OBJECTIVES:To examine the relationships among adult attachment styles, symptom distress, and depressive symptoms in colorectal cancer (CRC) survivors, and to explore whether mindfulness moderates these associations. SAMPLE AND SETTING:A cross-sectional study was conducted with 90 CRC survivors aged 20 years or older who had completed treatment within the past three months at a medical center in northern Taiwan. METHODS AND VARIABLES:Participants completed validated questionnaires measuring depressive symptoms (Beck Depression Inventory-II [BDI-II]), attachment style (Experience in Close Relationships Scale-Short Form), mindfulness (Five Facet Mindfulness Questionnaire), and CRC-specific symptom distress (European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-CRC Module). Data were analyzed using descriptive statistics, Pearson correlations, hierarchical regression, and the Hayes PROCESS macro. RESULTS:The mean BDI-II score was 4.96; 8% reported clinically significant depressive symptoms. Anxious attachment correlated with depression (r = 0.4, p < 0.001) and predicted depression in the initial regression model (beta = 0.5, p < 0.001). Avoidant attachment had an indirect effect through symptom distress (beta = 0.32, p = 0.002). Mindfulness moderated the anxious attachment-depression association (ΔR² = 0.03, p = 0.007), and acting with awareness moderated the avoidant attachment-depression association (ΔR² = 0.02, p = 0.02). IMPLICATIONS FOR NURSING:Findings suggest that routine assessment of attachment style and mindfulness traits may help identify CRC survivors at psychological risk. Incorporating mindfulness-based education into survivorship care may support emotional well-being.
OBJECTIVES:To characterize the severity of psychoneurological (PN) symptoms in cancer survivors who initiated immune checkpoint inhibitors (ICIs) at baseline and 12 weeks post-treatment and to examine the associations between PN symptoms and gut microbiome patterns. SAMPLE AND SETTING:15 patients (n = 9 males and n = 6 females, mean age = 70.9 years) with solid tumors who initiated ICIs were recruited from a cancer center. METHODS AND VARIABLES:PN symptoms were assessed using self-report questionnaires, and stool samples were analyzed using 16S rRNA sequencing. Alpha and beta diversity indices were calculated, and a least absolute shrinkage and selection operator regression model was fitted to assess associations between each symptom and the log-ratio of the genus abundance. RESULTS:Average fatigue levels increased during 12 weeks. The microbiome community varied by age, sex, and their interaction. At 12 weeks post-treatment, Oscillibacter (beta = -0.141), Limosilactobacillus (beta = 0.088), and Erysipelotrichaceae (beta = -0.021) were associated with average levels of fatigue, whereas Tannerellaceae (beta = -0.011), Bacteroides (beta = 0.474), and Acidaminococcus (beta = 0.193) were associated with pain severity (all p < 0.05). IMPLICATIONS FOR NURSING:Given the potential association between the gut microbiome and PN symptoms during ICI treatment, nurses are encouraged to assess dysbiosis risk, screen for treatment-related adverse symptoms, and educate patients about gut health while receiving ICIs.
PROBLEM IDENTIFICATION:Family caregivers of pediatric (aged 0-14 years) and adolescent and young adult (aged 15-39 years) patients with cancer face multifaceted financial toxicity involving multisource economic burdens, psychological distress, and unmet support needs, requiring evidence-based nursing and policy interventions. LITERATURE SEARCH:Systematic searches were performed across Wanfang Data, Web of Science, SINOMED, PubMed®, CNKI, EBSCO, VIP Chinese Science and Technology Periodicals Full-Text Database, and Cohrane Library from inception to April 15, 2025, to identify relevant qualitative studies. DATA EVALUATION:According to ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines, two investigators independently screened studies, extracted data, and synthesized findings via JBI meta-aggregation. The ConQual (Confidence in the Output of Qualitative Research Synthesis) approach was used to rate conclusions. SYNTHESIS:The 24 included studies yielded 103 findings (98 unequivocal themes and 5 credible themes), which were aggregated into eight main themes. The two core findings were as follows: (a) Financial toxicity among family caregivers is multifaceted, involving substantial multisource economic burdens and severe perceived financial distress, and (b) despite adopting diverse coping strategies, caregivers consistently reported unmet needs and persistent expectations for additional support. IMPLICATIONS FOR RESEARCH:Future research can focus on mechanisms specific to the United States, nurse navigator interventions, and subgroup differences. Clinical and policy interventions should integrate insurance navigation, paid leave, and culturally competent support.
