Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 26 appraisals
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Initial development and usability testing of a digital fertility preservation navigator for newly diagnosed young adult cancer survivors
PURPOSE: Young adults with cancer (YAs) are rarely provided the necessary resources to make informed decisions about fertility preservation (FP) prior to beginning treatment. Digital decision aids are a promising strategy to ensure YAs receive timely, guideline-concordant information. We developed an alpha version Fertilit-e, a digital FP navigator, and conducted usability testing to obtain feedback from YAs. METHODS: We designed an alpha version of Fertilit-e that drew from existing evidence-based FP resources. Feedback was obtained from two waves of participants using a think-aloud framework, and modifications were made to the decision aid. RESULTS: Across waves, participants (n = 12) understood the purpose of Fertilit-e and thought modules were comprehensive and easy to understand. The usability of Fertilit-e was rated as excellent across waves and devices (iPad and computer). Participants suggested reducing the use of and better defining medical terminology and adding text to videos to enhance comprehensibility. CONCLUSIONS: YAs reported that Fertilit-e provided important information regarding FP in an understandable manner. Participants made suggestions for how to improve comprehensibility and usability that will guide future iterations of Fertilit-e. For example, tailoring algorithms and reorganization may direct users to the most relevant information. IMPLICATIONS FOR CANCER SURVIVORS: Digital decision aids may be a feasible and useful strategy for helping YAs navigate decisions regarding whether to pursue FP at the time of diagnosis. Additional research is needed to refine and evaluate such tools before integration into routine care.
24 July 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
A machine learning approach to profiling anxiety risk among cancer patients on treatment
PURPOSE: Previous literature has identified multiple risk factors for anxiety among individuals with cancer. However, the relative importance across many interrelated variables is not clear. Further, it is unknown how combined psychosocial factors and demographic/clinical characteristics increase an individual's vulnerability to anxiety. The aims of this study are to systematically test the following: (1) the best predictors of anxiety, (2) the best-performing classifiers for distinguishing high versus low anxiety, and (3) the most informative combinations of psychosocial features and demographic/clinical characteristics that heighten an individual's vulnerability to anxiety. METHODS: Machine learning (ML) models were used. For Aim 1, we tested the predictors of anxiety using the models of regularized regressions, GAMS, and best subset selection. For Aim 2, models tested included support vector machines (SVM), random forest, nearest neighbors, and XGBoost as the classifiers to predict high versus low anxiety. For Aim 3, gradient-boosted decision tree models were trained to examine the most important combinations of candidate predictors. We used SHapley Additive exPlanations (SHAP) to improve the interpretability of our ML models. RESULTS: Across five imputed datasets, using linear regression as the primary benchmark (MSE = 69.945 ± 8.131; MAE = 6.636 ± 0.361), elastic net showed the lowest average prediction error (MSE = 65.486 ± 8.323; MAE = 6.504 ± 0.357), although differences among predictor-based models were modest. For classifiers, random forest achieved the highest mean accuracy (0.751 ± 0.015), kNN achieved the highest PR-AUC (0.797 ± 0.016), and logistic regression achieved the highest ROC-AUC (0.835 ± 0.005). Participation self-efficacy was the most consistent key predictor of anxiety across models. The most important risk combinations of demographic and psychosocial/symptom variables included age-symptom communication barriers, age-cancer coping self-efficacy, ECOG performance status-depressive symptoms, the type of helper-psychological well-being, and education-psychological well-being. CONCLUSION: Our findings may inform risk stratification in clinical settings and facilitate personalized intervention designs aiming at relieving anxiety among cancer patients.
19 July 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Psychosocial interventions for families with minor children affected by parental cancer: An umbrella review
PURPOSE: Research on psychosocial interventions for families with minor children affected by parental cancer has expanded over recent decades; however, the evidence remains fragmented across multiple systematic reviews. This umbrella review aims to gather and synthesize the existing systematic reviews, with a particular focus on intervention characteristics, implementation, effectiveness, methodological limitations, and implications for future research and clinical practice. METHODS: A comprehensive search of CINAHL, MEDLINE, PubMed, Web of Science, Scopus, PsycINFO, PsycArticles, Epistemonikos, and the Cochrane Database of Systematic Reviews was conducted in September 2025, including gray literature. Eligible reviews were published between 1990 and 2025 in English, Portuguese, or Spanish and had full-text availability. Methodological quality was assessed using AMSTAR-2. The review was registered in PROSPERO (ID 1139397). RESULTS: Eight systematic reviews met inclusion criteria and were synthesized narratively due to substantial clinical and methodological heterogeneity. Across these reviews, 46 distinct psychosocial interventions were identified. Overall, interventions were associated with preliminary beneficial outcomes for children, adolescents, parents, and families, particularly in improving children's understanding of parental illness, enhancing family communication and functioning, strengthening parenting skills, and promoting psychological well-being. However, confidence in these findings was limited by the generally low methodological quality of the included reviews and the high overlap of primary studies. CONCLUSIONS: Current evidence suggests that psychosocial interventions may support families with minor children affected by parental cancer, but conclusions remain tentative due to methodological limitations. There is a clear need for the development and rigorous evaluation of developmentally and disease-stage-sensitive interventions, supported by high-quality research and institutional collaboration. Strengthening the evidence base in this area is essential to inform clinical practice, guide supportive care services, and support policy development in psycho-oncology.
