Search Results (176)

Survivors of pediatric cancer are at risk for late effects and require risk-adapted long-term follow-up (LTFU) care. Yet less than 50% of survivors attend LTFU care. This study aimed to identify barriers and enablers of engaging with LTFU care as perceived by Canadian survivors of pediatric cancer and healthcare providers (HCPs). Survivors (n = 108) and HCPs (n = 20) completed surveys assessing barriers and enablers to attending LTFU care, summarized using descriptive statistics. Participants were invited to participate in survivor focus groups (n = 22) or HCP semi-structured interviews (n = 7). These were analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation for Behaviour Change (COM-B) model, which explores how an individual’s capability, opportunity, and motivation influence a target behaviour. Structural barriers, transitioning from pediatric to adult care, and time constraints were highlighted as barriers that affect survivors’ physical opportunity to engage in LTFU care. Accessibility, financial support, HCPs and family support, and community resources were highlighted as enablers that better survivors’ physical and social opportunity to engage in LTFU care. In conclusion, Canadian survivors of pediatric cancer highlighted barriers that limited their physical opportunity to attend LTFU care, while factors that enhanced their physical and social opportunities facilitated greater engagement with LTFU care. Full article

Background/Objectives: Colorectal cancer is a leading cause of cancer-related death worldwide, with rising incidence in younger adults. Unhealthy diets high in red and processed meat and low in fiber are key modifiable risk factors, highlighting the need for preventive nutritional strategies targeting CRC through dietary interventions. Methods: A one-day sample diet for colorectal cancer prevention, consisting of fiber-rich meals excluding red meat and incorporating whole grains, legumes, vegetables, fruits, nuts, and lean protein alternatives (such as fish and poultry), was developed. Its acceptability was assessed in a cross-sectional study using an online questionnaire among healthy Romanian adults aged 18–50, with a total of 395 included participants. Results: Of the 395 respondents meeting the inclusion criteria (aged 18–50, no cancer or chronic gastrointestinal disorders), 63.5% were females, predominantly urban (90.1%), and highly educated. Mean age was 32.4 years; mean BMI was 25.07 kg/m². The proposed colorectal cancer-preventive diet was rated as “quite attractive” and “very attractive” by 74.9% of participants. All meals received high ratings, with dinner and the first snack being most favored. Most respondents (77.2%) found the diet satisfying and the satiety level and energy adequate, and 90.4% were willing to adopt it at least a few times per week. Financial accessibility was affirmed by 77.2% of the respondents. However, 61.8% reported difficulty eliminating red meat consumption. Female participants rated the diet significantly more attractive than males did (p = 0.041). Willingness to adopt the diet strongly correlated with higher acceptability (p < 0.0001), while BMI and education level showed no significant effect. Conclusions: The proposed colorectal cancer-preventive diet was well accepted by Romanian adults aged 18–50, with higher receptivity among women and those with higher education; willingness to adopt the diet at least a few days per week was high, especially among those psychologically ready for dietary change, while key barriers included red meat reduction and perceived cost, underscoring the need for gender-sensitive, culturally adapted interventions and further research on long-term adherence and clinical impact. Full article

Genetic factors play an important role in the risk of developing lung cancer, a disease that disproportionately affects African American (AA) individuals who smoke. Accumulating evidence suggests that specific ancestry-informative genetic markers are predictive of lung cancer risk in AA individuals who smoke. Although testing for, and communication of, genetic risk to patients should impact health and screening, results are mixed. The goal of this study was to evaluate the effects of genetic risk communication that also included ancestry-specific risk information among African American individuals who smoke. Using an experimental design, African American individuals who smoke (n = 166) were assigned randomly to receive hypothetical genetic test results that indicated (1) low vs. high genetic risk for lung cancer (“Risk”) and (2) European vs. African Ancestry (“Ancestry”). We hypothesized that participants who had been told that they were both at high risk for lung cancer based on genetic markers prominent in African persons at risk of lung cancer, and that they have African ancestry, would exhibit increases in cognitive (perceived lung cancer risk), emotional (cancer worry and psychological distress), and motivational (motivation to quit smoking) factors shown to predict longer-term health behavior change. Results revealed significant and moderate-to-large effects of Risk for all outcomes. There was also a significant Ancestry effect on perceived lung cancer risk: increased risk perceptions among participants who learned that they have high African genetic heritage. Path analytic modeling revealed that cognitive and emotional factors mediated the effects of both Risk and Ancestry feedback on motivation to quit smoking. Findings further highlight the importance of incorporating ancestry-specific genetic risk information into genetic counseling sessions, especially in underserved populations, as doing so may impact key cognitive, emotional, and motivational factors critical to behavior change. Full article

