Purpose Eating difficulties following nasopharyngeal carcinoma (NPC) treatment can persist into survivorship and reshape everyday dietary practices, family relationships, and social participation. Although previous studies have documented treatment-related symptoms, less is known about how survivors actively manage eating within their everyday lives. This study aimed to explore how NPC survivors experienced and negotiated changes in eating and diet after treatment. Methods A photovoice-informed qualitative design was used. Fourteen adult NPC survivors who had completed primary anticancer treatment were recruited through purposive sampling. Participants photographed eating- and diet-related situations in their daily lives over seven consecutive days, followed by individual photo-elicitation interviews. A total of 202 photographs were included in the analysis. Photographs and accompanying narratives were analyzed using thematic analysis. Results Three themes described survivors' post-treatment eating experiences: (1) relearning eating with a changed body, as swallowing difficulties, xerostomia, altered taste, and digestive discomfort required new eating routines; (2) negotiating dietary knowledge and food choices, as survivors navigated biomedical advice, traditional Chinese medicine, folk beliefs, and peer experiences; and (3) managing eating across family and social contexts, where care, dietary autonomy, family responsibilities, and social participation were continually negotiated. Conclusions Post-treatment eating among NPC survivors extends beyond nutritional intake to involve bodily adaptation, dietary decision-making, and relational negotiation. Survivorship care should integrate symptom assessment, swallowing and dietetic support, culturally sensitive dietary counselling, family communication, and practical support for social eating to help survivors rebuild workable everyday eating practices.
PURPOSE:Male breast cancer (MBC) is a rare malignancy. Unlike female breast cancer, existing research has focused largely on clinical treatment, leaving patients'illness experiences, social support, and care needs understudied. This study aimed to synthesize qualitative evidence on MBC patients' illness and psychological experiences to inform patient-centred nursing interventions. METHOD:A comprehensive search was conducted across five databases (PubMed, Web of Science, EMBASE, Cochrane Library, and CINAHL) for studies published in English from database creation to June 2025.The Joanna Briggs Institute (JBI) qualitative synthesis method was used to assess study quality and synthesize the findings. RESULTS:A total of 16 studies were included, and four themes were identified: patients with MBC experience substantial stress after diagnosis; they experience emotional changes during the disease course; they employ a myriad of strategies to cope with stress; and they are committed to self-reconstruction following the illness. CONCLUSIONS:MBC survivors face challenges related to information support, physical health, mental health, and finances during diagnosis, treatment, and care. Support programs for survivors should be multifaceted. We recommend multistakeholder collaboration to establish effective support and intervention strategies for reducing mortality rates, improving cure rates, enhancing the quality of care, and ultimately improving the quality of life for MBC survivors.
PURPOSE:Fertility preservation (FP) is essential for reproductive-age women with cancer who face fertility-damaging treatment. Despite technological progress in FP, decision-making is highly complex, utilisation remains suboptimal, and many patients suffer from decisional conflict and limited decision support with unsatisfactory care. This scoping review aims to identify, synthesize, and critically describe evidence on FP decisional conflict and its associated influencing factors among this patient group. METHOD:This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute (JBI) guidance for scoping reviews. Nine databases were systematically searched for studies published up to 1 October 2025. Eligible studies were screened using pre-specified inclusion and exclusion criteria. RESULTS:Eighteen studies were included. FP decisional conflict was mainly reflected in concerns about FP technologies, cancer-related sequelae, balancing cancer treatment and fertility, FP costs, limited decision-making time, insufficient decision support, and patients' health status. Influencing factors were grouped into attitudes, including personal values and FP-related knowledge, subjective norms, including social support, healthcare professionals' recommendations, marital status, and reproductive status, and perceived behavioural control, including age, financial burden, decision-making time, treatment timing, decision aids, and psychological factors. CONCLUSIONS:This scoping review highlights FP decisional conflict and its influencing factors among women of reproductive age with cancer. Future interventions should address attitudes, subjective norms, and perceived behavioural control to improve decision support and reduce decisional conflict.
