This study aimed to describe the health-related quality of life (HRQoL) of cancer survivors in China by the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire and to explore the impact of the comorbidity of pre-existing chronic conditions on HRQoL in cancer survivors. Data on cancer survivors were obtained from two cross-sectional surveys conducted in Shandong Province, China. The data of the Chinese general population, the Chinese diabetes population, the Chinese hypertension population, and the Chinese urban population from the published studies were used as the controls. The χ2 test was conducted to compare the incidence of five-dimensional problems between the study and control populations. The non-parametric Mann–Whitney U test and Kruskal–Wallis test were performed to examine the differences in EQ-5D-5L utility scores. Besides, the Tobit regression model was used to examine the variables influencing the EQ-5D-5L utility score. One thousand fifty-one adult cancer survivors were included. Cancer survivors had significantly lower EQ-5D-5L utility scores (Z = − 15.939, P < 0.001) and EQ-VAS scores (Z = − 11.156, P < 0.001) than the general adult population. The average EQ-5D-5L utility score of hypertensive cancer survivors was lower than that of the hypertensive population (Z = − 1.610, P = 0.107), but the difference was not statistically significant. Compared to the general population, the HRQoL of cancer survivors was extremely poor in all dimensions of the EQ-5D-5L. Pre-existing chronic conditions had significant antecedent effects on the HRQoL of cancer survivors. Therefore, more attention should be paid to chronic diseases, and effective interventions should be adopted based on this.

INTRODUCTION:Frailty has a significant impact on the overall quality of life of older cancer survivors, but the relationships among frailty symptoms are not well understood. This study aims to explore the specific associations among multidimensional symptoms of frailty among older cancer survivors by employing network analysis to provide supportive evidence for targeted interventions in the future. MATERIALS AND METHODS:Data were obtained by cluster sampling from three large Grade-A tertiary hospitals in Shandong Province, China, and collected through face-to-face interviews by trained investigators. We included patients who were diagnosed with a solid malignant tumor at the age of 60 years or older. Frailty indicators were measured by the Groningen Frailty Indicator (GFI) and analyzed primarily through network analysis, including network estimation, centrality, and stability analysis. The relative importance of a node in a network was tested by centrality analyses, and Spearman correlations were applied to estimate the relationships between symptom pairs (symptom score) and symptom clusters (standardized symptom score) in the symptom network. In terms of centrality, the indexes of strength, closeness, and betweenness were adopted to measure the importance of nodes. RESULTS:Five hundred and eight older cancer survivors were included, with an average age of 68.4 years (standard deviation [SD] = 5.4), and a higher proportion were male (n = 307[60.4%]). The prevalence of frailty among older cancer survivors was 58.9% (n = 299), with a mean GFI score of 4.46 (SD = 2.87). The strongest edge was between "dressing and undressing" and "going to the toilet" (r = 0.58). The nodes with the higher strength centrality were "going to the toilet" (rS=1.09), "walking around outside" (rS=0.97), and "part of social network" (rS=0.96); and the nodes with the higher closeness centrality were "mark physical fitness" (rC=0.005), "calm and relaxed" (rC=0.005), and "nervous or downhearted" (rC=0.005). DISCUSSION:This study demonstrated that older cancer survivors in China have a high prevalence of frailty, with self-care and social participation-related symptoms playing a key role in the multidimensional network of frailty symptoms. Psychological symptoms can rapidly influence other symptoms within this network. Therefore, prioritizing psychological symptoms in the assessment of older adults with cancer is essential for effective frailty management.