If the research process is disrupted, the science slows, affecting patients, workforce, leadership, and policy. Oncology nurse researchers must develop strategies to sustain research in a challenging environment, but those st.
OBJECTIVES:To evaluate the effect of yoga breathing exercise (YBE) on perceived stress and sleep quality in women with breast cancer undergoing chemotherapy. SAMPLE AND SETTING:This randomized, sham-controlled trial was conducted in the chemotherapy unit of a university hospital in Türkiye from November 2023 to April 2024 and involved 60 women with stage II-III breast cancer undergoing chemotherapy. METHODS AND VARIABLES:Participants were randomized to a YBE group or a sham breathing group. Both groups received standard oncology care, and the YBE group additionally practiced 4-4-4-4 yoga breathing twice daily for five minutes during 21 days. Data were collected at baseline and after the 21-day intervention period. Perceived stress and sleep quality were assessed using the Perceived Stress Scale and the Pittsburgh Sleep Quality Index. Data were analyzed using two-way repeated-measures analysis of variance. RESULTS:After 21 days, the YBE group showed significantly greater reductions in perceived stress (mean difference = -6.23, p < 0.001) and improved sleep quality (mean difference = -2.1, p < 0.001) compared with the sham group. No adverse events were reported. IMPLICATIONS FOR NURSING:YBE can be integrated into supportive oncology nursing care as a low-cost, nonpharmacologic intervention to address stress and sleep disturbances during chemotherapy.
PURPOSE:To explore the dynamic nature of family resilience among patients with lung cancer and the interactions among its core themes during adaptation. PARTICIPANTS AND SETTING:15 patients with lung cancer were purposively recruited from the Lung Cancer Center at the West China Hospital of Sichuan University from June to October 2023. METHODOLOGIC APPROACH:A descriptive phenomenologic approach was used. Face-to-face semistructured interviews were informed by Walsh's family resilience framework. Interviews were audio recorded, transcribed verbatim, and analyzed in Chinese using Colaizzi's seven-step method with NVivo, version 11.0. Data saturation was reached after 15 interviews. FINDINGS:Three interrelated themes of family resilience were identified-family belief system, organizational patterns, and communication and problem-solving-comprising 10 subthemes. Family attachment, family cohesion, and open expression contributed to the dynamic interactions among these domains and supported family adaptation. IMPLICATIONS FOR NURSING:Nurses can assess family strengths and vulnerabilities across these themes and provide tailored family-oriented interventions that promote psychological recovery, mobilize family and social resources, and facilitate open, patient-centered communication.
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PURPOSE:To describe the experiences of Turkish fathers whose child is undergoing cancer treatment. PARTICIPANTS AND SETTING:Participants were recruited at the pediatric hematology-oncology clinic of a university hospital in western Türkiye. A purposive sampling strategy was used to identify eligible fathers. Fathers whose child was aged 0-18 years and receiving cancer treatment were considered eligible. METHODOLOGIC APPROACH:This study was conducted using a descriptive qualitative research design. Semistructured individual interviews with 12 fathers of a child with cancer were used for data collection. Data were analyzed using the content analysis method. FINDINGS:The fathers' (N = 12) mean age was 36.83 years, and the children's mean age was 5.25 years. The following four main themes with interrelated subthemes and categories were identified that reveal the feelings, experiences, and expectations of fathers of children with cancer: diagnosis and treatment process experiences, postdiagnosis life changes, coping, and needs. IMPLICATIONS FOR NURSING:Pediatric oncology nurses can develop more inclusive care practices that support paternal involvement by considering the influence of gender roles on fathers' emotional expressions and help-seeking behaviors. Future research should examine fathers' experiences across diverse cultural and clinical settings to inform the development of father-focused interventions.
