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Cancer, a multifactorial and heterogeneous disease, poses a significant global health challenge. Despite current treatments such as surgery, radiotherapy, and chemotherapy, tumour recurrence and treatment side effects are common. These pitfalls necessitate a dire need for alternative therapeutic strategies with minimal side effects. This necessity has broadened the horizons of drug discovery into the marine domain, an exciting frontier for novel therapeutic agents. The marine ecosystem serves as a hub of diverse chemical groups with potential anti-cancer properties. Few marine-derived drugs are approved for cancer, and preliminary studies show that marine lead compounds can inhibit cancer cell growth and induce apoptosis. In this context, this review encapsulates an overview of ‘the current state of marine biodiscovery’. It explores the ‘potential of marine natural products in combating cancer’ with a particular focus on glioblastoma multiforme as a case study. Additionally, it discusses the ‘key strategies for advancing marine-derived anti-cancer compounds from the research stage to clinical use’. By tapping into the vast, unlocking the hidden treasures of the ocean, marine natural compounds could offer a hopeful perspective in the fight against cancer.
Chapter 6 shows how it is possible to use demographic metadata to study identities in health-related corpora. We present two case studies, based on research on patient feedback on NHS services in England. The first study compares how cancer patients of different age and sex groups evaluate healthcare services and, specifically, how they use distinct linguistic and rhetorical strategies to do this. The corpus was encoded with demographic metadata which allowed the researchers to explore the language used by people of different age and sex identity groups. For the second study, a different corpus of more general patient feedback was used, one which did not contain demographic information metadata. Instead, targeted searches were used to identify patients’ demographic characteristics based on cases where they made those characteristics explicit within their feedback. In contrasting these case studies, we also evaluate the two different approaches taken, considering the affordances and limitations of both. Taken together, the case studies demonstrate how language and identity can be explored in corpora with and without reliable demographic metadata.
Chapter 5 is concerned with sequential aspects of health-oriented interactions and the challenges this poses for corpus research. Two case studies demonstrate how conventional corpus procedures can be augmented with other linguistic approaches to facilitate a critical examination of the relationships between parts of the data that might otherwise be separated in corpus analysis. The first study is an investigation of a thread from an online forum dedicated to cancer – one that is explicitly dedicated to irreverent verbal play. We show how a corpus approach enabled the identification of humourous metaphors and helped us reveal recurrent lexical and grammatical features that facilitate discussion around sensitive topics, enable a coherent identity, and contribute to a sense of community. In the second study we use an approach that was originally applied to the Spoken BNC 2014 corpus to examine interactional data in terms of functional discourse units. We apply this coding framework to a sample of anxiety support forum data in order to document, quantify, and evaluate how various communicative purposes are formulated in forum posts and are met with different types of response.
Chapter 9 considers how the experience of illness is represented linguistically, focussing on two contexts. In the first case study, collocational patterns were examined in order to show how people represented the word anxiety. Different patterns around anxiety were grouped together in order to identify oppositional pairs of representation (e.g., medicalising/normalising). The second case study involved an examination of the ways in which cancer was constructed in a corpus of interviews with and online forum posts by people with cancer, family carers, and healthcare professionals. Using a combination of manual analysis and corpus searches, we considered how metaphors were used to convey a sense of empowerment or disempowerment in the experience of cancer. More specifically, the analysis of metaphors around cancer revealed insights into people’s identity construction and the relationships between doctors and patients.
This chapter uses the context of Michael Field’s letters and shared journal to discuss fin-de-siècle illness and disability, focusing on ‘hysterical blindness’ and cancer. The long-standing notion of Michael Field as an isolated dyad is placed in tension with Talia Schaffer’s work on Victorian ‘communities of care’. The chapter asserts that we need to consider audience when we read Michael Field’s representations of illness, and, using a queer, crip, lens suggests that Bradley and Cooper’s writing about their embodied selves is strategic, like the name Michael Field itself.
