Primary lung adenocarcinoma is extremely rare in children, and perioperative care requires simultaneous attention to physiological recovery, family adaptation, and restoration of age-appropriate social functioning. This case report describes a 7-year-old boy with invasive pulmonary adenocarcinoma of the left lower lobe, who underwent single-port three-dimensional reconstruction-guided video-assisted thoracoscopic lung wedge resection, managed with a nurse-led perioperative pathway integrating the Family-Centered Empowerment Model (FCEM) and Enhanced Recovery After Surgery (ERAS) principles. This multidisciplinary pathway incorporated multidimensional assessment, family-partnered education, multimodal analgesia, respiratory rehabilitation, progressive mobilization, discharge preparation, and structured school reintegration planning. The patient was discharged uneventfully on postoperative day four with no perioperative complications. Longitudinal follow-up from 2021 through the most recent assessment in 2026 has confirmed no evidence of recurrence, preserved pulmonary function, successful school reintegration, reduced parental anxiety and depression, alleviated caregiver burden, and high discharge readiness. The core components of this pathway have been applied to three additional school-age thoracic tumor patients. A prospective cohort study is currently underway to further evaluate this approach. This case illustrates the operational feasibility of integrating FCEM within an ERAS-aligned perioperative nursing pathway for rare thoracic malignancies, and serves as a practice-derived case example that does not provide definitive evidence of clinical effectiveness.

Cancer-related fatigue (CRF) remains difficult to manage, and the impact of metal ion-regulated cell death on peripheral fatigue during anticancer therapy is unclear. Here, we investigated whether ferroptosis inducers (FINs) potentiate copper ionophore (CIN)-triggered cuproptosis in skeletal muscle and aggravate lung cancer-related fatigue (LCaRF), and evaluated redox-based interventions. LCaRF cellular models were established using C2C12 exposed to LLC/M109 tumor-conditioned supernatants and treated with FINs (sorafenib/erastin) plus CIN + CuCl2 (CIN–Cu + FINs). Cell viability, lipid peroxidation, DLAT aggregation (cuproptosis hallmark), copper/glutathione (GSH), mitochondrial function, and FKBP5/Nrf2–HO-1 signaling were assessed with pharmacologic and genetic modulation. An orthotopic lung cancer mouse model underwent wheel-running, tail suspension, and open-field testing with tetrathiomolybdate (TTM) or hydrogen as interventions. FINs sensitized C2C12 cells to CIN–Cu cytotoxicity and increased DLAT aggregation; copper chelation with TTM attenuated these effects. FINs depleted GSH and amplified mitochondrial dysfunction/ROS; exogenous GSH or hydrogen reduced DLAT aggregation and restored mitochondrial indices. FKBP5 was markedly upregulated by CIN–Cu + FINs and linked to suppressed antioxidant defense (Nrf2/HO-1). In vivo, CIN–Cu + FIN treatment exacerbated fatigue-like behaviors, while TTM or hydrogen partially improved performance. FIN–CIN combinations may aggravate skeletal muscle injury and fatigue-like phenotypes in LCaRF models by promoting cuproptosis via GSH depletion and FKBP5/Nrf2-HO-1 dysregulation.

To evaluate whether an Information-Motivation-Behavioral Skills (IMB)-based perioperative nursing program was associated with better self-efficacy, quality of life, complication profiles, and nursing satisfaction in patients with lung cancer undergoing cryoablation. This single-center retrospective cohort study included 552 patients treated between July 2023 and March 2025. Patients received either IMB-based perioperative nursing (n = 268) or routine care (n = 284) according to routine clinical allocation rather than randomization. SUPPH and FACT-L scores were assessed at baseline and 3 months. Longitudinal changes were examined with repeated-measures models, and follow-up differences were further assessed with baseline-adjusted ANCOVA. Complications were compared with χ² or Fisher’s exact tests and summarized with risk ratios (RRs) and 95

