Association between fear of cancer recurrence and emotional distress in breast cancer: a latent profile and moderation analysis

BACKGROUND

Breast cancer patients often experience significant psychological challenges, particularly fear of cancer recurrence (FCR), which is a prevalent and distressing concern following diagnosis. FCR can lead to heightened emotional distress, including anxiety and depression. Resilience, the ability to adapt positively to adversity, may play a crucial role in mitigating these negative emotional outcomes. This study aims to explore the heterogeneity of FCR among breast cancer patients and examine the moderating effect of resilience on the relationship between FCR and emotional distress.

MATERIALS AND METHODS

A cohort of 398 breast cancer patients participated in the Be Resilient to Breast Cancer (BRBC) program between May and December 2023. Surveys were administered to assess FCR, resilience, and emotional distress levels. Data were analyzed using two approaches: latent profile analysis (LPA) to identify distinct FCR profiles and moderation analysis to evaluate the role of resilience.

RESULTS

Three distinct FCR profiles were identified: low (27.5%), middle (53%), and high (19.5%). Resilience significantly moderated the association between FCR and anxiety (B = 0.115, SE = 0.046, P = 0.014), but no significant moderating effect was observed for depression.

DISCUSSION

The findings highlight significant heterogeneity in FCR among breast cancer patients, with a substantial proportion experiencing moderate to high levels of FCR. Resilience was found to buffer the impact of FCR on anxiety, suggesting that interventions aimed at enhancing resilience could alleviate anxiety related to FCR in this population. These results underscore the importance of incorporating resilience-focused strategies into psychological therapies for breast cancer patients.

Interventions to enable and reach patients with heart failure and their caregivers, with palliative care (TIER-HF-PC): a study protocol of a two-armed parallel group, open label randomised controlled trial that evaluates the effectiveness of a tiered model of palliative care in tertiary cardiac institutes in Singapore

INTRODUCTION

Palliative care (PC) improves quality of life (QOL). However, PC is currently delivered 'too little, too late' in heart failure (HF). Timely interventions to enable and reach patients with HF and their caregivers, with PC (TIER-HF-PC) is a novel, nurse coach-led model of PC that integrates PC into HF care. We will compare the effectiveness of TIER-HF-PC against usual care for improving patient and caregiver health outcomes. We will also evaluate implementation outcomes (such as care experience) of TIER-HF-PC.

METHODS AND ANALYSIS

In TIER-HF-PC, patients undergo regular distress screening. The intensity of PC treatments will be tiered based on the severity of problems detected. Minimally, all patients will receive PC education resources. Patients with moderate-intensity needs will receive PC health coaching. Patients with high-intensity needs will receive a PC physician consultation, on top of PC health coaching. Patients in usual care are not screened but can be referred to a PC physician based on cardiologist discretion.We will recruit 240 English- or Mandarin-speaking patients with HF and up to 240 caregivers from 3 sites across 2 cardiac centres. Patients will be randomised in a 1:1 ratio to TIER-HF-PC or usual care. We will use an intention-to-treat approach for data analysis. Our primary outcome is patient QOL on the Kansas City Cardiomyopathy Questionnaire at 24 weeks. Secondary outcomes include patient healthcare utilisation, caregiver QOL and cost-effectiveness. All participants who received PC treatments will receive a service evaluation survey. Additionally, a sample of these participants and their treating healthcare staff will be purposively recruited for in-depth semistructured interviews on their TIER-HF-PC experience. Interviews will be thematically analysed. We will evaluate protocol fidelity through case notes and study process audits.

ETHICS AND DISSEMINATION

This study was approved by the SingHealth Institutional Ethics Review Board-review number: 2024-2213. Results of the study will be disseminated when data analysis is complete.

TRIAL REGISTRATION NUMBER

NCT06244953.

Effects of digital health on symptoms and health-related quality of life in children and adolescent cancer survivors: a meta-analysis and systematic review

OBJECTIVES

To assess the effectiveness of digital health on symptoms and health-related quality of life in children and adolescent cancer survivors.

METHODS

We searched PubMed, Embase, Web of Science, Cochrane Library, and CINAHL databases on July 11, 2024, to identify randomized controlled trials of the impact of digital health on children and adolescent cancer survivors aged 0-19 years. The Cochrane Risk of Bias Tool version 1.0 was used to evaluate the quality of randomized controlled trials. It was registered in PROSPERO with the number CRD42024526347.

RESULTS

A total of 23 randomized controlled trials were included, of which 18 were meta-analyzed. Compared with usual care, digital health interventions can significantly improve pain (SMD = -0.86, 95% CI: -1.21 to -0.51, P < 0.001), nausea and vomiting (SMD = -0.49, 95% CI: -0.97 to -0.02, P = 0.04), anxiety (SMD = -1.05, 95% CI: -1.60 to -0.50, P = 0.0002), distress (SMD = -0.74, 95% CI: -1.07 to -0.41, P < 0.001), fear (MD = -0.91, 95% CI: -1.40 to -0.42, P = 0.0003), and health-related quality of life (SMD = 1.41, 95% CI: 1.11 to 1.70, P < 0.001) in children and adolescent cancer survivors. However, improvements in fatigue and anger were not significant.

CONCLUSIONS

Our systematic review provides evidence that digital health interventions have great potential to improve the symptoms and health-related quality of life of children and adolescent cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Digital technologies to improve symptoms and health-related quality of life in children and adolescent cancer survivors deserve wider application.

A comparative study of nurses' competencies in integrating religion/spirituality into patient care

BACKGROUND

There is a need of research to evaluate and compare the competencies of nurses in integrating patients' religion and spirituality into nursing practice in various settings, including general and psychiatric hospitals. By understanding the competencies of nurses working in different environments, tailored spiritual care training programs can be developed to meet their specific needs. This study aimed to evaluate and compare the competencies of nurses in integrating patients' religion/spirituality into nursing practice in both a general and a psychiatric hospital.

METHODS

This cross-sectional descriptive-analytical study was conducted in two hospitals affiliated with Kerman University of Medical Sciences in southeastern Iran. Quota sampling was used to select 200 nurses (100 nurses from each hospital) in 2023. The Religious/Spiritually Integrated Practice Assessment Scale (RSIPAS) was used to evaluate and compare nurses' competencies in integrating the religion/spirituality of patients into their nursing practice.

RESULTS

The study revealed that nurses' competencies in integrating patients' religion/spirituality into nursing practice were moderate in both general (122.39 ± 19.40) and psychiatric hospitals (110.82 ± 25.63). Nurses in the general hospital had significantly higher competency scores compared to those in the psychiatric hospital (t = 3.59, p = 0.001). The type of hospital, work experience, and the involvement of professionals in providing religion/spirituality care were significant predictors of nurses' competencies in integrating patients' religion/spirituality into clinical practice.

CONCLUSIONS

The moderate levels of competencies among nurses highlight the need for further education and training to effectively integrate patients' religion/spirituality into nursing across various healthcare settings. The type of hospital also influenced their competencies. Therefore, it is crucial for nurses, particularly those working in psychiatric hospitals, to receive training that is tailored to the specific needs, culture, and context of their respective healthcare environments. It is essential to conduct a baseline assessment of nurses' readiness and competencies before implementing appropriate training programs.

Current Research in Drug-Free Cancer Therapies

Cancer treatment has historically depended on conventional methods like chemotherapy, radiation, and surgery; however, these strategies frequently present considerable limitations, including toxicity, resistance, and negative impacts on healthy tissues. In addressing these challenges, drug-free cancer therapies have developed as viable alternatives, utilizing advanced physical and biological methods to specifically target tumor cells while reducing damage to normal tissues. This review examines several drug-free cancer treatment strategies, such as high-intensity focused energy beams, nanosecond pulsed electric fields, and photothermal therapy as well as the use of inorganic nanoparticles to promote selective apoptosis. We also investigate the significance of targeting the tumor microenvironment, precision medicine, and immunotherapy in the progression of personalized cancer therapies. Although these approaches demonstrate significant promise, challenges including scalability, safety, and regulatory obstacles must be resolved for clinical application. This paper presents an overview of current research in drug-free cancer therapies, emphasizing recent advancements, underlying scientific principles, and the steps required for clinical implementation.

The spiritual health and breastfeeding behavior: a cross-sectional correlational study

BACKGROUND

Breastfeeding is the optimal choice for infant health, and spiritual health may assist mothers in adapting to maternal roles, including breastfeeding. This study aimed to evaluate the relationship between spiritual health and breastfeeding behavior among lactating mothers.

METHOD

This cross-sectional study included 400 lactating women who were selected using a multi-stage sampling method. Data collection tools included a socio-demographic and reproductive questionnaire, a spiritual health questionnaire, and a breastfeeding behavior assessment questionnaire. Data analysis was conducted using SPSS V23, incorporating independent t-tests, Pearson and Spearman correlation tests, and multiple linear regression analysis.

RESULTS

The study included 400 women aged 29.36 ± 5.67 years. The mean scores for spiritual health and breastfeeding behavior were 91.66 ± 6.80% and 80.07 ± 9.94%, respectively. Regression analysis revealed that spiritual health (Beta = 0.287, p < 0.01), infant age (Beta = - 0.19, p < 0.01), breastfeeding initiation time (Beta = 0.12, p = 0.009), and nipple care (B = 0.09, p = 0.04) were significant predictors of breastfeeding behavior.

CONCLUSIONS

The study found a positive relationship between spiritual health and breastfeeding behavior among women. Therefore, promoting spiritual health could be considered a strategy to improve breastfeeding behavior in lactating women.

Feasibility, Acceptability, and Potential Effects of a Digital Oral Anticancer Agent Intervention: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Individuals taking oral anticancer agents (OAAs) often face important challenges, requiring more timely informational support, ongoing monitoring, and side effect management.

OBJECTIVE

This study, guided by the Self-Efficacy Theory, aims to assess the feasibility, acceptability, and potential effects of a comprehensive, digital OAA intervention.

METHODS

A 2-arm, mixed methods, pilot randomized controlled trial took place at a large university-affiliated cancer center in Montreal, Quebec, Canada. Participants (N=52) completed baseline self-report e-questionnaires and subsequently were randomly assigned to the experimental group (intervention plus usual care, n=26) or control group (usual care only, n=26). The study intervention, designed to increase medication adherence via medication adherence self-efficacy and decreased symptom distress, included (1) OAA informational videos, (2) OAA-related e-handouts and other supportive resources, (3) nurse-led follow-up calls, and (4) e-reminders to take OAAs. The e-questionnaires were completed once a week for the first month and every 2 weeks for the subsequent 4 months, or until OAA treatment was completed. A subset from both groups (n=20) participated in semistructured interviews once they completed the study requirements. Study feasibility is assessed using recruitment, retention, and response rates, as well as intervention uptake. Through e-questionnaires and exit interviews, intervention acceptability is to be assessed prospectively at baseline and retrospectively upon study completion. Potential effects are then assessed via medication adherence self-efficacy, medication adherence self-report, and symptom distress.

