an essential role in providing palliative care to improve the quality of life of people with chronic diseases. The Willingness of nurses to engage in this cares is a necessary issue. Therefore, the evaluation of their willingness requires the use of valid, reliable, and suitable tools in the health system of Iran. This study was conducted to translate and validate the psychometric properties of the Persian version of the nurses' willingness to engage in the palliative care scale.

METHODS

This methodological study was conducted in 2023. 440 nurses were included using the convenience sampling in Baqiyatallah Hospital in Tehran. The translation was done using the forward-backward method. Face validity was done with a cognitive interview with 15 clinical nurses. Content validity was done using the opinions of 15 palliative expert nurses, and construct validity was done using exploratory factor analysis (n = 240) and confirmatory factor analysis (n = 200). The reliability was done using internal consistency and assessment of stability. The data were analyzed using SPSS v.25 and LISREL v.8.8.

RESULTS

In the face validity assessment, the items did not change. Brief changes were made in items 8 and 18, in the content validity assessment. In the exploratory factor analysis, 4 factors same as the original version were extracted with a cumulative variance of 59.52%. The results of confirmatory factor analysis showed that the 4-factor model was fit (RMSEA = 0.062, CFI = 0.97, NFI = 0.93, IFI = 0.97, GFI = 0.88). The internal consistency using Cronbach's alpha was 0.9 also the stability was 0.79.

CONCLUSION

The Persian version of nurses' willingness to engage in palliative care scale has sufficient validity and reliability for nurses in the Iranian population. Therefore, this tool can be used to measure nurses' willingness to engage in the palliative care and identify effective strategies. This tool can be used in clinical trials and research in order to improve the ability of nurses in palliative care in Iranian society.

Association between high-risk human papillomavirus and cervico-vaginal infections in tribal women screened for cervical precancers and cancers in Maharashtra, India: A cross-sectional study

Background The vaginal microenvironment is thought to impact infection and persistence of the human papillomavirus which is a necessity for cervical carcinogenesis. Tribal women are at risk for human papillomavirus and cervicovaginal infections due to polygamy, poor hygiene, and illiteracy. Aims We evaluated the association of common cervico-vaginal infections with human papillomavirus infection and cervical precancers among the tribal women of Dahanu taluka, Maharashtra, India. Methods For this cross-sectional study, tribal women from Dahanu taluka were recruited. Cervical brushing samples were collected from them and tested for human papillomavirus by the Hybrid Capture 2 method and polymerase chain reaction for Chlamydia trachomatis. Vaginal samples were collected for gram staining and examined for candidiasis and bacterial vaginosis, followed by visual inspection of the cervix with acetic acid. Results A total of 501 sexually active tribal women were recruited, among whom the human papillomavirus infection rate was 6.5%. Evaluation of vaginal smears by Nugent's scoring revealed bacterial vaginosis in 208 (41.5%), candidiasis in 30 (5.98%), and chlamydia in five (1%) participants. Bacterial vaginosis prevalence was higher in high-risk human papillomavirus-positive women. The presence of clue cells was associated with human papillomavirus positivity, suggesting an association between bacterial vaginosis and human papillomavirus infection and indicating an increased risk of human papillomavirus infection on co-infection with bacterial vaginosis. Limitations Only tribal women were screened, with no screening for other sexually transmitted infections. Since participants were recruited from healthcare centres instead of random sampling, this may have affected infection rate estimates. Due to regional differences in sexual behaviours and gynaecological morbidities, our findings cannot be generalised to tribal women from other regions. Conclusion Early detection and management of reproductive tract and sexually transmitted infections is paramount for preventing co-infections and reduces the risk of cervical carcinogenesis.

Association between psychological resilience and symptom burden in postoperative patients with brain gliomas and its influencing factors

OBJECTIVES

This study aimed to explore the relationship between psychological resilience (PR) and symptom burden in postoperative brain glioma (BG) patients and to identify factors influencing this relationship.

METHODS

A total of 296 postoperative BG patients were included in this study. Various scales were employed, including the General Information Questionnaire, the Psychological Resilience Scale for PR, the M.D. Anderson Symptom Inventory for Brain Tumors to assess symptom burden, the Social Support Rating Scale, and the General Self-Efficacy Scale. Pearson correlation and multifactor linear regression analyses were used to examine the relationship between PR and symptom burden, and to assess the impacts of social support and self-efficacy.

RESULTS

Higher PR was associated with younger age, higher educational level, and greater family income. A significant inverse correlation was found between PR and symptom burden (r=-0.827, P<0.001). Social support (r=-0.832, P<0.001) and self-efficacy (r=-0.116, P=0.046) were also negatively correlated with symptom burden. Multifactorial analysis revealed that both PR and social support independently influenced symptom burden.

CONCLUSIONS

Enhancing PR and social support in postoperative BG patients may reduce symptom burden and improve quality of life. Future research should investigate interventions to improve PR and evaluate their long-term effects on symptom management and recovery.

Factors influencing partnerships between care workers and families in nursing homes in South Korea

This study aimed to identify factors influencing partnerships between nursing home staff and families and explore means of improving these partnerships. It employed a cross-sectional survey design. Data were collected from 152 care workers who worked in 11 nursing homes in Gyeonggi-do. As research tools, the scale for staff-family partnership in long-term care, global interpersonal communication competence scale, emotional intelligence scale, and organizational culture scale were used. Participants had a mean age of 59.93 ± 7.72 years, and the mean partnership score was 48.81 ± 6.35. Partnership was influenced by communication competence (β = 0.26, p = .002); developmental culture, a sub-domain of organizational culture (β = 0.29, p < .001); and current work experience (β = -0.21, p = .004). The explanatory power was 32.1% (F = 24.81, p < .001, Adj.R² = 0.321). These findings highlight the need for practical strategies to enhance partnerships in nursing homes. Specifically, nurses who manage care workers should foster a work environment that promotes staff retention for more than 3 years through flexible organizational management, provide differentiated, experience-based communication training, and implement supervision to improve care expertise. By applying these measures, nursing homes can strengthen partnerships between staff and families, ultimately improving the quality of care services and the well-being of older residents.

[A systematic review of childhood cancer-related fatigue assessment tools based on the COSMIN guidelines]

OBJECTIVES

To systematically review the methodological quality and measurement properties of childhood cancer-related fatigue assessment tools based on the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines, providing a basis for clinical practitioners to select appropriate assessment tools.

