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On behalf of the Canadian Association of Psychosocial Oncology, we are pleased to present the abstracts from the 2026 Annual Conference, titled “A New Horizon: Expanding the Access and Impact of Psychosocial Oncology”. The 41st Annual CAPO Conference was held in St. John’s, Newfoundland from 8 June 2026 to 9 June 2026. As we stand at a new horizon in psychosocial oncology, we recognize the unprecedented opportunities to expand both the access to and the impact of comprehensive cancer care. This conference will explore innovative strategies for breaking down traditional barriers that have historically limited access to psychosocial support, including geographic isolation, resource constraints, cultural disparities, and systemic inequities in healthcare delivery. This expansion of reach and influence represents not merely growth in service numbers, but a fundamental transformation in how we conceptualize, design, and implement patient-centered psychosocial care across diverse communities and care settings. We will explore scalable solutions that amplify impact while maintaining the deeply personal, human-centered approach that defines excellence in psychosocial oncology. From telehealth innovations and peer support networks to community-based interventions and integrated care models, this conference will showcase evidence-based strategies that expand our collective ability to support individuals and families navigating the cancer journey, wherever they may be. This conference brought together key stakeholders including multidisciplinary professionals from nursing, psychology, psychiatry, social work, spiritual care, nutrition, medicine, rehabilitation medicine, occupational health and radiation therapy for both adult and pediatric populations. Participants included clinicians, researchers, educators in cancer care, community-based organizations and patient representatives. Patients, caregivers and family members presented abstracts that speak to their role in managing cancer experiences and care. Over one-hundred and fifty (150) abstracts were submitted for presentation as symposia, 20 min oral presentations, 10 min oral presentations, 90 min workshops and poster presentations. We congratulate all the presenters on their research work and contributions. Full article

Background: Cancer-related psychological distress is a major concern in comprehensive oncology care because it substantially impairs patients’ quality of life and may adversely affect treatment adherence, outcomes, and prognosis. Over the past decade, research in this field has expanded rapidly; however, the overall knowledge structure, global research patterns, major contributors, and emerging hotspots remain insufficiently characterized. A bibliometric analysis is therefore needed to systematically map the development of cancer-related psychological distress research and identify evolving directions for future investigation. Methods: Publications related to cancer-related psychological distress published between 1 January 2015 and 31 December 2024 were retrieved from the Web of Science Core Collection and Scopus databases. The database searches were conducted on 10 March 2025. Bibliometric analyses were performed using VOSviewer (version 1.6.20), CiteSpace (version 6.3.R1), and the R package bibliometrix (version 5.3). Publication trends, country and institutional contributions, journal distribution, author collaboration networks, co-cited references, keyword co-occurrence, burst keywords, and thematic evolution were analyzed. Results: A total of 7063 publications were included in the bibliometric analysis, including 6162 articles and 901 reviews. Annual publication output increased from 465 publications in 2015 to 924 publications in 2024. The main contributing countries were the United States, Australia, China, Germany, and the United Kingdom. The United States ranked first in publication volume and total citations. Psycho-Oncology and Supportive Care in Cancer were the leading journals by publication volume and total citations. Major research themes included quality of life, psychological distress, depression, anxiety, breast cancer, distress screening, survivorship, and palliative care. Seven high-frequency keywords—“cancer,” “quality of life,” “psychological distress,” “depression,” “anxiety,” “breast cancer,” and “distress”—each appeared more than 500 times, representing the core research topics. Emerging keywords such as “informal caregivers,” “young adults,” “guidelines,” and “adult survivors” reflected increasing attention to caregiver support, age-specific psychosocial needs, survivorship care, and standardized clinical management. Conclusions: This bibliometric analysis provides a comprehensive overview of global research on cancer-related psychological distress from 2015 to 2024. The findings reveal publication trends, major contributors, collaboration patterns, core research themes, knowledge structures, and emerging topics in this field. Current research has gradually shifted from general descriptions of psychological distress toward survivorship care, caregiver support, standardized screening, and guideline-based management. Future studies should strengthen interdisciplinary collaboration, improve standardized assessment and screening approaches, and further explore emerging areas such as caregiver support, young adult cancer populations, survivorship care, and digital health and artificial intelligence-assisted approaches, which require further validation before routine clinical implementation. Full article