Aims: To systematically review and synthesize qualitative research exploring the Breast Cancer Survivors (BCSs)’ perception of health promotion interventions and informing strategies to mitigate recurrence risk within five years post-treatment and improve clinical outcomes. Specifically, this study addresses the question: “How do women diagnosed with breast cancer perceive health promotion interventions for recurrence prevention?” Design: A systematic review and qualitative meta-synthesis were performed. Data Sources: A systematic search of scientific databases (CINAHL, MEDLINE, and Scopus) was undertaken in November 2024. The reference list was cross-referenced and hand-searched to identify additional articles. Review Methods: Studies were included if they met the following criteria: they were primary qualitative studies focusing on BCSs within five years post-treatment, involving participants who had completed surgery, radiotherapy, or chemotherapy in the same time frame, as this period is critical for monitoring recurrence and implementing health promotion interventions. Only studies published in peer-reviewed journals and written in Italian, English, French, or Spanish were considered, provided that an abstract and the full text were available. Moreover, eligible studies had to be conducted in high-income or middle-income countries. Studies were excluded if they focused exclusively on advanced or metastatic breast cancer, if they involved mixed cancer populations without reporting separate data for BCSs, or if they were non-qualitative studies or gray literature. The review study protocol was registered in the PROSPERO database (CRD42024626033). Results: The literature search identified 490 records, 13 articles from databases, and 3 articles identified via other methods (web and citation searching) that met inclusion criteria. A narrative synthesis approach allowed the emerging five themes: (I) Challenges, (II) Self-motivation and empowerment, (III) The relationships as a facilitator, (IV) Barriers to change, and (V) Proactive support strategies. Conclusions: Addressing internal and external factors that influence health behaviors is essential to improve adherence, reduce recurrence risk, and enhance quality of life. Tailored interventions, social support, and healthcare engagement are crucial in this effort. Impact: Our meta-synthesis highlighted significant challenges as well as valuable resources for health promotion among BCSs, suggesting practical and tailored approaches to improving the adoption of healthy behaviors, supported by relationships and targeted support strategies. Full article

Background/Objectives: Lung cancer remains a major cause of cancer-related mortality, with regional differences in incidence and patient characteristics. This study aimed to verify and quantify a perceived dramatic increase in lung cancer cases at a Romanian center, identify distinct patient phenotypes using unsupervised machine learning, and characterize contributing factors, including demographic shifts, changes in the healthcare system, and geographic patterns. Methods: A comprehensive retrospective analysis of 4206 lung cancer patients admitted between 2013 and 2024 was conducted, with detailed molecular characterization of 398 patients from 2023 to 2024. Temporal trends were analyzed using statistical methods, while k-means clustering on 761 clinical features identified patient phenotypes. The geographic distribution, smoking patterns, respiratory comorbidities, and demographic factors were systematically characterized across the identified clusters. Results: We confirmed an 80.5% increase in lung cancer admissions between pre-pandemic (2013–2020) and post-pandemic (2022–2024) periods, exceeding the 51.1% increase in total hospital admissions and aligning with national Romanian trends. Five distinct patient clusters emerged: elderly never-smokers (28.9%) with the highest metastatic rates (44.3%), heavy-smoking males (27.4%), active smokers with comprehensive molecular testing (31.7%), young mixed-gender cohort (7.3%) with balanced demographics, and extreme heavy smokers (4.8%) concentrated in rural areas (52.6%) with severe comorbidity burden. Clusters demonstrated significant differences in age (p < 0.001), smoking intensity (p < 0.001), geographic distribution (p < 0.001), as well as molecular characteristics. COPD prevalence was exceptionally high (44.8–78.9%) across clusters, while COVID-19 history remained low (3.4–8.3%), suggesting a limited direct association between the pandemic and cancer. Conclusions: This study presents the first comprehensive machine learning-based stratification of lung cancer patients in Romania, confirming genuine epidemiological increases beyond healthcare system artifacts. The identification of five clinically meaningful phenotypes—particularly rural extreme smokers and age-stratified never-smokers—demonstrates the value of unsupervised clustering for regional healthcare planning. These findings establish frameworks for targeted screening programs, personalized treatment approaches, and resource allocation strategies tailored to specific high-risk populations while highlighting the potential of artificial intelligence in identifying actionable clinical patterns for the implementation of precision medicine. Full article

