Metabolomic Associations With Fatigue and Physical Function in Children With Cancer: A Pilot Study

Background: Fatigue is a frequently reported symptom in children undergoing cancer treatment. Prior research shows an inverse relationship between fatigue and physical activity. Less is known about fatigue's relationship with physical function or the underlying biological mechanisms of fatigue. This study explored associations among fatigue, physical function, and associated metabolites. Methods: Children (7-18 years) provided serum samples and self-reports of fatigue and lower extremity physical function (mobility) using Pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) surveys at two timepoints during cancer therapy. PROMIS scores were categorized as high/low per established cut points (high fatigue T >47.5; high physical function T >51.5). High-resolution liquid chromatography-mass spectrometry extracted 29 metabolites hypothesized a priori to be associated with fatigue or physical function. Descriptive statistics summarized PROMIS scores, and linear mixed effect models estimated metabolite associations adjusting for age, gender and steroid use. Results: Forty children participated (female, 53%; 7-12 years, 38%; 13-18 years 62%; Hodgkins Lymphoma, 33%; Acute Lymphoblastic/Lymphocytic Leukemia, 40%; Osteosarcoma, 10%; Other, 17%). Physical function and fatigue were inversely related: T1 (r = -0.64; p < .001) and T2 (r = -0.63; p < .001). One metabolite (indole-3-latic acid) differentiated between low and high fatigue. Five metabolites differentiated significantly between low and high physical function (4-Hydroxybenzoic acid, m-Coumaric acid, myoinositol, tryptophan, and tyrosine). Conclusions:These findings substantiate prior studies showing metabolites, particularly amino acids, significantly associated with fatigue and physical function. All significant metabolites were associated with the gut microbiome. Physical function was inversely corelated with fatigue providing another potential intervention for fatigue management.

Nurses' Influence in Promotion of Cancer Health Equity in the World Health Organization Western Pacific region

PURPOSE

Nurses are instrumental in reducing cancer health disparities, ensuring that every individual can access cancer care services they need without experiencing financial hardship. This commentary reveals nurses' influence in promoting cancer health equity using examples from 4 low- and middle-income (LMIC) Western Pacific countries: China, Malaysia, the Philippines, and Vietnam.

METHODS/SOURCES

Literature searches were performed using search engine and databases available to the authors such as PubMed and Google search engine. The searches were conducted in 2024. Keywords used for literature search were "caner health disparities," "health equity," "national cancer control plan," "cancer prevention," "early detection of cancer," "cancer diagnosis," "cancer treatment," "cancer survivorship," "palliative care," "childhood cancer," "nurses" roles," "lower-and-middle-income countries," "LMICs," "China," "Malaysia," "Philippines," "Vietnam." Moreover, the Global Cancer Observatory (GCO) website was accessed to find the updated statistics about the cancer burden in the Western Pacific Region countries.

FINDINGS

Each example identifies major factors that contribute to cancer health disparities, challenges that nurses and other health professionals face, and innovative strategies that are used to overcome these difficulties.

CONCLUSIONS & IMPLICATIONS

These examples reflect the urgent need to optimize LMIC nurses' potential to promote cancer health equity in the Western Pacific region.

Perceptions of Ontological Coaching Among Nurses (OCN): A Descriptive Qualitative Study

AIM

To examine the perceptions of nurses receiving the Ontological Coaching among Nurses (OCN) intervention in Singapore.

DESIGN

Descriptive qualitative.

METHODS

Convenience sampling was used to recruit 34 nurses who received OCN intervention and three coaches who provided the intervention. Written informed consent was obtained, and semi-structured, one-on-one interviews were used to collect data, which were then transcribed verbatim. Thematic analysis was used to analyse the data.

RESULTS

Three themes with nine sub-themes were identified. The main themes were: (1) From 'Outlet to Confide': Ontological Coaching as an Enhanced Sense of Fulfilment; (2) Mindset Readiness and Openness for Successful Coaching; and (3) Future Endeavours for Sustainable Coaching Practices.

CONCLUSION

The findings show that nurses benefitted on personal and professional fronts from receiving coaching. Further evaluations are required to see the potential of using coaching intervention for novice nurses.

IMPLICATIONS AND IMPACT

As frontline key players in our healthcare system, nurses face a unique set of challenges that impact their psychological well-being. The impact is even more significant for early-to mid-career nurses, leading to poorer quality of life and high turnover rates. This paper highlighted the importance of resources made available to novice and mid-career nurses through coaching. The perceptions of nurses who received coaching intervention serve as a foundation for future studies examining the relevance of ontological coaching in the nursing profession. The nurses' recommendations reported in this paper include building awareness of coaching and incorporating flexibility into coaching programmes to help enhance their readiness to receive and engage with coaching for a more fulfilling coaching experience. Incorporating these recommendations can help inform future coaching-related interventional studies.

REPORTING METHOD

This study adhered to COREQ guidelines.

PATIENT AND PUBLIC CONTRIBUTION

None.

Factors predicting preoperative anxiety among adult patients undergoing cardiac surgery in China: A cross-sectional study

Background

Preoperative anxiety is a significant concern for patients undergoing surgery, as it can lead to adverse effects such as increased postoperative pain, delayed wound healing, prolonged hospital stays, higher incidences of postoperative complications, and even mortality. Preoperative anxiety is particularly common in patients undergoing cardiac surgery, but it is often overlooked and warrants further investigation.

Objective

This study aimed to explore preoperative anxiety and its predictors, including fear of surgery, preoperative sleep quality, perception of illness severity, and perceived social support among adult patients undergoing elective cardiac surgery.

Methods

A cross-sectional study was conducted with 142 adult patients undergoing elective cardiac surgery using simple random sampling. Data were collected from patients in the Class III Grade A general hospital in Wenzhou, China, between October 2023 and March 2024. Questionnaires were used to gather information about patients' demographic characteristics, fear of surgery, preoperative sleep quality, perception of illness severity, perceived social support, and preoperative anxiety. Descriptive statistics, Pearson correlation analysis, and multiple linear regression were employed for data analysis.

Results

The total score for preoperative anxiety was 15.98 ± 4.95. Fear of surgery, preoperative sleep quality, perception of illness severity, and perceived social support explained 37.3% of the variance in preoperative anxiety (Adjusted R2 = 0.373, F (4,142) = 26.77, p <0.05). Fear of surgery was the strongest predictor (β = 0.539, p <0.001), followed by preoperative sleep quality (β = -0.166, p <0.05) and perceived social support (β = -0.138, p <0.05). Perception of illness severity was not a significant predictor of preoperative anxiety.

Conclusion

Preoperative anxiety in adult patients undergoing elective cardiac surgery is significantly influenced by factors such as fear of surgery, preoperative sleep quality, and perceived social support. Nurses can implement targeted interventions to reduce preoperative anxiety. These interventions may include addressing the fear of surgery through health education and psychological counseling. Furthermore, improving the hospital environment to promote a calm and quiet atmosphere can enhance sleep quality. Encouraging social support to help patients build confidence in the success of their surgery and their ability to recover is also recommended.

Correlations of resilience with coping styles and quality of life in patients with malignancies

BACKGROUND

Resilience is an individual's ability and psychological rebound capacity to adapt well after experiencing adversity, trauma, etc. Patients with strong resilience can face illnesses actively.

AIM

To determine the association of resilience with coping styles and quality of life in patients with malignancies.

METHODS

This study included patients with malignant tumors who were hospitalized at Fuyang Hospital Affiliated to Anhui Medical University from March 2022 to March 2024. The Connor-Davidson Resilience Scale, Medical Coping Modes Questionnaire, Social Support Rating Scale, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 were utilized to assess patients' resilience, coping styles, social support, and quality of life, respectively. Pearson correlation analysis was conducted to assess the correlations.

RESULTS

A total of 175 patients with malignant tumors demonstrated no marked difference in terms of age, education level, employment status, monthly household income, and disease staging (P < 0.05). Further, patients with malignancies demonstrated scores of 17.49 ± 1.20, 17.27 ± 1.46, and 11.19 ± 1.29 points in terms of coping styles in confrontation, avoidance, and resignation dimensions, respectively. Subjective support, objective support, and support utilization scores in terms of social support were 10.67 ± 1.80, 11.26 ± 2.08, and 9.24 ± 1.14 points, respectively. The total resilience score and tenacity, self-improvement, and optimism dimension scores were positively correlated with the confrontation coping style score, whereas the total resilience score and tenacity and self-improvement scores were negatively associated with avoidance and resignation coping style scores (P < 0.05). The total resilience score and the tenacity dimension score were positively associated with physical, role, cognitive, emotional, and social functions, as well as global health status (P < 0.05), and were inversely related to fatigue, insomnia, and economic difficulties (P < 0.05).

CONCLUSION

The resilience of patients with malignancies is positively associated with the confrontation dimension in the coping style, the total and various social support domain scores, and the overall quality of life. Clinical medical staff need to pay attention to the effect of medical coping styles and social support on the resilience level of patients with malignancies to further improve their quality of life.

Construction and clinical application of a staging assessment index scheme for home hospice care

This study aimed to develop a comprehensive staging assessment framework for home hospice care in China and establishing evidence-based workflow standards. Through systematic literature review, Delphi technique, and Analytic Hierarchy Process, we identified staging parameters for four terminal disease categories. A detailed stage-specific care protocol was developed and rigorously clinically validated. Two-round expert consultation demonstrated high response rates (95.2 % and 100 %) with authoritative coefficients of 0.928 (SD=0.02) and 0.930 (SD=0.03). Kendall's coefficient of concordance for the primary and secondary indicators were 0.557 and 0.191 -0.288, respectively. The final staging assessment index scheme comprises 4 primary indicators and 31 secondary indicators, thereby establishing robust standards for assessment and nursing care plans. Utilizing Delphi method in constructing the staging assessment index scheme for home hospice care underscores its methodological rigor, reliability, and scientific robustness. Clinical validation has confirmed that the targeted care plan based on the care protocol derived can help rationally and effectively plan the frequency of visits and care preparation at different stages. This approach not only ensures the provision of psychological support and humanistic care but also enables the implementation of targeted nursing interventions. Consequently, it significantly improved the rationality and efficiency of work arrangement, as well as the satisfaction of patients and their families.

