Search

The economic burden of chronic diseases such as cancer could negatively impact patients' health and quality of life. The daily management of the disease results in economic needs that patients often face directly, which may lead to real toxicity, just defined as financial toxicity. This study aims to explore cancer patients' experiences, emotions, opinions, and feelings related to the phenomenon of financial toxicity. A phenomenological qualitative descriptive study was conducted through face-to-face interviews with adult oncological patients. The sample ( n = 20) was predominantly composed of females (with a meanly 58 years old) with breast cancer and in chemotherapy treatment. The most relevant topics that emerged from the patients' experiences were the impact on work, the distance from the treatment centre, the economic efforts, the impact on the quality of life, and the healthcare workers' support during the healthcare pathway. From the phenomenological analysis of the interviews, three main themes and seven related subthemes emerged. This study provided a phenomenological interpretation of financial toxicity in adult cancer patients and underlines that this issue involves families or caregivers, too. Financial problems appear relevant for those who experience cancer and should be included in a routine assessment by healthcare professionals.

Purpose: Cancer patients undergoing chemotherapy continue to experience significant fatigue, which affects their quality of life. The present study aims to evaluate the combined effect of comprehensive physical exercise, pranayama (regulated breathing practices of yoga), and dietary support intervention on fatigue in cancer patients undergoing chemotherapy., Methods: Non-advanced adult cancer patients undergoing chemotherapy (N = 52) were randomized into the intervention group (N = 26) or control group (N = 26). Fatigue assessment was done using the Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue Scale (version 4) at baseline and after 3 months. The intervention group participants practiced physical exercise, slow-paced pranayama and supplemented their diet with an intake of 100 g of millet protein powder (MPP), commonly known as "Sattu" in India. The control group received standard medical care., Results: A total of 39 patients (N = 13 in the intervention and N = 26 in the control group) were included in the statistical analysis. Within the intervention group, a statistically significant reduction in fatigue (p = 0.002) with a large effect size (d = 2.1) was observed. There was no statistically significant reduction in fatigue within the control group (p = 0.36). The group comparison showed a statistically significant reduction in post-scores of fatigue (p < 0.0001) in the intervention group as compared to the control group with a moderate effect size (R = 0.1). No unintended adverse effects related to the intervention were observed., Conclusion: The results suggest the potential role of integrated physical exercise, pranayama, and dietary support in reducing fatigue in cancer patients undergoing chemotherapy. Further validation with a larger sample size is required., Trial Registration: CTRI/2022/04/041717 [Registered prospectively on 07/04/2022]., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The COVID-19 pandemic impacted healthcare organizations, necessitating a rapid transition from in-person to virtual care. Our study explored the feasibility of a mixed in-person/telerehabilitation intervention for cancer patients and its effects on cancer-related fatigue (CRF), quality of life (QoL), physical function, patient satisfaction, and perceived usefulness., Methods: TRACE 2020 is an observational prospective study that enrolled adult cancer patients, between January 2021 and March 2023, who were eligible for a rehabilitation program to be provided also in telerehabilitation. Patients were assessed at baseline and after the rehabilitation program. Adherence to sessions, reasons for non-adherence and adverse events were collected., Results: Of the 23 patients enrolled, 87% received a mixed intervention, with an average of 60% in-person sessions and 40% telerehabilitation sessions. Adherence was very high (91%). Evaluation scales showed an improvement in CRF, QoL, and lower limb strength and a relevant increase in patients' level of physical activity (PA). Most patients reported good satisfaction; the few criticisms mainly concerned difficulties in connectivity, lack of physical contact and difficulties in understanding how to perform exercises during telerehabilitation sessions. The physiotherapist underlined the usefulness of the innovative approach and suggested ways to facilitate future implementation., Conclusion: A mixed intervention including telerehabilitation is feasible and accepted by cancer patients. It may have a positive effect on their CRF, QoL, and level of PA and render patient care more flexible. The findings suggest what characteristics the target population for telerehabilitation should have, in order to integrate telerehabilitation in standard care for cancer patients., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Background: Postoperative recovery in patients with cancer is a complex process that influences quality of life, functional recovery, and mental well-being. Smartphone app-based interventions have emerged as potential tools for improving various aspects of health and well-being in cancer patients. However, the existing literature lacks a consensus on the efficacy of these interventions, leading to conflicting outcomes., Methods: We searched multiple databases, including PubMed, Web of Science, Cochrane Library, Scopus, EMBASE, and MEDLINE Complete (EBSCO). We exclusively selected randomized controlled trials meeting the inclusion criteria for our systematic review and meta-analysis. Utilizing a random-effects model, we derived the pooled effect size estimates for the meta-analysis. Where applicable, we calculated the pooled standardized mean difference (SMD) with 95% confidence interval (CI). The Cochrane Collaboration tool (Cochrane ROB) was used to evaluate bias in randomized trials. The primary outcome was the quality of life. The secondary outcomes were psychological symptoms, health conditions, satisfaction, and self-efficacy., Results: Of 731 screened articles, 15 were included, comprising 1,831 participants. Our meta-analysis revealed that app-based interventions potentially improved quality of life (SMD =  -0.58, 95% CI -1.00 to -0.16), alleviated psychological symptoms (SMD =  -0.43, 95% CI -0.72,-0.15; p  = .003), and enhanced self-efficacy (SMD = 0.90, 95% CI 0.26 to 1.53; p   =  0.001). However, there was no statistically significant effect on satisfaction (SMD = 1.25, 95% CI-1.06 to 3.57; p   =  0.23)., Conclusions: Our findings suggest that mobile health apps hold promise in improving the well-being of cancer patients after surgery by enhancing their quality of life, health status, and self-efficacy, while also reducing anxiety and depression.

Background: Death anxiety is thought to cause a range of mental disorders among cancer patients, which may affect their mental health and even quality of life. This study sought to investigate experiential avoidance, meaning in life, and death anxiety among Chinese cancer patients and then explore the relationship between these 3 variables., Methods: A total of 300 cancer patients recruited from a tertiary cancer hospital participated in this study from October to December 2021. A cross-sectional survey was conducted using a demographic and clinical characteristics questionnaire, the Acceptance and Action Questionnaire II, the Meaning in Life Questionnaire, and Templer's Death Anxiety Scale. Correlation analysis, hierarchical regression analysis, and mediating effect analysis were used to analyze the relationship among experiential avoidance, meaning in life (including 2 dimensions: presence of meaning and search for meaning), and death anxiety., Results: A total of 315 questionnaires were distributed, and 300 valid questionnaires were returned, resulting in a valid response rate of 95.2%. Experiential avoidance (r = 0.552, p < 0.01) was moderately positively correlated with death anxiety. Presence of meaning (r = - 0.400, p < 0.01) was moderately negatively correlated with death anxiety, while search for meaning (r = - 0.151, p < 0.01) was weakly negatively correlated with death anxiety. Regression analysis showed that experiential avoidance (β = 0.464) and presence of meaning (β = -0.228) were predictors of death anxiety. Mediating effect analysis revealed that presence of meaning either completely or partially mediated the effect of experiential avoidance and death anxiety, and the indirect effect accounted for 14.52% of the total effect., Conclusion: Overall, experiential avoidance predicts death anxiety in cancer patients, and meaning in life can mediate this effect. The results of this study provide a new path for studying the mechanism of death anxiety and suggest a more positive and promising strategy for its management., (© 2024. The Author(s).)

Purpose: Many cancer patients have problems eating which are usually connected to taste and smell alterations due to side effects of cancer treatment. These problems have consequences both in terms of malnutrition and reduced quality of life. In order to explore social and psychological consequences of eating problems in cancer patients, qualitative interviews were conducted with cancer patients, their caregivers and healthcare professionals., Methods: The study was conducted in three European countries (Poland, Spain and the UK) that differed in culture, oncology care approaches and availability of nutritional products targeted to cancer patients in the market., Results: Differences in the social role of eating between the three European countries were observed which subsequently influenced the impact of eating problems for cancer patients in these countries. Furthermore, the study found that problems with food affect not only the quality of life of cancer patients, but can also distress their caregivers, who are often unable to cope with such food-related problems. In addition, the study showed that commercially available nutritional products for cancer patients focus on nutritional value but tend to neglect an important aspect of eating, which is the enjoyment of food, both individually and socially., (© 2024. The Author(s).)