Background: Physical activity (PA) is associated with lower mortality and cancer recurrence risks. Although evidence shows health benefits for cancer patients before, during, and immediately after treatment, PA recommendations are not regularly included in the standard care. Objective: The study aimed to identify perceived knowledge, barriers, and facilitators of oncology providers’ PA promotion for cancer patients using the 5A (Assess, Advise, Agree, Assist, and Arrange) framework. Methods: A qualitative research design with a phenomenological approach was adopted. A purposive sample of 16 oncology care providers in Nebraska participated in semi-structured interviews via Zoom/phone. Interviews were audio-recorded, transcribed, and imported into MAXQDA 2024 for thematic analysis. Results: Analysis of the qualitative data identified five themes: (i) Broad and inclusive conceptualizations of PA among oncology care providers suggested that they were able to define PA; (ii) Current Practices in PA Counseling included advising on PA and assessment; (iii) Barriers to PA counseling included lack of guideline awareness, insufficient training, low prioritization, uncertainty about responsibility, time constraints, limited resources, lack of referral systems, patient health conditions, and environmental factors; (iv) Facilitators were identified as acknowledged health benefits for cancer survivors, awareness of PA recommendations, access to community resources, and support from interdisciplinary teams; and (v) Expressed desire among oncology care providers for training on incorporating PA into oncology care. Conclusions: Oncology providers recognized PA’s health benefits for cancer survivors but did not promote it due to inadequate knowledge of guidelines and lack of resources. These barriers require improved PA counselling education to help providers incorporate PA into clinical care. Full article

Background: Gynaecological oncology (GO) surgery involves a wide range of procedures, from minor diagnostic interventions to highly complex cytoreductive operations. Accurate perioperative diagnostics—particularly in major surgery—are critical to optimise patient care, predict morbidity, and facilitate shared decision-making. This study aimed to evaluate current practices in perioperative risk assessment amongst UK GO specialists, focusing on the use, perception, and applicability of diagnostic risk prediction tools. Methods: A national multicentre survey was distributed via the British Gynaecological Cancer Society (BGCS) to consultants, trainees, and nurse specialists. The questionnaire examined clinician familiarity with and use of existing tools such as POSSUM, P-POSSUM, and ACS NSQIP, as well as perceived reliability and areas for improvement. Results: Fifty-four clinicians responded, two-thirds of whom were consultant gynaecological oncologists. While 51.9% used morbidity prediction tools selectively, only 7.4% used them routinely for all major surgeries. The most common models were P-POSSUM (39.6%) and ACS NSQIP (25%), though over 20% did not use any formal tool. Despite this, 80% of respondents expressed a desire for more accurate, GO-specific models. Conclusions: This study reveals a gap between available perioperative diagnostics and real-world clinical use in GO surgical planning. There is an urgent need for validated, user-friendly, and GO-specific risk prediction tools—particularly for high-risk, complex surgical cases. Further research should focus on prospective validation of tools such as ACS NSQIP and their integration into routine practice to improve outcomes in gynaecological oncology. Full article

