PurposeEffective parent–child communication is central to coping with psychosocial challenges of pediatric cancer, yet few studies have examined how caregivers and children perceive their communication. This study investigated differences between caregiver and child reports of communication and associations with family relationship quality. We hypothesized children would report more open and positive communication than caregivers report, reflecting directional discrepancies in communication quality.MethodsSeventy-six caregiver–child dyads (N = 152) were recruited from two Midwestern pediatric hospitals. Children aged 8–17 with cancer and their caregivers independently completed measures of parent–child communication (PCCS) and family relationships (PROMIS). Descriptive statistics, correlations, and paired- and independent-samples t-tests examined differences and associations across dyads. Exploratory Actor–Partner Interdependence Models (APIM) investigated dyadic associations between child and caregiver communication and child family relationships.ResultsCaregivers (10-item: M = 3.90, SD = 0.55; 20-item: M = 3.94, SD = 0.58) and children (M = 4.15, SD = 0.61) reported generally high-quality communication. However, significant differences emerged: children rated caregivers as more attentive listeners (t(74) = 2.53, p = .01, Cohen’s d = 0.29), emotionally open (t(74) = 2.30, p = .02, Cohen’s d = 0.27), and willing to discuss problems (t(74) = 2.86, p = .005, Cohen’s d = 0.33) than caregivers reported children. Across correlation and APIM analyses, child-reported communication was strongly associated with child-reported family relationships and caregiver-reported communication was strongly associated with caregiver-reported child family relationships (actor effects). Older caregiver and child age was linked to lower communication scores.ConclusionsInterdependent caregiver and child perceptions of communication represent an underrecognized factor influencing family functioning in pediatric cancer. Findings underscore the importance of routine communication assessment and highlight the need for developmentally tailored interventions.

PurposeBreaking bad news (BBN) in pediatric oncology is emotionally complex and often poorly supported by training or guidelines. The OKRA-Compass, developed through participatory research, provides practical recommendations aiming to enhance BBN quality in German pediatric oncology settings. This paper aims to track insights into the everyday BBN routine.MethodsAfter 6 weeks implementing the OKRA-Compass in five pediatric oncology clinics, a focus group and written feedback captured user experiences. Using thematic analysis, researchers coded and analyzed data to assess perceived changes. The participatory approach included co-researchers, and findings were linked to the Compass’s Delphi-based theses for deeper insight.ResultsApplying the OKRA-Compass revealed four key outcomes: (1) Considering BBN as a complex process, (2) addressing the multi-layered needs of BBN receivers, (3) encouraging new paths for shared decision-making, and (4) cultivating awareness of the needs of healthcare professionals. Interdisciplinary use enhanced preparation, communication, and emotional safety while highlighting the need for structured training and institutional anchoring of BBN practices.ConclusionThe OKRA-Compass supports high-quality, individualized BBN by structuring communication, fostering emotional attunement, and promoting shared decision-making. It enhances interdisciplinary collaboration and self-reflection among healthcare providers. Findings highlight its practical relevance, though broader evaluation is needed. The tool offers a promising framework for improving communication culture in pediatric oncology. This process demands a readiness to adapt, allocate resources, and invest in enhancing team communication skills.

PurposeTo evaluate the knowledge level of Turkish urologists regarding the lifestyle changes related to bladder cancer and to what extent they question patients’ lifestyles and guide them in making recommended changes.MethodsA 14-question online survey, based on a questionnaire prepared by Beeren et al. (Bladder Cancer 10(3):215-220, 2024), was sent to Turkish urologists. The survey included demographics, familiarity with guidelines, lifestyle assessment and advice, and perceived barriers during care for BC patients.ResultsThe mean age of the 252 participants was (44.8 ± 9.3), approximately 40% were affiliated with an academic hospital, and approximately 50% had more than 10 years of experience. Almost all were interested in uro-oncology, with 30% devoting more than half of their daily practice to uro-oncology. Smoking was reported as the most frequently questioned issue, for which advice was given and referrals to a lifestyle specialist provided when necessary. Asking about and giving advice regarding fluid intake came second, with approximately 50% mentioning this issue. Referral rates were low for lifestyle factors other than smoking. The most frequently reported barriers were a lack of information about where patients should be referred, insufficient motivation of patients, and concern about blaming patients.There is a positive correlation between knowledge on ideal body weight and physical activity with asking about lifestyle changes (p = 0.004, p = 0.000), and giving lifestyle advice (p = 0.014, p = 0.003) and between knowledge on ideal body weight with referring for lifestyle advice and perception in lifestyle factors (p = 0.035, p = 0.016).ConclusionsLifestyle changes in bladder cancer patients are not sufficiently integrated into routine clinical practice by urologists. Although lifestyle changes are perceived as important by most urologists, they encounter some barriers in making these recommendations to their patients.

