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Background: Despite being a widely used generic measure of health-related quality of life worldwide, there is limited evidence on the psychometric properties of the EuroQoL Five-dimensions five level (EQ-5D) among cervical cancer patients in Ethiopia., Objective: To evaluate psychometric properties of the Amharic version of EQ-5D among Ethiopian cervical cancer patients., Methods: A longitudinal survey of cervical cancer patients receiving treatment at two Ethiopian tertiary care facilities was conducted from March 2022 to July 2023. Participants completed the EQ-5D and the European Organization for Research and Therapy of Cancer (EORTC QLQ-C30) at baseline and after three months on treatment. Effect size and standardized response mean were used to assess responsiveness. Anchor-based and distribution-based methods were used to calculate the minimal clinically important difference (MCID). Minimal detectable change (MDC) ratios were computed at the individual and group levels. Statistical significance was determined at p < 0.05., Results: Three hundred seventy-one patients completed the survey at baseline and follow-up with a mean age of 49.72 (10.80) years. The majority (268,73%) of the patients had early-stage cancer. The EQ-5D index and EQ VAS scores respectively improved by 0.04 and 7.0 post-treatment.The physical domains of EORTC QLQ-C30 had showed high correlation with physical dimensions of EQ-5D (r > 0.6) and the instrument showed good discriminate validity between patients with different health states. The effect size ranged between - 0.12 and 0.60 for the EQ-5D index value and - 0.12 to 1.16 for the EQ VAS, indicating small to large responsiveness. The average (range) MCID value of the EQ-5D index was 0.10-0.15. The findings showed that MCID to MDC ratios at the group level were more clinically meaningful than the individual level., Conclusion: The EQ-5D effectively detected changes and discriminate patients with different levels of health. While group-level MCIDs were established in this study, further studies are recommended to prove its usefulness at the individual-level., Competing Interests: Declarations Ethics approval and consent to participate Ethical approval was obtained from the Ethics Review Board of the School of Pharmacy, Addis Ababa University (Ref. No.: ERB/SOP/405/14/2022) and permission was received from the study hospital. Written informed consent was obtained from patients. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Sexual health is an important survivorship issue in cervical cancer. We assessed patient-reported sexual health outcomes and correlations with oncologist-assessed vaginal toxicity (VT)., Methods: This was a prospective, cross-sectional study of stage IB-IVA cervical cancer patients treated with definitive chemoradiation, who completed a socio-demographic questionnaire and the following patient-reported-outcomes (PROs): Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Menopause Rating Scale (MRS), Hospital Anxiety and Depression Scale (HADS). VT was assessed using the CTCAE v4.0. Sociodemographic, clinical data, PROs and VT were summarized using descriptive statistics; correlations were evaluated using linear regression analyses., Results: Between August 2018 and April 2022, 73 patients were analyzed. Median age was 49 (range 25-81), 57.5% had vaginal involvement at diagnosis and 76.9% were partnered. Sexual dysfunction (FSFI score ≤ 26), sexual distress (FSDS-R ≥ 11), severe menopausal symptoms (MRS ≥ 17), anxiety (HAD-Anxiety >7) and depression (HAS-Depression >7) were reported in 86.3%, 54.5%, 36.2%, 46.6% and 24.7%, respectively. Grade 2+ VT was reported in 27.4%. No significant associations were found between PROs and VT. On multivariable analysis, non-partnered status, use of hormone replacement therapy, and International Commission on Radiation Units and Measurements - rectovaginal dose (ICRU-RV) >65Gy were associated with worse sexual health (p < 0.005)., Conclusion: Cervical cancer patients self-report high rates of sexual distress, dysfunction and menopause symptoms. Discordance between oncologist-assessed VT and PROs highlights the importance of evaluating the patient's experience. Proactive treatment of menopausal symptoms and attention to radiotherapy doses to the vagina should be considered., Competing Interests: Declaration of competing interest Dr. Kathy Han was on the Astra Zeneca Cervical Cancer Radiation Oncology and Merck Gynaecological Cancer Advisory Board. All the other co-authors report no conflict of interest., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Introduction: Women who receive a result of an abnormal Papanicolaou (Pap) smear can fail to participate in follow up procedures, and this is often due to anxiety. This study aimed to apply artificial neural networks (ANN) in prediction of anxiety in women with an abnormal Pap smear test, prior to and following diagnostic procedures., Methods: One hundred-seventy two women who received an abnormal Pap screening result took part in this study, completing a questionnaire about socio-demographic characteristics and Hospital Anxiety and Depression Scale (HADS), right before and two to four weeks after diagnostics (i.e. colposcopy/biopsy/endocervical curettage). A feedforward back-propagation multilayer perceptron model was applied in analysis., Results: Prior to diagnostic procedures 50.0% of women experienced anxiety, while after diagnostics anxiety was present in 61.6% of women. The correlation-based feature selection showed that anxiety prior to diagnostic procedures was associated with the use of sedatives, worry score, depression score, and score for concern about health consequences. For anxiety following diagnostics, predictors included rural place of residence, depression score, history of spontaneous abortion, and score for tension and discomfort during colposcopy. The ANN models yielded highly accurate anxiety prediction both prior and after diagnostics, 76.47% and 85.30%, respectively., Conclusion: The presented findings can aid in identification of those women with a positive Pap screening test who could develop anxiety and thus represent the target group for psychological support, which would consequently improve adherence to follow-up diagnostics and enable timely treatment, finally reducing complications and fatal outcome., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ilic et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The increased knowledge of cervical cancer (CC) risk factors and suboptimal performance of present screening programs has generated interest in shifting from a universal screening approach to one based on individual risk assessment. To inform the future development of risk-based CC screening programs, it is crucial to gain insight into the factors influencing the acceptability of such approach among screening target group women. The aim of this study was to prospectively investigate the acceptability of risk-based CC screening and to identify potential barriers., Methods: In this qualitative study, one-to-one semi-structured interviews were conducted with a purposeful sample including women aged 30-65 years to explore women's perspectives on the acceptability of risk-based CC screening. The study was conducted in Estonia, and interviews were conducted from March to September 2023. Potential participants were approached in person by a member of the study team or by their healthcare providers at primary care or gynaecology clinics. The interview guides were developed based on the concept of acceptability of healthcare interventions., Results: Twenty participants (mean age 44.5, SD = 8.6) with diverse backgrounds were interviewed. The seven components of acceptability (affective attitude, burden, ethicality, opportunity costs, perceived effectiveness, self-efficacy, and intervention coherence) were explored as key themes. Generally, women supported risk-based screening. However, we identified several factors that may compromise the acceptability of risk-based screening. The participants were reluctant to accept less intense screening for low-risk women and anticipated that if risk-based approach was implemented, more frequent testing would remain an option. Providing in-person clinician support was expected, requiring additional healthcare resources. Knowledge gaps in CC prevention highlighted the need for accessible information and education. Most women were unworried about sensitive data inclusion in risk score calculations. However, some participants were concerned about potential confidentiality breaches by healthcare workers., Conclusion: This study indicates that risk-based CC screening is acceptable, except for testing low-risk women less frequently. Our findings underscore the necessity for comprehensive understanding of the needs and concerns of the target group women for program development. Healthcare organizations are required to proactively address these needs by implementing comprehensive information dissemination and efficient communication approaches., (© 2024. The Author(s).)

Background: Breast, cervical, and ovarian cancers are among the top ten global cancers, affecting women, with age-standardized rates per 100,000 being 47.8 for breast, 13.3 for cervical, and 6.6 for ovarian cancer. The journey from cancer symptoms, through diagnosis and treatment, to survivorship, presents numerous challenges. These challenges encompass physical, psychological, and social aspects, significantly impacting patients' quality of life. It is crucial for research to explore not only the challenges faced by patients but also the strategies they employ to cope with these obstacles., Methods: This study employed a cross-sectional qualitative approach. Twenty respondents, aged between 15 and 45 years and had been diagnosed with a reproductive cancer (breast, ovarian, or cervical), and were either undergoing treatment or had completed treatment within one year of the study period were purposively selected. Respondents were interviewed using a semi-structured interview guide. A thematic analysis was conducted on twenty in-depth interviews (IDIs) to understand the challenges and support systems for cancer patients., Results: The study identified two principal themes: the challenges faced by patients and the available support systems. The findings are based on patient narratives regarding the obstacles encountered during diagnosis, treatment, and follow-up, along with the mitigation strategies employed. Patients reported a range of challenges, categorized into financial and non-financial. Prominent among the non-financial challenges were psychological distress, body image issues, reduced sexual drive, and overall health deterioration. Support was primarily found through personal relationships and religious or spiritual beliefs., Conclusion: The research highlights the extensive psychological and social effects of cancer and it's treatment. The study revealed the intertwined nature of financial difficulties and non-financial challenges, emphasizing the importance of social support, including religious, family, healthcare, and peer support. The findings suggest that a comprehensive, multidisciplinary management plan which encompasses both medical and supportive care is required to enhance patient well-being., (© 2024. The Author(s).)