Breast cancer (BC) is the leading cancer diagnosis among women in Puerto Rico. Psychological distress is prevalent in this population, and social determinants may exacerbate this risk. This study examines whether sociodemographic characteristics, financial burden, and social support levels are associated with symptoms of anxiety and depression in Puerto Rican women with BC. A quantitative secondary analysis was conducted on a sample of 208 Hispanic women with BC, utilizing the Patient Health Questionnaire (PHQ-8) and the Generalized Anxiety Disorder (GAD-7) questionnaire. These scores were compared with sociodemographic values and Interpersonal Support Evaluation List (ISEL-12) scores, establishing statistical significance through association, parametric, and non-parametric tests, and regression models. 38.5% and 26.4% of participants showed clinically significant symptoms of depression and anxiety, respectively. Age and perceived income showed significant associations with psychological outcomes. However, regression analysis revealed perceived income as the only significant predictor for both depression and anxiety. Tangible and belonging support were significantly lower in participants with symptoms of depression, while appraisal support was significantly lower in participants with symptoms of anxiety. Findings highlight the influence of perceived financial stress on mental health and the need for psychosocial interventions tailored to the patients’ economic context. Full article

Background/Objectives: Mediterranean diet (MD) adherence is associated with a lower risk of developing several chronic diseases, including cardiovascular and metabolic disorders, cancer, and mental health diseases. University students are vulnerable to mental disorders that considerably affect their well-being and quality of life, which may be ascribed to the stressful environment during their academic studies. This cross-sectional survey designed to explore the relationship between MD compliance and perceived stress levels as well as sleep quality in a representative sample of university students from Greece. Methods: This survey assigned 5433 university students from 10 Greek regions. We used qualified questionnaires to examine the socio-demographics of the assigned students. Anthropometrics were determined by qualified methods. Validated questionnaires were used to determine diverse lifestyle factors like physical activity, perceived stress, sleep quality and MD adherence. Results: Concerning the primary objectives of this study, greater MD compliance was independently and significantly related to lower incidence of perceived stress and poor sleep quality in university students. As far as the secondary objectives of this study concern, greater MD compliance was independently and significantly related to female gender, rural type of residence, living with family, smoking, biomedicine studies, being normal weight, and having enhanced physical activity. Conclusions: This study reinforces the idea that healthy dietary patterns like MD could be a significant modifiable factor against perceived stress and poor sleep quality of university students. Based on this evidence, longitudinal studies should be performed to confirm whether MD can exert a causal effect on perceived stress and sleep quality. Full article

Background/Objectives: Hypertension, diabetes, and cancer are three prevalent chronic conditions with distinct etiologies and significant global health impacts. This study aimed to explore the diverse impacts of different chronic illnesses on health behaviors and psychological well-being, with a focus on identifying and addressing the unique challenges faced by individuals with hypertension, diabetes, and cancer. It was hypothesized that health behaviors and psychological well-being would differ significantly among individuals with hypertension, diabetes, and cancer, reflecting the distinct demands and psychosocial impacts of each condition. Methods: The database of Americans’ Changing Lives, Wave 6, including 767 participants, was used (56.1% hypertension, 20.8% diabetes, and 19.9% cancer cases). Variables concerning physical and mental health issues were chosen. Descriptive statistics summarized the data. Chi-squared and t-tests assessed associations and group differences, with effect sizes reported. Logistic regression examined predictors of hypertension, diabetes, and cancer. Sensitivity analyses excluded outliers. Results: Hypertensive individuals are more likely to show cognitive impairment and unhealthy behaviors, including poor self-rated health, higher BMI, lower physical activity, and altered alcohol use. Risk increases with age, widowhood, retirement, hospital admissions, and poor mental health, while more emergency room or doctor visits slightly reduce it. People with diabetes experience greater depressive symptoms, hopelessness, and financial stress. They also tend to have poorer self-rated health, higher BMI, and less physical activity. Risk is higher for separated individuals and lower for females. Psychological distress is a key factor, while age, employment, and healthcare use show minimal influence. Cancer is linked to chronic stress, poorer perceived health, and mental health challenges. Risk is higher among older adults and those who keep house. Poor self-rated health, high BMI, low fruit and vegetable intake, and psychological distress increase risk, but healthcare use is not a strong predictor. Conclusions: While different chronic illnesses present distinct challenges to health behaviors and psychological well-being, they also share common features-such as increased stress and lifestyle disruptions-underscoring the importance of both tailored and cross-cutting interventions to effectively support individuals across conditions. Full article