RESULTS

Data collection was completed by December 2023 with a final sample size of 41. Results are expected to be published in 2025.

CONCLUSIONS

This study relies on a theoretically based, OAA digital intervention with modalities tailored to the needs and preferences of participants. The use of quantitative and qualitative methods enriches our understanding of the potential contributions of the intervention. In addition, following participants over the course of treatment captures potential changes in oral treatment-related processes and outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04984850; https://www.clinicaltrials.gov/study/nct04984850.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55475.

Hepatitis B knowledge and stigma in the United Arab Emirates

Globally, there are 1.2 million new chronic Hepatitis B Virus (HBV) infections every year. The UAE is a low-endemic region where no previous studies have explored HBV stigma. This study aims to evaluate the UAE's population HBV knowledge, HBV vaccine attitudes, and stigmatizing attitudes towards the HBV infection. A cross-sectional study was conducted to evaluate knowledge and stigma; the previously-developed and validated stigma scale (Hepatitis B Virus - Stigma Scale, HBV-SS) was used. A total of 601 responses were retained for analysis in both python-3 and R. Chi-squared, Mann-Whitney U and Kruskal-Wallis tests were used for bivariate analyses and ordinary least squares (OLS) regression was used for linear modelling. Confirmatory factor analysis (CFA) was conducted, and goodness-of-fit was evaluated. Overall, 77.5%, (n = 466/601) reported having some knowledge regarding HBV, only 19.3% (n = 90/466) had good knowledge regarding HBV, with most gaps occurring with symptoms, complications, and treatment of the infection. However, 84.03% (n = 505/601) were interested in learning more about the virus. Only 57.6% (n = 346/601) were aware of the existence of the vaccine; however, attitudes to it were overwhelmingly positive. Overall, non-stigmatising attitudes dominated; however, both labelling and separating domains highlighted specific items with highly stigmatising attitudes. CFA showed the HBV-SS model to have acceptable/good goodness-of-fit. OLS identified higher knowledge levels among healthcare workers and those with higher perceived knowledge. Only perceived knowledge was a significant predictor of lower stigma beyond the bivariate level. The UAE population has shown low levels of knowledge but overall non-stigmatising attitudes. It is imperative that campaigns focus on improving general population HBV infection and vaccine knowledge while also solidifying the widespread level of vaccine acceptance and non-stigmatising attitudes.

Enhancing nursing's role in community-based palliative care: closing gaps to improve patient outcomes

BACKGROUND

Nursing-led palliative care is essential for improving the quality of life of patients with life-limiting illnesses by addressing their physical, emotional and social needs. Effective symptom management, facilitated by nursing interventions, plays a critical role in this process.

AIM

This study aimed to evaluate the effectiveness of a community-based palliative care program designed to enhance the role of nursing in closing existing gaps in care.

METHODS

A quasi-experimental design with pre- and post-test assessments was conducted at the Oncology and Palliative Care Unit of Zagazig University Hospitals, Egypt. A convenience sample of 140 adult patients diagnosed with cancer or other life-limiting illnesses was recruited. Data were collected using three standardised instruments: the Palliative Outcome Scale (POS), the Edmonton Symptom Assessment Scale (ESAS) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The community-based palliative care programme was delivered over eight weeks and focused on symptom management, emotional support, educational resources, and social and spiritual care.

RESULTS

The intervention resulted in a significant reduction in symptom severity, with marked improvements in physical symptoms (mean score reduction from 3.5 to 1.0), psychological symptoms (from 5.3 to 2.5), emotional and spiritual needs (from 4.0 to 1.5), all statistically significant (p < 0.001). EORTC QLQ-C30 results showed improved quality of life, with physical functioning scores increasing from 60.0 to 80.0 and emotional functioning scores increasing from 55.0 to 75.0. Participants also reported improved perceptions of social support and general well-being, indicating an overall improvement in quality of life.

CONCLUSION

This study highlights the positive impact of structured, nurse-led community palliative care interventions on patient outcomes and highlights the importance of nursing involvement in community engagement to provide comprehensive support for people with cancer and other life-limiting conditions.

RECOMMENDATIONS

It is recommended that healthcare providers incorporate standardised assessment tools into routine palliative care practice and consider implementing similar community-based care programmes to improve the quality of care for patients with serious illness.

CLINICAL TRIAL

No clinical trial.

Effectiveness of face to face and virtual education to promote breast self-examination based on the theory of planned behavior: a randomized controlled trial study

BACKGROUND

Breast cancer (BC) is the most prevalent cancer among women in both developed and developing countries. Breast self-examination (BSE) is crucial for the early detection of BC. This study aimed to assess the effectiveness of face-to-face and virtual education on BSE, based on the theory of planned behavior (TPB).

METHODS

This randomized controlled trial was conducted on 240 women aged 30-55 in northern Iran from 2020 to 2022. Participants were selected using a random sampling method and were randomly assigned to three groups of 80 each (face to face, virtual, and control). The face to face educational intervention consisted of four consecutive weekly sessions (50 min each), with 20 participants per session. In the virtual training group, all teaching materials were delivered once a week via WhatsApp messenger. The control group did not receive any intervention. All participants completed questionnaires assessing demographic and fertility characteristics, BSE barriers, knowledge, and practice regarding BSE, as well as TPB constructs (attitude, subjective norm, perceived behavioral control, behavioral intention, and behavior) before, one month, and three months after the intervention. Data analysis was performed using SPSS version 23.0. Statistical tests included the chi-square test, t-test, analysis of variance, repeated measures RMANOVA, and Pearson's correlation coefficient. The significance level was set at P < 0.05.

RESULTS

The study results indicated that the mean BSE and TPB constructs increased in both the face to face and virtual education groups one and three months after the intervention (P < 0.001). In the face-to-face group, knowledge one month after the education was correlated with practice at both one and three months post-education (r = 0.304, P = 0.006, and r = 0.232, P = 0.038, respectively). Similarly, in the virtual group, knowledge and practice one month after the education was correlated with knowledge and practice three months post-education (r = 0.814, P = 0.001, and r = 0.722, P = 0.001, respectively).

CONCLUSIONS

The results of this study demonstrated that TPB is an effective theory for promoting BSE. Both face to face and virtual education interventions proved to be successful, with no significant difference between them.

TRIAL REGISTRATION

IRCT20230130057274N4 Date of registration: 2024-04-29 Retrospectively registered.

Development and Validation of a Nomogram Prediction Model for Key Symptoms of Post-Intensive Care Syndrome-Family in Family Members of Critically-Ill Patients: Focusing on Sleep Disturbance, Fatigue, Anxiety, and Depression

Purpose

To construct and validate a nomogram model predicting the risk of post-intensive care syndrome-family (PICS-F) in family members of critically ill patients.

Methods

This study was conducted on family members (parents, spouses, or children) of critically ill patients in the three intensive care units of Binzhou Medical University Hospital from December 2023 to June 2024, responsible for medical decisions and primary care. The sleep disturbances, fatigue, anxiety, and depression were assessed using the Pittsburgh Sleep Quality Index, the Subscale of Fatigue Assessment Instrument, and the Hospital Anxiety and Depression Scale, respectively. Predictive factors were identified through univariate and multivariate logistic regression, and a nomogram was constructed using R4.2.3. Internal validation used the Bootstrap sampling method, and external validation employed the time-period method.

Results

The study involved 567 participants divided into a modeling group (n = 432; median age = 46 years; 209 males, 223 females) and an external validation group (n = 135; median age = 45 years; 70 males, 65 females). The model included five predictive factors: family age, patient age, APACHE II score, average monthly income per family member, and PSSS score. The AUC of the modeling group was 0.894 (0.864 ~ 0.924), with a specificity of 85.4%, a sensitivity of 78.0%, and a maximum Youden index of 0.634. The H-L test revealed a good fit (X 2 value = 9.528, P = 0.300). The internal validation results of the Bootstrap sampling method showed that the calibration curve of the model was close to the ideal curve, and the DCA curve results indicated high clinical practicality. Moreover, the external validation results showed that AUC was 0.847 (0.782 ~ 0.912), with sensitivity and specificity of 74.5% and 86.3%, respectively. The H-L test results indicated a good fit (X 2 value = 9.625, P = 0.292).

Conclusion

The nomogram demonstrated strong predictive performance for PICS-F risk in ICU patients' families, offering a valuable tool for clinical assessment.

Spiritual Well-Being and Spiritual Care Competence: The Mediating Role of Resilience and Decision Fatigue

Purpose: This study aimed to examine the role of resilience and decision fatigue in mediating the relationship between spiritual well-being and spiritual care competence among nurses. Methods: A cross-sectional design was utilized. The study recruited 538 registered nurses from four referral hospitals in Jordan. Data were analyzed using descriptive statistics, Pearson's correlation, and Hayes Macro PROCESS model 6. Results: The average age of the 538 nurses was 35.75 years; 62.1% were female, and 96.6% were married. Bivariate correlations showed moderate correlations among all study variables. Decision fatigue negatively correlated with spiritual care competence, spiritual well-being, and resilience. The regression model indicated that spiritual well-being, resilience, and decision fatigue significantly predicted spiritual care competence, explaining about half of its variance. The bootstrapping analysis revealed that resilience significantly mediated the relationship between spiritual well-being and spiritual care competence, while the mediation role of decision fatigue was not significant. Conclusion: The study underscores the importance of spiritual well-being and resilience in enhancing nurses' spiritual care competence, aligning with the overarching goals of holistic nursing in creating a healing environment for both patients and caregivers. Nurse managers and educators should implement interventions to improve nurses' spiritual well-being and resilience, enhancing holistic care delivery.

Cachexia in oral squamous cell carcinoma Sudanese patients: an exploratory study

BACKGROUND

Cachexia status is a drastic issue in cancer patients. The main goal of this study; which is considered the first of its kind in Sudan, was to enhance our understanding of the clinical implications of oral cancer cachexia. Newly diagnosed Sudanese patients with oral squamous cell carcinoma (OSCC) were evaluated for the incidence and impact of cachexia.

METHODS

This is a longitudinal descriptive study conducted at Khartoum Teaching Dental Hospital before April 2023. A number of 40 OSCC participants above 18 years old were analyzed for Cachexia based on weight loss, low hemoglobin levels, albumin levels, elevated C-reactive protein, decreased mid-upper arm circumference, loss of appetite, and anorexia. Data were collected over three visits, and analyzed using descriptive and bivariate statistics.

RESULTS

The study included 40 newly diagnosed patients with OSCC, with a mean of age 56.8 years. The incidence of cachexia was 33.2% before surgery, 55% one month postoperatively, and 65% six months later. Cachexia was significantly correlated (p < 0.05) with delayed wound healing (p = 0.008), prolonged nasogastric feeding tube usage (p = 0.023), interrupted adjuvant therapy (p = 0.003), and mortality (p = 0.007). Low BMI, loss of appetite, food intake, low hemoglobin, and elevated CRP were significant diagnostic criteria as well (p < 0.05).