Background: Mexico reports low follow-up completion rates among women with abnormal cervical cancer screenings. This study aimed to identify barriers and facilitators to follow-up adherence among women with human papillomavirus (HPV) infection and premalignant cervical lesions in Mexico., Methods: A mixed-methods study was conducted from February to April 2019. Participants included women undergoing follow-up care for high-risk human papillomavirus (HR-HPV) and premalignant lesions, along with health personnel from the Women's Healthcare Center (CAPASAM) in Mexico. Quantitative data were obtained from the Women's Cancer Information System and through a questionnaire about factors affecting follow-up adherence. Additionally, the health personnel involved completed a compliance checklist regarding care regulations. Descriptive statistics were used for analysis. Qualitative data were collected via semi-structured interviews with both groups, followed by a content analysis based on identified categories. The Hazard Analysis and Critical Control Point System confirmed care process risks. Proposals to enhance the Early Detection Program for Prevention and Control of Cervical Cancer were collected from a CAPASAM health personnel nominal group., Results: Identified barriers to follow-up included low income among CAPASAM users, family provider roles limiting time for appointments, long waits for testing and results delivery, distant facilities, insufficient service hour communication, inadequate health personnel training, and a lack of systematic counseling. Hesitation toward follow-up was also linked to shame, apprehension, uncertainty, test aversion, fear of positive results, and limited cervical cancer and screening knowledge. Patriarchal attitudes of partners and limited access to the now-discontinued PROSPERA government program further discouraged follow-up. Facilitators comprised respectful treatment by CAPASAM staff, no-cost services, health campaigns, and positive user attitudes., Conclusions: The study found more barriers than facilitators to follow-up adherence, highlighting the need for strategies to bolster the Early Detection Program. Future strategies must address the comprehensive array of factors and incorporate stakeholder perspectives., (© 2024. The Author(s).)

Background: This study explored what patients identified with cervical cancer know about the link between human papillomavirus (HPV) and cervical cancer and where they learned this information. Patients share a great deal of information with family, friends and colleagues and we were interested in the accuracy and sources of information they are sharing., Methods: Patients identified through the EHR of a health system who had a history of cervical cancer were invited to participate in a brief survey of their experience. The sample represents an opportunity sample of patients who responded., Results: Generally, these patients, drawn from the Geisinger Health System in central Pennsylvania, were older (mean 57.5 years), White, and about half had annual household income of $35 K. Among all respondents about 17% had not heard of HPV, 21% did not know about an HPV vaccine, and about 38% did not know about the link between HPV and cervical cancer. Most frequently patients reported obtaining their information about HPV from television advertisements. About half received information from their oncologist. Patients reported having conversations with families about their own cancer, the cause of their cancer and HPV vaccination. It is important to note that these conversations were supported by information from many sources., Conclusions: Patients may serve as a conduit for information about their condition and may be informal 'educators' in the community. It is important to make certain that these opportunities are informed by information obtained from trusted and accurate sources., (© 2024 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

Purpose: This study aims to investigate the psychological distress experienced by patients with an initial diagnosis of abnormal Pap smears or dysplastic changes of the cervix uteri. It investigated whether patients' age, education, information level and approach to information acquisition have an impact on their psychological distress., Methods: A total of 364 female patients, aged 20-80 years, referred to the special dysplasia consultation hour at the Department of Obstetrics and Gynecology, Wuerzburg, completed a questionnaire containing validated items to assess information level, information acquisition, information needs and psychological distress, including a distress thermometer. Data from questionnaires and medical reports were used for analysis., Results: The study found that 56.9% of patients experienced psychological distress before their first visit. Patients under 44 years of age, especially those with concerns about fertility and sexuality, and those with lower levels of education showed higher levels of distress (p-value = 0.018 and p-value = 0.037). 40.9% of patients felt poorly informed and 53.7% of patients wanted more information before their visit. Correlational analysis showed that the method of obtaining information correlated with the desire for more information (p-value < 0.001). Those who received information via the Internet felt less informed, wanted more information and experienced more anxiety., Conclusion: These findings highlight the need for improved patient education strategies and effective doctor-patient communication to address the knowledge gap and reduce patient distress. In addition, healthcare providers should ensure that patients have access to reliable online resources for accurate information., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The persistent destructive power of cancer-related fatigue (CRF) has been regarded as the biggest influencing factor affecting the postoperative physical and mental health of patients with cervical cancer. During this process, patients might also experience different feelings of disease-related psychological. Therefore, this study aimed to adopt mindfulness-based stress reduction (MBSR) to intervene in patients with cervical cancer, and conducted follow-up for 3 and 6 months to observe the effects of changes in CRF, uncertainty in illness, coping styles, sense of coherence (SOC), and perceived social support (PSS)., Methods: A randomized controlled trial was conducted in ShengJing Hospital of China Medical University. A total of 102 patients were selected, and 78 patients completed the whole process, including 40 in the experimental group and 38 in the control group. Data were collected according to Cancer Fatigue Scale, Medical Coping Modes Questionnaire, Multidimensional Scale of Perceived Social Support, and Sense of Coherence-13. The change trend and difference of the two groups of research data were compared by repeated measurement analysis of variance. Bonferroni test was used for multiple tests between groups., Results: The CRF, SOC, and coping styles of the MBSR group showed a decreasing trend (P < 0.001) at after MBSR, 3 months follow-up, and 6 months follow-up compared to the before MBSR. However, the uncertainty in illness of the MBSR group showed a decreasing trend (P < 0.001) at after MBSR compared to the before MBSR, and it rose in 3 months follow-up and 6 months follow-up., Conclusion: MBSR can effectively alleviate the fatigue of CRF after treatment, while improving their psychological environment. Medical workers can consider implementing online MBSR for patients with cervical cancer in their daily rehabilitation nursing, which is beneficial for their recovery., Trial Registration: China Clinical Trial Registration Center ChiCTR2000040122 (https//www.chictr.org.cn/). Registered on November 21, 2020., (© 2024. The Author(s).)

Background: Cervical cancer continues to threaten women's health, especially in low-resource settings. Regular follow-up after screening and treatment is an effective strategy for monitoring treatment outcomes. Consequently, understanding the factors contributing to patient non-attendance of scheduled follow-up visits is vital to providing high-quality care, reducing morbidity and mortality, and unnecessary healthcare costs in low-resource settings., Methods: A descriptive qualitative study was done among healthcare providers and patients who attended the cervical cancer screening clinic at Mbarara Regional Referral Hospital in southwestern Uganda. In-depth interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and thematically analysed in line with the social-ecological model to identify barriers and facilitators., Results: We conducted 23 in-depth interviews with 5 healthcare providers and 18 patients. Health system barriers included long waiting time at the facility, long turnaround time for laboratory results, congestion and lack of privacy affecting counselling, and healthcare provider training gaps. The most important interpersonal barrier among married women was lacking support from male partners. Individual-level barriers were lack of money for transport, fear of painful procedures, emotional distress, and illiteracy. Inadequate and inaccurate information was a cross-cutting barrier across the individual, interpersonal, and community levels of the socio-ecological model. The facilitators were social support, positive self-perception, and patient counselling., Conclusions: Our study revealed barriers to retention in care after cervical cancer screening, including lack of partner support, financial and educational constraints, and inadequate information. It also found facilitators that included social support, positive self-perception, and effective counselling., (© 2024. The Author(s).)

Background: Cervical cancer-related stigma is common but understudied in the Caribbean. This study aims to describe the age difference of cervical cancer stigma and to evaluate the influence on the prevention practices among the Caribbean nonpatient population in Jamaica, Grenada, and Trinidad and Tobago., Methods: A cross-sectional study involving 1209 participants was conducted using a culturally trans-created Cancer Stigma Scale for the Caribbean context and supplemented with questions on cervical cancer and human papillomavirus (HPV) and HPV vaccine knowledge and beliefs. Descriptive analyses and χ2 tests were conducted., Results: The χ2 tests showed age is statistically significantly related to participants' response to stigma items such as "community members believe cervical cancer is viewed as shameful" (P = .0001); "women with cervical cancer are treated with less respect than usual by others" (P < .0001); "women with cervical cancer are rejected by family members" (P = .0007); "women with cervical cancer are rejected by intimate partners" (P < .0001); and "intimate partners blame women for having cervical cancer" (P = .0032). Additionally, age has statistically significant associations with endorsements of negative views of cervical cancer from the community (P < .0001) and family (P < .0001) as key barriers to cervical cancer care (item: "discourage women from seeking and obtaining screening and treatment"). Notably, younger respondents (18-25 years) are more sensitized to the unfair stigma and hold more stigma., Conclusions: Among Caribbeans, age influences cervical cancer stigma. Younger persons acknowledged greater stigma within families and communities. This study can guide age-informed interventions and programs to reduce stigma and improve cervical cancer screening and care seeking to reduce cervical cancer burden and disparities., (© The Author(s) 2024. Published by Oxford University Press.)

