'I cannot accept it' distressing experiences in parents of children diagnosed with cancer: A qualitative study.

AIMS: To explore the distressing experiences of Chinese parents of children with cancer from the perspective of psychological inflexibility. DESIGN: A qualitative study using a descriptive qualitative approach based on the model of psychological inflexibility was adopted. METHODS: Individual semi-structured interviews through synchronized online video were conducted with 21 Chinese parents of children with cancer from October 2020 to May 2021. Data were analysed using content analysis. RESULTS: Four themes and 11 subthemes were identified: (i) immersion in struggling and suffering, (ii) avoidance and suppression, (iii) blaming and complaint and (iv) helplessness and worthlessness. Parents were unwilling to accept the diagnosis and witness their children's suffering, trapped in uncontrollable negative emotions and thoughts. Avoiding emotions and socializing, blaming themselves or complaining of injustice were common. They felt helpless towards life and valueless without the child. CONCLUSION: The research findings provide additional perspectives in understanding the distressing experiences in parents of children with cancer. Overall, the emotional and coping styles indicated the lack of psychological flexibility of parents when facing childhood cancer, which is profoundly influenced by Chinese culture. IMPLICATIONS FOR THE PROFESSION: Healthcare professionals are recommended to provide culturally sensitive strategies or interventions for building psychological flexibility in addressing parental psychological distress. IMPACT: The study provides insights into exploring distressing experiences and reveals the inflexible psychological and behavioural patterns in parents of children with cancer, which could benefit healthcare providers in managing parental psychological distress and helping these parents build flexible coping strategies. REPORTING METHOD: The COREQ guideline was followed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement.

Effects of acceptance and commitment therapy on fatigue interference in patients with advanced lung cancer and caregiving burden: protocol for a pilot randomised controlled trial.

INTRODUCTION: Cancer-related fatigue is common in patients with advanced lung cancer. It not only interferes with patients' health-related quality of life, but also increases the caregiving burden of their caregivers. Acceptance and commitment therapy is emerging as a novel way to advocate accepting negative experiences and taking effective actions based on their own values to help patients commit meaningful actions in the course of cancer diseases. This trial aims to test the feasibility, acceptability and preliminary effects of acceptance and commitment therapy for fatigue interference in patients with advanced lung cancer and the caregiver burden. METHOD AND ANALYSIS: A two-arm, assessor-blind pilot randomised controlled trial will be conducted. A total of 40 advanced lung cancer patient-caregiver dyads, who live in rural areas, will be recruited from a university-affiliated hospital in central China. The participants will be randomised to receive an online six-session acceptance and commitment therapy (i.e. involving metaphors, experiential exercises and mindfulness exercises facilitated by virtual reality technology) plus health education (intervention group, n=20) or health education (control group, n=20). Outcomes will be measured at baseline and 1 week postintervention. The primary outcomes are study feasibility (i.e. eligibility rate, recruitment rate, attrition rate and adherence rate), fatigue interference and caregiver burden. The secondary outcomes are health-related quality of life, meaning in life, psychological flexibility and mindful attention. Semistructured interviews will be conducted to explore the feasibility and experiences of the intervention in a subsample of 10 participants from the intervention group. ETHICS AND DISSEMINATION: This study has been approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No. 2023.030) and the Medical Ethics Committee of Xiangya Hospital Central South University (No. 202305336). The findings will be disseminated in peer-reviewed journals and through local or international conference presentations. TRIAL REGISTRATION NUMBER: NCT05885984.

'Life became slow down': A descriptive qualitative study of the experiences of cancer-related fatigue amongst people with advanced lung cancer.

