The purpose of the study was to identify subgroups of advanced cancer patients who experienced grade 3–4 toxicities as reported by their oncologists as well as identify the demographic, clinical, and treatment symptom characteristics as well as QoL outcomes associated with distinct profiles of each patient. A prospective, multicenter, observational study was conducted with advanced cancer patients of 15 different hospitals across Spain. After three months of systemic cancer treatment, participants completed questionnaires that evaluated psychological distress (BSI-18), quality of life (EORTC QLQ-C30) and fatigue (FAS). The most common tumor sites for the 557 cancer patients with a mean age of 65 years were bronchopulmonary, digestive, and pancreas. Overall, 19% of patients experienced high-grade toxicities (grade 3–4) during treatment. Patients with recurrent advanced cancer, with non-adenocarcinoma cancer, undergoing chemotherapy, and a showing deteriorated baseline status (ECOG > 1) were more likely to experience higher toxicity. Patients who experienced grade 3–4 toxicities during cancer treatment had their treatment suspended in 59% of the cases. Additionally, 87% of the patients had a dose adjustment or a cycle delayed in their treatment due to a high risk of dying during treatment. Future research should focus on identifying interventions to reduce high-grade toxicities and improve quality of life in cancer patients.

Fear of cancer recurrence significantly impacts advanced cancer patients, prompting emotional distress and increased healthcare utilization. This present study aims to analyze the fear of recurrence among patients with advanced cancer undergoing systemic treatment and its relationship with sociodemographic, clinical, and psychological factors. A multicenter cross-sectional study was conducted in 15 oncology departments across Spain, involving patients with locally advanced, unresectable, or metastatic cancer eligible for systemic treatment. Participants provided demographic information and completed instruments such as the Cancer Worry Scale, Brief Symptom Inventory, Mishel Uncertainty in Illness Scale, and the Duke–UNC-11 Functional Social Support Questionnaire (DUFSSQ). A total of 1195 participants participated: median age 66, 56% male, mostly metastatic cancers (80%), and common tumor sites. Two fear groups emerged: 28% low and 72% high levels of fear. High fear was associated with being female, being younger, lower levels of education, and worse survival estimates. High fear correlated with more depression, anxiety, somatic symptoms, uncertainty, and stronger social support. Multivariate analyses indicated that younger patients, those with shorter survival estimates, higher depression and anxiety scores, more uncertainty, and stronger social support had a greater likelihood of experiencing fear of recurrence, while the opposite was true for older patients. This study underscores distinct fear of recurrence profiles in advanced cancer patients, emphasizing the need for targeted interventions and support. Future research should delve deeper into understanding their repercussions for improving patient care and well-being.

This research explores the results that an examinee would obtain if taking a multiple-choice questions test in which they have doubts as to what the true answer is among different options. This problem is analyzed by making use of combinatorics and analytical and sampling methodologies. The Spanish exam through which doctors become medical specialists has been employed as an example. Although it is difficult to imagine that there are candidates who respond randomly to all the questions of such an exam, it is common that they may doubt over what the correct answer is in some questions. The exam consists of a total of 210 multiple-choice questions with 4 answer options. The cut-off mark is calculated as one-third of the average of the 10 best marks in the exam. According to the results obtained, it is possible to affirm that in the case of doubting over two or three of the four possible answers in certain group questions, answering all of them will in most cases lead to obtaining a positive result. Moreover, in the case of doubting between two answer options in all the questions of the MIR test, it would be possible to exceed the cut-off mark.

Pretreatment health-related quality of life (HRQoL) may identify supportive care needs, but the joint contribution of symptom burden, depressive symptoms, and resilient coping remains insufficiently characterized. This multicenter baseline analysis included 194 adults with breast (n = 86), gynecological (n = 77), or genitourinary (n = 31) cancer from six Spanish hospitals before systemic therapy. Global HRQoL was assessed with the EuroQol visual analogue scale EQ-VAS; symptom burden with EORTC QLQ-C30 symptom scales/items; depressive symptoms with the Brief Symptom Inventory-18 depression subscale; and resilient coping with the Brief Resilient Coping Scale. EQ-VAS scores did not differ by tumor site (p = 0.369). Symptom burden was strongly inversely associated with HRQoL (r = −0.827, p < 0.001). In the moderated mediation model, higher symptom burden was associated with higher depressive symptoms (B = 0.275, 95% CI 0.118 to 0.431); symptom burden (B = −0.642, 95% CI −0.715 to −0.569) and depressive symptoms (B = −0.529, 95% CI −0.743 to −0.316) were associated with lower HRQoL scores. Indirect effects through depressive symptoms were statistically different from zero, but resilient coping did not significantly moderate this indirect association. These cross-sectional findings support pretreatment screening for symptoms and depressive symptoms to guide early supportive oncology care.