Background: Cervical cancer (CC) and breast cancer (BC) threaten women's well-being, influenced by health-related stigma and a lack of reliable information, which can cause late diagnosis and early death. ChatGPT is likely to become a key source of health information, although quality concerns could also influence health-seeking behaviours., Methods: This cross-sectional online survey compared ChatGPT's responses to five physicians specializing in mammography and five specializing in gynaecology. Twenty frequently asked questions about CC and BC were asked on 26th and 29th of April, 2023. A panel of seven experts assessed the accuracy, consistency, and relevance of ChatGPT's responses using a 7-point Likert scale. Responses were analyzed for readability, reliability, and efficiency. ChatGPT's responses were synthesized, and findings are presented as a radar chart., Results: ChatGPT had an accuracy score of 7.0 (range: 6.6-7.0) for CC and BC questions, surpassing the highest-scoring physicians (P < 0.05). ChatGPT took an average of 13.6 s (range: 7.6-24.0) to answer each of the 20 questions presented. Readability was comparable to that of experts and physicians involved, but ChatGPT generated more extended responses compared to physicians. The consistency of repeated answers was 5.2 (range: 3.4-6.7). With different contexts combined, the overall ChatGPT relevance score was 6.5 (range: 4.8-7.0). Radar plot analysis indicated comparably good accuracy, efficiency, and to a certain extent, relevance. However, there were apparent inconsistencies, and the reliability and readability be considered inadequate., Conclusions: ChatGPT shows promise as an initial source of information for CC and BC. ChatGPT is also highly functional and appears to be superior to physicians, and aligns with expert consensus, although there is room for improvement in readability, reliability, and consistency. Future efforts should focus on developing advanced ChatGPT models explicitly designed to improve medical practice and for those with concerns about symptoms., (© 2024. The Author(s).)

Purpose: Patients with cervical cancer undergoing chemoradiation have high symptom burden. We performed an analysis of prospectively collected data on patient-reported outcomes to determine characteristics predictive of poor treatment experience., Methods and Materials: Between 2021 and 2023, we prospectively collected data on patient-reported outcomes from patients with cervical cancer undergoing definitive chemoradiation. The European Organization for Research and Treatment of Cancer (EORTC)-Quality of Life Question-Core 30 and the EORTC-Quality of Life Question-Cervical Cancer module were completed at baseline (BL) and at the end of treatment (EOT). Poor treatment experience was defined as EOT poor health-related quality of life (HRQOL), low physical function, or significant overall symptom burden. Predictive factors analyzed included demographic, clinical, and disease-specific factors and BL financial toxicity, depression, social function, and emotional function. Receiver operating characteristic analysis provided appropriate predictive cutoff values. Univariable and multivariable (MVA) linear regression analyses were performed., Results: Forty-nine patients completed BL and EOT questionnaires. Median age was 43 years (range, 18-85 years). Most patients (59%) had stage III disease. BL financial toxicity ≥66.7, depression ≥66.7, social function ≤50, and emotional function ≤58 on the EORTC linear transformed scale of 0 to 100 were significant predictors for poor treatment experience (p ≤ .04) based on receiver operating characteristic analysis. On MVA, poor BL social function was associated with reduced EOT HRQOL (β, -9.3; 95% CI, -16.1 to -2.6; p < .008), decreased physical function (β, -24.4; 95% CI, -36.3 to -12.6; p < .001), and high symptom burden (β, 26.9; 95% CI, 17.5-36.3; p < .001). Earlier disease stage predicted decreased symptom burden (β, -6.7; 95% CI, -13.1 to -0.3; p = .039). BL financial toxicity was a significant predictor in univariable analysis (p = .001-.044) and showed a significant interaction term on MVA (p = .024-.041) for all 3 domains of poor treatment experience. Demographic and treatment-related factors were not predictive., Conclusions: Patients with cervical cancer with poor BL social function or high financial toxicity were at risk for increased symptom burden and poor HRQOL. Screening for these factors provides an opportunity for early intervention to improve treatment experience., Competing Interests: Disclosures None., (Published by Elsevier Inc.)

Objectives: This study investigated levels of trust and attributions of blame in connection with a cervical screening programme following a controversy related to the programme's audit, incorporating an experimental test of the effectiveness of new information materials., Design: We compared responses in Ireland (N = 872) to equivalent responses in Scotland (N = 400). Participants in Ireland were randomly assigned to either a treatment group that received the information materials or a control group that did not. Participants then responded to questions about their trust in cervical screening and to whom they would attribute blame in a range of scenarios describing women diagnosed with cervical cancer between screening rounds., Results: Results showed that the control group in Ireland had lower trust and attributed higher blame towards screening services than participants in Scotland. However, exposure to information materials in the treatment group improved trust and reduced blame., Conclusions: The findings suggest that public controversies influence perceptions of screening programmes and underscore the importance of transparent, choice-based communication in mitigating these effects. The findings have valuable implications for screening services worldwide as all screening programmes will have associated false negative and false positive results., (© 2024 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: This randomised controlled study was aimed at investigating the effects of WeChat-based cognitive behavioural stress management (WB-CBSM) on the mental health of patients with early-stage cervical cancer treated with surgical resection., Methods: A total of 184 patients with early-stage cervical cancer were randomised to receive either WB-CBSM ( n  = 92) or normal care (NC) ( n  = 92) for 8 weeks., Results: Compared with the NC group, the WB-CBSM group exhibited reduced Hospital Anxiety and Depression Scale (HADS)-anxiety scores at months (M)1 ( t  = 2.022, P  = 0.045), M3 ( t  = 2.575, P  = 0.011), and M6 ( t  = 2.709, P  = 0.007); anxiety rates at M3 ( χ 2 = 4.834, P  = 0.028) and M6 ( χ 2 = 5.182, P  = 0.023); HADS-depression scores at M3 ( t  = 2.069, P  = 0.040) and M6 ( t  = 2.449, P  = 0.015); and depression rates at M6 ( χ 2 = 4.268, P  = 0.039). Moreover, the WB-CBSM group showed increased Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale scores at M1 ( t  = -2.001, P  = 0.047), M3 ( t  = -2.281, P  = 0.024), and M6 ( t  = -3.501, P  = 0.001); the Quality of Life Questionnaire-Core 30 (QLQ-C30) global health score at M3 ( t  = -2.034, P  = 0.043) and M6 ( t  = -2.426, P  = 0.016); and QLQ-C30 function score at M3 ( t  = -2.009, P  = 0.046). However, the groups exhibited decreased EuroQol-5 dimension scores at M3 ( t  = 2.056, P  = 0.041) and M6 (( t  = 2.242, P  = 0.026) and QLQ-C30 symptom scores at M1 ( t  = 2.026, P  = 0.044) and M3 ( t  = 2.210, P  = 0.028)., Conclusion: WB-CBSM reduced anxiety and depression and improved the spiritual well-being and quality of life of patients with early-stage cervical cancer treated with surgical resection.

Background: Breast and cervical cancer are the most common cancers in women, and are associated with high morbidity and mortality rates. Cancer screening can facilitate early diagnosis, reduce mortality, and ease the burden of cancer. Social support and self-efficacy are strongly associated with cancer screening behavior. The present study aimed to explore the mediating effect of self-efficacy on social support and cancer screening behavior., Methods: In this cross-sectional survey study conducted from June to October 2023, 312 women aged 35-65 years were recruited from the East Coast area of China. A general information questionnaire, cancer screening behavior questionnaire, social support scale and self-efficacy scale were used to collect data. Descriptive statistics were used to analyze the general characteristics of participants; one-way analysis of variance was used to test for differences in the measured variables; and Pearson's correlation analyses were used to describe the relationship among social support, self-efficacy, and cancer screening behavior. A mediation model was constructed and analyzed using the PROCESS macro for SPSS., Results: The mean (standard deviation) screening behavior score for breast cancer and cervical cancer was 3.98 (2.79), representing an intermediate level. Self-efficacy was closely related to social support and cancer screening behavior. Social support showed a significant positive correlation with self-efficacy (r = 0.37, p < 0.01) and cancer screening behavior (r = 0.18, p < 0.01). Self-efficacy was also significantly positively correlated with cancer screening behavior (r = 0.19, p < 0.05). Self-efficacy showed a full mediating effect between social support and cancer screening behavior, with an explanatory power of 32%., Conclusions: The findings emphasize the need to increase women's level of social support and self-efficacy, which in turn can increase women's participation in breast and cervical cancer screening., (© 2024. The Author(s).)

Aim: This study aimed to investigate the psychometric properties of the Turkish adaptation of The Cervical Cancer Knowledge Scale (CCKS-T). This scale was designed for the assessment of cervical cancer knowledge levels among women in the screening period., Methods: Research was conducted with 307 women aged 21-65 years, who satisfied the eligibility criteria and agreed to participate. Data were collected via an online survey conducted during July and August 2023, utilizing both a Descriptive Information Form and the CCKS-T. To confirm the validity of the scale, language and content validity assessments were conducted, in addition to confirmatory factor analysis. The scale's reliability was evaluated using Cronbach's alpha, item-total correlation analysis, and a test-retest analysis. The scale consisted of eight items., Results: The content validity index of the scale items was found to be 1.0 with excellent sensitivity. Confirmatory factor analysis showed that the item factor loadings varied between 0.31 and 0.81 and the model had a good fit (x 2 /df = 2.200; GFI = 0.96; CFI = 0.96; RMSEA = 0.063). Cronbach's alpha of the Turkish version of the scale was found to be 0.80., Conclusion: The CCKS-T demonstrates both validity and reliability as an instrument for the assessment of Turkish women's knowledge about cervical cancer., (© 2024 Japan Society of Obstetrics and Gynecology.)

