PurposeThis study aims to develop and validate a stigma scale for Chinese patients with breast cancer.MethodsPatients admitted to the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, for breast cancer treatment participated in this study. Development of the Breast Cancer Stigma Scale involved the following procedures: literature review, interview, and applying a theoretical model to generate items; the Breast Cancer Stigma Scale’s content validity was assessed by a Delphi study (...) and feedback from patients with breast cancer ; exploratory factor analysis was used to assess the construct validity; convergent validity was assessed with the Social Impact Scale ; internal consistency Cronbach’s α, split-half reliability, and test–retest reliability were used to identify the reliability of the scale.ResultsThe final version of the Breast Cancer Stigma Scale consisted of 15 items and showed positive correlations with the Social Impact Scale. Exploratory factor analysis revealed four components of the Breast Cancer Stigma Scale: self-image impairment, social isolation, discrimination, and internalized stigma, which were strongly related to our perceived breast cancer stigma model and accounted for 69.443% of the total variance. Cronbach’s α for the total scale was 0.86, and each subscale was 0.75–0.882. The test–retest reliability with intra-class correlation coefficients of the total scale was 0.947, and split-half reliability with intra-class correlation coefficients of the total scale was 0.911. The content validity index was 0.73–1.0.ConclusionThe newly developed Breast Cancer Stigma Scale offers a valid and reliable instrument for assessing the perceived stigma of patients with breast cancer in clinical and research settings. It may be helpful for stigma prevention in China. (shrink)

Objective:Fear of Cancer Recurrence (FCR), Health Anxiety (HA), worry, and uncertainty in illness are psychological concerns commonly faced by cancer patients. In survivorship research, these similar, yet different constructs are frequently used interchangeably and multiple instruments are used in to measure them. The lack of clear and consistent conceptualization and measurement can lead to diverse or contradictory interpretations. The purpose of this scoping review was to review, compare, and analyze the current conceptualization and measurements used for FCR, (...) HA, worry, and uncertainty in the breast cancer survivorship literature to improve research and practice.Inclusion Criteria:We considered quantitative, qualitative, and mixed methods studies of breast cancer survivors that examined FCR, HA, worry, or uncertainty in illness as a main topic and included a definition or assessment of the constructs.Methods and Analysis:The six-staged framework was used to guide the scoping review process. Searches of PubMed, CINAHL, and PsycINFO databases were conducted. The principle-based qualitative analysis and simultaneous content analysis procedures were employed to synthesize and map the findings.Findings:After duplicate removal, the search revealed 3,299 articles, of which 82 studies met the inclusion criteria. Several critical attributes overlapped the four constructs, for example, all were triggered by internal somatic and external cues. However, several unique attributes were found (e.g., a sense of loss of security in the body is observed only among survivors experiencing FCR). Overall, findings showed that FCR and uncertainty in illness are more likely to be triggered by cancer-specific factors, while worry and HA have more trait-like in terms of characteristics, theoretical features, and correlates. We found that the measures used to assess each construct were on par with their intended constructs. Eighteen approaches were used to measure FCR, 15 for HA, 8 for worry, and 4 for uncertainty.Conclusion:While consensus on the conceptualization and measurement of the four constructs has not yet been reached, this scoping review identifies key similarities and differences to aid in their selection and measurement. Considering the observed overlap between the four studied constructs, further research delineating the unique attributes for each construct is warranted. (shrink)

BackgroundBody image is a subjective concept encompassing a person’s views and emotions about their body. Head and neck cancer diagnosis and treatment affects several psychosocial concepts including body image. Large numbers of HNC patients are diagnosed each year in India but there are no suitable measures in regional languages to assess their body image. This study assessed the psychometric properties of the Body Image Scale, a measure suitable for clinical and research use in HNC populations, translated into Tamil, (...) Telugu and Hindi and compared body image distress between language groups.MethodsTranslated versions of BIS were completed by HNC patients recruited from three cancer centers across India one time only. Psychometric evaluation was conducted including factor analysis using principal component analysis and internal consistency reliability using Cronbach’s alpha. Patients completed the EORTC Quality of Life Questionnaire C-30 and EORTC QLQ HN-35 measures to enable exploration of convergent and discriminant validity. ANOVA was used to calculate difference in mean values for body image.ResultsOur sample included 621 HNC patients. Factor analysis revealed a one-factor solution and Cronbach’s alpha coefficients ranged between 0.891 and 0.969 indicating good reliability. Hypothesized correlations between similar and different constructs were as expected, supporting construct validity. On the BIS, we found a statistically significant difference between means of Tamil, Telugu, and Hindi groups, with higher body image scores in Telugu and Hindi groups indicating more symptoms/body image distress, when compared to Tamil population.ConclusionThe reliability and validity of the three translated Indian versions of the BIS were maintained, providing a method for assessing body image of HNC population worldwide speaking Tamil, Telugu, and Hindi across the illness trajectory. (shrink)

Cancer is not one, but many diseases, and each is a product of a variety of causes acting (and interacting) at distinct temporal and spatial scales, or “levels” in the biological hierarchy. In part because of this diversity of cancer types and causes, there has been a diversity of models, hypotheses, and explanations of carcinogenesis. However, there is one model of carcinogenesis that seems to have survived the diversification of cancer types: the multi-stage model of carcinogenesis. This (...) paper examines the history of the multistage theory, and uses the theory as a case study in the limits and goals of unification as a theoretical virtue, comparing and contrasting it with “integrative” research. (shrink)

Cancer is a paradigmatic case of a complex causal process; causes of cancer operate at a variety of temporal and spatial scales, and the respects in which these causes act and interact are diverse. There are, for instance, temporal order effects, organizational effects, structural effects, and dynamic relationships between causes operating at different temporal and spatial scales. Because of this complexity, models of cancer initiation and progression often involve deliberate choices to focus on one time scale, (...) one causal pathway, or one aspect of cancer’s dynamics. As in most of biology, modeling cancer involves simplification and idealization. At the same time, theoretical perspectives inform the construction of these models. Such perspectives might involve viewing cancer ‘as’ a genetic disease, metabolic disease, stem cell disease, an infectious disease, or a disease of tissue disorganization. This paper will argue that purportedly competing theoretical views of cancer are not at odds, but can be viewed as mutually informative. Models are most often developed in the service of asking very specific questions, and this requires limiting our view of the phenomena to a specific temporal or spatial scale, a particular cause, or a particular outcome, dynamic, or pattern. Thus, while some models may seem at odds, often they are simply concerned with different questions, or, they are complementary and mutually informative. I hope to bring this case to bear on debates among philosophers of science over perspectivism and realism, as well pluralism about the aims and scope of scientific theory. (shrink)

BackgroundThe impact of a cancer diagnosis may be traumatic, depending on the psychological resources used by patients. Appropriate coping strategies are related to better adaptation to the disease, with coping flexibility, corresponding to the ability to replace ineffective coping strategies, demonstrated to be highly related with self-efficacy to handle trauma. The Perceived Ability to Cope with Trauma scale is a self-rated questionnaire that assesses the perceived ability to cope with potentially traumatic events, providing a measure of coping flexibility. (...) The current study aimed at examining the psychometric properties of the PACT Scale in Portuguese patients with breast cancer.MethodsThe study included 172 patients recently diagnosed with early breast cancer. Participants completed a Portuguese version of the PACT scale, and instruments of self-efficacy for coping with cancer, of quality of life, and of psychological distress that were used as convergent and divergent measures, thus assessing construct validity. A confirmatory factor analysis was performed to test the factor structure of the Portuguese version of PACT scale and reliabilities were examined.ResultsResults from the CFA confirmed the two-factor structure, consistent with the original Forward and Trauma focus subscales. The two subscales demonstrated high internal consistencies. Convergent and divergent validities were confirmed: the PACT scale was related to high self-efficacy to cope with cancer, to high perceived quality of life, and to low psychological distress.DiscussionOverall, the current results support and replicate the psychometric properties of the PACT scale. The scale was found to be a valid and reliable self-reported measure to assess Portuguese breast cancer patients regarding beliefs about their capabilities in managing the potentially traumatic sequelae of cancer. The PACT is a simple and brief measure of coping flexibility to trauma, with potential relevance for application in clinical and research settings. (shrink)

