Research Progress on Influencing Factors and Intervention Measures of Post-traumatic Growth in Breast Cancer Patients

Feasibility and preliminary efficacy of a systematic transaction model-guided dyadic coping nursing intervention for patients with breast cancer and their spousal caregivers: A pilot study

Objective

This study aimed to assess the feasibility, acceptability, and preliminary efficacy of a Systematic Transaction Model (STM)-guided dyadic coping nursing intervention for patients with breast cancer and their spouses.

Methods

A single-arm, pre-test/post-test pilot study was conducted at a tertiary hospital in Wuxi, China, recruiting 28 breast cancer patient-caregiver pairs. Each dyad participated in six hybrid intervention sessions. Paired t-tests were used to evaluate pre- and post-intervention changes, and effect sizes were calculated. Feasibility was assessed by recruitment and retention rates, acceptability via the Client Satisfaction Questionnaire-8 (CSQ-8), and preliminary efficacy through measures of body image, dyadic coping, post-traumatic growth, and marital satisfaction.

Results

All 28 dyads completed the intervention. Patients showed small-to-moderate improvements in body image, post-traumatic growth, dyadic coping, and marital satisfaction (d ​= ​0.4-0.5, P ​≤ ​0.022), with clinically meaningful changes observed in 39%-68% of patients. Spousal caregivers also demonstrated improvements in post-traumatic growth, dyadic coping, and marital satisfaction (d ​= ​0.3-0.6, P ​≤ ​0.033), with 36%-46% showing clinically important differences.

Conclusions

This pilot study supports the feasibility and initial efficacy of an STM-guided dyadic coping intervention, which may benefit breast cancer patients and their spouses as a unit. Further large-scale trials are recommended to validate these findings.

Trial registration

China Clinical Trial Registry (ChiCTR2400083416).

Effect of AI-based pre-hospital health education via QR code on APAIS scores in patients with breast nodules: A retrospective study

PURPOSE

To explore the effect of AI-based pre-hospital health education via QR code on preoperative anxiety and information needs in patients with breast nodules and provide a decision-making reference for ongoing optimizing clinical workflows.

METHODS

This retrospective study analyzed the clinical data of 718 breast nodule patients from January to December 2024. Patients were sequentially divided into a non-viewed group (receiving routine health education) and a viewed group (receiving AI-based pre-hospital health education) to compare Amsterdam Preoperative Anxiety and Information Scale (APAIS) scores between the two groups. Univariate analysis and multivariate regression were used to examine factors influencing preoperative anxiety and information needs in patients with breast nodules.

RESULTS

718 patients were included, with 367 in the non-viewed group and 351 in the viewed group. Patients in the viewed group reported higher satisfaction scores and had shorter hospital stay compared to those in the non-viewed group. The multiple linear regression analysis revealed a significant negative correlation between the viewed group and preoperative anxiety (β = -5.31, 95 % CI: -6.03, -4.59; P = 0.001) and information needs (β = -1.40, 95 % CI: -1.63, -1.18; P = 0.001). Additionally, patient satisfaction also influences their preoperative anxiety and information needs (P < 0.001).

CONCLUSION

AI-based pre-hospital health education can help reduce patients with breast nodules' preoperative anxiety and information needs, as well as increase their satisfaction and shorten hospital stay. AI-based pre-hospital health education via QR code can be applied in clinical practice.

Targeted editing of CCL5 with CRISPR-Cas9 nanoparticles enhances breast cancer immunotherapy

Breast cancer remains one of the leading causes of cancer-related mortality among women worldwide. Immunotherapy, a promising therapeutic approach, often faces challenges due to the immunosuppressive tumor microenvironment. This study explores the innovative use of CRISPR-Cas9 technology in conjunction with FCPCV nanoparticles to target and edit the C-C Motif Chemokine Ligand 5 (CCL5) gene, aiming to improve the efficacy of breast cancer immunotherapy. Single-cell RNA sequencing (scRNA-seq) and TCGA-BRCA data identified CCL5 as a key immune-related gene in breast cancer. Using CRISPR-Cas9, sgRNA targeting CCL5 was designed and delivered to breast cancer cells and humanized mouse models via FCPCV nanoparticles. In vitro experiments demonstrated that FCPCV nanoparticles effectively silenced CCL5, enhanced CD8+ T cell activity, and increased the production of cytokines such as IFN-γ, TNF-α, and GZMB. In vivo studies revealed significant tumor suppression, improved immune microenvironment, and increased CD8+/CD4+ ratios in treated mice, without notable toxic side effects. These findings highlight the potential of CRISPR-Cas9 nanoparticle-mediated gene editing as a novel strategy for enhancing breast cancer immunotherapy, providing a new direction for personalized and effective cancer treatment.