Clozapine is the gold standard for treatment-resistant schizophrenia. In the setting of malignancy with concurrent anti-cancer agent use, clozapine use may be of increased concern. Clozapine cessation holds its own risks. This study aims to systematically review all cases of concurrent pharmacotherapy with clozapine and anti-cancer agents and analyze the psychiatric and physical health outcomes. PubMed, EMBASE, CINAHL, and PsycINFO databases were searched from inception to February 2025. Descriptive statistics and narrative analysis of the included cases occurred. There were 53 cases of clozapine use with anti-cancer agents, with a male to female ratio of 1.7:1 and a mean age of 45.0 years. In 30 cases, clozapine was continued without interruption, and in additional 16 cases, clozapine was recommenced after a period of interruption. In cases with clozapine interruption or discontinuation, 90% noted significant deterioration in mental state despite alternative antipsychotic treatments. There were 34 cases of neutropenia, mostly (94%) in the setting of cytotoxic chemotherapy, with low rates of neutropenic complications. The successful continuation of clozapine with anti-cancer agents can occur, although risk-benefit analysis taking into account individual, clozapine, psychiatric, and physical health factors is required. Consideration of prophylactic neutropenia protective measures should form part of the discussion with the individual and their family.
This study aimed to investigate healthcare professionals’ experiences with using the PRO Palliative Care questionnaire (PRO-Pall) to identify palliative care symptoms and problems in non-specialized palliative care settings among patients with heart, lung, and kidney disease, and cancer. The study also investigated the PRO-Pall’s potential to ensure further initiatives and care.
Methods
A national, multicenter, observational study employing a mixed-methods approach. It includes quantitative analysis using an evaluation survey (n = 286) and qualitative analysis from workshops (n = 11). Quantitative data were analyzed descriptively, while qualitative data were analyzed thematically.
Results
Quantitative and qualitative data were organized according to 3 a priori-defined themes: Theme 1: Assessment of palliative symptoms, Theme 2: Support for dialogue, and Theme 3: Timely initiation of initiatives and care. The evaluation survey and qualitative interviews with healthcare professionals indicated that it was valuable to use PRO-Pall in a non-specialist palliative context to screen for symptoms and problems, as well as to initiate actions. PRO-Pall helped to structure the dialogue and had a positive effect on the quality of the conversation.
Significance of results
The findings highlight that it can be valuable to utilize the PRO-Pall in general palliative care settings for patients with heart, lung, or kidney diseases as well as cancer. When implementing PRO-Pall in practice, it is crucial to carefully consider the entire process, from administering the questionnaire to planning initiatives informed by patients’ PRO responses.
Travel distance is a key barrier for patients to participate in clinical trials or receive cancer care. The National Cancer Institute (NCI) is a major funder of cancer research infrastructure through grant programs like the NCI Cancer Center (NCICC) and NCI Community Oncology Research Program (NCORP); however, the majority of US sites that care for people with cancer do not directly receive this funding.
Methods:
Through geospatial analysis we examined patient distance to NCI-funded sites and evaluated demographic subgroups to identify potential disparities in access to research opportunities. We assessed whether new NCI support to previously unfunded sites could address identified barriers in access.
Results:
NCI-funded sites tend to be in urban centers and are less accessible to low-income or rural patients. Nearly 17% of the US population over 35 years old would have to drive over 100 miles to obtain care at an NCI-funded site; only 1.6% would be beyond that distance when non-funded sites are added. For those below poverty level, the proportions are 20.2% and 1.9%, respectively. Several US regions, including the South and Appalachia, have particularly limited access to NCI-funded sites despite high cancer incidence, and much of the West and Great Plains are distant from any cancer facilities.
Conclusions:
NCI could address travel distance as a major barrier to research participation by expanding the geographical footprint of its infrastructure funding using existing institutions in areas with identified gaps. Geospatial analysis at the census tract level is recommended and geospatial visualization can help identify strategic areas for interventions.
Being diagnosed with cancer can be stressful and has been linked to suicide. However, an updated analyses where a wide range of cancers are compared is lacking.
Aims
To examine whether individuals first-time diagnosed with cancer within the past 5 years had higher suicide rates than those with no such diagnosis. Associations with time since diagnosis, and stage and site of cancer, were analysed.
