The data suggest that DT has acceptable overall accuracy and reliability as a screening tool for testing distress severity and specific problems causing distress in Chinese cancer patients. It is worth being used in oncology clinic, the rapid screening and interview could help caregivers to identify psychological and psychiatric problems of cancer patients and provide useful information for further treatment.

Limonoids have been shown to inhibit the growth of estrogen receptor-negative and -positive human breast cancer cells in culture. The primary objective of this study was to test the antiproliferative activity of limonoids (obacunone 17 beta-D-glucopyranoside, nomilinic acid 17 beta-D-glucopyranoside, limonin, nomilin, and a limonoid glucoside mixture), found in high concentrations in mandarin (Citrus reticulata Blanco), against a series of human cancer cell lines. The human cancer cell lines included leukemia (HL-60), ovary (SKOV-3), cervix (HeLa), stomach (NCI-SNU-1), liver (Hep G2), and breast (MCF-7). The growth-inhibitory effects of the four limonoids and the limonoid glucoside mixture against MCF-7 cells were significant, and the antiproliferative activity of the different citrus limonoids was also dose and time dependent. No significant effects were observed on growth of the other cancer cell lines treated with the four individual limonoids at 100 micrograms/ml. At 100 micrograms/ml, the limonoid glucoside mixture demonstrated a partial inhibitory effect on SKOV-3 cancer cells. With use of flow cytometry, it was found that all the limonoid samples could induce apoptosis in MCF-7 cells at relatively high concentrations (100 micrograms/ml). Considering the high concentration needed to induce apoptosis, it is unlikely that this is the primary mechanism of action for the cytotoxic effects seen with limonoids in this study. Further work is needed in this area to establish the mechanism of action of citrus limonoids on human breast cancer cells.

Objective:We investigated the effect of stoma status (permanent stoma, temporary stoma, or non-stoma) on psychological distress and quality of life (QOL) in Chinese patients with colorectal cancer (CRC) in the early postoperative stage. We also investigated whether body image mediated the association between stoma status and psychological distress and QOL. Methods: A convenience sample of 282 CRC patients 1 to 2 weeks postsurgery participated in an observational, cross-sectional study. Participants completed the following self-report measures: Body Image Scale, Distress Thermometer, Hospital Anxiety and Depression Scale, and Core Quality of Life Questionnaire. Results: The temporary stoma group (TS) and the permanent stoma group (PS) reported worse body image and higher levels of anxiety and depression than the non-stoma group (P < .05). PS reported worse body image than TS (P < .01). Depression and significant body image problems were more prevalent in PS than in TS (P < .05). Stoma status was the strongest factor associated with body image, distress, and depression (P < .05). CRC patients who were younger or in later clinical stages had poorer body image. Body image fully mediated the effect of stoma status on anxiety, depression, and global QOL in PS and TS, but mediated the effect on distress only in PS. Conclusions: Body image problems are common in stoma patients in the early postoperative stage and require early assessment. This study helps to elucidate the role of body image as a mediator. Longitudinal studies are needed to further explore body image distress trajectories. K E Y W O R D S anxiety, body image, cancer, China, colorectal, depression, distress, oncology, quality of life

Background Both demoralization and depression are common forms of psychological distress in cancer patients. This study aimed to investigate the severity of demoralization in Chinese cancer patients and to explore the factors influencing depression and demoralization and their effects on quality of life to better understand the differences and the relationship between demoralization and depression. Methods Cross‐sectional study design, in‐patients sequentially recruited from a tertiary‐level cancer hospital in Beijing between January 2016 and April 2016 completed Mandarin version of Demoralization Scale (DS‐MV), Patient Health Questionnaire‐9 (PHQ‐9), Revised Life Orientation Test (CLOT‐R), Beck Hopelessness Scale (BHS), and the 12‐items Short Form Health Survey, version 2 (SF‐12 V2) and provided socio‐demographic and clinical information. Results 296/424 (70.0%) of patients completed questionnaires. The mean score of DS is 30.4 (SD = 13.0). There are 28% (83/296) patients who experienced a low level of depression but a high level of demoralization. Resignation medical coping method (b = 0.279, P < .001), hopelessness (b = 0.492, P < .001), positive life orientation (b = −0.170, P < .001), and education level (b = −0.132, P < .001) were found to be predictors of demoralization, while only resignation medical coping method (b = 0.373, P < .001) and hopelessness (b = 0.350, P < .001) were found to be predictors of depression. Depression is a mediator between demoralization and physical aspects of quality of life (γ = −0.1604, LLCI = −0.244, ULCI = −0.080). Conclusion Demoralization is a prevalent psychiatric problem in Chinese cancer patients, and a large proportion of patients had low depression but high demoralization. Therefore, screening for demoralization in Chinese oncology practice is essential. A positive life orientation was found to be protective against demoralization.

BackgroundTo evaluate the relationship between quality of life (QOL) and physical as well as psychological variables in Chinese breast cancer patients.MethodsThis multicenter cross-sectional study enrolled 254 Chinese breast cancer patients in different stages and treatment phases. They answered standard instruments assessing QOL (EORTC), somatic symptom severity (PHQ-15), depression (PHQ-9), anxiety (GAD-7), health-related anxiety (WI-7), illness perception (BIPQ), and sense of coherence (SOC-9). Canonical correlation was applied to identify the strongest correlates between the physical, emotional and social QOL scales and the physical and psychological variables.ResultsIn our sample, a low global QOL was significantly associated with the following physical and psychological variables: symptom-related disability (Karnofsky Index) (r = .211, p < .01), somatic symptom severity (r = −.391, p < .001), depression (r = −.488, p < .001), anxiety (r = −.439, p < .001), health-related anxiety (r = −.398, p < .001), dysfunctional illness perception (r = −.411, p < .001), and sense of coherence (r = .371, p < .001). In the canonical correlation analysis, high somatic symptom severity, depression, anxiety, dysfunctional illness perception, and low sense of coherence showed the strongest correlations with low physical, emotional and social functioning. The first three significant canonical correlations between these two sets of variables were .78, .56, and .45.ConclusionsQOL in Chinese breast cancer patients is strongly associated with psychological factors. Our results suggest that Chinese physicians and nurses should incorporate these factors into their care for women with breast cancer to improve patients’ QOL.