13 July 2026
Read appraisal →Journal of medical Internet research
Exploring the Narratives of Patients With Cancer Using Large Language Models: Topic Modeling and Social Network Analysis
BACKGROUND: Patients with cancer often experience diverse psychosocial stressors that profoundly affect disease trajectories, treatment adherence, and overall quality of life. Understanding how patients experience and articulate these issues is critical for designing patient-centered interventions. Conventional data collection methods, such as surveys and interviews, provide depth but are constrained by recall bias and scalability and may overlook sensitive or underreported concerns. Patient-authored narratives in online health communities present a valuable opportunity to identify prevalent and underserved issues. However, critical analytic challenges remain in generating coherent and interpretable insights due to their unstructured and large-scale nature. OBJECTIVE: This study aims to leverage TopicGPT, a prompt-based topic modeling framework powered by large language models (LLMs), in combination with network analysis for interpretable topic discovery and interrelationship analysis in the narratives of patients with cancer. METHODS: Patient-authored posts describing psychosocial challenges about cancer experience were collected from 4 online health communities. Eligible posts were preprocessed and analyzed using TopicGPT, wherein topics were generated hierarchically and mapped at the sentence level. Comparison analyses were conducted among 3 state-of-the-art LLMs through cosine similarity and manual evaluation. Results from the best-performing LLM were further compared with 2 conventional topic models through topic diversity and were used to construct the network subsequently. Topic co-occurrence was examined using the pointwise mutual information algorithm and centrality metrics to reveal influential topics and thematic interconnections across narratives. RESULTS: A total of 11,306 posts were collected from Reddit, Macmillan, Mijian, and Douban between December 6, 2006, and September 24, 2025. Of these, 3169 posts were retained for topic modeling and network analysis. DeepSeek-V3.2 consistently outperformed Gemini-2.5-Flash and GPT-4o, with similarity scores of 0.6295, 0.5342, and 0.5247, respectively. TopicGPT maintained consistently high topic diversity across languages. "Fear of cancer recurrence" and "Psychological distress" emerged as both most frequent and bridging topics across a hierarchy comprising 42 top-level and 58 subtopics. Strong connections were observed among "Sexual health concerns," "Reproductive concerns," and "Quality of life impact"; "Family communication concerns" frequently co-occurred with "Employment concerns," "Diagnostic delays and misdiagnosis," and "Social support." CONCLUSIONS: This study demonstrates the potential of LLM-based topic modeling for large-scale, context-sensitive analysis of patient-authored narratives. The proposed integrated, domain-adaptable pipeline enables the identification of high-fidelity topics and their interrelationships, offering a scalable and interpretable approach to qualitative data in health care. Importantly, our findings reveal substantial concerns and unmet needs among patients with cancer, with potential to support patient-centered research and inform future clinical assessment and supportive care strategies.
7 July 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Interventions to improve the psychosocial outcomes of individuals with lymphedema: a systematic review
PURPOSE: Lymphedema is a common and enduring consequence of cancer treatment with substantial physical and psychosocial morbidity, yet research predominantly focuses on physical outcomes. This systematic review examines psychosocial interventions for individuals with lymphedema, describing the intervention characteristics, methodological quality, and strength of the evidence. METHODS: A systematic literature search was conducted of studies published through November 2025. Empirical interventions with psychosocial components and outcomes for individuals with lymphedema were eligible. Methodological quality was assessed. Strength of the evidence was determined by combining quality with intervention effectiveness. RESULTS: Ten studies met inclusion criteria, including mind-body (n = 3), education and support (n = 3), and physical activity (n = 4) intervention models, and most delivered following completion of decongestive therapy. Psychosocial outcomes included mental health (n = 8) and quality of life (n = 6). Methodological rigor was mixed, with MQRS scores ranging from 5-13 (of 14). Interventions delivered in combined in-clinic and remote settings demonstrated stronger evidence for improving mental health outcomes than either setting alone. CONCLUSION: Few empirical evaluations exist targeting the psychosocial needs of individuals with lymphedema, particularly during intensive phases of decongestive therapy. Heterogeneity in intervention models, outcome measures, and treatment timing limits cross-study comparisons; however, hybrid delivery approaches show promise for improving psychosocial outcomes. Greater integration of psychosocial care across the lymphatic care continuum, supported by standardized outcome measures, may strengthen supportive care for individuals living with lymphedema.
5 July 2026
Read appraisal →JMIR cancer
Identification of Early Signs of Mental Health Disorders in Older Survivors of Cancer Using Patient-Generated Health Data: Observational Study
BACKGROUND: Older survivors of cancer face heightened risk of depression and anxiety related to cancer experiences, fear of recurrence, and aging-related difficulties. Conventional mental health monitoring approaches, such as clinical assessments and even electronic patient-reported outcomes, are limited by recall bias, patient burden, and infrequent data collection. Emerging patient-generated health data from wearables and smart home devices offer passive, low-burden, continuous monitoring, but their ability to capture mental health risks in older survivors of cancer remains unclear. OBJECTIVE: This study aims to explore whether patient-generated health data collected in the wild, either passively or actively, can classify older survivors of cancer as having or not having signs of anxiety and depression based on Patient Health Questionnaire-4 (PHQ-4) scores and to assess the potential added value of passive monitoring modalities, such as smart plugs. METHODS: This study recruited 41 older survivors of cancer (mean age 72.3, SD 6.81 years) from the LifeChamps project. Over a 12-week period, participants were monitored using an activity tracker to measure physical activity, sleep, and physiological metrics; a smart scale to capture weight and body composition; and a smart plug to track television use as a proxy for sedentary television viewing. Mental health status was self-reported via the PHQ-4 questionnaire in a mobile app. Machine learning models were trained to classify mental health risk based on features derived from each sensor modality, both independently and in combination. RESULTS: Tree-based gradient boosting models showed good performance in classifying PHQ-4-defined mental health risk. The best-performing configuration, combining smart plug and smart scale features, achieved a mean F1-score of 0.77 (SD 0.15) and a mean area under the receiver operating characteristic curve (AUC) of 0.85 (SD 0.10) across 3 repeated train-test splits. Standalone smart plug models, based solely on passive television use patterns, achieved a mean F1-score of 0.66 (SD 0.04) and a mean AUC of 0.71 (SD 0.06), outperforming models that relied only on activity tracker data (mean F1 0.59, SD 0.2). Multimodal combinations tended to improve average performance but did not consistently yield large gains over the strongest single-modality configurations, likely reflecting adherence-related data loss for wearables and scales. Crucially, passive monitoring of television use patterns emerged as a promising behavioral proxy measure of mental health states. CONCLUSIONS: This study pioneers the use of passively collected data (eg, smart plugs) for mental health monitoring in older survivors of cancer, demonstrating their potential. Smart plugs capture behavioral patterns without user burden, with reasonable standalone performance (mean AUC 0.71, SD 0.06), positioning them as a promising low-burden modality. Future work should validate findings in larger independent cohorts and in prospective clinical workflows. Such technologies could transform monitoring for vulnerable populations, enabling scalable, inclusive care while reducing health care burdens.