CONCLUSIONS

In this study, Cachexia was found to be a critical prognostic factor for OSCC patients. Larger-scale clinical research in Sudan is needed to provide definitive findings and strategies to support nutritional status during therapy.

Self-management behaviors in patients undergoing radical prostatectomy: A structural equation model

PURPOSE

To investigate factors influencing self-management behaviors in post-radical prostate cancer patients' behaviors grounded on the Integrated Theory of Health Behaviour Change and to clarify the interactions among these factors.

METHODS

In a cross-sectional study, 281 patients were recruited at The First Hospital of Wenzhou Medical University in China between December 2023 and April 2024. Illness perception, social support, self-regulation and self-management were assessed through Chinese versions of the Brief Illness Perception Questionnaire (BIPQ), Medical Outcome Study Social Support Survey-Chinese (MOS-SSS-C), Treatment Self-regulation Questionnaire (TSRQ) and The Cancer Patient Self-management Assessment Scale. Structural equations were used to explore the relationship between the four variables.

RESULTS

The final structural model using the Integrated Theory of Health Behaviour Change showed a suitable fit (RMSEA = 0.073, CMIN/DF = 2.482). Illness perception directly affected self-management (β = -0.416, P < 0.05) and indirectly affected self-management through self-regulation (β = 0.269, P < 0.05). Self-regulation directly affected self-management (β = 0.453, P < 0.05). Social support indirectly affected self-management (β = 0.225, P < 0.05). These variables contributed to 62.9 % of the variability in self-management behaviors among patients after radical prostate cancer treatment.

CONCLUSIONS

The present study suggested a model can be useful in better understanding self-management in post-radical prostate cancer patients. Besides, these patients experience bad self-management. Illness perception and social support can affect post-radical prostate cancer patients' self-management directly and indirectly through self-regulation.

A nomogram for predicting cancer-related cognitive impairment in lung cancer patients from a nursing science precision health model perspective

PURPOSE

The nursing science precision health (NSPH) model considers identifying the biological basis of symptoms in order to develop precise intervention strategies that ultimately improve the overall health of the symptomatic individual. This study sought to construct a nomogram for predicting cancer-related cognitive impairment (CRCI) in patients with lung cancer within the context of the NSPH model.

METHODS

A cohort of 252 patients with lung cancer was prospectively collected and randomly divided into training and validation cohorts in a 7:3 ratio. The least absolute shrinkage and selection operator (LASSO) regression method optimized variable selection, followed by multivariate logistic regression to develop a model, which subsequently formed the basis for the nomogram. The nomogram's discrimination and calibration were evaluated using a calibration plot, the Hosmer-Lemeshow test, and the receiver operating characteristic curve (ROC). Decision curve analysis (DCA) quantified the net benefits of the nomogram across various threshold probabilities.

RESULTS

Five pivotal variables were incorporated into the nomogram: age (≥ 65 years), treatment, education level, albumin, and platelet-to-lymphocyte ratio (PLR). The area under the ROC curve (0.970 for the training cohort and 0.973 for the validation cohort) demonstrated the nomogram's excellent discriminative ability. Calibration curves closely aligning with ideal curves indicated accurate predictive capability. Moreover, the nomogram exhibited a positive net benefit for predicted probability thresholds ranging from 1 to 98% in DCA.

CONCLUSION

Key risk factors, including advanced age (≥ 65 years), low education level, combined chemotherapy, low albumin, and high PLR, were significantly associated with higher CRCI incidence. This nomogram model has good performance and can help identify CRCI with high accuracy in lung cancer patients.

Quality of Life and Age-Related Predictor Symptoms in Breast Cancer Survivors Undergoing Hormone Therapy: A Study from the Northern Region of Morocco

Objective

The aim of this study was to assess the health-related quality of life (HRQoL) of breast cancer (BC) survivors during adjuvant hormone therapy (AHT) as a function of age and to identify predictor symptoms.

Materials and Methods

The study was based on a cross-sectional survey of 216 BC survivors undergoing AHT, in the Northern Region of Morocco. HRQoL was assessed using a validated HRQoL questionnaire, the Functional Assessment of Cancer Treatment (FACT-ES). Multiple linear regression analysis was used to identify predictor symptoms for the subscales of the FACT-ES.

Results

Younger women (<45 years) had lower scores on the emotional well-being subscale (p = 0.021). Irritability (b: -0.786; p = 0.001) and mood swings (b: -0.835; p = 0.031) were the strongest negative predictors of emotional quality of life. In both age groups, items related to social support had a positive effect on survivors' social HRQoL (p<0.05).

Conclusion

BC survivors' HRQoL during AHT differed by age group. Emotional problems negatively influenced HRQoL in younger women. Knowledge of the symptoms that predict HRQoL in BC survivors may help clinicians develop personalized interventions.

Expression of inflammatory states in response to psychological distress in breast cancer survivors and its relationship to subjective memory function complaints

BACKGROUND

Breast cancer (BC) survivors frequently endure psychological distress following chemotherapy, with subjective memory decline being a prevalent aspect of chemotherapy-related cognitive impairment (CRCI). This study aimed to assess the influence of psychological distress on subjective memory decline in BC survivors with CRCI and investigate potential underlying mechanisms.

METHODS

A total of 104 BC survivors who had completed chemotherapy were categorized based on the distress thermometer (DT) score into a no-psychological distress group (NPD group, n = 51) and a psychological distress group (PD group, n = 53). The groups were compared using the Mini-Mental State Examination (MMSE), the Prospective and Retrospective Memory (PM and RM) Questionnaire (PRMQ), cytokine levels (of interleukin-1β [IL-1β], tumor necrosis factor-alpha [TNF-α], and IL-4), and inflammatory markers (neutrophil-to- lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], monocyte count-to-lymphocyte ratio [MLR], granulocyte-to-lymphocyte ratio [GLR], and systemic immune-inflammation index [SII]). Mediation analysis was performed to explore whether cytokine and inflammatory marker levels mediate the effect of psychological distress on subjective memory function complaints.

RESULTS

The NPD group performed significantly better in the PD group both RM (z = -3.370, p = 0.001) and PM (z = -1.967, p = 0.049). The IL-1β levels were substantially higher in the PD group than in the NPD group (z = -2.920, p = 0.004). Similarly, NLR (z = -2.585, p = 0.010), GLR (z = -2.858, p = 0.004), and SII (z = -2.747, p = 0.006) were higher in the PD group. Mediation analysis revealed that IL-1β partially mediated the relationship between DT and RM (β = 0.019, p = 0.007), while SII fully mediated the relationship between DT and PM (β = 0.003, p = 0.017).

CONCLUSION

BC survivors experiencing psychological distress exhibited worse subjective memory and elevated levels of IL-1β, NLR, GLR, and SII. These findings suggest that inflammation may be a cause of subjective memory function complaints in BC survivors with psychological distress.

Core preoperative symptoms and patients' symptom experiences in oral cancer: a mixed-methods study

AIMS

Patients with oral cancer frequently experience a substantial symptom burden, especially during the preoperative phase, which is typically marked by increased anxiety, pain, and functional impairments. This study aimed to construct contemporaneous symptom networks and investigate symptom experiences of patients with preoperative oral cancer in China.

METHODS

This study employed a mixed-methods design that integrated a cross-sectional study with qualitative research. Data were collected from 527 patients with oral cancer at the Department of Head and Neck Oncology in a tertiary hospital between September 2023 and May 2024 in China. The MD Anderson Symptom Inventory for Head and Neck Cancer (MDASI-H&N) was used to assess the prevalence and severity of the cancer-related symptoms. Symptom networks were constructed using the networktools, qgraph, and Bootnet packages in R, with centrality indices calculated to identify core symptoms within the network. Qualitative data were analyzed using content analysis with NVivo software to extract themes, thereby providing a comprehensive understanding of patients' symptom experiences.

RESULTS

Distress (89.56%) and sadness (63.95%) were the most prevalent and severe symptoms, respectively. Two distinct symptom clusters emerged: the Emotional-Sleep Symptoms Cluster (Cluster 1) and Eating Disorder Symptoms Cluster (Cluster 2). Difficulty swallowing or chewing (rs = 0.87, rb = 102) and disturbed sleep (rs = 0.64, rb = 77) exhibited the highest centrality indices, indicating that these symptoms were more likely to co-occur with others within the network. Additionally, fatigue had the most significant negative impact on quality of life (r =  - 0.16).

CONCLUSION

This study identified core symptoms through preoperative symptom network analysis and offered valuable insights into the lived experiences of patients with oral cancer regarding their symptoms. These findings serve as a foundation for personalized targeted treatment strategies designed to improve symptom management and enhance quality of life in oral cancer care.

The patient enablement instrument for back pain turkish version, validity and reliability study

BackgroundThe only survey that assesses the ability of individuals with low back pain to self-manage their condition is the Patient Enablement Instrument for Back Pain (PEI-BP).ObjectiveThe study aims to create a Turkish version of PEI-BP and test its validity and reliability.Methods67 individuals (47 females, 20 males) with low back pain participated, comprising. Reliability was evaluated through test-retest reliability, internal consistency, and repeatability measures. Validity was assessed via structural, content, face validity analyses. Floor and ceiling effects were examined to ensure a comprehensive evaluation. Additionally, the relationship between PEI-BP and pain intensity, Brief Illness Perception Questionnaire (BIPQ), Fear Avoidance Beliefs Questionnaire (FABQ), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) was explored.ResultsThe Intraclass Correlation Coefficient value (0.795) and Cronbach's α (0.886) of PEI-BP were high. The goodness-of-fit values for the model, including fit indices and reference ranges, indicated strong validity. The PEI-BP demonstrated the absence of both floor and ceiling effects. Correlations between PEI-BP and pain intensity, BIPQ, FABQ, ODI, and SF-36 exhibited a range from weak to good (0.258 to -0.440).ConclusionsPEI-BP has demonstrated high reliability and good validity. PEI-BP can be used to evaluate Turkish-speaking individuals with low back pain.ClinicalTrials.gov ID: NCT06109246 (Date: 10/25/2023).

Multimodal interventions for cachexia management

BACKGROUND

Cachexia (disease-related wasting) is a complex metabolic syndrome which occurs in people with chronic illnesses, including cancer, HIV/AIDS, kidney disease, heart disease, and chronic obstructive pulmonary disease (COPD). People with cachexia experience unintentional weight loss, muscle loss, fatigue, loss of appetite, and reduced quality of life. Multimodal interventions which work synergistically to treat the syndrome could lead to benefits.

OBJECTIVES

To assess the benefits and harms of multimodal interventions aimed at alleviating or stabilising cachexia in people with a chronic illness.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsycINFO, and two trials registers in July 2024, together with reference checking, citation searching, and contact with study authors to identify studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) in adults with or at risk of cachexia, comparing multimodal interventions combining two or more modalities (of pharmacology, nutrition, exercise) to treatment as usual, variation of the intervention, or unimodal intervention.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened potentially eligible studies, extracted data, and assessed risk of bias (RoB 1). Primary outcomes were physical function, strength, and adverse events. Secondary outcomes were body composition and weight, quality of life (QoL), appetite, fatigue, and biochemical markers. We assessed the certainty of evidence with GRADE.

