Breast reconstruction improves body image, sexual experience, and well-being in patients with breast cancer. However, only about 10

Background:Cancer-related lymphedema (CRL) seriously affects patients' quality of life. Many practice guidelines emphasize the importance of early prevention. However, a significant gap exists between these guidelines and clinical practice. This study aimed to understand the current status of lymphedema management in Chinese hospitals and to provide a basis for promoting standardized practices in lymphedema care. Methods:A cross-sectional survey was conducted from September to November 2024 using a self-designed questionnaire on lymphedema management. A convenience sample of 45 hospitals nationwide was surveyed. Results:The survey revealed that 60% of hospitals had established outpatient clinics for lymphedema, while 46.7% routinely implemented manual lymphatic drainage. Additionally, 68.9% of hospitals performed routine high-risk screening or preoperative assessments for lymphedema. Regarding treatment management, the application rate of complete decongestive therapy (CDT) was 88.9%, but 42.2% of hospitals lacked a standardized fee system. Concerning personnel training, 37.8% of hospitals had not conducted lymphedema training. Conclusions:Challenges in lymphedema management in Chinese hospitals include the limited implementation of standardized care protocols, incomplete fee systems for treatments, and the low coverage of specialized training. Efforts should focus on enhancing medical staff training, establishing standardized care pathways, and improving technical fee structures to advance the standardized development of lymphedema care.

Objective To identify, appraise, and synthesize the best available evidence on complete decongestive therapy (CDT) for people with breast cancer-related lymphedema (BCRL). Methods Using an evidence-based healthcare pyramid approach, we searched bibliographic databases, guideline and professional organization websites, and clinical decision support sources from inception to October 1, 2025. Eligibility was defined using the PIPOST framework. Methodological quality was independently appraised by three reviewers for guidelines and by two reviewers for other evidence types using evidence-type-specific appraisal tools. Two reviewers extracted and synthesized the evidence. Evidence levels were assigned using the JBI 2014 system, and recommendation grades were determined through expert-panel assessment of feasibility, appropriateness, meaningfulness, and effectiveness. Results Thirty-one evidence sources were included, comprising clinical decision support sources, guidelines, evidence summaries, systematic reviews, and expert consensus documents. Thirty-seven evidence statements were synthesized across three domains: implementation principles, the intensive treatment phase, and the maintenance treatment phase. Nineteen statements (51.4%) were supported by Level 1 evidence, and 25 (67.6%) received Grade A recommendations. Conclusions This evidence summary provides an evidence-informed framework for CDT across the intensive and maintenance phases, with explicit attention to transition planning and self-management. The evidence is stronger for several core interventions than for implementation strategies and long-term self-management. Further high-quality primary and implementation research is needed.

e24099 Background: Hormone receptor-positive breast cancer is the most common cancer among women globally. Adjuvant endocrine therapy (AET) is a key treatment that reduces the risk of recurrence and improves survival rates. However, medication adherence remains a significant challenge, influenced by multiple factors. Existing research often focuses on measuring the effectiveness of interventions but tends to overlook the contextual and mechanistic aspects that influence their success. Objective: This study aims to explore how to optimize adherence interventions for breast cancer patients undergoing AET, analyze the mechanisms and contextual factors involved, and verify the effectiveness of these interventions through clinical practice. Methods: The study uses Realist Synthesis (RS) methodology, analyzing the ICAMO model (Intervention-Context-Actors-Mechanism-Outcomes) to understand the mechanisms behind adherence interventions. Data was integrated from systematic literature reviews, expert interviews, and stakeholder feedback to identify the key mechanisms driving successful outcomes and evaluate their effectiveness in promoting AET adherence. The evidence was then translated into clinical practice through an evidence-based clinical translation model to validate the intervention’s effectiveness. Results: The findings from the RS revealed that key mechanisms for improving adherence include enhancing patient beliefs about treatment efficacy, improving symptom management, providing behavioral cues, and offering emotional and social support. Contextual interventions tailored to individual patient needs and specific circumstances were found to be more effective than generalized approach. Particularly, interventions combining psychological support and symptom management had a greater impact on long-term adherence. Clinical practice verification showed that personalized interventions and regular follow-ups significantly improved adherence. The interventions included regular medication reminders, education on side effects, psychological support, and enhancing patient self-efficacy. Continuous involvement of healthcare providers and emotional support played a critical role in improving adherence. Conclusions: The application of the ICAMO model integrates various intervention strategies into a comprehensive framework, providing a holistic solution for improving AET adherence in breast cancer patients. By focusing on the mechanisms and contextual factors influencing adherence, the implementation of personalized and multi-layered intervention strategies plays a crucial role in enhancing medication adherence, ultimately improving patient outcomes in breast cancer care. This study provides important insights for optimizing clinical practice and policy recommendations. Clinical trial information: IRB#2021-07-05.

