The long-term effects of cancer on psychological symptoms and quality of life (QoL) have been widely reported, but they were seldom examined over time compared to the general population.

To investigate trajectories of depression and QoL over time among cancer survivors compared to individuals without cancer throughout Europe and identify associated factors.

Data from five waves of the Survey of Health, Ageing and Retirement in Europe study were used. The study sample featured 1066 cancer survivors and 9655 individuals without cancer from 13 European countries. Group-based trajectory modeling was used to identify depression and QoL trajectories, and a linear mixed-effects model was used to characterize their correlates.

Four depression trajectories-stable low, stable high, increasing, and decreasing-and four QoL trajectories were identified. All QoL trajectories were stable over time, but differed in their levels: low, low-medium, medium-high, and high. Depression and QoL trajectories were similar between cancer survivors and individuals without cancer. However, significantly more cancer survivors had high-depression and low-QoL trajectories. Further, better perceived health, activities of daily living, physical activity, and income adequacy levels were significantly associated with changes in depression and QoL levels over time.

Although depression and QoL trajectories did not differ between cancer survivors and individuals without cancer, more cancer survivors were characterized by high-depression and low-QoL life trajectories.

Providers should be aware and screen for cancer survivors with elevated depression and low QoL, and promote relevant psychosocial interventions. Modifiable factors associated with depression and QoL can be targets for cancer survivors' long-term care plans.

Patients with gynecologic cancers demonstrate different psychosocial outcomes based on their cancer site, which may affect treatment effectiveness and survivorship. Demographic differences and the relation with depression (DP) among women who have a gynecologic cancer diagnosis are not well understood.

To assess whether survivors of gynecologic cancer had a greater risk of DP compared with women with and without a history of cancer, 2020 BRFSS data was utilized. Pearson chi-square and multivariable logistic regression were conducted to obtain adjusted odds ratios.

Prevalence of DP was 20 % higher among survivors of gynecologic cancer; this was consistent across race/ethnic and urban/rural categories. Odds of DP among gynecologic cancer survivors were 2.5xs those without any history of cancer. Among Black and Hispanic gynecologic cancer survivors, the adjusted odds of DP were 4.5 and 3.2 times those with no cancer or a history of any cancer.

The odds of having DP were significantly higher among gynecologic cancer survivors compared to women without any history of cancer, breast cancer survivors, or survivors of other cancers.

The number of family caregivers of dependent older adults is increasing. The adverse effects of the work provided by these caregivers can have a negative impact on their own physical and mental health, so it is necessary to develop strategies that support and improve the quality of life and functional capacity of this group. Background/Objectives: The aim of this systematic review is to analyze physical exercise interventions for family caregivers and the effects on their physical and mental health, quality of life and functioning. Methods: A comprehensive search was conducted in the scientific databases PubMed, Embase, Scopus and CINAHL. Data extraction was carried out from the selected articles, obtaining information about the characteristics of the study subjects, type and characteristics of the intervention and results. Results: A total of 17 studies were selected for the review. All studies were based on physical exercise interventions and reported significant improvements in caregivers' physical and mental health, as well as an increase in their quality of life and functioning. Most of the study subjects were older adult women relatives. No adverse effects were found to the interventions. Conclusions: Physical exercise seems to be effective in improving the physical and mental health of family caregivers, increasing their quality of life and functional capacity. More future research is needed to make interventions more accessible to family caregivers.

Therapeutic progress has improved the overall survival of patients treated with allogeneic hematopoietic cell transplantation (alloHCT). Thus, the impact on quality of life (QoL) becomes increasingly relevant. However, QoL is not monitored regularly in clinical practice, and most trials stop QoL assessments early post-alloHCT, missing long-term dynamics. To address this knowledge gap, we conducted a cross-sectional survey of 214 adult alloHCT recipients (average age 53 y, 42.5% female, median follow-up 56 months) to evaluate QoL using patient-reported outcome measurements (PROMs), spanning a period from 30 days to over 10 years post-transplant. Participants completed the EORTC QLQ-C30 and FACT-BMT at a single follow-up timepoint to investigate QoL-related factors. Comparing long-term follow-up patients (beyond year 3, n = 125) with short-term follow-up patients (day 30 to month 12, n = 89) shows significantly better long-term QoL outcomes (P = 0.016). However, PROM symptom scales indicate moderate fatigue and insomnia rates in long-term survivors. Better QoL was associated with male gender, lower ECOG, RIC conditioning, no relapse, no ongoing immunosuppression and full-time work. Summarized, while we observe encouraging long-term outcomes, our data suggest that QoL recovery remain highly individual. We strongly recommend the use of PROMs to enhance our understanding of long-term survivorship post-alloHCT.

To explore the moderating role of physicians' behaviors in medical encounters with cancer patients in the association between physicians' public stigma towards functional disability and post-meeting patient anxiety.

A three time-point prospective nested study was conducted between November 2019 and July 2022 in two medical centres. Before the medical encounters, 32 physicians completed the Disability Attitudes in Health Care Scale, and 150 adult cancer patients completed the State-Trait Anxiety Inventory (STAI), pre and post medical encounters. During the medical encounters, structured 'real-time' observations of the physicians' behaviors were recorded using the Four Habits Coding Scheme.

The mixed linear analysis model revealed that the two-way interaction between stigma towards functional disability and physicians' communication behaviors was significantly associated with post-meeting anxiety (b=.161, p < .05). When physicians' behaviors were more negative, the association between physicians' stigma and patients' post-meeting anxiety was stronger. Additionally, pre-meeting anxiety was positively associated with post-meeting anxiety (b=.578, p < .01).

The findings highlight the positive effect of stigma and the importance of physicians' communication behaviors in alleviating patients' anxiety associated stigma towards functional disability.

Healthcare training programs should address stigma and develop protocols encouraging healthcare professionals to request patients' to share their specific needs.

The psychoactive drug consumption and the short- and long-term cardiovascular prognosis of patients with cancer admitted for acute cardiovascular events are not well established.

To assess the prevalence of psychoactive drug use, in-hospital outcomes and 1-year prognosis in patients with cancer hospitalized for acute cardiovascular events.

In a prospective multicentre study of all consecutive patients admitted to intensive cardiac care units, a history of cancer was recorded systematically. The primary outcome was the prevalence of psychoactive drugs detected by urine drug assay. The secondary outcomes were: the rate of in-hospital major adverse events, defined as all-cause death, cardiogenic shock and cardiac arrest; and the 1-year rate of major adverse cardiovascular and cerebrovascular events, defined as cardiovascular death, myocardial infarction and stroke.