14 June 2026
Read appraisal →Blood advances
A pilot randomized clinical trial of a peer support intervention for hematopoietic stem cell transplantation
Peer support has been associated with improved patient-reported outcomes (PROs), including reduced psychological distress, among patients undergoing hematopoietic stem cell transplantation (HSCT), but structured interventions are limited. This study assessed the feasibility, acceptability, and preliminary effects of a scalable peer support intervention to reduce psychological distress and enhance quality of life (QOL) post-HSCT. We conducted a pilot randomized clinical trial evaluating the Supporting Transplant Experiences with Peer Program (STEPP), a 5-session, telephone-based intervention delivered by an HSCT survivor offering psychoeducation and coping strategies. Participants were recruited 1 to 2 weeks pre-HSCT admission and randomized to STEPP or usual care. Feasibility was defined as ≥60% enrollment and ≥60% completing ≥3 sessions. Acceptability was assessed using the Client Satisfaction Questionnaire (CSQ; ≥3/4 mean benchmark). PRO measures of anxiety, depression (Hospital Anxiety and Depression Scale), posttraumatic stress (Post-Traumatic Stress Disorder Checklist-Civilian Version), QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplant), social support (Social Support and Effectiveness Questionnaire), and self-efficacy (Cancer Self-Efficacy Scale) were assessed pre-HSCT and at 30 and 60 days post-HSCT. Mixed-effects models explored preliminary effects. We enrolled 77% (90 of 117) of eligible patients (STEPP, n = 45; usual care, n = 45); 12 became ineligible due to HSCT cancellation or postponement. Among 78 active participants (mean age, 58.9 years [standard deviation, 12.3]; 57.7% women), all STEPP participants completed ≥3 sessions, and the mean CSQ score was 3.5. STEPP showed small-to-moderate improvements in day 30 anxiety (d = -0.36) and day 60 anxiety (d = -0.58), depression (d = -0.25), posttraumatic stress (d = -0.28), QOL (d = 0.48), social support (d = 0.36), and self-efficacy (d = 0.46). STEPP exceeds feasibility and acceptability thresholds, showing promising psychosocial benefits warranting a fully powered multisite efficacy trial. This trial was registered at www.clinicaltrials.gov as NCT06010017.
9 June 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Cancer patient distress and health service use is linked with carer distress: evidence from a systematic review and meta-analysis
BACKGROUND: Family carers (caregivers) of cancer patients often have poor mental health, which may adversely affect patient wellbeing and health service use. We examined the evidence for this using a systematic review and meta-analyses. METHODS: We systematically searched online databases for studies reporting associations between carer psychological health and either: (a) psychological health of patients with cancer they cared for; or (b) health service use in carers or patients. Studies' risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. We undertook meta-analyses to estimate pooled correlations for the most commonly reported associations between carer and patient psychological health. For associations between carer psychological health and carer and/or patient health service use, we conducted a narrative synthesis. RESULTS: Our search identified 11,911 records, 169 of which were eligible. The majority of studies were of high-to-moderate quality. Carers who were distressed, depressed, anxious, or had poor scores in the mental component of quality of life were significantly more likely to be caring for patients with these same outcomes (pooled effect sizes ranged from 0.28 to 0.42; all p < 0.001). Subgroup analyses by gender, disease stage, and study quality revealed no substantial differences. Carers with poor psychological health used general practice, mental healthcare, and hospital services more frequently than those who were psychologically healthy, and the patients they cared for used more medications and had more frequent emergency presentations. CONCLUSION: The inclusion of carers alongside patients in early psychosocial care may improve family outcomes and reduce health service use.
1 June 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Cancer patients' experiences of "time toxicity": a qualitative meta-synthesis
OBJECTIVE: To systematically review and synthesize qualitative studies on cancer patients' experiences of time toxicity, providing evidence to inform policy making. METHODS: We searched PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, Wanfang, VIP, SinoMed, and other databases for qualitative studies on cancer patients' experiences of time toxicity, from database inception to November 2025. Included studies were appraised using the 2016 edition of the JBI quality appraisal criteria for qualitative research from the Joanna Briggs Institute (Australia). Results were synthesized using an aggregation approach for meta-synthesis. RESULTS: Ten studies were included. Forty-one themes were extracted, which were grouped into 11 categories and further consolidated into 4 synthesized findings: (1) multidimensional sources of time toxicity; (2) negative impacts of time toxicity; (3) coping strategies adopted to address time toxicity; and (4) positive experiences from investing time in treatment. CONCLUSIONS: Time toxicity has multidimensional effects on cancer patients' daily rhythms, psychological states, and social roles, and requires coordinated attention from healthcare professionals, society, and policy makers. Future efforts should build systemic support through integrating healthcare resources, optimizing service processes, and strengthening social support to reduce patients' time toxicity.
