OBJECTIVE:Financial toxicity is a significant concern for reproductive system cancers. This study aimed to evaluate the level of financial toxicity among patients and survivors facing reproductive system cancers. METHODS:A systematic review and meta-analysis were carried out following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A comprehensive search of four electronic databases was conducted. RESULTS:A total of 67 studies were reviewed in the systematic review, and 9 were included in the meta-analysis. Meta-analysis revealed that the overall level of financial toxicity in reproductive system cancers was mild. Subgroup analyses showed that males and patients from the USA tended to experience higher financial toxicity. CONCLUSION:Awareness of financial toxicity is crucial to supporting the health of cancer patients and survivors. By effective policies and interventions financial toxicity can be reduced, access to care can be improved, and health outcomes can be enhanced.
BACKGROUND:Patients undergoing abdominoperineal resection (APR) for low rectal cancer often experience colostomy, sexual dysfunction, sleep disturbance, and psychological distress. Evidence for integrative supportive strategies is scarce. This study aimed to evaluate whether a structured integrative psychosocial and nutritional intervention could improve psychological recovery, sleep quality, sexual function, quality of life, and survival outcomes in patients undergoing APR for rectal cancer. METHODS:In this prospective controlled study, 190 patients scheduled for APR (January 2021-2023) were assigned to an integrative intervention (n = 96) or control group (n = 94). The intervention combined six psychosocial sessions-cognitive behavioral therapy for insomnia, resilience training, and narrative therapy-with individualized ESPEN-guided nutrition including early enteral feeding, protein-energy supplementation, and ω-3 fatty acids. The psychosocial program was delivered in a structured format over a 2-3 month perioperative period, while nutritional support was continuously implemented from the preoperative week to 6 months postoperatively. Primary outcomes were depressive symptoms (BDI-II), sleep quality (PSQI), and sexual function (IIEF-5/FSFI). Secondary outcomes included quality of life (EORTC QLQ-C30), disease-free survival (DFS), and inflammatory markers (CRP, IL-6, TNF-α). Overall survival (OS) was assessed as a prespecified secondary survival endpoint with 24-month follow-up. RESULTS:At 3 months, the intervention improved BDI-II (adjusted mean difference -6.8, p < 0.001) and PSQI (-3.4, p < 0.001), exceeding minimal clinically important differences. Sexual function and quality of life improved significantly, with benefits in sexual function emerging from 3 months and sustained up to 12 months, while QoL improvements were most pronounced at 3-6 months. At 24 months, DFS was significantly improved in the intervention group (HR 0.62, 95% CI 0.45-0.85, p = 0.003), whereas OS showed a favorable but non-significant trend. CONCLUSIONS:An integrative psychosocial and nutritional program significantly enhanced psychological well-being, sleep, and sexual function, while improving quality of life and DFS after APR. These findings suggest that structured multimodal supportive care may provide clinically meaningful benefits beyond standard perioperative management and may represent a feasible adjunct strategy within rectal cancer survivorship care pathways.
BACKGROUND:Cancer disrupts AYAs' school/work-related opportunities during a developmental phase when learning-related experiences are central to AYAs' growth and future outcomes. The National Comprehensive Cancer Network (NCCN) recommends clinics implement school/work support, but guidance is needed on what types of support to implement feasibly. OBJECTIVE:We aimed to understand AYAs' needs by comparing narrative accounts from AYAs, parents, and clinicians. METHODS:A secondary thematic analysis was conducted on two interview study datasets combined to compare three stakeholder groups' experiences: Parents of diagnosed AYAs (age 15-29), AYAs, and clinicians. Data from each group were inductively analyzed and triangulated to capture similarities/differences. RESULTS:32 interviews represented three stakeholder groups: 10 AYAs, 15 parents, 7 clinicians. All groups described school/work-related challenges in four areas: advocating for accommodations, losing extracurricular activities, navigating disrupted expected trajectories, and losing peer social connection. Parents and AYAs stressed a positive impact (school/work promoting empowerment) heightening the importance of protecting school/work experiences. Findings highlighted specific supports to implement in each area, with distinct insights made by each stakeholder group. CONCLUSIONS:Findings offer a roadmap to implementing the NCCN's "educational and career services" directive by identifying the types of supports to implement and how. AYAs and families would benefit from oncology teams providing accommodation guidance with integrated clinical advocacy tools, flexible practices that prioritize AYAs' socialization, and psychosocial support for grief coping, social skill development, and career decision making. Prioritizing school/work-related supportive care can be a feasible, patient-centered way to improve quality of life across the AYA cancer trajectory.
