This study aimed to clarify the characteristics of telenursing practices for palliative symptom management in patients with cancer. Participants were recruited using purposive and snowball sampling to identify nurses with experience in providing telenursing for patients with cancer. Semi-structured interviews were conducted face-to-face or online to explore participants' experiences between October 2024 and January 2025, and thematic analysis was then used to analyze the data. Ten participants (mean nursing clinical experience: 16.20 years; standard deviation [SD] = 13.44) were included in this study. Four themes were identified in telenursing practices for symptom relief in patients with advanced cancer: information gathering in telenursing under conditions of uncertainty, clinical reasoning in telenursing, telenursing care practices in non-face-to-face setting, and key elements in telenursing. Information gathering comprised two sub-themes: "Symptom data acquisition via remote devices," and "Addressing inadequate information from remote devices." Clinical reasoning included two sub-themes: "Clinical assessment of non-face-to-face patient data" and "Judgment of urgency." Care practices consisted of five sub-themes: "Strategies for non-face-to-face interactions," "Selecting intervention methods based on patient characteristics," "Practice based on protocols," "Selection of follow-up methods," and "Emergency response." Key elements include two sub-themes: "Safe and versatile telenursing systems" and "Trusting relationships." Telenursing practices for symptom relief in patients with cancer are characterized by adaptations to non-face-to-face care delivery while maintaining core nursing competencies. Notably, establishing trusting relationships remains a critical element of effective telenursing practice.
To explore psychological distress and its influencing factors, including hope, rumination, and fear of disease progression, among spouses of patients diagnosed with familial clustering of hepatitis B virus (HBV) -related hepatocellular carcinoma (HCC). A cross-sectional design was adopted. Using convenience sampling method, 218 spouses of patients with familial clustering of HCC were recruited between March 2024 and April 2025 in a tertiary cancer hospital, Tianjin, China. Survey questionnaires included the Psychological Distress Thermometer, Herth Hope Scale, Rumination Scale, and Fear of Progression Questionnaire. Hierarchical multiple linear regression was used to test the influencing factors of psychological distress. Psychological distress was prevalent among spouses, with 51.80% reporting severe to extreme levels. Psychological distress showed a negative correlation with hope (r = -0.162) and positive correlations with rumination (r = 0.380) and fear of disease progression (r = 0.528). Those spouses with the presence of children with HBV, three or more relatives diagnosed with HCC, and partial understanding of the patient's health condition were more psychologically distressed. Hierarchical multiple linear regression revealed that the presence of a child with HBV, three or more relatives diagnosed with HCC, partial understanding of the patient's health condition, and fear of disease progression were significant predictors of psychological distress (P < 0.05). However, hope and rumination did not remain significant predictors after controlling for fear of disease progression (P > 0.05). Spouses of patients with familial clustering of HCC experience notably high levels of psychological distress. Fear of disease progression, past family losses, the anticipated cancer risk for their children, and the demands of caregiving contribute to a significant level of psychological burden. It is critical to provide targeted clinical interventions to address their fear of disease progression, which may serve as a key factor in alleviating their psychological distress.
The aim of this study was to explore oncology nurses' awareness of cardio-oncology and cancer-related cardiotoxicity. This descriptive study was conducted with 152 oncology nurses between April 2025 and October 2025. Data were collected using the Cardio-Oncology Awareness Questionnaire for Nurses which was developed by the authors for this study. Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to analyze the data. Only 15% (n = 23) of the participants had received education on cardio-oncology and cancer-related cardiotoxicity and the majority reported acquiring their knowledge primarily from colleagues (63%). Participants expressed limited confidence in recognizing cancer-related cardiotoxicity (n = 66, 43%), while the majority (n = 147, 97%) indicated a need for further education on cancer therapy-related cardiotoxicity. The educational topics identified were cardiovascular risk factors, basic electrocardiogram (ECG) interpretation and arrhythmias, cardioprotective agents, and cardiovascular risk assessment during cancer survivorship." The findings revealed a lack of knowledge and practice regarding cardio-oncology and cardiotoxicity among oncology nurses, with most having not received formal education. With cardio-oncology emerging as an important sub-speciality, there clearly is a need for a structured cardio-oncology education in Türkiye.