Purpose: Multimodal digital health interventions (DHIs) may extend perioperative monitoring, rehabilitation, symptom support, and care coordination for patients undergoing lung cancer surgery, but their comparative effectiveness has not been systematically mapped. This review evaluated multimodal DHIs versus conventional perioperative management across clinical, patient-reported, and implementation outcomes. Methods: Ten English and Chinese databases, trial registries, grey literature sources, conference proceedings, and reference lists were searched from inception to June 2026. Eligible studies were randomized or nonrandomized controlled studies of adults undergoing lung cancer surgery that used at least two digital modality categories. Risk of bias was assessed using RoB 2.0 and ROBINS-I logic. Compatible randomized trials were synthesized using random-effects meta-analysis; nonrandomized evidence was summarized narratively using SWiM. Certainty was rated with GRADE. Results: Eleven controlled studies including 2,088 participants were included. Randomized-trial syntheses favored multimodal DHIs for pulmonary function (3 RCTs; n = 345; SMD 0.705, 95% CI 0.137 to 1.272) and health-related quality of life (4 RCTs; n = 438; SMD 0.647, 95% CI 0.276 to 1.018), but certainty was very low and heterogeneity was substantial. Length of stay was directionally shorter but inconclusive. Anxiety, depression, and prolonged hospitalization favored DHIs in single-study analyses; postoperative pulmonary complications and pain could not be pooled. Conclusion: Multimodal DHIs show promising but very low-certainty evidence as adjuncts to perioperative lung cancer supportive care. Future trials should standardize outcome reporting, directly compare DHIs with multidisciplinary management, and evaluate implementation, equity, and cost outcomes. PROSPERO registration: CRD420261417858.

Objective This study aimed to shed light on the potential relationships between blood volatile organic compounds (VOCs) and sleep health as well as mortality. Methods We employed generalized linear (GL), restricted cubic spline (RCS), weighted quantile sum (WQS), quantile-based g-calculation (QGC), and Bayesian kernel machine regression (BKMR) models to assess the relationship between blood VOCs-including bromoform (NHANES code: LBXVBF), bromodichloromethane (LBXVBM), chloroform (LBXVCF), dibromochloromethane (LBXVCM), and methyl tert-butyl ether (LBXVME)-and sleep health indicators (trouble sleeping, sleep disorders, and insufficient (< 6 h/day) or excessive (> 9 h/day) sleep) in participants from the NHANES 2007-2012. The Cox proportional hazards regression model was also used for survival analysis. Results The baseline profile categorized by sex showed that women had a higher prevalence of trouble sleeping, whereas men were more prone to insufficient sleep. We did not observe significant linear-correlations between VOCs and both increased sleep duration and poor sleep patterns, as shown by the weighted linear/logistic regression models. The RCS regression model indicated significant non-linear relationships (P for non-linear < 0.05) between certain VOC and sleep health. Adjusted QGC analysis highlighted LBXVBF as a crucial factor related to poor sleep quality (weighted 0.733). The BKMR analysis showed a positive trend between VOC levels (55th to 75th percentiles) and poor sleep pattern. Furthermore, the adjusted COX-RCS analysis identified LBXVME (P for non-linear = 0.0359) as a risk factor for all-cause mortality. Conclusions This study investigated the non-linear association between VOC exposure and sleep function, suggesting that VOC exposure may be linked to poor sleep patterns among U.S. adults.

OBJECTIVES:This study aimed to determine the prevalence of death anxiety and examine its psychological correlates within a hypothesized psycho-social-spiritual framework among Chinese patients with metastatic breast cancer. METHODS:Consecutive inpatients with metastatic breast cancer were recruited from the Breast Cancer Department at Peking University Cancer Hospital (Beijing, China) between January 2022 and March 2025. Of 412 consented patients, 400 completed all questionnaires (response rate: 97.1%). Measures included the Chinese Death and Dying Distress Scale, Patient Health Questionnaire-9, distress thermometer, Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, Brief Experiences in Close Relationships scale (ECR-M16), and Quality of Life at the End of Life in Cancer. RESULTS:Death anxiety was common: 37.5% reported mild symptoms and 19.0% reported moderate-to-severe levels. In multivariable ordinal logistic regression, higher death anxiety severity was associated with greater depressive symptoms (Patient Health Questionnaire-9), greater general distress (distress thermometer), higher attachment insecurity (ECR-M16), and poorer end-of-life preparation (all P < 0.001). In a theoretically informed path model, attachment insecurity showed a direct association with death anxiety and an indirect association through distress and depressive symptoms; spiritual well-being moderated the attachment insecurity-death anxiety association after adjusting for distress and depression (interaction P = 0.017). CONCLUSION:In this cross-sectional sample of Chinese patients with metastatic breast cancer, death anxiety was prevalent and was significantly associated with attachment insecurity, distress, depressive symptoms, and poorer end-of-life preparation. Higher spiritual well-being may buffer the association between attachment insecurity and death anxiety among patients with greater attachment vulnerability, highlighting the potential value of targeted psycho-social-spiritual assessment and supportive intervention.