PURPOSE:Geriatric Assessment with Management (GAM) is recommended for older patients with cancer. We evaluated the primary care implementation of a cross-sector GAM intervention for patients receiving radiotherapy. METHODS:GAM was initiated in hospital at the start of radiotherapy with subsequent weekly follow-up and symptom assessments by designated primary care nurses. This pre-planned feasibility assessment was performed using the Reach, Adoption, and Implementation domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. RESULTS:Eighty-nine patients (mean 74.2 years) from 14 primary care districts received the intervention. Post-radiotherapy, most were reached by the scheduled follow-up. Primary care involvement during the intervention mainly involved cancer nurses. Of 18 participating nurses, eight worked alone, 11 had part time positions and three were allocated to other tasks after the Covid-19 outbreak. Post-radiotherapy, 80% of scheduled symptom registrations were completed, 53% during treatment. New measures were documented for 7/12 patients reporting severe pain, 6/22 patients at risk of malnutrition, and for 3/23 and 9/37 patients with cognitive- or functional impairments, respectively. CONCLUSION:Factors potentially contributing to suboptimal intervention implementation were lacking administrative and collegial support, system integration, geriatric competence and local ownership, as well as cancer nurses facing challenging working conditions. Further research is needed to optimize cross-sector GAM for radiotherapy patients. TRIAL REGISTRATION:ClinicalTrials.gov ID NCT03881137.
PURPOSE:Curative treatment for rectal cancer includes removal of part or all of the rectum. As a result, patients may experience Low Anterior Resection Syndrome (LARS), characterized by bowel dysfunction that negatively affects quality of life. Nurses assist patients in the self-management of LARS, yet there is a need to develop more self-care modalities. Therefore, this study aimed to describe the experience using the Paula method of exercise in patients with LARS. METHODS:A qualitative study of semi-structured interviews of 17 patients who completed a 12-week exercise intervention as part of a larger multicenter randomized controlled trial. Interviews were recorded, transcribed, and analyzed thematically. RESULTS:Three main themes were identified: (1) The Paula Method Exercises with subthemes, Preferred/Nonpreferred Exercises and Frequency, Feeling in the Body, and The Paula Method Instructor; (2) Change in Bowel Function with subthemes, urgency, frequency/fragmentation, and incontinence/unpredictable stools; (3) Additional Self-Care Modalities to Manage LARS, with subthemes dietary/over-the-counter medications and schedule bowel movements/self-navigate. CONCLUSIONS:Participants perceived the Paula method exercises to be acceptable and reported that they helped alleviate symptoms, particularly bowel frequency and urgency. The exercises provided confidence and a feeling of reducing uncertainty. The Paula method may be added to complement existing self-care modalities.
PURPOSE:Acute postoperative pain after esophageal cancer surgery is highly prevalent and hinders rehabilitation. This study explores the trajectory and influencing factors of acute postoperative pain to guide targeted pain management. METHODS:A prospective design was adopted among 200 patients who had undergone esophageal cancer surgery in a tertiary hospital in Nanjing, China, from June to November 2025. Pain was assessed via the Numerical Rating Scale across 11 postoperative time-points (1 h after surgery, 8 a.m. and 8 p.m. from day 1 to 5 after surgery). Latent class growth analysis identified pain trajectories, while logistic regression and decision tree models evaluated influencing factors. RESULTS:Two distinct pain trajectories were identified, i.e., a mild-pain-stable group (81.0%) and a pain-exacerbated-then-relieved group (19.0%). Logistic regression identified smoking, drinking, preoperative sleep disorders, preoperative pain history, and chest tube indwelling time as significant predictors (P < 0.05). The decision tree model identified smoking, drinking, preoperative sleep disorders, and chest tube indwelling time as core variables, with chest tube duration showing the strongest correlation. Both models demonstrated promising preliminary predictive performance (Logistic regression AUC = 0.931; Decision tree AUC = 0.893), though these findings require external validation. CONCLUSION:Acute postoperative pain trajectories in esophageal cancer patients exhibit clear population heterogeneity. These preliminary findings suggest that the identified risk factors may inform targeted analgesic interventions in future study designs, but prospective validation in independent cohorts is warranted before clinical implementation.
