European Journal of Cancer Care最新文献

Purpose

To conduct an integrated systematic literature review to explore (1) the presence and impact of stigma surrounding palliative care (PC) in Oncology particularly related to the care of adults with advanced cancer and (2) how Oncology healthcare providers (OHCPs) may contribute and perpetuate PC stigma, a factor associated with the underutilization of PC.

Methods

A comprehensive search was conducted in four major databases using PRISMA guidelines. Thirty-two articles met the inclusion criteria focused on the perspectives of PC by OHCPs who treat adults with advanced cancer. Guided by Goffman’s Theory of Stigma, articles were iteratively reviewed and stigma-related themes were generated.

Results

Six major themes emerged defining the concept of Oncology PC stigma and were categorized into two groups, which Goffman labels as “stigmatized” and “stigmatizers.” Assumptions, fear, and discomfort are the three common perceptions OHCPs which drive their behaviors as the stigmatizers. Avoidance, undesired differentness, and negative association with the term “palliative care” are the three reoccurring behaviors and perceptions seen in adults with advanced-stage cancer, who are the stigmatized. A novel conceptual framework is presented with these six major characteristics of Oncology PC stigma with their corresponding outcomes.

Conclusion

Societal stigma associated with PC in Oncology is pervasive and driven by behaviors and perceptions of not only patients and their families who are reluctant to use PC but OHCPs themselves. Findings underscore the need for interventions that address OHCP’s lack of understanding about how their own perceptions and behaviors may impact patient PC utilization and outcomes.

Background

Colorectal cancer (CRC) ranks among the most prevalent forms of cancer and is a significant contributor to cancer-related mortality globally. Platelets play a crucial role in tumor biology by interacting with various immune cells, influencing multiple biological processes.

Methods

We utilized datasets from TCGA, GSE17536, GSE39582, and GSE103479 to develop a platelet-related gene signature (PRS) using least absolute shrinkage and selection operator (LASSO) analysis. The effectiveness of PRS in predicting responses to immunotherapy was assessed using three immunotherapy datasets (GSE91061, GSE78220, and IMvigor210) and several predictive scores.

Results

The PRS demonstrated robust performance in forecasting the survival outcomes of CRC patients. In the TCGA cohort, the areas under the ROC curves for 1-, 3-, and 5-year survival were 0.845, 0.849, and 0.785, respectively. Further analysis identified PRS as an independent risk factor for CRC patients. A nomogram was constructed to predict clinical outcomes for CRC patients. Additionally, a lower PRS score was associated with higher TMB scores, elevated PD1 and CTLA4 immunopheno scores, reduced TIDE and immune escape scores, higher response rates, and more favorable clinical outcomes, suggesting better immunotherapy responses. Conversely, lower PRS scores correlated with increased IC₅₀ values for certain drugs used in chemotherapy and targeted therapy. Patients in the high-risk group exhibited elevated gene set scores related to cancer hallmarks such as Notch signaling, hypoxia, and glycolysis.

Conclusion

Our study established a PRS for CRC that serves as a valuable tool for predicting prognosis, stratifying risk, and guiding treatment decisions for CRC patients.

Background

Prostate cancer is among the most common malignancies worldwide and a leading cause of premature mortality in men. Although survival rates have improved globally, disparities persist. Here, we aim to analyze the risk factors associated with prostate cancer-specific mortality among patients in a southeastern Brazilian state.

Methods

We conducted a retrospective cohort study using data from 10,556 patients diagnosed with prostate cancer between 2000 and 2016. Data were extracted from hospital-based cancer registries linked to the state Mortality Information System. Patients were followed up for a minimum of 5 years and classified as alive, deceased from prostate cancer, or deceased from other causes. Subdistribution hazard ratios (SHRs) were estimated using Fine–Gray competing-risks models.

Results

By the end of 2021, 6388 patients were alive, 1936 had died from prostate cancer, and 2232 had died from other causes. Older age increased prostate cancer-specific mortality (SHR per 10 year increment = 1.098; 95% CI: 1.024–1.176), while distant metastasis was the strongest clinical predictor (SHR = 5.315; 95% CI: 4.676–6.041). Higher educational attainment remained statistically associated with lower prostate cancer-specific mortality in the multivariable competing-risks model (SHR = 0.767; 95% CI: 0.629–0.935), although the protective effect was attenuated after adjustment. Surgery (SHR = 0.382; 95% CI: 0.309–0.471) and radiotherapy (SHR = 0.477; 95% CI: 0.396–0.575) were also associated with lower cancer-specific mortality, while hormone therapy remained associated with higher mortality, reflecting treatment selection among patients with a more advanced disease rather than a causal treatment effect.

Conclusion

Age, education, metastatic disease, and treatment modalities were significantly associated with prostate cancer-specific mortality. These findings reinforce the importance for equitable access to early diagnosis pathways and curative treatment options and highlight the value of competing-risks methods for accurately estimating prostate cancer outcomes in population-based settings.