METHODS

The databases searched included China National Knowledge Infrastructure, Wanfang Data, China Biomedical Literature, Weipu, PubMed, CINAHL, Embase, and Web of Science for studies published up to January 2024. Children under 12 years old and their primary caregivers were enrolled as subjects. Articles were screened based on inclusion criteria, and the key information regarding the assessment tools was extracted. The risk of bias checklist from the COSMIN guidelines and the quality standard rating scale were employed to evaluate measurement properties and formulate final recommendations.

RESULTS

A total of 18 articles were included, covering 7 fatigue measurement tools, consisting of 4 specific tools and 3 generic tools tools. Methodological differences were observed in measurement properties across these scales. The Chinese Version of the Pediatric Patient-Reported Outcomes Measurement Information System (C-Ped-PROMIS) was rated as grade A recommendation due to its adequate content validity and internal consistency, while the remaining six scales were rated as grade B recommendation since their content validity was assessed as "insufficient" based on moderate-level evidence or higher.

CONCLUSIONS

The C-Ped-PROMIS scale demonstrates good reliability, validity, and cross-cultural validity as the preferred tool for measuring childhood cancer-related fatigue. The scale can serve as an auxiliary tool, and future research should focus on the applicability of various tools to enhance the effectiveness of interventions for assessing childhood cancer-related fatigue.

The bittersweet experiences of providers of Home-Based Palliative Care (HBPalC): a qualitative study on the provider perspectives of HBPalC in Kerala, India

BACKGROUND

Home-based care is a fundamental component of the Kerala model of palliative care, which has received global recognition. The study explores the experiences of palliative care providers caring for a vulnerable community of patients. Findings may assist in identifying gaps and replicating Kerala's palliative care model in other settings.

METHODS

This descriptive qualitative study was conducted among palliative care providers (PCPs) and other stakeholders working with the Pain and Palliative Care Project of the National Health Mission (NHM), Thiruvananthapuram District, Kerala. Three Focus Group Discussions and 21 In-Depth Interviews were conducted among a purposively sampled group of participants including palliative care providers and patients. The validity of the data was ensured by data triangulation and member checks using standard methodologies. All interviews were audio recorded and thematic analysis was done using the Braun & Clarke method.

RESULTS

PCPs experienced a multitude of positive and negative experiences and challenges. They found contentment in establishing an intimate relationship with patients and their families, getting the opportunity to deliver need-based quality care, crossing the hurdles of social acceptance and creating opportunities from challenges; giving them a feeling of satisfaction and self-worth. Challenges faced by caregivers included a lack of acceptance from patients/families, stress, burnout, and helplessness. Additionally, although the program was running efficiently in the community, palliative care providers faced administrative, organizational, and personal barriers that they felt impeded their contributions.

CONCLUSIONS

The study gives an in-depth illustration of the challenges and ambivalent experiences of palliative care providers working under Kerala's home-based palliative care programme, providing care to a vulnerable section of society. The caregivers themselves represent an underprivileged community of nurses who struggle to provide the highest possible care despite the challenges and difficulties.

Co-producing a 'creative toolkit' to support the mental health and wellbeing of palliative care professionals: a community case study

Alterations to the clinical, social, and economic landscape have made palliative care an increasingly challenging sector in which to work; COVID-19 introduced further changes that pushed palliative care professionals to the breaking point. Their struggles at work are exacerbated by the fact that specialists in this field tend to ignore their own needs, instead centring and prioritising those of their patients-a situation that is not tenable. Within this community case study we describe how our team, comprising clinical and university staff, sought to address this by co-creating a suite of resources to support the physical, psychological, social, and spiritual health of palliative care workers. The result was the Creative Toolkit©, which is both an overall approach and a suite of materials that uses creative, arts-based intervention to facilitate reflection, relaxation, and rejuvenation-and to ensure that clinical staff feel connected and valued. Although participants sometimes initially hesitate due to their limited prior exposure to art-based methods, feedback on our sessions has been unanimously positive, revealing the value of creative activities for, among other things, aiding in processing difficult feelings and creating community amongst staff. While initial results are promising, we acknowledge the need for an expanded evidence base to encourage more widespread uptake of our method.

Structural equation modeling of hope, psychological distress, quality of life, and influencing factors in advanced cancer patients undergoing cancer pharmacotherapy in Japan

OBJECTIVE

The purpose of this study was to clarify the relationship between hope, psychological distress, and quality of life (QOL) of patients with advanced cancer undergoing cancer pharmacotherapy and their related factors.

METHODS

Participants were patients with advanced lung, colorectal, and breast cancer undergoing outpatient pharmacotherapy. The Herth Hope Index, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy-General were used as measurement tools in a cross-sectional survey. Data were analyzed using descriptive statistics, correlation analysis, t-test, one-way analysis of variance (ANOVA), and Structural Equation Modeling (SEM).

RESULTS

The number of valid responses to the questionnaire survey was 200 (91.7%). SEM included hope, psychological distress, QOL, social support, economic deprivation, physical symptoms, and performance status. The goodness of fit index for SEM was 0.989, adjusted goodness of fit index was 0.960, comparative fit index was 1.000, and root mean square error of approximation was 0.001. Hope had a negative impact on psychological distress (β = - 0.46) and a positive impact on QOL (β = .19).

CONCLUSION

Hope was shown to be a predictor of psychological distress and QOL in patients with advanced cancer receiving pharmacotherapy. Predictors of hope were social support and economic deprivation. The results suggest that early intervention for patients with characteristics that tend to lower levels of hope is effective in reducing patient anxiety and depression and improving QOL.

Financial Toxicity and Its Association with the Quality of Life of Greek Patients with Cancer: A Cross-Sectional Study

Background/Objectives: Greek cancer patients deal with high out-of-pocket medical expenses in comparison with the European Union average. All these high costs affect the quality of life of cancer patients, leading to financial toxicity. The purpose of this study is to investigate the association between financial toxicity and quality of life in patients undergoing cancer treatment. Methods: A cross-sectional study was conducted in four hospitals in Greece. The Comprehensive Score for Financial Toxicity (COST) Scale was used for the evaluation of financial toxicity, and the EORTC Core Quality of Life questionnaire (EORTC QLQ-C30) was used for the assessment of quality of life. Quantitative variables were first tested for normality using the Kolmogorov-Smirnov criterion. Spearman correlation coefficients (rho) were used to explore the association of two continuous variables. Multiple linear regression analysis was used with dependent the QoL subscales. Logarithmic transformations of the QoL scales were used for the regression analyses. Internal consistency reliability was determined by the calculation of Cronbach's α coefficient. All reported p values are two-tailed. Statistical significance was set at p < 0.05 and analyses were conducted using SPSS statistical software (version 27.0). Results: Greater financial toxicity score, i.e., lower toxicity, was significantly associated with greater global health status (rho = 0.34; p < 0.001) and greater physical (rho = 0.37; p < 0.001), role (rho = 0.17; p = 0.001), emotional (rho = 0.34; p < 0.001), cognitive (rho = 0.22; p < 0.001), and social (rho = 0.27; p < 0.001) functioning. Conclusions: There is a strong correlation between a greater financial toxicity score and the quality of life of Greek cancer patients, meaning the lower their financial toxicity, the better their quality of life.

