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Introduction: Cancer-related fatigue is common in patients with advanced lung cancer. It not only interferes with patients' health-related quality of life, but also increases the caregiving burden of their caregivers. Acceptance and commitment therapy is emerging as a novel way to advocate accepting negative experiences and taking effective actions based on their own values to help patients commit meaningful actions in the course of cancer diseases. This trial aims to test the feasibility, acceptability and preliminary effects of acceptance and commitment therapy for fatigue interference in patients with advanced lung cancer and the caregiver burden., Method and Analysis: A two-arm, assessor-blind pilot randomised controlled trial will be conducted. A total of 40 advanced lung cancer patient-caregiver dyads, who live in rural areas, will be recruited from a university-affiliated hospital in central China. The participants will be randomised to receive an online six-session acceptance and commitment therapy (i.e. involving metaphors, experiential exercises and mindfulness exercises facilitated by virtual reality technology) plus health education (intervention group, n=20) or health education (control group, n=20). Outcomes will be measured at baseline and 1 week postintervention. The primary outcomes are study feasibility (i.e. eligibility rate, recruitment rate, attrition rate and adherence rate), fatigue interference and caregiver burden. The secondary outcomes are health-related quality of life, meaning in life, psychological flexibility and mindful attention. Semistructured interviews will be conducted to explore the feasibility and experiences of the intervention in a subsample of 10 participants from the intervention group., Ethics and Dissemination: This study has been approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No. 2023.030) and the Medical Ethics Committee of Xiangya Hospital Central South University (No. 202305336). The findings will be disseminated in peer-reviewed journals and through local or international conference presentations., Trial Registration Number: NCT05885984., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To identify a cut-off score for the COmprehensive Score for financial Toxicity (COST) to predict a clinical implication of a high level of financial toxicity (FT)., Methods: A total of 640 cancer patients were recruited from three regional hospitals in Hong Kong. They completed a questionnaire comprising the COST measure and the Functional Assessment of Cancer Therapy - General (FACT-G) instrument. The cut-off score for the COST that predicts the lowest quartile of the FACT-G total score was identified by receiver operating characteristic (ROC) analysis. The sample was then stratified by this cut-off score, and characteristics were compared using Fisher's exact, chi-squared or independent sample t-test., Results: The mean scores were 20.1 ± 8.8 for the COST and 71.6 ± 15.5 for the FACT-G. The ROC analysis suggested that the cut-off of 17.5 yielded an acceptable sensitivity and specificity. Characteristics of patients with a higher level of FT included being younger, having a monthly household income of < 10,000 HKD (approximately 1290 USD), being more likely not employed, having stage IV cancer and receiving targeted and/or immunotherapy. In terms of financial support, a higher proportion of these patients had discussed financial issues with health care professionals and had received financial assistance. In addition, fewer of them were covered by private health insurance., Conclusion: Our findings suggest a cut-off for the COST that can be used to screen for FT in clinical settings. In addition, while a considerable proportion of high-FT patients received targeted therapy, they often received financial assistance. There is a gap between financial hardship and assistance that warrants attention., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: This study aimed to test the feasibility and estimate the effectiveness of a theory-driven and evidence-based educational intervention program to manage the nutrition impact symptom cluster in patients undergoing radiotherapy for nasopharyngeal carcinoma (NPC)., Methods: A pilot randomized controlled trial was performed. Forty patients were divided equally into the intervention and control groups. The patients in the intervention group attended 2 face-to-face individual instructional sessions to enhance their knowledge and skills in managing the cluster. The study outcomes were the severity of the nutrition impact symptom cluster, body weight, symptom interference, and quality of life (QOL). A generalized estimating equation model was used to compare the differences in the outcome variables between the groups over 3-time points., Results: The consent rate for the study was 95.2%, and the attrition rate was 5.0%. Although no significant differences between the groups were detected from T1 to T3, favorable effects on relieving the cluster itself (B [95% confidence interval (CI)] = -0.844 [-2.261, 0.572], p = 0.243, Cohen's d [95% CI] = -0.37 [-1.00, 0.28]) and improvements in physical well-being (B [95% CI] = 0.833 [-3.965, 5.632], p = 0.734, Cohen's d [95% CI] = -0.15 [-0.78, 0.49]) and in head and neck cancer-specific QOL (B [95% CI] = 0.061 [-4.061, 4.182], p = 0.977, Cohen's d [95% CI] = -0.05 [-0.68, 0.59]) were observed in the intervention group compared with the control., Conclusions: The educational intervention program is feasible and has promising effects on relieving the