Effects of web-based interventions on quality of life among patients with breast cancer: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Patients with breast cancer experience decreased quality of life due to various physical and psychological challenges. Web-based interventions are accessible, cost-effective, and convenient for improving their quality of life. This study evaluated whether web-based interventions improve quality of life and included only randomized controlled trials (RCTs) with clear evidence. METHODS: PubMed, Embase, Cochrane Library, CINAHL, Web of Science, and PsycINFO were searched for articles published until October 16, 2023. Inclusion criteria were RCTs evaluating the effect of web-based interventions on quality of life in patients with breast cancer. The risk of bias was assessed with Cochrane's Risk of Bias Tool 2.0. Standardized mean differences were calculated with a random effects model using R version 4.0.3, and subgroup and moderator analyses were performed. RESULTS: Since quality of life was measured using two different instruments in two studies, 21 comparisons were analyzed from 19 RCTs. As a result, the findings suggest that web-based interventions have a small effect size on improving the quality of life for patients with breast cancer (SMD = 0.27, 95% confidence intervals [CIs]: 0.15-0.38, p = 0.03). Heterogeneity was found to be low (I2 = 40%). The quality-of-life subdomain results showed a moderate effect size on the physical functioning and a small effect size on the cognitive and emotional functioning of patients with breast cancer but no significant impact on their role or social functioning. CONCLUSIONS: Web-based interventions are effective in improving patients' quality of life with breast cancer; they also improve physical, cognitive, and emotional functioning. However, evidence regarding intervention methods remains inconclusive due to the limited number of RCTs, necessitating further research.

Risk and Protective Factors of Psychosocial Functioning in Survivors of Childhood Cancer: Results of the DCCSS-LATER Study.

OBJECTIVE: This study examines the association between psychosocial risk and protective factors and a wide range of psychosocial outcomes including emotional, social, cognitive, and physical domains in childhood cancer survivors (CCS). METHODS: CCS from the Dutch Childhood Cancer Survivor Study (DCCSS)-LATER cohort (diagnosed 1963-2001) part 2 (age ≥ 18 years, diagnosed < 18 years, ≥ 5 years since diagnosis) completed questionnaires on psychosocial risk and protective factors (Benefit and Burden Scale, Illness Cognition Questionnaire, Rosenberg Self-Esteem Scale, and Impact of Cancer Scale), and psychosocial outcomes (Hospital Anxiety and Depression Scale, Self-Rating Scale for Post-Traumatic Stress Disorder, TNO-AZL Questionnaire for Adult Health-Related Quality of Life, and Short Form-36). Associations were assessed with regression analysis, adjusting for attained age, sex, number of health conditions, and time since diagnosis, while correcting for multiple testing (p < 0.004). RESULTS: A total of 1382 CCS participated, all diagnosed ≥ 15 years ago. The mean age of participating CCS was 36 years, and 51% were female. Perceived benefit and burden, acceptance, and helplessness, self-esteem and social support were associated with the psychosocial outcomes. In the models including all psychosocial factors, most associations with psychosocial outcomes were seen for self-esteem (10×), and perceived burden (9×). Self-esteem (all ß ≤ 0.47) and perceived burden (all ß ≤ 0.38) demonstrated strongest associations of medium/large size. CONCLUSIONS: Perceptions of childhood cancer, illness cognitions, self-esteem, and social support play a role in explaining psychosocial functioning in CCS, outweighing the influence of socio-demographic and medical variables. Addressing negative perceptions and reducing feelings of helplessness, while promoting acceptance, self-esteem, and social support, could provide intervention targets for CCS who encounter psychosocial challenges.

Bereavement guilt among young adults impacted by caregivers' cancer: Associations with attachment style, experiential avoidance, and psychological flexibility.