BACKGROUND: Cancer-related fatigue is a complex multidimensional concept. However, little is known about the experience of cancer-related fatigue in people with advanced lung cancer. How they emotionally react to and cope with the experience of cancer-related fatigue according to cultural influences has not been extensively explored. AIM: To explore the experience of cancer-related fatigue, its impacts and emotional reactions to and coping strategies for cancer-related fatigue amongst people with advanced lung cancer in China. DESIGN: This was a cross-sectional, descriptive qualitative study with face-to-face semi-structured interviews. Data were analysed using content analysis. SETTING/PARTICIPANTS: Twenty-one people with advanced lung cancer who experienced cancer-related fatigue were recruited in a hospital setting. RESULTS: Four themes were identified: multifaceted experiences of cancer-related fatigue, impacts of cancer-related fatigue, negative perceptions of cancer-related fatigue and avoiding cancer-related fatigue. The multifaceted experience of cancer-related fatigue had physical, psychological and social impacts along the cancer trajectory. Informants regarded it as a sign of a 'bad ending', searched for root causes and had negative attitudes towards role changes. Avoiding coping strategies included not discussing cancer-related fatigue, refusing encouragement and support, hiding feelings, withdrawing from social life and attempting to control cancer-related fatigue. CONCLUSION: The findings provide insights into the lack of flexibility of people with advanced lung cancer to adapt to the multidimensional experience of cancer-related fatigue. The reactions and coping towards cancer-related fatigue are profoundly influenced by Chinese culture. Developing psychological interventions based on the cultural background are highly recommended to cultivate the ability to cope flexibly with stressful events and live a meaningful cancer life.

Translation and validation of the Chinese version of the acceptance and action questionnaire for cancer in patients with advanced lung cancer.

Objective: This study aimed to examine the reliability and validity of the Chinese version of the Acceptance and Action Questionnaire for Cancer (C-AAQ-Cancer) in patients with advanced lung cancer. Methods: In Phase I, the AAQ-Cancer was translated from English to Chinese. In Phase II, an expert panel was invited to examine the content validity of the translated instrument, and pilot testing was performed. In Phase III, a total of 200 patients with advanced lung cancer from a university-affiliated hospital in central China were recruited to test the construct validity of the translated AAQ-Cancer using exploratory factor analysis, and reliability was assessed based on internal consistency and test-retest reliability. Results: The semantic equivalence and content validity index of the C-AAQ-Cancer were satisfactory. Exploratory factor analysis indicated that the C-AAQ-Cancer contained the following five subscales: cancer concerns, blunting, blame, distancing, and behavioral disengagement. These subscales explain 68.28% of the total variance. The Cronbach's α coefficient of the scale was 0.87, and the test-retest reliability was 0.839. Conclusions: This study evaluated the psychometric properties of the C-AAQ-Cancer. The findings support the reliability and validity of this instrument in evaluating experiential avoidance or acceptance levels in patients with advanced lung cancer.

Structural insights into DNA N6-adenine methylation by the MTA1 complex.

N6-methyldeoxyadenine (6mA) has recently been reported as a prevalent DNA modification in eukaryotes. The Tetrahymena thermophila MTA1 complex consisting of four subunits, namely MTA1, MTA9, p1, and p2, is the first identified eukaryotic 6mA methyltransferase (MTase) complex. Unlike the prokaryotic 6mA MTases which have been biochemically and structurally characterized, the operation mode of the MTA1 complex remains largely elusive. Here, we report the cryogenic electron microscopy structures of the quaternary MTA1 complex in S-adenosyl methionine (SAM)-bound (2.6 Å) and S-adenosyl homocysteine (SAH)-bound (2.8 Å) states. Using an AI-empowered integrative approach based on AlphaFold prediction and chemical cross-linking mass spectrometry, we further modeled a near-complete structure of the quaternary complex. Coupled with biochemical characterization, we revealed that MTA1 serves as the catalytic core, MTA1, MTA9, and p1 likely accommodate the substrate DNA, and p2 may facilitate the stabilization of MTA1. These results together offer insights into the molecular mechanism underpinning methylation by the MTA1 complex and the potential diversification of MTases for N6-adenine methylation.

