Circular RNA 0006349 Augments Glycolysis and Malignance of Non-small Cell Lung Cancer Cells Through the microRNA-98/MKP1 Axis.

Background: The involvement of dysregulated circular RNAs (circRNAs) in human diseases has been increasingly recognized. In this study, we focused on the function of a newly screened circRNA, circ_0006349, in the progression of non-small-cell lung cancer (NSCLC) and the molecules of action. Methods: The NSCLC circRNA dataset GSE101684, microRNA (miRNA) dataset GSE29250, and mRNA dataset GSE51852 obtained from the GEO database were used to identify the differentially expressed genes in NSCLC samples. Tumor and normal tissues were collected from 59 patients with NSCLC. The expression of circ_0006349, miR-98, and MAP kinase phosphatase 1 (MKP1) in collected tissue samples and in acquired cells was determined. The binding relationships between miR-98 and circ_0006349/MKP1 were predicted and validated. Altered expression of circ_0006349, miR-98, and MKP1 was introduced in NSCLC cells to examine their roles in cell growth, apoptosis, and glycolysis. Results: Circ_0006349 and MKP1 were upregulated, and miR-98 was poorly expressed in the collected tumor tissues and the acquired NSCLC cell lines. Circ_0006349 was identified as a sponge for miR-98 to elevate MKP1 expression. Silencing of circ_0006349 suppressed proliferation and increased apoptosis of Calu-3 and H1299 cells, and it reduced glycolysis, glucose uptake, and the production of lactate in cells. Upon circ_0006349 knockdown, further downregulation of miR-98 or upregulation of MKP1 restored the malignant behaviors of cells. Conclusion: This research demonstrated that circ_0006349 derepressed MKP1 expression by absorbing miR-98, which augmented the proliferation and glycolysis of NSCLC cells and promoted cancer development.

Supportive care needs and associated factors among Chinese cancer survivors: a cross-sectional study.

PURPOSE: To investigate the unmet supportive care needs (SCNs) of Chinese cancer survivors and to identify factors associated with the unmet SCNs of cancer survivors. METHODS: A cross-sectional survey of Chinese cancer survivors was conducted using validated scales of the Cancer Survivors Unmet Needs scale (CaSUN), physical symptom concerns (Cancer Survivors Survey of Needs-CSSN subscale), and a single-item measure of global quality of life (QoL) perception. RESULTS: There were 330 participants, with a mean score of 7.1 (0-10) in overall QoL. The reported rate of the 19 symptom concerns ranged from 19.4 to 72.2%. The level of unmet SCNs (moderate and strong need) ranged from 12.1 to 59.1%. The top five unmet needs included concerns about the cancer re-occurring (59.1%), accessing the best medical care (52.7%), accessing complementary therapy services (51.5%), changes to beliefs (48.2%), and survivor expectations (47.6%). The strength of unmet SCNs was negatively correlated with participant age (P < 0.05), average time since diagnosis (P < 0.05), and overall QoL (P < 0.01) and positively correlated with all symptom concerns (all P < 0.001). CONCLUSIONS: Study findings call attention to cancer survivors' unmet SCNs and related factors. Underscored areas in developing survivorship care included paying special attention to existential survivorship, empowering survivor management of chronic symptoms, particularly for younger survivors, as well as for survivors with poor QoL, and those with a shorter time since diagnosis. This tailored survivorship care should be developed and delivered by a multidisciplinary team to support cancer services, with a greater capacity to deliver individualized, unmet SCN-driven care to survivors.

The impact of depression and anxiety on quality of life in Chinese cancer patient-family caregiver dyads, a cross-sectional study.

BACKGROUND: Cancer and its treatment can result in psychological distress in both adults with cancer and in their family caregivers. This psychological distress acts as a significant adverse factor in patient-caregiver dyads. The study purposes included: (i) to assess anxiety and depression in adults with cancer and their family caregivers, and examine the dyadic relationship of anxiety and depression in patient-caregiver dyads; (ii) to investigate factors that may modify these relationships; and (iii) to explore the impact of anxiety and depression on patient-caregiver dyad quality of life (QOL). METHODS: This was a secondary analysis of a cross-sectional study. Participants consisted of 641 patient-caregiver dyads. Participants completed a survey assessing adults with cancer-related, family caregiver-related, and family-related variables using a demographic/clinical information sheet. In addition, anxiety/depression and QOL were assessed by using the Chinese version of the Hospital Anxiety and Depression Scale and SF-12 respectively. Data were analyzed by using descriptive statistics, Pearson correlations, subgroup analysis, and the Actor-Partner Interdependence Model. RESULTS: Nearly one-third of participants had experienced anxiety and depression. Adults with cancer and family caregivers experienced a similar degree of anxiety and depression. Correlations (r) of anxiety and depression between patient-caregiver dyads ranged from 0.25 to 0.32. Various factors influencing the anxiety and depression relationship between patient-caregiver dyads were identified, including adults with cancer-related (e.g., age, gender, marital status, level of being informed about the disease, different types of cancer and treatment), family caregiver-related (e.g., being the spouse of a patient, duration in their role as a family caregiver, and amount of time spent on caregiving each day), and family-related (family relationship pre- and post-cancer, financial burden on the family due to cancer treatment) variables. To some extent, both actor and partner effects were identified for anxiety and depression on the QOL of patient-caregiver dyads. CONCLUSIONS: Study findings call attention to anxiety and depression, as well as related factors, in patient-caregiver dyads. The underlined essential components and focus of intervention, which will be developed to decrease psychological distress and improve QOL in patient-caregiver dyads, included individual characteristics of patient-caregiver dyads, family relationship, and anxiety and depression in their counterparts.

