Oncology services in the Gaza Strip have been severely disrupted by the ongoing war since 2023. Therefore, the region provides a crucial example for understanding how pain affects health-related quality of life (HRQoL), psychological distress, and spiritual well-being under extreme conditions.

We conducted a cross-sectional study of 349 adult cancer patients attending the three operational outpatient cancer clinics in Gaza (July-August 2025). Data were collected using convenience sampling and employed the validated Arabic versions of the Brief Pain Inventory-Short Form (BPI-SF), the EORTC QLQ-C30, the PHQ-4, and the FACIT-Sp-12. Patients with a BPI-SF worst pain score ≥ 4 were classified as "having pain." Analgesic adequacy was assessed using the Pain Management Index (PMI). Group comparisons between patients with and without pain were performed using Mann-Whitney U and Chi-square tests, and associations were assessed using Spearman's rank correlation. Mediation analyses were conducted to test whether psychological distress mediated the relationship between pain and both spiritual well-being and global health status (QLQ-C30 GHS), using ordinary least squares regression with 2,000 bootstrap resamples, adjusting for age, sex, and income.

Among participants, 53.6% reported having cancer pain. Pain undertreatment was common: 41% of all participants were inadequately managed, and only about 10% received strong opioids. Those experiencing pain had markedly poorer HRQoL, with lower scores in global health status and functional domains and worse financial difficulties (all p < 0.001), along with substantially higher symptom burdens, including fatigue, nausea, insomnia, and appetite loss. Psychological distress was greater among patients with pain (PHQ-4 median 4.0, IQR 3.0-7.0, vs. 2.5, IQR 0.0-5.0; p < 0.001), with over one-third experiencing moderate-to-severe distress compared to about one-fifth without pain (35.8% vs. 21.0%). Spiritual well-being was also worse (FACIT-Sp: 32.0 vs. 38.0, p < 0.001), with lower scores on meaning, peace, and faith. Pain intensity correlated positively with psychological distress (ρ = 0.36, p < 0.001) and negatively with spiritual well-being (ρ = -0.37, p < 0.001), while psychological distress and spiritual well-being were strongly inversely related (ρ = -0.69, p < 0.001). Mediation analyses suggested that psychological distress may partially account for the association between pain and spiritual well-being (indirect effect = - 0.51, 95% CI - 0.68 to - 0.35; 56% of the total effect), and, to a lesser extent, the association between pain and global health status (indirect effect = - 1.01, 95% CI - 1.40 to - 0.66; 26% of the total effect).

Cancer patients in Gaza face significant multidimensional suffering, including undertreatment, poor HRQoL, and inadequate pain management. These findings underscore the pressing need for integrated pain, psychosocial, and palliative care services, as well as international efforts to safeguard healthcare services and ensure access to essential medicines in conflict zones.

Studies on intraosseous meningiomas requiring cranioplasty have been scarce, and surgical outcomes thus remain poorly characterized. Using a population-based, multicentre cohort of patients who had undergone resection of intraosseous meningioma with concurrent cranioplasty, we aimed to establish long-term outcomes, as well as rates and predictors of complications and tumour recurrence.

All patients who had undergone primary resection of an intraosseous meningioma with concurrent cranioplasty at four neurosurgical departments in Sweden between 2008 and 2022 were included. Data on patient demographics as well as tumour- and surgery-related data were collected retrospectively by scrutiny of medical records. Rates and predictors of surgical complications, and the composite outcome of tumour recurrence (including growth of residual tumour), were analysed using Cox regression.

Of the 119 patients included, 16% experienced surgical complications requiring reoperation, 10% underwent implant explantation, and 31% developed tumour recurrence. Choice of implant material differed significantly across the participating centres but did not influence complication rates. Markers of biological aggressiveness were associated with an increased risk of surgical complications and tumour recurrence.

Surgical complications and tumour recurrence are common following resection of intraosseous meningiomas with concurrent cranioplasty. Rather than the material used for cranial reconstruction, biological and anatomical tumour-related factors were the strongest predictors of adverse outcomes.

Non-Hodgkin's lymphoma (NHL) is a diverse group of lymphoproliferative malignancies that predominantly affects older adults. Chemotherapy remains the primary modality of treatment for many NHL subtypes, yet it often brings about adverse effects such as myelosuppression, anemia, and neuropathy, all of which contribute to a heightened risk of falls in older patients. Falls in this population can lead to serious complications, including fractures and intracranial injuries, thereby impacting functional status and potentially delaying oncological treatment.

This study was aimed at assessing the efficacy of a structured, evidence-based preventive nursing protocol in reducing falls among older patients with NHL undergoing chemotherapy compared to standard care.

