BACKGROUND:Psychosocial factors are argued to increase cancer risk. This study aims to clarify the association between various psychosocial factors and cancer incidence (including breast, lung, prostate, and colorectal cancers) via individual-participant data (IPD) meta-analysis. The psychosocial factors considered were perceived social support (PSS), loss, relationship status, neuroticism, and general distress. METHODS:The Psychosocial Factors and Cancer Incidence consortium used data from 22 cohorts with a measure of at least one psychosocial variable of interest at baseline (up to N = 421,799; cancer incidence, N = 35,319; person-years of follow-up, N = 4,378,582). In stage 1 of the IPD meta-analysis, Cox regression models were used with age as the timescale. In stage 2, results were pooled in random-effects meta-analyses. RESULTS:No psychosocial factors were associated with an increased risk of overall cancer and with breast, prostate, and colorectal cancers, as well as with cancers with alcohol as a common potential causal factor. PSS, currently not in a relationship, and a loss event were associated with an increased risk of lung cancer (hazard ratio [HR], 1.09-1.55). Estimates decreased for PSS and relationship status when adjusting for several known risk factors, such as a family history of cancer (HR, 1.05-1.08). Similar findings were observed for relationship status and cancers with tobacco smoking as a common potential causal factor. CONCLUSIONS:For most types of cancer, psychosocial factors (measured at a single point in time) were not associated with increased risk. PSS, currently not in a relationship, and loss were associated with an increased risk of lung cancer, although most effects attenuated when adjusting for several known risk factors.

Background Kidney transplantation is the preferred treatment for kidney failure. However, kidney transplant candidates often experience a decline in health while awaiting transplantation due to disease progression, comorbidities, and negatives effects of dialysis. Prehabilitation aims to optimize physical and psychological functioning prior to surgery, potentially improving overall health and outcomes. Despite its potential benefits, there are currently no official guidelines or standardized prehabilitation programs for kidney transplant candidates. Purpose To explore factors that influence the development and implementation of a prehabilitation program for kidney transplant candidates. Methods A mixed methods context analysis was conducted, guided by the Context and Implementation of Complex Interventions framework. Data collection included a survey, interviews, and focus groups. The survey was sent to kidney transplant candidates. It assessed current lifestyle-related practice patterns, health status including physical functioning, nutritional status, and psychological well-being, as well as needs, preferences, and perceived barriers and facilitators regarding prehabilitation. Qualitative data were collected from kidney transplant candidates and recipients, their significant others, and healthcare providers, addressing the same topics in greater depth. Quantitative data were analyzed using descriptive statistics and comparative analysis. Qualitative data were analyzed thematically. Results Eighty-seven kidney transplant candidates completed the survey. Additionally, 22 interviews and five focus groups were conducted. Findings were that clinical consultations primarily focused on medical aspects, with less emphasis on lifestyle factors such as physical activity. Nearly all participants reported issues related to physical functioning, nutritional status, or psychological well-being, with 44% experiencing problems across all three domains. All groups expressed a strong need for prehabilitation, emphasizing that programs should be tailored to individual needs and preferences, implemented in a home-based setting, and guided by a professional. Key facilitators for engagement included peer support and professional guidance, ease of access and convenience, and high levels of intrinsic and extrinsic motivation. Identified barriers included geographical and logistical challenges, fatigue, perceived lack of need, and time constraints. Conclusions This study highlights the need for home-based, tailored, and professionally guided prehabilitation programs for kidney transplant candidates. Key facilitators and barriers to participation were identified, emphasizing the need to address logistical, physical and psychological challenges to enhance engagement in this vulnerable population. The use of a mixed-methods approach, guided by the Context and Implementation of Complex Interventions framework, provided valuable insights into factors influencing the development and implementation of prehabilitation programs. Future research should explore the feasibility and effectiveness of prehabilitation in this vunerable patient group.

