Psycho‐Oncology最新文献

{"title":"Concurrent Antidepressant Use and Metastasis Risk Among Women Receiving Tamoxifen for Breast Cancer: A Real-World Cohort Study.","authors":"Shaimaa Elshafie, Mohammed Zuber, Ainhoa Gomez-Lumbreras, Daniel C Malone, Lorenzo Villa Zapata","doi":"10.1002/pon.70617","DOIUrl":"https://doi.org/10.1002/pon.70617","url":null,"abstract":"<p><strong>Objective: </strong>Concurrent use of antidepressants, particularly cytochrome P450 2D6 (CYP2D6) inhibitors, may reduce tamoxifen bioactivation and effectiveness. However, the clinical significance of this potential interaction remains inconclusive. This study examined whether concurrent antidepressant use is associated with increased metastasis risk among women receiving tamoxifen for nonmetastatic breast cancer.</p><p><strong>Methods: </strong>We conducted a cohort study using the Merative MarketScan Database. Eligible women with nonmetastatic breast cancer were followed from tamoxifen initiation until metastasis, disenrollment, or study end, whichever occurred first. Patients were classified as concurrent users (tamoxifen with overlapping antidepressant prescriptions) or nonusers (tamoxifen only). Time-dependent Cox models estimated metastasis risk. Analyses were stratified by concurrent exposure duration and CYP2D6 inhibition degree and adjusted for relevant covariates.</p><p><strong>Results: </strong>Among 14,771 women (mean age: 51 ± 10 years), 4780 (32.4%) used tamoxifen concurrently with an antidepressant, most commonly moderate inhibitors (n = 1815) and least commonly strong inhibitors (n = 427). Median overlap duration was 8 months (IQR: 3-20). During follow-up, 443 patients (3.0%) developed metastasis: 161 of 4780 concurrent users (3.4%) versus 282 of 9991 nonusers (2.8%). Concurrent antidepressant use was not significantly associated with metastasis risk (HR = 0.99; 95% CI: 0.81-1.21). Exposure duration was also not significantly associated with metastasis. Use of mixed-inhibitor regimens was associated with higher risk in partially adjusted models (HR = 1.39; 95% CI: 1.04-1.87), though full adjustment attenuated the association.</p><p><strong>Conclusions: </strong>Concurrent antidepressant use was not significantly associated with increased metastasis risk among women receiving tamoxifen for nonmetastatic breast cancer. Individualized and coordinated decisions regarding antidepressant selection may help balance cancer control goals with the psychological and symptomatic management needs in this population.</p>","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"35 10","pages":"e70617"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial Toxicity and Follow-Up Quality of Life Among Breast Cancer Survivors in the BOLD Cohort.","authors":"Ivan H C Wu, Rachel I Vogel, Patricia I Jewett, Anne H Blaes","doi":"10.1002/pon.70630","DOIUrl":"10.1002/pon.70630","url":null,"abstract":"<p><strong>Background: </strong>Financial toxicity is prevalent in cancer survivorship and has been associated with poorer health-related quality of life (HRQOL), yet longitudinal evidence remains limited. We examined associations between financial toxicity and HRQOL at baseline and 4-month follow-up among breast cancer survivors in the BOLD cohort.</p><p><strong>Methods: </strong>Data were drawn from self-report questionnaires completed by 182 breast cancer survivors at baseline, of whom 146 completed 4-month follow-up surveys. Financial toxicity was assessed at baseline using the Comprehensive Score for Financial Toxicity (COST). HRQOL outcomes were assessed at baseline and approximately 4 months later using the Functional Assessment of Cancer Therapy-General (FACT-G) subscales and total score, and a single-item measure of sleep disturbance. Multivariable linear regression models estimated adjusted cross-sectional associations and longitudinal associations between baseline financial toxicity and follow-up outcomes, adjusting for baseline levels of the corresponding outcome. Longitudinal measurement invariance of the COST was evaluated.</p><p><strong>Results: </strong>Greater baseline financial toxicity was associated with lower baseline physical, social/family, emotional, and functional well-being, lower FACT-G total score, and greater sleep disturbance. In longitudinal models, higher baseline financial toxicity was associated with lower follow-up physical, social/family, emotional, and functional well-being and lower FACT-G total score after adjustment for demographic and clinical covariates and the corresponding baseline outcome. Baseline financial toxicity was not associated with follow-up sleep disturbance.</p><p><strong>Conclusions: </strong>Financial toxicity was associated with poorer HRQOL at baseline and with lower physical, social/family, emotional, functional, and overall HRQOL at follow-up. These findings support greater attention to financial toxicity in survivorship care.