Mental Health in the Workplace from the Perspective of Oncology Nurses in Iran: A Qualitative Descriptive Study

Background

The workplace and the context in which oncology nurses work are unique due to the complex and dynamic nature of cancer care. Nurses who care for cancer patients are exposed to varying degrees of psychological pressure. The present study was conducted to explore oncology nurses' perceptions regarding mental health in the workplace.

Materials and Methods

This study was conducted in 2018-2019. The participants were recruited through purposive sampling from eight educational specialty cancer treatment centers in Iran. Data were collected through individual semistructured interviews and analyzed using the conventional qualitative content analysis method. The Consolidated criteria for Reporting Qualitative research (COREQ) checklist was used to document the report of the study.

Results

The extracted concepts were classified into three main categories and 17 subcategories. The main categories included attention to nurses' occupational stress-provoking factors, attention to emotional/psychological responses in the workplace, and healthy mental atmosphere in the workplace.

Conclusions

The findings indicate that oncology nurses need to be supported to enhance their mental health in the workplace. The findings of this study could help policymakers and nurse managers to understand the importance of improving the mental health of nurses in cancer care. In this regard, it is essential to make the necessary plans and scientific decisions to design and provide strategies to alleviate workplace problems and improve nurses' mental health.

Effect of Education on Nutritional Knowledge of Cancer Prevention based on Health Belief Model: A Systematic Review and Meta-Analysis

OBJECTIVE

This systematic review was conducted to examine the impact of education on nutritional knowledge for cancer prevention using the Health Belief Model.

METHODS

Comprehensive searches were performed in international electronic databases, including Scopus, PubMed, and Web of Science, from their inception until June 16, 2024. Keywords derived from Medical Subject Headings such as "Nutrition Knowledge," "Education," "Health Belief Model," and "Cancer" were utilized. Additionally, Iranian databases like Iranmedex were searched. The quality of randomized controlled trials (RCTs) and quasi-experimental studies was assessed using the Joanna Briggs Institute's (JBI) critical assessment checklist.

RESULTS

A total of 611 participants were enrolled in five studies. Among these participants, 78.39% were female, and 76.76% were in the intervention group. The mean age of participants was 42.12 years (SD = 6.47). The mean follow-up period was approximately 14 weeks, and the average duration of the intervention was 54 minutes. The findings indicated that education based on the Health Belief Model was effective in increasing nutritional knowledge. The meta-analysis revealed a significant improvement in nutritional knowledge among participants who received HBM-based education, with a pooled SMD of 0.75 (95% CI: 0.52-0.98, p < 0.001), indicating a moderate-to-large effect size. The intervention group demonstrated increased knowledge scores compared to controls, with an average follow-up period of 14 weeks and intervention duration of approximately 54 minutes per session.

CONCLUSION

Health professionals, such as nurses, can utilize this model to enhance nutritional knowledge. It is recommended that health managers and policymakers create environments that enable health professionals to employ educational strategies based on the Health Belief Model, thereby improving nutritional knowledge.

A clinical study on 3D virtual model-assisted precise navigation for laparoscopic partial nephrectomy

BACKGROUND

Laparoscopic partial nephrectomy (LPN) is a standard surgical treatment option for renal tumors. Prior to LPN, it is necessary to evaluate the tumor condition and develop a surgical plan using precise imaging.

OBJECTIVE

To explore the clinical application value of 3D virtual model (3DVM) in LPN.

METHODS

A total of 80 patients with renal tumor who underwent LPN were measured. Patients were divided into three cohorts (A, B, C) according to the difficulty of surgery. Each group was further divided into the test and control groups based on the application of preoperative 3DVM. Surgical safety and efficacy were assessed, and a questionnaire was developed to investigate the opinions of patients and physicians on 3DVM.

RESULTS

The duration of LPN and intraoperative renal artery occlusion were significantly different between the test and control groups in both cohorts A and B (P< 0.05). In cohort C, the surgical duration, duration of intraoperative renal artery occlusion, length of stay, time to postoperative ambulation, intraoperative bleeding, incidence of postoperative bleeding were significantly between the two groups (P< 0.05). The analysis both of patients and physicians questionnaire scores were statistically significant (P< 0.05).

CONCLUSIONS

3DVM contributes to safer and more effective LPN. It benefits both doctors and patients.

An Insight Into the Experiences of Malaysian Patients With Advanced Cancer and Their Preferences in End-of-Life Care: A Qualitative Study

BACKGROUND

Preferences of patients with advanced cancer are well studied in Western countries but less so in Asian communities where end-of-life discussions can be seen as taboo. This may lead to patients receiving care that is incongruent with their wishes as their disease progress. It is important for healthcare providers to have a better understanding of patients' experiences and preferences especially in a multicultural country like Malaysia with its diverse beliefs and values to facilitate better planning for future medical care.

OBJECTIVES

To explore the experiences and preferences of Malaysian patients with advanced cancer.

DESIGN

Qualitative study of semi-structured interviews with thematic analysis.

SETTING/SUBJECTS

Purposive sampling of 19 patients with Stage 4 cancer recruited from inpatient and outpatient settings in National Cancer Institute Malaysia.

RESULTS

Three major themes emerged in the exploration of patients' experiences and care preferences in facing advanced cancer namely: 1) Dealing with poor prognosis 2) Spirituality as a source of strength and 3) Enablers of advance care planning.

CONCLUSION

This study highlighted the preference for healthcare providers to be culturally sensitive during end-of-life care discussion and the need for improved spiritual care for Malaysian patients with advanced cancer. Further studies exploring the role of spiritual and cultural factors in advance care planning among Malaysians would be helpful in guiding these efforts.

Feasibility and psychometric quality of smartphone administered cognitive ecological momentary assessments in women with metastatic breast cancer

Objective

Metastatic breast cancer (MBC) is associated with burdensome side effects, including cognitive changes that require ongoing monitoring. Cognitive ecological momentary assessments (EMAs) allow for assessment of individual cognitive functioning in natural environments and can be administered via smartphones. Accordingly, we sought to establish the feasibility, reliability, and validity of a commercially available cognitive EMA platform.

Methods

Using a prospective design, clinical cognitive and psychosocial assessments (cognitive batteries; patient reported outcomes) were collected at baseline, followed by a 28-day daily EMA protocol that included self-ratings for symptoms and mobile cognitive tests (memory, executive functioning, working memory, processing speed). Satisfaction and feedback questions were included in follow-up data collection. Feasibility data were analyzed using mixed descriptive methods. Test-retest reliability was examined using intraclass correlation coefficients (ICCs) for each EMA, and Pearson's correlation were used to evaluate convergent validity between cognitive EMAs and baseline clinical cognitive and psychosocial variables.

Results

Fifty-one women with MBC (n = 51) completed this EMA study. High satisfaction (median 90%), low burden (median 19%), high adherence rates (mean 94%), and 100% retention rate were observed. ICCs for cognitive tests of working memory, executive function, and processing speed were robust (>0.90) and ICC for memory tests acceptable (>0.66). Other correlational findings indicated strong convergent validity for all cognitive and psychosocial EMAs.

Conclusion

Cognitive EMA monitoring for 28 days is feasible and acceptable in women with MBC, with specific cognitive EMAs (mobile cognitive tests; cognitive function self-ratings) demonstrating strong reliability and validity.

Translating Evidence-Based Self-Management Interventions Using a Stepped-Care Approach for Patients With Cancer and Their Caregivers: A Pilot Sequential Multiple Assignment Randomized Trial Design

BACKGROUND

Self-directed interventions are cost-effective for patients with cancer and their family caregivers, but barriers to use can compromise adherence and efficacy.

AIM

Pilot a Sequential Multiple Assignment Randomized Trial (SMART) to develop a time-varying dyadic self-management intervention that follows a stepped-care approach in providing different types of guidance to optimize the delivery of Coping-Together, a dyadic self-directed self-management intervention.

METHODS

48 patients with cancer and their caregivers were randomized in Stage 1 to: (a) Coping-Together (included a workbook and 6 booklets) or (b) Coping-Together + lay telephone guidance. At 6 weeks, change in distress level was assessed, and non-responding dyads were re-randomized in Stage 2 to (a) continue with their Stage 1 intervention or (b) be stepped-up. Benchmarks for acceptability, feasibility, and clinical significance (anxiety and quality of life (QOL)) were assessed via surveys and study logs.

RESULTS

Feasibility was supported by a low refusal rate at ≤ 30% and < 10% missing data. Men and women were enrolled in at least a 40:60 ratio for caregivers, but less for patients. Recruitment was slow at 1 dyad/week. Acceptability was supported by a low attrition rate (12.5%) and with 87% of participants finding the booklets helpful. Telephone guidance in Stage 1 increased adherence to Coping-Together; however, in Stage 1, participants benefited more from the self-directed format than the guidance. All patients who were stepped-up in Stage 2 benefited from their new assignment; this trend was less clear for caregivers.

SIGNIFICANCE

Findings suggest a 3-step approach to dyadic self-management support that warrants further testing.

TRIAL REGISTRATION

Clinical Trials Registration #: NCT04255030.

The Effect of Cervical Cancer Education Given to Women in Turkey on Knowledge, Attitudes, and Health Beliefs: A Randomized Controlled Study

OBJECTIVE

The objective of this study was to ascertain the impact of cervical cancer education provided to women in Turkey on their knowledge, attitudes, and health beliefs.

DESIGN

The study was conducted in accordance with the pretest-posttest randomized controlled trial model.

SAMPLE

The participants were randomly assigned to either the experimental or the control groups. The study was completed with a total of 105 women, 51 of whom were in the experimental group and 54 of whom were in the control group.

