OBJECTIVES:This study tested (1) whether intolerance of uncertainty (IU) and negative metacognitive beliefs independently differentiate fear of cancer recurrence (FCR) status, and (2) whether mediation by cognitive-attentional syndrome (CAS) elements modify the relationships of IU and metacognitive beliefs with FCR status. METHODS:Baseline data from 384 participants (collected ∼15.6 months post-diagnosis) pooled from a prospective longitudinal study and an FCR intervention trial were analyzed. Measures included FCRI-SF (FCR), MCQ-30 (metacognitive beliefs), IUS-12 (IU), and CAS-1 (CAS). FCR status was classified based on the FCRI-SF scores as non-clinical (< 13), subclinical (13-21), and clinically significant (≥ 22). Fully adjusted multinomial logistic regression examined direct effects of IU and metacognitive domains on FCR status and indirect effects via CAS. RESULTS:Compared to the non-clinical group (n = 116), subclinical (n = 190) and clinically-significant (n = 78) FCR groups showed greater negative beliefs about worry (OR range 1.297-1.500, p < 0.001), higher IU (OR 1.050-1.066, p = 0.037), increased use of CAS metacognitive strategies (OR 1.077-1.108, p = 0.021-< 0.001), and less perceived need to control thoughts (OR 0.847-0.857, p = 0.003-0.027). Clinically-significant FCR was additionally associated with poorer cognitive confidence (OR 1.122, p = 0.030). CAS partially mediated associations of FCR status with negative beliefs about worry, cognitive confidence, and IU, and fully mediated the association with need to control thoughts. CONCLUSIONS:IU and negative metacognitive beliefs can characterize individuals vulnerable to differentially-elevated FCR. CAS centrally mediates the relationships between FCR, IU, and metacognition. Cognitive-behavioral interventions for FCR explicitly targeting CAS should disrupt the impact of IU and metacognitive beliefs on FCR.

Introduction: Fear of cancer recurrence (FCR) is a prominent clinical issue among cancer survivors. This study evaluated the effectiveness of the culturally adapted ConquerFear-HK intervention in reducing FCR among Chinese cancer survivors, compared to standard survivorship care. METHODS:This assessor-masked, two-arm parallel randomized controlled trial, was conducted from June 2021 to February 2024. Cantonese- or Mandarin-speaking Chinese cancer survivors scoring ≥13 on the Fear of Cancer Recurrence Inventory Short Form (FCRI-SF) were randomized to either ConquerFear-HK, focusing on attention training, metacognition modification, acceptance, appropriate monitoring behaviour, and goal setting or active control providing standardized, multidisciplinary survivorship care. Primary outcome was changes in FCR assessed by FCRI at prior randomization, immediately post-intervention (T1), 3 months (T2), and 6 months (T3) post-intervention. Intention-to-treat analyses using linear mixed modelling compared outcome changes across time points. This trial was registered at ClinicalTrials.gov (NCT04568226). RESULTS:Of the 175/220 (79.5%) participants recruited, 89 were randomized to ConquerFear-HK and 86 to control. Significant greater FCRI reductions were observed in ConquerFear-HK at T1 (mean difference = -10.66; 95% CI:-20.15, -1.16) and T2 (mean difference = -12.00; 95% CI:-21.90, -2.11) vs. the control (g = 0.33-0.36). No significant between-group differences were found at T3. CONCLUSION:ConquerFear-HK demonstrates promising short-term (3-month) improvements in FCR among Chinese cancer survivors; however, no sustained benefits were found at 6 months. Possible explanations include the high attrition at 6-month follow-up, a potential early ceiling effect, unconscious therapist bias, or an accelerated adaptation effect in the intervention arm that was achieved later by the control group. .

Upper limb impairment is common among women receiving breast cancer treatment. Although yoga is popular and accessible in cancer support communities, its impact on upper limb function in these women is not well understood. This randomized controlled trial investigated the effects of yoga on shoulder range of motion in women recovering from breast cancer surgery. Eligible participants were Chinese women with early-stage breast cancer who had recently completed surgery and adjuvant treatment. Following the baseline assessment, they were randomly assigned (1:1:1) to a 12-week yoga intervention, a 12-week relaxation intervention (active control), or a postoperative exercise DVD (passive control). Primary outcomes measured shoulder rotation flexibility and range of motion. Secondary outcomes included health-related quality of life, fatigue, pain, sleep quality, anxiety, and depression. All outcomes were assessed at baseline, immediately post-intervention, and at 3, 6, and 12 months post-intervention. Out of 760 potential participants, 444 were enrolled and randomly assigned to yoga intervention (n = 148), active control (n = 148), or passive control (n = 148). Linear Mixed Modelling indicated that, compared to the Passive control group, the Yoga group showed significant improvement in shoulder rotation flexibility scores (p = 0.004) and right hand up back scratch test scores (p = 0.013) at all time points. There was no significant difference in the back scratch test scores for the left hand up between groups. Secondary outcomes did not significantly differ among the study groups. Study findings suggest that yoga intervention can improve upper-extremity mobility in women with breast cancer. Trial Registration: HKU Clinical Trials Registry, HKUCTR-1600. Registered 25 May 2013, https://www.hkuctr.com/Study/Show/36d8e3e8d051473b9c2e69bc8ee35dd1 .

