Search Results (537)

Background/Objectives: The rapid expansion of telemedicine has reshaped healthcare delivery, positioning telenursing as essential for continuity of care and patient management. This scoping review maps current evidence on telecare nursing practices, examining organizational models, professional roles, and key clinical and organizational outcomes. Methods: The review was conducted across five international databases, following the methodological framework proposed by Arksey and O’Malley, the interpretive extension by Levac et al., and the Joanna Briggs Institute guidelines, with reporting aligned to PRISMA-ScR recommendations. The search identified 1760 records, of which 1219 remained after duplicate removal. After title and abstract screening and full-text evaluation, 25 studies met the inclusion criteria. Results: Telenursing was implemented across diverse clinical contexts, particularly in chronic disease management, oncology, postoperative care, and emergency settings. Evidence indicates improvements in symptom management, therapeutic adherence, quality of life, and complication reduction, suggesting positive clinical and organizational impacts. The literature highlights the need for advanced digital, communication, and relational competencies, emphasizing the importance of targeted professional training. Cross-cutting trends include enhanced continuity of care, greater patient autonomy, improved integration between hospital and community services, and reduced healthcare costs. Conclusions: This review provides an updated overview of telenursing applications, highlighting their adaptability across clinical settings and the expanding strategic role of nurses in digital care. The findings indicate a rapidly evolving field and emphasize the need for further research to strengthen organizational frameworks, define advanced competencies, and support the sustainable integration of telenursing into healthcare systems. Full article

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal oncological diseases, with a 5-year survival rate of approximately 13%—among the lowest in oncology. Poor survival is driven by aggressive tumor progression and metastasis, which may be influenced by the tumor microbiome. This study aimed to evaluate the role of microbiome in PDAC progression and metastasis. First, we assessed the microbial composition of control samples (surface swabs, empty paraffin, extraction controls, and sequencing controls) and removed contaminant taxa. Overall bacterial biomass was extremely low, with no significant differences in alpha or beta-diversity between tumor and normal tissue. Kocuria rosea was significantly enriched in tumors compared to normal tissue, and this difference persisted after decontamination. Metastatic tumors showed altered abundance of K. rosea and Herbaspirillum huttiense, whereas non-metastatic tumors differed in Lysobacter bugurensis, Caulobacter ginsengisoli, and H. huttiense relative to normal tissue. No global compositional differences were observed between KRAS-mutant and wild-type tumors; however, KRAS-mutant tumors exhibited differential enrichment of K. rosea and L. bugurensis relative to adjacent normal tissue. The PDAC microbiome harbors very low bacterial biomass and does not robustly distinguish tumor from normal tissue at the community level. Nonetheless, K. rosea emerges as a candidate taxon differentially enriched in PDAC, with potential stage- and KRAS-associated patterns. These findings highlight the need for orthogonal validation (qPCR, FISH, culture) and larger prospective cohorts to differentiate true biological associations from residual contamination or stochastic noise in low-biomass settings. Full article

Background/Objectives: Clinical application of Doxorubicin (Doxo) is limited by cardiotoxicity, a process strongly associated with an interplay between oxidative stress and inflammatory signaling, particularly Nuclear Factor kappa-light-chain-enhancer of activated B cells (NF-κB) activation and Nucleotide oligomerization domain-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome engagement. Identifying strategies capable of mitigating these interconnected pathways is of critical importance in cardio-oncology. Simvastatin (SIM) is a promising option since it modulates oxidative stress, inflammation, and cell death through its pleiotropic effects, so this study aimed to evaluate whether SIM attenuates Doxo-induced inflammatory responses. Methods: Human Cardiomyocyte (HCM) cells were pre-treated with SIM (10 µM) for 4 h and then co-exposed to SIM and Doxo (1 µM) for 20 h. Cytofluorimetric analysis was used to evaluate inducible nitric oxide synthase (iNOS), Connexin 43 (Cx43), and Cx43 phosphorylated at Serine 368 (p^S368Cx43) levels. Real-time qPCR was performed to evaluate iNOS gene expression, while Nitric oxide (NO) release was evaluated by spectrophotometric analysis. Interleukin (IL)-1β, IL-18, IL-6, tumor necrosis factor alpha (TNF-α) production, and NLRP3 levels were evaluated by means of ELISA assay. Expression levels of inhibitor of nuclear factor kappa B alpha (IκB-α), Caspase-1, and Gasdermin D (GSDMD) were evaluated by Western Blot analysis. Nuclear translocation of NF-κB was evaluated by immunofluorescence assay. Results: In our experimental model, SIM significantly (p < 0.01) reduced Doxo-induced nitrite release, as well as iNOS gene expression (p < 0.05) and protein levels (p < 0.01). SIM also markedly attenuated Doxo-induced NF-κB signaling, pro-inflammatory cytokines production (TNF-α and IL-6, p < 0.01), and inflammosome-related responses (cleaved caspase-1, IL-1β, N-terminal domain of GSDMD), and NLRP3 expression p < 0.05). Additionally, SIM significantly attenuated the overexpression of Cx43 and its phosphorylated form (p^S368Cx43), which are responsible for impairing intercellular communication and electrical coupling in cardiomyocytes and contribute to arrhythmias and conduction abnormalities characteristic of acute Doxo-induced cardiotoxicity. Conclusions: Overall, these findings demonstrate that SIM exerts a multifaceted cardioprotective effect against Doxo-induced injury, thereby targeting interconnected inflammatory and pro-arrhythmic pathways implicated in Doxo cardiotoxicity. Full article

