The role of digital health in supporting cancer patients' mental health and psychological well-being for a better quality of life: A systematic literature review

Correlations of resilience with coping styles and quality of life in patients with malignancies

BACKGROUND

Resilience is an individual's ability and psychological rebound capacity to adapt well after experiencing adversity, trauma, etc. Patients with strong resilience can face illnesses actively.

AIM

To determine the association of resilience with coping styles and quality of life in patients with malignancies.

METHODS

This study included patients with malignant tumors who were hospitalized at Fuyang Hospital Affiliated to Anhui Medical University from March 2022 to March 2024. The Connor-Davidson Resilience Scale, Medical Coping Modes Questionnaire, Social Support Rating Scale, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 were utilized to assess patients' resilience, coping styles, social support, and quality of life, respectively. Pearson correlation analysis was conducted to assess the correlations.

RESULTS

A total of 175 patients with malignant tumors demonstrated no marked difference in terms of age, education level, employment status, monthly household income, and disease staging (P < 0.05). Further, patients with malignancies demonstrated scores of 17.49 ± 1.20, 17.27 ± 1.46, and 11.19 ± 1.29 points in terms of coping styles in confrontation, avoidance, and resignation dimensions, respectively. Subjective support, objective support, and support utilization scores in terms of social support were 10.67 ± 1.80, 11.26 ± 2.08, and 9.24 ± 1.14 points, respectively. The total resilience score and tenacity, self-improvement, and optimism dimension scores were positively correlated with the confrontation coping style score, whereas the total resilience score and tenacity and self-improvement scores were negatively associated with avoidance and resignation coping style scores (P < 0.05). The total resilience score and the tenacity dimension score were positively associated with physical, role, cognitive, emotional, and social functions, as well as global health status (P < 0.05), and were inversely related to fatigue, insomnia, and economic difficulties (P < 0.05).

CONCLUSION

The resilience of patients with malignancies is positively associated with the confrontation dimension in the coping style, the total and various social support domain scores, and the overall quality of life. Clinical medical staff need to pay attention to the effect of medical coping styles and social support on the resilience level of patients with malignancies to further improve their quality of life.

The determinants of help-seeking behaviors among cancer patients in online health communities: Evidence from China

OBJECTIVE

Although online health communities offer a new approach to patient interaction, the help-seeking behaviors of cancer patients within these platforms remain unexplored. This study aims to identify the determinants influencing online help-seeking behaviors among cancer patients.

METHOD

Based on motivation theory, we proposed six hypotheses and developed a research model. Data were collected from 1100 cancer patients who sought help in a leading Chinese online cancer community in March, June, and September 2023. We used the fixed-effect negative binomial model to test research hypotheses.

RESULTS

The findings indicated that the time since diagnosis (β = -0.127, P < 0.001) was negatively associated with online help-seeking behaviors among cancer patients. In contrast, social support (β = 0.002, P = 0.003) and disease stigma (β = 0.170, P < 0.001) positively influenced their help-seeking behaviors in online health communities. Furthermore, while male and female cancer patients showed decreased help-seeking behaviors as time since diagnosis increased, the decline was less pronounced for females (β = 0.040, P < 0.001). The positive impact of disease stigma on help-seeking behaviors is stronger for female patients than male patients (β = 0.098, P < 0.001).

CONCLUSION

This research broadens the understanding of how cancer patients seek help in digital environments and enhances theoretical insights into these behaviors.

Exploring the Influence of Virtual Reality on Psychological Variables Within Paediatric Oncology Treatment: A Systematic Review

INTRODUCTION

Virtual reality (VR) is a burgeoning technology with applications across healthcare. It remains unclear what the effect of VR on psychological factors within paediatric oncology is.

METHOD

A systematic review was conducted according to PRISMA guidelines. 436 records were screened against the inclusion and exclusion criteria, with adult focused studies, those with an unclear definition of VR, and non-oncology-based studies excluded. Once final studies were identified, an effect direction plot and narrative review was completed.

RESULTS

Seventeen records met criteria. Ten studies were RCTs, the remaining studies (n = 7) were various designs. Psychological factors included impact on anxiety, distress, depression, and positive psychological variables.

CONCLUSIONS

Some studies indicated some positive effects on psychological variables whilst other results from the studies were mixed, with non-significant findings. It is difficult to reach firm conclusions regarding the effect of VR, given the poor quality of studies, risk of bias, and the unresolved issue of how the quality of VR platform may influence outcomes.