Patient preferences and willingness to pay for transitional care in breast cancer: a discrete choice experiment

PURPOSE

Most chemotherapy reactions occur outside of the hospital; therefore, providing transitional care (TC) to patients is essential. However, patients' preferences for TC remain poorly understood. This study aims to investigate the preferences and willingness to pay for TC among breast cancer patients.

METHODS

Data were collected using a discrete choice experiment from a large general hospital in North China. The study used six attributes to describe the preferences of patients for TC. Conditional logit and mixed logit models were applied to assess patient preferences, estimate willingness to pay, and simulate uptake probabilities across different scenarios.

RESULTS

A total of 261 respondents completed the survey. The study showed that patients strongly preferred a TC to be provided by a specialist doctor and specialist nurse (β = 0.925; p < 0.001) and were willing to pay CNY¥105.381. The service content most preferred was symptom management, psychological care, and rehabilitation guidance (β = 0.286; p < 0.001), and patients were willing to pay CNY¥32.606. The forms of services most preferred were at outpatient clinics (β = 0.239; p < 0.001), and patients were willing to pay CNY¥27.285. Low out-of-pocket expense was preferred by patients (β = - 0.009; p < 0.001). When TC was provided by a specialist doctor and specialist nurse in an outpatient clinic in conjunction with multidimensional care services and out-of-pocket payment of CNY¥20 per visit, the probability of breast cancer patients' participation increased to 91.39%.

CONCLUSION

The results of this study suggest that breast cancer patients have strong preferences for the provider, content, and form of transitional care (TC), as well as for minimizing out-of-pocket costs.

A comprehensive review of computational diagnostic techniques for lymphedema

Lymphedema is localized swelling due to lymphatic system dysfunction, often affecting arms and legs due to fluid accumulation. It occurs in 20% to 94% of patients within 2-5 years after breast cancer treatment, with around 20% of women developing breast cancer-related lymphedema. This condition involves the accumulation of protein-rich fluid in interstitial spaces, leading to symptoms like swelling, pain, and reduced mobility that significantly impact quality of life. The early diagnosis of lymphedema helps mitigate the risk of deterioration and prevent its progression to more severe stages. Healthcare providers can reduce risks through exercise prescriptions and self-manual lymphatic drainage techniques. Lymphedema diagnosis currently relies on physical examinations and limb volume measurements, but challenges arise from a lack of standardized criteria and difficulties in detecting early stages. Recent advancements in computational imaging and decision support systems have improved diagnostic accuracy through enhanced image reconstruction and real-time data analysis. The aim of this comprehensive review is to provide an in-depth overview of the research landscape in computational diagnostic techniques for lymphedema. The computational techniques primarily include imaging-based, electrical, and machine learning (ML) approaches, which utilize advanced algorithms and data analysis. These modalities were compared based on various parameters to choose the most suitable techniques for their applications. Lymphedema detection faces challenges like subtle symptoms and inconsistent diagnostics. The research identifies bioimpedance spectroscopy (BIS), Kinect sensor and ML integration as the promising modalities for early lymphedema detection. BIS can effectively identify lymphedema as early as four months post-surgery with sensitivity of 44.1% and specificity of 95.4% in diagnosing lymphedema whereas ML and artificial neural network achieved an impressive average cross-validation accuracy of 93.75%, with sensitivity at 95.65% and specificity at 91.03%. ML and imaging can be integrated into clinical practice to enhance diagnostic accuracy and accessibility.

Social risk factors screening preferences among breast and prostate cancer survivors: A qualitative study

OBJECTIVES

This project aimed to understand the experiences and preferences for social risk factor screening among racially, ethnically, and linguistically diverse cancer survivors in the Washington, DC, region.

METHODS

Semi-structured interviews were conducted with English, Spanish, and Amharic-speaking breast and prostate cancer survivors. Data were inductively coded to identify themes, and differences by race and preferred language were evaluated.

FINDINGS

Twenty-two interviews in English (n = 14), Spanish (n = 7), and Amharic (n = 1) among participants who identified as Black (n = 8), White (n = 5), Asian (n = 1), Other (n = 6), and multiracial (n = 2) were completed. Participants reported unresolved needs during treatment including transportation, healthful food, mental health care, financial help, and employment assistance. COVID-19 exacerbated many needs. Most participants did not recall discussing needs with oncology teams, but all participants were open to having these conversations.

CONCLUSION(S)

This research reveals that cancer survivors might benefit from culturally appropriate strategies that address social needs.

Core capabilities of Chinese centers for disease control and prevention public health personnel: a network analysis from Northeast China

BACKGROUND

The COVID-19 pandemic has highlighted the continued inadequacy of the capability of Center for Disease Control and Prevention (CDC) public health personnel to respond effectively to emerging infectious disease outbreaks, as well as the urgent need for specific tools to assess the capability needed by CDC public health personnel in the post-pandemic era. Using network analysis, we aimed to analyze the comprehensive capacities of CDC public health staff and the relationships between these capacities. We also examined the impact of standardized public health training on their capacities and provided actionable recommendations for improving their training and overall capability.

METHODS

This study employs a cross-sectional design. A self-developed questionnaire was used to evaluate the capabilities of public health personnel in CDC. Network analysis was conducted using the qgraph package in R (version 4.3.1) to construct a capability network model, while the bootnet package ensured the stability and reliability of the network through bootstrapping. The NetworkComparisonTest package was applied to compare network structures and identify differences between groups.

RESULTS

Over half (51.80%, N = 11,912) of public health personnel rated their comprehensive capabilities as poor. Core capabilities, including research, motivation, and emergency response, were identified as pivotal within the capability network. The network stability coefficient for strength was 0.75, indicating reliable results. The capability networks of those who participated in standardized training differed significantly from those who did not (P = 0.04).