Context: Research about the end of life with the help of patient-reported outcomes in vulnerable populations such as cancer patients is needed but is potentially burdensome and can therefore raise concerns., Objectives: To assess the response burden due to questionnaires about the end of life in cancer patients and to explore associations with individual variables., Methods: In a cross-sectional design response burden was assessed using a six-item instrument after completion of a survey that concerned the end of life. Associations with age, gender, type of care (curative/palliative), years since diagnosis, distress, depression, anxiety, death anxiety, readiness for end-of-life conversations, and readiness for advance care planning were explored via correlational analyses and multiple regressions. Burden due to the topic of end-of-life and completing questionnaires in general was compared., Results: A total of 269 cancer patients (mean age 61.4 (SD =12.3); 59.5% male; 58.4% in palliative care) completed the survey in a German hospital. The majority did not report response burden; 29.7% reported at least some burden due to study participation. The multiple regression (F [10,26] = 9.97, p < 0.001) indicated that stable predictors of response burden were higher death anxiety (ß = 0.4), lower readiness to talk about one's end of life (ß = -0.34) and higher age (ß = 0.23). No additional subjective burden due to the topic of end-of-life was reported., Conclusion: The reported response burden seems acceptable since it was generally low. However, a subgroup did report some burden. Minimising burden and enhancing participants' benefits without compromising the research quality should further influence study designs in this field., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Insomnia is a common health problem among cancer patients, which is not only a physical problem but also a psychological problem. Sleep plays an important role in the mental and somatic rehabilitation of cancer patients, and the sleep beliefs and attitudes of cancer patients are key factors in improving their sleep situation and quality of life. The aim of this study was to translate the Cancer-Related Dysfunctional Beliefs and Attitudes about Sleep (C-DBAS-14) scale into Chinese and to validate its reliability and validity in cancer patients., Method: The C-DBAS-14 scale was translated into Chinese using the backward and forward translation procedure. The reliability of the scale was measured by internal consistency, split-half reliability and retest reliability. The validity of the scale was assessed through the content validity indicators, exploratory factor analysis and validation factor analysis., Result: The Cronbach's ɑ coefficient of the Chinese version of the C-DBAS-14 was 0.932 while the McDonald's omega coefficient (ω t) was 0.934. The split-half reliability coefficient was 0.908, and the test-retest reliability was 0.857. The four-factor model was obtained using exploratory factor analysis, explaining 72.7% of the variance, with each item loading greater than 0.4 on the common factor. The results of the confirmatory factor analysis revealed that all indicators of model fit were within an acceptable range, indicating a well-fitting model., Conclusion: The Chinese version of the C-DBAS-14 has good reliability and validity among cancer patients. It can be used to measure the sleep beliefs and attitudes of Chinese cancer patients., (© 2024. The Author(s).)

Purpose: Hope is vital for cancer patients to cope with their illnesses. It is positively associated with better health outcomes, quality of life, and daily functioning. However, restoring hope after a cancer diagnosis can be challenging, especially for young adult cancer patients. This research aimed to investigate hope among young adults with cancer throughout their cancer experience and the exploration of hope preservation in these individuals. Methods: This qualitative study involved 14 young adults recruited from a closed Facebook group. The median age of the participants was 30.5 years (range 20-39 years), and their median survival year was 3 years (range 1-18 years from the date of diagnosis). Semistructured interviews and a thematic analysis were performed to identify the major themes that emerged from these interviews. Results: The findings identified that young adults expressed hopes for cancer advocacy, good physical and mental health, ease in the afterlife, and uncertain hopes due to thoughts of death. Three areas that influenced their hope are: (1) active hope with cancer peers; (2) cancer prognosis and hope; and (3) hope comes from prayer. Their cultural and religious beliefs influenced the various forms of hope and affected their experiences with cancer. In addition, this study discovered that not all positive communication with their physician resulted in hope. Conclusion: These findings provide important insight to health care professionals (HCPs) by encouraging young adults to discuss hope and improving the existing oncology social work-based intervention. This study suggests that hope is essential for chronic illness patients and should be supported continuously during and after treatments.

Background: Integrative nursing (IN) is an essential component of integrative medicine and integrative oncology. IN includes a range of external naturopathic, integrative nursing interventions, such as compresses, embrocation, and foot/hand baths, aimed at alleviating symptoms and side effects of conventional treatment. The project IMPLEMENT-UKU ("Implementation of IN at the University Hospital Ulm") was accompanied by a descriptive pilot study on the use of IN interventions on cancer-related symptoms in oncology inpatients, the characterization of these patients and the evaluation of the impact., Methods: A single-arm study was conducted using a paper-based questionnaire administered before the IN interventions (t0) and 24 hours after the IN interventions (t1). Topics included sociodemographic data, symptoms, quality of life, health status, psychological burden, attitudes, and experience and satisfaction with the IN interventions. Analyses were descriptive using absolute and relative frequencies., Results: During the 6-month study period out of 66 patients recommended for IN consultation by medical and nursing staff on 2 wards, 62 (93.9%) accepted the offer. Of those patients who received IN, 21 patients (33.9%) participated in the study. The number of IN interventions received per patient ranged from 1 to 3 during the 24-hour survey period. And a total of 36 IN interventions were performed: The most treated body region was the feet/legs (50.0%), followed by the back (25.0%), using oils such as solum oil (41.7%) and lavender oil (13.9%). Embrocation (77.8%) was the predominant type of IN intervention. For patients, the mean FACIT-F score was 29.2 ± 12.5. The mean PHQ-4 score was 3.0 ± 1.9. Regarding sleep quality in the last 4 weeks, 13 participants (61.9%) described it as rather or very poor. Satisfaction with the IN was high, with a large proportion of participants evaluating the IN interventions very positively., Conclusion: The study's findings suggest that there is a great need for IN among oncology inpatients. These patients are open to and interested in IN interventions and evaluate them positively. IN provides a promising opportunity to provide non-pharmacological support to inpatients. The integration of IN in conventional oncology care settings may enhance patient-centered care and contribute to improved patient wellbeing., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study aimed to explore the moderating role of socioeconomic status (SES) in the association between multimorbidity and health-related quality of life (HRQOL) among cancer patients in Anhui China. A total of 560 cancer patients were recruited for the cross-section study. Socio-demographic and clinical characteristics were analyzed using descriptive statistics. Tobit regression analysis was employed to investigate the relationship between multimorbidity and HRQOL as well as to assess the moderating effect of SES. The research findings indicated that 76.61% of cancer patients experienced multimorbidity, with psychological multimorbidity being the most prevalent (45.54%), followed by physical-psychological multimorbidity (20.89%). Moreover, physical-psychological multimorbidity had the most substantial adverse effect on HRQOL ( P < .001). The presence of multimorbidity was correlated with a significant decline in HRQOL, with a 17.5% ( P < .001) decrease in HRQOL for each additional multimorbidity. Additionally, SES played a significant role in moderating the impact of multimorbidity on HRQOL in cancer patients. (Marginal effect = -0.022, P < .01). The high SES group exhibited a higher overall HRQOL than the low SES group (Marginal effect = 0.068, P < .001). And with the increase of multimorbidity, HRQOL in the higher SES showed a more pronounced downward trend, compared with the lower SES ( β = -.270 vs β = -.201, P < .001). Our findings underscore the importance of preventing and managing multimorbidity in cancer patients, particularly those with low SES. Furthermore, it is essential to consider the impact of the rapid decline in HRQOL as the number of multimorbidity increases in individuals with higher SES. It is imperative to explore interdisciplinary and continuous collaborative management models., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To develop and test the content validity of the Self-Care of Oral Anticancer Agents Index (SCOAAI)., Data Sources: SCOAAI items were developed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. The Middle Range Theory of Self-Care of Chronic Illnesses informed item generation. A four-phase procedure was followed; Phase 1: items were created based on a previous systematic review and a qualitative study; Phase 2: the SCOAAI comprehensibility and comprehensiveness were established through qualitative interviews with clinical experts and with patients (Phase 3); and Phase 4: the SCOAAI was then administered through an online survey to a group of clinical experts for the Content Validity Index (CVI) calculation., Conclusion: The first version of the SCOAAI included 27 items. Five clinical experts and 10 patients tested the comprehensiveness and comprehensibility of instructions, items, and response options. Fifty-three experts (71.7% female, mean experience with patients on oral anticancer agents 5.8 years [standard deviation ± .2]; 66% nurses) participated in the online survey for content validity testing. The final version of the SCOAAI includes 32 items. Item CVI ranges between 0.79 and 1; the average Scale CVI is 0.95. Future studies will test the psychometric properties of the tool., Implications for Nursing Practice: The SCOAAI showed excellent content validity, confirming its usefulness for assessing self-care behaviors for patients on oral anticancer agents. By implementing this instrument, nurses could define and implement targeted interventions for improving self-care and obtaining more positive outcomes (eg, better quality of life, reduced hospitalizations and emergency department visits)., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Fatigue is a typical consequence of cancer that can affect one's quality of life (QOL). The goal of this review is to provide comprehensive data on the impact of fatigue on QOL of cancer patients., Methods: An electronic data search in Web of Science, SCOPUS, and PubMed for relevant papers; those written in English; those reporting quantitative data; and those including more than one hundred patients who received just chemotherapy were included. Studies involving participants that received other kinds of anti-neoplastic therapies were excluded., Results: A total of 35 papers published between January 2000 and December 2021 were retrieved from the search databases of which (11612 patients) met the inclusion criteria. Findings showed that fatigue negatively affected QOL with a pooled prevalence of 49% (95% CI; 25.00-74.00) and the significant heterogeneity between articles was (I²=98%, P <0.001). Further, breast cancer contributed to the majority of selected articles with about 55 % (95%CI; 9:00- 94:00), followed by cancer (unspecified) 44% (95%CI; 5:00 - 92:00). Most studies (71%) (95%CI; 4:00 - 99:00) used the brief fatigue inventory (BFI) tool to assess severity of fatigue and 39% (95%CI; 17:00 -68:00) employed the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire to evaluate QOL among cancer survivors., Conclusion: The prevalence of fatigue in cancer patients is high and fatigue has a negative impact on QOL of cancer patients receiving chemotherapy. Directionality, fatigue needs to be addressed and treated properly for better improvement of health status and QOL in cancer patients.