Cancer is not one, but many diseases, and each is a product of a variety of causes acting at distinct temporal and spatial scales, or ‘‘levels’’ in the biological hierarchy. In part because of this diversity of cancer types and causes, there has been a diversity of models, hypotheses, and explanations of carcinogenesis. However, there is one model of carcinogenesis that seems to have survived the diversification of cancer types: the multi-stage model of carcinogenesis. This paper examines (...) the history of the multistage theory, and uses the theory as a case study in the limits and goals of unification as a theoretical virtue, comparing and contrasting it with ‘‘integrative’’ research. (shrink)

BackgroundMeasuring the outcomes of palliative care plays an important role to improve the quality, efficiency, and availability of these services in patients with cancer. Using valid, reliable, and culturally appropriate tools has a considerable role to measure these outcomes. This study aimed to assess the psychometric properties of the translated version of the Palliative care Outcome Scale.MethodsThis methodological study was conducted in two outpatient clinics related to Shohada Tajrish and Baqiyatallah hospitals in Tehran in 2019–2020. The translation was (...) done using the Forward-Backward approach after gaining permission from the developer. Face validity was tested with 10 patients with cancer through cognitive interviewing, as well as content validity with four experts. Construct validity was performed by exploratory factor analysis and confirmation. To assess the reliability, internal consistency was assessed by using Cronbach's alpha coefficient, and relative stability was assessed using the interclass correlation coefficient. Furthermore, interpretability and ceiling and floor effects were assessed.ResultsA total of 353 patients with cancer under palliative care were included in the study. Then, three psychological, physical, and social factors with a cumulative variance of 54.34% were extracted in exploratory factor analysis. Confirmatory factor analysis showed that the model has a good fit of information. Cronbach's alpha coefficient for scale was 0.719. Furthermore, the ICC was 0.812. The scale was interpretable, and ceiling and floor effects were 0%.ConclusionPersian version of the POS was evaluated as a valid and reliable tool. Therefore, it can be used by the clinician to monitor the consequences of palliative care in Iranian cancer patients. (shrink)

Cancer is a chronic disease that causes the most deaths in the world, being a public health problem nowadays. Even though breast cancer affects the daily lives of patients, many women become resilient after the disease, decreasing the impact of the diagnosis. Based on a positive psychology approach, the concept of co-vitality arises understood as a set of socio-emotional competencies that enhance psychological adaptation. In this sense, emotional intelligence is one of the main protective factors associated with resilience. (...) However, it is not always as beneficial as it seems, and can lead to collateral effects on psychological adjustment. Given this controversy, this study aims to find the specific processes through which the dimensions of Perceived Emotional Intelligence can act as a risk or protective factor in the development of resilience. The total sample was 167 women, 46.7% were breast cancer survivors, and 53.3% were healthy controls. The selection of women with breast cancer carries out randomly, recruited through the Oncology Units. The sample completed measures of resilience and PEI, through Resilience Scale and TMMS-24. The results showed that breast cancer survivors showed higher age and greater levels of resilience and mood repair than healthy women. The mediation analysis revealed that breast cancer survival and PEI predicted 28% of the variance of resilience. The direct effects showed that emotional clarity and mood repair increased resilience levels. Although breast cancer did not predict resilience directly, it does through mood repair by an indirect process. Besides, the analysis showed that emotional attention played a role in vulnerability, decreasing mood repair, and resilience. These research support theories that point to a possible dark side of PEI, thus, a great level of emotional attention makes dark the positive effect of mood repair and personal growth if a clear perception of emotions does not complement it. These results provide empirical support concerning the need to work complementary each dimension of PEI to avoid unwanted effects on intrapersonal adjustment. (shrink)

Objectives: To compare attitudes of medical and law students toward informing a cancer patient about diagnosis and prognosis and to examine whether differences are related to different convictions about benefit or harm of information.Setting and design: Anonymous questionnaires were distributed to convenience samples of students at the University of Geneva containing four vignettes describing a cancer patient who wishes, or alternatively, who does not wish to be told the truth.Participants: One hundred and twenty seven medical students and 168 (...) law students.Main outcome measures: Five point Likert scale of responses to the vignettes ranging from “certainly inform” to “certainly not inform” the patient.Results: All medical students and 96% of law students favoured information about the diagnosis of cancer if the patient requests it. Seventy four per cent of medical students and 82% of law students favoured informing a cancer patient about his or her prognosis . Thirty five per cent of law students and 11.7% of medical students favoured telling about the diagnosis and 25.6% of law students and 7% of medical students favoured telling about the prognosis even if the patient had clearly expressed his wish not to be informed. Law students indicated significantly more often than medical students reasons to do with the patient’s good, legal obligations, and the physician’s obligation to tell the truth, and significantly less often than medical students that their attitude had been determined predominantly by respect for the autonomous choice of the patient.Conclusion: Differences in attitudes according to the type of case and the type of studies were related to convictions about the benefit or harm to the patient caused by being given information. The self reported reasons of future physicians and future lawyers are helpful when considering means to achieve a better acceptance of patients’ right to know and not to know. (shrink)

This study investigated the usefulness of the six-item Stress and Anxiety to Viral Epidemics scale and the Coronavirus Anxiety Scale as tools to assess anxiety related to coronavirus disease in cancer patients. A total of 221 patients with cancer responded to an anonymous online questionnaire between 15 July and 15 August 2020. The functional impairment of the patients was assessed using the Work and Social Adjustment Scale, and the SAVE-6 and CAS were also applied. Among (...) these 221 cancer patients, 110 had SAVE-6 scores ≥ 15 and 21 had CAS scores ≥ 5. Within the study population, 104 and 29 patients had WSAS scores ≥ 11 and ≥ 21, respectively. The correlations between the SAVE-6 and WSAS and CAS scores were statistically significant. The cut-off for the SAVE-6 was 15 points, while that for the WSAS was 11. Our results suggested that the SAVE-6 and CAS could be used to evaluate moderate and severe degrees of functional impairment related to mental health, respectively, in cancer patients during viral epidemics. (shrink)

BackgroundProphylactic Bilateral Salpingo-Oophorectomy reduces the risk of developing ovarian cancer. However, the psychological mechanisms that may affect post-surgery Quality of Life among patients who underwent PBSO are still largely unknown. Thus, this study aimed at exploring the direct and indirect associations of satisfaction with medical communication and cancer anxiety on post-surgery QoL among women at high risk of developing ovarian cancer.MethodFifty-nine women who underwent PBSO took part in this cross-sectional study, filling out a sociodemographic and clinical questionnaire, (...) a battery of validated psychological measures and an ad hoc developed scale for the assessment of cancer anxiety. We first examined the correlations among all variables of interest, and then tested if cancer anxiety mediated the association between satisfaction with medical communication and post-surgery psychological QoL, controlling both for time from surgery and education.ResultsPost-surgery psychological QoL was unrelated from any sociodemographic or clinical variable. Cancer anxiety had a significant direct negative effect on psychological QoL, while satisfaction with medical communication had a significant positive direct effect on it. Finally, cancer anxiety significantly mediated the association between satisfaction with medical communication and post-surgery psychological QoL.DiscussionResults suggest that post-surgery psychological QoL of patients who underwent PBSO may be increased with interventions, delivered in a genetic counselling setting, targeting quality of medical communication and cancer anxiety. (shrink)