OBJECTIVES: This paper focuses on the experiences of bereavement guilt among young adults bereaved by a caregiver's cancer, examining associations with attachment style, experiential avoidance, and psychological flexibility with the aim of informing psychosocial interventions for this population. METHODS: Ninety-seven young adults (18-25 years) bereaved by a parent/guardian's cancer completed an online survey, including measures of bereavement guilt, attachment style, experiential avoidance, and psychological flexibility. Mediation analyses explored the associations between attachment style (anxious, avoidant) and bereavement guilt, and if these associations were mediated by experiential avoidance or psychological flexibility. RESULTS: Bereavement guilt was significantly positively associated with anxious, but not avoidant, attachment to the deceased; the relationship between anxious attachment and bereavement guilt was partially mediated by experiential avoidance. Bereavement guilt was also negatively associated with psychological flexibility and engagement with bereavement counseling. SIGNIFICANCE OF RESULTS: Given the limited literature on cancer-related bereavement in young adulthood, this study offers important theoretical and clinical insights into factors associated with more complex aspects of grief in this population. Specifically, this work identified that anxious attachment is associated with ongoing bereavement complications in the years following the death of a caregiver to cancer, with experiential avoidance partially mediating this relationship. While further research is needed to better understand the interaction between these factors and other related constructs, such as psychological flexibility, these findings may be helpful in selecting therapeutic approaches to use with this population.

Experiences and Needs of Carers of Patients With Head and Neck Cancer: A Systematic Review.

PURPOSE: The needs of head and neck cancer (HNC) carers tends to be poorly addressed as most support systems are directed towards patients. This systematic review synthesises the existing qualitative evidence from carers for adult HNC patients to explore their experiences and needs as a basis to inform the initial development of an item prompt list for HNC carers for use in routine clinical practice. METHODS: Seven electronic databases were searched from their inception until November 2022, supplemented by citation chaining and snowballing. Primary qualitative or mixed-methods studies reporting the experiences of carers for HNC patients, elicited using interviews, were included. Screening and selection, data extraction and quality assessment (Critical Appraisal Skills Programme Checklist) were independently conducted by two researchers. Data were analysed using inductive thematic synthesis and confidence evaluated using GRADE CERQual. RESULTS: Thirty studies met the inclusion criteria. Two overarching themes and nine subthemes emerged: (i) the experiences of loss associated with being a carer (loss of: role and everyday routine, certainty leading to emotional distress, security as fear of recurrence prevailed, finances, intimacy and togetherness, enjoyment from social activities); and (ii) factors promoting coping and adjustment to role of carer (information, supportive mechanisms, personal attributes). CONCLUSION: New insight into the experiences of HNC carers provides the basis for item generation of a HNC carer prompt tool. IMPLICATIONS FOR CANCER SURVIVORS: With such a range of potential unmet concerns, the development of a prompt list should help to elicit these and provide additional means to targeted support.

Beyond the battle: A cross-sectional study on cancer-related fatigue and predictors of quality of life in female adolescent and young adult survivors.

OBJECTIVES: The study delves into the intricacies of cancer-related fatigue (CRF), the quality of life (QoL), and other demographic variables of female adolescent and young adult cancer survivors (AYACS) in the landscape of Kerala, India. METHODS: The cross-sectional study included 288 female AYACS who were selected through purposive sampling and completed self-reported questionnaires on CRF, QoL, and demographic and clinical data. Statistical analyses were applied, including correlation, one-way ANOVA, and regression. RESULTS: and discussion: The temporal dimension is particularly interesting, as individuals three to five years post-treatment report heightened CRF and QoL scores. Furthermore, the research unveils the pivotal role played by predictors such as marital status, educational attainment, and employment status in shaping QoL. Marital status and education emerge as positive predictors of well-being. The study unveils compelling insights into AYA cancer survivorship, revealing a profound impact of CRF on the quality of life dimensions. The role of spirituality, sometimes affecting social connectedness, adds intrigue. CONCLUSION: The findings provide insights into the complex world of female AYACS, compelling researchers to ponder the significance of addressing CRF and tailoring rehabilitation systems during the critical post-treatment phase, with recognition of gender-specific challenges.

Effect of Meaning-in-Life Interventions for Advanced Cancer Patients: A Systematic Review and Meta-Analysis.