MEASUREMENTS

The personal information form, the human papillomavirus (HPV) knowledge scale, and the health belief model scale for cervical cancer and Pap smear test were employed as data collection instruments. The data were analyzed using the SPSS 25.0 package program, and the number, percentage, independent samples t-test, and paired t-test were utilized for data analysis.

RESULTS

Upon completion of the training program, the mean scores of the experimental group demonstrated a statistically significant increase in knowledge related to general HPV information, HPV screening tests, general HPV vaccines, and HPV vaccine programs when compared to the control group (p < 0.001). Upon conclusion of the educational intervention, it was determined that the mean scores of cervical cancer sensitivity, caring, health motivation, Pap smear utility, and motivation of women in the experimental group exhibited an increase, while their general perception of Pap smear demonstrated a decrease (p < 0.05).

CONCLUSION

The findings of this study indicate that educational initiatives targeting women regarding cervical cancer have a beneficial impact on their knowledge, attitudes, and health beliefs.

TRIAL REGISTRATION

NCT05990270 registered on https://clinicaltrials.gov/.

Lifestyle Behaviors and Needs After Breast Cancer Diagnosis: A Qualitative Assessment

PURPOSE

There is a need to gain a deeper understanding of facilitators and barriers involving lifestyle behaviors among newly diagnosed breast cancer patients. Design: Research team explored influences (e.g., social, cultural, environmental) for healthy lifestyle behaviors (nutrition, physical activity (PA), and self-care).

METHOD

One researcher conducted semi-structured interviews. Qualitative data were analyzed through content analysis. Demographic data were collected via survey, and descriptive statistics were generated.

SETTING

Patients were recruited, and interviews conducted via Zoom or phone.

PARTICIPANTS

Twenty-eight newly diagnosed, treatment naïve breast cancer patients were interviewed, a majority were non-Hispanic White women (n=23; 82%) with invasive (n=14; 50%) breast cancer.

RESULTS

Themes related to nutrition, PA, and self-care emerged, including influences (e.g., environmental, cultural, social), barriers, facilitators, and lived experiences. Most patients stressed the importance of maintaining healthy eating habits (n=23), and some were interested in understanding the relationship between nutrition and cancer (n=7). Sixteen reported sustaining their PA levels, while others (n=11) explained barriers, such as time, distance, and pain. All patients reported utilizing self-care strategies, and most reported increased engagement in self-care since being diagnosed (n=14).

CONCLUSION

This study sheds light on factors influencing and hindering the adoption of healthy eating, PA, and self-care strategies among newly diagnosed breast cancer patients. The findings reflect the importance of healthy lifestyle behaviors as critical areas for upstream intervention.

Impact of Livelihood Diversification on Rural Households' Food and Nutrition Security: Evidence from West Shoa Zone of Oromia Regional State, Ethiopia

Background

Food and nutrition insecurities continue to be significant issues for communities in developed and developing countries, even when there are plentiful harvests. In Ethiopia, climate change and other human-induced challenges are key factors contributing to this insecurity. Research and development experts suggest that implementing sustainable livelihood diversification strategies could be a viable solution.

Objectives

The objective of the study was to analyze the determinants of choice of livelihood diversification strategies and its impact on food and nutrition security among smallholder farmers in the West Shoa zone, Oromia region, Ethiopia.

Methods

The research employed quantitative approaches for data gathering and analysis. A multistage sampling method was utilized to choose the study locations. A total of 385 smallholder farming households (215 diversifiers and 170 nondiversifiers) were randomly chosen as participants from the 2 districts and 7 rural villages in the area. Descriptive statistics (frequencies, percentages, and cross-tabs) and econometric models [multinomial logit model and multinomial endogenous switching regression (MESR) model] were employed to analyze the quantitative data.

Results

More than half (56%) of the farming households were able to diversify their livelihoods, whereas the remaining 44% were unable to do so, indicating a lack of means to engage in any form of livelihood diversification activity beyond agriculture. The results of the multinomial logit regression model revealed that various factors such as gender, age, family size, education level, farm experience, social norms, land ownership, livestock possession, access to credit, access to extension services, working capital, government policies, climate variability, livelihood training, and proximity to markets significantly influenced smallholder farming households' choices and adoption of diversification strategies. The MESR model demonstrated that engaging in farming and off-farming activities could increase food and nutrition security for farm households by 74.6% and 33.3%, respectively. Similarly, participating in farming and nonfarming activities was associated with a 71.3% improvement in food security and a 42.3% enhancement in nutrition security. However, combining farming with both nonfarm and off-farm activities did not have a significant impact on food security, but it did lead to a 15.2% increase in nutrition security.

Conclusions

Involving smallholder farmers in livelihood diversification reduces poverty, food insecurity, and unemployment. This study shows that diversifying livelihoods positively impacts food and nutrition security by enabling farmers to produce more for consumption and income generation.

Shared challenges and opportunities: Uncovering common ground in patient participation across different healthcare settings and patient groups. A qualitative meta-summary on patient-reported barriers and facilitators to participation in shared decision-making

OBJECTIVE

We aim to provide an updated literature overview on patient-reported barriers and facilitators to participation in SDM across different patient groups and healthcare settings to uncover the 'common ground' and to reach for a more generalizable, uniform and inclusive insight in patients' perspective on participation in SDM.

METHODOLOGY

We conducted a qualitative meta-summary, using five databases. Search terms were based on the concepts: 'decision-making', 'patient participation', 'patient perceptions' and 'study design' (of patient reporting).

RESULTS

We found 9265 unique references, selected 209 studies for further sampling and finally withheld 90 studies for further analysis in this review. In total, we identified 34 different barriers and facilitators. Based on most frequently reported barriers and facilitators, we defined four broad analytical themes corresponding to patients' shared expectations concerning doctors', patients' and others' facilitative roles in SDM: (1) 'Doctors explaining well', (2) 'Doctors listening well, and fostering a trusting relationship', (3) 'Patients being assertive, (4) 'Patients being socially supported'.

CONCLUSION

The majority of barriers and facilitators we found transcended differences in patient characteristics or healthcare setting, suggesting that patients are, overall, facing shared challenges and opportunities in SDM, that are mostly generalizable and irrespective of variabilities in decisional setting or patient group. We uncovered new trends such as patients' growing openness to assertiveness and the involvement of significant others, and highlighted some culture-based nuances, compared to earlier literature.

PRACTICE IMPLICATIONS

These new insights need to be integrated in SDM strategies so that they may serve the ethical imperative of a greater equality and inclusion of diverse patient groups in different SDM settings.

Aided and Unaided Decision-Making Among Partial Denture-Seeking Prosthodontic Patients Utilizing the Decisional Conflict Scale at the Dental Clinics of a College in Riyadh: A Questionnaire Study

Background The Decisional Conflict Scale (DCS) evaluates the decisional conflict patients experience during their healthcare-related decision-making process. There are various versions of the DCS, of which DCS-16 was originally recommended and put to use. It analyzes the patient treatment choice process on five subscales, hence, the study aimed to assess the influence of patient decision-making aid (PDA) on patients seeking prosthodontic care for partial dentures through the DCS. Methods All patients were randomly allocated into aided and unaided consultation groups, and patients seeking partial denture services were recruited from the college outpatient. Results The mean DCS score for the aided and unaided groups was 8 (±6.4) and 20.6 (±15.9), respectively. The age of the patient was significantly associated with the response to a question in the uncertainty sub-scale. In the aided category, the younger age group (20-40 years) was significantly (p = 0.00) less likely to feel sure about their decision on treatment options compared to the elderly age group (41-60 years) (OR: -17.8, CI: 1.47-2.28). Conclusion The present study revealed a significant association between decision-making among partial denture-seeking patients and their age, along with a substantial difference in decisional conflict between patients counseled using a standardized aid and unaided patients.

A Systematic Review of Yoga Interventions on the Mental Health of Nursing Professionals and Students

This systematic review aimed to evaluate the impact of yoga interventions on preventing and alleviating mental health issues, including stress, anxiety, burnout, depression, and other related factors among nursing professionals and students. The review adhered to the PRISMA guidelines and was registered in PROSPERO (CRD42024512366). A comprehensive literature search was conducted in Google Scholar and PubMed using keywords such as "nursing students," "nursing professionals," "yoga interventions," and "mental health." Eligible studies were randomized controlled trials (RCTs) published from 1st January 2014 to 31st December 2024, involving nursing population and yoga-based interventions targeting mental health outcomes. The risk of bias was assessed using the CASP tool. The search identified 14 RCTs (967 participants, predominantly female, age range - 18 to 69 years) that met the eligibility criteria. The yoga intervention varied in duration (10 minutes to 1 hour per session), frequency (once to five times weekly), and protocols (Laughter yoga being the most common). Mental health outcomes such as stress, anxiety, burnout, mindfulness, depression, quality of sleep, and life satisfaction were assessed. Most studies reported significant improvements in these outcomes in the yoga intervention groups compared to control groups. Nine studies showed a significant stress reduction, and 3 studies found a decrease in anxiety. No adverse effects were reported, and dropout rates varied between 0% to 52.1%. Yoga was found to be effective in improving mental health and well-being among nursing professionals and students. Yoga mainly reduced stress, anxiety, burnout, and depression, suggesting its potential as a low-cost, accessible intervention for mental health management in this population. Future studies should focus on refining protocols and exploring long-term effects to establish yoga as an integral part of mental health care for nursing professionals and students.