CONCLUSION

CDC public health personnel exhibit significant capability gaps, particularly in research and leadership. Standardized training provides some benefits but remains insufficient. Policymakers should address these gaps by aligning training content with critical capability needs, offering flexible and targeted training methods (e.g., virtual courses, self-paced modules), and implementing capability-based assessments to evaluate training outcomes.

Modulation of the Neuro-Cancer Connection by Metabolites of Gut Microbiota

The gut-brain-cancer axis represents a novel and intricate connection between the gut microbiota, neurobiology, and cancer progression. Recent advances have accentuated the significant role of gut microbiota metabolites in modulating systemic processes that influence both brain health and tumorigenesis. This paper explores the emerging concept of metabolite-mediated modulation within the gut-brain-cancer connection, focusing on key metabolites such as short-chain fatty acids (SCFAs), tryptophan derivatives, secondary bile acids, and lipopolysaccharides (LPS). While the gut microbiota's impact on immune regulation, neuroinflammation, and tumor development is well established, gaps remain in grasping how specific metabolites contribute to neuro-cancer interactions. We discuss novel metabolites with potential implications for neurobiology and cancer, such as indoles and polyamines, which have yet to be extensively studied. Furthermore, we review preclinical and clinical evidence linking gut dysbiosis, altered metabolite profiles, and brain tumors, showcasing limitations and research gaps, particularly in human longitudinal studies. Case studies investigating microbiota-based interventions, including dietary changes, fecal microbiota transplantation, and probiotics, demonstrate promise but also indicate hurdles in translating these findings to clinical cancer therapies. This paper concludes with a call for standardized multi-omics approaches and bi-directional research frameworks integrating microbiome, neuroscience, and oncology to develop personalized therapeutic strategies for neuro-cancer patients.

Nurses' perception of anticipated nursing care: A qualitative research

BACKGROUND

Anticipated nursing care is provided significantly earlier than expected by nurses, caregivers, and other healthcare staff for patients. This type of care is influenced by many factors and is followed by various positive and negative consequences. Accordingly, the present study sought to explore nurses' perceptions of anticipated nursing care.

METHODS

This qualitative study was conducted using content analysis on twelve nurses from different internal and surgical wards of Shahid Sadoughi Hospital, Yazd, Iran from November 2022 to September 2023The participants were selected using purposive sampling. The data were collected through semi-structured interviews with the nurses and analyzed using Graneheim and Lundman's qualitative content analysis method.

RESULTS

Data analysis revealed four main categories and eleven subcategories. The main categories included early and priority care with two subcategories, scope of anticipated care with four subcategories, predictors of anticipated care with three subcategories, and outcomes of anticipated care with two subcategories.

CONCLUSIONS

Based on the findings, it is suggested that nursing managers must focus on the antecedents of anticipated care and address strategies to improve the working conditions of nurses, changing routine procedures for providing care and the doctor-nurse interaction, developing and organizing training programs on clinical reasoning, decision-making and time management for nurses.

Efficient Escherichia coli Platform for Cannabinoid Precursor Olivetolic Acid Biosynthesis from Inexpensive Inputs

Olivetolic acid (OLA), an initial precursor of cannabinoids, is catalyzed by type III polyketide synthase, which has a wide range of pharmacological activities, such as antimicrobial and cytotoxic effects. Here, we applied systematic metabolic engineering to develop a multienzyme cascade system to produce OLA via two low-cost inputs. The polyketide synthase (OLS) and cyclase enzymes (OAC), along with the best combination of hexanoyl-CoA and malonyl-CoA synthetases (AEE3 and MatB), were first introduced into the biocatalytic system to increase the supply of hexanoyl-CoA and malonyl-CoA as starting and extender units. To drive the catalysis smoothly, an ATP regeneration system and a CoA-sufficient supply system were incorporated into the biocatalysts to provide enough cofactors. Furthermore, malonyl-CoA flux was redirected to OLA biosynthesis through delicate control of the fatty acid biosynthesis (FAB) pathway via promoter engineering. Collectively, these strategies have led us to produce OLA at a titer of 102.1 mg/L with a productivity of 25.5 mg/L/h by using malonate and hexanoate as direct substrates. Our biocatalytic system provides an effective platform for the production of the cannabinoid precursor OLA in Escherichia coli and may be a valuable reference for the development of microbial cell factories that use hexanoyl-CoA and malonyl-CoA as important intermediates.

Bridging Gaps in Pain Management: The Effectiveness of Educational Intervention for Nurses in a Teaching Hospital of Low- and Middle-Income Countries

Background: Regular on-the-job training and educational courses may improve nurses' knowledge and practice regarding pain assessment and initial treatment. Objectives: To assess the impact of a newly developed educational course in terms of improvement in knowledge regarding pain assessment and initial treatment by using pretest and posttest multiple-choice question scores and to determine the retention of knowledge 3 months after the educational course and perceived change in clinical practices among nurses working in adult surgical and medical wards at the Aga Khan University Hospital. Methods: After getting approval from the institutional review committee, an education course was developed and conducted. A total of 86 participants attended both online and physical components. Teaching methodologies included online lectures, small group tutorials and hands-on workshops using demonstrations of locally developed videos. Pretests and posttests were conducted to assess the knowledge. All participants were requested to complete an online questionnaire to know the impact of the course on their clinical practice. Results: Eighty-six participants completed the course, of which 52 (60.5%) were female and 34 (39.5%) were male. The mean difference between the pretest and posttest scores of participants was 4.72 (39.66%), which was statistically significant (p ≤ 0.001). The mean posttest multiple-choice question score of participants was 16.70 ± 3.56, and the mean posttest multiple-choice question score of participants after 3 months was 15.60 ± 4.09 with a mean difference of 1.10 (6.59%), which was not statistically significant (p=0.121). Conclusion: The hybrid educational course had a significant learning impact on the knowledge of participants and their clinical practice.

Artificial Intelligence for Neuroimaging in Pediatric Cancer

BACKGROUND/OBJECTIVES

Artificial intelligence (AI) is transforming neuroimaging by enhancing diagnostic precision and treatment planning. However, its applications in pediatric cancer neuroimaging remain limited. This review assesses the current state, potential applications, and challenges of AI in pediatric neuroimaging for cancer, emphasizing the unique needs of the pediatric population.

METHODS

A comprehensive literature review was conducted, focusing on AI's impact on pediatric neuroimaging through accelerated image acquisition, reduced radiation, and improved tumor detection. Key methods include convolutional neural networks for tumor segmentation, radiomics for tumor characterization, and several tools for functional imaging. Challenges such as limited pediatric datasets, developmental variability, ethical concerns, and the need for explainable models were analyzed.