Background: Managing the symptoms of cancer patients is challenging for health care providers and interventions individually designed are required to improve the quality of life (QOL) of cancer patients., Objective: to assess the efficacy of symptom management intervention on symptom reduction and the QOL of cancer patients., Methods: A Quasi-experimental study using pre and post-test design was conducted among 200 cancer patients selected by a convenient sampling technique from the selected cancer hospitals. The intervention group received symptom management intervention and the control group received routine clinical care. The data were collected from individuals who had been diagnosed with breast/head and neck cancer and were in the third or fourth stages of cancer, using symptom assessment and Functional Assessment of Cancer Therapy (FACT) QOL tool. After the pre-test, symptom management intervention was provided, and a post-test was conducted at one month and three months after the intervention., Results: The mean age was 50.93 years among the participants. Fifty-two percent and 68% of them were in stage IV cancer in the intervention group and control group respectively. The mean QOL score of head and Neck cancers in the intervention group increased from 20.76 (1.82) to 97.03 (3.33) and the mean scores of QOL of breast cancer patients in the intervention group increased from 22.44 (2.92) to 94.39 (8.30). Repeated measure ANOVA showed that the intervention program was effective in enhancing symptom reduction and QOL among cancer patients (Head and Neck cancers F(1.3, 114) =391.62, p< 0.001 and Breast cancer F (1, 75) =177.41.41, p=.001)., Conclusion: Nurses play a vital role in providing care to cancer patients and improving their quality of life since nurses are more involved in care.

The aim of this study was to investigate the psychometric properties of the Greek version of FACIT-COST, as well as to assess the levels of financial distress of patients suffering from lung cancer in relation to their quality of life and lung cancer symptom burden. This was a cross-sectional quantitative study. A self-assessment instrument was used to gather the data. The study involved 120 lung cancer patients who were treated using chemotherapy in a day clinic of a General Hospital in Athens. Data were collected with the COST-FACIT-v2 (used to assess the patients' financial toxicity), The 12-item Health Survey (SF-12), and functional Assessment of Cancer Therapy-Lung Symptom Index Questionnaire-7 items-version 4 (FACIT-FACT-LCS). Descriptive statistics as well as exploratory factor analysis performed all the statistical analyses, which were conducted using IBM SPSS Statistics 25 and had p-values with a significance level of 0.05. The majority of the participants were male (68.3%), married or cohabitated (81.3%), and had been diagnosed with microcell cancer (90%). The factor analysis resulted in one factor that interpreted 35% of the total variance. FACT-L (r = 0.365, p < 0.001), physical component SF-12 (r = 0.184, p = 0.045), and mental health component SF-12 (r = 0.268, p = 0.003) were positively correlated to FACIT-OST, as expected. The Greek validated COST-FACIT-v2 is a reliable tool in providing rapid assessment of cancer patients' level of financial distress., (© 2023. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Background: Cancer-related cognitive impairment is a common and potentially debilitating symptom experienced by patients with non-central nervous system (CNS) cancers, with negative impact on their quality of life. The Functional Assessment of Cancer Therapy-Cognitive Function-Version 3 (FACT-Cog-v3) is the most extensively used instrument specifically developed to evaluate cognitive complaints in adult cancer patients. Nevertheless, this self-report measure is not yet validated for the Portuguese population. Therefore, the purpose of this study was to evaluate the psychometric properties of the FACT-Cog-v3 among patients with non-CNS cancers in Portugal., Methods: The validation study was conducted based on a convenience sample of 281 patients with non-CNS cancers, aged between 18 and 65 years, recruited online. A confirmatory factor analysis (CFA) was used to test the factor structure of the Portuguese FACT-Cog-v3 version; internal consistency analysis was also conducted. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30-version 3) and the Hospital Anxiety and Depression Scale (HADS) were also used to test the concurrent, convergent, and discriminant validity of the scale., Results: CFA supported a four-factor model with good fix indexes and internal consistencies: perceived cognitive impairments (α = 0.97), comments from others (α = 0.92), perceived cognitive abilities (α = 0.93), and impact on quality of life (α = 0.92). Concurrent, convergent, and discriminant validities were confirmed. Moderate and strong correlations were found between the FACT-Cog-v3 subscales and the QLQ-C30 cognitive functioning subscale. Good convergent validity, with moderate correlations, was found between the FACT-Cog-v3 subscales and the HADS-A, HADS-D, and QLQ-C30 fatigue, sleep disturbance, and global health status subscales. Acceptable discriminant validity, with weak and moderate correlations, was demonstrated between the FACT-Cog-v3 subscales and the QLQ-C30 pain and nausea/vomiting subscales., Conclusions: The Portuguese FACT-Cog-v3 version can be considered a reliable and valid measure to assess cognitive concerns of patients with non-CNS cancers, with relevance for research and clinical practice., (© 2022. The Author(s).)

The assessment of stigma among cancer patients is of the utmost importance as stigma may lead to various psychological sequelae and a lower quality of life. This study aimed to translate the English version of the Shame and Stigma Scale (SSS) into Malay and validate the Malay version of the SSS (SSS-M) to assess the degree of stigma among cancer patients in Malaysia. Initially, the concurrent translation and back translation of the SSS-M were performed, and the face and content validity were assessed. Subsequently, the SSS-M was administered to a total of 234 patients with mixed types of cancer to assess its reliability (internal consistency and test-retest reliability), construct validity (convergent and discriminant validity), and conduct an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA). The SSS-M total score registered a good internal consistency (a Cronbach's α of 0.881) and test-retest reliability (an intraclass correlation coefficient of 0.876, p < 0.001). The EFA and CFA confirmed that the SSS-M consisted of 16 items in 3 domains. Its convergent and discriminant validity were achieved. Hence, the SSS-M demonstrated good psychometric properties and is available for use to assess stigma among cancer patients in Malaysia.

