Search Results (3,463)

Background: Perfectionism is a multidimensional disposition marked by exceptionally high standards and self-worth contingent on flawless performance. In university settings, academic demands may amplify perfectionistic pressure, with maladaptive outcomes most consistently linked to socially prescribed expectations and self-critical failure processing. This study profiled perfectionism dimensions in Italian university students and examined their associations with perceived relational and self-related correlates (Roots). Methods: A multicenter cross-sectional study was conducted with Italian university students. Participants completed two validated tools: the 14-item Multidimensional Perfectionism Scale—Revised (MPS-R) and the 16-item Roots questionnaire. Descriptive statistics, Spearman correlations, and non-parametric group comparisons were performed. Results: Self-oriented perfectionism was the most prominent dimension, while socially prescribed perfectionism (SPP) was comparatively lower but showed the clearest links with vulnerability-related correlates. Lower perceived parental and interpersonal trust was associated with stronger failure-based self-appraisals and perceived excessive demands from others. Higher SPP was observed among women and younger students and in more evaluative study contexts. Conclusions: Perfectionism in this sample was predominantly self-directed, yet risk-relevant profiles were characterized by SPP and self-critical failure processing in conjunction with lower perceived trust/acceptance. These findings support screening approaches that move beyond global scores and inform prevention strategies targeting fear of mistakes, contingent self-worth, and perceived evaluative pressure to promote student well-being. Longitudinal and intervention studies are needed to test temporal pathways and scalable, targeted prevention strategies. Full article

Background and Objectives: Genitourinary syndrome of menopause (GSM), previously known as vulvovaginal atrophy, is a chronic, progressive hypoestrogenic condition affecting vulvovaginal, urinary and sexual health in women. Common symptoms include vaginal dryness, itching, dyspareunia, urinary urgency and recurrent urinary tract infections (UTIs). Despite the high prevalence, GSM is underdiagnosed and undertreated, thereby negatively impacting women’s quality of life. To illustrate the practical aspects of GSM diagnosis and provide evidence-based management, we present a case-based narrative review synthesizing recently published, high-quality evidence. Materials and Methods: Evidence was drawn from multiple sources through targeted searches of databases, and included the 2025 AUA/SUFU/AUGS guideline (AUA), the 2024 NICE network meta-analyses (NICE), a 2025 systematic review/meta-analysis in breast-cancer survivors, the 2020 Menopause Society GSM Position Statement, the 2018 NAMS/ISSWSH breast cancer consensus, several primary source citations and other high quality peer-reviewed publications. Results: Five illustrative composite case vignettes of GSM are presented to highlight the evaluation strategy and evidence-supported treatment choices. Nonhormonal options are the first line treatments for mild GSM symptoms, either with or without the addition of vaginal estrogen therapy. For moderate to severe GSM, low-dose vaginal estrogen, vaginal DHEA, and ospemifene are all effective FDA-approved options. In breast cancer survivors, individualized decisions with oncology input are warranted. Maximal caution and a shared decision-making approach is required for women using Aromatase Inhibitors (AIs) for breast cancer risk reduction when choosing treatments for GSM. Conclusions: Treating GSM improves vaginal, sexual and urinary outcomes and quality of life of women. Clinicians need to proactively screen for GSM and offer evidence-based treatment options. The treatment decisions in breast cancer survivors are nuanced, requiring a shared-decision approach. Full article

Background/Objectives: Platinum resistant ovarian cancer represents a treatment challenge due to lack of efficient treatments and the absence of prognostic biomarkers. The circulating tumor DNA (ctDNA), methylated homebox A9 (meth-HOXA9), has been suggested as a biomarker for ovarian cancer, and might have a clinical impact in terms of predicting progression and supporting clinical decision making. Hence, this study investigated the prognostic value of meth-HOXA9 in platinum resistant recurrent ovarian cancer (PR-ROC) treated with bevacizumab and tocotrienol. Methods: Twenty patients with platin-resistant recurrent ovarian cancer were prospectively enrolled in this non-randomized phase II study. The treatment consisted of bevacizumab (Avastin) 10 mg/kg intravenously every three weeks and tocotrienol (Traptol) capsules 300 mg orally three times daily as a continuous treatment. The Level of meth-HOXA9 was measured at baseline and every three weeks. Results: The overall survival (OS) in the cohort was 7.5 months (95% CI 3.0–10.0), and the progression free survival was 4 months (95% CI 1.4–6.6). Comparing meth-HOXA9 ctDNA levels at baseline, there was no statistic significant difference in OS (p = 0.23). Conclusions: Treatment was well tolerated in this heavily pretreated cohort of PR-ROC patients with expected poor prognostic outcomes, with a few individuals showing extraordinary response in terms of progression free survival. The study was not powered to reproduce evidence of potential of meth-HOXA9 as a prognostic biomarker in PR-ROC. Full article