In this review, we discuss the application of mouse models to the identification and pre‐clinical validation of novel therapeutic targets in colorectal cancer, and to the search for early disease biomarkers. Large‐scale genomic, transcriptomic and epigenomic profiling of colorectal carcinomas has led to the identification of many candidate genes whose direct contribution to tumourigenesis is yet to be defined; we discuss the utility of cross‐species comparative ‘omics‐based approaches to this problem. We highlight recent progress in modelling late‐stage disease (...) using mice, and discuss ways in which mouse models could better recapitulate the complexity of human cancers to tackle the problem of therapeutic resistance and recurrence after surgical resection. (shrink)

The coronavirus disease 2019 pandemic has strongly affected oncology patients. Many screening and treatment programs have been postponed or canceled, and such patients also experience fear of increased risk of exposure to the virus. In many cases, locus of control, coping flexibility, and perception of a supportive environment, specifically family resilience, can allow for positive emotional outcomes for individuals managing complex health conditions like cancer. This study aims to determine if family resilience, coping flexibility, and locus of control can (...) mitigate the negative affect caused by the pandemic and enhance positive affect in breast cancer patients. One hundred and fifty-four female patients with breast cancer completed the Walsh’s Family Resilience Questionnaire, the Perceived Ability to Cope With Trauma Scale, the Positive-Negative Affect Schedule, and the Mini Locus of Control Scale. Family resilience and internality of locus of control contribute significantly to positive affective responses. Family resilience is responsible for mitigating the negative affect perceived during the pandemic and is enhanced by external locus of control. Evidence suggests that clinical psychologists should develop and propose programs to support oncology patients’ family resilience, coping flexibility, and internal locus of control, allowing for decreased stress and improved adaptability for effectively managing cancer treatment during the pandemic. (shrink)

Cancers rely on multiple, heterogeneous processes at different scales, pertaining to many biomedical fields. Therefore, understanding cancer is necessarily an interdisciplinary task that requires placing specialised experimental and clinical research into a broader conceptual, theoretical, and methodological framework. Without such a framework, oncology will collect piecemeal results, with scant dialogue between the different scientific communities studying cancer. We argue that one important way forward in service of a more successful dialogue is through greater integration of applied sciences (experimental (...) and clinical) with conceptual and theoretical approaches, informed by philosophical methods. By way of illustration, we explore six central themes: (i) the role of mutations in cancer; (ii) the clonal evolution of cancer cells; (iii) the relationship between cancer and multicellularity; (iv) the tumour microenvironment; (v) the immune system; and (vi) stem cells. In each case, we examine open questions in the scientific literature through a philosophical methodology and show the benefit of such a synergy for the scientific and medical understanding of cancer. (shrink)

One of the major developments in cancer research in recent years has been the construction of models that treat cancer as a cellular population subject to natural selection. We expand on this idea, drawing upon multilevel selection theory. Cancer is best understood in our view from a multilevel perspective, as both a by-product of selection at other levels of organization, and as subject to selection at several levels of organization. Cancer is a by-product in two senses. (...) First, cancer cells co-opt signaling pathways that are otherwise adaptive at the organismic level. Second, cancer is also a by-product of features distinctive to the metazoan lineage: cellular plasticity and modularity. Applying the multilevel perspective in this way permits one to explain transitions in complexity and individuality in cancer progression. Our argument is a reply to Germain’s scepticism towards the explanatory relevance of natural selection for cancer. The extent to which cancer fulfills the conditions for being a paradigmatic Darwinian population depends on the scale of analysis, and the details of the purported selective scenario. Taking a multilevel perspective clarifies some of the complexities surrounding how to best understand the relevance of evolutionary thinking in cancer progression. (shrink)

Graphical AbstractCancer is a complex disease, with sophisticated cellular mechanisms as the targets of evolutionary processes driven by random genetic and epigenetic mutations. Oncogenesis is evolutionarily linked to stem cell numbers/mutations and organ/body size; therefore, inter-disciplinary frameworks across different scales (cellular, tissue, organs and species) are necessary to decipher cancer progression.

Alternative Food Networks (AFNs), which include local food and Fair Trade, work to mitigate some of the many shortcomings of mainstream food systems. If AFNs have the potential to make the world’s food systems more just and sustainable (and otherwise virtuous) then we may have good reasons to scale them up. Unfortunately, it may not be possible to increase the market share of AFNs while preserving their current forms. Among other reasons, this is because there are limits to both (...) the productive capacities of small owner-operated farms and to the distribution capacities of Farmers Markets and Community Supported Agriculture (CSA). These limits tell in favor of AFN partnerships with larger producers and distributors. But some advocates of AFNs have worried that these partnerships would sacrifice too much. (shrink)

Objectives: Childhood cancer is a life-threatening disease that poses significant challenges to the life of the diagnosed child and his/her family members. Based on the ABCX-model, the aim of the current study was to explore the association between family functioning, cancer appraisal and the individual adjustment of patients, parents and siblings. Method: Participants were 60 children with leukemia or non-Hodgkin lymphoma, 172 parents and 78 siblings (115 families). Time since diagnosis varied from zero to 33 months. Patients, parents (...) and siblings completed the Family Environment Scale, Perceived Stress Scale, Situation-Specific Emotional Reactions Questionnaire and Pediatric Quality of Life Inventory/Maudsley Marital Questionnaire. Results: Family functioning and the appraisal of the cancer diagnosis proved to be related to patients’, parents’ and siblings’ cancer-related emotions and quality of life post-diagnosis. In addition, family members differed in their perception of some family functioning domains, the appraisal of the cancer diagnosis, positive feelings and quality of life. Discussion: Our findings led to the conclusion that family functioning and the appraisal of the cancer diagnosis are important for the individual adjustment of patients, parents and siblings when facing a diagnosis of cancer in the child. Differences across members within one family speak to the need of screening all family members and intervening at the level of the family unit. (shrink)

The triumvirate of HIV/AIDS, tuberculosis, and malaria have dominated our public health focus in the developing world. Having claimed millions of lives, these infectious diseases have prompted a large-scale response. Concomitant with these efforts has been a burgeoning bioethics literature examining global health and distributive justice. A scholarly waste-land only a decade ago, there is now a growing and rich literature that aims to unpack our moral obligations when it comes to diseases that affect the majority of the world (...) (many living in absolute poverty). Now, added to the persistent challenges posed by infectious diseases is the growing burden of diseases such as cancer, which disproportionately affect .. (shrink)