Background: Multidisciplinary team meetings (MDTs) are a mandatory requirement of modern oncology. During the COVID-19 pandemic, virtual MDTs replaced nearly all face-to-face MDTs. This study evaluated strengths, weaknesses, perceived quality, and outcomes of virtual MDTs compared to face-to-face MDTs. Furthermore, the extent of permanent implementation of virtual MDTs in oncology after COVID-19 was evaluated. Methods: Switzerland-wide, participants of MDTs were surveyed with 44 questions concerning different dimensions of perceived meeting quality and technical aspects. Descriptive and comparative analysis was performed. Results: In 170 responses, communication discipline, meeting dedication, or perceived quality were rated comparably to standard MDTs. Time efficiency and outcomes of virtual meetings were rated similarly by 68% and 75% of all participants, respectively. Workspace setup did not significantly influence the subjective quality, while surgeons were less likely to rate the quality as good. After COVID-19, 41 (38%) of 108 MDTs have been permanently converted to a virtual format. Conclusion: A substantial proportion of Swiss MDTs have permanently switched to a purely virtual format or offer a hybrid option. Meeting quality, communication discipline, and dedication were comparable. However, assessing the quality of MDTs remains challenging due to their multifactorial nature. Full article

Cancer patients with an enterostomy or urostomy face significant physical and psychological challenges that impact their sexuality and quality of life. Despite its importance, this topic is often overlooked in clinical settings. This study explores the lived experiences of these patients regarding their sexual health. Using a descriptive phenomenological approach, researchers performed face-to-face interviews with 33 adult cancer patients living with enterostomy or urostomy at Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute of Rome, Italy. Data were analyzed according to Giorgi’s method to identify core themes. Four primary themes emerged: the emotional weight of surgery, fear of rejection or disgust, the influence of partner reactions on intimacy, and the struggle to find professional guidance. Participants reported reduced desire and altered body image, though many utilized coping strategies like personal resilience and partner support. Stoma surgery profoundly affects sexuality, yet professional support remains inadequate. The study highlights a critical need for multidisciplinary care and proactive communication. Integrating sexual health into routine oncological practice is essential for providing person-centred care and improving overall quality of life. Full article

Although breast cancer has been associated with subclinical left ventricular dysfunction in humans, the cardiac effects of CMTs remain poorly defined. This pilot, exploratory (communication) study compared clinical and echocardiographic parameters between dogs with CMTs and healthy controls and assessed the feasibility of combining myocardial deformation imaging with exploratory data-driven analysis for preoperative cardiac assessment. All dogs underwent a standardized clinical and echocardiographic assessment, including two-dimensional speckle-tracking echocardiography (2D-STE). Given the limited sample size, analyses were designed to generate hypotheses rather than to provide definitive predictive conclusions. Exploratory machine learning modeling (XGBoost), receiver operating characteristic (ROC) analysis, calibration, and decision curve analysis were performed as proof-of-concept approaches without external validation. Despite normal conventional systolic indices, dogs with CMTs exhibited reduced global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE) (p < 0.01), suggesting subclinical systolic dysfunction. Deformation-derived parameters appeared more sensitive for detecting subtle myocardial alterations within this cohort. The exploratory machine learning model demonstrated moderate discrimination (AUC-ROC = 0.75); however, these findings are preliminary and should not be interpreted as evidence of clinical predictive performance. Overall, these results suggest that conventional systolic indices may underestimate early myocardial changes in dogs with CMTs. This communication highlights the feasibility of integrating deformation imaging with exploratory analytical approaches and provides a basis for future large-scale, validated studies in veterinary cardio-oncology. Full article