RESULTS

AI has shown significant potential to improve imaging quality, reduce scan times, and enhance diagnostic accuracy in pediatric neuroimaging, resulting in improved accuracy in tumor segmentation and outcome prediction for treatment. However, progress is hindered by the scarcity of pediatric datasets, issues with data sharing, and the ethical implications of applying AI in vulnerable populations.

CONCLUSIONS

To overcome current limitations, future research should focus on building robust pediatric datasets, fostering multi-institutional collaborations for data sharing, and developing interpretable AI models that align with clinical practice and ethical standards. These efforts are essential in harnessing the full potential of AI in pediatric neuroimaging and improving outcomes for children with cancer.

Nutritional Prehabilitation: Trends in Supplementation Based on Sustainable Dairy Protein Sources

PURPOSE OF REVIEW

Prehabilitation is an emerging clinical practice that aims to improve the surgical recovery and quality of life of patients undergoing intensive treatments. This review intends to describe the state of the art in prehabilitation, highlighting the role of nutritional strategies and the current trends in supplements.

RECENT FINDINGS

Up-to-date studies have shown the importance of optimizing the nutritional status of patients to cope with the physical and metabolic demands of surgery and intensive treatments. In the context of nutritional prehabilitation, oral nutritional supplementation has emerged as a preferred strategy. The effectiveness of prehabilitation has been demonstrated in various clinical contexts. However, the lack of standardized protocols makes it hard to compare the outcomes. Despite the variability in this type of nutritional intervention found in reports, it has been shown that the most common oral nutritional supplements (ONS) contain dairy proteins. The use of whey proteins represents a promising approach from both a nutritional and a sustainability perspective.

Knowledge, attitude, and practice towards uterine cervical cancer screening in Egyptian females: a nationwide cross-sectional study

BACKGROUND

Cervical cancer is a major cause of morbidity and mortality among women worldwide; it is ranked the 4th most common cancer among women globally. The current recommendation for cervical cancer (CC) screening involves the use of cytology examination methods like Pap smear. However, there is a lack of data on the practice of Pap smear screening in Egypt. Furthermore, understanding the knowledge, attitudes, and barriers related to cervical cancer screening among potential participants is crucial.

METHODS

In this cross-sectional study, we conducted interviews with female patients aged 21 years or more who visited outpatient clinics in six university hospitals across Egypt. The survey aimed to assess participants' compliance with CC screening guidelines, their knowledge of and attitude toward CC screening, and their perception of potential barriers.

RESULTS

A total of 897 participants from the six study centers completed the survey. Only a small percentage (1.1%) of participants had undergone CC screening, although only (0.8%) of the participants were referred to do CC screening. The referral rate was more likely to be higher in participants who had one of their first-degree relatives or the surrounding people with a history of CC compared to those who have no one with CC (37.5% vs. 0.4%, P < 0.001; 5% vs. 0.6%, P = 0.035 respectively). Moreover, the referral rate was higher among participants who discussed CC and CC screening with their physicians (15.8% vs. 0.5%, P < 0.001; 23.5% vs. 0.3%, P < 0.001 respectively). Knowledge of CC screening was limited, with only 2.7% of respondents demonstrating good actual knowledge. However, after introducing the concept of CC screening to all participants, the majority (74.6%) showed a positive attitude towards undergoing the procedure. Lack of knowledge about the procedure, its tool, the place to do it, and financial burden were cited as the most common barriers to CC screening (79.8%, 65.9%, 64.2%, and 53.2%, respectively).

CONCLUSION

Despite inadequate knowledge about CC screening, there is a positive attitude toward it among eligible participants in Egypt. This lack of knowledge likely contributes to low compliance with current CC screening guidelines and calls for national-level efforts to address this issue.

Coping strategies utilized by patients with cervical cancer: an explorative qualitative study at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania

BACKGROUND

Cervical cancer ranks as the fourth most prevalent cancer among women globally, particularly affecting socioeconomically disadvantaged populations such as those in Tanzania. Receiving a cervical cancer diagnosis induces considerable stress and elicits negative reactions. Coping mechanisms, ranging from adaptive to maladaptive, are employed to navigate this challenging condition and are influenced by factors such as race, socioeconomic status, and sociocultural background. Despite its significance, little is known about the coping strategies utilized by cervical cancer patients in Tanzania.

METHODS

By employing purposeful sampling, a qualitative descriptive study was conducted at the Ocean Road Cancer Institute in Dar es Salaam from December 2022 to January 2023, aiming to explore coping strategies adopted by cervical cancer patients. Thematic analysis was employed to analyse the gathered data.

FINDINGS

The key themes that emerged included problem-focused coping, emotion-focused coping, social support, religious coping, and escapism.

CONCLUSIONS

Cervical cancer patients employ a diverse array of coping strategies to manage their condition. While many strategies observed were adaptive, some proved to be maladaptive, underscoring the importance of ongoing assessments to bolster adaptive coping mechanisms among this population.

Self-reported knowledge and difficulties towards palliative care among healthcare professionals in rural China: a cross-sectional study

BACKGROUND

Palliative care (PC) in rural China remains underdeveloped, with limited specialized services and significant challenges for healthcare professionals. This study aimed to examine the difficulties in providing PC and their factors from the perspective of healthcare professionals in rural Henan province, China, where specific PC services are currently unavailable.

METHODS

A cross-sectional study was conducted between June and July 2024, using a convenience sample of 255 healthcare professionals from four secondary/tertiary hospitals participated. Data were collected on participants' demographic characteristics, information on recently deceased cancer patients they had cared for, and PC-related information. PC knowledge and PC difficulties were assessed using the Palliative Care Knowledge Questionnaire-Chinese version (PCKQ-PCN) and the Palliative Care Difficulties Scale (PCDS). Linear regression analysis identified factors associated with PC difficulties.

RESULTS

Among the 255 participants (Mean[age]: 34.82 ± 7.04), 71.8% were females, 57.3% were physicians, and the average work experience was 10.20 years. Regarding PC experience, 48.2% had participated in 1-2 training sessions annually over the past two years, and 32.2% reported a poor understanding of PC. The total PCKQ-PCN mean score was 13.28 ± 2.62, with 25.2% of participants classified as having poor knowledge. The PCDS mean score was 42.58 ± 13.59. Linear regression analysis showed that participating in at least one PC training session every six months (β = -10.66; p = 0.032), having experience caring for seriously ill people at home (β =  -6.31; p = 0.024), greater knowledge of symptom management (β = -3.72; p = 0.012), and higher levels of basic knowledge (β = -5.12; p = 0.007) were negatively associated with PC difficulties. Conversely, limited understanding of PC (β = 12.95; p = 0.021), greater knowledge of spiritual care and death education (β = 4.95; p = 0.034), and having new rural cooperative medical insurance (β = 6.36; p = 0.023; β = 3.21; p = 0.042) were positively associated with PC difficulties.