Background Financial toxicity (FT) is a common issue faced by breast cancer patients worldwide. Although financial navigation (FN) is a promising approach to alleviate FT, its effectiveness in China's context remains underexplored. Objectives To evaluate the effects of a FN intervention on FT, cost-related health literacy (CRHL), shared decision-making (SDM) ability, and perceived stress of patients with breast cancer. Methods This was a cluster randomized controlled trial. Participants were randomized to the FN group or control group (n = 41 per group). Outcomes including FT (primary outcomes), and other secondary outcomes (i.e., CRHL, SDM ability, and perceived stress) were assessed at baseline (T0), one month post-discharge (T1) and three months post-discharge (T2). Results Of 311 assessed patients, 82 eligible participants were recruited. There were significant group × time interaction effects on subjective FT (χ2group×time = 18.998, P < 0.001) and CRHL (χ2group×time = 31.535, P < 0.001). However, the group × time interaction effects on SDM (χ2group×time = 2.906, P = 0.234) and perceived stress (χ2group×time = 0.579, P = 0.749) were not statistically significant. Additionally, no significant effects were found on material and behavioral domains of FT. Conclusions This study found FN intervention could alleviate subjective FT and enhance CRHL among breast cancer patients in China, which provided preliminary evidence for integrating FN into clinical practice for FT management. Registration This study was registered at ClinicalTrials.gov (ID: NCT06484140).

Endocrine therapy is an essential component of breast cancer care but is often associated with musculoskeletal symptoms and reduced long-term adherence. Mobile health (mHealth) apps can provide scalable support for home-based exercise rehabilitation; however, evidence on the usability of artificial intelligence (AI) - driven apps in this context remains limited. This study aimed to develop a vision-based home rehabilitation app (SPARK) grounded in Symptom Management Theory (SMT) for breast cancer patients undergoing endocrine therapy, and to evaluate its usability. SPARK integrates AI-driven motion recognition and interactive feedback to support personalized symptom management. A multidisciplinary team designed the app based on the SMT and incorporated AI visual algorithms for movement recognition and feedback. Twenty-four patients participated in a 4-week app-based intervention. Usability was assessed using the Post-Study System Usability Questionnaire (PSSUQ), the User Interaction Satisfaction Questionnaire (QUIS), and post-intervention qualitative interviews. Quantitative data were analyzed descriptively, and qualitative data were thematically analyzed. The app comprised five modules: symptom logging, movement capture, AI-based motion computation, real-time personalized feedback, and encrypted data management, enabling symptom monitoring and rehabilitation evaluation. Usability testing showed high levels of satisfaction across dimensions of usefulness, information quality, and interface design (PSSUQ Cronbach’s α=0.978; QUIS Cronbach’s α=0.965). Qualitative feedback indicated that patients found the app convenient and motivating, particularly for exercise adherence, while suggesting improvements such as enhanced interactivity and personalized rehabilitation plans. The AI vision–based self- management and home rehabilitation app demonstrated favorable usability and strong potential to support personalized, home-based exercise interventions for breast cancer patients on endocrine therapy. These findings highlight the feasibility of integrating AI-driven digital tools into long-term cancer survivorship care and provide a foundation for larger-scale trials. none