Background:Synchronous multiple primary lung cancers (sMPLCs) represent 0.8% to 20% of new lung cancer diagnoses. Currently, there is a lack of risk prediction models for venous thromboembolism (VTE) after video-assisted thoracoscopic surgery (VATS) in sMPLC patients. This study seeks to create and validate a VTE risk prediction model tailored for sMPLC patients undergoing VATS. Methods:A retrospective cohort analysis was conducted on patients who underwent lung cancer resection from November 2017 to December 2024 using Hospital Information System (HIS), telephone follow-up, and the Questionnaire Star electronic questionnaire. Categorical variables were analyzed using χ2 tests and continuous variables were assessed with t-tests for univariate analysis. Variables with statistical significance from the univariate analysis and the least absolute shrinkage and selection operator (LASSO) regression algorithm were included in the logistic regression analysis to identify risk factors and construct the prediction model. A nomogram was used for the visualization of the model. The discriminative ability and calibration of the model were evaluated using the area under the receiver operating characteristic (ROC) curve and calibration plots, respectively. The clinical utility of the model was assessed using decision curve analysis. Results:The occurrence of VTE post-VATS in patients with sMPLC was associated with age, smoking history, coronary artery disease, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), atherosclerotic plaques in the extremities, surgical method, intraoperative transfusion, Postoperative Caprini score, and the number of primary lesions (P<0.05). The area under the ROC curve was 0.917 [95% confidence interval (CI): 0.894-0.941], with a sensitivity of 0.885 and a specificity of 0.818. The calibration curve demonstrated a good fit between the observed and predicted curves, with a mean absolute error of 0.008. The clinical decision curve analysis indicated that the model offered superior clinical benefits compared to the Caprini score. Conclusions:The prediction model constructed in this study exhibits robust predictive performance, providing a theoretical basis for clinical medical staff to identify high-risk groups of patients with sMPLC who may develop VTE after VATS at an early stage and to facilitate timely interventions.

Background:Patients with cancer frequently experience psychological and social challenges, including depression, anxiety, and isolation, which are often intensified by treatment side effects and unmet psychosocial needs. Conventional support systems are often inaccessible, under-resourced, or poorly tailored to diverse patient populations. In this context, virtual communities have emerged as promising alternatives that enable peer interaction, emotional support, and information exchange. However, their implementation and sustainability are influenced by complex sociotechnical and organizational factors that remain underexplored. Objective:This scoping review applies the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework to examine how virtual communities have been implemented in cancer care. It aims to identify key barriers and facilitators, evaluate the alignment between platform features and user needs, and synthesize evidence to inform sustainable integration into care systems. Methods:A systematic search was conducted across 6 databases (PubMed, Scopus, Embase, Web of Science, PsycINFO, and CINAHL), covering studies published between 2019 and 2024. Eligible studies were empirical and reported on the development, implementation, or evaluation of virtual communities for patients with cancer. Data were extracted using a structured Non-adoption, Abandonment, Scale-up, Spread, and Sustainability-based matrix and synthesized thematically across diverse research designs. Results:The search yielded 322 records, of which 175 full-text studies were assessed for eligibility, and 25 studies were included in the review. These studies covered a range of virtual community formats used by patients with cancer. All included studies reported psychosocial benefits, including reduced loneliness, improved emotional well-being, and greater opportunities for experience sharing. However, key challenges remained, such as low user retention, limited participation from underrepresented groups, and difficulties integrating these platforms into existing health care systems. Few studies reported longitudinal follow-up or detailed engagement metrics, limiting insights into long-term effectiveness. Conclusions:Virtual communities show strong potential to address the psychosocial needs of patients with cancer, especially in underserved populations. However, to ensure long-term effectiveness, attention must be paid to inclusivity, user retention, ethical considerations, and system-level integration. Future research should incorporate standardized metrics, longitudinal designs, and equity-oriented approaches to optimize the development and implementation of virtual communities in cancer care.