Among 1499 patients recruited, 151 had a history of cancer (10%), including 61 (40%) with active cancer and 90 (60%) with cancer in remission. Among patients with a history of cancer, 39 (25.8%) tested positive for at least one psychoactive drug. Using a matching approach based on the likelihood of having a cancer, a history of cancer was not associated with an increased risk of in-hospital major adverse events (odds ratio: 1.54, 95% confidence interval: 0.68-3.45; P=0.3). However, a history of cancer was associated with a higher incidence of 1-year major adverse cardiovascular and cerebrovascular events (hazard ratio: 3.04, 95% confidence interval: 1.63-5.67; P<0.001).

The prevalence of psychoactive drug use among patients with a history of cancer hospitalized for acute cardiovascular events was 25.8%. A history of cancer was an independent predictor of 1-year major adverse cardiovascular and cerebrovascular events.

Due to the lack of available knowledge in the current literature, this systematic review and meta-analysis was aimed to assess the effectiveness of exercise-based lifestyle interventions, including healthy diet and/or psychological well-being on mental, physical and global health-related quality of life (HRQoL) in adults after cancer treatment.

MEDLINE (via PubMed) and Web of Science databases were searched for randomised controlled trials (RCTs) published until August 2024 evaluating exercise-based lifestyle interventions, including healthy diet and/or psychological well-being, which assessed mental, physical and global HRQoL.

Of 6193 screened studies, 32 RCTs met the criteria. The total sample comprised 5528 participants (3003 intervention and 2525 control). There was a small effect size in a pooled analysis that found exercise-based lifestyle interventions improve mental HRQoL (d 0.11, 95 % CI 0.05 to 0.18). These effects were greater in those studies that combined exercise with psychological well-being (d = 0.19, P = 0.004), and with moderate-to-high intensity aerobic exercise (moderate intensity; d = 0.11, P = 0.02, high intensity; d = 0.16, P = 0.02, aerobic exercise; d = 0.16, P = 0.26).

Exercise-based lifestyle interventions do not enhance physical nor global HRQoL, yet those combined with psychological well-being seem to improve mental HRQoL in individuals after cancer treatment.

CRD42022369169.

Despite the availability of patient reported outcome (PRO) measures (PROMs) for assessing survivorship care needs, their successful implementation remains limited. This study aimed to improve the likelihood of implementation success by actively engaging end-users in developing a PROM designed to address implementation barriers.

Selected barriers for implementation were: (1) PROMs do not adequately address relevant issues, (2) PROMs can inhibit patient-clinician interaction, and (3) PROMs are not suitable for all patients. Management of these barriers were discussed at two 1-day workshops at Vejle Hospital with in-person attendance by colorectal cancer (CRC) survivors and informal caregivers (ICs). Relevant issues of CRC survivorship care (barrier 1) were defined based on data from four distinct sources. Solutions to overcoming barriers 2 and 3 were discussed at the workshops. Workshop data were guided by the Qualitative Analysis Guide of Leuven (QUAGOL) guide.

The four distinct sources provided data from 4,545 CRC survivors. Thirteen individuals attended the in-person workshops. The following constructs were identified as relevant (barrier 1): self-rated well-being relative to pre-diagnosis, late effects encompassing both psychological and physical aspects, the role of caregivers, identity considerations, support systems, economic impacts, rehabilitation needs, and information provision. Specific element (e.g., keywords, prioritisation and agenda-setting) were incorporated to facilitate patient-clinician interactions (barrier 2). All constructs were considered relevant across all stages of CRC survivorship (barrier 3). The final PROM comprised 34 items.

This dialogue-tool is designed to address implementation barriers by providing direct feedback on relevant late effects and supportive care needs from CRC survivors to clinicians.

Anxiety and depression are common in many cancers but, to our knowledge, have not been systematically studied in patients with histiocytic neoplasms (HNs). We sought to estimate rates of anxiety and depression and identify clinical features and patient-reported outcomes (PROs) associated with anxiety and depression in patients with HNs. A registry-based cohort of patients with HNs completing PROs including the hospital anxiety and depression scale (HADS) from 2018 to 2023 was identified. Moderate or severe anxiety or depression were respectively defined as a score of ≥11 on the HADS anxiety or depression subscales. Associations of variables, including other validated PROs, with moderate or severe anxiety or depression were modeled with logistic regression to estimate odds ratios and 95% confidence intervals. In 215 patients, ∼1 in 3 met the criteria for anxiety or depression, and 1 in 7 met the criteria for moderate or severe anxiety or depression. These estimates remained stable over a 12-month trajectory. Rates of depression, but not anxiety, significantly differed across HN types, with patients with Erdheim-Chester disease experiencing the highest rate. In addition, neurologic involvement, unemployment, and longer undiagnosed illness interval were significantly associated with increased risk of depression. Financial burden, financial worry, and severe disease-related symptoms were correlated with increased risk of both anxiety and depression. Conversely, increased general and cognitive health-related quality of life (HRQoL) were correlated with decreased risk of both anxiety and depression. In patients with HN, anxiety and depression are prevalent, stable over time, and correlated with financial burden, symptom severity, and HRQoL. This trial was registered at www.clinicaltrials.gov as #NCT03329274.

To measure the quality of life of women breast cancer (BC) survivors and to detect differences according to clinical and sociodemographic variables.

Cross-sectional observational study from May to August 2024.

Spain.

Women BC survivors, selected by non-probabilistic purposive sampling, from the database of the Spanish Association Against Cancer.

Self-administered form that included the validated Quality of Life in Adult Cancer Survivors questionnaire along with a series of questions referring to clinical and sociodemographic variables. A descriptive analysis was performed and the mean scores of the scale domains were compared by Student's t-test and one-factor analysis of variance.

A total of 1293 women participated. The total score of the Quality of Life in Adult Cancer Survivors and most of its domains decreased significantly as both the age of the BC survivors and the time elapsed since completion of primary treatment increase. In addition, participants who were receiving hormone treatment reported worse quality of life at the time of the interview. The concern that a family member will be diagnosed with cancer is very frequent and remains constant for almost all groups.

Differences among BC survivors highlight the need for personalized comprehensive care, helping professionals and patients to make informed decisions, reducing oncologic impact and improving quality of life in the short and long term.