Background: Case management (CM) is widely utilized to improve health outcomes of cancer patients, enhance their experience of health care, and reduce the cost of care. While numbers of systematic reviews are available on the effectiveness of CM for cancer patients, they often arrive at discordant conclusions that may confuse or mislead the future case management development for cancer patients and relevant policy making. We aimed to summarize the existing systematic reviews on the effectiveness of CM in health-related outcomes and health care utilization outcomes for cancer patient care, and highlight the consistent and contradictory findings., Methods: An umbrella review was conducted followed the Joanna Briggs Institute (JBI) Umbrella Review methodology. We searched MEDLINE (Ovid), EMBASE (Ovid), PsycINFO, CINAHL, and Scopus for reviews published up to July 8th, 2022. Quality of each review was appraised with the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. A narrative synthesis was performed, the corrected covered area was calculated as a measure of overlap for the primary studies in each review. The results were reported followed the Preferred reporting items for overviews of systematic reviews checklist., Results: Eight systematic reviews were included. Average quality of the reviews was high. Overall, primary studies had a slight overlap across the eight reviews (corrected covered area = 4.5%). No universal tools were used to measure the effect of CM on each outcome. Summarized results revealed that CM were more likely to improve symptom management, cognitive function, hospital (re)admission, treatment received compliance, and provision of timely treatment for cancer patients. Overall equivocal effect was reported on cancer patients' quality of life, self-efficacy, survivor status, and satisfaction. Rare significant effect was reported on cost and length of stay., Conclusions: CM showed mixed effects in cancer patient care. Future research should use standard guidelines to clearly describe details of CM intervention and its implementation. More primary studies are needed using high-quality well-powered designs to provide solid evidence on the effectiveness of CM. Case managers should consider applying validated and reliable tools to evaluate effect of CM in multifaced outcomes of cancer patient care., (© 2022. The Author(s).)

Introduction: Many cancer patients experience psychosocial challenges that affect quality of life during the trajectory of their disease process. We aimed at estimating quality of life among cancer patients at two major tertiary hospitals in Malawi., Methods: The study was conducted among 398 cancer patients using semi-structured questionnaire. Quality of life was measured using EQ-5D-3L instrument., Results: Mean age was 45 years ± 12.77. Pain (44%) was the most prevalent problem experienced by cancer patients. About 23% had worst imaginable health status on the subjective visual analogues scale. Attending cancer services at QECH (AOR= 0.29, 95% CI: 0.17-0.54, p<0.001) and having normal weight (AOR=0.25, 95% CI: 0.08-0.74, p = 0.012), were associated with improved quality of life. A history of ever taken alcohol (AOR= 2.36, 95% CI: 1.02-5.44, p = 0.045) and multiple disease comorbidities (AOR= 3.78, 95% CI: 1.08-13.12, p = 0.037) were associated with poor quality of life., Conclusion: Loss of earning, pain, marital strife, sexual dysfunction, were among the common psychosocial challenges experienced. History of ever taken alcohol and multiple comorbidities were associated with poor quality of life. There is need to integrate psychosocial solutions for cancer patients to improve their quality of life and outcomes., (© 2022 Banda JC et al.)

Objective: Some psychological interventions have been developed to improve cancer patients' and survivors' quality of life, well-being, and health engagement. However, studies are usually focused on effectiveness and less on factors influencing survivors' decision to participate, both subjective (e.g., needs) and contingent (e.g., factors related to participation/non participation). This scoping review identifies factors influencing participation, decline to participate, attrition and adherence in psychological interventions., Methods: 3 electronic databases were searched for published studies on psychological interventions. Retrieved publications were scanned by authors against inclusion criteria and forty-two articles were selected. Relevant information were summarized narratively., Results: More information is available on attrition and factors related to participation/non participation, so that future psychological interventions may employ ad-hoc tools to take into consideration patients' reasons to adhere to psychological interventions. Secondarily, non-participation/dropout is often linked to factors related to intervention' commitment and its interference with daily life. On the contrary, patients' reasons to participate often identify with the value they find in the intervention according to their personal needs and experience of illness., Conclusion: We suggest that future research should analyze patients' representation of psychological interventions and take them into account to tailor the interventions on participants' lived experience, to improve participation.

Objective: To report the feasibility and effectiveness of a newly developed clinical exercise program for improving maximal cardiorespiratory fitness in Spanish cancer patients receiving adjuvant chemotherapy or radiation. We also examined the effectiveness of the exercise program for improving maximal muscular strength, body composition, fatigue, and quality of life, and explored if the effectiveness varied based on selected patient characteristics., Design: The study was a single group implementation feasibility study using a pre-posttest design., Methods: Participants performed a 12-week, twice-weekly, supervised, multi-component exercise program during adjuvant therapy. Paired t -tests were used to assess pre-post changes, and analyses of covariance were used to compare effectiveness based on selected patient characteristics., Results: We had 100 cancer patients referred to the clinical exercise program of which 85 (85%) initiated the exercise program and 76 (89%) completed the post-intervention fitness assessment. Exercise significantly improved VO 2max by 4.8 mL/kg/minutes ( P  < .001, d  = 0.74). Exercise also significantly improved chest strength ( P  < .001, d  = 0.82), leg strength ( P  < .001, d  = 1.27), lean body mass ( P  < .001, d  = 0.11), skeletal muscle mass ( P  < .001; d  = 0.09), fat mass ( P  < .001; d  = 0.10), % body fat ( P  < .001; d  = 0.17), quality of life ( P  = .0017; d  = 0.41), and fatigue ( P  = .007; d  = 0.46). Treatment modality, cancer type, and age affected some exercise responses, especially related to body composition changes., Conclusions: A 12-week, supervised, multi-component exercise program was effective for improving health-related fitness and quality of life in Spanish cancer patients receiving adjuvant therapy. Our results show the benefits of incorporating clinical exercise programming into the supportive care of cancer patients receiving treatments., Registration: The study protocol is registered at ClinicalTrials.gov (NCT05078216).

Introduction: cancer is viewed in the African context as a death sentence. Its effect can be overwhelming to both the patient and their support system. The objective of the study was to assess the perceived quality of life of cancer patients undergoing varied cancer treatments in a tertiary health institution in Ekiti State and to determine the life style modification of cancer patients undergoing varied treatments in the same health facility., Methods: the study employed a descriptive cross-sectional design. A consecutive sampling approach was utilized to select 80 respondents among the cancer patients who attended the cancer registry within the study time frame. Data was collected from these cancer patients by using structured and validated questionnaire. Data was analyzed using descriptive statistics and inferential statistics with level of significance set at p < 0.05., Results: respondent´s ages ranged from 20 - 61 years with a mean age of 50 ± 18.3 years. Only 7.8% are not dependent on medications to function in their daily life. Most of the participants reported that their sex life has been affected (61.1%) and 77% of the respondents reported fatigue. About 76% of respondents need varying measure of medical treatment to function in their daily life. Overall, 44.8% have poor quality of life, while 55.1% had good quality of life in this current study. Moreover, a significant relationship was found between quality of life and self-assessment of patient´s health (p < 0.001). Multivariate analysis predicting factors affecting quality of life of respondents revealed that self-assessment of respondents (AOR: 3.389; 95% CI: 1.897-6.054) remained a significant and more likely predictor of quality of life while respondent´s age (AOR: 0.244; 95% CI: 0.068-0.876) and level of education (AOR: 0.054; 95% CI: 0.005-0.546) were less likely predictors., Conclusion: one quarter of the participants have poor life and majority of the participants need varying measure of medical treatment to function in their day to day life. Management of cancer patients should be geared towards improving/ameliorating symptoms and improving quality of life of cancer patients., Competing Interests: The authors declare no competing interest., (Copyright: Deborah Tolulope Esan et al.)

Introduction: chronic disease comorbidities are common among cancer patients in most parts of the world, however; there are limited data on the same for Malawi. Comorbidities worsen clinical outcomes and are associated with lower quality of life among cancer patients. We aimed at estimating chronic disease comorbidities and associated factors among cancer patients attending oncology services at the Queen Elizabeth Hospital (QECH) and Kamuzu Central Hospital (KCH) in Blantyre and Lilongwe respectively., Methods: we conducted a cross-sectional study at QECH and KCH in Malawi from January to March 2021. Participants were recruited using simple random sampling technique at the oncology clinics and were interviewed using structured questionnaires. The College of Medicine Research and Ethics Committee (COMREC) approved the study and informed consent was obtained with each participant. Data were analyzed in Stata version 14 and summary statistics were presented as frequencies and proportions., Results: we interviewed 398 cancer patients and the mean age was 45.4years (SD± 12.77). The common cancers were cervical (30%), Kaposi´s sarcoma (24%), breast (11%), esophageal (4%) and leukemia (4%). The prevalence of chronic disease comorbidities was 61.56% (n=398) and common conditions included: HIV and AIDS (43%), depression (9%) hypertension (8%) and anemia (9%). Chronic disease comorbidities were significantly associated with formal employment (p<0.01) and obesity (p<0.02)., Conclusion: chronic disease comorbidities were prevalent among cancer patients in the study settings in Malawi. There is a need to develop a multidisciplinary approach when managing cancer patients with emphasis on active screening for the common conditions as reported by this study., Competing Interests: The authors declare no competing of interests., (Copyright: Jonathan Chiwanda Banda et al.)