BACKGROUND:This study examines the impact of financial toxicity levels on shared decision-making in cancer patients. While the impact of financial toxicity on clinical outcomes has been elucidated by numerous studies, its effect on shared decision-making is quite limited. METHODS:A quantitative research design was used. The study included 216 cancer patients. RESULTS:Patients with high levels of financial toxicity reported lower levels of shared decision-making. Financial toxicity was found to have a critical effect on the level of shared decision-making. Furthermore, some socio-demographic and economic characteristics of the participants were found to be associated with financial toxicity and shared decision-making. CONCLUSIONS:Financial toxicity has been shown to be not only an economic burden but also a psychosocial determinant affecting patients' autonomy and active participation in decision-making processes. It is recommended that support mechanisms be established to raise patients' awareness of financial considerations.
PURPOSE:Although resilience and perseverance are known for their physical health benefits, evidence on their effects on cognitive health, specifically subjective cognitive decline (SCD) among cancer survivors, is limited. This study examined the associations between resilience, perseverance of effort, and their interaction on SCD among cancer survivors in Nigeria. METHODS:Adult cancer survivors (N = 146; Mage = 52.3 years) completed measures of resilience, SCD, and socio-demographic characteristics. Multiple linear regression model was fit to assess associations between resilience, and perseverance of effort (a grit subscale), with SCD. The model also tested the moderation effect of perseverance of effort on the association between resilience and SCD, adjusting for sociodemographic factors, years since diagnosis, and depression. RESULTS:Resilience was not significantly associated with SCD (β = -0.136, p < 0.061). Higher perseverance of effort was asso-ciated with lower SCD (β = -2.01, p < 0.001). The interaction term of resilience and perseverance of effort was associated with SCD (β = 0.234, p < 0.013). Probing the moderation result revealed that the protective effect of resilience on SCD was strongest at low perseverance, weaker at moderate perseverance, and nonsignificant at high perseverance, indicating that the benefit of resilience diminishes as perseverance increases. CONCLUSION:This study highlights psychosocial factors influencing SCD among cancer survivors in Nigeria. Resilience and perseverance may be protective, but high perseverance reduced resilience's benefit. Interventions should build resilience while promoting flexibility and help-seeking. Routine screening for SCD and psychosocial factors may enable early detection in low-resource settings.
BACKGROUND:Quality of life (QoL) in patients undergoing cancer treatment is shaped by psychosocial and existential factors beyond physical symptoms. This study examined the association between perceived social support and QoL in patients receiving active oncologic therapy and tested whether spirituality mediates this relationship. METHODS:This cross-sectional study included patients receiving active cancer treatment. Perceived social support was assessed using the Multidimensional Scale of Perceived Social Support (MSPSS), QoL using the WHOQOL-BREF, and spirituality using the WHOQOL-SRPB. RESULTS:The final sample comprises 182 adults undergoing cancer treatment. Higher perceived social support was associated with better overall QoL across all domains. Spirituality correlated strongly with overall QoL (r = 0.568; p < 0.001), especially psychological well-being and social relationships. Path analysis showed direct and indirect effects of social support on QoL through spirituality, indicating partial mediation across domains, strongest in social relationships. CONCLUSION:Findings highlight the importance of integrating social and spiritual dimensions into comprehensive, patient-centered oncology care to improve overall well-being.