Background and Objectives: A good intimate relationship (IR) can relieve the psychological distress of patients with cervical cancer and promote a sense of well-being during stressful times. Researchers have found that IR is related to illness perception (IP) and dyadic coping (DC). Therefore, this study aimed to (1) describe the IR of patients with cervical cancer, (2) identify the relationships and pathways among IP, DC and IR in patients with cervical cancer and (3) explore the mediating role of DC between IP and IR in cervical cancer patients., Methods: A total of 175 patients with cervical cancer were recruited at a tertiary hospital in China from September 2021 to January 2023. The data were collected through a general demographic and disease-related information questionnaire, the Locke-Wallace Marriage Adjustment Test, the Revised Illness Perception Questionnaire of Cervical Cancer and the Dyadic Coping Inventory., Results: The mean score for intimate relationships was 107.78 (SD = 23.99, range 30-154). Pearson's correlation analysis revealed that intimate relationships were positively correlated with IP (personal control) and DC (stress communication, supportive DC, delegated DC and common DC) and were negatively correlated with IP (consequence, timeline acute/chronic, timeline cyclical and emotional representation) and negative DC. As for the results of the structural equation model, DC fully mediated the influencing effects of both positive and negative IP on IR., Conclusions: The level of IR of patients with cervical cancer in China should be improved. DC has a significant mediating effect on the link between the IP and IR., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Cervical cancer is one of the causes of female deaths worldwide. Cervical cancer incidence is rising with almost three thousand (2797) women in Ghana being diagnosed with the condition each year, with almost two thousand (1,699) of them dying from its complications Nurses caring for cervical cancer patients are exposed to emotional and psychological distress due to late presentation, the burden of care, patients' suffering and the alarming number of deaths associated with it. Improving positive patient outcomes require identifying the challenges and support systems available to nursing staff so as to harness these support systems for improving care outcomes., Aim: This study explored the challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana., Method: In this study, we adopted an exploratory qualitative design. The study was conducted among eleven (11) nurses and nine (9) midwives engaged at the national referral hospital in Ghana who were providing care for patients with advanced cervical cancer for over a year who were purposively sampled. The data was collected using in-depth interviews with a pre-tested semi-structure interview guide from the twenty participants. We recorded the interviews using an audio-tape. The audio files were transcribed verbatim and thematic analysis was undertaken with the aid of Nvivo 10.0., Results: The challenges when rendering nursing care faced by participants of this study were exposure to frequent deaths, inadequate resources, and workload. Most participants lamented that they received absolutely no support from their workplace, hence their only form of support was from their family and friends. They also added that most of them were general nurses and midwives with no special training in oncology nursing or palliative nursing., Conclusion: Nurses and midwives experience resource, knowledge and skill challenges when caring for patients with advanced cervical cancer. However, the nurses and midwives had emotional attachment to their jobs and their patients and were not distracted by their bad experiences. We recommend improving resource allocation for cervical cancer care through the National Health Insurance Authority (NHIA), Ghana and increased training of nurses in oncology and palliative nursing by the Ministry of Health, Ghana to improve knowledge and skills of the nurses and midwives caring for women with advanced cervical cancer to improve their quality of care. Further, hospitals must make it a priority to have more nurses and midwives trained in oncology and end of life care to improve the knowledge and skills of nurses and midwives caring for advanced cervical cancer patients. Also, these findings should trigger policy-level discussions at the Ministry of Health, Ghana on the training of specialized nurses and midwives in cancer and end of life care to help Ghana meet the sustainable development goal targets related to health., (© 2024. The Author(s).)

Introduction: Cervical cancer (CC) and its treatments impact various dimensions of quality of life (QoL), including physical, psychological, and sexual functioning. Sexual health, a crucial QoL aspect, is often compromised, highlighting the necessity for open sexual communication., Materials and Methods: This study involved 60 women diagnosed with stage IIb-IIIa CC. The 36-Item Short Form Survey (SF-36) was used to measure physical and psychological components of QoL, the Female Sexual Function Index-6 (FSFI-6) to assess its sexual component, and the Sexual Communication Self-Efficacy Scale (SCSES) to diagnose communication confidence. Self-administered questions gauged patient-provider sexual communication. The results include quotes from participants, providing additional insight., Results: Sexual communication self-efficacy and patient-provider communication correlated significantly with QoL components. Only 23.33% discussed sexual issues with their doctors. Participants' experiences highlighted the impact of cancer on sexuality and the need for tailored support., Discussion: Post-diagnosis psychosexual changes emphasize the importance of communication in renegotiating sexual identity and needs. Effective communication is associated with improved QoL, highlighting the role of healthcare professionals in addressing psychosexual issues. Integrating PLISSIT and BETTER models provides a comprehensive approach to sexual communication in the cancer context., Conclusion: The study demonstrates the importance of sexual communication self-efficacy in QoL of CC patients and highlights the need for healthcare professionals to include sexual communication education in cancer care., (© 2024. The Author(s).)

Cervical cancer is a common and significant health issue for women worldwide. To address the dearth of research on male partners' experiences when their significant others are diagnosed with cervical cancer, we aim to explore the unique challenges and perspectives encountered by men in these circumstances. The study adopted interpretive phenomenological analysis to qualitatively assess the experiences of males with partners diagnosed of cervical cancer. A phenomenological research design with purposive sampling technique was used to recruit and collect data from 38 participants until saturation occurred. Face to face interviews were conducted using a developed semi-structured interview guide. The data collected was analyzed using content analysis after verbatim transcription was done. The study resulted in the identification of 2 main themes, and 10 subthemes. These themes focused on the multifaceted impact of cervical cancer on spousal caregivers' lives and the coping and support mechanisms utilized by spouses of cervical cancer patients. The findings indicated that men faced several challenging experiences as a result of their spouses' condition and revealed the strategies they employed to cope with the stress of caring for their wives. Almost every man adopted a strategy to cope with the condition of their wives. This study would assist other men to understand the psychological, social, emotional, and spiritual experiences the men went through to appreciate and adopt their coping strategies whenever they go through such challenges., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

The prevalence of deaths from cervical cancer (CC) in the word was around 350.000 in the last 5 years, indicating the need to analyze the potential causality and current management approaches. This study aimed to evaluate the level of knowledge regarding CC, including its risk factors, signs and symptoms and early detection methods, as well as the awareness and attitude of participants toward the screening tests., Methods: This cross-sectional study was conducted between August and October of 2023 in a representative sample of 18-59 years old Armenian women. Data were generated using structured interviews with self-administered questionnaire and adopted from similar studies and translated into Armenian., Results: Majority of the survey respondents demonstrated moderate awareness about the risk factors, signs and symptoms of the condition. The poorest knowledge regarding the preventive colposcopy screening method of CC was observed. Comparison of demographic characteristics of participants and their awareness regarding the inquired topics revealed evident relationship between the disease rate and studied variables. A strong relationship was observed between the awareness of CC risk factors and CC symptoms of the disease and age groups, residency, number of children, insurance and employment status, level of education and level of income., Conclusion: The short period of the survey and a fast track of data analysis with independent variables has revealed the region-specific current rates for the assessed variables and their relationship. The study added more facts to the existing body of knowledge about the implementation strategies and limitations of CC screening programs.

Introduction: Due to different social and cultural backgrounds, cervical cancer patients' experience of the treatment process and quality of life after treatment will be different. This study sought to gain in-depth understanding of the experiences of Chinese cervical cancer patients as regards their quality of life and physical symptoms., Methodology: Semi-structured interviews were used to collect data. We recruited 15 women with cervical cancer in eastern China for in-depth interviews. All data were entered into the NVivo 12 software program for analysis., Results: Four themes emerged from the data: (a) uncertainty; (b) physical suffering; (c) psychological pressure; and (d) challenges of marriage and family., Discussion: Cervical cancer patients showed concerns about the disease itself and the physical discomfort it causes, as well as changes in social relations. Health professionals need to talk about these issues and develop strategies to address them accordingly., 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: This study aimed to explore the relationship between health-related social media use and HPV-related health knowledge, attitudes, and practices (KAP)., Method: Data were derived from a subset of the national cohort from the 2022 Health Information National Trends Survey (HINTS 6), including only women aged 21 to 65 years old (n = 2013). Ordinary least squares regression and structural equation modeling were used to answer the research question and test hypotheses., Results: Participants with a family history of cancer, higher education, and White showed more HPV knowledge. Older females were associated with lower HPV knowledge, less worry and fewer timely cervical cancer screening. Additionally, HPV knowledge positively predicted worry and cervical cancer screening. Health-related social media use positively predicted HPV knowledge, worry, and cervical cancer screening., Conclusion: This study identified populations with HPV knowledge and hesitated cervical cancer screening and tested hypothesized models that combine social media use with the KAP survey., Practice Implications: Future health interventions should strategically leverage the role of social media to enhance public awareness of HPV knowledge and cancer concerns. By promoting HPV knowledge and awareness, such interventions can subsequently encourage timely cervical cancer screening., Competing Interests: Declaration of Competing Interest The author declares no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: This cross-sectional study aims to investigate parameters that predict relevant levels of distress in women in a perioperative setting undergoing treatment for cervical cancer., Materials and Methods: Data from 495 patients with cervical cancer that were treated at the university hospital Aachen between 2010 and 2022 were analysed based on their respective National Comprehensive Cancer Network (NCCN) Distress Thermometer score (DT) and Problem List (PL) and their clinical history. 105 patients were enrolled in the study. 18 medical and demographic variables were analysed using multivariate logistic regression., Results: Three variables contributed significantly to the prediction of a DT score ≥ 5. Significant distress was defined as a DT score of ≥ 5, which was observed in 70.5% of the participants (mean: 5.58 ± 2.892). Women who chose to receive psycho-oncological counselling were more likely to have a DT score ≥ 5 (Odds Ratio(OR) = 3.323; Confidence Interval (CI95%): 1.241-8.900; p-value: 0.017). In addition, women who did not receive chemoradiation had significantly higher DT scores (OR = 3.807; CI 95%:1.185-12.236; p-value: 0.025), as did women whose Distress Thermometer was assessed in the first month after their initial diagnosis (OR = 3.967; CI 95%:1.167-13.486; p-value: 0.027)., Conclusion: Increased distress in women with cervical cancer is common especially in the first month after diagnosis, in patients who do not receive chemoradiation and in patients who seek psycho-oncological counselling. Surgical factors do not play a major role in patient distress., (© 2024. The Author(s).)