This study aimed to explore the effects of meaning-in-life intervention on meaning in life, quality of life, spiritual well-being, anxiety, and depression in advanced cancer patients. Databases, including Ovid Medline, Cochrane, PsycINFO, CINAHL, and Embase, were searched to identify relevant randomized controlled trials based on predefined criteria. Seven studies were included. Meta-analysis was performed for five studies, involving 718 patients with advanced cancer. The meta-analysis revealed no significant effects of the meaning-in-life intervention on spiritual well-being, depression, and anxiety of advanced cancer patients. The insufficient number of studies and risk of bias limit the strength of the conclusions. Therefore, further studies with larger sample sizes and methodologically rigorous designs are required to evaluate the effects of meaning-in-life interventions for advanced cancer patients. Our findings can support a better understanding of the need to study meaning-in-life interventions in advanced cancer patients and foster sustained attention to recognize meaning-in-life interventions as an effective method in healthcare.

Parents' experiences with sequencing of all known pediatric cancer predisposition genes in children with cancer.

PURPOSE: Germline DNA sequencing is increasingly used within pediatric oncology, yet parental experiences remain underexplored. METHODS: Parents of children undergoing cancer predisposition gene panel sequencing (143 genes) were surveyed before and after disclosure of results. Questionnaires assessed knowledge, expectations, worries, satisfaction, and regret. Next to descriptives, linear mixed models and generalized mixed models were utilized to explore factors associated with knowledge and worries. RESULTS: Out of 325 eligible families, 310 parents (176 mothers and 128 fathers of 188 families) completed all after-consent questionnaires whereas 260 parents (150 mothers and 110 fathers of 181 families) completed all after disclosure questionnaires. Most parents hoped their participation would benefit others, although individual hopes were also common. Sequencing-related worries were common, particularly concerning whether their child would get cancer again, cancer risks for family members and psychosocial implications of testing. Parental satisfaction after disclosure was high and regret scores were low. Lower education was associated with lower knowledge levels, whereas foreign-born parents were at increased risk of experiencing worries. CONCLUSION: Germline sequencing of children with cancer is generally well received by their parents. However, careful genetic counseling is essential to ensure that parents are adequately informed and supported throughout the process.

Alcohol consumption in cancer patients receiving psycho-oncologic care analysis of socio-demographic, health-related and cancer-related factors.

PURPOSE: The carcinogenic effects of alcoholic beverages and the negative impact of alcohol consumption on cancer progression and treatment outcomes are well established in oncology research. Many cancer patients experience significant psychological distress, often manifesting as elevated levels of depression and anxiety. In the general population, alcohol consumption is commonly used as a coping mechanism for such distress. For cancer patients facing substantial psychological challenges, psycho-oncology care is available to help manage their symptoms and the overall impact of their condition. However, there is limited understanding of the alcohol consumption patterns in this particularly vulnerable group of patients, as well as the disease-related factors that may influence their drinking behavior. This study aims to examine the prevalence of potentially risky alcohol consumption in cancer patients receiving psycho-oncology care and to identify sociodemographic, health-related, and psychosocial factors associated with alcohol consumption after cancer diagnosis. By understanding drinking patterns and the factors associated with them, we aim to promote healthier behaviors and enhance treatment outcomes for cancer patients receiving psycho-oncology care. METHODS: A consecutive sample of 1.225 patients from the psycho-oncology outpatient clinic of the University Medical Center Hamburg Eppendorf (UKE) was analyzed with regard to their alcohol consumption behavior using the Alcohol Use Disorders Identification Test-Consumption Items (AUDIT-C). Self-report questionnaires were employed to assess sociodemographic, health-related, and cancer-specific information. For statistical analysis, multiple linear regression was utilized. RESULTS: In the sample of cancer patients receiving psycho-oncology support one in six of both female and male patients showed risky alcohol drinking behavior (e.g. AUDIT-C above three for women and four for men). In the analysis (R-Square: 0.056) male gender (regression coefficient B 0.686, 95% CI: 0.453-0.919) and patients reporting a higher physical health-related quality of life (SF8-PCS) (B 0.021, 95% CI: 0.011-0.032) were associated with higher levels of alcohol consumption, whereas having children (B -0.481, 95%CI: -0.700- -0.262) was associated with lower alcohol consumption. With regard to cancer type, a single-factor analysis of variance with gender as the centered covariate showed that patients with gastrointestinal cancer had had lower average consumption levels compared to the groups of patients with breast cancer, melanoma, genitourinary cancer, and lymphoma. Also, patients with sarcoma had lower average consumption levels than patients with lymphoma. CONCLUSIONS: The results allow to identify patient characteristics and cancer types associated with higher or lower alcohol consumption levels and higher likelihood of risky consumption behavior in this sample of cancer patients receiving psycho-oncological support. IMPLICATIONS FOR CANCER SURVIVORS: Cancer patients are particularly susceptible to the hazardous effects of alcohol consumption. The results of this study help to identify cancer patients at risk of worsening prognosis due to alcohol consumption and to develop intervention programs to minimize alcohol consumption in this group.