Factors moderating the mutual impact of benefit finding between Chinese patients with cancer and their family caregivers: A cross-sectional study.

OBJECTIVE: With growing recognitions of the significance of benefit finding (BF) in cancer practice, research has increased to explore factors that may influence BF in the cancer context. Few studies have focused explicitly on factors influencing BF from the dyadic perspective of cancer patient (CP)-family caregiver (FC) dyads. The objectives of the study were to examine BF relationship between CPs and FCs and to investigate factors that may modify the BF relationships between CPs and FCs. METHODS: Participants consisted of 772 dyads of CPs and FCs. Three types of variables were collected as potential modifying factors, including CP-related variables, FC-related variables, and psychological-related variables. Descriptive statistics, T test, Pearson correlations, and subgroup analysis were applied to conduct the data analysis. RESULTS: Cancer patients and FCs experienced similar moderate to high BF ranging from 65% to 81%, with the exception of acceptance, in that CPs had higher levels of acceptance than did FCs (P < .05). Various factors modifying the BF relationships between CPs and FCs were identified, including dyads' gender, marital status, education level, employment status, level of being informed about the disease, and cancer type and treatment, anxiety, depression, and self-efficacy. CONCLUSIONS: Study findings call attention to the BF, as well as related factors, from the dyadic perspective of CP-FC dyads. Health care professionals need to include FCs of the CPs in their care and provide them with support, to encourage the CP-FC dyads to share their experience and improve BF together, and to develop a dyadic-based intervention program to help enhancing dyads BF.

Construct validity of the 17-item Benefit Finding Scale in Chinese cancer patients and their family caregivers: a cross-sectional study.

PURPOSE: With increasing interest in, and growing recognition of, the importance of evaluating benefit finding (BF) in cancer practice, the construct validity of a majority of the instruments that claim to assess BF, however, requires further validation. The purpose of the present study is to evaluate the construct validity of the 17-item Benefit Finding Scale (BFS) in Chinese cancer patient-caregiver dyads and to evaluate the association between the BFS patients and the BFS caregivers. METHODS: There were 772 dyads of patients with cancer and their family caregivers who completed a survey assessing their demographic information and BF from November 2014 to December 2015. Both exploratory and confirmatory factor analysis was applied to evaluate the construct validity of the 17-item BFS. RESULTS: Dimensionality analysis confirmed a three-dimensional structure validity. The extracted three factors were personal growth, improved relationships, and acceptance. The overall and three subscales of BFS in both cancer patients and family caregivers had good internal consistency, with all of the Cronbach's α ≥0.819. Scores of the three subscales and overall scale between cancer patients and family caregivers were correlated to one another (r = 0.224-0.437, P < 0.001). CONCLUSIONS: This study provides the three-factor construct validity of the 17-item BFS when applied in the sample of Chinese patients with cancer and their family caregivers. The mutual impact of benefit finding between Chinese patients with cancer and their family caregivers highlights the importance that healthcare professionals need paying special attention to the BF on the dyadic level when supporting patients with cancer.

The Chinese version of hospital anxiety and depression scale: Psychometric properties in Chinese cancer patients and their family caregivers.

PURPOSE: The Hospital Anxiety and Depression Scale (HADS) acts as one of the most frequently used self-reported measures in cancer practice. The evidence for construct validity of HADS, however, remains inconclusive. The objective of this study is to evaluate the psychometric properties of the Chinese version HADS (C-HADS) in terms of construct validity, internal consistency reliability, and concurrent validity in dyads of Chinese cancer patients and their family caregivers. METHODS: This was a cross-sectional study, conducted in multiple centers: one hospital in each of the seven different administrative regions in China from October 2014 to May 2015. A total of 641 dyads, consisting of cancer patients and family caregivers, completed a survey assessing their demographic and background information, anxiety and depression using C-HADS, and quality of life (QOL) using Chinese version SF-12. Data analysis methods included descriptive statistics, confirmatory factor analysis (CFA), and Pearson correlations. RESULTS: Both the two-factor and one-factor models offered the best and adequate fit to the data in cancer patients and family caregivers respectively. The comparison of the two-factor and single-factor models supports the basic assumption of two-factor construct of C-HADS. The overall and two subscales of C-HADS in both cancer patients and family caregivers had good internal consistency and acceptable concurrent validity. CONCLUSIONS: The Chinese version of the HADS may be a reliable and valid screening tool, as indicated by its original two-factor structure. The finding supports the basic assumption of two-factor construct of HADS.