Background/Objectives: Psychosocial, neuropsychological, social, and academic difficulties may persist after pediatric cancer treatment. We described parent/caregiver-reported functioning and support needs and explored their associations with clinical, family-related, socio-economic, premorbid, and place-based characteristics in an Italian survivorship setting. Methods: This single-center cross-sectional exploratory study included 93 of 130 families approached between November 2022 and January 2023 (response rate, 71.5%). One parent or caregiver completed a purpose-built questionnaire for each survivor. The cohort included 38 survivors with central nervous system (CNS) tumors and 55 with non-CNS tumors. Outcomes were evaluated relative to retrospectively reported pre-diagnosis functioning. Exact confidence intervals, effect estimates, multivariable Firth logistic regression, and Benjamini–Hochberg false discovery rate correction were used. Results: Worsening internalizing difficulties were reported for 48/90 survivors (53.3%), neuropsychological difficulties for 42/90 (46.7%), academic worsening for 30/85 (35.3%), and social integration difficulties for 27/90 (30.0%). CNS survivors more frequently had social integration difficulties than non-CNS survivors (47.4% versus 17.3%; odds ratio, 4.22; 95% confidence interval, 1.50–12.73; q = 0.015) and underwent cognitive assessment after cancer (50.0% versus 17.0%; odds ratio, 4.80; 95% confidence interval, 1.71–14.44; q = 0.013). Municipality size and geographic area showed no nominal associations with parent-reported outcomes. No candidate-variable association in the exploratory screen remained significant after false discovery rate correction. Conclusions: Parent-reported difficulties and support needs were common, with differences by CNS versus non-CNS tumor site. Family-related, premorbid, and place-based patterns are hypothesis-generating and require prospective evaluation using validated multi-informant measures. Full article

Cancer patient–informal caregiver dyads function as core collaborative units across the cancer trajectory from diagnosis to recovery. A central challenge for these dyads lies in managing illness uncertainty alongside the demands of dyadic coping, two interrelated factors that jointly shape long-term quality of life, psychological well-being, and disease adaptation. These two factors interact to shape their long-term quality of life, psychological well-being, and disease adaptation. Past studies have mostly examined dyadic coping and illness uncertainty separately. Employing a narrative review design, this study searched the PubMed database for literature published from 2021 to 2025, and synthesizes evidence on association pathways and moderating factors between dyadic coping and illness uncertainty among adult cancer patient–informal caregiver dyads. Existing research on dyadic coping has predominantly focused on the effects of interventions (e.g., enhanced spousal communication, joint exercise) on emotional health and relationship quality. Studies on illness uncertainty have largely examined its association with anxiety and depression, but have failed to provide a comprehensive understanding of the interactive pathways between the two constructs. This review addresses this gap by synthesizing evidence from three perspectives: interactive mechanisms, heterogeneous characteristics, and integrated intervention directions. Evidence from the reviewed literature suggests that illness uncertainty represents a critical antecedent of dyadic coping among cancer dyads. Illness uncertainty and dyadic coping share a bidirectional association, and this relationship is moderated by factors including cancer type, patient age, and cultural background. Most uncertainty management interventions effectively reduce illness uncertainty in specific populations. Synthesized evidence indicates that dyadic coping is a significant predictor of relationship satisfaction among couples coping with chronic illness. Interventions that are made for these couples need to include things like psychoeducation and skill-building parts that are about dyadic coping, so that they can improve the couples’ relationship satisfaction. Based on predominantly observational evidence with heterogeneous study designs, the authors propose that combining uncertainty management interventions with dyadic coping skills training represents a key direction for future clinical care optimization. This review provides evidence-based implications for developing targeted dyadic care strategies and advancing family-centered, full-course cancer care models. Full article