Method
A population-based cohort study design applied to nationwide, longitudinal data on all persons aged 15 years or above (N = 6 987 998) and living in Denmark between 2000 and 2021. Specific sites of cancer first-time diagnosed were considered as exposure for the subsequent 5 years, and death by suicide was examined as outcome. Adjusted incidence rate ratios (aIRRRs) were calculated using Poisson regression models and adjusted for sociodemographics, psychiatric disorders and suicide attempts prior to cancer diagnosis.
Results
In total, 707 513 (10%) individuals were included. While 12 800 individuals died by suicide in the non-cancer group, 601 died of suicide in the cancer group, resulting in an aIRR of 2.0 (95% CI: 1.9–2.1). The highest rate was found in the period immediately following diagnosis (<6 months: 3.9, 95% CI: 3.6–4.2 versus 4–5 years: 1.8, 95% CI: 1.5–2.0). Also, higher rates were found for high-stage tumours (3.1, 95% CI: 2.8–3.4). The highest aIRRs were found for pancreatic cancer (7.5, 95% CI: 5.8–9.7) and oesophageal cancer (7.1, 95% CI: 5.4–9.3). Almost all sites of cancer analysed showed elevated rates of suicide compared with individuals without cancer.
Conclusions
Several recently diagnosed cancers were linked to elevated rates of suicide, especially during the first period following diagnosis. High tumour stage was associated with the highest rates, as were cancer sites with poor prognosis, suggesting prioritisation of these patient groups for suicide prevention efforts.
Individuals admitted to the Intensive Care Unit (ICU) due to cancer frequently encounter cognitive impairment and alterations in their mental health, which engenders psychological distress and considerably impacts their quality of life. In Mexico, there is an imperative for valid and reliable clinical tools to identify these symptoms, to providing timely and appropriate psychological intervention.
Objectives
To determine the psychometric properties of the Intensive Care Psychological Assessment Tool (IPAT) in a Mexican population with cancer discharged from ICU.
Methods
A cross-sectional instrumental design with non-probability convenience sampling was employed. Data were collected between February 2023 and October 2024 with 75 people discharged from the ICU. Factor structure (confirmatory factor analysis), reliability (internal consistency), measurement invariance, and criteria validity (convergent, discriminant, and known-groups) were assessed. Patients were assessed during oncological hospitalization, following ICU.
Results
The participants were predominantly male, residing in the interior of the country, with an average age of 44 years (range 19–78, SD 16.21). Internal consistency results were deemed to be satisfactory (α = 0.78) for 9 items. The CFA indices were adequate [χ2 (gl) 27.436 (24), CMIN/DF 1.143, CFI 0.96, GFI 0.97, SRMR 0.036, RMSEA 0.044] as were the scalar invariance indices for invasive mechanical ventilation [CFI = 0.871; RMSEA = 0.058; χ2/gl = 20.519 (10)] and for gender, restricted invariance indices [CFI = 0.849; RMSEA = 0.068; χ2/gl = 23.302 (12)].
Significance of results
The Mexican version of the IPAT for people with cancer is a valid and reliable tool for use in oncology and critical care settings in Mexico. It is recommended for use at the time of discharge from the ICU, as it allows the identification of psychological distress for timely intervention. For future considerations, diverse clinical settings and patient populations should be explored to enhance the tool’s applicability and generalizability in the varied contexts of cancer in ICU.
Social determinants of health (SDHs) exert a significant influence on various health outcomes and disparities. This study aimed to explore the associations between combined SDHs and mortality, as well as adverse health outcomes among adults with depression.
Methods
The research included 48,897 participants with depression from the UK Biobank and 7,771 from the US National Health and Nutrition Examination Survey (NHANES). By calculating combined SDH scores based on 14 SDHs in the UK Biobank and 9 in the US NHANES, participants were categorized into favourable, medium and unfavourable SDH groups through tertiles. Cox regression models were used to evaluate the impact of combined SDHs on mortality (all-cause, cardiovascular disease [CVD] and cancer) in both cohorts, as well as incidences of CVD, cancer and dementia in the UK Biobank.
Results
In the fully adjusted models, compared to the favourable SDH group, the hazard ratios for all-cause mortality were 1.81 (95% CI: 1.60–2.04) in the unfavourable SDH group in the UK Biobank cohort; 1.61 (95% CI: 1.31–1.98) in the medium SDH group and 2.19 (95% CI: 1.78–2.68) in the unfavourable SDH group in the US NHANES cohort. Moreover, higher levels of unfavourable SDHs were associated with increased mortality risk from CVD and cancer. Regarding disease incidence, they were significantly linked to higher incidences of CVD and dementia but not cancer in the UK Biobank.