Background: Psychological disorders are prevalent in patients having undergone gastrointestinal cancer surgery, and their emotional status may further deteriorate during subsequent chemotherapy. Psychobiotics are specific probiotics that have the unique characteristics of producing neuroactive substances that are thought to act on the brain-gut axis. The aim of the present study was to evaluate the benefits of a psychobiotic formula on depression and anxiety status, as well as on perceived stress, versus a placebo in patients on a chemotherapy course following gastrointestinal surgery for cancer. Patients: The enrolled patients, allocated to the psychobiotic and placebo groups, were assessed by means of these psychometric tests: Beck's Depression Inventory and the Hamilton Depression Rating 17-item Scale for depression; the General Anxiety Disorder-7 for anxiety; and the Perceived Stress Scale-14 Item for perceived stress at three time-points: upon allocation [T1], after one month of treatment [T2], and two months thereafter [T3]. Results: In total, 266 patients were included. One month of psychobiotic treatment improved [i] depression status by 60.4% [48 depressed patients at T1, reduced to 16 at T3]; [ii] anxiety by 57.0% [72 patients at T1, 26 at T3]; and [iii] stress by 60.4% [42 at T1, 14 at T3]. The placebo-treated patients experienced a deterioration in all parameters studied, i.e., depression increased by 62.9%, anxiety by 39.7%, and stress by 142.5%. Conclusions: Based on these findings, it can be recognized that psychobiotic treatment has great potential for every patient at risk of suffering from depression, anxiety, or stress during the course of surgery/chemotherapy for gastrointestinal cancer.

Depression and anxiety are prevalent psychological disorders that significantly affect physical, emotional, and social well-being, reducing quality of life and increasing medical costs. These issues are especially challenging for cancer survivors, complicating treatment management, affecting adherence, and potentially impacting survival rates. Thus, this umbrella review aimed to evaluate the global prevalence of pain, depression, and anxiety, as well as their determinants among cancer patients.

An exhaustive umbrella review was conducted to systematically assess the prevalence and determinants of pain, depression, and anxiety among cancer survivors worldwide by analyzing systematic reviews and meta-analyses. The review involved a thorough search of multiple databases and included studies published in English up to July 2024 that reported on these symptoms. The process involved screening and selecting studies based on specific criteria, assessing the risk of bias using the AMSTAR tool, and analyzing data with statistical methods to determine overall prevalence and identify predictors. This comprehensive approach aimed to provide a detailed understanding of these psychological issues in cancer survivors and guide future research and interventions.

The global summary prevalence of depression among cancer survivors was 33.16% (95% CI 27.59-38.74), while anxiety had a prevalence of 30.55% (95% CI 24.04-37.06). Pain prevalence after treatment was 39.77% (95% CI 31.84-47.70). Before treatment, 65.22% (95% CI 62.86-67.57) of cancer patients reported pain, which persisted in 51.34% (95% CI 40.01-62.67) during treatment. The analysis also found that during the COVID-19 pandemic, depression and anxiety rates among cancer patients were at their highest, with prevalences of 43.25% (95% CI 41.25-45.26) and 52.93% (95% CI 50.91-54.96), respectively.

The umbrella review found that depression and anxiety prevalence among cancer survivors was 33.16% and 30.55%, respectively, with significantly higher rates during COVID-19 at 43.25% and 52.93%. Key factors contributing to depression included poor social support, advanced cancer stage, and inadequate sleep, while anxiety was significantly linked to advanced cancer stage and poor sleep quality.

Not applicable.

Treatment modifications and contact restrictions were common during the COVID-19 pandemic and can be stressors for mental health. There is a lack of studies assessing pandemic-related risk factors for anxiety and depression of cancer patients and survivors systematically in multifactorial models. A total of 2391 participants, mean age 65.5 years, ≤5 years post-diagnosis of either lung, prostate, breast, colorectal cancer, or leukemia/lymphoma, were recruited in 2021 via the Baden-Württemberg Cancer Registry, Germany. Sociodemographic information, pandemic-related treatment modifications, contact restrictions, and anxiety/depression (Hospital Anxiety and Depression Scale, HADS) were assessed via self-administered questionnaire. Clinical information (diagnosis, stage, and treatment information) was obtained from the cancer registry. Overall, 22% of participants reported oncological care modifications due to COVID-19, mostly in follow-up care and rehabilitation. Modifications of active cancer treatment were reported by 5.8%. Among those, 50.5% had subclinical anxiety and 55.4% subclinical depression (vs. 37.4% and 45.4%, respectively, for unchanged active treatment). Age <60 years, female sex, lung cancer, low income, and contact restrictions to peer support groups or physicians were identified as independent risk factors for anxiety. Risk factors for depression were lung cancer (both sexes), leukemia/lymphoma (females), recurrence or palliative treatment, living alone, low income, and contact restrictions to relatives, physicians, or caregivers. The study demonstrates that changes in active cancer treatment and contact restrictions are associated with impaired mental well-being. The psychological consequences of treatment changes and the importance for cancer patients to maintain regular contact with their physicians should be considered in future responses to threats to public health.

The diagnosis of metastatic breast cancer (MBC) marks a transition from curative to palliative care, bringing significant psychosocial challenges, often exacerbated by racial and ethnic disparities. This mixed-methods study, grounded in the socioecological model, sought to examine distress levels among MBC patients and caregivers across academic and safety-net healthcare settings and to explore how individual, interpersonal, and system-level factors-shaped by intersecting identities such as race/ethnicity and socioeconomic status-influence unmet supportive care needs and intervention preferences.

Surveys and interviews were conducted with a racially and ethnically diverse group of MBC patients (N = 27) and caregivers (N = 19), recruited from a comprehensive cancer center with academic practice and safety-net hospital affiliates.

Quantitative analyses found no significant differences in distress levels between patients at safety-net and academic hospitals or between patients and caregivers. Qualitative analysis identified six categories of supportive care needs: personalized supportive care, comprehensive health and symptom management, emotional and psychosocial support, interpersonal and family support, sexual health and intimacy support, and equitable access to care-with patients and caregivers strongly preferring targeted, multilevel interventions to address these needs.

Findings underscore the multifaceted nature of MBC care needs and the importance of developing targeted interventions to address the individual, interpersonal, and systemic challenges faced by patients and caregivers.

Cancer is a significant global health challenge. One of the biggest health issues that cancer patients face is depression and anxiety. This has a significant impact on their quality of life and treatment outcomes.

The aim of this study was to investigate the frequency of depression and anxiety among cancer patients in Qatar.

This study was a cross-sectional design using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. A total of 500 cancer patients were surveyed from the National Center for Cancer Care and Research in Doha.

