A program to enhance family resilience through improved family communication for young and middle-aged breast cancer survivors and their spouses: A feasibility study

PURPOSE

This study aimed to assess the feasibility, acceptability, and preliminary efficacy of a Family Communication-focused Family Resilience-enhancing Program (FC-FRP) for young and middle-aged breast cancer survivors and their spouses.

METHODS

A pre- and post-test single-group pilot study was conducted in China. Survivors and their spouses received 5-week online courses on the topic of family resilience as well as related tasks. The feasibility of the program was assessed by calculating recruitment rates, sample attrition rates, and intervention adherence rates. Program acceptability was assessed through participant feedback post-intervention. Psychosocial variables were collected at baseline (T0), immediately post-intervention (T1), and 1 month post-intervention (T2) to evaluate the preliminary efficacy of FC-FRP.

RESULTS

A total of 40 eligible survivor-spouse dyads were included, with a sample attrition rate of 22.5% at T1 and 35.0% at T2. The minimum completion rate for all tasks was 80.0%. Participant satisfaction with the program ranged from 82.7% to 92.3%. The intervention had a small to moderate effect size in improving family resilience and other outcomes for breast cancer survivors and spouses, validating the initial effects of the program.

CONCLUSIONS

The FC-FRP is feasible and acceptable with the promise of improving psychosocial outcomes in young and middle-aged breast cancer survivors and their spouses. A large-scale randomized controlled trial is needed to refine and validate the program further.

Investigating factors affecting the effectiveness of Gardasil 4, Cervarix, and Gardasil 9 vaccines considering the WHO regions in females: A systematic review

BACKGROUND

Currently, the best method for preventing Human Papilloma Virus (HPV) infection is vaccination. The present systematic review aims to review the latest findings on the factors affecting the efficacy of Gardasil 4, Cervarix, and Gardasil-9 vaccines on reducing pregenital lesions and reducing high-risk genotypes of cervical cancer in females aged 9-45 years and to examine the distribution of studies conducted in this regard in regions. In this study only the names of the vaccines were used and the vaccines were examined only according to the name. The name of WHO is only used to imply the distribution and access to health services in the world and not in terms of the vaccine approval in different organizations.

METHODS

A search for each vaccine was performed using PubMed, Scopus, and Web of Science. Five hundred and forty, 257, and 191 unique studies were obtained from the aforementioned databases for Gardasil 4, Cervarix, and Gardasil 9 vaccines, respectively. After applying the inclusion and exclusion criteria, 17 studies on Gardasil 4, seven studies on Cervarix, and two studies on Gardasil 9 were reviewed.

RESULTS

This study indicated that within various regions of the WHO, comprehensive effectiveness studies have not been conducted, and specifically within the Eastern Mediterranean Region (EMR) and South-East Asia Region (SEAR), no effectiveness studies have been recorded. Consequently, these regions necessitate the execution of effectiveness studies. Therefore, it is advisable to undertake investigations regarding the effectiveness of papillomavirus vaccination in the EMR and SEAR regions as delineated by the WHO. Moreover, it was demonstrated that in diverse nations, an array of factors such as age, gender, prevalent genotypes within the population, culture, the age at sexual activity initiation, the healthcare infrastructure, and timely screening can significantly impact the effectiveness of the vaccine. Furthermore, in nations with suboptimal vaccination coverage, a robust healthcare system coupled with the implementation of specialized testing and prompt follow-up can substantially aid in cancer prevention. The outcomes of this investigation confirm the administration of at least one dose of the vaccination. It reveals that in the absence of vaccination, a stringent healthcare system may contribute to the reduction of cervical cancer incidence. Additionally, in these nations, enhancements in healthcare systems, screening protocols, and public awareness play a crucial role in augmenting vaccination effectiveness. Collectively, a lower age at the time of vaccination (9-15 years), reduced sexual exposure prior to vaccination, vaccination prior to the onset of precancerous lesions, and adherence to the recommended vaccination schedule are associated with heightened vaccine effectiveness. Furthermore, the effectiveness of the vaccination dose is age-dependent, as one dose can be effective for individuals aged 15 years or younger.

CONCLUSIONS

Various factors, including age, sex, common genotypes in population, culture, age at sexual initiation, healthcare system, and screening at recommended time, can play a significant role in vaccine effectiveness. Additionally, it is suggested that in the developing countries, a single dose vaccination program is sufficient for children aged 15 years or younger. Also in these countries, improving the care system, screening system, and awareness play a significant role in enhancing the effectiveness of vaccination. It is also recommended that studies on the effectiveness of the papilloma vaccination in the EMR and SEAR regions covered by the WHO to be conducted. According to the inclusion criteria, all countries were included in the study; thus, the effects of the individual's genotype, which depends on the geographical region, can affect the vaccine effectiveness. Individuals aged 9-45 who can receive the vaccine according to the guidelines, were included in the study. Age is one of the factors affecting the vaccine effectiveness. Also, according to the policies of healthcare organizations, including the Ministries of Health of countries, various health services are provided in different geographical regions. Therefore, females's access to the vaccine occurs at different ages, and the effectiveness of the vaccine decreases by increasing the age at which the vaccine is received. Countries with poor healthcare system have less access to the vaccine, which can affect the effectiveness of the vaccine and herd immunity.

TLR/NLRP3 inflammasome signaling pathways as a main target in frailty, cachexia and sarcopenia

Mobility disability is a common condition affecting older adults, making walking and the performance of activities of daily living difficult. Frailty, cachexia and sarcopenia are related conditions that occur with advancing age and are characterized by a decline in muscle mass, strength, and functionality that negatively impacts health. Chronic low-grade inflammation is a significant factor in the onset and progression of these conditions. The toll-like receptors (TLRs) and the NLRP3 inflammasome are the pathways of signaling that regulate inflammation. These pathways can potentially be targeted therapeutically for frailty, cachexia and sarcopenia as research has shown that dysregulation of the TLR/NLRP3 inflammasome signaling pathways is linked to these conditions. Activation of TLRs with pathogen-associated molecular patterns (PAMPs or DAMPs) results in chronic inflammation and tissue damage by releasing pro-inflammatory cytokines. Additionally, NLRP3 inflammasome activation enhances the inflammatory response by promoting the production and release of interleukins (ILs), thus exacerbating the underlying inflammatory mechanisms. These pathways are activated in the advancement of disease in frail and sarcopenic individuals. Targeting these pathways may offer therapeutic options to reduce frailty, improve musculoskeletal resilience and prevent or reverse cachexia-associated muscle wasting. Modulating TLR/NLRP3 inflammasome pathways may also hold promise in slowing down the progression of sarcopenia, preserving muscle mass and enhancing overall functional ability in elderly people. The aim of this review is to investigate the signaling pathways of the TLR/NLRP3 inflammasome as a main target in frailty, cachexia and sarcopenia.

Extended reality for neurocognitive assessment: A systematic review

OBJECTIVE

The objective of this study is to evaluate the effectiveness, feasibility, and clinical relevance of extended reality (XR) technologies for neurocognitive assessment.

METHODS

A systematic review of published literature on augmented reality (AR), mixed reality (MR) and fully immersive virtual reality (VR) technologies for neurocognitive assessment was conducted. Studies were included if they evaluated XR for assessing neurocognitive domains, with outcomes related to diagnostic accuracy or usability.

RESULTS

28 studies met the inclusion criteria. VR-based tools (n = 26) were the most commonly utilized, offering immersive environments for assessing several cognitive domains including memory, attention and executive function. AR applications (n = 2) were less frequently utilized but showed promising potential in cognitive impairment detection. No studies utilized MR technology for assessing neurocognitive functions. XR technologies were found to be more sensitive, ecologically valid, and engaging compared to traditional assessment tools.

DISCUSSION

XR technologies offer a transformative approach to neurocognitive assessments by providing immersive, interactive environments that go beyond the limitations of traditional methods. Despite their potential, XR technologies face limitations such as high costs and technical challenges like motion sickness. Future efforts should focus on improving accessibility, user interfaces, and incorporating social and emotional dynamics to create more realistic assessments.

Risk Factors for Financial Toxicity in Patients With Pancreatic Cancer

BACKGROUND

The increasing costs of cancer treatment impose a tremendous economic burden on patients and their families, adversely impacting their quality of life and patients' outcomes. Financial toxicity (FT), as a concept describing the economic burden on patients, is crucial to comprehend the extent and determinants within specific contexts.

OBJECTIVE

To understand the current status of FT among Chinese pancreatic cancer (PC) patients, identify risk factors for FT, and summarize the characteristics of high-risk groups.

METHODS

A cross-sectional study involving 296 PC patients was conducted to investigate their general information, financial toxicity, quality of life, positive and negative affects, and social support. Univariate and multiple linear regression analyses were used to examine the correlation between FT and other variables.

RESULTS

The PC patient's FT score was 54.27 ± 14.50, with 25.7% being forced to change their work status due to the disease diagnosis and 29.4% exhibiting economically related treatment nonadherence behaviors. Factor analysis showed financial toxicity associated with fewer household savings, more total out-of-pocket (OOP) costs, treatment nonadherence, unemployment, diminished positive affect, and insufficient social support.

CONCLUSIONS

FT was highly prevalent among PC patients and associated with factors such as household savings and total OOP costs. There was a need to identify and manage patients exhibiting high-risk characteristics and to implement targeted interventions to mitigate their economic burden.