Post-traumatic growth and influencing factors of parents with children with Duchenne muscular dystrophy: a cross-sectional survey study

BACKGROUND

The aim of the study was to identify the post-traumatic growth status and influencing factors of parents with children with Duchenne muscular dystrophy (DMD).

METHODS

We adopted a cross-section survey study. Between February and December 2022, 181 parents responded to the survey including a participants' characteristics section, post-traumatic growth assessment scale, caregiver burden scale, and social support assessment scale. Multiple linear regression analysis was used to investigate influencing factors of post-traumatic growth.

RESULTS

The mean score of post-traumatic growth of parents was 56.66 (SD ± 18.67). Post-traumatic growth was positively correlated with social support (r = 0.452, P < 0.01) and negatively correlated with care burden (r = -0.207, P < 0.01). Multiple linear regression showed that the child's age, course of disease, self-care ability, parent's working condition, residence, education, number of children, and health status were the main influencing factors for the post-traumatic growth of parents (P < 0.001).

CONCLUSION

The post-traumatic growth of parents with children with DMD was at a moderate level. Healthcare professionals should pay attention to the psychological state of parents with children with this rare disease and promote post-traumatic growth through psychological mindfulness interventions, strengthening family and social support, and providing care knowledge and skills.

Effects of expressive writing of positive emotions on mental health among patients with ovarian cancer undergoing postoperative chemotherapy

PURPOSE

Patients with ovarian cancer often experience significant psychological distress during postoperative chemotherapy, including anxiety and depression. Expressive writing of positive emotions has shown potential in improving psychological health and fostering post-traumatic growth (PTG) in cancer patients. However, its application to ovarian cancer patients undergoing chemotherapy remains under-explored.

METHODS

A quasi-experimental study was conducted with 82 ovarian cancer patients undergoing postoperative chemotherapy at a tertiary hospital in Changchun, China. Patients were divided into an experimental group (n = 40) receiving expressive writing intervention and a control group (n = 42) receiving routine care. Outcomes were assessed using the Post-Traumatic Growth Inventory (PTGI), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) at baseline and after a 6-week intervention.

RESULTS

After the intervention, the experimental group exhibited significantly higher PTGI scores (mean ± SD: 73.43 ± 6.95) compared to the control group (63.19 ± 5.91, P < 0.001), with improvements observed across all five PTG dimensions (P < 0.05). The experimental group also showed a greater reduction in SAS (mean ± SD: 38.25 ± 4.31 vs. 45.12 ± 5.17, P < 0.001) and SDS scores (mean ± SD: 42.10 ± 3.86 vs. 48.75 ± 4.62, P < 0.001).

CONCLUSIONS

Expressive writing of positive emotions significantly enhances PTG and reduces anxiety and depression in ovarian cancer patients undergoing chemotherapy. This intervention offers a cost-effective and feasible approach for psychological support in clinical settings.

The influence of locus of control, coping strategies and time perspective on post-traumatic growth in survivors with primary breast cancer

BACKGROUND

Breast cancer, a potential traumatic stressor, may be accompanied by positive changes, such as post-traumatic growth (PTG), which may allow patients to overcome this stressful event more easily. Our aim was to identify factors associated with PTG in breast cancer survivors (BCSs).

METHODS

We conducted a cross-sectional study in Seintinelles volunteers who answered online questionnaires. PTG was measured using the Post-Traumatic Growth Inventory (PTGI). Data on sociodemographic, health-related factors and lifestyle habits, fear of cancer recurrence, health locus of control, coping strategies, and time perspective were collected.

RESULTS

The study included 821 BCSs aged 26 to 79 years, one to 16 years after cancer diagnosis. Mean of PTG scores were: relating to others 20.27 ± 6.61; new possibilities 14.00 ± 5.44; personal strength 12.24 ± 4.32; spiritual change 2.95 ± 2.54; appreciation of life 10.59 ± 3.00 and total PTG 60.05 ± 18.11. Several factors were associated with PTG: health-related factors (satisfaction with one's own health, longer time since diagnosis), lifestyle habits (increasing physical activity level and stopping or reducing alcohol consumption after diagnosis), elements of locus of control (powerful others), coping strategies (positive thinking, seeking social support) and time perspective (present hedonistic), which were significantly positively associated with PTG. Chance locus of control and coping avoidance were inversely related to several PTG domains, even several years after diagnosis.