BACKGROUND:Patients need cognitive and social skills in order to be able to make informed healthcare decisions. Health literacy (HL) encompasses these skills, enabling individuals to manage their conditions and adapt to challenges. HL interventions in patients could be a powerful way of optimizing self-management (SM) in individuals with chronic diseases. PURPOSE:To examine the efficacy of HL interventions on the medical, emotional, and role management domains of SM, theoretical foundations, conceptualizations of HL and SM, and intervention components. METHODS:Health literacy interventions aimed at increasing SM in adults (≥18 years) with chronic diseases were considered. A database search was conducted in PubMed, Scopus, SciELO (Scientific Electronic Library Online), and Web of Science from 2014 to 2024. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Risk of bias was assessed using the Joanna Briggs Institute Checklist. RESULTS:Fourteen studies were included. Interventions improved 3 components of medical management: medication adherence, disease knowledge, and self-efficacy. However, the effects on adherence to diet and exercise regimens, also part of medical management, were inconclusive. Emotional and role management received limited attention. There was inconsistency between HL definitions and instruments. Most interventions were delivered through in-person sessions. Overall, studies showed moderate risk of bias, which may have influenced the results. CONCLUSIONS:Theory-based interventions, methodological consistency, and comprehensive HL and SM measures are needed to understand interventions' effectiveness. To support behavioral change, HL interventions must address emotional and role management. Future high-quality research is required to determine optimal strategies for strengthening SM through HL interventions.

People with chronic kidney failure (CKF) on dialysis who perceive little control in life are at risk for a reduced well-being. We developed and tested an intervention aiming to enhance their perceptions of control. To gain insight into patients' care needs and acceptance of the intervention, we examined the prevalence of patients perceiving low control, their characteristics, and their reasons for (not) accepting the intervention. We consecutively screened 430 people on dialysis on perceived control, with those reporting low control offered to participate in the intervention study. We used data of a Randomized Controlled Trial examining the feasibility, acceptability and efficacy of the intervention. Perceived control was assessed with the Pearlin Mastery scale. About half (55%) of the sample perceived low control, particularly those with more comorbidities. Most persons eligible for receiving the intervention did not accept the intervention (89%), especially older persons. Main reasons were experiencing little burden of perceiving low control as well as no need for care to increase perceived control. A significant number of people on dialysis perceived low control in life, yet very few accepted an intervention for regaining a sense of control. In-depth qualitative research is needed for a more comprehensive understanding of the personal experience and perceived impact of low control on health and well-being, activities and relationships as well as people's reasons and needs for enhancing a sense of control and attitude towards psychological interventions aiming to enhance perceived control.

Individual participant data (IPD) meta-analysis provides important opportunities to study interaction and effect modification for which individual studies often lack power. While previous meta-analyses have commonly focused on multiplicative interaction, additive interaction holds greater relevance for public health and may in certain contexts better reflect biological interaction. Methodological literature on interaction in IPD meta-analysis does not cover additive interaction for models including binary or time-to-event outcomes. We aimed to describe how the Relative Excess Risk due to Interaction (RERI) and other measures of additive interaction or effect modification can be validly estimated within 2-stage IPD meta-analysis. First, we explain why direct pooling of study-level RERI estimates may lead to invalid results. Next, we propose a 3-step procedure to estimate additive interaction: (1) estimate effects of both exposures and their product term on the outcome within each individual study; (2) pool study-specific estimates using multivariate meta-analysis; (3) estimate an overall RERI and 95% confidence interval based on the pooled effect estimates. We illustrate this procedure by investigating interaction between depression and smoking and risk of smoking-related cancers using data from the PSYchosocial factors and Cancer (PSY-CA) consortium. We discuss implications of this procedure, including the application in meta-analysis based on published data.