MAIN RESULTS

We included nine studies with 926 adults (mean age: 63 years). Study sample sizes ranged from 20 to 332 participants. Six studies were conducted in Europe, and one each in Turkey, New Zealand, and the USA. There were six studies in people with cancer, and one each in people with COPD, chronic kidney disease, and HIV/AIDS. We judged four studies to be at an overall high risk of bias, and five at an overall unclear risk. All outcomes in all comparisons had very low-certainty evidence, downgraded once for risk of bias and/or indirectness and twice for imprecision. Multimodal intervention (pharmacological, nutritional, and/or exercise) compared to treatment as usual One cancer study randomised 46 participants, with 41 included in all analyses except adverse events. The study assessed outcomes immediately after treatment, lasting six weeks. Compared to treatment as usual, there is no clear evidence for an effect of a multimodal intervention on: physical function (mean difference (MD) -16.10 m, 95% confidence interval (CI) -79.06 to 46.86; 41 participants); strength (MD 3.80 kg, 95% CI -3.21 to 10.81; 41 participants); adverse events (risk ratio (RR) 1.36, 95% CI 0.70 to 2.65; 46 participants); body composition (MD 7.89 cm2, 95% CI -10.43 to 26.21; 41 participants); weight (MD 5.89 kg, 95% CI -1.45 to 13.23; 41 participants); appetite (MD 0.68 points, 95% CI -0.60 to 1.96; 41 participants); fatigue (MD 0.12, 95% CI -1.05 to 1.29; 41 participants); and biochemical markers (MD 2%, 95% CI 0.99 to 3.01; 41 participants), but the evidence was very uncertain; QoL was not reported. Multimodal intervention compared to variation of the intervention Three cancer studies and one HIV/AIDS study randomised 192 participants. We could not use the available data, nor obtain additional data, from two studies (one in cancer, one in HIV/AIDS). The studies assessed outcomes immediately after treatment, ranging from three to seven months. Compared to a variation of the intervention, there is no clear evidence for an effect of a multimodal intervention on: physical function (MD 10.0 m, 95% CI -36.27 to 56.27; 1 study, 56 participants); strength (MD 0.7 kg, 95% CI -3.75 to 5.15; 1 study, 56 participants); adverse events (RR 0.87, 95% CI 0.38 to 2.02; P = 0.75, I2 = 0%; 2 studies, 95 participants); body composition (MD -2.67 kg, 95% CI -5.89 to 0.54; P = 0.10, I2 = 0%; 2 studies, 95 participants); weight (MD -2.47 kg, 95% CI -7.11 to 2.16; P = 0.30, I2 = 0%; 2 studies, 95 participants); QoL (standardised mean difference (SMD) -0.15, 95% CI -0.55 to 0.26; P = 0.47, I2 = 0%; 2 studies, 95 participants); appetite (SMD -0.34, 95% CI -1.27 to 0.59; P = 0.48, I2 = 79%; 2 studies, 95 participants); fatigue (MD 6.40 points, 95% CI -1.10 to 13.90; 1 study, 56 participants); or biochemical markers (MD 9.80 pg/mL, 95% CI -6.25 to 25.85; P = 0.23, I2 = 73%; 2 studies, 95 participants), but the evidence is very uncertain. Multimodal intervention compared to unimodal intervention We included six studies (802 participants) in this comparison: three cancer studies, and one each in people with COPD, chronic kidney disease, and HIV/AIDS. The studies assessed outcomes immediately after treatment, ranging from three to seven months. We could not use the available data, nor obtain additional data, from the HIV/AIDS study. Compared to a unimodal intervention, there is no clear evidence for an effect of a multimodal intervention on: physical function (SMD 0.02, 95% CI -0.22 to 0.26; P = 0.86, I2 = 0%; 2 studies, 348 participants); strength (SMD 0.23, 95% CI -0.81 to 1.27; P = 0.66, I2 = 0%; 2 studies, 348 participants); adverse events (RR 0.87, 95% CI -0.43 to 1.73; P = 0.68, I2 = 45%; 2 studies, 395 participants); body composition (SMD 0.11, 95% CI -0.28 to 0.50; P = 0.58, I2 = 74%; 5 studies, 742 participants); body weight (SMD -0.02, 95% CI -0.38 to 0.33; P = 0.90, I2 = 49%; 4 studies, 431 participants); QoL (SMD 0.22, 95% CI -0.29 to 0.73; P = 0.39, I2 = 61%; 3 studies, 411 participants); appetite (SMD -0.09, 95% CI -0.58 to 0.40; P = 0.72, I2 = 58%; 2 studies, 395 participants); fatigue (MD -6.80 points, 95% CI -12.44 to -1.17; 1 study, 244 participants); and biochemical markers (SMD 0.11, 95% CI -0.59 to 0.80; P = 0.76, I2 = 79%; 3 studies, 411 participants), but the evidence is very uncertain.

AUTHORS' CONCLUSIONS

The review found insufficient evidence to support or refute the use of multimodal interventions in managing cachexia. The certainty of the evidence was very low. Methodologically rigorous, well-powered RCTs with adequate interaction times are needed to assess the effectiveness of multimodal interventions in managing cachexia across chronic illnesses.

Nurses' lived experiences of self-control in emergency settings: a qualitative study

BACKGROUND

Given nurses' vital role in emergencies, it is essential to understand their perceptions and strategies for self-control. This study examines nurses' experiences and insights regarding self-control during high-pressure scenarios. The findings could inform the development of effective stress management strategies and enhance nursing training programs, ultimately improving patients' overall quality of care.

METHODS

This study utilized a qualitative, descriptive design with a content analysis approach. Data was collected through semi-structured interviews with 24 nurses in various wards of five university-affiliated hospitals, including [specific wards, e.g., emergency, intensive care, internal, etc.]. The nurses were selected using a purposive sampling technique, and the data were analyzed through qualitative content analysis.

FINDINGS

Nurses' lived experiences and understanding of self-control in emergencies revealed three main categories, each comprising several sub-categories: Managing Emotional Intelligence in Crisis Situations (Emotion Regulation in Critical Situations, Using Resources and Experiences for Emotion Management, and Control of Individual Emotions), Adherence to Principles in Crisis Situations (Compliance with Ethical Standards, Ethical Decision-Making, Patient-Centered Focus, and Effective Communication), and Self-Control in Managing Stress and Fatigue (Fatigue Management and Interpersonal Interaction and Collaboration).

CONCLUSION

This study highlights the importance of self-control for nurses working in high-stress environments. It emphasizes that enhancing emotional intelligence, adhering to professional standards, and effectively managing stress are crucial for overcoming workplace challenges. These factors not only foster resilience but also support self-control, which is essential for maintaining composure and making informed decisions during emergencies. The findings advocate for creating supportive work environments and implementing evidence-based policies to improve nurses' self-control skills, ultimately leading to better patient outcomes. These insights can guide enhancements in nursing education and overall care quality.

Pain Self-Management Behaviors in Breast Cancer Survivors Six Months Post-Primary Treatment: A Mixed-Methods, Descriptive Study

Background/Objectives: One-third of breast cancer (BC) survivors experience chronic treatment-related pain (CTP) that requires multimodal management strategies, which may include pain self-management behaviors (PSMBs). Most studies exploring PSMBs focus on patients with advanced cancer, who may differ from survivors in their pain management needs and access to resources. This mixed-methods study explored PSMBs of survivors of BC, referral sources, and goals for pain relief, and examined the relationship between PSMB engagement and pain intensity/interference. Methods: Survivors of BC who were six months post-treatment completed measures assessing their pain intensity/interference and PSMB engagement. Purposive sampling identified a subset of participants who completed interviews, which were analyzed using thematic analysis. Results: Participants (n = 60) were 60 ± 10 years old. Worst Pain Intensity and Pain Interference were 3.93 ± 2.36 and 2.09 ± 2.11, respectively. Participants engaged in 7 ± 3.5 PSMBs. The most common were walking (76%) and distraction (76%). PSMBs described in the interviews (n = 10) were arm stretching and strengthening exercises, seeking specialized pain management services, and avoidance. Most PSMBs were self-directed or suggested by friends. All pain relief goals were to minimize pain interference. PSMB engagement was not associated with Worst, Least, or Average Pain Intensity (all rs ≤ -0.2, p ≥ 0.05) but was associated with Pain Interference (rs = 0.3, p ≤ 0.01). Conclusions: The survivors of BC engaged in many PSMBs, with varying levels of effectiveness and a varying quality of supporting evidence. Most PSMBs were self-directed and some required intervention from healthcare providers or other people, while others required access to limited specialized pain management services.

Mediating and moderating roles of individual resilience, caring ability and social support: a cross-sectional study on the association between family resilience and caregiving burden among primary family caregivers of cancer patients in China

OBJECTIVES

This study aimed to evaluate the caregiving burden among primary caregivers of cancer patients, clarify the relationship between family resilience and caregiving burden, and explore the mediation and moderation effects.

DESIGN

A cross-sectional study design was used.

SETTING

The study was conducted at a specialised tumour hospital in Harbin, China.

PARTICIPANTS

The study included a sample of 402 primary family caregivers of patients with cancer. Ultimately, 367 participants completed valid questionnaires, yielding a response rate of 91.2%.

OUTCOME MEASURES

Participants completed scales evaluating caregiving burden, caring abilities, individual resilience, family resilience and social support. We performed structural equation modelling to analyse mediation and moderation effects.

RESULTS

Out of 367 responses, approximately 50% of primary family caregivers reported moderate to severe caregiving burden. Family resilience was found to reduce caregiving burden (β=-0.386, p=0.005), while individual resilience fully mediated the relationship between family resilience and caregiving burden (95% CI -0.659 to -0.161). Caring ability moderated both the first and second halves of the mediating path. Furthermore, social support doubly moderated the moderating role of caring ability in both the first and second halves of the mediating path.

CONCLUSIONS

This study demonstrated the mediating role of individual resilience and the moderating roles of caring ability and social support in the relationship between family resilience and caregiving burden. We suggest that medical institutions should enhance caregiving training and psychological counselling services. Additionally, the government should collaborate with medical institutions and social organisations to improve social welfare policies and the medical insurance system.

What services are available for culturally and linguistically diverse (CALD) patients in the cancer survivorship setting? An Australian study

PURPOSE

People of Culturally and Linguistically Diverse (CALD) backgrounds face disparities in cancer care. This study aimed to explore CALD-specific Cancer Survivorship (CS) resources and supports in Australian oncology centres.

METHODS

This was an interview-based, qualitative study. Oncology professionals were interviewed using a questionnaire exploring demographics, available resources and referral patterns, and factors influencing CALD CS care. Purposive sampling was used to ensure representation across states and remoteness areas. Contextual survey data were analysed with descriptive statistics, and interviews were recorded and transcribed for thematic analysis.