OBJECTIVES:To identify healthcare access and utilization (HCAU) needs in a national sample of veterans with cancer. SAMPLE AND SETTING:This study includes participants in the All of Us Research Program who reported a history of military service and a diagnosis of cancer. METHODS AND VARIABLES:This secondary analysis includes demographics, electronic health record-confirmed cancer, and HCAU variables (transportation, duties and responsibilities, healthcare attitudes, general healthcare cost, vision or dental cost, medication cost, and mental healthcare cost). RESULTS:The sample included 18,678 veterans. Women comprised 19% of the sample but reported barriers across domains more frequently than men (transportation: 12% vs. 6%; duties and responsibilities: 16% vs. 6%, and mental healthcare cost: 41% vs. 21%). Veterans aged 18-44 years comprised 12% of the sample but 40% of those struggling to manage health care while maintaining duties and responsibilities (time off work, child care, elder care). Veterans in the lowest income bracket comprised 27% of the sample and reported barriers across domains (51% of those reporting difficulties with transportation, and about one-third of those reporting barriers in all other HCAU domains). IMPLICATIONS FOR NURSING:This study identified gaps in HCAU for veterans with cancer and provides important information on those at highest risk, including veterans who are female, who are younger, and with lower incomes. These results will inform future studies in this vulnerable population.
OBJECTIVES:To develop and evaluate the feasibility, acceptability, and preliminary effectiveness of a symptom management theory-based lower extremity lymphedema prevention program (LEL-PP) for women undergoing gynecologic cancer surgery. SAMPLE AND SETTING:A pilot randomized controlled trial was conducted with 27 women undergoing gynecologic cancer surgery involving lymph node dissection in the gynecologic oncology unit of a hospital in Istanbul, Türkiye. METHODS AND VARIABLES:Participants were randomly assigned to an intervention group (n = 14) that received structured nurse-led education and follow-up support (LEL-PP), or a control group (n = 13) that received standard care. Quality of life, self-efficacy, lymphedema symptoms, and leg circumferences were assessed at baseline, postoperative day 3, and three-month follow-up using validated instruments. RESULTS:The LEL-PP was feasible, with 93.3% participation and 96.4% completion, and highly acceptable, with a mean satisfaction score of 4.54 of 5. The intervention group reported significantly greater improvements in quality of life, general health, and self-efficacy, and reduced lymphedema symptoms. No significant short-term changes in leg circumference measurements were observed, except for point left 6 in the control group. IMPLICATIONS FOR NURSING:The symptom management theory-based LEL-PP is feasible and well accepted, and it may be beneficial for the prevention and early detection of LEL.
There are limitations to what cancer centers can and will do to assess for and mitigate cancer treatment disparities. The clinic is downstream. If the goal is to move the needle on cancer equity, the clinic alone cannot get u.
PROBLEM IDENTIFICATION:Breast cancer is the most common cancer type in women globally. Although survival rates have improved, treatments cause lasting issues, including impaired cardiorespiratory fitness, chronic inflammation, and reduced quality of life (QOL). Exercise is recommended to alleviate these burdens, but evidence remains inconsistent regarding its effects on cardiorespiratory function, inflammatory markers, and QOL, with limited integrated evaluation. LITERATURE SEARCH:A systematic search was conducted in the Cochrane Central Register of Controlled Trials, Embase®, PubMed®, and Web of Science for articles published from database inception to April 15, 2025. DATA EVALUATION:The systematic review contained 32 studies involving 1,754 survivors. Literature quality was assessed using the Cochrane Risk of bias assessment tool 2, with analyses performed using RevMan, version 5.4, and Stata, version 18.0. SYNTHESIS:Exercise significantly improved peak oxygen consumption (weighted mean difference [WMD] = 1.22, p < 0.001) and QOL (general: WMD = 6.05, p < 0.001; breast cancer-specific: WMD = 5.13, p = 0.045). No significant effects were found on maximum oxygen consumption, C-reactive protein, interleukin-6, or tumor necrosis factor-alpha (p > 0.05). IMPLICATIONS FOR PRACTICE:Clinical practice should routinely recommend exercise to improve cardiopulmonary fitness and QOL in breast cancer survivors. Clinicians should incorporate exercise into rehabilitation plans and encourage participation, and future research should explore its specific effects on inflammatory markers.