Background/Objectives: Head and neck cancer (HNC) is associated with substantial morbidity, functional impairment, and represents a substantial socioeconomic burden worldwide. Although advances in surgery, radiotherapy (RT), and systemic therapies have improved oncologic outcomes, treatment-related toxicities frequently overlap with profound economic consequences for patients and caregivers. Financial toxicity (FT), defined as the objective financial burden and subjective financial distress associated with cancer care, has emerged as a clinically relevant determinant of treatment adherence, quality of life (QoL), and survival. In HNC, FT appears particularly critical during active treatment, when multimodal therapies, nutritional compromise, work interruption, transportation costs, and supportive care needs converge. Methods: This structured narrative review synthesizes current literature regarding FT during active treatment for HNC, focusing on conceptual definitions, measurement approaches, temporal dynamics, clinical and psychosocial consequences, and health system determinants. The review was conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA) framework using searches of PubMed/MEDLINE, Scopus, Embase, and Google Scholar. Results: Available evidence suggests that FT may emerge early during treatment and evolve dynamically throughout the care trajectory. Lower socioeconomic status, treatment intensity, work interruption, and limited social support have been reported in association with increased FT. FT has also been linked to worse health-related QoL, higher symptom burden, treatment interruptions, hospitalization, and reduced survival, although the limited number of studies and methodological heterogeneity preclude definitive conclusions. Emerging evidence suggests that FT may be partially modifiable through interventions such as financial counseling and patient navigation. Conclusions: Future research should prioritize prospective and interventional designs using standardized multidimensional instruments capable of capturing both objective and subjective domains of FT. Integrating routine FT assessment into supportive oncology workflows may help identify vulnerable patients and support more equitable, patient-centered HNC care. Full article

Biliary tract cancers (BTCs), including cholangiocarcinoma and gallbladder cancers, are characterized by their rarity, poor prognosis, limited treatment options, and significant psychosocial burden among affected individuals. Hope and loneliness are known to play significant roles in shaping cancer-related experiences and outcomes; however, their trajectories in the context of rare cancers remain unexplored. The Canadian Cholangiocarcinoma Collaborative (C3) was founded to enhance access to treatment, research, and support for individuals affected by BTC in Canada. This mixed-methods study aimed to measure hope and loneliness among patients and caregivers over time and to gain a deeper understanding of their experiences. A total of 92 patients and 44 informal caregivers, self-, peer-, or physician-referred, consented to participate in this study. Participants completed electronic self-reported measures of hope (Hope Herth Index (HHI), 12 items) and loneliness (UCLA Loneliness scale, 20 items) upon joining C3 (baseline, T0), following the first informational session with a C3 research navigator (T1), and after two to three months (T2). A subsample (n = 14) also participated in two online focus groups. At baseline, participants reported relatively high levels of hope (patients: M = 39.8, SD = 4.9; caregivers: M = 38.9, SD = 4.68), with the HHI ranging from 12 to 48, where higher scores indicate higher hope. They also reported low-to-moderate levels of loneliness (patients: M = 32.13, SD = 9.63; caregivers: M = 36.69, SD = 12.37), with the scale ranging from 20 to 80, where low loneliness: 20–34; moderate: 35–49; moderately high: 50–64; and high: 65–80. At T1, a significant decrease in hope (mean difference [MD] = −1.38, 95% CI [−2.64, −0.11], p = 0.029) and a significant increase in loneliness (MD = 1.75, 95% CI [0.27, 3.23], p = 0.016) were found among patients, with no further significant changes from T1 to T2. Among caregivers, no significant changes were observed from baseline to T1; however, at T2, there was a significant decrease in hope (MD = −2.01, 95% CI [−3.61, −0.40], p = 0.010) and a significant increase in loneliness (MD = 4.54, 95% CI [1.31, 7.77], p = 0.004). No significant differences in hope or loneliness were found between participants who engaged in C3 activities and those who did not. Dyadic analysis revealed significant correlations between patients’ and caregivers’ hope and loneliness at baseline and at T2. Despite the significant changes, findings indicate consistently high levels of hope and low-to-moderate levels of loneliness over time. Focus group analyses further contextualize quantitative findings by highlighting patients’ and caregivers’ experiences in greater depth. The results serve to inform current and future initiatives aimed at providing timely, personalized psychosocial support to patients and caregivers affected by BTC. Full article