Background and Purpose: Oral mucositis is one of the most common treatment-induced adverse side effects in head and neck cancer patients. The purpose was to evaluate the reliability and validity of the Greek version of the Oral Mucositis Weekly Questionnaire-Head and Neck Cancer (OMWQ-HN)., Methods: The data were retrieved from 72 head and neck cancer patients who were undergoing oral radiotherapy as monotherapy or in combination with chemotherapy and surgery. Data analyses included internal consistency reliability, criterion related validity, and cross-sectional validity., Results: The OMWQ-HN demonstrated good criterion validity. Strong correlations were observed between OMWQ-HN with EORTC QLQ-C30 and EORTC QLQ-H&N35 that showed good concurrent validity. The tool has a strong internal consistency index with α = .92., Conclusion: The Greek version of OMWQ-HN is a reliable and valid instrument that can be used for the assessment of oral mucositis in this context., (© Copyright 2021 Springer Publishing Company, LLC.)

Objectives: Advances in cancer treatments have allowed improved outcomes, even with advanced disease. However, this progress has resulted in a new toxic effect termed 'financial toxicity.' Financial toxicity severely impacts quality of life, even among those insured. The purpose of this article is to gain better understanding of this relatively new concept to better care for our patients, presented primarily from a US perspective., Data Sources: These include medical databases (PubMed, Scopus) and researcher experience., Conclusion: Financial toxicity is highly prevalent in patients with advanced cancer, and it is associated with multiple worsened outcomes. Those with advancing cancer are at accumulating risk of financial toxicity, exacerbated by other known risk factors. The effects of financial toxicity are debilitating, resulting in deleterious physical, psychological, spiritual, and social effects drastically affecting quality of life. Coping strategies such as taking less than prescribed therapy, delays seeking care, and poorly managed comorbid conditions potentially cause increased symptoms and worse outcomes., Implications for Nursing Practice: Careful assessments by multidisciplinary health care teams could allow early intervention, timely referral to health professionals including social work or financial navigators, and provision of emotional support. Further studies are needed to explore solutions on an institutional and national level that can guide health policy and the creation of practice models that can reduce the harm of financial toxicity., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: To permit timely mitigation of adverse effects on overall clinical outcome, it is essential to understand how the pandemic influences distress and health-related quality of life (HRQOL) in cancer patients during the coronavirus disease 2019 (COVID-19) pandemic., Methods: In this cross-sectional study, adult cancer patients, without COVID-19 symptoms, completed a 13-item questionnaire about the pandemic's impacts on distress and everyday-life; associations with age, sex, or impaired HRQOL were then assessed by binary logistic regressions. In a subsample of patients with HRQOL assessment available from both before and during the pandemic, we evaluated the pandemic's impact on longitudinal changes in HRQOL reported within 6 months before versus during the COVID-19 lockdown using McNemar's test, and thresholds for clinical importance., Results: We consecutively enrolled 240 patients with solid (50%) or hematological (50%) cancers. Median age was 67 years, 46% were females. The majority ranked heeding their health (80%) and keeping their appointment schedule in hospital (78%) as important. Being younger than 60, or aged 60-70 was independently associated with limitations in everyday life (OR = 3.57, p < 0.001; and 2.05, p = 0.038); female individuals and those with restricted emotional functioning were more distressed by the COVID-19 situation (OR = 2.47, p = 0.040; and 3.17, p = 0.019); the latter group was also significantly more concerned about being a patient at risk (OR = 2.21, p = 0.029). Interestingly, in a subsample of patients (n = 47), longitudinal comparisons pre- versus during the pandemic revealed that HRQOL was not substantially affected by the pandemic., Conclusion: Particularly younger and female cancer patients, and those with impaired emotional functioning are distressed by COVID-19. During the first COVID-19 lockdown, cancer patients remained predominantly resilient. This analysis highlights the need to mitigate distress situations in vulnerable patients and thereby enhance resilience during pandemics., (© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

This study aimed to determine the predictors of spiritual wellbeing of non-terminal stage cancer patients hospitalized in oncology units in Lithuania. An exploratory cross-sectional study design was employed. During structured face-to-face interviews, 226 cancer patients hospitalized in oncology units responded about their spiritual wellbeing, perception of happiness, satisfaction with life, pain intensity, levels of education and physical functioning, and length of inpatient stay. A set of standardized tools were used: spiritual wellbeing scale SHALOM, brief multidimensional life satisfaction scale, Oxford Happiness Questionnaire, Barthel Index questionnaire, and verbal pain intensity scale. Additionally, social- and health-related factors were included in data analyses. Structural equation modeling was adapted for a comprehensive assessment of the mediating effect of spiritual wellbeing on the relationship between different health- and value-related factors. The overall fit of the structural model was generally good: [Formula: see text] = 66.94 (χ 2 /df = 2.31), CFI = 0.94, RMSEA = 0.08, and SRMR = 0.06. Data were analyzed using the Statistical Package for Social Sciences (IBM SPSS Statistics) version 24.0 and Mplus version 8.2. Level of happiness, life satisfaction, and spiritual wellbeing scored in the moderate upper range. The communal domain of spiritual wellbeing rated with the highest mean score and transcendental domain with the lowest score. Education (b = 0.208, p = 0.004), physical functioning (b = 0.171, p = 0.025), and hospital duration (b = - 0.240, p = 0.001) were significant predictors of spiritual wellbeing. Happiness and life satisfaction were negatively influenced by pain intensity, which ranged from mild to moderate. Levels of education, physical functioning, and length of hospital stay predict spiritual wellbeing of non-terminally ill cancer patients. Happiness, as well as life satisfaction, was negatively predicted by pain intensity but had no direct influence on spiritual wellbeing of cancer patients. Spiritual wellbeing positively influences emotional wellbeing (happiness and life satisfaction), and its influence is stronger than the negative influence of physical pain has on emotional wellbeing.

Background: Accurate awareness of the prognosis is an important factor in the treatment decision of patients with advanced cancer; however, prognostic disclosure is still subject to debate because it can reduce patient's satisfaction and increase depression., Aim: The purpose of this study is to assess whether patients' prognostic awareness is associated with decreased quality of life (QoL) or increased depressive mood in patients with advanced cancer., Design and Participants: In this cohort study, 386 patients with advanced cancer were recruited across 3 periods from December 2016 to August 2018. The outcome of this study was a change in QoL and depression according to the patients' prognostic awareness at baseline, 3 months, and 6 months., Results: This study found significant differences in changes of QoL based on patients' prognostic awareness. From baseline to 3 months, emotional functioning ( P = .039), pain ( P = .042), existential well-being ( P = .025), and social support ( P = .038) subscale scores improved significantly more in those with lack of prognostic awareness. Over 6 months, the group without prognostic awareness improved significantly in terms of physical functioning ( P = .037), emotional functioning ( P = .002), nausea/vomiting ( P = .048), and constipation ( P = .039) subscale scores and existential well-being scores ( P = .025). No significant difference between the groups was found in terms of depression., Conclusion: Accurate prognostic awareness may pose harm and may provide no additional benefits in terms of QoL and mood among patients with advanced cancer for a short period of time.

Purpose: Financial toxicity (FT) is the unintended, potential economic harm or damage of oncologic treatments that has become a medical problem with political implications. To assess FT, the COmprehensive Score for financial Toxicity (COST) questionnaire was developed. Since an Italian version is not available yet, we aimed to validate the Italian version of the COST questionnaire in a population of cancer patients during oncologic treatments or follow-up., Methods: A sample of Italian native outpatients were asked to fill the Italian version of the COST and five other self-administered questionnaires to assess quality of life, treatment-related symptoms, hope, distress, and unmet needs. Additionally, a subsample of patients was asked to retake the COST after 2-6 weeks., Results: A single factor better represents the scale structure. Internal consistency and test-retest reliability were good. Evidence of convergent and discriminant validity was provided and criterion validity was established, showing that financial toxicity predicts the patient's distress. Finally, known-groups validity was confirmed, testing the differences related to treatment-related expenses, sociodemographic characteristics, stage of the disease, and performance status., Conclusion: The current findings suggest the Italian version of the COST is a psychometrically sound scale that potentially offers an added value in assessing FT in patients with cancer.

