Objective: This study systematically reviewed the effect of melatonin (MLT) on quality of life (QoL) and symptoms among patients with cancer. Design: Systematic review and meta-analysis. Data sources: Cochrane Library, PubMed, Embase, Web of Science, Medline, CINAHL, Scopus, ClinicalTrials.gov, China Biology Medicine (CBM), ProQuest and Open Grey were searched from inception to November 2021. Eligibility criteria: We included randomised controlled trials (RCTs) assessing the effects of MLT on QoL, sleep quality, fatigue, depression, pain, stomatitis rate and stomatitis severity in adult patients with cancer, without language restrictions. Studies that reported the effects of MLT along with other interventions and had incomplete or absent outcome data were excluded. Data extraction and synthesis: Two independent reviewers extracted data, and another two reviewers assessed the risk of bias. The risk of bias for each eligible study was assessed using the Cochrane assessment tool. The mean difference or standard mean difference (SMD) with 95% CIs was used in the computation of continuous variables to synthesise data. The relative risk was used for dichotomous outcomes. Heterogeneity was assessed and quantified (I ² statistic). Results: A total of 19 qualified studies that included 2101 patients with cancer (MLT: 1078, control: 1023) were included in the meta-analysis. The results indicated that MLT had no significant effect on QoL (SMD=−0.01, 95% CI (−0.14 to 0.11), p=0.83), sleep quality (SMD=−0.18, 95% CI (−0.62 to 0.26), p=0.42), fatigue (SMD=−0.34, 95% CI (−0.73 to 0.06), p=0.10), pain (SMD=−0.34, 95% CI (−0.7 to 0.02), p=0.06) or stomatitis severity (RR=0.78, 95% CI (0.47 to 1.30), p=0.35). MLT reduced stomatitis rate among patients with cancer (RR=0.47, 95% CI (0.26 to 0.88), p=0.02), except those with head and neck cancer (RR=1.09, 95% CI (0.92 to 1.29), p=0.35). MLT eased depression in patients who received administration for more than 14 days (SMD=−0.14, 95% CI (−0.27 to –0.01), p=0.03) and those who underwent surgery (SMD=−0.17, 95% CI (−0.32 to –0.03), p=0.02). Conclusion: The findings showed that MLT did not improve the QoL, sleep quality, fatigue, pain or stomatitis severity among patients with cancer. It had a limited effect on decreasing the stomatitis rate and easing depression. Different treatments, durations and cancer types were the main sources of heterogeneity. Further large-scale RCTs are urgently needed. In addition, the effects of different combinations of MLT dosage and duration, administration types and joint measures are worthy of further study. PROSPERO registration number: CRD42021292855.

Objectives To explore genetic/genomic nursing competency and associated factors among nurses from tertiary general and specialist cancer hospitals in mainland China and compare the competencies of nurses from the two types of hospitals. Design and setting A cross-sectional survey was conducted from November 2019 to January 2020, wherein 2118 nurses were recruited from 8 tertiary general hospitals and 4 cancer hospitals in mainland China. We distributed electronic questionnaires to collect data on nurses’ demographics, work-related variables and genomic nursing competency. Participants 2118 nurses were recruited via a three-stage stratified cluster sampling method. Results More than half (59.1%, 1252/2118) of the participants reported that their curriculum included genetics/genomics content. The mean nurses’ genomic knowledge score was 8.30/12 (95% CI=8.21 to 8.39). Only 5.4% had always collected a complete family history in the past 3 months. Compared with general hospital nurses, slightly more cancer hospital nurses (75.6% vs 70.6%, p=0.010) recognised the importance of genomics, while there was no significant difference in the knowledge scores (8.38 vs 8.21, p>0.05). Gender (β=0.06, p=0.005), years of clinical nursing (β=−0.07, p=0.002), initial level of nursing education (β=0.10, p<0.001), membership of the Chinese Nursing Association (β=0.06, p=0.004), whether their curriculum included genetics/genomics content (β=0.08, p=0.001) and attitude towards becoming more educated in genetics/genomics (β=0.25, p<0.001) were significantly associated with the nurses’ genomic knowledge score. Conclusion The levels of genomic knowledge among mainland Chinese nurses in tertiary hospitals were moderate. The overall genomic competency of cancer hospital nurses was comparable to that of general hospital nurses. Further genomic training is needed for nurses in China to increase their genomic competency and accelerate the integration of genomics into nursing practice.