</p>","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"35 10","pages":"e70630"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Diagnosis Depression and Suicide Risk Among Cancer Survivors: A Nationwide Population-Based Cohort Study.","authors":"Sangjun Lee, Soyeoun Kim","doi":"10.1002/pon.70635","DOIUrl":"https://doi.org/10.1002/pon.70635","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer are at increased risk of suicide, but the contribution of depression arising after cancer diagnosis remains poorly characterised.</p><p><strong>Aims: </strong>To evaluate whether first-recorded depression after cancer diagnosis was associated with subsequent suicide risk among adults with cancer who had no documented depression before cancer diagnosis.</p><p><strong>Methods: </strong>Using the South Korean National Health Insurance Service database. 755,079 adults newly diagnosed with cancer between 2009 and 2013, without documented depression before cancer diagnosis, were followed through 2023. Depression after cancer diagnosis was defined using ICD-10 codes and modelled as a time-dependent exposure, and suicide was identified from national mortality records. The primary analysis used cause-specific Cox regression to estimate adjusted hazard ratios (aHRs); Fine-Gray regression was used as a complementary analysis accounting for non-suicide death as a competing event.</p><p><strong>Results: </strong>During a median follow-up of 13.0 years, 1926 deaths by suicide occurred. Suicide incidence rates were higher among patients with post-diagnosis depression than among those without depression (47.0 vs. 17.7 per 100,000 person-years). In multivariable time-dependent Cox models, post-diagnosis depression was associated with a substantially increased risk of suicide (aHR 4.76, 95% confidence interval [CI] 4.28-5.28). The association was stronger among patients younger than 60 years and among women (both p for interaction < 0.001).</p><p><strong>Conclusion: </strong>Depression arising after cancer diagnosis was strongly associated with suicide risk in this nationwide cohort and represents a clinically relevant marker of suicide risk among cancer survivors, supporting the integration of systematic mental health assessment into routine oncology care.</p>","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"35 10","pages":"e70635"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Needs of Rural Caregivers of Patients With Cancer: A Scoping Review of Evidence From North America, Europe, and Australia.","authors":"Jeanne M Ward, Christa Torrisi, Nicole Werner, Victoria Champion","doi":"10.1002/pon.70615","DOIUrl":"10.1002/pon.70615","url":null,"abstract":"<p><strong>Introduction: </strong>Informal caregivers (caregivers) in rural areas experience many stressors affecting their mental and physical health. This review will synthesize the current needs of cancer caregivers in rural areas to inform future research and interventions.</p><p><strong>Methods: </strong>Five databases (PsycInfo, CINAHL, EMBASE, PubMed, and Family & Society Studies Worldwide) were queried to identify studies examining mental health and quality-of-life outcomes in rural caregivers of cancer patients worldwide, using the Arksey and O'Malley principled analytic framework. A priori criteria included rural caregivers of adult cancer patients in peer-reviewed studies from 2005 to 2025.</p><p><strong>Results: </strong>Database searches yielded 337 records. After title and abstract screening, 134 articles were reviewed, and of these, 35 met a priori criteria. The most frequent problems identified among rural cancer caregivers were mental health issues (depression and anxiety), loneliness or isolation, fatigue and physical issues, provider issues, and financial issues, especially related to travel, balancing duties, and cultural differences between rural populations and urban providers. Most articles were from outside the U.S.; however, results from rural caregivers in the U.S. described needs reflected in literature from other countries.</p><p><strong>Conclusions: </strong>Given increased utilization of caregivers in the U.S. and the rural burden of cancer, it is crucial to identify caregivers' unmet needs. Home-based cancer care is increasing, necessitating additional studies to determine needs and develop effective interventions for rural caregivers. Rurally competent care from healthcare providers who interface with caregivers of their cancer patients is vital, as caregivers are well-positioned to partner with providers to improve the well-being of those patients.