Psycho‐Oncology最新文献

Aims: Digital tools offer scalable support for cancer survivors' psychological well-being, however, direct efficacy comparisons between artificial intelligence (AI)-Enhanced and clinician-guided digital interventions are scarce. This study evaluated an AI-Enhanced expressive writing intervention against clinician-guided digital support and usual care for cancer survivors.

Methods: In this randomized controlled trial, 120 cancer survivors (111 completers) were randomized (1:1:1) to AI-Enhanced, clinician-guided, or usual care groups for a 4-week expressive writing intervention. Outcomes, including depression, anxiety, fear of progression (FoP), and resilience, were assessed at baseline, post-intervention, and 1-month follow-up between September 2024 and April 2025. Data were analyzed using repeated-measures ANOVAs and thematic analysis of semi-structured interviews.

Results: Both AI and clinician-guided interventions significantly reduced depression (AI: d = 0.92; Clinician: d = 0.98) and anxiety (AI: d = 0.59; Clinician: d = 0.66) versus usual care, with comparable efficacy. However, clinician-guided support demonstrated greater efficacy in reducing FoP (d = 0.62 vs. AI). Resilience improved over time across all groups, with no significant inter-group differences. Qualitatively, AI offered reduced stigma and accessibility, while the clinician-guided approach provided valued empathetic connection.

Conclusion: AI-Enhanced expressive writing is a viable, scalable tool for reducing depression and anxiety in cancer survivors. Yet, the greater efficacy of clinician-guided digital support for complex issues like FoP highlights the value of human-mediated empathy. This advocates for hybrid models in psychological care that integrate AI's scalability with the relational depth of clinical expertise to enhance survivor well-being.

Trial registration: Chinese Clinical Trial Registry (ChiCTR2400089455).

Background: Cancer pharmacotherapy imposes substantial physical and psychosocial burdens that affect patients' quality of life (QoL). While oncologic outcomes are well studied, the psychological dimensions-particularly future perspective, emotional resilience, and body image-remain underintegrated into routine care. The growing recognition of psycho-oncology highlights the need for synergistic collaboration between oncology and clinical psychology.

Aim: To evaluate changes in QoL before and after pharmacotherapy among women with breast cancer and identify domains most vulnerable to psychological distress, thereby informing the need for integrated psycho-oncologic care.

Methods: This prospective study included 106 women with breast cancer undergoing pharmacotherapy. Sociodemographic and clinical characteristics were collected, including cancer stage, treatment modalities, and baseline cardiometabolic parameters. QoL was assessed pre- and post-treatment using EORTC QLQ-C30 and BR23 instruments. Paired comparisons were performed using Wilcoxon signed-rank tests, and correlations with age were analyzed using Spearman or Pearson methods as appropriate.

Results: Global health status declined significantly after pharmacotherapy (83.3 to 66.7; p = 0.002). Functional domains-including physical, role, and social functioning-also worsened, while emotional functioning improved modestly. Symptom burden increased across fatigue, nausea, pain, appetite loss, and systemic side effects (all p < 0.001). Breast-cancer-specific domains such as body image and future perspective showed minimal change but remained highly variable, indicating psychosocial vulnerability. Distress related to hair loss demonstrated a modest inverse correlation with age (r = -0.296; p = 0.003).

Conclusion: Pharmacotherapy substantially reduces multiple QoL domains, highlighting symptom-function trade-offs and persistent psychological concerns. The patterns in emotional functioning and future perspective indicate unmet psychosocial needs. These findings underscore the imperative for integrated psycho-oncology models to enhance holistic survivorship care.

Background: Global illness-related stigma is increasingly recognized as a formidable barrier to health-seeking behavior, engagement in care, and adherence to treatments across a range of disease conditions. Stigma is experienced by many patients with lung cancer (PwLC) in the United States; however, less is known about how lung cancer stigma operates in Nigeria.

Aims: This qualitative study was conducted to describe lung cancer stigma and examine the cultural adaptability of the conceptual model of lung cancer stigma in Nigeria.