To characterize public climate scepticism in Hong Kong, China, and investigate its associations with emotional and behavioural engagement with climate change and adaptation to heat we conducted a two-wave randomly sampled population-based survey in 2020. The 1st wave, conducted in spring and early summer, was to characterize patterns of climate change scepticism, and the 2nd wave, conducted during the hot mid-summer asked the same participants, about climate-related anxiety, pro-environmental behaviours, sustainable intention, attention to heat-related information, perceived heat-related health risk, and heat protection behaviours. Among our sample of 1705 Hong Kong adults, we identified five latent classes of climate scepticism: “low scepticism” (24.9%), “attribution and impact scepticism” (20.9%), “social response and impact scepticism” (18.3%), “extensive scepticism” (18.2%), and “pessimistic scepticism” (17.7%). Compared with the “low scepticism” class, the “social response and impact scepticism” class, who were more likely to be better-educated middle-aged males and more socio-economically privileged, behaved less sustainably. For heat adaptation, compared with the “low scepticism” class, the “attribution and impact scepticism” class, an older and less-educated group, perceived lower heat-related health risk and adopted fewer heat protection behaviours. Our study highlights the value of more nuanced understanding of audience segmentation based on the multiple dimensions of climate scepticism to inform climate change communication strategies.

Introduction:Existing evidence of returning-to-work (RTW) after cancer comes predominately from Western settings, with none prospectively examined since the initial diagnostic phase. This study prospectively documents RTW-rate, time-to-RTW, work productivity loss, and activity impairment, within the first-year post-surgery among Chinese women with breast cancer (BCW) and identify potential causal co-variants. Methods:This observational longitudinal study followed 371 Chinese BCW who were employed/self-employed at the time of diagnosis at 4-week post-surgery (baseline). RTW-status and time-to-RTW were assessed at baseline (T1), 4-month (T2), 6-month (T3), and 12-month (T4) post-baseline. WPAI work productivity loss and activity impairment were assessed at T4. Baseline covariates included demographics, medical-related factors, work satisfaction, perceived work demand, work condition, RTW self-efficacy, B-IPQ illness perception, COST financial well-being, EORTC QLQ-C30 and QLQ-BR23 physical and psychosocial functioning, and HADS psychological distress. Results:A 68.2% RTW-rate (at 12-month post-surgery), prolonged delay in RTW (median = 183 days), and significant proportions of T4 work productivity loss (20%), and activity impairment (26%), were seen. BCW who were blue-collar workers with lower household income, poorer financial well-being, lower RTW self-efficacy, poorer job satisfaction, poorer illness perception, greater physical symptom distress, impaired physical functioning, and unfavorable work conditions were more likely to experience undesired work-related outcomes. Discussion:Using a multifactorial approach, effective RTW interventions should focus on not only symptom management, but also to address psychosocial and work-environmental concerns. An organizational or policy level intervention involving a multidisciplinary team comprising nurses, psychologists, occupational health professionals, and relevant stakeholders in the workplace might be helpful in developing a tailored organizational policy promoting work-related outcomes in BCW.