</p>","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"35 10","pages":"e70615"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Clinical Reality to Blueprint Designing: A Qualitative Study Exploring Communication Challenges and Unmet Needs for Patient Decision Aid Development in Early-Stage Breast Cancer.","authors":"Serena Sdinami, Martina Maialetti, Valeria Sebri, Paola Zagami, Roberto Grasso, Giuseppe Curigliano, Gabriella Pravettoni","doi":"10.1002/pon.70622","DOIUrl":"https://doi.org/10.1002/pon.70622","url":null,"abstract":"<p><strong>Introduction: </strong>A diagnosis of early-stage Breast Cancer (BC) induces significant psychological distress in patients, who are then required to make complex treatment decisions. Evidence-based tools like Patient Decision Aids (PDAs) have been proposed as tools to support communication and Shared Decision-Making (SDM). However, their successful use in clinical practice depends also on real-world consultation dynamics. Existing literature suggests that insufficient attention to contextual and user-centered factors may limit the relevance and uptake of PDAs. A bottom-up approach grounded in clinical reality may therefore be essential to inform their design and future integration into care.</p><p><strong>Aims: </strong>This study aimed to explore experiences, unmet needs and expectations of both patients and healthcare professionals involved in early-stage breast cancer care regarding decision-making support and standard oncological consultations, in order to identify patient- and clinician-derived design requirements for a future PDA supporting shared treatment decision-making in early-stage breast cancer.</p><p><strong>Methodology: </strong>We conducted 52 semi-structured interviews with 20 patients and 32 HCPs at the European Institute of Oncology in Milan from 10 January 2025 to 30 August 2025. Interviews were transcribed and analyzed using thematic analysis, with coding performed by two independent researchers and discrepancies resolved through independent discussion with two other authors.</p><p><strong>Results: </strong>HCPs highlighted three key themes: variability in patient information needs, misconceptions about treatments (especially chemotherapy and radiotherapy), and the multifactorial nature of treatment decisions. Patients emphasized the importance of trust in physicians, the need for practical information on side effects and coping strategies, and the role of peer support, often found through informal networks or social media. These findings identified preliminary requirements for a future PDA: adaptable information depth and timing; plain-language responses to common misconceptions; structured values-clarification prompts; practical preparation and side-effect-management information; signposting to vetted psychosocial and peer-support resources.</p><p><strong>Conclusions: </strong>Findings highlight communication challenges and unmet psychosocial and informational needs within standard oncological consultations for early-stage breast cancer. By grounding decision support development in the perspectives of both patients and healthcare professionals, this study provides formative, pre-implementation insights to guide the design of PDAs that are responsive to real-world clinical contexts and patient experiences.</p><p><strong>Trial registration: </strong>clinicaltrials.gov, identifier: NCT06762496. Registered 7th January 2025 -https://clinicaltrials.gov/study/NCT06762496.</p>","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"35 10","pages":"e70622"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manifestations of Body Image Distress in AYA Cancer Survivors: A Qualitative Analysis of Participants in an Expressive Writing Intervention.","authors":"Victoria Wytiaz, Amy Hecht-Zizes","doi":"10.1002/pon.70626","DOIUrl":"10.1002/pon.70626","url":null,"abstract":"<p><strong>Background: </strong>Body image distress is a major concern for cancer survivors and includes views on physical appearance and body functions. As body image is largely developed in adolescence and young adulthood with implications for self-identity and social relationships, it may impact adolescent and young adult (AYA) cancer survivors in distinct ways.</p><p><strong>Aims: </strong>Explore the manifestations of body image distress in adolescent and young adult cancer survivors who participated in a body image-focused expressive writing intervention.</p><p><strong>Methods: </strong>Semi-structured interviews focusing on the body image experience were conducted and reviewed with a reflexive thematic analysis approach embedded within an interpretative phenomenological framework.</p><p><strong>Results: </strong>Qualitative analysis of 24 interviews revealed the following themes: Feasibility and Acceptability; Reconciling Intellectual and Emotional Understanding of Anticipated Body Image Changes; What We Gained and What We Lost; Body Image Distress as a Source of Guilt and Shame; We are a Community, but We Lack a Community.</p><p><strong>Conclusions: </strong>Discussion of body image distress represented an example of trauma-informed care that allowed participants to build a small community within the study and regain a sense of self identity lost in the cancer experience. This approach informs suggestions for cancer survivorship care and adopting a trauma-informed care approach during clinical or research environment. Future studies will endeavor to facilitate the adaptation of expressive writing to the needs of a given cancer survivor while building a community around those who seek to further their intellectual and emotional understanding of the ramifications of body image distress with peers.