Purpose: Brachytherapy for gynecological cancer is reported to cause pain, anxiety, and distress with no clear guidance for optimizing patient experiences. The aim of this study was to explore patient experiences of brachytherapy and views on improvement., Methods and Materials: Semistructured interviews were undertaken with patients who had received brachytherapy for locally advanced cervical cancer. Two cohorts were recruited: cohort 1 had recently had brachytherapy, and cohort 2 was a year post brachytherapy. Four recruitment sites were selected, where brachytherapy is given in different ways, some with short day case procedures and others having 1 or 2 overnight stays with applicators in place. Consecutive patients were invited to interview. Participants were asked to retell their brachytherapy story, with views on their care and ideas for improvement. Interviews were audio recorded, transcribed, and data analyzed following Braun and Clarke's method for reflexive thematic analysis., Results: Thirty-five interviews were conducted (20 in cohort 1 and 15 in cohort 2). Participant's ages ranged from 28 to 87 years. The interview duration ranged from 22 to 78 minutes. Difficult and traumatic experiences were reported, including periods of severe pain and perceptions of poor care. However, some participants described positive experiences and what went well. Three themes were developed: (1) how the patient got through it, (2) unpleasantness, discomfort, and the aftermath, and (3) emotional consequences and trauma. Some aspects of medium and long duration brachytherapy were found to be more problematic compared with short duration brachytherapy. Exploring experiences at 1-year post brachytherapy has provided insights into the long-lasting impact of brachytherapy experiences., Conclusions: Hearing the patient voice has demonstrated that further work is needed to improve patient care in modern brachytherapy techniques using different regimens and durations, to minimize difficult and traumatic patient experiences. Study insights will inform future work to develop clinical care recommendations., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Uterine and Cervical cancer survivors face challenges like the disruption of emotional and sexual relationships, struggle to maintain sexual life and intimacy, and the possibility of divorce. The study aimed to determine the effect of group counseling based on couples' constructive communication on perceived spousal support in uterine and cervical cancer survivors., Methods: A randomized controlled trial on 40 women who survived uterine and cervical cancer were recruited using convenience sampling and then randomly allocated to a couple-based constructive communication intervention group and a routine cancer center care control group from June 2019 to March 2020 in Motahhari and Imam Khomeini hospitals in Urmia. The intervention group was involved in a group counseling session weekly for 5 weeks, regarding constructive couple communication skills. Perceived spouse support was assessed using the sources of social support scale which has 4 subscales informational, instrumental, emotional, and negative support before and one week after the end of the intervention in both groups. Data analysis was performed using SPSS version 24 through Independent and paired t-tests, Mann-Whitney U test, Wilcoxon, chi-square, and ANCOVA. P value<0.05 was considered statistically significant., Results: The effect of the intervention was statistically significant in reducing negative support in the intervention group (2.70±0.80) in comparison with the control group (3.40±1.04) (P=0.03). It was also statistically significant in increasing informational support (3.45±0.71 vs. 2.15±0.80, P<0.001), instrumental support (3.15±0.58 vs. 2.85±0.74, P<0.001), and emotional support (19.40±1.60 vs. 16.10±2.10, P<0.001)., Conclusion: Group counseling based on couple constructive communication increased perceived spousal support in uterine and cervical cancer survivors. Trial Registration Number: IRCT20150125020778N22., Competing Interests: None declared., (Copyright: © International Journal of Community Based Nursing and Midwifery.)

Background: Cervical cancer (CxCa), although preventable, is still among the most prevalent cancers in women. Mortality from this cancer is high, especially in low-income countries where preventive strategies are often lacking. We studied the knowledge, attitudes, and practices regarding CxCa among Yemeni women., Methods: This cross-sectional study was conducted in 2019 among 399 women in five major hospitals in Sanaa, the capital city of Yemen. Data were collected through face-to-face interviews using structured questionnaires. We used logistic regression models to analyze the likelihood of hearing about CxCa, believing that CxCa is treatable and preventable, awareness of the Pap smear test, and ever having this test, in relation to participant's age, education level, working outside the household, and family history of CxCa., Results: Only 66.7% of the women had heard of CxCa. Women with higher education, working outside the household, and with a family history of CxCa were more likely to be aware of CxCa. Working outside the household was the only variable related to a higher likelihood of knowing that CxCa is a treatable and preventable. Furthermore, women with a family history of CxCa were more likely to have knowledge about Pap smear test and were more likely to have Pap smear test in the past., Conclusion: This study identified a low awareness of CxCa and its prevention among Yemeni women. In order to reduce the burden of CxCa in Yemen and save women's lives, it is necessary to raise women's awareness of this disease, especially among those with lower education and those not involved in work outside their homes., (© 2024. The Author(s).)

Purpose: The aim of this study is to reveal female university students' knowledge and perceptions about cervical cancer (CC) and human papillomavirus (HPV), and relationship with e-health literacy (e-HL). It also aims to determine the predictors affecting CC and HPV. Methods: A cross-sectional study was conducted with 589 female university students in Türkiye. Data were collected using a "Cervical Cancer and HPV Awareness Questionnaire" and an "E-health Literacy Scale (e-HLS)." Analysis involved Pearson correlation analysis, Independent Sample t -test, one-way analysis of variance, and Linear Regression analysis. Results: Results indicate that female students exhibited a low level of knowledge and perception about CC and HPV. Only 2.90% of students reported being vaccinated, while 39.90% had sexual experience. Higher knowledge levels were observed among married individuals, those familiar with HPV and the HPV vaccine, those who had undergone Pap smear tests, sexually active individuals, and consistent condom users. e-HL had a positive impact on knowledge and perceived threat about CC and HPV. The affecting predictors for knowledge about CC and HPV were found to be e-HLS (β = 0.911), having prior knowledge of HPV (β = 0.201), and being aware of the HPV vaccine (β = 0.172). In terms of perceived threat, the affecting predictors were e-HLS (β = 0.207), having heard of HPV (β = 0.101), and having knowledge of the HPV vaccine (β = 0.092). Conclusion: e-HL emerged as a crucial predictor positively influencing knowledge and perceptions about CC and HPV. This suggests the potential for organizing digital health campaigns to enhance awareness and understanding of CC and HPV.

Purpose: Few studies have examined experiences of stigma and factors associated with symptoms among cervical cancer survivors from diverse racial and ethnic backgrounds. We investigated survivorship experiences and patient-reported outcomes in the SPADE symptom cluster (sleep disturbance, pain interference, anxiety, depression, and energy/fatigue) among Black, Latina, and Chinese American women diagnosed with cervical cancer., Methods: In two phases of research with cervical cancer survivors, we collected qualitative data through individual interviews (N=12; recruited through community referrals) and quantitative data from an observational cohort study (N=91; recruited through 4 national cancer registries). We coded interview transcripts to describe the survivors' experiences. We then evaluated associations between social support, spirituality, and SPADE symptom cluster domains using linear regression models., Results: Qualitative analysis yielded four themes: perceptions of stigma, empowerment, physical and psychological effects, and social support. These concepts revolved around internal and external stigmas, emotional responses, strengthened faith, and different social support types. Quantitative analyses indicated that greater spirituality was associated with lower symptom burden on all five SPADE domains (p<0.01). We observed nuanced associations between specific types of social support and SPADE domains., Conclusions: The survivorship experiences of Black, Latina, and Chinese American women with cervical cancer are negatively influenced by perceptions of stigma. Higher scores on spirituality and varied types of social support were significantly associated with fewer symptoms in the SPADE symptom cluster., Implications for Cancer Survivors: Results suggest targets for future interventions to reduce symptom burden among women diagnosed with cervical cancer by leveraging spirituality and social support., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Self-blame for past sexual behaviors or for the personal character may be associated with the development of cervical cancer. Purpose: Aims were to understand the burden of self-blame attribution (SBA) among women with cervical cancer by (1) examining relationships between SBA, psychological distress (PD), and spiritual well-being (SWB); (2) determining differences between behavioral (BSB) and characterological self-blame (CSB) attribution; and (3) describing associations between SBA and unwanted past sexual experiences. Methods: Women attending a cancer center in the southeastern United Stats ( N  = 106) completed an online survey including a demographic questionnaire and three instruments: (1) SBA for Cancer Scale; (2) Psychological Distress Subscale of the Psychological Adjustment to Cancer Scale-Self Report; and (3) Functional Assessment of Cancer Therapy-Spiritual Well-being. Results: Women with cervical cancer, 26-64 years of age, identified moderate levels of SBA, PD, and SWB. Relationships were found between PD, BSB and CSB, and unwanted sexual experiences. Significant inverse correlations between religious faith, BSB, unwanted sexual experiences, and SWB were noted. Unwanted sexual experiences were a significant predictor of SBA. Conclusion: SBA places women at risk for increased burden. Recognizing SBA in vulnerable cancer survivors is important to providing holistic nursing care.

