Effectiveness of an Intervention to Promote Self-Efficacy on Quality of Life of Patients with Nasopharyngeal Carcinoma of the Zhuang Tribe Minority in Guangxi, China: A Prospective Study

Psychological intervention improves quality of life in patients with early-stage cancer: a systematic review and meta-analysis of randomized clinical trials

The effectiveness of psychological interventions (PI) for malignant diseases is controversial. We aimed to investigate the effect of PI on survival and quality of life (QoL) in patients with cancer. We performed a systematic search of MEDLINE, Cochrane, and Embase databases to identify randomized controlled trials comparing PI to standard care (PROSPERO registration number CRD42021282327). Outcomes were overall survival (OS), recurrence-free survival (RFS), and different domains of QoL. Subgroup analysis was performed based on the provider-, type-, environment-, duration of intervention; cancer stage, and type. Pooled hazard ratios (HR) and standardized mean difference (SMD) with 95% confidence intervals (CI) were calculated using a random-effects model. The OS and RFS did not differ significantly between the two groups (OS:HR = 0.97; CI 0.87-1.08; RFS:HR = 0.99; CI 0.84-1.16). However, there was significant improvement in the intervention group in all the analyzed domains of QoL; in the global (SMD = 0.65; CI 0.35-0.94), emotional (SMD = 0.64; CI 0.33-0.95), social (SMD = 0.32; CI 0.13-0.51) and physical (SMD = 0.33; CI 0.05-0.60) domains. The effect of PI on QoL was generally positive immediately, 12 and 24 weeks after intervention, but the effect decreased over time and was no longer found significant at 48 weeks. The results were better in the breast cancer group and early stages of cancer. PIs do not prolong survival, but they significantly improve the QoL of cancer patients. PI should be added as standard of care 3-4 times a year, at least for patients with early-stage cancer.

Exploring the use of rehabilitation in individuals with head and neck cancer undergoing treatment: a scoping review

Explore the use, characteristics, feasibility, and functional outcomes of rehabilitation interventions used for individuals with head and neck cancer (HNC) during treatment.

Searches were conducted in four databases from Jan 2011 to Dec 31, 2022. Included studies had to include adults with HNC undergoing treatment, a rehabilitation intervention, an assessment of functional outcome(s) addressed by the International Classification of Functioning Framework (ICF) and be published in English language. Title and abstract screening, full-text review, and data extraction were completed independently, in duplicate. Descriptive statistics and a qualitative synthesis summarized findings.

Twenty-seven studies were included in this review. The majority of studies were randomized controlled trials (70%). Most individuals represented in the included studies were males (92% of all participants) between 50 and 60 years of age. Interventions led by a speech language pathologist (33%) were most commonly described. Sixteen studies (59%) described primary outcomes that fit the ICF "impairment" domain.

We identified few studies that explored the use, feasibility, and effectiveness of rehabilitation interventions for individuals with HNC during treatment. Future research should assess the effectiveness of rehabilitation interventions on functional outcomes beyond the ICF body function and structure domain.

Application value of self-management manual combined with case management superiority model in postoperative management of nasopharyngeal carcinoma after radiotherapy

OBJECTIVE

To explore the application value of the self-management manual combined with the case management model in postoperative management of nasopharyngeal carcinoma after radiotherapy.

METHODS

Eighty-four patients with nasopharyngeal carcinoma admitted to Yingtan People's Hospital from May 2020 to April 2022 were retrospectively included in this study. They were divided into the experimental group (receiving self-management manual combined with case management mode scheme, n=42) and the control group (receiving continuous management after conventional nasopharyngeal carcinoma radiotherapy, n=42) according to mode differences. The cancer-related fatigue [Cancer Fatigue Scale (CFS)], comfort status [General Comfort Questionnaire (GCQ)], self-management efficacy [Chinese Strategies Used by People to Promote Health (C-SUPPH)], self-care ability (self-care ability measurement), pain score [Visual analogue scale (VAS)], and quality of life [European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30)] were compared between the two groups after 4 weeks of radiotherapy. The adverse reactions of the two groups were recorded. Combined with periodic review and follow-up records, the prognostic factors of the two groups of patients were analyzed.