OBJECTIVE:This study sought to understand the differences in how young adults with various cancer predisposition syndromes (CPS) feel toward disclosing their diagnosis to romantic partners. METHODS:Young adults with a CPS completed a cross-sectional survey. Data analysis of 158 responses was performed via SPSS v 27.0 descriptive statistics. One-way ANOVA analyses, and post-hoc pairwise comparisons examining CPS, gender, and sexual orientation were performed. RESULTS:Individuals with Lynch syndrome favored disclosing later in a relationship compared to those with Li-Fraumeni syndrome (LFS) (p = 0.050). Individuals who identified as bisexual preferred disclosing more information about their CPS than those who identified as heterosexual (p = 0.035). CONCLUSIONS:Individuals with various CPS experience a myriad of feelings and attitudes surrounding dating and disclosure. This information can lead to better sensitivity and awareness of this topic by healthcare providers, ultimately improving the level of care given to these individuals.
BACKGROUND:The Social Relationship Coping Efficacy Scale (SRCE) evaluates how effectively cancer patients maintain social relationships. This study aimed to adapt the scale into Turkish (SRCE-TR) and examine its psychometric properties. METHODS:This methodological study included 202 adult cancer patients in Türkiye who were aware of their diagnosis. Data were collected using the SRCE-TR, the Multidimensional Scale of Perceived Social Support (MSPSS), and the Brief Resilience Scale (BRS). Content validity was confirmed by expert opinions, and construct validity was evaluated through Exploratory Factor Analysis and convergent validity analyses (Pearson correlation and bootstrap multiple linear regression). Reliability was assessed using Cronbach's alpha and test-retest methods. RESULTS:Exploratory Factor Analysis revealed a single-factor structure explaining 51.13% of the total variance. The SRCE-TR demonstrated moderate constructive validity, correlating significantly with the MSPSS (r = 0.308) and BRS (r = 0.310). Furthermore multiple linear regression analysis with bootstrapping indicated that the model significantly predicted SRCE-TR scores (R2_{adj} = 0.219, p < 0.001). Perceived family support (β = 0.360, p < 0.001) and resilience (β= 0.258, p < 0.001) emerged as the primary significant predictors of the scale scores. CONCLUSION:The SRCE-TR is a valid and reliable tool for assessing coping efficacy in maintaining social relationships among Turkish cancer patients.
BACKGROUND:In addition to psychological wellbeing, adverse childhood experiences (ACEs) can pose a significant threat to physical health as individuals age. These risks may be particularly burdensome for cancer survivors. AIMS:This study assessed relationships between ACEs and physical symptoms associated with cancer survivorship in a mixed cancer sample. We used multiple mediation to test if different emotion regulation mediated the relationship between ACEs and physical health. Moderated mediation tested whether these mediation effects differed between those who were currently undergoing or had finished cancer treatment. METHODS:Cancer patients and survivors (N = 244) completed the Adverse Childhood Experiences Scale (ACES) to assess histories of traumatic experiences before age 18. Patients and survivors also completed the Short Form-36 to measure their self-reported health, physical functioning, pain, and fatigue and the PROMIS Applied Cognition subscale to assess self-reported cognitive difficulties. To index emotion regulation, they completed the Difficulties with Emotion Regulation Scale, Penn State Worry Questionnaire, Rumination-Reflection Questionnaire, and the Mindful Attention and Awareness Scale. RESULTS:Worry, rumination, mindfulness, and difficulties with emotion regulation mediated the association between ACEs and pain, fatigue, self-rated health, physical functioning, and cognitive problems. Moderated mediation models revealed that with difficulties with emotion regulation as the mediating variable, models were significant only for participants who were currently undergoing cancer treatment. CONCLUSIONS:Maladaptive and adaptive emotion regulation strategies provide a pathway through which ACEs can alter physical health during cancer treatment and survivorship. These findings emphasize the need for emotion regulation skills training to ameliorate the physical impact of ACEs as individuals navigate cancer.
