PurposeLong-term breast symptoms (pain, sensitivity, swelling and skin problems) after breast cancer treatment can affect survivors' quality-of-life. The trajectory of breast symptoms over time and risk factors associated with their development are not well understood.MethodsThis study built on the work of the international prospective REQUITE cohort study. Patients who underwent breast-conserving surgery and adjuvant radiotherapy (± chemotherapy) completed the EORTC-QLQ-BR23 questionnaire items relating to breast symptoms at four timepoints up to 24 months following radiotherapy. Patients at were re-contacted to complete additional psychometric questionnaires on different aspects of pain perception and the Hospital Anxiety & Depression Scale (HADS), with 237 respondents.ResultsAverage breast symptoms peaked on completion of radiotherapy but returned to levels equal to or below baseline by 24 months. Patients with more severe breast symptoms at baseline continued to have worse symptoms long-term. In multivariable mixed models, higher breast symptom scores were associated with smoking (p = 0.036), any analgesic use at baseline (p = 0.005), and post-operative haematoseroma (p = 0.034), while older age and use of intensity modulated radiotherapy (IMRT) were protective (p = < 0.001 and p = 0.045 respectively). Psychometric questionnaire scores for life interference and pain severity perception were associated with persistently increased breast symptoms at 24 months on multivariable analysis, while anxiety (as determined by HADS) was associated on univariable analysis.Conclusions and implications for cancer survivorsThis study identifies several risk factors for persistent breast symptoms including younger age, smoking, and post-operative haematoseroma. This particularly highlights the importance of smoking cessation and use of IMRT in women at higher risk of side effects.

PurposeIncreased distress has been associated with impairment related to cancer treatment and with post-traumatic growth (PTG), but the influence of treatment-related impairment on PTG has not been explored. This study aimed to understand the lived experience of PTG for cancer survivors living with treatment-related impairment.MethodsHermeneutic phenomenology was used to develop a deep understanding of the lived experience of adult cancer survivors living with ongoing treatment-related impairment who had experienced self-perceived PTG following their cancer experience. Semi-structured individual interviews conducted with eight participants were transcribed, manually coded, and thematically analysed.ResultsThis study demonstrated that people with ongoing treatment-related impairment can experience PTG through coping with cancer. PTG was both a coping process and an outcome of coping with adversity. Participants experienced growth outcomes in the domains of new possibilities, relating to others, personal strength, and appreciation of life. Participants first experienced a state of incongruence arising from the intrusion of cancer, which challenged their existing world view and self-concept. They reported using coping strategies to manage distress, enabling productive meaning making. A notable absence of distress about impairment was attributed to participants facing this later in their cancer trajectory when meaning making was well established, and their experience of impairment more readily assimilated.ConclusionThe extent of PTG in cancer survivors may depend on the degree of incongruence they experience and their ability to accommodate these contradictions to develop new meaning. Further research is needed to understand how early or visible treatment-related impairment influences cancer survivors’ PTG.

BackgroundThe growing global cancer burden highlights the urgent need to improve long-term outcomes among cancer survivors. Age-related biological changes may modify the associations between lifestyle factors and mortality, yet the joint effects of diagnostic age and lifestyle factors remain poorly understood.MethodsCancer survivors diagnosed between 2010 and 2018 in Guangzhou were followed up until 2023. Associations of lifestyle factors with all-cause mortality risk were examined, stratified by early-onset (< 50 years) and late-onset (≥ 50 years) cancers. Interactions were evaluated on multiplicative and additive scales.ResultsAmong 22,079 cancer survivors, 10,839 deaths occurred during a median follow-up of 4.14 years. An antagonistic interaction of diagnostic age with physical activity on all-cause mortality risk was observed. Compared with inactivity, physical activity (≥ 150 min/week) was associated with a 15% lower risk of all-cause mortality (restricted mean survival time [RMST] difference: 0.29 years) in early-onset survivors and a 23% lower risk in late-onset survivors (RMST difference: 0.69 years). A synergistic interaction of diagnostic age with sleep duration was observed. Compared with 7 h/day, short sleep duration (≤ 5 h/day) was associated with a higher mortality risk (RMST difference: −0.43 years) in early-onset survivors, while 8 h/day was associated with a lower risk in late-onset survivors (RMST difference: 0.13 years).ConclusionsSufficient physical activity and sleep duration were significantly associated with improved survival, with their effects varying by diagnostic age. These findings underscore the importance of tailored lifestyle management strategies for early-/late-onset cancer survivors to mitigate mortality burden.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10325-6.