PROBLEM IDENTIFICATION:Thriving, a construct reflecting personal growth, resilience, and emotional vitality after adversity, is gaining attention in oncology and health-related quality-of-life research. However, consensus is lacking on which patient-reported outcome measures (PROMs) best assess thriving in individuals with breast cancer. LITERATURE SEARCH:A systematic search across nine databases identified studies reporting the development or psychometric evaluation of PROMs for thriving in adults. DATA EVALUATION:Two reviewers independently assessed methodologic quality using the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) Risk of Bias checklist. Measurement properties were evaluated against COSMIN criteria and graded using the COSMIN-modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. SYNTHESIS:Five PROMs were identified: Thriving Scale, Psychological Thriving Scale, Comprehensive Inventory of Thriving, Brief Inventory of Thriving, and Brief Thriving Scale. No instrument was originally developed or validated in individuals with cancer. The Brief Inventory of Thriving scale shows the greatest potential for use in breast cancer care but requires further validation. IMPLICATIONS FOR RESEARCH:The lack of validated measures limits nurses' ability to assess thriving in cancer care. The Brief Inventory of Thriving scale appears promising but requires cancer-specific validation. Engaging survivors in tool development may enhance content relevance.
PURPOSE:To explore caregivers' perspectives on cancer-related cognitive impairment (CRCI) experiences in older adults with acute myeloid leukemia receiving chemotherapy. PARTICIPANTS & SETTING:Eight caregivers, including adult children and spouses, of older adults with acute myeloid leukemia receiving chemotherapy from the control arm of a clinical trial were interviewed. METHODOLOGIC APPROACH:Semistructured interviews were conducted at the second, fourth, and seventh cycles of chemotherapy. All interviews were audio recorded and transcribed verbatim. Two researchers independently analyzed 16 transcripts using thematic analysis. FINDINGS:Four themes were identified: (a) CRCI experiences, (b) impact of CRCI, (c) CRCI coping strategies, and (d) perceived CRCI-related factors. Caregivers observed changes in memory, concentration, and information processing in their loved ones and developed various strategies to better support or cope with CRCI. In addition, CRCI influenced caregivers' emotions, lives, and relationships with their loved ones. IMPLICATIONS FOR NURSING:Caregivers of older adults with acute myeloid leukemia play a vital role in CRCI symptom monitoring. The impact of CRCI on caregivers highlights the importance of supporting caregivers, and the identified coping strategies can provide guidance for future intervention development.
OBJECTIVES:To describe the long-term trajectories of cognitive impairment in older adult cancer survivors and to identify factors associated with distinct trajectories. SAMPLE & SETTING:Data were sourced from the National Health and Aging Trends Study (2015-2021), a nationally representative cohort study of community-dwelling older adults aged 65 years or older. METHODS & VARIABLES:Cognitive function was assessed annually with self-reported diagnoses and cognitive function tests. Group-based trajectory models were used to identify cognitive trajectories, and multinomial logistic regression models were used to examine associations between baseline characteristics and trajectory affiliations. RESULTS:1,564 older adults with cancer and 3,447 without cancer were included. Four trajectories of cognitive impairment were identified: low-stable (64%), low-slowly deteriorating (18%), low-rapidly deteriorating (6%), and persistent-high (12%). Older age, lower education and income levels, poorer self-rated health, physical frailty, and comorbidities were significantly associated with persistent-high or deteriorating trajectories (p < 0.05). IMPLICATIONS FOR NURSING:The current study highlights the specific dynamic features of cognitive decline among older adult cancer survivors and identifies risk factors for early identification of patients at high risk for less favorable trajectories.
PROBLEM IDENTIFICATION:Cancer family resilience has become an important interdisciplinary focus in oncology, nursing, and psychosocial care. However, global development patterns, key contributors, and emerging trends have not been systematically examined. LITERATURE SEARCH:A bibliometric analysis of publications related to cancer, family, and resilience indexed in the Web of Science Core Collection from 2008 to 2025 was conducted. Publication growth, journal distribution, country contributions, collaboration patterns, and keyword hot spots were examined. DATA EVALUATION:944 records were identified. Publications and citations increased rapidly, particularly after 2020. Research output was concentrated; 84 journals published on this topic, but more than half published only one article. Publications came from 52 countries, led by the United States (257 articles) and China (250 articles). SYNTHESIS:Chinese work emphasized measurement of family resilience, psychosocial intervention, and support for patients and caregivers, and other countries' work more often addressed theoretical frameworks and longitudinal follow-up. High-frequency and emerging topics included family resilience, caregivers, quality of life, and financial toxicity. IMPLICATIONS FOR RESEARCH:Future work is expected to focus on vulnerable subgroups (e.g., adolescents, siblings, financially stressed families), use digital and artificial intelligence-supported approaches, and strengthen international collaboration to improve real-world support for patients and families.
