The survival impact of open esophagectomy (OE) versus thoracoscopic esophagectomy (TE) in patients with esophageal squamous cell carcinoma (ESCC) based on tumor location remains debated. This study employs energy balancing weights (EBW) to compare long-term survival between OE and TE across tumor locations. This ambispective cohort study analyzed 1778 patients with ESCC undergoing OE or TE at a tertiary hospital between January 2015 and December 2016. Primary endpoints were 5-year overall survival (OS) and disease-free survival (DFS); secondary endpoints included operative safety. EBW-adjusted Cox regression was used to compare long-term survival, with sensitivity analyses via inverse probability of treatment weighting and matching weight methods. The median survival times for upper, middle, and lower tumor locations were 60.06, 60.48, and 64.35 months, respectively. Compared with OE, the Cox regression analysis of TE showed that in the upper group, the HR was 0.45 (95

Purpose:To explore the factors influencing dietary guidance adherence in esophageal cancer patients receiving neoadjuvant therapy and to understand their decision-making process through the theoretical lens of the health belief model (HBM). Methods:A descriptive qualitative study was conducted via in depth, semistructured interviews. A purposive sample of 15 esophageal cancer patients receiving preoperative neoadjuvant therapy was recruited until data saturation was achieved. The data were analyzed via directed content analysis, guided by the core constructs of the HBM. Results:Six categories and fifteen subcategories were identified: perceived susceptibility (intuitive perception of body signals, risk awareness via medical information); perceived severity (insufficient threat recognition, awareness of malnutrition-related harm); perceived benefits (improving physical condition, promoting disease recovery); perceived barriers (treatment-related side effects, economic burden, psychological distress, conflicts in dietary habits); self-efficacy (empowerment strategies of highly efficacious individuals, the helplessness of those with low efficacy); and cues to action (professional nutritional education, family supervision and support, peer support). Conclusion:This study suggests that clinical medical workers should fully recognize the impact of personal health beliefs on dietary behavior compliance. This study provides a robust, theory-driven evidence base for developing targeted, multicomponent nutritional interventions that are fundamentally patient-centered, with the ultimate goal of improving treatment tolerance, surgical outcomes, and overall survival.

Background: Postoperative pneumonia (POP) is a critical complication after minimally invasive esophagectomy (MIE) for esophageal squamous cell carcinoma (ESCC). However, the comparative odds of POP among different neoadjuvant treatment strategies remain controversial. This study aimed to compare the associations between different treatment strategies and POP in this population. Methods: A retrospective cohort of ESCC patients undergoing MIE between March 2021 and July 2025 was analyzed. Patients were divided into four groups: the surgery alone (S-alone) group (n = 282), the neoadjuvant chemotherapy (NCT) group (n = 127), the neoadjuvant chemoradiotherapy (NCRT) group (n = 60), and the neoadjuvant chemoimmunotherapy (NCIT) group (n = 71). To address baseline confounding, generalized overlap weighting (GOW) was used for the four-group comparison, and overlap weighting (OW) was used for the pairwise comparisons of NCRT versus NCT and NCIT versus NCT. Logistic regression models were used to evaluate the associations between treatment strategies and the odds of POP. Sensitivity analyses of the pairwise comparisons were performed using stabilized inverse probability of treatment weighting (S-IPTW). Results: In the four-group comparison, neither NCT nor NCRT was associated with significantly higher odds of POP than S-alone, whereas NCIT was associated with higher odds (weighted odds ratio [OR], 1.95; 95% confidence interval [CI], 1.02-3.70). In pairwise analyses, the weighted ORs were 0.45 (95% CI, 0.20-1.01) for NCRT versus NCT and 2.32 (95% CI, 1.14-4.71) for NCIT versus NCT. Sensitivity analyses were directionally consistent. Conclusions: In this single-center observational cohort, NCRT was not associated with higher odds of POP than S-alone or NCT, whereas NCIT was associated with higher odds of POP. These findings support careful perioperative respiratory management in patients receiving neoadjuvant immunotherapy.