Relationship between dyadic coping and quality of life among women of childbearing age with cancer and their spouses: mediating roles of fertility concerns and self-disclosure based on the actor-partner interdependence mediation model

PURPOSE

To explore the influence of dyadic coping (DC) strategies on the quality of life (QoL) of women of childbearing age with cancer and their spouses, considering fertility concerns and self-disclosure as mediators.

METHODS

A total of 302 couples (patients and spouses) were recruited from five tertiary hospitals in China between March and October 2023. Data were collected using the self-designed information scale and standardized scales (Dyadic Coping Inventory, COMPI-Fertility Problem Stress Scales-Short Form, Distress Disclosure Index, World Health Organization Quality of Life Scale-BREF) and analyzed via Actor-Partner Interdependence Mediation Model (APIMeM).

RESULTS

Patients reported a mean QoL score of 54.58 ± 6.81, while spouses scored 56.23 ± 7.24. Both partners' DC strategies positively correlated with their own QoL. Spouses' DC indirectly influenced patients' QoL through patients' fertility concerns (β = 0.028, P = 0.020) and their own QoL via spouses' fertility concerns (β = 0.052, P = 0.002). Patients' DC mediated their own QoL through self-disclosure (β = 0.028, P = 0.018).

CONCLUSIONS

This study highlights the bidirectional relational dynamics of DC in cancer-affected couples. While DC strategies directly enhance individual QoL, spouses' coping behaviors indirectly shape partners' well-being through fertility-related distress, whereas patients' DC primarily influences their own QoL via communication processes. These findings emphasize DC as a relational process requiring couple-centered interventions to address interdependent coping needs, rather than isolated individual approaches.

Navigating decisional conflict: laser peripheral iridotomy for primary angle-closure glaucoma prevention

AIM

To investigate decisional conflict among patients diagnosed with primary angle-closure suspect (PACS) or primary angle-closure (PAC) who are considering laser peripheral iridotomy (LPI) treatment.

METHODS

A total of 111 individuals diagnosed with PACS or PAC were selected through convenient sampling from March 2023 to December 2023. These participants then completed a general information questionnaire and the Decision Conflict Scale. Data analysis was performed using multiple linear regression to reveal factors influencing decisional conflict.

RESULTS

The mean Decisional Conflict Score among patients with PACS or PAC was 48.58±10.01, with 99.1% of these individuals reporting experiencing decisional conflict. Multiple linear regression analysis revealed that females (P=0.002) and patients with a shorter duration of the disease (P=0.006) had higher levels of decisional conflict. Additionally, patients diagnosed during medical visits (P=0.049), those who refused LPI treatment (P=0.032), and individuals facing significant economic burdens related to medical expenses (P=0.005) exhibited higher levels of decisional conflict. Furthermore, patients who preferred to make medical decisions independently (P=0.023) and those who favored involving family members in decision-making (P=0.005) experienced increased levels of decisional conflict.

CONCLUSION

Patients with PACS or PAC who undergo LPI treatment often encounter significant decisional conflict. Healthcare professionals should thoroughly assess a range of factors that influence this conflict, including gender, duration of disease, method of diagnosis acquisition, LPI treatment, economic burden of medical expenses, and patient preferences regarding medical decision-making. By considering these variables, tailored decision support can be developed to address individual patient needs, ultimately reducing decisional conflict and optimizing the quality of decisions made regarding treatment options.

Financial Toxicity and Psychosocial Challenges of Chinese Parents in Pediatric Cancer Treatment: A Phenomenological Study

BACKGROUND

Multimodal treatment and care for pediatric cancer can result in catastrophic medical expenses. However, the lived experiences of parents in navigating financial toxicity during their child's cancer treatment have not been fully explored.

OBJECTIVE

This study aims to explore the essence of the lived experiences of parents facing financial toxicity when their child undergoes cancer treatment.

METHODS

A descriptive phenomenological study was conducted, involving in-depth interviews with parents of children with cancer.

RESULTS

Four major themes emerged: (1) facing moments of complex challenges: risk factors for financial toxicity, (2) "everything for the child": existential guilt and embodied experiences, (3) "trapped time": the collapse of the future dimension and the life resistance in trauma, and (4) "overdrawing the entire family": the impact of financial toxicity on family functioning.

CONCLUSION

This study explored the subjective experiences of financial toxicity among 18 parents of children with cancer within the sociocultural context of China. The findings indicate that the impact of financial toxicity on some parents extends well beyond material hardship, reshaping their lived experiences through complex physical and psychological pathways. Notably, some participants demonstrated proactive family resilience in the context of posttraumatic growth by embracing a "living in the moment" mindset.

IMPLICATIONS FOR PRACTICE

Based on the findings of this study, nurses could consider assessing the financial toxicity of families in similar contexts and providing those in need with information on financial support.

Artificial Intelligence in Oral Diagnosis: Detecting Coated Tongue with Convolutional Neural Networks

Background/Objectives: Coated tongue is a common oral condition with notable clinical relevance, often overlooked due to its asymptomatic nature. Its presence may reflect poor oral hygiene and can serve as an early indicator of underlying systemic diseases. This study aimed to develop a robust diagnostic model utilizing convolutional neural networks and machine learning classifiers to improve the detection of coated tongue lesions. Methods: A total of 200 tongue images (100 coated and 100 healthy) were analyzed. Images were acquired using a DSLR camera (Nikon D5500 with Sigma Macro 105 mm lens, Nikon, Tokyo, Japan) under standardized daylight conditions. Following preprocessing, feature vectors were extracted using CNN architectures (VGG16, VGG19, ResNet, MobileNet, and NasNet) and classified using Support Vector Machine (SVM), K-Nearest Neighbors (KNN), and Multi-Layer Perceptron (MLP) classifiers. Performance metrics included sensitivity, specificity, accuracy, and F1 score. Results: The SVM + VGG19 hybrid model achieved the best performance among all tested configurations, with a sensitivity of 82.6%, specificity of 88.23%, accuracy of 85%, and an F1 score of 86.36%. Conclusions: The SVM + VGG19 model demonstrated high accuracy and reliability in diagnosing coated tongue lesions, highlighting its potential as an effective clinical decision support tool. Future research with larger datasets may further enhance model robustness and applicability in diverse populations.

Understanding post-treatment self-management learning needs of young adults diagnosed with hematological cancer: a qualitative study

PURPOSE

To better support and promote an active role in survivorship, the purpose of this study was to identify and understand the perspective of young adults diagnosed with a hematological cancer in regard to their post-treatment self-management learning needs.

METHOD

An interpretative-descriptive study was conducted. Semi-structured individual interviews were carried out with eight young adults (ages 18 to 29 at the end of active treatment), diagnosed with a leukemia or lymphoma, who have not received active treatment for at least one year. Iterative content analysis of interview data was performed.

RESULTS

According to participants, it is when young adults experience transitions or feel alone in dealing with post-treatment challenges that they can identify a learning need. Protective factors and precipitating factors related to young adults, their entourage and their care providers (e.g., young adult characteristics, level of support, quality of patient education) can contribute to shape their view of self-management learning needs. For young adults, an underlying motivation guides the identification of attitudes (autonomy, responsibility, acceptance), knowledge (physical and psychosocial challenges, rights to accommodation for disability) or skills (self-assessment, action-planning, self-advocacy) to be gained.

CONCLUSIONS

This study supports that young adults need more than information to feel confident in their ability to self-manage post-treatment challenges. Learning to self-manage is therefore a process of personal transformation, fueled by internal motivation, that also benefits from external support through collaboration between young adults, their entourage, and their care providers including oncology nurses.

Postoperative Symptom Cluster in NSCLC Patients and Its Relationship with Social Support and Self-Efficacy: A Cross-Sectional Study

Purpose

The study aimed to identify symptom clusters among NSCLC patients within 3 months postoperatively and analyze the relationships between symptom clusters and social support and self-efficacy.

Methods

We conducted a cross-sectional study from January 1 to May 31, 2024, involving NSCLC patients undergoing surgery at hospitals in Jiangsu Province. Data were collected using the MD Anderson Symptom Inventory, the Perceived Social Support Scale (PSSS), and the Strategies Used by People to Promote Health (SUPPH).

Results

Exploratory factor analysis revealed five distinct symptom clusters: respiratory distress, respiratory tract discomfort, physical exhaustion, digestive dysfunction, and nighttime disturbances. The severity of physical exhaustion and nighttime disturbances was negatively correlated with PSSS scores. Conversely, the severity of respiratory distress, respiratory tract discomfort, and digestive dysfunction symptoms was negatively correlated with SUPPH scores.

Conclusion

Our findings may guide medical professionals in managing postoperative symptoms in NSCLC patients. Social support and self-efficacy appear to be significant factors influencing the severity of symptom clusters.

The role of social comparative orientation in social anxiety among breast cancer survivors: a moderated mediation model of body image and self-concept clarity

BACKGROUND

It is well known that social rehabilitation is an important part of the overall recovery of breast cancer survivors. Previous research has demonstrated that social anxiety is prevalent among breast cancer survivors, which is not only a significant psychological issue, but also impairs survivors' social rehabilitation and diminishes their quality of life. Therefore, understanding the factors and mechanisms influencing social anxiety in breast cancer survivors is crucial. This study aimed to investigate the mediating and moderating effects of body image and self-concept clarity on social comparison orientation and social anxiety in breast cancer survivors.