PURPOSE:To identify postoperative weight-loss trajectories during the first six months after gastrectomy and develop an interpretable machine-learning model to predict rapid decline before adjuvant chemotherapy. METHODS:This single-centre retrospective cohort included 546 patients undergoing radical gastrectomy followed by adjuvant chemotherapy. Patients were divided into a training cohort (n = 435) and an independent test cohort (n = 111). Group-based trajectory modelling was fitted exclusively in the training cohort, with fixed parameters applied to the test cohort. Six machine-learning models used predictors available by admission for the first chemotherapy cycle. Discrimination, calibration, and decision curve analysis assessed performance, and SHapley Additive exPlanations interpreted the final model. RESULTS:Three trajectories were identified: stable (n = 177, 32.4%), moderate decline (n = 279, 51.1%), and rapid decline (n = 90, 16.5%). The rapid-decline trajectory reached approximately 22% weight loss by postoperative month 6. CatBoost showed the best overall performance in the test cohort, with an area under the receiver operating characteristic curve of 0.808 (95% confidence interval, 0.695-0.902), a Brier score of 0.112, and a calibration slope of 0.954. Decision curve analysis indicated greater net benefit than the treat-all and treat-none strategies across threshold probabilities of approximately 5%-30%. Preoperative body mass index, histological subtype, and gastrointestinal reconstruction were the leading predictors, while psychosocial variables provided complementary information. CONCLUSIONS:Postoperative weight loss followed distinct trajectories. CatBoost may identify patients at risk of rapid, sustained weight loss when adjuvant chemotherapy begins. External multicentre validation is required before clinical implementation.
PURPOSE:This study aimed to assess skin cancer knowledge, attitudes, and sun-protective behaviors among university students in Lebanon, and to examine the effects of gender, university type, and geographic region on protective practices. METHOD:A cross-sectional survey of 1330 university students in Lebanon assessed skin cancer knowledge, attitudes, and sun-protective behaviors using a structured questionnaire. Participants recruited via convenience and snowball sampling from randomly selected public and private institutions across various regions were analyzed using Pearson correlations and multivariate regression to identify behavioral predictors. RESULTS:Despite 86.4% awareness of skin cancer, misconceptions were widespread: 35.9% believed that darker-skinned individuals are protected against sunburn, and only 38.2% identified melanoma as a type of skin cancer. Just 33.8% consistently used sun protection, and only 12.6% reapplied sunscreen every 2-3 h. Knowledge, attitude, and behavior scores were positively moderately correlated (r = 0.193-0.274; p < 0.001). Female sex independently predicted higher scores across all domains, with the strongest effect on protective behaviors (β = 1.45; p < 0.001). Although students at private universities exhibited significantly greater knowledge than their public counterparts (β = 0.36; p < 0.001), their sun-protective behaviors were notably poorer (β = -0.31; p < 0.001), revealing a persistent and clinically relevant knowledge-behavior gap. Less urbanized regions showed lower knowledge and practice scores (p < 0.05). Only 46.8% of students sought medical advice for a changing mole, and 79.3% reported ≥1 lifetime sunburn. CONCLUSIONS:Among young adults, awareness alone does not translate into protective behavior. Behaviorally informed interventions are needed to bridge this gap and reduce the future skin cancer burden.
