OBJECTIVE:To identify and characterize cognitive trajectories over 3 years in men with prostate cancer (PCa) and their associated sociodemographic, clinical, and treatment-related factors. METHODS:This study included 454 men with PCa from the NEON-PC cohort. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), before treatment and at 1- and 3-year follow-ups. Probable cognitive impairment (PCI) was defined using age- and education-adjusted cut-offs. Model-based clustering and clinical interpretability were used to identify cognitive trajectories. Adjusted odds ratios (aORs) were estimated using multinomial logistic regression. RESULTS:Four cognitive trajectories were identified: (1) consistently high (highest scores throughout follow-up); (2) moderate-stable (stable intermediate scores); (3) moderate-downward (intermediate baseline scores and declining over the follow-up); and (4) consistently low (lowest baseline scores). PCI prevalence increased over time in the moderate-downward trajectory (8.1%-33.3%, p < 0.001) and remained high in the consistently low trajectory (29.8%-32.6%, p = 0.537). Compared with the consistently high trajectory, age (≥ 75 vs. ≤ 65: OR = 4.00; 95% CI: 1.61-9.93), education (≥ 10 vs. ≤ 4 years: aOR = 0.02; 95% CI: 0.01-0.06), and depressive symptoms (per one-point increase in the Hospital Anxiety and Depression Scale: aOR = 1.12; 95% CI: 1.01-1.24) were associated with the consistently low trajectory. Androgen deprivation therapy (ADT) was associated with the moderate-downward trajectory (aOR = 2.33; 95% CI: 1.01-5.36). CONCLUSIONS:Four distinct cognitive trajectories were identified among men with PCa over 3 years, with worse trajectories associated with sociodemographic, psychological distress, and treatment-related factors.
BACKGROUND:Demoralization is a maladaptive coping response to stressful situations, characterized by thoughts of hopelessness, helplessness, and loss of meaning and purpose. Demoralization is clinically measurable using the Demoralization Scale 2 (DS-II). Pancreatic cancer (PC) patients, who carry a notoriously poor prognosis, are hypothesized to be at higher risk of demoralization. AIMS:This study uses the DS-II to gauge the impact of demoralization in PC patients compared to a heterogenous cancer population and establish its relation to depression. METHODS:Patients completed the DS-II, PHQ-9, and a demographic survey. The mean DS-II score of PC patients was compared with that of a previously published heterogenous cancer cohort reported by Ignatius et al. using a one-sample t-test. The univariable association between DS-II scores and PHQ-9 scores was examined using linear regression models. RESULTS:Of the 206 patients enrolled in the study, 47% were women and the mean age was 67 ± 10 years. The mean DS-II total score was 4.9 ± 5.2 points, significantly lower than the mean of 10.8 ± 8.0 previously reported by Ignatius and De La Garza II in a psychiatric oncology cohort (p < 0.001). There was no significant difference in demoralization scores across disease stages (p = 0.8). DS-II scores in univariable models were associated with depression (β = 0.79, p < 0.001), age (β = -0.09, p = 0.008), and women (p = 0.002). CONCLUSION:Demoralization in this cohort of patients with PC was lower than that reported by Ignatius et al., although differences in recruitment settings and patient characteristics limit direct comparisons. Though disease stage did not impact demoralization scores in PC, our study found demoralization was strongly associated with concurrent depression, young age, and women. Understanding the risk factors associated with demoralization in PC can help enhance the quality of psychosocial care in oncology.