Purpose: To explore the association between anxiety levels and health outcomes in long-term breast cancer survivors (LTBCSs) and to identify predictors of anxiety in this population. Methods: A multicenter cross-sectional study was conducted with 80 LTBCSs, categorized into two groups based on their anxiety levels: low anxiety (≤3.4) and high anxiety (≥3.5). The analysis focused on variables assessed at least five years after diagnosis, including sociodemographic and clinical data, mood, cancer-related fatigue (CRF), pain, self-perceived physical fitness, physical activity (PA), and health-related quality of life (HRQoL). ANOVA, Mann–Whitney U, and chi-square tests were conducted, along with correlation and multiple regression analysis. Effect sizes were calculated using Cohen’s d. Results: Among the participants, 46.25% exhibited higher anxiety levels. This group showed significantly worse mood, self-perceived physical fitness, and HRQoL and elevated CRF and pain (p < 0.05). Regression analysis identified “total CRF” (β = 0.51; p < 0.01) and “cognitive functioning” (β = −0.24; p = 0.02) as significant predictors of higher levels of anxiety (r² adjusted = 0.470). Conclusions: Anxiety significantly impacts multiple dimensions of health in LTBCSs. Total CRF and cognitive functioning are key predictors of anxiety. These findings have direct clinical implications: routine psychological and physical assessments should be integrated into survivorship care to identify individuals at risk and inform targeted interventions to enhance long-term well-being and HRQoL. Full article

Objectives: Human papillomavirus (HPV) is a leading cause of several cancers, yet HPV vaccination rates among U.S. young adults remain low. This study evaluated the effect of a brief educational video, co-developed with college students, in increasing HPV vaccination intention among unvaccinated college-aged individuals. Methods: A two-group randomized controlled trial was conducted among 215 college students aged 18–26 who had not received the HPV vaccine. Participants were randomly assigned to two interventions: a video group (n = 111) or a leaflet group that viewed a CDC-based educational sheet (n = 104). Pre- and post-intervention surveys assessed HPV knowledge, perceived risk, facilitators and barriers to vaccination, cultural beliefs, and vaccination intention. Data were analyzed using descriptive statistics, t-tests, Wilcoxon Signed-Rank, and Mann–Whitney U tests. Results: At baseline, approximately 56% of the sample (n = 215; mean age = 23.5, 71.2% male) have learned about HPV in the past. Although both groups improved in HPV knowledge, perceived lower risk, and cultural beliefs, between-group differences in these theoretical mediators were not statistically significant. Vaccination intention (those who responded “Yes” or “Maybe”) increased by 10.8% in the video group but decreased by 11.6% in the leaflet group following the intervention; the difference between the two groups was statistically significant (p = 0.03). Conclusions: A brief, participatory, and theory-based video significantly increased HPV vaccination intent among unvaccinated college students. Compared to the leaflet intervention, the video intervention offers a promising and scalable public health strategy for promoting HPV vaccination in this high-risk population. Full article

Purpose: Adjuvant endocrine therapy (AET) significantly diminishes recurrence and mortality risks in hormone receptor-positive breast cancer (BCa) patients. Nonetheless, suboptimal adherence and premature discontinuation during the initial year of treatment undermine these positive outcomes. This study aims to understand the potential diverse factors associated with perceived barriers to AET compliance at the onset of medication. Methods: We assessed perceived barriers to AET using the ASK-20 instrument for BCa patients initiating AET within 3 months. Our survey also included demographic variables (e.g., musculoskeletal symptoms) and clinical traits (e.g., medication type). Stepwise regression analyses were employed to elucidate the links between multilevel factors and perceived barriers to AET adherence. Results: In our cohort of 272 women, the mean ASK-12 score was 38.2 +/− 9.2 (range 20–100). In the multivariable regression model, greater perceived barriers to adhering to AET were found to be associated with African American ethnicity (Β  =  2.47; 0.53–4.21; p  <  0.05), lower self-efficacy in medication management (Β  =  −0.80; −1.03–−0.58; p  <  0.001), higher psychological distress (Β  =  2.79; 0.61–4.97; p  <  0.05), increased reported distress related to musculoskeletal side effects (Β  =  0.64; 0.31–0.97; p  <  0.001), weight gain symptoms (Β  =  0.61; 0.18–1.03; p  <  0.05), less family support (Β  =  −0.38; −0.53–−0.13; p  <  0.05), and higher levels of concern pertaining to AET (Β  =  0.64; 0.41–0.87; p  <  0.001). Conclusions: Modifiable factors are associated with women’s perceived barriers to AET at the onset of treatment. Proactively addressing patient concerns about AET, improving self-regulatory skills for medication management and family support, and enhancing symptom management strategies, along with addressing distress at the onset of treatment, hold promise for mitigating barriers to AET. Furthermore, recognizing the distinctive challenges faced by African American subgroups is crucial, necessitating culturally tailored interventions to reduce potential disparities and ensure equitable access and adherence to AET. Continued research and tailored interventions are important for optimizing outcomes and reducing the impact of modifiable barriers on AET adherence. Full article

