Cancer Survivors Research Articles

Psychosocial burden and sociodemographic characteristics of cancer survivors seeking support for work-related issues in outpatient cancer counseling centers

ABSTRACT Introduction Outpatient cancer counseling centers (OCCs) are important social work facilities that provide support for cancer survivors who have psychosocial and sociolegal challenges. This paper explores clinical and sociodemographic characteristics, psychosocial burden as well as access routes of clients in OCCs seeking work-related counseling. Methods Between May 2022 and December 2023, data were collected in 19 OCCs, using questionnaires and documentation by counselors. Results The 719 cancer survivors surveyed had a mean age of 50 and were predominantly female (78%); 46% had been diagnosed with breast cancer. Most respondents had university entrance certificates (42%). The respondents rated their overall life and job satisfaction at a mean of 5 and distress at a mean of 7. The majority of respondents had received information about the OCC from the hospital. Discussion The results show that especially women with breast cancer and high socioeconomic status made use of counseling in the CARES study. The respondents also had a high sense of burden and dissatisfaction and access routes to the OCCs were mainly through recommendations of the treating hospitals or physicians. These findings can be used to ensure need-based counseling in the OCC, as well as to address additional target groups that are currently underrepresented.

Partners' Perspectives on the Impact of Cancer on Romantic Relationships and Marriage in Adolescent and Young Adult Cancer Survivors.

Purpose: This study aims to explore the impact of cancer on romantic relationships and marriage from the perspective of partners of adolescent and young adult (AYA) cancer survivors. Methods: Semistructured interviews were conducted with 10 partners, of any gender and cancer type, who entered into a relationship or decided to marry after the AYA's cancer diagnosis. Results: Three key themes emerged regarding the impact of cancer on romantic relationships and marriage: no change or impact, positive impact, and anxiety. Negative impacts were rarely reported, although some participants suggested that, had the illness been more severe or active at the time they met, they might have hesitated to commit or marry. Positive impact included respect for cancer survivors and a sense of fulfillment from having overcome the disease together. Conclusion: Partners of AYAs generally accepted the disclosure of the survivor's cancer history without distress and demonstrated supportive attitudes. There were few negative effects on relationships or marriage, and no differences in impact were found based on cancer type. Cultural differences were noted in attitudes toward having children, in contrast to findings from studies conducted in Western countries.

Global prevalence and moderating factors of malnutrition in colorectal cancer survivors: A meta-analysis.

This meta-analysis aims to estimate the global prevalence of severe, moderate, overall malnutrition and moderating factors of malnutrition in colorectal cancer (CRC) survivors. A comprehensive search was conducted in Embase, CINAHL, Medline-OVID, PubMed, Scopus, and Web of Science from inception to February 8, 2024, without language, region, or publication date restrictions. A generalized linear mixed model and random-effects model were used to examine the pooled prevalence, and moderator analyses were implemented to investigate variations in the pooled prevalence. In 35 studies involving 9,278 colorectal cancer survivors, the global prevalence was 12.10% for severe malnutrition (95% confidence interval (CI): 7.28-16.92; n = 507), 33.13% for moderate malnutrition (95% CI: 28.93-37.34; n: 2,192), and 47.78% for overall malnutrition (95% CI: 41.60-53.96; n: 3,812). Asia showed higher rates of severe malnutrition 16.67% (95% CI: 4.66-28.68, n: 232) and overall malnutrition 53.17% (95% CI: 39.66-66.69, n: 1,913), whereas low-middle income countries demonstrated higher rates of overall malnutrition 67.46% (95% CI: 30.25-100.00, n: 82). Male sex, colon cancer, advanced stage, metastasis, chemotherapy, surgery, adjuvant treatment, smoking, alcohol consumption, hypertension, and diabetes significantly moderated overall malnutrition prevalence. This meta-analysis reports detailed data on the global prevalence of CRC survivors experience malnutrition, highlighting that health-care professionals should consider the identified moderating factors. Addressing malnutrition in CRC survivors is critical, as early and proactive nutritional management can enhance recovery, improve quality of life, and potentially reduce cancer-related complications associated with malnutrition.

Duration of aromatase inhibitor use and long-term cardiovascular risk in breast cancer survivors.