The study found that a significant proportion of cancer patients suffered from depression, with an average PHQ-9 score indicating mild levels of severity. Depression was commonly categorized as mild, with a smaller percentage experiencing moderate, moderate-to-severe, or severe depression. Additionally, patients were predominantly anxious, as reflected by an average GAD-7 score, with most patients experiencing mild to moderate symptoms, while a few experienced moderate or severe anxiety. These findings highlight the significant prevalence of both depression and anxiety among cancer patients, pointing to the importance of comprehensive mental health support. Moreover, patients with advanced-stage cancer, those in their 40s and 60s, those undergoing radiotherapy or hormone therapy, and female patients were found to be more susceptible to depression and anxiety.

Treatment of mental health issues is essential to enhancing the effectiveness of cancer treatment. Cancer patients can have a higher quality of life and better adherence to cancer treatments when mental illnesses such as depression and anxiety are identified and treated early. Furthermore, most patients reported having depression and anxiety, according to the study, which showed that these conditions were more common in Qatar than in other countries. Several demographic groups have been linked to higher rates of depression and anxiety, including women, middle-aged adults, people with stage IV cancer, and patients receiving therapies such as radiotherapy and chemotherapy.

Robust evidence highlights the crucial role of nutrition for people with cancer, and international organizations recognize it as a basic human right linked to health and food. Within this context, we aim to emphasize the critical role of nutrition care for cancer patients and to highlight the essential contributions of nurses in providing patient-centered nutrition care.

This opinion paper synthesizes evidence and perspectives from peer-reviewed articles and position papers. Furthermore, insights were drawn from the European Commission's Health Policy Platform thematic network "Integrated Nutrition Cancer Care".

Implementation of nutrition care is inconsistent, which can lead to inequalities in care. In oncology, nutrition care is vital as nutrition-related issues significantly impact clinical and patient outcomes. Studies show that cancer nurses can effectively integrate and manage nutrition care. Failure to address nutrition issues negatively impacts an array of patient outcomes and reduces quality of life. Thus, integrating nutrition care throughout routine cancer care is essential.

Cancer nurses, as core multidisciplinary team members, are often the initial and consistent contact for cancer patients. They are ideally positioned to play a key role in securing nutrition care throughout the trajectory of cancer care.

Cancer nurses should be empowered and enabled to manage all aspects of nutrition care in tandem with dietitians. This approach can improve patient outcomes, enhance quality of life, and ensure equitable access to essential nutrition care for all cancer patients.

Fear of cancer recurrence is the most prevalent and burdensome emotional concern among cancer survivors' spouses after treatment. This qualitative study aimed to reveal death-related experiences of spouses of cancer survivors in remission, in the context of fear of cancer recurrence. Seven spouses (aged 35-56), four women and three men were explored. Data were obtained using an unstructured interview and analyzed by inductive thematic analysis. The spouses associate cancer relapse with death, risk of losing their spouse. The threat of death triggers not only the feelings of insecurity, uncertainty about the future and loss of control, but also appreciation of life, focus on positive aspects in relationships. Planning for the "worst" scenarios and avoidance helped spouses to reduce tension and enhance control. Interventions for spouses should focus on promotion of emotional expression of death related concerns underlying fear of relapse, also developing new coping strategies to accept and tolerate uncertainty.

Breast cancer causes significant distress in patient-caregiver dyads. While psychosocial and/or mHealth-based interventions have shown efficacy in improving their psychosocial well-being, no reviews have synthesised the effectiveness of such interventions delivered specifically to the breast cancer patient-caregiver dyad.

To synthesise available evidence examining the effectiveness of mHealth-based psychosocial interventions among breast cancer patient-caregiver dyads in improving their psychosocial well-being (primary outcomes: dyadic adjustment, depression and anxiety; secondary outcomes: stress, symptom distress, social well-being and relationship quality), compared to active or non-active controls.

A systematic review and meta-analysis.

Randomised controlled trials and quasi-experimental studies were comprehensively searched from seven electronic databases (PubMed, CENTRAL, CINAHL, Embase, PsycINFO, Scopus, Web of Science), ongoing trial registries (ClinicalTrials.gov, WHO ICTRP) and grey literature (ProQuest Dissertations and Theses Global) from inception of databases till 23 December 2022. Studies involving breast cancer patient-caregiver dyads participating in mHealth-based psychosocial interventions, compared to active or non-active controls, were included. Exclusion criteria were terminally ill patients and/or participants with psychiatric disorders or cognitive impairment and interventions collecting symptomatic data, promoting breast cancer screening or involving only physical activities. Screening, data extraction and quality appraisal of studies were conducted independently by two reviewers. Cochrane Risk of Bias Tool version 1 and JBI Critical Appraisal Checklist were used to appraise the randomised controlled trials and quasi-experimental studies, respectively. Meta-analyses using Review Manager 5.4.1 synthesised the effects of outcomes of interest. Sensitivity and subgroup analyses were conducted. The GRADE approach appraised the overall evidence quality.

Twelve trials involving 1204 breast cancer patient-caregiver dyads were included. Meta-analyses found statistically significant increase in caregiver anxiety (standardised mean difference (SMD) = 0.43, 95% confidence interval (CI) [0.09, 0.77], Z = 2.47, p = 0.01), involving 479 caregivers in 5 studies, and stress (SMD = 0.25, 95% CI [0.05, 0.45], Z = 2.44, p = 0.01), involving 387 caregivers in 4 studies post-intervention, favouring control groups. The intervention effects on the remaining outcomes were statistically insignificant. Beneficial effects of such interventions remain uncertain. The overall quality of evidence was very low for all primary outcomes.

Results of the effectiveness of mHealth-based psychosocial interventions on the psychosocial well-being of breast cancer patient-caregiver dyads are inconclusive. The high heterogeneity shown in the meta-analyses and very-low overall quality of evidence imply the need for cautious interpretation of findings. Higher-quality studies are needed to assess the effects of psychosocial interventions on dyadic outcomes and determine optimal intervention regimes.

This article reviews the contemporary and inclusive definition of cancer survivorship, including patients with and without disease who have completed or continue to undergo treatment. The Spanish Society of Medical Oncology (SEOM) describes in this article the needs of these patients and outlines a care model based on an estimation of cancer incidence and identification of patient needs, to enable the provision of practical actions to achieve effective care. The objectives of this review are to identify the main effects of cancer on survivors and to establish appropriate ways of measuring these effects, as well as discussing the management of physical, psychological and social, occupational, financial, and other health-related needs. We suggest a multidisciplinary care model and training programs for the different professionals involved in care, and highlight challenges and the future role of the SEOM and health-care policy in ensuring optimum care of cancer survivors.

Regular and thorough skin self-examination (SSE) is an important strategy to reduce mortality among melanoma survivors. However, less than a quarter of melanoma survivors participate in skin self-examination.

The aim of this study was to systematically review the effectiveness of digital interventions on SSE-related practices in melanoma survivors.