A prospective, single-center randomized controlled trial enrolled 210 older patients (≥ 65 years) newly diagnosed with or relapsed NHL requiring chemotherapy. Participants were randomly assigned to an Intervention Group-receiving a multifaceted preventive nursing program based on individualized risk assessment-or a Control Group that received standard oncology nursing. Primary outcomes included fall incidence and recurrence. Secondary outcomes encompassed fall-related injuries, Timed Up and Go (TUG) test performance, chemotherapy completion, and quality of life. Statistical analyses were conducted using SPSS 27.0 with significance set at p < 0.05.

Of 210 participants enrolled, 194 (98 in the Intervention Group and 96 in the Control Group) completed the 12-week follow-up. The Intervention Group demonstrated a significantly lower fall incidence (7.1%) compared with the Control Group (19.8%, p = 0.012). Patients in the Intervention Group had fewer severe injuries, better chemotherapy adherence, improved functional mobility as measured by TUG tests, and higher quality of life scores.

A targeted, multifactorial nursing intervention substantially reduced falls and fall-related complications among older adults with NHL receiving chemotherapy. Integration of fall prevention measures into routine oncologic care is strongly recommended to safeguard treatment continuity and patient well-being. Further multicenter and long-term studies are warranted to validate these findings and refine comprehensive fall prevention strategies.

Tumescent local anaesthesia (TLA) is an upcoming alternative to general anaesthesia. No data exists regarding patient satisfaction, necessary volume of TLA, frequency of supplementary analgosedation, and associated complication rate after different kinds of breast surgeries in TLA.

In this retrospective study 104 patients, who underwent breast surgery in TLA between 1/2022 and 1/2023, answered a questionnaire. Patients were categorized according to histology and surgical complexity into two groups: those with benign histology undergoing minor procedures (outpatients) and those with malignant histology undergoing more complex surgical procedures (inpatients). Perioperative data was retrieved from the patients' files.

96.1% of all patients were (very) satisfied with the surgery, with inpatients being significantly more satisfied (p = 0.022). No significant differences were observed between the groups regarding perception of TLA-infiltration, likelihood of recommending the procedure in TLA, or willingness to undergo the procedure again in TLA. Six patients (5.8%) had postoperative complications with no significant difference in frequency of complications. Outpatients needed significantly less TLA-volume (184.7ml ± 131.4 ml), compared to inpatients with a total TLA-volume of 473.3 ml ± 205.2 ml (p < 0.001). 25 patients (24.0%) opted for an intraoperative midazolam sedation (mean 1.5 mg, SD 0.9mg), predominantly in more extensive procedures.

Patients' high satisfaction and recommendation level and the low rate of complications are convincing reasons to offer TLA as an alternative to general anaesthesia for a large spectrum of breast surgeries.

Depression is a heterogeneous construct comprising distinct symptom domains, including motivational anhedonia, consummatory anhedonia, and negative affect, commonly experienced by colorectal cancer (CRC) survivors. Inflammation has been implicated in depression, its association with specific depressive symptom domains in CRC survivors remains insufficiently characterized.

CRC patients (n = 497) completed questionnaires assessing depressive symptoms 12- and 24-months post-diagnosis: motivational anhedonia (Multidimensional Fatigue Inventory), consummatory anhedonia (Hospital Anxiety and Depression Scale-depression), and negative affect (EORTC QLQ-C30, emotional functioning). Associations between 11 inflammatory markers (CRP, IL-1α, IL-1β, IL-6, IL-8, IL-10, IL-17A, IL-22, IFN-γ, sTNFRI, and sTNFRII) at 12-months and depressive symptoms at 12- and 24-months were examined using linear mixed models.

IL-1β (Est = 0.089, p = 0.003) and IFN-γ (Est = 0.067, p = 0.001) were associated with more consummatory anhedonia symptoms across time, and a small sTNFRI × time interaction was found (Est = 0.000, p = 0.007). Negative affect was associated with IL-1β (Est = -0.496, p < 0.001), IFN-γ (Est = -0.354, p < 0.001), and sTNFRI (Est = -0.003, p < 0.001). A significant IL-1α × time interaction was observed (Est = 0.250, p = 0.038) for motivational anhedonia.

Most consistently IL-1β, IFN-γ, and sTNFRI was associated with greater consummatory anhedonia and more negative affect in CRC survivors. In addition, inflammatory correlates (IL-1α and sTNFRI) of motivational anhedonia and consummatory anhedonia changed over time. These findings suggest that selected inflammatory pathways may contribute to specific depressive symptom domains during colorectal cancer survivorship. Given the exploratory nature of the analyses, replication in independent cohorts is required before clinical implications can be drawn.