Objective: Cervical cancer affects survivors' overall coping. Yet, specifically emotional and behavioral expression patterns among cervical cancer survivors have barely been examined. In addition, no study has focused on survivors' experiences of sequences related to coping. Understanding these perceptions can help provide a tailored response and improve psycho-social interventions. The aim of this study was to gain a better understanding of the emotional and behavioral motives involved in coping with cervical cancer recovery., Methods: Qualitative interviews were conducted with 15 survivors of cervical cancer (stages I and II), using a semi-structured in-depth questionnaire. The interviews were recorded, transcribed, and analyzed by three researchers using thematic analysis., Results: Six main themes emerged: (i) Reasons and benefits for keeping the disease a secret or sharing it with others; (ii) "When you get used to despair, there's also room for hope": Despair alongside hope; (iii) Self-guilt following the disease, but also knowing how to forgive yourself; (iv) Deep loneliness alongside a significant need for support; (v) Finding the way from passivity to activity; and (vi) When meaning in life is missing, and the importance of meaning when it is present. There was a balance between negative emotions and behaviors (despair, confidentiality, guilt, loneliness, passivity, lack of meaning) and positive emotions and behaviors (hope, openness, forgiveness, significant support, activity, meaning)., Significance of the Results: The study revealed that in some cases cervical cancer coping during the recovery period moves across sequences. The women's narratives portray past difficulties as the reason for present psychological health, and their experience of a healthy present is intensified by their past difficulties. Implications for practice are discussed.

Background: The aim of this study was to investigate the knowledge, awareness, and attitude of mothers of preadolescent girls regarding the HPV vaccination and cervical cancer, and to understand how to improve the efficacy of the Italian vaccination campaign through the gathered data., Methods: A questionnaire-based survey was conducted in mothers of unvaccinated 9 to 12-year-old girls in Italy from November 2018 to July 2019, to evaluate their awareness and the attitude toward HPV, its vaccination, and the information sources of the vaccination campaign. The selection of the distribution sites of the questionnaire was performed with randomization of 50 major places of aggregation located throughout the Italian territory., Results: Three hundred mothers of unvaccinated girls were included in the study and divided into two groups (191 subjects <45 years old, 109 subjects >45 years old). Results showed that 79.6% of <45 years old knew what HPV is, compared to 60.6% of >45 years old (P value <0.001); only 60.2% (<45 years old) and 54.1% (>45 years old) showed awareness about the HPV vaccine (P value 0.03). The percentage of parents against vaccination in preadolescent was higher in the >45 years old (29.4%); however, most of them appeared favorable to the information campaigns regarding the vaccine (P value <0.001)., Conclusions: Our study showed that mothers of unvaccinated preadolescent girls have suboptimal knowledge on the topic. Moreover, the implementation of communication strategies dedicated to the population segment appears as a central aspect. As HPV vaccination keeps being a public health concern, it is fundamental to understand which trigger should be managed by healthcare decision makers to boost the vaccination campaigns.

Objective: The impact of cervical cancer treatment on the quality of life of long-term survivors compared with the general female population is controversial, and no studies have been conducted comparing patients with benign gynecological diseases. The aim of this study was to compare the quality of life of cervical cancer survivors with that of healthy controls., Study Design: A case-control study was conducted to compare the quality of life of 106 cervical cancer survivors from a tertiary hospital and 185 women admitted to a gynecological outpatient clinic from the same health area for a healthy woman check-up (n 46) or for a benign gynecological disorder (symptomatic, n 113; asymptomatic, n 26). To measure quality of life, self-administered questionnaires, such as the Functional Assessment Cancer Therapy-cervix and World Health Organization quality of life-brief version, were employed. Baseline scores were collected when patients first reported, and further evaluations were completed at 0-6, 7-12, 13-24, 25-60, and more than 60 months. For the contrastive analysis hypothesis, we employed R statistical software., Results: Except for the environment domain at 0-6, 7-12, and 13-24 months (51.52 vs. 60.73, p < 0.0001; 52 vs. 60.73, p < 0.0001; 49.81 vs. 60.73, p < 0.0001, respectively), we found no statistically significant differences in the quality of life between cervical cancer survivors and controls. We did find differences in the physical health domain scores at 0-6 months (60.22 vs. 72.42, p = 0.039) and the social relationships domain scores at 13-24 months (54 vs. 71.42, p = 0.017) between cases and asymptomatic controls., Conclusion: Except for physical well-being, environment and social relationships, which were substantially better for controls, especially in the asymptomatic, long-term cervical cancer survivorśquality of life did not vary from that of controls., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Cervical cancer patients commonly experience psychological supportive care needs, necessitating diverse interventions to enhance psychological well-being and alleviate physical symptoms. This systematic review, covering English-published articles from January 1999 to April 2023, assessed the impact of psychological supportive care interventions on anxiety and depression. Twenty-Six studies, including 11,638 patients, were analyzed, comprising randomized controlled trials; quasi-experimental, and pre-post-test designs from PubMed; Science Direct; Wiley online library; Google Scholar; Cochrane Library; and JSTOR. The extraction of data was done by two independent authors and a third independent author checked the data extraction. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 2020 statement was adopted. The population, intervention, comparator, and outcomes (PICO) search strategy was applied. Effective Public Health Practice Project (EPHPP) tool was used to assess the quality of selected articles. Various interventions, such as psychological nursing, exercise, counselling, psycho-curative approaches, peer and family education, psychotherapy, and medication, were identified. Two studies incorporated homework sessions, predominantly administered by nursing staff. Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were commonly used instruments. Statistical analysis revealed a significant difference in anxiety and depression scores between treatment and control groups (p < 0.005) post-intervention across all studies. A subsequent meta-analysis of eight homogeneous studies, utilizing a random-effects model, showed a moderate-to-high overall effect size (1.35, 95% CI: 0.75 to 1.94), indicating a statistically significant positive impact. Various studies exhibited variability in effect sizes ranging from low to high. While the meta-analysis included 936 participants, the forest plot visually represents individual study effect sizes and the combined effect size. Preliminary evidence supports the positive impact of psychological supportive care interventions on cervical cancer outcomes, urging further research, especially exploring long-term effects and employing rigorous study designs., (© 2024. The Author(s).)

Background: Quality of life research can guide clinical workers to adopt more targeted treatment and intervention measures, so as to achieve the purpose of improving patients' quality of life. The objective of this study was to evaluate health-related quality of life in Chinese patients with cervical cancer and to explore its influencing factors., Methods: A total of 186 patients with cervical cancer were investigated by using the QLICP-CE (V2.0) scale (Quality of Life Instruments for Cancer Patients-Cervical Cancer) developed by our group in China. The data were analyzed by t-test, one-way ANOVA, univariate analysis, and multivariate linear regression., Results: The total score of quality of life scale for cervical cancer patients was (62.58 ± 12.69), Univariate analysis of objective clinical indexes showed that creatinine concentration was a negative influence factor in the psychological domain, potassium ion concentration was a negative influence factor in the common symptoms and side effect domain, erythrocyte content was a positive influence factor physical domain and common general domain. Multiple linear regression results suggested that clinical staging was the influencing factor of common symptom and side effect domain, common general module and total score of scale. Marital status has different degrees of influence on the psychological, social, and common general domains. The level of education also influenced scores in the social domain., Conclusion: The total score of quality of life in patients with cervical cancer who received active treatment was acceptable. Marital status, clinical staging, and educational level are the factors that affect the quality of life of patients with cervical cancer. At the same time, potassium ion concentration, red blood cell count and creatinine concentration also have important effects on quality of life in patients with cervical cancer. Therefore, it is very important to give personalized treatment and nursing to patients based on various factors., (© 2024. The Author(s).)