There are limited data on duration of aromatase inhibitor (AI) and cardiovascular disease (CVD) risk in breast cancer (BC) survivors. We examined risk of CVD and mortality associated with duration of AI use in postmenopausal women with early-stage hormone receptor-positive BC. Postmenopausal women diagnosed with hormone receptor-positive BC (n = 5,853) who used an AI were included. Cause-specific hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between AI use duration (short-term: >0 and <2 years; intermediate-term: ≥2 and <5 years; long-term: ≥5 years) and CVD and mortality outcomes. The landmark method was used to avoid immortal time bias; the selected landmark was 6 years after BC diagnosis. Anastrozole was the AI predominantly prescribed (95.4%). Over a median follow-up of 3 years for women who survived 6 years after BC diagnosis, a lower risk of stroke was observed in intermediate-term AI users (HR = 0.60, 95% CI: 0.37-0.96) and long-term AI users (HR = 0.51, 95% CI: 0.30-0.85), than in short-term AI users. The longer duration of AI use was also associated with lower risk of all-cause mortality and non-CVD-related mortality. In addition, long-term AI users were at 37% lower risk of CVD-related mortality than short-term AI users. No significant differences were observed in risks of major adverse cardiovascular events, ischemic heart disease, and heart failure across the three groups. Among postmenopausal women with early-stage hormone receptor-positive BC who survived to 6 years after BC diagnosis, longer duration of AI use was not associated with elevated CVD risk.

Pre-diagnostic exposures and cancer survival: Can a meaningful causal estimand be specified?

Pre-diagnostic exposures and cancer survival: Can a meaningful causal estimand be specified?

Remote symptom monitoring with patient-reported outcomes and nudges during lung cancer immunotherapy in China (PRO-NET): protocol for a randomised controlled trial

IntroductionLung cancer is the leading cause of cancer-related mortality globally, with non-small cell lung cancer (NSCLC) comprising the majority of cases. For advanced NSCLC, immunotherapy offers substantial survival benefits but...

LINC01224 promotes the Warburg effect in gastric cancer by activating the miR-486-5p/PI3K axis.

The Warburg effect, a common feature of solid tumors, rewires the metabolism and promotes growth, survival, proliferation, and long-term maintenance in gastric cancer (GC). We performed in vitro and in vivo studies of the pathogenesis of GC to investigate the effects and mechanism of LINC01224 in this cancer. qRT-PCR was used to measure the expression of LINC01224 or miR-486-5p in GC cells, and the expression of LINC01224 in GC tissues by FISH (Fluorescence in situ hybridization) analysis was evaluated. Bioinformatics predicted the target gene of LINC01224, Western blotting was used to measure the protein expression of genes in the PI3K/AKT/mTOR/HIF-1α axis and Warburg effect in GC cells. The function of LINC01224 in GC cells was determined using measurements of EDU assay, colony formation, apoptosis, cell migration, and cell invasion. Glucose metabolism was evaluated using a glucose uptake assay and measurements of lactate. A tumor xenograft model was used to examine the effect of LINC01224 on GC growth in vivo. We found that upregulation of LINC01224 in GC cells activated the miR-486-5p/PI3K axis and promoted aerobic glycolysis, thereby increasing cell viability, proliferation, migration, invasion and anti-apoptosis. LINC01224 downregulation had the opposite effect. LINC01224 expression promoted the in vitro and in vivo pathogenesis of GC by promoting aerobic glycolysis. LINC01224 is a promising target in the treatment of GC.

Feasibility, Acceptability, and Outcomes of Project Rally: Pilot Study of a YMCA-Based Pickleball Program for Cancer Survivors

Feasibility, Acceptability, and Outcomes of Project Rally: Pilot Study of a YMCA-Based Pickleball Program for Cancer Survivors

Patient-Reported Perception of Exercise and Receptiveness to Mobile Technology in Cancer Survivors Living in Rural and Remote Areas