The aim of this study was to investigate the level of posttraumatic growth of cancer patients post-treatment in the context of selected sociodemographic characteristics, clinical markers, and psychological variables (positive and negative emotions, anxiety and depressive symptoms, gratitude, forgiveness, hope, importance of the spiritual aspect of life and the practice of religious faith). The study sample consisted of 110 patients post-treatment aged 22-79 years and with an average time since the completion of the last treatment ranging from 5 to (...) 396 months. The Posttraumatic Growth Inventory, the Positive and Negative Affect Schedule, screening methods to measure anxiety (General Anxiety Dis- order-7) and depression (Patient Health Questionnaire-9), and questionnaires to measure dispositional gratitude (Gratitude Questionnaire GQ-6), dispositional hope (Adult Dispositional Hope Scale), and forgiveness (Heartland Forgiveness Scale) were used to measure the psychological variables. There were no differences in the level of posttraumatic growth in terms of sociodemographic characteristics and clinical markers. Partner status, employment status, presence of recurrence, and comorbidities did not differentiate its level either. The rate of posttraumatic growth was related to the experience of positive emotions, gratitude, the importance of the spiritual aspect of life, and the practice of religious faith. In the regression model that explained 21.90% of the variance in posttraumatic growth, only the level of positive emotions was a significant predictor. The results of the present research point suggest that the level of posttraumatic growth is associated with several areas of emotional experience and cognitive adjustment of cancer patients post-treatment. (shrink)

ABSTRACT I propose a division of the literature on natural kinds into metaphysical worries, semantic worries, and methodological worries. I argue that the latter set of worries, which concern how classification influences scientific practices, should occupy centre stage in philosophy of science discussions about natural kinds. I apply this methodological framework to the problems of classifying chemical species and nanomaterials. I show that classification in nanoscience differs from classification in chemistry because the latter relies heavily on compositional identity, whereas the (...) former must consider additional properties, namely, size, shape, and surface chemistry. I use this difference to argue for a scale-dependent theory of scientific classification. _1_ Introduction _2_ The Methodological Problem of Kinds _3_ Chemical Kindhood: Reactivity, Microstructure, and the Structure–Property Paradigm _4_ Scale-Dependence and Nanoscale Kinds _5_ Conclusion. (shrink)

Since the 1970s, estrogen have sometimes been used in adolescent girls to reduce very tall adult expected height. Worries about long-term effects have led to a proposal to link treatment data with cancer registers. How should one deal with informed consent for such a study? We designed a qualitative study with semi-structured telephone interviews. From 1200 women who were to be followed-up in cancer registers, we randomly selected 22 women. Major themes were a wish to be involved and (...) a positive attitude to the proposed register research. The women did not express worry after reading the study protocol, but did convey considerable frustration that this research had not been initiated earlier. Active consent was not seen as crucial. We found strong interest in a high participation rate and a concern over missing data. The selection of information and consent or the decision to go ahead without consent in register follow-up is a delicate balancing act. Study participants wish to be contacted, but acknowledge the primary goal of answering important questions. Our study provides support for safeguarding privacy in epidemiological linkage studies and in follow-up of medical treatment without losing the scientific value by requesting for informed consent. (shrink)

Since the 1970s, estrogen have sometimes been used in adolescent girls to reduce very tall adult expected height. Worries about long-term effects have led to a proposal to link treatment data with cancer registers. How should one deal with informed consent for such a study? We designed a qualitative study with semi-structured telephone interviews. From 1200 women who were to be followed-up in cancer registers, we randomly selected 22 women. Major themes were a wish to be involved and (...) a positive attitude to the proposed register research. The women did not express worry after reading the study protocol, but did convey considerable frustration that this research had not been initiated earlier. Active consent was not seen as crucial. We found strong interest in a high participation rate and a concern over missing data. The selection of information and consent or the decision to go ahead without consent in register follow-up is a delicate balancing act. Study participants wish to be contacted, but acknowledge the primary goal of answering important questions. Our study provides support for safeguarding privacy in epidemiological linkage studies and in follow-up of medical treatment without losing the scientific value by requesting for informed consent. (shrink)

Background: The role of personality in cancer incidence and development has been studied for a long time. As colorectal cancer is one of the most prevalent cancer types and linked with lifestyle habits, it is important to better understand its psychological correlates, in order to design a more specific prevention and intervention plan. The aim of this systematic review is to analyze all the studies investigating the role of personality in CRC incidence.Methods: All studies on CRC and (...) personality up to November 2020 were scrutinized according to the Cochrane Collaboration and the PRISMA statements. Selected studies were additionally evaluated for the Risk of Bias according to the Newcastle-Ottawa Scale.Results: Eight studies met the inclusion criteria and were eventually included in this review. Two main constructs have been identified as potential contributors of CRC incidence: emotional regulation and relational style.Conclusion: Strong conclusions regarding the influence of personality traits on the incidence of CRC are not possible, because of the small number and the heterogeneity of the selected studies. Further research is needed to understand the complexity of personality and its role in the incidence of CRC and the interaction with other valuable risk factors. (shrink)

Objectives: Pediatric cancer is a life-threatening disease that poses significant challenges to the life of all family members (diagnosed child, parents, siblings) and the family as a whole. To date, limited research has investigated family adjustment when facing pediatric cancer. The aim of the current longitudinal study was to explore the predictive role of protective factors at the individual (parental psychological flexibility), intrafamilial (dyadic coping) and contextual level (network support) in explaining family adjustment as perceived by parents of (...) children with leukemia or non-Hodgkin lymphoma. In addition, we were interested to see whether these protective factors could be predictive for family adjustment at a later time point. Method: Participants were 70 mothers and 53 fathers (80 families) of children with leukemia or non-Hodgkin lymphoma. Mean time since diagnosis was 5.26 (T1) and 18.86 (T2) months post-diagnosis. Parents completed the Acceptance and Action Questionnaire II (to assess psychological flexibility), Dyadic Coping Inventory, a network support questionnaire, Impact on Family Scale and the Family Adjustment Scale. Both concurrent and prospective association models were tested. Results: Psychological flexibility, dyadic coping and network support proved to be cross-sectionally and positively related to parents’ perception of family adjustment post-diagnosis; psychological flexibility and dyadic coping proved to predict better family adjustment over time. Conclusions: Our findings led to the conclusion that protective factors at all three levels (individual, intrafamilial and contextual) are important for explaining family adjustment as perceived by parents facing a diagnosis of cancer in their child. Interventions targeting the individual, couple, as well as family level are warranted to enhance family adjustment. (shrink)