PurposeAdvance directives (AD) are a key tool within advance care planning (ACP), intended to support patient autonomy and guide end-of-life care. Despite their legal recognition in France, their use in the general population remains limited. Moreover, data on AD use among patients with advanced cancer, a population particularly concerned by end-of-life decisions, remain scarce. This study aimed to assess the knowledge and opinions regarding AD among patients with advanced cancer in France who were receiving specialized palliative care.MethodsBetween 2016 and 2020, we conducted a multicenter cross-sectional study across 14 palliative care departments in France. Patients with advanced cancer completed a standardized questionnaire assessing their awareness, use, and perceptions of AD, along with sociodemographic and clinical characteristics.ResultsA total of 331 patients were included. Among them, 53.5% were aware of AD, and 23.6% had completed one. Overall, 72.2% of patients supported legally binding AD, and 66% opposed fixed expiration dates; among those favoring time limits, most chose 1–3 years. In multivariable analysis, a higher educational level and prior treatment during the curable phase were independently associated with knowledge of AD, while completion was associated with older age, higher education, and the absence of ongoing cancer treatment. A higher educational level was also associated with favoring legally binding AD.ConclusionFrench rates of AD completion remain modest. Our findings highlight the need for personalized, repeated discussions about end-of-life preferences and for enhanced clinician training in ACP. AD should be approached as a flexible tool within broader patient-centered discussions.Clinical trials identifierNCT03664856.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10352-3.

PurposeCancer-related cognitive impairment (CRCI) can impact cancer survivors’ return to work and occupational functioning for many years following the completion of cancer treatment. Understanding the characteristics of CRCI-related occupational difficulties and unmet supportive care needs is critical for the development of effective interventions. Within occupational roles, a higher level of education is typically associated with greater cognitive load and different demands. The objective of this study was to examine whether the level of education accounted for CRCI-related (a) occupational difficulties and (b) occupational unmet supportive care needs, beyond the contributions of perceived cognitive functioning and employment level.MethodsA cross-sectional design was utilised using a sub-section of an existing self-reported dataset involving 358 employed cancer survivors, comprising demographic and clinical data, as well as data from MASCC COG-IMPACT and PROMIS Cog tools. Hierarchical multiple linear regression models were used for hypothesis testing.ResultsAfter accounting for perceived cognitive functioning and employment level, highest level of education did not account for a significant amount of unique variance in CRCI-related occupational difficulties (R2 Change = 0.004, F Change (1, 354) = 3.26, p = .147). However, after accounting for perceived cognitive functioning and employment level, highest level of education did account for a significant amount of unique variance in CRCI-related occupational unmet needs (R2 Change = 0.011, F Change (1, 354) = 4.75, p = .030).ConclusionTheoretical explanations of findings, including compensatory accommodations such as role adjustment and differences in the availability of occupational support, are provided. It is proposed that those with higher levels of education may not have access to appropriate levels of supportive care as it relates to CRCI in occupational settings, thus potentially informing future interventions. It is proposed that individuals with higher levels of education may experience gaps in supportive care for CRCI, particularly in relation to maintaining work performance and meeting occupational expectations. This suggests that future interventions should consider strategies to better support cognitive functioning in workplace contexts for cancer survivors.

PurposeFebrile neutropenia (FN) is a common side effect of chemotherapy. It may be prevented by granulocyte colony-stimulating factors (G-CSF), requiring customization based on patients’ risk factors, the type of cancer and chemotherapy, and the formulation used. This observational study investigated all-day use of a pegfilgrastim formulation, also available for self-administration.MethodsIn outpatient clinics across Germany, doctors recorded data of adult patients suffering from a malignant disease routinely treated with chemotherapy and pegfilgrastim.ResultsOverall, 1636 patients received pegfilgrastim, predominantly women suffering from yet untreated breast cancer, 62% being at moderate and 38% at high risk of FN. In total, 2.5% of patients experienced FN despite treatment with pegfilgrastim, with 52.5% requiring hospitalization; in 40%, subsequent chemotherapy had to be postponed or reduced in dose. FN incidence and hospitalization rates were slightly lower when pegfilgrastim was given for primary versus secondary prophylaxis whereas there was no difference when given on day 1 or any later day following chemotherapy. FN incidence was much higher in patients with hematological as compared to solid tumors, particularly when treated with BEACOPP regimens. By contrast, related hospitalization depended less on cancer type and chemotherapy. Pegfilgrastim counterbalanced patients’ risk factors, but a previous FN episode and male sex still increased the risk of hospitalization. Overall, 13.4% of patients experienced infections. The most common side effect of pegfilgrastim was bone-related pain. The syringe and self-injector formulations showed comparable effectiveness and safety.ConclusionsPegfilgrastim (Pelgraz®) treatment appeared to be effective and safe in all-day practice.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10354-1.

