European Journal of Cancer Care最新文献

Purpose: To improve the understanding of what influences the motivation of children and adolescents diagnosed with cancer to engage in exercise during the first six months of treatment.

Materials and Methods: Qualitative design using semistructured interviews with children (6–17 years) diagnosed with cancer (n = 12) and their parents (n = 12). A deductive thematic analysis based on self-determination theory was applied.

Results: Three predefined themes described different aspects of motivation for exercise during treatment.

Amotivation: Treatment-related illness and fatigue causing amotivation was described as a dominant barrier. Exercise driven by negative reinforcements facilitated short-term exercise engagement but was perceived as amotivation.

Controlled Regulation: Exercise regulated by exercise professionals could facilitate and introject positive experiences with exercise (i.e., ameliorated side effects) and create confidence in physical capabilities.

Autonomous Self-Regulation: An autonomy-supportive approach using cocreation and age-appropriate and treatment-regulated exercise, facilitated trust, and confidentiality with exercise professionals.

Conclusion: Motivation for exercise is a dynamic interplay that can be facilitated or negatively affected by treatment, parents, peers, and external regulation. Exercise interventions should use an individual and autonomy-supportive approach, encompassing treatment-related daily variations of physical capacity. Externally regulated motivation can facilitate exercise on a short-term basis when children are inactive or hesitant to engage in exercise.

Background and Objective: Managing diabetes in cancer patients presents unique challenges, necessitating effective self-intervention strategies. The research aimed to evaluate self-intervention behaviors in diabetic cancer patients. The Information-Motivation-Behavioral Skills (IMB) paradigm serves as the guidance.

Methods: This qualitative cross-sectional investigation was conducted in general hospitals throughout China from March 14 to April 25, 2024. It involved 300 patients diagnosed with cancer and type 2 diabetes, using a structured questionnaire to assess diabetes knowledge, self-management behaviors, family support, and self-efficacy.

Outcomes: The participants had a mean age of 69.14 ± 23.04 years, with a diabetes duration of 23 ± 7.7 years. The research discovered notable variations in medical evaluations and self-management practices (such as retinal examinations and blood pressure checks) (p < 0.05). Family assistance had a mean score of 16.60 ± 7.40 (p = 0.029), and knowledge of diabetes scored 11.40 ± 4.25 (p < 0.001). Additionally, diabetes-related emergencies, skin infections, and heart incidents increased significantly during the year following a cancer diagnosis.

Conclusion: The research highlights the complexity of diabetes treatment for cancer patients and underscores the necessity of focused interventions to enhance self-monitoring and capitalize on family support.

Introduction: Haematopoietic stem cell transplantation (HSCT) recipients and their caregivers may experience psychological distress. This study aimed to evaluate anxiety and depression in patients and caregivers throughout the HSCT process. As a secondary objective, we explored the association between anxiety and depression in patient and caregiver over the same period and compared anxiety and depression according to sociodemographic factors and whether HSCT was homebound or hospitalised.

Methodology: Longitudinal descriptive study. Seventy-two HSCT patients and their caregivers were consecutively included at a Spanish hospital between October 2019 and February 2021. The HADS instrument was used to assess anxiety and depression at six time-points, including pre-HSCT, the acute period and one-year follow-up. An adjusted linear mixed model assessed variable changes over time-points and a correlational analysis evaluated the relationship between anxiety and depression. To detect differences between groups over time, a linear mixed model was adjusted.

Results: Participants’ anxiety levels were high at all time-points and consistently higher among caregivers than patients. Patients and caregivers’ depression levels were low pre-HSCT and increased significantly during hospitalisation. Patients’ depression decreased during follow-up but remained stable among caregivers. We observed moderate positive correlations between patient and caregiver anxiety or depression at all time-points except pre-HSCT. Caring for other dependents increased depression in patients and being female increased both anxiety and depression in caregivers. Residing in social housing increased patient anxiety and depression and caregiver depression.

Conclusions: Diverging trajectories for patient and caregiver anxiety and depression were observed. Caregivers showed higher levels of anxiety than patients throughout the HSCT process and higher levels of depression from 3 months after HSCT. Admission was a critical time that increased depression in both. This study supports the need for new intervention approaches in prevention, early detection and treatment of anxiety and depression in patients receiving HSCT and their caregivers.

Objective: In the context of serious illnesses, such as cancer, effective communication is vital. This study explores how registered nurses (RNs), medical doctors (MDs), and professional interpreters (PIs) experience communication in cancer care with patients who have limited proficiency in the dominant language.

Methods: A phenomenological-hermeneutic approach was employed using focus group interviews. A total of 23 informants participated and were divided into six groups: three groups of nurses, two groups of doctors, and one group of interpreters. All interviews were audio-recorded and transcribed verbatim, with Paul Ricoeur’s critical hermeneutics serving as the theoretical framework for analysis and interpretation.