Data-driven prediction of prolonged air leak after video-assisted thoracoscopic surgery for lung cancer: Development and validation of machine-learning-based models using real-world data through the ePath system

Introduction

The reliability of data-driven predictions in real-world scenarios remains uncertain. This study aimed to develop and validate a machine-learning-based model for predicting clinical outcomes using real-world data from an electronic clinical pathway (ePath) system.

Methods

All available data were collected from patients with lung cancer who underwent video-assisted thoracoscopic surgery at two independent hospitals utilizing the ePath system. The primary clinical outcome of interest was prolonged air leak (PAL), defined as drainage removal more than 2 days post-surgery. Data-driven prediction models were developed in a cohort of 314 patients from a university hospital applying sparse linear regression models (least absolute shrinkage and selection operator, ridge, and elastic net) and decision tree ensemble models (random forest and extreme gradient boosting). Model performance was then validated in a cohort of 154 patients from a tertiary hospital using the area under the receiver operating characteristic curve (AUROC) and calibration plots.

Results

To mitigate bias, variables with missing data related to PAL or those with high rates of missing data were excluded from the dataset. Fivefold cross-validation indicated improved AUROCs when utilizing key variables, even post-imputation of missing data. Dichotomizing continuous variables enhanced performance, particularly when fewer variables were employed in the decision tree ensemble models. Consequently, regression models incorporating seven key variables in complete case analysis demonstrated superior discriminatory ability for both internal (AUROCs: 0.77-0.84) and external cohorts (AUROCs: 0.75-0.84). These models exhibited satisfactory calibration in both cohorts.

Conclusions

The data-driven prediction model implementing the ePath system exhibited adequate performance in predicting PAL post-video-assisted thoracoscopic surgery, optimizing variables and considering population characteristics in a real-world setting.

Patterns of Psychological Distress of Chinese Elderly Cancer Patients: A Latent Profile Analysis

AIM

To identify the group patterns of psychological distress and its predictors among Chinese elderly cancer patients. To examine the effect of profile on patients' Quality of Life (QOL).

DESIGN

This was a cross-sectional study conducted in accordance with the STROBE guidelines.

METHODS

This study included 357 patients with cancer aged ≥ 60 years. Latent Profile Analysis (LPA) was used to analyse psychological distress collected using the Patient-reported Outcome Measurement Information System (PROMIS) Anxiety Short Form 8a and Depression Short Form 8a. Univariate analysis and univariate multinormal logistic regression were used to examine the correlates of latent membership. Kruskal-Wallis H test was used to assess profile differences in self-reported QOL.

RESULTS

The best fit was a three-profile solution: low psychological distress (34.7%), moderate psychological distress (35.6%) and high psychological distress (29.7%). Patients in the moderate psychological profile were more likely to be female, have religious relief, not be in marriage, have financial burden, and be under treatment; they were less likely to be diagnosed with gynaecological cancer and breast cancer. Patients in the high psychological profile were more likely to be older, female, have a high school or above educational background, have religious relief, live in the country, be retired, have no knowledge about the disease, be unaware of tumour metastasis, have no tumour metastasis, be under treatment, and have complications; they were less likely to be diagnosed with colorectal cancer and gynaecological cancer. Different psychological distress profiles were associated with QOL, with the low distress group reporting significantly higher QOL.

PATIENT OR PUBLIC CONTRIBUTION

Chinese elderly cancer patients who met the inclusion criteria completed the questionnaires.

Factors Affecting Patient Safety in Inpatient Rehabilitation Hospital: A Multidisciplinary Perspective

Patient safety (PS) is of special importance in Inpatient Rehabilitation Hospital (IRH). Few studies have assessed the factors affecting PS in IRH. Therefore, this study aimed to explore the factors affecting PS based on the experiences of the rehabilitation team in an IRH. This qualitative study was conducted using the conventional content analysis approach in 2020-2021. The participants were 16 members of the rehabilitation team. They were purposively selected from Rofaydeh rehabilitation hospital, Tehran, Iran. Data collection was performed through semi-structured interviews and was continued up to data saturation. The mean age of the participants was 37.31 ± 8.68 years and their mean work experience was 8.75 years. The factors affecting PS in IRH were classified into five main categories, namely shortage of organizational resources, inappropriate physical environment of the IRH, inappropriate PS culture, patients' and their caregivers' limited participation in safety programs, and poor fall prevention programs. The results of this study revealed the factors affecting PS in IRH. Accurate identification of the influential factors on PS can help healthcare providers, managers, and policymakers use multi-component interventions to improve PS culture and increase PS in IRHs. Action research studies are also recommended to determine the main components of such interventions.

Non-pharmacological treatment options for fatigue: A systematic review of RCTs in adults

OBJECTIVE

Fatigue is a significant contributor to the burden experienced by patients with chronic disorders. The development of standardized treatments is challenging due to the lack of consensus concerning the etiology of fatigue. The aim of this systematic review is to provide an overview of non-pharmacological interventions for fatigue. The efficacy and differences in fatigue treatment across conditions will be explored.

METHODS

A systematic literature search was conducted using the databases PubMed, Web of Science, PsycInfo and CINAHL. Trials were eligible when (1) adult patients (≥ 18 years old) with disorders causing fatigue were included, (2) non-pharmacological interventions performed, (3) treatment was compared to standard care, placebo or active control group, (4) fatigue was the only primary outcome assessed with a multidimensional tool, and (5) a randomized controlled trial (RCT) design was applied.

RESULTS

7592 papers were screened. 91 RCTs were eligible, with data reported in 95 papers. Specific fatigue interventions were present for a broad range of conditions. Findings demonstrated promising evidence for physical activity, CBT, online programs and multidimensional modules. Additional types of interventions were effective, but evidence was limited due to risk of bias and small sample sizes. Due to high heterogeneity concerning methodology, a meta-analysis was not possible.

CONCLUSION

Several non-pharmacological treatment options for fatigue are promising. No clear evidence was found that fatigue should be treated differently depending on the underlying condition. However, further research is necessary with a focus on a transdiagnostic approach to fatigue, high study quality and long-term follow-ups.

Prevalence and risk factors of suicidal ideation in oral cancer: a systematic review and meta-analysis

The objective was to estimate the pooled prevalence of suicidal ideation (SI) and related risk factors in oral cancer (OC). Studies that specified SI in OC patients were considered eligible. SI prevalence and associated risk factors were extracted from the included studies for qualitative analysis and meta-analysis. Five studies (two retrospective, two cross-sectional, and one prospective longitudinal) were included in this review. Out of a total 15,475 OC patients, SI was reported in 117. The pooled prevalence of SI was 6% (95% confidence interval 1-22%). The prevalence of SI varied widely across the included studies, from 0.26% to 18.7%. Four studies described SI assessment methods, which were DS-MV, PHQ-9, Beck Scale for Suicidal Ideation, and psychiatric interviews. Older age, depression, demoralization, previous cancer history, psychiatric history, alcohol dependence, anxiety, living alone, and poor quality of life were frequently mentioned as risk factors of SI. The prevalence of SI varied across studies and was probably affected by the method of assessment, treatment, and postoperative care. SI was consistently predicted with psychological distress. It is essential to raise awareness of demographic, clinical, and psychological associations with SI in order to assess risks and design interventions for this cohort.

Experiences With Cancer Screenings Among Arabic-Speaking Refugee Women

OBJECTIVE

To explore breast, colorectal, and cervical cancer screening experiences among Arabic-speaking refugee women in Massachusetts.

DESIGN

Qualitative descriptive.

SETTING

The research was conducted in central Massachusetts, an area with a large refugee population from the Middle East. Despite cancer being the leading cause of death among Middle Eastern women aged 40 to 79 years, refugees experience significant disparities in cancer screenings. These refugees often pass through intermediary countries before permanently resettling, leading to preventive care becoming a lower priority as other life stressors take precedence.

PARTICIPANTS

Eleven women participated. Participants had an average age of 47 years; had come from Iraq, Syria, and Egypt; and had been in the United States an average of 7 years.

METHODS

In 2022, semistructured individual interviews were conducted in person or via Zoom. An interview guide, constructed based on components of the Health Equity Implementation Science Framework and an expert panel of partners, refugee women, and medical providers, was used. Conventional content analysis was used to analyze the data.

RESULTS

Three themes emerged: Facilitators of Cancer Screening, Barriers to Cancer Screening, and Interpreter-Related Factors. Women positively described providers' efforts to provide knowledge regarding screenings; however, language barriers, the invasive nature of some screenings, and scheduling appointments for screening posed significant obstacles.

CONCLUSION

This study highlights the unique health challenges faced by Arabic-speaking refugee women, focusing on their beliefs, experiences in clinical encounters, and communication regarding cancer screenings. Nurses can address these challenges by providing culturally sensitive care and building relationships with community resources.

Lifestyle-Related Risk Factors for Pancreatic Ductal Adenocarcinoma: A Longitudinal Analysis of 1,120,377 Individuals From the NHISS Cohort

OBJECTIVE

Utilizing data from the National Health Insurance Sharing Service database, this study explored significant risk factors for pancreatic cancer in a cohort of 1,120,377 South Korean individuals over a 10-year period (2009-2019).

METHODS

Propensity score matching was employed to ensure comparability between 3535 pancreatic cancer patients and a control group with a common cold diagnosis. The study analyzed various lifestyle factors and biochemical markers, including smoking status, alcohol consumption, fasting blood glucose (FBS) levels, liver enzyme levels, and Charlson comorbidity index (CCI) scores.