CONCLUSIONS

This study highlights critical gaps in rural China's PC services, including inadequate training, limited focus on spiritual needs and death education, and disparities in insurance coverage. Targeted training programs in healthcare professionals and policy reforms are urgently needed to improve PC quality and accessibility in rural areas.

Shared decision-making competency and its associated factors among palliative care nurses: a cross-sectional study in China

BACKGROUND

The role of nurses in shared decision-making (SDM) within the healthcare decision-making process has increasingly gained attention The ability of nurses to engage in effective SDM can significantly impact patient outcomes and satisfaction with care. Given the palliative care continues to evolve, this study aimed to investigate the level of SDM competency and explore associated factors among palliative care nurses in China.

METHODS

A cross-sectional study was conducted between June and July 2024. The convenience sample was recruited from five online Chinese palliative care nurse groups. Anonymous data were collected through a self-designed sociodemographic questionnaire, the Shared Decision-Making Competency Scale (SDMCS) and the Empathy Ability Scale (EAS). Multivariate linear regression was performed to explore the factors associated with SDM competency.

RESULTS

A total of 429 palliative care nurses from 30 provinces or municipalities across China participated in this study. The Chinese palliative care nurses had a high level of SDM competency (mean total SDMCS 211.72 ± 25.75) and high empathic ability (EA), (mean total EAS 132.63 ± 20.30). There was a positive correlation between EA and SDM competency (r = 0.704, P < 0.01). The EA (β = 0.683, P<0.001), experiences of SDM training (β=-0.155, P<0.001) and educational background (β=-0.142, P = 0.007) were statistically significant factors influencing nurses' SDM competency based on multiple linear regression analysis. These associated factors could explain 55.4% of the difference in SDM competency.

CONCLUSIONS

This study found that palliative care nurses in China exhibited high levels of SDM competency and a high level of EA. Nurses with postgraduate education, SDM training experience, and high EA demonstrated higher levels of SDM competency compared to those without these attributes. The findings underscore the importance of incorporating structured SDM training programs in nursing education and professional development initiatives, particularly focused on building empathy skills.

Non-cancerous CT findings as predictors of survival outcome in advanced non-small cell lung cancer patients treated with first-generation EGFR-TKIs

PURPOSE

To identify non-cancerous factors from baseline CT chest affecting survival in advanced non-small cell lung cancer (NSCLC) treated with first-generation Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors (EGFR-TKIs).

METHODS

Retrospective study of 172 advanced NSCLC patients treated with first-generation EGFR-TKIs as a first-line systemic treatment (January 2012 to September 2022). Baseline CT chest assessed visceral/subcutaneous fat (L1 level), sarcopenia, and myosteatosis (multiple levels), main pulmonary artery (MPA) size, MPA to aorta ratio, emphysema, and bone mineral density. Cox regression analyzed prognostic factors at 18-month outcome.

RESULTS

Median overall survival was 17.57 months (14.87-20.10) with 76 (44.19%) patients died at 18 months. Deceased had lower baseline BMI (21.10 ± 3.44) vs. survived (23.25 ± 4.45) (p < 0.001). Univariable analysis showed 5 significant prognostic factors: low total adiposity with/without cutoff [HR 2.65 (1.68-4.18), p < 0.001; 1.00 (0.99-1.00), p = 0.006;], low subcutaneous adipose tissue (SAT) with/without cutoff [HR 1.95 (1.23-3.11), p = 0.005; 0.99 (0.98-0.99), p = 0.005], low SAT index (SATI) with/without cutoff [1.74 (1.10-2.78), p = 0.019; 0.98 (0.97-0.99), p = 0.003], high VSR [1.67 (1.06-2.62), p = 0.026], and high MPA size with/without cutoff [2.23 (1.23-4.04), p = 0.005; 1.09 (1.04-1.16), p = 0.001]. MPA size, MPA size > 29 mm, and total adiposity ≤85 cm2 remained significant in multivariable analysis, adjusted by BMI [HR 1.14 (1.07-1.21), p < 0.001; 3.10 (1.81-5.28), p < 0.001; 3.91 (1.63-9.40), p = 0.002]. There was no significant difference of sarcopenic and myosteatotic parameters between the two groups.

CONCLUSION

In advanced EGFR-mutated NSCLC patients, assessing pre-treatment prognosis is warranted to predict the survival outcome and guide decision regarding EGFR-TKI therapy. Enlarged MPA size, low total adiposity, and low subcutaneous fat (lower SAT, lower SATI, and higher VSR) are indicators of poor survival. Large MPA size (>29 mm) or low total adiposity (≤85 cm2) alone predict 18-month death.

Technological-Based Interventions in Cancer and Factors Associated With the Use of Mobile Digital Wellness and Health Apps Among Cancer Information Seekers: Cross-Sectional Study

BACKGROUND

Mobile digital wellness and health apps play a significant role in optimizing health and aiding in cancer management and decision-making.

OBJECTIVE

This study aims to identify the factors influencing the use of mobile health and wellness apps among cancer information seekers in the United States.

METHODS

We conducted a cross-sectional study using data from the Health Information National Trends Survey. Our analysis focused on 4770 participants who sought cancer information. We performed weighted univariate and multivariable logistic regression to determine the association between the use of health and wellness apps and socioeconomic factors, medical history and conditions, and lifestyle and behavioral factors.

RESULTS

A total of 4770 participants who sought cancer information were included in the final analysis. Of these, 80.9% (n=2705) were health and wellness app users, while 19.1% (n=793) were nonusers. In the final adjusted model, participants with household incomes ≥US $50,000 had 49% higher adjusted odds of using these apps than those with incomes

CONCLUSIONS

Age, education, household income, and use of the internet are the major determinants of the adoption of digital health and wellness apps among seekers of cancer information. Hence, public health programs could be directed toward addressing these factors to improve cancer diagnosis, treatment, and management using these apps.