Abstract Background Psychological distress often co-occurs with sleep disturbances; but the specific mechanisms linking the two remain unclear. A qualitative study explored perceptions and factors associated with sleep disturbances in cancer survivors between patients with varying levels of psychological distress. Methods Thirty-three Cantonese speaking mixed type cancer survivors were recruited from a community cancer care program. Participants that scored > 5 on the Pittsburgh Sleep Quality Index and had non-clinical or borderline to clinical levels of psychological distress underwent semi-structured interviews. Interviews were analyzed using grounded theory. Results Common triggers of sleep disturbances included unresolved treatment side-effects, intrusive thoughts about cancer and fear of cancer recurrence or progression, poor sleep hygiene and a lack of routine. Those with higher levels of distress exhibited more worry about recovery after cancer. Further, they engaged in thought suppression and experienced meta-worry about negative emotions and worry of poor sleep impacting recovery and cancer progression. They commonly exhibited high sleep reactivity and were observed to have limited social support. In contrast, those with low distress adopted better adaptive mechanisms, including a changed commitment to prioritizing health and positive reappraisal of their recovery progress. Self-distraction was used to cope with sleep disturbances and they had fewer expectations of good sleep quality. Conclusions Findings provided insights into the suitability of interventions for patients with sleep disturbances. Interventions targeting maladaptive emotion-focused coping may be more effective in addressing sleep disturbances in cancer survivors with higher distress. Interventions adopting a stepped-care approach may be advantageous in managing sleep disturbances by catering for varying levels of distress.

INTRODUCTION This prospective, single-arm, pragmatic implementation study evaluated the feasibility of a nurse-led symptom-screening program embedded in routine oncology post-treatment outpatient clinics by assessing (1) the acceptance rate for symptom distress screening (SDS), (2) the prevalence of SDS cases, (3) the acceptance rate for community-based psychosocial support services, and (4) the effect of referred psychosocial support services on reducing symptom distress. METHODS Using the modified Edmonton Symptom Assessment System (ESAS-r), we screened patients who recently completed cancer treatment. Patients screening positive for moderate-to-severe symptom distress were referred to a nurse-led community-based symptom-management program involving stepped-care symptom/psychosocial management interventions using a pre-defined triage system. Reassessments were conducted at 3-months and 9-months thereafter. The primary outcomes included SDS acceptance rate, SDS case prevalence, intervention acceptance rate, and ESAS-r score change over time. RESULTS Overall, 2988/3742(80%) eligible patients consented to SDS, with 970(32%) reporting ≥1 ESAS-r symptom as moderate-to-severe (caseness). All cases received psychoeducational material, 673/970(69%) accepted psychosocial support service referrals. Among 328 patients completing both reassessments, ESAS-r scores improved significantly over time (p < 0.0001); 101(30.8%) of patients remained ESAS cases throughout the study, 112(34.1%) recovered at 3-month post-baseline, an additional 72(22%) recovered at 9-month post-baseline, while 43(12.2%) had resumed ESAS caseness at 9-month post-baseline. CONCLUSION Nurse-led SDS programs with well-structured referral pathways to community-based services and continued monitoring are feasible and acceptable in cancer patients and may help in reducing symptom distress. We intend next to develop optimal strategies for SDS implementation and referral within routine cancer care services.

INTRODUCTION:Fear of cancer recurrence (FCR) is a prevalent and frequently debilitating response to a cancer diagnosis, affecting a substantial proportion of cancer survivors. Approximately 30% of local Hong Kong Chinese cancer survivors in a recent survey reportedly experienced persistent high FCR over the first-year post-surgery. This was associated with lower levels of psychological well-being and quality of life. A manualised intervention (ConquerFear) developed primarily based on the Self-Regulatory Executive Function Model and the Rational Frame Theory, has been found to reduce FCR effectively among Caucasian cancer survivors. The intervention now has been adapted to a Chinese context; ConquerFear-HK. The primary aim of this study is to evaluate its efficacy vs a standard-survivorship-care control (BasicCancerCare) in FCR improvement in a randomised control trial (RCT).METHODS AND ANALYSIS:In this RCT, using the sealed envelope method, 174 eligible Chinese cancer survivors will be randomised to either the ConquerFear-HK or BasicCancerCare intervention. Both interventions include six sessions over 10 weeks, which will be delivered via face to face or online by trained therapists. The ConquerFear-HK intervention incorporates value classification, metacognitive therapy, attentional training, detached mindfulness and psychoeducation; BasicCancerCare includes relaxation training, dietary and physical activity consultations. Participants will be assessed at prior randomisation (baseline; T0), immediately postintervention (T1), 3 months (T2) and 6 months postintervention (T3) on the measures of FCR (Fear of Cancer Recurrence Inventory) as a primary outcome; metacognition (30-item Metacognitions Quesionnaire) and cognitive attentional syndrome (Cognitive-attentional Syndrome Questionnaire) as process outcomes; psychological distress (Hospital Anxiety and Depression Scale), cancer-related distress (Chinese Impact of Events Scale), quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire) and treatment satisfaction are secondary outcomes.ETHICS AND DISSEMINATION:Ethics approval has been obtained from HKU/HA HKW Institutional Review Board (ref: UW19-183). The patients/participants provide their written informed consent to participate in this study. The study results will be disseminated through international peer-review publications and conference presentations.TRIAL REGISTRATION NUMBER:NCT04568226.