Background

The return to work (RTW) is critical for physical, psychosocial, and financial wellbeing and the normalization of breast cancer (BC) survivors. While research indicates that these survivors experience several barriers to the RTW after treatment, limited knowledge exists on preparing the RTW during treatment from women’s perspectives.

Objective

To explore the experiences of women with BC preparing their RTW during cancer treatment.

Methods

A qualitative, inductive study was performed and 21 BC survivors with experience from RTW were interviewed individually. Qualitative content analysis was used to analyze the interviews.

Results

Most participants believed that their RTW would be unproblematic. They used all their energy to remain hopeful. Losing value as a human being and as an employee was a painful experience. The need for support to keep hope alive and nurture their feelings of value was described as crucial.

Conclusions

Feelings of hope and value were sustained through positive contact with the workplace, receipt of realistic information on the RTW, continuity of treatment and care, experiencing active listening from healthcare providers, and receipt of information about and coordination of support services.

Implications for practice

HCPs should inform BC survivors that their disease may have long-term side effects and is a burden that may affect their work life and cause cognitive and psychological distress.

HCPs must strive to provide continuity and individualized information during treatment regarding optimal use of the sick leave system, legal rights, support service, contact with work, and individualized RTW planning.

Background

Esophageal cancer (EC) is a leading cause of cancer-related deaths globally, with South Asia bearing a particularly high disease burden. While ¹⁸F-FDG PET/CT-derived SUV-max values are explored for their prognostic relevance, previous findings remain inconsistent, and data from South Asian populations are limited.

Methods

This retrospective study analyzed data from 42 biopsy-confirmed EC patients treated between June 2019 and December 2024 at a tertiary care center. All included patients had initially received standardized neoadjuvant chemoradiotherapy and underwent both pre- and posttreatment 18F-FDG PET/CT imaging. Associations between clinicopathological factors and survival status were evaluated using the independent t-test, Chi-square test, and Fisher’s exact test. Receiver operating characteristic (ROC) analysis was performed to determine optimal SUV-max cutoffs. Survival outcomes were assessed using Kaplan–Meier estimates, log-rank test, and Cox proportional hazards regression to identify independent predictors of mortality.

Results

Kaplan–Meier analysis showed significantly reduced survival in patients with elevated nodal SUV-max values both pre- and posttreatment. In multivariate Cox regression, posttreatment nodal SUV-max was the strongest independent predictor of mortality (HR = 52.9, p = 0.012), followed by pretreatment nodal SUV-max (HR = 15.3, p = 0.034), while tumor SUV-max values (pre- and posttreatment) did not demonstrate independent prognostic significance.

Conclusions

Nodal SUV-max on PET/CT is a strong, independent predictor of survival in EC and may effectively guide personalized treatment decisions.

Background

Colorectal cancer reported the fourth most common cancer in Iran. The aim of this study was to describe the time trends of colorectal cancer mortality from 1990 to 2021, focusing on the effects of age, period, and cohort.

Method

Our data included the number of colorectal cancer deaths and population recorded by the global burden of disease (GBD) and categorized by 5-year age groups from 1990 to 2021. Joinpoint regression and the age–period–cohort (APC) model were used to reflect temporal trend and effects of age, period, and cohort on colorectal cancer mortality, respectively.

Results

The crude mortality rate of colorectal cancer was significantly increased in men, with an average annual percentage change (AAPC) of 1.558% (95% confidence interval [CI]: 1.398%, 1.778%), while the crude mortality rate increased (AAPC = 1.340%; 95% CI: 1.215%, 1.465%) and the age-standardized mortality rate decreased in women (AAPC = −0.307%; 95% CI: −0.460%, −0.152%). APC analysis showed that the risk of death increased with age in both genders (Coef_15–19 = −2.823 vs. Coef_> 95 = 1.731 in men and Coef_15–19 = −2.628 vs. Coef_> 95 = 1.964 in women) and time (Coef_1992–1996 = −0.385 vs. Coef_2017–2021 = 0.438 in men and Coef_1992–1996 = −0.271 vs. Coef_2017–2021 = 0.380 in women) and was lower in later-born cohort (Coef_2002–2006 = −1.590 in men and Coef_2002–2006 = −1.543 in women) than earlier-born cohort (Coef_< 1901 = 1.458 in men and Coef_< 1901 = 1.208 in women).

Conclusions

Due to the increasing trend from colorectal cancer mortality and age and period effects, it seems necessary to modify early detection strategies and increase public awareness to reduce the burden of this cancer.

Aim

This study was conducted to examine the emotional experiences of lung cancer patients.

Methods

This study, carried out with an intervention design, is a mixed-method study in two parts. The qualitative part of the mixed method was enriched with photovoice methodology. The study used a criterion sampling technique, and 17 participants were interviewed. Some scales collected quantitative data from the survey, and qualitative data were collected through “semistructured interviews” and “photographs.”