Family Caregivers of Cancer Patients: Burdens and Support Preferences of Partner, Parent and Adult-Child Caregivers.

OBJECTIVE: The aim of this study is to (1) identify similarities and differences in psychosocial burdens and support needs experienced by parent, partner and adult-child caregivers and (2) identify support needs of family caregivers regarding peer support programs. METHODS: Semi-structured interviews (n = 30) were conducted with family caregivers of cancer patients. Interviews were transcribed and analyzed by inductive content analysis to identify themes. RESULTS: Ten categories of burden were identified for all three groups of caregivers. Partners emphasized the time burden through caregiving, parents and adult-child caregivers accentuated the emotional burden. All caregivers wished for peer-to-peer exchange which will provide the feeling not to be alone, to share emotions and to prepare for what will come next. Preferences for matching with peers with similar prognosis for their sick relative and similar living conditions were found. CONCLUSIONS: Partner, parent and adult-child caregivers describe similar burdens of caregiving. They wish for peer support programs that allow them to share their experiences with persons who understand their situation. Therefore, caregivers desire a good match with peers to enhance the positive outcome of peer exchange.

The Impact of Depression on Adherence to Diabetes Self-Management Behaviors in Breast Cancer Survivors.

OBJECTIVE: Breast cancer survivors (BCS) have higher rates of depression which is associated with lower adherence to medications, diet, and physical activity. Managing diabetes (DM) requires adherence to several of these self-management behaviors (SMB), and BCS have an increased risk of DM. We investigated whether depressive symptoms were associated with adherence to DM SMB in a cohort of BCS. METHODS: BCS with DM were surveyed semiannually for 2 years. Depression was assessed with the Hospital Anxiety and Depression Scale (HADS). Adherence to DM medication, diet, and physical activity was self-reported using the Medication Adherence Report Scale (MARS), Summary of Diabetes Self-Care Activities Assessment (SDSCA), and International Physical Activity Questionnaire (IPAQ), respectively. Using generalized linear equation modeling, the association of depressive symptoms with nonadherence to SMB was assessed, adjusting for age, race, marital status, education level, and beliefs about cancer and DM risk. RESULTS: Among 244 BCS with DM, those who were nonadherent to medication, diet, and/or physical activity had higher depression scores (p < 0.01). In adjusted analyses, higher depression scores were independently associated with dietary (OR = 1.16, p < 0.001) and physical activity nonadherence (OR = 1.18, p < 0.001) but not with medication nonadherence. Concerns about medications was independently associated with medication nonadherence (OR = 1.17, p = 0.024). CONCLUSIONS: Higher depression scores are associated with nonadherence to DM SMB in this cohort of BCS. These findings highlight the importance of addressing depressive symptoms in BCS to help improve adherence to DM medications, diet, and physical activity.

Psychosocial interventions for post-treatment haematological cancer survivors: An integrative review.