Background: In Ethiopia, both incidence and mortality of cervical cancer are relatively high. Screening services, which were implemented during the past few years, are currently being expanded. The World Health Organization recommends patients with a positive VIA (visual inspection with acetic acid) result should immediately receive treatment followed by rescreening after 1 year as precancerous lesions can reoccur or become residential despite treatment., Materials and Methods: Screening logbooks dating between 2017 and 2020 were retrospectively reviewed in 14 health facilities of Addis Ababa and Oromia region. Data for 741 women with a VIA-positive result were extracted and those women were asked to participate in a questionnaire-based phone interview to gain insights about adherence to treatment and follow-up. Data were analyzed using descriptive methods and then fitted into 2 generalized linear models to test variables for an influence on adherence to follow up., Results: Around 13 800 women had received a VIA screening, of which approximately 820 (5.9%) were VIA positive. While over 90% of women with a positive screen received treatment, only about half of the treated patients returned for a follow-up examination. After treatment, 31 women had a VIA-positive re-screen. We found that educational status, age over 40, no/incorrect follow-up appointment, health facility-related barriers, and use of reminders are important drivers of adherence to follow up., Conclusion: Our results revealed that adherence to treatment after VIA positive screening is relatively high whereas adherence to follow up recommendations still needs improvement. Reminders like appointment cards and phone calls can effectively reduce the loss of follow-up., (© The Author(s) 2024. Published by Oxford University Press.)

Purpose: To assess experiences of sexuality and of receiving sexual healthcare in cervical cancer (CC) survivors., Methods: A qualitative phenomenological study using semistructured one-on-one interviews was conducted with 15 Belgian CC survivors recruited in 5 hospitals from August 2021 to February 2022. The interviews were audiotaped and transcribed verbatim. Data were analyzed using inductive thematic analysis. COREQ and SRQR reporting guidelines were applied., Results: Most participants experienced an altered sexuality after CC treatment with often long-term loss/lack of sex drive, little/no spontaneity, limitation of positions to avoid dyspareunia, less intense orgasms, or no sexual activity at all. In some cases, emotional intimacy became more prominent. Physical (vaginal bleeding, vaginal dryness, dyspareunia, menopausal symptoms) and psychological consequences (guilt, changed self-image) were at the root of the altered sexuality. Treatment-induced menopause reduced sex drive. In premenopausal patients, treatment and/or treatment-induced menopause resulted in the sudden elimination of family planning. Most participants highlighted the need to discuss their altered sexual experience with their partner to grow together toward a new interpretation of sexuality. To facilitate this discussion, most of the participants emphasized the need for greater partner involvement by healthcare providers (HPs). The oncology nurse or sexologist was the preferred HP with whom to discuss sexual health. The preferred timing for information about the sexual consequences of treatment was at treatment completion or during early follow-up., Conclusion: Both treatment-induced physical and psychological experiences were prominent and altered sexuality. Overall, there was a need for HPs to adopt proactive patient-tailored approaches to discuss sexual health., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Infectious disease is an important health problem in border areas as there is a possibility that the migrants may carry the disease into the area. The purpose of this study is to evaluate the knowledge and behaviors toward human papillomavirus (HPV) and cervical cancer in the women of reproductive age in the Thailand-Myanmar border area., Methods: A survey study in a population of 418 women of reproductive age in Mae Hong Son Province in the Thailand-Myanmar border area. Knowledge and risk behaviors of HPV and cervical cancer were described using descriptive statistics., Results: Fifty percent of the participants had sexual debut at age less than 20 years, 27% had more than one lifetime sexual partner and only 3% had sex outside a monogamous relationship during the past 12 months. In term of knowledge, 62.5% knew about HPV. The proportion of correct answers about HPV and cervical cancer questions ranged from 14-95% and 52-94%, respectively. Among the cervical cancer screening target, 69.4% accessed the screening. The factors associated with better knowledge about HPV and cervical cancer were education level higher than high school and sexual debut., Conclusion: The women of reproductive age in the Thailand-Myanmar border areas showed relatively low sexually risk behaviors for HPV infection. More than one-third of the participants did not know about HPV. The percentage of correct answer to questions about cervical cancer were low.  We encourage the Thai Ministry of Public Health to increase health promotion and health literacy on prevention of HPV and cervical cancer in the women of pre- and reproductive age in the Thailand-Myanmar border area.

Background: Mongolia faces a significant burden of cervical cancer, with the highest prevalence of Human Papillomavirus (HPV) in the region. Cervical cancer ranks as the third most common cancer among women in the country. This study aimed to assess the acceptance of self-sampling among young women in Mongolia and evaluate their knowledge regarding HPV and cervical cancer., Methods: In this study, participants provided a self-administered vaginal swabs to detect high-risk HPV genotypes. Both acceptability of self-sampling using swabs and participants knowledge regarding HPV and cervical cancer through a scored questionnaire were assessed.  The knowledge scale was categorized into three groups: low (0-2), moderate (3-4) and high (5-6)., Results: A total of 203 women aged 24-28 years completed the questionnaire and provided self-administered vaginal swabs. The majority (95.1%) found self-sampling technique using Copan Self Vaginal FLOQSwabs® easy to perform. Additionally, 98.5% indicated that the self-swab instructions were clear and comprehensive, while 94.1% reported no pain during the process. Furthermore, 67.8% of participants expressed a preference for performing the swab in a clinic rather than at home. All respondents chose self-sampling due to greater personal privacy, tranquility, reduced anxiety and time optimization. The questionnaire results revealed an overall low level of knowledge about HPV among participants, with a mean score at 1.9 out of 6 [95%CI 1.67-2.21] and a moderate level of knowledge regarding cervical cancer risks, with a mean score at 3.7 out of 6 [95%CI 3.19-4.21]. This pattern was consistent across both vaccinated and unvaccinated cohorts, indicating a strong demand for enhanced awareness of HPV and cervical cancer., Conclusions: This study demonstrates the high acceptance of self-sampling among young women aged 24-28 years in Mongolia. However, it also  underscores a significant need for improved awareness initiatives concerning HPV and cervical cancer in Mongolia.

Objective: This study aimed to analyse the family resilience of patients with stress urinary incontinence (SUI) after cervical cancer surgery and its influencing factors., Methods: Patients with cervical cancer postoperative SUI admitted to our hospital from May 2020, to May 2023, were retrospectively selected. They were divided into low-resilience group and high-resilience group in accordance with the Family Resilience Questionnaire (FaREQ). The general demographic data of the two groups were statistically analysed, and correlation and logistic regression analyses were performed., Results: The FaREQ score of 222 patients was (93.61 ± 8.45). Amongst these patients, 21.62% scored less than 84 points, and 78.38% scored more than 84 points. Significant differences were found in the educational level, indwelling catheter time, family monthly income, religious belief, hope index, psychological resilience, family function and social support between the two groups ( p < 0.05). A significant positive correlation was observed between family resilience and the above indicators ( p < 0.05). The variance inflation coefficient values of educational level and indwelling catheter time were 15.764 and 43.766, and the tolerance values were 0.063 and 0.023, respectively. After removing them, family monthly income, religious belief, hope index, psychological resilience, family function and social support were the factors affecting the family resilience level of patients with SUI after cervical cancer surgery., Conclusions: The level of family resilience of patients with SUI after cervical cancer surgery is low. Many factors, such as family monthly income and religious belief, affect the level of resilience. Therefore, corresponding measures could be formulated in advance to improve the level of family resilience of such patients., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s).)

Objectives: Cervical cancer prevention practices are desperately low in the Caribbean. This study aims to describe the cervical cancer stigma and to evaluate the influence of the prevention practices among the Caribbean non-patient population in Jamaica, Grenada, Trinidad and Tobago. Methods: A cross-sectional study involving 1,207 participants was conducted using a culturally trans-created Cancer Stigma Scale for the Caribbean context and supplemented with questions on cervical cancer and HPV/HPV vaccine knowledge and beliefs. Data collection took place online from October 2022 to March 2023. Results: Participants are young, single, well-educated, and have stable financial resources. Over a quarter (26.4%) agreed women with cervical cancer are more isolated in their country. Almost half (47%) of respondents agreed cultural background plays a big part in how they feel about illness and getting well. One in six participants believe women with cervical cancer are treated with less respect than usual by others in their country. Conclusion: Cancer stigma of cervical cancer exists in Jamaica, Trinidad and Tobago, and Grenada. Particularly, cultural background and social norms are closely linked to stigma., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Thomas-Purcell, Bailey, Sealy, Song and Ashing.)

Anxiety is one of the most common causes of withdrawal from follow-up among women with abnormal Papanicolaou screening results. The purpose of this study was to investigate predictors of anxiety in women with abnormal Papanicolaou smear in cervical cancer screening program. A population-based, cross-sectional study concerning the factors related to anxiety was carried out during 2017 in a cohort of women ( N  = 172) with positive Papanicolaou screening test before and after diagnostic procedures (colposcopy/biopsy/endocervical curettage) at one university Clinical Center in Serbia. Women completed a socio-demographic questionnaire and scale concerning anxiety (Hospital Anxiety and Depression Scale, subscale HADS-Anxiety) immediately before and 2-4 weeks after the diagnostic procedures. Multivariate logistic regression was applied in the data analysis. In our study, 35.2% ( n  = 52) of women had abnormal anxiety scores before the diagnostic procedures and 40.1% ( n  = 69) after the diagnostic procedures. Predictors of anxiety before diagnostic procedures were family history of noncervical gynecological cancers, higher level of worry and high burden of depressive symptoms. Significant independent predictors of anxiety after diagnostic procedures in women were rural residence, tension and discomfort during medical procedures, and less satisfaction with information/support. Although there was no significant difference in the prevalence of anxiety before and after diagnostic procedures in women with abnormal Papanicolaou screening results, results of this research will enable doctors to successfully make decisions concerning timely psychological support for women with positive screening test for cervical cancer that is necessary to decrease anxiety in our population.