</p>","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"35 10","pages":"e70626"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric Properties of Patient-Reported Outcome Measures for Cancer-Related Cognitive Impairment: A Systematic Review.","authors":"Yuan-Mei Lan, Zi-Tian Zhu, Hao-Qi Wu, Yue-Ying Feng, Tian-Chao Chen, Yun-Feng Bai, Chen Zhu, Ying Liu, Ming-Xi Zhao, Yuan Xu, Xin-Juan Wu","doi":"10.1002/pon.70619","DOIUrl":"10.1002/pon.70619","url":null,"abstract":"<p><strong>Objective: </strong>To systematically identify and evaluate the psychometric properties of patient-reported outcome measures for assessing cancer-related cognitive impairment.</p><p><strong>Methods: </strong>This systematic review was conducted in accordance with COSMIN methodology. Five databases (PubMed, Embase, CINAHL, Web of Science and PsycInfo) were searched from inception to December 31, 2025. Studies reporting the development and/or validation of PROMs for assessing CRCI were eligible for inclusion. Methodological quality was assessed using the COSMIN Risk of Bias Checklist. Psychometric properties were rated using the COSMIN criteria, and the quality of evidence for each instrument was graded using a modified GRADE approach.</p><p><strong>Results: </strong>A total of 28 studies encompassing 19 PROMs for assessing CRCI were included. Measurement error and responsiveness were each evaluated in one study. The EORTC IADL-BN32 was the only Grade A instrument, although its evidence was restricted to adults with brain tumours. The other 18 instruments received Grade B recommendations, indicating that they have potential for use but require further validation.</p><p><strong>Conclusions: </strong>The EORTC IADL-BN32 is currently the best-supported instrument for adults with brain tumours, but its applicability to broader CRCI populations remains uncertain and requires further validation. Evidence for interpreting change was particularly limited, since measurement error and responsiveness were each evaluated in only one study, and neither yielded sufficient evidence. Instrument selection should be population- and purpose-specific, and further validation of measurement error, responsiveness and cross-cultural validity is required. Future studies should adhere to COSMIN guidelines to ensure comprehensive evaluation of all psychometric properties during instrument development and validation.</p><p><strong>Registration: </strong>PROSPERO (CRD420251033872).</p>","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"35 10","pages":"e70619"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial Well-Being and Care Among Advanced Cancer Patients: A Multi-Country Southeast Asia Study.","authors":"Irene Teo, Vinh Anh Huynh, Chetna Malhotra, Semra Ozdemir, Dang Hoai Bao, Nattiya Kapol, Maria Fidelis Manalo, Pham Nguyen Tuong, Rudi Putranto, Wah Wah Myint Zu, Eric A Finkelstein","doi":"10.1002/pon.70620","DOIUrl":"https://doi.org/10.1002/pon.70620","url":null,"abstract":"<p><strong>Background: </strong>Psychosocial care is an integral part of palliative oncology care, yet little is known about psychosocial well-being and care in Southeast Asia. This study examined psychosocial well-being and its associated factors among advanced cancer patients across the region, and explored psychosocial support services they received.</p><p><strong>Method: </strong>This cross-sectional, multi-country study recruited 1198 adults diagnosed with stage IV solid cancer who were receiving oncology care in Indonesia, Myanmar, the Philippines, Singapore, Thailand and Vietnam.</p><p><strong>Results: </strong>Using the Functional Assessment of Cancer Therapy-General, the mean emotional and social well-being scores were 17.22 (SD = 5.30) and 20.59 (SD = 4.48) respectively, with larger cross-country variation in emotional than social well-being. Greater symptom burden and financial difficulties were associated with poorer emotional well-being <math><mrow><mi>β</mi></mrow> </math>  = -0.34 (95% CI: -0.39, -0.29), -0.36 (-0.53, -0.20) and social well-being -0.13 (-0.17, -0.08), -0.44 (-0.62 to -0.27), respectively. Being 45 years and younger -0.84 (-1.52, -0.16) and knowledge of one's advanced-disease -1.33 (-2.17, -0.49) were associated with poorer emotional well-being, while having less years of education 0.09 (0.02-0.16) and being assessed during an outpatient visit 0.89 (0.20, 1.58) were associated with poorer social well-being. Among those who completed depression screeners, 21% met the threshold scores for depression. Despite this, only 3% of the overall sample received psychosocial support services, though 42% of those who did not indicated openness to a referral.</p><p><strong>Conclusions: </strong>There is a vital unmet need for psychosocial oncology support services in Southeast Asia. Efforts to systematically screen for distress and develop psychosocial support services are warranted.