Background: Delivering comprehensive cancer prevention, diagnosis, and treatment across Hawaiʻi and the U.S.-Affiliated Pacific Islands (USAPI) is constrained by geographic isolation, oncology workforce shortages, and persistent cancer inequities. Objectives: The University of Hawaiʻi Cancer Center, the state’s only National Cancer Institute-designated cancer center, partners with community healthcare systems to address cancer health disparities. Here, we describe an implementation-focused strategy initiated in December 2024 that is designed to improve equitable access to evidence-based oncology services across the catchment area. Approach: This program description integrates publicly available demographic and health system data and presents a structured implementation framework centered on (1) workforce development and oncology training pathways; (2) a statewide clinical oncology network supported by telehealth; (3) community-engaged screening and early detection outreach; and (4) strengthening clinical research and trial infrastructure with deliberate inclusion of underserved populations. Evaluation: We outline an evaluation framework incorporating process and outcome metrics spanning workforce capacity, screening participation, timeliness of care, clinical trial enrollment, and equity indicators stratified by county, island, and population group. Conclusions: This approach offers a scalable, implementation-oriented model for developing an academic oncology ecosystem that emphasizes measurement, accountability, and equity, with potential applicability to other geographically dispersed and ethnically diverse regions. Full article

Background/Objectives: Breaking bad news is crucial for patient-centered care. This study aimed to assess physicians’ skills and investigate the possible factors affecting their ability to communicate bad news. Methods: This web-based cross-sectional survey of 633 Greek physicians included demographic and other breaking bad news related questions to evaluate their skills and practices in breaking bad news to patients with cancer. Results: Most physicians defined bad news (91.5%) and frequently used both verbal and non-verbal communication (82.6%). About three-quarters rated their ability to communicate bad news as good to very good (75%) and about half (50.4%) disclosed bad news in a private and comfortable setting. Emotional responses, like sadness (53.4%) and compassion (49.6%), were common, while fears mainly focused on diminishing patients’ hope (60.8%) or managing patients’ reactions (53.9%). Female physicians showed higher anxiety (15.9% vs. 4.3%, p < 0.0005) and sadness (53.4% vs. 43.5%, p = 0.018) and lower self-perceived competence (p = 0.001) compared to males. Specialists and physicians with formal training demonstrated greater competence (p < 0.0005) and were more likely to choose private and comfortable settings (p < 0.0005). Multivariable logistic regression identified increased age (OR = 1.03; p = 0.018), male sex (OR = 1.63; p = 0.015), formal training in breaking bad news (OR = 9.34; p < 0.0005), residence outside Athens (OR = 2.27; p = 0.002), working in oncology (OR = 1.90; p = 0.043), and employment in private hospitals (OR = 1.81; p = 0.014) as statistically significant predictors of good to very good ability to communicate bad news to cancer patients. Conclusions: These findings highlight the value of structured training, targeted practice and institutional support in fostering physicians’ communication skills and boosting patient-centered care. Full article

Background: Recent advances in spatial transcriptomic technologies enable in situ gene expression profiling while preserving spatial context. This capability is particularly important for studying the tumor microenvironment (TME), where diverse and admixed cell populations interact within highly organized spatial niches that influence tumor progression and therapeutic response. However, the limited resolution of early spatial transcriptomic platforms results in each spatial spot capturing transcripts from multiple cell types, making accurate spot deconvolution or annotation a critical yet challenging step in downstream data analysis. The level of complexity will be particularly prominent in heterogeneous samples like the tumor microenvironments where multiple cell types are highly admixed and reliable single-cell reference atlases may usually be unavailable. Methods: In this paper, we developed our method called STEA, which is a novel and accurate reference-independent enrichment-based annotation algorithm for major cell type. Unlike the existing approaches, STEA does not require single-cell RNA sequencing datasets as reference, offering both flexibility and computational efficiency in execution. Results: We performed comprehensive benchmarking using a variety of simulated datasets across different platforms and scenarios and demonstrated the superior accuracy of STEA. Apart from synthetic data, we also evaluated multiple real datasets to further exemplify its practical applicability on both oncology-related and oncology-unrelated data. More importantly, we could confidently demonstrate the high concordance between prediction of STEA and histological classification by experienced pathologist. Conclusion: Our STEA algorithm provides a practical reference-independent framework to complement the cutting-edge spatial transcriptomics in genomics studies, facilitating accurate downstream high-dimensional spatial characterization of cellular and molecular landscapes, reconstruction of tissue architecture as well as cell–cell communication in malignant and non-malignant scenarios. Taken together, our comprehensive evaluation demonstrates the robustness and reliability of STEA, highlighting its potential as a valuable tool for studying complex tissue organization, particularly within heterogeneous TME. Full article