Aim: To identify the associated factors of hope during treatment in cancer patients., Background: Hope is very important to cancer patients at all stages of the disease process. Hope is seen as an important coping mechanism. Most research about hope in cancer patients considered the end of life or in palliative care. Several and different factors are associated with hope. It is not yet sufficiently clear which factors are associated with hope during the treatment., Design: A systematic literature review of quantitative empirical studies on hope in cancer patients during treatment., Data Sources: Search in MEDLINE (PubMed interface), CINAHL (EBSCO interface), Psychinfo and Cochrane (January 2009-December 2018)., Review Methods: Empirical quantitative studies were included regardless of the disease stage, written in English or Dutch, measuring hope from the perspective of cancer patients. Two authors independently screened all the studies and assessed their quality., Results: Thirty-three studies were included. Positive relationship has been established between hope and quality of life, social support, spiritual and existential well-being. Hope appears to be negatively associated with symptom burden, psychological distress and depression. There appears to be no relationship between hope and demographic and clinical variables. The relationship between anxiety and hope remains unclear., Conclusions: Hope primarily seems to be a process that takes place in a person's inner being rather than being determined from outside., Impact: Health professionals may want to focus on the meaning of hope for cancer patients in relation to the associated factors. A better understanding of the meaning of hope during treatment can be of great value in supporting cancer patients with regard to treatment decisions, psychosocial support, the experienced quality of life and symptom burden and any wishes they may have with regard to advanced care planning., (© 2020 John Wiley & Sons Ltd.)

Background: Patients with acute leukaemia (AL) usually require prolonged periods of hospitalisation. The treatment and clinical symptoms may lead to patients' supportive care needs (SCNs) not being met and impairs their quality of life (QoL). Studies on QoL and SCNs among AL patients are limited. This study aimed to identify the unmet SCNs and its relation to QoL of adult AL patients in China., Methods: This multicentre cross-sectional study recruited 346 participants to complete a self-developed questionnaire, detailing demographic information and disease-related variables. A 34-item Supportive Care Needs Survey (SCNS-SF34) was used to identify unmet SCNs, and the Functional Assessment of Cancer Therapy-Leukaemia (FACT-Leu) questionnaire measured patients' QoL., Results: Unmet SCN rates for the 34 items ranged from17.6 to 81.7%. Patients' needs were high for health systems and information, but low in the sexual domain. The results reveal nine factors associated with the unmet SCNs of adult AL patients, including marital status, original residence, age, education, occupation, other diseases, chemotherapy course, disease course, and treatment stage (p < 0.05). The total score of the FACT-Leu negatively correlated with the SCNS-SF34 in the physical/daily living (r = - 0.527, p < 0.01), psychological (r = - 0.688, p < 0.01), sexual (r = - 0.170, p < 0.01), patient care and support (r = - 0.352, p < 0.01), and health systems and information (r = - 0.220, p < 0.01) domains., Conclusions: Adult AL patients exhibit a high demand for unmet SCNs, especially in the domain of health systems and information. There was a significant association between patients' unmet SCNs and QoL. Future research should develop tailored interventions to address the unmet SCNs of adult AL patients, to further improve their QoL.

Objectives: Patients with cancer who are at a transition to Phase I investigational treatments have been identified as an underserved population with regard to palliative care. This disease transition is often accompanied by spiritual and existential concerns. The study objective was to conduct a secondary analysis of data from a larger study testing a palliative care intervention. This paper reports the findings of this secondary focus on the spiritual needs of this population., Methods: Patients (n = 479) were accrued to this study prior to initiating a Phase I clinical trial with data collected at baseline, and 4, 12, and 24 week follow-up., Results: Qualitative data revealed that the transition to Phase 1 trial participation is a time of balancing hope for extended life with the reality of advancing disease. Quantitative results demonstrated increased spirituality over time in both religious- and non-religious-affiliated patients., Conclusions: Patients entering Phase I trials have important spiritual needs as they face treatment decisions, advancing disease, and often mortality. Spiritual care should be provided to seriously ill patients as a component of quality care., (© 2020 John Wiley & Sons, Ltd.)

Purpose: The study addresses the spiritual dimension of care of non-terminally ill cancer patients by measuring their spiritual needs in association with indicators of quality of life (i.e., happiness, satisfaction with life, pain intensity, functional capacity) and personal and illness characteristics., Method: A descriptive, cross-sectional survey included 227 patients with cancer. All patients that underwent treatment at a nursing and supportive treatment unit were interviewed face-to-face between January and November 2018. Regression models were used to control for gender, education, religiosity, pain intensity, functional capacity, life satisfaction and happiness., Results: The non-terminally ill cancer patients experienced the exceptional importance of Inner Peace and Giving/Generativity and Forgiveness, while Religious and Existential needs were scored marginally lower, but nevertheless much higher as compared to patients with cancer from West-Europe. Correlation analysis revealed strong positive and in one case moderate interconnections among each of four spiritual needs, with the strongest association between Existential needs and the other three domains. Unmet Religious needs were positively associated with pain intensity and reduced physical capacity of patients, but less with life satisfaction. Pain intensity was the strongest predictor of cancer patients' Existential, Inner Peace and Giving/Generativity and Forgiveness needs., Conclusion: This study provides the first empirical evidence about the spiritual needs of cancer patients' care in Lithuania. Findings will serve as the basis for specific strategies to enhance the holistic well-being of these patients. The insights into oncology patients' unmet spiritual needs may be relevant to other Eastern European and former Soviet Union countries with similar developmental histories., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The 5th EORTC Quality of Life in Cancer Clinical Trials Conference presented the current state of quality of life and other patient-reported outcomes (PROs) research from the perspectives of researchers, regulators, industry representatives, patients and patient advocates and health care professionals. A major theme was the assessment of the burden of cancer treatments, and this was discussed in terms of regulatory challenges in using PRO assessments in clinical trials, patients' experiences in cancer clinical trials, innovative methods and standardisation in cancer research, innovative methods across the disease sites or populations and cancer survivorship. Conferees demonstrated that PROs are becoming more accepted and major efforts are ongoing internationally to standardise PROs measurement, analysis and reporting in trials. Regulators are keen to collaborate with all stakeholders to ensure that the right questions are asked and the right answers are communicated. Improved technology and increased flexibility of measurement instruments are making PROs data more robust. Patients are being encouraged to be patient partners. International collaborations are essential, because this work cannot be accomplished on a national level., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The purpose of this study was to evaluate the effect of palliative care intervention on the quality of life among Jordanian caregivers of cancer patients. Repeated measures design was used in this study. Data were collected from 137 Jordanian caregivers of cancer patients utilizing a self-administered questionnaire. An intervention program called SHARE was implemented to the experimental groups and its effectiveness in improving the overall quality of life for caregivers of cancer patients was evaluated using repeated measure ANOVA test. The results showed a statistically significant effect on the quality of life domains. For workshop experimental group (F = 26.822, p < .001) and for home visit experimental group (F = 10.236, p = .003).