Objective: Endometrium and cervical cancer is a common and important health problem that affects women in many physical, emotional and psychological aspects. This study aimed to determine the levels of depression and self-esteem in women with endometrial and cervical cancer receiving chemotherapy, determine the factors affecting them, and examine the relationship between the levels of depression and self-esteem., Methods: This descriptive and cross-sectional study was conducted with 158 women who came to the gynecology-oncology policlinic and chemotherapy unit of a training and research hospital in Izmir, western Türkiye, between April 2022 and April 2023. Data were collected with the "Descriptive Information Form", "Beck Depression Inventory" and "Rosenberg Self-Esteem Scale". Descriptive and inferential statistics were performed to analyse the association between the study variables., Results: In this study, 52.5% of women were diagnosed with endometrial cancer and 47.5% with cervical cancer. Beck Depression Inventory mean total score was 11.28 ± 6.35, and 20.3% of them were at risk of depression (BDI ≥ 17). Rosenberg Self-Esteem Scale mean total score was 21.06 ± 3.85, and 97.5% of them had high self-esteem. There was a statistically significant and strong negative correlation between the mean total scores of the Beck Depression Inventory and Rosenberg Self-Esteem Scale (r = 0.723; p < 0.05). It was determined that an increase in the Rosenberg Self-Esteem Scale mean total score by 1 unit decreased the Beck Depression Inventory mean total score by 1.2 units and was responsible for 52% of the variance (B = -1.192; R 2  = 0.523)., Conclusion: It was determined that one-fifth of women experienced moderate/severe depression and the majority of them had high self-esteem. The increase in women's depression levels decreased their self-esteem. Health professionals and oncology nurses should perform screenings to determine the depression and self-esteem levels of women with endometrial and cervical cancer and provide necessary education, counseling, and care to women., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Objective: We investigated the utility of telehealth instruction versus mail-based written instruction in facilitating high-risk human papillomavirus (hrHPV) self-collection among post-menopausal patients compared with pre-menopausal patients, as well as the impact on acceptability and feasibility., Methods: We conducted a prospective, randomized study of people eligible for cervical cancer screening, stratified by menopausal status, to undergo standard written or telehealth-based instructions for hrHPV self-collection. English speaking individuals residing in Oregon, with a cervix, eligible for primary hrHPV testing, and with access to a video-capable device were included. Patients with prior hysterectomy, trachelectomy, diagnosis of cervical cancer, or pelvic radiation for gynecologic cancer were excluded. We compared preference for and opinions about self-collection and hrHPV test results, by randomization group and stratified by menopausal status using descriptive statistics., Results: Among 123 patients enrolled, 61 identified as post-menopausal with a median age of 57 years. While the majority of post-menopausal participants who received telehealth instructions found it helpful, only 6.1% considered telehealth instructions necessary to complete self-testing. There was no difference in opinion of telehealth by menopausal status. Overall, 88.5% of post-menopausal participants preferred self-collection to provider-collection. There were no significant differences between pre- and post-menopausal participants in terms of test preference, discomfort, ease of use, or perceptions of self-collection., Conclusion: Telehealth instruction did not add significant value to patients participating in hrHPV self-collection, nor did it alter the acceptability of hrHPV-self collection among an English-speaking cohort. Compared with prior experiences with provider-collected screening, hrHPV self-collection was preferred by both pre- and post-menopausal participants. There were no significant differences in preference for provider- versus self-collection when stratified by menopausal status., Competing Interests: Competing interests: Author AB is funded through an NCI K08 award and the Robert Wood Johnson Foundation. The remaining authors have no funding or conflicts of interest to disclose., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Cervical cancer (CC) has been increasing in prevalence, imposing a high economic burden, that is a serious problem for health care system, despite the success of HPV vaccination and the use of screening programs. Additionally, studies on rehabilitation programs impact on anxiety and depression in patients after CC surgery remain limited., Objective: To evaluate the level of anxiety and depression in females undergoing various rehabilitation programs in the recovery period after surgery of early-stage CC., Material and Methods: The study included 103 female patients with CC divided into 2 groups: 1) undergoing multicomponent rehabilitation (CC-1, 51 patients) and 2) undergoing rehabilitation according to the principles of approved guidelines (CC-2, 52 patients). The level of anxiety and depression was evaluated before surgery and during 36 months after surgery according to the Hospital Anxiety and Depression Scale., Results: The anxiety level before surgery was in average 10.7±3.0 scores on the HADS in the CC-1 group and 10.9±2.0 scores in the CC-2 group. It decreased up to 7.1±3.3 scores at the 3 rd month and remained within 5.6±3.4-5.4±3.5 scores in the CC-1 group, while in CC-2 group it varied between 8.0±2.1-9.6±2.3 scores throughout the study period. The depression level before surgery was 9.7±2.3 scores on the HADS in the CC-1 group and 9.9±2.8 scores in the CC-2 group. It reached 5.2±2.4 scores at the 3 rd month in the CC-1 group remaining further within the range of 5.3±2.5-5.7±2.7 scores until the 36 th month. The depression level remained in the range of 7.8±3.1-10.2±3.0 scores throughout the study period in the CC-2 group., Conclusion: Multicomponent rehabilitation led to a faster and more pronounced reduction of anxiety and depression. This confirms the necessity of such programs application in the clinical practice in recovery period after surgery of early-stage CC.

Aims: To examine the utility of the health belief model (HBM) and other socioeconomic factors in shaping cervical screening behaviors. Also, to provide recommendations on improving screening uptake., Methodology: A systematic literature search was conducted using the PubMed/MEDLINE, Cochrane/CENTRAL, and Web of Science databases for articles reporting on the factors associated with cervical screening using the HBM within the period from January of 2002 to January of 2023. Effect sizes for the various HBM constructs were pre-determined using the log odds ratio (logOR) and expressed with their confidence intervals. All reporting was in line with the PRISMA guidelines., Results: A total of 21 studies were included in the final analysis comprised of 15,365 participants. Our pooled analysis demonstrated that perceived susceptibility (OR: 1.40, 95% CI, 1.03-1.89), perceived benefits (OR: 1.30; 95% CI, 1.13-1.50), and self-efficacy (OR: 1.11; 95% CI, 1.05-1.17) were significantly associated with both the uptake of and intention to adopt preventive measures against cervical cancer. Conversely, women with higher perceptions of barriers were less likely to adopt any measure for cervical cancer screening or prevention (OR: 0.72; 95% CI, 0.57-0.91). In terms of sociodemographic effectors, older age (OR: 1.09; 95% CI, 1.01-1.19), graduate/post-graduate education (OR: 2.80; 95% CI, 1.46-5.37), higher knowledge of cervical cancer (OR: 2.21; 95% CI, 1.27-3.84), and being married (OR: 3.89; 95% CI, 1.38-10.92) were all associated with altering preventive behaviors and intentions toward cervical cancer., Conclusion: This review delineates the most important and effective cognitive components that should be targeted within interventions aiming to promote cervical cancer prevention., (© 2023 John Wiley & Sons Ltd.)

Background: HAPPY (Humanity Assurance Protocol in Interventional Radiotherapy) reports the necessity for gynecological cancer patients to undergo interventional radiotherapy (IRT, also called brachytherapy). The present paper has evaluated how some precautions may improve the psychological well-being of the patients during IRT., Methods: Patients with gynecological cancer undergoing IRT-HDR were analyzed. Patients answered three questionnaires before the IRT procedure (T0) and at the end of IRT (T1): Distress Thermometer (DT), Numerical Rating Scale for IRT procedure distress (NRS), and Hospital Anxiety and Depression Scale (HADS). Correlations have been calculated pairwise through pandas. corrwith with a Pearson algorithm, and the p-values have been calculated through scipy.stats.pearsonr. Plots have been generated through seaborn and matplotlib. A Wilcoxon test was used., Results: 55 patients were selected for this study. The median age of the patients was 64 (range, 39-84) years. 52 patients were with stage I endometrial cancer, whereas 3/3 patients with cervical cancer had locally advanced stages (IIB-IVA). 26 patients had a high education level (47.3%), and 38 were married or with a partner (69.1%). Only 14/55 (25.45%) patients were working. The HADS, DT, and NRS averages before the IRT procedure (T0) were 10.2, 3.8, and 4.3, respectively. After applying the HAPPY protocol, the HADS, DT, and NRS averages after IRT (T1) were 9.4, 3.4, and 2.6, respectively. The Wilcoxon signed rank test analysis showed a significant improvement in NRS (p < 0.00001) and HADS (p = 0.034). Living with a partner, parents or relatives was the only parameter statistically significantly associated with better DT pre-IRT (p = 0.04), HADS pre-IRT (p = 0.01), DT post-IRT (p = 0.01), and HADS post-IRT (p = 0.04)., Conclusion: In our study, the HAPPY protocol was associated with a significant reduction in patients' distress, anxiety, and discomfort., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)