We are delighted to continue the Academic Express section, which aims to facilitate academic exchanges and further the development of oncology nursing. In every issue, we present ground-breaking research contributions from esteemed members in the field. 

In this issue, we’ll continue focus on pioneering oncology research from China, featuring a novel multidimensional assessment of adolescent and young adult gynecological cancer patients. Through synchronized actigraphy, circadian chronotyping, and serum inflammatory marker quantification (including TNF-α), this Cancer Nursing (2025) study establishes an objective framework during active treatment.

Our recent publication, “The Level of Psychological Distress Is Associated with Circadian Rhythm, Sleep Quality, and Inflammatory Markers in Adolescent and Young Adults with Gynecological Cancer,” which published in Cancer Nursing, investigates associations between psychological distress, circadian rhythm, sleep quality, and inflammatory markers in adolescent and young adults with gynecological cancer.As researchers and clinicians working with young cancer patients, we are deeply aware of the unique psychosocial and physiological challenges faced by adolescent and young adult (AYA) women with gynecological cancers. This study aimed to explore the interrelationships among circadian rhythm, sleep quality, inflammatory markers, and psychological distress in this vulnerable population.

Why We Chose This Topic

AYA gynecological cancer patients not only confront a life-threatening diagnosis but also face threats to fertility, body image, and sexual health, which can exacerbate psychological distress.
Previous research has shown that circadian disruption, poor sleep, and systemic inflammation are linked to worse mental health in cancer patients, but few studies have focused specifically on AYAs with gynecological cancers. We believed a deeper understanding of these factors could inform more holistic and effective supportive care strategies.

What We Discovered

Our study included 64 AYA gynecological cancer patients in active treatment. We found that the average psychological distress level (4.23 on the Distress Thermometer) exceeded the clinical cutoff, indicating significant psychological burden. Key findings include:

• Patients with high psychological distress were more likely to have evening-type circadian preferences.
• Those with high psychological distress had significantly worse sleep quality, including shorter total sleep time (TST), longer sleep onset latency (SOL), and lower sleep efficiency (SE).
•   Inflammatory markers, particularly TNF-α, were elevated in highly distressed patients and positively correlated with psychological distress levels.
• Stepwise regression identified TST, SOL, and TNF-α as significant predictors of psychological distress.

Implications for Cancer Care

Our findings highlight the need for integrated care that addresses both psychological and physiological aspects of health in AYA gynecological cancer patients. Specifically, we recommend:

•  Routine screening for circadian preference and sleep quality using validated tools like MEQ and actigraphy.
• Early intervention for sleep disturbances through cognitive-behavioral therapy for insomnia (CBT-I), light therapy, or sleep hygiene education.
•  Monitoring inflammatory markers such as TNF-α may help identify patients at risk of severe distress and guide targeted support.
• Multidisciplinary collaboration among oncologists, nurses, psychologists, and rehabilitation specialists to address the complex needs of these patients.

By addressing circadian rhythm disruption, improving sleep quality, and mitigating inflammation, we can better support the mental health and overall well-being of AYA women with gynecological cancer. This holistic approach is essential not only for improving quality of life but also for enhancing treatment adherence and outcomes. 

Source:

Luo, Y., Duan, Y., Zhou, Y., Yi, S., Dai, C., Luo, X., Kang, Y., Wan, Z., Qin, N., Zhou, X., Liu, X., Xie, J., & Cheng, A. S. K. (2025). The Level of Psychological Distress Is Associated With Circadian Rhythm, Sleep Quality, and Inflammatory Markers in Adolescent and Young Adults With Gynecological Cancer. Cancer nursing, 48(5), E289–E295. https://doi.org/10.1097/NCC.0000000000001325

Jianfei Xie, The Third Xiangya Hospital, Hunan, China