CONCLUSIONS

PTG may be increased in BCSs by acting on its modifiable factors. This includes adopting healthy behaviours, such as increasing physical activity and stopping/reducing alcohol consumption, and developing locus of control elements, such as powerful others, and coping strategies, such as positive thinking and seeking social support, through targeted interventions. Further studies, especially longitudinal studies, are needed to confirm the observed associations between health behaviours, health locus of control, time perspective, and PTG scores. Other measures, such as post-traumatic stress, should be considered because of possible inferences with PTG.

The relationship between dyadic coping and post-traumatic growth in breast cancer patients and spouses: based on potential profile analysis

BACKGROUND

The disease impact of breast cancer is to view the couple as a whole, breast cancer is a disease shared by the couple. Cancer coping has evolved from an individual perspective to a dyadic coping perspective for couples. The purpose of this study was to identify and describe the dyadic coping categories of couples with breast cancer and to analyze the relationship between dyadic coping categories and post-traumatic growth (PTG) in couples with breast cancer.

METHOD

In this study, breast cancer patients and their spouses were selected as the study population from several tertiary hospitals in Jinzhou City using convenience sampling method in 2023. A general information questionnaire, Dyadic Coping Inventory (DCI), and Post-traumatic Growth Inventory (PTGI) were used to survey 254 couples with breast cancer. Latent profile analysis (LPA) was performed using Mplus (version 8.3). SPSS 26.0 was used for data entry, and data were analyzed using one-way analysis of variance and multifactor logistic regression. Significance level α = 0.05.

RESULT

The study examines the influence of various factors such as educational attainment, age, income, residence, medical insurance, surgical procedure type, disease stage, and breast cancer recurrence on patients' coping strategies. Multiple logistic regression analysis showed that education level, age at marriage, place of residence, form of health care coverage, stage of the disease, and whether or not the disease recurred were significant predictors of each indicator (P < 0.05). The LPA yielded four dyadic coping subgroups, with high relative entropy (0.942), respectively, each accounting for 7.4%, 17.1%, 24.3%, and 51.2% of the total. The study found that the high-level coping group scored significantly higher in all dimensions of binary coping with post-traumatic growth among different patient and spouse subgroups.

CONCLUSION

Couple dyadic coping in breast cancer patients was categorized into four groups. The low-level coping group is the one that needs focused observation and intervention. This is a better reference for caregivers to provide more targeted coping programs based on the different dyadic coping categories of couples of breast cancer patients.

Testing the efficacy of a brief online writing intervention on body image and distress in female cancer survivors

OBJECTIVE

This study tested the feasibility and efficacy of two iterations of a low-intensity online writing intervention, Expand Your Horizon (EYH), in improving body image and distress in a cancer population.

METHODS

In study 1 (3-session version of EYH), adult female cancer survivors (N = 201) were randomised to EYH, where they described their body functionality, or a creative writing control. Outcomes assessed at baseline and one-week follow-up included body appreciation, body dissatisfaction, and distress. In study 2 (1 session version of EYH), adult female cancer survivors (N = 65) were randomised to EYH or a neutral writing control. Outcomes (assessed at baseline, immediately post-intervention and one-week follow-up) included body appreciation, body functionality appreciation, body dissatisfaction and distress.

RESULTS

Study 1 experienced severe attrition; only 14 participants (7 %) completed the intervention and follow-up. Study 2 had higher retention, with 74 % completing the study. In study 2, while no significant differences emerged between EYH or control, both groups significantly improved immediately post-intervention across all outcomes. No differences were found at follow-up.

CONCLUSIONS

A single-session online writing intervention for cancer survivors appears to be more feasible than multi-session, however the efficacy of EYH for this population remains to be established.

An integrated intervention on well-being: A qualitative study on relationships and emotions

BACKGROUND

Oncological treatments lead to physical and emotional difficulties with notable consequences in everyday life. Thus, integrated interventions that can promote quality of life are needed. Since current studies suggest that integrated programs of both physical exercises and psychological sessions can promote positive emotions, this pilot study aims to explore the impact of a one-week intervention that combines sailing activities and psychological support.

METHODS

Twenty-nine breast cancer survivors took part in this study. Before and after the intervention, participants were invited to answer three open questions to evaluate their perceptions of personal evaluations about their relationships and emotions. A Qualitative Thematic Analysis was used to evaluate participants' answers and to compare the sub-themes that emerged in the two times.