Background: Parents of children with cancer experience significant psychological distress that is associated with poorer health outcomes. A recent review of caregiver interventions illustrated none targeting Latino parents of children with cancer and a significant need for culturally congruent intervention approaches. Aims: Following our first paper in this issue describing the development of a community co-developed intervention to address psychosocial outcomes in Spanish-speaking Latino families impacted by childhood cancer, this second paper describes the formative evaluation and exploratory analysis of preliminary efficacy in a single-arm pre–post trial. Methods: A total of 32 Spanish-speaking Latino parents/caregivers of children with cancer received the 12-session intervention targeting health literacy, culturally congruent care, and caregiver well-being. Quantitative measures of health literacy and emotional well-being were collected at baseline, post-intervention, and 3 months post-intervention and mixed methods formative evaluation data were collected immediately post-intervention. Results: Mixed methods formative evaluation showed that the intervention was useful, helpful, and relevant. Exploratory preliminary efficacy data using a non-parametric Friedman test showed that health literacy doubled from pre- (33%) to post-intervention (67%) and was sustained at 3 months (X²(2) = 12.52, p = 0.002; Cohen’s d = 0.65). Repeated measures ANOVA showed that emotional distress decreased significantly from baseline to immediately post-intervention with sustained treatment effects at 3 months post-intervention (F(2,62) = 4.37, p = 0.046; Cohen’s d = 0.42). Satisfaction scores were well above treatment acceptability (M = 39.13, SD = 2.80). Conclusions: Implementation of a community co-developed intervention with the goal of achieving cultural congruency was feasible, likeable, and relevant for Spanish-speaking Latino parents and caregivers of children undergoing treatment for cancer. Moreover, the exploratory analysis showed the intervention was associated with improvements in health literacy and emotional well-being and high levels of treatment satisfaction. Full article

Background/Objectives: One of the most relevant risk factors for suicide is the terminal stage of oncological disease. However, it remains unclear whether palliative care affects suicide rates in this population. This study aimed to compare suicide rates in oncological patients receiving palliative care to a general oncological cohort. Methods: The rate of suicide among all patients admitted to the palliative care ward at the Medical University of Vienna for oncological diagnoses from November 2012 to March 2022 was compared to that of a diagnosis-matched control group retrieved from the Austrian Cancer Registry. Competing risk models in SAS (SAS Institute Inc., Cary, NC, USA) were used to test for significant differences in cumulative incidences of death by suicide. Cumulative incidences were also compared for sex and the most common diagnostic groups separately. Results: 1524 patients with oncological diagnoses receiving palliative care and 794,986 patients in the control group were included in the analysis. No excess suicide mortality was revealed (p = 0.117) in the group of patients receiving palliative care. Importantly, this remained true, after also including any potential cases of suicide within the palliative care sample in the analysis (p = 0.467). Only for patients with pancreatic cancer, a higher cumulative suicide incidence in the palliative care sample was found (p = 0.008). Conclusions: Palliative care for oncological patients may be able to alleviate the excess suicide mortality that is otherwise expected in terminally ill patients. This study underscores the importance of comprehensive multidisciplinary end-of-life care that addresses not only physical but also psychosocial aspects. Full article

