Psycho‐Oncology最新文献

Background: Fear of cancer recurrence (FCR) is a major psychological burden for breast cancer survivors, impairing daily functioning and quality of life. Fear of Recurrence Therapy (FORT), a cognitive-behavioral group intervention, has shown efficacy in Western settings. This study evaluated the effectiveness of an adapted FORT program in Turkish breast cancer survivors.

Methods: A single-blind, parallel-group randomized controlled trial was conducted between February and March 2025. Stage I-III survivors within 5 years post-treatment (N = 100) were randomized (1:1) to FORT or a CBT-based intervention. Both interventions comprised six weekly online sessions; however, the adapted version of FORT program was extended to 150 min per session, while the CBT group maintained 120-min sessions. The primary outcome was FCR (Fear of Cancer Recurrence Inventory). Secondary outcomes were anxiety and depression (HADS), distress (Emotion Thermometer), quality of life (EORTC QLQ-C30), intolerance of uncertainty (IUS-12), self-efficacy (SEMCD), and coping skills (CCQ). Analyses followed intention-to-treat (ITT) and per-protocol (PP) principles.

Results: ITT analysis showed significant reductions in FCR in both groups; the ANCOVA-adjusted mean difference favoring FORT was -5.99 points (95% CI -10.95 to -1.03, p = 0.018, partial ω² = 0.047). Between-group differences favored FORT on FCRI subscales (triggers, metacognitions, emotion-focused coping) and intolerance of uncertainty (F(1,95) = 2.174, p = 0.032). PP analysis indicated additional benefits for anxiety (F(1,84) = 5.735, p = 0.019), depression (t = -2.174, p = 0.032), and functional quality of life (z = -2.079, p = 0.038). Adherence was high, with most participants completing all sessions.

Conclusions: Adapted FORT reduced FCR and psychological distress among Turkish survivors. Its effective online delivery demonstrates feasibility and scalability, supporting integration into psycho-oncological care.

Trial registration: NCT06676228.

Background: Rural residents are more likely to be caregivers and face significant burdens in caring for cancer patients. Rural caregivers can benefit from tailored interventions addressing their unique and complex needs.

Aims: This single-arm study evaluated the feasibility, acceptability, and preliminary outcomes of an adapted social support intervention, enCompass Carolina, for caregivers of rural cancer patients.

Methods: EnCompass Carolina is an 8-week one-on-one caregiver coaching program paired with a web-based support mapping tool (Clinical Trials #NCT05828927). Caregivers were recruited via patients treated in infusion clinics. Caregiver outcomes captured at enrollment, 4 weeks, and 8 weeks included coping self-efficacy, burden, anxiety, depression, and social support. Patient outcomes captured at enrollment and 8 weeks were anxiety, depression, and distress. Feasibility was measured using caregiver participation and completion rates and acceptability ratings. Generalized estimating equation methods accounted for repeated measures per person and were used to evaluate scores over time.

Results: Of 137 invited caregivers, 59 (44%) participated. 73% were female, 79% were non-Hispanic White, and average age was 60. 52 caregivers completed the support tool and 1+ coaching session, 46 (78%) completed post-intervention measures at 4 weeks, and 44 (75%) completed post-intervention measures at 8 weeks. Average acceptability ratings were 4.6 out of 5. Caregiver coping self-efficacy, anxiety, and depression significantly improved from pre-to post-intervention. No significant effects were seen on caregiver burden, support, or patient outcomes.

Conclusions: This one-on-one caregiver coaching program is feasible and acceptable for rural cancer caregivers, and it appears to be a promising intervention suitable for efficacy testing in future larger studies.

Background: Childhood cancer is highly stressful and potentially traumatic for families. While trauma-informed care (TIC) aims to address these impacts, little is known about how pediatric oncology nurses understand and use TIC in practice.