RESULTS

After treatment, the scores of physical fatigue (12.83±1.10), emotional fatigue (9.78±1.32), cognitive fatigue (5.62±1.31), and total score of CFS (28.24±2.26) in the experimental group were 12.83±1.10. The control group physical fatigue (13.90±1.25) points, emotional fatigue (10.55±1.40) points, cognitive fatigue (6.80±1.75) points, and total CFS (31.33±2.59) points in both groups were lower than before treatment. The experimental group was lower than the control group (ALL P<0.05). The physiological, psychological, spiritual, socio-cultural, and environmental scores of the experimental group were higher than those of the control group (all P<0.05). The scores of health knowledge, self-care skills, self-care responsibility, and self-concept score of patients in the experimental group were higher than the control group (all P<0.05). After intervention, the VAS score of the experimental group was lower than that of the control group (P<0.05). After intervention, the EORTC QLQ-C30 score of both groups increased significantly as compared with pre-intervention. The score in the experimental group was significantly higher than that in the control group [(80.05±10.72) vs (68.11±12.10), P<0.05]. Postoperative (various) adverse reactions in the experimental group were lower than the control group (all P<0.05). The factors influencing the prognosis of nasopharyngeal carcinoma patients were age, tumor stage, and intervention mode by Cox model analysis (all P<0.05).

CONCLUSION

The self-management manual combined with the case management mode can alleviate cancer fatigue, improve postoperative self-management ability, self-care ability, and quality of life of patients with nasopharyngeal cancer radiotherapy, reduce the occurrence of adverse reactions and improve the prognosis of patients. It is worth promoting in clinical settings.

Movement Through Chemotherapy Delay to Initiation Among Breast Cancer Patients: A Qualitative Analysis

Purpose

(Neo) adjuvant chemotherapy decreases the risk of recurrence and improves overall survival among breast cancer patients; however, delays in chemotherapy initiation are associated with adverse health outcomes. The causes of delay are complex and include interrelated social, economic, cultural, environmental, and health system factors. Project Start was a qualitative study designed to assess and identify the multilevel factors contributing to the barriers and facilitators of initiating chemotherapy.

Patients and Methods

Women diagnosed with primary invasive breast cancer who experienced ≥60 day delay in (neo) adjuvant chemotherapy initiation were included. Participants completed semi-structured interviews exploring barriers and facilitators to starting chemotherapy. Interviews were transcribed and coded to identify themes using the Sort and Sift, Think and Shift analytic approach. This analysis included thorough examination of the data by advancing through iterative analytic phases to identify core topics within and across transcripts.

Results

We enrolled (N=22) participants with median age at diagnosis 53.5 years (range 27-70) who identified as Latina (n=8), Black (n=5), and non-Latina White (n=9). Participants described a common chemotherapy initiation process reflecting their unique needs as they transitioned through four stages: 1) receiving diagnosis and treatment recommendations; 2) processing treatment options; 3) "Flipping the Switch"; and 4) activating treatment and engaging in care. Limited explicit insight into their chemotherapy delay was expressed. Engagement across the self-, family-, community-, and medical-realms revealed interlinked and pivotal sources of support that helped participants navigate toward initiating chemotherapy. Specifically, the overarching themes included logistical, emotional, financial, and social sources of support and the relationship of these sources of support to participants' perceived self-efficacy to move toward initiating treatment.

Conclusion

Activating women to be engaged in the treatment process across multiple levels appeared to facilitate initiating chemotherapy. Multilevel interventions that engage the patient, family, community, and medical team may support the initiation of timely chemotherapy.

Effect of Implementing a Life Skills Program on the Perceptions of Aging and Self-efficacy in Postmenopausal Women: A Field Trial

Background

Complications experienced by women during menopause affect their self-efficacy and can cause a negative attitude toward this period and lifestyle changes. The aim of this study was to investigate the effects of a life skills program on the perception of aging and self-efficacy in postmenopausal women.

Materials and Methods

This study was performed as a field trial on 70 postmenopausal women referring to Imam Ali and Navaab Safavi health centers in Isfahan, Iran, in 2018-19. The eligible subjects were randomly divided into experimental and control groups using a number table. The experimental group received the life skills program in five sessions and the control group shared their experiences in two sessions. Data were collected using a demographic characteristics form and the Ageing Perceptions Questionnaire (APQ) and General Self-Efficacy Scale (GSE) and were analyzed using descriptive and inferential statistical tests in SPSS software.

Results

The results revealed that the mean score of aging perception immediately and 1 month after the intervention in the experimental group was significantly lower than that in the control group (p < 0.001). There was a significant increase in the self-efficacy score in the experimental group immediately (F_1,67 = 121.89, p < 0.001) and 1 month after the intervention (F_1,67 = 121.89, p < 0.001) compared to the control group.

Conclusions

This life skills program was able to reduce the perception of aging and physical complaints during menopause and improve self-efficacy in women. Therefore, the implementation of this intervention is recommended in women.