cluster., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Aims and Objectives: To explore the experience of multiple concurrent symptoms over time and their impact on daily living in patients with end-stage renal disease undergoing dialysis., Background: Patients undergoing dialysis experienced multiple concurrent symptoms because of the disease and treatment. Evidence suggests that these symptoms cluster around and have a significant impact on quality of life. However, the experience of this impact remained not clear., Design: A longitudinal descriptive qualitative study., Methods: Ten patients were purposely selected from the cohort of a longitudinal quantitative study in Hong Kong. A total of 28 face-to-face semi-structured interviews were conducted between July 2017 and July 2018. Interviews were audiotaped, transcribed and analysed using a thematic analysis approach. Findings were reported following the COREQ checklist., Results: Four themes emerged from the data. The first theme "complex symptom experience" described a dynamic pattern of symptoms among patients. Although patients were unaware of the relationships among symptoms, a cluster of tiredness, breathlessness, dizziness and sleep disturbance was identified in the narratives of individual symptoms. The report of symptom experience and its change revealed a unique pattern of symptom perception. The three other themes illustrated the impact of multiple concurrent symptoms on daily living, namely "decreased physical functioning," "changes in social functioning" and "diet and fluid restrictions.", Conclusions: Patients perceived dynamic and complex symptom experiences. This perception appears to be modulated by a number of factors. In addition, these experiences had negative and positive effects on patients' daily living., Relevance to Clinical Practice: Patients perceived unique impact of symptoms on daily living. Therefore, a nurse-led person-centred approach of care is warranted. In addition to routine symptom assessment, nurses need to capture the specific impact of symptoms on day-to-day life. Based on this assessment, symptom management interventions (e.g. health education, referral) can be tailor-made and prioritised., (© 2020 John Wiley & Sons Ltd.)

Context: Patients with end-stage renal disease undergoing dialysis experience multiple concurrent symptoms. These symptoms cluster together and have negative impacts on patient outcomes. However, information on changes in symptom clusters over time is limited., Objectives: This longitudinal study examined the stability of symptom clusters and their impacts on health-related quality of life and functional status over a period of one year., Methods: Eligibility criteria were patients diagnosed with end-stage renal disease; had received dialysis consecutively for at least three months; and had given written informed consent. Dialysis Symptom Index, Kidney Disease Quality of Life 36, and Karnofsky Performance Status Scale were used to evaluate the impacts of symptom clusters and outcomes. Exploratory factor analyses and multiple regression analyses were used to determine symptom clusters and their associations with patient outcomes., Results: Among the 354 recruited patients, 271 completed the 12-month assessment. Four symptom clusters were identified across the three assessments, namely, uremic, gastrointestinal, skin, and emotional. Within each cluster, the specific symptoms were varied. The uremic symptom cluster accounted for the largest amount of variability. Across the three assessments, a higher uremic cluster factor score was associated with poorer physical well-being, whereas a higher emotional cluster factor score was consistently associated with poorer mental well-being., Conclusion: Symptoms in patients on dialysis clustered in relatively stable patterns. The four symptom clusters identified had consistent negative effects on various aspects of patients' well-being. Our findings suggest the need for ongoing symptom assessment and early recognition of symptoms that may contribute to adverse patient outcomes., (Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Aim: The aim of the study was to translate the Cancer Survivors' Unmet Needs (CaSUN) scale into Chinese, and then test its psychometric properties, for cancer survivors in Hong Kong., Methods: The original questionnaire was translated from English into traditional Chinese (CaSUN-Chi), following standardized procedures. An expert panel was invited to assess the items' content validity, and pilot test on 15 patients to evaluate its readability. The sample for psychometric evaluation was drawn from a large multinational study assessing unmet needs of cancer survivors, with a convenience sample of 300 was recruited. Cronbach's α coefficient was used to assess the internal consistency of the scale, and confirmatory factor analysis to evaluate its construct validity., Results: The CaSUN-Chi had good readability and high content validity (S-CVI 0.98). Cronbach's α for the entire scale was 0.93 and 0.71-0.91 for the five subscales. Confirmatory factor analysis indicated that the five-factor structure of the CaSUN-Chi was good fit to the data (CFI = 0.99, AGFI = 0.98, RMSEA = 0.054, SRMR = 0.071)., Conclusion: The CaSUN-Chi showed desirable psychometric properties for assessing unmet needs of cancer survivors in Hong Kong. Using the newly translated scale to identify individual supportive care unmet needs can bridge the gap between patients' experiences and expectations, and improve healthcare provision and resource allocation., (© 2019 John Wiley & Sons Australia, Ltd.)