To identify latent profiles of Fear of Progression (FoP) in parents of children with cancer, explore their associated factors, and test the mediating role of Sense of Coherence (SOC) between FoP and psychological distress (PD). A cross-sectional study was conducted with 273 parents of children with cancer in China. We used latent profile analysis (LPA) to identify FoP profiles, multinomial logistic regression to determine associated factors, and mediation analysis to test the role of SOC. Three distinct FoP profiles were identified: medication sensitive with low fear (38%), treatment sensitive with moderate fear (21%), and overall high fear (41%). These profiles were significantly differentiated by disease-related (e.g., treatment history), individual-related, and interpersonal-related (e.g., self-disclosure) factors. Across the sample, higher FoP was associated with greater PD. Importantly, mediation analyses revealed that SOC significantly mediated the relationship between FoP and PD for the moderate and high FoP profiles, but not for the low LoP profile. Parents of children with cancer exhibit heterogeneous FoP profiles. SOC acts as a crucial mediator between FoP and PD, particularly for parents with moderate and high FoP profiles. These findings underscore the importance of screening for specific FoP profiles and suggest that tailored interventions designed to enhance SOC could effectively reduce PD in high-risk parents.
Poor medication adherence is common among breast cancer patients undergoing endocrine therapy. Although previous studies have shown that symptom distress, illness perception, and fear of recurrence can have a connection with medication adherence, the underlying mechanism remains unclear. This study explored the effect of symptom distress on medication adherence, the mediating role of illness perception between symptom distress and medication adherence, and the moderating role of fear of recurrence among those factors. Symptom distress, illness perception, fear of recurrence, and medication adherence were assessed in 405 patients. A structural equation model verified the mediating role of illness perception, and a multi-cluster analysis tested the moderating role of fear of recurrence. Illness perception had a mediating effect between symptom distress and medication adherence (effect size: -0.213), accounting for 28% of the total effect. A significant difference was observed in the path coefficient of "illness perception → medication adherence" between the low and high fear of recurrence group (CR ​= ​|-3.578| ​> ​1.96, P ​< ​0.05). In the high fear of recurrence group, the association between symptom distress and medication adherence was mediated by illness perception, while in the low fear of recurrence group, medication adherence was only connected by symptom distress. The links of symptom distress and medication adherence were mediated by illness perception, whereas fear of recurrence moderated this relationship. To improve medication adherence, oncology nurses should alleviate symptom distress and implement interventions for patients with high fear of recurrence to reduce negative illness perception.
The quality of end-of-life care for cancer patients in China remains unsatisfactory, particularly during their last days and hours, highlighting an urgent need for improvement. This study is aimed to develop and implement a hospital-based quality improvement (QI) program to provide supportive care for terminally ill cancer patients, with the goal of improving the quality of death of cancer patients and family satisfaction. This QI program primarily included three phases: developing evidence-based practice standards and related materials; conducting stratified training and providing the bundled supportive care strategies; and implementing quality supervision. The supportive care provided to terminally ill cancer patients and their families consists 30 bundled strategies divided into 5 parts: recognition and confirmation that the person may enter the last few days of life, end-of-life communication, patient-centered supportive care, family-centered supportive care and bereavement support for the family. The quality of death of cancer patients was assessed from the perspective of charge nurses and family members using the Good Death Inventory (GDI), and family satisfaction was evaluated using the Family Satisfaction with Advanced Cancer Care-2 (FAMCARE-2) scale. One hundred and fourteen patients from five hospitals located in Beijing, Nanjing, and Kunming were provided the supportive care between May 2023 to August 2024, and 112 (98.2%) nurses and 103 (90.4%) families completed the follow-up evaluation. The total GDI score, which ranges from 54 to 378 with higher score indicating a better quality of death, was recorded as 299.81 ± 53.70 from the perspectives of nurses and 310.76 ± 49.55 from family members. The FAMCARE-2 score ranging from 17 to 85 with higher scores indicating greater satisfaction was 80.52 ± 8.75, with scores for symptom control, information support, family support, and patient psychological support at 23.73 ± 2.80, 18.87 ± 2.25, 18.94 ± 2.35, and 18.98 ± 1.95, respectively. This study systematically implemented supportive care strategies tailored to the needs of patients and their families at the end of life through a hospital-based program and achieving satisfactory outcomes. The systematic approach and innovation of the program are worthy of further promotion.
