Patient and public involvement is essential for developing patient-centered and acceptable eHealth interventions, yet little is known about how digital collaboration with patient representatives can best be implemented in psycho-oncological research. This study aimed to identify the benefits and barriers of digital collaboration in the development of an e-mental health application and provide recommendations to optimize digital collaboration with patient representatives in psycho-oncology research. Conducted from July to September 2023, this study involved digital semistructured interviews with 5 patient representatives from the Reduct trial, a multicenter randomized controlled trial to evaluate the efficacy of the web-based psycho-oncological training Make It. The interviews were analyzed using qualitative content analysis. The findings highlighted multiple advantages of digital collaboration. These included significant reductions in travel costs and effort, personal acceptance and preference for digital methods, enhanced flexibility and accessibility, a reduced health burden, increased efficiency, and scalability. Conversely, several challenges were identified: social impacts or impediments due to less face-to-face interaction, technical difficulties, compromised effectiveness and quality of communication, diverse personal preferences and acceptance levels, organizational issues, cognitive demands, socioeconomic barriers, and safety concerns. The following recommendations to optimize digital collaboration were identified: maintaining regular communication and information exchange, valuing and committing to the collaboration, using diverse communication channels, ensuring comprehensible communication, integrating feedback, fostering openness and understanding, diligent documentation and recordkeeping, and providing targeted training and support for patient representatives. These findings confirm and specify previously known opportunities and challenges of digital collaboration, adding crucial insights for its implementation in psycho-oncological research. This research contributes to enhancing patient-centered approaches in psycho-oncology.
Background/Objectives: Patients with breast cancer show substantial heterogeneity in terms of psychological adjustment following diagnosis. We aimed to characterize longitudinal trajectories of quality of life (QoL) and depressive symptoms during the first 18 months post-diagnosis and to identify robust clinical, psychosocial, and behavioral predictors associated with distinct adjustment pathways. Methods: Women (N = 538; mean age 55.4 years; range 40-70) with operable breast cancer (stages I-III) were drawn from the multicenter BOUNCE cohort. QoL (Global Health Status/QoL scale of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) and depressive symptoms (depression subscale of the Hospital Anxiety and Depression Scale) were assessed at baseline and months 3, 6, 9, 12, 15 and 18. Latent class growth analysis and growth mixture modeling identified distinct trajectory classes. Associations between early predictors and trajectory membership were examined using logistic regression combined with elastic net regularization. Results: Depression trajectories demonstrated heterogeneity, with groups characterized by persistent resilience (59.7%), stable moderate/high (25.3%), delayed onset (5.0%), and recovery (10.0%). QoL trajectories ranged from stable excellent (13.2%) and stable high (40.7%) to moderate (31.4%) and persistent low/deteriorating (6.9%), as well as a distinct recovering trajectory (7.8%). Trajectory differentiation was primarily driven by psychological resources, symptom burden, functional status, and coping processes, alongside specific contributions from clinical factors. Conclusions: Distinct subgroups of women with breast cancer follow divergent adjustment pathways. These findings highlight the multidimensional nature of resilience and support the need for tailored interventions that promote long-term well-being beyond simple risk reduction.
Childhood cancer profoundly alters family dynamics, concentrating emotional and institutional resources on the affected child while generating symbolic and relational losses for healthy siblings that often remain invisible to healthcare systems. This systematic review examines disenfranchized grief among siblings of children with cancer, a population underrepresented in pediatric psycho-oncology. Following PRISMA 2020, a systematic search (2020-2025) was conducted in PubMed and ProQuest. Twelve empirical studies were included, examining the emotional experiences of healthy siblings during the illness, excluding post-death bereavement. Siblings showed elevated psychological distress, including anxiety, stress, guilt, and emotional suppression, associated with ambiguous loss, disrupted family routines, reduced parental emotional availability, and limited social recognition. Emotional validation, open family communication, and psychosocial support emerged as protective factors. Findings highlight the need for a systemic, sibling-inclusive approach in Pediatric Psycho-Oncology, including structured psychosocial risk screening to enable early identification, intervention, and prevention of long-term psychological sequelae.