Purpose: This review measured the relationships between psychosocial factors and biomarkers in cancer research setting in order to summarize their relationship. It may help to clarify the roles of psychosocial factors and biomarkers in cancer treatment, provide information for developing interventions, and contribute to personalized medicine., Methods: A total of 4 databases were searched and 2151 articles were screened. Thirty eligible articles were captured including 2093 cancer patients with 11 different kinds of tumor., Results: Totally 10 groups of biomarkers, 7 positive and 7 negative psychosocial factors were identified. Higher scores of positive psychosocial factors and lower scores of negative psychosocial factors were associated with biomarkers indicating good clinical results. Tumor types can affect the significance of results. Interactions among psychosocial factors may influence the main effect of the targeted psychosocial factors. Biomarkers in reviewed studies were immune response-related biomarkers., Conclusions: The identified psychosocial factors may provide information for intervention development to increase the quality of life of cancer patients during their cancer treatment and promote better clinical outcomes. When investigating the relationship between psychosocial factors and biomarkers, the tumor type and interaction among psychosocial factors should be noted., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: With rise in incidence and prevalence of cancers in the ageing population, the need for an age sensitive comprehensive assessment measure has been felt. Comprehensive Geriatric Assessment (CGA) is often difficult to implement due to time and logistic constraints. A brief assessment tool encompassing the specific domains of the CGA would be a better way to assess older adults with cancer. These tools exist but have not necessarily been culturally adapted. The main aim of the study was to develop a culturally relevant short geriatric assessment tool and explore its psychometric properties., Methodology: An initial item pool was formed after review of the literature and study of the existing scales. This draft tool was then pre and pilot tested to finalize the items and check the feasibility of application. The final tool was validated by exploratory factor analysis on a sample of 100 older patients with cancer., Results: After pre and pilot study on fifteen and thirty older patients with cancer respectively, this tool consisting of a total of 38 items spread over eight domains was developed and validated on a sample of 100 subjects. Due to co-linearity, three items were deleted after exploratory factor analysis, bringing the final item number to35. The Cronbach's alpha was 0.93 and the intra-class correlation co-efficient (ICC) was 0.94. Thus, the final tool had 13 questions with sub-parts (35 items in total). The time taken to administer the tool was around 25 min., Conclusion: The tool developed is valid and reliable and can be used for the initial assessment and further care planning of older Indian patients with cancer., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Digital health interventions (DI) open the possibility for cancer patients and survivors to manage the disease and its side effects when they return home after treatment. This study aims to highlight the components of DI, investigate patient engagement with DI, and explore the effects of DI on psychosocial variables., Methods: In September 2017, we performed a systematic review of studies focusing on DI which target cancer patients or survivors., Results: A total of 29 articles (24 studies) were reviewed. There was considerable heterogeneity in study methods, in outcome definitions, in measures for engagement with DI and in psychosocial variables assessed. Results from the studies showed a high level of engagement. Self-efficacy, psychological symptoms, and quality of life were the most commonly assessed psychosocial variables. However, results for the effect of DI on psychosocial variables were inconsistent. Regarding pain management, results were in line with what one would expect., Conclusions: The present review showed that despite the heterogeneity in the studies assessed and inconsistent results, DI may constitute an excellent means to help cancer patients and survivors cope better with the disease and with treatment side effects, as they can improve self-management and wellbeing. In order to acquire a greater understanding of the mechanisms underlying cancer patients'/survivors' psychological and behavioral changes in terms of adopting DI, direct comparison between studies is needed. However, this can only come about if methodological and conceptual standardization of DI is implemented., (© 2018 John Wiley & Sons, Ltd.)

Background: Cancer is a serious public health problem not only in Malaysia, also worldwide. The aim of this study was to determine the determinants of quality of life (QOL) among cancer patients in Peninsular Malaysia., Methods: A cross sectional study was conducted among 2120 cancer patients in Peninsular Malaysia, between April 2016 to January 2017. All cancer patients aged 18 years old and above, Malaysian citizens and undergoing cancer treatment at government hospitals were approached to participate in this study and requested to complete a set of validated questionnaires. Inferential statistical tests such as t-test and one-way ANOVA were used to determine the differences between demographic variables, physical effects, clinical factors, psychological effects and self-esteem with the quality of life of cancer patients. Predictor(s) of quality of life were determined by using Multivariate linear regression models., Result: A total 1620 out of 2120 cancer patients participated in this study, giving a response rate of 92%. The majority of cancer patients were female 922 (56.9%), Malays 1031 (63.6%), Muslim 1031 (63.6%), received chemotherapy treatment 1483 (91.5%). Overall, 1138 (70.2%) of the patients had depression and 1500 (92.6%) had anxiety. Statistically significant associations were found between QOL and clinical factors, physical side effects of cancer, psychological effects and self-esteem (p < 0.05). However, among socio-demographics only age, race, religion, working status were significantly associated with QOL. Based on the multivariate regression analysis, the main predictors of QOL among cancer patients in Malaysia were age, self-esteem as positive predictors, and Indian race, nausea, fatigue, hair loss, bleeding as negative predictors., Conclusion: The findings of this study provide a scientific basis to develop a comprehensive program for improving quality of life of cancer patients in Malaysia.

Purpose: This study examines the prevalence and degree of emotional distress, anxiety and depression, and social difficulties and their effect on cancer patients' quality of life (QoL). It describes the characteristics of patients who are at high risk of emotional distress., Methods: A descriptive cross-sectional design was used. A total of 226 patients with cancer completed the Hospital Anxiety and Depression scale (HAD), social difficulties inventory, comfort scale and EORTC-QoL-C30. Anxiety and depression were identified using the internationally recognized cut-off points of HAD-A ≥ 8 and HAD-D≥ 8. Adjusted odd ratio was calculated using socio-demographic and clinical factors., Results: Both anxiety and depression were common among Jordanian cancer patients, although depression was the main emotional problem with a higher prevalence than anxiety (67.6% vs. 43%). Patients with anxiety or depression were more likely to have lower QoL scores and higher scores for complaints about symptoms. They were more likely to have social difficulties in everyday life. The results of logistic regression indicated that a high depression score was predicted by older age, a poor QOL total score, and a high social difficulty score. A high anxiety score was predicted by advanced cancer stage, in female patients, hospital readmission and a poor QOL total score., Conclusion: The significant level of emotional distress among cancer patients highlighted the importance of early assessment and identification of patients at greater risk of emotional distress, those with an advanced stage of cancer, having a poor quality of life and serious social difficulties., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Increasing evidence indicates unmet supportive need as a detrimental effect on patients' well-being. However, the unmet needs and correlations with quality of life (QOL) in mainland Chinese cancer patients remain unclear. This study aimed to assess the unmet needs and QOL in Chinese cancer patients, and further explore the influencing factors. A cross-sectional descriptive study design was applied. Using a convenience sampling method, 300 cancer patients, including 176 females and 124 males were recruited from five tertiary hospitals in Xi'an city during April to July 2015. Self-administered questionnaires including general information, Comprehensive Needs Assessment Tool (CNAT) and the 36-item Short-Form Health Survey (SF-36) were used for data collection. The mean age of the participants was 52.96 ± 13.45 years. The total score of CNAT was 46.37 ± 21.87, and the most unmet comprehensive needs were healthcare staff, information and health facilities and services domain. The total score of QOL was 48.95 ± 18.80 and 50.35 ± 19.77 for physical and mental QOL respectively. Multiple regression analysis revealed that age, employment status (employed), marital status (unmarried/divorced/widowed) and high needs in physical symptoms were associated with physical QOL. In addition, gender (female), marital status (unmarried/divorced/widowed), and needs in health and psychological problem and physical symptoms domains are significant factors to the mental QOL. These findings from the study provide useful information for care providers to identify and meet specific needs for cancer patients to improve QOL., (© 2018 John Wiley & Sons Ltd.)

Aims and Objectives: To develop a Meaning in Life Scale for cancer patients in Chinese version and to test the validity and reliability., Background: Meaning in life is a protective factor of psychological well-being and is negatively related to depression and demoralisation among cancer patients. The existing scales measuring meaning in life are mostly designed in English and there is no scale designed for Chinese cancer patients based on Chinese cultural background., Design: Process of instrument development and psychometric evaluation were used., Methods: Items were generated from literature review and a focus group interview. Delphi technique was used to test the content validity. Item analysis and exploratory factor analysis were performed with data from 251 cancer patients. The internal consistency of the scale was tested by Cronbach's alpha., Results: A 25-item Meaning in Life Scale in Chinese version with five domains was developed. The five factors explained 62·686% of the variance. The Cronbach's alpha for the total scale was 0·897., Conclusions: The Meaning in Life Scale in Chinese version has acceptable internal consistency reliability and good content validity and acceptable construct validity. The content of the scale reflected the attitudes of cancer patients towards meaning in life based on Chinese cultural background., Relevance to Clinical Practice: The Chinese version of Meaning in Life Scale for Cancer Patients appears to be a new scale to assess meaning in life among Chinese cancer patients exactly and the concept of meaning in life presented in this scale provides new ideas of meaning intervention in routine clinical practice., (© 2016 John Wiley & Sons Ltd.)