BACKGROUND:Veterans report greater comorbidity and psychosocial burden but have enhanced healthcare access through the Veterans Health Administration (VHA). We sought to characterize health-related quality of life (HRQoL) differences between veteran and civilian cancer survivors. METHODS:We analyzed cancer survivors from the 2017-2022 Behavioral Risk Factor Surveillance System. Outcomes included fair/poor general health, poor physical health, poor mental health, and activity-limiting poor health. Sex-stratified, survey-weighted Poisson regression with robust variance estimated incidence rate ratios (IRRs) for day-count outcomes and prevalence ratios (PRs) for binary outcomes, controlling for sociodemographic and clinical covariates. RESULTS:Among 65,613 survivors (32,710 men; 32,903 women), 11,213 men (34.3%) and 753 women (2.3%) were veterans. Male veterans were older than civilian men (≥ 75 y: 54.4% vs. 25.9%), less likely to be employed (20.1% vs. 39.6%) or be college graduates (41.9% vs. 47.5%), and frequently reported history of cerebrovascular accident (9.8% vs. 5.7%) or coronary artery disease (25.4% vs. 15.9%) (all p < 0.001). Compared with female civilians, female veterans reported no differences in education, employment status, or history of chronic conditions (p > 0.05). Among female cancer survivors, veteran status was associated with higher prevalence of poor physical-health (aPR 1.35, 95% CI 1.02-1.77) and poor mental-health (aPR 1.45, 95% CI 1.06-1.98). Among males, veteran status was not associated with poor physical or mental health (all p > 0.05). CONCLUSIONS:The findings highlight the importance of sex-responsive survivorship care integrating chronic-disease management, mental-health support, and social-risk screening across VHA and civilian systems.
BACKGROUND:Patient-reported outcome measures (PROMs) are fundamental in evaluating cancer treatments within clinical research and practice. The existence of various PROMs that assess similar health domains presents challenges for comparing or aggregating study results and data. Score linking is a well-established method for addressing this issue by converting scores from the metric of one PROM to another. AIMS:To provide equipercentile equating of psychosocial scales from commonly used PROMs in cancer patients to facilitate data pooling and comparisons. METHODS:Cancer patients with diverse diagnoses from five European countries completed the EORTC CAT Core, EORTC QLQ-C30, FACT-G, SF-36, and HADS Emotional, Role, and Social functioning (EF; RF; SF) scales. For scales with Spearman correlations exceeding 0.70, scores were linked using equipercentile equating as provided by the R package "equate". To evaluate linking precision, Standardized Mean Absolute Errors (SMAEs) were calculated. RESULTS:A total of 945 cancer patients were included in the analysis (mean age 58.4 years; 54.7% male). Bidirectional conversion tables were established for three pairs of SF/RF scales and 10 pairs of EF scales. Overall, linking was possible for most scales from the EORTC Measures, SF-36, and HADS, whereas the FACT-G allowed linking only for its Emotional Well-Being (EWB) scale. CONCLUSIONS:The findings suggest greater linking ability for EF scales compared to RF and SF scales, which seem to be more heterogeneous in terms of content. The established crosswalks support the combined evaluation of data from different PROMs.
BACKGROUND:Meaning making is increasingly recognized as an important determinant of psychosocial adjustment in adult oncology. However, how school-aged children make meaning of cancer and how developmental, relational, and sociocultural influences shape this process remain insufficiently characterized, particularly because frameworks are largely derived from adult research and centered on intrapersonal processes. AIMS:To synthesize evidence on meaning making among school-aged children with cancer and examine these findings through Park's meaning-making model while identifying dimensions not fully captured by the model. METHODS:A scoping review was conducted according to PRISMA-ScR guidelines. Four databases and reference lists were searched for peer-reviewed studies examining meaning making through direct reports from children aged 6-12 years with cancer. Park's meaning-making model informed study selection, data extraction, and deductive coding, while inductive coding identified dimensions not represented in the model. RESULTS:Thirty-nine studies were included. Children's meaning making encompassed global beliefs and developmental and healthcare-related goals; appraisals of threats to the self, normalcy, relationships, and future; and cognitive, emotional, socially informed, spiritual, experiential, and avoidance-related processes. Meaning making emerged as a dynamic, developmentally grounded, and relational process shaped by caregivers, healthcare professionals, and sociocultural contexts across the cancer trajectory. Evidence regarding children's sense of meaning or purpose and meanings made was limited. CONCLUSIONS:School-aged children actively construct meaning throughout the cancer trajectory. Integrating interdisciplinary support for meaning making that is child-centered and developmentally and culturally responsive into psychosocial care, serious illness communication, and pediatric palliative care may strengthen children's participation, coping, and psychosocial-spiritual well-being.