30 May 2026
Read appraisal →PloS one
One out of four patients with pancreatic cancer experience psychological symptoms: A systematic review and meta-analysis
The death rate from pancreatic cancer is one of the highest of all cancers, with increasing incidence every year over the past decades. As the prognosis remains extremely poor, this trend brings not only a growing clinical challenge, but also a significant psychological toll for patients. In comparison to other types of cancer, our understanding of the psychological burden of such a deadly disease is still limited. Recognizing and addressing the psychological aspects of pancreatic cancer are crucial for comprehensive patient care. We, therefore, aimed to quantify the psychological burden of patients with pancreatic cancer. We conducted a systematic search (PROSPERO: CRD42022288805) of MEDLINE, Cochrane, and Embase databases to identify articles reporting on the prevalence of psychological symptoms among patients with pancreatic cancer. The symptoms examined were depression, anxiety, distress, fatigue, sleep disturbances. Study quality for the included studies was assessed using the Joanna Briggs Institute tool. Relevant data were extracted and exported for quantitative synthesis. The meta-analysis of the proportion of symptoms with a 95% confidence interval (CI) was conducted using frequentist random-effects models. Subset analyses were performed based on the severity of depression. A total of 28 articles were included in the meta-analysis and 31 in the systematic review. Our results showed that the proportion of depression (19 studies; 78,930 patients) was 0.27 (95% CI: 0.18-0.39). The proportion for anxiety (18 studies; 26,538 patients) was 0.29 (95% CI: 0.16-0.46; for distress (6 studies; 2746 patients) 0.43 (95% CI: 0.25-0.63); for fatigue (7 studies; 11 338 patients) 0.40 (95% CI: 0.21-0.63); and for sleep disturbances (3 studies; 10,645) 0.31 (95% CI: 0.06-0.77). These findings highlight the urgent need to integrate psychological care into pancreatic cancer treatment. Future research should explore sources of heterogeneity to better identify which approaches provide the most psychological benefit and tailor interventions to patient needs accordingly.
28 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Psychological distress in cancer survivors: a population-based analysis and machine learning-based risk stratification
PURPOSE: As the number of cancer survivors increases, psychological distress has become an important issue. Using nationally representative data, we evaluated mental health outcomes among Korean cancer survivors compared with cancer-free controls and developed models to identify individuals at risk of psychological distress. METHODS: We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2021. Psychological outcomes were assessed using standardized questionnaires, and a composite distress outcome was constructed. Risk stratification models were developed among cancer survivors using logistic regression and machine learning algorithms, including random forest, XGBoost, LightGBM, support vector machines, k-nearest neighbors, and naïve Bayes. RESULTS: A total of 88,061 participants were included, comprising 3733 cancer survivors and 84,328 cancer-free controls. Compared with cancer-free controls, cancer survivors had higher odds of depressed mood (OR 1.33; 95% CI 1.18-1.51), suicidal ideation (OR 1.14; 95% CI 1.00-1.31), suicide planning (OR 1.91; 95% CI 1.37-2.65), and mental health counseling (OR 1.36; 95% CI 1.08-1.71). Among cancer survivors, multiple models were evaluated, with logistic regression showing the highest performance (AUROC 0.689), followed by XGBoost (0.686). In logistic regression, longer working hours, depression history, activity limitation, female sex, smoking, employment, low income, and distorted body image were independently associated with distress. SHAP analysis identified activity limitation, sex, and depression history as key factors. CONCLUSIONS: Cancer survivors experience increased psychological distress across multiple outcomes. Machine learning-based models may help identify individuals at higher risk of psychological distress, supporting risk-based assessment in survivorship care.
28 May 2026
Read appraisal →Current oncology reports
Mind-Body Therapies for Depression and Anxiety Symptoms in People with Cancer: A Systematic Review with Network Meta-Analysis
INTRO: Mind-body therapies (MBTs) are promising forms of treatment for depression and anxiety symptoms in people with cancer, however, their effectiveness has not been compared. The objective of this study is to rank the effectiveness of MBTs for depression and anxiety symptoms in people with cancer. METHODS: EMBase, PubMed, Cinahl, PsychINFO, IndMED, CSI-NISCAIR, CNKI, Clinicaltrial.gov, ChiCTR, and CTRI were searched until February 2025 for randomised controlled studies in which MBTs were tested in a cancer population. Network meta-analyses were used on the selected studies to rank the reduction in depression and anxiety symptoms compared with usual care. RESULTS: A total of 182 studies which involved 16,835 participants were included. The network meta-analysis showed a statistically significant large effect compared with usual care for biofeedback (standardised mean difference, SMD = -1.18, p = 0.038), spiritual interventions (SMD = -0.98, p = 0.047), and mindfulness-based interventions (MBIs; SMD = -0.87, p < 0.001) for depression symptoms and yoga (SMD = -1.13, p < 0.001), MBIs (SMD = -1.02, p < 0.001), physical relaxation (SMD = -0.93, p < 0.001), qigong/Tai Chi (QTC; SMD = -0.90, p = 0.004) and music therapy (SMD = -0.90, p < 0.001) for anxiety symptoms. CONCLUSIONS: The MBTs that should be prioritised are biofeedback, spiritual interventions, and MBIs for depression symptoms and yoga, MBIs, physical relaxation, QTC, and music therapy for anxiety symptoms in people with cancer.
20 May 2026
Read appraisal →Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
Health-related quality of life domains relevant to people in Europe undergoing cancer treatment: a systematic review of qualitative research
PURPOSE: To identify and synthesize evidence from European qualitative studies on cancer-related quality of life outcomes, needs, experiences, preferences, and concerns of people undergoing cancer treatment in the last decade. METHODS: Systematic review ( https://www.crd.york.ac.uk/PROSPERO , CRD42024575065) of European studies using qualitative methodology, assessing constructs related to HRQoL, and involving adults receiving cancer treatment. The search was performed in PubMed and Scopus from January 2013 to July 2024. Titles, abstracts, and full texts screening, data extraction and risk of bias assessment were conducted independently by two researchers. The main outcomes were the themes reported in each study. The thematic analysis was performed by organizing the themes of the studies into categories. RESULTS: Out of 18,256 articles initially identified, 36 met the inclusion criteria: 21 with generic and 15 with specific objectives. Five categories encompassing 110 themes were identified from the generic studies: Psychological Function (n = 41), Clinical Management (n = 26), Symptoms and Physical Function (n = 18), Social Function (n = 16), and Life Disruption (n = 9). Eleven studies with specific objectives focused on clinical management with all their themes fitting within the categories identified in the generic studies. CONCLUSIONS: Results showed the predominance of psychological function and clinical management themes. Symptoms and physical function, social function, and life disruption maintained their importance within the classical HRQoL framework. The emergence of clinical management is consistent with the growing patient-centered care approach, suggesting the need to integrate this content into the evaluation of patients undergoing cancer treatment. LIMITATIONS: most European countries were not represented, and publication bias could hide traditional domains.