PURPOSE: To synthesize literature regarding the implementation and evaluation of psychosocial interventions designed to reduce distress in post-treatment haematological cancer survivors. METHODS: An integrative review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched were Medline, Cinahl, PsychInfo, WoS, and EMBASE, during November 2022. RESULTS: The total number of eligible studies was 14. The interventions comprised four main intervention categories: care planning, psychological therapy-based, supported self-care/self-management, and survivorship clinic visits. Overall psychosocial interventions were shown to improve outcomes for haematological cancer survivors. CONCLUSIONS: Psychosocial interventions may play a role in reducing distress for post-treatment haematological cancer survivors and have shown improvements in both psychological and physical outcomes. However, the evidence base was limited and heterogeneous indicating the need for more research. IMPLICATIONS FOR CANCER SURVIVORS: Psychosocial interventions for haematological cancer survivors have the potential to reduce psychosocial distress during the post-treatment period.

Associations Between a Social Determinant of Health Summary Measure and Self-Reported Physical and Mental Health Among Cancer Survivors.

OBJECTIVE: We sought to examine the associations between a social needs measure and physical, and mental health among cancer survivors in the United States. METHODS: We conducted a cross-sectional analysis using the 2022 Behavioral Risk Factor Surveillance System survey involving 16,930 eligible cancer survivors. The primary outcomes of interest were self-reported physical and mental health in the past 30 days. A social needs measure was our primary exposure of interest. Multivariate logistic regression was used to examine the associations of interest. RESULTS: Overall, 56% and 73% survivors with several days of poor physical and mental health, respectively, reported having two or more social needs. In multivariate analysis, those having at least one social need were more likely to report several days of poor physical (one need: OR, 1.62; 95% CI, 1.31-2.00, two or more needs: OR, 3.52; 95% CI, 2.84-4.35) and mental health (one need: OR, 3.07; 95% CI, 2.07-4.57, two or more needs: OR, 9.69; 95% CI, 6.83-13.74). Among survivors with two or more social needs, having exercised in the past 30 days were 41% and 59% less likely to experience poor physical and mental health, respectively (p-value < 0.05). However, having at least one chronic disease was associated with several days of poor physical/mental health among those with two or more needs (p-value < 0.05). CONCLUSION: Having social needs was associated with self-reporting of several days of poor physical and mental health among cancer survivors. Integrated care should include mental/physical health management addressing cancer survivors' various social needs.

Building on and tailoring to: Adapting a cancer caregiver psychoeducational intervention for rural settings.

INTRODUCTION: Rural cancer caregivers experience obstacles in accessing services, obtaining respite, and ensuring their care recipients receive quality care. These challenges warrant opportunities to participate in evidence-based behavioral intervention trials to fill support gaps. Adaptation to rural settings can facilitate appropriate fit, given higher caregiver service needs and unique challenges. We present findings from the adaptation process of a psychoeducational intervention designed to support cancer caregivers in rural settings. METHODS: We adapted Reblin's CARING intervention, designed for neuro-oncology, to target caregivers of rural cancer patients across cancer sites. First, we conducted formative work to determine the unmet social and supportive care needs rural cancer caregivers faced. We used the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to guide the modifications. To conduct the adaptation, we elicited feedback through qualitative interviews of seven caregivers and three cancer hospital staff and thematic analysis to inform intervention modifications. Our qualitative study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS: Interviews revealed that service access was a pressing need, along with financial (e.g., treatment costs, employment challenges) and geographic barriers (e.g., distance to treatment, road conditions). We modified content, training, and context using the FRAME-IS steps. Changes enhanced fit through the following adaptations: changes to social support domains, session content, interventionist training, resource offerings, screening and recruitment processes, and virtual delivery. DISCUSSION: Challenges to establishing successful psychosocial oncology interventions may be improved through participant-centered approaches and implementation science. Additional systemic challenges, including lack of systematic documentation of caregivers, persist and may especially disadvantage under-represented and underserved groups, such as rural dwellers. The enCompass intervention is undergoing ongoing single-arm pilot of rural cancer patient/caregiver dyads targeting caregiver coping self-efficacy and patient/caregiver distress (Clinical Trials #NCT05828927).

Role of emotional control on anxiety and stress among cancer patients.