Cochrane Library, Web of Science, PubMed, and EBSCO were used to identify literature with a search period from January 1, 2000, to June 11, 2024. Two researchers conducted the quality evaluation and summarized and analyzed the included literature.

Twelve articles were included, with a quality score of 5-9 and an average score of 7.67 for the included studies. The digital intervention methods are web based (n = 5), mobile applications (n = 5), videos (n = 1), and interactive multimedia (n = 1). Eleven studies used at least 1 theoretical framework to guide their intervention design. Ten studies reported SSE rates, 2 studies reported SSE areas, and 2 studies reported SSE frequencies and other practical effects. Compared with the control group, the increase in SSE rate ranged from 26.2% to 78.9%; 90% of participants had a frequency of SSE ≥ 2 times per month, with an average of 5.14 areas of SSE; the usage rate of mirrors ranged from 67% to 88%.

Digital intervention can effectively improve the rates, frequency, and number of areas of SSE for melanoma survivors.

Digital intervention can be used in clinical practice to provide efficient and effective SSE for melanoma survivors in the short to medium term.

TNBC, the most aggressive form of breast cancer, lacks accurate and effective therapeutic targets. Immunotherapy presents a promising approach for addressing TNBC. Anxiety and depression are frequently concurrent symptoms in TNBC patients. MDD affects the tumor immune microenvironment of TNBC, with its characteristic genes affecting the pathophysiology of MDD and potentially increasing the risk of TNBC recurrence and metastasis. This study reveals significant differences in T lymphocyte infiltration between high-risk and low-risk TNBC groups based on MDD feature genes. This finding aids in identifying TNBC patients who may benefit from immunotherapy, providing new insights for future TNBC immunotherapy strategies. Our aim is to identify MDD-related genes involved in the pathogenesis of TNBC and to provide predictive biomarkers for TNBC immunotherapy.

Patients with triple-negative breast cancer (TNBC) are at high risk for breast cancer recurrence and metastatic disease, yet the scholarly literature on the distress and uncertainty of this vulnerable population is limited. This study aimed to characterize the experiences of patients with TNBC and obtain feedback about the development of a supportive care intervention targeted to this population's psychosocial needs.

From 9/2021 to 2/2023, we purposefully recruited 23 patients with stage I-III TNBC who recently completed curative therapy and conducted a parallel mixed qualitative and quantitative study. We conducted in-depth semi-structured interviews regarding the transition from curative therapy to surveillance. Patients also completed self-report measures of fear of cancer recurrence (FCR) (Fear of Cancer Recurrence Inventory Severity) and psychological distress (Hospital Anxiety and Depression Scale; PROMIS Anxiety).

Patients were, on average, 51 years old (SD = 13.56). Most patients (87.0%) reported elevated FCR (cutoff = 16; M = 18.91; SD = 6.22). Major themes identified in the qualitative interviews included feelings of dissimilarity among other breast cancer survivors, quality of life interference persisting in the surveillance phase, "shifting the focus away from cancer" as a coping strategy, and FCR as a primary concern. Patients also shared preferences for a TNBC-specific supportive care intervention.

Patients with TNBC experience significant challenges during the transition from curative therapy to surveillance and desire psychosocial support during this critical period. These findings illustrate potential intervention targets for a future supportive care intervention tailored to patients with TNBC.

Cancer survivors experience an array of physical, psychological, and social problems after treatment has ended. Perceived social isolation may exacerbate the effects of physical problems on mental health. We examined the association between physical health (cancer-related fatigue and physical function) and mental health (depression and anxiety symptoms) in cancer survivors in the first year of survivorship (i.e., up to one year after the end of treatment with curative intent), as well as the moderating role of perceived social isolation.

Survey data were collected from 118 cancer survivors who completed treatment with curative intent in the last year. We assessed mental and physical health symptoms, as well as perceived social isolation.

In multivariable analyses, fatigue was significantly associated with both depression (β = 0.279, 95% CI: 0.193,0.362) and anxiety symptoms (β = 0.189, 95% CI: 0.106,0.272). Social isolation moderated the effect of fatigue on depression and anxiety such that higher social isolation exacerbated the association of fatigue with mental health.

Cancer survivors who continue to experience fatigue after curative treatment are at risk for mental health problems, including depression and anxiety symptoms. For cancer survivors who feel socially isolated, the association between fatigue and mental health may be stronger. The current standard of care for survivorship does not sufficiently address psychosocial needs. Future research should evaluate the inclusion of social support interventions in early-term survivorship care.

In this study, we applied the actor-partner interdependence model (APIM) to explore the associations between personality traits (Big Five) and psychological flexibility, on the one hand, and depression and anxiety, on the other hand, among patients with cancer and their spouses. Method: Forty-six patient-spouse dyads (N = 92) completed the anxiety and depression scales from the Patient-Reported Outcomes Measurement Information System (PROMIS), the ten-item personality inventory (TIPI), and the psychological flexibility scale (AAQ-2). Multilevel APIM models, adjusted for multiple testing, showed that neuroticism and psychological flexibility had actor effects on patients' depression and anxiety. Furthermore, neuroticism had actor effects on spouses' depression and anxiety, and agreeableness had actor effects on spouses' anxiety. In addition, patients' psychological flexibility and neuroticism had partner effects on spouses' depression. Conclusion: Being psychologically flexible but emotionally stable is important for one's own and one's partner's psychological outcomes in the context of dyadic coping with cancer. Implications include informing couples' therapists in the context of psycho-oncology on the importance of considering personality traits and improving psychological flexibility.

Peritoneal mesothelioma is a rare life-limiting cancer that is likely to have an extremely negative impact on mental health; however, no studies to date have explored the impact and needs of those living with the condition. Ten individuals diagnosed with peritoneal mesothelioma (eight women, two men) participated in interviews and could share and discuss photographs to convey their illness experiences. Data analysis was informed by 'Interpretative Phenomenological Analysis'. Two themes are presented: 'Experiences of Care' and 'Psychological Distress'. Individuals experienced a lengthy diagnostic journey with little follow-up support. Women also reported negative impacts on body image due to abdominal swelling and scaring, diminished sexual ability and loss of fertility. Individuals recalled vivid feelings of anxiety and post-traumatic stress, and tried to cope by compartmentalising their fears and modifying diets. These findings demonstrate the need to further signpost services, help individuals manage gendered issues, and alleviate feelings of anxiety.

The active coping strategies of family members can help breast cancer patients better handle the crisis, and family adaptation is a manifestation of the family's active coping with the crisis. In the study of breast cancer, a disease that predominantly affects women, we explored the influence of spouses on patients' family adaptation. This aspect has not been explored in previous studies.