Conclusions
Combined unfavourable SDHs were associated with elevated risks of mortality and adverse health outcomes among adults with depression, which suggested that assessing the combined impact of SDHs could serve as a key strategy in preventing and managing depression, ultimately helping to reduce the burden of disease.
Supporting a family member with cancer poses significant challenges for family caregivers, who have unmet supportive care needs. Psychosocial oncology professionals (PSOP) are often the primary source of support for cancer caregivers in Iran. Given the lack of supportive care resources, innovative strategies are needed to support caregivers. This study explores the views of PSOP and caregivers regarding the challenges, potential solutions, and the role of digital technologies in supporting caregivers.
Methods
Employing a qualitative descriptive design, we conducted individual interviews and focus groups with 30 participants (15 PSOPs and 15 caregivers), recruited from five settings in Tehran, Iran(2023-2024). All sessions were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.
Results
PSOP identified challenges in delivering psychosocial care to caregivers , including inconsistency, uncertainty, and fragmented use of technology. Their recommendations included flexible psychosocial care via blended multi-modal digital technologies, professional development opportunities, and formal recognition and integration within the oncology setting. Caregivers experiencing frustration with the healthcare system expressed a need for family-centered care, flexible psychosocial care, and organized peer support networks.
Significance of results
Current psychosocial care in Iran is insufficient and misaligned with the preferences of PSOP and caregivers. PSOP and caregivers advocate for flexible psychosocial care through blended digital strategies. Public health strategists in Iran, as a low-resource setting with a family-centered context, should optimize resource utilization by prioritizing the training of PSOP, developing blended digital interventions, and leveraging trained peers to provide navigation and support to families, thereby easing the PSOP workload.
Cancer patients often suffer from refractory symptoms near death. The use of sedatives aims to relieve suffering caused by these symptoms. The practice varies broadly. The aim of this study was to evaluate the role and trends of midazolam use in cancer patients dying in a university hospital oncology ward.
Methods
The study population of this retrospective registry-based study consists of patients who died in a university hospital oncology ward in Eastern Finland in 2010–2018 (n = 639). Information about treatment decisions, midazolam use, and background factors were gathered.
Results
During the study period, 14.7 % of the patients dying in the ward received midazolam with sedative intent prior to death. 4.7 % (n = 30) of the whole study population had continuous infusion and the rest of the midazolam use was one or multiple single doses. Documented discussion of possible palliative sedation (PS) use was found in almost one third of all patients. Out of those, eventually receiving midazolam with sedative intent, two thirds had had this discussion. The most common symptoms leading to midazolam were dyspnea, pain, and delirium. In continuous use the median midazolam infusion rate was 4.0 mg/h. The continuous infusion started median of 23.25 h and multiple single doses 19 h before death. If only one dose of midazolam was needed, it was given median of 30 minutes prior to death and the most common symptom was dyspnea. Those who received midazolam were more likely to be younger (p = 0.003) and had had a palliative outpatient clinic visit (p = 0.045).
Significance of results
This is the first study to report the trends and practices of midazolam use for refractory symptoms in Finland. Midazolam was used for approximately every 7th dying cancer patient. Applying midazolam was supported by a history of palliative clinic visits and younger age.
This study sought to examine the validity and reliability of the Turkish adaptation of the Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE) scale. The primary objective was to evaluate the scale’s psychometric properties in measuring acceptance and coping among cancer patients.
Methods
The study included 90 cancer patients who completed the 12-item PEACE scale. The scale consists of two distinct subscales: the 5-item Peaceful Acceptance subscale and the 7-item Struggle With Illness subscale. Reliability was examined using Cronbach’s alpha and test-retest reliability (r = 0.916). Content validity was assessed using the content validity index (CVI = 0.84). Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to examine the underlying factor structure and evaluate model fit indices.