The evolution of non-invasive mechanical ventilation (NIV) from the iron lung of the 1950s to the use of sophisticated ventilators with mask apparatus has allowed for the optimal management of a wide range of respiratory disorders. NIV is now a mainstay in the management of acute, chronic and acute-on-chronic hypoxemic and hypercapnic respiratory failure from diverse etiologies. While NIV offers an effective approach to avoid invasive mechanical ventilation with its inherent risks of lung injury and sedation-related harms, it is a complex modality that requires a nuanced approach to management As the use of NIV has become ubiquitous, complex challenges are faced in the initiation, management and discontinuation of the treatment. We review complex clinical scenarios that present during liberation from non-invasive mechanical ventilation and an approach to successful weaning and liberation in these patient populations. Full article

Objectives: To report the outcomes of a population of fetuses and neonates with life-limiting (LL) or life-threatening (LT) diagnoses leading to adverse prognoses cared for by a service of perinatal palliative care (PPC), the Percorso Giacomo (PG). Study design: This is a single center retrospective cohort study of all fetuses and neonates prenatally or postnatally diagnosed with LL or LT conditions whose families opted to continue the pregnancy at IRCCS Policlinico di Sant’Orsola in Bologna, Italy, from 2013 to 2025. Results: There were 83 fetuses and/or neonates including 64 diagnosed prenatally and 19 postnatally with annual significant increments in number. All families encountered the PG team. Overall, the cohort demonstrated a very high cumulative rate of comfort care plan (90%) with high rate of redirection of goals of care from intensive to palliative. Conclusions: PG showed a significant growth over 13 years suggesting the strong need of a service of PPC. The continuity of care provided by PG facilitated parental decision-making process towards redirection of goals of care. The outcomes observed provided valuable insights related to the wide range of prognoses for each diagnosis that will enable more informed counseling in the future. Full article

Background/Objectives: Open anterolateral cordotomy (OALC) is a surgical intervention that has been performed to treat patients with persistent pain for more than a century. In recent decades, its application has been reduced in favor of other less invasive treatments. The present article aims to define indications, safety, and the efficacy profile of this procedure for the contemporary neurosurgeon. Methods: A systematic review of articles published from 2010 to 2025 has been performed. Only patients who underwent OALC for cancer pain were included. Results: Eleven articles were included in the systematic review for a total of 33 patients. Adequate pain response was obtained in 87.9% of cases. In 21.2% of patients, some kind of complication was reported, but they persisted only in three patients (9%). A single case of mirror pain was described. Conclusions: OALC is a procedure still performed in selected cases of persistent cancer pain with a favorable safety and efficacy profile. Full article

Psychosocial and cognitive interventions are increasingly implemented in pediatric hospital settings. However, evidence regarding their structure, delivery, and outcomes remains dispersed. This scoping review aimed to synthesize current evidence on these interventions, focusing on their design, professional delivery, reported outcomes, and existing research gaps. It was conducted using established scoping review methodology and is reported in accordance with PRISMA-ScR guidelines. Systematic searches were conducted in PubMed, Scopus, Web of Science, PsycINFO, and ProQuest Dissertations to identify peer-reviewed and grey literature published between 2009 and 2024. Following study selection based on predefined inclusion criteria, data were charted using a standardized data extraction form and analyzed to synthesize and map key characteristics of interventions and outcomes in relation to the review questions. Sixty-one studies met the inclusion criteria. Interventions primarily targeted school-aged children and adolescents and were delivered by psychologists, educators, and nurses, frequently within interdisciplinary teams. A wide range of materials and resources were used, including digital technologies, playful and artistic materials, audiovisual and informational supports, and sensory or therapeutic objects. Techniques primarily involved guided conversation, cognitive and body-based exercises, and play-based approaches. Outcomes mainly focused on emotional well-being and recovery, while fewer interventions explicitly addressed cognitive processes such as attention and executive functioning. Overall, reported effects were generally positive. These findings suggest that psychosocial and cognitive interventions in pediatric hospital settings reflect a wide range of approaches, while also revealing methodological heterogeneity, variability in reporting, and the underrepresentation of low- and middle-income countries, pointing to the need for more robust and inclusive future research. Full article