RESULTS

Twenty-two interviews from 15 institutions across 6 Australian states were conducted from May to August 2023. Six (40%) centres reported seeing > 25% CALD patients. Six (40%) centres reported having dedicated CS services dichotomised into clinic-based or needs-based services. Ten (67%) centres reported having CALD-specific resources/supports for oncology patients, and three (20%) had CS-specific services. Four themes were identified: patient-clinician interface; in-language resources with a focus on cultural relevance; structural and logistical considerations, particularly interpreter services, workflow management and models of care; and education and collaboration between healthcare professionals and survivors, carers and community leaders.

CONCLUSIONS

Cancer survivors from CALD backgrounds face unique challenges in receiving optimal care, with limited availability of CALD-specific resources in Australian cancer centres. Future work should utilise a tailored and collaborative approach to optimise cultural relevance and service engagement.

[Nursing management of malignant wounds]

Malignant wounds affect 5 to 10% of patients with metastatic cancer. The management of symptoms (hemorrhage, odors, exudates, pain) linked to the presence of these lesions is sometimes complex and requires a multidisciplinary approach, where everyone acts in complementarity. Local solutions can be proposed for each local symptom. The nurse must strive to develop for each patient a wound care protocol that is always as simple as possible and allows for home care-hospital continuity. Care protocols must be frequently readjusted based on wound fluctuations. Nursing care is not limited to wound care, it includes monitoring the risks and the global condition of the patient, in particular the nutritional state and the functional and psychological consequences linked to the presence of the malignant wound.

The impact of depression on the quality of life of lung cancer patients undergoing chemotherapy: mediating effects of perceived social support

Background

Quality of life (QOL) in patients undergoing chemotherapy for lung cancer has been a key research area. Numerous studies have examined the relationships among depression, perceived social support (PSS), and QOL. However, the mechanisms underlying PSS in lung cancer patients receiving chemotherapy remain underexplored.

Objective

To investigate the mediating role of PSS in the relationship between depression and QOL in lung cancer patients undergoing chemotherapy.

Methods

A convenience sample of 390 lung cancer patients undergoing chemotherapy was selected from the outpatient clinics and wards of the Department of Oncology at a tertiary hospital in Deyang City between January 2024 and June 2024. Participants completed a general information questionnaire, Self-Rating Depression Scale (SDS), Multidimensional Scale of Perceived Social Support (MPSSS), and Functional Assessment of Cancer Therapy-Lung Cancer (FACT-L) scale. SPSS 26.0 was used to analyze correlations between depression, PSS, and QOL, while AMOS 26.0 assessed the mediating effect of PSS on the relationship between depression and QOL.

Results

The mean scores for depression, PSS, and QOL were 39.79 ± 11.63, 68.96 ± 13.09, and 66.43 ± 23.67, respectively. Pearson's correlation analysis showed that depression was negatively correlated with QOL (r = -0.319, P < 0.001) and positively correlated with PSS (r = -0.484, P < 0.001). Additionally, PSS was positively correlated with QOL (r = 0.349, P < 0.001). PSS partially mediated the relationship between depression and QOL, with a mediating effect value of -0.165, accounting for 50.3% of the total effect.

Conclusion

Depression in lung cancer patients undergoing chemotherapy directly impacts QOL and indirectly affects it through PSS. Clinically, healthcare providers should address depression in these patients and offer psychological support and interventions as needed. Additionally, medical institutions can implement targeted strategies to help patients build a strong social support system, reduce negative emotions, enhance psychological well-being, and improve overall QOL.

The effect of mindfulness-based nursing support on the psychosocial status of women receiving infertility treatment: a randomized controlled trial

BACKGROUND

This study aimed to evaluate the effect of mindfulness-based support on the psychosocial status of women undergoing infertility treatment.

METHOD

The study was conducted with 34 women who were about to start in vitro fertilization (IVF) and met the inclusion criteria. Participants were randomly assigned to either the experimental group (n = 17) or the control group (n = 17) using random number sequences generated on " http://www.random.org . This process accounted for potential participant loss and was implemented in the order of participation. When cases withdrew, new participants were assigned based on the random sequence. All participants were women over the age of 18, literate, and users of smartphones. The experimental group used the IVFmind mobile application, specially developed for this study to facilitate mindfulness practices for infertility treatment. Psychosocial status was assessed using the Mindfulness Attention Awareness Scale, Infertility Self-Efficacy Scale-Short Form, Infertility Adjustment Scale, and Depression Anxiety Stress Scale. Data were collected through pre-tests and post-tests, and statistical analyses were performed.

RESULTS

There were no significant differences between the experimental and control groups in terms of socio-demographic characteristics and infertility-related factors (p > 0.05). Mindfulness Attention Awareness Scale: No significant difference was found between groups in the pre-test scores (U = 120,000, p = 0.398). However, post-test scores of the experimental group were significantly higher than those of the control group (U = 0.000, p < 0.001). Infertility Self-Efficacy Scale-Short Form: No significant difference was found between groups in the pre-test scores (U = 125,500, p = 0.503). In the post-test, the experimental group scored significantly higher than the control group (U = 0.000, p < 0.001). Infertility Adjustment Scale: Pre-test scores showed no significant differences between the groups (U = 106,500, p = 0.184). In the post-test, the experimental group had significantly lower scores compared to the control group, indicating better adjustment (U = 3,000, p < 0.001). Depression Anxiety Stress Scale: There was no significant difference between the groups in the pre-test scores (U = 141,000, p = 0.904). However, post-test scores of the experimental group were significantly lower than those of the control group (U = 56,500, p = 0.002).

CONCLUSIONS

The mindfulness-based mobile application positively impacted the psychosocial status of women undergoing infertility treatment, demonstrating significant improvements. The experimental group showed notable increases in mindfulness, self-efficacy, and adjustment levels, along with significant reductions in depression and anxiety. These results highlight the effectiveness of mindfulness-based interventions in addressing psychological challenges associated with infertility and suggest that mobile applications can be a valuable tool for supporting mental health in this context.

TRIAL REGISTRATION

The research was registered on http://clinicaltrials.gov (ID: NCT05708937). Date of Registration: 01\24\2023.

Quantitative evaluation of radiation-induced heart disease in beagle dogs by speckle tracking echocardiography

OBJECTIVE

This study aimed to detect early changes in left ventricular systolic function in Beagle dogs after radiotherapy using two-dimensional speckle tracking echocardiography and to explore its potential value in evaluating radiation-induced heart disease.

METHODS

Thirty-six Beagle dogs were randomized into a control group (n = 18) and an irradiation group (n = 18). The irradiation group received a single dose of 20 Gy to the left ventricular anterior wall, while controls underwent sham irradiation. Conventional echocardiography and 2D speckle tracking echocardiography were performed at baseline and 3, 6, and 12 months post-procedure. Additionally, six dogs were randomly selected from each group and euthanized at 3-, 6-, and 12-month post-irradiation, and their hearts were collected for histopathological testing.

RESULTS

In the irradiation group, the global longitudinal strain of the left ventricle and regional strain in the irradiated area were significantly reduced versus baseline and controls by 3 months, with progressive decline at 6 and 12 months. Strain reduction correlated spatially with pathological injury. Conversely, there were no substantial differences in conventional echocardiographic parameters between the groups after 3 months. Conventional parameters (e.g., LVEF) showed differences only at later timepoints. Histopathology revealed progressive cardiomyocyte damage, fibrosis, and microvascular injury in irradiated regions, extending to the posterior wall by 12 months.

CONCLUSION

Two-dimensional speckle tracking echocardiography-derived strain parameters spatially correlate with radiation-induced pathological changes and detect subtle systolic dysfunction prior to irreversible remodeling. Speckle tracking may localize regions of peak radiation dose delivery.

The role of disease duration in the use of complementary and integrative medicine for cancer-related fatigue: a cross-sectional study

PURPOSE

This study aimed to assess the use of complementary and integrative medicine among cancer patients in Turkey for managing fatigue and to examine the moderating effect of disease duration on the relationship between fatigue levels and patients' attitudes toward complementary and integrative medicine.

METHODS

A cross-sectional study was conducted with 231 cancer patients recruited from a chemotherapy center in western Turkey. Participants completed sociodemographic forms, the Holistic Complementary and Alternative Medicine Questionnaire, and the Visual Analog Scale for Fatigue. Data were analyzed using linear regression and moderation analysis.

RESULTS

Among the participants, 38.5% reported using complementary and integrative medicine to manage fatigue, with biologically based treatments such as vitamin supplements and herbal tea being the most common. Regression analysis showed that younger age (p < 0.05), longer disease duration (p = 0.005), absence of complementary and integrative medicine-related complications (p < 0.001), and higher fatigue levels (p < 0.001) were significant predictors of positive attitudes toward complementary and integrative medicine. Additionally, disease duration moderated the relationship between fatigue levels and attitudes toward complementary and integrative medicine, with longer disease duration strengthening the association (B =  - 0.269, SE = 0.078, p = 0.001).

CONCLUSION

The findings suggest that fatigue and prolonged disease duration significantly influence cancer patients' attitudes toward complementary and integrative medicine. Given the increasing use of complementary and integrative medicine, healthcare professionals should provide evidence-based guidance to ensure its safe and effective use. Future research should explore the long-term effects of complementary and integrative medicine on cancer-related fatigue.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the importance of addressing cancer-related fatigue and recognizing the growing use of complementary and integrative medicine among cancer patients.

PATIENT OR PUBLIC CONTRIBUTION

Patients were invited to complete questionnaires. Investigators explained the study's objectives and content and addressed any concerns raised during data collection.

A Study of Skin Cancer Knowledge, Attitudes, and Preventive Practices Among Healthcare Professionals and the General Population in Pakistan: Insights for Healthcare Interventions and Policy Development

Background: Skin cancer is a major global health issue that can be life-threatening. The current study explores the knowledge, attitudes, and practices of healthcare professionals and the general population regarding skin cancer. Method: A cross-sectional study was conducted between January and June 2023 in Lahore, the second-largest city in Pakistan. A total of 407 respondents from the general population and 230 healthcare professionals were recruited using a convenient and snowball sampling technique, respectively. Data were collected using questionnaires and statistical analysis, including chi-square tests, and bivariate logistic regression was performed using SPSS Version 20. Result: In the overall population, 46.4% identified as male, 45.0% as female, and 8.6% chose not to disclose their gender. Significantly differing levels of skin cancer knowledge were observed between genders, with males reporting a higher knowledge (36.4%, crude odds ratio = 1.413, p < 0.001) compared to females (32.9%). In addition, females displayed a more positive attitude (crude odds ratio = 1.874, p < 0.001) and practice (crude odds ratio = 1.401, p < 0.05) toward skin cancer prevention. Furthermore, younger age groups exhibited greater knowledge, attitudes, and practices regarding skin cancer. Education and employment status also have a direct influence on skin cancer knowledge and practices. Moreover, in the current study, healthcare professionals comprised 61.3% physicians, 16.5% nurses, and 22.2% pharmacists. Among these, 37.3% of physicians, 11.3% of nurses, and 12.6% of pharmacists demonstrated the ability to identify common signs and symptoms of skin cancer in a patient (p < 0.001). Furthermore, 44% of physicians regarded regular skin cancer screenings as "very important" (p < 0.01). In addition, 27.4% of physicians and 8.7% of pharmacists exhibited a positive attitude toward regular screening of at-risk patients (p < 0.05). Conclusion: The current study highlights gender and age disparities in skin cancer knowledge and prevention among the general population, emphasizing the need for targeted public health interventions to enhance knowledge and proactive practices. In addition, among healthcare professionals, it reveals variations in knowledge levels, emphasizing the importance of tailored education initiatives to promote consistent skin cancer prevention and management practices within the healthcare community.