Factors influencing the health-related quality of life of Chinese advanced cancer patients and their spousal caregivers: a cross-sectional study.

BACKGROUND: Cancer and its treatment have a major impact on the lives of patients and their intimate partners, such as on their health-related quality of life (HRQOL). The aims of this study are to: (i) assess the HRQOL of advanced cancer patients and spousal caregivers, and explore the relationship between the HRQOL of cancer patients and that of their spousal caregivers; (ii) detect factors influencing the HRQOL of cancer patients and spousal caregivers; and (iii) explore the impact of anxiety and depression on the HRQOL of couples. METHODS: A total of 131 couples where one of the partners was hospitalized for advanced cancer were invited to complete a survey to assess their demographic and background information, HRQOL, and anxiety and depression. HRQOL was measured using the SF-12, while anxiety and depression were measured using the Hospital Anxiety and Depression Scale. Data were analyzed using a T-test, Pearson correlations, multiple linear regressions, and structural equation modeling. RESULTS: In general, the spousal caregivers had higher levels of HRQOL (seven out of eight SF-12 domains and two SF-12 dimensions) p = 0.038-0.000, anxiety (p = 0.002), and depression (p = 0.011) than patients. Correlations of HRQOL between patients and spouses were small to moderate (r = 0.193-0.398). Multiple independent factors influencing the physical component summary (PCS), mental component summary (MCS), vitality (VT), and role emotional (RE) sections of the SF-12 were identified, including: gender, time since diagnosis, levels of education, working status, the extent to which spousal caregivers were informed about the disease, improved marital relationship after the diagnosis of cancer, and anxiety and depression. For both patients and spousal caregivers, the strongest independent factor influencing HRQOL (SF-12 PCS, MCS, VT, and RE) was anxiety and depression. Anxiety and depression may have both actor and partner effects on the HRQOL of couples to various degrees. CONCLUSIONS: The findings of this study call attention to the HRQOL of couples and its influencing factors. Individual characteristics of cancer patients and spouses, marital relationship, and anxiety and depression are highlighted as areas in which couples coping with cancer could benefit from interventions to improve their HRQOL.

Re-affirmation of a Preliminary Live with Love Conceptual Framework for cancer couple dyads: A couple-based complex intervention study.

PURPOSE: The relational dynamics of couples may be under great strain due to the diagnosis and treatment of cancer. A complex "Caring for Couples Coping with Cancer" (4Cs) intervention program, guided by a Preliminary Live with Love Conceptual Framework (P-LLCF) for Cancer Couple Dyads, was developed to support couples going through such hardship. The purpose of this paper is to present a re-analysis of the results of the 4Cs intervention program to determine whether the findings provide evidence to support the constructs in the P-LLCF. METHODS: The 4Cs intervention was provided to support cancer patients and their spousal caregivers. The pre- and post-intervention findings of the 4Cs intervention program were re-analyzed using descriptive-correlational analysis and structural equation modeling (SEM) to test whether the findings provide evidence to support the constructs in the P-LLCF. RESULTS: A total of 92 out of the 117 dyads at baseline (T0) were successfully followed-up at 6 weeks (T1). The re-analysis of the findings from the 4Cs program (T1 outcomes) showed inter-relationships among the components included in the P-LLCF: dyadic mediators, dyadic coping, dyadic appraisal, and dyadic outcomes. The SEM of all six models resulted in convergence and showed goodness of fit to the data and variables, which is supportive of the constructs in the P-LLCF. CONCLUSIONS: The present analysis of the T1 outcome measures of the 4Cs program provides evidence to support the constructs in the P-LLCF. Multiple mutual effects existed between couples in the process of living and coping with cancer as dyads.

The development of a complex intervention in China: the 'Caring for Couples Coping with Cancer "4Cs" Programme' to support couples coping with cancer.