METHODS

The convenience sampling method was employed to survey 382 breast cancer survivors. The sample comprised participants aged 30-69 years: 69 - 56 years(28.01%), 45-55 years (39.53% ), and 30-44 years (32.46%). Data was collected using a general information questionnaire, the Social Anxiety Scale, the Body Image Scale, the Social Comparison Orientation Scale, and the Self-Concept Clarity Scale. The SPSS macro program PROCESS plug-in was utilized for mediation and moderation analyses.

RESULTS

This study revealed a partial mediation effect of body image between social comparison orientation and social anxiety (β = 0.100, 95% CI [0.052, 0.162]), accounting for 27% of the total variance. Furthermore, self-concept clarity moderates the influence of social comparison orientation on social anxiety through body image. Specifically, as self-concept clarity increases, the influence of social comparison orientation on body image is gradually weakened, and the impact of body image on social anxiety becomes progressively weaker.

CONCLUSIONS

Social comparison orientation influences the social anxiety of breast cancer survivors through body image. Self-concept clarity exerts a moderating effect, attenuating the influence of social comparison orientation on body image and body image on social anxiety. The findings provide a theoretical and practical foundation for research on the social rehabilitation of breast cancer survivors.

CLINICAL TRIAL NUMBER

Not applicable.

Benefits of a mindfulness and compassion program for cancer patients: experience in a Spanish public hospital setting

BACKGROUND

Mindfulness-based interventions have been shown to improve the quality of life of cancer patients and are widely recommended.

METHODS

This was a non-randomized, single-center study designed to assess the feasibility and benefits of a mindfulness and compassion program for individuals living with cancer (MCP-C). The primary objective was to evaluate the feasibility of the program, while the secondary objective was to assess its effectiveness in adult cancer patients and their relatives. Before and after completing the program, participants completed the 12-item General Health Questionnaire (GHQ- 12) and the Hospital Anxiety and Depression Scale (HADS). A qualitative study was also conducted using focus groups and a structured qualitative survey.

RESULTS

A total of eight courses were delivered, six in person in 2019 and two online in 2020. A total of 153 participants were enrolled, of whom 142 were considered evaluable. Among them, 90 (64.3%) completed the program, including 75 patients (83.3%) and 15 relatives. The intervention was associated with significant reductions (p < 0.01) in mean scores on the GHQ- 12 and the HADS-A and HADS-D subscales. In the qualitative assessment, participants reported multiple benefits, including increased awareness of health-related decision-making, improved relationship with the disease, a sense of companionship, emotional support, and overall enhancements in daily life.

CONCLUSIONS

Implementing an 8-week mindfulness and self-compassion program within the routine practice of a public hospital was feasible and led to significant improvements in the psychological well-being of cancer patients and their relatives.

Attitudes toward end-of-life care and preferred death locations: A latent profile analysis

Older adults' attitudes toward end-of-life (EOL) care significantly affect its utilization. This study explored latent profiles of EOL care attitudes, their characteristics, and relations to prefer death locations among 498 Chinese community-dwelling adults aged 50 and above. Exploratory factor analysis identified four distinct dimensions of EOL care attitudes: "life reflection and legacy," "physical comfort and pain management," "autonomy and decision-making," and "spiritual and religious comfort." Latent profile analysis revealed four latent profiles: "holistic preparers" (40.04%), "physical comfort-focused individuals" (36.11%), "passive respondents" (14.66%), and "autonomy and spiritual-comfort seekers" (9.19%). Factors such as religious belief, education, chronic disease, exposure to cancer death, and caregiving experience predicted latent profile membership. Participants in different latent profiles showed significant differences in preferred death locations, with home and hospital being the most favored places. These findings highlight the diverse attitudes and preferences toward EOL care, providing insights for individualized EOL care planning and resource allocation.

Caregiving experience of family caregivers for people with colorectal cancer: a qualitative systematic review protocol

OBJECTIVE

This review aims to synthesize the most robust evidence regarding family caregivers' experiences of caring for people with colorectal cancer (CRC).

INTRODUCTION

Caring for people with CRC places a significant burden on caregivers that can affect their physical and psychological well-being. Understanding the unique experiences of family caregivers is essential for developing effective support systems that enhance their well-being.

INCLUSION CRITERIA

This review will consider studies exploring the experiences of family caregivers caring for people with primary CRC. The studies will focus on qualitative data, including designs such as phenomenology, grounded theory, ethnography, qualitative descriptive studies, action research, feminist research, mixed methods studies, and program evaluations with embedded qualitative data.

METHODS

The review will follow the JBI methodology for systematic reviews of qualitative evidence. The search strategy will aim to locate published and unpublished studies, with no date or language restrictions. PubMed, CINAHL (EBSCOhost), Web of Science Core Collection, PsycINFO (EBSCOhost), Scopus, China National Knowledge Infrastructure, and Wanfang databases will be searched. The search for gray literature will include Google Scholar and ProQuest Dissertations and Theses. Two reviewers will independently select the studies, extract data, and critically appraise the methodological quality of the studies using the JBI critical appraisal checklist for qualitative research. The findings will be pooled using the meta-aggregation approach or presented in narrative format. The final synthesized findings will be graded for certainty according to the ConQual approach.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42024517472.

REVIEW REGISTRATION

PROSPERO CRD 42024517472.

Effects of childhood cancer on family functioning: A mixed-methods study from parental perspective

This mixed-methods study examined the impact of childhood cancer on family functioning from a parental perspective. Parents of children on-treatment were included in the study. Quantitative data were collected from 246 parents, and multiple regression analyses were conducted to identify key predictors. Additionally, qualitative data were obtained through semi-structured interviews with 28 parents and analyzed using thematic analysis. Quantitative results indicated that higher perceived social support, parental resilience, and effective coping strategies were positively associated with family functioning, whereas a longer cancer trajectory and heavier caregiving burden had negative effects (p < 0.05). Qualitative findings revealed that parents experienced significant emotional strain, evolving family roles, and challenges in balancing attention across family members. Supportive networks, empathic healthcare providers, and adaptive coping strategies may serve as important protective factors against the negative impact of a cancer diagnosis, which affects not only the diagnosed child but also the entire web of family relationships.

Non-Invasive Auricular Acupoint Stimulation Improves Slow-Transit Constipation: Evidence From a Randomized Controlled Trial

BACKGROUND Slow-transit constipation lacks optimal therapies due to the adverse effects and limited efficacy of current treatments. Auricular acupoint stimulation offers a potential adjunctive approach through neuromodulation, yet its clinical efficacy and mechanistic role in slow-transit constipation remain unestablished. MATERIAL AND METHODS Sixty patients diagnosed with slow-transit constipation, ranging in age from 40 to 75 years, were randomly allocated into 2 distinct cohorts: a study group and a control group. The study group, comprising 30 individuals, received a combination therapy of non-invasive auricular acupoint stimulation and prucalopride, while the control group, also consisting of 30 patients, was administered prucalopride as a monotherapy. To assess the efficacy of the interventions, various parameters were monitored, including serum levels of neuropeptide Y, nitric oxide, fecal water content, and gastrointestinal transit. The comparative therapeutic outcomes were determined by calculating symptom scores. RESULTS The study group exhibited a significantly higher overall efficacy rate (93.3%) compared to the control group (84.6%, P<0.05). Post-treatment assessments revealed a reduction in neuropeptide Y and nitric oxide levels in both cohorts, while colonic transit capacity and fecal water content showed an increase. Notably, the study cohort demonstrated a more pronounced decrease in neuropeptide Y and nitric oxide concentrations and a more substantial increase in colonic transit capacity and fecal water content compared to the control cohort (P<0.05). CONCLUSIONS Non-invasive auricular acupoint stimulation significantly enhances symptom relief in patients with slow-transit constipation, suggesting its potential as a complementary therapy for constipation management.

The Efficacy of Digital Interventions on Adherence to Oral Systemic Anticancer Therapy Among Patients With Cancer: Systematic Review and Meta-Analysis

Background

Digital interventions have been increasingly applied in multidisciplinary care plans to improve medication adherence to oral systemic anticancer therapy (SACT), the crucial lifesaving treatments for many cancers. However, there is still a lack of consensus on the efficacy of those digital interventions.

objectives

This systematic review and meta-analysis aimed to investigate the efficacy of digital interventions in improving adherence to oral SACTs in patients with cancer.

Methods

This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. The protocol has been registered at PROSPERO (no. CRD42024550203). Fully published, randomized controlled trials (RCTs) in English on adults with cancer assessing digital interventions for improving adherence to oral SACTs were retrieved from MEDLINE, Embase, APA PsycINFO, and CINAHL Plus up to May 31, 2024. Adherence measures compared between digital intervention users and nonusers were extracted. The proportions of poor adherence were synthesized using a random-effects model. The pooled results were reported as the odds ratio and 95% CI. The heterogeneity was assessed with the I2 test (%). The mean difference and 95% CI were calculated from the mean adherence score and SD. A risk of bias assessment was conducted using version 2 of the Cochrane Risk of Bias Assessment Tool (RoB 2) for RCTs, which ensured that a quality assessment of all included studies was conducted as recommended by the Cochrane Collaboration.