Definition and recommendations of advance care planning: A Delphi study in five Asian sectors

BACKGROUND

In Confucian-influenced Asian societies, explicit end-of-life conversations are uncommon and family involvement in decision-making is crucial, which complicates the adoption of culturally sensitive advance care planning.

AIM

To develop a consensus definition of advance care planning and provide recommendations for patient-centered and family-based initiatives in Asia.

DESIGN

A five-round Delphi study was performed. The rating of a definition and 84 recommendations developed based on systematic reviews was performed by experts with clinical or research expertise using a 7-point Likert scale. A median = 1 and an inter-quartile range = 0-1 were considered very strong agreement and very strong consensus, respectively.

SETTING/PARTICIPANTS

The Delphi study was carried out by multidisciplinary experts on advance care planning in five Asian sectors (Hong Kong/Japan/Korea/Singapore/Taiwan).

RESULTS

Seventy-seven of 115 (67%) experts rated the statements. Advance care planning is defined as "a process that enables individuals to identify their values, to define goals and preferences for future medical treatment and care, to discuss these values, goals, and preferences with family and/or other closely related persons, and health-care providers, and to record and review these preferences if appropriate." Recommendations in the domains of considerations for a person-centered and family-based approach, as well as elements, roles and tasks, timing for initiative, policy and regulation, and evaluations received high levels of agreement and consensus.

CONCLUSIONS

Our definition and recommendations can guide practice, education, research, and policy-making in advance care planning for Asian populations. Our findings will aid future research in crafting culturally sensitive advance care planning interventions, ensuring Asians receive value-aligned care.

Advance care planning for patient with chronic obstructive pulmonary disease: An evolutionary concept analysis

AIM

This study aimed to analyze the concept of advance care planning (ACP) for patients with chronic obstructive pulmonary disease (COPD), by systematically clarifying the attributes, antecedents, consequences, surrogate terms, related concepts, and historical transition of the concept.

METHODS

Following Rodgers' method of concept analysis, the academic development of concepts related to ACP for patients with COPD, as well as changes in the concept over time, is comprehensively organized and described. A search formula for relevant literature was created using the two keywords "chronic obstructive pulmonary disease" and "advance care planning". The databases of CENTRAL, PubMed, CINAHL Plus with Full Text, Embase, and PsycInfo were searched without limitation by the year of publication and restricted to English and Japanese languages.

RESULTS

Of the 3433 retrieved articles, 30 peer-reviewed articles were included in the analysis. Data extraction was conducted to identify concepts relevant to ACP for patients with COPD, resulting in the identification of four antecedents (COPD progression, decline in QOL, attitude toward facing death and dying, and interdisciplinary team approach); four attributes (discussion process, documentation, support for facing death, and dying, holistic approach); and four consequences (dialogical process, improved support of decision-making, physical impacts, and psychological impacts).

CONCLUSIONS

This conceptual framework, identified through this analysis, shows an evolution from a medical perspective to encompassing humanistic perspectives in addressing patient needs and emphasizes the importance of nursing practices. The elucidated concept characteristics may enhance its application, practice promotion, and interdisciplinary understanding across healthcare professions in the end-of-life field.

Best Evidence Summary for the Improvement and Management of Disorders of Consciousness in Patients With Severe Brain Injury

BACKGROUND AND PURPOSE

The treatment effect of consciousness after brain injury is currently uncertain. Thus, this study aimed to retrieve the evidence from neurologists around the world on the management of consciousness disorders in patients with severe brain injury and evaluate and summarize the evidence, providing the guidance on the related management for clinicians.

METHODS

Following the evidence summary report standard of Fudan University Center for Evidence-Based Nursing, clinical guidelines, expert consensuses, systematic reviews, and evidence summaries were systematically retrieved from UpToDate; BMJ Best Practice; Guidelines International Network; the Cochrane Library; Embase; PubMed; Sinomed; Web of Science; CNKI; WanFang database; American Academy of Neurology (AAN); American Congress of Rehabilitation Medicine (ACRM); European Academy of Neurology; and National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The publishing timeline for articles was limited from January 2017 to January 2024.

RESULTS

Fourteen articles were finally identified. The 26 best pieces of evidence were recommended by inducting and integrating the evidence from these articles, covering the following seven aspects: consciousness assessment, multidisciplinary team, intervention in facilitating arousal, sensory stimulation programs, drug administration, rehabilitation program, and prevention of complications.

CONCLUSION

This study summarized the evidence of consciousness management in patients with brain injury, providing guidance for clinicians to develop and apply those interventions to improve the patient's clinical outcomes and quality of life. In addition, relevant factors such as the clinical environment and cooperation with the patient's family members should be evaluated and adjusted before applying such evidence. Future studies should focus on more targeted randomized clinical trials.

Linking online health information seeking to cancer information overload among Chinese cancer patients' family members

Background

While previous studies indicated that seeking online health information could reduce individuals' cancer information overload, the results are inconsistent and have remained unknown in China. This study focuses on cancer patients' family members to determine whether online health information seeking helps lessen cancer information overload and the processes underlying this association.

Objective

To examine the relationship between online health information seeking and cancer information overload through psychological empowerment and anxiety in the sequel, we carried out a quota sampling online survey in mainland China in 2023. We also looked at the underlying mechanism's moderated role in eHealth literacy.

Methods

We standardized all variables from 0 to 1 using a Min-max normalization and conducted Model 6 and Model 92 of Process Macro to examine the mediation and moderation effects. The final sample size was 628 cancer patients' family members.

Results

We found that online health information seeking negatively impacted cancer information overload through psychological empowerment and anxiety (bp  = -.007, CI: [-.013, -.002]). Specifically, online health information seeking was positively related to psychological empowerment (bp  = .201, CI: [.149, .252]), which eased family members' anxiety (bp  = -.271, CI: [-.420, -.122]) and eventually reduced cancer information overload (bp  = .120, CI: [.063, .177]). Moreover, we observed that while online health information seeking increased family members' anxiety (bp  = .126, CI: [.023, .228]), eHealth literacy served as a moderator to mitigate this association (bp  = -.668, p < .05).

Conclusion

The findings can be used by healthcare workers, public health policymakers, and online health information providers to advise Chinese cancer patients' family members about the overwhelming amount of information they may encounter when seeking online health information.

New Carbothioamide and Carboxamide Derivatives of 3-Phenoxybenzoic Acid as Potent VEGFR-2 Inhibitors: Synthesis, Molecular Docking, and Cytotoxicity Assessment

INTRODUCTION/BACKGROUND

Because of the well-established link between angiogenesis and tumor development, the use of antiangiogenic therapeutics, such as those targeting VEGFR-2, presents a promising approach to cancer treatment. In the current study, a set of five hydrazine-1- carbothioamide (compounds 3a-e) and three hydrazine-1-carboxamide derivatives (compounds 4a-c) were successfully synthesized from 3-phenoxybenzoic acid. These compounds were specially created as antiproliferative agents with the goal of targeting cancer cells by inhibiting VEGFR- 2 tyrosine kinase.

MATERIALS AND METHODS

The new derivatives were synthesized by conventional organic methods, and their structure was versified by IR, 1HNMR, 13CNMR, and mass spectroscopy. In silico investigation was carried out to identify the compounds' target, molecular similarity, ADMET, and toxicity profile. The cytotoxic activity of the prepared compounds was evaluated in vitro against three human cancer cell lines (DLD1 colorectal adenocarcinoma, HeLa cervical cancer, and HepG2 hepatocellular carcinoma). The effects of the leading compound on cell cycle progression and apoptosis induction were investigated by flow cytometry, and the specific apoptotic pathway triggered by the treatment was evaluated by RT-PCR and immunoblotting. Finally, the inhibitory activities of the new compounds against VEGFR-2 was measured.

RESULTS

The designed derivatives exhibited comparable binding positions and interactions to the VEGFR-2 binding site to that of sorafenib (a standard VEGFR-2 tyrosine kinase inhibitor), as determined by molecular docking analysis. Compound 4b was the most cytotoxic compound, achieving the lowest IC50 against HeLa cells. Compound 4b, a strong representative of the synthesized series, induced cell cycle arrest at the G2/M phase, increased the proportion of necrotic and apoptotic HeLa cells, and activated caspase 3. The EC50 value of compound 4b against VEGFR-2 kinase activity was comparable to sorafenib's.

CONCLUSION

Overall, the findings suggest that compound 4b has a promising future as a starting point for the development of new anticancer drugs.

Prehabilitative/rehabilitative exercise, nutrition, and psychological support for bladder cancer: A scoping review of randomized clinical trials

The study of prehabilitation and rehabilitation ([p]rehabilitation) to alleviate the sequelae of bladder cancer and its treatment has generated numerous opportunities to improve the quality of life of bladder cancer survivors. The authors conducted a scoping review of randomized clinical trials (RCTs) to identify knowledge gaps in and research directions for (p)rehabilitative support for those affected by bladder cancer. The authors systematically searched six databases and synthesized key findings from RCTs conducted from January 1, 2004, through March 15, 2022, that enrolled participants with bladder cancer, survivors, or caregivers in outpatient (p)rehabilitative programs (e.g., exercise, nutrition, or psychological support). Outcomes were characterized according to eight prespecified, clinically relevant categories. The search retrieved 10,968 records, 27 of which met the inclusion criteria, and 24 described unique RCTs with 2471 enrolled participants. Of 24 interventions, 17 (71%) yielded statistically significant results for the outcome of interest. Only one RCT included a cost-effectiveness analysis, and only two characterized the efficacy of interventions for caregivers. Of 11 RCTs involving psychological support, eight yielded statistically significant results, as did nine of 11 RCTs with physical exercise interventions, three of four RCTs with educational interventions, three of four RCTs with nutritional support interventions, one of two RCTs with pharmacologic medications, and zero of one RCT with physical therapy. The most promising interventions for inclusion in multimodal, personalized (p)rehabilitation programs included exercise, stress management training, cognitive training, smoking and alcohol cessation counseling, immunonutrition, stoma education, and penile rehabilitation. Further studies of the cost effectiveness and efficacy for caregivers of such interventions are needed. PLAIN LANGUAGE SUMMARY: In a scoping review of all randomized clinical trials involving prehabilitative or rehabilitative diet, exercise, and psychological support interventions for patients with bladder cancer, survivors, and their caregivers, 17 of 24 (71%) interventions yielded statistically significant improvements in the outcome of interest. Clinicians should consider implementing such interventions for those affected by bladder cancer.