Abstract Background: Depression commonly occurs in patients with breast cancer (BC), significantly affecting their quality of life. We screened Georgian women diagnosed with BC for depressive symptoms to determine their prevalence and examine associations with various sociodemographic and clinical characteristics. This is the first study focusing on mental well-being in patients with cancer in Georgia. Methods: In a multicenter observational study, 177 women receiving BC treatment were examined at three tertiary oncology hospitals in Georgia. Patient Health Questionnaire 9 (PHQ-9) was used for the identification of depressive symptoms. Patients were stratified using basic information on age, marital status, educational level, social and financial support, employment status, and clinical characteristics. Results: The average age was 52.9 years (34–77); 117 (66%) were married; 79 (45%) were working, but only 30 (17%) reported having adequate financial status; 128 (72%) had stage I-III disease; and 64 (36%) reported some degree of pain. Using pro-rated PHQ-9 scores, 46 patients (44%; 95% CI, 37–51) reported some level of depressive symptoms while 25 women (14%; 95% CI, 9–19) met the criteria for probable depressive disorder. A higher proportion of patients reporting pain also reported depressive symptoms (37/66, 56%) compared with those reporting no pain (41/111, 34%) (P = .013); women with stage IV disease were more likely to report depressive symptoms (26/44, 57%) compared with those with stages I-III (53/133, 40%) (P = .049); and single/previously married women (42/60, 70%) were more likely to report depressive symptoms than married women (51/117, 44%) (P = .001). Depressive symptom reporting did not differ by age or reported support. Conclusion: One in six of this sample of Georgian patients with BC had depressive symptom levels consistent with a depressive disorder. Depressive symptoms covaried by marital status, staging, and reported pain. These results can inform practitioner oncologists in Georgia of the needs for psychological support for patients with cancer and assist in building such support services.

Study Objectives: To examine the trajectories of sleep disturbance in cancer survivors during the first 2 years post-treatment and to investigate whether psychological, cognitive, and physical factors differentiate trajectories.Methods: A total of 623 Chinese cancer survivors of diverse cancer types participated in a 2-year-long prospective study after the completion of cancer treatment. Sleep disturbance was measured using Pittsburgh Sleep Quality Index at 3 (T2), 6 (T3), 12 (T4), 18 (T5), and 24 (T6) months after baseline (within 6-months post-treatment; T1). Latent growth mixture modeling identified distinctive sleep disturbance trajectories and tested if these longitudinal patterns were predicted by baseline psychological distress, attentional control, attentional bias and physical symptom distress and T2 cancer-related distress. Fully adjusted multinomial logistic regression then identified whether these factors differentiated trajectories.Results: Two distinct sleep disturbance trajectories were identified, namely stable good sleepers (69.7%) and persistent high sleep disturbance (30.3%). Compared to those in the stable good sleep group, patients in the persistent high sleep disturbance group were less likely to report avoidant (OR=0.49, 95% CI = 0.26-0.90), while more likely to report intrusive thoughts (OR = 1.76, 95% CI = 1.06-2.92) and cancer-related hyperarousal (OR = 3.37, 95% CI = 1.78-6.38). Higher depression scores also predicted persistent high sleep disturbance group membership (OR = 1.13, 95% CI = 1.03-1.25). Attentional bias, attentional control, anxiety, and physical symptom distress did not predict sleep trajectory membership.Conclusions: One in three cancer survivors experienced persistent high sleep disturbance. Screening and managing depressive symptoms and cancer-related distress in early cancer rehabilitation may reduce risk of persistent sleep disturbance among cancer survivors.

As animals benefit from improved chronic disease care, more pet-parents and veterinarians face issues of late life and terminal care. Management of life limiting disease commonly considers the timing of euthanasia, often overlooking the role of supportive palliative care. Necessary communications between vet and pet-parents are rarely emphasized. However, as in human palliative care, the central role of good communications is critical. In particular, three communication elements are primary, namely: empathic communication and shared decision-making; managing progressive symptoms, and; advanced directives. Moreover, focusing only on euthanasia can easily discount the profound emotional legacy of bereavement. This Perspective illustrates how communications policies derived from human palliative care are exemplified in the management of a case of canine lung cancer, to the wider practice benefits of pets, pet-parents and veterinary practice staff.