Liver transplantation has emerged as a curative treatment option for selected patients with unresectable hepatic malignancies beyond hepatocellular carcinoma, marking a paradigm shift in transplant oncology. For colorectal cancer liver metastases (CRLM), prospective trials have demonstrated that highly selected patients achieve 5-year OS rates of 60–83%, with the Oslo score identifying optimal candidates for transplantation. Perihilar cholangiocarcinoma (pCCA) has been successfully treated using strict patient selection criteria combined with neoadjuvant therapy, achieving 5-year OS rates of 50–68%, though emerging data suggests chemotherapy-based approaches may be preferable to radiation in selected cases. Intrahepatic cholangiocarcinoma (iCCA), previously considered a contraindication to transplantation, can now achieve excellent long-term outcomes (79.5% 5-year OS) in patients demonstrating sustained response to neoadjuvant chemotherapy and radioembolization, with metabolic tumor volume < 70 cm³ serving as an objective prognostic marker. Across these three emerging indications, successful outcomes depend on strict patient selection based on tumor biology, intensive multimodal neoadjuvant therapy, multidisciplinary evaluation in high-volume centers, and careful observation during treatment to exclude patients with aggressive disease. This evolution in transplant practice offers curative intent therapy to patients that previously only had palliative therapeutic options, fundamentally transforming hepatobiliary and oncologic surgery. Full article

Background/Objectives: The primary objective of this study was to assess the symptom profile and changes observed at discharge of lung cancer (LC) patients following comprehensive palliative care. The secondary objective was to evaluate potential differences between LCr patients and those with other cancer (OC) diagnoses. Methods: A consecutive sample of LC patients admitted to the acute palliative care unit (APCU) was prospectively assessed and compared with a random sample of patients with OC. All patients underwent comprehensive palliative care treatment. Demographic data, Karnofsky, referral sources, recent oncological treatments, and patient status at admission and discharge (on-treatment, off-treatment, or uncertain) were collected. At admission (T0) and at the time of discharge (TX), symptom burden was assessed using the Edmonton Symptom Assessment Scale (ESAS). Lastly, there was subsequent referral to next care settings (discharge home, home palliative care, hospice, other units). Results: A total of 159 patients with LC were compared with a similar sample of OC. In all patients a significant decrease in the number of “on therapy” patients were reported at discharge, and concomitantly the number of “off-therapy” patients increased (p < 0.0005) in comparison with the data recorded at admission. Dyspnea intensity was higher in group LC at T0 and TX (p < 0.0005), as well as pain intensity, which was significant at TX (p < 0.0005). A statistical difference in MDAS was also observed at TX (p = 0.034). LC patients had a lower overall survival (p = 0.034). Conclusions: Comprehensive palliative care in APCU provided relevant changes in symptom burden, with the potential to prevent inappropriate admissions to other hospital units and to reduce costs associated with non-specialist interventions. Full article

Patients with end-stage liver disease (ESLD) and their caregivers experience extensive physical, psychological, and social burdens and needs for resources. However, empirical evidence on patients’ and caregivers’ specific reported use of resources to help manage ESLD is lacking. Understanding the type and helpfulness of resources used could strengthen clinical care to address individual needs for resources. Aim: To examine and compare resources patients and caregivers identified as being most helpful in managing ESLD in relation to resources they felt would be helpful. Methods: Patients with ESLD and their caregivers responded in writing to two open-ended questions as part of a survey: (1) What resources have you found most helpful in dealing with patient’s liver disease? and (2) What resources would be helpful in dealing with patient’s liver disease? Conventional content analysis was used to identify resource categories. Results: A total of 192 patients and 198 caregivers completed surveys. We identified two major resource domains—medical and non-medical—and five categories within each. Analysis revealed participant group- and disease severity-based differences in helpful resources. Conclusions: Proactively engaging patients and caregivers early in the course of illness to identify relevant resources that might facilitate ability to manage ESLD. An interprofessional care approach would facilitate efforts supporting financial, social, spiritual, emotional, and mental health needs. Future longitudinal research of unique resource needs along the disease trajectory may help to develop effective interventions. Full article