In recent years, with the development of family stress coping theory, cancer coping styles have shifted from an individual focus to a whole-family approach. This shift has the potential to help families of cancer patients adapt to the crisis. This study aimed to explore the correlation between dyadic coping, family adaptation, and benefit finding in couples with breast cancer.

Using convenience sampling, the study included 325 pairs consisting of breast cancer patients and their spouses who attended breast surgery, oncology, and chemotherapy sessions between April and November 2023. The survey utilized the General Information Questionnaire for patients and spouses, the Dyadic Coping Scale, the Benefit Finding Scale, and the Family Adaptability and Cohesion Evaluation Scales. Data analysis was conducted using SPSS 25.0 and Amos 24.0 software.

In the actor effect of dyadic coping on family adaptation, the benefit finding of patients and their spouses played a mediating role. Regarding the partner effect (B = 0.019, 95% CI = 0.003-0.045, P < 0.05), the dyadic coping of spouses indirectly affected the family adaptation of patients through the benefit findings of patients. The patient's dyadic coping can directly affect the spouse's family adaptation. The spouse's dyadic coping can influence the patient's benefit finding.

There is a partial interaction between breast cancer patients and their spouses' dyadic coping, benefit finding, and family adaptation. Therefore, clinical staff should promptly identify patients and spouses with poor coping abilities and provide them with positive psychological interventions to enhance the dyadic coping abilities of both partners and assist them in overcoming the problems encountered during the treatment process, ultimately helping them better cope with family crises.

Faced with cancer patients in the near-death stage, spousal caregivers may experience a series of stress reactions and have a high risk of suffering from physical and psychological problems. Good social support can help alleviate stressful reactions.

To investigate stress responses and social support among spouse caregivers of young and middle-aged patients with terminal cancer in the near-death stage, and to explore the death care experience of spouse caregivers.

A prospective mixed-methods study was conducted. Questionnaires of stress response questionnaire and social support rating scale were used to investigate stress responses and social support of spouse caregivers. And semi-structured interviews were conducted to explore the death care experience of spouse caregivers in at a university-affiliated hospital in China.

Spouse caregivers with higher social support scores were significantly more likely to have poor stress response. Meanwhile, whether the spouses had alternative care for other dependents, the number of venous pathways and instruments in/on the patient's body significantly affected the spousal stress response. Among them, spousal social support was the best influencing factor to predict spousal stress response. Four qualitative themes of the death care experience were identified. Theme 1: Psychological feelings of spouses caregivers when they care for the patients' physical function. Theme 2: Psychological feelings of spouse caregivers when they communicated with the patients. Theme 3: Psychological feelings of spouses caregivers when they will being widowed soon. Theme 4: The focus of life shift, and life concept change.

Overall, spousal stress response was statistically affected by alternative caregivers for spouses, spousal social support, and the number of venous pathways and instruments in/on the patient's body. Among that, social support was the best influencing factor to predict the stress response. Meanwhile, spousal caregivers was distressed and felt deeply fear, wronged and helpless deep and when facing the patients' dying symptoms and communicating with patient, and reflected on the essence of life, and changing the concept of life.

Medical staff should pay special attention to spousal caregivers' physical discomfort and improve spousal social support, and provide targeted information and assistance to decrease spousal stress response in the near-death stage of cancer patients.

Despite improvements in early detection and therapeutic interventions, the mortality rate for Black breast cancer patients is still significantly higher than that of White breast cancer patients. This study seeks to understand differences in the patient experience that lead to this disparity. Semi-structured interviews were conducted to understand the breast cancer treatment process and patient experiences. This study collected health services and timeline data from medical records. Based on these two data sources, the patient's journey in breast cancer treatment was mapped and a thematic analysis was conducted to identify challenges and barriers in the process. The cancer care continuum consists of four stages-diagnosis, surgery, chemotherapy/radiation, and follow-up care. The themes contributing to patient experiences and challenges were identified and compared in each stage for both Black and White patients. Both Black and White participants faced challenges related to financial constraints, treatment changes, lack of autonomy, and insufficient emotional support. However, Black participants additionally faced significant barriers in terms of cultural concordance, effective patient-provider communication, and delay in diagnosis. This study highlights the importance of incorporating effective provider-patient communication, navigation, and emotional support, especially for Black breast cancer patients throughout the cancer care continuum to address healthcare disparities.

We aimed to compare the risk of incident depression, anxiety, non-fatal self-harm and completed suicide in survivors from a wide range of cancers versus cancer-free individuals.

We used electronic health records from the United Kingdom Clinical Practice Research Datalink linked to cancer registry data, hospital admissions data and death records between 1998 and 2021. Adult survivors of the 20 most common cancers were matched (age, sex, general practice) 1:10 to cancer-free individuals. Cox regression models, adjusted for shared risk factors, were used to estimate associations between cancer survivorship and mental health outcomes.

853,177 adults with cancer diagnosed in 1998-2018 were matched to 8,106,643 cancer-free individuals. Survivors of all 20 cancer types under study had a higher risk of experiencing a new episode of anxiety and depression during follow-up compared with cancer-free individuals; there was also evidence of raised risks of non-fatal self-harm in 17/20 cancers and completed suicide in 8/20 cancers. Effect sizes were greatest in cancers with poorer 5-year survival: hazard ratios (HRs) for anxiety and depression of 1.1-1.2 were seen for malignant melanoma survivors, while HRs for both outcomes were >2.5 for lung and oesophageal cancer survivors. HRs were highest in the first year from cancer diagnosis, reducing over time since diagnosis. However, 5-year cancer survivors still experienced elevated risks of a subsequent new episode of anxiety or depression, in 18/20 cancers.

Survivors of the 20 most common cancers were at increased risk of experiencing depression and anxiety, and these increased risks persisted in medium-to long-term cancer survivors. Substantially raised risks of non-fatal self-harm and completed suicide were also seen for several types of cancer. The risks of all mental health outcomes were generally higher in survivors of cancers with poorer prognosis. Our findings suggest a need for improved psychological support for all patients with cancer.

Wellcome Trust.