Background: Primary dysmenorrhoea is common in girls who have begun menstruating. However, few studies have examined its effect on the quality of life of a young population. The study aimed to evaluate the quality of life of adolescent girls with dysmenorrhoea in Hong Kong., Methods: The study adopted a cross-sectional descriptive approach. A convenience sample of 653 girls aged 13 to 19 years old was recruited from three secondary schools in Hong Kong. The 36-item Short-Form Health Survey was used to examine the health-related quality of life of the participants. The severity of dysmenorrhoea was assessed using a 10-point visual analog scale., Results: Girls suffering from dysmenorrhoea reported high pain prevalence and intensity. However, the majority of girls with dysmenorrhoea did not seek medical advice (93.2%) or self-medicate (82%). The role-physical, bodily pain, general health and social functioning domain scores of girls with dysmenorrhoea were significantly lower than those without dysmenorrhoea. Moreover, girls with severe dysmenorrhoea had a significantly lower quality of life in the bodily pain domain than those with mild and moderate forms of condition., Conclusions: Findings suggest that dysmenorrhoea is highly prevalent among adolescent girls in Hong Kong. Girls may suffer severe pain, which degrades their quality of life.

Key points: Few experimental studies have tested Acceptance and Commitment Therapy (ACT) in parents of children with cancerACT is feasible considering the high rates of recruitment, adherence and retentionACT is well accepted with high levels of satisfactionACT is effective in improving psychological flexibility and reducing guilt and worryFuture full‐scale RCTs are warranted to confirm the results of this work [ABSTRACT FROM AUTHOR]

Cancer-related fatigue is common in patients with advanced lung cancer, persistently interfering with their health-related quality of life. Acceptance and Commitment Therapy (ACT) may effectively reduce fatigue interference and improve health-related quality of life in the advanced lung cancer population. This study aimed to evaluate the effects of an ACT-based intervention on fatigue interference and health-related quality of life in patients with advanced lung cancer. An assessor-blinded, two-arm randomised controlled trial with 160 patients with advanced lung cancer was conducted. Participants were randomly allocated into either a four-week ACT-based intervention group (n = 80) or usual care control group (n = 80). The intervention consisted of a face-to-face session and three video-conferencing-based sessions and was delivered on an individual basis. The primary outcomes were fatigue interference and health-related quality of life. The secondary outcomes included cancer-related fatigue, depression and anxiety, cancer-specific distress, and activity level. Changes in psychological flexibility (PF), experiential avoidance, and cognitive fusion were also evaluated. Outcomes were measured at baselines (T0), one-week post-intervention (T1), and 3-month follow-up (T2). The intervention effects were assessed using generalised estimating equation models. Compared with the control group, the intervention group demonstrated significant improvements in fatigue interference (T1: β = −0.50, p < 0.001; T2: β = −0.16, p = 0.007), health-related quality of life (T1: β = 16.01, p < 0.001; T2: β = 11.21, p < 0.001), depression (T1: β = −0.32, p < 0.001) and anxiety (T1: β = −0.20, p < 0.001), cancer-specific distress (T1: β = −7.37, p < 0.001; T2: β = −8.00, p < 0.001), activity level (intensity, T1: β = 3.24, p = 0.004; T2: β = 2.61, p = 0.020; frequency, T1: β = 2.44, p < 0.001; T2: β = 1.96, p < 0.001; duration, T1: β = 1.36, p < 0.001), PF (T1: β = 5.54, p < 0.001; T2: β = 8.63, p < 0.001), experiential avoidance (T1: β = −7.70, p < 0.001; T2: β = −10.07, p < 0.001), and cognitive fusion (T2: β = −3.31, p = 0.007). The changes in experiential avoidance at one-week post-intervention mediated the effects of ACT on reducing cancer-specific distress (β = −7.40, p < 0.001; β = −3.68, 95%CI, −5.77 to −1.58) and promoting HRQoL (β = 11.15, p < 0.001; β = 5.49, 95%CI, 3.09 to 8.31) at three-month follow-up. The changes in PF at one-week post-intervention mediated the effect of ACT on HRQoL (β = 11.15, p < 0.001; β = 2.25, 95%CI, 0.66 to 4.19) at three-month follow-up. ACT-based intervention can effectively reduce fatigue interference and improve health-related quality of life in patients with advanced lung cancer. The intervention can be integrated into palliative care within the cancer system to contribute to the well-being of patients with advanced cancer. • ACT can effectively improve fatigue interference and HRQOL in advanced lung cancer. • The ACT intervention effects were mediated by experiential avoidance. • Hybrid ACT benefits those who are geographically dispersed and need support. [ABSTRACT FROM AUTHOR]