RESULTS

The findings revealed that current smoking, frequent alcohol consumption, and elevated levels of FBS and liver enzymes were associated with an increased risk of pancreatic cancer. Conversely, engaging in high-intensity exercise (≥ 20 min, twice weekly) was correlated with a 20% reduction in pancreatic cancer risk (p < 0.05). Additionally, optimal thresholds for total cholesterol (179.50 mg/dL), GGT (29.50 U/L), low-density lipoprotein cholesterol (104.50 mg/dL), and CCI score (2.50) were identified, which may facilitate early diagnosis and intervention.

CONCLUSIONS

These findings underscore the importance of modifiable lifestyle factors in managing pancreatic cancer risk and highlight the potential of personalized, evidence-based interventions-such as high-intensity exercise programs-in improving prevention and treatment outcomes.

Nursing Students' Perceptions of Spiritual Care in Türkiye: A Mixed Methods Study

Student nurses' sensitivity and personal perceptions about spirituality and spiritual care are important in providing spiritual care because student nurses need to explore their spirituality and their relationship to care. The study was carried out with a sequential explanatory mixed method design. Quantitative data for the research was collected using the descriptive characteristics form and the spirituality and spiritual care rating scale. As a result of the data obtained from the focus group interviews, the authors identified five contexts, fifteen themes and many sub-themes. As a result of this study, it was determined that the student's perceptions of spirituality and spiritual care were above average, and they saw spiritual care as a dimension of holistic care. However, they did not feel competent in providing spiritual care in clinical practice.

Effectiveness of Managing Cancer and Living Meaningfully Therapy on Health-Related Outcomes for Patients With Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Managing cancer and living meaningfully (CALM) therapy is a psychosocial intervention designed to enhance the well-being of cancer patients; however, its impact on health-related outcomes in cancer patients remains unclear.

AIMS

This study aimed to systematically synthesize current evidence to assess the impact of CALM therapy on health-related health outcomes and identify key features for optimizing the intervention.

METHODS

An exhaustive search was conducted across seven databases from inception to July 5, 2024. Two reviewers separately evaluated the eligibility of studies, performed data extraction, and examined the methodological quality using the Cochrane's risk of bias tool. The certainty of evidence was evaluated using GRADE, and data analysis was conducted with Review Manager 5.4. The study protocol was registered with PROSPERO (CRD42024568561).

RESULTS

Eleven studies (n = 1284) were included. CALM therapy showed significant improvements in psychological distress (MD = -2.43, 95% CI [-3.99, -0.86], p = 0.002), anxiety (SMD = -1.06, 95% CI [-1.78, -0.34], p = 0.004), depression (SMD = -0.65, 95% CI [-1.13, -0.17], p = 0.008), quality of life (SMD = 1.44, 95% CI [0.47, 2.40], p = 0.003), cancer-related fatigue (SMD = -3.54, 95% CI [-5.84, -1.23], p = 0.003), and sleep disturbance (SMD = -1.00, 95% CI [-1.86, -0.14], p = 0.02). However, its effects on alleviating the fear of cancer recurrence were not statistically significant.

LINKING EVIDENCE TO ACTION

CALM therapy has demonstrated positive effects on psychological distress, anxiety, depression, cancer-related fatigue, sleep disturbance, and quality of life. However, evidence regarding its effects on the fear of cancer recurrence remains limited. While we explored potential sources of heterogeneity, no primary cause was identified. Our findings remained largely consistent after this exploration, but due to the observed heterogeneity, these results should still be interpreted with caution. Further high-quality randomized controlled trials with larger sample sizes are needed to confirm these findings and assess the long-term implications of CALM therapy.

Greater Symptom Burden and Poorer Quality of Life Outcomes Are Associated With The Co-Occurrence of Anxiety and Depression During Cancer Chemotherapy

OBJECTIVES

Anxiety and depression are common symptoms in oncology patients undergoing chemotherapy. Study purpose was to evaluate for differences in severity of common symptoms (ie, fatigue, energy, sleep disturbance, cognitive function, pain) and quality of life (QOL) outcomes among three subgroups of oncology outpatients with distinct joint anxiety and depression profiles.

METHODS

Oncology outpatients (N = 1328) completed measures of state anxiety and depression, six times over two cycles of chemotherapy. Latent profile analysis was done to identify subgroups of patients with distinct joint state anxiety AND depression profiles. Patients completed measures of trait anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive function, and pain, as well as generic and disease-specific measures of QOL at enrollment. Differences among the classes in symptom severity scores and QOL scores were evaluated using parametric and non-parametric tests.

RESULTS

Three distinct joint anxiety AND depression profiles were identified and named: Low Anxiety and Low Depression (57.5%, Both Low), Moderate Anxiety and Moderate Depression (33.7%, Both Moderate), and High Anxiety and High Depression (8.8%, Both High). All of the symptom severity scores showed a "dose-response effect" (ie, as the joint anxiety AND depression profiles worsened, the severity of all of the symptoms increased). Likewise, for both the general and disease-specific QOL (except spiritual well-being) measures, all of the scores decreased as the joint anxiety AND depression profiles worsened. Compared to the Both Low classes, the other two classes reported lower scores for the spiritual well-being domain.

CONCLUSIONS

More than 40% of patients receiving chemotherapy experience moderate to high levels of both anxiety AND depression. These patients report an extremely high symptom burden and significant decrements in all domains of QOL.

IMPLICATIONS FOR NURSING PRACTICE

Clinicians need to perform comprehensive assessments of depression and anxiety and other common symptoms and QOL outcomes during chemotherapy. In addition, referrals for targeted interventions are needed to manage multiple symptoms and improve patients' QOL.

Effects of chemotherapy on attention function in breast cancer patients: Meta-analysis of longitudinal prospective cohort studies

PURPOSE

This study aimed to quantify the impact of chemotherapy on attention function, assessed by neuro-psychological tests and to identify the time point of impact.

METHODS

This is a meta-analysis with 16 independent data sets from 18 studies. Literature was searched in 5 databases. We calculated Hedges' g as an effect size (ES) for mean differences between groups by time point: chemotherapy treated patients (CTX group); nonchemotherapy patients (NCP group); and healthy control (HC group). The neuropsychological tests were classified and analyzed separately: time spent and correct or incorrect answer count.

RESULTS

In both tests, the CTX and NCP groups did not differ. Yet, after excluding an influential study in the answer-based test, the CTX group showed significantly lower attention function than the NCP group at within 1 year post-CTX(ES = -0.22, p = 0.03). In both tests, the CTX group had significantly lower attention function than HC at within 1 year post-CTX (ES = 0.36, p = 0.05; ES = -0.30, p < 0.01). Contrarily, the NCP and HC groups did not differ at each follow-up time. ES was largest at within 1 year post-CTX, suggesting the CTX impact on attention function may be delayed, not acute.

CONCLUSION

This study provide the evidence that CTX deteriorates patients' attention function, beyond patients' subjective experience. Yet, findings from individual studies were mixed and some of them greatly influenced the overall effect of chemotherapy, requiring additional well-designed studies. Clinicians must know the impact of chemotherapy on attention functions and available supportive cares.

REGISTRATION NUMBER

PROSPERO CRD42023481642.

A meta-analysis of the utility of cryotherapy for preventing peripheral neuropathy among breast cancer patients receiving paclitaxel and nab-paclitaxel

BACKGROUND

Cryotherapy with taxane infusion is a noninvasive strategy for preventing peripheral neuropathy (PN), but the efficacy of this approach has not been proven.

METHODS

A systematic search was conducted, and 477 records were initially identified. The titles were screened independently by 2 reviewers. Fourteen studies were ultimately included for meta-analysis, which was conducted using the meta package in the R software. Only studies that analysed cryotherapy use in breast cancer patients who received paclitaxel or nab-paclitaxel were included. Relative risks (RRs) were calculated using the random effects model to compare the occurrence of PN between the paclitaxel and nab-paclitaxel groups.

RESULTS

The incidence of Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 2 PN was 24.85% (81/326) in the cryotherapy arm and 42.35% (72/170) in the placebo arm. The overall RR CTCAE grade ≥ 2 PN in the cryotherapy group compared with the placebo group was 0.45 [0.27, 0.77, p = 0.0031]. The RR for sensory PN was 0.19 [0.05, 0.66, p = 0.009], and that for motor PN was 0.18 [0.03, 0.99, p = 0.0491]. The RR for Patient Neurotoxicity Questionnaire (PNQ) scores ≥ D, which indicate severe neuropathy, was 0.24 [0.09, 0.62; p = 0.0035]. Cold intolerance was the most reported t adverse effect, with a prevalence of 15% (37/247).

CONCLUSIONS

The use of cryotherapy decreased the occurrence of CTCAE grade ≥ 2 PN by 55%. Cold intolerance was the most frequently reported adverse effect associated with cryotherapy, but this adverse effect did not lead to high discontinuation rates.