This study aimed to whether different patterns of postoperative psychological intervention were associated with subsequent adherence to adjuvant endocrine therapy and survival in women with hormone receptor-positive (HR+) breast cancer. We conducted a single-center retrospective cohort study including 318 women with stage I-III, HR+ breast cancer who underwent curative-intent surgery between June 2022 and June 2024 at a tertiary hospital in China. Psycho-oncology care delivered within 6 months of surgery was grouped into 3 patterns: no/minimal care (0-1 session), early structured care (≥3 sessions starting within 3 months) and delayed/low-intensity care (≥3 sessions starting > 3-6 months, or 2 sessions spread over >3 months). Overall survival and disease-free survival were evaluated using a 6-month landmark approach. Associations between intervention patterns and outcomes were assessed with logistic regression and Cox models incorporating inverse probability of treatment weighting based on multinomial propensity scores. In total, 215 of 318 patients (67.6%) met the definition of good 1-year adherence. The proportion with good adherence was higher in the early structured (77.0%) and delayed/low-intensity groups (71.6%) than in the no/minimal group (55.7%). Relative to no/minimal care, early structured intervention was associated with a significantly greater odds of good adherence (adjusted odds ratio [OR] 2.15, 95% confidence interval [CI] 1.27-3.64; P = .004), and delayed/low-intensity intervention showed a more modest but still favorable association (adjusted OR 1.81, 95% CI 1.01-3.24; P = .045). In inverse probability of treatment weighting analyses, the ORs for good adherence were 2.05 (95% CI 1.23-3.42; P = .006) for early structured and 1.67 (95% CI 0.95-2.94; P = .075) for delayed/low-intensity care compared with no/minimal care. After a median follow-up of 24.1 months, early structured intervention was associated with lower,. In this postoperative cohort of women with stage I-III, HR+ breast cancer, early structured psychological intervention was independently linked with better 1-year adherence to adjuvant endocrine therapy. Apparent advantages for overall survival and disease-free survival were consistent in direction but imprecise. The findings support embedding structured psycho-oncology care into routine postoperative follow-up to address distress and help patients maintain long-term endocrine therapy.
Breast cancer remains the most frequently diagnosed cancer among women worldwide, and its burden is particularly severe in regions affected by conflict and war. In these settings, oncology care is often disrupted by the destruction of healthcare infrastructure, displacement of populations, shortages of trained personnel, and limited access to diagnostics and treatment. This paper presents a multidisciplinary, practice-oriented, and resource-stratified framework for delivering breast cancer care in conflict zones, offering practical guidance for clinicians, healthcare workers, and humanitarian organizations. Drawing on literature, field experiences, and expert insight across oncology, pathology, radiology, surgery, radiation oncology, psycho-oncology, and public health, we outline key challenges and propose context-adapted strategies spanning early detection, diagnosis, treatment, and psychosocial support. Emphasis is also placed on multidisciplinary and collaborative efforts, policy and strong advocacy at local, national, and international levels, as well as ethical considerations in humanitarian settings.
It has been well-established that social isolation, loneliness, and inadequate social support are critical determinants of psychological and physical outcomes in persons with cancer. In contrast to latent variable analysis, upon which most current research is based, psychometric network analysis offers a framework for understanding how these social factors relate to specific symptoms, coping resources, and wellbeing in the context of cancer. Although very few studies in this area of research have used network analysis methods, this presentation focuses on a small number of recent network-analytic studies in oncology and other related examples, emphasizing methodological choices, stability procedures, interpretation of centrality indicators, and global network analyses. In addition, recommendations are presented for future research, such as longitudinal models, network analysis of interventions, and multifaceted data integration that might inform translational work in psycho-oncology. Psychometric network analysis holds strong potential to advance psychosocial oncology through the identification of specific modifiable targets that might help mitigate social isolation, loneliness, and inadequate support.