BACKGROUND:Adolescents with osteosarcoma face clinical and psychosocial challenges during the transition from adolescence to adulthood. AIMS:This study examined the effects of a nurse-navigated game-based intervention (N2-GBI) on transition readiness in adolescents. METHODS:Participants in the control group received usual care, whereas the intervention group received the N2-GBI programme alongside usual care. Transition readiness was assessed using the Self-Management and Transition to Adulthood with Rx = Treatment Questionnaire as the primary outcome. Secondary outcomes included cancer worry, transition expectation and patient activation, which were measured using the Cancer Worry Scale, Transition Expectation Scale, and Patient Activation Measure, respectively. Outcomes were assessed at baseline (T0), immediately after intervention (T1) and at 12-week follow-up (T2). Generalized estimating equations were used to estimate the intervention effects. RESULTS:A total of 59 adolescents were enrolled. The intervention and control groups comprised 32 and 27 adolescents, respectively, with mean ages of 15 and 13 years, respectively. A total of 19 and 15 participants were male in the intervention and control groups, respectively. Compared with the control group, the N2-GBI group showed significantly greater improvement in transition readiness at T1 (β = 8.83, p < 0.001) and T2 (β = 7.97, p = 0.001). The N2-GBI programme also significantly reduced cancer worry (p = 0.009) and increased patient activation (p = 0.001), but had no significant effect on transition expectation (p = 0.056). CONCLUSIONS:The N2-GBI programme improved transition readiness, reduced cancer worry, and increased patient activation among adolescents with osteosarcoma, but did not significantly improve transition expectation. This intervention may be a useful nurse-led approach to transition preparation in pediatric oncology care. Future studies with larger sample sizes and prolonged follow-up durations are needed.
BACKGROUND:Insomnia affects 30%-60% of cancer survivors, with around 20% meeting criteria for insomnia disorder. Cognitive behavioral therapy for insomnia (CBTi) is the first-line treatment, but access is limited by cost and therapist availability, prompting exploration of alternative delivery modes, including digital interventions. PURPOSE:To systematically review and conduct a network meta-analysis (NMA) of the efficacy of different CBTi delivery methods for managing insomnia in cancer survivors. METHODS:The PubMed, Embase, CINAHL and Cochrane Library were searched for relevant articles published before September 25, 2025. Only randomized controlled trials of adult cancer patients evaluating the effects of any CBTi delivery mode on subjective sleep outcomes were included. Primary outcome was insomnia severity index (ISI) score; secondary outcomes included sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE). A frequentist random-effects NMA was conducted. RESULTS:Twenty-two trials involving 2040 participants were included. Compared with treatment as usual (TAU), digital CBTi (dCBTi) demonstrated the largest reduction in ISI scores (MD = -9.70, 95% CI = -10.80 to -8.61), followed by telephone CBTi (MD = -8.74). dCBTi also significantly improved SOL (-30.95 min), WASO (-25.62 min), TST (+31.67 min), and SE (+14.63%). Group CBTi significantly improved SOL (-11.60 min) and WASO (-22.03 min). Meta-regression analyses identified breast cancer diagnosis as a significant moderator of dCBTi effects on SOL (coefficient = 25.20, p = 0.015) and SE (coefficient = -16.17, p = 0.007). The certainty of evidence ranged from low to very low, primarily because of imprecision and network incoherence. CONCLUSIONS:dCBTi demonstrated the greatest potential for improving insomnia outcomes among the evaluated CBTi delivery modalities. However, given the low certainty of evidence and the presence of network inconsistency for selected outcomes, these findings should be interpreted cautiously. High-quality head-to-head trials are needed to confirm the comparative effectiveness of different CBTi delivery modalities in oncology populations. TRIAL REGISTRATION:The study protocol was prospectively registered on PROSPERO (registration no. CRD42023429081).