Effects of a Virtual Reality-Based Meditation Intervention on Anxiety and Depression Among Patients With Acute Leukemia During Induction Chemotherapy: A Randomized Controlled Trial.

BACKGROUND: Emerging evidence supports that virtual reality (VR)-based meditation interventions may improve anxiety and depression among patients with cancer. However, empirical studies involving patients with acute leukemia during induction chemotherapy are limited. OBJECTIVE: This study aimed to examine the effects of VR-based meditation intervention on alleviating anxiety and depression and improving the quality of life among patients with acute leukemia during induction chemotherapy. METHODS: This randomized controlled trial recruited 63 patients newly diagnosed with acute leukemia. Participants were randomly assigned to an intervention group (received VR-based meditation for 20 min daily for 14 days) and a control group. Anxiety, depression, and quality of life were measured using the State Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, and the Functional Assessment of Cancer Therapy-Leukemia Questionnaire, respectively. All outcomes were measured at baseline and post-intervention. RESULTS: Compared with patients in the control group, those in the intervention group demonstrated a significantly greater reduction in anxiety (P = .04) and improvement in quality of life (P = .04). However, no significant difference was noted in depression levels between groups (P = .09), although a decreasing trend was observed in the intervention group. CONCLUSION: Virtual reality-based meditation intervention effectively alleviated anxiety and improved the quality of life among acute leukemia patients during induction chemotherapy. Future randomized controlled trials with larger sample sizes and longer follow-up periods are warranted. IMPLICATION FOR PRACTICE: Virtual reality-based meditation can be applied in clinical practice virtually anytime and anywhere to provide a convenient intervention for anxiety reduction for acute leukemia patients during induction chemotherapy.

Effects of Acceptance and Commitment Therapy on fatigue interference and health-related quality of life among patients with advanced lung cancer: A pilot randomized controlled trial.

Objective: The present study aimed to examine the feasibility and preliminary effects of Acceptance and Commitment Therapy (ACT) on fatigue interference and health-related quality of life in patients with advanced lung cancer. Methods: In a single-blinded, parallel-group randomized controlled trial, 40 patients with advanced lung cancer were randomized to either the intervention group, which received the four-session individual ACT in 4 weeks, or the control group, which received usual care. The outcomes were evaluated at baseline and one week postintervention. Results: Intervention feasibility and acceptability were established with a high attendance rate of 88.75% and a high retention rate of 75%. Approximately 95% of the participants reported satisfaction with the intervention. Despite the insignificant effects on fatigue interference, statistically significant interactions effects of ACT for health-related quality of life (P â€‹= â€‹0.001), cancer-related fatigue (P â€‹< â€‹0.001), depressive symptoms (P â€‹< â€‹0.001), anxiety (P â€‹< â€‹0.001), and distress (P â€‹= â€‹0.003) were noted. Conclusions: This pilot trial supports the feasibility and acceptability of conducting ACT for patients with advanced lung cancer. The findings show the potential positive effects of ACT on health-related quality of life. Future studies with full-scale samples are recommended to evaluate the long-term effects of ACT on fatigue interference.

Prevalence and factors associated with compassion satisfaction and compassion fatigue among Chinese oncology healthcare professionals: A cross-sectional survey.

Objective: This cross-sectional study examined the prevalence and factors associated with compassion satisfaction and fatigue among oncology healthcare professionals (doctors and nurses) in mainland China. Methods: A total of 337 subjects were recruited via convenience sampling from the oncology departments of five general hospitals in Guangzhou, Guangdong, China. They were invited to complete a survey that included demographic characteristics, the Profession Quality of life Scale, the Brief Cope Questionnaire, and the Connor-Davidson Resilience Scale. Results: The findings showed medium levels of compassion satisfaction, burnout, and secondary traumatic stress among oncology healthcare professionals in China, reaching rates of 78.34%, 63.50% and 75.96%, respectively. Multiple regression analyses suggested that active coping, positive reframing, and strength were the significant factors of compassion satisfaction, explaining 48.6% of the total variance (P â€‹< â€‹0.001). Substance use and self-blame were the significant factors of burnout, explaining 45.1% of the total variance (P â€‹< â€‹0.001). Venting, denial, substance use, self-blame, and strength were the significant factors of secondary traumatic stress, explaining 37.6% of the total variance (P â€‹< â€‹0.001). Conclusions: The high prevalence of compassion fatigue warrants the attention of the hospitals' senior management. The effective coping styles identified may be considered when developing strategies to improve the professional quality of life among oncology healthcare professionals.