Background/Objectives: In Palliative Care (PC), the communication is an essential aspect of care becoming particularly significant at the end-of-life. In neurodegenerative diseases, communication involves additional complexity due to prolonged disease trajectories, early cognitive decline, and frequent loss of decision-making capacity. The aim of this study was to explore PC healthcare professionals’ experiences with communication process and relational dynamics involving families of patients with advanced and terminal neurogenerative disease. Methods: The study design was qualitative, using semi-structured interviews and reflexive thematic analysis. Participants were healthcare professionals directly involved in communication with the family. Results: Twenty PC professionals were interviewed, generating 792 coded excerpts. Four themes emerged: (1) Navigating PC in neurodegenerative diseases, highlighting shift from oncology-centred palliative models toward neuropalliative care, with distinctive relational challenges; (2) Navigating conversations between professionals and families, describing multidisciplinary communication, core clinical and emotional topics, and goal-oriented decision-making in contexts of impaired patient capacity; (3) Facing challenges in health care professional–family communication, including conspiracy of silence, absence of Advance Treatment Directives (ATD) or Shared Care Planning (SCP), and limited collaboration with neurologists; and (4) Envisioning methods for improvement, emphasizing the need for disease-specific competencies, advanced relational skills, interprofessional coordination, and support for professionals’ emotional wellbeing. Conclusions: Communication in neurodegenerative palliative care is an ongoing relational and interpretative process requiring professionals to mediate uncertainty, surrogate decision-making, and caregiver burden. Strengthening disease-specific communication skills, early integrated PC, and structured interprofessional collaboration may enhance shared decision-making, caregiver support, and care continuity. Full article

Ototoxicity represents a clinically significant complication of anticancer therapy in pediatric patients. Cytotoxic agents used in oncology, particularly platinum-based chemotherapy, may induce damage to the auditory and vestibular systems, resulting in hearing loss, tinnitus, and balance disturbances. Even mild hearing impairment during childhood may negatively affect speech perception, language development, communication abilities, and subsequent educational and psychosocial functioning. This narrative review aims to synthesize current evidence on treatment-related ototoxicity in children, with particular focus on commonly implicated therapies, clinical consequences, diagnostic approaches, and potential preventive strategies. A focused literature search was conducted in PubMed for publications from 2019 to 2025 addressing ototoxicity associated with pediatric anticancer treatment and audiological monitoring methods. The analysis indicates that platinum-based compounds, especially cisplatin and carboplatin, remain the primary agents associated with ototoxicity, with reported incidence ranging from approximately 20–70% for cisplatin and 10–30% for carboplatin. Additional risk factors include young age, baseline hearing status, renal function, and exposure to other ototoxic agents such as aminoglycoside antibiotics. Early detection relies on comprehensive audiological monitoring combining behavioral and objective methods, including pure-tone audiometry, extended high-frequency audiometry, otoacoustic emissions, and auditory brainstem response testing. Standardized grading systems such as ASHA, Brock, Chang, and SIOP Boston criteria play a key role in identifying and classifying ototoxic changes. Emerging research focuses on improved monitoring protocols, biomarker identification, and the development of otoprotective strategies, including sodium thiosulfate and experimental molecular therapies. Implementing systematic hearing monitoring and preventive strategies is essential to reduce long-term auditory complications and improve quality of life in pediatric cancer survivors. Full article

Primary squamous cell carcinoma (SCC) of the prostate is a rare and biologically aggressive malignancy lacking a standardized management strategy. De novo primary SCC arising without prior androgen deprivation therapy or radiotherapy is uncommon and presents significant diagnostic and therapeutic challenges. We present the clinical presentation, diagnostic evaluation, treatment strategy, and early therapeutic response of de novo primary SCC of the prostate in a 56-year-old male with end-stage renal disease on maintenance hemodialysis. The patient presented with gross hematuria and a bulky prostate mass invading the bladder with bilateral pelvic lymphadenopathy despite low prostate-specific antigen (PSA) levels. Histopathological and immunohistochemical analyses confirmed pure SCC, staged as cT4N1M0. Because systemic chemotherapy was contraindicated and surgery was not feasible, definitive whole-pelvis radiotherapy with a simultaneous integrated boost was administered. Marked tumor regression was observed one month after treatment. Subsequent imaging demonstrated extensive tumor necrosis with fistulous communication in the context of locally invasive disease. Because long-term oncologic durability could not be assessed owing to non-oncologic clinical deterioration, these findings suggest that definitive radiotherapy may provide meaningful locoregional tumor control in selected medically inoperable patients with de novo prostatic SCC. Full article