As an editor, I think of myself as a disseminator, not a researcher. Serving as an editor is my contribution to helping oncology nursing science reach the clinicians and scholars who can translate it into practice. In that wa.
OBJECTIVES:To assess differences in risk factors for uterine cancer (UC) mortality, differences in five-year overall survival across clinical and demographic characteristics, and independent predictors of mortality among Black and White patients. SAMPLE & SETTING:Patients treated between January 1, 2002, and December 31, 2022, at a specialized urban cancer center in the northeastern United States. METHODS & VARIABLES:This study used a retrospective analysis of data from an internal registry. Differences in overall survival across age, race, education, area income, stage, grade, and histology were compared using Kaplan-Meier curves. Survival was compared across characteristics using pairwise log-rank tests, followed by a Cox proportional hazards regression model to identify predictors of mortality. RESULTS:Among 4,891 patients, 262 self-identified as African American or Black. Compared to non-Hispanic White patients, Black patients were more likely to experience risk factors for UC mortality. Kaplan-Meier curves suggested reduced survival in patients with fewer resources. In the adjusted model, older age, advanced disease, higher tumor grade, and not having graduated from high school were associated with a greater likelihood of mortality. IMPLICATIONS FOR NURSING:Socioeconomic factors may contribute to racial disparities in UC survival. Earlier diagnosis and enhanced patient support may address modifiable risk factors for UC mortality.
OBJECTIVES:To examine the relationship between side effect severity and self-management ability in patients taking capecitabine and investigate whether medication beliefs mediate this relationship. SAMPLE & SETTING:A secondary analysis was conducted using data from a descriptive study of 50 patients with gastrointestinal cancer receiving capecitabine at the University of Michigan Rogel Cancer Center. METHODS & VARIABLES:Self-management ability was assessed using the Measure of Drug Self-Management. The severity of capecitabine-related side effects was measured using the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. Patients' perceived necessity of and concerns about capecitabine were evaluated using the Beliefs about Medicines Questionnaire (adapted for capecitabine). Descriptive statistics, multiple linear regression, and PROCESS macro mediation analysis were employed. RESULTS:Self-management ability was significantly associated with total side effect severity (beta = -1.09, p = 0.003). This relationship was partially mediated by patients' overall beliefs about capecitabine (beta = -0.74, p = 0.04) and fully mediated by concerns about its potential harms (beta = -0.6, p = 0.11). IMPLICATIONS FOR NURSING:Oncology nurses should adopt a patient-centered approach that includes counseling about the benefits of capecitabine, addressing concerns about adverse effects, and reinforcing patients' self-efficacy and social support networks to enhance self-management during therapy.
OBJECTIVES:To characterize patient and caregiver end-of-life (EOL) information needs through analysis of inquiries received by the National Cancer Institute's Cancer Information Service (CIS). SAMPLE & SETTING:The sample consisted of CIS inquiries received between September 2018 and June 2024 that were (a) initiated by patients or caregivers and (b) coded as focusing on the EOL phase of the cancer continuum. METHODS & VARIABLES:Descriptive and network analyses were conducted to characterize CIS inquiries and explore patterns of co-occurrence related to subjects of inquiry. RESULTS:Of the 81,836 inquiries received by the CIS during the study period, 3% (n = 2,333) focused on EOL; of these, 90% were initiated by caregivers. Patterns of subject-of-inquiry co-occurrence related to palliative care/hospice, finding healthcare services, cancer-directed therapies, coping, and clinical trials were observed. Patient and caregiver network structures were highly correlated (r = 0.799, p < 0.001), suggesting similar patterns of information needs. IMPLICATIONS FOR NURSING:Tailoring informational support and bundling common information needs are crucial strategies to optimally support patients with cancer and caregivers at the EOL. These findings highlight the need for nurse-led, novel care delivery models that can address unmet needs and improve the provision of support, such as caregiver-focused, community-based navigation; delivery of palliative care concurrent with cancer-directed therapies; and embedded caregiver clinics within cancer centers.