OBJECTIVE:Caregivers of children with hematologic malignancies experience prolonged treatment demands, uncertainty, and substantial psychosocial burden. This study explored how caregivers navigate everyday caregiving responsibilities, decision-making, and emotional endurance under conditions of uncertainty and constrained choice. METHODS:A qualitative study informed by a descriptive phenomenological orientation was conducted with 15 primary caregivers recruited from a pediatric hematology unit in China using purposive sampling. Data were collected through semi-structured interviews and supplemented by non-participant observation. Data were analyzed using reflexive thematic analysis. An existential-oriented interpretive lens was introduced during later stages of analysis to deepen understanding of agency, responsibility, and meaning within caregiving experiences. RESULTS:Caregivers described caregiving as an ongoing process of negotiating treatment demands, family responsibilities, financial pressures, and emotional strain under conditions of limited control. Everyday life became reorganized around the child's illness, with caregivers adopting present-oriented routines focused on symptom monitoring, treatment continuity, and maintaining immediate stability. Emotional endurance was sustained through regulation of distress, selective focus on incremental improvement, and maintenance of everyday relational continuity. Caregivers' experiences were also shaped by sociocultural expectations surrounding parental responsibility, emotional restraint, and family obligation. CONCLUSION:Caregiving in pediatric hematologic oncology involves continuous adaptation within conditions of uncertainty rather than discrete coping responses to stress. Psychosocial support may therefore benefit from approaches that help caregivers sustain everyday functioning, navigate ongoing decision-making, and maintain emotional continuity while living with unresolved uncertainty.
BACKGROUND:Psychological prehabilitation aims to prepare patients for cancer treatment, yet psychological readiness is under-specified and distress during and after treatment is common. A patient-informed account of readiness is needed to guide readiness-focused, proactive psychological support in cancer care. AIMS:To examine patients' experiences of psychological readiness for cancer surgery across the prehabilitation-treatment pathway. METHODS:We used a longitudinal qualitative design. Ten adults enroled in a tertiary cancer prehabilitation service for major elective surgery completed semi-structured interviews before surgery (T1) and after surgery (T2). We analysed data using Reflexive Thematic Analysis with an inductive, semantic approach, and compared change and stability across time points using a longitudinal analytic matrix. RESULTS:Participants described psychological readiness as developing a future-focused "mindset to have surgery", comprising three interrelated elements that were stable from T1 to T2: confidence, motivation, and contained anxiety, that is, anxiety that remained expected and manageable rather than absent or overwhelming. Three processes shaped this mindset. Reliable and complete information from professionals and credible peers supported clearer and more concrete expectations, increased confidence, and helped keep anxiety manageable. Participants preferred candid information about plausible difficulties over reassurance that downplayed them. Reciprocal support from family, peers, and professionals strengthened motivation and reduced loneliness. Readiness could be held back when participants found it difficult to tell loved ones about their diagnosis. Agency developed through drawing on personal resources and taking controllable steps, including making progress visible through prehabilitation activity and staff encouragement. CONCLUSIONS:These findings identify provisional, patient-informed targets for psychological preparation within multimodal prehabilitation. They provide a foundation to operationalise and measure readiness and, following work on transferability, co-production and feasibility, to test whether readiness-focused support in prehabilitation is associated with post-operative adjustment.
BACKGROUND:People with primary bone and soft tissue sarcoma are a unique and vulnerable population at high risk of physical dysfunction and disability. Treatment often leads to complex challenges, including pain, limited mobility, and loss of function. Exercise has the potential to improve strength and function, reduce disability, and improve quality of life. Nutrition plays a crucial role in supporting recovery and immune function, and enhancing treatment outcomes. Yet, limited research has explored physical activity and nutritional needs of people with sarcoma. AIM:To explore the physical activity and nutritional supportive care needs of people living with sarcoma from the perspectives of people with sarcoma, their carers, and HCPs. METHOD:A phenomenological approach was employed to understand lived experiences of people with sarcoma and their carers focusing on what physical activity and nutritional supportive care people received. Semi-structured interviews and focus groups were conducted with people with sarcoma, carers, and healthcare professionals. Multiple perspectives were included to understand the current clinical landscape for people experiencing sarcoma and healthcare professionals. Reflexive thematic analysis was used to draw meaning from the data and information power informed sample size. RESULTS:We interviewed 46 participants (people with sarcoma n = 18, current carers n = 10, bereaved carers n = 3, and healthcare professionals n = 15) who emphasised the need for more information and support for physical activity and nutrition. Five themes were identified: Physical impact of sarcoma; Uncertainty about looking after the person with sarcoma; Needing rehabilitation support; Creating a new normal; and, Physical activity and healthy diet promote psychosocial well-being. CONCLUSION:As sarcoma substantially impacts physical functioning, it is essential that sarcoma-specific physical activity and nutrition information and supports are available and tailored to individuals. Multidisciplinary teams should provide ongoing physical activity and nutritional supportive care from diagnosis and throughout survivorship to improve health outcomes and QoL for people with sarcoma.