Method: This study was conducted using a qualitative descriptive design to explore pediatric oncology nurses' perceptions of trauma and trauma-informed care. Fifteen nurses with at least 1 year of experience working in a pediatric oncology unit in a city hospital in Türkiye were recruited through purposive sampling. Data were collected between June and July 2025 through face-to-face interviews using a semi-structured interview guide based on the Trauma-Informed Care Pyramid, and analyzed using Braun and Clarke's six-phase thematic analysis approach.

Results: Five major themes were identified: (1) family- and child-centered communication and care, (2) understanding the health effects of trauma, (3) interprofessional collaboration, (4) understanding one's own history and reactions, and (5) screening and evaluation processes. Additionally, metaphor analysis revealed that nurses frequently described trauma as destructive objects, dark colors, natural disasters, harsh seasons, and bitter tastes underscoring perceptions of trauma as overwhelming and difficult to endure. These findings highlight both the potential for TIC integration and the current gaps in systematic training and organizational support.

Conclusion: Pediatric oncology nurses recognize the effects of trauma and the need for psychosocial care, yet structured TIC practices remain limited. Integrating TIC principles into nursing education, strengthening team collaboration, and implementing systematic screening are key to improving holistic, family-centered care.

Aims: To explore patterns of medical service and medication use for mental health in women with breast cancer (BC) pre- and post-diagnosis.

Methods: Population-based South Australian Cancer Registry linked with medical services and medication prescriptions data for all women with BC diagnosed between April/2013 and March/2014. The patterns of medication and medical service use for mental health were examined in 1-yearly intervals between 1-year before and 5-years after BC diagnosis. Generalised estimating equations models with binary logistic distribution were used to examine characteristics associated with medication and medical service use for mental health.

Results: Data of 1143 women were analysed. The proportion of people who had a prescribed medication for mental health increased from 23% 1-year pre-diagnosis to 29% in the first year of diagnosis and remained stable at 29%-30% throughout 5 years post-diagnosis. The prevalence of medical service use for mental health increased from 7% 1-year pre-diagnosis to 13% in the first year of diagnosis, although the percentage decreased gradually over time post-diagnosis. A higher burden of comorbidity and time period after BC diagnosis were associated with increased likelihood for medication and medical service use for mental health, while older age, residing outside of major cities and receipt of radiotherapy were associated with decreased likelihood of mental health service use.

Conclusion: There is an apparent increase in medical service and medication use for mental health in the first year of BC diagnosis. These findings support the importance of early mental health screening to identify at-risk individuals for targeted intervention.

Aim: This study aimed to identify individual variability in day-to-day physical activity (PA) and sedentary behavior (SB) as well as effects of pain, fatigue, and well-being among patients with head and neck cancer (pwHNC) on both movement behaviors.

Methods: A total of 52 pwHNC (age ≥ 18 years, participation rate 73.2%) consented to wear an accelerometer during waking hours for seven consecutive days and to answer questionnaires. Applying a predefined accelerometer protocol resulted in a final analysis sample of 41 pwHNC. A dynamic structural equation modeling approach (DSEM) was employed that combines time series modeling and multilevel modeling. At the within-person level, autoregressive and bidirectional relationships between PA and SB were analyzed. At the between-person level, moderator effects of pain, fatigue, and well-being on these relationships were analyzed.

Results: A proportion of 87.8% among the pwHNC were men, mean age 65.8 years, and 72.2% had finished curative care. The average accelerometer wear time was 710.2 ± 153.1 min/d. Of this time, an average of 461.3 ± 151.0 min/d was spent in SB and 248.9 ± 121.6 min/d in PA. At the within-person level, PA and SB data showed no significant autoregressive relationships; that is, previous PA (or SB) did not predict PA (or SB) on the next day, respectively. No bidirectional relationships were found between PA and SB; that is, previous PA did not predict the next-day SB and vice versa. At the between-person level, neither fatigue, pain nor well-being significantly changed the slope and path parameters of PA and SB.