15 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Evaluating the efficacy of two body image online writing interventions against a neutral writing control in targeting positive body image and distress in female cancer survivors: a randomised controlled trial
OBJECTIVE: This study evaluated the efficacy of two online writing interventions, Expand Your Horizon (EYH) and My Changed Body (MyCB), compared to control, in improving body image and distress in a cancer population, and investigated whether they target different mechanisms. METHODS: Adult female cancer survivors (N = 132) were randomised to EYH, MyCB, or a neutral writing control. Body appreciation, body dissatisfaction, body functionality appreciation, self-compassion and distress were measured at baseline, immediately post-intervention, 1-week, and 2-week follow-up. RESULTS: EYH participants demonstrated significantly higher body appreciation (p = .002, d = 0.31) and significantly lower body dissatisfaction (p = .002, d = -0.22) immediately post-intervention compared to control. The same pattern existed for MyCB participants but was not significant. No significant differences in proposed mechanisms-self-compassion or functionality appreciation-emerged between groups. Main effects of time emerged on body dissatisfaction, distress, and self-compassion at the 1-week and 2-week follow-ups, with all participants improving over time. CONCLUSION: The findings support the efficacy of EYH to improve state body appreciation and reduce body dissatisfaction in female cancer survivors. Further research is necessary to determine the optimal dose needed to produce sustained improvements in body image and distress.
12 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
A Noddings' caring theory-based intervention to enhance coping with death competence in advanced lung cancer patients: a randomized controlled trial
PURPOSE: This randomized controlled trial aimed to evaluate the effects of a Noddings' caring theory-based intervention on coping with death competence (CDC), death attitudes, and psychological distress in patients with advanced lung cancer. METHODS: Seventy inpatients were randomly allocated to the intervention group (n = 35) or the control group (n = 35). The 3-week intervention comprised modeling, dialogue, practice, and recognition phases. Outcomes, including CDC, attitude toward death, anxiety, and depression, were assessed at baseline (T0), post-intervention (T1), and 1-month follow-up (T2). RESULTS: No significant between-group differences were observed at baseline. Following the intervention, patients in the intervention group demonstrated significantly higher CDC total and subscale scores, more positive death attitudes, and lower anxiety and depression scores than those in the control group at both post-intervention and 1-month follow-up. CONCLUSION: The Noddings-based program effectively enhanced death-coping competence, improved death attitudes, and reduced psychological distress in patients with advanced lung cancer. TRIAL REGISTRATION: ChiCTR2600118530, 2/6/2026 retrospectively registered.
12 May 2026
Read appraisal →Palliative & supportive care
Manic and hypomanic states in cancer patients: A systematic review
OBJECTIVES: While there have been reports on the relationship between cancer and depression, reports on the association between cancer and manic states, a reciprocal state of depression, have been relatively few. Therefore, we conducted a systematic review on the relationships between cancer and manic states, focusing on their etiology, clinical course, and impact on cancer treatments. METHODS: A systematic review was conducted using four electronic databases, following the PRISMA guidelines. The scope of the study included research on manic or hypomanic states associated with cancer in patients with no prior history of mental illness, published from 1950 to August, 2021. The study protocol was registered with PROSPERO (CRD42020182372). RESULTS: Fifty-six studies, including 67 cases, were identified. The etiology of manic states in cancer patients was classified into organic, drug-induced, and psychogenic, with steroids being the most predominant causative agent. Approximately half of the patients discontinued cancer treatment following the onset of manic states. This was associated with a low rate of pharmacological treatment during the acute and maintenance phase of mania. The onset of manic states was most frequent during cancer treatment; however, about 15% of the cases exhibit manic symptoms before cancer diagnosis. SIGNIFICANCE OF RESULTS: This systematic review illustrated the clinical characteristics of manic state regarding differences in the etiology, timing of onset, pharmacological treatments, duration to remission, recurrence, and impact on cancer treatment. Manic states, which are comorbid with cancer, have significant clinical impacts on cancer prognosis. Therefore, appropriate pharmacological treatment for manic states is critical to consolidate appropriate cancer treatment. A substantial proportion of patients exhibit manic symptoms prior to the diagnosis of cancer, warranting further investigation into the possibility of the concept of "premonitory mania."
12 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Telemedicine adoption, pandemic-related fear, and treatment adherence in cancer care during COVID-19: a prospective cohort study
PURPOSE: To evaluate the impact of telemedicine adoption and pandemic-related fear on treatment adherence, healthcare utilization, and supportive care processes among patients undergoing cancer therapy during the COVID-19 pandemic. METHODS: In this prospective cohort study, we followed 149 cancer patients over two years to evaluate telemedicine utilization, treatment modifications, and COVID-19-related fear. We employed validated psychometric tools, including the COVID-19 Fear Scale. RESULTS: Telemedicine adoption (24.8% of patients) was associated with fewer hospital visits (7.3 ± 3.2 vs 9.4 ± 4.1, p = 0.004) and reduced emergency room utilization (16.2% vs 46.4%, p < 0.001). Treatment modifications occurred in 55.9% of patients, predicted by COVID-19 infection (OR = 2.8, 95% CI:1.7-4.6) and neutropenia (OR = 2.1, 95% CI:1.3-3.4). High fear scores were linked to increased mortality (8.1% vs 2.7%, p = 0.032), disease progression (37.8% vs 21.4%, p = 0.018), lower treatment adherence (75.7% vs 87.5%, p = 0.041), and higher hospitalization rates (51.3% vs 24.1%, p < 0.001). CONCLUSION: This study demonstrates that telemedicine can reduce acute care utilization while treatment modifications and high pandemic-related fear significantly worsen cancer outcomes. These findings highlight the need for oncology teams to proactively integrate remote care strategies and targeted psychological support to maintain treatment adherence and mitigate adverse outcomes during health crises.