This narrative poem reflects on the psychosocial realities of cancer care through the intertwined experiences of a patient and an oncology clinician. Centering on the issue of financial toxicity, the piece illustrates how cancer extends beyond diagnosis and treatment into the fragile structures of family life, caregiving, emotional endurance, and everyday survival. Through the patient's voice, the poem reveals that the burden of cancer is often measured not only in medical terms, but also in unpaid bills, interrupted routines, and the fear of becoming a burden to loved ones. Through the clinician's perspective, it highlights the role of psychosocial care in addressing distress, restoring dignity, and helping patients navigate both practical and emotional crises. The poem also reflects on the clinician's own emotional labor, showing how oncology practice leaves lasting impressions beyond the clinical encounter. By presenting cancer as both a medical and social experience, this piece underscores the importance of compassionate, holistic, and interprofessional psychosocial support in oncology. It invites readers to recognize that, amid financial strain and uncertainty, hope may still be sustained through small acts of care, recognition, and human presence.
BACKGROUND:Pancreatic cancer (PC) remains one of the most lethal malignancies, with a five-year survival rate of only 12%, largely due to late diagnosis. Depression is frequently reported in PC and may precede its onset, yet underlying mechanisms remain unclear. AIMS:This systematic review examined (1) the prevalence of depression in PC, (2) potential psychological, clinical, and biological mechanisms, and (3) the temporality of depressive symptoms relative to PC diagnosis. METHODS:Following PRISMA guidelines, EMBASE, MEDLINE, Web of Science, and Cochrane were searched through February 2025 (PROSPERO: CRD42022378830). Studies including adults with PC assessing depression or related biomarkers were analyzed. RESULTS:Twenty-six studies met inclusion criteria. Depression prevalence ranged 3.5-51.8%. Six studies reported depressive symptoms often preceding diagnosis by 3-6 months. Biomarker studies identified elevated IL-6, CRP, and kynurenine-tryptophan pathway alterations. CONCLUSIONS:Depression may represent a paraneoplastic or early manifestation of PC. Further prospective, mechanistic studies are warranted.
BACKGROUND:Narrative interventions benefit adolescents and young adults with cancer (AYAC), but less is known about unaffected siblings (SIBS), despite evidence of sibling distress. This study compared narrative themes, perceived benefits, and quality of life (QOL) between AYAC and SIBS. METHODS:Participants were pediatric cancer survivors diagnosed ages 11-18 and off treatment ≥1 year (AYAC; n = 20) and unaffected siblings of pediatric cancer survivors (SIBS; n = 20). Participants recorded video narratives and completed the Pediatric Quality of Life Inventory (PedsQL) and Post Video Impressions Questionnaire (PVIQ). Videos were coded using population-specific thematic codebooks. RESULTS:Both groups demonstrated high meaning-making and reported similarly positive perceived benefits. AYAC discussed diagnosis/treatment and identity themes more deeply, whereas SIBS discussed others' mental health more deeply. AYAC reported significantly poorer QOL across all domains than SIBS. CONCLUSIONS:Despite poorer QOL among survivors, both groups reported comparable benefits from narrative expression, supporting narrative interventions for survivors and siblings.
Our understanding of the sexual lives and experiences of sexual violence among women undergoing breast cancer treatment is notably limited. This gap in knowledge hinders our ability to fully grasp the challenges these women face during and after treatment. This qualitative study aimed to explore the experiences of intimate partner sexual violence (IPSV) and its impact on women's lives among breast cancer survivors in Türkiye. We employed a qualitative research approach, involving 29 breast cancer survivors selected through purposeful sampling. Data were collected through in-depth semi-structured interviews, and content analysis was utilized to analyze the findings. Inclusion criteria included living with a partner at the time of diagnosis, at least six months post-treatment, no prior history of sexual dysfunction, and willingness to participate. Four main themes emerged from the analysis: (1) The Personal Meaning of Sexual Violence Experience and Individual Experiences, (2) The Implications of Sexual Violence Experience, (3) Coping with Sexual Violence, and (4) Reasons Preventing Help-Seeking. The findings provide valuable insights into how IPSV significantly impacts women's health, with responses often shaped by societal taboos, patriarchal gender roles, and the specific cultural context of Türkiye. These findings underscore the need for healthcare providers to understand these challenges and develop effective support strategies.