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This study aims to improve understanding physical activity behaviour in patients with metastatic breast cancer, based broadly on Ajzen's Theory of Planned Behaviour (TPB). We assessed the role of different pathways in the TPB and of cancer specific barriers to find points of leverage for improving exercise support and behaviour in this vulnerable population. In addition, we explored international differences in the model's pathways. We conducted an international survey (n = 420) amongst patients with metastatic breast cancer, including items assessing attitude, injunctive subjective norm, intention, perceived behavioural control (PBC), and self-reported physical activity. Additionally, we examined the relative importance of health-related barriers on motivational pathways. Model fit indices indicated a reasonable fit for the TPB (cfi = 0.98, rmsea = 0.08) with small (standardized absolute coefficients 0.13-0.30) but statistically significant associations in the expected directions according to the theoretical model, except for subjective norm (β = 0.05). The interaction of PBC with intention was statistically significant, but adding this term diminished overall model fit (cfi = 0.85, rmsea = 0.13). The presence of health-related barriers impacted behaviour (β = -0.19) whilst acting as a mediator for PBC on intention. International differences in the strength of model pathways suggest cultural variation. Findings support the applicability of the TPB for understanding and supporting physical activity behaviour in patients with MBC. Targeting perceived behavioural control may be especially effective in overcoming health-related barriers in this population. Additionally, improving affective and instrumental attitude towards physical activity could enhance intervention outcomes.
Patients with pre-existing severe mental disorders (SMD) face barriers to optimal cancer treatment. Structured interventions may improve care, but knowledge about their feasibility in daily clinical practice is needed. To assess the feasibility of the CASEMED Model. This mixed-methods feasibility study was conducted at Aarhus University Hospital and included patients with pre-existing SMD and breast, lung, or head and neck cancer. The intervention components included early detection of psychiatric comorbidity, screening for physical and psychiatric symptoms, involvement of caregivers, continuity, education, and enhanced cross-sector collaboration through an onco-psychiatric multidisciplinary team conference (opMDT). Data were collected from patient records and interviews focusing on intervention delivery, acceptability, burden, unintended consequences, and mechanisms of change. Of 27 eligible patients, 23 (85%) participated. Patients had breast (48%), lung (26%), or head and neck cancer (26%) and were diagnosed with moderate to severe depression (65%), bipolar affective disorders (26%), or schizophrenia and other psychotic disorders (9%). Overall, the intervention was feasible and well-accepted, with minimal burden reported. It facilitated a multidisciplinary approach, patient-centered care and cross-sector collaboration. The main implementation barriers included difficulties identifying the appropriate target population, lengthy questionnaires, lack of continuity among oncological professionals, and low general practitioner participation in opMDTs. This feasibility study demonstrates that the CASEMED Model is acceptable and feasible, with a low level of burden and few implementation barriers. The intervention facilitated a multidisciplinary approach with potential to enhance cancer care. Further research is needed to confirm its effectiveness and generalizability in other healthcare settings.
Cancer negatively affects patients' physical status as well as their mental health, increasing the burden of family members and caregivers as well. Thus, the screening of psychological and cognitive functioning is key for the referral to mental health specialists. Identify available and validated screening tools to assess psychological, psychosocial and cognitive impairment in cancer patients (adults and children), caregivers and family members. An umbrella review was conducted according to PRISMA guidelines. The search strategy was applied to five databases. Reviewers screened titles/abstracts, and the articles included in this initial phase were retrieved for full-text assessment. All conflicts during the screening phase were discussed, and a third reviewer was consulted if discrepancies were not solved. A narrative synthesis and tabulated summaries of results were conducted. A total of 2304 records were initially identified through systematic searches. Following screening and eligibility assessment, 67 systematic reviews were included. Across the included reviews, 586 different tools were identified and classified into nine thematic domains: (1) Anxiety and Depression, (2) General Mental Disorders, (3) Distress and Fear of Cancer Recurrence, (4) Body Image, Sexuality, and Self-Perception, (5) Caregiving and Social Impact, (6) Cognitive Functioning, (7) Coping Assessment, (8) Unmet Needs, and (9) Other miscellaneous constructs. A wide variety of mental health screening tools are available, covering key psychosocial and cognitive aspects relevant to cancer care. Although most instruments were not specifically developed for oncological populations, many have been validated in this context and appear to perform adequately.