Technological-Based Interventions in Cancer and Factors Associated With the Use of Mobile Digital Wellness and Health Apps Among Cancer Information Seekers: Cross-Sectional Study

BACKGROUND

Mobile digital wellness and health apps play a significant role in optimizing health and aiding in cancer management and decision-making.

OBJECTIVE

This study aims to identify the factors influencing the use of mobile health and wellness apps among cancer information seekers in the United States.

METHODS

We conducted a cross-sectional study using data from the Health Information National Trends Survey. Our analysis focused on 4770 participants who sought cancer information. We performed weighted univariate and multivariable logistic regression to determine the association between the use of health and wellness apps and socioeconomic factors, medical history and conditions, and lifestyle and behavioral factors.

RESULTS

A total of 4770 participants who sought cancer information were included in the final analysis. Of these, 80.9% (n=2705) were health and wellness app users, while 19.1% (n=793) were nonusers. In the final adjusted model, participants with household incomes ≥US $50,000 had 49% higher adjusted odds of using these apps than those with incomes

CONCLUSIONS

Age, education, household income, and use of the internet are the major determinants of the adoption of digital health and wellness apps among seekers of cancer information. Hence, public health programs could be directed toward addressing these factors to improve cancer diagnosis, treatment, and management using these apps.

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Key Words

• United States
• adult
• barrier
• cancer information
• cancer intervention
• cancer management
• cancer screening
• cross-sectional study
• decision-making
• digital health
• digital health and wellness apps
• digital health engagement
• diversity
• engagement
• health seeking behavior
• knowledge seeking
• logistic regression
• mhealth
• mobile health
• mobile phone
• regression analysis
• telehealth
• utilization
• young adult

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MESH Headings

• Humans
• Cross-Sectional Studies
• Female
• Male
• Mobile Applications/statistics & numerical data
• Neoplasms/therapy
• Middle Aged
• Adult
• Aged
• Young Adult
• United States
• Adolescent
• Socioeconomic Factors

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Grants Collapse

Affiliation(s)

Ogochukwu Juliet Ezeigwe Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Kenechukwu Obumneme Samuel Nwosu Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Oladipo Kunle Afolayan Department of Biostatistics, The University of Texas Health Science Center, Houston, TX, United States
Akpevwe Amanda Ojaruega Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Jovita Echere Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Manali Desai Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Modupe Olajumoke Onigbogi Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Olajumoke Ope Oladoyin Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, United States
Nnenna Chioma Okoye Department of Pharmaceuticals, Gwarinpa General Hospital, Abuja, Nigeria
Pierre Fwelo Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States

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Demographic Disparities and Factors Influencing Cancer Treatment Decision-Making

This study aims to explore disparities in cancer treatment decision-making and the factors associated with the decision to pursue treatment. We used Behavioral Risk Factor Surveillance System (BRFSS) data collected between 2017 and 2022. We employed the PRECEDE-PROCEED model to guide our analysis of factors associated with treatment decisions. Descriptive statistics and multivariable logistic regression analysis were conducted to assess the association between treatment decision-making and the predisposing, enabling, and reinforcing factors (following the PRECEDE-PROCEED model). All analyses were weighted and adjusted for the demographic characteristics of the participants. Our sample included N = 19,388 cancer patients, 20.98% of whom refused treatment. American Indians, younger adults, and breast cancer patients were more likely to decide to go for treatment. Patients who had private insurance (OR = 1.25, P = .037) and those who did not have problems affording care (OR = 1.22, P = .02) were more likely to decide to get treatment. The more patients had regular doctors, the more they decided to continue to pursue treatment for cancer (Only one doctor: OR = 1.20, P = .042; More than one: OR = 1.28, P = .007). Finally, the more days patients experienced a bad health situation, the more they decided to have cancer treatment (for 14 + days with bad health: OR = 1.20, P < .001). The results suggest the need for enhanced patient education to improve cancer treatment adherence and informed decision-making. It highlights the importance of culturally tailored educational programs, age-related concerns, addressing financial barriers, and emphasizing the importance of regular healthcare visits for cancer patients.

Are digital psychological interventions for psychological distress and quality of life in cancer patients effective? A systematic review and network meta-analysis

BACKGROUND

Many cancer patients experience psychological distress and/or poor quality of life during or after their cancer treatment, yet they face multiple barriers to accessing psychological support. Digital psychological interventions represent a promising approach for addressing these barriers, however their comparative effectiveness remains uncertain.