1520 Background: Financial toxicity (FT) is a common and burdensome consequence of breast cancer treatment, adversely affecting patients’ psychological well-being, treatment adherence, and quality of life. Financial navigation (FN) has been proposed as an effective strategy to mitigate FT; however, high-quality randomized evidence evaluating its impact on patient-centered outcomes remains limited. Methods: This assessor-blinded, parallel-group randomized controlled trial enrolled adult female patients with breast cancer who had undergone surgery and were receiving or scheduled for adjuvant therapy. Participants were randomized to an FN intervention or usual care (n = 41 per group). The FN intervention included individualized needs assessment, cost-related health education, referral to financial and social resources, and personalized counseling. Outcomes were assessed at baseline (T0), 1 month (T1), and 3 months (T2) post-discharge. Primary outcome was FT, with secondary outcomes including cost-related health literacy (CRHL), shared decision-making (SDM) ability, and perceived stress. Intention-to-treat analysis using generalized estimating equations was applied. Results: Of 311 patients screened, 82 were enrolled. Compared with controls, the FN group demonstrated significantly lower subjective FT at T1 (mean difference = 4.76, 95% CI 0.75–8.76, P = 0.020) and T2 (mean difference = 4.66, 95% CI 0.94–8.37, P = 0.014). CRHL significantly improved at T1 (mean difference = 3.15, 95% CI 0.91–5.38, P = 0.006) and further increased at T2 (mean difference = 5.56, 95% CI 3.53–7.59, P < 0.001). SDM ability was also higher in the FN group at T2 (mean difference = 3.24, 95% CI 0.47–6.00, P = 0.022). No significant effects were observed in material or behavioral FT domains. Perceived stress was higher in the FN group at T2 ( P = 0.032). Conclusions: This randomized controlled trial demonstrates that financial navigation is an effective intervention for alleviating subjective financial toxicity and improving cost-related health literacy and shared decision-making among patients with breast cancer. By providing rigorous randomized evidence, this study advances the field beyond descriptive and observational research and offers high-level evidence supporting financial navigation as a clinically actionable strategy to address cancer-related financial toxicity. These findings contribute to the global effort to mitigate financial toxicity and support the integration of structured financial navigation programs into survivorship care models across diverse healthcare settings. Clinical trial information: NCT06484140 .

Objective To synthesize publicly available guidance on communicating with children about a parent’s cancer from official national cancer organization websites. Methods We conducted a qualitative document analysis of eligible webpages and PDF resources identified through systematic Google and within-site searches. Thirteen resources from 13 countries were analyzed using the READ (Ready, Extract, Analyze, Distil) approach and conventional content analysis.. Results Six themes described why, when, and how to communicate; who should be involved; what information should be discussed; and how emotional support could be provided. The resources generally favored honest, developmentally appropriate communication, preparation for treatment-related and daily-life changes, and involvement of trusted family members and professionals when needed.. Conclusions The study provides a structured thematic synthesis of publicly available guidance rather than a validated communication framework. All included resources were from Europe, North America, or Oceania, which limits transferability to other sociocultural settings. Further research should culturally adapt and empirically evaluate these strategies across disease stages, child developmental stages, and family structures.

Aromatase Inhibitors Associated Musculoskeletal Symptoms (AIMSS) are common side effects among hormone receptor-positive breast cancer patients, significantly affecting patients’ treatment adherence and quality of life. The individual genetic susceptibility mechanism underlying AIMSS was not well understood yet. This study aimed to validate the association between genetic polymorphisms and AIMSS among Chinese breast cancer patients. This was a cross-sectional study. Participants were recruited from a tertiary hospital in China from May 2023 to June 2024. Musculoskeletal symptoms were measured using the Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) and the Western Ontario and McMaster Osteoarthritis Index (WOMAC) among hormone receptor-positive patients receiving aromatase inhibitor therapy. Six genes (i.e., ESR1, ESR2, RANK, OPG, TCL1A and CYP19A1) related 20 SNPs were tested. Multivariate linear regression analysis was used to explore the association between different genotypes and the severity of AIMSS. Among 171 participants, the standardized M-SACRAH score was 3.33 (IQR 0.00–9.17) and the standardized WOMAC score was 5.83 (IQR 2.08–17.29). Patients carrying the ESR1 rs9340799 AG genotype (vs. AA) had a significant reduction in the severity of hand joint symptoms [adjusted β = -4.51, 95