Results

This study included 13 RCTs on digital interventions for improving adherence to oral SACTs in patients with cancer. The 13 RCTs, published between 2016 and 2024, were conducted in the United States, South Korea, France, Egypt, Finland, Australia, Colombia, Singapore, and Turkey. The technologies used were mobile apps (n=4), reminder systems (n=4), telephone follow-ups (n=3), and interactive multimedia platforms (n=2). Adherence was measured by surveys (n=8), relative dose intensity (n=2), pill count (n=1), self-reported missed doses (n=1), a smart pill bottle (n=1), and urine aromatase inhibitor metabolite assays (n=1). Concerns regarding risk of bias primarily involved randomization, missing outcome data, and outcome measurement, including nonblinded randomization, subjective patient-reported data, and difficulties in distinguishing between missed appointments and actual medication nonadherence. Pooled results from 11 trials showed that digital technology users had significantly lower risk of poor adherence (odds ratio 0.60, 95% CI 0.47-0.77). Two studies reported positive mean differences in adherence scores comparing digital intervention users and nonusers. However, due to considerable heterogeneity (I²=73.1%), it is difficult to make a definitive conclusion from the pooled results about the effect of digital interventions upon adherence to oral anticancer therapy.

Conclusions

Digital intervention users exhibited significantly lower risk of poor oral SACTs adherence than nonusers. Acknowledging individual variation and tailoring digital technologies to prioritize patient needs is essential.

The longitudinal relationship between depression and anxiety in colorectal cancer patients undergoing chemotherapy and family caregivers: A cross lagged panel model

BACKGROUND

Family caregivers play a crucial caregiving role for colorectal cancer patients undergoing chemotherapy, and the emotional states of both patients and caregivers can influence each other. A high prevalence of depression and anxiety exists among both patients and caregivers, with their emotional states mutually influencing each other. This significantly impacts the quality of life for both parties. However, there is limited research on the bidirectional relationship between depression and anxiety in both groups.

OBJECTIVE

This study aims to investigate the longitudinal bidirectional relationship between depression and anxiety in colorectal cancer patients and their family caregivers using a cross-lagged panel model.

METHOD

A total of 244 pairs of colorectal cancer patients undergoing chemotherapy and their family caregivers were assessed using the Hospital Anxiety and Depression Scale. Data collection was conducted at four time points: the initial chemotherapy session and 1-, 3-, and 6- months post-chemotherapy. A cross-lagged panel model was employed to analyze the longitudinal interrelationship between depression and anxiety within and between the two groups.

RESULT

The study found high prevalence rates of depression and anxiety in both colorectal cancer patients and their caregivers. The cross-lagged model revealed a dynamic, bidirectional relationship between depression and anxiety in patients and caregivers from the second wave onwards (P <  0.05).

CONCLUSION

The emotional states of depression and anxiety in colorectal cancer patients and their caregivers show dynamic changes and are longitudinally interrelated. These findings underscore the importance of early psychological assessment and interventions targeting both patients and caregivers.

Case Report: A rare case of sintilimab-induced dermatomyositis in a patient with gastric cancer

The PD-1 inhibitor sintilimab has been approved for the treatment of various malignancies. Here, we reported a rare case of sintilimab-induced dermatomyositis in a patient with gastric cancer and liver metastasis to raise awareness of this serious adverse event. A 64-year-old man presented with the onset of gastric cancer and liver metastasis and received two cycles of sintilimab plus nab-paclitaxel. The patient experienced fever, thrombocytopenia, and rash during the first-cycle treatment, followed by bilateral ptosis, dysphagia, slurred speech, and myalgia during the second-cycle treatment. Elevated muscle enzymes, electromyography, and positive myositis antibodies confirmed the diagnosis of dermatomyositis. He was treated with high-dose corticosteroids and immunoglobulin, resulting in symptom improvement. This case widens the spectrum of immune-related toxicity associated with sintilimab, as well as highlights the need for early recognition and management of these events in patients receiving ICIs.

Effect of nursing application of emotion freedom technique on perceived stress, resilience and sexual satisfaction among women after mastectomy

BACKGROUND

A breast cancer diagnosis extends beyond physical health concerns, profoundly impacting a woman's psychological well-being, resilience and sexual satisfaction. Mastectomy intensifies these challenges, potentially affecting overall quality of life and long-term well-being. Understanding the interrelationships between perceived stress, resilience and sexual satisfaction is crucial for designing targeted interventions that effectively support mastectomized women. This study evaluates the effectiveness of the Emotional Freedom Technique in mitigating stress, enhancing resilience and improving sexual well-being post-mastectomy.

METHODS

A quasi-experimental pretest-posttest design was employed with a convenient sample of 112 Egyptian women who had undergone mastectomy. Participants were recruited from the Outpatient Oncology Clinic at Beni-Suef University Hospital. Data were collected over six months (January-June 2024) and analyzed using SPSS version 26.0. The intervention consisted of six structured EFT sessions delivered over six weeks. Paired t-tests assessed pre- and post-intervention differences, while Pearson and Spearman correlation analyses examined relationships between variables to accommodate different data distributions.

RESULTS

Post-intervention assessments revealed statistically significant improvements. Perceived stress scores decreased from 32.42 ± 1.70 to 17.27 ± 2.96 (t = 49.130, p < 0.001, Cohen's d = 3.2), resilience scores increased from 11.53 ± 1.67 to 31.46 ± 5.48 (t = 36.454, p < 0.001, Cohen's d = 2.8) and sexual satisfaction scores improved from 17.03 ± 1.55 to 31.00 ± 4.31 (t = 13.245, p < 0.001, Cohen's d = 2.5). Strong negative correlations were found between perceived stress and both resilience (r = -0.692, p < 0.001) and sexual satisfaction (r = -0.835, p < 0.001), while resilience and sexual satisfaction were strongly positively correlated (r = 0.890, p < 0.001).

CONCLUSION

EFT is a cost-effective, non-invasive intervention that significantly reduces stress, enhances resilience and improves sexual satisfaction in women post-mastectomy. To optimize clinical integration, healthcare institutions should develop structured EFT training programs for nurses, incorporating theoretical foundations, hands-on practice and competency assessments. Standardized protocols should be established to guide EFT implementation in post-mastectomy care. Further research should explore long-term effects and broader applicability across diverse healthcare settings.

CLINICAL TRIAL NUMBER

NCT06583629 on 4/9/2024.

The influence of evidence-based nutritional support plans on the nutritional status and adverse effects of radiotherapy in individuals with nasopharyngeal carcinoma

Objective

Radiotherapy serves as the primary treatment for patients with nasopharyngeal carcinoma (NPC). However, it frequently results in a progressive decline in nutritional status, which is linked to unfavorable clinical outcomes. This study aims to evaluate the effects of an evidence-based nutritional support program on nutritional status, radiotherapy-related side effects, and quality of life (QoL) in NPC patients undergoing radiotherapy.

Methods

A historical control trial was conducted. Patients with NPC admitted between May 2023 and August 2023 were allocated to the control group and received routine care, whereas those admitted between September 2023 and December 2023 were assigned to the intervention group and provided with a multidisciplinary, professional, individualized, and comprehensive evidence-based nutritional support program. Nutritional status was assessed through anthropometric measurements (e.g., body mass index, BMI), laboratory indicators (hemoglobin and albumin levels), the Nutritional Risk Screening 2002 (NRS2002), and the Patient-Generated Subjective Global Assessment (PG-SGA). Additionally, radiotherapy-related side effects, radiotherapy interruption rates, and QoL were monitored.

Results

Both groups comprised 40 patients each. By the conclusion of radiotherapy, a decline in nutritional status was observed in both groups; however, BMI was higher in the intervention group (23.14 ± 2.62) compared to the control group (21.38 ± 2.73). The NRS2002 score (2.73 ± 1.45) and PG-SGA score (6.13 ± 3.22) in the intervention group were significantly lower than in the control group (3.33 ± 1.16 and 7.73 ± 2.72, respectively; p < 0.05). The incidence of severe malnutrition was significantly lower in the intervention group (52.5%) compared to the control group (75%) (p < 0.05). Albumin and hemoglobin levels were significantly higher in the intervention group (albumin: 120.75 ± 16.52 vs. 113.50 ± 12.08, p = 0.028; hemoglobin: 41.24 ± 4.54 vs. 37.62 ± 5.04, p = 0.001). The severity of radiotherapy-related side effects, including radiation-induced oral mucositis, dermatitis, and myelosuppression, was significantly lower in the intervention group (p < 0.05). All patients completed radiotherapy, and no significant difference was observed in radiotherapy interruption rates between groups (control group: 6 interruptions; intervention group: 1 interruption; p > 0.05). Post-radiotherapy QoL scores demonstrated that the intervention group achieved superior outcomes in physical, role, emotional, cognitive, and social functioning (p < 0.05).

Conclusion

Implementing evidence-based nutritional support programs has the potential to prevent the decline in nutritional status among NPC patients receiving radiotherapy, reduce the occurrence of treatment-related side effects, and enhance overall quality of life.

A psycho-behavioral perspective research for elderly leisure sports participation via big-data and comparative analyses

BACKGROUND

The health of the elderly and the need for research to support them has never been more important. This study aims (a) to analyze the participation behavior of the elderly in leisure sports through big-data analysis and (b) to compare and analyze the motivations, limitations, and satisfaction of participation in leisure sports by age group.

METHODS

First, big-data analysis using text-mining technique was conducted using the TEXTOM program to collect and analyze data between May 1, 2023 and November 24, 2024. Next, a survey was conducted among adults aged 20 years and older who regularly participate in leisure sports to determine their motivations, limitations, and satisfaction with leisure participation. From June to December 2024, the data of 301 participants were collected and analyzed using SPSS 28.0. Specifically, this study analyzed the validity and reliability of the data and then compared and analyzed the three age groups through multivariate analysis of variance.

RESULTS

Big-data analysis identified key terms and four clusters related to senior leisure sports participation: (a) Policy, (b) Welfare, (c) Senior Sports, and (d) Employment. The results of the comparative study through the questionnaire showed that compared to younger participants in leisure sports, the elderly showed higher results in the factors of self-challenge motive, social interaction motive, and leisure participation satisfaction, but lower results in the factor of cost constraints. This means that the elderly participate in leisure sports for challenge and social interaction, are more satisfied, and are less constrained by cost.