METHODS

Nine databases were searched for randomized controlled trials (RCTs) from inception to July 2024. The primary outcomes were psychological distress and quality of life, and the secondary outcomes were measures of depression, anxiety, insomnia, fatigue, and fear of cancer recurrence in this study.

RESULTS

One hundred and thirty-six RCTs with 23,154 participants were identified. Of these interventions, three types-digitally-delivered cognitive behavioral therapy (CBT), health education, and virtual reality therapy (VRT)-demonstrated significant reductions in psychological distress compared to non-active controls. Digital CBT, narrative interventions, and VRT significantly improved quality of life compared to non-active controls. For depression, both digital CBT and VRT were superior to the non-active control group. Regarding anxiety, CBT, psychoeducation, and VRT outperformed the non-active control group. In terms of fatigue, CBT, psychoeducation, VRT, and multi-component interventions all showed enhanced efficacy compared to the non-active control group. However, only CBT exhibited significantly superior effectiveness in alleviating insomnia compared to non-active controls. Similarly, only mindfulness-based interventions significantly reduced fear of cancer recurrence compared to the non-active control condition.

CONCLUSIONS

Our results suggest that digital CBT and VRT are highly promising options for reducing psychological distress and enhancing the quality of life among cancer patients; further high-quality randomized controlled trials involving diverse populations are essential to validate these findings.

Evaluating the cost, cost-effectiveness and survival of an eHealth-facilitated integrated care model for allogeneic stem cell transplantation: Results of the German SMILe randomized, controlled implementation science trial

PURPOSE

eHealth-facilitated integrated care models (eICMs) have proved effective in improving outcomes for chronically ill patients. However, evidence on cost-effectiveness of eICMs is scarce so far. Allogeneic stem cell transplantation (alloSCT) recipients' post-discharge treatment costs and mortality are greatly influenced by complications. Within the international, multicentric SMILe implementation science project, the eHealth-facilitated SMILe integrated care model (SMILe-ICM) was developed to support patients minimize complications' effects within the first year post-alloSCT. Using initial effectiveness findings from the first center that implemented the SMILe-ICM, this study provides a cost and cost-effectiveness evaluation considering one-year and long-term survival effects, post-discharge costs, and patient-related factors.

METHODS

A single-center hybrid effectiveness implementation randomized controlled trial was conducted at a German university hospital from 2/2020 to 8/2022. Eligible alloSCT patients were randomized to the SMILe-ICM or usual care, i.e., one pre-transplant educational nursing visit followed by a physician-led follow-up. The intervention group received usual care plus the SMILe-ICM's four intervention modules (i.e., monitoring of medical/symptom-related parameters, medication adherence, infection prevention, physical activity). All modules were delivered by Advanced Practice Nurses (APNs) in face-to-face visits, combined with continuous online support. Daily, patients entered seventeen medical and symptom-related parameters to the SMILe App, so that APNs could monitor for and investigate possible pre-complication signs. Healthcare utilization costs were assessed at eight time-points (d+30 post-alloSCT-d365) on fourteen self-reported cost indicators and validated against health records. To calculate costs, we applied German standardized unit costs. Cost- and cost-effectiveness were analyzed in five steps: 1.) Calculate total costs, including for the alloSCT inpatient stay and post-discharge follow-up. 2.) Determine life-years gained (survival) as a health benefit unit. 3.) Calculate overall and rehospitalization-free survival estimates. 4.) Calculate the intervention's long-term cost-effectiveness, including extended follow-up, rate of survival until day 1000, and restricted mean survival time. 5.) Contrast these long-term estimates to current post-discharge costs with comparable patient-related factors (age ≥ or < 65, living alone, gender).

RESULTS

Seventy-two patients participated (n = 36/group). Total intergroup healthcare utilization and post-discharge costs differed, but non-significantly. Survival rates improved with the SMILe-ICM (88% vs. 80%) at least until day +1000. Rehospitalization-free survival showed improvement (38% vs. 30%); however, considering this sample size, both findings were nonsignificant. Cost-effectiveness analysis showed an overall post-discharge cost-effectiveness of 35,364.01€/patient and 6,742€/life year gained - a mean of 79.21 additional days of life for an intervention investment of 1.464€/patient in the first year post-alloSCT. One-year cost-effectiveness was highest for patients living alone. Younger age correlated with longer survival but higher costs.