Effectiveness of Mindfulness-Based Interventions for Reducing Anxiety Among Women With Breast Cancer

After receiving a diagnosis of breast cancer, patients may experience negative physical, mental, and psychological symptoms. When excessive and uncontrollable, anxiety can become a pathological disorder. Mindfulness-based interventions (MBIs) are psychological approaches that incorporate practices individuals can use to promote awareness, nonjudgmental acceptance, and present-moment focus. We conducted this study to evaluate the effect of MBIs for reducing anxiety among women who had undergone surgical interventions for removal of breast cancer. We used a quasi-experimental design and a convenience sample of 30 women. We used three tools for data collection: a structured questionnaire that collected sociodemographic data and assessed the participants' knowledge about breast cancer, the Freiburg Mindfulness Inventory, which is a self-reported Likert scale designed to assess core characteristics of mindfulness, and the Hamilton Anxiety Rating Scale that measures the severity of an individual's anxiety. The results of our study showed that the majority (n = 24; 79.6%) of women who participated in our training program developed high levels of awareness about mindfulness. We found a highly statistically significant difference in the participants' levels of awareness of mindfulness between the pre- and postprogram evaluations (χ²[29, 30] = 56.143, p < .001), and a highly statistically significant difference in the participants' anxiety levels between the pre- and postprogram evaluations (χ²[29, 30] = 24.178, p < .001). We concluded that implementing a mindfulness training program significantly reduced the participants' level of anxiety. We recommend including MBIs in the treatment protocol for women with breast cancer as a method for reducing anxiety.

Assessing the Acceptability of a Vaginal Self-Sampling Device in a Rural Parish of Cuenca, Ecuador

INTRODUCTION

Cervical Cancer (CC) is a preventable and treatable disease if detected early, yet it remains a global health challenge. In Ecuador, CC is the second most common cancer; however, screening uptake remains suboptimal due to poor knowledge, low willingness, and limited access to healthcare. Traditionally, CC screening requires a healthcare professional, creating social and access barriers. Innovative techniques such as "self-sampling" (SS) for human papillomavirus (HPV) detection offer a promising alternative.

OBJECTIVE

This study evaluates the acceptability, attitudes, and user experience of a community-based SS program among a hard-to-reach population following a local educational session.

METHODS

A quasi-experimental study was conducted in a rural community in Cuenca, Ecuador. Educational sessions were organized, after which women were offered the option to perform SS for HPV detection. Three questionnaires were administered to assess population characteristics, risk factors, and experiences toward the process.

RESULTS

Of the 130 participants, 90% accepted SS, and 10% rejected SS. A significant number of women reported that SS was faster and less painful compared to traditional Papanicolaou tests (P < .05).

CONCLUSIONS

SS shows strong potential for increasing CC screening, especially in hard-to-reach areas, emphasizing the need to adapt screening programs to meet diverse community needs.

Methylmalonic acid induces metabolic abnormalities and exhaustion in CD8+ T cells to suppress anti-tumor immunity

Systemic levels of methylmalonic acid (MMA), a byproduct of propionate metabolism, increase with age and MMA promotes tumor progression via its direct effects in tumor cells. However, the role of MMA in modulating the tumor ecosystem remains to be investigated. The proliferation and function of CD8+ T cells, key anti-tumor immune cells, declines with age and in conditions of vitamin B12 deficiency, which are the two most well-established conditions that lead to increased systemic levels of MMA. Thus, we hypothesized that increased circulatory levels of MMA would lead to a suppression of CD8+ T cell immunity. Treatment of primary CD8+ T cells with MMA induced a dysfunctional phenotype characterized by robust immunosuppressive transcriptional reprogramming and marked increases in the expression of the exhaustion regulator, TOX. Accordingly, MMA treatment upregulated exhaustion markers in CD8+ T cells and decreased their effector functions, which drove the suppression of anti-tumor immunity in vitro and in vivo. Mechanistically, MMA-induced CD8+ T cell exhaustion was associated with a suppression of NADH-regenerating reactions in the TCA cycle and concomitant defects in mitochondrial function. Thus, MMA has immunomodulatory roles, thereby highlighting MMA as an important link between aging, immune dysfunction, and cancer.

Impact of Remote Symptom Management on Exercise Adherence After Video-Assisted Thoracic Surgery for Lung Cancer in a Tertiary Hospital in China: Protocol for a Prospective Randomized Controlled Trial

BACKGROUND

Regular pulmonary rehabilitation exercises are crucial for patients with lung cancer after surgery. However, poor adherence to outpatient exercises is difficult to address due to inadequate supervision. The integration of remote symptom management through electronic patient-reported outcomes (ePROs) offers a potential solution to improve adherence by enabling more effective monitoring and intervention.

OBJECTIVE

This study aims to evaluate the impact of ePRO-based remote symptom management on enhancing adherence to outpatient pulmonary rehabilitation exercises following video-assisted thoracic surgery for lung cancer.

METHODS

In this single-center, prospective, randomized controlled trial, 736 patients undergoing minimally invasive lung resection will be recruited. All patients will use a smartphone app for perioperative management, allowing periodic PRO measurement and recording of exercise participation. Upon discharge, patients will be randomly assigned 1:1 into either an intervention or control group. The intervention group will complete the Perioperative Symptom Assessment for Patients Undergoing Lung Surgery (PSA-Lung) scale on the day of discharge and postdischarge days 3, 7, 14, 21, and 28. Alerts will be triggered at the provider side if any of the 5 core symptoms (pain, cough, shortness of breath, sleep disturbance, and fatigue) scored ≥4, prompting remote symptom management. The control group will complete the PRO measures without triggering alerts. The primary outcome is the rehabilitation exercise adherence rate. Secondary outcomes include postdischarge pulmonary complication rate, 30-day readmission rate, trajectory of symptom severity changes, exercise participation rate, and patient satisfaction.

RESULTS

The enrollment of study participants started in December 2023 and is expected to end in March 2025. The final comprehensive analysis of the results is planned for May 2025, after all data have been collected and thoroughly reviewed.

CONCLUSIONS

This study is among the first to investigate the feasibility and effectiveness of ePRO-based remote symptom management in enhancing rehabilitation adherence after video-assisted thoracic surgery for lung cancer. If successful, this approach could significantly influence postoperative care practices and potentially be adopted in similar settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05990946; https://clinicaltrials.gov/study/NCT05990946.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/60420.

Sacral Metastasis in Follicular Thyroid Carcinoma: Cytology Pitfalls and Serum Thyroglobulin Utility

Sacral bone metastasis from primary follicular thyroid carcinoma (FTC) is rare. Most reported cases include factors indicative of thyroid origin, such as a history of treated thyroid cancer or newly identified thyroid nodules with malignant cytology. We herein report a 57-year-old woman with a metastatic sacral lesion of thyroid origin, initially misdiagnosed due to a false-negative fine-needle aspiration (FNA) cytology result of a thyroid nodule. The diagnosis was suspected based on an abnormally elevated serum thyroglobulin (sTg) level and confirmed through repeat core biopsy with thyroid-specific immunohistochemistry. This case highlights the limitations of FNA cytology in large thyroid nodules and underscores the potential role of sTg in diagnosing metastatic FTC in certain clinical scenarios. Thyroid carcinoma should be considered in the differential diagnosis of sacral metastases when the primary tumor is unknown.

Psychological Distress and Problems Among Young and Middle-Aged Cancer Patients Undergoing Treatment in China

OBJECTIVE

Influenced by their life stage and socio-cultural background, young and middle-aged cancer patients in China may experience unique psychological distress. Therefore, this study investigated the severity, problems, and associated factors of psychological distress among young and middle-aged cancer patients.

METHODS

We conducted a cross-sectional study on young and middle-aged cancer patients aged 18-59 who were treated at a radiotherapy center from February 2022 to September 2023. Participants' psychological distress severity and problems were measured using the Distress Thermometer and the Problem List. Binary logistic regression was used to identify sociodemographic and clinical factors, as well as PL items, associated with clinically significant psychological distress in young and middle-aged cancer patients.

RESULTS

Among the 510 participants, 102 (20.0%) had DT scores ≥ 4, reported an average of 3.36 ± 3.78 problems, and 360 (70.6%) reported at least one problem. The five most frequently reported problems were worry, no time and energy to take care of children/elderly people, memory loss/lack of concentration, appearance/shape, and work/school. Annual household income, self-reported loneliness, nervousness, loss of interest in daily activities, eating, and nausea were associated with DT scores ≥ 4.

CONCLUSIONS

One-fifth of young and middle-aged cancer patients experienced clinically significant psychological distress. Greater attention should be paid to patients with lower household incomes and those who self-report loneliness, nervousness, loss of interest in daily activities, eating, and nausea, providing targeted support to alleviate psychological distress.