Patients with cancer often experience intertwined symptom burden and functional decline that contribute to falls, unsafe transfers, uncontrolled symptoms, caregiver strain, and crisis-driven care. Physical medicine and rehabilitation (PM&R), also known as physiatry, and specialty PC both address suffering and quality of life through complementary clinical approaches; however, collaborative care with and between these two specialties is inconsistent in routine oncology practice. This paper presents a clinical implementation framework informed by targeted literature synthesis for bidirectional referral and co-management between PM&R and PC in oncology. The framework was informed by the PC referral criteria literature, cancer rehabilitation triage literature, trigger-based serious illness identification models, and implementation science. Four clinic-usable tools are proposed, including a scope and overlap map, a clinical-needs gradient, a referral trigger table linking common clinical signals to the reason for referral and expected clinical actions, and a primary-service triage workflow. This framework is intended to clarify which service is best positioned to be the primary supportive service according to the patient’s current needs, when rehabilitation therapy alone may be sufficient, and when co-management should be the default. This concept-to-practice model is designed to facilitate early, needs-based referrals and coordinated supportive care in oncology settings. Full article

The fifth annual pan-tumour Early Age Onset Cancer (EAOC) Symposium, held in November 2025 and organized by the Colorectal Cancer Resource & Action Network (CCRAN), convened clinicians, researchers, policymakers, patients, and caregivers to address the rising incidence of cancers in individuals under 50 years. In addition to discussions around diagnostic and therapeutic advances for patients with late-stage disease, content centered on addressing critical gaps along the EAOC care continuum, including (i) diagnostic delays related to limited awareness and suboptimal primary care pathways, (ii) screening eligibility criteria for colorectal cancer (CRC) that no longer reflect current disease epidemiology, and (iii) insufficient age-appropriate infrastructure to meet the EAOC population’s unique unmet needs with respect to psychosocial support, fertility counseling, financial navigation, and survivorship planning. The symposium generated consensus recommendations such as the embedding of EAOC education into medical training curricula to increase the index of suspicion of EAOC in primary care, lowering the CRC screening age to 45 years to match this population’s rising disease incidence, and expanding multidisciplinary adolescent and young adult (AYA) and EAOC programs—including through the use of virtual models—to ensure that patients receive coordinated, comprehensive, equitable and age-appropriate care across the country. Full article

Background: Cervical cancer remains a significant health issue in Indonesia, where structural barriers, fragmented information, and sociocultural norms continue to hinder timely diagnosis and treatment. Families play a central role throughout the illness journey, yet their perspectives are often overlooked in the development of digital patient navigation systems. This study explored family experiences, caregiving challenges, and expectations for a family-centered digital navigation model, DIVA.ID, by integrating Digital Health frameworks and Family Systems Theory. Methods: A qualitative descriptive approach was employed through semi-structured, in-depth interviews with 18 purposively selected family caregivers of women with cervical cancer at a major referral hospital in West Java. Participants were selected because they were directly involved in daily care, treatment decisions, logistical support, or emotional assistance. Interviews were conducted between August and October 2025 and continued until thematic saturation was reached, as indicated by repetition of categories and the absence of new major codes in the final interviews. Data were analyzed using inductive–deductive content analysis guided by Elo and Kyngäs, with five researchers conducting independent coding, iterative code comparison, consensus meetings, and theoretical mapping. Results: Four main themes emerged: (1) family involvement in decision-making, including collective discussion, shifting authority roles, and patient autonomy; (2) caregiver burden, involving physical exhaustion, psychological distress, social restriction, stigma, financial pressure, and employment disruption; (3) psycho-spiritual coping mechanisms, including emotional sharing, prayer, crying, patience, and surrender to God; and (4) digital healthcare needs, covering BPJS guidance, treatment information, scheduling, communication pathways, shelter support, and mental–spiritual support. Mapping these themes to Digital Health frameworks and Family Systems Theory clarified how DIVA.ID could translate family experiences into practical navigation functions. Conclusions: This study provides empirical foundations for a culturally sensitive, family-centered digital navigation model in Indonesia. Rather than demonstrating effectiveness, the findings identify design requirements for DIVA.ID that should be tested in subsequent feasibility, usability, and intervention studies. Full article