CONCLUSION

The SMILe-ICM appears to offer survival and rehospitalization benefits, particularly for vulnerable groups, e.g., patients living alone. Larger, adequately powered studies are needed to validate these findings.

Randomized clinical trial of a digital integrative medicine intervention among patients undergoing active cancer treatment

Exercise and mindfulness-based interventions have growing evidence for managing fatigue and comorbid symptoms; however, packaging them in a cohesive digital way for patients undergoing cancer treatment has not been evaluated. We conducted a randomized controlled trial to assess the impact of a 12 week digital integrative medicine program, Integrative Medicine at Home (IM@Home), versus enhanced usual care on fatigue severity (primary outcome), comorbid symptoms and acute healthcare utilization (secondary outcomes), in 200 patients with solid tumors experiencing fatigue during treatment. Fatigue severity decreased more in IM@Home than in the control (1.99 vs. 1.51 points; p = 0.04). IM@Home participants also had reduced symptom distress (p = 0.003), anxiety (p = 0.03), and depression (p = 0.02). Acute healthcare utilization was lower with IM@Home, with fewer emergency department visits (rate ratio 0.49; p = 0.04), hospitalizations (4% vs. 12.9%; p = 0.03), and shorter hospital stays (4.25 vs. 10 days; p < 0.001). These promising findings should be confirmed in phase III clinical trials. "Study registered at clinicaltrials.gov (NCT05053230) on 09-20-2021".

The impact of malignancy on death anxiety and psychological well-being in middle-aged and older patients undergoing abdominal surgery: a quasi-experimental study

BACKGROUND

Malignancy is a critical factor affecting death anxiety and psychological well-being. This study examined the impact of malignancy on death anxiety and psychological well-being in middle-aged and older adult patients undergoing abdominal surgery and projected it along with sociodemographic profiles.

METHODS

This study is quasi-experimental in design. It was conducted with patients undergoing abdominal surgery at a university hospital due to suspected malignancy. A total of 93 patients participated in the study: 57 patients diagnosed with malignancy were included in the experimental group, while 36 patients without a malignancy diagnosis were included in the control group. Data were collected using a questionnaire developed by the researchers based on the literature, the 'Turkish Death Anxiety Scale', and the 'Psychological Well-being Scale'. The analyses revealed that the data were normally distributed, and parametric tests were used to analyze differences between demographic variables and groups. Cohen's d and r values were examined to assess the effect size in the tests.

RESULTS

The study found a significant difference in death anxiety between the experimental and control groups (P < 0.05), with higher mean scores in the experimental group. Malignancy had a large effect on death anxiety (d = 1.42). Additionally, the control group had significantly higher mean psychological well-being scores compared to the experimental group (P < 0.05).

CONCLUSIONS

The study found that malignancy significantly affects death anxiety and psychological well-being. Increased death anxiety in patients with malignancy was associated with reduced psychological well-being. Thus, assessing death anxiety and providing targeted nursing care are essential for supporting the psychological well-being of these patients.

Application of mobile internet management in the continuing care of patients after radical prostatectomy

Prostate cancer, a common malignancy in older men, often requires laparoscopic radical prostatectomy, considered the gold standard treatment. However, postoperative complications can significantly impact quality of life and psychological well-being. The emergence of mobile internet health management offers a promising approach for accessible and effective post-discharge care. This study evaluates the effectiveness of mobile internet management in postoperative care for prostate cancer patients, focusing on disease knowledge, psychological well-being, self-care capabilities, and quality of life. From September 2020 to September 2021, prostate cancer patients who underwent radical surgery at our Department of Urology were divided into a control group receiving standard care and an intervention group receiving mobile internet-based care. Patients were followed over six months, with assessments conducted at both 3 and 6 months post-intervention. We evaluated changes in disease knowledge, psychological status (using SAS/SDS scales), self-care ability (via the ESCA scale), and quality of life (measured by SF-36). A total of 112 patients were divided into two groups of 56 each. Repeated measures ANOVA indicated significant improvements in disease knowledge over time, between groups, and in their interaction (P < 0.05). Mastery scores of disease knowledge increased at both 3 and 6 months post-intervention compared to baseline (P < 0.05). The intervention group showed significantly reduced scores on the self-rating depression scale (SDS) and self-rating anxiety scale (SAS) compared to the control group (P < 0.05). Self-care capabilities-including self-directed concept, nursing responsibility, skills, and health knowledge level-also improved, with more pronounced gains in the intervention group (P < 0.05). Quality of life scores in domains such as social function, mental health, vitality, role emotional, bodily pain, role physical, physical function, and general health were higher in the intervention group than in the control group post-intervention (P < 0.05). Mobile internet management significantly enhances postoperative care for prostate cancer patients by improving disease knowledge, psychological well-being, self-care capabilities, and quality of life. These findings support further research to validate long-term benefits and broader application potentials.