BACKGROUND:Cancer survivors often experience depression and stigma associated with chronic diseases, which may increase the risk of subclinical hikikomori. AIMS:This study examined the prevalence of subclinical hikikomori and its nonlinear associations with depression and stigma among cancer patients. METHODS:A cross-sectional survey was conducted among 1951 cancer survivors. Depression and stigma associated with cancer were measured using the Patient Health Questionnaire-9 (PHQ-9) and Stigma Scale for Chronic Illnesses 8-Item Version (SSCI-8) scales, respectively, while subclinical hikikomori was assessed using the 1-month version of the validated 25-item Hikikomori Questionnaire (HQ-25M). Logistic regression and restricted cubic splines analysis were employed to explore the associations between depression, stigma, and subclinical hikikomori. RESULTS:Of the 1951 cancer survivors, the prevalence of subclinical hikikomori was 21.6% (95% CI: 19.8%-23.5%). Both depression (OR = 1.06, 95% CI: 1.033-1.086, p < 0.001) and stigma (OR = 1.16, 95% CI: 1.132-1.182, p < 0.001) were significantly and positively associated with subclinical hikikomori. Nonlinear analyses revealed inflection points at PHQ-9 = 1.96 and SSCI = 9.41, beyond which the association between depression, stigma, and subclinical hikikomori significantly strengthened. Cancer survivors with chronic diseases, first-time cancer diagnoses, or a history of chemotherapy exhibited higher odds ratios of subclinical hikikomori across all measures. CONCLUSIONS:Subclinical hikikomori was common among cancer survivors and was significantly associated with both depression and stigma. To prevent subclinical hikikomori, these findings underscore the importance of early intervention to address depression and stigma, especially for those with chronic health conditions, first-time cancer diagnoses, or prior chemotherapies.

BACKGROUND:Intermediate phenotypes, such as characteristic neuroimaging patterns, offer unique insights into the genetic and stress-related underpinnings of neuropsychiatric disorders like depression. This study aimed to identify neuroimaging intermediate phenotypes associated with depression, bridging etiological factors to behavioral manifestations and connecting insights from animal models to diverse clinical populations. METHODS:We analyzed datasets from both rodents and humans. The rodent studies included a genetic model (P11 knockout) and an environmental stress model (chronic unpredictable mild stress), while the human data comprised 748 participants from three cohorts. Using the amplitude of low-frequency fluctuations, we identified neuroimaging patterns in rodent models. We then applied a machine-learning approach to cluster neuroimaging subtypes of depression. To assess the genetic predispositions and stress-related changes associated with these subtypes, we analyzed genotype and metabolite data. Linear regression was employed to determine which neuroimaging features predicted core depression symptoms across species. RESULTS:The genetic and environmental stress models exhibited distinct neuroimaging patterns in subcortical and sensorimotor regions. Consistent patterns emerged in two neuroimaging subtypes identified across three independent depressed cohorts. The subtype resembling P11 knockout demonstrated higher genetic susceptibility, with enriched expression of risk genes in brain tissues and abnormal metabolites linked to tryptophan metabolism. In contrast, the stress animal-like subtype did not show changes in genetic risk scores but exhibited enriched risk gene expression in somatic and endocrine tissues, along with mitochondrial dysfunction in the antioxidant stress system. Notably, these distinct subcortical-sensorimotor neuroimaging patterns predicted anhedonia, a core symptom of depression, in both rodent models and depressed subtypes. CONCLUSIONS:This cross-species validation suggests that these neuroimaging patterns may serve as robust intermediate phenotypes, linking etiology to anhedonia and facilitating the translation of findings from animal models to humans with depression and other psychiatric disorders.

BACKGROUND:This study aims to evaluate the symptom burden of advanced liver cancer, explore factors related to quality of life (QoL), and investigate the relationship between insomnia and QoL. METHODS:This is a secondary analysis of a multicenter cross-sectional study that included data from patients with advanced liver cancer (n = 364) recruited from 10 cancer centers across China. Participants were required to complete Patient Health Questionnaire-9 (PHQ-9), MD Anderson Symptom Inventory (MDASI), Insomnia Severity Index (ISI), 5-level EQ-5D (EQ-5D-5L). Factors associated with QoL were identified through a multiple stepwise linear regression model and the LASSO regression approach. The mediating effect between insomnia and quality of life was tested using the bootstrap method. RESULTS:The three most prevalent symptoms were fatigue (17.0%), sleep disturbance (16.2%), and pain (15.8%). Insomnia, depression, and the 13 core symptoms in the MDASI were strongly correlated with reduced QoL (all p < 0.001). The mediating effect analysis showed that depression, dry mouth, pain, forgetfulness and fatigue were partial mediating variables between insomnia and QoL. CONCLUSION:Various physical and psychological symptoms could affect the QoL in patients with advanced liver cancer. Insomnia and related symptoms such as depression, dry mouth, pain, forgetfulness and fatigue should be identified and appropriately addressed to improve QoL for this population.