BACKGROUND:Psychological distress is an important component of cancer survivorship, particularly among patients undergoing radical cystectomy (RC) for bladder cancer. However, the prognostic significance of postoperative psychiatric medication exposure following RC remains unclear. AIMS:To investigate the association between postoperative antidepressant and/or anxiolytic exposure and survival outcomes following RC for bladder cancer. METHODS:This retrospective propensity score-matched cohort study used data from the TriNetX US Collaborative Network. Adult patients who underwent RC for bladder cancer (2005-2025) were identified. Postoperative psychiatric medication exposure was defined as new use of antidepressants (Anatomical Therapeutic Chemical: N06A) and/or anxiolytics (ATC: N05B). The primary analysis evaluated combined antidepressant/anxiolytic exposure, with separate antidepressant-only and anxiolytic-only subgroup analyses. Overall survival (OS) and all-cause mortality were evaluated after 1:1 propensity score matching (PSM). RESULTS:The primary analysis identified 2461 exposed and 7257 unexposed patients, yielding 1521 matched pairs after PSM. Patients exposed to postoperative psychiatric medication were associated with significantly poorer OS than their matched controls (hazard ratio [HR]: 1.377, 95% confidence interval [CI]: 1.261-1.502; log-rank p < 0.001). Similar associations were observed in subgroup analyses. Antidepressant-only exposure was associated with poorer OS (HR: 1.260, 95% CI: 1.161-1.367; p < 0.001), and the anxiolytic-only subgroup demonstrated the strongest association with poorer survival (HR: 1.457, 95% CI: 1.324-1.604; p < 0.001). CONCLUSIONS:Psychiatric medication use may represent a clinically observable marker of psychological burden and survivorship vulnerability following RC. Early recognition of postoperative psychological vulnerability may facilitate timely psycho-oncological support and multidisciplinary survivorship care following RC.
BACKGROUND:Pelvic exenteration (PE) is a radical surgery for advanced pelvic malignancies that carries substantial psychosocial impacts. Assessing distress is critical for timely support. AIMS:To evaluate the responsiveness-to-change and convergent validity of the distress thermometer (DT), and to determine an optimal cutoff score for detecting clinically significant distress in a PE cohort. METHODS:Secondary analyses of cohort study data involving adult patients who underwent PE at a quaternary referral hospital. Responsiveness was evaluated by determining whether the DT differentiated cases of decreased emotional well-being and health-related quality of life from pre- to post-surgery, using the Functional Assessment of Cancer Therapy-General (FACT-G), FACT-Colorectal, and Emotional Well-Being (EWB) subscale as external criteria. Convergent validity was evaluated using the correlation between the DT and the EWB subscale scores. Cutoff scores were examined by reviewing the following indices, using an existing EWB cutoff as an external anchor: sensitivity, specificity, positive/negative predictive values, and clinical utility index (CUI). RESULTS:The analysis included 377 patients (mean age: 61 years, 56% male; 41% recurrent rectal cancer). The DT demonstrated responsiveness, with AUCs > 0.7 for detecting emotional and quality-of-life decline post-surgery. Convergent validity was demonstrated through a moderate correlation between the DT and the EWB subscale scores (rs = -0.56, p < 0.001). The optimal DT cutoff score was 4: Sensitivity; 87.0%, Specificity; 52.7%, CUI- value; 0.49 (ruling out cases: satisfactory utility), CUI+ value; 0.33 (case finding: poor utility). CONCLUSION:The DT is a valid and responsive tool for detecting psychological distress in PE patients. Its high sensitivity supports its use in routine screening.