Benign facial nerve tumors have unique presentations granting distinct diagnostic and management implications. Unlike acute-onset facial paralysis, the gradual, intermittent course complicates diagnosis, treatment strategy, and timing, especially when considering potential reanimation. This study presents our institutional experience and proposes approaches to management and evaluation of patients with slowly progressive facial weakness due to benign tumors.

A retrospective review included patients between August 2009 and April 2026 with slowly progressive facial weakness or hemifacial spasm due to a benign facial nerve tumor. Demographics, facial palsy history, tumor characteristics, treatment strategies, reanimation procedures, and outcomes were analyzed.

Fifteen patients met inclusion criteria with a mean age of onset of 45 years. Sixty-seven percent were initially misdiagnosed. Forty-seven percent presented with synkinesis. The most common tumor type was facial nerve schwannoma (60%). Forty percent underwent complete resection, 27% received radiation, and 27% are under observation. Six patients underwent dynamic facial reanimation: proactively (before tumor extirpation) in three cases, with one undergoing both proactive and concomitant reanimation during extirpation, concomitantly with extirpation in one, and following radiation in one. All achieved recovery of motion on average 3.7 months (range 2-7) later. Two patients are currently planned for reanimation.

Benign facial nerve tumors require individualized management based on functional trajectory, tumor characteristics, and patient preference. Treatment options range from observation and radiation to surgical extirpation, but due to the slowly progressive and partial nature of the facial paralysis, the reanimation strategy is guided not only by mimetic musculature viability but also by patient preference on timing. In patients with progressive weakness and anticipated nerve sacrifice during extirpation, proactive reanimation using nerve transfers, cross facial nerve grafts, and free functional muscle transfer should be considered early to establish reinnervation pathways before the denervation window closes, avoiding irreversible facial paralysis.

Pulmonary sequestration (PS) is a congenital lung malformation, which is defined by an anomalous arterial supply from systemic circulation and an absence of communication with the tracheobronchial tree. It is further divided into intralobar and extralobar PS. Pulmonary sequestrations are usually treated surgically, especially if they are symptomatic. Malignant tumors are rarely found within such malformations, mainly adenocarcinomas. We report a case of a malignant melanoma found in a patient operated for intralobar pulmonary sequestration, which is, to the best of our knowledge, the first reported case of a malignant melanoma occurring within a pulmonary sequestration.

We present a case of an 84-year-old male patient who underwent surgical treatment for a symptomatic pulmonary sequestration. The patient was first diagnosed with an intralobar PS two years prior to the surgery by a multislice computed tomography (MSCT) scan. It was located in the left lower lung lobe and had an anomalous arterial supply from an artery arising from the thoracic aorta. Two years later, the patient presented twice to the emergency department with hemoptysis and was thereafter referred to the thoracic surgeon. Another MSCT scan conducted before the surgery showed a newly formed solid lesion within the previously described PS. The thoracic surgeon therefore performed a left lower lobectomy and lymphadenectomy via thoracotomy. Histopathological analysis discovered two melanomas in the specimen, measuring 6 × 5 × 4 cm and 1.7 × 1.7 × 1.5 cm. The patient was referred to an oncologist. A positron emission tomography/computed tomography (PET/CT) scan, along with other diagnostic procedures, didn't show any other signs of malignant disease elsewhere in the body. Several other skin lesions were excised and biopsied, but none have turned out to be melanomas. A year after surgery, the disease disseminated.

Although the origin of the melanoma in this case could not be definitively established, this report demonstrates that pulmonary sequestration may harbor malignant neoplasm and highlights the diagnostic challenges in distinguishing primary pulmonary melanoma from metastatic melanoma. The appearance of a new solid lesion within a pulmonary sequestration necessitates careful evaluation and consideration of surgical resection.

Gastric squamous metaplasia is a rare condition whose clinical significance and malignant potential remain unclear. Most reported cases are located in the cardia and are continuous with the esophageal squamous epithelium. Ectopic gastric squamous metaplasia, defined as lesions discontinuous from the esophagus, is exceedingly rare, and its association with gastric neoplasms has not been well characterized.

An 81-year-old woman with a history of Helicobacter pylori eradication underwent esophagogastroduodenoscopy for gastric cancer screening. A 20-mm discolored, slightly depressed lesion was identified on the greater curvature of the upper gastric body. The lesion was discontinuous from the esophageal mucosa and appeared as an iodine-unstained area. Magnifying endoscopy with narrow-band imaging revealed intrapapillary capillary loop-like vascular dilation with background coloration. Biopsy specimens suggested squamous metaplasia with reactive atypia, and en bloc resection was performed by endoscopic submucosal dissection. Postoperative histopathological examination identified mature stratified squamous epithelium consistent with gastric squamous metaplasia, and incidentally identified a well-differentiated adenocarcinoma confined to the mucosa adjacent to the metaplastic lesion without lymphovascular invasion. Immunohistochemical analysis revealed a linear arrangement of p63-positive cells along the basal layer of the metaplastic epithelium with a subset of Ki-67-positive cells indicating proliferative activity at the basal layer. p53 expression showed a wild-type pattern.