10 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Online self-compassion-based interventions on patient outcomes in patients with cancer: a systematic review
PURPOSE: This systematic review investigates the effectiveness of online self-compassion-based interventions and their impact on the outcomes of cancer patients. METHODS: A comprehensive search was carried out in the Web of Science Core Collection, Cochrane Library, CINAHL, PubMed, ScienceDirect, Scopus, Ovid, and SpringerLink databases without any year limitation until January 01, 2026. Cochrane and PRISMA guidelines were used for systematic review and reporting. RoB2 and Joanna Briggs Institute guidelines were utilized to assess the risk of bias. RESULTS: Eight studies included in the systematic review were conducted between 2017 and 2025 in Australia, the USA, the Netherlands, China, and Türkiye. The self-compassion interventions applied in the studies included mindful self-compassion, self-compassion-focused writing, compassion mind training, and kindness interventions. Online self-compassion-based interventions have been found to increase patients' levels of self-compassion, mindfulness, body image appreciation, well-being, self-acceptance, posttraumatic growth, and positive affect while reduce their levels of self-criticism, social isolation, anxiety, stress, and depression, body image distress. CONCLUSIONS: Studies have shown the positive effects of self-compassion-based interventions on patient outcomes. A sensitivity analysis that included only randomized controlled trials demonstrated robustness in all outcomes except anxiety; however, some research results were obtained from a single randomized controlled trial. Since some study results were derived solely from quasi-experimental studies, they were not included in the analysis. Therefore, more randomized controlled research is required to integrate these interventions into clinical patient care. Online self-compassion interventions can contribute to the planning of holistic nursing interventions for patient outcomes.
25 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Implementing an electronic health record workflow to identify parents with cancer and implications for supportive oncology care
PURPOSE: Parents with cancer face unique psychosocial challenges as they navigate treatment while caring for dependent children, yet parenthood status is rarely captured in oncology workflows. This initiative evaluated the feasibility and outcomes of a new electronic health record (EHR)-based workflow to systematically identify parents with cancer and then connect them to family-focused assessment and supportive care. METHODS: A two-phase quality improvement initiative was conducted at an NCI-designated comprehensive cancer center. Phase 1 included process mapping, analysis of tumor registry and distress screening data, and development of an EHR screening item assessing parenting status. Phase 2 implemented the item ("Patient is a parent/caregiver with child/ren < 22 years of age?") into oncology workflows, linking identified parents to a new supportive care program, Family Circle, which includes psychosocial assessment, navigation, and family-centered support. Training for oncology clinicians included in-service education. Analyses examined prevalence estimates and associations between parenting, distress, anxiety, and depression and reports of quality improvement metrics. RESULTS: Among N = 2,172 screened patients, 20.6% identified as parents; the age-adjusted prevalence of parenting with children under 21 was 16.9%, consistent with national estimates. Parents reported significantly higher distress (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.11-1.64, p = 0.003) and anxiety (OR = 1.28, 95% CI = 1.06-1.52, p = 0.009) than matched non-parents. Parents with younger children exhibited greater anxiety than those with older children (F = 4.32, df = 2, 393, p = .01). During implementation, N = 431 parents were identified in 6 months (79.4% through the EHR item). CONCLUSION: Embedding parenting status screening into the EHR is feasible, accurate, and critical for linking parents with cancer to supportive care. Wider implementation of such workflows may enhance psychosocial oncology practice and improve cancer parenting outcomes.
24 Apr 2026
Read appraisal →Journal of medical Internet research
Long-Term Outcomes, Moderators, and Predictors in Online Mindfulness-Based Cognitive Therapy for People With Cancer: Secondary Analysis of a Randomized Controlled Trial
BACKGROUND: A 3-armed randomized controlled trial (RCT) demonstrated that 2 formats of online mindfulness-based cognitive therapy (eMBCT)-group-blended and individual-unguided-effectively reduced psychological distress and improved positive health outcomes in people with cancer and survivors, when compared to care as usual, up to 3 months posttreatment. However, the long-term effectiveness and possible predictors and moderators of treatment outcomes remain unknown. OBJECTIVE: This study examined the long-term effects (up to 9 months posttreatment) of group-blended and individual-unguided eMBCTs on psychological distress and other mental health outcomes in people with cancer. Additionally, it explored possible predictors and moderators of treatment effects across the 2 delivery formats. METHODS: The study population consisted of people with cancer who were initially randomized to group-blended or individual-unguided eMBCT within a 3-arm RCT, augmented by those who completed the waitlist condition and were subsequently randomly allocated to one of the eMBCT formats. Both groups were assessed over a 9-month follow-up period. Outcomes completed at baseline, posttreatment, and 3-, 6-, and 9-month follow-up assessments included psychological distress (primary), fear of cancer recurrence, rumination, fatigue, mindfulness skills, decentering, self-compassion, and well-being. Linear mixed-effects models examined changes over time, while linear mixed-effects models and binary logistic regression analyzed potential predictors and moderators of psychological distress and dropout. RESULTS: Of the 186 participants enrolled in the 3-arm RCT, 161 participants were randomly assigned to either group-blended or individual-unguided eMBCTs after adding those initially assigned to the waiting condition (group-blended: n=71; individual-unguided: n=90). The majority of participants were female (n=129, 80%), diagnosed with breast cancer (n=78, 48%), and were undergoing or had completed treatment with curative intent (n=124, 77%). The mean age was 52.8 (SD 11.4) years. Both eMBCT formats resulted in significant reductions in psychological distress, fear of cancer recurrence, rumination, and fatigue, alongside improvements in mindfulness skills, decentering, and self-compassion, up to 9 months posttreatment. Higher baseline rumination, as well as lower mindfulness skills and self-compassion at baseline, predicted larger reductions in psychological distress from baseline to the 9-month follow-up period. Additionally, highly distressed participants in the group-blended eMBCT arm were more prone to dropout than those with lower distress scores, whereas psychological distress was not associated with dropout in the individual-unguided format. No other significant moderators were identified. CONCLUSIONS: Group-blended and individual-unguided eMBCTs effectively reduced psychological distress and improved well-being among people with cancer and survivors, with greater benefits for those with fewer psychological resources. However, individuals experiencing higher levels of distress were more likely to discontinue group-blended eMBCT. These findings highlight the importance of considering individual preferences and pragmatic factors in treatment decisions. Larger, fully powered RCTs are needed to confirm these results and provide more definitive guidance on treatment format selection.