Alcohol Use Disorder (AUD) has become a significant medical problem among young adults from ethnic minorities. Despite being disproportionately affected by AUD, existing literature often overlooks factors contributing to AUD within this group compared to the general population. Therefore, this study aimed to identify factors associated with AUD among young adults from ethnic minorities in Hong Kong, China. A cross-sectional study was conducted from May 22 to October 21, 2024. Participants were recruited through convenience sampling from a large non-governmental organization. Of the 254 invited participants, 81.5

Chemotherapy induced peripheral neuropathy (CIPN) is a symptom commonly reported by pediatric oncology patients who receive neurotoxicity agents. Early identification is imperative for the intervention implementation. Currently, the Pediatric Chemotherapy-Induced Neuropathy (P-CIN) is an age-appropriate, patient-reported outcome (PRO) for pediatric CIPN. However, it has not been used in China, and importantly does not contain a cut-off value to guide healthcare professionals for clinical decision making. We aimed to cross-cultural adapt the P-CIN into Chinese context, and assess its psychometric properties. Methodological and descriptive study. Shenzhen Children’s Hospital, Henan Cancer Hospital and Shanghai Children’s Medical Center in China. 313 pediatric oncology patients were conveniently sampled. The Chinese P-CIN version was cross-culturally adapted and validated according to the established methodological guidelines. Participants were asked to provide demographic and clinical information, complete the translated P-CIN, Wong-baker FACES Pain Rating scale, and Pediatric Quality of Life Inventory (PedsQL) Cancer Module, and nerve conduction study. The Chinese P-CIN version showed satisfactory internal consistency (Cronbach’s alpha coefficient: 0.771) and good test-retest reliability for 2-week interval (intraclass correlation coefficient: 0.810). Excellent content validity was demonstrated; the item content validity index (CVI) ranged from 0.90 to 1.00, the average-CVI was 0.98 and the universal-CVI was 0.85. The total score of the translated P-CIN was strongly correlated with the Wong-baker FACES Pain Rating scale (Spearman’s correlation coefficient (r): 0.909, p < 0.001) and PedsQL Cancer Module (r = -0.710, p < 0.001), presenting good convergent validity. Using the clinician diagnosis of pediatric CIPN as a reference criterion, the area under the curve was 0.894. The optimal cut-off value to identify significant symptom burden of CIPN was 9. Exploratory factor analysis yielded a two-factor model (Sensory symptoms and Functional Task Performance Ability). The confirmatory factor analysis results supported the good fit of the two-factor model. Known-group validity was supported by the significant differences in the translated P-CIN score between patients grouped by neurotoxic chemotherapy agents (p = 0.014, ηp²=0.019) and cancer diagnosis (p = 0.026, ηp²=0.016). Besides, 82

Oropharyngeal dysphagia affects over half of neurological and oncological populations, yet rehabilitation is constrained by a global therapist shortage that human-AI collaboration has not demonstrably addressed. Here we report a systematic review of 31 studies (1012 participants; PROSPERO: CRD420251115997) evaluating AI-augmented swallowing rehabilitation in adults with oropharyngeal dysphagia, or in healthy volunteers testing systems designed for clinical application. We synthesised findings by aetiology and collaboration mode, assessing risk of bias and certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation, GRADE). AI-augmented interventions produce short-term gains in functional oral intake and physiological measures (GRADE moderate/low certainty), but these effects attenuate within weeks of cessation, and adherence declines sharply once clinician supervision is withdrawn. NASSS framework analysis reveals a central paradox: the adopter domain-digital literacy, cognitive impairment, interface usability-is the dominant implementation barrier (61.3% rated high), meaning the populations with the greatest need face the steepest barriers to adoption. AI algorithm performance is rated at very low certainty, with validation largely confined to healthy volunteers. These findings support advancement to pragmatic trials for supervised post-stroke rehabilitation but underscore that evidence for other aetiologies, unsupervised settings, and sustained outcomes remains insufficient.