More than "hematology": a qualitative study on the experience of hematologists treating people with blood cancer in Greece

PURPOSE

The present study aims to investigate the experiences of hematologists providing care to patients with hematological malignancies, whose care is pertinent to oncology.

METHODS

Semi-structured interviews with 30 hematologists across Greece were conducted. The interviews took place over the course of 6 months at 2020. Reflexive thematic analysis was employed for data analysis.

RESULTS

Three key themes (personal impact, organizational framework, and relating to patients) and eight subthemes were generated: (1) Hematologists were greatly affected on a personal level, as they had poor life-work balance and impacted social relationships. They experienced a great emotional toll, sometimes questioning the meaning of their work. They frequently struggled with loss, by witnessing people's passing. Nevertheless, they reported coping better over time. (2) On an organizational level, hematologists supported each other emotionally, but only rarely had formal support in managerial or administrative recourses. They were also hindered by structural restraints, both in terms of limited psychosocial training and supportive services. (3) Hematologists' relationship with their patients increased their job satisfaction. However, they strived to keep boundaries while balancing how close they got to their patients.

CONCLUSION

High job demands, organizational shortcomings, and emotional challenges negatively impact their well-being and pose the risk of developing compassion fatigue or burnout. At the same time, individual resources, teamwork, and strong personal relationships emerged as crucial coping elements, providing meaning and resilience. Psychosocial training and institutional support should be offered both personally and professionally to enhance hematologists' well-being and reduce potential turnover.

Longitudinal Assessment of Fatigue in Pregnancy Complicated by Cervical Cancer: A Prospective Case Study and Implications for Nursing and Midwifery Practice

Background: This case report describes the rare coexistence of cervical cancer with pregnancy, a challenging scenario requiring careful balance between maternal treatment and fetal safety. In Poland, cervical cancer remains a significant health issue, highlighting the need for effective multidisciplinary strategies. Methods: This case report was prepared based on CARE guidelines for medical case reporting. The patient was observed by a clinical psycho-oncologist-midwife and a psychologist (also specializing in clinical psycho-oncology) from the start of oncological treatment until delivery and early postpartum. During pregnancy, the pregnant woman was asked three times (at the 23rd, 32nd, and 38th weeks of pregnancy) to complete questionnaires: a self-report questionnaire collecting sociodemographic data, clinical information, and perception of causes and effects of fatigue, the Chalder Fatigue Questionnaire (CHFQ-PL), the Fatigue Management Barriers Questionnaire (FMBQ), the Multidimensional Social Support Scale (MSPSS), and the Walsh Family Resilience Questionnaire (WFRQ-PL). Results: The patient, a 37-year-old woman in her second pregnancy, presented with cervical cancer diagnosed in the first trimester. Major concerns included fatigue, emotional distress, and treatment-related uncertainties. Throughout the pregnancy, she underwent four chemotherapy cycles and participated in psycho-oncological assessments to monitor fatigue, which increased as treatment progressed and affected daily functioning and emotional well-being. To enable the early continuation of oncology treatment, the pregnancy was electively terminated by cesarean section at 37+5 weeks, resulting in the good condition of the infant and a stable maternal postpartum condition, though anemia and emotional concerns required further management. Conclusions: As research on fatigue in pregnant oncology patients is limited, this case underscores the value of structured psycho-oncological support to enhance care and outcomes for both mother and child.

From awareness to acceptance: understanding HPV and vaccine knowledge, attitudes and beliefs among university students in Punjab, Pakistan

Background

Human Papillomavirus (HPV) infections can lead to various cancers globally, and immunization can prevent HPV-associated cancers. This study intended to evaluate university students' knowledge, awareness, and attitudes/beliefs toward HPV and HPV vaccine uptake in Punjab, Pakistan.

Methods

A descriptive cross-sectional study was conducted in ten institutes across six cities using pre-validated questionnaires. Descriptive statistics and Rasch analysis were utilized to describe awareness levels, knowledge, and attitudes scores respectively. Regression analysis was utilized to explore association between demographic factors, knowledge levels, and attitudes/ beliefs. SPSS® (IBM, version 23.0) and Winstep® (version 3.75.0) software were used for analysis.

Results

Out of 1200 students approached, 1056 responded (response rate 88.0%). The mean age of students was 19.5 ± 0.5 years; 31.3% had heard about HPV, 16.4% were aware of the HPV vaccine's availability, and 2.3% were vaccinated against HPV. The mean Rasch knowledge score was -0.368 logits (SD: 0.893; SEM: 0.027), depicting below-average HPV knowledge. The mean Rasch attitudes/beliefs score was 0.049 logits (SD: 1.013; SEM: 0.031), which depicted positive attitudes towards HPV and its vaccination. Females (OR:1.742; 95%CI: 1.352-2.320), health-sciences students (OR: 1.692; 95%CI: 1.290-2.220), and urban residents (OR:1.621; 95%CI: 1.244-2.223) possessed positive attitudes towards HPV vaccination. Recommendations from physicians (Median: 4.0; IQR: 4.0-5.0) followed by parents (Median: 4.0; IQR: 3.0-5.0), and friends (Median: 4.0; IQR: 3.0-4.0) shaped vaccination decisions.

Conclusion

Despite their inadequate knowledge levels and poor vaccine uptake, students showed positive attitudes towards HPV vaccination. Awareness about HPV, including testing and vaccination, should be raised through community outreach programs, social media, and university curricula.

Beyond p-values: a cross-sectional umbrella review of chemotherapy-induced peripheral neuropathy treatments

Introduction

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of neurotoxic chemotherapy agents, significantly impacting the daily lives of many cancer survivors. Despite thousands of articles published on CIPN, we remain no closer to a successful treatment regimen for the condition. In recent years, several new clinical trials and systematic reviews have been published, many exploring nonpharmaceutical interventions, prompting the need for a comprehensive synthesis of this emerging evidence.

Methods

We conducted an umbrella review to identify and appraise the 19 systematic reviews (SRs) published in 2023 that examined randomized controlled trials (RCTs) for established CIPN treatment. We focused our analysis on the three most researched treatment options: oral drugs, exercise, and acupuncture. RCTs not previously synthesized together were reviewed, and effect size analyses were performed to allow readers to interpret the existing literature beyond binary p-values.

Results

Our analysis of RCTs revealed the following key findings. For cancer survivors with CIPN after completing chemotherapy, serotonin-norepinephrine reuptake inhibitors (SNRIs) as well as acupuncture provided at least short-term relief for pain and sensory symptoms. For patients with CIPN who were actively undergoing chemotherapy, home-based balance and strength training exercises appeared to alleviate symptoms. Effect size analyses highlighted variability in treatment responses, underscoring the limitations of relying solely on p-values to assess intervention efficacy.

Discussion

Through an umbrella review approach, we demonstrate that SRs are often less systematic than expected. None of the 19 SRs captured all relevant RCTs within their search timeframe. However, by cross-referencing SRs, we identified 41 RCTs across 42 publications, illustrating the feasibility of an umbrella review approach to uncover relevant trials. Furthermore, many SRs exhibited methodological concerns that limit the interpretability of their findings. Finally, we discuss multiple opportunities for refining methods and reporting in future CIPN treatment trials.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024508283, PROSPERO (42024508283).

Bidirectional relationship between platelet count and skin cancer: tumor drug resistance mechanisms

BACKGROUND

Platelets (PLT) play a crucial role in tumor progression, including tumor growth, metastasis, and immune evasion. However, the relationship between PLT count and specific skin cancer subtypes, particularly melanoma skin cancer (MSC) and non-melanoma skin cancer (NMSC), remains poorly understood. Clarifying this association could identify potential biomarkers and therapeutic targets for personalized treatments.

METHODS

We applied bidirectional Mendelian randomization (MR) to investigate the causal relationship between PLT count and skin cancer risk, focusing on MSC and NMSC. Genetic variants associated with PLT and skin cancer served as instrumental variables for causal inference. Nine MR analysis methods, with inverse-variance weighted (IVW) as the primary method, were used to assess robustness, heterogeneity, and pleiotropy.

RESULTS

Forward MR analysis showed no significant relationship between PLT count and overall skin cancer or NMSC. However, elevated PLT was linked to an 18.6% increased risk of MSC. Reverse MR analysis revealed that skin cancer, particularly NMSC, negatively affected PLT count, while MSC was associated with a positive influence on PLT levels. No significant heterogeneity or pleiotropy was detected.

CONCLUSIONS

Our findings reveal a bidirectional, subtype-specific relationship between PLT and skin cancer. Elevated PLT levels specifically increase the risk of MSC, while MSC influences PLT count positively. In contrast, NMSC is associated with lower PLT levels. These results suggest that PLT could serve as both a prognostic marker and a potential therapeutic target, particularly for MSC. Further research is needed to explore the molecular mechanisms underlying these associations and to investigate the role of PLT in overcoming tumor resistance to therapies.

Illness cognitions and psychological distress among young and middle-aged couples with colorectal cancer: A dyadic study

This study explored the relationship between illness cognitions (helplessness, acceptance, and perceived benefits) and psychological distress in colorectal cancer couples. A cross-sectional study involving 403 colorectal cancer patients aged 26-59, diagnosed within 5 years, and their spouses in China was conducted from May to September 2023. Self-report questionnaires assessed illness cognitions, dyadic coping, and psychological distress. The results revealed that positive illness cognitions (acceptance and perceived benefits) and helplessness of patients and spouses both had direct and indirect effects on their own psychological distress through dyadic coping. The spouses' coping mediated the relationship between patients' positive illness cognitions and spouses' psychological distress. Patients' coping mediated the association between spouses' positive illness cognitions and patients' psychological distress. The same results were found in the relationships between helplessness and psychological distress. Interventions targeting illness cognitions in colorectal cancer couples may promote better coping and alleviate psychological distress.