Methods: Individual and small group interviews were conducted with PwLC (N = 16) at University College Hospital (UCH), Ibadan and at Obafemi Awolowo University Teaching Hospitals Complex (OAU), Ile-Ife.

Results: Data analyses revealed that overall, the responses mapped onto the conceptual model of lung cancer stigma and participants described their perceptions of others' stigmatizing attitudes or behaviors, consistent with "perceived stigma" as well as feelings of self-blame, guilt, shame, and regret, consistent with "internalized stigma." Participants also characterized both adaptive and maladaptive consequences of stigma, including distress/depression and constrained disclosure. Further, participants described some specific cultural contexts (moderators) that are important in understanding the landscape of lung cancer stigma in Nigeria, namely causal attributions, cancer as a spiritual attack, financial constraints, systemic delays, and non-disclosure by clinicians.

Conclusions: PwLC experience stigma in Nigeria, which may get triggered during clinical interactions with oncology care clinicians. Communication skills trainings for clinicians in empathy and compassion may help mitigate lung cancer stigma and improve quality of care for PwLC in Nigeria.

Background: Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals in the US face significant health inequities driven by structural stigma. However, the health impacts of LGBTQ+ stigma and hypervigilance among LGBTQ+ individuals who are also a cancer caregiver are understudied.

Methods: LGBTQ+ adults in the US who provided unpaid care to a cancer patient ( $\le$  3 years prior) were recruited for an online survey. Survey domains/measures included sociodemographics, State Equality Index, Sexual Stigma Scale (adapted), Riggle Hypervigilance Measure, as well as health outcomes (PROMIS anxiety, depression, sleep disturbance, and fatigue). Latent class analysis (LCA) was used to group participants based on LGBTQ+ stigma and hypervigilance scores. Multivariable linear regression models tested the association between LCA classes and each PROMIS measure.

Results: Among 332 LGBTQ+ cancer caregivers, LCA identified four distinct classes: 1. Low stigma and hypervigilance (31.0%), 2. Moderate stigma and behavioral hypervigilance (21.7%), 3. Moderate contextual hypervigilance and scanning (19.3%), and 4. High stigma and hypervigilance (28.0%). In multivariable linear regression models, class 4 was associated with a 10.43-unit higher anxiety T-score (95% CI: 7.75-13.11), a 9.61 unit higher depression T-score (95% CI: 6.67-12.54), a 9.50-unit higher sleep disturbance T-score (95% CI: 7.02-11.98), and a 12.11-unit higher fatigue T-score (95% CI: 8.88-15.35) in comparison to class 1. Similar, but lower magnitude, trends were seen across the associations of classes 2 and 3.

Conclusions: The findings of this study algin with the LGBTQ+ literature and suggest that among LGBTQ+ cancer caregivers, increased levels of LGBTQ+ stigma and the resulting hypervigilance drive health inequities.

Objectives: This study evaluated the effectiveness of a social media-based life review intervention on happiness in advanced cancer patient-caregiver dyads and explored participants' subjective experiences.

Methods: A mixed-methods design was employed in oncology wards of a medical center in northern Taiwan between September 2024 and January 2025. Sixty patient-caregiver dyads were recruited through convenience sampling and randomly assigned to an experimental (social media-based life review) or control group (standard care). Final analysis included 28 dyads in the experimental group and 29 in the control group. Quantitative data were collected at baseline and post-intervention using the Subjective Happiness Scale and analyzed with descriptive statistics, t-tests, chi-square tests, and generalized estimating equations (GEE). Qualitative data were collected through two consecutive semi-structured interviews and were analyzed thematically to explore participants' experiences of happiness.

Results: Patients in the experimental group maintained stable happiness, whereas those in the control group decline significantly (p = 0.023). Between-group differences were non-significant. Caregivers in the experimental group demonstrated a significant improvement in happiness (p = 0.025), with no change in control group. Patient happiness was positively associated with family support and self-acceptance, whereas caregiver happiness was influenced by age, family support, and patient educational. Qualitative themes were "Always being there is happiness" and "Rediscovering us through memories."