Use of Digital Health Interventions for Cancer Prevention Among People Living With Disabilities in the United States: A Scoping Review

BACKGROUND

The use of digital health strategies for cancer care increased dramatically in the United States over the past 4 years. However, a dearth of knowledge remains about the use of digital health for cancer prevention for some populations with heath disparities. Therefore, the purpose of the present scoping review was to identify digital health interventions for cancer prevention designed for people with disabilities.

METHODS

This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and the Arksey and O'Malley methodological framework. The Embase, PubMed, Ovid MEDLINE, and CINAHL/EBSCO databases were searched for peer-reviewed articles published from database inception to February 5, 2024. Reports published in English of studies that employed digital health strategies for cancer prevention, were conducted among people with disabilities regardless of age, and were conducted in the United States were included.

FINDINGS

Following screening for eligibility, seven articles were identified. The types of disabilities were cancer (n = 4), bipolar I or II disorder (n = 1), obesity (n = 1), and deafness (n = 1). Interventions focused on education (n = 4), screening (n = 3), smoking cessation (n = 3), physical activity (n = 1), and cessation support (n = 1). Digital health strategies consisted of educational content delivered online, text messaging, interactive educational games, and downloadable informational applications. The common outcome of interest across all manuscripts was intervention efficacy.

INTERPRETATION

Overall, limited research is available to evaluate the use of digital health for cancer prevention among people with disabilities. This review identified gaps in knowledge that, if addressed, may help guide continued innovation in the use of digital health strategies for cancer prevention among people with disabilities.

Psychosocial aspects of quality of life outcomes in post-treatment human papillomavirus-associated cancer survivors in the United States: A scoping review

Human papillomavirus (HPV)-associated cancers (oropharyngeal, cervical, vulvar, vaginal, anorectal, and penile cancers) have previously been reported to have favorable survival outcomes making patients' quality of life (QoL) an important consideration for clinicians. This scoping review examined the literature on the post-treatment psychosocial QoL outcomes in patients HPV-associated cancers in the United States. The final set of 57 articles were comprised of patients that predominantly identified as Non-Hispanic White, females, or those with cervical or gynecologic cancers. Physical and psychological QoL were the most studied domains. Qualitative studies demonstrated salient themes including low health literacy on HPV-associated cancers, decreased sexual well-being, and increased feelings of stress and fear. Future work is needed in understanding psychosocial QoL in non-gynecologic HPV-associated cancers among individuals from underrepresented racial/ethnic groups, male patients, and those of lower socioeconomic status. Additionally, cancer-related stigma is relatively understudied among patients with HPV-associated cancers.

Textbook oncological outcome of locally advanced gastric cancer patients with preoperative sarcopenia: a multicenter clinical study

BACKGROUND

The impact of postoperative sarcopenia on the Textbook Oncological Outcome (TOO) in locally advanced gastric cancer (LAGC) remains uncertain. This study investigates the relationship between sarcopenia and TOO, explores its long-term prognostic value, and develops a prognostic model incorporating sarcopenia and TOO for survival prediction.

METHODS

We performed a retrospective analysis of clinical and pathological data from patients with LAGC who underwent radical surgery at two Chinese tertiary referral hospitals. Sarcopenia was defined as an SMI < 36.4 cm2/m2 in males and < 28.4 cm2/m2 in females. TOO was defined as the addition of perioperative chemotherapy to the textbook outcomes (TO). A nomogram was developed to predict postoperative overall survival (OS) and recurrence-free survival (RFS) in LAGC patients.

RESULTS

The study included 972 patients with LAGC. The overall TOO achievement rate was 67.1%. The TOO achievement rate was significantly higher in patients non-sarcopenia compared to those with sarcopenia (68.9% vs. 61.1%, P = 0.031). Logistic regression revealed that age ≥ 65, high ASA score, and sarcopenia were independent risk factors for TOO failure. Cox regression analysis identified TOO, sarcopenia, tumor size, differentiation, vascular invasion, pT stage, and pN stage as independent predictors of OS and RFS. Nomogram models based on sarcopenia and TOO accurately predicted the 3-year and 5-year OS and RFS.

CONCLUSION

Preoperative sarcopenia was an independent predictor of TOO implementation. A prognostic prediction model that integrates preoperative sarcopenia and TOO, which outperforms the current staging system, can aid clinicians in effectively assessing the prognosis of patients with LAGC.

Awareness of prostate cancer and its screening tests in men in the Middle East: A systematic review and meta-analysis

Prostate cancer (PCa) is a significant health issue characterized by the uncontrolled growth of cells in the prostate gland primarily affecting men 50 years old or older. The aim of this research was to assess the level of knowledge and attitudes of men in the Middle East towards PCa. A comprehensive search strategy in major databases from the date of first publication on this topic to April 2024 was conducted of cross-sectional studies assessing the knowledge and attitudes of adult men in the Middle East toward PCa. Data on the study's methodology, participant characteristics, and outcomes related to the knowledge of PCa and attitudes towards PCa were extracted and analyzed using the comprehensive meta-analysis software. The Newcastle-Ottawa Scale was used for quality assessment. The meta-analysis of 26 studies revealed significant heterogeneity among studies, with an overall rate of previous education on PCa at 76.3% (95% confidence interval [CI]: 61.2%- 86.8%), but a much lower rate of education on PCa screening at 20.5% (95% CI: 7.2%-46.2%). Knowledge of PCa, its screening tools, symptoms, risk factors, and treatments, as well as attitudes towards PCa screening, varied widely, with knowledge rates of 50.5% for PCa, 32.3% for screening tools, 45.5% for symptoms, 49.4% for risk factors, and 58.4% for treatments. The rate of favorable attitude towards PCa screening was reported at 50.0% (95% CI: 36.7%-63.3%). The Middle East has some understanding of PCa but there is little knowledge of screening techniques, symptoms, risk factors, and treatments. To improve early detection and patient outcomes, comprehensive education and culturally sensitive communication strategies are necessary.

Unveiling the cognitive burden: The impact of stigma on distorted thinking among individuals living with hepatitis B

Hepatitis B (HBV) is a prevalent chronic illness affecting approximately 254 million individuals worldwide, with China accounting for nearly one-third of cases. Despite its widespread impact, stigma associated with HBV significantly hinders access to testing, diagnosis, and treatment. This study investigates the relationship between HBV stigma and cognitive distortions among individuals living with HBV by analyzing 35,697 posts from Yiyou Forum, China's largest HBV online community. Utilizing a large language model (LLM) for stigma classification, posts were categorized into stigma-related (S-posts) and non-stigma-related (N-posts). A schema comprising 235 n-grams was employed to identify 12 types of cognitive distortions within these posts. Statistical analyses revealed that S-posts had a prevalence ratio (PR) of 1.824 (95%CI [1.636, 2.074]) for cognitive distortions compared to N-posts, indicating that distorted thinking patterns were approximately 1.8 times more common in stigma-related discussions. Specific distortions such as disqualifying the positive, labeling and mislabeling, mental filtering, and should statements were significantly more prevalent in S-posts. User-level analysis confirmed that individuals engaging in stigma-related posts consistently displayed higher levels of cognitive distortions. These insights underscore the potential of targeted cognitive-behavioral therapy (CBT) interventions to address and mitigate cognitive distortions, thereby alleviating the psychological burden of HBV stigma. Additionally, this study demonstrates the efficacy of advanced computational methods in psychological research.

Lived Experiences of Pancreatic Cancer Patients Undergone Whipple Procedure: A Qualitative Study

Objectives

Pancreatic cancer is a devastating illness with significant impacts on patients' health-related quality of life (HRQoL). The Whipple procedure, a common surgical intervention for pancreatic cancer, presents numerous challenges for recovery and adaptation. This study aims to provide a comprehensive understanding of the lived experiences of patients' post-Whipple surgery. The objective of the study is to explore the lived experiences of patients having cancer of the pancreas undergone Whipple's procedures.

Materials and Methods

A qualitative phenomenological approach was employed to delve into the experiences of patients who underwent the Whipple procedure. Twenty-seven patients attending the surgical gastroenterology outpatient department of a tertiary care institution for follow-up were enrolled in the study. The patients were enrolled consecutively till the saturation of data. An interview guide was used to collect the data. The data were analysed using Colaizzi's method to identify the key themes.

Results

The participants, with a mean age of 51.61 ± 10.89 years, were predominantly male (61.7%) and Hindu (70%) by religion. Most participants had tumours of the head of the pancreas and were hospitalised for 16-30 days at the time of surgery. Thematic analysis revealed eleven themes, i.e. post-diagnosis reaction, burden of the disease, physical problems, socioeconomic burden, psychological issues, impact on social life, financial support, disturbed body image, spirituality, communication with healthcare professionals and hospital experiences.

Conclusion

This study underscores the multifaceted challenges faced by pancreatic cancer patients post-Whipple procedure, highlighting the importance of addressing physical, emotional and socioeconomic aspects to improve their HRQoL. The findings can inform healthcare professionals in developing holistic care strategies tailored to these patients' unique needs.

The impact of malignancy on death anxiety and psychological well-being in middle-aged and older patients undergoing abdominal surgery: a quasi-experimental study

BACKGROUND

Malignancy is a critical factor affecting death anxiety and psychological well-being. This study examined the impact of malignancy on death anxiety and psychological well-being in middle-aged and older adult patients undergoing abdominal surgery and projected it along with sociodemographic profiles.