Background/Objectives: This study aimed to analyze the relationship between emotional functioning and health status in long-term breast cancer survivors (LTBCSs). Additionally, it sought to identify factors that could influence emotional functioning in this population at least five years after cancer diagnosis. Methods: This cross-sectional observational study included 80 LTBCSs, classified into the following two groups, according to their emotional functioning: those experiencing psychological distress (≤90) and those with satisfactory psychological well-being (≥91). The study examined various factors at least five years post-diagnosis, including sociodemographic and clinical characteristics, health-related quality of life (HRQoL), mood state, self-perceived physical fitness, physical activity (PA) level, pain, and cancer-related fatigue (CRF). ANOVA, Mann–Whitney U, and Chi-square tests were conducted, along with correlation and multiple regression analysis. Effect sizes were calculated using Cohen’s d. Results: Among the 80 LTBCSs, 47.50% reported psychological distress, while 52.50% maintained satisfactory psychological well-being. Participants in the psychological distress group exhibited significantly poorer HRQoL, lower mood, and reduced self-perceived physical fitness, as well as higher levels of physical inactivity, pain, and CRF (p < 0.05). Regression analysis revealed that “role functioning” (β = 0.59; p < 0.01), “cognitive functioning” (β = 0.26; p < 0.01), “self-perceived physical fitness” (β = 0.20; p = 0.02), and “sadness–depression” (β = 0.18; p = 0.04) were significant predictors of emotional functioning (r² adjusted = 0.642). Conclusions: These results emphasize the association between emotional functioning and health status in LTBCSs. Role functioning, cognitive functioning, self-perceived physical fitness, and mood state were identified as relevant factors influencing emotional well-being in this population. Considering these relationships, integrating psychological and physical assessments into survivorship care could support the early detection of at-risk individuals. This approach could also guide interventions to improve their long-term well-being and HRQoL. Full article

Background: Clinical trials are essential tools for advancing cancer treatment, improving survival rates, and introducing innovative therapies. However, patient participation in clinical trials remains low in the Middle East, including Saudi Arabia. This study explores Saudi cancer patients’ awareness, perceptions, and willingness to participate in clinical trials while identifying key barriers to enrollment. Methods: A cross-sectional survey was conducted using a self-administered questionnaire distributed via email and social media. Saudi cancer patients aged 14 and older, fluent in Arabic or English, and with a confirmed cancer diagnosis were eligible. Ethical approval was obtained, and participation was voluntary with ensured data confidentiality. The survey assessed awareness of clinical trials, perceived benefits, willingness to enroll, and barriers to participation. Data were analyzed using SPSS version 23, with chi-square tests used to examine associations. Results: A total of 201 participants completed the survey. Most were female (69.2%), with a mean age of 39.5 years. Awareness of clinical trials was moderate (51.2%), with social media and healthcare providers being primary information sources. While 57.2% recognized the benefits of clinical trials, 44.8% expressed concerns about risks. Trust in healthcare providers influenced willingness to participate, with 49.8% confident in their physician’s recommendations. The most common barriers were fear of side effects (82.6%) and lack of information (42.8%). Only 5.5% had prior experience with clinical trials, but 35.3% expressed willingness to enroll if recommended by a healthcare provider. Gender and income were significantly associated with perceptions and willingness to participate. Conclusions: Findings highlight the need for targeted educational initiatives to improve awareness and trust in clinical trials among Saudi cancer patients. Addressing key barriers, particularly concerns about side effects and limited information, could enhance participation, ultimately advancing cancer research and treatment in the region. Full article