Current Oncology

Insomnia is prevalent during breast cancer and exacerbates other common symptoms such as fatigue, distress, and pain, which in turn worsen sleep. This symptom burden is disproportionate for women receiving treatment in rural areas. Nite2Day is a mindfulness-based, behavioral insomnia and symptom management intervention previously applied in hematologic cancer. We adapted and pilot-tested Nite2Day in patients with breast cancer in rural areas. Patient (N = 8) and clinician (N = 6) interviews informed adaptation. A single-arm pilot (N = 15) evaluated feasibility (accrual, attrition, adherence), acceptability, and changes to patient-reported outcomes (insomnia symptoms, fatigue, distress, pain, pre-sleep arousal, mindfulness, symptom management self-efficacy) from baseline to post-intervention. Participants were enthusiastic about mindfulness and behavioral skills to address symptoms. Qualitative feedback guided protocol changes (e.g., mindfulness definitions, telephone and evening sessions). Nite2Day was feasible. The accrual target was met in 6 months, and all participants completed the intervention and post-treatment assessments. Acceptability of Nite2Day was strong (M = 30.53/32). Pre-post change for all patient-reported outcomes was in the expected direction. These feasibility and acceptability data provide support for next-step pilot testing using a randomized design. This research could extend access to an evidence-based behavioral intervention targeting concurrent insomnia, fatigue, distress, and pain symptoms reported by patients in rural cancer care settings.

Sexual dysfunction is a frequent but often under-recognised consequence of cancer and its treatment in women, with potential implications for quality of life and survivorship care. This cross-sectional study evaluated sexual dysfunction, health-related quality of life, and sexual healthcare experiences in 246 women with a history of breast and/or gynaecological cancer. Sexual function was assessed using the Female Sexual Function Index and health-related quality of life using the EORTC QLQ-C30. Female Sexual Function Index scores were ≤26.55 in 89.0% of participants, with a mean total score of 14.9 ± 8.94. Lubrication and orgasm were the most impaired domains. In the primary analysis, better physical functioning and lower insomnia were independently associated with better sexual function. In sensitivity analyzes, the insomnia association persisted, while physical functioning estimates were smaller and their confidence intervals included zero: no statistically significant independent associations were detected for age or menopausal status, although these findings require cautious interpretation given the subgroup imbalance. A healthcare professional initiated a discussion about sexuality in 46/246 participants (18.7%). These findings highlight the high prevalence and multidimensional nature of sexual dysfunction after cancer and support more systematic assessment, individualized management, and integration of sexual health into survivorship care.

Lower lobe torsion after lobectomy is a rare complication, and torsion of the left lower lobe after a left upper lobectomy is rarer still. We describe a 69-year-old man with left upper lobe adenocarcinoma who, after neoadjuvant chemoimmunotherapy, negative mediastinoscopy samples, and a negative intraoperative frozen section of the aortopulmonary window node, underwent robotic left upper lobectomy with mediastinal lymph node dissection. On postoperative day 3, chest radiography showed left lower lobe opacification, and computed tomography and bronchoscopy confirmed torsion with complete bronchial occlusion, and thoracotomy confirmed torsion. Emergent thoracotomy revealed a twisted, ischemic lower lobe, which was detorsed and secured to the diaphragm. The lobe remained congested, and follow-up CT showed evolving necrosis and a loculated pleural collection prompting completion pneumonectomy. He remains without evidence of recurrence at 26 months. Persistent congestion after detorsion warrants concern for incomplete recovery of lobar perfusion despite initial clinical stability.