Implementation of a Faith Community Nursing Transition of Care Program in the USA: A Propensity Score Matching Analysis

Faith community nursing (FCN) is a specialty nursing practice that integrates spiritual and religious practices into patient care. This study aimed to quantitatively assess the impact of the standardized FCN transition of care (TOC) program on the rate of hospital readmission and length of stay (LOS) through propensity score matching and difference-in-differences methods. Compared with those in the non-FCN group (n = 409), patients in the FCN group (n = 66) had a reduced likelihood of hospital readmission at 30, 90, and 180 days after discharge (by 8.8%, 9.0%, and 9.5%, respectively). Additionally, the FCN group exhibited a shorter LOS by 0.31, 0.53, and 0.87 days at 30, 90, and 180 days, respectively. The present study thus demonstrated the successful implementation of the FCN TOC program in a hospital setting, which reduced both the hospital readmission rate and LOS after discharge.

Social Determinants of Health Influencing the Health of Patients With a Stoma: A Discursive Paper

Social determinants of health are responsible for health inequalities. There is increasing agreement that addressing the social determinants of health is vital to achieving health equity, especially for vulnerable people such as patients with a stoma. This paper aimed to examine social determinants of health that influence the well-being of patients with a stoma. The literature published between 2014 and 2024 in PubMed, CINAHL, SCOPUS and EMBASE was searched. This paper examined selected social determinants of health, including education opportunities, employment and working conditions, income, access to health services and quality, and social support. Several studies have found that social determinants of health are causative factors that impact the health of patients with a stoma. Social determinants of health are a prevalent topic in developed and developing countries worldwide. Factors such as access to health services, education opportunities, income level, employment and social support can influence the health and quality of life of patients with a stoma. Nurses could assess patients with a stoma regarding social determinants of health and provide them with equally accessible health care by caring for and educating them, considering their social needs and gaining insights that can help patients better adapt to healthy living.

Post-traumatic stress disorder, stress burden, and quality of life among caregivers of children with cancer in Egypt

Caregivers of children with cancer frequently endure considerable psychological distress. The challenging nature of caregiving, combined with the emotional burden of witnessing a child's illness and treatment, can impact the quality of life and lead to the development of post-traumatic stress disorder (PTSD) in these caregivers. The aim of this study was to assess the prevalence of PTSD among caregivers of pediatric cancer patients and to identify the risk factors contributing to its development. Additionally, it examined the stress burden on caregivers and its impact on their quality of life. A cross-sectional comparative study was conducted over six months at the outpatient pediatric oncology clinics in Ain Shams University Hospital and the National Cancer Institute, Cairo, Egypt. The Post-Traumatic Stress Disorder Checklist for DSM-5, Zarit Burden Interview, and PCASEE quality of life were utilized to assess the PTSD symptoms, perceived burden, and quality of life, respectively. A total of 60 caregivers of children with cancer and 60 caregivers of children without cancer were included. Among the caregivers of children with cancer, 91.3% (n = 55) exhibited post-traumatic stress symptoms, with 31.3% (n = 19) meeting the diagnostic criteria for PTSD, compared to 0% of caregivers of children without cancer. Caregivers of children with cancer had significantly higher stress burden and lower quality of life scores compared to caregivers of children without cancer (48.66 ± 9.95 vs 13.25 ± 5.64; p = 0.001 and 51.8 ± 15.2 vs 72.2 ± 14.3; p < 0.001, respectively). Young age (p = 0.033), being a mother (p = 0.003), and taking care of those with tumor relapse (p = 0.012) were identified as significant factors associated with PTSD development among caregivers of cancer patients. Moreover, caregivers of children with cancer experienced significantly higher stress burden levels and reduced quality of life compared to those caring for children without cancer (p = 0.001), further increasing their risk of developing PTSD. These findings highlight the critical need for targeted psychological support and interventions to improve the well-being of these caregivers.

How family support alleviates death anxiety in breast cancer patients: the mediating role of meaning in life

Previous studies have predominantly focused on the relationship between death anxiety and quality of life in breast cancer patients, with limited exploration on how to alleviate their death anxiety. To address this gap, we recruited 533 breast cancer patients and utilized structural equation modeling and Process Model 4 to analyze the internal mechanisms and boundary conditions between family support and death anxiety. The study results indicated that family support significantly negatively impacts death anxiety in breast cancer patients; similarly, meaning in life also significantly negatively impacts death anxiety. More importantly, we found that meaning in life plays a full mediating role between family support and death anxiety. This study suggests that by enhancing family support levels and strengthening patients' perception of meaning in life, we can significantly improve the psychological health status of breast cancer patients, thereby potentially improving their quality of life.

Detection of HPV 16 and 18 L1 genes by a nucleic acid amplification-free electrochemical biosensor powered by CRISPR/Cas9

Cervical cancer, closely linked to Human Papillomavirus (HPV) infection, remains a significant health threat for women worldwide. Conventional HPV detection methods, such as reverse transcription polymerase chain reaction (RT-PCR), rely on nucleic acid amplification (NAA), which can be costly and time-consuming. This study introduces an NAA-free electrochemical Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-based biosensor designed to detect HPV 16 and HPV 18 L1 genes simultaneously. The system utilizes a Cas9-single guided RNA complex to initiate a selective cleavage reaction, releasing Methylene blue or Ferrocene-labeled fragments correlate to L1 gene concentrations. These fragments then interact with modified gold electrodes immobilized with a complementary probe, allowing precise electrochemical signal measurement during hybridization. The biosensor offers a wide detection range from 1 fM to 10 nM, with detection limits as low as 0.4 fM for HPV 16 L1 and 0.51 fM for HPV 18 L1, providing a sensitive and efficient solution for L1 gene detection. Additionally, its specificity and sensitivity closely match RT-PCR results in clinical testing, highlighting its potential for molecular diagnostics and point-of-care applications.

Steroid-refractory severe immune-related mucositis following adjuvant anti-PD-1 therapy for resectable melanoma: a case report

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment and are increasingly used, also in the adjuvant and neoadjuvant settings. ICIs, however, can induce immune-related adverse events (irAEs), which range from mild to life-threatening. As the use of ICIs expands, prompt identification and management of especially severe and life-threatening irAEs are crucial. We report a case of grade 4 steroid-refractory immune-related mucositis in a 60-year-old male treated with pembrolizumab following complete resection of stage IIIC melanoma. The patient received seven courses of adjuvant pembrolizumab without adverse events until 2 weeks after the seventh dose, when he presented with acute respiratory distress, dysphagia, and dyspnea. Examination revealed significant throat swelling and mucosal edema. Despite initial treatment with high-dose steroids, the patient's condition deteriorated, and he was admitted to the ICU for intubation and close monitoring. Infliximab was administered for steroid-refractory mucositis, resulting in rapid symptom resolution and successful extubation 5 days later. This case highlights the challenges in managing severe steroid-refractory irAEs. The rapid response to infliximab suggests the benefit of early intervention with alternative immunosuppressive agents in severe irAEs. Increased awareness of rare irAEs is essential for optimizing treatment and improving outcomes for patients receiving ICIs.

Psychosocial adjustment and influencing factors in patients with newly diagnosed colorectal cancer: A latent profile analysis

PURPOSE

To identify subgroups of psychosocial adjustment among patients with newly diagnosed colorectal cancer, and to examine the inflencing factors of different subgroups.

METHODS

The study surveyed 490 participants in Guangzhou from July 2022 to June 2023 using face-to-face method. The scales measured psychosocial adjustment, resilience, and coping styles. Statistical analysis included latent profile analysis and multinomial logistic regression. The STROBE guidelines were followed in this study.

RESULTS

Three subgroups of psychosocial adjustment were identified: the low adjustment (23.7%), the moderate adjustment (44.5%), and the high adjustment (31.8%). Factors influencing psychosocial adjustment included optimism, resignation coping style, household per capita monthly income, and tumor metastasis.

CONCLUSIONS

This study employed a human-centered approach to identify three types of psychosocial adjustment in newly diagnosed colorectal cancer patients. Variations were observed in optimism, resignation coping, tumor metastasis, and household income. Prompt identification of high-risk groups and tailored interventions are essential for improving psychosocial adjustment.

Exploring nurses' experiences of caring for older adults with cancer: a meta-synthesis of qualitative evidence

Nurses' important role in cancer treatment shows the need to explore their experiences caring for older adults with cancer, an area where previous research has identified a research gap.

This review aimed to synthesize the existing qualitative findings on nurses' experiences of caring for older adults with cancer.

Meta-synthesis.

A systematic search of four electronic databases was conducted using relevant keywords, from January 2000 to April 2024, with an update in July 2024.

A meta-synthesis using thematic analysis was employed to integrate the primary qualitative findings. The reporting of this review adhered to the ENTREQ guidelines.

Four analytical themes emerged: (1) unpacking the emotional and psychological toll, (2) facilitating effective connections with patients, (3) addressing practical and logistical challenges, and (4) navigating role dynamics in cancer care.

This meta-synthesis identified the need of prioritizing nurses' emotional, psychological, and practical well-being in cancer care, particularly when caring for older adults. By acknowledging and addressing the emotional and psychological strain, fostering meaningful patient connections, managing practical challenges, and navigating role dynamics, healthcare systems can enhance the quality of care for older cancer patients and support the well-being of nurses in this critical role.

Factors influencing the hope of patients with advanced cancer while receiving cancer pharmacotherapy

AIM

This study aims to clarify the factors influencing hope in patients with advanced cancer undergoing cancer pharmacotherapy, as influential factors have not been explored in previous studies.

METHODS

Participants were patients with advanced lung, colorectal, and breast cancer who were undergoing outpatient pharmacotherapy. A cross-sectional survey was conducted using the Herth Hope Index, the Multidimensional Scale of Perceived Social Support, and the Japanese version of the Integrated Palliative Care Outcome Scale with some additional questions. Data were obtained and analyzed using SPSS version 29.0, with descriptive statistics, t-test, one-way ANOVA, correlation analysis, and multiple regression analysis.