Objective:To examine the musculoskeletal symptom experiences of Chinese patients with breast cancer receiving aromatase inhibitor (AI) therapy and identify patient-centered strategies for symptom management. Methods:A descriptive qualitative study was conducted from June to August 2023 at a tertiary hospital in Shanghai, China. Using purposive sampling with maximum variation, 37 women with hormone receptor-positive (HR+) breast cancer (stages I-III) undergoing AI therapy participated in semi-structured telephone interviews. Data were audio-recorded, transcribed verbatim, and analyzed thematically. Results:Four themes were identified: (1) Symptom burden-persistent joint pain, stiffness, and fatigue interfered with daily activities; (2) Emotional impact-symptoms provoked anxiety, frustration, and reduced well-being; (3) Social challenges-decreased participation in social and family life led to feelings of isolation; and (4) Coping strategies-pharmacological measures (e.g., calcium and vitamin D supplementation) and non-pharmacological interventions (e.g., exercise, acupuncture) were adopted, though access to reliable information and professional guidance was often inadequate. Conclusions:Musculoskeletal symptoms related to AI therapy impose considerable physical, emotional, and social burdens on Chinese patients with breast cancer, potentially undermining treatment adherence. Culturally appropriate, patient-centered management incorporating both pharmacological and non-pharmacological interventions is essential to optimize symptom control and quality of life.

BACKGROUND:Financial toxicity (FT) from cancer treatment significantly impacts the quality of life among breast cancer patients. The study aimed to assess the longitudinal associations between FT and symptom burden in Chinese breast cancer patients. METHODS:This prospective cohort study was conducted from November 2022 to March 2024. Participants were recruited from four Grade-A public hospitals across different areas of China using convenience sampling. FT was assessed using the Comprehensive Score for Financial Toxicity, with higher scores indicating better financial well-being. Symptom burden was measured with the BCPT (Breast Cancer Prevention Trial) Eight Symptom Scale and the Memorial Symptom Assessment Scale-Short Form Psychological Subscales, with higher scores indicating greater psychological symptom burden. Assessments were conducted at baseline (T1), 3 months (T2), 6 months (T3), and 12 months (T4) post-surgery. RESULTS:Among 378 participants (all women; mean [SD] age, 48.9 [9.97] years), a moderate negative association was found between physical symptom burden and FT (r = -0.498 to -0.411) and between psychological symptom burden and FT (r = -0.493 to -0.392). Random Intercept Cross-lagged Panel Model demonstrated that FT negatively predicted the subsequent physical symptom burden (r = -0.166 to -0.122, p < 0.05). Physical symptom burden at T1 and T3 also negatively predicted the subsequent FT (r = -0.294 to -0.186, p < 0.05). Additionally, psychological symptom burden negatively predicted FT at the subsequent time point (r = -0.116 to -0.069, p < 0.05). CONCLUSIONS:This study found vicious associations between FT and symptom burden in breast cancer patients. Future interventions addressing FT should incorporate the monitoring and management of symptom burden.

BACKGROUND:Patients with breast cancer experience varying levels of financial toxicity (FT), but the factors contributing to sustained financial toxicity remain poorly understood. METHODS:This longitudinal study was conducted from November 2022 to March 2024 in China. Participants were recruited from four Tertiary Level A hospitals using convenient sampling. FT was assessed using the Comprehensive Score for Financial Toxicity (COST) at baseline (T1), 3 months (T2), 6 months (T3), and 12 months (T4) post-surgery. Growth Mixture Modeling was used to identify the different trajectories of the FT. Multivariable logistic regression were employed to explore the predictive factors with different trajectory categories. RESULTS:Among 378 participants (all women; median [SD] age, 48.9 [9.97] years), the COST score was lowest at T2. Three distinct FT trajectories were identified: 91 patients (24 %) in the "Severe FT with Gradual Relief" group (trajectory 1), 190 patients (50 %) in the "Persistently Low-Level FT" group (trajectory 2), and 97 patients (26 %) in the "Moderate FT with Gradual Worsening" group (trajectory 3). Using trajectory 2 as the reference, predictors for trajectory 1 included symptom burden, location, cancer stage, cost-related health literacy, resilience, and difficulty affording basic expenses. For trajectory 3, predictors included monthly household income, symptom burden, location, and cancer stage. CONCLUSIONS:The FT experienced by breast cancer patients changes over time and follows distinct dynamic trajectories, influenced by multiple factors. In future clinical practice, early identification and intervention for high-risk FT groups should be prioritized.