Background The survival benefit of neoadjuvant therapy (NAT) in patients with esophageal squamous cell carcinoma (ESCC) undergoing thoracoscopic esophagectomy (TE) remains controversial. This study aims to evaluate the long-term survival impact of NAT followed by surgery versus surgery alone (S-alone) in this population. Methods This ambispective cohort study retrospectively collected baseline data and prospectively followed patients until July 2022. All enrolled patients had ESCC and underwent TE between January 2015 and December 2016. Patients were divided into the NAT group (n = 269) and the S-alone group (n = 569). The primary outcome was 5-year overall survival (OS), with 5-year disease-free survival (DFS) as a secondary outcome. After balancing baseline characteristics with overlap weighting (OW), survival outcomes were analyzed with weighted Cox regression. Sensitivity analyses based on propensity score matching (PSM) and matching weights (MW) were conducted to test the results. Results This study included 838 patients with ESCC who underwent TE. The median OS for the entire cohort was 5.32 years, and the median DFS was 5.13 years. After OW, all covariates were balanced between the groups. Kaplan-Meier analysis with the log-rank test showed no statistically significant differences in 5-year OS or DFS between the two groups (P > 0.05). The weighted hazard ratio (HR) for 5-year OS was 0.98 (95% confidence intervals, CI: 0.72,1.35) and for 5-year DFS was 1.00 (95% CI: 0.75,1.33). Subgroup analysis showed that NAT was associated with a survival benefit in patients with clinically node-positive ESCC (P < 0.05). Sensitivity analyses were aligned with the primary analysis. Conclusions NAT followed by surgery did not improve OS or DFS compared to S-alone in patients with ESCC undergoing TE. However, subgroup analysis suggested a potential survival benefit for patients with more advanced disease. These findings support a stage-guided, individualized approach to NAT in ESCC rather than its uniform application.

BACKGROUND:Sexual dysfunction is a well-documented long-term side effect of pediatric cancer treatment, which significantly impacts the overall health of childhood cancer survivors (CCSs). There is a relative lack of qualitative research on sexual dysfunction among CCSs. AIM:This study aimed to explore sexual experience, psychological factors, and typical response strategies among CCSs with sexual dysfunction in China. METHODS:A qualitative descriptive study employing semi-structured interviews was conducted. Based on purposive sampling and data saturation principles, CCSs with sexual dysfunction from the previous cross-sectional study were selected for semi-structured interviews. Data relevant to the research question was analyzed and coded using thematic analysis. RESULTS:15 female and 15 male survivors provided written-informed consent and were interviewed in this study. Four core themes were identified, including: common sexual problems, psychological factors associated with sexual dysfunction and their related pathways, and coping strategies for sexual and psychological challenges. These themes were further categorized into 15 sub-themes. CLINICAL IMPLICATIONS:The findings of this study are expected for health professionals to develop a culturally specific intervention to improve the sexual function in childhood cancer survivors. Strengths & Limitations: To our knowledge, this qualitative study is the first to provide in-depth exploration on the sexual experience, how the identified psychological factors led to sexual dysfunction, and the coping strategies for sexual dysfunction in Chinese childhood cancer survivors. However, the findings may not be fully generalizable to older cancer survivors, and conducting interviews online may have influenced the richness of the data collected. CONCLUSIONS:The present findings contribute to our understanding of sexual experience, psychological factors, and coping strategies to sexual problems among CCSs. The findings indicate that psychology is a significant factor for CCSs with sexual dysfunction and identify the mediating role of attention and self-compassion. Future research should develop an appropriate intervention based on the underlying psychological mechanisms of sexual dysfunction to improve the overall sexual function in CCSs.

IntroductionAlcohol use disorder (AUD) is prevalent among ethnic minority young adults. However, there is limited evidence exploring its health impact and contributing factors in ethnically marginalized young adults. Therefore, this study examined the reasons for developing AUD and its effect on the daily lives of ethnic minority young adults.MethodA descriptive phenomenological study was conducted from March 1 to June 30, 2023. Participants were recruited through referral using the exponential snowball sampling technique. A total of 22 ethnic minority young adults were interviewed using a semi-structured interview guide. The sample size was determined based on data saturation. All interviews were audio-recorded and transcribed verbatim in English. Then, the data was analyzed using Colaizzi’s method.ResultsThis study suggested that the reasons for developing AUD among ethnic minority young adults were (1) culture and family, (2) hedonistic motives, (3) curiosity, (4) low-risk perception, (5) coping motives, (6) social influences, and (7) subjective cravings. Moreover, this study indicated that ineffective daily performance, emotional turmoil, financial constraints, and social relationship issues were the impacts of AUD on this segment of the population.ConclusionThe findings highlighted the multifaceted reasons contributing to AUD among ethnic minority young adults, including coping, low-risk perception, and influences from culture, family, and peers. The findings also showed how AUD severely affected their daily lives. Therefore, future interventional studies should consider cultural, family, social, and psychological aspects.