RESULTS

Two hundred valid responses (91.7%) were collected. The average age of the participants was 65.4 years. Multiple regression analysis demonstrated that hope had significant standardized partial regression coefficients with gender (β = -0.137, p = .022), social support (β = -0.246, p = .008), relationship with significant others (β = -0.224, p = .015), sleepiness (β = -0.141, p = .025), nausea (β = -0.159, p = .011), occupation (β = -0.140, p = .021), and economic status (β = -0.124, p = .038) (adjusted R2 = 0.341).

CONCLUSIONS

Social support, physical symptoms, and economic and occupational status influence the hope of patients with advanced cancer undergoing cancer pharmacotherapy. Assessing the impact of medication and physical symptoms associated with cancer progression on patients' lives, economic impact of long-term medication, and extent of relationship with people available through work and family may lead to early intervention by identifying individuals who are more likely to experience lower levels of hope.

Assessing Skin Tear Knowledge Among Nurses: A Multicentre Cross-Sectional Survey

AIMS

To assess the knowledge of nurses in Chinese hospitals regarding skin tears, focusing on evaluating their understanding and proficiency in managing and preventing skin tears, exploring the impact of demographic and professional factors on their knowledge levels and identifying specific areas where additional training or education is needed.

DESIGN

This study is a multicentre cross-sectional survey conducted in the Henan province of China using a stratified cluster sampling method.

METHODS

The study utilised the Chinese version of the Skin Tear Knowledge Assessment Instrument (OASES) for evaluating nurses' knowledge levels based on a questionnaire comprising 22 questions on the online platform Wenjuanxing (www.wjx.cn). All questions had to be answered, with only one option selectable per question. Response validity was ensured by excluding questionnaires that showed a clear response pattern, were completed in under 60 s, or scored 0 points. Descriptive analysis, item-level analysis and multiple linear regression analysis were performed.

RESULTS

A total of 1675 clinical nurses participated in this study. Age was a significant factor influencing skin tear knowledge, with older nurses (age, 41-60 vs. 18-40 years) demonstrating higher knowledge scores. Additionally, female nurses exhibited higher average knowledge scores compared to male nurses. Further, different departments, education levels, job titles and having completed relevant courses significantly influenced skin tear knowledge among nurses. However, on multivariate analyses, we found that working in the intensive care unit, having a higher education background and job title and having studied courses on wound, ostomy or incontinence were independent factors influencing knowledge on skin tear, indicating the need for targeted educational interventions.

CONCLUSION

In conclusion, targeted educational interventions and continuous professional development are essential to bridge the identified knowledge gaps among nurses in Chinese hospitals regarding skin tear management.

REPORTING METHOD

The Strengthening the Report of Observational Studies in Epidemiology checklist guidelines were followed.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Enhancing nurses' knowledge and skills in skin tear management through targeted educational programmes could improve patient care quality, reduce the incidence of skin tears and promote better wound care outcomes in clinical settings.

IMPACT

This study addresses the problem of knowledge gaps in skin tear management among nurses. The main findings indicate varied understanding and significant factors influencing this knowledge. The research impacts nurses and patients in Chinese hospitals, emphasising the need for specialised training and professional development to improve skin tear management and patient care. No patient or public contribution.

Multicomponent Interventions for Adults With Cancer Cachexia: A Systematic Review

BACKGROUND

Cancer cachexia has substantial impacts on people's quality of life. There is no current gold standard treatment, but the complex pathophysiology of cachexia suggests that a multitargeted and individualised treatment approach is needed. We aimed to evaluate the extent to which multicomponent interventions have targeted the key features of cachexia and been tailored to individuals, and differential effects on quality of life.

METHODS

We conducted a systematic review of multicomponent interventions for adults with cancer cachexia. We searched four databases, two clinical trial registers and MedRxiv on 20 June 2024. Intervention components were classified by intervention category (nutritional, exercise/physical activity, pharmacological and psychosocial), cachexia feature(s) targeted (reduced energy intake, altered metabolism, involuntary weight loss and decline in physical function) and level of tailoring. Within-arm standardised mean changes in quality of life over time, as well as standardised mean differences between study arms, were calculated.

RESULTS

Sixty-two multicomponent interventions were included, of which two combined components from all four intervention categories, and nine targeted all four key features of cachexia. Eighteen multicomponent interventions were fully tailored and 30 were partly tailored to individuals. Within-arm standardised mean changes in quality of life were calculated for thirteen studies; all had a high risk of bias or raised concerns. In eleven studies, quality of life scores improved following the intervention, whereas in two studies they declined. Standardised mean differences between study arms were calculated for four studies; in three, the intervention arm showed a greater improvement in quality of life scores than the usual care arm. Amongst these data, there was no indication that the number of cachexia features targeted, or the extent of tailoring, was associated with a greater improvement in quality of life scores; however, the heterogeneity prevented us from concluding on our hypothesis.

CONCLUSIONS

This review mapped out in detail the combinations of intervention categories used, the key features of cachexia targeted, and the extent of tailoring across multicomponent interventions for adults with cancer cachexia. Only a small proportion of the multicomponent interventions targeted all four key features of cachexia, but most were either partly or fully tailored to individuals. Despite sixty-two multicomponent interventions being investigated, only four studies compared these to usual care and reported quality of life outcomes. High risk of bias, low sample sizes and variable outcome data remain challenges to the interpretability of results in this field.

High specificity clinical signs of impending death: A scoping review

BACKGROUND

Accurate diagnosis of impending death is essential to provide proper care in the last days and hours of life. Recognising the death situation immediately allows adjustment of care goals, ensuring that they suit the patient's condition, as well as tuning the team's and family's expectations.

OBJECTIVE

To map and describe evidence on high specificity clinical signs of impending death in cancer and noncancer hospitalised patients over 18 years of age.

METHODS

A comprehensive search of the published literature was conducted According to Joanna Briggs Institute's methodology for scoping reviews. Online databases, including MEDLINE, CINAHL complete, SCOPUS, WEB OF SCIENCE, and the Cochrane Database of Systematic Reviews, and the search for unpublished studies included OpenGrey, DART-Europe, and RCAAP. Publications in English, French, Portuguese, and Spanish were included, and no period was set. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions to scoping review guidelines were used to report the results. The review protocol was registered in Open Science Framework (Simões et al., 2022).

RESULTS

The 15 studies included in this review were published in English between 2013 and 2023. In addition to identifying the clinical signs of impending death, some researchers intend to develop accurate prognostic models for this clinical situation. Only two studies in the noncancer population met the inclusion criteria. Twelve articles were prospective observational studies (seven were multicentre studies), one was a retrospective cohort study, and two were narrative reviews. A clinical sign that is common to studies in both populations is respiration with mandibular movement, particularly in the last 12 h of life.

CONCLUSIONS

Clinical signs of impending death and prediction models can help clinicians identify impending death. However, they should not replace clinical judgement. Further research is required to understand whether the dying process differs among different patient populations and care settings.

PocketOnco®: Prototyping a mobile app for health literacy and self-management of oncological diseases

BACKGROUND

The study aims to present and explain the development stages of a mobile app designed to improve health literacy for self-management of oncological diseases. Through the integration of gamification, the app aims to enhance patient engagement and education in an interactive manner.

METHODS

The methodology of Design Science in Information Systems and Software Engineering was employed, which included stages of needs identification, requirements definition, prototyping, and iterative validation of the developed artifact. A total of 132 participants, consisting of patients and healthcare professionals, were involved in the development of the PocketOnco application. The subsequent implementation of the App, PocketOnco, involved usability testing, System Usability Scale assessment, and the collection of qualitative feedback.

RESULTS

The usability testing analysis revealed excellent acceptance of PocketOnco, with the gamified elements such as quizzes and reward systems being particularly appreciated for their ability to consistently engage and motivate users.

CONCLUSION

The various stages in the development of this resource ensure the quality of its purpose. The application proved to be a viable and attractive solution for both patients and healthcare professionals, suggesting a promising path for future digital interventions in the field of oncology.

Effects of non-pharmacological interventions on cancer-related cognitive impairment in patients with breast cancer: A systematic review and network meta-analysis

PURPOSE

To compare and rank the effectiveness of non-pharmacological interventions on cancer-related cognitive impairment (CRCI) for breast cancer patients.

METHODS

A systematic review and network meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials from January 1, 2000 to October 11, 2024 were searched in nine electronic databases. Studies involving non-pharmacological interventions for managing CRCI in breast cancer were included. Methodological quality was assessed using the Cochrane Collaboration's Risk of Bias 2 assessment tool. Stata 15 was used for data analysis.

RESULTS

A total of 42 eligible studies were identified, covering eight non-pharmacological interventions. Psychological interventions (98.7%), Tai Chi/Qigong/Baduanjin (74.5%), and cognitive rehabilitation (70.1%) were the three most effective methods to improve subjective cognition. Cognitive training showed the highest effectiveness for working memory and executive function, with effectiveness rates of 78.3% and 83.4%, respectively. Cognitive rehabilitation (87.1%) was also the most effective for learning memory., while meditation/mindfulness-based stress reduction (71.8%) led in processing speed.