Advanced cancer is an incurable and life-threatening disease that poses a major challenge to patients' psychological and physical well-being. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy for managing health outcomes and inducing health-related behaviour changes. However, the components and modality of Acceptance and Commitment Therapy and its effectiveness on health outcomes for patients with advanced cancer remain unclear. This review aimed to identify the main content, delivery mode, dosage and duration of Acceptance and Commitment Therapy, and to systematically summarise evidence regarding its application in patients with advanced cancer for improving physical and psychological outcomes and health-related quality of life. Systematic review. PubMed, British Nursing Index, Medline, PsycINFO, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure and WANFANG Data were searched to identify eligible clinical trials. Two reviewers independently assessed the eligibility of each study and extracted data. The Joanna Briggs Institute critical appraisal checklist was used to evaluate the risk of bias in the included studies. Narrative synthesis was used to present the findings of this review. Six studies involving 261 participants were included in this review, including five randomised control trials and one with a pretest-posttest design. Two out of the five studies reported Acceptance and Commitment Therapy significantly reduced depressive symptoms and psychological distress post-intervention with a large effect size compared with usual care. One study indicated significant improvements in anxiety, sleep characteristics and health-related quality of life with a large effect size post-intervention. Non-significant changes in fatigue and pain were found. Intervention programmes with no more than four sessions had high adherence rates. Acceptance and Commitment Therapy may be a beneficial way to improve depressive symptoms, anxiety, psychological distress, sleep characteristics and health-related quality of life in patients with advanced cancer. However, limited studies, small sample size and methodological heterogeneity weaken the evidence. More rigorous research using brief Acceptance and Commitment Therapy programmes should be conducted within larger samples to further confirm the effectiveness and evaluate its long-term effect on this population. [ABSTRACT FROM AUTHOR]

Context: Patients with end-stage renal disease receiving dialysis experience multiple concurrent symptoms. A person-centered understanding of patients' symptom experiences may offer insights into individualized management.Objectives: We identified subgroups of patients based on their symptom experiences and the characteristics that differentiated among these subgroups. Outcomes associated with these subgroups were evaluated.Methods: A total of 354 patients on dialysis were recruited at two regional hospitals in Hong Kong. While the Dialysis Symptom Index was adopted to assess symptoms, the Kidney Disease Quality of Life 36 and Karnofsky Performance Status Scale were used to evaluate the quality of life outcomes. Information on health care utilization and mortality were retrieved from medical records. Subgroups of patients were identified using latent class analysis based on the occurrence ratings. Differences in characteristics and outcomes were determined using Chi-squared test, analysis of variance, and Cox regression analysis.Results: Three latent classes were identified: low (37.8%), moderate physical-low psychological (29.7%), and moderate physical-high psychological (32.5%). Higher comorbidity burden and lower serum albumin levels differentiated between the low and moderate physical-low psychological classes. The moderate physical-high psychological class had the highest number of symptoms, poorest quality of life outcomes, and more unscheduled clinic visits. A shorter mean survival time (421 vs. 431 days) was also found.Conclusion: Consistent with findings in other chronic conditions, subgroups of patients on dialysis have unique symptom experiences. Therefore, an individualized approach to symptom management is warranted. Our findings offer a phenotypic characterization for research on the underlying mechanisms for these symptom experiences. [ABSTRACT FROM AUTHOR]