Objective: To explore the perspectives of healthcare professionals involved in the reproductive management of young women with breast cancer based on social-ecological systems. Methods: A descriptive qualitative study was conducted. Purposive sampling was used to select 15 healthcare professionals from breast cancer specialties between January and June 2024. Face-to-face in-depth interviews were conducted. Interview data were analyzed using Colaizzi's content analysis method. Results: Three themes emerged from the data: the reproductive decision-making process needs to involve multiple parties; multiple supports should be provided during reproductive management; and reproductive management requires multi-system preparedness. Conclusions: From the patient's perspective, we should respect their will, consider family decisions, and strengthen learning abilities. From the professionals'perspective, we should improve the reproductive management awareness of healthcare professionals, their professional learning ability and their cancer reproductive consultation and communication abilities. At the organizational level, social resources could be integrated to provide multidisciplinary information and multi-dimensional emotional support to promote smooth reproductive decision-making in young patients with breast cancer to improve their quality of life.

This study aims to understand the current status of knowledge, health beliefs, and behavior related to osteoporosis prevention in patients with breast cancer during endocrine therapy and to analyze its influencing factors. From December 2022 to June 2023, convenience sampling was used to investigate patients with breast cancer receiving endocrine therapy in a Class III Grade A hospital in Shanghai using the general information questionnaire, Osteoporosis-Related preventive Behavior Questionnaire, Osteoporosis Knowledge Questionnaire (OKT), and Osteoporosis Health Belief Scale (OHBS). Four hundred thirty-five questionnaires were distributed, and 403 valid questionnaires were collected, with an effective recovery rate of 92.6%. OKT failed in 282 cases (70.0%), and the standard score was (52.53 ​± ​12.01). The standard score of OHBS was (72.46 ​± ​5.79). The results of univariate analysis showed that age was negatively correlated with daily sunshine time. It was positively correlated with calcium/vitamin D supplementation and bone mineral density measurement. Multiple linear regression analysis showed that age and education level influenced OKT and OHBS scale scores (P ​< ​0.05). Pearson correlation analysis showed a significant positive correlation between OKT and OHBS (P ​< ​0.05). Patients with breast cancer with endocrine therapy have poor knowledge of osteoporosis and low levels of health belief, and most of them have wrong prevention behaviors.

Financial toxicity from cancer treatment significantly impacts the quality of life among patients. Understanding how financial toxicity interacts with symptom burden is crucial for developing effective interventions. This study aimed to assess the longitudinal associations between financial toxicity and symptom burden in cancer patients in China. Conducted from November 2022 to March 2024, this prospective cohort study recruited participants from four Grade-A public hospitals across China using a convenient sampling method. Eligibility criteria included age ≥18 years, cancer diagnosis with surgery, scheduled anti-tumor treatments, and Mandarin proficiency. Financial toxicity was measured using the Comprehensive Score for Financial Toxicity (range, 0-44; higher scores indicate better financial well-being), while symptom burden was assessed with the BCPT Eight Symptom Scale (range, 0-120; higher scores reflect greater symptom annoyance) and the Memorial Symptom Assessment Scale – Short Form Psychological Subscales (range, 4-16; higher scores indicate greater burden). Assessments occurred at baseline (T1), 3 months (T2), 6 months (T3), and 12 months (T4) post-surgery. Among 378 participants (median age, 48.9 years), moderate negative associations were found between physical symptom burden and financial toxicity (r = -0.498 to -0.411) and between psychological symptom burden and financial toxicity (r = -0.493 to -0.392). A Random Intercept Cross-lagged Panel Model demonstrated that financial toxicity negatively predicted subsequent physical symptom burden (r = -0.122 to -0.166, p<0.05), while physical symptom burden at T1 and T3 negatively predicted financial toxicity at subsequent time points (r = -0.186 to -0.294, p<0.05). Additionally, psychological symptom burden negatively predicted financial toxicity at the following time points (r = -0.069 to -0.116, p<0.05). Bidirectional associations between financial toxicity and symptom burden were found in this study. Future research should simultaneously take measures to alleviate symptom burden and improve financial toxicity in order to break the vicious cycle between symptom burden and financial toxicity.