CONCLUSIONS

This network meta-analysis found that psychological interventions was the most effective for improving subjective outcomes. cognitive training proved most effective for working memory and executive function, while cognitive rehabilitation was most effective in enhancing learning memory, and meditation/mindfulness-based stress reduction ranked highest for processing speed.

Effect of a Self-Efficacy-Promoting Program on Pain Management Among Patients with Cancer: A Quasi-Experimental Study

PURPOSE

To examine the effect of a self-efficacy-promoting program on pain management among patients with cancer.

METHODS

A quasi-experimental design was carried out. Fifty-eight participants were recruited by using consecutive sampling and then divided, according to time period, into either the control group or the experimental group, 29 people for each group. Data collection was completed in the control group before starting it in the experimental group to prevent contamination of the experiment. The control group received standard care, whereas the experimental group received a self-efficacy-promoting program. The pain self-efficacy questionnaire was employed to examine patients' self-efficacy, while a numeric rating scale was utilized to evaluate pain levels.

RESULTS

Compared to the control group, the participants in the experimental group had higher pain self-efficacy scores (p < .05) and lower pain levels (p < .05).

CONCLUSIONS

The self-efficacy-promoting program effectively improved patients' self-efficacy scores and pain levels. Therefore, the program should be applied in nursing to assist cancer patients with pain management.

CLINICAL IMPLICATIONS

Pain is high prevalence among patients with cancer. Self-efficacy program can be used as a guide and framework for pain management among adult cancer patients in clinical care.

Characteristics and influencing factors of fear of cancer recurrence among family caregivers of breast cancer patients: a latent class analysis

BACKGROUND

Family caregivers of breast cancer patients often experience significant psychological challenges, including depression, anxiety, and fear of cancer recurrence (FCR), yet these issues receive insufficient attention. This study aims to explore the heterogeneity of FCR among family caregivers and identify distinct subgroups based on their FCR levels.

METHODS

A cross-sectional survey was conducted with 866 family caregivers of breast cancer patients at two tertiary hospitals in Guangzhou, Guangdong Province. All participants completed the Fear of Cancer Recurrence Scale (FCR-7), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Scale (GAD-7) to assess their levels of FCR, depression, and anxiety. Latent class analysis (LCA) was used to identify subgroups of FCR, and multiple logistic regression analyses were performed to explore factors influencing FCR.

RESULTS

Three distinct subgroups of FCR were identified: low FCR group (16.17%), moderate FCR group (13.16%), and high FCR group (70.67%). Predictors of higher FCR included lower income, higher anxiety, and higher depression levels.

CONCLUSIONS

Family caregivers of breast cancer patients exhibit varying levels of FCR, with significant predictors being income, anxiety, and depression. Targeted interventions (e.g., psychoeducation, stress management, mindfulness exercises, and cognitive-behavioral therapy) that address these factors may help improve the mental health and well-being of family caregivers.

Perceived self-efficacy in physical examination skills, clinical practice experiences, and utilization of findings in care plans among senior nursing students: a cross-sectional study

BACKGROUND

In nursing education, physical examination skills are a fundamental requirement for clinical practice. Nevertheless, there is a lack of evidence concerning the perceived self-efficacy of senior nursing students in these skills, their use in the clinical environment, and their integration into care plans. The study aimed to determine the perceived self-efficacy of senior nursing students regarding physical examination, their application of physical examination skills in the clinic, and their use of physical examination findings in care plans.

METHODS

This descriptive cross-sectional study was conducted during the 2023-2024 academic year at a university in Western Turkey. A convenience sampling method was employed, and 107 students (71%) who met the inclusion criteria, completed all forms, and voluntarily agreed to participate were included in the study. Data were collected using the Student Identification Form, Physical Examination Perceived Self-Efficacy Instrument for Undergraduate Nursing Students, and student care plans.

RESULTS

In this study, the total score of nursing students' perceived self-efficacy in physical examination was 2.18 ± 0.41 ('not very sure'). The Cardio sub-dimension of physical examination skills (2.50 ± 0.54) had the highest mean sub-dimension score, while the eye sub-dimension (1.75 ± 0.54) had the lowest mean sub-dimension score. More than half of the students were found to have no confidence in their ability to perform 14 physical examination skills and never practiced the skills in the clinic. It was determined that the students used only 20 physical examination skills in the data collection phase of the care plans, and only 6 of these skills were practiced by more than half of the students.

CONCLUSIONS

This study reveals a significant gap in the self-efficacy and practical skills of nursing students related to physical examination. Based on these findings, the nursing curriculum should include more hands-on training and clinical practice should provide students with more opportunities to apply physical examination skills.

CLINICAL TRIAL NUMBER

Not applicable.

Career adaptability and patient safety culture perceptions among newly graduated oncology nurses: a latent profile analysis

BACKGROUND

Newly graduated nurses in cancer hospitals face significant challenges in high-pressure environments, struggling with career adaptability due to limited clinical experience. This adaptability is crucial for managing occupational stress and influences perceptions of patient safety culture. However, existing studies have not explored this group's latent profiles of career adaptability, underscoring the need for further research.

OBJECTIVES

This study aims to identify latent profiles of career adaptability among newly graduated nurses in cancer hospitals and examine their impact on perceptions of patient safety culture.

DESIGN

This study employed a quantitative, cross-sectional design.

METHODS

Between October and November 2023, newly graduated nurses from a tertiary cancer hospital in Beijing, China, were recruited through convenience sampling. Data were gathered using a General Information Questionnaire, the Career Adaptability Scale, and the Hospital Survey on Patient Safety Culture Scale. Latent profile analysis was performed using the R3STEP and BCH methods.

RESULTS

A total of 365 newly graduated nurses participated. Career adaptability was categorized into three profiles: "low" (14.0%), "moderate" (41.4%), and "high" (44.7%). Significant predictors included age, education level, clinical practice duration, unclear career planning, and lack of tertiary hospital internship experience. Perceptions of patient safety culture varied significantly across the profiles.

CONCLUSION

Career adaptability among newly graduated nurses in cancer hospitals exhibits heterogeneous characteristics that significantly impact their perceptions of patient safety culture. Nursing managers and educators should recognize this diversity and implement individualized strategies to enhance these perceptions.

Breast Cancer Vlogs on YouTube: Descriptive and Content Analyses

Background

Many women with breast cancer document their experiences in YouTube vlogs, which may serve as peer-to-peer and community support.

Objective

This study aimed to determine (1) the forms of content about breast cancer that tend to be discussed in vlogs, (2) the reasons why women choose to vlog their breast cancer experiences, and (3) the potential for breast cancer vlogs to serve as an alternative or complement to peer-to-peer support as well as a site of digital community overall.

Methods

YouTube was searched in incognito mode in November 2023 using the search terms "breast cancer vlog." A maximum of 10 videos/creator were included based on viewership and date created. Video characteristics collected included title; length; number of views, likes, comments; and playlist inclusion. Videos were assessed for sponsorship; presence of explanation and discussion on breast cancer; type of content; and themes. Creator characteristics included age, location, and engagement approaches. Descriptive and content analyses were performed to analyze video content and potential areas where peer-to-peer support may be provided.

Results

Ninety vlogs by 13 creators were included, all from personal accounts. The mean (SD) video length, number of views, and number of comments were 21.4 (9.1) minutes, 266,780 (534,465), and 1485 (3422), respectively. Of the 90 videos, 35 (39%) included hashtags, and 11 (12%) included paid sponsorships. The most common filming location was the home (87/90; 97%), followed by the hospital (28/90; 31%) and car (19/90; 21%). Home vlogs were most often set in the living room (43/90; 44%), bedroom (32/90; 33%), or kitchen (20/90; 21%). Thirty-four of 60 videos (57%) included treatment visuals and physical findings. Creators addressed motivation for vlogging in 44/90 videos (49%); the two most common reasons were wanting to build a community and helping others. In 42/90 videos (47%), creators explicitly expressed emotion. Most common themes were treatment (77/90; 86%), mental health (73/90; 81%), adverse effects (65/90; 72%), appearance (57/90; 63%), and family relationships (33/90; 37%). Patient-directed advice was offered in 52/90 videos (58%), mostly on treatment-related issues. In 51/90 videos (57%), creators provided explicit treatment definitions. Chemotherapy was discussed in 63/90 videos (70%); surgery in 52/90 (58%), primarily mastectomy; radiation in 27/90 (30%); and general adverse effects in 64/90 (71%). Twenty-two of 90 videos (24%) were about a new diagnosis. When mentioned (40/90; 44%), the most common creator location was the United States. When mentioned (27/90; 30%), the most common age was 20-29 years.

Conclusions

The dedication to building community support by vlog creators, and the personal nature of their storytelling, may make vlogs a potential resource for peer-to-peer support.

The Effect of Cold Therapy on the Prevention of Chemotherapy-Induced Peripheral Neuropathy in Oncology Patients: A Systematic Review Study

OBJECTIVE

The aim of this study was to investigate the effect of cold therapy on the prevention of chemotherapy-induced peripheral neuropathy in oncology patients.

METHODS

This review was prepared based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. The Medline, CINAHL, Embase, Cochrane Library, PubMed, Scopus and Web of Science databases were searched for studies published between January 1997 and June 2024. Two reviewers independently evaluated study suitability and extracted data. The Jadad critical appraisal scale and Methodological Index for Non-Randomized Studies (MINORS) risk of bias tool was used for quality assessment. The findings of this review are presented using a narrative synthesis.