Effects of Acceptance and Commitment Therapy on health-related outcomes for patients with advanced cancer: A systematic review.

BACKGROUND: Advanced cancer is an incurable and life-threatening disease that poses a major challenge to patients' psychological and physical well-being. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy for managing health outcomes and inducing health-related behaviour changes. However, the components and modality of Acceptance and Commitment Therapy and its effectiveness on health outcomes for patients with advanced cancer remain unclear. OBJECTIVES: This review aimed to identify the main content, delivery mode, dosage and duration of Acceptance and Commitment Therapy, and to systematically summarise evidence regarding its application in patients with advanced cancer for improving physical and psychological outcomes and health-related quality of life. DESIGN: Systematic review. DATA SOURCES: PubMed, British Nursing Index, Medline, PsycINFO, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure and WANFANG Data were searched to identify eligible clinical trials. REVIEW METHODS: Two reviewers independently assessed the eligibility of each study and extracted data. The Joanna Briggs Institute critical appraisal checklist was used to evaluate the risk of bias in the included studies. Narrative synthesis was used to present the findings of this review. RESULTS: Six studies involving 261 participants were included in this review, including five randomised control trials and one with a pretest-posttest design. Two out of the five studies reported Acceptance and Commitment Therapy significantly reduced depressive symptoms and psychological distress post-intervention with a large effect size compared with usual care. One study indicated significant improvements in anxiety, sleep characteristics and health-related quality of life with a large effect size post-intervention. Non-significant changes in fatigue and pain were found. Intervention programmes with no more than four sessions had high adherence rates. CONCLUSION: Acceptance and Commitment Therapy may be a beneficial way to improve depressive symptoms, anxiety, psychological distress, sleep characteristics and health-related quality of life in patients with advanced cancer. However, limited studies, small sample size and methodological heterogeneity weaken the evidence. More rigorous research using brief Acceptance and Commitment Therapy programmes should be conducted within larger samples to further confirm the effectiveness and evaluate its long-term effect on this population.

The 2'-O-methyladenosine nucleoside modification gene OsTRM13 positively regulates salt stress tolerance in rice.

Stress induces changes of modified nucleosides in tRNA, and these changes can influence codon-anticodon interaction and therefore the translation of target proteins. Certain nucleoside modification genes are associated with regulation of stress tolerance and immune response in plants. In this study, we found a dramatic increase of 2'-O-methyladenosine (Am) nucleoside in rice seedlings subjected to salt stress and abscisic acid (ABA) treatment. We identified LOC_Os03g61750 (OsTRM13) as a rice candidate methyltransferase for the Am modification. OsTRM13 transcript levels increased significantly upon salt stress and ABA treatment, and the OsTrm13 protein was found to be located primarily to the nucleus. More importantly, OsTRM13 overexpression plants displayed improved salt stress tolerance, and vice versa, OsTRM13 RNA interference (RNAi) plants showed reduced tolerance. Furthermore, OsTRM13 complemented a yeast trm13Δ mutant, deficient in Am synthesis, and the purified OsTrm13 protein catalysed Am nucleoside formation on tRNA-Gly-GCC in vitro. Our results show that OsTRM13, encoding a rice tRNA nucleoside methyltransferase, is an important regulator of salt stress tolerance in rice.