Digital Health Technology & Cancer Care: Conceptual Framework Leading Comprehensive Fruitfulness

Digital technologies are now integral to daily life. However, their applications for the health of populations remain largely untapped. Increasing cancer incidence, and it being the leading cause of death in every country in the world, justifies the need for increasing healthcare. Digital health technology is a promising field. Digital health means different things to different people. Thus, the need for a concrete, distinctive, comprehensive action plan. Conceptual frameworks represent ways of thinking about a problem and how complex things work. We elaborate on the latest evidence with examples for the role of Digital Health Technology (DHT) as a comprehensive multi-faceted 'Conceptual Framework -5Ps' comprising: (i) DHT for Proper assessment: right from history taking to digital biopsies. (ii) DHT for Pertinent treatment: including genomic data analysis for precision treatment. Artificial Intelligence-based digital pathology approaches are practical and are increasingly improving selective cancer treatments. Digital self-management interventions improve symptom outcomes in adult cancer patients. Digital health can help cancer patients gain more autonomy, self-acceptance, and personal growth. (iii) DHT for Progress monitoring: comprehensively and remotely. The concept "hospital at home" feasible with DHT. (iv) DHT for Prevention applications: reaching all rewardingly. (v) DHT for Professional standards: education excellence. Proficiency is desirable when using DHTs fast-advancing applications. Doctors may not have the information they need to use a given DHT. General Medical Council, UK, and Medical Council India have been proactive in technology training. Regulations & ethics rigour are required energetically. All new technologies must meet the same bar for clinical evidence as other clinical interventions. Digital Health Academy is required to meet the highest standards, energizing and ensuring excellence. In the current state of healthcare and growing demands, good developments in DHT seem the solution. A conceptual framework is a good start for generous success. We hope our work progresses mindsets, practices, and policies majorly.

Exploring the Impact of Digital Health Tools in Enhancing Quality of Life and Psychological Adjustment in Long-term Blood Donors: A Cross-Sectional Study

BACKGROUND

Blood donation plays a critical role in public health, yet long-term donors (donating at least twice per year, for at least three years) often face challenges related to psychological adjustment and quality of life. Digital health tools could offer innovative solutions to address these issues by providing personalized support, tracking, and mental health interventions.

AIM

This study investigates the impact of digital health tools on the quality of life (QoL) and psychological adjustment of long-term blood donors in Saudi Arabia, with attention to demographic factors influencing engagement and perceptions.

METHODS

A cross-sectional survey was conducted among 498 long-term blood donors aged 18-60, recruited from blood donation centers across Saudi Arabia. Participants were recruited through social media platforms, university networks, and professional organizations to ensure a diverse sample in terms of background, long-term donation history (more than 10 times), and daily digital usage habits. Participants completed an online questionnaire incorporating the WHO Quality of Life-Brief Version (WHOQOL-BREF) and Coping Orientation to Problems Experienced Inventory (Brief-COPE) inventory to assess QoL and coping mechanisms. Descriptive statistics, two-sample t-tests, and ANOVA analyses were performed to examine differences in perceptions based on age, gender, and educational level.

RESULTS

The findings indicate a generally positive perception of digital health tools, with mean QoL scores for self-distraction (Mean ± SD: 3.33 ± 0.97), active coping (3.29 ± 0.97), and psychological well-being (3.31 ± 0.82). Significant differences were observed across age groups, with older participants reporting higher perceived benefits ( p < .0001). Gender differences were also significant, with females showing higher mean scores in psychological adjustment factors such as active coping (3.75 ± 0.62) compared to males (2.8 ± 0.81), p < .0001.