The aim of this study is to develop a structured and quantifiable system of nursing-sensitive quality indicators (NSQIs) for evaluating perioperative care in breast reconstruction surgery. A mixed-methods study was conducted. First, a literature review and qualitative study were conducted to identify the potential NSQIs for perioperative care in breast reconstruction surgery. Subsequently, a two-round Delphi study with 15 experts was conducted to reach a consensus and establish the final version of NSQIs system. The final NSQIs system for perioperative care in breast reconstruction surgery consisted of 3 first-level indicators (Structure, Process, and Outcome), 9 second-level indicators and 24 third-level indicators. The Structure level focuses on organizational resources, including human resources and environmental equipment; the Process level emphasizes nursing assessment and interventions (particularly flap monitoring and wound management); and the Outcome level evaluates patient satisfaction, clinical complications, and psychosocial function. This study developed objective and practical NSQIs for perioperative care in breast reconstruction surgery. The NSQIs system provided a quantifiable evaluation tool and a scientific basis for nursing management. The implementation of the NSQIs system is expected to standardize nursing practice and guide the continuous quality improvement of perioperative care for breast reconstruction patients.
暂无摘要（点击查看详情）
Anastomotic fistula is a common complication in patients with esophageal cancer following surgery. It leads to delayed healing, malnutrition, reduced quality of life, and increased patient pain and medical costs. Preventing anastomotic fistula can significantly enhance patients' quality of life. This study aimed to summarize the best evidence for the prevention and management of anastomotic fistula after esophagectomy in patients with esophageal cancer, providing a reference for clinical nursing practice. Following the '6S' evidence resource model, evidence retrieval was conducted from the top-down, collecting clinical practice guidelines, systematic evaluations, meta-analyses, and expert consensus. The retrieval period spanned from database inception to February 2026. Two reviewers independently screened and assessed the literature, subsequently extracting and summarizing the evidence according to the JBI system for grading evidence and recommendations. A total of 11 articles were included: 3 guidelines, 6 systematic reviews, and 2 randomized controlled trials. A total of 19 best evidence were identified for the prevention and management of anastomotic fistula in postoperative patients with esophageal cancer. These pieces of evidence encompass key areas including monitoring and evaluation, fistula care, pipeline care, respiratory tract management, psychological care, nutrition management, drug management, complication management, and health education. This study summarized the best evidence for the prevention and management of anastomotic fistula after esophagectomy in patients with esophageal cancer, providing a reference for clinical nursing practice. The application of evidence should be tailored according to the department's clinical condition and individual patient circumstances. This study was registered at the Fudan University Centre for Evidence-based Nursing (Registration No. ES20244220).
