Psycho‐Oncology最新文献

Objective: The aim of this study was to determine which cognitive patient reported outcome measure (PROM) best represents self-reported cognitive functioning in real-world environments among breast cancer survivors (BCS) as measured by ecological momentary assessments (EMA), and to compare their ability to predict future everyday functioning.

Methods: One-hundred twenty-four BCS (ages 24-88) completed self-report measures of cognitive functioning (FACT-Cog PCI, PROMIS Cog, CFQ, EORTC-CF) and everyday functioning (SDI, FACT-G Functional Well-being subscale) at baseline (Time 1) and at 9 weeks follow up (Time 2). Between assessments, EMA protocols (including one item to assess cancer-related cognitive symptoms) were administered every other day for 8 weeks. Person-specific means and standard deviations were calculated for EMA data. Hierarchical linear regression models were used to model cognitive PROM predictors of person-specific averages and variability in EMAs, SDI, and FACT-G functional well-being, and model parameters (R², AIC, BIC, semi-partial R) were compared.

Results: Follow-up FACT-Cog PCI most accurately predicted both the average (ΔR² = 0.213, p < 0.001) and variability (ΔR² = 0.071, p < 0.001) in EMA CRCI symptoms. For future functional outcomes, the PROMIS Cog and FACT-Cog PCI at baseline demonstrated similar predictive power for Time 2 Functional Well-being (ΔR² = 0.210, p < 0.001). Additionally, baseline FACT-Cog PCI was the strongest predictor of social dysfunction (SDI; ΔR² = 0.205, p < 0.001).

Conclusions: These findings support the ecological validity of cognitive PROMs in BCS and indicate that both FACT-Cog PCI and PROMIS Cog effectively capture real-world cognitive symptoms and predict future everyday functioning, including social function and well-being.

Background: Breast cancer, the most common cancer among women, has a high survival rate due to advances in medical treatment. Mobile health (mHealth) interventions offer promising avenues for psychosocial support, yet limited evidence exists regarding their feasibility and acceptability among Asian breast cancer populations.

Aims: This study developed and pilot-tested a mobile app designed to enhance self-efficacy and resilience among breast cancer patients undergoing chemotherapy.

Methods: This study was conducted in two phases. Phase One involved qualitative research and expert panel discussions to develop the "i KMU Breast Cancer Care Hub" prototype based on patient needs. Phase Two conducted a randomized controlled trial (RCT) using a two-group pretest-posttest design in a medical center in southern Taiwan. Seventy-three patients were randomized to receive either standard care plus app access (n = 37) or standard care alone (n = 36). Feasibility outcomes included recruitment rate, retention rate, adherence, and usability scores. In addition, data on self-efficacy and resilience were collected at baseline and 4 weeks post-intervention using validated scales.

Results: High task completion rates and good app usability were observed, along with generally positive user satisfaction (75.88 ± 15.87). Eighty-three patients were approached, with a refusal rate of 12%. No attrition was observed during the study. The experimental group showed significant improvements in self-efficacy (p = 0.01), especially in decision-making (p = 0.03) and positive attitude (p = 0.01), compared to the control group (p = 0.01 and p = 0.02, respectively). No significant change was observed in stress reduction (p = 0.13). Although resilience declined in both groups, the experimental group experienced a smaller decrease, suggesting a protective effect of the intervention.

Conclusions: The mobile application demonstrated good feasibility, high acceptability, and significant psychosocial benefits by enhancing self-efficacy and mitigating declines in resilience. These findings contribute to the growing evidence supporting the use of mHealth interventions within psycho-oncology to empower breast cancer patients during active treatment.

Trial registration: https://clinicaltrials.gov/: NCT05576545.

Objective: This meta-analysis systematically evaluated the efficacy of web-based interventions in reducing psychological distress in patients with cancer.

Methods: We conducted a comprehensive literature search of five major databases-PubMed, Web of Science, Embase, CINAHL, and the Cochrane Library-through April 05, 2025. Following the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions, we identified randomized controlled trials comparing web-based interventions to control conditions. We extracted standardized mean differences (SMDs) and 95% confidence intervals (CIs) to quantify the effect sizes. Between-study heterogeneity was assessed using the I² statistic, and predefined subgroup analyses were used to explore potential moderators. Two independent reviewers appraised the methodological quality using the Cochrane Risk of Bias 2.0 tool, and the overall certainty of evidence was graded using the GRADE framework.

Results: Twenty RCTs, including 2470 participants, met the inclusion criteria. Pooled analysis showed that web-based interventions significantly reduced psychological distress compared to controls (SMD = -0.37, 95% CI: -0.55, -0.18), with substantial heterogeneity (I² = 73.2%; p < 0.001). Studies assessing psychosocial distress as a primary outcome showed larger effects, contributing to heterogeneity. Subgroup analyses indicated that therapist-guided interventions produced greater reductions in psychosocial distress than self-guided approaches.