ObjectivesPeople with chronic kidney failure (CKF) on dialysis who perceive little control in life are at risk for a reduced well-being. We developed and tested an intervention aiming to enhance their perceptions of control. To gain insight into patients' care needs and acceptance of the intervention, we examined the prevalence of patients perceiving low control, their characteristics, and their reasons for (not) accepting the intervention.DesignWe consecutively screened 430 people on dialysis on perceived control, with those reporting low control offered to participate in the intervention study.MethodsWe used data of a Randomized Controlled Trial examining the feasibility, acceptability and efficacy of the intervention. Perceived control was assessed with the Pearlin Mastery scale.ResultsAbout half (55%) of the sample perceived low control, particularly those with more comorbidities. Most persons eligible for receiving the intervention did not accept the intervention (89%), especially older persons. Main reasons were experiencing little burden of perceiving low control as well as no need for care to increase perceived control.ConclusionsA significant number of people on dialysis perceived low control in life, yet very few accepted an intervention for regaining a sense of control. In-depth qualitative research is needed for a more comprehensive understanding of the personal experience and perceived impact of low control on health and well-being, activities and relationships as well as people's reasons and needs for enhancing a sense of control and attitude towards psychological interventions aiming to enhance perceived control.

BACKGROUND:Fatigue is a prevalent and debilitating symptom among kidney transplant candidates (KTCs), significantly affecting their quality of life and overall well-being. Its complexity necessitates a comprehensive approach to manage fatigue in this population. PURPOSE:To explore the effectiveness of nonpharmacological interventions in reducing fatigue in KTCs. METHODS:Nonpharmacological interventions targeting fatigue in participants aged ≥18 years, who were either on the kidney transplantation waitlist or eligible candidates, were considered. A database search was conducted in PubMed, Embase, PsycINFO, CINAHL, and Web of Science. Results were reported in accordance with the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols extension for Scoping Reviews Checklist. RESULTS:In total, 67 studies were included. Interventions were divided into manipulative and body-based practices, exercise, mind-body therapies, energy healing, and combined interventions. Thirty-eight studies (76%) demonstrated a significant effect on fatigue, with effect sizes ranging from 0.43 to 4.85. Reflexology, massage therapy, progressive muscle relaxation, and acupressure combined with massage therapy showed the strongest significant intervention effects on fatigue and had the strongest study quality. However, the overall study quality was weak, particularly concerning confounding control, blinding procedures, and withdrawals and dropouts. CONCLUSIONS:Manipulative and body-based interventions showed the strongest significant effects on fatigue with the highest study quality. These interventions underscore the multifactorial nature of fatigue by targeting both its physical and psychological dimensions. Future high-quality research is needed to determine the optimal strategy for managing fatigue in KTCs.

The standard surgical treatment for rectal cancer is total mesorectal excision (TME), which may negatively affect patients’ functional outcomes and quality of life (QoL). However, it is unclear how different TME techniques may impact patients’ functional outcomes and QoL. This systematic review and meta-analysis evaluated functional outcomes of urinary, sexual, and fecal functioning as well as QoL after open, laparoscopic (L-TME), robot-assisted (R-TME), and transanal total mesorectal excision (TaTME). A systematic review and meta-analysis, based on the preferred reporting items for systematic reviews and meta-analysis statement, were conducted (PROSPERO: CRD42021240851). A literature review was performed (sources: PubMed, Medline, Embase, Scopus, Web of Science, and Cochrane Library databases; end-of-search date: September 1, 2023), and a quality assessment was performed using the Methodological index for non-randomized studies. A random-effects model was used to pool the data for the meta-analyses. Nineteen studies were included, reporting on 2495 patients (88 open, 1171 L-TME, 995 R-TME, and 241 TaTME). Quantitative analyses comparing L-TME vs. R-TME showed no significant differences regarding urinary and sexual functioning, except for urinary function at three months post-surgery, which favoured R-TME (SMD [CI] –0 .15 [− 0.24 to − 0.06], p = 0.02; n = 401). Qualitative analyses identified most studies did not find significant differences in urinary, sexual, and fecal functioning and QoL between different techniques. This systematic review and meta-analysis highlight a significant gap in the literature concerning the evaluation of functional outcomes and QoL after TME for rectal cancer treatment. This study emphasizes the need for high-quality, randomized-controlled, and prospective cohort studies evaluating these outcomes. Based on the limited available evidence, this systematic review and meta-analysis suggests no significant differences in patients' urinary, sexual, and fecal functioning and their QoL across various TME techniques.