OBJECTIVE:Despite the benefits of using evidence-based tobacco treatment to quit smoking, many cancer patients continue smoking after diagnosis. Many survivors decline assistance with smoking cessation due to the desire to quit without assistance. This qualitative study sought to describe cancer patients' physical and psychological reasons for their decision to decline assistance with smoking cessation. METHOD:Participants were 35 adult cancer patients who were recruited from outpatient oncology clinics. Participants reported tobacco use in the past month and declined referral to an "in-house" tobacco treatment due to the desire to quit without assistance. On average, participants were 54.4 years old, mostly female (68.57%) and White, non-Hispanic (85.7%). The most common cancer site was gynecological (28.6%. RESULTS:Multiple physical and psychological reasons for declining tobacco treatment emerged, including distress, feeling overwhelmed, cancer treatment intensity and treatment side-effects. CONCLUSIONS:These findings underscore the need to address psychological and physical reasons for cancer patients' decline in tobacco treatment. Psychosocial practitioners can play a role in addressing these factors. Interventions to address these factors should offer flexible, time-limited, and tailored tobacco treatment to increase treatment acceptance.
PURPOSE:Cancer-related financial hardship can significantly affect patients and their families' well-being. Cancer patients in rural regions face unique challenges, yet little is known about the scope of rural financial hardship. This study explored potential contributing factors and types of financial hardship experienced by breast cancer patients in the rural California region. METHODS:Using a qualitative approach, individual interviews were conducted with 25 Latinas and non-Latina Whites with breast cancer. Data were analyzed using a thematic analysis. RESULTS:Factors contributing to financial hardship include patients' employment disruption and loss of familial financial contributions. The participants experienced financial hardship related to material, psychological, and behavioral aspects, which is complicated by socio-geographic characteristics and familial context. CONCLUSIONS:Financial hardship was a significant concern, resulting in adverse effects across multiple aspects. It is important to provide financial interventions that address the multi-level challenges and to expand the corresponding services accordingly.
BACKGROUND:Depression and anxiety are common and debilitating in people with cancer and may adversely affect treatment adherence, quality of life, and medical outcomes. Cognitive Behavioral Therapy (CBT) is a widely recommended psychosocial intervention. While its effectiveness across cancer types and delivery formats has been well studied, this meta-analysis uniquely explores how CBT outcomes vary by geographic region and income level. OBJECTIVE:This meta-analysis evaluated the overall effectiveness of CBT in reducing depression and anxiety in people with cancer and examined moderators that may influence treatment outcomes. METHODS:A systematic review of 52 randomized controlled trials (RCTs), including 9,151 participants, was conducted. Random-effects meta-analyses were used to calculate standardized mean differences (SMDs). Subgroup analyses assessed variations by CBT format, delivery mode, cancer type and stage, region, country income level, and comparator type. RESULTS:CBT reduced both depression (SMD = -1.16) and anxiety (SMD = -0.75) compared to control groups, which included standard care, waitlist, active interventions, and pretest conditions. Improvements were maintained at follow-up (SMD = -0.65), based on the longest available follow-up time point in each study (up to 12 months). Adapted CBT (i.e. CBT tailored to cancer-specific concerns) was associated with larger reductions in symptoms (SMD = -1.17), as were individually delivered CBT (SMD = -2.83) and interventions targeting adults with breast cancer (SMD = -1.30). Regional subgroup analyses showed the largest symptom reductions in North America (SMD = -1.97), followed by Africa (SMD = -1.69) and Asia (SMD = -0.91), indicating geographic variation in symptom improvement. Heterogeneity was substantial (I2 > 90). CONCLUSIONS:CBT reduces depression and anxiety in people with cancer, with improvements that are maintained over time and vary by delivery method, cancer type, and geographic setting. These findings support integrating tailored CBT programs into cancer care, particularly in high-need and resource-limited populations.