Conclusion: This study serves as an example of how DSEM can be used to examine how different movement behaviors interact with each other. Presumably, there is a need for more long-term assessment for the detection of consistency in the temporal information of movement behaviors in pwHNC.

Trial registration: German Registry of Clinical Trials (DRKS00028062).

Purpose: Marriage is associated with better health-related quality of life (HRQOL) among cancer survivors, but it is unclear whether these benefits generalize across sexual orientation and gender identities (SOGI). We examined whether marriage is associated with better HRQOL among cancer survivors with diverse SOGI.

Methods: We analyzed Behavioral Risk Factor Surveillance System (BRFSS) data from 2014 to 2023 among U.S. adults aged 18 and older who self-reported a cancer diagnosis and completed the optional SOGI module (N = 220,896). HRQOL was assessed using the CDC HRQOL-4, including self-rated general health, frequent mental or physical distress, and activity limitation (each defined as ≥ 14 days in the past 30 days). Logistic regression models estimated adjusted odds ratios for HRQOL outcomes by marital status (married, unmarried couple, not married) within SOGI subgroups, controlling for sociodemographic and healthcare access factors.

Results: Marriage was consistently associated with better HRQOL among heterosexual men and women. Among SGM survivors, gay men and transfeminine individuals showed the clearest marriage-related benefits, including lower odds of mental distress and activity limitation. No consistent benefit was observed among lesbian or bisexual women, bisexual men, or transmasculine individuals. Unmarried couples did not consistently show similar protective effects in any group, though small cell sizes limit precision.

Conclusion: The health benefits of marriage vary across SOGI subgroups, challenging assumptions of a universal marriage advantage in survivorship.

Implications for cancer survivors: Survivorship care should account for relational and structural differences in support networks, especially among SGM individuals who may not benefit equally from legal marital status.

Objective: This study identified psychological empowerment profiles of women with breast cancer to provide a clinical care framework.

Methods: This multicenter cross-sectional qualitative study used an interpretative phenomenological approach with semi-structured in-depth interviews. Participants were selected from five tertiary hospitals in northeast (Harbin and Shenyang), east (Nanjing), and northwest (Xi'an) China. Each participant underwent a face-to-face interview lasting 30-60 min. Data were collected between September and December 2024 and thematically analyzed. Forty-six women (33-72 years old) with breast cancer were interviewed; the rehabilitation timeframe spanned three days after surgery to 19 years after initial diagnosis.

Results: The psychological empowerment profile comprised 25 subthemes and six themes. Themes 1 (Informed and Stress) and 2 (Ambivalence and Distress) reflect the negative profile; Theme 3 (Challenge and Confrontation) marks the turning point between negative and positive coping modes; Themes 4 (Adjustment and Buffer), 5 (Rationality and Acceptance), and 6 (Insight and Growth) reflect positive profiles. Participants receiving treatment (n = 36) showed higher counts in Themes 1, 3, and 4. Those from Harbin and Shenyang had higher counts across themes than those from Nanjing and Xi'an. Survivors (n = 10) dominated Theme 6, with Nanjing survivors exhibiting greater counts across themes than their Xi'an counterparts.

Conclusions: Women with breast cancer showed a negative-positive psychological empowerment trajectory during rehabilitation. Geographic differences revealed the impact of healthcare infrastructure and culture, with northeastern cities (Harbin/Shenyang) engaging more themes (5/6) than eastern and northwestern cities (Nanjing/Xi'an), indicating the need for regional support programs.

Objective: Depression is common among patients with lung cancer, but evidence from large, population-based studies is limited. This study examined antidepressant use and hospital-diagnosed depression before and after lung cancer diagnosis in Denmark.

Methods: We conducted a nationwide registry-based study including all patients diagnosed with lung cancer from 1998 to 2022 and a comparison cohort (1:4 ratio) matched on age, sex, municipality, and marital/cohabiting status. Data on hospital diagnoses and redeemed antidepressant prescriptions were obtained from Danish national registries.