We report an extremely rare case of ectopic gastric squamous metaplasia associated with well-differentiated adenocarcinoma. Although a direct histogenetic relationship between the two lesions remains uncertain, their coexistence raises important considerations regarding the pathogenesis of gastric squamous metaplasia and its potential clinical significance. The immunohistochemical findings may support a possible role of competitive epithelial replacement in the development of gastric squamous metaplasia. Careful endoscopic and histopathological evaluation is warranted when this rare lesion is encountered.

Given the differences between biopsy techniques, especially regarding the representativeness and amount of tissue obtained upon diagnostic workup of suspicious bone and soft tissue lesions, this study aimed at evaluating the diagnostic conclusiveness of different biopsy techniques at a tertiary sarcoma centre.

Overall, 222 consecutive patients (50.9% males, median age 63.3 [IQR 47.4-71.8] years) undergoing biopsy for a suspected bone or soft tissue lesion at a single centre between December 2021 and December 2023 were included. Biopsy techniques included core needle biopsy in the outpatient setting (without image guidance), sonography-guided and CT-guided and open biopsy. The conclusiveness rate of the first biopsy was defined as a histologically plausible result that enabled subsequent treatment planning.

Soft tissue and bone lesions were present in 114 (51.4%) and 108 (48.6%) patients, respectively. Core needle (n = 85; 38.3%) and CT-guided biopsies (n = 61; 27.5%) were most commonly employed. Median interval from first presentation to biopsy was 14 (IQR 3-29) days for bone and 0 (IQR 0-17) days for soft tissue lesions, attributable to the long delay of CT-guided biopsies (bone: median 28 [IQR 15-47] days; soft tissue: median 18 [14-45] days; p < 0.001). Complications were highest following CT-guided biopsies for soft tissue lesions (n = 2/18; 11.1% [95% CI 1.4%-34.7%]) and sonography-guided biopsies for bone lesions (n = 1/5; 20.0% [95% CI 5.1%-71.6%]). Overall, the first biopsy was conclusive in 88.0% (95% CI 80.3%-93.4%; n = 95/108) and 88.6% (95% CI 81.3%-93.8%; n = 101/114) of bone and soft tissue lesions, respectively, with no difference between biopsy types. A repeated biopsy became necessary in 9.5% of patients (n = 21/222). None of the parameters investigated (BMI, age, lesion size, biopsy type, location) were associated with the conclusiveness rate of bone or soft tissue biopsies.

The time delay from initial presentation to biopsy varies with the biopsy technique employed, as do complication rates. Yet, all biopsy techniques-when applied according to clinical indication-achieve high diagnostic conclusiveness rates.

IV.

With the rising global prevalence of cancer and the extensive demands of patient care, informal caregivers play an increasingly critical role. The substantial burden associated with caregiving can compromise their resilience and overall health. This review aimed to map the types of non-pharmacological interventions implemented for informal cancer caregivers and to identify understudied health domains.

This review followed the JBI scoping review framework and adhered to the PRISMA-ScR guidelines. Interventional studies involving informal caregivers of cancer patients were identified through searches of PubMed, Web of Science, and Scopus from January 1, 2015, to January 1, 2024. Data were extracted and synthesized descriptively, with critical appraisal conducted using the CONSORT 2025 checklist.

Thirty-five studies were included. Most interventions targeted caregivers of patients undergoing active treatment. Between 2015 and 2017, interventions were predominantly psycho-educational; from 2018 to 2020, they shifted toward combined physical-psychological approaches; and from 2020 to 2024, online delivery formats became predominant. Overall, there was a clear evolution from traditional, largely paper-based or booklet-facilitated educational programs to psychological and predominantly psycho-educational online and smartphone-based digital interventions.

Existing research has primarily focused on psycho-educational interventions, with quality of life, anxiety, and depression as the most frequently examined outcomes among informal cancer caregivers. However, several important domains-such as cultural and spiritual challenges, dyadic relationship quality, and insurance literacy-remain understudied. Future research should prioritize rigorous study designs with long-term follow-up, incorporate dyadic (patient-caregiver) and hybrid (in-person/online) interventions, and address emerging variables including resilience, digital health literacy, and decision-making burden.