AIMS:To develop a theoretical framework for understanding the adaptation process to altered bowel function in patients with rectal cancer. METHODS:This is a constructivist grounded theory study using theoretical sampling to select 24 patients who experienced low anterior resection syndrome, and were followed-up at a cancer centre in Northern Taiwan. Data were collected using interviews until theoretical saturation was reached. During the interview, field notes synchronously were written as a memo to capture what was seen, heard, felt, and thought. Data were analysed using iterated constant comparisons, initial coding, focused coding, and theoretical coding. RESULTS:A substantive theory was developed that describes how participants adapted to altered bowel functioning. These categories encompassed experiences of altered bowel functioning, distress from altered bowel functioning, tolerance of distress fuels motivation for self-empowerment, dynamic self-regulation styles, and "living with" altered bowel functioning. From this process, a core category emerged: "The journey from painful struggles toward self-empowerment." CONCLUSION:These findings could guide healthcare professionals to comprehensively evaluate patients' distress from altered bowel functioning, witness those who are motivated to govern their situation, and provide timely information and tailored resources to sustain the growth of compassionate self-care strategies that enable them to deal with, and live with, their altered bowel function. In future research, the findings could help researchers to develop a tool to comprehensively evaluate distress from altered bowel function and design a timely, ongoing, individual, and cost-effective protocol that guides patients on a healing pathway.
BACKGROUND:The need for psychological skills training among the cancer workforce has been recognised since NHS recommendations (2004) suggested that more holistic support is needed to address the psychosocial impact of cancer. Previous research has focused on the development of training for clinical staff, however with supportive roles (such as Care Navigators) developing to include increased patient contact. This service evaluation aims to address the gaps in training for this staff group. AIMS:We aimed to evaluate a one-day training package developed and delivered at Calderdale and Huddersfield NHS Foundation Trust to support the improvement of psychological skills and staff wellbeing among supportive and assistive staff. METHODS:The effectiveness of training was assessed using pre-post self-rated competency scales, standardised wellbeing measures, and semi-structured interview data analysed using thematic analysis. RESULTS:Psychological skills training significantly improved staff's self-perceived competency in identifying and supporting psychological distress. Wellbeing measures indicated no change, although interview data suggested a positive impact on wellbeing. Thematic analysis indicated that the training was valued by staff, increasing their confidence, knowledge and skills, motivating them to develop further. Some staff remained less confident in their ability to address suicidality and would benefit from further support through extra training or supervision. CONCLUSIONS:The findings from this service evaluation suggest this training package may benefit the psychological skills of those in supportive and assistive roles, and that this was experienced positively by staff. Further implementation and evaluation is warranted before generalising these findings to routine clinical practice.
OBJECTIVE:Depression and anxiety are hypothesized to increase the risk for the development of chronic disease(s), including cancer. Several published observational studies and meta-analyses have investigated the link between depression and anxiety in cancer but have reported conflicting results. To clarify this relationship, a meta-analysis of observational studies reporting an association between depression, anxiety, and cancer incidence was performed. METHODS:Prospective and retrospective cohort studies investigating the relationship between depression, anxiety, and cancer incidence were included. A literature search of the PubMed was performed, with the final search conducted in March 2026. Egger's test and funnel plots were used to evaluate publication bias. Meta-analysis was performed using a random-effects model because high heterogeneity among the studies was expected. RESULTS:In the analysis including both retrospective and prospective studies, patients with depression or anxiety exhibited an elevated risk for lung, hepatobiliary-pancreatic (HBP), hematological, and kidney, ureter, and bladder (KUB) cancers. In the analysis including only prospective studies, patients with depression or anxiety exhibited an elevated risk for female reproductive organ and lung cancer. Finally, in the analysis including only retrospective studies, patients with depression or anxiety exhibited an elevated risk for lung, HBP, hematological, KUB, and oral cancers, and a notably lower risk for female reproductive organ cancer. CONCLUSIONS:Results of this study revealed that depression and anxiety were associated with an elevated risk for specific cancers. A future meta-analysis including only prospective cohort studies with the same measures of depression or anxiety may further clarify this relationship.
