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:The aim of this study was to examine the effects of nurse-led laughter yoga intervention on symptom severity, hope, and life engagement in patients undergoing chemotherapy. METHODS:This study was conducted between January and June 2025 at the chemotherapy unit of Atatürk University Research Hospital. Sixty patients were randomized (30 per group). Five were excluded after randomization before baseline assessment because of changes in medical treatment, leaving 55 participants in the per-protocol analysis (intervention n = 27; control n = 28). Symptom severity, hope, and life engagement were measured at baseline and after four weeks using the Edmonton Symptom Assessment Scale (ESAS), Herth Hope Scale (HHS), and Life Engagement Scale (LES). RESULTS:Baseline ESAS, HHS, and LES scores were similar between groups (p > 0.05); however, baseline ESAS tiredness was significantly higher in the intervention group (p < 0.05). After the intervention period, the intervention group had lower adjusted symptom severity (X±SE = 3.07 ± 0.05 vs. 4.21 ± 0.05; p < 0.001; η2 = 0.823), significantly higher levels of hope (X±SE = 72.84 ± 0.81 vs. 47.19 ± 0.79; p < 0.001; η2 = 0.908), and life engagement (X±SE = 26.61 ± 0.23 vs. 22.74 ± 0.22; p < 0.001; η2 = 0.738) compared to the control group at post-test. CONCLUSIONS:As part of supportive care, laughter yoga as a low-cost, non-pharmacological therapy that can be easily integrated into nursing care may reduce symptom severity, increase hope, and may enhance life participation in patients undergoing chemotherapy. Future studies should examine its long-term effects to evaluate the impact of laughter yoga on physical and psychological issues in oncology nursing.
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).
Purpose Cancer-related fatigue (CRF) is a major burden for cancer survivors, limiting their functioning in society. Due to the complexity of CRF, a holistic perspective is required to provide treatment advice that aligns with the experience and perpetuating factors of CRF. A holistic assessment of CRF (HA-CRF) questionnaire was developed previously. This study evaluates the feasibility and usability of the HA-CRF questionnaire in daily life to gain insight into the barriers and facilitators for successful implementation into clinical practice. Methods The HA-CRF questionnaire was implemented in an app and used every other week for four weeks by breast cancer survivors (BCS). Feasibility was assessed by adherence to and completion of the HA-CRF questionnaire (compliance), and acceptability was assessed using a questionnaire based on the Unified Theory of Acceptance and Use of Technology model. Usability was assessed during a group interview. Results Nineteen BCS participated, of whom eleven also participated in the group interview. While completion rates were high (>75%), adherence to the strict monitoring schedule was low (21%). Acceptability varied. BCS provided suggestions to improve usability, including an overview of the HA-CRF questionnaire use, remembering log-in details, and notifications. BCS suggested personalizing the frequency to their individual situation and a figure to display results. Conclusion Feasibility and usability were suboptimal although BCS were involved in the development and validation. For optimal use, suggested improvement could resolve the barriers. The HA-CRF questionnaire could aid specialized nurses and BCS as a practical tool to assess and manage CRF.