This study aimed to explore the psychological and emotional experiences, as well as coping strategies, of mothers of young women with breast cancer in Chinese families. A descriptive qualitative study was conducted from March to July 2025. Semi-structured interviews were carried out with 16 mothers of daughters diagnosed with breast cancer at a tertiary hospital in China. Data were analyzed using thematic analysis, and reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Four overarching themes were identified: (1) emotional turmoil, including shock, emotional suppression, guilt, self-blame, and persistent anxiety; (2) cultural silence and social withdrawal, reflected in linguistic avoidance, fatalistic interpretations of illness, and the protection of family privacy; (3) reconfiguring care and family roles, characterized by reactivated maternal caregiving and strengthened family cohesion; and (4) meaning-making in the face of illness, involving spiritual coping, preservation of memories, reframing life meaning, and efforts to balance caregiving with self-care. The findings suggest that mothers often experience substantial psychological distress shaped by Confucian familism, gender norms, and filial expectations. Mothers of patients with breast cancer in Chinese families experience profound emotional burden and role disruption, yet many also demonstrate resilience through family-centered and meaning-focused coping. Oncology nurses should provide culturally sensitive, family-oriented psychological support that addresses guilt, anxiety, and emotional suppression while strengthening coping resources and supportive communication.
Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000-489 000), 144 000 deaths (131 000-162 000), and 11·7 million (10·7-13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5-36·1) globally, from 197 000 (173 000-218 000) in 1990, but increased in the WHO African region by 55·6% (25·5-92·4), from 31 500 (24 900-38 500) to 49 000 (42 600-58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5-26·5) in GBD 2017 to 10·5% (8·1-13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2-52·0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.
Human papillomavirus (HPV) vaccines are effective preventive measures against HPV-related diseases. Mothers play an important role in HPV vaccination decision-making for their daughters. Ethnic inequality in HPV vaccination uptake is a global problem and is expected to affect the South Asian (SA) ethnic population in Hong Kong. This study explored the factors influencing SA mothers' behaviour regarding HPV vaccination for their daughters. This study used a convergent parallel mixed methods design. Data from a quantitative survey (n = 1083) and qualitative focus group discussions with SA mothers (n = 73) were collected. Data from both strands were analysed independently and then integrated during data interpretation. Meta-inferences were drawn accordingly. The findings of the quantitative strand identified five influential factors, namely age of daughters, awareness of HPV vaccines, perceived benefits of HPV vaccination, perceived barriers (safety concerns), and cues to action. The qualitative data revealed that the mothers' decision to vaccinate their daughters could be hindered by language barriers, religious and cultural influences, and health-information-seeking behaviours. The mixed-methods integration revealed that the mothers' vaccination decision was influenced by the availability of a school-based vaccination programme, their awareness of HPV vaccines, their perceived benefits of and barriers to HPV vaccination, and their receipt of health care professionals' recommendations. The vaccination decisions of SA mothers in Hong Kong are influenced by multiple factors, which should be addressed in future interventions. These interventions could include delivering appropriate contents for health promotion, providing cultural sensitivity training to health care professionals and conducting catch-up vaccination programmes for adolescent daughters not eligible for the current programme.
This study aimed to explore the impact of fear of cancer recurrence on anxiety and depression in female cancer patients, and to examine the chain mediating roles of financial toxicity and psychological distress in this relationship. Between February and July 2024, a total of 417 female cancer patients from top-tier cancer hospitals across 13 regions in China were recruited. Participants completed the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Hospital Anxiety and Depression Scale (HADS), the Comprehensive Score for Financial Toxicity (COST), and the Distress Thermometer (DT). (1) Fear of recurrence, financial toxicity, psychological distress, anxiety, and depression were significantly correlated. (2) Two mediating pathways were identified: a direct path where fear of recurrence increased psychological distress, leading to heightened anxiety and depression; and an indirect chain mediation path wherein fear of recurrence elevated financial toxicity, which in turn intensified psychological distress, ultimately contributing to anxiety and depression. Health care providers should be aware of the psychological and financial burdens associated with fear of recurrence in women with cancer. Addressing these issues may enhance the effectiveness of psychological interventions, reduce emotional distress, and ultimately improve patients' quality of life.