INTRODUCTION:Physical activity intolerance (PAI) is common among oncology inpatients, leading to reduced autonomy, increased symptom burden, and diminished quality of life. OBJECTIVES:To evaluate the feasibility of delivering rehabilitation nursing interventions and to estimate changes in performance status, symptom burden, and well-being in hospitalized older adults with cancer and PAI. METHODS:A quantitative, prospective, single-arm pre-post study was conducted in a General Oncology Surgery Department in collaboration with the In-Hospital Palliative Care Support Team. Participants were inpatients aged ≥65 years. Assessments included the Edmonton Symptom Assessment System (ESAS-r), Palliative Performance Scale (PPS), diagnostic confirmation of PAI, and physiological measurements. Rehabilitation nursing interventions-respiratory and motor re-education and activities of daily living training-were delivered. Changes between pre- and post-intervention scores were estimated using mean differences with 95% confidence intervals (CIs) and standardized within-participant effect sizes (Cohen's d_z). RESULTS:Thirty inpatients (67% male; mean age 76.7 ± 7.3 years) participated. Performance status increased by a mean of +7.67 points (95% CI 3.00 to 12.34; d_z 0.61). Overall well-being improved (mean change -3.30 points; 95% CI -4.06 to -2.54; d_z -1.62). Fatigue decreased from 5.33 ± 2.51 to 2.87 ± 2.29 (mean change -2.47; 95% CI -3.68 to -1.25; d_z -0.76). Most symptoms showed changes toward improvement, whereas appetite loss and dyspnoea showed minimal change. CONCLUSIONS:Rehabilitation nursing interventions were feasible to deliver, and estimates suggested improvement in performance status and selected symptoms. Given the small sample size and single-arm design, findings should be interpreted cautiously and confirmed in controlled studies.
PURPOSE:To evaluate the effects of a symptom network-based core symptom management program targeting fatigue, cough, and dyspnea on symptom burden, symptom management self-efficacy, and quality of life in patients undergoing lung cancer surgery. METHOD:This parallel-group randomized controlled trial was conducted at a tertiary hospital in Jiangsu Province, China, between March and December 2024. A total of 114 patients were randomly assigned to receive standard perioperative care or a symptom network-based core symptom management program, and 99 participants completed all three assessments. Outcomes included overall symptom burden, core symptom severity, symptom management self-efficacy, and quality of life, assessed at admission, discharge, and one month postoperatively. Group, time, and group × time effects were analyzed using repeated-measures ANOVA. RESULTS:Significant group, time, and group × time effects were observed for overall symptom burden and core symptoms (all P < 0.05). Compared with the control group, the intervention group reported lower overall symptom burden and core symptom severity at discharge and one month postoperatively. Symptom management self-efficacy improved significantly (P < 0.001), with improvements also observed across multiple quality-of-life domains. CONCLUSIONS:The symptom network-based core symptom management program was associated with reduced symptom burden, improved symptom management self-efficacy, and enhanced quality of life among patients undergoing lung cancer surgery. These findings support the clinical value of targeting network-identified core symptoms in perioperative symptom management.
PURPOSE:Patients with advanced pancreatic or lung cancer face substantial physical, psychological, and existential challenges. While symptom burden is well documented, less is known about how patients articulate their concerns and priorities during palliative oncological treatment. This study explored patient-reported concerns, priorities, and preferred discussion topics among patients with advanced pancreatic or lung cancer receiving first-line systemic therapy. METHODS:This qualitative exploratory study draws on data from the BetterEveryDay feasibility study, which evaluated a supportive digital application with integrated patient-reported outcomes. Over 12 weeks, participants reported symptoms and side effects and answered three open-ended questions on a weekly basis. Data were analyzed using thematic analysis and supplemented with frequency analysis. RESULTS:Of the 31 participants enrolled, 27 provided qualitative data. Thematic analysis identified three themes related to concerns, four themes related to priorities, and three themes related to preferred discussion topics. Participants emphasized maintaining a sense of normality and identity as central priorities. Family relationships, everyday functioning, and independence emerged as key sources of meaning, while physical symptoms, uncertainty, and relational concerns were closely connected to existential reflections. Responses captured concerns extending beyond symptom burden and highlighted topics participants wished to address during consultations. CONCLUSIONS:The findings suggest that integrating open-ended questions into digital patient-reported outcome platforms may help healthcare professionals identify patients' broader priorities, facilitate more person-centered consultations and shared decision-making, and ensure that supportive and palliative care is better aligned with individual needs. CLINICAL TRIALS REGISTER:NCT04611867 (BetterEveryDay).