RESULTS

Overall, cold therapy was effective in preventing CIPN in more than half of the studies. Cold therapy methods such as cold hilotherapy, frozen gloves and socks, cold mitts and slippers, and cooling gloves/socks were found to be the most effective in six studies. In contrast, three studies that applied interventions like frozen gloves and socks, crushed ice, and various cooling methods did not show a significant effect.

CONCLUSION

Cold therapy was found to be a reasonable option for preventing CIPN in patients receiving taxane-based chemotherapy, as it does not result in serious side effects. Due to the heterogeneity of studies with different methods, sample sizes and measurement procedures for CIPN, it is difficult to make a clear statement about the duration and temperature of cold application that the patient can tolerate.

IMPLICATIONS FOR NURSING PRACTICE

Cold therapy can provide a useful option for the prevention of CIPN in patients receiving taxane-based chemotherapy. Nurses should increase patient and provider awareness of the benefits of cold therapy for CIPN.

PROSPERO REGISTRATION ID

CRD42024619942.

Mental Health Symptoms Between Developed and Developing Regions for People Living With HIV in China: A Network Analysis of 40 Psychological Symptom Scales

BACKGROUND

People living with HIV (PLWH) frequently encounter mental health symptoms. Yet, a notable gap exists regarding the divergence in core mental health symptoms among PLWH across developed and developing regions. This study aims to explore the differences in mental health symptom networks among PLWH in both developed and developing regions.

METHODS

A multicenter cross-sectional study was conducted in China from April 2022 to April 2023. Six designated HIV hospitals enrolled 2436 participants, including 1430 PLWH from developed regions and 1006 PLWH from developing regions. The study assessed 40 mental health symptoms across six dimensions: somatization symptoms, negative affect, cognitive processes, cognitive function, interpersonal communication, and social adaptation among PLWH.

RESULTS

The diverse developed regions exhibited varying mental health symptoms among PLWH, particularly concerning their core symptoms. In the developed regions of China, PLWH predominantly experience core symptoms centered around "Sadness," "Anger," and "Distress." In contrast, PLWH from developing regions tends to manifest core symptoms such as "Inability to integrate into society," "Difficulty in managing daily work and study," and "Hostility."

CONCLUSIONS

The regional variation in mental health symptoms among PLWH underscores the disparities in their circumstances. This insight is crucial for crafting tailored intervention strategies for urban PLWH. In developed regions, psychological interventions such as catharsis and empathy are integral to clinical practice, while in less developed regions, family support interventions are paramount, given the limited social interactions available to PLWH.

REPORTING METHOD

This study was reported according to the STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Sentinel and Networked Symptoms During Remission Induction Chemotherapy in Acute Lymphoblastic Leukemia Children

BACKGROUND

Children with acute lymphoblastic leukemia experience various adverse symptoms during remission induction. Elucidating the interrelationships among symptoms can facilitate precise and efficacious symptom management.

OBJECTIVE

This study aimed to elucidate symptom clusters and sentinel symptoms and to examine core and bridge symptoms within the symptom network in children with acute lymphoblastic leukemia during remission induction.

METHODS

A cross-sectional survey of 226 children aged 8 to 16 years with a new diagnosis of acute lymphoblastic leukemia during remission induction chemotherapy was conducted using the Chinese version of the Memorial Symptom Assessment Scale 10-18. Symptom clusters and sentinel symptoms were identified using exploratory factor analysis and Apriori algorithm. Core and bridge symptoms were identified using network analysis.

RESULTS

Five symptom clusters and sentinel symptoms were identified: gastrointestinal (constipation as the sentinel symptom), emotional (feeling sad as the sentinel symptom), and somatic (cough as the sentinel symptom); however, the sentinel symptoms of neurological and self-image impairment symptom clusters were not specified. In symptom network, feeling sad and nausea were core symptoms, whereas dizziness and lack of energy were the bridge symptoms.

CONCLUSIONS

The somatic symptom cluster should be prioritized for intervention during remission induction. Network analysis and sentinel symptom analysis must be extended to the symptom research in pediatric cancer to provide a scientific basis for symptom management.

IMPLICATIONS FOR PRACTICE

Nurses should aim to identify and intervene with sentinel and networked symptoms to ensure that children are effectively supported during the remission induction, reducing symptom burden and improving quality of life.

Effectiveness of a family-management program for family having children with acute lymphoblastic leukemia: a quasi-experimental study

PURPOSE

To examine the impact of a family-management program (FMP) on family management, family, and child quality of life (QOL) among parents of children with acute lymphoblastic leukemia (ALL).

METHODS

Participants included 46 parents of children aged 2-5 years with ALL. Participants were recruited via a convenience sampling method at a tertiary hospital in Thailand. Twenty-three intervention participants received a 3-weekly FMP and routine care while the other 23 control participants received only routine cancer care. Data was collected in the hospital setting and/or via telephone follow-up calls. Study outcomes were evaluated at 3 time points (i.e., baseline, post-intervention, and follow-up) using the following: Family Management Measure, Beach Center Family Quality of Life Scale, and Quality of Life of Children with cancer module. Data were analyzed using two-way repeated-measures analysis of variance (ANOVA).

RESULTS

The findings revealed that family management and child QOL in the intervention group was higher than the control group at follow-up (p < .05), but not for family QOL. Within the intervention group, there was significant improvement in family management, family QOL and child QOL at post-intervention and follow-up.

CONCLUSIONS

The FMP was effective in fostering improved outcomes among enrolled parents that received the FMP compared to parents in the control group. Healthcare providers, especially nurses that work with parents of children with ALL, can easily offer the FMP to parents to help foster optimal family management, family QOL, and child QOL.

Sex and Gender in Myeloid and Lymphoblastic Leukemias and Multiple Myeloma: From Molecular Mechanisms to Clinical Outcomes

Biological sex and gender factors significantly influence the pathogenesis, progression, and treatment response in hematologic malignancies. This comprehensive review examines sex-specific differences in acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, and multiple myeloma through systematic analysis of the peer-reviewed literature published between 2014-2024 and identified through structured searches of PubMed, Web of Science, and MEDLINE databases. Epidemiological data demonstrate higher disease incidence (57% male vs. 43% female in MM, 63% male vs. 37% female in AML hospitalizations for ages 18-39) and inferior outcomes in male patients across malignancy types (5-year relative survival rates of 48.8% vs. 60.4% in females with AML), while female patients exhibit superior survival despite experiencing greater treatment-related toxicities. Our analysis reveals consistent sex-specific patterns in molecular mechanisms, including distinct mutational profiles, differences in immune system function, and sex-based pharmacokinetic variations that collectively suggest the necessity for sex-differentiated treatment approaches. The review identifies reproducible patterns across diseases, particularly in cytogenetic and molecular characteristics, with females demonstrating favorable prognostic mutations in leukemias and higher rates of chromosomal abnormalities in multiple myeloma. Despite these identifiable patterns, significant knowledge gaps persist regarding the underlying mechanisms of sex-based outcome differences. Incorporating sex and gender considerations into precision medicine frameworks represents a critical advancement toward optimizing treatment strategies and improving clinical outcomes for patients with hematologic malignancies.

Oral adverse effects of head and neck radiotherapy with/without chemotherapy in a southern Brazil hospital

The aim of this study was to evaluate the main oral adverse effects and their relationship with dental care before radiotherapy (RT) and combined RT and chemotherapy (RT+CT). Additionally, we assessed the association of other risk factors with the development of these adverse effects. This paper is a retrospective cross-sectional analytical study of data from medical records of patients with head and neck cancer (HNC) who underwent RT or RT+CT attended at the stomatology unit in a southern Brazil hospital. The records of 78 patients with HNC were accessed. Demographic data, tumor characteristics, cancer treatment, follow-up data, adverse effects, and dental treatment prior to RT were evaluated individually for descriptive analysis. Kaplan-Meier survival curves were plotted. Risk factors were assessed using chi-square or Mann-Whitney test. The results showed that most patients were male (88.3%) in their 6th decade of life. Tumors were mostly located in the oral cavity (52.6%) and squamous cell carcinoma was the main diagnosis (94.8%). Most cases were diagnosed in advanced stages (67.9%). RT was of 2D or 3D types in 93.6% of patients. Oral adverse effects were observed in 94.7% of patients treated with RT or RT+CT. Osteoradionecrosis (ORN), oral mucositis (OM), candidiasis, and xerostomia were the main complications. Patients who received 2D RT had higher risk of developing ORN and xerostomia compared to those who received 3D RT. The risk of developing ORN was higher in smokers compared to non-smokers and in patients who had not previously consulted a dentist. This study showed that patients who underwent RT for HNC have a high occurrence of oral complications. Dentists play a key role in the management of these oral side effects.