Background Although behavioral mechanisms in the association among depression, anxiety, and cancer are plausible, few studies have empirically studied mediation by health behaviors. We aimed to examine the mediating role of several health behaviors in the associations among depression, anxiety, and the incidence of various cancer types (overall, breast, prostate, lung, colorectal, smoking-related, and alcohol-related cancers).Methods Two-stage individual participant data meta-analyses were performed based on 18 cohorts within the Psychosocial Factors and Cancer Incidence consortium that had a measure of depression or anxiety (N = 319 613, cancer incidence = 25 803). Health behaviors included smoking, physical inactivity, alcohol use, body mass index (BMI), sedentary behavior, and sleep duration and quality. In stage one, path-specific regression estimates were obtained in each cohort. In stage two, cohort-specific estimates were pooled using random-effects multivariate meta-analysis, and natural indirect effects (i.e. mediating effects) were calculated as hazard ratios (HRs).Results Smoking (HRs range 1.04-1.10) and physical inactivity (HRs range 1.01-1.02) significantly mediated the associations among depression, anxiety, and lung cancer. Smoking was also a mediator for smoking-related cancers (HRs range 1.03-1.06). There was mediation by health behaviors, especially smoking, physical inactivity, alcohol use, and a higher BMI, in the associations among depression, anxiety, and overall cancer or other types of cancer, but effects were small (HRs generally below 1.01).Conclusions Smoking constitutes a mediating pathway linking depression and anxiety to lung cancer and smoking-related cancers. Our findings underline the importance of smoking cessation interventions for persons with depression or anxiety.

Combinations of health-related research data and clinical data generated, e.g., from wearables, can increasingly provide new insights about a person's health. Combining these data in a personal health record (PHR), which is managed by citizens themselves, can enhance research and enable both personalized care and prevention. We piloted a hybrid PHR using it for scientific research and the concomitant return of individual findings for clinical information and prevention purposes. The obtained information on the quality of daily dietary intake allowed researchers to further investigate the association between diet and inflammatory bowel diseases (IBDs). Additionally, the feedback enabled participants to adjust their food intake to improve the quality and prevent nutritional deficiency, thereby increasing their health. Our results showed that a PHR including a Research Connection can be successfully used for both purposes but requires a good embedding in both research and healthcare processes with the cooperation of healthcare professionals and researchers. Addressing these challenges is key in the pursuit of delivering personalized medicine and building learning health systems with PHRs.

ObjectiveCancer patients are at an increased risk for affective problems, including feelings of anxiety and depression. Mindfulness has been linked to an array of benefits for affective functioning in various populations including cancer patients, but the mechanisms underlying this relationship are still poorly understood. Based on emotion-regulation and stress-coping models, this study examined the potential mediating role of stress appraisal and coping strategies in the associations between mindfulness and cancer patients' positive and negative affect. MethodsFor this cross-sectional study, 245 cancer patients completed self-report questionnaires measuring mindfulness (FFMQ), positive and negative affect (PANAS), stress appraisal (SPSI-R:S), coping through positive reappraisal and positive refocusing (CERQ), rumination (RRQ), and distraction (COPE). Serial mediation analyses were conducted using the regression-based bootstrapping method. ResultsHigher levels of mindfulness were associated with higher levels of positive affect; this relationship was mediated via stress appraisal and positive reappraisal. We also found an indirect effect from mindfulness directly via positive reappraisal to positive affect. In addition, higher levels of mindfulness were negatively associated with negative affect; this relationship was mediated via stress appraisal and rumination, with also an indirect effect from mindfulness directly via stress appraisal to negative affect. ConclusionsResults suggest that stress appraisal and distinct coping strategies mediate the relationship between mindfulness and affect. Mindfulness may provide benefits for cancer patients' affect by allowing adaptive stress appraisal and ways of coping through more positive and less negative thinking.