Results: The overarching theme identified was Communication as an Unequal Game, with three subthemes: (1) Communicating on unequal terms, (2) Lack of agreed roles and shared rules, and (3) Missing opportunities as an invisible consequence. The findings reveal an experience across professions of being at a disadvantage from the start due to strict time constraints and lack of access to essential knowledge. Differing views on the roles of interpreters, including whether they should act as robots or engage as human beings, further complicate communication. Without clearly agreed-upon roles and shared rules, decisions about briefing or booking interpreters come to rely on individual perceptions, leading to inconsistent practices and communication inequalities among professional groups. The findings highlight the less visible consequences of language barriers in healthcare encounters, including lack of treatment options being presented to patients and the mental and physical withdrawal of nurses when no interpreters are available to facilitate verbal communication.

Conclusion: While it is necessary to embrace the inherent complexity of language-discordant communication, it is equally important to establish a more level and stable “playing field,” including targeted interprofessional collaboration. In the current unequal game of communication, language barriers not only impede effective communication but also make choices—and care—disappear.

Background: Breast cancer patients often undergo artificial vascular implantation for long-term intravenous therapies, which can significantly impact their quality of life (QoL). While vascular access is critical for treatment, the relationship between artificial vascular implantation and QoL outcomes remains underexplored. Understanding the factors influencing QoL after implantation, such as patient demographics, disease characteristics, and treatment protocols, is essential for optimizing patient care and improving recovery.

Objectives: This research investigated the impact of artificial vascular implantation on the QoL in patients with breast cancer.

Sample and Setting: A case-control study design was utilized in this research. Data collection was conducted from January 1, 2023, to June 31, 2023, encompassing 120 patients diagnosed with breast cancer who had undergone artificial vascular implantation within the previous three years of Zuoying Armed Forces General Hospital in Taiwan.

Methods: Data acquisition was executed via questionnaires, followed by analysis employing descriptive statistics and multivariate regression to facilitate inferential statistical assessments.

Results: Breast cancer patients with hypertension (β = −0.612) have a lower QoL after artificial in breast cancer patients after artificial vascular implantation.

Conclusions: This research underscores the potential advantages of artificial blood vessel implantation, not only in terms of medical outcomes but also in enhancing patients’ daily lives. However, breast cancer patients with hypertension experience a lower QoL after the procedure. Future studies should address the current limitations and further investigate the long-term effects of this procedure on cancer survivors, with the goal of improving their treatment experiences and overall well-being.

Background: Geriatric assessments (GAs) can guide treatment decision-making for older adults with cancer and identify those at risk of treatment complications. Given the number of systematic reviews conducted in the last 10 years, this umbrella review aimed to summarise and synthesise the evidence for (i) what constitutes a GA in cancer care, (ii) how GAs are conducted, and (iii) how implementation of GAs in cancer settings are reported.

Methods: PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Library and Web of Science databases were searched and updated in September 2024. Systematic reviews with or without meta-analyses that (i) described the use or value of GA for older adults with cancer, or (ii) information related to GA implementation in cancer settings were included in this review. Quality of the reviews were assessed using the AMSTAR-2 tool, and results were descriptively summarised using a narrative synthesis.

Results: Twenty-nine reviews were included. A GA was commonly defined as a systematic, multidimensional evaluation of an older person. Recommendation for domains included within the GA differed across reviews. However, commonly reported domains and tools across reviews broadly mapped to the National Comprehensive Cancer Network guideline recommendations. Fifteen reviews specified timing of GA; most reported assessments were performed prior to treatment and administered by a range of individuals including patient themselves, the multi-disciplinary team, individual nurse or cancer specialists or geriatrician-led consultation or assessments. Barriers and enablers to GA implementation were discussed in three reviews. Four reviews described GA feasibility, primarily reporting patient acceptability of self-administered or computer-based assessments.

Discussion: Heterogeneity across reviews in GA definition could impact on perceived feasibility of GA implementation. Standardisation of GA domains is required to facilitate evidence-based research and to guide integration of GA and GA-based interventions within cancer settings.

This study aimed to examine the correlation between Ki-67 expression and clinicopathological features of oral and oropharyngeal squamous cell carcinoma (OSCC/OPSCC), evaluate the prognostic value of Ki-67, and develop a prognostic model incorporating Ki-67 expression. A total of 469 patients diagnosed with OSCC/OPSCC, hospitalized between 2012 and 2022, were included. Patients’ surgical specimens were subjected to immunohistochemical staining to determine their Ki-67 expression. Clinicopathological data of patients were also collected. Patients exhibiting male sex, poor pathological differentiation, advanced TNM stage, and metastasis demonstrated elevated levels of Ki-67 expression. Age and recurrence did not affect that. According to the Cox proportional hazards model, Ki-67, age, recurrence, metastasis, and primary tumor site were identified as independent risk factors for patient prognosis. Kaplan–Meier survival analysis indicated that the higher the Ki-67 expression, the shorter the patients’ overall survival. A prognostic model using independent risk factors was developed. The model was presented as a nomogram with a c-index of 0.768. The calibration curve also showed a good predictive performance of the model. This study confirmed the prognostic significance of Ki-67 expression in OSCC/OPSCC. A prognostic prediction model that incorporated Ki-67 expression was developed, providing a new tool for predicting patient prognosis in clinical practice.