CONCLUSIONS

The scientific and objective results of this study could be used as a resource to specifically understand the leisure sports participation behavior of the elderly.

The Moderating Role of Person-Job Fit and Person-Organization Fit on the Relationship Between Workplace Spirituality and the Physical and Mental Health Among Nursing Staff

Background: The physical and mental health of nursing staff is crucial, affecting them personally and influencing the quality of medical care they provide. In this study, we used positive psychology to examine the effect of workplace spirituality on the physical and mental health of nursing staff. We also employed person-environment fit theory to identify the moderating effects of person-job and person-organization fit on the aforementioned relationship. Methods: Full-time nursing staff employed for more than 6 months at a medical center were recruited. Stratified random sampling was conducted together with a questionnaire survey, yielding 320 nursing staff participants and 255 valid questionnaire responses. Results: Workplace spirituality was found to have a positive effect on physical and mental health. Better person-organization fit was associated with better person-job fit and a stronger effect of workplace spirituality on physical health. In addition, more favorable person-job fit was associated with a stronger effect of workplace spirituality on mental health. Conclusions: This study emphasized the effect of workplace spirituality on the physical and mental health of nursing personnel. It also considered the moderating effects of person-organization fit and person-job fit. Managers should prioritize and support the cultivation of workplace spirituality, involve employees in shaping the culture of their organization, and ensure alignment between employee's job requirements and skills.

Mepitel Film Versus StrataXRT in Managing Radiation Dermatitis in an Intra-Patient Controlled Clinical Trial of 80 Postmastectomy Patients

BACKGROUND

Mepitel film decreases the severity of radiation dermatitis in breast cancer patients, but its application is resource-intensive. Many departments therefore use StrataXRT, a gel that patients apply themselves. We compared the protective effects of Mepitel film and StrataXRT on radiation dermatitis during and immediately after radiation therapy.

METHODS

This phase III multicentre randomised intra-patient-controlled clinical trial recruited breast cancer patients receiving radiation therapy following mastectomy in three New Zealand Hospitals. Lateral and medial aspects of the chest wall were randomised to either Mepitel film or StrataXRT. Overall skin reaction severity was measured using RISRAS and RTOG once a week during treatment and for 4 weeks after treatment completion. The primary outcome was moist desquamation (with a non-inferiority margin of 7.5%); secondary outcomes were overall skin reaction severity, patient tolerability, satisfaction and cost.

RESULTS

Between June 2021 and May 2024, 93 patients were recruited, and 80 patients completed the trial. The absolute difference in moist desquamation rates was 6% lower under Mepitel film (p = 0.413, 95% CI -5%, 18%). Overall skin reaction severity was significantly lower for Mepitel film (Researcher RISRAS: p = 0.022; RTOG: p = 0.011). Mepitel film was cheaper to apply but was less well tolerated, with poor skin adherence being an issue for many patients.

CONCLUSION

The study did not show non-inferiority for StrataXRT; overall skin reaction severity and costs were significantly lower under Mepitel film; however, StrataXRT was better tolerated.

TRIAL REGISTRATION

ACTRN12621000124831.

Effects of a nurse-led individualized mHealth nutrition intervention for post-discharged gastric cancer patients following gastrectomy: A randomized controlled trial

OBJECTIVE

To evaluate the effects of a nurse-led individualized mHealth nutrition intervention on nutritional status, nutritional intake, cognitive beliefs related to nutritional behavior, weight loss, blood parameters, gastrointestinal symptoms, and quality of life in post-discharged gastric cancer patients following gastrectomy.

DESIGN

This was an assessor-blinded parallel-arm randomized controlled trial with a repeated-measures design.

SETTING(S)

The participants were recruited from inpatient gastric surgery units of two tertiary hospitals in Guangzhou, China.

PARTICIPANTS

A total of 108 patients with gastric cancer who underwent gastrectomy and were scheduled to be discharged to their homes were included.

METHOD

Participants were randomly allocated to either the intervention or the control group (n = 54 per group). The intervention group received the nurse-led individualized mHealth nutrition intervention in addition to the usual care, whereas the control group received only usual care. The intervention included face-to-face education before discharge, the use of an applet and phone consultations. Baseline data were collected on the day of discharge from the hospital (T0). The patients' nutritional status, cognitive beliefs related to nutritional behavior, nutritional intake, weight loss, blood parameters, gastrointestinal symptoms and quality of life were repeatedly measured at 4-week (T1) and 12-week (T2) after discharge.

RESULTS

Compared with the control group, the intervention group showed significant improvement in nutritional status (ꞵ₄ weeks = -1.08, 95 % CI -2.12 to 0.04, p = 0.042; ꞵ₁₂ weeks = -1.52, 95 % CI -2.57 to -0.47, p = 0.005). Improvements were also observed in energy and protein intake, weight loss, and cognitive beliefs related to nutritional behavior, including risk perception, outcome expectancy, self-efficacy, intention, and action plan (p < 0.05). However, no statistically significant differences were observed in coping plan, gastrointestinal symptoms, blood parameters, and quality of life (p > 0.05).

CONCLUSIONS

The nurse-led individualized mHealth nutrition intervention was effective for improving the cognitive beliefs related to nutritional behavior, energy and protein intake, and nutritional status, as well as reducing weight loss among post-discharged gastric cancer patients following gastrectomy.

REGISTRATION NUMBER

ChiCTR2200064808.

Recommendations for Improving Equitability of Care for Pediatric Oncology Patients in Lebanon

OBJECTIVES

There is a severe economic crisis in Lebanon that has significantly impacted its healthcare system, particularly pediatric oncology. With a high cancer incidence rate and increasing pediatric cancer burden, it remains inequitable to access specialized care, particularly among rural and refugee communities. Pediatric oncology services are centralized in few tertiary care centers within Beirut, with no access to specialized healthcare professionals.

METHODS

This review addresses the provision of care for pediatric oncology in Lebanon through the deployment of healthcare personnel, the availability of diagnostic and therapeutic services, and the operation of national and international assistance systems. Information was gathered from hospital records, government reports, and studies on child cancer care in Lebanon with a focus on the availability of services, workforce, and barriers to equal access.

RESULTS

The economic crisis has severely limited access to treatment, diagnostics, and basic supportive care, including psychosocial and palliative support. Although centers such as the Children's Cancer Institute of the American University of Beirut Medical Center provide high-quality, donor-funded care, financial and logistical barriers deprive many children of timely therapy. In addition, maintaining cancer registries is also an issue, particularly for refugees, and therefore planning services and distributing resources is even more challenging.

CONCLUSIONS

Scaling up decentralized pediatric oncology care, integrating digital health technologies, and strengthening international partnerships are essential to bridging these gaps. Further, investment in healthcare workforce capacity building, particularly in nursing and psychosocial support, is crucial to sustaining care delivery. Lebanon's National Cancer Plan provides a framework for bridging these disparities, but greater governmental investment and long-term international partnerships are required.

IMPLICATIONS FOR NURSING PRACTICE

This review highlights the urgent need for systemic reforms to ensure equitable access to pediatric oncology care, improve patient outcomes, and mitigate the long-term impact of Lebanon's healthcare crisis.

Post-mastectomy wound care - need for an empathetic approach

Mastectomy, a surgical procedure involving the removal of breast tissue, is a common treatment option for breast cancer. Post treatment, survivors often experience both physical and psychological symptoms, which in turn delay the recovery phase. Post-mastectomy wound complications, such as infection, pain, delayed healing, seroma formation, persistent discomfort and limited mobility often lead to prolonged hospital stays and reduced quality of life. Proper wound care, including dressing changes and wound management, is crucial for optimal healing. However, mastectomy also has a significant emotional and psychological impact on patients, leading to depression, anxiety, and poor body image due to significant changes in the body such as loss of hair, unsightly scars and weight changes. Patients also feel uncomfortable when medical professionals concentrate solely on survival, rather than empathizing with them. While these emotional reactions are often expected and considered normal during breast cancer treatment, what comes as a surprise is the additional harm caused by healthcare providers' communication and behaviour when treating breast cancer patients. Despite advances in medical technology, there remains a significant gap in providing psychosocial support for breast cancer survivors. Undergoing a mastectomy is an emotionally challenging experience, and healthcare providers play a vital role in establishing the groundwork for psychological recuperation. By incorporating empathetic practices into daily patient care, healthcare providers can be trained to create an unbiased, informative, and compassionate environment, to improve patient outcomes and satisfaction. The use of compassionate communication when interacting with the patient and their care givers can foster a more nurturing atmosphere for all parties involved. By prioritizing empathy in post-mastectomy wound care, healthcare providers can enhance the overall well-being of breast cancer survivors. This review explores the physical and emotional impact of mastectomy on patients, the healing process, and the importance of integrating empathy into post-mastectomy wound care.

Molecular Subtypes and Targeted Therapeutic Strategies in Small Cell Lung Cancer: Advances, Challenges, and Future Perspectives

Small cell lung cancer (SCLC) is a highly aggressive malignancy characterized by rapid progression, early metastasis, and high recurrence rates. Historically considered a homogeneous disease, recent multi-omic studies have revealed distinct molecular subtypes driven by lineage-defining transcription factors, including ASCL1, NEUROD1, POU2F3, and YAP1, as well as an inflamed subtype (SCLC-I). These subtypes exhibit unique therapeutic vulnerabilities, thereby paving the way for precision medicine and targeted therapies. Despite recent advances in molecular classification, tumor heterogeneity, plasticity, and therapy resistance continue to hinder clinical success in treating SCLC patients. To this end, novel therapeutic strategies are being explored, including BCL2 inhibitors, DLL3-targeting agents, Aurora kinase inhibitors, PARP inhibitors, and epigenetic modulators. Additionally, immune checkpoint inhibitors (ICIs) show promise, particularly in immune-enriched subtypes of SCLC patients. Hence, a deeper understanding of SCLC subtype characteristics, evolution, and the regulatory mechanisms of subtype-specific transcription factors is crucial for rationally optimizing precision therapy. This knowledge not only facilitates the identification of subtype-specific therapeutic targets, but also provides a foundation for overcoming resistance and developing personalized combination treatment strategies. In the future, the integration of multi-omic data, dynamic molecular monitoring, and precision medicine approaches are expected to further advance the clinical translation of SCLC subtype-specific therapies, ultimately improving patient survival and outcomes.