Background/Objectives: Breast cancer affects working-age women not only through treatment and survival but also through health-related quality of life (HRQoL), work capacity and informal caregiving needs. Evidence from Central and Eastern Europe remains limited. This study estimated the indirect societal burden of breast cancer among working-age women in Croatia and reported economic indirect costs separately from monetised HRQoL/welfare loss. Methods: A multicentre cross-sectional study conducted in 2024 included women aged 18–65 years receiving outpatient oncology care at two tertiary centres in Croatia. HRQoL was assessed with the EuroQol five-dimension five-level instrument (EQ-5D-5L) and compared with Croatian general-population norms. Utility decrements were annualised and monetised using a national willingness-to-pay threshold of €17,000 per quality-adjusted life year (QALY). Work productivity impairment was measured using the Work Productivity and Activity Impairment: General Health (WPAI:GH) questionnaire and valued, together with informal care, using the human-capital approach. Deterministic sensitivity analyses and approximate 95% confidence intervals were used to show how the estimates changed under key assumptions. Results: A total of 271 women participated (mean age 51.3 years among age-eligible records). Mean EQ-5D-5L utility was 0.76 versus 0.91 in the general population, corresponding to an annual QALY loss of 0.15 and a monetised HRQoL/welfare loss of €2550 per patient-year (95% CI €2083–€3017). Among employed participants, mean overall work productivity loss was 43.9% (842.9 h/year), equivalent to €7333 annually (95% CI €6311–€8355). Informal caregiving was reported by 54.7% of participants, with mean annual costs of €1566 (95% CI €1269–€1863). Economic indirect costs were €8899 per patient-year (95% CI €7835–€9963). In an extended welfare-inclusive scenario, the estimated burden was €11,449 per patient-year (95% CI €10,287–€12,611), corresponding to an illustrative national estimate of €86 million (95% CI €77–€95 million; 0.11% of gross domestic product). Conclusions: Breast cancer in working-age women imposes a substantial societal burden in Croatia, driven by reduced HRQoL, productivity losses and informal caregiving needs. These findings support taking societal burden into account in public health planning, survivorship care and health policy decision-making. Full article

Background/Objectives: Girls living with HIV (GLHIV) or vulnerable to HIV have a higher risk of HPV infection and cervical cancer as they age. We determined acceptability and vaccination uptake after integrating HPV vaccination into HIV prevention and treatment services for girls in Mozambique and Zimbabwe. Methods: Pre-integration and integration HPV vaccination information were abstracted from routine records of girls aged 9–14 years offered HPV vaccine through HIV services in 54 health facilities (HFs) and surrounding communities between February and December 2025. Caregivers participated in quantitative surveys about vaccine perceptions and integration model experiences in a subset of 16 HFs. Results: In total, 6377 records of girls (median age: 11 years) were abstracted. Among the vaccine recipients, 63 (3.0%) girls received vaccine pre-integration and 2019 (97.0%) post-integration in Mozambique and 743 (17.3%) pre-integration and 3541 (82.7%) post-integration in Zimbabwe. Among GLHIV, 95.8% and 69.6% received a first HPV vaccine in Zimbabwe and Mozambique, respectively. Full vaccination with two doses occurred in 49.1% of eligible girls in Mozambique and 73.9% in Zimbabwe. Overall, 461 (67.8%) caregivers had heard of the HPV vaccine and 85.9% of cervical cancer, 99.6% were satisfied with vaccination in integration settings, and 78.6% preferred facility-based vaccination models. Conclusions: We demonstrated that HPV/HIV service integration was an effective strategy to increase HPV vaccine uptake among young girls at increased risk of HPV and cervical cancer. We found high vaccine and model acceptability and awareness of cervical cancer among caregivers. Optimization of this approach requires better integrated tools and model adaptations to fit the needs of girls and health systems. Full article

Significant gaps exist in survivorship services across the cancer care continuum for Indigenous Peoples in the United States. Despite overcoming overwhelming cancer burden and high mortality risk, Indigenous cancer survivors report lower quality of life compared to non-Indigenous cancer survivors. Using an Indigenous social determinants of health framework, this article shares reflective commentaries from four Indigenous (Haudenosaunee) cancer care professionals who provide insights into the need for traditional Indigenous land-based healing practices among Indigenous cancer survivors, their families, and caregivers. Results suggest that (1) traditional Indigenous healing practices, (2) Indigenous patient navigation services, (3) communities of care, and (4) Indigenous lands and social determinants of health are important factors to support the health and wellbeing of Indigenous cancer survivors. Land-based healing for Indigenous cancer survivors requires further research for future implementation. Full article