METHODS

This study is quasi-experimental in design. It was conducted with patients undergoing abdominal surgery at a university hospital due to suspected malignancy. A total of 93 patients participated in the study: 57 patients diagnosed with malignancy were included in the experimental group, while 36 patients without a malignancy diagnosis were included in the control group. Data were collected using a questionnaire developed by the researchers based on the literature, the 'Turkish Death Anxiety Scale', and the 'Psychological Well-being Scale'. The analyses revealed that the data were normally distributed, and parametric tests were used to analyze differences between demographic variables and groups. Cohen's d and r values were examined to assess the effect size in the tests.

RESULTS

The study found a significant difference in death anxiety between the experimental and control groups (P < 0.05), with higher mean scores in the experimental group. Malignancy had a large effect on death anxiety (d = 1.42). Additionally, the control group had significantly higher mean psychological well-being scores compared to the experimental group (P < 0.05).

CONCLUSIONS

The study found that malignancy significantly affects death anxiety and psychological well-being. Increased death anxiety in patients with malignancy was associated with reduced psychological well-being. Thus, assessing death anxiety and providing targeted nursing care are essential for supporting the psychological well-being of these patients.

A Web-Based Education Program About Primary Palliative Care for Heart Failure: A Study Protocol of Wait-Listed Randomized Controlled Trial

BACKGROUND

The number of patients with heart failure (HF) is rapidly increasing as palliative care is being integrated into HF management and the need for a nursing workforce to meet these demands grows. To address this, we have developed a Web-based educational program on primary palliative care for HF among general registered nurses caring for patients with HF in Japan.

OBJECTIVE

The aim of this study was to evaluate the program's effectiveness on nurse-reported palliative care practice, difficulty, and knowledge.

METHODS

In this open-label, individual-level, wait-listed randomized controlled trial, 150 Japanese general registered nurses, with experience in caring for patients with HF and clinical ladder level ≥ 2 in inpatient, outpatient, and home-visiting care settings, will be randomly divided (1:1 ratio) into a Web-based educational program group and a wait-list control group. The follow-up period is 6 months after the intervention. The primary outcome is the nurse-reported practice score in primary palliative care, and the secondary outcomes are the nurse-reported difficulties score and knowledge score.

CONCLUSIONS AND CLINICAL IMPLICATIONS

We herein describe the study protocol of a wait-listed randomized controlled trial regarding a Web-based educational program, which is a novel approach for these nurses. If the results of this study support our hypothesis, they could help expand primary palliative care, including daily nursing practices, such as symptom management and interdisciplinary collaboration, in the field of cardiovascular nursing.

Relatives' Unmet Needs in the Last Year of Life of Patients With Advanced Cancer: Results of a Dutch Prospective, Longitudinal Study (eQuiPe)

Objective(s): Unmet needs of relatives of patients with advanced cancer not only reduce their own health-related quality of life, but may also negatively affect patients' health outcomes. The aim of this study was to assess changes in relatives' unmet needs of patients with advanced cancer in the last year of life and to identify differences in unmet needs by gender and type of relationship. Methods: Relatives of patients with advanced cancer in the Netherlands were included in a prospective, longitudinal, observational study. Relatives' unmet needs were measured every 3 months with an adapted version of the Problems and Needs in Palliative Care (PNPC) questionnaire Caregiver form (44 items, 12 domains). Questionnaires completed in the patients' last year of life were analyzed. Change of unmet needs in the last year, and differences in unmet needs by gender and type of relationship were analyzed. Results: A total of 409 relatives were included with a median of 4 unmet needs in the patient's last year. Unmet needs were most prevalent at all time points during the last year in the domains "caring for the patient" (highest need = 35%) and "psychological issues" (highest need = 40%). The number of unmet needs of relatives did not change significantly during the last year of life (P=.807). There were no significant differences in the number of unmet needs between male and female partners and between partners and other relatives. Conclusion: The most unmet needs for relatives were in the domains "caring for the patient" and "psychological issues." Professional support should focus on these items. Within these domains, it seems especially important that relatives get more knowledge and support about what scenarios to expect and how to deal with them.

Adapted physical activity programs for the prevention and treatment of musculoskeletal pain induced by aromatase inhibitors in non-metastatic breast cancer patient: A scoping review

BACKGROUND

Aromatase inhibitor is associated with a high incidence of Aromatase Inhibitor-Associated Musculoskeletal Syndrome (AIMSS) in postmenopausal women with hormone-sensitive breast cancer.

OBJECTIVE

This scoping review aims to identify available information regarding the frameworks, models, or strategies of adapted physical activity (APA) programs implemented for the prevention and management of AIMSS.

METHODS

Search was realized by two independent reviewers in six databases following PRISMA-ScR guidelines. Data of included articles were extracted, and risk of bias analyzed.

RESULTS

Finally, 14 were included. No study has examined APA in the prevention of AIMSS. There is no solid evidence supporting the impact of APA on the management of AIMSS. However, evidence suggests that an APA program can reduce the worst joint pain and improve the quality of life.

CONCLUSION

Future research will enlighten clinical practices with the development of personalized APA programs in hormone-sensitive breast cancer.

Managing medications for patients with cancer and chronic conditions: It's time for collaboration between primary care and oncology pharmacists

OBJECTIVE

To provide a rationale for a collaborative care model involving oncology and primary care pharmacists to improve the coordination of care of medications for cancer patients with multiple chronic conditions.

DATA SOURCES

A review of selected literature and the authors' own research was used. Studies illustrating the gaps in care for medications and pharmacists' roles in oncology and primary care settings from PubMed were reviewed.

DATA SUMMARY

There has been a substantial increase in the development and utilization of oral anticancer agents (OAAs). Although OAAs offer convenience and flexibility, they also introduce challenges related to medication adherence, monitoring, and managing side effects. Up to 17.5% of patients experience moderate to severe symptoms from OAAs and about 30% report less than excellent medication adherence. Further, studies showed that 30% to 53% of adult cancer patients have at least one chronic condition that complicates their treatment plan due to the need for medications, increasing the risk of drug interactions, side effects, and non-adherence. The Primary Care Oncology Model (PCOM) incorporates both primary care and oncology pharmacists with comprehensive medication review and patient-reported outcome measure, respectively, to enhance medication appropriateness and effectiveness, and improve overall patient experience.

CONCLUSION

Implementing PCOM may improve the medication management of patients taking OAAs for active cancer treatment and chronic medications for their multiple chronic conditions. This collaborative approach can transform patient care by leveraging the expertise of both primary care and oncology pharmacists.

Nanoparticles and the Vaginal Microbiota: Diagnostic and Therapeutic Innovations in Human Papilloma Virus-associated Cervical Cancer - A Systematic Review

Cervical cancer (CC) remains a significant global health challenge, with the interplay between microbiome and cancer progression becoming increasingly evident. A comprehensive literature search was conducted across multiple databases, including Embase, NCBI, Google Scholar, Elsevier, Science Direct and PubMed, utilising the specific keywords such as 'cervical cancer', 'cervical microbiome', 'vaginal microbiome', 'Human papillomavirus', 'nanoparticles', 'drug delivery' and 'dysbiosis'. Studies published over the past 15 years were reviewed. A total of 400 articles were identified and 65 research articles were finally included. This systematic approach identified relevant studies, enabling an in-depth analysis of microbial species, such as Parabacteroides, Escherichia, Shigella, Gardnerella and Fusobacterium which are recognised as the potential biomarkers for CC diagnosis and progression. Dysbiosis is characterised by a reduction in helpful bacteria and a proliferation of harmful ones. It is linked to chronic inflammation and human papillomavirus infection, both of which facilitate the CC progression. Advanced nanotechnology presents innovative therapeutic options for CC treatment, enhancing drug delivery systems and targeting tumour cells more effectively. Moreover, incorporating nanocarriers into treatment regimens aims to improve the bioavailability and efficacy of existing therapies, potentially transforming the clinical approaches to CC management. This review highlights the dual role of the microbiome as both a diagnostic and prognostic biomarker and elucidates the potential of nanotechnology in optimising treatment strategies, advocating for further research on microbial interactions in cancer pathology.

Health behavior and social crisis in the era of COVID-19 in Malawi: A decolonizing approach to a qualitative study

BACKGROUND

The rapid spread and severity of COVID-19 brought major health challenges and dealt a heavy blow to key health services and daily life in Africa, including Malawi.

PURPOSE

To explore and examine the impact of the COVID-19 pandemic on cervical cancer (CC) prevention behavior in Malawi through a decolonized lens.

METHODS

A qualitative descriptive study informed by a decolonized perspective was conducted during the COVID-19 pandemic. A purposive sampling was taken from 17 key informant interviews, including, seven Malawian women living with HIV infection (WLWHIV).

RESULTS

Themes explored were that COVID-19 was indiscriminate towards not only health deterioration but also a social crisis and health was no longer an individual problem but a public and global issue across borders.

CONCLUSION

To uproot global health inequities, templates revolved around Western ways of knowing over national and global health need to be reexamined and methods reinvented to be relevant to local ways of knowing.

Dyadic interventions for cancer patient-caregiver dyads: A systematic review and network meta-analysis

BACKGROUND

Cancer imposes significant psychological distress on both patients and caregivers. Dyadic interventions are designed to concurrently address the health problems of both, yet there remains limited evidence as to which specific dyadic interventions yield the most effective outcomes for both partners.

OBJECTIVES

To systematically synthesize and evaluate the comparative efficacy of various dyadic interventions on a wide range of outcomes within cancer patient-caregiver dyads.