BackgroundDepression and anxiety have long been hypothesized to be related to an increased cancer risk. Despite the great amount of research that has been conducted, findings are inconclusive. To provide a stronger basis for addressing the associations between depression, anxiety, and the incidence of various cancer types (overall, breast, lung, prostate, colorectal, alcohol-related, and smoking-related cancers), individual participant data (IPD) meta-analyses were performed within the Psychosocial Factors and Cancer Incidence (PSY-CA) consortium. MethodsThe PSY-CA consortium includes data from 18 cohorts with measures of depression or anxiety (up to N = 319,613; cancer incidences, 25,803; person-years of follow-up, 3,254,714). Both symptoms and a diagnosis of depression and anxiety were examined as predictors of future cancer risk. Two-stage IPD meta-analyses were run, first by using Cox regression models in each cohort (stage 1), and then by aggregating the results in random-effects meta-analyses (stage 2). ResultsNo associations were found between depression or anxiety and overall, breast, prostate, colorectal, and alcohol-related cancers. Depression and anxiety (symptoms and diagnoses) were associated with the incidence of lung cancer and smoking-related cancers (hazard ratios [HRs], 1.06-1.60). However, these associations were substantially attenuated when additionally adjusting for known risk factors including smoking, alcohol use, and body mass index (HRs, 1.04-1.23). ConclusionsDepression and anxiety are not related to increased risk for most cancer outcomes, except for lung and smoking-related cancers. This study shows that key covariates are likely to explain the relationship between depression, anxiety, and lung and smoking-related cancers. Preregistration number.

Long-term physical activity (PA) maintenance is challenging for older adults. Equipping older adults with strategies to support long-term PA maintenance can be an effective way to tackle this problem. Moreover, there is a lack of studies regarding long-term PA maintenance among older adults from non-Western settings. This qualitative research is one of the first studies conducted in an Indian context that explores the strategies developed and utilized by older adults who have successfully maintained their PA for the long term (>1 year) in their home settings. In-depth semistructured interviews were conducted with 19 older adults, and data were analyzed using an inductive reflexive thematic analysis approach. This article reports five strategies of PA maintenance, together comprising 13 substrategies. This study highlights the importance of using strategies to support the long-term maintenance of PA among older adults in India. However, these strategies would also be useful in other sociocultural contexts.

Background Even with the introduction of new genetic techniques that enable accurate genomic characterization, knowledge about the phenotypic spectrum of rare chromosomal disorders is still limited, both in literature and existing databases. Yet this clinical information is of utmost importance for health professionals and the parents of children with rare diseases. Since existing databases are often hampered by the limited time and willingness of health professionals to input new data, we collected phenotype data directly from parents of children with a chromosome 6 disorder. These parents were reached via social media, and the information was collected via the online Chromosome 6 Questionnaire, which includes 115 main questions on congenital abnormalities, medical problems, behaviour, growth and development. Methods Here, we assess data consistency by comparing parent-reported phenotypes to phenotypes based on copies of medical files for the same individual (n = 20) and data availability by comparing the data available on specific characteristics reported by parents (n = 34) to data available in existing literature (n = 39). Results The reported answers to the main questions on phenotype characteristics were 85–95% consistent, and the consistency of answers to subsequent more detailed questions was 77–96%. For all but two main questions, significantly more data was collected from parents via the Chromosome 6 Questionnaire than was currently available in literature. For the topics developmental delay and brain abnormalities, no significant difference in the amount of available data was found. The only feature for which significantly more data was available in literature was a sub-question on the type of brain abnormality present. Conclusion This is the first study to compare phenotype data collected directly from parents to data extracted from medical files on the same individuals. We found that the data was highly consistent, and phenotype data collected via the online Chromosome 6 Questionnaire resulted in more available information on most clinical characteristics when compared to phenotypes reported in literature reports thus far. We encourage active patient participation in rare disease research and have shown that parent-reported phenotypes are reliable and contribute to our knowledge of the phenotypic spectrum of rare chromosomal disorders.