Results

The themes in the first part are “meeting with cancer and a new life.” The second part determines the “range of emotions, the world through my window, and perspective.” The study revealed in striking detail that lung cancer patients experience many different emotions simultaneously. There was no significant difference in the scale mean scores of the participants.

Conclusion

Phototherapy is essential for revealing lung cancer patients’ emotions and concentrating on positive emotions. Cancer nurses can also add phototherapy as a simple, feasible, and accessible method of caring for lung cancer patients. Thus, lung cancer patients can participate in life through the photographs they take.

Objective

To explore the decision-making conflicts regarding vascular access devices in Chinese breast cancer patients undergoing chemotherapy and the influencing factors.

Design

A multicenter cross-sectional survey study.

Method

A total of 308 breast cancer patients undergoing chemotherapy were included. Questionnaires were conducted using a general information questionnaire, the Chinese version of the Decision Conflict Scale, the Decision Participation Expectation Scale, and the Decision Preparation Scale. Multivariate linear regression analysis was used to investigate the influencing factors of decision conflict regarding vascular access devices in breast cancer patients undergoing chemotherapy.

Result

The level of decision conflict in the patients was relatively high, with a score of 40.88 ± 9.64, significantly higher than the critical value of 37.5. During the decision-making process of the patients, 162 cases (52.6%) tended to share the decision with the doctor, but in the actual participation process, 105 cases (34.9%) made the decision passively. There were a negative correlation between patient decision conflict and decision preparation and a positive correlation between patient decision conflict and decision participation. Age, unmarried status, average monthly family income, understanding of the disease, understanding of vascular access, and decision preparation were the main influencing factors of decision conflict.

Conclusion

There is a discrepancy between the expected decision-making for vascular access devices among Chinese breast cancer chemotherapy patients and the actual participation. The level of decision conflicts is relatively high, and it is influenced by multiple factors. Medical staff should enhance communication with patients, respect their decision preferences, develop decision support tools, provide appropriate decision support to patients, reduce decision conflicts, and minimize decision regret.

Objective

This study aimed to construct interpretable machine learning models to predict family intimacy in cancer patients and identify the most influential predictors through SHAP-based analysis.

Methods

A total of 259 cancer patients were surveyed. The data cleaning process involved handling missing values, normalizing continuous variables, and applying one-hot encoding to categorical variables. Statistically significant sociodemographic variables (age, marital status, education, and income) and psychosocial attributes (self-esteem and three resilience subdimensions: tenacity, strength, and optimism) were selected using LASSO regression. Four regression models—gradient boosting (GB), random forest (RF), XGBoost (XGB), and decision tree (DT)—were trained and evaluated using R², mean-squared error (MSE), and mean absolute percentage error (MAPE).SHapley Additive exPlanations (SHAP) was used to interpret the GB model.

Results

The GB model achieved the best predictive performance (R² = 0.6985, MSE = 0.2405), followed by XGB (R² = 0.6794), RF (R² = 0.6653), and DT (R² = 0.5912). SHAP analysis revealed that psychological variables—tenacity, strength, and self-esteem—were the most influential predictors, all exerting strong positive effects. Age group and education showed moderate impact, while income, gender, and marital status contributed minimally.

Conclusion

Gradient boosting offers a robust and interpretable framework for predicting family intimacy in cancer patients. Positive psychological resources—especially resilience and self-esteem—outperform traditional demographics as a predictive foundation, highlighting their clinical significance in survivorship care planning.

Background and Objectives

Breast cancer patients are at high risk of malnourishment. However, data concerning the nutritional status of breast cancer patients are very limited. We aimed to assess the nutritional status and diet of women diagnosed with breast cancer.

Methods

A total of 32 women diagnosed with breast cancer were included in this cross-sectional study. Patients were recruited via an online survey that was distributed in multiple social media applications as well as shared in oncology clinics. Demographic data were collected via the online survey, while dietary data were collected during a phone interview.

Results

Prevalence of overweight and obesity among study samples was 18.8% and 56.3%, respectively. Only 18.8% of the patients reported visiting a dietitian, while 59.4% of the patients met the recommendation of free sugar intake of < 5%. Most of the patients (81%) did not meet their energy requirements, whereas none of the patients met their protein requirement. Diet quality score and dietary intake were not associated with dietitian visit or stages of breast cancer. Stepwise regression analysis indicated significant association between iron intake and weight status (B = −1.56, SE = 0.69, and [95% confidence interval (CI): −2.97–−0.15]). Results also indicated that age and percentage of free sugar from total energy predicted BMI of patients (age: B = 0.20, SE = 0.08, and [95% CI: 0.06–035]; percent of free sugar: B = 0.66, SE = 0.24, and [95% CI: 0.18–1.15]). Weight status was significantly associated with adequacy of energy intake.

Conclusions

High prevalence of overweight and obesity, high intake of free sugar, and limited intake of protein were observed among women diagnosed with breast cancer. There is an urgent need to provide nutritional care for breast cancer patients in Saudi Arabia that is delivered by experienced dietitian to improve the nutritional status of these patients.