Esophageal cancer is life-threatening, and esophagectomy patients have a high incidence of intraoperative hypothermia (linked to adverse postoperative outcomes), with no stable predictive indicator available. The Geriatric Nutritional Risk Index (GNRI), a validated tool for predicting cancer prognosis/complications, has not been studied for its association with intraoperative hypothermia in esophageal cancer surgery. This study evaluated their association and GNRI's predictive efficacy. A retrospective analysis of 676 esophageal cancer surgery patients (Fujian Provincial Cancer Hospital, July 2022-February 2025) was conducted. Logistic regression assessed GNRI-hypothermia association, restricted cubic splines (RCS) explored nonlinear relationships, and receiver operating characteristic (ROC) curves evaluated predictive efficacy. Intraoperative hypothermia was defined as core temperature ≤ 36°C. Among the 676 patients, the incidence of intraoperative hypothermia was 41.4%. Multivariate logistic regression analysis indicated that patients in the nutritional risk group (GNRI < 98) had a significantly higher risk of intraoperative hypothermia compared to those without nutritional risk (GNRI≥ 98). The adjusted odds ratio (OR) was 1.95 (95% confidence interval [CI]: 1.34-2.82, P < 0.05) in the fully adjusted model. The RCS analysis confirmed a nonlinear relationship between GNRI and intraoperative hypothermia (P < 0.0001), identifying a threshold at 93, which indicated a progressive increase in hypothermia risk when GNRI was below this point. Furthermore, GNRI demonstrated a sensitivity of 0.511 and a specificity of 0.852 for predicting intraoperative hypothermia; its incorporation significantly improved the area under the curve (AUC) of the prediction model (P = 0.048). Preoperative GNRI is an independent predictor of intraoperative hypothermia in patients undergoing esophageal cancer surgery. The thresholds of 93 and 98 can serve as clinical reference points for nutritional interventions, offering a novel assessment tool for perioperative temperature management in esophageal cancer patients.
The incidence of breast cancer in young women (< 40 years old) has been increasing in recent years. Patient delay is significant to disease prognosis, thus early diagnosis and prompt effective therapy represent the key elements in controlling breast cancer. This study aimed to identify determinants of patient delay and assess the association of patient delay with quality of life (QoL). A cross-sectional study was conducted among 286 young patients with breast cancer from October, 2022 to March, 2023 at four tertiary hospitals in Hunan province, China with the guidance of Andersen Behavioral Model of Health Services Utilization. Determinants of patient delay were identified using binary logistic regression analysis. The association between patient delay and QoL was analyzed using linear regression. A total of 106 (37.06%) young patients with breast cancer had experienced patient delay, indicating that more than one in three women faced this critical barrier to timely care. Patients who lived in countryside (odd ratio [OR] 3.676, 95% confidence interval [CI] 1.468-9.206), had an initial outpatient consultation to other department (OR 3.910, 95% CI 1.439-10.624), waited > 7-day for initial outpatient consultation (OR 11.350, 95% CI 3.450-37.345) were more likely to experience patient delay. Detecting disease at routine physical examination (OR 0.208, 95% CI 0.045-0.967), having higher critical health literacy (OR 0.676, 95% CI 0.506-0.904), and having more friend support (OR 0.921, 95% CI 0.855-0.993), patients were less likely to experience patient delay. Patient delay was negatively correlated with QoL including overall FACT-B (t = -2.443, P = 0.015), physical well-being (t = -3.526, P < 0.001), functional well-being (t = -2.077, P = 0.039), and additional concerns (t = -1.974, P = 0.049). Waiting time for initial outpatient consultation > 7-day was the strongest determinant of patient delay among young women with breast cancer. Other significant factors included rural residence and initial consultation in non-specialist departments, while higher health literacy, friend support, and detection via physical examination were protective. Patient delay was significantly associated with poorer QoL, particularly in the domains of physical well-being, functional well-being, and additional concerns. These findings underscore the need for interventions targeting health care access to reduce patient delay and improve patient health outcomes.