Background: Despite a plethora of evidence available on the benefits of palliative care (PC), it is estimated that only about 14% of those living in low- to middle-income countries (LMIC) or developing countries have access to PC. Objective: To globally examine PC expert perspectives regarding PC infrastructure and resources within each country, drug and opioid availability to provide PC, and workforce and educational issues. Design: Descriptive, open-ended survey seeking first-hand qualitative perspectives. Setting/Subjects: PC experts from 21 developing countries representing 5 continents around the world. Measurements: Qualitative narratives and discussions with PC experts. Results: The summaries inform four key recommendations for future progress of PC in developing countries: (1) PC infrastructure should increase accessibility to both urban and rural areas; (2) increasing medication and nonpharmacologic approaches for symptoms is essential; (3) interdisciplinary education should continue to expand and include scholarships, PC certifications, and advanced education; and 4) future research with developing countries is desperately needed to advance care and progress. Conclusions: Considerable PC progress has been accomplished; however, significant gaps remain. This report can be used to discuss PC capacity building within a country. It could serve as an important document while negotiating with authorities and Ministries of Health about expanding PC infrastructure, especially in rural areas. Finally, PC champions can use this report to advocate for increased opioid availability to promote comfort; in particular, increased availability of oral opioids is essential, so that patients can die comfortably at home.

The CACA clinical guidelines for psychosocial care provide a framework and systematic recommendations for addressing psychological issues in patients with cancer, as well as for meeting the psychosocial needs of cancer patients and their families. These recommendations facilitate the integration of psychosocial care into routine clinical cancer care, enhancing holistic treatment approaches. Regular distress screening for cancer patients is recommended and should be conducted using a strategic process with an electronic platform. Specific assessment tools, medications, and non-pharmaceutical interventions are provided for common symptoms such as anxiety, depression, insomnia, pain, fatigue, and delirium. Additionally, various evidence-based psychotherapies are recommended for patients experiencing specific psychological distress and addressing different individual needs.

PURPOSE Early interdisciplinary supportive care (ESC), including psychological interventions, can improve the survival of patients with metastatic esophagogastric cancer (EGC). The purpose of the study was to evaluate the association between psychological factors and survival in patients with metastatic EGC. METHODS A secondary analysis was conducted for an open-label randomized controlled trial of ESC, in which 246 patients with EGC completed a distress measure (the distress thermometer) and a depression symptom measure (the Patient Health Questionnaire-9 [PHQ-9]) at baseline before cancer treatments. Cox regression was applied to explore the influence of psychological distress and depressive symptoms on overall survival (OS) and progression-free survival (PFS). RESULTS Patients with moderate depressive symptoms (PHQ-9 ≥8) had shorter PFS (3.5 v 6.0 months, P < .001) and shorter OS (10.7 v 15.0 months, P = .001) than those without. Patients with significant psychological distress had worse PFS (4.8 v 6.3 months, P = .035) and worse OS (13.4 v 15.5 months, P = .039) than those without. After controlling for performance status, group, sex, primary tumor site, tumor histology, and age, only depressive symptoms remained associated with worse PFS (adjusted hazard ratio [HR], 2.02 [95% CI, 1.41 to 2.91]; P < .001) and worse OS (adjusted HR, 1.70 [95% CI, 1.17 to 2.47]; P = .006). CONCLUSION This study shows that depressive symptoms at baseline were associated with poor survival in patients with newly diagnosed metastatic EGC. Therefore, screening and preventive intervention for depression should be integrated into routine cancer care for this population.