Purpose: Cancer survivors in rural and underserved areas face barriers such as limited access to oncology exercise programs and limited facilities, contributing to health inequities in cancer survivorship. This study explored cancer survivors’ thoughts on exercise and mobile technology for exercising with a mobile application (app) during and after treatment in rural and remote areas. Methods: Three online focus groups were conducted in February 2024 using semi-structured interviews with 12 open-ended questions. Eligible participants were adult cancer survivors or caregivers living in medically underserved areas, English-speaking, consented to being audiotaped, and attended one 60-min group interview. The discussions were transcribed verbatim and analyzed via a content analysis approach with consensus. Results: Fifteen participants attended from four States. None of the participants were advised to exercise; availability of exercise resources depended on geographic location and a cancer-specific exercise app was desired. They understood the benefits of exercise after diagnosis but expressed a need for more guidance during treatment. Geographic location shaped their activities, with most engaging in daily physical tasks rather than structured exercise. Most participants were receptive to using an exercise app to manage fatigue. Suggested key features to exercise with an app included live trainers, exercise checklists, visual benchmarks, and programs tailored to different fitness levels. Conclusions: These results emphasize the need for personalized resources, guidance, and on-demand accessibility to an exercise oncology app. A cancer-specific exercise mobile app will mitigate health inequities for cancer survivors residing in rural and remote areas.

A Machine Learning Approach Using Topic Modeling to Identify and Assess Experiences of Patients With Colorectal Cancer: Explorative Study.

The rising number of cancer survivors and the shortage of health care professionals challenge the accessibility of cancer care. Health technologies are necessary for sustaining optimal patient journeys. To understand individuals' daily lives during their patient journey, qualitative studies are crucial. However, not all patients wish to share their stories with researchers. This study aims to identify and assess patient experiences on a large scale using a novel machine learning-supported approach, leveraging data from patient forums. Forum posts of patients with colorectal cancer (CRC) from the Cancer Survivors Network USA were used as the data source. Topic modeling, as a part of machine learning, was used to recognize the topic patterns in the posts. Researchers read the most relevant 50 posts on each topic, dividing them into "home" or "hospital" contexts. A patient community journey map, derived from patients stories, was developed to visually illustrate our findings. CRC medical doctors and a quality-of-life expert evaluated the identified topics of patient experience and the map. Based on 212,107 posts, 37 topics and 10 upper clusters were produced. Dominant clusters included "Daily activities while living with CRC" (38,782, 18.3%) and "Understanding treatment including alternatives and adjuvant therapy" (31,577, 14.9%). Topics related to the home context had more emotional content compared with the hospital context. The patient community journey map was constructed based on these findings. Our study highlighted the diverse concerns and experiences of patients with CRC. The more emotional content in home context discussions underscores the personal impact of CRC beyond clinical settings. Based on our study, we found that a machine learning-supported approach is a promising solution to analyze patients' experiences. The innovative application of patient community journey mapping provides a unique perspective into the challenges in patients' daily lives, which is essential for delivering appropriate support at the right moment.

Fitness, Body Composition, and Health Behaviors in Long-Term Survivors of Adolescent and Young Adult Cancers.

Purpose: To investigate cardiorespiratory fitness (CRF), body composition, health behaviors, and health-related quality of life (HRQoL) in adolescent and young adult cancer survivors (AYA-CS) compared with age-matched counterparts without a cancer diagnosis. Methods: This cross-sectional study recruited participants aged 15-25 years at the time of their cancer diagnosis and ≥ 5 years post-treatment. Participants completed cardiopulmonary exercise testing, dual-energy X-ray absorptiometry, food diaries, physical activity (PA), fatigue, and HRQoL questionnaires. Results: We recruited 22 participants aged 27.9 (standard deviation [SD] 3.3) years (54.5% female) and 7.2 (SD 2.2) years post-treatment. AYA-CS had lower CRF compared with age-matched norms (female 27.1 vs. 39.1 mL/kg/min, p ≤ 0.0001; male: 39.7 vs. 45.6 mL/kg/min, p = 0.04). Bone mineral density Z-scores were all within normal ranges; however, male AYA-CS had higher body fat percentage (male: 27.1% vs. 21.2%, p = 0.01) and a trend toward higher body fat percentage in female AYA-CS (32.2% vs. 29.8%, p = 03). AYA-CS had lower HRQoL, with no difference observed with fatigue. A higher proportion of AYA-CS met recommendations for weekly PA (36.4% vs. 27.3%, p = 0.34) and daily servings of fruit and vegetables (13.6% vs. 3.9%, p = 0.02) compared with normative data, demonstrating better health behaviors. A higher proportion of AYA-CS reported one or more chronic diseases compared with Australian normative data (63.7% vs. 41.5%, p = 0.04). Conclusions: AYA-CS exhibit significantly lower CRF and unfavorable body composition to age-matched counterparts. These health outcomes may adversely impact everyday functional performance and increase the risk of multimorbidity development. Interventions are needed to address these issues to improve health outcomes in AYA-CS.