Conclusion: Social media-based life review intervention enhanced caregiver happiness and prevented decline in patient happiness, highlighting the potential of digitally mediated, family-centered interventions in advanced cancer care.

Trial registration: ClinicalTrials.gov identifier: NCT06559917.

Introduction: While surgery is considered a standard treatment for patients diagnosed with early-stage lung cancer, it often brings significant challenges for patients including functional limitations and post-operative symptoms. Family caregivers play a critical role in care coordination, post-operative management, and addressing emotional distress often with limited preparation and support. Despite their importance, few studies have assessed the interrelationship between patient and caregiver outcomes during the peri-operative period.

Methods: This study is a secondary analysis of data from a randomized controlled trial involving 190 patient-caregiver dyads who participated in a dyadic multimedia self-management intervention. Structural equation modeling (SEM) was used to evaluate the impact of various sociodemographic variables and psychosocial mediators on dyadic outcomes.

Results: Self-efficacy was a consistent predictor, with positive effects on preparedness and quality of life (QOL) and negative effects on psychological distress. While activation and knowledge were positively associated with self-efficacy and preparedness, they showed minimal effects on caregiver burden and distress. When evaluating the interdependent relationship, higher patient QOL was associated with improved caregiver preparedness and reduced burden. Caregiver distress significantly predicted greater patient distress and lower patient QOL.

Conclusions: The results of this study support the interdependent, bi-directional associations of patient and caregiver well-being. Further multi-media interventions in the peri-operative period focused on self-efficacy and promoting emotional resilience among caregivers may substantially improve post-operative outcomes for both members of the dyad.

Introduction: Patients with cancer increasingly engage in online health information seeking (OHIS), yet the impact thereof on their anxiety and uncertainty remains unclear. This study aimed to: (1) examine how, when, and why patients engage in OHIS before and after oncological consultations; (2) identify patient characteristics (sociodemographic, medical, psychological) associated with OHIS; and (3) explore the relationship between OHIS, state anxiety, and uncertainty.

Methods: Patients with various cancer diagnoses and at various phases-of-care completed three self-report questionnaires: before (T0), directly after (T1), and 2 weeks after (T2) their outpatient consultation.

Results: Half (50%) of patients (n = 281) engaged in OHIS. Commonly sought topics included physical complaints (T0: 57%, T2: 51%), chances of recovery after treatment and life expectancy (T0: 48%, T2: 47%), and common treatments (T0: 43%, T2: 33%). A stronger monitoring coping style, higher levels of trait anxiety, higher educational levels, and early phase-of-care were significantly associated with OHIS (all p < 0.01). Age, gender, health literacy, or uncertainty intolerance were not associated with OHIS (all p > 0.05). Seekers reported more uncertainty than non-seekers (p < 0.001), but OHIS was not significantly associated with state anxiety (p = 0.642).

Conclusion: One in two patients engaged in OHIS, particularly those who are recently diagnosed, highly educated, generally anxious or have a stronger monitoring coping style. Clinicians should not be concerned that patients' OHIS will increase patients' anxiety, as this study found no such association. As OHIS was associated with uncertainty, future research should explore whether addressing OHIS in consultations reduces uncertainty.

Objective: Sarcoma is a rare cancer with complex treatment phases, leaving people with sarcoma and their carers with unmet information and support needs. This review provides an evaluation of sarcoma websites internationally to inform the development of online resources for the SUN-SHINE sarcoma project, aimed at addressing the unmet needs of people with a sarcoma diagnosis.

Methods: A review of sarcoma information websites was conducted via Google search, with the first 3 pages of results of 19 searches undergoing eligibility screening. Of 95 websites yielded by the initial screening, 40 were eligible for assessment using the Flesch-Kincaid Grade Level (FKGL), Gunning-Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG) Index, and Flesch-Kincaid Reading Ease (FRE) for readability, and the Patient Education Materials Assessment Tool (PEMAT) for understandability and actionability. Readability was assessed against the Australian recommendation of grade 8 reading level for health information and higher PEMAT scores indicated greater understandability and actionability.