Curcumol simultaneously induces both apoptosis and autophagy in human nasopharyngeal carcinoma cells

Autophagy is usually considered as a protective mechanism against cell death, and in the meantime, leads to cell injury even apoptosis. Apoptosis and autophagy are very closely connected and may cooperate, coexist, or antagonize each other on progressive occurrence of cell death triggered by natural compounds. Therefore, the interplay between the two modes of death is essential for the overall fate of cancer cells. Our previous study revealed that curcumol induced apoptosis in nasopharyngeal carcinoma (NPC) cells. Recently, curcumol was found to induce autophagy in cancer cells. However, whether curcumol can induce NPC cells autophagy and the effects of autophagy on apoptosis remain elusive. In this study, we found that curcumol induced autophagy through AMPK/mTOR pathway in CNE-2 cells. Moreover, inhibiting autophagy by autophagy inhibitor 3-methyladenine (3-MA) or apoptosis inhibitor z-VAD-fmk significantly increased proliferation while attenuated apoptosis and autophagy compared with the curcumol 212 μM group. In contrast, combining curcumol with autophagy agonist rapamycin and apoptosis inducer MG132 synergized the apoptotic and autophagic effect of curcumol. Taken together, our study demonstrates that curcumol promotes autophagy in NPC via AMPK/mTOR pathway, induces autophagy enhances the activity of curcumol in NPC cells; the combination of autophagy inducer and curcumol can be a new therapeutic strategy for NPC.

Effects of Cognitive Behavioral Therapy for Depression and Anxiety, Response Rates and Adverse Events in Patients with Locoregional Advanced Nasopharyngeal Carcinoma

Purpose:

This retrospective study investigated the effects of cognitive behavioral therapy (CBT) on depression, anxiety, response rates, and adverse events in patients with locoregional advanced nasopharyngeal carcinoma (NPC).

Methods:

A total of 269 patients with diagnosis of stage III-IVA NPC received either CBT plus chemoradiotherapy (CBT group, n = 136) or treatment as usual (TAU) plus chemoradiotherapy (TAU group, n = 133). Patients in the CBT group received a series of 6 CBT sessions for 6 weeks during concurrent chemoradiotherapy. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS) score at baseline, the completion of radiotherapy, and 6, 12, and 24 months after radiotherapy. Response rates and adverse events were also evaluated.

Results:

Patients in the CBT group showed significantly less depression and anxiety than patients in the TAU group after the completion of radiotherapy (P < .05). Complete response rates were 99.3% (135/136) and 92.5% (123/133) in the CBT group and TAU group with a small effect size (Phi coefficient = .171), respectively (P = .005). Compared with the TAU group, the CBT group showed a significantly lower incidence of acute adverse events and late toxic effects.

Conclusions:

The addition of CBT to chemoradiotherapy significantly reduced depressive and anxiety symptoms. CBT combined with chemoradiotherapy is associated with improved response rates, with reduced incidence of toxic effects in patients with locoregional advanced NPC. Based on this study, we registered a randomized controlled clinical trials to better define the role of CBT in patients with locoregional advanced NPC (Registration number: ChiCTR2000034701).

Translation and validation of the Chinese version of medical maximizer-minimizer scale: a cross-sectional study

OBJECTIVE

Medical overutilisation and underutilisation affect optimal healthcare. The Medical Maximizer-Minimizer Scale (MMS) was developed to assess individual medical maximising and minimising tendencies. Despite significant improvement in the healthcare system over the past four decades, no psychometric scales to examine treatment maximising and minimising preferences are available in China. This study aimed to translate the MMS into Chinese and examine its reliability and validity in a Chinese population.

DESIGN

This cross-sectional study was conducted in December 2019 through an online survey panel.

METHODS

The MMS was translated into a Chinese version (CN-MMS) using a forward-backward translation procedure. Next, a random online survey of the general population in China was conducted. Exploratory factor analysis (EFA) and confirmatory factor analysis were performed to examine the underlying factor structure of the CN-MMS. The internal consistency reliability of the scale was determined using Cronbach's α coefficient and corrected item-total correlation. A multivariate linear regression analysis was used to examine associations between medical maximising and minimising preferences and demographic variables in the Chinese population.

RESULTS

This study included 984 participants aged 18-80 years. The CN-MMS retained 10 items, and the EFA supported a two-factor structure. The model fit for this two-factor structure of the CN-MMS was acceptable with χ²/df=3.7, comparative fit index=0.958, goodness-of-fit index=0.951, Tucker-Lewis Index=0.944 and root mean square error of approximation=0.074. The scale had a Cronbach's α coefficient of 0.864, corrected item-total correlation of 0.451-0.667, and test-retest reliability of 0.815. Significant predictors of CN-MMS total score were nationality and household monthly income.

CONCLUSIONS

The CN-MMS showed satisfactory psychometric properties. Therefore, it can be used to investigate the individual medical maximising and minimising tendencies among the general Chinese population.