Objective: This study aimed to assess the occurrence of chemotherapy-induced nausea and vomiting (CINV) in acute phase (24 h after chemotherapy) and delayed phase (2–5 days after chemotherapy) after standard antiemetic therapy and to explore the risk factors of CINV in the acute and delayed phases. Methods: This prospective and observational study analyzed the data of 400 breast cancer patients scheduled for chemotherapy in two hospitals. The self-report survey was developed to assess the occurrence of CINV and their associated factors. On day 2 and day 6 of chemotherapy, CINV was evaluated by the Multinational Association of Supportive Care in Cancer Antiemetic Tool (MAT). The incidence of acute and delayed CINV was expressed as frequency and percentage. Results: Among 400 patients, 29.8% and 23.5% experienced acute and delayed CINV, respectively. Logistic regression analysis showed that the risk factors associated with acute CINV included pain/insomnia, history of CINV, and highly emetogenic chemotherapy. The history of motion sickness (MS), history of CINV, number of chemotherapy cycles completed, and the incidence of acute CINV were significant risk factors for delayed CINV (all P < 0.05). Conclusions: The results of this study are helpful for nurses to identify high-risk patients with CINV, formulate effective treatment plans, and reduce the incidence of CINV.

Objective. This study aimed to conduct a retrospective observational study to understand the status of characteristics of pain and identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP) in advanced cancer patients. Methods. Advanced cancer patients over 18 years of age; diagnosed with cancer of any type and stage III or IV in the palliative care ward with available data were enrolled between 2018 and 2020. Demographic data and pain-related information were collected by using structured electronic extraction form from Hospital Information System (HIS). Patients who had well-controlled background pain with an intensity 4 on a 010 numerical scale for >12 hours/day, the presence of transient exacerbations of pain with moderate-severe intensity (5), and clearly distinguish from background pain were regarded to have suffered BTP. Spearman correlation was conducted to explore the relationship between pain score and demographics characteristics. Factors significant in univariate analysis were included in the multiple regression model to explore independent predictive factors associated with the BTP. Results. Of 798 advanced cancer patients, the mean age was 56.7 (SD=11.84) years. Lung cancer (29.95) was the most common cancer, and pain (93) was the most common symptom. More than half (n=428, 53.6) of the patients experienced BTP. The median number of BTP episodes was 4 (IQR=2, 7, range: 142). The median intensity of BTP was 6 (IQR=6, 7, range 510). Patients with severe background pain or BTP had longer hospital stay and more symptoms. Besides, more severe background pain was related to higher activity of daily living. Intramuscular injection of hydromorphone hydrochloride was the main medication for BTP onset. Younger age, background pain, anorexia, and constipation were independently associated with the presentation of BTP. BTP pain intensity was independently associated with bloating. Symptom numbers were an independent factor and positively associated with BTP episodes. Conclusions. BTP resulted in poor prognosis, which has a variable presentation depending on interdependent relationships among different characteristics. Good controlling of background pain and assessment of pain-related symptoms are essential for BTP management. BTP should be managed individually, especially the invisible pain among aged patients. Furthermore, BTP-related education and training were still needed.

Background: With the development of digital health platforms, patients with breast cancer are increasingly relying on web-based resources to search for disease-related information. Proper usage of web-based health information by patients with breast cancer is crucial for understanding disease information and participating in treatment decisions. However, in the face of the large amount and complexity of information, it is still unclear how patients can make psychological adjustments and behavioral responses. Problems such as variable information quality and conflicting information are also affecting the cognitive and treatment decision-making process of patients with breast cancer. Objective: This study aims to explore the real experiences of Chinese patients with breast cancer in their search for web-based health information from a phenomenological perspective, providing insights for optimizing future web-based health information support for patients. Methods: This qualitative study used semistructured, in-depth face-to-face interviews to collect data. Through purposive and convenience sampling, 18 female patients with breast cancer were recruited from a tertiary cancer hospital in China. The data saturation principle was observed to determine the endpoint of data collection. The collected data were analyzed using thematic analysis. Results: From 18 original interview documents, three themes and 11 subthemes were categorized as follows: (1) driving force of information search (emotion-based information search, problem-solving–oriented information search), (2) cognitive judgments amidst the information fog (interweaving of multichannel information, judgment of information authenticity, information applicability assessment, cognitive confusion in the context of information conflict, and construction of information meaning), and (3) adaptation under the pressure of web-based information (transform information into action, emotional regulatory coping, build a support network, and acceptance and adjustment of expectations). Conclusions: This study reveals that the experiences of patients with breast cancer within web-based health information environments resemble an information navigation journey. Patients continuously search, evaluate, and adjust within the sea of information to maintain cognitive clarity and emotional equilibrium. The findings offer valuable insights for clinical health care providers, health information platform developers, and policymakers. They can help optimize digital health services and design personalized information support that better meets patients’ needs.