BACKGROUND: As the primary informal caregiver for cancer patients, spousal caregivers are a population at a high risk of hidden morbidity. The factors impacting couples coping with cancer are complex, and within spousal caregiver-patient dyads the impact is mutual. The aim of this study is to explain the process that led to the development of an acceptable, feasible, and potentially effective 'Caring for Couples Coping with Cancer "4Cs" Programme' to support couples coping with cancer as the unit of intervention in China. METHODS: The Medical Research Council's (MRC) framework for developing and evaluating complex interventions was adopted to develop an intervention for couples coping with cancer. Three steps were taken in the process of developing the 4Cs programme, namely: (1) identifying the evidence base by conducting a series of extensive reviews of the relevant literature and conducting a focus group study; (2) identifying/developing a theory by proposing a preliminary Live with Love Conceptual Framework 'P-LLCF' for cancer couple dyads; and (3) modelling the process and outcomes of the 4Cs programme. RESULTS: The programme that was developed is comprised of six individual sessions to be delivered by the researcher/therapists over 6 weeks. The main contents of the sessions of the 4Cs programme are: primary stressors (section 1); secondary stressors (section 2); dyadic mediator (section 3); dyadic appraisal (section 4); dyadic coping (section 5); and a programme overview (section 6). The emphasis of the programme is on supporting couples coping with cancer. A booklet was developed to provide the participants with easy access to written information about their common concerns in caring for loved ones with cancer. CONCLUSIONS: Guided by the MRC guidelines, a potentially effective, feasible, and acceptable 4Cs programme aimed at supporting couples coping with cancer as a dyad was developed. Future research is needed to pilot and evaluate the feasibility, modelling, and outcomes of this 4Cs programme.

Testing a Preliminary Live with Love Conceptual Framework for cancer couple dyads: A mixed-methods study.

PURPOSE: The purpose of this study was to test the previous proposed Preliminary Live with Love Conceptual Framework (P-LLCF) that focuses on spousal caregiver-patient couples in their journey of coping with cancer as dyads. METHODS: A mixed-methods study that included qualitative and quantitative approaches was conducted. Methods of concept and theory analysis, and structural equation modeling (SEM) were applied in testing the P-LLCF. RESULTS: In the qualitative approach in testing the concepts included in the P-LLCF, a comparison was made between the P-LLCF with a preliminary conceptual framework derived from focus group interviews among Chinese couples' coping with cancer. The comparison showed that the concepts identified in the P-LLCF are relevant to the phenomenon under scrutiny, and attributes of the concepts are consistent with those identified among Chinese cancer couple dyads. In the quantitative study, 117 cancer couples were recruited. The findings showed that inter-relationships exist among the components included in the P-LLCF: event situation, dyadic mediators, dyadic appraisal, dyadic coping, and dyadic outcomes. In that the event situation will impact the dyadic outcomes directly or indirectly through Dyadic Mediators. The dyadic mediators, dyadic appraisal, and dyadic coping are interrelated and work together to benefit the dyadic outcomes. CONCLUSIONS: This study provides evidence that supports the interlinked components and the relationship included in the P-LLCF. The findings of this study are important in that they provide healthcare professionals with guidance and directions according to the P-LLCF on how to plan supportive programs for couples coping with cancer.

A couple-based complex intervention for Chinese spousal caregivers and their partners with advanced cancer: an intervention study.

BACKGROUND: Guided by the Preliminary Live with Love Conceptual Framework (P-LLCF) for Cancer Couple Dyads, a Caring for Couples Coping with Cancer (4Cs) program was developed to support couples coping with cancer as a unit. This study examined the acceptability, feasibility, and the preliminary effect of the 4Cs program. METHODS: A pre- and post-intervention study design with no control group was conducted among Chinese cancer patients and their spousal caregivers. Among the 135 couples approached, a total of 117 dyads were successfully recruited at baseline, with 92 dyads successfully followed-up at 6 weeks. Outcome measures, including dyadic mediators (self-efficacy), dyadic appraisal (Cancer Related Communication Problem, CRCP), dyadic coping (Dyadic Coping Inventory, DCI), and dyadic outcomes (physical and mental health, negative and positive emotions, and marital satisfaction), were assessed at T0 (pre-intervention) and T1 (post-intervention). Repeated measures analysis of variance was applied in testing the outcomes of the 4Cs program. RESULTS: The recruitment and retention rates were 86.7% and 78.6%, respectively. Significant improvements were seen in the couples' scores on overall (total) self-efficacy (P < 0.01), CRCP (P < 0.05), DCI (P < 0.05), the physical component summary (PCS) of SF-12 (P < 0.05), anxiety (P < 0.01), and benefit findings (P < 0.05) from T0 to T1. Spousal caregivers scored significantly higher on self-efficacy (P < 0.05), the PCS (P < 0.01), and anxiety (P < 0.05) than the patients. The overall effect sizes calculated in this study ranged from medium to small. CONCLUSIONS: This study provides evidence suggesting that the 4Cs program is acceptable, feasible, and improved outcomes in supporting Chinese couples coping with cancer as dyads.