Background:Online communities, platforms that facilitate social connections, have gained attention in the medical field, particularly for their potential to support patients. However, there is currently no online community specifically designed for patients with cancer receiving outpatient care. This study introduces a customized online community aimed at providing companionship and sharing to enhance the quality of life (QOL) among these patients. Objective:The purpose of this study was to assess the feasibility and initial effectiveness of a newly developed online community app in improving the QOL of patients with cancer receiving outpatient care. Methods:This pilot intervention-only study involved patients with cancer participating in a 4-week online community intervention through a mobile app. Eligible patients were aged 18 years or older, diagnosed with cancer, with an Eastern Cooperative Oncology Group Performance Status score of ≤2. The feasibility of the intervention was evaluated by community task participation rate, community task completion rate, and community daily login rate. Patients completed a QOL questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, QLQ-C30) at baseline (T0), week 2 (T1), and week 4 (T2). After the intervention, participants were free to answer 3 questions about their user experience. Results:Baseline assessments were conducted on 30 patients, with 25 patients assessed at T1 (83.3%) and 22 at T2 (73.3%). The 4-week average community daily login rate was 60.37% (18.11/30 on average), with community task participation and community task completion rates reaching 42.25% (12.68/30 on average) and 22.38% (6.7/30 on average), respectively. Notably, after the study ended, participants continued logging into the app and completing tasks. Patients who actively engaged in community activities demonstrated significant improvements in global health status (mean 11.04, SD 10.3 vs mean -6.56, SD 11.58; P=.004), emotional function (mean 17.7, SD 22.93 vs mean -2.89, SD 13.9; P=.04), and constipation (mean 11, SD 16.5 vs mean 14.67, SD 17.39; P=.005) at T2, compared to those less active. The intervention enhanced emotional functioning and overall health and alleviated insomnia symptoms among active participants. Conclusions:The online community intervention, emphasizing companionship and sharing, was well accepted by patients with cancer and demonstrated initial effectiveness in enhancing the QOL. The study findings suggest that such interventions can provide a supportive environment for patients to cope with psychological, social, and physical challenges. Future validation of its effectiveness will require well-designed randomized controlled trials, and continued optimization tailored to specific user groups will be crucial to meet the evolving needs of the community. The core value of the online community lies in companionship and sharing, which can serve as a foundation for future research and development in this area.

Introduction Symptom management is crucial in cancer care, yet patient symptoms are often overlooked in routine care. There is some evidence that electronic symptom monitoring and management can improve patients’ physical function, symptom control, quality of life and survival outcomes. However, the evidence of the impact on survival outcomes in patients with advanced cancer is still limited and debated. This study aims to conduct a prospective randomised controlled trial by a professional symptom management team to monitor and manage symptoms in advanced cancer patients via an electronic information systems for patient-reported outcomes (ePRO) system (WeChat mini-program) and to verify its effectiveness on improving overall survival.Methods and analysis This is a single-centre, prospective, open-labelled, randomised, parallel-controlled clinical trial targeting patients with advanced cancer. We plan to recruit 940 patients using a stratified block randomisation method based on different tumour types. The control group will receive a symptom management self-care manual (both electronic and paper versions). Similarly, the intervention group will receive the same manual and education while also received symptom management by the hospital’s specialised symptom management team through the ePRO system. The primary outcome is comparison of overall survival between groups at the 24-month follow-up. Secondary outcomes will include quality of life, psychological status and incidence of adverse events.Ethics and dissemination The study protocol and related documents received approval from the Ethics Committee of Peking University Cancer Hospital (IRB) in December 2023 (2023YJZ99). Ethical approval will be obtained before implementing any major study revisions in the future. The results of this study will be disseminated through academic seminars, peer-reviewed publications and academic conferences.Trial registration number ChiCTR2400081247.

The aims of this study were to evaluate insomnia status in advanced cancer patients been served for 4 weeks symptom management in psycho-oncology service, and to explore predictors for the persistent or worsen insomnia. This was a real world longitudinal study among advanced cancer patients been referred to the psycho-oncology symptom management clinic in Peking University Cancer Hospital. Patients repeatedly completed the Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale (HADS), and MD Anderson Symptom Inventory (MDASI) on Day 0 (baseline), Day 14, and Day 28 by using an electronic patient-reported outcomes (ePRO) system. At baseline, 50.6

