Cancer-related fatigue (CRF) is a distressing symptom in terminally ill patients with cancer. While many studies have been conducted on the relationship between fatigue and quality of life (QOL) among patients undergoing treatment, only a few have been conducted to measure fatigue from multiple perspectives or clarify its impact on patients in advanced stages or those receiving palliative care.

To examine the impact of fatigue on QOL in terminally ill patients with cancer, using a questionnaire that measures CRF from 3 perspectives.

CRF and QOL were measured using the Cancer Fatigue Scale (CFS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative (EORTCQLQ-C15-PAL), respectively, and the correlation between them was evaluated. Web-based questionnaires were completed by patients receiving hospice and palliative care.

Twenty-nine participants provided valid responses. Median CFS and global health status/QOL scores were as follows: total fatigue 25.0, physical fatigue 11.0, affective fatigue 9.0, cognitive fatigue 5.0, and global health status/QOL 50.0. QOL showed significant correlations with total fatigue (rs = −0.44, p = 0.017, 95% CI: −0.70, −0.09) and physical fatigue (rs = −0.38, p = 0.038, 95% CI: −0.66, −0.02), but none with affective fatigue (rs = −0.02, p = 0.917, 95% CI: −0.38, 0.35) and cognitive fatigue (rs = −0.33, p = 0.074, 95% CI: −0.63, 0.03).

Of the 3 aspects of fatigue, physical fatigue may be most closely related to QOL; however, its accurate assessment may depend on the scale used. Therefore, it is necessary to select an appropriate scale for patients with terminal cancer.

To examine the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) in Mexican cancer patients, and to evaluate their utility as brief screening measures for depressive and anxiety symptoms in oncology care.

In this cross-sectional study, 357 adult patients receiving oncological treatment at a cancer hospital in Mexico completed the culturally adapted Spanish versions of the PHQ-9 and GAD-7. Exploratory and confirmatory factor analyses were conducted to assess the factorial structure of both instruments, and internal consistency was evaluated using Cronbach’s alpha. Concurrent validity was examined through correlations with related measures.

The PHQ-9 yielded a 2-factor structure with acceptable internal consistency (Cronbach’s α = 0.837), while the GAD-7 showed a 1-factor structure with good internal consistency (Cronbach’s α = 0.881). The PHQ-9 explained 55.3% of the variance and the GAD-7 explained 58.5%. Confirmatory factor analyses indicated adequate model fit for both instruments.

Findings suggest that the PHQ-9 and GAD-7 are brief, valid, and reliable tools for detecting depressive and anxiety symptoms in Mexican cancer patients. Their use may facilitate the early identification of symptoms of anxiety and depression in oncology settings and support both clinical care and psycho-oncology research.

This study examined longitudinal associations between spirituality and quality of life (QoL) in women newly diagnosed with breast cancer and undergoing chemotherapy at a large tertiary cancer center.

Women (N = 114) completed measures of spirituality (3 subscales of the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale: Meaning, Peace, and Faith) and health-related QoL (36-Item Short Form Health Survey) at study entry and 3- and 15-months later. Bias-corrected bootstrap tests were used to examine whether baseline Faith was indirectly associated with mental and physical QoL 15 months later via Meaning and Peace at 3 months.

Baseline Faith was positively associated with Meaning (β = .31, p = .001) and Peace (β = .38, p < .001) at 3 months. Both Meaning [n = 94, effect = .07 (95% CI: .002, .17)] and Peace [n = 93, effect = .13 (95% CI: .02, .28)] mediated the association between Faith and mental QoL at 15 months. When baseline Meaning was controlled, the indirect effect of baseline Faith on mental QoL remained significant, [n = 94, effect = .07 (95% CI: .001, .18)], and increases in Meaning over the first 3 months became an even stronger predictor of later mental QoL (β = .36, p = .004), suggesting that change in meaning during active treatment is an especially important predictor of mental QoL.

Overall, findings demonstrate that Faith is indirectly associated with long-term QoL through early increases in Meaning and Peace. Because 90% of participants were within 6 weeks of diagnosis, the study provided a unique perspective on spirituality during the early treatment period. Clinically, results highlight the importance of early assessment of spiritual well-being and suggest that meaning-focused interventions may enhance long-term QoL for women undergoing chemotherapy.

Family caregiving for individuals in a permanent vegetative state (PVS) represents an extreme form of ambiguous loss characterized by prolonged emotional strain, suspended grief, and profound identity disruption. Despite its complexity, few qualitative studies have examined how families navigate this uniquely challenging condition and construct meaning around it.

Adopting a phenomenologically informed, interpretative approach, we conducted semistructured interviews with 13 family caregivers (in northeastern Italy). Data were analyzed via reflexive thematic analysis, following Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

Four interconnected themes emerged: (1) “the paradoxical coexistence of presence and absence”; (2) “identity disruption and emergent growth”; (3) “bodily relational practices that sustain emotional bonds and resist biomedical finality”; and (4) “the ‘double face’ of waiting and farewell, spanning ontological and biological loss.” Caregivers described symbolic acts that maintain relational continuity and challenge dominant medical framings of the patient’s body.

Ambiguous loss in PVS should be understood as a dynamic relational and symbolic process rather than a static burden. Effective support must honor families as active meaning-makers. Clinical practice and policy should integrate narrative and relational ethics to mitigate prolonged grief and enhance caregiver resilience.