OBJECTIVE:Distress management guidelines emphasize the importance of addressing psychological symptoms in cancer patients. Mental health interventions that are time-bound are more easily integrated into oncology care. We tested the feasibility of a time-bound Focused Acceptance and Commitment Therapy (FACT) protocol for anxiety, depression, and psychological flexibility in cancer patients. METHODS:Breast, prostate, stage III/IV colorectal cancer, or leukemia patients who scored ≥5 on the PHQ-9 and/or GAD-7 were included. The intervention group completed three virtual FACT sessions; controls received written FACT exercises and phone check-ins. All received a one-month follow-up call. RESULTS:Twenty-seven participants completed follow-up (intervention n = 10; control n = 17). Feasibility was mixed: 57.1% of prescreened patients met screening eligibility (64/112), but overall conversion from initially interested patients was 27.8% (64/230). Per Red-Amber-Green criteria, enrollment was 100% (64/64; green/go) and retention was 42.2% (27/64; red/major redesign). Acceptability was high across groups. CONCLUSION:Initial recruitment was strong and clinical need was clear. Low retention highlights a need to improve procedures to support engagement among a high-burden population. Because ease of access is critical, we will apply lessons learned to refine the protocol.
BACKGROUND:Lung cancer is associated with substantial psychosocial burden for those affected and their relatives. This trial evaluates effects of CALM-based psycho-oncological counseling (Managing Cancer And Living Meaningfully) for relatives of lung cancer patients and explored indirect effects on patient outcomes. METHODS:In this multi-center randomized controlled trial, patient-relative dyads were assigned to an intervention (IG; three to six CALM-based sessions) or control group (CG; usual care). All patients could access standard support. Assessments occurred at baseline and after six weeks. The primary outcome was relatives' anxiety; secondary outcomes were depression, distress, and quality of life. Patient outcomes included anxiety, depression, and distress. Effects were analyzed with ANCOVA, and within-group comparisons. Secondary analyses explored dyadic relationships using multilevel models. RESULTS:Among 86 relatives (40 IG, 46 CG), no group-level effects emerged. Within the IG depression and distress decreased significantly (medium to large effect). Patients whose relatives attended at least one counseling session experienced reduced distress. There was strong dyadic dependence for couples across all outcomes. DISCUSSION:Despite lacking group-level effects, individual improvements highlight the potential of CALM-based counseling and the importance of integrating relatives and dyadic counseling into psycho-oncological care.
BACKGROUND AND OBJECTIVE:Clinically, existential issues are of significant importance in cancer patients, particularly existential guilt. To measure this construct, a suitable tool is needed. Therefore, this study aimed to design and validate the Existential Guilt Questionnaire (EGQ) in cancer patients. METHOD:This study employed a sequential exploratory mixed-method design for tool development. In the qualitative phase of tool design, the hybrid concept analysis method was used to explain the concept of existential guilt and generate items. Subsequently, psychometric properties such as face and content validity, construct validity through exploratory and confirmatory factor analysis, and reliability through internal consistency (Cronbach's alpha) and stability (relative and absolute reliability) were assessed. RESULTS:The 27- item EGQ, rated on a five-point Likert scale, was obtained with these psychometric properties: face validity (Impact Score > 1.5), content validity ratio (CVR > 0.62), average content validity index (SCVI/Ave > 0.8), exploratory factor analysis with four factors (unlived life, being another, dialogical or interpersonal dimension, and incompleteness) with a cumulative variance of 40.3%, and good fit indices in confirmatory factor analysis including RMSEA =0.07, χ2/df = 2.50, comparative fit index (CFI) = 0.91, and incremental fit index (IFI) = 0.91. Additionally, internal consistency reliability (α = 0.87), relative reliability (ICC = 0.985), and absolute reliability (SEM = 2.29), interpretability, responsiveness, and ceiling and floor effects were obtained. CONCLUSION:This valid and reliable questionnaire for measuring existential guilt in cancer patients helps therapists assess patients in this regard and implement therapeutic interventions in response to this issue.