Impact of Collaborative Empowerment Education on Psychological Distress, Quality of Life, and Nutritional Status in Esophageal Cancer Patients Undergoing Concurrent Chemoradiotherapy

Esophageal cancer (EC) patients undergoing concurrent chemoradiotherapy (CCRT) often face significant psychological distress, impaired quality of life (QoL), and poor nutritional status. This study evaluates the impact of multidisciplinary collaborative empowerment education (MCEE) in addressing these challenges. According to the inclusion criteria, 160 patients were recruited and randomly assigned to either the MCEE group (n = 80) or the control group (n = 80). The MCEE group received a tailored program consisting of psychological support, nutritional counseling, and educational interventions. Outcome measures, including psychological distress (using the Kessler Psychological Distress Scale), quality of life (using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), and nutritional status (using hemoglobin, serum protein, and albumin levels), were evaluated at baseline and after four cycles of concurrent chemoradiotherapy. Post-intervention, the MCEE group showed significant improvements in psychological distress. QoL improvements were noted across all functional domains, including physical, emotional, cognitive, and social functions (all Ps ≤ 0.001), with significant reductions in fatigue, insomnia, and pain. Nutritional status also improved, with higher levels of hemoglobin, serum protein, and albumin, as well as less weight loss in the intervention group (all Ps ≤ 0.001). MCEE effectively reduces psychological distress, improves QoL, and enhances nutritional status in EC patients undergoing CCRT. This patient-centered, multidisciplinary approach offers a promising strategy for improving treatment outcomes and overall well-being in cancer care.

Feasibility and patient reported tolerance of cryotherapy with Cooral mouth cooling device in patients undergoing radiation therapy (CooRay): a pilot study

Background

Radiation-induced oral mucositis (RIOM) is a major side-effect of (chemo)radiation (CRT) of patients with head and neck cancer (HNC). This study tries to establish a novel cryotherapy (CyT) method using a mouth care device (MCD; Cooral®, BrainCool AB, Lund, Sweden) to prevent RIOM.

Methods

Patients were non-randomly assigned to use the MCD after every radiotherapy session for 30-60 minutes. Subjects were asked to answer daily questionnaires assessing tolerability of the intervention. Mucositis was assessed at baseline, once weekly and at weeks 1/3/6 after CRT. The primary endpoint was patient tolerance, defined by the time the MCD was used and the patients' perception. Secondary outcomes were the degree (CTCAE v5.0) and duration of RIOM.

Results

Ten patients were eligible with a mean age of 62 years. Four patients received concurrent platinum-based CRT, whereas the others received radiotherapy alone. Overall, 214 CyT sessions were performed (73% of planned CyT sessions). The mean daily CyT duration was 48 minutes (range, 30-60 minutes). All patients reported cooling as comfortable. Nine completed the intervention, one terminated it early due to hypersalivation. No Grade 4 RIOM was observed. Grade 3 mucositis was observed in 4 and Grade 2 in 3 cases.

Conclusions

The Cooral System was well tolerated, with a duration of application that was acceptable for most patients. We concluded that the MCD can be safely used in patients undergoing CRT. A prospective phase II trial, assessing the efficacy in preventing RIOM, is planned.

Outcomes and experiences of an art workshop on young people's symptoms of depression and anxiety in Peru: a non-controlled trial

BACKGROUND

Art-based interventions are recognised for their mental health (MH) benefits. This study assessed the changes in symptoms of anxiety and depression in young adults and their experiences after participating in a three-session mixed arts workshop.

METHOD

This non-controlled trial study included a pre-intervention and two post-intervention measurements of depression (PHQ-8) and anxiety (GAD-7) symptoms and exit interviews with participants and facilitators. The registration number of this trial is ISRCTN16079466.

RESULTS

Thirty-seven young adults participated in the study. Over 78% of participants reduced their PHQ-8 and GAD-7 scores by at least 3 points after the workshop. Three months later, over 75% maintained that reduction on both scores. Participants reported experiencing social, emotional, and individual benefits after the workshop.

CONCLUSIONS

Art-based workshops offer promising benefits for youth's MH. This intervention can be short and cost-effective. An integrative approach combining arts and MH may be positive for individuals with anxiety and depression.

Trajectories of aerobic physical activity and fruit and vegetable intake in adults with cancer: Predictors and outcomes of class membership

PURPOSE

Advances in cancer treatment have led to increased survival rates, but cancer survivors often face challenges such as physical and psychosocial impairments, accelerated aging, and reduced quality of life. While regular physical activity (PA) and a heathy diet, particularly fruit and vegetable (F&V) intake, are known to benefit recovery, many survivors do not meet recommended health behavior guidelines.

METHODS

Latent class linear mixed modeling was used to analyze YUCAN study data, identifying distinct trajectories of aerobic PA and F&V intake in adults with breast, prostate, or colorectal cancer, during the transition from treatment to early survivorship. We examined trajectory patterns, identified socio-demographic, clinical, and psychosocial predictors of trajectory groups, and explored associations with physical health and distress. Participant (n = 501) surveys were analyzed at baseline (~ 3 months from treatment completion) and at 3-month intervals for 12 months.

RESULTS

Three PA trajectories were identified: "consistently low," "low and increasing," and "high and decreasing." Two F&V intake trajectories were found: "moderate and increasing," and "consistently low." Socio-demographic factors, such as older age and racial-ethnic minority status, as well as psychosocial factors, including resilience and perceived controllability of the illness, were significant predictors of PA trajectory membership. Higher F&V intake was also associated with better physical health at T5.

CONCLUSION

These findings highlight the intragroup variability in health behavior trajectories, predictors and health outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

This variability indicates that survivors may require individualized support to adopt healthier behaviors during the transition to early survivorship.

Colonoscopy Uptake in First-Degree Relatives of CRC Patients: Challenges and Intervention Strategies

Objective

Colorectal cancer (CRC) screening is crucial for early detection and prevention. However, the willingness of first-degree relatives of CRC patients to undergo colonoscopy often remains low, impacting early diagnosis and treatment outcomes.

Methods

This article reviewed the relevant concepts, research status, evaluation methods, influencing factors and intervention measures of first-degree relatives of patients with colorectal cancer.

Results

Through the review, it is found that there is still a large gap in the research on the development of assessment tools and intervention programs. Existing intervention programs often fail to address the unique demographic, cognitive, psychological, family dynamic, and social barriers faced by this population. Future research should prioritize the development of specific assessment tools that can accurately measure the willingness of first-degree relatives to undergo colonoscopy, taking into account cultural nuances and contextual factors. By addressing psychological and social factors, researchers can develop more targeted and effective programs that enhance understanding and motivation for colonoscopy screening.

Conclusion

This study provides references for domestic research on the willingness of first-degree relatives for colonoscopy, provide new ideas for formulating intervention methods more suitable for first-degree relatives for colonoscopy, and promote their willingness to perform colonoscopy.

Educational intervention program regarding safe administration of chemotherapy: A quasiexperimental study among nursing personnel in a tertiary care hospital

Chemotherapy is one of the major choices for treatment of cancer and closely controlling this fatal disease. A registered nurse is primarily responsible for administering chemotherapy with specific drug knowledge and expertise in preparation, administration, and toxicity management. One of the hazards in the healthcare settings is the occupational exposure to chemotherapeutic or cytotoxic drugs. Hence, the study was conducted aiming to evaluate the effectiveness of educational intervention programs in relation to safe administration of chemotherapy among nursing personnel. One group pretest post-test design with quasiexperimental design and the nonprobability purposive sampling technique was employed to select 38 nursing personnel in different chemotherapy units. The data were collected using a structured knowledge questionnaire consisting of 27 knowledge items from different areas like chemotherapy preparation, administration, management of side effects, management of extravasation, safe handling practices, and chemotherapy exposure. Descriptive and inferential statistics were utilized for analysis and interpretation of the obtained data. The overall mean of pretest knowledge score regarding safe administration of chemotherapy among nursing personnel was 16.21 ± 3.82, and the post-test knowledge score was 20.49±2.00. The educational intervention was beneficial in enhancing the knowledge score (P < 0.001). Moreover, after the educational intervention, 68% of the respondents had very good knowledge, 11% had excellent knowledge, and 21% had good knowledge (P < 0.001). The educational intervention program was beneficial in meliorating the knowledge of nursing personnel on safe administration of chemotherapy.

The holistic model of leukaemia survivorship care: derived from a qualitative exploration of leukaemia survivorship

PURPOSE

Increasing survival rates have left many leukaemia survivors with debilitating effects from the disease and its treatments. However, little is known about the persistent unmet needs of people living with leukaemia.

METHODS

We aimed to qualitatively explore the experiences of individuals living with leukaemia and suitability of the Clinical Oncology Society of Australia's (COSA) Model of Survivorship Care (2016) to reflect leukaemia survivorship. We used an inductive qualitative approach, conducting semi-structured interviews with leukaemia survivors recruited via social media and cancer advocacy organisations. Interviews were continued until information power was deemed appropriate. Reflexive thematic analysis (RTA) was used to describe and interpret key themes and meta-themes in the data.

RESULTS

Overall findings were examined alongside the COSA Model. Twenty-four leukaemia survivors were interviewed; six themes were identified: (1) leukaemia is impactful, life-altering, and unexpected; (2) leukaemia is enduring, life-limiting, and uncertain; (3) survivorship is a team effort; (4) centrality of work as identity, focus, and financial security; (5) the dynamic landscape of coping; and (6) survivorship as adjusting. Overall, participants described leukaemia survivorship as (1) recursive and (2) holistic.

CONCLUSIONS

Our findings, while broadly corresponding with the COSA Model, demonstrate it lacks nuances specific to leukaemia survivorship. We recommended the HMLS be used to guide future leukaemia-specific development of the COSA Model and survivorship services.

IMPLICATIONS FOR CANCER SURVIVORS

We identified key domains and stages common across leukaemia survivorship, presented in our proposed Holistic Model of Leukaemia Survivorship (HMLS), addressing these domains are critical to the provision of quality survivorship care.