CONCLUSION

Digital health tools are perceived as beneficial for supporting QoL and psychological adjustment among blood donors, particularly for emotional and health management. Demographic factors such as age, gender, and education play a significant role in shaping these perceptions, highlighting the need for tailored interventions. Further research should explore longitudinal impacts to inform the design of more effective, culturally aligned digital health solutions for donor support.

Mobile Applications in Breast Cancer Postoperative Care: A Scoping Review

BACKGROUND

The utilization of mobile application in postoperative care for breast cancer patients has seen a significant rise in recent years. This study aimed to synthesize the literature to identify the features of breast cancer postoperative care mobile applications.

METHODS

This scoping review was conducted using the framework developed by Arksey and O'Malley. All articles published from inception until July 25, 2024, were searched in the PubMed, Scopus, Web of Science, IEEE, and Cochrane databases. The quality of publications was evaluated using the mixed-methods appraisal tool (MMAT).

RESULTS

A total of 999 publications were found, of which 28 studies were considered in this review. Out of these studies, 14 used native apps, 14 used hybrid apps. Nine features were used in applications, and Tracker, Tailored Education, and Community Forum were the most repetitive features. In five studies, various devices and sensors, like Bluetooth and GPS, were utilized in mobile applications to monitor physical activity, stress levels, heart rate, sleep patterns, and calorie intake.

CONCLUSIONS

Mobile applications for postoperative breast cancer care encompass a range of features. In a co-design approach, understanding patients' required features could help to develop usable applications to improve the postoperative care for breast cancer patients.

Disparities and Determinants of Online Medical Record Access among Cancer Survivors

Access to online medical records (OMRs) can help enhance cancer patient engagement and improve their health outcomes. This study investigates disparities in OMR access among cancer survivors and examines the association between OMR access and health perceptions. We conducted a cross-sectional analysis using data from the National Cancer Institute's Health Information National Trends Survey (HINTS) from 2017 to 2022. The sample included 4713 cancer survivors. We employed regression analysis to assess the associations between the different factors. Overall, 18.78% of participants accessed their OMRs once or twice, while 36.69% accessed them three times or more. Gender minority groups (β = -0.0038, p = 0.01), older adults (β = -0.1126, p < 0.001), and racial minority groups (β = -0.059, p < 0.001) were less likely to access their OMRs. Additionally, higher education levels (β = 0.274, p < 0.001), insurance coverage (β = 0.365, p < 0.001), and higher incomes (β = 0.115, p < 0.001) were associated with increased OMR access. Positive health perceptions were significantly associated with OMR usage, including perceived good health (β = 0.148, p < 0.001), quality of care (β = 0.15, p = 0.026), and self-efficacy (β = 0.178, p = 0.002). Disparities in OMR access among cancer survivors are influenced by socio-economic factors and health perceptions. Interventions targeting vulnerable groups, enhancing digital health literacy, and improving health perceptions could promote equitable OMR usage.

Recent advances in cancer therapy-associated oral mucositis

Oral mucositis (OM) is a common and debilitating toxicity of cancer treatments - chemotherapy, radiotherapy, hematopoietic cell transplant, or combinations. OM is associated with severe oral pain and has negative impacts on patient function and quality of life. Additionally, OM has accompanying systemic complications that may have critical implications. These local and systemic consequences can alter cancer treatment, and add an economic burden. This review covers the clinical presentation and course of OM, differential diagnosis, clinical and economic impacts, pathogenesis, risk factors, assessment measures, biomarkers and prediction of OM, management, research advances in the development of new drugs and treatments, and big data.

Guidance on mucositis assessment from the MASCC Mucositis Study Group and ISOO: an international Delphi study

BACKGROUND

Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment.

METHODS

This study was conducted over two stages (January 2022-July 2023). The first phase involved a survey to MASCC-MSG members (January 2022-May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023-May 2023). Consensus was defined as agreement on a parameter by >80% of respondents.

FINDINGS

Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus).

INTERPRETATION

These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice.

FUNDING

No funding was received.

Impact of an automated, remote monitoring and coaching intervention in reducing hospice cancer family caregiving burden: A multisite randomized controlled trial

BACKGROUND

Care for those with life-limiting cancer heavily involves family caregivers who may experience significant physical and emotional burden. The purpose of this study was to test the impact of Symptom Care at Home (SCH), an automated digital family caregiver coaching intervention, during home hospice, when compared to usual hospice care (UC) on the primary outcome of overall caregiver burden. Secondary outcomes included Caregiver Burden at weeks 1 and 8, Mood and Vitality subscales, overall moderate-to-severe caregiving symptoms, and sixth month spouse/partner bereavement outcomes.