The Experiences of Black Men Who Survived a Gunshot Wound and Were Treated With a Colostomy

In the United States, rates of fatal and nonfatal firearm injuries differ substantially by race and sex, with Black men being more likely than any other group to be shot. Many people who survive a gunshot wound have complex physical, psychological, and social challenges during their recovery. Public health programs, including hospital-based violence intervention programs (HVIPs), have been designed to reduce the likelihood of reinjury for their participants and to support their well-being. However, little is known about how Black men who survive a gunshot wound and receive care from these programs conceptualize the best ways to support their healing and the barriers they experience in achieving their health-related goals. This case study, drawing from ethnographic research conducted during 2013-2023 at the second busiest HVIP in Maryland, examines the experiences of 6 Black men who were treated with a colostomy after surviving a gunshot wound. Emergent themes included increased psychological stress from being treated with a colostomy and wearing a waste collection pouch, disruptions to everyday life, and insufficient access to colostomy care and education. The findings from this case study highlight the importance of providing access to psychological services, colostomy education, and health care supplies to meet the needs of HVIP participants and improve health outcomes for this population.

Overview of Oncology: Drug-Induced Cardiac Toxicity

Cancer medications can cause cardiac issues, which are difficult to treat in oncologic patients because of the risk of complications. In some cases, this may significantly impact their well-being and treatment outcomes. Overall, these complications fall under the term "drug induced cardiotoxicity", mainly due to chemotherapy drugs being specifically toxic to the heart, causing a decrease in the heart's capacity to pump blood efficiently and leading to a reduction in the left ventricular ejection fraction (LVEF), and subsequently possibly leading to heart failure. Anthracyclines, alkylating agents, and targeted therapies for cancer hold the potential of causing harmful effects on the heart. The incidence of heart-related issues varies from patient to patient and depends on multiple factors, including the type of medication, dosage, duration of the treatment, and pre-existing heart conditions. The underlying mechanism leading to oncologic-drug-induced cardiovascular harmful effects is quite complex. One particular group of drugs, called anthracyclines, have garnered attention due to their impact on oxidative stress and their ability to cause direct harm to heart muscle cells. Reactive oxygen species (ROS) cause harm by inducing damage and programmed cell death in heart cells. Conventional biomarkers alone can only indicate some degree of damage that has already occurred and, therefore, early detection is key. Novel methods like genetic profiling are being developed to detect individuals at risk, prior to the onset of clinical symptoms. Key management strategies-including early detection, personalized medicine approaches, and the use of novel biomarkers-play a crucial role in mitigating cardiotoxicity and improving patient outcomes. Identification of generated genetic alterations and the association to an increased likelihood of cardiotoxicity will allow treatment in a more personalized approach, aiming at decreasing rates of cardiac events while maintaining high oncological efficacy. Oncology drug-induced cardiotoxicity is managed through a combination of preventive strategies and therapeutic interventions from the union of cardiac and oncological knowledge.

Breast Cancer Screening Practices Among Women in Low- and Middle-Income Countries: A Perspective from Vietnam

OBJECTIVES

This study aimed to examine the breast cancer screening status of women residing in a rural community in Vietnam and factors associated with their breast cancer screening behavior.

METHODS

A cross-sectional design was employed among 498 Vietnamese women aged 20 to 84 years by completing a self-administered Vietnamese version of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ). To assess the effect of demographic variables on the likelihood of women adhering to recommended screening practices, multivariable logistic regression analyses were conducted.

RESULTS

The majority of participants (68.5%) had heard of breast self-examination (BSE), while about one third had heard of clinical breast examination (CBE) and mammograms (38.6% and 29.7%, respectively). Only 18.8% performed BSE monthly and 22.4% had practiced CBE, among those, only 20.5% of women within the targeted age group had annual CBE. None of women within the targeted age group reported they had a mammogram biennial. Education level was the determining factor for participating in CBE.

CONCLUSIONS

Our study reveals that actual participation in these practices remains low. It is crucial to enhance awareness of mammography and gain a comprehensive understanding of the barriers affecting women's participation in screening practices.

IMPLICATIONS FOR NURSING PRACTICE

This study underscores the need for targeted nursing intervention to address critical barriers to early breast cancer early detection, which contribute to improve access to timely treatment for rural Vietnamese women.

Relationship between psychological resilience and quality of life in cancer patients and the multiple mediating roles of stigma and self perceived burden

The goal of this study was to explore the impact of psychological resilience on the QOL of cancer patients and the multiple mediating roles of stigma and self-perceived burden. This study utilized a cross-sectional design. The study population consisted of 364 cancer patients selected by convenience sampling method between November 2022 and May 2023 in two tertiary hospitals in Jinzhou City, Liaoning Province. All participants volunteered to participate in the study and signed an informed consent form. Data were collected using questionnaires. The questionnaires included the General Information Questionnaire, the Psychological Resilience Scale, the Stigma Scale, the Self-Perceived Burden Scale, and the Quality of Life Questionnaire. SPSS 25.0 and PROCESS 3.5 macros were employed for description statistics and related analyses of the data, as well as multiple mediation effect tests. Psychological resilience directly affects QOL (β = 0.929, 95% CI 0.729-1.130) and indirectly through three mediating pathways: stigma (β = 0.275, 95% CI 0.154-0.398, 19.76% of total effect), self-perceived burden (β = 0.115, 95% CI 0.046-0.205, 8.26% of total effect), and both stigma and self-perceived burden (β = 0.073, 95% CI 0.029-0.132, 5.24% of total effect), accounting for 33.26% of the overall mediated effect. Stigma and self-perceived burden act as mediators in influencing psychological resilience and QOL of cancer patients. Enhancing psychological resilience and reducing stigma and self-perceived burden is crucial for improving their QOL.

The effect of muscles in the treatment of lower limb lymphedema: respiratory muscles or leg muscles?

PURPOSE

This study aimed to compare the effects of manual lymphatic drainage and bandaging (MLDB) combined with calf muscle exercise training (CMT) and/or inspiratory muscle training (IMT) on edema, muscle strength, functional capacity, functionality, and quality of life (QoL) in patients with secondary lower limb lymphedema (LLL).

METHOD

A total of 76 patients (mean age: 47.06 ± 16.16 years; 84.2% female) with LLL were included in the study and randomized into four groups: MLDB alone (Group 1), MLDB + CMT (Group 2), MLDB + IMT (Group 3), and MLDB + CMT + IMT (Group 4). The training programs were administered for 30 min per day, five days per week, over three weeks. Edema was assessed using circumference measurements (CM) and tissue dielectric constant (TDC). Muscle strength was evaluated using maximum inspiratory/expiratory pressure (MIP/MEP) and a dynamometer. Functional capacity was assessed with the 6-Minute Walk Test (6MWT), functionality with the Lower Extremity Functional Scale (LEFS), and QoL with the Lymphedema Quality of Life Scale (LYMQOL).

RESULTS

In the intra-group analyses, all assessments improved in all groups, except for MIP, MEP, and gastrocnemius muscle strength in Group 1 and MIP in Group 2 (p < 0.05). In the inter-group analyses, Group 3 showed the largest effect sizes (ES) for reductions in TDC (ES: 2.34) and improvements in LYMQOL (ES: 1.74), MEP (ES: 1.46), and LEFS (ES: 1.44) (p < 0.001 for all). Group 4 had the largest ES for increases in MIP (ES: 1.42, p < 0.001). Group 2 showed the largest ES for improvements in gastrocnemius muscle strength (ES: 1.41, p < 0.001). However, there were no significant differences among the groups in CM or 6MWT results (p > 0.05).

CONCLUSION

Compared to enhancing leg muscle strength, improving respiratory muscle function in addition to MLDB had a greater impact on reducing edema and enhancing functionality and QoL.

TRIAL REGISTRATION NUMBER

NCT05609526. Registration Date: 14.11.2022.

Effects of Fospropofol Disodium and Propofol on the Postoperative Recovery of Elderly Patients Who Underwent Total Hip Arthroplasty: A Retrospective Study

Purpose

Propofol is widely used for general anesthesia in elderly patients. Fospropofol disodium, a precursor of propofol, may reduce the incidence of postoperative nausea and vomiting (PONV). However, the effects of these two drugs on patients' postoperative recovery quality are unclear. The present study aimed to evaluate the effects of the two drugs on postoperative recovery quality in elderly patients who underwent total hip arthroplasty.

Patients and Methods

We retrospectively analyzed 168 patients from the First Affiliated Hospital of USTC from October 2022 to June 2024. These individuals were assigned to fospropofol disodium group (F) or propofol group (P) according to the patients' anesthesia induction and maintenance medication. The primary outcome was the rate of occurrence of PONV. The secondary outcomes included the time of extubation and the time of stay in post-anesthesia care unit (PACU), hospital length of stay, perioperative hemodynamic data and patients' liver and renal functions.