To evaluate the impact of an oral anti - cancer drug safety management program on nurses and patients. This study was a hospital-level quality-improvement evaluation (pre-post, quasi-experimental design) and was not registered as a clinical trial. It was conducted from August 2024 to December 2024 in a tertiary hospital in Beijing. The program comprised three stages: preparation, training, implementation and supervision. It included tiered training for nurses based on established nursing standards, standardized health education checklists for patients, and continuous support through virtual and in-person clinic visit. Associated improvements were evaluated using self-designed questionnaires. Data were collected from nurses before training and 2 months after program implementation, and from patients before and 1 month after education. Descriptive statistics and non-parametric paired sample tests were used for analysis. A total of 632 nurses participated in the program, of which 381 nurses completed both evaluations. The knowledge and behavior scores of nurses regarding on correct medication administration, protection against drug exposure, and early management of adverse reactions improved significantly (P < 0.001). The full-score rates for knowledge and behavior increased from 71.82% and 71.55% to92.65% and 94.49%, respectively (Z = -11.462, -13.104, respectively; both P < 0.001). A total of 643 patients received guidance, of which 384 patients completed both evaluations. The knowledge and behavior scores of patients also improved significantly (P < 0.001), with the full-score rates increasing from 59.46% and 68.29% to78.62% and 85.11%, respectively (Z = -11.473, -12.415, respectively; both P < 0.001). Meaningful improvements were achieved through enhancements to the oral anti-cancer drug safety management program. Standardized training and structured implementation enabled nurses to provide evidence-based patient guidance, thereby enhancing patients' knowledge and skills in safe medication management.
To identify key risk factors for peripherally inserted central catheter -related deep venous thrombosis (PICC-RVT) in patients with cancer through a systematic review and meta-analysis, develop risk prediction model and validate its performance. A systematic literature search was performed in Pubmed, EMBASE, Web of Science (core collection), Scopus, CINAHL and Ovid databases from the time of their inception to June 2025. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) checklist. Meta-analysis was performed using RevMan 5.4 statistical software to identify independent risk factors for PICC-RVT in adult patients with cancer, then the effect of each independent risk factor was determined using β - formation conversion for developing the risk predictive model. Finally, we collected the clinical datal of 338 adult patients with cancer who underwent PICC catheterization from June 2024 to May 2025 to evaluate the predictive performance of the risk predictive model by drawing the receiver of curve (ROC). A total of 32 cohort studies involving 28,813 individuals (28 from China, 2 from UK, 1 each from US and Canada) were included. Twenty-one independent risk factors were identified through meta-analysis. The risk prediction model was developed using β - coefficient transformation: pooled odds ratios (ORs) from meta-analysis were converted to β coefficients through natural logarithmic transformation (β = ln[OR]), then each β - coefficient was multiplied by 10 and rounded to one decimal place to create a point-based scoring system. The total risk score was calculated by summing individual factor scores. Preliminary external validation was conducted in 338 patients with cancer (15 thrombosis events, 4.4% incidence) from a single Chinese center, yielding an area under curve (AUC) of 0.792 (95% [confidence interval (CI)] 0.653-0.931). The model showed acceptable calibration (Hosmer-Lemeshow P = 0.082) but validation was underpowered (15 events vs. recommended 100+ events for precise performance estimation). This study developed a PICC-RVT risk prediction model based primarily on Chinese patients with cancer. The model demonstrated moderate discrimination in preliminary single-center validation, but requires multi-center validation with adequate event numbers before clinical implementation. The model provides a framework for PICC-RVT risk stratification in Chinese and similar healthcare settings. PROSPERO (CRD420250651190).