Conclusions: Web-based interventions provide a modest but significant benefit in alleviating psychological distress among patients with cancer, with greater efficacy when therapist support is included. Despite the substantial heterogeneity across trials, these findings underscore the scalability and accessibility of online mental health tools for oncology care. Future research should address optimal intervention components and delivery strategies to maximize clinical impact.

Background: IBP therapies (immunotherapies, biologics and precision therapies) have had a significant impact on cancer survival. They differ from conventional cancer treatments in that they may be used long term and have less predictable adverse effects. We aimed to explore the psychological impact of IBP therapies from the perspectives of those living with advanced cancer.

Methods: Semi-structured interviews with 20 women and 11 men with advanced cancer - (lung, colorectal, ovary, (female) breast, renal and malignant melanoma) - about their experiences of IBP therapies. Data were analysed thematically.

Results: We elicited two overarching themes from the data: (1) the psychological impact of a stage IV diagnosis and living with advanced cancer, and (2) uncertainty and dependency associated with IBP therapies. Although some were relieved to have a diagnosis, others responded with shock and disbelief. Day to day, cancer was foremost in the minds of many, and the remainder chose to push these thoughts aside and focus on making the most of life. Living with cancer led to a shift in their sense of self. Uncertainty and dependency throughout the care pathway were centred around treatment effectiveness, heightened by the belief that the therapy was keeping them alive. Participants were uncertain and anxious about any interruption of, or changes to, their current treatment regimen, stopping their current treatment and next steps.

Conclusion: Interventions are needed to support the psychological needs of people using IBP therapies. These should go beyond monitoring and managing IBP treatment-related adverse effects and address uncertainty and psychological dependency.

Objective: To evaluate the effectiveness of an integrative intervention combining psychological and physical therapies with pharmacologic treatment for postmastectomy pain syndrome (PMPS), and to assess its impact on pain, anxiety, and quality of life in breast cancer patients.

Methods: In this prospective randomized controlled study, 302 breast cancer patients with chronic postoperative pain were assigned to a control group (standard pharmacologic treatment) or an experimental group (combined drug, psychological, and physical therapies). Key outcomes included NRS scores during movement and rest, pain interference, Hospital Anxiety and Depression Scale (HADS), and Breast-Q scores, assessed at T0 (baseline), T1 (end of intervention), and T2 (3 months after intervention).

Results: At T2, the experimental group showed significantly lower movement NRS scores (p = 0.0143), pain interference scores (p = 0.0488), and anxiety scores (p = 0.0001) compared to the control group. Two-way ANOVA revealed significant time × group interactions for multiple pain-related outcomes (p < 0.05). Quality of life improved over time (p = 0.0026), but no significant between-group difference was found.

Conclusion: A multimodal integrative intervention combining psychological and physical therapies can enhance pain relief and emotional well-being in patients with PMPS. This approach supports the application of integrative medicine in oncology rehabilitation.

Background: Distress affects about one-third of people with cancer, yet many never want, seek, or receive mental health care. Identifying the barriers that distinguish those who obtain help from those who do not can guide service design in psychosocial oncology.

Aims: To examine how attitudinal, stigma, instrumental, financial, and accessibility barriers predict mental-health care need status (met need, unmet need, or low perceived need or reluctance).

Methods: Survey data from 300 distressed adults in the Cancer Support Community's Cancer Experience Registry (August 2022) were analyzed. Need status reflected desire for, attempts to access, and receipt of mental health care. Multinomial logistic regression tested barrier-domain associations with need status, adjusting for sociodemographic and clinical variables.

Results: Thirty-eight percent reported met need, 25% unmet need, and 37% low perceived need or reluctance. Each one-point increase in attitudinal barrier scores was associated with a higher likelihood of reporting unmet need (relative risk ratio [RRR] = 4.21, 95% CI 1.56-11.37) and low perceived need or reluctance (RRR = 2.85, 95% CI 1.17-6.91) compared to met need. Greater accessibility barriers were also linked to a higher likelihood of unmet need (RRR = 1.73, 95% CI 1.11-2.67). Stigma, instrumental, and financial barriers were not independent predictors in multivariate analyses.

Conclusion: In oncology, help-seeking and access to mental health care appear negatively associated with patient attitudinal beliefs and system-level constraints. Interventions that normalize mental health care, provide education on its benefits, and embed providers within oncology services may reduce the distress burden more effectively than strategies focusing solely on cost or logistics.

Objective: Informal caregivers of patients with terminal cancer can experience an emotionally difficult time in the final stages of their caregiving journey with implications on their bereavement experience. The current study examined anxiety and depression among caregivers of terminal cancer patients and subsequent bereavement adjustment.

Method: Caregivers from the Singapore COMPASS cohort study (N = 192) were prospectively followed from 6-month pre- to 6-month post-patient death. Multinomial and logistic regression models were performed to examine factors associated with anxiety, depression and complicated grief that may be targets for intervention.