Prognostic factors for overall survival in castration-resistant metastatic prostate cancer treated with docetaxel (MeProCSS): results from a German real-world cohort.

To identify prognostic factors for overall survival (OS) and develop a prognostic score in patients receiving docetaxel in metastatic castration-resistant prostate cancer (mCRPC). Retrospective analysis was conducted on mCRPC patients treated with docetaxel at a German tertiary center between March 2010 and November 2023. Prognostic clinical and laboratory factors were analyzed using uni- and multivariable logistic regression. Next, the result of the modified Glasgow Prognostic Score (mGPS), neutrophil-to-lymphocyte ratio (NLR) (cut-off ≥3), the presence of high-volume bone metastases (as defined by CHAARTED criteria), hemoglobin (Hb) (cut off < 13.2 g/dl), Gleason score ≥8, and presence ofvisceral metastases were combined into the Metastasized Prostate Cancer Survival Score (MeProCSS). Patients were then stratified into three prognostic groups. Their OS was assessed by Kaplan-Meier analysis. Median OS for the overall cohort (n = 153) and the first-line cohort (n = 83) was 18 and 21.5 months, respectively. In multivariable analysis, high-volume bone metastases and Hb levels below the norm were significant predictors of shorter OS in the total cohort. The MeProCSS demonstrated an area under curve (AUC) of 0.837 in the overall cohort and 0.946 in first-line cohort. Kaplan-Meier analysis revealed a significant association between lower MeProCSS and longer OS in both the overall (p<0.001) and first-line (p = 0.035) cohort. MeProCSS, consisting of routinely collected parameters prior to the start of chemotherapy, seems to effectively stratify patients with mCRPC into risk groups based on their metastatic burden, nutritional and inflammatory status. This model may guide treatment decisions and reveal a potentially often underestimated or overlooked urgency for additional measures as supportive palliative care in mCRPC patients. Further large and prospective studies are necessary for validation of MeProCSS-also in other systemic PC therapy regimens.

Historical redlining and survival among children, adolescents, and young adults with cancer diagnosed between 2000-2019 in Seattle and Tacoma, Washington.

Historical redlining has been associated with inferior survival in adult-onset cancers. However, its relationship with pediatric, adolescent, and young-adult-onset cancer outcomes is unknown. This study identified incident cancer among individuals <40 years of age living in Seattle and Tacoma between 2000-2019 via the population-based Cancer Surveillance System. The authors determined case redlining status using Home Owners' Loans Corporation data overlaid with 2000 and 2010 census tracts. Kaplan-Meier methods and multivariable Cox proportional hazards models were used to determine 5- and 10-year overall survival and hazard ratio (HR) of death according to redlined status. Cox models adjusted for patient and tumor characteristics and area-level poverty; interaction between redlining and area-level poverty was also assessed. Among 4355 cases (median age at diagnosis 32 years), overall survival at 5 years was lower (85.1%; 95% confidence interval [CI], 83.5%-86.5%) among individuals residing in redlined neighborhoods compared with those in unexposed neighborhoods (90.3%; 95% CI, 89.0%-91.5%). Survival differences persisted at 10 years. The unadjusted hazard of death for redlined exposed individuals with cancer was higher than redlined unexposed (hazard ratio [HR], 1.62; 95% CI, 1.39-1.89). In the fully adjusted model, mortality remained higher for redlined cases (HR, 1.32; 95% CI, 1.12-1.56). There did not appear to be effect modification from area-level poverty in the relationship between redlining and death (p=.49). Among young individuals with cancer, residence at diagnosis in previously redlined neighborhoods was associated with lower survival compared with those residing in nonredlined neighborhoods, supporting the hypothesis that structural racism exerts persistent effects on contemporary health outcomes.

Tumor-Infiltrating Lymphocytes Assessed Using the International TILs Working Group System Are Not Prognostic in Medullary Thyroid Cancer.