Background: Aromatase inhibitors-related musculoskeletal syndrome (AIMSS) is a common side effect experienced by early breast cancer patients undergoing endocrine therapy. This condition can result in medication discontinuation and a diminished quality of life. The objective of this study was to characterize AIMSS, investigate its pathogenesis, and identify potential biomarkers at both the protein and metabolic levels. Methods: We collected peripheral blood samples from 60 women diagnosed with breast cancer undergoing aromatase inhibitor therapy, of whom 30 had AIMSS and 30 did not. The samples were analyzed using four-dimensional data-independent acquisition (DIA)-based proteomics and untargeted metabolomics, employing liquid chromatography–mass spectrometry (LC–MS) on the latest platform. Results: The mean age of participants was 49.2 (11.3) years in the AIMSS group and 50.1 (11.5) years in the non-AIMSS group. There were no statistically significant differences between the two groups in terms of age, BMI, education level, clinical stage, and treatment. In total, we identified 3473 proteins and 1247 metabolites in the samples. The chemokine signaling pathway (p = 0.015), cytokine–cytokine receptor interaction (p = 0.015), complement and coagulation cascades (p = 0.004), neuroactive ligand–receptor interaction (p = 0.004), and the estrogen signaling pathway (p = 0.004) were significant enriched in differentially expressed proteins (DEPs). GnRH secretion (p < 0.001), sphingolipid signaling pathways (p < 0.001), endocrine resistance (p < 0.001), the estrogen signaling pathway (p = 0.001), endocrine and other factor-regulated calcium reabsorption (p = 0.001), dopaminergic synapse (p = 0.003), regulation of lipolysis in adipocytes (p = 0.004), biosynthesis of cofactors (p = 0.004), thyroid hormone synthesis (p = 0.008), aldosterone synthesis and secretion (p = 0.001), taurine and hypotaurine metabolism (p = 0.011), ovarian steroidogenesis (p = 0.011), and the cAMP signaling pathway (p = 0.011) were significantly enriched in differentially expressed metabolites (DEMs). Complement C3 (p = 0.004), platelet factor 4 (p = 0.015), KRT10 (p = 0.004), KRT14 (p = 0.004), beta-estradiol (p = 0.019), testosterone (p = 0.023), sphingosine (p < 0.001), and 1-stearoyl-2-arachidonoyl-sn-glycerol (p = 0.039) could be the monitoring and therapeutic targets for AIMSS. Conclusions: This study offered new insights into the mechanisms underlying musculoskeletal symptoms associated with aromatase inhibitors. It also highlighted potential biomarkers for predicting and addressing these symptoms in breast cancer patients, paving the way for improved intervention strategies.

Objectives:This study aims to understand the current status of knowledge, health beliefs, and behavior related to osteoporosis prevention in patients with breast cancer during endocrine therapy and to analyze its influencing factors. Methods:From December 2022 to June 2023, convenience sampling was used to investigate patients with breast cancer receiving endocrine therapy in a Class III Grade A hospital in Shanghai using the general information questionnaire, Osteoporosis-Related preventive Behavior Questionnaire, Osteoporosis Knowledge Questionnaire (OKT), and Osteoporosis Health Belief Scale (OHBS). Results:Four hundred thirty-five questionnaires were distributed, and 403 valid questionnaires were collected, with an effective recovery rate of 92.6%. OKT failed in 282 cases (70.0%), and the standard score was (52.53 ​± ​12.01). The standard score of OHBS was (72.46 ​± ​5.79). The results of univariate analysis showed that age was negatively correlated with daily sunshine time. It was positively correlated with calcium/vitamin D supplementation and bone mineral density measurement. Multiple linear regression analysis showed that age and education level influenced OKT and OHBS scale scores (P ​< ​0.05). Pearson correlation analysis showed a significant positive correlation between OKT and OHBS (P ​< ​0.05). Conclusions:Patients with breast cancer with endocrine therapy have poor knowledge of osteoporosis and low levels of health belief, and most of them have wrong prevention behaviors.