Factors shaping Covid-19 vaccine acceptability among young people in South Africa and Nigeria: An exploratory qualitative study

Covid-19 vaccine hesitancy among young people can be seen as an acute - but not isolated - phenomenon within an alarming longer-term trend of broader vaccine distrust in Africa. Yet there are still considerable knowledge gaps in relation to the scope and drivers of low vaccine acceptability among young people. Moreover, better frameworks and tools are needed to conceptualise and better understand acceptability in this population group. We applied the recently published Accelerate Framework for Young People's Acceptability to guide qualitative research with young people living in South Africa and Nigeria. We aimed to investigate their overall acceptability of the Covid-19 vaccine, and explore factors shaping this acceptability and willingness to be vaccinated. In collaboration with seven community-based organisation partners, we conducted 12 in-person focus groups and 36 remote interviews with 163 individuals aged 15-24. Through a collaborative, iterative process we conducted thematic analysis, incorporating aspects of both deductive and inductive approaches. Our findings show how vaccine acceptability is shaped by a multiplicity of inter-related factors. They also provide a more in-depth perspective of some of these phenomena, their relative importance and their connections in this group of young people. Limited vaccine understanding, conflicting information and distrust, the influence of others, and fear of side effects were key inter-related drivers of low vaccine acceptability. Factors promoting Covid-19 vaccine acceptability were instead: positive perceptions of vaccine safety and efficacy, protection from disease, protection of others, and a desire to return to normal activity. We discuss implications of these findings for policy and practice, both to increase acceptability of Covid-19 vaccination among young people, and more broadly promote vaccination as a critical component of public health programs. Lastly, we reflect on this first application of theAccelerate Framework, and implications for its use in future studies.

Confidence in China's healthcare system: a focus on lower-middle class

BACKGROUND

During the post-pandemic era, there has been growing anxiety regarding health security, especially among the middle class worldwide. The public's confidence in the healthcare system encompasses their expectations and perceptions of the healthcare system's ability to meet their needs without financial hardship. This study aims to examine the disparities of confidence and to identify potential vulnerable subgroups.

METHODS

Adopting the China General Social Survey (CGSS) 2021, we performed multivariate logistic regression to analyze the associations between confidence level and socioeconomic classes, controlling for demographics.

RESULTS

Among all respondents (n = 2341), 71% reported confidence. However, respondents identified as lower-middle class had the least likelihood of reporting confidence (OR = 0.64, p = 0.006) compared to the lowest social class. De facto married respondents had 21% lower odds of confidence (OR = 0.78, p = 0.046) compared to unpartnered respondents.

CONCLUSIONS

Our findings reveal that, contrary to expectations, the lower-middle class in China-rather than the lowest social strata-exhibits the least confidence in the healthcare system. This low confidence appears closely linked to heightened insecurity about downward social mobility stemming from catastrophic healthcare expenditure. Moreover, married individuals also revealed low level of confidence in the healthcare system. These results underscore the urgent need for universal healthcare policies in China and similar emerging economies that specifically address the unique health security concerns of the lower-middle class and consider the dynamics inherent in marriages and families associated.

High Removal Efficiency of Radioactive Iodine with In Situ-Synthesized Ag2O-Mg(OH)2 Plate Composites

To promote the capacity of adsorbing radioactive iodine (I-) in acid and alkaline situations, a high-removal-efficiency adsorbent based on silver oxide (Ag2O) and magnesium hydroxide (Mg(OH)2) was synthesized by the in situ method. To determine the mechanism of this novel absorbent, batch experiments related to the temperature, pH, competitive ion (Cl-), and kinetic analysis were carried out. The results showed that the Ag2O-Mg(OH)2 plate composites had high adsorption capacity and efficiency for I- (409 mg/g, 25 °C) with a wide range of pH values (3-9). In addition, the adsorption time from the initial concentration to I- removal (97.36%) was only 20 min. Competitive ion experiments depicted that Cl- influenced the capacity of adsorbing I-. The k value of the pseudo-second-order model and regression factor R 2 were 7.86 × 10-3g mg-1 min-1 and 0.999 at 25 °C, respectively. The kinetics and XPS results proved that the mechanism of adsorption was chemical adsorption. Compared with other commercial adsorbents, the Ag2O-Mg(OH)2 plate composites had potential for application in nuclear wastewater treatment with low cost and high efficiency.

Spectrum of gynecologic malignancies in Northeastern Nigeria

Background

The burden of female genital tract cancers in low-and middle-income countries (LIMC) is not yet well investigated. Although available studies are few, they are mainly based on single institutions. Here, four-year multi-institutional data on gynecologic cancers in northeastern Nigeria were examined to determine their distribution by age and subtype.

Patient and Methods

This is a cross-sectional descriptive study using available data on histologically diagnosed gynecologic cancers archived in the pathology departments and/or cancer registries of six tertiary hospitals in northeastern Nigeria over four years. Alongside tumor type (according to site), patient age and presenting complaints were also documented. Descriptive statistics were used to present categorical variables as proportions, while quantitative variables of age were presented as medians.

Results

A total of 863 gynecologic cancers were included in this study. The median age was 50 years (3 - 95 years) with a peak at 40 - 49 years. The uterine cervix was the most common site of cancer (66.6%, 575/863), while uterine corpus (15.5%, 134/863) and ovarian cancers (14.8%; 128/863) were nearly equal in proportion. Squamous cell cancer was the commonest histotype overall, while ovarian cancers had a preponderance of epithelial tumors in 67.9% (87/128) over sex cord stromal (12.5%; 16/128) and germ cell (9.4%, 12/128) tumors. The most common symptom was abnormal vaginal bleeding (38%) followed by abdominal swelling (21.1%) and foul-smelling vaginal discharge (14.1%). Population-based data also showed high parity among women in the region, ranging from 4 births to 7 births per woman in a reproductive lifetime (total fertility rate, TFR).

Conclusion

The spectrum of cancers of the female genital tract in this study mirrors the population demographics characterized by a high proportion of young women in their reproductive age. Efforts to reduce the burden of this disease are urgently warranted.

Religious affiliation and perceptions of healthcare access during and after COVID-19 in Poland

Introduction

In response to the unprecedented impact of the COVID-19 pandemic on healthcare systems and social life worldwide, this study examines the role of religion in shaping perceptions of healthcare access in Poland during and after the pandemic.

Methods

The research is based on anonymous surveys conducted among adult Poles during the third wave of the pandemic and in the post-pandemic period, with participants divided by the timing of their responses. The research employed a cross-sectional survey design with a validated questionnaire. Data collection occurred during the third wave of the pandemic and the post-pandemic period. The questionnaire incorporated demographic questions and assessed the significance of religion in respondents' lives using a Visual Analogue Scale (VAS) for healthcare accessibility.

Results

Participants (n = 541) were recruited through online and paper-based surveys, meeting the inclusion criteria of being aged 18 or older and residing in Poland. Findings indicate that Roman Catholic respondents rated healthcare accessibility higher than non-religious individuals, potentially due to social and community support. However, statistical analysis revealed no significant differences in actual healthcare access among groups, suggesting systemic factors played a larger role.

Discussion

These results highlight religion as a source of emotional support rather than a determinant of healthcare access.

Evaluating the efficacy and impact of neutropenic diet in pediatric hematology patients: a longitudinal cohort study on adherence, clinical outcomes, and socioeconomic factors

Background and aim

A neutropenic diet aims to reduce hospitalizations from febrile neutropenia and sepsis in pediatric hematology patients during chemotherapy. This study aimed to evaluate its effectiveness in improving mortality, morbidity, and overall outcomes while considering limitations, adherence rates, and its impact on hospital admissions and culture positivity.

Method

A prospective 18-month observational study was conducted on pediatric hematology patients in a pediatric department at a tertiary care center. Using a baseline questionnaire at the introduction of a neutropenic diet, the study assessed the clinical history, diagnosis, clinicopathological parameters, dietary recommendations, and socio-demographic data of the patients. Patients were followed up for up to 1 year to evaluate diet adherence, outcomes, mortality, and morbidity, as indicated by hospital admissions for febrile neutropenia.

Results

An analysis involving 100 patients was conducted to assess adherence to a neutropenic diet and its ramifications on clinical outcomes over a period of 18 months. Initial follow-up data were accessible for 83 patients, revealing an adherence rate of 66%, which subsequently declined to 57% following a 6-month interval. Patients were categorized as compliant or non-compliant, but no correlation was found between adherence and febrile admissions, sepsis, hospitalizations, or mortality. Among compliant patients, 62% showed sepsis signs, though only 19% had positive blood cultures in the whole study group. Non-adherence was linked to demographic factors such as large family size, financial constraints, and limited resources. The neutropenic diet showed minimal impact on morbidity and mortality.

Conclusion

Our study does not support the strict adherence to the neutropenic diet, as there is no evidence of reduced infections and the dietary adherence also imposes an undue financial burden on patients. Instead, focusing on the safe acquisition of food, food processing, and proper hand cleanliness will probably provide superior protection against infection.

Quality of Life Status and Its Influencing Factors Among Lung Cancer Chemotherapy Patients in China: A Cross-Sectional Study

Background

Improving the quality of life (QOL) of lung cancer patients undergoing chemotherapy is an indispensable part of cancer treatment, as it not only pertains to their physical health but also to their psychological and social well-being. Previous research has primarily focused on investigating health-related quality of life, while studies specifically addressing the QOL of lung cancer patients remain underrepresented and under researched.

Purpose

The study aims to investigate the current status of QOL among lung cancer patients and identify the predictive factors associated with QOL.

Patients and Methods

From January 2024 to June 2024, lung cancer patients undergoing chemotherapy will be recruited from the outpatient clinics or wards of a tertiary A-level hospital in Deyang City as research subjects. They will be surveyed using the general information questionnaire, the Self-rating Depression Scale (SDS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale. Multiple linear regression analysis will be employed to determine the variables associated with QOL.

Results

A total of 390 lung cancer patients undergoing chemotherapy were recruited for this study, with a male predominance accounting for 72.31%. The mean age was (59.11±11.37) years. The overall QOL score was (66.43±23.67). Age, family monthly income per capita, cancer clinical stage, depression, and perceived social support (PSS) were identified as independent factors influencing the QOL of lung cancer patients, accounting for 19.4% of the total variance.

Conclusion

There is still considerable room for improvement in the overall QOL of lung cancer patients undergoing chemotherapy. Based on the analysis of influencing factors, targeted and personalized intervention measures should be implemented to enhance the QOL for these patients.

Falls among geriatric cancer patients: a systematic review and meta-analysis of prevalence and risk across cancer types

BACKGROUND

Falls represent a significant health concern among the older adults, particularly geriatric cancer patients, due to their increased susceptibility from both age-related and cancer treatment-related factors. This systematic review and meta-analysis aimed to synthesize global data on the prevalence and risk of falls in this population to inform targeted fall prevention strategies.

METHODS

Following PRISMA 2020 guidelines, we conducted a comprehensive search of PubMed, Embase, and Web of Science up to October 2024. Articles were screened using Nested Knowledge software by two independent reviewers. Eligible studies included those involving geriatric cancer patients aged 60 years or older reporting on fall prevalence. Quality assessment was performed using a modified Newcastle-Ottawa Scale, and meta-analysis was conducted using random-effects models with R software.