20 Apr 2026
Read appraisal →Journal of affective disorders
Association of social isolation and loneliness with cancer prognosis: an analysis of the UK Biobank
BACKGROUND: Evidence is scarce for the association between social isolation and loneliness and prognosis of any cancer or other common cancer types. METHODS: To address this gap, we performed a cohort study from 2006 to 2022 using data from the UK Biobank (UKB). Social isolation and loneliness were identified based on the questionnaire of the UKB. Cases of death were obtained from the death registry, where both primary and contributory causes were recorded using ICD-10 codes. The Cox proportional hazard models were used to estimate hazard ratios (HRs) and associated 95% confidence intervals (CIs) of death in relation to social isolation and loneliness among patients with cancer. RESULTS: Among cancer patients studied, 6206 (9.6%) were socially isolated and 3130 (4.8%) reported loneliness. Over a median follow-up of 6.7 years, there were 2378 deaths (38.3%) among exposed patients and 16,566 deaths (29.1%) among unexposed patients. Social isolation was associated with poorer cancer prognosis overall (HR 1.21, 95% CI 1.16-1.26, P < 0.001), while loneliness correlated with a similar risk (HR 1.18, 95% CI 1.11-1.25, P < 0.001). Social isolation specifically impacted survival in colon, melanoma, breast, prostate, kidney, and bladder cancers, as well as myeloproliferative neoplasms. Loneliness was linked to poorer outcomes in breast, prostate, and bladder cancers. CONCLUSIONS: Our findings suggested that social support for these vulnerable patients might have the potential to improve prognosis.
15 Apr 2026
Read appraisal →JMIR cancer
Empathic AI for Patient-Centered Cancer Care: A Scoping Review of Patient Navigation, Support, and Clinical Practice
BACKGROUND: Artificial intelligence (AI) is rapidly reshaping oncology, offering advancements in clinical care and patient support. A growing area of interest is the integration of empathic AI: systems integrating clinical precision with emotional intelligence to support medical decision-making and the emotional and psychosocial well-being of patients and caregivers. OBJECTIVE: This review aimed to explore the role of empathic AI in cancer care, with a focus on its applications in patient education, clinician support, and emotional care. It also evaluated the ethical, cultural, and implementation challenges associated with its integration into clinical practice in oncology. METHODS: A systematic search of literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Peer-reviewed papers published between January 2018 and January 2025 were identified through a search of PubMed, Scopus, and IEEE Xplore, and citation tracking. Eligible studies focused on applications of empathic AI in oncology. A total of 44 studies were included and analyzed thematically across 3 core clinical domains: tailored communication and education, diagnostics and care plan optimization, and emotional and psychosocial support. RESULTS: Empathic AI demonstrates the potential to improve cancer care by enhancing patient education, clinical decision-making, and emotional support. Common applications include personalized education for patients and providers, support for diagnostic and therapeutic decisions, and tools designed to recognize and respond to patient distress. Several studies noted improved patient engagement and reduced clinician burden. However, concerns were identified regarding overreliance on AI systems, cultural insensitivity, and patient privacy. CONCLUSIONS: Empathic AI represents a promising advancement in patient-centered oncology, integrating emotional intelligence into clinical care. Its successful implementation will require careful attention to ethical, cultural, and clinical considerations to ensure health equity, trust, and safety in AI-assisted cancer care.
10 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
A trifold prehabilitation model prior to induction chemotherapy in patients with leukemia: a randomized controlled trial
PURPOSE: A trifold prehabilitation program that integrates exercise, nutritional support, and psychological care has not yet been incorporated into routine care for leukemia patients prior to induction chemotherapy. This study aimed to evaluate the safety and feasibility of this trifold intervention and to further examine its potential impact on physical fitness, nutritional risk, and psychological health. METHODS: In a single-blind, parallel-group randomized trial, 86 newly diagnosed leukemia patients at a tertiary hospital in China were randomly assigned to a 12-week prehabilitation group (n = 43) or usual care (n = 43). Primary outcomes were recruitment, attrition, and safety. Secondary outcomes included the 6-min walk test (6MWT), exercise self-efficacy, cancer-related fatigue (CRF), anxiety, depression, and nutrition. Assessments occurred at baseline (T0), pre-chemotherapy (T1), and 1 (T2) and 3 months (T3) post-chemotherapy. RESULTS: The recruitment rate was 60.14%, with an attrition rate of 20.93%, and no serious adverse events occurred. Compared with controls, the intervention group showed significantly greater improvements in 6-min walk distance and cancer-related fatigue from T1 to T3 (all p < 0.05). Improvements in exercise self-efficacy were significant at T2 and T3 but not at T1. Nutritional status improved at T3 (p = 0.033). Anxiety and depression levels were consistently lower across all follow-up points (p < 0.01). CONCLUSIONS: This study demonstrates that prehabilitation is safe, feasible, and potentially beneficial for physical, nutritional, and psychological outcomes in leukemia patients. TRIAL REGISTRATION: China Clinical Trials Registration Platform: ChiCTR2500105061, date of registration: June 27, 2025 (retrospectively registered).