The aim of this study is to investigate the potential profile of decision-making conflicts in early-stage non-small cell lung cancer (NSCLC) patients, and to explore the mediating role of financial toxicity between psychological resilience and decision-making conflicts. A cross-sectional survey was conducted to analyze 310 patients with early-stage NSCLC who visited a tertiary Grade A oncology hospital in Beijing, China from August 2023 to April 2024. General information questionnaires, the Cancer Specific Resilience Scale (RS-SC), the Decision Conflict Scale (DCS), and the COST-PROM were collected. Decision conflict among early-stage NSCLC patients was classified into three subgroups: 44.5% of patients exhibited low decision conflict (mean score 10.97 ± 1.73), 30.3% exhibited moderate decision conflict (mean score 18.21 ± 2.89), and 25.2% exhibited high decision conflict (mean score 23.90 ± 3.31). Independent factors associated with decision conflict included lower education level, lower monthly income, unemployment, and participation in the New Rural Cooperative Medical Insurance (all P < 0.05). Mediation analysis showed that financial toxicity significantly mediated the relationship between psychological resilience and decision conflict. The direct effect of psychological resilience on decision conflict was significant (β = -0.162, P = 0.004), as was the indirect effect through financial toxicity (β = -0.041, P = 0.017). Financial toxicity accounted for 18.1% of the total mediation effect. Early-stage NSCLC experience varying degrees of decision conflict. Financial toxicity plays a partial mediating role between psychological resilience and decision conflict. Interventions aimed at reducing financial toxicity may improve psychological resilience and reduce decision conflict in these patients.
This study aims to identify the latent profiles of sense of coherence (SOC) in patients with advanced cancer and explore its influencing factors encompassing sociodemographic and clinical characteristics, and generalized resistance resources (GRRs). A cross-sectional study of 262 patients with advanced cancer was conducted by convenience sampling in Guangzhou, China, from September 2023 to July 2024. Data were collected including sociodemographic and clinical characteristics, SOC-13, Revised Life Orientation Test (LOT-R), Rosenberg Self-Esteem Scale (RSES), Inner Peace State Scale (IPSS), Gratitude Questionnaire-6 (GQ-6), and Social Support Rating Scale (SSRS). Statistical analysis was performed using latent profile analysis (LPA) and multivariate logistic regression analysis. Three latent profiles of SOC were identified: low SOC and low comprehensibility group (29.01%), moderate SOC and high meaningfulness group (40.08%), and high SOC and high manageability group (30.91%). This study found that SOC was impacted by self-perceived severity of the disease and GRRs including optimism, self-esteem, and inner peace (P < 0.05). SOC in patients with advanced cancer exhibited different characteristics. Enhancing positive disease perception and GRRs including optimism, self-esteem, and inner peace may be effective strategies for improving their SOC. Healthcare professionals can formulate strategies such as tailored health education, symptom management, and positive psychological interventions to enhance SOC in patients with advanced cancer.
To develop a machine learning-based risk prediction model for acute radiation enteritis (ARE) in patients with cervical cancer, providing a new method for early and accurate prediction of ARE during radiotherapy. This prospective study enrolled patients with cervical cancer undergoing radiotherapy from March 2024 to March 2025. The patients were randomly divided into training and test sets at a 7:3 ratio. Prediction models were constructed using Logistic Regression (LR), Decision Tree (DT), and Random Forest (RF) algorithms. Model performance was evaluated based on the area under the receiver operating characteristic curve (AUC), accuracy, precision, sensitivity, specificity, and F1-score. The incidence of ARE was 52.85% (204/386). Among the three models, the Random Forest model demonstrated the best performance, with an AUC of 0.961, sensitivity of 0.934, and F1-score of 0.905. These performance metrics were consistently higher than those of the LR (AUC, 0.860; sensitivity, 0.739; F1-score, 0.736) and DT (AUC, 0.910; sensitivity, 0.887; F1-score, 0.873) models. The RF model showed good clinical utility in effectively identifying high-risk patients for early intervention. Feature importance ranking derived from the RF model identified the parametrial dose, radiotherapy time, clinical stage, rectal V40, age, Platelet-to-Lymphocyte Ratio (PLR), concurrent chemotherapy, and hypertension as the most influential predictors, in descending order of importance. The RF-based risk prediction model exhibited excellent performance in assessing the risk of ARE among patients with cervical cancer undergoing radiotherapy, thereby enabling individualized risk assessment and facilitating early preventive strategies.