Patients with advanced cancer frequently experience pain and psychological distress, often requiring controlled substances such as opioids and benzodiazepines. Although access to these medications increases risk of substance misuse, little is known about how clinicians and patients discuss controlled substance use during cancer care. Understanding these conversations may inform safer prescribing, improve patient outcomes, and support management of substance use disorder (SUD) risk. We aimed to characterize discussions of controlled substance use in oncology visits, including who initiated conversations, clinician responses, and verbalized SUD risk factors.

Five coders reviewed 826 audio-recorded oncology visits from a prior clinical trial. Encounters were coded for substance type, initiator (patient, clinician, both, neither), clinician/patient response style (avoidant, concerned/emotional, engaged, neutral, resistant), and substance misuse risk factors.

Mean patient age was 59.5 years; most were female (55.8%), White (81.7%), and married (71.7%). Substance-related content appeared in 14.6% of counters (n = 121; 92 unique patients). Mentioned substances included opioids and sedative-hypnotics (benzodiazepines/sleep aids), with oxycodone referenced in 67 visits. Patients initiated discussions more frequently (n = 51) than clinicians (n = 33), though not significantly, χ2(1, N = 95) = 33.00, p = 0.078. For the remaining encounters, neither initiated (n= 24) or both initiated (n=13). Among patient-initiated discussions, clinician response types were engaged (n = 25), neutral (n = 10), avoidant (n = 12), concerned/emotional (n = 1), or resistant (n = 3). Common substance misuse risk factors included inadequate pain management (n = 28), medication concerns (n = 17), dose escalation (n = 11), psychological concerns (n = 11), and substance misuse/drug-seeking (n = 5).

Despite widespread prescribing of controlled substances in oncology, discussions remain infrequent, and clinician responses to SUD-related concerns are often insufficient. These findings highlight opportunities to improve communication and risk management in cancer care.

The primary objective of healthcare personnel involved in end-of-life care is to ensure a good and dignified death. However, end-of-life care is delivered across various healthcare settings. This qualitative study aimed to identify the priorities and concerns related to end-of-life care shared by healthcare personnel working in hospitals, nursing homes, and municipal home care.

Twenty-two healthcare personnel from across Norway participated in virtual focus group interviews. Participants represented 3 distinct healthcare settings and had diverse professional backgrounds. Each interview was audio-recorded and transcribed verbatim. Qualitative content analysis was conducted and informed by theory on professional competence.

The analysis demonstrated that ensuring a good death was a shared focus among participants. Across settings, they expressed aligned priorities and concerns regarding end-of-life care. They likened their role to that of a pilot boat skipper, guiding the end-of-life process with a clear focus on: 1) offering support and information, 2) providing symptom relief, and 3) ensuring a presence at the bedside. Each of these themes highlights a key priority in end-of-life care across healthcare settings, along with its associated concerns.

This study demonstrates that healthcare personnel across hospitals, nursing homes, and municipal home care share core priorities of what constitutes a good and dignified death. The findings challenge setting-specific assumptions in end-of-life care and support an emphasis on shared core competencies in education and practice. Overall, the study contributes to a more unified understanding of end-of-life care by highlighting foundational care values that transcend organizational boundaries and professional backgrounds, thereby supporting policies that promote continuity and coherence across care environments.

Although spiritual pain in cancer patients has been extensively studied, little is known about the spiritual pain experienced by bereaved caregivers in Japan.

This preliminary scale development aimed to clarify the structure of spiritual pain experienced by bereaved caregivers of cancer patients.

This preliminary scale development was conducted as a secondary analysis of the nationwide J-HOPE4 survey, a cross-sectional questionnaire study of bereaved family members of cancer patients. Thirty-five items related to spiritual pain were analyzed using exploratory factor analysis (EFA).

Responses were obtained from 930 bereaved caregivers in general hospitals and palliative care units. Seven constructs were obtained through the EFA: Loneliness, Life’s heartlessness, A sense of unfinished business, Distress over patient deterioration, Remorse, Regret, and A sense of loss.

This preliminary scale development provides insights into the structure of spiritual pain experienced by bereaved caregivers of cancer patients. Further validation using independent samples is required.

Seven factors of spiritual pain were identified among bereaved caregivers of cancer patients, and understanding this multidimensional experience may inform supportive care.

While parental prognostic awareness is a vital concept, its complexity can sometimes be underestimated. Our study aimed to understand how parents of children with serious illness engage with the idea of their child’s death from a lived experience perspective.

Bereaved parents of children known to a statewide pediatric palliative care service, who died at the age of 16 years or younger from any medical condition, participated in semi-structured interviews. Reflexive thematic analysis was employed, informed by a phenomenological framework.

Twenty bereaved parents (6 fathers) participated; children ranged in age from 1 day to 16 years. Findings were categorized into 2 main themes: (1) Daily realities of engaging with the idea of death, with subthemes: variability in contemplating death, conversations with their child, conversations with family and friends, conversations with clinicians, making treatment decisions, and not engaging with death, and (2) factors influencing engagement, with subthemes: implicit factors, changes in clinical condition, and clinician communication.

Parents’ engagement with the idea of their child’s death was individual and dynamic. Our findings offer tangible examples of how parents contemplate and operationalize this engagement over time, helping clinicians appreciate the complex and non-binary nature of prognostic awareness. Clinicians should explore how parents engage with the idea of their child’s death both during and outside clinical encounters over time, acknowledge their role in supporting and guiding parents, and recognize that there is no single way for parents to process the idea of their child’s death.