As the global cancer burden rises, adults with advanced cancer face significant physical and psychosocial symptoms requiring early integration of palliative and supportive care. Nurses in oncology, emergency, and community settings are central to symptom assessment, care coordination, communication, and advance care planning, yet their roles in early integration remain underexplored. This scoping review mapped nursing contributions to early palliative and supportive care for adults with advanced cancer and described related patient, caregiver, and system outcomes. A search of PubMed, CINAHL, Scopus, and ScienceDirect was conducted for English-language studies published between January 2016 and November 2025 involving nursing-relevant interventions in early palliative or supportive care. Fourteen studies were included: trials, observational studies, qualitative research, reviews, and a meta-analysis. Six domains emerged. Early integration consistently improved quality of life and reduced symptom burden. Nurse-led interventions increased end-of-life discussions and advance directive completion. Telehealth and telephone follow-up proved feasible for symptom management. Studies noted moderate palliative competence but gaps in communication and structural support. Caregiver-focused interventions enhanced caregiver quality of life and self-efficacy. Conclusions: Nurses are pivotal in early palliative care. Expanding structured nurse-led models, strengthening communication training, and addressing organizational barriers are essential to deliver timely, person-centered care. Full article

Background: Chemotherapy and radiation accelerate aging of multiple systems, including the immune and musculoskeletal systems. Resistance training may mitigate some of the late physiologic effects of cancer therapy. Methods: We developed a community-based pilot study of resistance training for long-term cancer survivors meeting criteria for pre-frailty or frailty (N = 8; 6 allogeneic hematopoietic cell transplant, 1 autologous hematopoietic transplant, 1 breast cancer survivor) and their caregivers (N = 8 healthy controls) consisting of a baseline assessment, 10 weeks of personalized resistance training at least once weekly as a group and as many additional times on an individual basis as their schedule allowed, and an end-of-study assessment to measure change in strength and body composition. Blood samples were collected at the start of the study and after the 10-week training program to assess changes in peripheral blood mononuclear cell DNA methylation patterns, gene expression measured by RNA sequencing, and stool microbiome analysis using metagenomics. The median number of resistance training sessions was 25 sessions. Results: Cancer survivors and controls both more than doubled their squat and press volume after 10 weeks. At baseline, cancer survivors exhibited a pro-inflammatory transcriptomic and epigenetic profile with elevated interferon signaling and reduced naïve T cell signatures compared to healthy controls, consistent with immune senescence. After 10 weeks of resistance training, these differences normalized, suggesting that exercise exerted anti-inflammatory and immune-restorative effects in cancer survivors at both gene expression and methylation levels. Ten fecal microbial pathways that were lower in relative abundance in patients compared with controls at baseline were no longer significantly different post-exercise. Conclusions: Our data suggest that in addition to beneficial changes in body composition, resistance training may exert an immune restorative effect in cancer survivors. Full article

Family caregivers play a critical role in supporting patients with advanced cancer, yet their quality of life (QoL) is often adversely affected and remains insufficiently addressed in routine care. Although family relationships have been widely recognized as important in the caregiving context, their specific domains have rarely been examined in relation to caregiver outcomes. This study aimed to examine the associations between distinct domains of family relationships and caregiver QoL. A total of 170 caregivers were recruited from nine hospice units in Korea between September 2021 and March 2024. for this multicenter study. The Family Relationship Assessment Scale (FRAS) and the Korean version of the Caregiver QOL Index-Cancer (CQOLC-K) were used to assess family relationships and caregiver QoL, respectively. Multivariate regression analyses were performed to evaluate the associations between specific domains of family relationships and caregiver QoL. Family relationship domains were differentially associated with caregiver QoL. Overall family relationship scores were positively associated with QoL (β = 0.30, p = 0.004), while family conflict showed the strongest negative association (β = −1.03, p = 0.001). In contrast, family support was associated with better positive adaptation (β = 0.24, p = 0.027). The associations between family relationships and QoL were more pronounced among vulnerable caregivers, including those who were younger, unemployed, had lower social support or resilience, or were dissatisfied with care. Family relationships, particularly conflict and support, are important correlates of caregiver QoL. Incorporating the assessment of family relationship domains helps identify caregivers at increased risk and informs the development of more family-centered supportive approaches in palliative oncology care. Full article