Results: Rates of anxiety and depression significantly increased closer to patient death (Anxiety: 47%-61%; Depression: 31%-42%) before decreasing 6-month post-patient death (Anxiety: 21%, Depression: 24%). 16% of caregivers reported persistent anxiety and 15% reported persistent depression from 6-month pre- to 6-month post-patient death, which were associated with the following pre-death caregiver factors: poorer physical health and high caregiving burden impacting their schedule and health. 33% of caregivers reported sub-threshold/likely complicated grief, which was associated with close caregiver-patient relationship, caregiver anxiety or depression at pre-patient death and greater perceived patient suffering.

Conclusions: Efforts to identify and support caregivers pre- and post-patient death are important to mitigate psychological sequalae.

Background: Breast cancer can negatively impact survivors' physical activity (PA). Social cognitive theory (SCT) constructs may be correlated with PA, but it is unclear if cancer-related factors affect these relationships.

Aims: To examine associations between PA, self-efficacy, social support, and exercise barriers interference in breast cancer survivors and whether cancer-related factors moderate these relationships.

Methods: Baseline data from 341 post-primary treatment breast cancer survivors in a web-based diet/exercise intervention trial were analyzed. SCT constructs, accelerometry-measured and self-reported moderate-to-vigorous physical activity (MVPA), and cancer-related factors (stage, time since diagnosis, history of chemotherapy, history of radiation, and hormone therapy status) were examined using Pearson correlation analysis and multivariable linear regression analyses.

Results: Exercise barriers interference was inversely associated with self-reported (r = -0.272, p < 0.001); and accelerometry-measured MVPA (r = -0.128, p = 0.020). No other statistically significant associations were found. Stage and history of chemotherapy moderated the association between social support and self-reported MVPA. The association was stronger among survivors diagnosed with DCIS/stage I versus stage II/III (β = 4.14, p = 0.043, CI = -2.20-10.49) and weaker among individuals who previously received chemotherapy versus no chemotherapy history (β = -5.02, p = 0.026, CI = -11.51-1.47); effects were independent of one another.

Conclusions: Cancer stage and previous chemotherapy moderate the association between social support and MVPA. Targeting social support in early-stage breast cancer survivors or survivors that did not receive chemotherapy may improve intervention effectiveness.

Background: Three subgroups of adolescent and young adult patients (AYAs; 18-39 at diagnosis) with an uncertain or poor cancer prognosis (UPCP-those diagnosed with advanced disease, who will likely die prematurely) were previously identified: those receiving traditional treatments (chemotherapy and/or radiotherapy), newer treatments (immunotherapy or targeted therapy), and patients with glioma. This study examines differences in health-related quality of life (HRQoL) among these subgroups, and comparisons between AYAs with a UPCP, recently diagnosed AYAs, and a healthy control group.

Methods: Data were collected from two AYA cohorts: CORD-AYA (n = 155), including AYAs with a UPCP any moment post-diagnosis, and COMPRAYA (n = 549), including AYAs within 6 months after diagnosis. A healthy control group, matched by age and sex, was also included (n = 430). All completed the EORTC QLQ-C30.

Results: No significant HRQoL differences emerged between the traditional versus new treatment group. However, patients with glioma reported significantly lower cognitive functioning compared to patients on newer therapies. AYAs with a UPCP scored lower across all HRQoL scales than the control group. Despite being further along in their disease trajectory, UPCP patients reported HRQoL levels comparable to newly diagnosed patients. AYAs with a UPCP experienced higher financial burden but reported better global quality of life than COMPRAYA patients.

Conclusions: No significant differences in HRQoL were found between treatment groups, but patients with glioma should be considered a distinct subgroup as they have shown reduced cognitive functioning, necessitating specialized care. Individualized care is crucial, as a lack of personalized support may lead to long-term functional impairment, especially among UPCP patients.

Background: Women across the breast cancer continuum navigate diverse care pathways, yet there is limited understanding of longitudinal care trajectories, particularly for recurrent and metastatic disease. Pathway research has predominantly focused on quantitative service utilisation, overlooking patients' experiential navigation of care.

Aims: This study explored the lived experiences of key events and phases throughout the breast cancer care trajectory through treatment and service utilisation patterns.

Methods: Thirty-two women, at least 2 years post-initial breast cancer diagnosis, participated in semi-structured focus groups. Participants were recruited from cancer consumer forums across Australia and grouped by typology based on cancer stage and recurrence status. Using qualitative framework analysis and a micro-to-macro analytical approach, we analysed participants' treatment and service utilisation experiences to construct typological timelines and develop a generalised typology care trajectory map.

Results: We identified four typologies among participants: non-metastatic, de novo metastatic, recurrent non-metastatic, and recurrent metastatic. Five overarching care phases emerged: initial diagnosis and treatment planning, initial treatment, post-treatment care management and recovery, managing recurrent and progressive disease, and end-of-life care. Trajectory mapping revealed fundamentally non-linear pathways with frequent cycling between phases, particularly for metastatic disease. Patient-described care phases differed significantly from clinical pathway terminology, revealing critical care coordination gaps during vulnerable transitions.

Conclusion: The trajectory map provides valuable insights into experiential care patterns, revealing gaps between clinical pathways and patient experiences. These findings can inform health service planning, improve care coordination during transitions, and enhance visibility of care needs in recurrent and metastatic disease.