Background: Sinonasal mucosal melanoma is a rare and aggressive malignancy arising from the nasal cavity and paranasal sinuses, characterized by high local recurrence rates and poor survival. Skull-base and orbital progression can occur rapidly, particularly when preoperative imaging underestimates local extension. This paper reports a case of sinonasal mucosal epithelioid melanoma with fulminant postoperative skull-base breach and orbital invasion, highlighting its clinical course, management challenges, and histopathological features. Methods: A 60-year-old woman with progressive unilateral nasal obstruction, recurrent epistaxis, and headache underwent clinical evaluation, contrast-enhanced head MRI, CT, and PET-CT staging. Preoperative imaging demonstrated no intracranial or orbital invasion. Biopsy confirmed mucosal epithelioid melanoma with high proliferative activity (Ki-67 ~80–85%). The patient underwent extensive image-guided endoscopic resection with intraoperative cerebrospinal fluid leak repair. Results: Definitive histopathology confirmed pigmented epithelioid melanoma with extensive necrosis, bone invasion, and non-assessable resection margins due to specimen fragmentation (pT4a, Rx). Within two weeks postoperatively, CT and MRI demonstrated extensive local recurrence with cribriform plate destruction, anterior skull-base dural infiltration, and rapid orbital progression with optic nerve compression and loss of vision. Despite hemorrhage control and hypofractionated palliative radiotherapy (VMAT, 33 Gy in 11 fractions), the patient experienced progressive neurological decline, refractory pain, and recurrent tumour bleeding, and died approximately 4.5 months after initial presentation. Conclusions: In patients with sinonasal mucosal epithelioid melanoma, fulminant local progression with skull-base and orbital involvement may occur despite apparently limited preoperative imaging. When rapid vision loss, dural infiltration, and refractory nasal bleeding develop, structured palliation, hemorrhage control, and aggressive multimodal analgesia should be prioritized early alongside ongoing multidisciplinary decision-making. Full article

Feline pulmonary carcinomas are rare and often carry a poor prognosis, particularly when associated with feline lung–digit syndrome. We report a cat with primary pulmonary carcinoma and extensive metastases—including digits, pleura, mandible, scapula, spleen, skeletal muscle, and distant lymph nodes—supporting the broader “MODAL syndrome” concept. Palliative therapy with toceranib phosphate and meloxicam achieved prolonged survival and excellent quality of life, with no adverse effects despite dose escalation. Rapid progression after discontinuation suggests a role for toceranib in delaying tumour growth. Immunohistochemistry revealed c-kit expression in one metastatic lesion but not in the primary tumour or most metastases, highlighting intratumoral heterogeneity and the complexity of targeted therapy. The observed benefit likely reflects toceranib’s multi-target activity (VEGFR2, PDGFR), impacting angiogenesis and tumour progression. This case represents the first report of toceranib phosphate use in feline pulmonary carcinoma and underscores its potential as a palliative option. Full article

Background: Cancer health disparities among Latinos in the United States are pervasive and manifest in higher morbidity and mortality among pediatric cancer patients and their parents/caregivers. There is a need to engage in culturally congruent approaches to develop interventions that effectively mitigate cancer health disparities among Latino caregivers. Aims: The purpose of this manuscript is to present the methodological process of adopting a community-based participatory research (CBPR) approach to develop a culturally congruent intervention to address psychosocial cancer health disparities in Spanish-speaking Latino families impacted by childhood cancer. Materials and Methods: We established two partnerships with Spanish-speaking parents of children previously treated for cancer and whose children were currently undergoing cancer treatment to collaboratively identify psychosocial intervention targets. A total of 22 meetings were held with community collaborators (n = 13) that followed CBPR principles. All meetings were audio recorded, transcribed, and coded using an inductive approach. Results: The intervention framework identified three psychosocial outcomes: caregiver health literacy, culturally congruent care, and emotional well-being. A 12-session intervention addressing the three outcomes was developed integrating cultural values and bilingual and bicultural community and healthcare providers. Conclusions: A CBPR approach was adopted to address disparities in quality of life in Spanish-speaking caregivers of children with cancer, which resulted in a multicomponent intervention that addresses the informational, practical, and psychosocial needs of Latino caregivers. The intervention can help mitigate disparities in well-being for Latino families impacted by childhood cancer by incorporating culturally relevant strategies to optimize health. Full article