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Cancer survivors frequently experience persistent physical and psychological sequelae, including impaired physical function, fatigue, anxiety/depressive symptoms, and reduced health-related quality of life (HRQoL). Exercise is an effective non-pharmacological intervention; however, comparative evidence between multicomponent training (MCT) and aerobic training (AT) using a multidomain framework remains limited. In this randomized controlled parallel-group trial, 47 cancer survivors (mean age 63.0 ± 8.9 years) were allocated to a 24-week supervised MCT programme (n = 16), an AT programme (n = 16), or a non-exercise control group (CG; n = 15). Outcomes were assessed at baseline and post-intervention including body composition (BIA), physical performance, fatigue (FSS), anxiety (STAI-Y1/Y2), depressive symptoms (BDI), and HRQoL (EORTC QLQ-C30). Fat mass decreased in both MCT (p = 0.005) and AT (p = 0.034), whereas arm circumference increased only in MCT (p < 0.001). Significant Group × Time interactions were observed for major physical performance outcomes; improvements were broader in MCT, while AT showed its largest change in aerobic endurance. Between-group contrasts indicated greater gains with MCT than AT for chair-stand (p = 0.046), sit-and-reach (p = 0.048), and handgrip strength (p = 0.049). Significant interaction effects were also observed for fatigue and psychological outcomes (FSS: p = 0.003; STAI-Y1 and STAI-Y2: p < 0.001; BDI: p < 0.001) and for HRQoL global health (p = 0.003), with larger improvements in MCT than AT for fatigue, state anxiety, and depressive symptoms (all p < 0.05), but not for trait anxiety (p > 0.05). A 24-week supervised MCT programme produced broader benefits than AT alone across physical function and selected psychological outcomes in cancer survivors. These findings support the incorporation of multicomponent exercise into survivorship care as a feasible and effective strategy for addressing multidimensional treatment sequelae.
Modern medicine, especially oncology in low- and middle-income countries (LMICs), requires clinicians to remain updated in a rapidly evolving field of medicine in the face of a high clinical load. Clinicians need to be able to critically evaluate published evidence and make informed decisions about the individual patients they treat. A clinical culture that encourages clinicians to question and think critically would produce high-quality research from parts of the world that have highest disease burden but lowest contribution to published research. A two-day research methods course was conducted jointly by the Tata Medical Center, Kolkata and the West Bengal Chapter of the Indian Psychiatric Society on 22nd-23rd August 2025. We report on our experience of organising this course and the lessons learned from interacting with the audience in an LMIC setting. Live anonymous participant responses were captured using Mentimeter software during the training, and written anonymous feedback were provided by majority of attendees. The three main barriers to conducting research that our participants reported were: 'lack of training in research', 'difficulties in writing a research paper' and the 'researcher's personal circumstances'. The participants in our course comprised both men and women clinicians, mostly in their early careers and this group of learners appreciated hands-on training on literature search, reference management and working with the SPSS statistical software to conduct standard statistical tests. To achieve this, institutions and individuals need to foster a conducive environment for research, inspiring those who will be responsible for the future health care delivery.
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Adolescent and young adult (AYA) patients with cancer frequently experience psychosocial distress, yet age- and gender-related differences in distress in routine care are not fully understood. To examine age- and gender-related differences in distress and specific psychosocial concerns among AYA patients with cancer using routine distress screening. This retrospective single-center study included AYA patients aged 15-39 years who completed distress screening with the Distress Thermometer (DT) and problem checklist prior to first-line cancer treatment. Clinically significant distress was defined as DT ≥ 4 based on NCCN guidelines and institutional practice. Distress levels and checklist items were compared across age groups (teens, 20s, 30s), gender, cancer stage, and time from diagnosis to screening. Among 213 patients, clinically significant distress (DT ≥ 4) was more frequent among teenage males than among males in their 30s. Female patients reported more emotional concerns across all ages, while fertility-related concerns were reported by both males and females. Financial concerns, reflecting financial toxicity, were most common among patients in their 30s and those with advanced-stage disease. A shorter interval between diagnosis and screening was associated with higher distress levels. Using the standard DT cutoff of ≥4, distress among AYA patients with cancer varied significantly by age and gender. Teenage males represented a particularly vulnerable group with elevated distress at diagnosis, while financial toxicity was a major concern among patients in their 30s. These findings emphasize the need for early, age- and gender-tailored psychosocial screening and support in AYA oncology care.