Results
The internal consistency for both subscales was satisfactory (Cronbach’s α = .78 for both). EFA indicated that the two subscales explained 53.169% of the total variance. CFA substantiated the two-factor model, demonstrating adequate model fit indices (χ2/df = 1.689,Root Mean Square Error of Approximation = 0.088). These findings collectively establish the Turkish version of the PEACE scale as a psychometrically sound tool.
Significance of Results
The PEACE scale is a valid and reliable instrument for assessing levels of acceptance and coping in cancer patients. Its use can help healthcare professionals better understand patients’ emotional states and guide interventions aimed at improving their quality of life.
Laryngeal dysplasia is a pre-cancerous lesion within the larynx. This study aims to identify factors influencing progression to cancer by analysing long-term follow-up data.
Methods
Data from 221 patients diagnosed between 2005 and 2017 were reviewed retrospectively. Patient demographics, treatment strategies and follow-up results were compared.
Results
Progression to cancer occurred in 26 patients (11.7 per cent). A significant association was found between cancer progression and initial biopsies obtained from the anterior commissure (34.6 per cent in progressing cases vs. 6.2 per cent in non-progressing; p < 0.001). Carcinoma in situ cases showed a higher progression rate (21.7%) compared to mild dysplasia (3.4 per cent) (p = 0.007). The group with cancer progression also had higher rates of other cancers (15.4 per cent vs. 2.1 per cent; p = 0.008), including lung cancer (11.5 per cent vs. 0 per cent; p = 0.001).
Conclusion
The study determined an 11.7 per cent progression rate of laryngeal dysplasia to cancer. Lesions involving the anterior commissure carried an approximately 8.1-fold increased risk of progression.
Expressive writing interventions (EWIs) are associated with important psychological and physical outcomes in patients with cancer. However, EWIs have not been widely integrated into routine psychosocial care of cancer populations. A review of the current literature on EWIs’ impact on the cancer patient experience, including qualitative analyses of patient perspectives, will increase our understanding of barriers and facilitators to adoption in clinical settings.
Objectives
To bridge existing gaps in the literature by examining quantitative and qualitative studies on EWIs for patients with cancer. To present recent data examining the benefits of EWI’s for patients with cancer.To provide strategies for clinicians engaging in EWI’s for their patients.
Methods
Informed by the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, we completed a scoping review of relevant quantitative and qualitative articles published from 2015 to 2025 to assess the impact of EWIs on health-related outcomes (e.g., physical symptoms and quality of life [QOL]) as well as approaches to improve their use in patients with cancer.
Results
Of the 28 studies with 3527 patients that we analyzed, 24 were quantitative and 4 were qualitative. Most studies were conducted in the USA (42.8%) or China (28.6%) and included patients with breast cancer (71.4%) or only included women (71.4%). Of the patients in the studies, 46.8% identified as White, 42.8% as Asian, 5.5% as Black, and 4.5% as Latino. Twenty-one of the quantitative studies found that EWIs were positively associated with cancer patients’ QOL and/or physical health outcomes. Of the 4 qualitative studies, themes of narrative reconstruction, cultural disclosure norms, and intervention delivery format emerged. The characteristics of EWI methods can be tailored to maximize therapeutic benefits through cultural adaptation, timing, and privacy.
Significance of results
Despite promising associations between EWIs and health-related outcomes in patients with cancer, EWIs for cancer populations are heterogeneous and randomized clinical trials are limited. Larger trials that establish the efficacy of EWIs in diverse cancer populations are warranted.
As cancer incidence and survival rates rise, caregivers responsible for providing diverse support face increased burden and reduced quality of life (QoL). Although research on web-based interventions for this group is expanding, the impact of these interventions on caregiver burden and QoL remains unclear. This study aims to investigate the effects of web-based interventions on the caregiver burden and QoL of caregivers of patients with cancer.
Methods
Searches were conducted in PubMed, Web of Science, Cochrane Library, CINAHL, Embase, and PsycINFO from database inception to 10 June 2024. Two reviewers independently assessed each study and extracted data. The risk-of-bias in the studies was evaluated using Cochrane’s Risk-of-Bias tool for randomized controlled trials. The intervention effects were calculated using R package Meta version 4.0.3, utilizing standardized mean differences (SMD; Hedge’s ĝ) to calculate pooled effect sizes with 95% confidence intervals (CI). Publication bias assessment and sensitivity analysis were conducted to ensure the robustness of the results.