Background We aimed to conduct a narrative synthesis of components and indicators of community vulnerability to a pandemic and discuss their interrelationships from an ecological perspective. Methods We searched from PubMed, Embase, Web of Science, PsycINFO, and Scopus (updated to November 2021) for studies focusing on community vulnerability to a pandemic caused by novel respiratory viruses on a geographic unit basis . Studies that reported the associations of community vulnerability levels with at least one disease morbidity or mortality outcome were included. Results Forty-one studies were included. All were about the COVID-19 pandemic. Suitable temperature and humidity environments, advanced social and human development (including high population density and human mobility, connectivity, and occupations), and settings that intensified physical interactions are important indicators of vulnerability to viral exposure. However, the eventual pandemic health impacts are predominant in communities that faced environmental pollution, higher proportions of socioeconomically deprived people, health deprivation, higher proportions of poor-condition households, limited access to preventive health care and urban infrastructure, uneven social and human development, and racism. More stringent social distancing policies were associated with lower COVID-19 morbidity and mortality only in the early pandemic phases. Prolonged social distancing policies can disproportionately burden the socially disadvantaged and racially/ethnically marginalized groups. Conclusions Community vulnerability to a pandemic is foremost the vulnerability of the ecological systems shaped by complex interactions between the human and environmental systems. Registration PROSPERO (CRD42021266186).

Objectives:Working-age cancer patients face barriers to resuming work after treatment completion. Those resuming work contend with reduced productivity arising from persisting residual symptoms. Existing studies of return to work (RTW) after cancer diagnosis were done predominantly in Western countries. Given that employment and RTW in cancer survivors likely vary regionally due to healthcare provision and social security differences, we documented rates and correlates of RTW, work productivity, and activity impairment among Chinese cancer survivors in Hong Kong at one-year post-treatment. Methods:Of 1,106 cancer patients assessed at six-months post-cancer treatment (baseline), 593 previously worked; detailed work status, psychological distress (HADS), physical symptom distress (MSAS-SF), supportive care needs (SCNS-SF34-C), health-related quality of life (SF12), and illness perception (B-IPQ) were assessed. Six months later (follow-up), work productivity and activity impairment were assessed (WPAI; n = 402). Descriptive analyses examined RTW rate. Fully adjusted regressions determined RTW, work productivity, and activity impairment predictors. Results:At baseline, 39% (232/593) were working, 26% (153/593) on sick leave, and 35% (208/593) were unemployed. Compared to patients returning to work, unemployed participants were older, likely manual/service-oriented workers, and had lower family income, chemotherapy, fewer unmet health system and information needs, poorer physical functioning, and negative illness perceptions. Sick leave participants were likely service-oriented workers, who had head and neck cancer, chemotherapy, and poor physical functioning. At FU, baseline depressive symptoms, physical symptom distress, and negative illness perceptions predicted presenteeism and work productivity loss; gynecological cancer, fewer unmet health system and information needs, and greater unmet sexuality needs predicted absenteeism; physical symptom distress, negative illness perception, and poor physical functioning predicted activity impairment. Conclusion:Cancer survivors who had more physically demanding jobs and poorer physical functioning delayed RTW. Unmanaged physical symptom and psychological distress hindered work productivity.

Vaccine hesitancy can be heightened due to increasing negative reports about vaccines. Emphasizing the social benefits of vaccination may shift individual attention from individual to social benefit of vaccination and hence promote prosocial vaccination. In six rounds of a population-based survey conducted over one major community epidemic of coronavirus disease 2019 (COVID-19) in Hong Kong from June to November 2020, we manipulated the question asking about acceptance of a COVID-19 vaccine with or without emphasizing the social benefit of vaccination against COVID-19 (prosocial priming) and monitored the changes of vaccine confidence by news media sentiment on vaccines. Population-weighted percentages of accepting COVID-19 vaccines by priming condition and vaccine confidence were compared across survey rounds. Logit regression models assessed the main effect of prosocial priming and the modification effects of vaccine confidence and perceived personal risk from COVID-19 on acceptance of COVID-19 vaccines. We found that prosocial priming significantly increased acceptance of COVID-19 vaccines across all survey rounds except for Round 3 when incidence of COVID-19 reached a peak. Vaccine confidence significantly declined in Round 6 when news media sentiment on vaccines became predominantly negative. The effect of prosocial priming on promoting vaccine acceptance was significantly greater in participants with low vaccine confidence and those perceiving the severity of COVID-19 to be mild/very mild. Our study suggests that packaging vaccination against COVID-19 as a prosocial behaviour can help overcome low vaccine confidence and promote prosocial vaccination particularly when disease incidence temporarily declines and the public perceive low severity of COVID-19.