BackgroundAt the start of 2021, oncologists lacked the necessary scientific knowledge to adapt their clinical practices optimally when faced with cancer patients refusing or reluctant to be vaccinated against COVID-19, despite the marked vulnerability of these patients to severe, and even fatal forms of this new viral infectious disease. Oncologists at Foch Hospital were confronted with this phenomenon, which was observed worldwide, in both the general population and the population of cancer patients.MethodsBetween April and November 2021, the Ethics (...) and Oncology Departments of Foch Hospital decided to investigate this subject, through an empirical and interdisciplinary study in bioethics. Our scientific objective was to try to identify and resolve the principal bio-ethical issues, with a view to improving clinical practices in oncology during future major pandemics of this kind, from a highly specific bio-ethical standpoint. We used a mainly qualitative methodological approach based on questionnaires and interviews.ResultsIn April 2021, 29 cancer patients refused or were reluctant to be vaccinated. Seventeen of these patients said that making vaccination mandatory would have helped them to accept vaccination. In October 2021, only 10 cancer patients continued to maintain their refusal. One of the main reasons for the decrease in refusals was probably the introduction of the “pass sanitaire” in July 2021, which rendered vaccination indispensable for many activities. However, even this was not sufficient to convince these 10 cancer patients.ConclusionWe identified a key bio-ethical issue, which we then tried to resolve: vaccination policy. We characterized a major tension between “the recommendation of anti-COVID-19 vaccination” and “free will”, and the duty to “protect each other”. Mandatory vaccination, at least in France, could resolve this tension, with positive effects on quality of life, or survival, in cancer patients initially refusing or reluctant to be vaccinated, but only if collective and individual scales are clearly distinguished. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Family, Friends, and Cancer:The Overwhelming Effects of Brain Cancer on a Child’s LifeLynne ScheumannOur son was diagnosed with a medulloblastoma at the old age of 13. The “lucky” part for him was his brain was almost fully developed at this age as opposed to most “medullo” patients. While this was a benefit to him it was also one of the hardest things for him.He went into surgery (...) a highly intelligent, active, and left handed boy and came out unable to move his left side, could barely speak, and very much aware of what he just lost. We, as a family, were totally unprepared for how globally this would [End Page 23] affect the rest of his life. As we spent time in the hospital I would look at the children with other types of cancer and see them walking and talking and doing their schoolwork and God forgive me I would be jealous. The fact that the cancer was in his brain, the part of his body that makes him who he is changed everything forever.He lost all of his friends because 13–year–old boys communicate best through physical activity and that was not an option for him. He still has the same personality and sense of humor, but he will not be the architect or engineer he once dreamed of being. Math, that was once so easy for him was now like a foreign language, never to be mastered again. He was able to graduate from High School and takes classes at our local Junior College in Computer Assisted Drafting, but he can only manage one or two classes a semester due to the fatigue he still suffers from.What I most worry about and wish I had been forewarned about is his long–term quality of life. Physically he has come such a long way from how he was after the resection. It was a very slow process in which the first year of rehab was slowed by the fact that one of the chemo agents causes peripheral neuropathy. He developed contractures in his ankles and needed serial casting and ankle–foot orthotics (AFO) not just on the left leg, but now the right. He was able to switch his handedness fairly easily and his left hand will always be of limited usefulness because of ataxia. I would get angry at him that he gave up on his left side so quickly until it was finally explained to me years later that the ataxia would never get better.As far as his walking ability goes he has come a long way. At first he was unable to walk and once he started rehab he went back to learning to crawl and progressed to a walker. The first time I saw him walk with the walker brought tears to my eyes. It was so much more of an event for me than when he took his first steps as a toddler. This was so much more hard fought. He never complained, just always did what was asked of him. It had to have been such hard work and also somewhat embarrassing, as he needed help to literally do everything for months. He progressed to a cane and about two years ago decided not to use that or his AFO’s. He now wears high top boots that substitute for the AFO’s but don’t make him appear disabled. Recently he decided there are times when he would be safer if he had his cane and purchased one that looks more like a hiking stick than a cane. I think he has come to terms with the fact that physically he is as good as he is going to get and works hard to maintain what he did regain. He has a trainer and goes to the gym on a regular basis with no prompting from us. I do not know if he realizes that as he ages things will be harder for him than the average person. I think in some way he is aware of that because he did decided to use the cane if safety is an issue.His... (shrink)

The relevance of the Planck scale to a theory of quantum gravity has become a worryingly little examined assumption that goes unchallenged in the majority of research in this area. However, in all scientific honesty, the significance of Planck’s natural units in a future physical theory of spacetime is only a plausible, yet by no means certain, assumption. The purpose of this article is to clearly separate fact from belief in this connection.

Breast cancer treatments have multiple adverse effects, including concerns about body appearance and function that are experienced by most patients. Altered body image negatively affects mental health, social, and relationship functioning. While the relationship with a partner is critical for patients’ psychological wellbeing and partners can promote positive body image, limited research has investigated individual and relational factors affecting the experience of both. This cross-sectional study aimed at exploring rates of body image concerns among breast cancer patients, and (...) identifying dyadic profiles among participating dyads. Couples composed by patients who had undergone surgery and their romantic partners were recruited from the Breast Unit of a hospital in northern Italy. Both partners completed measures of personality characteristics, psychological distress, coping flexibility, dyadic coping, and closeness. Body image and adjustment to cancer measures were completed by patients only. K-mean cluster analyses identified 2-cluster solution among patients and partners, respectively. “Active patients” reported low rates of body image concerns, anxious preoccupation, negative dyadic coping, and self-oriented stress communication, compared to “worried patients”. “Comfortable partners” reported lower anxiety and depression, self-oriented negative dyadic coping and closeness than “uncomfortable partners”. Three different dyadic profiles emerged: functional, dysfunctional, and ambivalent. Significant variations by anxiety, depression, and delegating dyadic coping existed. Results indicate there are groups of couples at greater risk for impaired psychological distress and body image concerns, which should be addressed in the context of dyadic psychosocial interventions. (shrink)

Large-scale whole genome sequencing (WGS) studies promise to revolutionize cancer research by identifying targets for therapy and by discovering molecular biomarkers to aid early diagnosis, to better determine prognosis and to improve treatment response prediction. Such projects raise a number of ethical, legal, and social (ELS) issues that should be considered. In this study, we set out to discover how these issues are being handled across different jurisdictions.

Paediatric cancer care poses ethically difficult situations that can lead to value conflicts about what is best for the child, possibly resulting in moral distress. Research on moral distress is lacking in paediatric cancer care in Sweden and most questionnaires are developed in English. The Moral Distress Scale-Revised is a questionnaire that measures moral distress in specific situations; respondents are asked to indicate both the frequency and the level of disturbance when the situation arises. The aims of (...) this study were to translate and culturally adapt the questionnaire to the context of Swedish paediatric cancer care. In doing so we endeavoured to keep the content in the Swedish version as equivalent to the original as possible but to introduce modifications that improve the functional level and increase respondent satisfaction. The procedure included linguistic translation and cultural adaptation of MDS-R’s paediatric versions for Physicians, Nurses and Other Healthcare Providers to the context of Swedish paediatric cancer care. The process of adjustment included: preparation, translation procedure and respondent validation. The latter included focus group and cognitive interviews with healthcare professionals in paediatric cancer care. To achieve a Swedish version with a good functional level and high trustworthiness, some adjustments were made concerning design, language, cultural matters and content. Cognitive interviews revealed problems with stating the level of disturbance hypothetically and items with negations caused even more problems, after having stated that the situation never happens. Translation and cultural adaptation require the involvement of various types of specialist. It is difficult to combine the intention to keep the content as equivalent to the original as possible with the need for modifications that improve the functional level and increase respondent satisfaction. The translated and culturally adapted Swedish MDS-R seems to have equivalent content as well as improved functional level and respondent satisfaction. The adjustments were made to fit paediatric cancer care but it could be argued that the changes are relevant for most areas of paediatric care of seriously ill patients. (shrink)