10 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Digital and AI-enhanced psychosocial interventions in breast cancer patients: a systematic review and meta-analysis
PURPOSE: Digital and AI-supported psychosocial interventions are increasingly implemented to address psychological distress among women with breast cancer. However, their effectiveness and sustainability remain uncertain. This review aimed to systematically evaluate randomised controlled trials (RCTs) assessing the impact of digital and AI-enhanced psychosocial interventions on stress, anxiety, depression, and health-related quality of life (HRQoL). METHODS: Following PROSPERO registration and PRISMA 2020 guidelines, comprehensive searches of multiple databases were conducted up to June 2025. Eligible studies included RCTs involving breast cancer populations and reporting validated psychosocial outcomes. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was evaluated with GRADE. Random-effects meta-analyses using standardised mean differences (Hedges' g) were conducted to pool outcomes measured with different instruments. RESULTS: Thirty-five RCTs (n ≈ 7551 participants) met inclusion criteria. Pooled analyses indicated modest but consistent reductions in stress, anxiety, and depressive symptoms, alongside improvements in HRQoL. Interventions grounded in cognitive behavioural therapy, mindfulness, or psychoeducation produced the most reliable outcomes. AI-assisted and blended formats tended to show stronger effects compared with static or minimally interactive platforms. However, heterogeneity in intervention design, short follow-up periods, reliance on self-reported outcomes, and small single-centre samples limited certainty. Cultural adaptation and representation from low- and middle-income countries were minimal. CONCLUSION: Digital and AI-supported psychosocial interventions show promise in reducing distress and improving HRQoL among women with breast cancer. Evidence certainty remains moderate, constrained by methodological limitations. Larger, multicentre trials with longer follow-up and diverse populations are needed to establish sustainability, generalisability, and clinical integration. RELEVANCE: These findings suggest that digital and AI-enhanced psychosocial interventions may serve as adjuncts to conventional care, with potential to improve access to supportive oncology services. Further high-quality, long-term studies are needed before informing guidelines, policy, or widespread implementation. TRIAL REGISTRATION: PROSPERO (CRD420251074813; registered 16 June 2025).
9 Apr 2026
Read appraisal →Medicine
Effectiveness of mindfulness-based stress reduction in managing fatigue, anxiety, and depression among non-small cell lung cancer patients receiving surgery and adjuvant chemotherapy: A randomized controlled trial
BACKGROUND: Non-small cell lung cancer (NSCLC) patients undergoing surgery and adjuvant chemotherapy often experience debilitating physical and psychological symptoms, including cancer-related fatigue, anxiety, and depression. Mindfulness-based stress reduction (MBSR) has emerged as a complementary intervention to alleviate these burdens and enhance quality of life, but evidence in NSCLC populations remains limited. METHODS: This randomized controlled trial enrolled 80 NSCLC patients, evenly divided into an MBSR group and a Control group. The MBSR group underwent an 8-week mindfulness program, while the Control group received standard care. Outcomes, including fatigue (Piper Fatigue Scale), anxiety (Self-Rating Anxiety Scale), depression (Self-Rating Depression Scale), self-efficacy (General Self-Efficacy Scale), and mindfulness awareness (Mindful Attention Awareness Scale), were assessed at 4 time points: baseline (before surgery), at the fourth week (before chemotherapy), and at 1 and 3 months post-intervention. Statistical analyses included repeated-measures ANOVA and t tests to evaluate group differences. RESULTS: The MBSR group demonstrated significant improvements across all outcomes compared to the Control group. Fatigue levels in the MBSR group peaked at the fourth week but returned close to baseline levels by 3 months post-intervention, while the Control group maintained elevated fatigue scores (P < .05). Anxiety (Self-Rating Anxiety Scale) and depression (Self-Rating Depression Scale) scores significantly decreased in the MBSR group by the fourth week and continued to improve at subsequent time points (P < .01). Self-efficacy (General Self-Efficacy Scale) and mindfulness awareness (Mindful Attention Awareness Scale) showed consistent improvements in the MBSR group, with significant differences evident at 1 and 3 months post-intervention (P < .01). CONCLUSIONS: Mindfulness-based stress reduction effectively reduced fatigue, anxiety, and depression while enhancing self-efficacy and mindfulness awareness in NSCLC patients undergoing surgery and chemotherapy. These findings support the integration of mindfulness-based interventions into routine care to improve patient well-being during and after treatment.
5 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
A systematic review of the implementation of cancer-specific holistic needs assessment (HNA) in adult clinical practice, and applicability to the brain tumour population
PURPOSE: This review aimed to identify and review any brain tumour-specific holistic needs assessment (HNA) and the clinical implementation of any HNAs in an adult cancer population. METHODS: A systematic review and narrative synthesis. Five electronic databases were searched from 2008 to 2023 and updated in January 2025. Reference lists of systematic reviews were screened for relevant studies. Two independent reviewers performed study selection, critical appraisal, and data extraction. RESULTS: Four HNA tools implemented in clinical practice, across 9 studies, were included. One study was adapted for brain tumour patients. Evidence of widespread implementation in clinical practice was limited and varied evidence, relating to the timing, location and mode of delivering. Patients were more likely to report on physical rather than psychosocial needs, with limited evidence of patient and staff satisfaction with the use of HNA. CONCLUSION: There is limited and varied evidence of HNAs being successfully implemented in brain tumour and the wider cancer healthcare settings. Tailored interventions for the needs of people with brain tumour have the potential to address the complexities this population faces. However, clear evidence-based guidance to develop relevant HNAs for successful implementation in clinical settings is needed.
4 Apr 2026
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