METHODS

Searches of eight electronic databases from inception to July 2, 2023, were performed. Data extraction and quality assessment were independently conducted by two reviewers utilizing the Cochrane risk of bias tool and the Jadad score. Stata 17.0 was used for network meta-analysis, with the Surface Under the Cumulative Ranking (SUCRA) curve employed to rank interventions based on efficacy for each outcome. Effect sizes were reported using standardized mean difference (SMD) with a 95 % confidence interval (CI), and publication bias was assessed via Egger's test. The study protocol was registered in PROSPERO under CRD42023467172.

RESULT

A total of 37 studies, spanning 8 countries, were included. According to SUCRA rankings, WeChat couple-based psychosocial support and the eHealth symptom and complication management program were identified as the most effective interventions for improving quality of life in both patients and caregivers (SUCRA = 82.1 %, SMD = 7.30, 95 % CI: 1.02, 13.58; SUCRA = 86.6 %, SMD =1.17, 95 % CI: 0.04, 2.31, respectively). Emotionally focused therapy was ranked as the most effective intervention for enhancing dyadic adjustment (SUCRA = 100 %, SMD = 1.63, 95 % CI: 0.91, 2.36; SUCRA = 99.9 %, SMD = 2.04, 95 % CI: 1.26, 2.82, respectively). Couple-based intimacy enhancement and telephone-based dyadic psychosocial interventions were deemed most effective interventions in alleviating anxiety (SUCRA = 88.2 %, SMD = -0.83, 95 % CI: -1.65, -0.00; SUCRA = 95.6 %, SMD = -1.08, 95 % CI: -1.76, -0.41, respectively), while telephone-based dyadic psychosocial intervention and coping skills training were the most efficacious interventions for reducing depression in both partners (SUCRA = 95.2 %, SMD = -0.89, 95 % CI: -1.55, -0.23; SUCRA = 99.8 %, SMD = -2.31, 95 % CI: -3.27, -1.35, respectively). Additionally, caregiver educational program was ranked highest for reducing caregivers burden (SUCRA = 95.6 %, SMD = -1.20, 95 % CI: -1.55, -0.23).

CONCLUSION

The highest-ranked dyadic interventions identified in this analysis offer valuable insights for clinical practice, providing strategies to enhance the quality of life, strengthen dyadic relationships, and alleviate anxiety, depression, and caregiver burden. Nevertheless, further robust randomized controlled trials are necessary to confirm these findings.

The effect of psychosocial interventions by nurses on the well-being of aged Indian adults

The challenge posed by aging, particularly in enhancing psychosocial health in nursing homes has to be addressed. Hence, we evaluated the nurse-led psychosocial interventions to improve social well-being and reduce residents' loneliness. Fifty participants from Chennai engaged in a mixed-methods design, where pre- and post-tests measured social well-being and loneliness. Over four weeks, structured social activities and emotional support interventions resulted in significant improvements in social well-being and notable reductions in loneliness. The study's findings demonstrate that nurse-led psychosocial interventions can effectively enhance well-being and minimise loneliness in elderly care settings, supporting the need for targeted strategies in elderly care.

Anesthetic approaches and 2-year recurrence rates in non-muscle invasive bladder cancer: a randomized clinical trial

BACKGROUND

The effect of anesthesia methods on non-muscle invasive bladder cancer (NMIBC) recurrence post-resection remains uncertain. We aimed to compare the oncological outcomes of spinal anesthesia (SA) and general anesthesia (GA) in patients with NMIBC.

METHODS

This prospective randomized controlled trial recruited 287 patients with clinical NMIBC at Seoul National University Hospital from 2018 to 2020. The patients underwent transurethral resection of the bladder tumor within 4 weeks of randomization. Intrathecal hyperbaric bupivacaine (0.5%) and a mixture of propofol (1-2 mg/kg) and fentanyl (50-100 μg/kg) were used as induction agents in the SA and GA groups, respectively, with desflurane or sevoflurane used for maintaining anesthesia. The primary and secondary outcome measures were disease recurrence and disease progression, respectively, at 2 years after resection. Cumulative incidence of outcomes was compared between the two groups using time-to-event analyses.

RESULTS

15 patients required alternative anesthesia owing to clinical needs such as SA failure or significant obturator reflex, resulting in a modified intention-to-treat (ITT) population of 272 patients. Time-to-event analysis showed a significantly lower recurrence of NMIBC in the SA group than in the GA group, in both ITT (27.4% vs 39.8%) and modified ITT populations (26.8% vs 39.6%). Disease progression occurred more frequently in the GA than in the SA group (15.2% vs 7.8%), although the difference was not statistically significant.

CONCLUSIONS

A notable reduction in the 2-year recurrence rate was observed in patients who underwent SA than in those who underwent GA. Thus, SA may be considered the preferred anesthetic approach.

TRIAL REGISTRATION NUMBER

NCT03597087.

Health and economic impact of caregiving on informal caregivers of people with chronic diseases in sub-Saharan Africa: A systematic review

With a disproportionate burden of chronic diseases and severe shortage of health workers in sub-Saharan Africa, the region implicitly relies on informal caregivers (ICGs) to support the patients both within and outside the health facilities. The aim of this review is to systematically summarise evidence on the health and economic impact of caregiving on informal caregivers of patients with chronic diseases in sub-Saharan Africa. Medline (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), Embase (Ovid), Global Health, and Web of Science databases were systematically searched to identify original articles that considered the economic and/or health impacts of caregiving in sub-Saharan Africa. The results from the included studies were synthesised narratively. After screening 4,951 records, 47 studies were included for synthesis. The articles were from all sub-regions of sub-Saharan Africa with more than half (25/47) of the studies focussing on caregivers for patients with cancer. Although the primary motivation for becoming caregivers was love and responsibility, the caring responsibilities described in twenty studies, had profound effects on the caregiver's lives. Healthwise, the informal caregivers experienced changes in their physical and mental health like developing musculoskeletal problems and depression. Economically, caregiving was expensive, and financially draining. The opportunity cost of caregiving included loss of jobs, loss of income, foregoing planned important activities and missed education opportunities. Informal caregivers reported a range of mainly negative health and economic effects of the work they do. Health care systems should consider how to better support caregivers in terms of their own physical and mental wellbeing. Also, governments should develop strategies to financially support informal caregivers.

Evaluating massage therapy for radiation-induced fibrosis in rats: preliminary findings and palpation results

Radiation-induced fibrosis (RIF) is a common side effect of cancer treatment, but can manifest into a devastating syndrome for which there is no preventive measure or cure. In rats who perform a repetitive work task, who left untreated develop signs and symptoms that resemble repetitive motion disorders in humans, we have shown that manual therapy prevents the development of fibrosis and other key biomarkers. The fibrosis of RIF and repetitive motion disorders has similar biomarkers. In rats, we sought to determine if manual therapy would alter key biomarkers of post-irradiation fibrosis following X-ray irradiation given to the rat forelimb. One limb of rats was given a damaging dose of X-ray irradiation. Some limbs were massaged using a protocol previously described and characterized. Serum inflammatory markers, histological assays of tissue fibrosis and nerve pathology, and electrophysiology for neuropathic discharge were assayed after 8 weeks. We also tested if an experienced therapist could identify the irradiated limb using blinded palpation at the 8 week end-point. While preliminary assays showed robust changes compared to control limbs, the other assays did not show similar pathology. Our therapist could detect each irradiated limb. Serum inflammatory markers were reduced by massage to the irradiated limb. We conclude that blinded palpation is sensitive to detect subtle changes in tissue following irradiation. In contrast to the preliminary studies, the dose of irradiation used was insufficient to induce long-lasting deep fibrosis or nerve degeneration. We suspect that a difference in housing, and thus physical activity, was the plausible reason for this difference.

Predictive modeling of breast cancer-related lymphedema using machine learning algorithms

Background

Breast cancer-related lymphedema (BCRL) is one of the common complications after breast cancer surgery. It can easily lead to limb swelling, deformation and upper limb dysfunction, which has a serious impact on the physical and mental health and quality of life of patients. Previous studies have mostly used statistical methods such as linear regression and logistic regression to analyze the influencing factors, but all of them have certain limitations. Machine learning (ML) is an important branch of artificial intelligence, which can effectively overcome the problems of multivariate interaction and collinearity. This study aimed to explore the influencing factors for the occurrence of BCRL in breast cancer patients, and construct a predictive model with ML algorithms and validate its predictive value on this basis.

Methods

Clinical data of breast cancer patients admitted to Hainan Cancer Hospital from September 2018 to May 2024 were retrospectively collected. BCRL was considered as the outcome measurement, and the data were divided into training and validation sets in a ratio of 7:3. In the training set, random forest (RF), support vector machine (SVM), and eXtreme Gradient Boosting (XGBoost) algorithms were used to construct predictive models. The discrimination accuracy of the models was evaluated with receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, and F1 score. The calibration of the models was assessed using calibration curves and the Hosmer-Lemeshow (H-L) Chi-squared test.

Results

Two hundred and forty patients who met the inclusion criteria were screened, and they were randomly divided into a training set (168 patients) and a validation set (72 patients) in a 7:3 ratio. In the training set, 44 cases developed BCRL, while 124 did not. There were statistically significant differences (P<0.05) in hypertension history, number of dissected lymph nodes, postoperative complications, postoperative functional exercises, chemotherapy, radiotherapy, tumor node metastasis (TNM) stage, and level of axillary lymph node dissection between the BCRL and non-BCRL groups. Among the four models, the XGBoost model showed the best predictive performance, with an area under the curve (AUC) of 0.99 in the training set and 0.89 in the validation set. The XGBoost model demonstrated good calibration in both the training and validation sets, showing good consistency with the ideal model.

Conclusions

The ML-based XGBoost model for predicting BCRL exhibits excellent performance and assists healthcare professionals in rapidly and accurately assessing the risk of BCRL occurrence.