IntroductionThe present study aims at analysing how social support received and provided by parents of children, adolescents and young adults (AYA) diagnosed with cancer, as well as their sociodemographic and clinical variables, affect those parents’ stress levels and life and family satisfaction.Materials and MethodsA total of 112 parents of children and AYAs who had been diagnosed with cancer and who received treatment in Malaga participated in the study. In the study, participated all parents who voluntarily agreed to fulfil (...) the questionnaire. The main inclusion criterion was that their child had cancer. Instruments used were Questionnaire on the Frequency of and Satisfaction with Social Support (QFSSS), Paediatric Inventory for Parents (PIP), Life Satisfaction Scale and Family Satisfaction Scale.ResultsIn the mean difference analyses, male parents showed 3.38 (SD = 0.56) in social support received and female parents showedM = 3.08 (SD = 0.72). Conversely, in social support provided, female parents showed 3.22 and male parents showedM = 3.55 (p = 0.020). Significant differences were also found in family satisfaction, where female parents (M = 3.64) feel more satisfied than male parents (M = 3.06;p = 0.027). Parents of children aged between 0 and 14 years (M = 3.06) feel more stress than those parents of children aged 15–21 (M = 2.61;p = 0.021). The correlation analysis shows that there is a negative and significant relation between stress levels experienced by parents when facing different situations related to the child’s disease and both types of support, receivedr = −0.411,p < 0.001 and providedr = −0.282,p < 0.01. There is also a positive and significant relation between life satisfaction and social support receivedr = 0.292,p < 0.01, and social support providedr = 0.409,p < 0.001. There is a positive and significant relation between family satisfaction and social support receivedr = 0.330,p < 0.01, in the same way as with social support providedr = 0.222,p < 0.05. The regression analysis related to stress levels of parents indicates that social support received predicts levels of stress significantlyp < 0.001, with the variable of number of children being the one that showed to be significantp < 0.05. Social support provided showed the most significant resultsp = 0.001, meaning that social support provided increased life satisfaction. Social support received explains family satisfaction (p = 0.50), as it increases the family satisfaction of parents of children with cancer.DiscussionAnalysing social support received and provided, as well as sociodemographic and clinical variables, allowed us to broaden the knowledge on the effect social support has on stress levels, life satisfaction and family satisfaction in parents of children and AYAs diagnosed with cancer. This may have relevant practical implications for the design of interventions that would improve parents’ lives. (shrink)

The rapid pace of development over the last few decades in the domain of machine learning mirrors the advances made in the field of quantum computing. It is natural to ask whether the conventional machine learning algorithms could be optimized using the present-day noisy intermediate-scale quantum technology. There are certain computational limitations while training a machine learning model on a classical computer. Using quantum computation, it is possible to surpass these limitations and carry out such calculations in an optimized (...) manner. This study illustrates the working of the quantum support vector machine classification model which guarantees an exponential speed-up over its typical alternatives. This research uses the quantum SVM model to solve the classification task of a malignant breast cancer diagnosis. This study also demonstrates a comparative analysis of distinct forms of SVM algorithms concerning their time complexity and performances on standard evaluation metrics, namely accuracy, precision, recall, and F1-score, to exemplify the supremacy of quantum SVM over its conventional variants. (shrink)

RESUMEN El cáncer constituye un serio problema de salud y una de las primeras causas de muerte a nivel mundial, con serias repercusiones sociales, sicológicas, y familiares. Actualmente su prevención y control representa un reto que es necesario asumir teniendo en cuenta todas sus dimensiones. El presente trabajo tiene como objetivo exponer los fundamentos teóricos de la estrategia de intervención sicosocial para la prevención y tratamiento del cáncer en el consejo popular San Juan de Dios. Se revela la fundamentación teórica (...) de la estrategia de intervención desde los diferentes aparatos conceptuales de las ciencias sociales y se hace énfasis en los enfoques sociológicos y sicológicos. Se ofrece el diseño de la estrategia con todos los aspectos contentivos, y se describen las diferentes etapas que la comprenden. ABSTRACT Cancer constitutes a serious problem of health and one of the first causes of death on a global scale, with serious social, psychological, and familiar aftereffects. At present its prevention and control represents a challenge that is necessary to accept bearing in mind all its dimensions. The present work has as objective to exhibit the theoretical basis of the strategy of psychosocial intervention for the prevention and treatment of the cancer in the popular council San Juan de Dios. It reveals the theoretical foundation of the strategy of intervention from the different conceptual devices of the social sciences and emphasizes on the sociological and psychological approaches. The design of the strategy is offered with all the comprising aspects, and there are described the different stages that comprise it. (shrink)

Body awareness refers to the individual ability to process signals originating from within the body, which provide a mapping of the body’s internal landscape and its relation with space and movement. The present study aims to evaluate psychometric properties and validate in French two self-report measures of body awareness: the Postural Awareness Scale, and the last version of the Multidimensional Assessment of Interoceptive Awareness questionnaire. We collected data in a non-clinical, adult sample using online survey, and a subset of (...) the original sample also completed the retest control. Factor analyses and reliability analyses were conducted. Construct validity of the PAS and the MAIA-2 were examined by testing their association with each other, and with self-report measures of personality, alexithymia and dispositional trait mindfulness. Factor analyses of the PAS supported the same two-factor structure as previously published versions. For the MAIA-2, factor analyses suggested that a six-factor structure, excluding Not-Worrying and Not-Distracting factors, could successfully account for a common general factor of self-reported interoception. We found satisfactory internal consistency, construct validity, and reliability over time for both the PAS and the MAIA-2. Altogether, our findings suggest that the French version of the PAS and the MAIA-2 are reliable self-report tools to assess both components of body awareness. (shrink)

BackgroundUncertainty intolerance (IU), the tendency to think or react negatively toward uncertain events may have implication on individuals’ mental health and psychological wellbeing. The Intolerance of Uncertainty Scale-12 (IU-12) is commonly used across the globe to measure IU, however, its’ psychometric properties are yet to be evaluated in Iran with a Persian-speaking population. Therefore, the purpose of this research was to translate and validate the IU-12 among Iranian undergraduate students.Materials and MethodsThe multi-stage cluster random sampling was employed to recruit (...) 410 Iranian undergraduate students (260 females) from the Azad University to complete the IU-12, the Depression Anxiety Stress Scale-2, and the Penn State Worry Questionnaire in a cross-sectional design. In this study, face validity, content validity, construct validity, and concurrent validity were measured and Construct Reliability (CR) and Cronbach’s alpha were used to measure reliability.ResultsThe impact score of the translated IU-12 indicated acceptable face validity (value of impact score was greater than 1.5). The value of Content Validity Index (CVI) and the value of Content Validity Ratio (CVR) were above 0.7 and 0.78, respectively. The values of CVI and CVR indicated the items had acceptable content validity and were deemed essential to the measure. The measurement model analysis showed the measure with two subscales had good fit indices (CMIN/df = 2.75, p < 0.01, RMSEA = 0.07, TLI = 0.94, CFI = 0.95, GFI = 0.94). A Confirmatory Factor Analysis (CFA) indicated the scale was composed of the two subscales found in the English-version of the scale (prospective anxiety and inhibitory anxiety), and no items were removed from the scale. The values of CR (0.86) and Cronbach’s alphas (0.89) showed the measure had appropriate internal consistency.ConclusionThe findings support the psychometric properties of the Persian version of the IU-12. This scale could be used to reliably and accurately measure uncertainty intolerance among undergraduate students in Iran. (shrink)

IntroductionHead and neck cancer diagnosis and treatment can be a significant life trauma. Some HNC survivors experience post-traumatic growth, which has been linked with better health-related quality-of-life. Empirical research on PTG, and theoretical models, point to the importance of being able to purposely make sense of the traumatic experience. Intrusive rumination, by contrast, is linked to poorer outcomes. This study explored HNC survivors’ experiences of rumination.MethodsTwenty HNC survivors between 9 months and 5 years post-diagnosis were recruited. They had a (...) range of HNC sub-types and cancer treatments. Participants underwent a semi-structured interview about their cancer diagnosis and treatment. Reflexive thematic analysis identified themes and sub-themes around rumination.ResultsFour themes with linked subthemes on the content and process of rumination were identified. Theme 1 was rumination and worry related to diagnosis. Here, survivors discussed how the HNC diagnosis and plans for treatment had dominated their initial thoughts. Theme 2 was processing the trauma of HNC. This theme reflected rumination on the traumatic experience of diagnosis and treatment and how the participant was reacting to it. Theme 3 was considering the impact. This theme encompassed retrospective thinking and comparisons between the participant now versus the early days after diagnosis. Theme 4 was continued rumination. This theme included ongoing intrusive and distressing rumination about the trauma and impact of cancer. Those who expressed ongoing rumination revisited fears or returned to negative experiences.ConclusionThis study uniquely describes the nature and content of rumination following HNC. Early intrusive rumination is common and may reflect perceptions of cancer as an existential threat. Over time, rumination can become more reflective and move towards deliberate meaning-making. Some HNC survivors may benefit from interventions to reduce barriers to this transition. The content of distressing and difficult to control rumination helps to identify those who may benefit from more directed psychological support. (shrink)