PURPOSE:Illness uncertainty, as conceptualised in Mishel's theory, is an important psychosocial issue in paediatric oncology. This study aimed to describe illness uncertainty from adolescents' perspective, examine its item-level network structure and identify central concerns and key co-occurring pathways. METHODS:Illness uncertainty was assessed using the Chinese version of the Uncertainty Scale for Kids, which includes the unpredictability (UP), complexity (CP) and uncertainty (UC) dimensions, with a total score ranging from 0 to 80. An item-level partial correlation network was estimated, and the node strength centrality and edge weights were examined. RESULTS:The mean total illness uncertainty score was 42.94 ± 11.46, indicating a moderate level of illness uncertainty. Items UC11 (expected illness course; strength = 1.292), UP15 (changes in condition; strength = 1.068), UP4 (illness outcome; strength = 1.039) demonstrated the highest strength centrality. The strongest edges formed four co-occurring pathways: disease trajectory judgment, including UP3-UP4 (weight = 0.324), UC9-UP20 (weight = 0.279), UP3-UP5 (weight = 0.249) and UP15-UC16 (weight = 0.242); symptom attribution, represented by CP18-UC19 (weight = 0.354); treatment-related risk, including UC12-CP14 (weight = 0.389) and CP8-UP13 (weight = 0.258); and information interpretation, represented by CP7-UC11 (weight = 0.251). CONCLUSION:The findings underscore the importance of assessing illness uncertainty from the perspective of adolescent patients. Given the cross-sectional design, use of convenience sampling and absence of subgroup network analyses in this study, future longitudinal and multicentre studies are recommended to validate the above findings.
PURPOSE:Self-blame is a common psychological response after cancer diagnosis. It can impair patients' emotional adjustment and thereby increase their need for supportive care and psychological interventions. This study aimed to translate the Self-Blame Attribution for Cancer Scale (SBAC) into Chinese and to conduct a preliminary psychometric evaluation of the Chinese version (SBAC-C) in patients with gynecologic cancer. METHODS:This methodological study was conducted in three phases: translation using the Brislin model, cross-cultural adaptation through two rounds of expert consultation and pilot testing, and psychometric evaluation in a convenience sample of 132 patients with gynecologic cancer. Item analysis, content validity, preliminary dimensional analysis using exploratory factor analysis with principal axis factoring, internal consistency, split-half reliability, and test-retest reliability were assessed. RESULTS:The final SBAC-C contained 11 items across two dimensions: behavioral self-blame and characterological self-blame. Item-level content validity indices ranged from 0.89 to 1.00, and the scale-level content validity index was 0.82. Exploratory factor analysis using principal axis factoring suggested a preliminary two-factor pattern, explaining 74.818% of the extracted variance, with factor loadings ranging from 0.460 to 0.932. Cronbach's alpha for the total scale was 0.905. Split-half reliability was 0.945, and test-retest reliability over a 3-week interval was 0.833. CONCLUSIONS:The SBAC-C demonstrated acceptable reliability and initial evidence of validity in patients with gynecologic cancer. The SBAC-C may serve as a preliminary tool for research use. Large-scale, multicenter validation including confirmatory factor analysis is warranted to firmly establish the factor structure.
PURPOSE:This study aimed to explore the lived experiences of pain catastrophizing among adult cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN) who reported high levels of pain catastrophizing. METHODS:In this qualitative study, adult cancer survivors with persistent CIPN who scored 30 or higher on the Pain Catastrophizing Scale participated in semi-structured interviews. Data from 19 participants were analyzed according to Giorgi's phenomenological procedures to identify the essential meaning and structure of pain catastrophizing experiences. RESULTS:Five constituents reflecting the lived experience of pain catastrophizing among cancer survivors with CIPN were identified through the analysis. The participants described living under the dominance of pain, with daily life centered on persistent symptoms. They constantly anticipated worsening pain, which heightened their anxiety and sensitivity to bodily sensations. Pain was projected onto the future, shaping negative expectations and disrupting life plans, roles, and sense of identity. Ongoing pain also led to gradual emotional exhaustion, marked by emotional fatigue and ambivalence toward treatment. Simultaneously, participants described actively attempting to regulate their minds through acceptance, cognitive reframing, emotional regulation, and intentional strategies. Taken together, these findings illustrate the psychological processes underlying pain catastrophizing. CONCLUSIONS:This study provides an in-depth understanding of pain catastrophizing among cancer survivors with persistent CIPN as a complex lived experience that extends beyond maladaptive thinking. The findings highlight the need for interventions that address physical symptoms as well as the emotional and existential dimensions of pain, supporting the development of targeted psychological interventions to reduce catastrophizing in this population.