OBJECTIVE: The article aims to assess the role of stress and anxiety in relation to the level of emotional control among cancer patients. Currently cancer ranks second, after cardiovascular disease, as the most common cause of death. Moreover, it is predicted that in the coming years, cancer will become the leading cause of death worldwide. This is due to the extended lifespan of the population and also to the presence of carcinogenic factors in the surrounding environment. The emergence of cancer is a significant stressor that affects individuals in diverse ways, leading to cognitive, behavioral, and emotional consequences. In line with the adopted aim, emotional issues are the chosen area of exploration in this article. METHODS: The study included 102 patients. The differences between the patients' results according to various scales and the results produced by the validation group data were examined using one-sample t-tests. The relationships between the quantitative variables were determined using Spearman's rho coefficients, and the relationships between the quantitative and qualitative variables were verified using Kruskal-Wallis tests. RESULTS: The participants exhibited higher anxiety suppression levels than individuals in the normalization group. They sought emotional support more frequently than the average person in the population, turned to religion, engaged in other such activities, lived in denial more often, discontinued activities, and displayed a sense of humor less frequently. The more frequently they controlled their anger, the less they sought emotional and instrumental support, catharsis, and attempted to accept the situation and cease being active. Additionally, controlling anxiety, sadness, and depression coexisted with self-blame, denial, and compensatory actions. CONCLUSIONS: Cancer patients face intense anxiety. Emotional and instrumental support, along with the ability to express and manage emotions, are crucial for these patients, especially within the context of facing the challenge of cancer. Finding constructive ways to express strong and difficult emotions prevents their accumulation and reduces the need for emotional suppression. Preventive actions should be oriented toward supporting the emotional competencies of patients.

Impact of gynecological cancers on women's mental health.

Gynecological cancers and their treatments are associated with both specific and non-specific long-term physiological effects. Cancer patients face transformations in their lifestyle, body image, role, and social interactions and suffer from physical, psychological, and economic problems. The mental health of cancer patients is of great importance and requires special attention, as growing evidence demonstrates its influence not only on quality of life but also on treatment compliance. Gynecological cancers have peculiar psychological consequences, which are linked to the specificity of the site of the neoplasia. Clinicians should be aware of the importance of protecting the psychophysical health of these patients and the fact that their physical health and quality of life also depend on the quality of their mental health. It is possible to structure targeted and effective prevention interventions and treatments to reduce psychological distress and improve the quality of life of subjects living with gynecological cancers.

"Art is just something that makes people heal"-a qualitative investigation of tattoo artists' perspectives on cancer survivorship therapeutic tattoos.

PURPOSE: Many cancer treatments can lead to a disrupted body image and identity. One intervention to address these outcomes is therapeutic tattooing. However, despite the wide dissemination of this practice for cancer survivors (CSs), current research on it is lacking. This study aimed to identify tattoo artists' (TAs') perspectives on the types, impacts, barriers, and facilitators of therapeutic tattooing for CSs and the impact of doing this work on themselves. METHODS: Twenty-two international TAs who tattoo CSs were interviewed and resultant transcripts were analyzed thematically. RESULTS: The following themes emerged: Emotional Management of Artists, Emotional Transformation of CSs, Stigma and its effects on CSs, Artist Barriers, CS Barriers, Artist Facilitators, and CS Facilitators. The findings also identify a typology of cancer survivorship therapeutic tattoos. CONCLUSION: This is the first study to identify barriers/facilitators of therapeutic tattooing, a typology of cancer survivorship therapeutic tattoos, TAs' perspectives on therapeutic tattooing, and potential negative outcomes from this practice. The findings indicate that therapeutic tattooing can be both beneficial and harmful for CSs and TAs, that there is a need for better therapeutic tattooing training for TAs and healthcare providers (HPs), increased awareness of therapeutic tattoos, and a reduction in barriers to the practice and greater collaboration between HPs and TAs. IMPLICATIONS FOR CANCER SURVIVORS: Findings from this study have major policy implications for healthcare systems, non-profit organizations, and regulatory bodies, which could serve to empower cancer survivors to make more informed decisions about their bodies and support enhanced training and accreditation of this practice.

'I Live With Lynch. Cancer Worry Ebbs Into the Background, Then Something Brings It to the Fore.' A Qualitative Interview Study Exploring How Lynch Syndrome Carriers Make Sense of Their Cancer Risks and Implications to Support Decision Making.