Objective:Patients experience diverse symptoms during the oral intake rehabilitation period after esophagectomy, yet symptom interactions remain poorly understood. This study aimed to identify symptom clusters, core symptoms, and their relationships to inform targeted nursing interventions. Methods:In this cross-sectional study, 252 participants completed the Anderson Symptom Assessment Scale and the European Organization for Research and Treatment of Cancer quality of life questionnaire, specifically the esophageal-specific module (EORTC QLQ-OES18). Symptom clusters were derived via Principal Component Analysis (SPSS 26.0), and a network analysis (R4.3.1) was conducted to explore symptom centrality and interconnectedness. Results:Five symptom clusters emerged: reflux symptoms, unpleasant eating changes, low spirits symptoms, nerve damage symptoms, and energy deficiency symptoms. Distress (strength ​= ​4.878, betweenness ​= ​20, closeness ​= ​0.263) and trouble enjoying meals (strength ​= ​4.666, betweenness ​= ​28, closeness ​= ​0.258) were identified as core symptoms and with the highest bridge strength (distress: 3.400; trouble enjoying meals: 3.210). Patients experiencing these symptoms exhibited significantly greater weight loss (distress: 2.60 ​± ​2.52 vs. 1.68 ​± ​2.10 kg, P ​= ​0.002; trouble enjoying meals:2.42 ​± ​2.56 vs. 1.65 ​± ​2.00 kg, P ​= ​0.009). Conclusions:Distress and trouble enjoying meals are not only core symptoms but also bridge symptoms. Future interventions targeting these two symptoms may be able to alleviate the overall symptoms and reduce weight loss during the oral intake rehabilitation period following esophagectomy.

Objective:This study aims to develop a financial navigation program among patients with breast cancer in China and assess its feasibility, acceptability, and preliminary effects on cost-related health literacy and financial toxicity (FT). Methods:The Medical Research Council (MRC) framework were adopted to guide the development of the financial navigation program, providing a structured approach to complex intervention development and evaluation. It consisted of three phases: evidence identification via a scoping review, intervention content modeling through qualitative study analysis, and outcome mapping based on social stress theory. The feasibility, acceptability and primary effectiveness were examined in a single-center, assessor-blinded pilot randomized controlled trial with 26 recruited patients. Results:The financial navigation program consists of needs assessment, cost-related health education, resource/service referral and personalized counseling. The consent rate and a 1-month attrition rate for the feasibility study of the intervention were 55.9% and 7.7%, respectively. Most (91.7%) participants were satisfied with the program and perceived benefits. The intervention significantly improved cost-related health literacy, although no statistically significant between-group difference in FT was observed. Conclusions:The MRC framework serves as a useful scientific basis for developing financial navigation program with a culturally sensitive approach. The financial navigation program was feasible, acceptable, effective in improving cost-related health literacy and has the potential to enhance FT among patients with breast cancer in China. Trial registration:ClinicalTrials.gov Identifier NCT06355440.

Background:Breast cancer-related lymphedema (BCRL) seriously affects patients' quality of life. We aimed to understand the stage of postoperative lymphedema and the occurrence of related symptoms in breast cancer patients, and to analyze the relationship between the two, so as to provide reference for the implementation of targeted clinical interventions. Methods:Convenience sampling method was used to select postoperative breast cancer patients attending the lymphedema evaluation clinic of a tertiary hospital in Shanghai for questionnaire survey. A professional lymphedema therapist assessed the severity of the patients' lymphedema according to the International Society of Lymphology (ISL) lymphedema grading criteria, and the Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI) was used to assess the severity of the patients' lymphedema and patients' experience of lymphedema-related symptoms. This study aimed to understand the occurrence of lymphedema in breast cancer patients after surgery, and to explore the characteristics of related symptoms in patients with different stages of lymphedema. Results:Of the 1,021 patients, 744 (72.86%) were in stage 0, 161 (11.36%) in stage 1, 98 (9.5%) in stage 2, and 18 (1.7%) in stage 3. The higher the lymphedema stage, the number and severity of symptoms significantly increased (P<0.001), with stage 2 and 3 patients reporting more symptoms and greater severity compared to stage 0 and 1 patients. In terms of symptom distress, the higher lymphedema stage was associated with a significant increase in the total symptom distress score as well as in the functional and emotional dimensions of distress (P<0.001). Conclusions:The number of symptom presentations, symptom severity and their degree of distress increased with higher lymphedema stage. Attention should be paid to patients' symptom complaints, and early identification and timely intervention should be made in patients with stage 0 and 1 lymphedema to alleviate their symptoms and slow down the progression of edema.