NCG 4.0 is the latest update of the Network of Cancer Genes, a web-based repository of systems-level properties of cancer genes. In its current version, the database collects information on 537 known (i.e. experimentally supported) and 1463 candidate (i.e. inferred using statistical methods) cancer genes. Candidate cancer genes derive from the manual revision of 67 original publications describing the mutational screening of 3460 human exomes and genomes in 23 different cancer types. For all 2000 (...) class='Hi'>cancer genes, duplicability, evolutionary origin, expression, functional annotation, interaction network with other human proteins and with microRNAs are reported. In addition to providing a substantial update of cancer-related information, NCG 4.0 also introduces two new features. The first is the annotation of possible false-positive cancer drivers, defined as candidate cancer genes inferred from large-scale screenings whose association with cancer is likely to be spurious. The second is the description of the systems-level properties of 64 human microRNAs that are causally involved in cancer progression (oncomiRs). Owing to the manual revision of all information, NCG 4.0 constitutes a complete and reliable resource on human coding and non-coding genes whose deregulation drives cancer onset and/or progression. NCG 4.0 can also be downloaded as a free application for Android smart phones. (shrink)

IntroductionThe Managing Cancer and Living Meaningfully therapy for patients with advanced cancer was tested against a supportive psycho-oncological counseling intervention in a randomized controlled trial. We investigated whether CALM was delivered as intended ; whether CALM therapists with less experience in psycho-oncological care show higher adherence scores; and whether potential overlapping treatment elements between CALM and SPI can be identified.MethodsTwo trained and blinded raters assessed on 19 items four subscales of the Treatment Integrity Scale covering treatment domains (...) of CALM. A random sample of 150 audio recordings were rated on a three-point Likert scale with 1 = “adherent to some extent,” 2 = “adherent to a sufficient extent,” 3 = “very adherent.”ResultsAll 19 treatment elements were applied, but in various frequencies. CALM therapists most frequently explored symptoms and/or relationship to health care providers and allowed expression of sadness and anxiety about the progression of disease. The exploration of CALM treatment element SC_1 was most frequently implemented in a satisfactory or excellent manner, whereas the treatment element SMP_4: Therapist promotes acknowledgment that some life goals may no longer be achievable was not implemented in a satisfactory manner. In terms of treatment differentiation, no treatment elements could be identified which were applied significantly more often by CALM therapists than by SPI therapists.ConclusionResults verify the application of CALM treatment domains. However, CALM therapists’ adherence scores indicated manual deviations. Furthermore, raters were not able to significantly distinguish CALM from SPI, implying that overlapping treatment elements were delivered to patients. (shrink)

The present study tested the impact of attention training on cognition; secondary appraisal of perceived stress, and on metacognition; meta-worry in stressed students. Theoretically derived from the Self-Regulatory Executive Function model (S-REF model; Wells & Matthews, 1994a; 1996), the Attention Training Technique (ATT; Wells, 1990) is intended to promote flexible, voluntary external attention and has been shown to reduce symptoms of psychological distress. The present experimental study explored the effects of ATT on cognitive and metacognitive levels of appraisal, namely (...) perceived stress (primary outcome) and meta-worry (secondary outcome). Stressed students were randomized to an experimental ATT group (n = 23) or a control group (n = 23). The ATT group attended an initial training session followed by four weeks of individual (12 minutes) daily ATT practice. The control group waited for four weeks before receiving the intervention. The outcomes were scores on the Perceived Stress Scale 14 (PSS-14) and the Meta-Worry Questionnaire (MWQ) frequency and belief subscales at post study. Both measures decreased significantly following ATT with large pre to post effect sizes but there were minimal changes in the control group. The between group differences were statistically significant. The results add to the literature on the potential effects of ATT by demonstrating effects on the content of cognitive stress appraisals and on meta-worry in an academic setting in a stressed student sample. (shrink)

Solar radiation management (SRM) may help to reduce the negative outcomes of climate change by minimising or reversing global warming. However, many express the worry that SRM may pose a moral hazard, i.e., that information about SRM may lead to a reduction in climate change mitigation efforts. In this paper, we report a large-scale preregistered, money-incentivised, online experiment with a representative US sample (N = 2284). We compare actual behaviour (donations to climate change charities and clicks on climate (...) change petition links) as well as stated preferences (support for a carbon tax and self-reported intentions to reduce emissions) between participants who receive information about SRM with two control groups (a salience control that includes information about climate change generally and a content control that includes information about a different topic). Behavioural choices are made with an earned real-money endowment, and stated preference responses are incentivised via the Bayesian Truth Serum. We fail to find a significant impact of receiving information about SRM and, based on equivalence tests, we provide evidence in favour of the absence of a meaningfully large effect. Our results thus provide evidence for the claim that there is no detectable moral hazard with respect to SRM. [Open access]. (shrink)

Theories of embodied cognition hypothesize interdependencies between psychological well-being and physical posture. The purpose of this study was to assess the feasibility of objectively measuring posture, and to explore the relationship between posture and affect and other patient centered outcomes in breast cancer survivors with persistent postsurgical pain over a 12-week course of therapeutic Qigong mind-body training. Twenty-one BCS with PPSP attended group Qigong training. Clinical outcomes were pain, fatigue, self-esteem, anxiety, depression, stress and exercise self-efficacy. Posture outcomes were (...) vertical spine and vertical head angles in the sagittal plane, measured with a 3D motion capture system in three conditions: eyes open, eyes open relaxed and eyes closed. Assessments were made before and after the Qigong training. The association between categorical variables was measured by Cramer’s V. In the EO condition, most participants who improved in fatigue and anxiety scales also had better vertical head values. For the EOR condition, a moderate correlation was observed between changes in vertical head angle and changes in fatigue scale. In the EC condition, most of the participants who improved in measures of fatigue also improved vertical head angle. Additionally, pain severity decreased while vertical spine angle improved. These preliminary findings support that emotion and other patient centered outcomes should be considered within an embodied framework, and that Qigong may be a promising intervention for addressing biopsychosocially complex interventions such as PPSP in BCSs. (shrink)