Results

PONV occurred to be lesser in group F than in group P (15.94% vs 33.33%, P < 0.05). Group P spent less in the extubation time (25.71 vs 33.36 min, P < 0.05) and PACU stay length (62.61 vs 65.65 min, P > 0.05), but hospital length of stay is longer (6.24 vs 5.8 days, P > 0.05). Liver and renal functions indexes and hemodynamic data between the 2 groups were similar (P > 0.05). The type of drug was a factor affecting the time of extubation. The type of drug and the patient's gender were influential factors in the incidence of PONV.

Conclusion

Fospropofol disodium reduces the incidence of PONV in patients. And the effects of fospropofol disodium on postoperative recovery quality are similar to that of propofol in older patients who underwent total hip arthroplasty.

The Relationship Between Personality and Self-Management Behavior in Chinese Young and Middle-Aged People with Chronic Illness: The Chain Mediating Role of Family Health and Health Literacy

Purpose

Although the factors influencing chronic disease self-management have been extensively investigated, the ways in which personality traits, family health, and health literacy influence self-management require further exploration. This study aimed to explore the relationships and pathways among personality traits, family health, health literacy, and chronic disease self-management, with the goal of providing insights for chronic disease management.

Patients and Methods

This study was based on a national cross-sectional survey conducted in 2021, which included 1063 young and middle-aged individuals (aged 19-59) with chronic diseases. Structural equation modeling was used to analyze the path relationships between personality traits, family health, health literacy, and chronic disease self-management levels.

Results

Agreeableness directly and negatively predicted self-management outcomes (estimate: -0.557, 95% CI: -0.964 to -0.149). When examining health as the mediating variable between personality traits and self-management, it was observed that although different personality traits exert either positive or negative influences on family health, family health invariably had negative impact on self-management to varying extents (βextraversion: -0.111, P<0.01; βagreeableness: -0.083, P<0.05; βconscientiousness: -0.113, P<0.01; βneuroticism: -0.111, P<0.01; βopenness: -0.107, P<0.01). However, when considering the chain mediation effect, family health could positively influence health literacy, which subsequently had a beneficial impact on self-management. Additionally, health literacy served as an independent mediator in the relationship between extraversion and openness and self-management, with indirect effects of 0.163 and 0.274, respectively.

Conclusion

Different personality traits exerted varying effects on self-management, which could be either direct or indirect, through the mediating roles of family health and health literacy. Family health seemed to be a double-edged sword for self-management. Future chronic disease self-management should consider the importance of family health, health literacy, and the complex pathways through which personality traits influence management behaviors, to maximize self-management outcomes.

Caregiving Burden and Coping Strategies Among Informal Caregivers of Cancer Patients in Nigeria: From Duty to Distress

Objectives

This study aims at determining the caregiving burden and the coping strategies adopted by informal caregivers of patients with cancer in tertiary health facilities in Enugu state.

Methods

A cross-sectional study was conducted among 105 informal caregivers of cancer patients in tertiary health facilities in Enugu State using interviewer-administered questionnaires over 6 weeks. Data analysis was performed using SPSS version 27 and Chi square test of statistical significance was used to determine factors associated with caregiving burden and coping strategies.

Results

The majority (27.6%) of caregivers were aged 41-50 years and females (62.9%). More than half (56.2) were not involved in the patients' Activities of Daily Living (ADL). The most commonly utilized coping mechanisms was religion (92.4%) while behavioral disengagement (1%) and self-blame (1%) were the least utilized. Factors associated with caregiving burden include educational level, duration of patient's illness and dependency of patient on caregiver.

Conclusion

This study highlights the varying levels of caregiving burden and the predominant reliance on religious and acceptance-based coping strategies among informal caregivers in Enugu.

The role of glycemic control and symptoms and symptom clusters in breast cancer survivors with type 2 diabetes

PURPOSE

The purpose of the study was to describe the type and number of symptoms and examine symptom clusters of breast cancer survivors (BCS) with diabetes (type 2) by glycemic control (HbA1c < 7 or ≥ 7%).

METHODS

A retrospective cohort study was conducted. Symptom data were extracted from clinical notes in the electronic health record. BCS (stage I-III) diagnosed between 2007 and 2019 had diabetes, and at least one HbA1c within 8 months of initial chemotherapy was included. Zero-inflated negative binomial regression analysis was used to examine total symptoms by glycemic control. Exploratory factor analysis was conducted to identify symptom clusters.

RESULTS

Three hundred twenty-seven BCS met the inclusion criteria. Two symptom clusters were identified in BCS with HbA1c ≥ 7%: a psychoneurological cluster (anxiety, fatigue, peripheral neuropathy, and depression) and a gastrointestinal cluster (vomiting, nausea, and constipation). Two symptom clusters were identified in BCS with HbA1c < 7% a mixed gastrointestinal/psychoneurological cluster (vomiting, nausea, peripheral neuropathy, fatigue, and constipation) and a mental health symptom cluster (depression and anxiety).

CONCLUSION

The symptom clusters of BCS differed by glycemic control. Prospective research studies are needed to examine the role of glycemic control in symptoms in BCS with diabetes. Understanding the influence of glycemic control can help providers identify BCS at high risk for troublesome symptoms and symptom clusters, thereby facilitating interventions that target glycemic control, potentially mitigating symptoms, and symptom clusters, and improving outcomes for BCS with diabetes.

Latent profile analysis and related factors for meaning in life among young and middle-aged cancer patients

PURPOSE

This study identified different subgroups of meaning in life among young and middle-aged cancer patients, examined the sociodemographic and disease-related factors associated with these subgroups, and explored the correlation between these subgroups and psychological distress and post-traumatic growth.

METHODS

A total of 500 young and middle-aged cancer patients aged 18 to 59 completed the sociodemographic and disease-related questionnaire, the Purpose in Life Test, the Chinese version of the Posttraumatic Growth Inventory, and the Distress Thermometer. Latent profile analysis and multivariate logistic regression analysis were used to explore the subgroups of meaning in life and their associated socio-demographic and disease-related factors. Linear regression was used to investigate the correlation between these subgroups and psychological distress and post-traumatic growth.

RESULTS

The meaning in life among young and middle-aged cancer patients can be categorized into three profiles: low, moderate, and high meaning groups. The results of the multivariate logistic regression showed that age, gender, educational level, financial stress, disease duration, presence of commercial insurance, and family history were significant factors associated with the subgroups of meaning in life. Linear regression analysis indicated that meaning in life was negatively correlated with psychological distress and positively correlated with post-traumatic growth.

CONCLUSIONS

The meaning in life among young and middle-aged cancer patients was heterogeneous. Healthcare providers should develop and offer targeted intervention strategies based on the characteristics of different subgroups to enhance their meaning in life, thereby maintaining good psychological health.

Effect of Prehabilitation Interventions in People Affected by Bladder Cancer on Long-Term Physical, Clinical, and Patient-Reported Outcome Measures: A Systematic Review

PURPOSE

To understand the effect of prehabilitation interventions on ≥30 days post-treatment outcomes including physical functioning, clinical, and patient-reported outcomes in people affected by bladder cancer.

METHODS

This systematic review included all randomized, quasi-randomized, or single-arm studies in patients affected by bladder cancer (irrespective of stage or treatment modality) that compared prehabilitation intervention(s) with standard care. A range of key terms related to bladder cancer and prehabilitation were developed to search the four electronic databases. Articles were assessed according to predetermined inclusion and exclusion criteria. A methodological quality assessment was performed.

RESULTS

Of the 932 studies identified, 14 studies were included and represented 1,034 participants. The interventions included multimodality prehabilitation (n = 5), exercise-only programs (n = 3), nutrition-focused interventions (n = 2), educational support (n = 3), and smoking/alcohol cessation counseling (n = 1). All of the studies were conducted in patients treated by surgery, therefore clinical and research gaps exist in the prehabilitation interventions among patients treated by intravesical therapy (ie, BCG) or radiotherapy. The key findings highlighted that multimodal program mainly showed improvements in physical function outcomes. Exercise-only interventions demonstrated some benefits in physical function. Nutrition-only interventions did not show any statistically significant improvements. Education programs showed improvements in patient-reported outcomes. Smoking and alcohol cessation counseling achieved notable abstinence rates, which were associated with fewer postoperative complications.

CONCLUSION

This review suggests that prehabilitation interventions may benefit patients with bladder cancer, particularly exercise and education programs, which showed improvements in physical function and patient-reported outcomes. However, the evidence remains inconclusive, with no clear impact on clinical outcomes such as complications or hospital stay. More robust studies are needed to determine the most effective prehabilitation strategies for patients with bladder cancer.

Digital Health Intervention on Awareness of Vaccination Against Influenza Among Adults With Diabetes: Pragmatic Randomized Follow-Up Study

BACKGROUND

Diabetes mellitus significantly increases the risk of severe complications from influenza, necessitating targeted vaccination efforts. Despite vaccination being the most effective preventive measure, coverage remains below the World Health Organization's targets, partly due to limited awareness among patients. This study evaluated a digital health intervention aimed at improving influenza vaccination rates among adults with diabetes.

OBJECTIVE

This study aimed to demonstrate the effectiveness of digital health platforms in increasing vaccination rates among people with diabetes and to emphasize the impact of tailored messaging frequency on patient engagement and health behavior change. We hypothesized that digital tools providing empirical evidence of increased health risk awareness can effectively drive preventive actions.

METHODS

The study leveraged the Dario (Dario Health Corp) digital health platform to retrospectively analyze data from 64,904 users with diabetes assigned by the platform into three groups: (1) Group A received previously studied monthly flu nudge messages; (2) Group B received an adapted intervention with 2-3 monthly messages; (3) Group C served as the control with no intervention. Surveys were conducted at baseline, 3 months, and 6 months to assess vaccination status, awareness of influenza risks, and recollection of educational content. Statistical analyses, including logistic regression, chi-square tests, and t tests, were used to evaluate differences between groups.