IntroductionPrehabilitation is an increasingly recognised strategy designed to optimise patients’ physical, nutritional, and psychological status before major surgery. While the benefits of trimodal prehabilitation have been documented, we developed and implemented a quadrimodal model that incorporates occupational therapy as a fourth component. This comprehensive intervention targets frail patients with advanced oncogynecologic disease, a population at high risk for postoperative complications.Material and methodsThe study recruited 40 patients, 32 of whom successfully completed an intensive 3-week prehabilitation programme. The programme comprised four modules: physiotherapy, nutritional support, psychological support, and occupational therapy. Patients completed 4 days of inpatient care and 3 days of home care per week. The effectiveness of the programme was assessed using a range of methods, including physical tests (6-min walk test, 5 × sit-to-stand test), psychological status questionnaires (perceived stress scale) and nutritional assessment using established questionnaires (MUST and PONS).ResultsThe results demonstrated statistically significant enhancements in physical fitness assessments, a decline in the frailty index, and an augmentation in psychological well-being. Notably, three patients no longer fulfilled the frailty criteria at the conclusion of the programme. Spirometric parameters, including FVC, FEV1, and PEF, exhibited substantial improvement. The nutritional intervention resulted in a reduction in the number of patients at high risk of malnutrition. Additionally, there was a notable improvement in the nutritional parameters.ConclusionThis quadrimodal prehabilitation model, integrating occupational therapy, demonstrated effectiveness in preparing frail oncologic patients for radical surgery. The approach not only improved physical and psychological readiness but also allowed for patient stratification into responders and non-responders. Its implementation in clinical practice could enhance patient outcomes and reduce the burden of postoperative recovery.

PurposeFor those with a life-limiting illness, advance care planning (ACP) is essential for patient-centered care. However, there is limited research available on the timing and impact of ACP on patients with brain tumors, particularly with glioblastoma. The primary aim of this study was to determine if there is a relationship between advance directive (AD) documentation, a part of ACP, and depression, performance status scores, or demographics of patients with glioblastoma.MethodsThe sample consisted of 146 patients with glioblastoma, 98 of whom had documented AD, defined as within the 14 days prior to diagnosis or during their disease course, at a single comprehensive cancer center. Demographic characteristics, depression scores, performance status scores, and AD documentation were extracted from electronic medical records over repeated clinical time points. Logistic regression, mixed model, and generalized estimating equations models were used to assess relationships between patient variables and documentation of AD.ResultsNo statistically significant difference in depression scores was found between those with and without documented AD. There was a statistically significant difference in performance status, such that those with worse performance status were more likely to have a documented AD. Patients who were female, older, and not married were more likely to have documented AD.ConclusionIn our sample, AD was more likely to be established for patients with advanced disease and specific demographic factors, whereas depression scores did not predict presence or absence of AD. This may indicate that patients with decreased performance status may be more receptive to completing AD than those with better performance status. Alternatively, it could reflect that providers are more likely to approach the subject as their health deteriorates. Patients preparing for neurosurgical intervention might be more receptive to AD completion and ACP discussion than patients in other phases of care. We offer recommendations to promote a more proactive approach to AD so that more patients are prepared by the time their performance status starts to decline.Supplementary informationThe online version contains supplementary material available at 10.1007/s00520-026-10492-6.

PurposeTo investigate the long-term impact of hematopoietic cell transplantation (HCT) on oral health-related quality of life and dental treatment needs 5–10 years post-HCT.MethodsThis study combined questionnaires with a retrospective analysis of dental records. Adult survivors (219) of Radboudumc HCT-treatment in 2012–2017 received OHIP-14, summated XI, MFIQ and OES questionnaires. If returned with informed consent, dental records were requested from the dentist and the number of extractions and restorations performed from 7 years before to 10 years post-HCT was counted. Negative binomial and logistic regression models, adjusted for confounders, were used to evaluate the impact of HCT type (autologous vs. allogeneic) on questionnaire scores, extractions, and restorations.ResultsA total of 169 HCT recipients (84 allogeneic) completed questionnaires, and dental records were available for 145 patients. Allogeneic HCT recipients had significantly higher sum scores for the OHIP, XI, and MFIQ questionnaires (OHIP IRR = 2.1 [95% CI 1.4, 3.3]; XI IRR = 1.17 [95% CI 1.03, 1.34]; MFIQ IRR = 2.6 [95% CI 1.5, 4.5], respectively), but no significant difference was found for the OES. Allogeneic HCT recipients were more likely to have one or more extractions (OR = 4.5 [95% CI 1.3, 17.7]) compared to autologous HCT recipients. No significant difference was observed in the number of restorations between the two groups.ConclusionAllogeneic HCT recipients reported worse oral health-related quality of life, more xerostomia complaints, and more mandibular-function complaints than autologous HCT recipients. They were also more likely to undergo extractions post-HCT but no significant difference in restorations was observed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10685-z.

PurposeDetermine the acceptability of a community-based, practical Geriatric Assessment (GA) intervention among community health workers (Promotoras) and cancer survivor key informants. Promotora-delivered health assessment, education, and social support models of care are feasible and effective in chronic disease management, but more evidence is needed in the cancer survivorship context. Promotoras function as a bridge, connecting community-based services with populations with historically limited healthcare engagement.MethodsDescriptive qualitative design. We held focus groups with promotora key informants and interviews with older cancer survivor consultants, between January and February 2024. Researchers developed a semi-structured interview guide, informed by conceptual models and an implementation framework, to facilitate perceptions of promotora-guided interventions, GA, and cancer survivorship. Researchers performed content analysis with deductive and inductive techniques on transcribed interviews.ResultsAcceptability of the GA intervention was described by promotoras and cancer survivor consultants within three distinct categories: The GA intervention employs a motivator to help address survivorship complexities; the GA intervention plans for impaired ADLs and IADLs in survivorship; the GA intervention integrates promotoras with clinical oncology care.ConclusionThe proposed implementation of a practical GA intervention by promotoras was deemed acceptable. The findings provided essential contextual data to ensure that the pilot, practical GA study can establish feasibility and preliminary efficacy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10473-9.