Around 42% of individuals with cancer experience distress. Acceptance and commitment therapy (ACT) can reduce distress, but effects are small, and mechanisms unclear. This review aimed to identify associations between ACT processes and distress in cancer. Search terms included cancer, ACT processes, self-compassion, and distress. Six online databases and grey literature were searched until March 2022. Of 6555 papers screened, 108 studies were included with 17,195 participants. Five meta-analyses of 77 studies were conducted. Random effects meta-analyses of correlations revealed higher scores on flexible processes (acceptance, present moment awareness, self-compassion) were associated with lower distress (rpooled = -0.24, -0.39, -0.48, respectively); whilst higher scores on inflexible processes (experiential avoidance, cognitive fusion) were associated with higher distress (rpooled = 0.58, 0.57, respectively). Meta-analyses displayed moderate-to-high heterogeneity with most studies assessed as low risk of bias. Meta-regressions revealed no significant moderators (stage, time since diagnosis, gender and age). This review provides a theoretically aligned evidence base for associations between ACT processes and distress in cancer, supporting elements of ACT theory and providing targeted directions for intervention development. Due to limited evidence, future research should focus on self-as-context, values and committed action and conduct mediation analysis in controlled trials of ACT processes on distress in cancer.

Cancer diagnosis not only impacts physical health but also mental well-being, often leading to significant stress, fear, and depression among patients.The utilization of CAM has shown a rising trend, influenced by the availability of different modalities offered by healthcare services, sometimes in an ad hoc fashion. This study seeks to examine and compare the respective impacts of warm foot baths and foot reflexology on depression in patients undergoing radiotherapy.

A randomized clinical trial was conducted at Mashhad University of Medical Sciences in Iran in 2019, following CONSORT guidelines. Participants included non-metastatic cancer patients aged 18-60 undergoing a 28-day radiotherapy course. Patients were randomly assigned to receive either warm footbaths or foot reflexology as interventions, performed daily for 20 min over 21 days. The data were analyzed using appropriate statistical tests.

Statistical analysis indicated no significant differences in demographic attributes between the two groups. Both interventions led to a significant reduction in depression scores post-treatment compared to pre-treatment assessments. Foot reflexology showed a greater reduction in depression scores compared to footbaths with warm water.

Both warm footbaths and foot reflexology are effective in alleviating depression in patients undergoing radiotherapy, with foot reflexology showing a greater impact on improving depression levels. The study recommends foot reflexology as a preferred intervention for managing depression in these patients if conditions and facilities permit.

The article aims to assess the role of stress and anxiety in relation to the level of emotional control among cancer patients. Currently cancer ranks second, after cardiovascular disease, as the most common cause of death. Moreover, it is predicted that in the coming years, cancer will become the leading cause of death worldwide. This is due to the extended lifespan of the population and also to the presence of carcinogenic factors in the surrounding environment. The emergence of cancer is a significant stressor that affects individuals in diverse ways, leading to cognitive, behavioral, and emotional consequences. In line with the adopted aim, emotional issues are the chosen area of exploration in this article.

The study included 102 patients. The differences between the patients' results according to various scales and the results produced by the validation group data were examined using one-sample t-tests. The relationships between the quantitative variables were determined using Spearman's rho coefficients, and the relationships between the quantitative and qualitative variables were verified using Kruskal-Wallis tests.

The participants exhibited higher anxiety suppression levels than individuals in the normalization group. They sought emotional support more frequently than the average person in the population, turned to religion, engaged in other such activities, lived in denial more often, discontinued activities, and displayed a sense of humor less frequently. The more frequently they controlled their anger, the less they sought emotional and instrumental support, catharsis, and attempted to accept the situation and cease being active. Additionally, controlling anxiety, sadness, and depression coexisted with self-blame, denial, and compensatory actions.

Cancer patients face intense anxiety. Emotional and instrumental support, along with the ability to express and manage emotions, are crucial for these patients, especially within the context of facing the challenge of cancer. Finding constructive ways to express strong and difficult emotions prevents their accumulation and reduces the need for emotional suppression. Preventive actions should be oriented toward supporting the emotional competencies of patients.

People with cancer may suffer negative psychosocial outcomes due to the challenges of cancer. LGBTQ2S+ people routinely experience negative psychosocial outcomes in health care settings, but have showcased resilience in the face of discrimination; however, this has never been studied in a cancer context. Thus, this study aims to assess coping and resilience in LGBTQ2S+-identifying people diagnosed with cancer using a strengths-based approach. A qualitative exploratory design was used. Ten self-identified LGBTQ2S+ people who have completed their cancer treatment were recruited. Participants completed clinical, health, and demographic questionnaires and, subsequently, semi-structured qualitative interviews. Conceptualizations of coping and resilience in the semi-structured interviews were analyzed using interpretative phenomenological analysis (IPA). Participants were members of various gender identities and sexual orientations. In addition to identifying needed LGBTQ2S+-specific resources, four narratives emerged: support networks, regaining control in life, conflicting identities, and traditional coping methods. Most participants' cancer journeys were characterized by a 'Second Coming-Out' phenomenon, where LGBTQ2S+ people with cancer use coping strategies, similar to those used when coming out, to produce resilience throughout their cancer journey. This work provides exploratory insight into LGBTQ2S+ people with cancer, but more research is required with a larger sample.

It has long been documented that cognitive behavioral therapy (CBT) has positive impacts on improving mental health (MH) and quality of life (QoL) in the general population, but investigations on its effect on cancer survivors remain limited, especially for QoL outcomes. The purpose of this meta-analysis is to investigate the effects of CBT as compared to control on cancer patients' MH and QoL outcomes. Control is defined in this study as standard therapy, waitlist control, and active/alternative therapy.

In total, 154 clinical trials creating a sample size of 1627 individuals were collected. Analysis focusing on MH and QoL excluded 29 clinical trials resulting in a final analysis of 132 clinical trials (and 1030 effect sizes). R Statistical Software (version 4.2.2) and the robumeta package were utilized to complete analysis, which entailed robust variance estimation (RVE) in intercept-only meta-regression, and univariate meta-regression (for moderator analysis).

Across 132 clinical trials and 1030 effect size estimates, we identified that CBT moderately improves MH and QoL in cancer patients d = 0.388, 95% CI 0.294-0.483, p < 0.001. Additionally, age and delivery format can influence the efficacy of CBT in this patient population.

CBT statistically improves the MH and QoL psychosocial parameters in cancer patients with greater efficacy in younger patients. Important clinical and intervention-related factors, that is, age and delivery, should be considered when oncologists consider CBT as a psychotherapeutic intervention for individuals with cancer.

We expand on prior systematic reviews of Tai chi/Qigong (TCQ) practice on depression or anxiety symptoms in adults with cancer to estimate the mean effect of TCQ on depression and anxiety in randomized controlled trials. Additionally, we perform moderator analysis to examine whether effects vary based on patient features, TCQ stimuli properties, or characteristics of research design.