RESULTS

Out of 64,904 users, 8431 completed the surveys. Vaccination rates were 71.0% in group A, 71.9% in group B, and 70.5% in group C. Group B showed significantly higher awareness of influenza risks compared with the control group odds ratio (OR; OR 1.35, 95% CI 1.12-1.63; P=.001), while group A did not (OR 1.10, 95% CI 0.92-1.32; P=.27). Recollection of educational content was also higher in groups A (OR 1.29, 95% CI 1.07-1.56; P=.008) and B (OR 1.92, 95% CI 1.59-2.33; P<.001) compared with the control. In addition, a significant correlation between awareness and vaccination rates was found only in group B (χ2(df=1)=6.12, P=.01).

CONCLUSIONS

The adapted digital intervention (group B) effectively increased awareness of influenza risks and recollection of educational content, which correlated with the higher trend in vaccination rates. This study demonstrates the potential of digital health tools to enhance influenza vaccination among people with diabetes by improving risk awareness and education. Further research should focus on optimizing these interventions to achieve significant improvements in vaccination uptake and overall public health outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06840236; https://clinicaltrials.gov/study/NCT06840236.

Management of Regorafenib-Induced Hand-Foot Skin Reaction with Topical Chinese Medicine and Urea Ointment: A Case Report and Literature Review

Regorafenib, a multikinase inhibitor, frequently induces severe hand-foot skin reactions (HFSR), often requiring dose reduction or discontinuation. This case report demonstrates the successful management of HFSR in a patient with fibromyxoid sarcoma using topical Chinese medicine "Shouzuping" soaking combined with urea ointment. It suggests the unique advantages of integrated traditional Chinese and Western medicine in managing HFSR. This article further reviews the clinical characteristics, pathogenesis, prevention and treatment strategies of HFSR caused by targeted therapies, with a view to providing valuable clinical insights.

Deep Learning Approaches to Forecast Physical and Mental Deterioration During Chemotherapy in Patients with Cancer

Background/Objectives: Predicting symptom escalation during chemotherapy is crucial for timely interventions and improved patient outcomes. This study employs deep learning models to predict the deterioration of 12 self-reported symptoms, categorized into physical (e.g., nausea, fatigue, pain) and mental (e.g., feeling blue, trouble thinking) groups. Methods: The analytical dataset comprises daily self-reported symptom logs from individuals undergoing chemotherapy. To address class imbalance-where 84% of cases showed no escalation-symptoms were grouped into intervals of 3 to 7 days. Convolutional Neural Networks (CNNs), Long Short-Term Memory (LSTM), and Gated Recurrent Unit (GRU) models were trained on 80% of the data and evaluated on the remaining 20%. Results: Results showed that 3-day intervals yielded the best predictive performance. CNNs excelled in predicting physical symptoms, achieving 79.2% accuracy, 84.1% precision, 78.8% recall, and an F1 score of 81.4%. For mental symptoms, GRU outperformed other models, with an accuracy of 77.2%, precision of 71.6%, recall of 62.2%, and an F1 score of 66.6%. Performance declined for longer intervals due to reduced temporal resolution and fewer training samples, though CNNs and GRU remained relatively stable. Conclusions: The findings emphasize the advantage of categorizing symptoms for more tailored predictions and demonstrate the potential of deep learning in forecasting symptom escalation. Integrating these predictive models into clinical workflows could facilitate proactive symptom management, allowing timely interventions and enhanced patient care during chemotherapy.

Understanding the disease experiences of thyroid cancer survivors with distant metastases: A qualitative descriptive study

PURPOSE

Thyroid cancer is often accompanied by a favorable prognosis; however, its survivors with distant metastasis experience significant physical and psychological challenges. To better understand their challenges, in this study, we investigated the experience of thyroid cancer survivors with distant metastasis.

METHODS

A qualitative descriptive design was applied to 21 survivors of thyroid cancer with distant metastasis in South Korea. Semi-structured interviews were conducted between August 2021 and June 2022, and the results were analyzed using qualitative content analysis.

RESULTS

Two main themes on the experiences of thyroid cancer survivors with distant metastasis were extracted with five subthemes. The two main themes are: (1) Adverse effects of treatment and (2) coping strategies. Survivors experienced physical side effects such as pain, gastrointestinal problems, and fatigue. Psychologically, they faced fear of recurrence, uncertainty, and regret. Coping strategies include sharing experiences with similar patients, accepting cancer, and consolation that it is better than other cancer types.

CONCLUSION

Qualitative descriptive analysis conducted in this study confirms that survivors of thyroid cancer with distant metastasis indeed experience multiple physical and psychological challenges. Comprehensive care from healthcare providers is necessary to assist thyroid cancer survivors, who resiliently reframe their illness and seek social support by themselves. These efforts of comprehensive care include proactive management of treatment side effects, accurate communication about prognosis, and psychosocial support access, which will improve survivors' quality of life.

Off-label use of sodium cantharidinate and vitamin B6 injection in cancer: a protocol for a systematic review and meta-analysis

BACKGROUND

In China, sodium cantharidinate/vitamin B6 (SC/VB6) injection has been approved since 2002 for the treatment of lung cancer and primary liver cancer. In addition to these authorized indications, clinical application of SC/VB6 is also common in various other types of cancer. However, there is a lack of comprehensive understanding on this topic. Thus, this systematic review and meta-analysis aims to consolidate evidence regarding the efficacy and safety of off-label use of SC/VB6 in oncology.

METHODS

International databases including PubMed, Embase, Cochrane Library, Web of Science, and CINAHL Plus, as well as Chinese databases including China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Wanfang, will be searched from the inception to 31 December 2024. Comparative studies that evaluated the add-on effect of SC/VB6 to conventional cancer treatments against the use of conventional treatments alone will be considered in the scope of this review. The primary outcomes are objective response rate and performance status. Secondary outcomes are disease control rate (DCR), progression-free survival (PFS), disease-free survival (DFS), overall survival (OS), and adverse events (AEs). Depending on heterogeneity, data will be synthesized using either the Mantel-Haenszel fixed-effect or the DerSimonian and Laird random-effect model. Subgroup analyses will be conducted for the following variables: type of cancer, study design, SC/VB6 dosage, treatment duration, and combined therapies, provided that each subgroup contains at least two studies. Sensitivity analyses will be performed on efficacy outcomes. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) will be utilized to appraise the overall quality of evidence.

DISCUSSION

This review will encompass both randomized controlled trials (RCTs) and cohort studies, thereby enabling us to synthesize and assess evidence across experimental and real-world observational settings. Our findings will contribute to a better understanding on the benefit-risk profile regarding the off-label use of SC/VB6 in oncology, guiding the trajectory of future research, and offering a robust scientific foundation to inform clinical and regulatory decision-making process.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42024504977.

Dyadic effects of perceived burden and psychological distress on quality of life among Chinese advanced cancer patients and their caregivers

This study aims to explore the mediating role of psychological distress in the association between perceived burden and quality of life (QoL) in advanced cancer patient-caregiver dyads. 241 dyads in five tertiary hospitals in a province were investigated by using the Edmonton Symptom Assessment System, Zarit Burden Interview, the Patient Health Questionnaire-4, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative scores, and the Short Form Health Survey 8. The actor-partner interdependence mediation model (APIMeM), which assesses both individual (actor) and interdependent (partner) effects within dyadic relationships, was employed to analyze how burden and psychological distress interact across dyad members. Analysis was conducted using Mplus v8.0. Regarding the actor effects, the mediating role of psychological distress between perceived burden and QoL was confirmed in advanced cancer patients (B = -0.223, p = 0.001) and their caregivers (B = -0.168, p < 0.001). Regarding the partner effects, there were no significant correlations between caregiver burden and patients' psychological distress (B = 0.015, p = 0.199), patients' QoL (B = 0.113, p = 0.278), or the indirect association of caregiver burden with patients' QoL through psychological distress (B = -0.034, p = 0.259). However, caregivers' psychological distress was positively correlated with patients' symptom burden and mediated the association between patients' symptom burden and caregivers' QoL (B = -0.090, p = 0.001). The study highlights the importance of taking a dyadic perspective in the context of advanced cancer. Dyadic interventions targeting their perceived burden and psychological distress may be beneficial to their QoL.

Preoperative malnutrition is a risk factor for prolonged postoperative ileus for patients undergoing gastrointestinal surgery

Background

Prolonged postoperative ileus (PPOI), a common complication after gastrointestinal (GI) surgery, seriously affects the postoperative recovery rate. However, there are few previous studies on the effect of preoperative nutritional status on the occurrence of PPOI in patients with GI cancer.

Objective

To evaluate the value of preoperative nutritional status for predicting the occurrence of PPOI in patients undergoing GI surgery.

Methods

We retrospectively analyzed the clinical data of GI cancer patients who were admitted to our hospital between June 2021 and June 2023. The nutritional status of all patients was assessed using the Nutritional Risk Screening 2002 (NRS2002) and the Patient-Generated Subjective Global Assessment (PG-SGA). The independent risk factors for PPOI identified via univariate and multivariate logistic regression analyses were used to establish nomogram for the prediction of PPOI.

Results

The clinical data of 310 patients with GI cancer who underwent surgical resection were analyzed. PG-SGA score, serum albumin concentration, hemoglobin concentration, operation time, tumor stage, and previous abdominal surgery are independent risk factors for PPOI. The nomogram developed to predict PPOI performed well [area under the curve (AUC) = 0.835]. The calibration curve showed high consistency between the observed and predicted results. The decision curve analysis (DCA) revealed that the nomogram was clinically useful. The predictive ability of this nomogram is better than that of albumin level and PG-SGA score.

Conclusion

The preoperative nutritional status of GI cancer patients has a significant effect on the occurrence of PPOI. The nomogram developed in this study accurately predicted PPOI in GI surgery patients.