BackgroundCancer treatments often cause skin toxicities that disrupt therapy and reduce patients’ quality of life, yet research on their management in the Middle East is scarce. This study aims to examine the practices and challenges of managing skin-related adverse effects in cancer patients.MethodsA mixed-method survey was conducted on a sample of dermatologists and oncologists practicing in Middle Eastern countries who were invited to participate in Pierre Fabre's annual Middle East Medical Convention. A brief online questionnaire, distributed to 250 dermatologists and 19 oncologists, using both quantitative and qualitative approaches, assessed the frequency, types, and management of skin conditions, alongside perceived barriers and referral practices.ResultsThe study included responses from 117 dermatologists and 19 oncologists. Oncologists encountered cancer-related skin manifestations considerably more often, with 44.4% seeing such cases daily compared to 8.1% of dermatologists (p < 0.001). Notable differences were also observed in the types of skin conditions reported, such as nail changes, which were significantly more frequent among dermatologists (72.6% vs. 31.6%, p < 0.001), whereas hand-foot syndrome was markedly more commonly observed among oncologists (89.5% vs. 6.0%, p < 0.001). Dermatologists reported feeling very comfortable managing these conditions more often than oncologists (50.4% vs. 10.5%, p = 0.004). Key barriers included the severity of skin conditions, selecting appropriate dermo-cosmetic products, and limited knowledge in onco-dermatology. The qualitative analysis highlighted oncologists’ challenges in managing skin toxicities under three main themes: (1) preventing cancer treatment interruptions, (2) limited specialized dermatologic knowledge and support, and (3) addressing patient-centered issues.ConclusionFindings reveal differing perspectives between dermatologists and oncologists and underscore the need for greater collaboration to optimize the management of cancer-related skin toxicities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-025-10254-w.

PurposeAssisted suicide (AS) is a socio-political and healthcare challenge. In Germany, AS is legal, with further regulation pending. Previous German legislation drafts proposed involving psychosocial professionals like psycho-oncologists. These are experienced in supporting seriously ill patients and end-of-life decisions. However, there is a lack of studies on their role in AS. This study aimed to explore psycho-oncologists’ current and future roles, tasks, and needs regarding AS requests.MethodsWe conducted a cross-sectional, qualitative interview study with psycho-oncologists in Germany. Inclusion criteria were current clinical activity as a psycho-oncologist and having talked to at least one patient about AS. Invitations to participate were distributed via email and social media using the study team’s network. Interested participants responded voluntarily (convenience sample). Data were analyzed using Practical Thematic Analysis and qualitative content analysis.ResultsTwelve interviews were conducted (average length of 42 min). Participating psycho-oncologists (58% female, 50% up to 40 years, 91.7% psychological and 8.3% medical professional background) primarily saw themselves as open-minded conversation partners, both currently and in the future. Opinions differed as to whether psycho-oncologists should assess decision-making capacity. The vast majority rejected participation in the actual act of ending one’s life. They opposed psycho-oncologists having to fulfill mandatory tasks in the context of AS. Key needs for engaging in AS-related work included clinical practice guidelines, legal clarity, and specific training opportunities.ConclusionThis study provides initial insights into (potential) roles, tasks, and needs of psycho-oncologists in AS requests. It can serve as a basis for follow-up studies. Suitable structures and training opportunities should be developed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10656-4.

AimsThis study aimed to identify the behavioral determinants influencing the integration of physical activity into the care pathway of postmenopausal women with hormone receptor–positive breast cancer. It specifically addressed the following research question: What are the main barriers and facilitators, from both patient and healthcare professional perspectives, that influence the integration of physical activity into routine care?MethodsThis qualitative study was based on the Theoretical Domains Framework and the Capability, Opportunity, Motivation – Behavior (COM-B) model.Semi-structured interviews were conducted and the analysis was guided by these frameworks, complemented by inductive thematic analysis, to capture nuanced insights in this clinical context.ResultsBarriers for patients include misconceptions, fatigue and difficulties with autonomous PA practice, while healthcare professionals emphasize the need for practical training and clear protocols. Key enablers included early physical activity assessment, personalized and playful interventions, peer support, and the emerging role of advanced practice nurses in structuring care transitions. Digital tools show promise for sustainable engagement when co-designed with patients and integrated into therapeutic relationships.ConclusionThe study identifies concrete levers for integrating physical activity into oncology care, combining behavioral frameworks with nursing science to better understand clinical realities. These findings provide practical guidance for developing sustainable strategies and reinforce the need for person-centered, coordinated approaches to make physical activity a fully recognized component of breast cancer care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10469-5.