To update the systematic review of assessment tools on chemotherapy-induced peripheral neuropathy (CIPN) for pediatric oncology patients based on the evidence available after the published review in 2020. Seven English-language databases (PubMed, CINAHL, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, Scopus and Web of Science) were searched for studies published from Nov 9, 2018, to May 20, 2024. Studies that contained subjects who had a cancer diagnosis and were aged under 18 years and discussed the development of a tool to measure CIPN or assessed all test items and response categories for CIPN were included. Data were screened and extracted independently using predesigned tables. The quality of each study was assessed based on Joanna Briggs Institute’s critical appraisal tools for analytical cross-sectional studies and case control studies. The quality of identified instruments for CIPN was evaluated by the modified version of Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. A total of 5 studies (with 633 patients) were included in the systematic review. Only one study was rated as high quality. We newly identified two patient-reported outcome measures (PROMs), one objective assessment and a pain scale, and three new studies about the previous identified CIPN assessment measures. Based on the current evidence, the pediatric-modified Total Neuropathy Score (ped-mTNS) and the Total Neuropathy Score-Pediatric Vincristine (TNS-PV) are still the two most appropriate tools for healthcare professionals to use in clinical settings. Our results also addressed the gap in existing literature by showing two newly PROMs for CIPN in pediatric oncology patients with acceptable quality. The combination of physician-based assessment tools and PROMs are recommended to evaluate the patients’ CIPN-related symptoms.

The survival differences between open esophagectomy (OE) and thoracoscopic esophagectomy (TE) for patients with esophageal squamous cell carcinoma (ESCC) across different pathological tumor–node–metastasis stage (pStage) remain controversial. Therefore, this study aims to compare long-term survival between OE and TE in patients with ESCC across different pStage groups using overlap weighting. This ambispective cohort study analyzed patients with ESCC who underwent OE or TE between January 2015 and December 2016 at a tertiary hospital in Henan Province. The primary endpoints were 5-year overall survival (OS), while disease-free survival (DFS) was a secondary endpoint. Operation safety was also assessed. Cox regression was used after overlap weighting, with sensitivity analysis by propensity score matching. The study cohort included 1715 eligible patients. Median survival was 66.07 months for pStage 0/I/II and 38.47 months for pStage III/IV. Overlap-weighted Cox regression showed significant survival benefits of TE. In the pStage 0/I/II group, the hazard ration (HR) for OS was 0.43 (95

IntroductionAlcohol use disorder (AUD) significantly impacts the lives of young adults from ethnic minority groups. Understanding their experiences with quitting is essential for developing culturally specific interventions. Therefore, this study aimed to explore the perceptions, barriers, and coping strategies related to quitting among young ethnic minority adults with AUD.MethodA descriptive phenomenology study was conducted. The sample size of 22 was determined by achieving data saturation, the point at which no additional themes were identified in the analysis. Interviews were audio-recorded, transcribed, and analyzed using Colaizzi’s method.ResultsA total of 22 participants were interviewed. Themes related to perceptions included: (1) alcohol use is normal; (2) quitting is good for health but difficult, and (3) Quitting is nice but not now. The study also identified four barriers including separation from family, withdrawal symptoms, peer influences, and challenges arising from acculturation. Coping preferences highlighted in the study included distraction, exercise, counseling, and reuniting with family.ConclusionThe findings underscore the complex interplay of cultural, social, and personal factors in the quitting process and emphasize the need for culturally tailored interventions. Mental health nurses should pay special attention to ethically marginalized and discriminated populations. These findings can also guide nurses in considering the cultural context, barriers, and perceptions of ethnic minorities in quitting, thereby enhancing culturally competent care.