Introduction: Our group previously demonstrated the feasibility of the HuCare Quality Improvement Strategy (HQIS), aimed at integrating into practice six psychosocial interventions recommended by international guidelines. This trial will assess whether the introduction of the strategy in oncology wards improves patient's health-related quality of life (HRQoL)., Methods and Analysis: Multicentre, incomplete stepped-wedge cluster randomised controlled trial, conducted in three clusters of five centres each, in three equally spaced time epochs. The study also includes an initial epoch when none of the centres are exposed to the intervention, and a final epoch when all centres will have implemented the strategy. The intervention is applied at a cluster level, and assessed at an individual level with cross-sectional model. A total of 720 patients who received a cancer diagnosis in the previous 2 months and about to start medical treatment will be enrolled. The primary aim is to evaluate the effectiveness of the HQIS versus standard care in terms of improvement of at least one of two domains (emotional and social functions) of HRQoL using the EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 items) questionnaire, at baseline and at 3 months. This outcome was chosen because patients with cancer generally exhibit low HRQoL, particularly at certain stages of care, and because it allows to assess the strategy's impact as perceived by patients themselves. The HQIS comprises three phases: (1) clinician training-to improve communication-relational skills and instruct on the project; (2) centre support-four on-site visits by experts of the project team, aimed to boost motivation, help with context analysis and identification of solutions; (3) implementation of Evidence-Based Medicine (EBM) recommendations at the centre., Ethics and Dissemination: Ethics committee review approval has been obtained from the Ethics Committee of Parma. Results will be disseminated at conferences, and in peer-reviewed and professional journals intended for policymakers and managers., Trial Registration Number: NCT03008993; Pre-results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: It is well known that cancer patients' perception of social support is associated with their depressive symptoms and health-related quality of life. However, there have been little studies that compared the variates of cancer patients with the general population. We sought to compare differences in the level of perceived social support and the impact of perceived social support on depressive symptoms and health-related quality of life between cancer survivors and the general population., Methods: Data were collected from 1818 cancer patients treated at the National Cancer Center and regional cancer centers in South Korea. The control group of the general population was composed of 2000 individuals without cancer from community., Results: Cancer patients reported significantly higher level of perceived social support than the general population, while they reported lower health-related quality of life and were more susceptible to depression. The positive associations of higher perceived social support with lower depressive symptoms, as well as with higher health-related quality of life, were stronger among cancer patients than among the general population., Conclusions: The interaction effect suggests that the impact of social support would be stronger among cancer patients than the general public. Thus, it would be beneficial to pay attention to providing social support to cancer patients, particularly to those who are more vulnerable. Furthermore, investigation of the most effective and efficient methods to deliver social support interventions would be worthwhile., (© The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The Healing Skills Project, consisting of five, four-session self-hypnosis classes, was a pilot-study to evaluate the impact of self-hypnosis on the quality of life for breast cancer patients. The impact of self-hypnosis in women with breast cancer was measured using a self-report instrument, the Functional Assessment of Cancer Therapy-Breast, pre- and post-intervention (Brady, et al., 1997; Maratia, Cedillo, & Rejas, 2016). After employing the self-hypnosis interventions, statistically significant changes were noted on 16 of the 36 items, despite the small sample size (N = 23). In summary, participants reported significantly less trouble meeting the needs of their family; less side effects; felt less ill, sad, and nervous; had less worry about dying and their condition getting worse; less shortness of breath; less swelling or tenderness in their arms; and less worry about the effects of stress on their illness. Participants also reported being significantly more able to enjoy life and sleep well; enjoy the usual things they do for fun; more content with their quality of life; feeling more attractive and more like a woman. Additionally, on a brief evaluation of the intervention form 86% of the participants indicated that the self-hypnosis classes were very useful and 100% indicated that it contributed to a noticeably improved quality of life. The pilot study offers support for the value of teaching self-hypnosis to breast cancer patients. This article includes an outline of the protocol for the four-session self-hypnosis classes.

Background/aim: Cancer has become an important public health challenge all around the world. Though the demographic and clinical features of cancer patients are well documented in Turkey, the establishment of social support networks has been somewhat neglected. The aim of the study was to assess cancer patients' perceived social support and quality of life characteristics., Materials and Methods: The Multidimensional Perceived Social Support Scale, European Organization of Research and Treatment of Cancer Quality of Life Questionnaire, and Turkish version of the EUROHIS measurements were obtained from the study group. Associations between the scores and sociodemographic variables of the patients were evaluated. Determination of the best predictors that affect social support perception scores was performed by multiple linear regression analysis., Results: A total of 364 patients (217 females, 147 males) were analyzed. Regarding the mean scores of perceived social support, statistically significant differences were found between education, perceived economic status, and ECOG groups (P < 0.001)., Conclusion: The best predictors that have an effect on perceived social support need to be studied in depth with further research.

Introduction: Family caregivers of cancer patients often suffer from impaired quality of life (QOL) due to stress arising from the responsibility of caregiving. Most research on such QOL impairments was conducted in Western populations. Thus, this exploratory study sought to (a) examine the QOL levels of family caregivers of cancer patients in an Asian population in Singapore, in relation to caregivers from other countries within and outside of Asia; and (b) investigate the association between sociodemographic factors and QOL impairments in family caregivers in Singapore., Methods: A total of 258 family caregivers of cancer patients who were receiving outpatient treatment completed the Caregiver Quality of Life Index-Cancer (CQOLC) and a sociodemographic survey. We compared the published CQOLC total scores from Turkey, Iran, Taiwan, South Korea, the United Kingdom, the United States and Canada with the Singapore dataset and examined the demographic relationships., Results: Caregivers in Singapore and Asia had lower CQOLC total scores than their Western counterparts. Caregivers who were male, of Chinese ethnicity, had parental relationships with their care recipient, or cared for advanced-stage cancer patients were found to have impaired QOL., Conclusion: The findings of this study highlight possible areas in which support can be provided for family caregivers of cancer patients, and underscore the need to reconcile cultural diversity, values, societal expectations and demographic characteristics in Singapore., (Copyright: © Singapore Medical Association)

Purpose: This systematic review was intended to identify the effectiveness and inclusion of essential components of self-management education interventions to support patients with cancer in developing the skills needed for effective self-management of their disease and the acute or immediate, long-term, and late harmful effects of treatments., Methods: Self-management education interventions were included if they were randomized controlled trials (RCTs) containing at least one of the eight core elements outlined by the research team. A systematic search was conducted in Ovid MEDLINE (2005 through April 2015), Embase (2005 to 2015, week 15), the Cochrane Database of Systematic Reviews (Issue 4, April 2015), CINAHL (2005 to 2015) and PsychINFO (2005 to 2015). Keywords searched include 'self-management patient education' or 'patient education'., Results: Forty-two RCTs examining self-management education interventions for patients with cancer were identified. Heterogeneity of interventions precluded meta-analysis, but narrative qualitative synthesis suggested that self-management education interventions improve symptoms of fatigue, pain, depression, anxiety, emotional distress and quality of life. Results for specific combinations of core elements were inconclusive. Very few studies used the same combinations of core elements, and among those that did, results were conflicting. Thus, conclusions as to the components or elements of self-management education interventions associated with the strength of the effects could not be assessed by this review., Conclusion: Defining the core components of cancer self-management education and the fundamental elements for inclusion in supporting effective self-management will be critical to ensure consistent and effective provision of self-management support in the cancer system.

The purpose of this study was to show the different components of spirituality in the last few weeks of life for advanced cancer patients admitted to hospice and to evaluate quality of life (QoL), pain, anxiety, depression and psychological adjustment to cancer. One hundred and fifteen patients were interviewed with a series of rating scales: the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale, the Hospital Anxiety and Depression Scale, the Visual Analogue Scale for pain, the Brief Coping Orientation to Problem Experienced and the Functional Assessment of Cancer Therapy Scale - General Measure. Workers and single patients with higher education level showed a worse QoL. Moreover, anxiety and pain were negatively associated with QoL, while spirituality and 'Instrumental Support' coping style were positively associated with QoL. In the Italian sample, it was observed that when patients are close to death, faith is a more important component of spirituality than meaning/peace. This study confirms that QoL could be related to physical and psychological symptoms, and this reiterates the importance of faith in end-of-life care., (© 2015 John Wiley & Sons Ltd.)

Objective: The purpose of this study was to examine the longitudinal relationship between Positivity (POS), defined as a stable disposition to view at experience under a positive outlook, and physical and psychological functioning in a sample of cancer patients immediately after diagnosis and one year later., Methods: A total of 110 patients (40% males) with pulmonary, colorectal and breast cancer, aged 30-75 (M age = 59.62; SD = 10.33), have been prospectively enrolled between 2012 and 2013, at the S. Andrea Hospital in Rome. All patients were previously aware of their diagnosis. A follow-up one year after diagnosis was conducted. We used structural equation modeling in order to analyse the specific effects of POS on functioning impairment from diagnosis to follow up., Results: POS was associated with less functioning impairment both at diagnosis and follow-up assessments. Furthermore, POS level at diagnosis continued to be associated with less functioning impairment one year later, after controlling for its stability., Conclusions: Patients with higher level of POS tended to report less symptoms associated with negative affect such as anxiety and despondency and to preserve their habitual relationships and social roles. POS may act as a basic disposition that sustains patients' efforts to deal efficaciously with severe illness, by complying with medical treatment and using cognitive strategies that enable individuals to cope with concurrent and prospective challenges of illness.