The Financial Toxicity Experience of Patients with Colorectal Cancer During Chemotherapy: A Qualitative Study

BACKGROUND

This study aimed to explore the experience of financial toxicity in patients with colorectal cancer during chemotherapy and to inform the development of targeted interventions.

METHODS

A descriptive qualitative research method was used to conduct semi-structured interviews with a purposive sample of 15 patients with colorectal cancer undergoing chemotherapy who attended the Department of Medical Oncology of the First Affiliated Hospital of Anhui Medical University from March to June 2024, and the data were organized and analyzed using the Nvivo 11.0 qualitative data analysis software and the thematic analysis method.

RESULTS

Four themes were extracted: patients with chemotherapy-stage colorectal cancer bear direct and indirect multifaceted economic pressures, are affected by multidimensional risk factors, which cause multiple adverse outcomes, and cope with financial toxicity in various ways.

CONCLUSIONS

The experience of financial toxicity in colorectal cancer patients undergoing chemotherapy is presented in a multidimensional format, with multiple causes influencing their financial toxicity. In the future, healthcare professionals should identify patients at high risk for financial toxicity, provide financial toxicity interventions and support, and mitigate their exposure to financial toxicity.

Awareness-raising activities of advance care planning for community residents: a nationwide cross-sectional survey in Japan

BACKGROUND

Japan is implementing awareness-raising of advance care planning for older adults; however, only 451 out of 1 741 municipalities were engaged in advance care planning awareness-raising activities among residents, according to a 2017 survey. This study examined advance care planning awareness-raising activities among community residents by local governments after the 2018 revision of the government guidelines, as well as utilization of the revised guidelines, issues in awareness-raising activities, and directions for future activities.

METHODS

This cross-sectional questionnaire survey was conducted in prefectures and municipalities nationwide in 2022. Questions included the status, content, and issues of advance care planning awareness-raising activities for community residents. A multi-level logistic regression analysis was used to examine the characteristics of municipalities engaged in activities.

RESULTS

Responses were received from 43 prefectures (response rate: 91.5%) and 912 municipalities (response rate: 53.1%). Of the municipalities, 63.6% (n = 580) reported "active" advance care planning awareness-raising. A high financial capability index and implementation of awareness-raising activities in the prefecture where the municipality was located were significantly associated with its awareness-raising activities. Municipalities engaged in awareness-raising activities reported experiencing issues related to the objectives, methods, and outcome evaluation of the activities.

CONCLUSIONS

Five-hundred eighty municipalities engaged in awareness-raising activities-a number that had increased significantly since the 2017 survey. Municipalities that could not engage in awareness-raising activities should receive financial support and other forms of support from prefectures. Furthermore, to ensure that municipalities clarify the purpose of awareness-raising and the desired outcomes, indices for quantitatively measuring results and achievements should be developed.

Enhancing critical thinking and emotional coping of nursing students through life skills training

In the dynamic healthcare landscape, nurses must develop life skills beyond clinical expertise to provide effective patient care and ensure professional growth. This study evaluates the effectiveness of a structured life skills training program for first-year B.Sc. Nursing students in Tamil Nadu, India. This true experimental pre-test-post-test design study was conducted in six randomly selected nursing colleges in Trichy district, Tamil Nadu. The sample included 257 first-year B.Sc. Nursing students, with 126 in the experimental group and 131 in the control group. The eight-week Life Skills Training Program consisted of weekly two-hour sessions. The experimental group showed significant improvements in critical thinking (F=64.26, p<0.001), decision making (F=35.02, p<0.001), problem solving (F=77.54, p<0.001) and coping with emotions (F=39.03, p<0.001) compared to the control group. Associations were found between life skills and socio-demographic variables such as the number of friends, hobbies, reason for choosing nursing and interest in the course.

Knowledge and beliefs on breast cancer screening and uptake among Yemeni female school teachers in Malaysia

Limited breast cancer screening uptake among women may lead to late-stage diagnosis and reduce the survival rate. Hence, this study was conducted to determine breast cancer screening (BCS) uptake and its association with knowledge, beliefs, and socio-demographic factors among female Yemeni school teachers in Malaysia. A cross-sectional study was conducted as part of a large cluster-randomized controlled trial (CRT) among 180 Yemeni female teachers aged 20 years and above. The sample was selected using cluster sampling from 12 Arabic schools in the Klang Valley area, Malaysia. Data was collected using a validated Arabic questionnaire. Data analysis was performed using the SPSS 22.0 software. Both descriptive and logistic regression analyses were employed. The logit model with a p-value less than 0.05 was conducted to determine the predictors of BCS uptake. The screening uptake by the study participants was 23.3% (n = 42), 21.1% (n = 38), and 5.6% (n = 10) for breast self-examination (BSE), clinical breast examination (CBE) and mammogram (MMG), respectively. Additionally, the total mean knowledge score was 18.02 (SD = 5.82). Regarding the participants' beliefs, the mean benefits and mean barriers of BSE were 23.29 (SD = 3.77), and 12.97 (SD = 3.80), respectively. In addition, mean confidence in doing BSE and mean health motivation were 31.85 (SD = 7.17) and 27.95 (SD = 4.22), respectively. Besides, the mean benefits of MMG were 21.26 (SD = 4.07), and the mean barriers to MMG were 14.81 (SD = 2.14). The logit model showed that higher knowledge among study participants increased the probability of performing BSE, CBE, and MMG with (OR = 1.09, 95% CI 1.01-1.17, p = 0.021), (OR = 1.08, 95% CI 1.00-1.16, p = 0.036), and (OR = 1.47, 95% CI: 1.14-1.91, p = 0.003), respectively. In addition, the higher confidence level increased the probability of performing BSE (OR = 1.090, 95% CI 1.017-1.168, p = 0.014). However, more barriers to CBE were associated with a decrease in the probability of performing CBE (OR = 0.892, 95% CI 0.802-0.992, p = 0.034). Moreover, as the participants got older, the MMG uptake increased (OR = 1.418, 95% CI 1.116-1.801, p = 0.004). Breast cancer screening uptake and knowledge, as well as beliefs concerning BCS are low among Yemeni school teachers in Malaysia. Conducting educational interventions on BCS is needed to improve awareness and encourage early detection of BC among women.

Development and validation of a web-based calculator for determining the risk of psychological distress based on machine learning algorithms: A cross-sectional study of 342 lung cancer patients

PURPOSE

Early and accurate identification of the risk of psychological distress allows for timely intervention and improved prognosis. Current methods for predicting psychological distress among lung cancer patients using readily available data are limited. This study aimed to develop a robust machine learning (ML) model for determining the risk of psychological distress among lung cancer patients.

METHODS

A cross-sectional study was designed to collect data from 342 lung cancer patients. Least Absolute Shrinkage and Selection Operator (LASSO) was used for feature selection. Model training and validation were conducted with bootstrap resampling method. Fivefold cross-validation evaluated and optimized the model with parameter tuning. Feature importance was assessed using SHapley additive exPlanations (SHAP) method.

RESULTS

The model identified seven independent risk factors of psychological distress: residence (β = 0.141), diagnosis duration (β = 0.055), TNM stage (β = 0.098), pain severity (β = 0.067), perceived stigma (β = 0.052), illness perception (β = 0.100), and coping style (β = 0.097). Among the eight ML algorithms evaluated, the extreme gradient boosting (XGBoost) algorithm demonstrated the highest performance with AUROC values of 0.988, 0.945, and 0.922 for the training, validation, and test sets, respectively. The model's results were further explained using SHAP, which revealed the importance and contribution of each risk factor to the overall distress risk. A web-based tool was developed based on this model to facilitate clinical use.

CONCLUSION

The XGBoost classifier demonstrated exceptional performance, and clinical implementation of the web-based risk calculator can serve as an easy-to-use tool for health practitioners to formulate early prevention and intervention strategies.

Effect of Qigong exercise on quality of life and cortisol in patients with cancer: a non-randomized controlled trial

PURPOSE

The aim of this study was to investigate the effect of a 6-month Guolin Qigong on quality of life and serum cortisol among patients with cancer.

METHODS

This study was a two-arm and non-randomized controlled trial. Forty-nine patients with cancer who were over 18 years of age and diagnosed with cancer were enrolled in this study and assigned to either the Guolin Qigong intervention group (IG, n = 26) or the usual care group (UC, n = 23) for 6 months. During the Guolin Qigong exercise, the participants completed a training program consisting of five sessions per week and 40-60 min per session. The UC group maintained their usual lifestyle. The main outcomes included self-reported quality of life (European Organization for Research and Treatment of Cancer, EORTC-QLQ-C30) and well-being (General Well-Being Schedule, GWB). The second outcome was stress-related hormone serum cortisol measured by enzyme-linked immunosorbent assay. All measurements were assessed at baseline and 6 months.

RESULTS

Forty-nine participants (57.4% females, 26 in IG vs 23 in UC) were enrolled in the study, and forty-five participants completed all tests after the 6-month intervention (48.9% females, 25 in IG vs 20 in UC). Compared to the UC group, quality of life, physical function, and pain significantly improved in the IG (P < 0.05). Similarly, some sub-scales of GWB improved in the IG group compared to the UC group, especially for cheerful distracted and overall score (P < 0.05). However, there was no significant difference in serum cortisol between the two groups either at baseline or after intervention (P > 0.05).

CONCLUSIONS

Six-month Guolin Qigong could improve quality of life, physical function, and pain, and have a beneficial effect on the well-being of cancer patients. Further studies are warranted to confirm these results.