Background: Breast cancer poses not only a physical health threat but also significant emotional and identity challenges for women, particularly regarding femininity and body image. Understanding how patients adapt psychologically can guide effective psychosocial interventions. Objective: This study aimed to evaluate psychological adaptation, coping strategies, illness acceptance, and body image in women with breast cancer and identify factors associated with better adjustment. Methods: A cross-sectional study was conducted among 30 women aged 22-66 undergoing treatment at the Wielkopolskie Centrum Onkologii, Poland. Standardized tools included the Mini-MAC scale (coping strategies), Acceptance of Illness Scale (AIS), and Body Image Scale (BIS). Descriptive statistics and correlations were analyzed. Results: Most participants exhibited a constructive coping style, with positive redefinition and fighting spirit being predominant. Some women simultaneously showed elements of a destructive coping style, including helplessness and hopelessness, indicating complex emotional reactions. Overall, participants demonstrated high illness acceptance, despite notable body image-related discomfort, particularly shame, reduced perceived attractiveness, and appearance-related anxiety. While age did not correlate significantly with coping or body image, a significant negative association was found between age and illness acceptance, with younger women showing better adjustment. Conclusions: Psychological adaptation to breast cancer is multidimensional and individualized, dependent on personality traits, internal resources, and social support. Findings highlight the need for holistic, patient-centered psychosocial care, addressing both emotional adaptation and body image-related distress, including support for intimacy and prosthetic interventions. Individualized strategies can improve quality of life and functional outcomes during and after cancer treatment.
Hematologic malignancies (HMs) require intensive treatment procedures which significantly reduce quality of life for patients. Patients with HM often rely on family caregivers to provide emotional and instrumental support. It is therefore essential to understand patients' and caregivers' experiences to inform psychosocial interventions. This study explores the impact of HM on patients' and caregivers' lived experiences during the acute treatment period. Interview responses from patients with HM (n = 24) and their caregivers (n = 24) were coded via content analysis to describe the meaning that participants assigned to their experiences, and code frequencies were calculated. Results identified themes of emotional, physical, logistical, and financial impacts of the disease as well as supports and challenges in families' interactions with the healthcare system. Patients most frequently discussed the physical impact of their illness, while caregivers made the most comments about their relationship with healthcare providers. Findings underscore patient, caregivers, and healthcare team successes and challenges as well as the need for early interventions that help families feel more prepared to cope with cumulative strains of cancer treatment and caregiving.
To systematically evaluate the effects of different exercise interventions on sleep quality improvement in patients with cancer and compare the relative effectiveness of various exercise programs using a network meta-analysis, providing evidence-based guidance for developing personalized exercise intervention strategies in clinical practice. We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and other databases for randomized controlled trials on exercise interventions for sleep quality in patients with cancer, published from database inception to September 2025. Two researchers independently performed literature screening, data extraction, and Cochrane risk-of-bias assessment. Network meta-analysis was performed with Stata 18.0 software, and the relative effectiveness of exercise interventions was ranked using surface under the cumulative ranking curve values. Forty-five randomized controlled trials covering nine exercise interventions were included. Network meta-analysis revealed statistically significant differences in sleep quality improvement among progressive muscle relaxation exercise, aerobic exercise, and walking (p < 0.05). Surface under the cumulative ranking curve rankings were as follows: progressive muscle relaxation exercise (98.6%) > aerobic exercise (70.7%) > walking (68%) > tai chi qigong (53%) > dance (51.2%) > yoga (48.7%) > combination exercise (41.1%) > resistance exercise (30.2%) > high-intensity interval training (25.3%) > control group (13.1%). Progressive muscle relaxation exercises are the preferred recommendation for sleep intervention in patients with cancer. Aerobic exercise and walking are alternative options. Individual patient conditions should be considered to tailor intervention plans in clinical practice.