Results
We reviewed 13 randomized controlled trials; our analysis indicated a small effect size of web-based interventions on caregiver burden (SMD = −0.19, 95% CI: −0.36 to −0.01). However, sensitivity analysis concluded that the effect was very small or nearly absent. Additionally, there was no statistically significant effect on QoL (SMD = 0.15, 95% CI: −0.05 to 0.36).
Significance of results
Web-based interventions did not significantly reduce caregiver burden or improve caregivers’ QoL. To improve caregiver burden and QoL in the future, comprehensive and tailored web-based interventions for this population are needed.
The aim of this article is to develop and pilot test a new supportive care intervention, Empower GBM, designed for patients with glioblastoma and their family caregivers to reduce psychological distress and improve quality of life.
Methods
Qualitative interviews were conducted with patients diagnosed with glioblastoma and their caregivers to obtain information about their experiences and needs in coping with glioblastoma. We also gathered their feedback about the supportive care intervention we were proposing (Phase I). Following Phase I, we conducted a single-arm pilot to evaluate the feasibility and acceptability of the 6-session intervention (Phase II).
Results
During interviews (N = 14), patients and caregivers reported having the most difficulty and distress surrounding disease progression and management, maintaining dignity and autonomy, negotiation of roles and responsibilities, and maintaining connection with one another. Participants endorsed that an intervention like Empower GBM with skills focused on managing symptoms to increase independence, increasing caregiving efficacy and support, and coping with dyadic challenges would be of potential benefit. Preliminary results from the pilot study (N = 11) suggested the intervention is both feasible (e.g., 82% completed all 6 sessions and post-treatment surveys) and acceptable (88.9% reported a mean satisfaction score of 3 or higher; mean score of 3.57/4.0). Improvements in psychological outcomes, functional well-being, and caregiving efficacy from pre- to post-treatment survey results suggested the potential benefits of the intervention.
Significance of results
We developed a novel supportive care intervention informed by the dyadic illness model that is designed to meet the individual and interpersonal needs of patients with glioblastoma and their caregivers. Unique features include its flexibility to be delivered to patients and/or their family caregivers individually or jointly, while providing skills and strategies to meet the needs of both individuals and the dyad as the unit of care in coping with glioblastoma.
Persistent malnutrition is associated with poor clinical outcomes in cancer. However, assessing its reversibility can be challenging. The present study aimed to utilise machine learning (ML) to predict reversible malnutrition (RM) in patients with cancer. A multicentre cohort study including hospitalised oncology patients. Malnutrition was diagnosed using an international consensus. RM was defined as a positive diagnosis of malnutrition upon patient admission which turned negative one month later. Time-series data on body weight and skeletal muscle were modelled using a long short-term memory architecture to predict RM. The model was named as WAL-net, and its performance, explainability, clinical relevance and generalisability were evaluated. We investigated 4254 patients with cancer-associated malnutrition (discovery set = 2977, test set = 1277). There were 2783 men and 1471 women (median age = 61 years). RM was identified in 754 (17·7 %) patients. RM/non-RM groups showed distinct patterns of weight and muscle dynamics, and RM was negatively correlated to the progressive stages of cancer cachexia (r = –0·340, P < 0·001). WAL-net was the state-of-the-art model among all ML algorithms evaluated, demonstrating favourable performance to predict RM in the test set (AUC = 0·924, 95 % CI = 0·904, 0·944) and an external validation set (n 798, AUC = 0·909, 95 % CI = 0·876, 0·943). Model-predicted RM using baseline information was associated with lower future risks of underweight, sarcopenia, performance status decline and progression of malnutrition (all P < 0·05). This study presents an explainable deep learning model, the WAL-net, for early identification of RM in patients with cancer. These findings might help the management of cancer-associated malnutrition to optimise patient outcomes in multidisciplinary cancer care.
Emergency department (ED) visits in the United States by patients living with cancer are increasing. although the ED admission rate for this population is higher than for the noncancer population, not all cancer patients require prolonged hospitalization. Observation care offers a promising alternative to admission for the management of many common oncologic emergencies that require care outside the scope of what is achievable during an ED visit.