METHODS

Using a randomized, multisite, nonblinded controlled trial, 332 cancer family caregivers were enrolled and analyzed (159 SCH vs. 173 UC). Caregivers were primarily White (92%), female (69%), and spouse caregivers (53%). Caregivers provided daily reports on severity levels (0-10 scale) for their anxiety, depressed mood, fatigue, disturbed sleep, and caregiving interference with normal activities. These scores combined constituted the Caregiver Burden primary outcome. Based on reported symptoms, SCH caregivers received automated, tailored coaching about improving their well-being. Reports of moderate-to-severe caregiving symptoms also triggered hospice nurse notification. Secondary outcomes of Mood and Vitality were subcomponents of the Caregiver Burden score. A combined bereavement adjustment tool captured sixth month bereavement.

RESULTS

The SCH intervention reduced overall Caregiver Burden compared to UC (p < .001), with a 38% reduction at 8 weeks and a medium-to-large effect size (d = .61). SCH caregivers experienced less (p < .001) disruption in both Mood and Vitality. There were higher levels of moderate-to-severe caregiving symptoms overtime in UC (OR, 2.722). All SCH caregivers benefited regardless of caregiver: sex, caregiver relationship, age, patient diagnosis and family income. SCH spouse/partner caregivers achieved better sixth month bereavement adjustment than UC (p < .007).

CONCLUSIONS

The SCH intervention significantly decreased caregiving burden over UC and supports the maintenance of family caregiver mood and vitality throughout caregiving with extended benefit into bereavement.

Anxiety and depression among cancer patients in Ethiopia: a systematic review and meta-analysis

Introduction

Anxiety and depression are among the common comorbidities of people diagnosed with cancer. However, despite the progress in therapeutic options and outcomes, mental health care and support have lagged behind for cancer patients. Estimating the extent and determinants of mental health disorders among cancer patients is crucial to alert concerned bodies for action. In view of this, we aimed to determine the pooled prevalence and determinants of anxiety and depression among cancer patients in Ethiopia.

Methods

Relevant literatures were searched on PubMed, African Journals Online, Hinari, Epistemonikos, Scopus, EMBASE, CINAHL, Cochrane Library, and Gray literature sources. Data were extracted into an Excel spreadsheet and analyzed using STATA 17 statistical software. The random effect model was used to summarize the pooled effect sizes with their respective 95% confidence intervals. The I2 statistics and Egger's regression test in conjunction with the funnel plot were utilized to evaluate heterogeneity and publication bias among included studies respectively.

Results

A total of 17 studies with 5,592 participants were considered in this review. The pooled prevalence of anxiety and depression among cancer patients in Ethiopia were 45.10% (95% CI: 36.74, 53.45) and 42.96% (95% CI: 34.98, 50.93), respectively. Primary and above education (OR= 0.76, 95% CI: 0.60, 0.97), poor social support (OR= 2.27, 95% CI: 1.29, 3.98), occupational status (OR= 0.59; 95% CI: 0.43, 0.82), advanced cancer stage (OR= 2.19, 95% CI: 1.38, 3.47), comorbid illness (OR= 1.67; 95% CI: 1.09, 2.58) and poor sleep quality (OR= 11.34, 95% CI: 6.47, 19.89) were significantly associated with depression. Whereas, advanced cancer stage (OR= 1.59, 95% CI: 1.15, 2.20) and poor sleep quality (OR= 12.56, 95% CI: 6.4 1, 24.62) were the factors associated with anxiety.

Conclusion

This meta-analysis indicated that a substantial proportion of cancer patients suffer from anxiety and depression in Ethiopia. Educational status, occupational status, social support, cancer stage, comorbid illness and sleep quality were significantly associated with depression. Whereas, anxiety was predicted by cancer stage and sleep quality. Thus, the provision of comprehensive mental health support as a constituent of chronic cancer care is crucial to mitigate the impact and occurrence of anxiety and depression among cancer patients. Besides, families and the community should strengthen social support for cancer patients.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023468621.

Bibliometric analysis and visualization of research trends in total mesorectal excision in the past twenty years

BACKGROUND

Rectal cancer leads a major disease burden worldwide. Total mesorectal excision (TME) is the standard treatment for locally advanced or node-positive rectal cancer, while attempts to improve the surgery such as laparoscopic and transanal TME are widely used but have their inherent limitations. This bibliometric study analyzed research trends, cooperation, and knowledge dissemination on TME over the past 20 years to inform future directions.