Results: The 40 websites reviewed were based in Europe (n = 13), Oceania (n = 12), North America (n = 10), and Asia (n = 4), with one multinational site. Websites generally contained pages on sarcoma definitions, diagnosis, and treatments, but lacked information on supportive and psychosocial care. Readability assessments exceeded (were less readable than) the general population reading level (M = 10.5; SD = 2.0). PEMAT scoring of websites revealed understandability averaging 70.7% (SD = 14.8), but lower actionability (M = 29.1%; SD = 26.4).

Conclusions: Limited sarcoma supportive care information exists, with no caregiver-focused websites and little tailoring for specific populations. Websites contained some components to support their readability, such as sub-headings and summaries, but more inclusive and accessible websites are warranted.

Objective: Lymphomas are one of the primary cancers that affect adolescents and young adults (AYAs). We examined the feasibility of two group-based interventions-one meditation-based and one education-based-for AYAs with lymphoma. We also explored their potential benefits for reducing psychological distress and cancer-related symptom burden.

Methods: Patients aged 18-39 years with lymphoma undergoing chemotherapy were randomized to either the meditation or psychoeducation intervention. Both received 5 weekly sessions (60 min each) delivered in a group setting via videoconferencing. Participants were assessed at baseline (T1), 6 weeks (T2), and 12 weeks (T3).

Results: Participants were randomized to the meditation (n = 28) or psychoeducation intervention (n = 32) with a consent rate of 51.4%. Session attendance was similar across interventions, with 60.7% in the meditation intervention and 56.3% in the psychoeducation intervention attending all 5 sessions (χ²(4) = 0.65). Assessment completion rates in the meditation intervention were 75% at T2 and 64% at T3; in the psychoeducation intervention, rates were 78% at both time points. From T1 to T3, the psychoeducation intervention showed significant improvements in cancer-related symptom severity (mean difference = 0.75, p = 0.041) and interference (mean difference = 1.07, p = 0.028).

Conclusions: Videoconference-delivered, group-based supportive care for AYAs with lymphoma during active cancer treatment appears feasible and may help reduce symptom burden or prevent further worsening of quality of life. Virtual delivery enhances accessibility and scalability across diverse clinical settings. Strategies to improve adherence and retention are needed to optimize engagement in this population.

Clinical trial registration: ClinicalTrials.gov Identifier NCT04270266.

Background: Professional grief refers to the emotional response healthcare professionals may experience following patient deaths. Although likely relevant in clinical practice, this phenomenon has been overlooked in research-particularly among psycho-oncologists. This study examined the emotional impact, coping strategies, and support needs related to professional grief in a German sample of psycho-oncologists.

Methods: A cross-sectional online survey was disseminated via professional associations and randomly selected cancer centers in Germany. Eligible participants were working in psycho-oncology and had experienced at least one patient death. The survey included two established instruments (Texas Revised Inventory of Grief-Present Feelings [TRIG-D], Professional Bereavement Scale [PBS-D]) and self-developed items on emotional responses, coping behaviors, and support needs.

Results: 258 participants (91% female; mean age 48 years) were included. Participants reported an average of three patient deaths per month and moderate overall distress (scale 0-10, M = 5.02, SD = 2.14). Scores on both grief scales were in the low to moderate range. Most participants reported positive effects of professional grief on for example their sense of purpose, with minimal impact on relationships. Common coping strategies included adopting an accepting stance and peer support. Unmet support needs were identified, particularly regarding professional training and timely communication about patient deaths.

Conclusion: This study offers the first quantitative insight into professional grief among psycho-oncologists in Germany. Professional grief levels were low to moderate. The reported positive changes suggest that patient deaths may even pose a chance for professional growth. Future research should explore relevant risk and protective factors to guide targeted support.