Results: Among 73,930 patients with lung cancer and 293,892 matched comparison subjects, antidepressant use was already higher among lung cancer patients two years before diagnosis (12.7% vs. 9.9%) and increased markedly after diagnosis (23.7% vs. 11.9% 2 years post-diagnosis, p < 0.001). Among individuals without prior antidepressant use, 8.4% of patients with lung cancer initiated antidepressants within the first year and 13.7% within the second year, compared with 1.9% and 3.4% of controls (p < 0.001). Hospital-diagnosed depression occurred in 2.1% of lung cancer patients versus 0.8% of controls, with higher rates among females.

Conclusions: Antidepressant use is prevalent before, and rises further after, a lung cancer diagnosis. The difference relative to the comparison cohort was most evident among individuals with no history of antidepressant use. These findings underscore the need for systematic psychosocial assessment and integrated mental health support throughout the lung cancer care pathway.

Objective: This study aims to develop a brief screening questionnaire for early identification of radiotherapy mask-related anxiety in patients with head and neck cancer.

Methods: A cross-sectional study recruited 512 patients undergoing radiotherapy between April 2016 and February 2021. Participants completed a screening questionnaire assessing mask-related anxiety and were assessed for anxious response during CT or MRI planning scans. A subgroup completed the Claustrophobia Questionnaire (CLQ) for comparison. Data were analyzed using multivariate logistic regression and discriminant validity was evaluated using the area under the ROC curve (AUROC).

Results: The study developed the Radiotherapy Mask Anxiety Questionnaire (R-MAQ), consisting of four items, derived from the screening questionnaire, which showed good model fit (Hosmer-Lemeshow p = 0.92) and predictive accuracy (AUROC = 0.78). Of the 410 participants (mean age 62), 27.3% presented an anxious response to the immobilization mask during planning exams. The R-MAQ demonstrated comparable or superior validity to the CLQ and effectively identified patients at risk of radiotherapy mask-related anxiety.

Conclusions: The R-MAQ is a valid and efficient tool for identifying patients at risk of mask-related anxiety during radiotherapy for head and neck cancer. It offers a clinically relevant, context-specific method for early intervention, potentially improving treatment adherence and outcomes. Future research should explore its broader applicability and impact on treatment efficacy.

Objective: Despite the importance of follow-up care for childhood cancer survivors (CCS), adherence remains below recommended levels. Potential barriers include geographical distance. We aimed to improve our understanding of the accessibility of survivorship follow-up care at a Long Term Survivor Clinic (LTSC).

Methods: Questionnaire data on health status of CCS enrolled in a LTSC in Calgary, Canada (collected between 2021 and 2024) was linked to CCS' medical records and the Canadian Index of Multiple Deprivation via postal codes. Linear, logistic, and negative binomial regression models were conducted to explore the association between health status and travel time, and between health status and socio-economic situation, and demographic and treatment-related factors.

Results: We included 203 CCS (48% female; mean age = 23 years; mean time after diagnosis = 14 years). Most CCS (75%) lived less than 1 hour away from the LTSC and traveled from within the province. Travel time was not significantly associated with health status. Health status was significantly associated with sex, time since diagnosis, and certain socioeconomic factors. Females reported more current health problems than males (IRR = 2.170; p < 0.001) and higher anxiety scores (β = 4.109; p = 0.011). Socio-economic factors were associated with reporting more depressive symptoms (β = 3.835; p = 0.040) and fear of second cancers (OR = 2.375; p = 0.022) and a more recent diagnosis with fear of cancer recurrence (OR = 0.873; p < 0.001).

Conclusions: Instead of travel time, individual factors were associated with health status, providing opportunities for targeted interventions to ensure continued attendance. Enhancing general LTFU access through location-appropriate services and addressing underlying socio-economic inequalities are crucial to ensure engagement in LTFU care and improve health outcomes for CCS.