Introduction Kidney transplant candidates (KTCs) need to be in optimal physical and psychological condition prior to surgery. However, KTCs often experience compromised functional capacity which can be characterised as frailty. Prehabilitation, the enhancement of a person’s functional capacity, may be an effective intervention to improve the health status of KTCs. The PREhabilitation of CAndidates for REnal Transplantation (PreCareTx) study aims to examine the effectiveness of a multimodal prehabilitation programme on the health status of KTCs, and to explore the potential of implementation of prehabilitation in daily clinical practice. Methods and analysis This study uses a single centre, effectiveness-implementation hybrid type I study design, comprised of a randomised controlled trial and a mixed-methods study. Adult patients who are currently on the transplant waiting list or are waitlisted during the study period, at a university medical centre in The Netherlands, will be randomly assigned to either prehabilitation (n=64) or care as usual (n=64) groups. The prehabilitation group will undergo a 12-week home-based, tailored prehabilitation programme consisting of physical and/or nutritional and/or psychosocial interventions depending on the participant’s deficits. This programme will be followed by a 12-week maintenance programme in order to enhance the incorporation of the interventions into daily life. The primary endpoint of this study is a change in frailty status as a proxy for health status. Secondary endpoints include changes in physical fitness, nutritional status, psychological well-being, quality of life and clinical outcomes. Tertiary endpoints include the safety, feasibility and acceptability of the prehabilitation programme, and the barriers and facilitators for further implementation. Ethics and dissemination Medical ethical approval was granted by the Medical Ethics Committee Groningen, Netherlands (M22.421). Written informed consent will be obtained from all participants. The results will be disseminated at international conferences and in peer-reviewed journals. Trial registration number ClinicalTrials.gov, NCT05489432 .

OBJECTIVE:Around 25% of cancer patients experiences depressive symptoms. However, the majority does not receive formal psychological care because patients often prefer managing symptoms alone or with informal social support. Previous research has shown that adaptive coping and social support can indeed be effective in managing relatively mild depressive symptoms. However, higher depressive symptom levels rarely improve without psychological treatment. This longitudinal study examined how and to what extent coping and social support are related to reductions in depressive symptoms in cancer patients with moderate to severe depressive symptoms. METHODS:Respondents were diagnosed with cancer in the past five years, experienced high depressive symptom levels (PHQ-9 ≥ 10) and were not receiving psychological care at baseline. We collected data with self-report questionnaires (including PHQ-9, brief COPE and Social Support List) at two assessments, taken three months apart. RESULTS:Although depressive symptoms decreased significantly between baseline and follow-up, the average level at follow-up was still moderate to severe. Patients using less avoidant coping, specifically less substance use, were more likely to report a reduction of depressive symptoms. We found no significant beneficial effects of approach coping and social support (coping) on the course of depressive symptoms. CONCLUSIONS:A significant group of cancer patients with high levels of depressive symptoms do not seem able to effectively manage depressive symptoms by themselves, especially those more likely to avoid dealing with their symptoms. Cancer patients can be educated about avoidant coping and its possible detrimental effects, as well as being informed about possibilities of psychosocial services.

Background: Up to 75% of cancer patients with depressive symptoms do not make use of psychological care. Objective: To examine how perceptions of and coping with depressive symptoms and perceived social support in adults with cancer are associated with their need for psychological care, concurrently and over time. Methods: In this longitudinal study, 127 participants who received a cancer diagnosis in the past 5 years, experienced at least moderate depressive symptoms, and were not receiving psychological help, completed 2 self-report questionnaires (3 months apart) including the brief Illness Perception Questionnaire and brief Coping Orientation to Problems Experienced Inventory and Social Support List. Results: Participants with stronger belief in the efficacy of psychological care and more likely to use avoidant coping reported a greater need for psychological care at both data points. Social support was not significantly associated with perceived need for psychological care. Conclusions: Stronger perceived treatment control and greater use of avoidant coping were significantly associated with a greater perceived need for psychological care. Implications for practice: People with cancer may benefit from being informed about the efficacy of depression treatment. Furthermore, health care professionals should be aware that avoidant coping may complicate psychological care seeking for a group of adults with cancer experiencing depressive symptoms and having a need for psychological care. Foundational: Illness perceptions and coping mechanisms can predict cancer patients’ need for psychological care. Providing information about treatment options and its efficacy, together with targeting avoidant coping may increase adequate decision-making and possibly the uptake of psychological care.