BACKGROUND:Cancer patients often suffer from neurocognitive impairments due to cancer treatment, the cancer itself, and/or coping with the illness, significantly impairing quality of life and everyday functioning. AIMS:This study evaluates the effectiveness of an online MBSR course regarding neurocognitive functioning and well-being of cancer patients. METHODS:A total of 170 cancer patients with cognitive impairments 3 months to 5 years after completing antitumor therapy were randomized to an online MBSR course led by an experienced therapist or a waitlist control group. Assessments were conducted online at baseline (T0) and post-intervention (T1, 8 weeks). The control group then received the intervention and was assessed again after 8 weeks (T2). Both groups completed a 3-month follow-up (T3). The primary outcome was subjective neurocognitive functioning (FACT-Cog). Secondary outcomes included quality of life (FACT-G), fatigue (BFI), depressive symptoms (PHQ-9), attention (Go-No-Go), and verbal learning and memory (VLMT). Outcomes were analyzed using mixed models for repeated measures. RESULTS:Subjective neurocognitive functioning (FACT-Cog) improved significantly in the intervention group compared to controls at T1 (Cohen's d = 0.36-0.72, p = 0.004-< 0.001, depending on subscale), as well as quality of life (FACT-G, Cohen's d = 0.32, p = 0.001), fatigue (BFI, Cohen's d = -0.47, p < 0.001), and depressive symptoms (PHQ-9, Cohen's d = -0.57, p < 0.001). Objective memory performance (VLMT, Cohen's d = 0.25, p = 0.030) improved. Effects were maintained at 3-month follow-up. CONCLUSIONS:The online MBSR course can effectively improve cancer-related cognitive impairment and well-being of cancer patients.
BACKGROUND:Sleep disturbance is highly prevalent among cancer patients and closely associated with depressive symptoms. However, it remains unclear whether sleep problems present at cancer diagnosis primarily reflect depression or also indicate an underlying biological susceptibility. AIM:This study aimed to examine the relationships between sleep disturbance, depressive symptoms, and systemic inflammatory-nutritional burden in newly diagnosed, treatment-naïve cancer patients. METHODS:In this cross-sectional study, sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) in patients at diagnosis before oncological treatment. Poor sleep quality (PSQ) was defined as PSQI ≥ 5, and sleep disturbance severity was evaluated using the total PSQI score. Depressive symptoms were measured with the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D). Systemic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR) and lactate dehydrogenase-to-albumin ratio (LAR), were calculated from routine laboratory data. Multivariable logistic regression and generalized linear models assessed factors associated with PSQ and sleep disturbance severity, respectively. Receiver operating characteristics (ROC) analyses evaluated the discriminatory performance of depressive symptoms and inflammatory indices. Stratified analyses were conducted according to depression status (HADS-D < 8 vs. ≥ 8). RESULTS:Sleep disturbance was highly prevalent at diagnosis. Depressive symptom burden was independently associated with both PSQ and higher PSQI scores. Importantly, systemic inflammatory indices remained independently associated with sleep disturbance after adjustment for depressive symptoms and clinical variables. NLR showed moderate discriminatory ability for PSQ, while LAR was independently associated with sleep disturbance severity. ROC analyses indicated that depressive symptoms and inflammatory burden jointly improved discrimination of PSQ. In stratified analyses, LAR remained significantly associated with PSQI scores regardless of depression status. CONCLUSION:Sleep disturbance at cancer diagnosis is independently associated with both depressive symptoms and systemic inflammatory-nutritional burden, suggesting that it may reflect not only psychological distress but also underlying biological processes. Routine sleep assessment alongside inflammatory markers may help identify vulnerable patients and support early supportive care planning.
BACKGROUND:Cancer patients in the Gaza Strip have long faced major barriers to timely diagnosis, treatment, and continuity of care. These barriers have become substantially more severe under war conditions, displacement, and the collapse of health services. This study aimed to explore the experiences of adults with cancer in the Gaza Strip before and during war, with a particular focus on access to healthcare, support mechanisms, and basic living conditions. METHODS AND RESULTS:This qualitative study was conducted with 12 adults diagnosed with cancer and living in shelters, displacement centres, or tents in the Gaza Strip. Data were collected through in-depth semi-structured interviews in Arabic and analysed using content analysis. The analysis identified six key themes describing cancer care in the Gaza Strip, organized within two temporal categories: three themes characterized the pre-war period and three themes characterized the wartime period. The pre-war themes were problems in access to healthcare services, support mechanisms, and positive aspects related to diagnosis and treatment. The wartime themes were problems in access to healthcare services, insufficiency of support mechanisms, and inadequacy of basic living conditions. Participants reported that even before the war, they experienced delayed diagnosis, fragmented treatment pathways, financial hardship, and limited psychosocial support, although some described positive experiences with functioning hospitals and treatment availability. During the war, participants described severe disruption of medical follow-up, hospital inaccessibility, medication shortages, inability to travel for treatment, irregular or insufficient support, displacement, food insecurity, and worsening physical and psychological burden. CONCLUSIONS:The findings show that cancer care in the Gaza Strip was already fragile before the war and became profoundly disrupted during it. The experiences of patients highlight the need for integrated responses that address not only treatment continuity, but also psychosocial support, nutrition, and basic survival needs. The study also underscores the interdisciplinary relevance of cancer care in conflict settings for medicine, nursing, and social work. By showing how treatment uncertainty, disrupted support, and unmet survival needs interact, the study identifies patient-level psycho-oncological priorities for cancer care in conflict and crisis settings.