Drinking is a common unhealthy behaviour among youth smokers aged 25 or below. However, the effects of drinking on smoking cessation outcomes are not well understood. This study aimed to explore the impact of drinking on smoking cessation outcomes among Hong Kong Chinese youth smokers who received smoking cessation counselling. This study adopted a cross-sectional design at the Youth Quitline, which is the only government-funded hotline providing telephone smoking cessation counselling to Hong Kong smokers aged 25 or younger. Of the 142 participants at the six-month follow-up, 75 were in the drinking group and 67 in the non-drinking group. Multiple logistic regression analyses were performed to identify any significant differences in self-reported quit rates, smoking reduction by at least 50%, quit attempts, and biochemically validated quit rates between the drinking and non-drinking groups. The results showed a significant difference in self-reported quit rate between the two groups at 6-month, but no significant difference in smoking reduction by at least 50%, quit attempts, and biochemically validated quit rate. Alcohol drinking and male were identified as significant factors decreasing self-reported quit rate at 6 months. The study revealed that drinking could decrease quit rates among young smokers who received counselling, but not their smoking reduction or quit attempts. Given the negative impact of drinking on smoking abstinence and the increased popularity of drinking among the youth, assessment of alcohol use and brief advice on smoking are recommended to be an integral part of smoking cessation counselling for youth smokers.

Objective:This study aimed to evaluate the knowledge, attitudes, and practices (KAP) regarding nutritional management among patients with gastrointestinal cancer. Methods:A descriptive cross-sectional study was conducted from December 2023 to May 2024 across hospitals in Jiangsu, Henan, Shanghai, and Tianjin, China. Participants completed questionnaires that collected demographic data and assessed their KAP toward nutritional management. Results:A total of 1239 valid questionnaires were analyzed. Among the participants, 769 (62.1%) were male, and 452 (36.5%) had been diagnosed with gastrointestinal cancer for less than six months. The proportion of participants demonstrating adequate knowledge, positive attitudes, and proactive practices were 1018 (82.1%), 328 (26.4%), and 403 (32.5%), respectively. Multivariate logistic regression identified several factors independently associated with proactive practices, including adequate knowledge, lack of insurance, a gastrointestinal tumor duration of 2-3 years or more, no doubts about nutritional management, absence of nutritional screening, and having others as primary caregivers. Structural equation modeling revealed direct effects of knowledge on both attitude (β ​= ​0.308, P ​< ​0.001) and practice (β ​= ​0.475, P ​< ​0.001), as well as of attitude on practice (β ​= ​0.286, P ​< ​0.001). Additionally, knowledge indirectly influenced practice through attitude (β ​= ​0.088, P ​< ​0.001). Conclusions:While most gastrointestinal cancer patients demonstrated adequate knowledge regarding nutritional management, their attitudes were predominantly negative, and their practices were largely inactive. These findings highlight a critical need for targeted educational interventions to bridge knowledge gaps and encourage more active engagement with nutritional guidelines.

BACKGROUND:This ambispective cohort study aimed to explore the influence of surgeon age on long-term prognosis and surgical safety in esophagectomy patients, as well as in different surgical approaches. METHODS:Patients who underwent esophagectomy at Henan Cancer Hospital between 2015 and 2016 were included and followed up until July 2022. The primary endpoints were 5-year overall survival (OS) and disease-free survival (DFS). The secondary outcome was surgical safety. Multivariable Cox regression analysis was performed to assess the impact of surgeon age on OS and DFS, and propensity score matching (PSM) was conducted to balance potential confounding factors. RESULTS:A total of 1761 patients were included with a median follow-up time of 61.73 months. The 5-year OS and DFS for <50 years surgeons were 65.41 % and 60.34 %, and they were 61.19 % and 57.35 % for ≥50 years surgeons. In the multivariate Cox regression analysis, operations performed by older surgeons were associated with higher risks of reduced survival (OS: HR = 1.20, 95 % CI: 1.03-1.40; DFS: HR = 1.16, 95 % CI: 1.00-1.35). No differences were observed in the number of lymph node dissection and incidence of vascular cancer thrombus. Similar results were seen with OS in patients underwent open esophagectomy and PSM. CONCLUSIONS:This study indicated that increasing surgeon age may reduce the long-term survival rate especially in patients underwent open esophagectomy, but not of surgical safety.