Background: Effective communication improves patient satisfaction and reduces stress for both patients and physicians. Surveys consistently highlight the importance of strong communication skills among physicians, especially in oncologic settings. Yet, communication training is neither ubiquitous nor standardized in medical studies or residency, and physicians report that this task represents a burden for them. Given the limited data addressing the observations and expectations of patients with gynecologic malignancies when receiving bad news, this survey aimed to assess their perspective on this topic. Methods: We examined throughout an anonymous questionnaire how patients with gynecological and breast cancer experienced the delivery of bad news. Data were collected in Germany from July 2024 to September 2025. The questionnaire was available online and in paper form in four languages (German, English, Turkish, Arabic), with the purpose of recording culture-specific data. Results: A total of 249 patients completed the survey. Regarding the overall need for improvement in delivering bad news, 222 women (94.5%) declared that improvement was necessary, with 92 (39.1%) of them indicating that substantial improvement was required. While 67.9% of patients were content with the physician’s professional competence, 30.5% stated a lack of empathy, and 32.9% stated insufficient time for conversation. When comparing satisfied and dissatisfied patients, significant differences were observed across several aspects, such as consultation length, nonverbal communication, calmness of the setting, stress level after the conversation, and the offer to bring a trusted person or arrange a follow-up conversation. Conclusions: This patient survey highlights a persistent gap between patients’ expectations and physicians’ performance when it comes to delivering bad news. The findings underline the urgent need for the implementation of systematic training programs and structured communication protocols in gynecologic oncology. Full article

Background/Objectives: Cancer-related terminology is not merely descriptive and plays a critical role in shaping emotional responses, personal identity, and communication across clinical, social, and public spheres. Despite growing interest in the psychosocial dimensions of illness language, few studies have centered the lived experiences of individuals navigating cancer through the lens of terminology. This study explores how people living with and beyond cancer perceive, interpret, and emotionally respond to cancer-related language, focusing on the way terminology influences identity, stigma, and communicative interaction. Methods: A sequential mixed-methods design was employed. The quantitative phase involved 146 participants with a cancer diagnosis completing a structured questionnaire on preferred terminology and emotional impact. The qualitative phase followed, using open-ended questionnaires with 11 participants to deepen understanding of linguistic experiences. Thematic content analysis was used to identify patterns across narratives. Results: These findings reveal that labels such as “cancer patient” evoke strong negative emotional reactions, associated with stigma, fear, and identity reduction. Person-first and context-sensitive language was perceived as more respectful and empowering. Emotional responses to language varied widely, from fear to neutrality, shaped by speaker role, context, and time since diagnosis. Media representations were often seen as dramatizing or moralizing, reinforcing the need for communicative clarity, empathy, and education in both clinical and public discourse. Conclusions: Cancer-related language is a powerful psychosocial force. It shapes how individuals are seen and see themselves and can either reinforce stigma or foster dignity and resilience. This study highlights the urgent need for person-centered, context-aware communication practices across healthcare, media, and society. Full article

Background: Disparities in esophageal cancer (EC) outcomes persist, partially due to inequitable access to high-quality surgical care, particularly for socioeconomically disadvantaged populations. This study evaluates the impact of social determinants of health (SDHs) on achieving textbook oncological outcomes (TOOs) and survival in operable EC patients. Methods: Using the National Cancer Database (2010–2021), we analyzed 26,367 stage I–IV A esophageal adeno- and squamous cell carcinoma patients undergoing esophagectomy after neoadjuvant chemoradiation. An SDH score (0–4) was derived from income, education, rurality, and hospital type. TOOs were defined as R0 resection, ≥20 lymph nodes examined, no 30-day mortality, and no prolonged hospitalization. Multivariable logistic and Cox regression models assessed predictors of TOOs and survival. Results: Overall, 19% achieved TOOs. Median survival time was 6.4 years for TOO+ versus 3.2 years for TOO−. Patients with favorable SDH had longer survival than those with unfavorable SDHs (median 4.0 vs. 3.5 years), but this disparity was largely confined to TOO− patients. Across stages II–III, low income and treatment at community hospitals were consistently associated with higher mortality among TOO− patients (HRs ~1.08–1.21), whereas SDH factors were largely attenuated among TOO+ patients. Stage-stratified analyses demonstrated that SDH effects were minimal in stage I and IV disease but pronounced in intermediate stages, especially in TOO− patients. Conclusions: TOOs are a powerful modifier of survival disparities in esophageal cancer. While SDH strongly influences outcomes among patients with suboptimal care pathways, achieving high-quality, textbook oncologic care attenuates these effects. Efforts to improve TOO achievement and expand access to high-quality centers may reduce socioeconomic inequities in survival. Full article