Guided by PRISMA guidelines, we located articles published before August 31, 2023 using a combination of electronic database search and a complementary manual search through reference lists of articles and published reviews. Two separate multilevel meta-analyses with random-effects model were employed to estimate the overall effect of TCQ on depression and anxiety respectively. Further, multilevel meta-regression analysis was utilized to examine moderating effects based on moderators derived from patient features, TCQ stimuli properties, or characteristics associated with research design. Meta-analyses were performed in R4.0.0 and certainty of evidence with GRADEpro software.

The TCQ intervention yielded a standardized mean effect size of 0.29 (95% CI, 0.18 to 0.40) for anxiety, indicating homogeneity among the included studies. Conversely, for depression, the standardized mean effect size was 0.35 (95% CI, 0.14 to 0.55), signifying heterogeneity: reductions were larger when the trial primary outcome, predominantly function-related outcomes, changed significantly between the TCQ and control group.

TCQ practice exhibits small-to-moderate efficacy in alleviating depression and anxiety symptoms among cancer patients and survivors. Moreover, patients with depressive symptoms for whom TCQ intervention coupled with improvements in function-related outcomes manifested greater antidepressant effect.

Health-related quality of life (HRQOL) in cancer patients has attracted increasing attention, which may be associated with self-rated health (SRH), anxiety, and depression. However, limited studies have focused on the mediating role of anxiety and depression in the relationship between SRH and HRQOL among cancer patients. Therefore, this study aims to explore the serial multiple mediating effects of anxiety and depression between SRH and HRQOL in cancer patients.

This cross-sectional study investigated a total of 565 hospitalized cancer patients in Anhui province in China from November 2020 to October 2021. SRH was assessed using a single-item measure, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) and HRQOL was assessed using the EuroQol-5 Dimension (EQ-5D, three-level version). Socio-demographic and clinical characteristics were analyzed using descriptive statistics. The relationships between SRH, anxiety, depression, and HRQOL were evaluated by Pearson correlation analysis. The serial multiple mediation of anxiety and depression was assessed by SPSS PROCESS macro.

SRH, anxiety, depression and HRQOL were significantly correlated(P < 0.001). In comparison to the fair SRH, the good SRH exhibited a significantly positive direct effect (Effect = 0.2366, Bootstrap 95%CI: 0.0642 ~ 0.4090) and total effect on HRQOL (Effect = 0.4761, Bootstrap 95%CI: 0.2975 ~ 0.6546). Conversely, the poor SRH demonstrated a significantly negative total effect on HRQOL (Effect= -0.4321, Bootstrap 95%CI: -0.7544~ -0.1099). When considering the fair SRH as the reference group, the poor SRH displayed a negative indirect effect on HRQOL through the single mediation of anxiety (Effect= -0.1058, Bootstrap 95%CI: -0.2217~ -0.0107) and the serial mediation of anxiety and depression (Effect= -0.0528, Bootstrap 95%CI: -0.1233~ -0.0035). Conversely, the good SRH had a positive indirect impact on HRQOL through the single mediation of anxiety (Effect = 0.1153, Bootstrap 95%CI: 0.0583 ~ 0.1900) and depression (Effect = 0.0667, Bootstrap 95%CI: 0.0206 ~ 0.1234), as well as the serial mediation of anxiety and depression (Effect = 0.0575, Bootstrap 95%CI: 0.0192 ~ 0.1030).

SRH can improve HRQOL through the decrease of anxiety and depression in cancer patients. Focusing on SRH would be beneficial for their mental health and HRQOL in cancer patients.

Cancer-related cognitive impairment (CRCI) refers to a cognitive decline associated with cancer or its treatments. While research into CRCI is expanding, evidence remains scattered due to differences in study designs, methodologies, and definitions. The present umbrella review aims to provide a comprehensive overview of the current evidence regarding the impact of different breast cancer therapies on cognitive functioning, with a particular focus on the interplay among objective cognitive deficits (ie, measured with standardized tests), subjective cognitive concerns, (ie, self-reported), and other mediating psycho-physical factors.

The search was made in Pubmed, Embase, and Scopus for articles published until July 2023, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis protocol.

Chemotherapy and endocrine therapy appear consistently associated with CRCI in patients with breast cancer, primarily affecting memory, attention/concentration, executive functioning, and processing speed. Subjective cognitive concerns were often found weakly or not associated with neuropsychological test results, while overall CRCI seemed consistently associated with psychological distress, fatigue, sleep quality, and inflammatory and biological factors.

Current evidence suggests that CRCI is common after chemotherapy and endocrine therapy for breast cancer. However, heterogeneity in study designs and the scarcity of studies on more recent treatments such as targeted therapies and immunotherapies, highlight the need for more systematic and harmonized studies, possibly taking into account the complex and multifactorial etiology of CRCI. This may provide valuable insights into CRCI's underlying mechanisms and potential new ways to treat it.

Both depression and insomnia are found to be more prevalent in cancer patients compared to the general population. This study compared the network structures of depression and insomnia among cancer patients versus cancer-free participants (controls hereafter).

The 8-item Center for Epidemiological Studies Depression Scale (CESD-8) and the 4-item Jenkins Sleep Scale (JSS-4) were used to measure depressive and insomnia symptoms, respectively. Propensity score matching (PSM) was used to construct the control group using data from the Health and Retirement Study (HRS). In total, a sample consisting of 2216 cancer patients and 2216 controls was constructed. Central (influential) and bridge symptoms were estimated using the expected influence (EI) and bridge expected influence (bridge EI), respectively. Network stability was assessed using the case-dropping bootstrap method.

The prevalence of depression (CESD-8 total score ≥ 4) in cancer patients was significantly higher compared to the control group (28.56 % vs. 24.73 %; P = 0.004). Cancer patients also had more severe depressive symptoms relative to controls, but there was no significant group difference for insomnia symptoms. The network structures of depressive and insomnia symptoms were comparable between cancer patients and controls. "Felt sadness" (EI: 6.866 in cancer patients; EI: 5.861 in controls), "Felt unhappy" (EI: 6.371 in cancer patients; EI: 5.720 in controls) and "Felt depressed" (EI: 6.003 in cancer patients; EI: 5.880 in controls) emerged as the key central symptoms, and "Felt tired in morning" (bridge EI: 1.870 in cancer patients; EI: 1.266 in controls) and "Everything was an effort" (bridge EI: 1.046 in cancer patients; EI: 0.921 in controls) were the key bridge symptoms across both groups.

Although cancer patients had more frequent and severe depressive symptoms compared to controls, no significant difference was observed in the network structure or strength of the depressive and insomnia symptoms. Consequently, psychosocial interventions for treating depression and insomnia in the general population could be equally applicable for cancer patients who experience depression and insomnia.