RESULTS

From 1,365 identified studies, 86 met the inclusion criteria, encompassing 180,974 participants. The pooled prevalence of falls was 24% (95% CI, 20%-28%), with substantial heterogeneity (I2 = 100%). Country- and cancer-type-specific analyses revealed variability in fall prevalence, with breast cancer patients showing the highest prevalence. The comparative risk analysis did not show a statistically significant difference in fall risk between cancer patients and non-cancer controls.

CONCLUSION

Falls are a prevalent and concerning issue among geriatric cancer patients, with substantial variability influenced by cancer type and study design. Personalized fall prevention strategies tailored to cancer-specific risk factors are essential. Further research is warranted to explore the complex interplay of cancer treatments, frailty, and fall risk in this vulnerable population.

Examining the Contribution of Nurse Practitioners to Geriatric and Palliative Care in Israel

Background/Objectives: Nurse practitioners (NPs) play a pivotal role in delivering medical care, leveraging their specialized training and broader range of authorities than registered nurses, as approved by the Ministry of Health. Since 2009, Israel has expanded NP training to include diverse specialties such as palliative care, geriatrics, diabetes, surgery, and health policy. Introducing a new professional role into the health system is a complex, resource-intensive process that requires collaboration across stakeholders. Globally, NPs are recognized for preventing hospitalizations and achieving improved care outcomes, with high patient satisfaction. However, in Israel, NPs' perceptions of their role and contributions remain underexplored. This study aims to assess NPs' role perception, contributions to the health system, and attitudes toward their professional development in palliative and geriatric care. Methods: The mixed-methods study included 26 in-depth interviews with palliative and geriatric NPs and an online survey of 89 NPs (29 in geriatrics and 60 in palliative care). Results: Most NPs are women (84%), Israeli natives (69%), and Jewish (64%). More than half (53%) have 1-4 years of experience as practitioners, and 71% are employed full time. Regarding their work environment, the NPs feel that their supervisors and patients are appreciative of their work and that they are considered professional authorities. The qualitative findings also point to several challenges in their work: (1) The NPs' status vis-à-vis medical staff and patients is insufficiently established; (2) the NPs lack practical and theoretical learning over time; (3) there is a shortage of positions; and (4) there is a sense of high work and emotional load and difficulty in implementing palliative care within the health system. With regard to their training, 58% of NPs were satisfied with the course, while 71% felt it lacked content. Looking forward, 76% of the NPs believed that over the next five years, the NP role would expand significantly, and 88% would recommend that other nurses become NPs. Conclusions: To maximize NPs' potential, the study recommends clarifying their role, expanding authorities, aligning training with professional demands, and fostering trust between NPs and the medical establishment. Branding efforts and emotional support for NPs, especially in palliative care, are essential to enhance their integration and effectiveness in the health system.

The Cancer and Work Scale (CAWSE): Assessing Return to Work Likelihood and Employment Sustainability After Cancer

Background: Returning to and sustaining employment after cancer presents significant challenges for individuals touched by cancer (ITBC). While vocational rehabilitation and workplace accommodations are critical, existing return to work (RTW) assessments lack cancer-specific considerations, limiting their clinical and occupational utility. Purpose: This study aimed to develop and validate the Cancer and Work Scale (CAWSE), a psychometrically robust tool designed to assess RTW likelihood and employment sustainability among ITBC, while also providing avenues for targeted interventions. Methods: A two-phase cross-sectional study was conducted. Study I (n = 130) assessed content validity and construct development, leading to a refined 43-item CAWSE. Study II (n = 216) employed exploratory and confirmatory factor analyses to establish structural validity, reliability, and responsiveness. Additional validation included correlations with fatigue, cognitive difficulties, depression, and anxiety. Results: Factor analysis supported a seven-factor structure with 31 final items. The CAWSE demonstrated good internal consistency (α = 0.787), construct validity, and moderate responsiveness (AUC = 0.659). High sensitivity allowed for accurate identification of RTW difficulties, with an established cut-off score of 123.5 on the total CAWSE. Implications: The CAWSE fills a critical gap in oncology-specific vocational rehabilitation, offering healthcare providers a validated tool for targeted interventions to enhance RTW outcomes and long-term employment sustainability for ITBC.

Gender-specific differences in factors influencing supportive care needs in colorectal cancer patients

BACKGROUND

Unmet supportive care needs reducing the quality of life of colorectal cancer (CRC) patients. As existing studies have indicated the supportive care needs of CRC patients of different genders differ, the main aim of this study was to investigate the factors influencing the supportive care needs of CRC patients based on gender.

METHODS

CRC patients were categorized by gender to compare each group's supportive care needs and demographic characteristics. Multiple linear regression analysis was employed to identify factors impacting the supportive care needs of patients by gender.

RESULTS

The study involved 257 males and 146 females CRC patients. Female patients reported higher levels of supportive care needs. Among male patients, those with higher education levels, higher anxiety, and a diagnosis of rectal cancer exhibited more significant supportive care needs. In contrast, anxiety was the only factor affecting supportive care needs for female patients.

CONCLUSION

This study provides new insights into the factors influencing supportive care needs in CRC patients. It revealed distinct differences in the levels and determinants of supportive care needs between male and female patients. Specifically, a higher level of education and the presence of rectal cancer were associated with increased supportive care needs in male patients. Meanwhile, increased anxiety levels were linked higher supportive care needs across both genders.

The Impact of Spirituality and Social Support on Health-Related Quality of Life in Breast Cancer Patients, Marrakech, Morocco

Breast cancer is a major global problem affecting women, leading to changes in their physical and mental health and affecting their quality of life. Social and spiritual support can provide strength and resilience to improve their well-being. A cross-sectional study was conducted among breast cancer patients in Marrakech, Morocco. Data were collected via an interviewer-administered questionnaire by covering (a) sociodemographic, economic, and clinical data, (b) quality of life with the "EORTC Core Quality of Life Questionnaire", (c) social support with the "Multidimensional Scale of Perceived Social Support", and (d) beliefs with the "System of Beliefs Inventory." Descriptive and correlational analyses were performed. The study included 220 breast cancer patients, with a mean age of 49.7 ± 10 years, who were mostly married (69.5%). The assessment revealed moderate perceptions of social support (4.9 ± 1.45) and beliefs (40.7 ± 5.9). Significant associations were found between the level of education and religious beliefs/social support (β =  - 0.235, p = 0.023; β = 0.217, p = 0.035), living alone and social support (β = 0.282, p = 0.001), time since diagnosis and social support/SBI (β =  - 0.183, p = 0.031; β - 0.248, p = 0.004), chemotherapy treatment and hormone therapy with SBI (β - 0.223, p = 0.005; β =  - 0.168, p = 0.031), and comorbidities and social support (β = 0.170, p = 0.024). Although social support and spirituality are important, they are not directly related to quality of life, suggesting the influence of other factors on patients' perceptions of quality of life. Promoting social support for breast cancer patients is crucial for healthcare professionals, emphasizing the importance of assessing patients' social support systems and integrating resources into treatment plans. Future research should explore the types of beneficial social support, influences on QoL, the role of digital support networks, and the conduct of longitudinal studies for more meaningful results.

Patient-reported outcomes in head and neck cancer: a cross-sectional analysis of quality of life domains across early and advanced UICC stages

BACKGROUND

Head and neck cancer (HNC) patients experience a variety of post-treatment symptoms that affect their quality of life (QoL). This study aims to assess the most prevalent symptoms and their relationship to cancer stage (UICC I-IV) while identifying areas for targeted intervention.

METHODS

A cross-sectional study was conducted involving 340 HNC patients at the University Hospital Erlangen from January to December 2019. QoL and its domains were assessed using the German version of the University of Washington Quality of Life Questionnaire Version 4 (UW-QoL v.4), with comparisons made between early-stage (UICC I & II, n = 180) and advanced-stage (UICC III & IV, n = 160) patients. Statistical analysis examined differences in QoL and its individual domains.

RESULTS

Advanced-stage patients reported significantly greater impairments in several QoL domains, including swallowing (p = 0.003, η2 = 0.038), saliva production (p < 0.001, η2 = 0.104), and taste (p = 0.009, η2 = 0.030), compared to early-stage patients. Psychological symptoms, such as anxiety and mood disturbances, were prevalent across all stages, but no significant differences were found between early- and advanced-stage patients for pain, speech, mood, or anxiety (p > 0.05). Patient demographics, including age, gender, and comorbidities, were similar between groups. The greater impairments in QoL domains observed in advanced-stage patients are likely due to more intensive treatments, such as multimodal therapy and radiochemotherapy.

CONCLUSION

Advanced-stage HNC patients experience a significantly higher burden of physical symptoms, particularly issues with swallowing, saliva, and taste, necessitating early and targeted interventions. Psychological issues are also prevalent and should be addressed in both early- and advanced-stage patients. Despite non-significant differences in some symptoms, their clinical relevance may still be important, particularly in individual cases. Comprehensive care, including physical and emotional support, is essential to improving long-term QoL for HNC patients. Further research should focus on longitudinal assessments and clinically meaningful thresholds for symptom management.

Exploring prehabilitation interventions for patients with gynaecological cancer undergoing radiotherapy: A scoping review

PURPOSE

Radiotherapy imposes a significant physiological and psychological burden on gynaecological cancer patients. Prehabilitation is being increasingly used to prepare individuals for cancer treatment and improve their well-being and resilience. Whilst prehabilitation has demonstrated benefit for individuals undergoing cancer surgery, the structure, role and implementation of prehabilitation prior to radiotherapy are poorly defined and relatively unexplored. This scoping review aims to provide a comprehensive overview of the current literature regarding prehabilitation interventions for individuals with gynaecological cancer undergoing radiotherapy.

METHODS

This review was conducted following the gold-standard Joanna Briggs Institute guidelines for scoping reviews. Literature searches were completed in October 2024 across: the Allied and Complementary Medicine Database; British Nursing Index; Cumulative Index to Nursing and Allied Health Literature; Cochrane library (Controlled trials and systematic reviews); Embase; Medical Literature Analysis and Retrieval System Online; and the Psychological Information Database. Grey literature searches were conducted via Google Scholar, Overton.io, and Trip Pro Medical Database.

RESULTS

Ninety records met the inclusion criteria, pertaining to 56 studies. Cervical cancer was the most represented gynaecological cancer type across studies. A small number of multimodal prehabilitation studies were identified (n = 4). Studies evaluating unimodal interventions were more common, with nutritional interventions (n = 24) being the most frequent, followed by psychological (n = 22) and physical exercise (n = 6) interventions. There was considerable variation across studies in respect to intervention initiation, duration, delivery and outcome measures.

CONCLUSIONS

The physiological and psychological impacts of cancer diagnosis and treatment are closely entwined. Further development of multimodal prehabilitation to cohesively address these is an important area for future research. Studies evaluating exercise interventions are relatively unexplored in this patient population and the potential barriers to engagement must be considered. Future research should focus on complete and transparent reporting of interventions, with input from those with lived experience, and adopting a standardised set of outcome measures reported across all trials.