Introduction: Cancer survivors with adequate social support often show increased motivation to return to work. While prior research has explored the determinants of return to work among cancer survivors, there is a paucity of studies focusing on public attitudes toward their reintegration into the workplace, particularly those attitudes shaped by social and cultural factors.

Methods: This study is qualitative, grounded in social support theory. We employed a semistructured interview approach to engage 28 public members in Jiangsu Province. Data were analyzed thematically using both inductive and deductive methods.

Results: The public attitudes toward cancer survivors returning to work encompass six themes and twelve subthemes: (1) work ability (ability diminished and changing jobs or positions), (2) health status (enhancing physical and mental health and adverse effects on physical and mental health), (3) support system (policy support, employer’s support, and colleague and family support), (4) returning to family, (5) self-realization (self-reconstruction and physical and mental reintegration), and (6) pressure from colleagues and leaders (interpersonal relationship pressure and psychological burden).

Conclusion: The public exhibits a range of complex and diverse attitudes toward cancer survivors resuming employment, influenced by underlying social, cultural, and psychological factors. While there is widespread understanding and support, concerns and anxiety also persist. This multifaceted perspective mirrors the intricate perceptions of cancer and its ramifications. Nurses play a critical role in facilitating the reintegration of cancer survivors into the workforce by identifying factors that either facilitate or impede this process. By recognizing and addressing these factors, nurses can significantly support the return to work of cancer survivors.

Purpose: Due to the fact that a significant proportion of cancer cases occur in children and women of reproductive age, fertility preservation (FP) has become an increasingly important issue. Presenting the experiences of women who undergo these treatments from a holistic perspective will contribute to clinical practice. Most studies in the literature focus on the decision-making process. Departing from the predominant focus of previous studies on the decision-making phase, this study aims to provide an in-depth understanding of the emotional responses, challenges, and support mechanisms experienced by women throughout the entire FP process.

Methods: This descriptive qualitative study was conducted with 12 women diagnosed with cancer who underwent FP approaches. Data were collected via in-depth semistructured face-to-face interviews and concurrently analyzed via conventional content analysis.

Results: The experiences of women undergoing the FP process were categorized into five main themes and 17 subthemes: the emotional impact of cancer diagnosis and the threat of fertility loss (initial shock and grief, psychological burden, and changing priorities), factors influencing decision-making (doctor’s advice, limited information and awareness, personal values and beliefs, and partner and family support), challenges encountered during FP (side effects, financial burden, logistical difficulties, and challenges faced by single women), support from healthcare professionals (importance of communication and information, emotional support and empathy, and need for psychological support), and hope of having children (optimism and empowerment, changing perspectives on motherhood, and acceptance of uncertainty).

Conclusion: Our study has provided insights into significant issues such as the decision-making process, treatment process, and emotional outcomes related to FP approaches in women with cancer.

Implications for Practice: The findings of this study highlight the need for patient-centered fertility counseling for women with cancer. Healthcare providers should offer timely and individualized information, ensure emotional support throughout the FP process, and incorporate psychosocial care into routine oncology and reproductive services.

Background: Unfavorable patient–professional and interprofessional communication have been identified as barriers to guideline-oriented, effective care of cancer-related fatigue (CRF).

Objectives: To illuminate these interactional challenges, this study aimed to explore the perceptions of healthcare professionals (HCPs) regarding (a) handling patients with CRF, (b) challenges in patients’ everyday life, and (c) suggestions to improve CRF management.

Methods: Two focus groups were recruited at the University Hospital Würzburg, Germany. Participants were HCPs working with cancer patients in the fields of medicine (n = 4), nursing (n = 3), and psycho-oncology (n = 4). Data were subjected to qualitative content analysis.

Results: A circular model was generated, illustrating the potential interaction between HCPs and patients with CRF from the HCP perspective. Concerns of HCPs, such as low self-efficacy in counseling on CRF and feelings of inadequacy through lack of feedback, interplay with patients’ suffering, resulting frustration, and pressure of expectation among others. This complicates empathic exchange, which HCPs actually highlight to meet patients’ needs and realize effective CRF management. To improve CRF management, HCPs suggested implementing standardized operating procedures to clarify responsibilities and to promote interprofessional collaboration in CRF care. Further, they expressed the need for professional training on CRF and on how to communicate with patients in this respect. Additionally, HCPs pointed out the necessity of cultivating reflective practice as HCPs to enhance empathy toward patients presenting CRF.

Conclusions: The interprofessional focus-group discussions improved our understanding of the challenges HCPs may perceive in managing CRF, outlined tasks on the institutional level to be addressed in the future, and provided suggestions for immediate adjustments on the individual level.

Trial Registration: ClinicalTrials.gov identifier: NCT04921644