AIM:Breast cancer imposes a serious disease and economic burden on patients. This guideline aims to develop a living evidence-based clinical practice recommendations to guide the use of integrative therapies for the improvement of patient-reported outcomes (PROs) in breast cancer survivors. METHODS:We searched systematic reviews and meta-analyses or conducted de nova systematic reviews and meta-analyses to support the recommendations. The grading of recommendations, assessment, development, and evaluation approach was used to rate the certainty of evidence and the strength of recommendations. RESULTS:The guideline panel issued 17 recommendations: for alleviating anxiety, strong recommendations in favor of muscle relaxation training, yoga, acceptance and commitment therapy, cognitive behavioral therapy, psychological education, and Tai Chi in general breast cancer survivors; for alleviating depression, strong recommendations in favor of mindfulness therapy, cognitive behavioral therapy, group psychotherapy, muscle relaxation training, acceptanceand commitment therapy in general breast cancer survivors, and exercise intervention for patients received radiotherapy; for sleep quality, conditional recommendations for all therapies; for pain, strong recommendations in favor of exercise intervention for postoperative breast cancer survivors; for alleviating fatigue, strong recommendations in favor of mindfulness therapy and group psychotherapy in general breast cancer survivors; for improving the quality of life, strong recommendations in favor of mindfulness therapy in general breast cancer survivors, Baduanjin and exercise intervention for patients undergoing anticancer treatment. CONCLUSION:This proposed guideline provides recommendations for improving the PROs of breast cancer survivors. We hope these recommendations can help support practicing physicians and other healthcare providers for breast cancer survivors.

Cancer survivors often face significant psychological challenges, including depression, anxiety, and social isolation, exacerbated by treatment side effects. Traditional psychosocial support systems are usually inaccessible, underfunded, or not tailored to the needs of underserved populations, limiting their effectiveness. Virtual communities have emerged as an alternative, providing emotional support and opportunities for information exchange. However, the implementation and sustainability of these platforms are constrained by technological, organizational, and policy-related barriers. This systematic review applies the NASSS (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability) framework to evaluate the characteristics, implementation challenges, and sustainability of virtual communities in cancer care. A comprehensive search of six major electronic databases identified 25 relevant studies, published between 2019 and 2024, that met predefined inclusion criteria. Data extraction focused on how virtual community features match the needs of cancer patients and their impact on mental health and quality of life. Key factors contributing to the success of virtual communities include platform design, user engagement, organizational support, and adaptability to evolving patient needs. While virtual communities provide emotional support, reduce loneliness, and facilitate information sharing, challenges such as privacy concerns, limited scalability, and integration with healthcare systems remain. Virtual communities offer significant potential for supporting cancer patients, particularly in improving psychological well-being and facilitating access to information. However, challenges regarding technology, privacy, and system integration must be addressed to ensure their long-term success. Future research should focus on adapting these platforms to meet the evolving needs of patients throughout various cancer stages (e.g., diagnosis, treatment, remission) and integrating them into existing healthcare frameworks to enhance effectiveness. PROSPERO CRD42025638853; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=638853

AbstractObjectivesPatients with advanced colorectal cancer (CRC) have multiple concurrent physical and psychological symptoms. This study aimed to explore the relationship between anxiety, depression, and symptom burden in advanced CRC.MethodsA multicenter cross‐sectional study was conducted in 10 cancer centers from geographically and economically diverse sites in China. A total of 454 patients with advanced CRC completed the Hospital Anxiety and Depression Scale and the MD Anderson Symptom Inventory. Multiple regression analysis was applied to explore the relationship between anxiety, depression and symptom burden.ResultsAbout one‐third of the patients showed symptoms of anxiety or depression. Patients with anxiety or depression reported significantly higher symptom burden than those without (p < 0.001). Patients with anxiety or depression reported a higher proportion of moderate‐to‐severe (MS) symptom number than those without (p < 0.001). About 52% of the patients with anxiety or depression reported at least three MS symptoms. The prevalence of MS symptoms was ranging from 7.3% (shortness of breath) to 22% (disturbed sleep), and in patients with anxiety or depression was 2–10 times higher than in those without (p < 0.001). Disease stage (β = −2.55, p = 0.003), anxiety (β = 15.33, p < 0.001), and depression (β = 13.63, p < 0.001) were associated with higher symptom burden.ConclusionsAnxiety and depression in patients with advanced cancer correlated with higher symptom burden. Findings may lead oncology professionals to pay more attention to unrecognized and untreated psychological symptoms in symptom management for advanced cancer patients.