Collapse

Key Words

• United States
• adult
• barrier
• cancer information
• cancer intervention
• cancer management
• cancer screening
• cross-sectional study
• decision-making
• digital health
• digital health and wellness apps
• digital health engagement
• diversity
• engagement
• health seeking behavior
• knowledge seeking
• logistic regression
• mhealth
• mobile health
• mobile phone
• regression analysis
• telehealth
• utilization
• young adult

Collapse

MESH Headings

• Humans
• Cross-Sectional Studies
• Female
• Male
• Mobile Applications/statistics & numerical data
• Neoplasms/therapy
• Middle Aged
• Adult
• Aged
• Young Adult
• United States
• Adolescent
• Socioeconomic Factors

Collapse

Grants Collapse

Affiliation(s)

Ogochukwu Juliet Ezeigwe Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Kenechukwu Obumneme Samuel Nwosu Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Oladipo Kunle Afolayan Department of Biostatistics, The University of Texas Health Science Center, Houston, TX, United States
Akpevwe Amanda Ojaruega Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Jovita Echere Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Manali Desai Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Modupe Olajumoke Onigbogi Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Olajumoke Ope Oladoyin Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, United States
Nnenna Chioma Okoye Department of Pharmaceuticals, Gwarinpa General Hospital, Abuja, Nigeria
Pierre Fwelo Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States

Collapse

Collaborators Collapse

Experiences of health information-seeking behaviour in preoperative patients with lung cancer: a qualitative study in China

OBJECTIVE

Surgery represents the primary therapeutic modality for lung cancer, typically administered promptly following diagnosis. Accessing pertinent information and making well-informed decisions are imperative to navigate this challenging stage. This study aimed to explore preoperative lung cancer patients' experiences related to health information-seeking process, based on the information and methodological characteristics of health information-seeking behaviour (HISB).

DESIGN

The study used a qualitative descriptive design, adhering to the Consolidated Criteria for Reporting Qualitative Research guidelines. 23 participants were purposively selected for semistructured interviews. Data analysis was conducted using inductive conventional content analysis.

SETTING

The study was conducted in the thoracic surgery ward of a tertiary hospital located in China.

PARTICIPANTS

A total of 23 participants, consisting of 12 males and 11 females, were recruited. Eligible participants were patients with lung cancer aged 18 and above, capable of articulate expression, informed about their diagnosis, preparing for surgical intervention and willing to engage voluntarily in the study.

RESULTS

Four main categories were identified. Participants exhibited different psychological coping strategies and personalised health information needs in their information-seeking behaviour. Challenges emerged in comprehending and assessing factors related to lung cancer, treatment alternatives, surgical complications, online media resources and preoperative exercise protocols. The importance of preoperative respiratory training was often underestimated. Additionally, some participants displayed a tendency to passively receive information, thereby impeding their ability to effectively self-manage throughout the perioperative stage.

CONCLUSIONS

Understanding the experiences in HISB is crucial for improving the health outcomes of patients with lung cancer. Healthcare providers should adopt a patient-centred approach to health education, with a targeted effort to recognise and mitigate specific barriers in clinical practice. Further research is needed to explore effective strategies aimed at augmenting health information-seeking process among patients with lung cancer before surgery.

Smoking Avoidance, Physical Activity and Diet as Preventative Behaviours for Lung, Prostate and Colorectal Cancer - A Comparison of the Extended Parallel Process Model Groups

Objectives

An analysis of men's perceptions of the role of three health behaviours (smoking avoidance, physical activity, and diet) in relation to the subjective threat of lung, prostate, and colorectal cancers, with adoption of the Extended Parallel Process Model (EPPM).

Methods

The study was conducted using a survey questionnaire by Computer Assisted Web Interviewing on a representative sample of 1,000 male Polish citizens aged 18-65.

Results

Prostate cancer was considered the most likely and most severe type of cancer. A healthy diet was the intervention that was considered the most effective and the one most likely to be implemented for colorectal cancer. Respondents perceived smoking avoidance to be the most effective intervention, while considering this to be the least feasible strategy to implement for lung cancer. In all of the behaviours, the Indifferent group was the most numerous. Belonging to the EPPM groups was mainly associated with educational level, financial situation, and self-assessed health status.

Conclusion

The need to implement interventions aimed at: increase the perceived risk of smoking in the context of lung cancer incidence, increase men's self-efficacy in smoking avoidance and reduce the level of perceived losses from undertaking a healthy diet and smoking avoidance.

Association among financial toxicity, depression and fear of cancer recurrence in young breast cancer patient-family caregiver dyads: an actor-partner interdependence mediation model

PURPOSE

This study aimed to investigate the depression situation and the mediating role of fear of cancer recurrence (FCR) in the relationship between financial toxicity and depression in young breast cancer (BC) patient-family caregiver dyads.

METHODS

A total of 196 young BC patient-family caregiver dyads at four hospitals in China were investigated. The Comprehensive scores for financial toxicity based on patient-reported outcome measures, the Hospital Anxiety and Depression Scale, and the FCR Inventory Short Form were assessed. The actor-partner interdependence mediation model using structural equation modelling in AMOS software was applied to examine the direct and indirect effects.

RESULTS

In this study, there were 196 pairs of patients and family caregivers. The findings indicated a significant correlation between financial toxicity and FCR in both young BC patients and their family caregivers. Two significant partner effects were observed: the family caregiver's financial toxicity significantly influenced the patient's FCR (β=-0.450, P < 0.001), and the patient's FCR influenced the family caregiver's depression (β = 0.570, P < 0.001). Furthermore, financial toxicity in both young BC patients and family caregivers markedly affected both the actor and partner effects on dyadic depression, primarily through the patients' FCR.

CONCLUSIONS

Depression in young BC patients was affected not only by themselves but also by their family caregivers. Emphasis should be placed on the interplay between financial toxicity and FCR of patients and family caregivers, with the aim of improving depression for young BC patients.

CLINICAL IMPLICATIONS

The study emphasized the importance of addressing the experiences of both patient and family caregivers in clinical interventions. By demonstrating how financial toxicity and FCR are interlinked with depression in both parties, the study supports the development of we offer empirical support for developing comprehensive intervention strategies to alleviate mental distress and enhance mental health for patients and family caregivers.

The effect of non-pharmacological interventions on cognitive function in cancer: an overview of systematic reviews

PURPOSE

A significant number of cancer survivors experience cancer-related cognitive impairment (CRCI), which can impact their ability to think, reason, make decisions, and perform daily actions. In recent years, non-pharmacological interventions for CRCI have gained significant attention. These interventions include exercise, cognitive behavioural therapy, cognitive training/remediation, dietary, mind-body, and multi-modal/complex interventions. This umbrella review provides a critical overview to inform guidelines and current practice, identify the most promising interventions, and uncover gaps in the research literature.