Background: Tumor-infiltrating lymphocytes (TILs) are a protective prognostic factor in several solid tumors and predict response to immune checkpoint inhibitor therapy. The prognostic impact of TILs in medullary thyroid cancer (MTC) is poorly understood. Materials and Methods: In this retrospective cohort study, we assessed the TILs profile of primary MTC tumors using the International TILs Working Group system and correlated this with clinicopathological prognostic variables, including the International Medullary Thyroid Cancer Grading System (IMTCGS) grade and survival outcomes. Results: We identified 71 patients with primary MTC tumors who were treated surgically between 1995 and 2016 at the Royal North Shore Hospital in Sydney, Australia. The median (interquartile range) duration of follow-up was 69 (90) months. Using the ITWG system, all patients with MTC had low TILs, with a median (range) of 3% (0-10%). This group was further subdivided into "very low" (0-4%) and "low" (5-10%), and on Cox regression analysis, increasing TILs were associated with increased local recurrence (log-rank p = 0.022, odds ratio [OR] 1.94 [confidence interval or CI 0.61-6.16], p = 0.26), reduced disease-specific survival (log-rank p = 0.015, OR 5.11 [CI 1.01-26.0], p = 0.049), and a trend to decreased distant metastasis-free survival (log-rank p = 0.14). When examining the association between TILs and other prognostic factors, only "high IMTCGS grade" was significantly associated with increased TILs (OR 7.29 [CI 1.21-43.90], p = 0.015). In the multivariable logistic regression analysis, there was no significant association between TILs and local recurrence or disease-specific survival. Conclusions: In our study, the prognostic value of TILs in MTC was limited. Even high-grade MTC can be considered an immune quiescent tumor, and the adverse prognostic factors associated with higher grade tumors outweigh the marginal increase in immune recognition associated with a slight increase in TILs. The low level of TILs in MTC and their lack of correlation with survival suggest that immune checkpoint inhibitor therapy may not be effective.

Patient-reported long-term sexual morbidity in prostate cancer survivors treated with external beam radiation therapy alone or combined with high-dose-rate brachytherapy

Background: Prostate cancer can be treated with external beam radiation therapy (EBRT) alone or combined with high-dose-rate brachytherapy (HDR-BT+), usually with additional hormonal treatment (HT). The aim of this long-term cross-sectional study was to compare patient-reported sexual function, hormonal symptoms and quality of life (QoL) after EBRT-only or HDR-BT+. Methods: In 2016, minimum 5 years after treatment, men treated with HDR-BT+ (n = 248) or EBRT-only (n = 91) responded to a questionnaire containing the Expanded Prostate Cancer Index Composite (EPIC)-26 and the Short Form-12 (SF-12). Results: Median age at time of answering the questionnaire was 74 years (range 54–86). The majority in the HDR-BT+ group received HT for ≥ 2 years compared to 1/3rd in the EBRT-only group. In crude analyses, the sexual domain summary score (DSS) was significantly higher in the HDR-BT+ compared to the EBRT-only group (32.3 vs. 24.1). All sexual items were significantly better in the HDR-BT+ group except sexual problem. Significantly less fatigue was seen in the HDR-BT+ group despite longer duration of HT. Physical and mental health were similar in both groups. When adjusted for possible confounders, the differences between treatment groups were no longer statistically significant. Only age was significantly associated with lower sexual scores. Low hormonal DSS was significantly associated with decreased QoL. Conclusion: Patients treated with HDR-BT+ had not worse long-term sexual function than men treated with EBRT-only. However, this difference disappeared when adjusted for possible confounders. Thus, the interplay of age, HT and fatigue indicates a strong impact on both QoL and sexual function.

Fear of cancer recurrence in long-term colorectal cancer survivors: a nationwide cross-sectional study.

Knowledge about fear of cancer recurrence (FCR) among recurrence-free long-term colorectal cancer survivors (CRCS) is limited. This national cross-sectional study aimed to (1) assess the prevalence and correlates of FCR among CRCS; (2) investigate associations between colorectal cancer-specific symptoms and FCR; and (3) identify predictors of interest in engaging in FCR treatment. We identified 9638 living Danish CRCS, age above 18years, diagnosed between 2014 and 2018 through the Danish Clinical Registries. Electronic surveys were distributed between May 2023 and May 2024. FCR was measured on the Fear of Cancer Recurrence Inventory - Short Form (FCRI-SF). Associations with colorectal cancer-specific physical symptoms and psychological symptoms were analyzed using logistic regression models. Of 5480 respondents (56.9%; mean age: 73, range (30-99; 42% female), 5.3% of survivors reported clinical FCR (cFCR). In multivariate analyses, having severe abdominal pain (OR 8.7 (95% CI 4.8-15.8)), abdominal bloating, tension, or heaviness (OR 10.0 (95% CI (6.1-16.3)) and tiredness (OR 7.1 (95% CI (4.1-12.1)) were associated with increased odds of cFCR, as were psychological symptoms (health anxiety; OR 19.7 (95% CI (13.5-28.6)), anxiety; OR 11.2 (95% CI (6.4-19.6)), depression; OR 5.5 (95% CI (2.6-11.9)) compared to no FCR. Among those with cFCR, 75% were interested in treatment, with higher interest among males and chemotherapy recipients. FCR severity is strongly associated with specific colorectal symptoms, tiredness, and psychological symptoms. Addressing cancer-specific physical symptoms may be a promising strategy for reducing FCR.