All epistemic agents physically consist of parts that must somehow comprise an integrated cognitive self. Biological individuals consist of subunits (organs, cells, molecular networks) that are themselves complex and competent in their own context. How do coherent biological Individuals result from the activity of smaller sub-agents? To understand the evolution and function of metazoan bodies and minds, it is essential to conceptually explore the origin of multicellularity and the scaling of the basal cognition of individual cells into a coherent larger (...) organism. In this paper I synthesize ideas in cognitive science, evolutionary biology, and developmental physiology toward a hypothesis about the origin of Individuality: “Scale-Free Cognition”. I propose a fundamental definition of an Individual based on the ability to pursue goals at an appropriate level of scale and organization, and suggest a formalism for defining and comparing the cognitive capacities of highly diverse types of agents. Any Self is demarcated by a computational surface – the spatio-temporal boundary of events that it can measure, model, and try to affect. This surface sets a functional boundary - a cognitive “light cone” which defines the scale and limits of its cognition. I hypothesize that higher-level goal-directed activity and agency, resulting in larger cognitive boundaries, evolve from the primal homeostatic drive of living things to reduce stress – the difference between current conditions and life-optimal conditions. The mechanisms of developmental bioelectricity - the ability of all cells to form electrical networks that process information - suggests a plausible set of gradual evolutionary steps that naturally lead from physiological homeostasis in single cells to memory, prediction, and ultimately complex cognitive agents, via scale-up of the drive of infotaxis. Recent data on the molecular mechanisms of pre-neural bioelectricity suggest a model of how increasingly sophisticated cognitive functions emerge smoothly from cell-cell communication used to guide embryogenesis and regeneration. This set of hypotheses provides a novel perspective on numerous phenomena, such as cancer, and makes several unique, testable predictions for interdisciplinary research that have implications not only for evolutionary developmental biology but also for biomedicine and perhaps artificial intelligence and exobiology. (shrink)

ObjectivesThe breast cancer stigma affects Health-related quality of life, while general resilience resources, namely, sense of coherence, social support, and coping skills, are thought to alleviate this effect. The study aimed to explore the mediating/moderation role of GRRs in the relationship between stigma and HRQoL and its dimensions in Iranian patients with breast cancer.MethodsIn this cross-sectional study, Stigma Scale for Chronic Illness 8-item version, SOC-13, Medical Outcome Survey- Social Support Scale, Brief COPE, and Functional Assessment of (...) Cancer Therapy-Breast were investigated in a convenience sample of Iranian women with confirmed non-metastatic breast cancer. Following the establishment of correlations using Pearson’s correlation, single and parallel mediation analysis and moderation analysis were conducted to determine the extent to which each GRR might be impacted by stigma or decrease the adverse impact of stigma on HRQoL.ResultsAn analysis of 221 women with the mean age of 47.14 showed that stigma was negatively correlated to all HRQoL’s dimensions, SOC, social support, and the bulk of coping skills. In the single mediation analysis, stigma affected all facets of SOC, all subscales of social support, and positive reframing, which partially reduced breast cancer HRQoL. Stigma affects general HRQoL through damaging meaningfulness, social support, and positive reframing. Meaningfulness was marked as the most impacted GRR in terms of all domains of HRQoL. In parallel mediation, reduced meaningfulness, total social support, and positive reframing were highlighted as the pathways of diminished breast cancer HRQoL. Moderation analysis indicated the higher levels of humor, behavioral disengagement, and use of instrumental support behaviors to be functional in protecting different dimensions of HRQoL, while the results were mixed for venting, especially in patients with mastectomy surgery.ConclusionWhile GRRs may be impacted by stigma, they exert a relatively small protective effect against the impact of stigma on HRQoL. This study provides some novel findings, but longitudinal studies are needed to further verify these before any causal conclusion or recommendations for health policy can be drawn. (shrink)

Background: A significant concern for patients treated for cancer is fear of cancer recurrence. Although a common experience, some patients report high levels of FCR that are difficult to manage and result in over vigilant checking and high use of health services. There has been speculation about the relationship of FCR with gender with mixed reports from several systematic reviews.Aims: To determine the association of FCR with gender in previous reported studies and investigate the strength of this relationship (...) with various moderators including year of publication, type of cancer and measurement attributes of self-reported FCR instruments.Methods: A systematic review was conducted with searches of the literature from the MEDLINE, PubMed, Embase, and PsycINFO databases following PRISMA guidelines. All the included papers were divided into two groups, namely: “pure” that comprise only of patients with cancer types that both men and women can contract and “mixed” that report on patients with a variety of cancer types. The association between gender and FCR level was assessed by meta-analysis. A meta-regression was performed to investigate the moderating effects of factors including: the year of publication, cancer type, mean age of the sample and the length of the FCR scale measurement. This review was registered with PROSPERO, ID: CRD42020184812.Results: Finally, 29 studies were included. The N size of pooled participants was 33,339. The meta-analysis showed females to have an overall higher level of FCR than males. The meta-regression of moderating or control variables found little, if any, systematic variation in effect-sizes.Conclusion: This systematic review has clarified a potentially confused pattern of previous results in understanding the relationship between gender and FCR. Women report higher levels of FCR than men and this feature is one that clinicians and researchers can factor into their practice and future studies. The effect size is moderate, hence there is ample variation in FCR level, independent of gender, that requires further investigation. (shrink)

The psychological cost on emotional well-being due to the collateral damage brought about by COVID-19 in accessing oncological services for breast cancer diagnosis and treatment has been documented by recent studies in the United Kingdom. The current study set out to examine the effect of delays to scheduled oncology services on emotional and cognitive vulnerability in women with a breast cancer diagnosis in Iran, one of the very first countries to be heavily impacted by COVID-19. One hundred thirty-nine (...) women with a diagnosis of primary breast cancer answered a series of online questionnaires to assess the current state of rumination, worry, and cognitive vulnerability as well as the emotional impact of COVID-19 on their mental health. Results indicated that delays in accessing oncology services significantly increased COVID related emotional vulnerability. Regression analyses revealed that after controlling for the effects of sociodemographic and clinical variables, women’s COVID related emotional vulnerability explained higher levels of ruminative response and chronic worry as well as poorer cognitive function. This study is the first in Iran to demonstrate that the effects of COVID-19 on emotional health amongst women affected by breast cancer can exaggerate anxiety and depressive related symptoms increasing risks for clinical levels of these disorders. Our findings call for an urgent need to address these risks using targeted interventions exercising resilience. (shrink)

ObjectivesDepression and anxiety persist in cancer patients, creating an additional burden during treatment and making it more challenging in terms of management and control. Studies on the prevalence of depression and anxiety among cancer patients in the Middle East are limited and include many limitations such as their small sample sizes and restriction to a specific type of cancer in specific clinical settings. This study aimed to describe the prevalence and risk factors of depression and anxiety among (...) cancer patients in the inpatient and outpatient settings.Materials and MethodsA total of 1,011 patients formed the study sample. Patients’ psychological status was assessed using the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, and the Generalized Anxiety Disorder 7-item scale. The prevalence rate of depressive and anxious symptomatology was estimated by dividing the number of patients who exceeded the borderline score: 10 or more for each subscale of the HADS scale, 15 or more for the GAD-7 scale, and 15 or more in the PHQ-9 by the total number of the patients. Risk factors were identified using logistic regression.ResultsThe prevalence of depressive and anxious symptomatology among all patients was 23.4% and 19.1–19.9%, respectively. Depressive symptomatology was more prevalent across patients who were hospitalized compared with patients in the outpatient setting. Similarly, anxious symptomatology was more prevalent in the inpatient setting. In the inpatient setting, depressive symptomatology was more prevalent among patients with bladder cancer, while severe anxious symptomatology was more prevalent across patients with lung cancer. In the outpatient setting, depressive and anxious symptomatology was more prevalent among breast and prostate cancer patients, respectively. Despite that, around 42.7% and 24.8% of the patients, respectively, reported that they feel anxious and depressed, and only 15.5% of them were using medications to manage their conditions.ConclusionOur study findings demonstrated a higher prevalence of depressive and anxious symptomatology in the inpatient setting and advanced disease stages. In addition, the underutilization of antidepressant therapy was observed. There is a need to consider mental disorders as part of the treatment protocol for cancer patients. Enhanced clinical monitoring and treatment of depression and anxiety of cancer patients are required. (shrink)