METHODS

This umbrella review of systematic reviews was pre-registered on Open Science Framework and PROSPERO. Six databases were searched. Systematic reviews (SR) assessing any non-pharmacological interventions to improve cognition in cancer (any type) were included. The overview followed gold-standard guidelines and recommendations. The results were narratively synthesised, and descriptive statistics and effect size ranges were calculated.

RESULTS

Sixty-four (n = 64) SRs were included. Results were synthesised into four non-pharmacological domains. Cognitive training/rehabilitation had the strongest evidence for efficacy. Physical activity/exercise showed promising efficacy; however, the variability of findings was considerable. Mind-body and psychological/behavioural therapy interventions were limited, but there was evidence for short-term effectiveness. Multi-modal/complex interventions showed potential for improving cognition in cancer but were poorly defined.

CONCLUSIONS

Overall, non-pharmacological interventions demonstrated efficacy for improving cognition in cancer. There were limited intervention characteristics within domains which were consistently related to efficacy. Three key recommendations are provided for future research: (1) adopt harmonisation and reporting guidelines; (2) develop definitional guidelines of cognitive domains for CRCI research; and (3) assess intervention and participant characteristics associated with positive versus null/negative findings.

Socio-demographic disparities in global trends of lip and oral cavity neoplasms from 1990 to 2021

Oral cancer, the 13th most common globally, is primarily squamous cell carcinoma linked to tobacco, alcohol, and HPV. Despite advances in care, it remains a major health concern due to high mortality and its impact on quality of life. This study analyzed socio-demographic disparities in oral cancer burden using data from 1990 to 2021. We analyzed annual incidence, mortality, and DALYs across 204 countries, using age-standardized rates and the Socio-demographic Index (SDI) to assess development-related impacts. Statistical methods included Kruskal-Wallis tests, linear regression, joinpoint regression for trends, and Exponential Smoothing for forecasts (2022-2030), with analyses conducted in STATA and Python, and p < 0.05 as significant. Incidence was highest in high SDI countries, while mortality and DALYs were highest in low and middle SDI countries (p < 0.001). From 1990 to 2021, incidence increased (AAPC: 0.5-1.0%), while mortality (APC: - 0.5%) and DALYs (APC: - 0.6%) declined in low SDI regions. Significant disparities across SDI categories (p < 0.001) showed incidence rising with socio-demographic development (R2 = 0.102, p < 0.001), with high-middle SDI regions bearing the highest mortality and DALYs. These findings highlight the need for awareness, prevention, early detection, and accessible care, especially in lower SDI regions.

Using ultrasound sequential images processing to predict radiotherapy-induced sternocleidomastoid muscle fibrosis

PURPOSE

The purpose of this study was to evaluate the thickness and biomechanical parameters of the sternocleidomastoid muscle (SCM) before, during, and after radiotherapy using ultrasound elastography to predict radiotherapy-induced muscle fibrosis.

MATERIALS AND METHODS

The mean daily absorbed doses of 20 SCMs were determined. To find out the Young and shear modulus, shear wave elastography (SWE) and the B-mode sequential images processing method were implemented. In the B-mode sequential images processing method, by administering dynamic stress, the Young and shear modulus were estimated utilizing the maximum gradient and the block-matching algorithms, respectively. The imaging was done before, during the third and sixth weeks of treatment, and 3 months after radiotherapy.

RESULTS

There was a statistically significant increase in the maximum thickness during the sixth week compared to before radiotherapy (p = .043). However, this parameter did not change significantly 3 months later (p = .095). The Young modulus (p = .611) derived from SWE did not differ significantly throughout any of the weeks of radiotherapy. But Young and shear modulus increased significantly in the B-mode sequential images processing method before and during the third and sixth weeks of treatment (p = .001). The outcomes observed 3 months after radiotherapy revealed a statistically significant increase in both Young modulus (p = .029) and shear modulus (p = .004) compared to pre-radiotherapy.

CONCLUSION

The Young modulus and shear modulus are introduced as biological markers used to detect the onset of the fibrosis process during the initial radiotherapy fractions.

What does intimate partner violence mean for women with breast cancer? Experiences of Iranian women

BACKGROUND

The aim of this study was to identify the women's experiences of intimate partner violence (IPV) after breast cancer.

METHOD

This is a qualitative descriptive study. Semi-structured interviews were carried out with 11 women with breast cancer, all participants referred to the outpatient Oncology Clinic in IRAN. Data were analyzed using conventional content analysis approach.

RESULTS

The results revealed the essential category of "pervasive violence" which was manifested through six subcategories: 1) psychological violence, 2) physical violence, 3) sexual violence, 4) economic violence, 5) controlling behaviors, and 6) neglect.

CONCLUSION

Women with breast cancer are more vulnerable to IPV and experience a wide range of IPV forms. Healthcare providers should monitor women with breast cancer in terms of IPV to prevent the consequences of IPV on the cancer treatment process.

Cross-Lagged Panel Network Analysis of Symptoms in Patients with Gastric Cancer Undergoing Postoperative Chemotherapy

OBJECTIVES

To develop temporal symptom networks at three postoperative chemotherapy time points and investigate the longitudinal relationships between 18 symptoms in patients with gastric cancer undergoing postoperative chemotherapy in China.

METHODS

Symptom prevalence and severity were measured using the M. D. Anderson Symptom Inventory (MDASI) and Gastrointestinal Cancer Module of the MDASI (MDASI-GI) at T1, T2, and T3 on the day after the first, third, and sixth chemotherapy sessions, respectively. Cross-lagged panel network (CLPN) models were employed to examine the temporal dynamics of the 18 symptoms and their interrelationships.

RESULTS

In total, 379 participants were included. Dry mouth had the highest out-prediction (r = 0.101) and out-strength (r = 0.863) values during T1→T2. The strongest direct effect was observed for the change in taste → lack of appetite (β = 0.38) during T2→T3. Feeling bloated had the highest values for out-strength (r = 0.910), out-prediction (r = 0.215), and bridge strength (r = 1.010) during the T2→T3 period. The two CLPNs showed medium to high stability based on the centrality stability coefficients of out-strength and in-strength.

CONCLUSIONS

Lack of appetite can be improved during chemotherapy by managing vomiting and taste changes. Attention should be paid to the dry mouth and feeling bloated, as they are the strongest predictors in the early and middle stages of treatment.

IMPLICATIONS FOR NURSING

Understanding the relationship between symptoms during chemotherapy in patients with postoperative gastric cancer can help clinicians identify targets for intervention at different times.