Spiritual well-being is the fourth dimension of well-being for pediatric cancer patients. A high level of spiritual well-being can protect them from psychological symptoms. Few interventions, however, have been focused on the spiritual dimension among pediatric patients with cancer. This study aimed to examine the feasibility and preliminary effectiveness of an integrated hope techniques and narrative-based card game (HT-NCG) intervention for pediatric cancer patients on spiritual and psychological well-being and quality of life (QoL). A total of 60 Chinese pediatric cancer patients aged 12–17 years were recruited from the pediatric oncology ward of Hunan Children’s Hospital, China. Among them, 30 participants were randomized to the experimental group and received four sessions of the HT-NCG intervention. Another 30 participants were allocated to the control group and received a placebo intervention. Spiritual well-being, hope, anxiety, depressive symptoms, and QoL were assessed at baseline (T0), post-intervention (T1), and at 1-month (T2) and 3-month (T3) follow-up. Assessors were blinded to the group allocation. The feasibility outcomes and results from generalized estimating equations were reported. The feasibility of the HT-NCG intervention was demonstrated by a high recruitment rate (80

PURPOSE:Sexual functioning is a crucial component of general health. Less is known about the late effects of childhood cancer on adult survivors' sexual functioning. This study aimed to determine the prevalence and associated factors of sexual dysfunction among adult survivors of childhood cancer. METHODS:A multicenter cross-sectional study was conducted. Survivors diagnosed with any cancer type before the age of 18, and aged more than 18 years old, were recruited by purposive sampling. From October to December 2023, potential survivors were identified from hospital information systems in four tertiary hospitals in mainland China. Invitations were sent to potential survivors between January to July 2024. Data were collected using a set of questionnaires based on a framework of associated factors of sexual functioning among adult survivors of childhood cancer. Descriptive and univariate analyses and multiple logistic regressions were conducted. RESULTS:290 out of 720 approached survivors were included and completed the questionnaire. The prevalence of sexual dysfunction in female survivors was 66.18 % and 59.09 % in male survivors. The three most commonly reported sexual problems for female survivors were related to sexual desire, sexual arousal and sexual satisfaction; and those for male survivors were related to intercourse satisfaction, orgasmic function and overall satisfaction. The associated factors of sexual dysfunction among Chinese female survivors include comorbidities, menses, being overweight, depression, and sexual shame, while age at diagnosis, self-esteem, anxiety and depression, and sexual shame were found in male survivors. CONCLUSIONS:The high prevalence of sexual dysfunction among Chinese adult survivors of childhood cancer underscores an urgent need for routine assessment and appropriate interventions. Our findings highlight modifiable psychological factors, e.g., depression, anxiety and sexual shame as important constructs that can be targeted by interventions, with an ultimate goal to improve sexual function among this population.

Objective The study aimed to determine the nutritional status and its prognostic effect on survival of patients with advanced gastrointestinal cancer. Methods An observational cohort study design was conducted in a tertiary hospital in Shanghai, China. The study consisted of 202 advanced gastrointestinal (GI) cancer patients from a palliative care unit. The following data was collected from the patients: biochemical indicators, i.e. anemia (hemoglobin levels), albumin, pre-albumin, C-reactive protein (CRP), and anthropometric parameters, i.e. body mass index, nutritional status by Patient-Generated Subjective Global Assessment (PG-SGA), symptoms in nutrition by a structured questionnaire and performance status by Karnofsky Performance Status (KPS). Severe malnutrition was confirmed with the PG-SGA score of ≥9. Kaplan-Meier survival analysis and the log-rank test were used to calculate overall survival (OS). The effect of nutritional status on survival was performed by Cox regression analysis. Results Severe malnutrition was found in 71.3% of patients according to the cutoff of the PG-SGA. PG-SGA score ≥ 9, albumin level < 35 g/L and CRP level ≥10 mg/L predicted shorten life expectancy. Multivariate Cox regression analysis results showed that PG-SGA score ≥ 9 and the albumin level < 35 g/L were predictive of OS. Conclusion Our data supported that severe malnutrition was a predictor for OS in advanced GI cancer patients. Information on nutritional status should be considered to individualize palliative care plan for these patients, and hence improve their quality of life.