BACKGROUND: Lynch syndrome carriers ('carriers') are presented with complex, emotionally laden choices regarding management of increased genetic cancer risks. Decision aids encourage active involvement in values-based health decisions. This paper aimed to address the research question: How do Lynch syndrome carriers make sense of their chances of developing cancer, and what are the implications for providing support with decision making about genetic cancer risk management? METHODS: Adult carriers were recruited through a genetics service or involvement with Lynch Syndrome UK. Semi-structured interviews explored lived experiences of carriers' access to care with a focus on decision support. Themes were constructed using framework analysis. These were developed into a conceptual model with recommendations for codevelopment of improved information and support including a tailored decision aid to complement integrated healthcare. RESULTS: Twenty participants included 12 women and eight men, half with a history of cancer. Six overarching themes were: (1) finding balance with Lynch; (2) living 'on higher alert'; (3) managing uncertainty: 'I've thought about it a lot'; (4) burden of responsibility: 'It's on me'; (5) access to joined-up care and support: 'There's something missing'; and (6) influence/pressure from others. CONCLUSIONS: This qualitative interview study provided in-depth insights from Lynch syndrome carriers about their lived experiences, informed by their values. Recommendations to empower carriers to make sense of genetic cancer risks and support decisions included accessible, trusted information, educated healthcare professionals, shared decision making, and joined-up integrated care pathways complemented by tailored decision aids.

A Preliminary Phenomenological Exploration of Experiences of the Empty Pelvis Syndrome Derived From a Modified-Delphi: The Price of Survival Following Pelvic Exenteration for Advanced Pelvic Cancer.

OBJECTIVE: The empty pelvis syndrome (EPS) is common after pelvic exenteration (PE), causing fluid collections, bowel obstruction, perineal sinuses, and fistulas. The best approach to fill the pelvis to mitigate this remains controversial, and the impact of EPS on health-related quality of life (HrQoL) is unknown. This study is the first to begin to explore lived-experiences of EPS complications. METHODS: Unstructured EPS virtual focus group meetings were conducted with a convenience sample of patients who underwent PE, as an extension of a modified-Delphi study. Interpretative phenomenological analysis was conducted on verbatim transcripts to generate group experiential themes. RESULTS: Twelve patients (eight UK, one Dutch, and three Belgian) participated in four focus groups. Eight EPS complications were reported, (two pelvic collections, five chronic perineal sinuses, and one bowel obstruction). Group experiential themes were 'Out of Options', depicting patients forced to accept complications or limited survival; 'The New Normal', with EPS potentially delaying adaptation to post-PE HrQoL; 'Information Influencing Adaptation,' emphasising the significance of patients understanding EPS to cope with its effects; and 'Symptoms,' reporting manifestations of EPS, the resultant physical limitations, and an intangible feeling that patients lost part of themselves. CONCLUSIONS: EPS may influence patient decision-making, regret, adaptation, and information-seeking. It can cause a variety of unpleasant symptoms and physical limitations, which may include phantom phenomenon. This work supports ongoing purposeful HrQoL research to better define these themes.

Foundations for a Personalized Psycho-Oncology: The State of the Art.

Personalized psycho-oncology represents a major challenge for the holistic care of cancer patients. It focuses on individualized psychotherapeutic and psychiatric interventions to address specific psychological needs. This narrative review summarizes the current literature on personalized psycho-oncology and highlights the prevalence and impact of psychiatric/psychological disorders in cancer patients. Personalized approaches, including tailored interventions and interdisciplinary collaboration, have been shown to be effective in improving mental health and overall quality of life. The integration of inflammatory biomarkers into treatment plans is a promising but challenging way to alleviate mental health problems. In addition, there is a need for specific diagnostic tools and treatment guidelines that take into account the specific psychological impact of different types of cancer. Future research should aim to refine these personalized strategies, improve diagnostic accuracy, and evaluate the cost-effectiveness of these interventions to improve both the psychological well-being and treatment outcomes of cancer patients.