Sleep problems and depression are common among cancer survivors and there is an urgent need for effective strategies to improve their long-term health and survival. However, evidence of the association between sleep duration, depression, and mortality in cancer survivors is limited. To examine the individual and joint associations of baseline sleep duration and depression with follow-up all-cause, cancer-specific, and non-cancer mortality in a nationally representative US sample of cancer survivors. Participants were involved in the National Health and Nutrition Examination Surveys from 2005 to 2014 and were linked to a mortality database up to 31 December 2019. Sleep duration was self-reported at baseline, whereby participants were asked “How many (hours) did you sleep (<6, 6, 7, 8, or >8 h/day)?” Depression was assessed using the nine-item Patient Health Questionnaire (PHQ-9) and a total score of ≥ 10 is considered clinically relevant depression. The dose-response relationship between sleep duration and mortality was evaluated with a restricted cubic spline. The individual and joint associations between sleep duration, depression, and mortality were investigated using the Cox proportional hazards regression model. A total of 699 deaths occurred among 2,111 participants (mean [SE] age, 61.9 [14.5] years; 1129 [57.9%] female) during a median follow-up period of 99 months. A nonlinear relationship between sleep duration and total mortality was found using restricted cubic spline analysis (p < 0.01), with a higher risk of total mortality in both long- and short-sleepers. Compared with those in patients who slept 7 h, positive associations of < 6 h (hazard ratio [HR], 1.87; 95 % confidence interval [CI], 1.32–2.65), 8 h (HR, 1.47; 95 % CI, 1.17–1.85), and > 8 h (HR, 1.55; 95 % CI, 1.13–2.11) durations with all-cause mortality were observed. In the joint analysis, the combination of abnormal sleep duration and depression was associated with total mortality risk. Specifically, cancer survivors with depression had a higher risk of all-cause mortality when sleeping < 6 h (HR, 1.81; 95% CI, 1.17-2.81) or ≥ 8 h (HR, 1.76; 95% CI, 1.16-2.67); while survivors without depression who slept ≥ 8 h also had an increased risk of all-cause mortality (HR, 1.23; 95% CI, 1.03-1.46). Excessive (≥ 8 h) and insufficient (< 6 h) sleep duration was both associated with increased risks of all-cause deaths after adjusting for depression scores. We also observed a joint effect of sleep duration and depression. The findings may provide evidence to guide optimal sleep time for prolonged cancer survival.

Background Pediatric cancer patients in China often present at an advanced stage of disease resulting in lower survival and poorer health outcomes. One factor hypothesized to contribute to delays in pediatric cancer has been the online health information–seeking (OHIS) behaviors by caregivers. Objective This study aims to examine the association between OHIS behaviors by caregivers and delays for Chinese pediatric cancer patients using a mixed methods approach. Methods This study used a mixed methods approach, specifically a sequential explanatory design. OHIS behavior by the caregiver was defined as the way caregivers access information relevant to their children’s health via the Internet. Delays in pediatric cancer were defined as any one of the following 3 types of delay: patient delay, diagnosis delay, or treatment delay. The quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and binary logistic regression analysis, all performed using Stata. The qualitative analysis methods included conceptual content analysis and the Colaizzi method. Results A total of 303 pediatric cancer patient-caregiver dyads was included in the quantitative survey, and 29 caregivers completed the qualitative interview. Quantitative analysis results revealed that nearly one-half (151/303, 49.8%) of patients experienced delays in pediatric cancer, and the primary type of delay was diagnosis delay (113/303, 37.3%), followed by patient delay (50/303, 16.5%) and treatment delay (24/303, 7.9%). In this study, 232 of the 303 (76.6%) caregiver participants demonstrated OHIS behaviors. When those engaged in OHIS behaviors were compared with their counterparts, the likelihood of patient delay more than doubled (odds ratio=2.21; 95% CI 1.03-4.75). Qualitative analysis results showed that caregivers’ OHIS behaviors impacted the cancer care pathway by influencing caregivers’ symptom appraisal before the first medical contact and caregivers’ acceptance of health care providers’ diagnostic and treatment decisions. Conclusions Our findings suggest that OHIS among Chinese pediatric caregivers may be a risk factor for increasing the likelihood of patient delay. Our government and society should make a concerted effort to regulate online health information and improve its quality. Specialized freemium consultations provided by health care providers via online health informatic platforms are needed to shorten the time for caregivers’ cancer symptom appraisal before the first medical contact.

Objective:To systematically review the qualitative research on the treatment decision-making of elderly cancer patients,so as to provide references for improving the quality of life of patients.Methods:This study searched nine literature data-bases,including PubMed,Web of Science,CNKI and so on from inception to December 31,2022 and collected qualitative studies with the theme of treatment decision-making of elderly cancer patients.The 2016 version of the Joanna Briggs Institute's critical ap-praisal tool for qualitative studies in Australia was used to evaluate the quality of the literature.Meta-synthesis was applied to in-tegrate research results.Results:A total of 13 articles were included and summarized into 3 integration results.The decision-mak-ing modes of elderly cancer patients'preferences included orientation of patients,doctors and nurses,family members and sharing of multiple subjects.The factors that affected the decision-making of elderly cancer patients mainly included patient characteristics,medical supply status and so on.There were individual differences in the attitude of elderly cancer patients towards information see-king,and they preferred to collect practical information,probability information and professional information of doctors through self-study or seeking help from others.Conclusion:The treatment decisions of elderly cancer patients arise from specific social and cultural backgrounds.Physical function and quality of life are the core treatment demands of patients.The quality of decision infor-mation directly affects the final decision.