BACKGROUND:Shared decision-making (SDM) emphasizes informed, value-aligned choices, yet affect has not been a primary focus and is rarely addressed explicitly in cancer contexts. Among men with low-to intermediate-risk prostate cancer (LIRPC), active treatment and active surveillance each involve distinct affective challenges that may influence risk perception, decisional uncertainty, and treatment satisfaction. Despite prior work in affect and decision making literature, its integration into cancer contexts remains limited. AIMS:To address the gap, this study examined how affect, alongside cognition and psychosocial factors, was reflected in men's accounts of LIRPC treatment decision making, guided by SDM and affective science frameworks. METHODS:We conducted semi-structured interviews with 28 men with LIRPC across three treatment pathways: AS, AT, and AS-AT transition. Interviews were theory-informed and explored (a) how participants learned and interpreted diagnostic information; (b) how thoughts, emotions, and relationships were experienced in decision-making; and (c) how men reflected on preferred roles. Participants also completed the Control Preferences Scale. RESULTS:Eleven themes emerged across domains. Understanding of information depended on both the clarity of medical communication and its relational context. Participants described strong affective responses at diagnosis, awaiting test results, and shortly before surgery. Decision-making was often deliberative, with men weighing options alongside personal values and priorities, physician trust, and family support. Post-treatment reflections emphasized autonomy and value alignment, with coping used to manage affect and maintain a sense of control. CONCLUSIONS:In LIRPC decision-making, affect appeared to vary across contexts and time points. Although decisions were often described as deliberative, affect seemed embedded in how men interpreted information, navigated relationships, and defined what mattered (including quality of life, anticipated treatment outcomes, and autonomy), which influenced how options were weighed. Incorporating affect into decision support, particularly around key moments, may strengthen SDM and treatment satisfaction.
BACKGROUND:Participation in cancer clinical trials is essential for advancing oncologic care, yet enrollment among rural populations remains disproportionately low. These communities face many hurdles including geographical distance from medical centers, healthcare workforce shortages, and deep-seated medical mistrust that may contribute to survival inequities. AIMS:To address these gaps, a Research Navigator program was launched through the Florida Cancer Specialists & Research Institute to engage rural Florida residents in focus group sessions to identify barriers to trial participation. METHODS:Utilizing the Integrated Behavioral and Socioecological Framework (IBSF), the study conducted five semi-structured focus groups with 30 participants recruited from rural Florida counties. Participants included cancer survivors, advocates, caregivers, and those currently in treatment. Discussions centered on knowledge, experiences, perceived barriers, and willingness to participate in cancer clinical trials. RESULTS:Although most participants expressed awareness of cancer clinical trials, focus group discussions revealed misconceptions regarding trial purpose, process, and accessibility. Across groups, commonly reported barriers to participation included limited access to reliable transportation, financial concerns, and mistrust of medical professionals and healthcare systems. Thematic analysis of focus group transcripts yielded four themes: (A) perception and lived experience, (B) trial information dissemination, (C) enrollment impediments, and (D) intervention strategies and implementation. CONCLUSION:In rural settings, decisions regarding cancer clinical trial participation are shaped by a complex interplay of trust, logistics, and information access. This study emphasizes the importance of viewing trials as routine care and suggests that navigator-led outreach and patient-centric technology are essential for creating equitable access.