Validating the Black Identity, Hair Product Use, and Breast Cancer Scale (BHBS) Among Black Breast Cancer Survivors

Personal care products containing toxic chemicals (e.g., endocrine-disrupting chemicals) may increase breast cancer risk, especially for Black women who use these products more than other racial groups. There are limited tools that examine the intersections of identity, behaviors, and attitudes surrounding product use, perceived safety, and breast cancer risk; thus, the Black Identity, Hair Product Use, and Breast Cancer Scale (BHBS) was developed to bridge this gap. While initial validations lacked diverse survivor representation, this study seeks to validate the BHBS among Black survivors. Methods: This study is a part of the Bench to Community Initiative (BCI), where respondents (n = 167) completed a 41-item survey including the BHBS between 2020 and 2022. The use of Principal Component Analysis (PCA) and confirmatory factor analysis (CFA) established the underlying component structures and model fit. CFA measures used to confirm component structures included the Root Mean Square Error of Approximation, the Comparative Fit Index, and the Tucker Lewis Index. Results: Black survivors on average were diagnosed with breast cancer before age 40 (37.41 ± 8.8) with Stage 1 (45%) disease. Sixty-three percent of the total variance resulted in a two-component structure. Subscale 1 (S1) measures the sociocultural perspectives about hair and identity (28% of the total variance; α = 0.73; 95% CI = 0.71–0.82). Subscale 2 (S2) can be used to assess perceived breast cancer risk related to hair product use (35% of the total variance; α = 0.86; 95% CI = 0.81–0.94). The two-component structure was confirmed with Root Mean Square Error of Approximation = 0.034, Comparative Fit Index = 0.93, and Tucker Lewis Index = 0.89. Discussion/Conclusions: The BHBS is a valid tool to measure identity, attitudes, and behaviors about product use and breast cancer risk among survivors. Hair is a significant cultural identity expression, and the health effects of styling products should be considered in future interventions.

Lung cancer survivorship research at the National Institutes of Health funded during Fiscal Years 2017–2024

Lung cancer survivorship research at the National Institutes of Health funded during Fiscal Years 2017–2024

The impact of informed decision-making on prostate cancer survivorship

The impact of informed decision-making on prostate cancer survivorship

"I just felt that everything came tumbling down around me"-Barriers in cancer care for patients with severe mental illness: A qualitative study.

Patients with severe mental illness experience serious inequity when facing cancer treatment. They are less likely to be referred for cancer treatment following recommended guidelines and have poorer cancer survival than patients without mental illness. Relevant specialties such as psychiatry and general practice are rarely involved, and the patient perspective is rarely represented in research in the field. The present study investigated how patients with severe mental illness experience barriers to and facilitators of patient-centred cancer treatment and care. In this qualitative case study, field observations, semi-structured interviews, and patient file analysis were performed with five patients with cancer in an adult psychiatric setting, included through purposeful sampling. Our analysis showed one major theme, "Complexity on many levels", and four subthemes: "How the mental illness is affected by the cancer trajectory", "The complexity of patient vulnerability", "Fragmented healthcare system and lack of structure", and "The role of the relationship between patient and health professional." Barriers included the cancer trajectory leading to severe worsening of the mental illness, as well as fragmentation of the healthcare system and a lack of a systematic approach to the patient group. Facilitators included the health professionals acknowledging the patient's own resources and approaching the patient as a person rather than a disease. This study highlights critical focal points to improve care for patients with cancer who also struggle with severe mental illness. By addressing these target areas, healthcare providers can better tailor their approach to meet the unique needs of this population.