Children with cancer and their parents require continuous psychosocial support beyond hospital-based care, particularly in settings where structured, family-centered psychosocial services are limited. Although evidence-based psychosocial interventions exist, these are predominantly developed and implemented in well-resourced healthcare systems and may not be readily accessible or scalable in different care contexts. However, evidence on structured, technology-based psychosocial empowerment programs targeting both children and parents within home-based care remains limited. This study aimed to evaluate the effectiveness of a technology-based psychosocial empowerment program for children with cancer receiving care in the home setting and their parents. This parallel-group randomized controlled trial included 64 children with cancer (aged 8-18 years) and their parents, who were randomly assigned to either an intervention (n = 32) or a control (n = 32) group. The intervention group took part in a 4-week, web-based psychosocial empowerment program based on Psychological Empowerment Theory, which included modules designed specifically for children and parents. In comparison, the control group received standard care. Psychosocial outcomes were assessed using validated measures of self-efficacy, anxiety, coping, problem-solving, and psychological resilience at baseline, post-intervention, and at the 1-month follow-up. Data were analyzed using variance analysis. Children in the intervention group showed significantly higher levels of self-efficacy and coping, along with lower levels of state and trait anxiety compared to the control group (all p < 0.001; η p 2 ${\eta }_{p}^{2}$ range = 0.48-0.68). Similarly, parents in the intervention group showed significantly higher self-efficacy, problem-solving skills, and psychological resilience than those in the control group (all p < 0.001; η p 2 ${\eta }_{p}^{2}$ range = 0.40-0.82). These effects were maintained at the 1-month follow-up. Technology-based psychosocial empowerment programs integrated into home-based care effectively enhance the psychosocial well-being of children with cancer and their parents. These psychological empowerment programs provide a systematic, innovative, and sustainable approach that can be integrated into home-based care and follow-up processes in pediatric oncology. ClinicalTrials.gov (NCT05566951), https://clinicaltrials.gov/study/NCT05566951, registered on April 25, 2023.
Cancer-related cognitive impairment (CRCI) is a frequent side effect of cancer and its treatment that can persist well after treatment completion, with major impacts on quality of life, daily living activities, and return to work. This randomised pilot study assesses the feasibility and acceptability of methods and procedures intended for use in a definitive trial of a web-based cognitive rehabilitation program-'Responding to Cognitive Concerns" (eReCog)-in people with low perceived cognitive function after chemotherapy for aggressive lymphoma within the past 5 years and were in remission. Potential efficacy was also explored. Participants were randomised one-to-one to receive usual care or eReCog plus usual care. The 4-week eReCog program consists of four online modules based on the principles of cognitive behavioral therapy. Operational, neuropsychological test and patient-reported outcome measures (PROMs) data were collected before randomisation and approximately 8 weeks later to assess trial outcomes. Primary feasibility outcomes included recruitment and retention rates (a priori progression criteria: ≥ 3 patients/month and ≥ 80% of participants complete the trial, respectively). Feasibility data were summarised using a rate or proportion, as appropriate, with 95% confidence intervals. Neuropsychological test and PROMs data were analyzed using analysis of covariance. 38 of 53 eligible participants consented to participate over 10 months (3.8 patients/month, 95% CI [2.7, 5.2]), 19 were randomised to each arm, and 36 of 38 (95%, 95% CI [83, 99]) completed the trial, indicating acceptable feasibility. Acceptable feasibility was also found for all four secondary outcomes: adherence to, usability of, and intrinsic motivation to engage with eReCog; and compliance with assessments. A large-sized difference favoring the intervention arm was observed on the SCWT Word score measuring processing speed. Medium-sized differences were observed on other neuropsychological test and PROM scales, but confidence intervals were wide and included zero. Recruitment and retention rates, compliance with assessments and favorable changes on potential outcome measures suggest a large-scale, appropriately powered trial is warranted, as do findings that eReCog is acceptable to the study population. Australian New Zealand Clinical Trials Registry ACTRN 12623000705684.