METHODS

Relevant literature from 2003 to 2023 was extracted from the Web of Science Core Collection and analyzed with VOSviewer, CiteSpace, and R for publication patterns, countries, institutions, authors, and research hotspots.

RESULTS

Five thousand three hundred forty-five related publications were included, with rising annual output and citations. The US and China contributed the most studies, while the Netherlands had greater influence. Leiden University ranked first in publications. The top authors were Heald, Kapiteijn, Sauer, Nagtegaal, and Peeters. Research shifted from cancer-focused to patient-centered care and from radiotherapy/chemotherapy to advanced surgery. Multicenter trials became more common.

CONCLUSION

Although the United States and China have the largest number of publications, it should be noted that the influence of these two countries in the field of TME research is not the highest, which does not match the number of publications. In addition, telemedicine, interdisciplinary, medical-industrial integration, etc. may be potential directions for future research in the field of TME.

Is digital intervention for fear of cancer recurrence beneficial to cancer patients?: A systematic review and meta-analysis

OBJECTIVE

This study aimed to compare the effectiveness of digital and face-to-face interventions in reducing fear of cancer recurrence (FCR) among individuals with cancer.

METHODS

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for evaluating the efficacy of psychological interventions for FCR published between July 2018 and December 2021. We searched for research papers using PubMed, Embase, and Cochrane and assessed their quality using the Revised Cochrane risk-of-bias tool for randomized trials.

RESULTS

Of the 2113 identified studies, we analyzed 17 samples (N = 1482) from 14 studies, of which 13 were RCTs. The overall sample showed a moderate effect size (Hedges' g = 0.607; 0.356 to 0.858; p < 0.001; I2  = 81.29%) in FCR reduction. The overall effect size was 0.621 (95% CI, 0.276 to 0.966; p < 0.001; I2  = 81.78%) for face-to-face interventions and 0.517 (95% CI, 0.093 to 0.941; p = 0.017; I2  = 83.19%) for digital interventions. The difference between the two effect sizes was not statistically significant.

CONCLUSION

Our meta-analysis suggests that digital interventions are moderately effective in reducing FCR, similar to face-to-face interventions. However, given the high degree of heterogeneity, this conclusion should be interpreted with caution. Further studies are required to identify the most effective digital interventions and the populations that may benefit from them.

The role of digital health in supporting cancer patients' mental health and psychological well-being for a better quality of life: A systematic literature review

BACKGROUND

This work aims to evaluate the role of digital health in supporting the mental and psychological well-being of patients with cancer and identify the associated challenges of use and implementation.

METHODS

Eligibility criteria: We included peer-reviewed studies (quantitative/qualitative) published between January 2011 and July 2022, that are written in English using technology to support cancer patients' mental health. We excluded opinion papers, editorials, and commentaries.

INFORMATION SOURCES

The systematic review was conducted across ProQuest CENTRAL, Scopus, PubMed, PsycInfo, Web Of Science, and IEEE Xplore. The study selection followed the Preferred Reporting Items for Systematic Reviews, meta-Analysis Reviews, and meta-Analysis guidelines (PRISMA). Risk of bias: All screening steps followed a consensus between the authors to minimize bias or discrepancy. Synthesis of the results: Data were extracted following the Six-factor Model of Psychological Well-being (SMPW). The technology challenges are summarized following the Systems Engineering Initiative for Patient Safety model (SEIPS), focusing on design, impact on processes, and outcomes.

RESULTS

We included 25 studies satisfying our inclusion criteria. The studies had little interest in minorities and sociodemographic factors' assessment within their results. The review showed that mental health and psychological well-being tools cover many applications. In addition to allowing personal growth, digital health can help cancer patients gain more autonomy and self-acceptance. Moreover, these health technologies can aid in mastering the environment, shaping social relationships, and pursuing life goals. Many challenges were identified related to the environment, organization, users, and tasks.

DISCUSSION

Digital health applications for cancer care cover a broad spectrum of mental health interventions. Challenges warrant analyzing the needs and usability. Lessons learned during COVID-19 may help refine technology interventions for mental health in cancer care. More interest in minorities is needed when designing technologies for patients to ensure more access to equitable care.