</p>","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"35 10","pages":"e70620"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregiver Burden and Neuro-Oncology Patient Function: Impacts on Relationship Quality.","authors":"Maija Reblin, Deanna Witte, Kristen J Wells, Peter Forsyth, Margaret M Byrne","doi":"10.1002/pon.70634","DOIUrl":"10.1002/pon.70634","url":null,"abstract":"<p><strong>Background: </strong>Prior work has identified the protective effects of relationship quality on cancer outcomes. However, less work has focused on how the cancer experience can change relationship quality.</p><p><strong>Aims: </strong>To describe neuro-oncology patient-caregiver relationship quality over time and identify the impact of caregiver burden and patient physical and cognitive function on perceptions of relationship quality.</p><p><strong>Methods: </strong>This is a secondary analysis of data obtained at enrollment and 8 weeks. Actor-partner interdependence models of patient and caregiver ratings of their relationship to each other (Couples Satisfaction Index) over time also included baseline measures of patient cognitive and physical function (Neuro-QOL), caregiver burden (Zarit), and change in these measures.</p><p><strong>Results: </strong>Data from 124 neuro-oncology patient-caregiver dyads were analyzed. Relationship quality at both time points, on average, indicated non-distressed relationships, but patients rated relationship quality significantly better than caregivers. Both rated relationship quality significantly worse over time (p values < 0.022). At baseline, caregiver burden was significantly negatively associated with patient (p = 0.014) and caregiver relationship quality (p < 0.001). Patient and caregiver baseline relationship quality predicted their own 8-week scores (actor effect; p values < 0.001). Baseline patient cognitive function (p = 0.011) and change in patient cognitive function (p = 0.039) were positively associated with 8-week patient relationship quality. Change in caregiver burden was negatively associated with 8-week caregiver relationship quality (p < 0.001).</p><p><strong>Conclusions: </strong>Prior research has largely focused on relationship quality as a resource, but factors associated with the cancer experience may impact perceptions of relationship quality. Lowering caregiver burden may be beneficial to preserving this important coping resource.</p>","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"35 10","pages":"e70634"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Double Awareness Model Among Patients With Advanced Cancer in China: A Constructivist Grounded Theory Study.","authors":"Ruoyi Xu, Dong Zhang, Xiaoxiao Hu, Qingchun Geng, Jun Luo, Yaqin Zhou, Yanfei Jin","doi":"10.1002/pon.70623","DOIUrl":"https://doi.org/10.1002/pon.70623","url":null,"abstract":"<p><strong>Objective: </strong>Double awareness, defined as the capacity to engage with life while acknowledging mortality, has been conceptualized primarily within Western cultural contexts. This study aimed to develop a contextually informed interpretive model of double awareness among patients with advanced cancer in China.</p><p><strong>Methods: </strong>A constructivist grounded theory approach was adopted. Semi-structured interviews were conducted with 10 patients with stage IV or recurrent/metastatic cancer recruited from an oncology department and a hospice care facility in China. Data were analyzed iteratively using initial, focused, and theoretical coding, together with constant comparison.</p><p><strong>Results: </strong>Double awareness was conceptualized as an interpretive model comprising three interrelated experiential domains: Life Engagement, Death Contemplation, and Legacy Continuation. These domains were described as coexisting and interconnected rather than unfolding as a fixed sequence. Psychosomatic Adjustment, encompassing fluctuations in physical symptoms, emotional states, temporal perception, and energy allocation, emerged as a regulatory process that shaped how participants sustained, negotiated, or experienced these domains. In this sample, Legacy Continuation was particularly salient in some participants' accounts, especially in relation to family relationships, intergenerational responsibilities, and the transmission of values.</p><p><strong>Conclusions: </strong>Among Chinese patients with advanced cancer, double awareness was conceptualized as a multidimensional and contextually situated experience. The model provides a preliminary conceptual framework for generating hypotheses and informing future culturally responsive psychosocial and palliative care research, with further validation needed across diverse populations, care settings, and longitudinal contexts.</p>","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"35 10","pages":"e70623"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}