PurposeAccurate illness understanding is a necessary component of goal-concordant care. Few prior studies have investigated systematic screening for illness understanding. The objectives of this study were to determine the extent of agreement between patient-reported and oncologist-documented cancer treatment intent using systematic screening and to explore the association between such agreement and patient characteristics.MethodsWe implemented illness understanding screening for patients who presented to our supportive care center (SCC). We compared patient responses regarding chance of cure and primary treatment goal on a survey administered at their initial consultation visit with the oncologist-documented treatment intent in the electronic health record.ResultsThe analysis included 300 patients (mean age, 59 years); most were women (56%), were White (80.3%), and had advanced disease (78%). Regarding concordance, 152 (50.7%) patients had concordant treatment intent (cure, n = 64; non-cure, n = 88), and 148 (49.3%) patients had discordant treatment intent, with 98.6% (n = 146) of patients with discordant treatment intent inaccurately reporting a treatment intent of cure. Patients with discordant treatment intent were more likely to be Black (OR = 3.13, p = 0.02), have a primary cancer site of “other” (mostly melanoma and sarcoma) (OR = 2.30, p = 0.04), have advanced disease (OR = 6.25, p < 0.001), and report lower spiritual pain (OR = 0.88, p = 0.04).ConclusionThe rate of inaccuracy in patient-reported curability perception and primary treatment goal at our SCC is high, supporting the need for systematic screening and communication interventions to improve illness understanding and provide goal-concordant care.

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.

PurposeWe examined trends in emotional distress among survivors of childhood and adolescent and young adult (CAYA) cancers.MethodsWe analyzed the 2008–2018 National Health Interview Survey (NHIS) data among individuals (n = 6451) who were diagnosed with cancer between 0 and 39 years of age. Emotional distress was assessed using the validated Kessler 6-item scale. Respondents rated how often they felt nervous, hopeless, restless, or fidgety, so sad that nothing could cheer them up, that everything was an effort, and worthless in the past 30 days. Responses were scored and added to produce a range of 0–24. We classified emotional distress as mild/no (score of less <5), moderate (score between 5 and 12), or severe distress (≥ 13). Joinpoint regression estimated yearly increases/decreases in psychological distress using annual percent changes.ResultsOverall, the proportion of individuals experiencing mild/no psychological distress increased by 1.68% annually between 2008 and 2014 and then decreased by 1.34% annually between 2014 and 2018, although not statistically significant. The proportion of individuals experiencing moderate distress decreased by 3.06% annually between 2008 and 2014 and then increased by 4.18% annually between 2014 and 2018, although not statistically significant. The proportion of individuals experiencing severe distress remained stable between 2008 and 2014 and then decreased by 7.36% annually between 2014 and 2018, although not statistically significant. No statistically significant trend in emotional distress was observed when stratified by patients’ demographics and access to mental health services.ConclusionWe found that trends in emotional distress among survivors of CAYA cancers have not changed significantly over the 2008–2018 decade, overall and when stratified by gender, race/ethnicity, marital status, and visit to a mental health professional within the past year.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10580-7.

PurposeThe Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO) has published evidence-based international guidelines for the management of oral mucositis (OM). However, adherence to these guidelines has not been evaluated. This survey assessed OM management in hematopoietic cell transplantation (HCT) centers in Australia and New Zealand.MethodsSpecialist nurses in 41 transplant hospitals were invited to complete a survey. Questions covered general unit information, oral assessment (tools, assessors, frequency), prevention strategies (guidelines, oral care, cryotherapy, photobiomodulation, palifermin, and barriers to use), and treatment strategies (pain management and nutritional support).ResultsOf 41 hospitals, 24 (59%) responded. All but one responder were specialized nurses. Oral assessment was primarily conducted by nurses (100%) and doctors (80%). The most commonly used tools were the World Health Organization grading scale (42%), pain scores (46%), and EviQ (Australian online cancer resource) (42%). EviQ guidelines (67%), which exclude palifermin and photobiomodulation, followed by institutional guidelines (29%) and MASCC/ISOO guidelines (17%). Oral care (100%) and cryotherapy with melphalan (96%) were widely adopted, while photobiomodulation and palifermin were rarely used due to cost and access barriers. For OM-related pain, as-needed opioids (100%), patient-controlled analgesia (58%), and topical analgesics (46%) were common. When OM impaired oral intake, supportive measures included supplemental drinks (88%), enteral nutrition (50%), and parenteral nutrition (67%).ConclusionIn Australia and New Zealand, national EviQ guidelines are used more often than the MASCC/ISOO guidelines. Feasibility for implementing palifermin and photobiomodulation should be reassessed, and greater collaboration in developing guidelines is necessary.