RESULTS

Findings highlighted three main themes: a) caregivers and emotional closeness - family members are generally a crucial point of reference for participants. Friends, colleagues, and healthcare professionals were also cited as relevant figures during the cancer journey and after the psychological intervention; b) emotions towards others - positive and negative emotions towards these figures emerged, and some women felt alone, and c) emotions towards oneself - exploring emotions related to themselves highlighted positive and negative feelings and the desire for change to promote love and care towards themselves. Interestingly, the number of negative emotions towards themselves decreased after the intervention.

CONCLUSIONS

The integrated intervention could promote the reflection on personal relationships and emotions.

Relationships between body image, dyadic coping and post-traumatic growth in breast cancer patients: a cross-sectional study

Background

The diagnosis and treatment of cancer triggers not only a negative psychological response for the patient, but also a positive psychological outcome. Positive dyadic coping, as a form of coping for mental health outcomes, can maintain or reestablish internal stability between the patient and his or her spouse, resulting in positive physical and psychological changes. However, there is a paucity of research on body image, dyadic coping, and post-traumatic growth in breast cancer patients. The purpose of this study was to explore the relationship and pathways between body image, dyadic coping, and post-traumatic growth in breast cancer patients.

Methods

A cross-sectional study was conducted from November 2022 to November 2023 at a tertiary care hospital in Wuxi, Jiangsu, China. This study was conducted among 154 breast cancer patients treated at the Affiliated Hospital of Jiangnan University, all of whom completed demographic and clinical information questionnaires, Body image self-rating questionnaire for breast cancer (BISQ-BC), Dyadic Coping Inventory (DCI) and Post Traumatic Growth Inventory (PTGI). A Pearson correlation analysis was used to explore the relationship between body image, dyadic coping, and post-traumatic growth. Structural equation modeling was used to analyze the path relationships among the three and to explore the mediating role of dyadic coping.

Results

The level of body image was negatively correlated with post-traumatic growth (r = -0.462, p < 0.01); and the level of body image was negatively correlated with dyadic coping (r = -0.308, p < 0.01). And dyadic coping was positively associated with post-traumatic growth (r = 0.464, p < 0.01). The structural equation modeling results supported the mediation model with the following model fit indices, chi-square to degrees of freedom ratio (χ2/df = 2.05), goodness of fit index (GFI = 0.93), comparative fit index (CFI = 0.99), canonical fit index (NFI = 0.93), incremental fit index (IFI = 0.99), non-canonical fit index (TLI = 0.99) and the root mean square of the difference in approximation error (RMSEA = 0.03). Body image and dyadic coping directly affected post-traumatic growth (β = -0.33, p < 0.05; β = 0.43, p < 0.05). And body image indirectly influenced post-traumatic growth through dyadic coping (β = -0.17, p < 0.05).

Conclusion

Interconnections between body image, dyadic coping, and post-traumatic growth in breast cancer patients. A preliminary validation of the mediating role of dyadic coping between body image and post-traumatic growth, body image can have an impact on dyadic coping, which in turn can have an impact on post-traumatic growth. Whereby higher levels of dyadic coping in patients may also be associated with higher levels of post-traumatic growth, whereas body image disturbance may impede levels of post-traumatic growth.

Transcending the self to transcend suffering

Suffering is inevitable in human life. Our perspective paper theorizes on precise mechanisms for how self-transcendence-the state in which an individual looks beyond the self and adopts a larger perspective including concern for others and the world-may help people endure the experience of suffering. From an examination of empirical literature ranging from social psychology to clinical research, we propose that self-transcendence may aid the endurance of suffering along three psychological levels: (1) On the level of affect, the unique profundity and positivity of self-transcendent experiences (e.g., awe, flow, compassion) may supersede and reduce the salience of negative affect arising from suffering (e.g., fear, despair, depressive mood). (2) On the level of cognition, the larger frame of reference provided by self-transcendent thinking may contextualize one's suffering as something comprehendible, thereby helping to resolve the challenges of making meaning from suffering (e.g., that one's existing meaning systems are unable to explain the suffering event). (3) On the level of motivation, the drive to fulfill one's need for self-transcendence may counterbalance the more hedonically-oriented motivations that can promote negative coping strategies in response to suffering (e.g., avoidance, substance abuse). All three mechanisms may also provoke downstream prosocial behaviors that help embed the individual into networks of social support. Altogether, by synthesizing specific mechanisms from affective, cognitive, and motivational self-transcendent processes, our paper establishes a theoretical framework for how self-transcendence may help people endure and transcend suffering, thereby elevating the conditions and experiences of our existence.