Journal of School of Public Health and

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In recent years the patterns of mortality have changed in Iran, and cancers are playing a greater role in this regard in this country. Various reports indicate that gastric cancer is highly prevalent it is the second most common cancer in men, and fourth in the general population. The purpose of this study was to determine the five-year survival rate of gastric cancer patients who had undergone surgical treatment at one of the most important cancer treatment centers, the Iran Cancer Institute, and to assess its associated factors. Three hundred and 30 patients with gastric cancer who had been admitted to and operated on at the Iran Cancer Institute between January 1996 and April 2000 were enrolled in this study. The patients’ life expectancy after surgery was determined, and its relationship with variables of age at the time of surgery, gender, and factors related to the disease such as the cancer site, pathologic type, stage, presence of metastasis, and sites of metastases were assessed. The five-year survival rate and the median life expectancy in the studied patients were 23.6% and 19.90 months, respectively. Univariate analysis showed that gender, cancer site, and pathologic type did not affect life expectancy significantly. But the five-year survival rate significantly decreases with age. As expected, those involved with metastasis had a significantly lower five-year survival rate, and the disease stage significantly affected the patients’ life expectancy (P<0.001). The Cox proportional hazards model was used to assess the effect of different variables simultaneously, and it showed that age, distance metastasis, and disease stage influenced the rate of survival. Gastric cancer patients in Iran have a low five-year survival rate. One of the most important reasons seems to be delayed consultation and diagnosis. Most patients are seen first with the disease in the late stages. At this point, most have lymph node and liver metastasis which makes treatment even more complex. Thus, it is necessary to employ mass media for extensive public education about the early warning signs of the disease and performing periodic examinations.

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Background and Aim: Limitations of the traditional methods for assessing G*E interaction- including case-control studies- led to development of several non-traditional approaches. This study aims to assess the interaction between the genetic background (history of breast cancer in first degree relatives) and environmental influences (reproductive/menstrual factors) in patients with breast cancer we also compare the statistical efficiency and power of case-control and case-only designs in this setting.
Materials and Methods: In a matched case-control study in Mazandaran province (Iran), 250 incident biopsy-proven cases of breast cancer and 250 age-matched neighbor controls were interviewed. History of breast cancer in mother and/or sister(s) was taken as a surrogate measure of genetic predisposition, while age at first birth, parity, breast feeding, age at menarche and irregular menstruation were considered as relevant environmental factors. For the matched case-control design, we used a conditional logistic regression model to examine main effects and the G*E interaction. In the case-only design, logistic regression analysis was applied to obtain an estimate of G*E interaction, after checking for the independence assumption. We also calculated the power for detecting the interaction by matched case-control and case-only analyses.
Results: Age at first delivery did not meet the assumption of independence (p=0.02), and so was not included in the case-only analysis. No statistically significant interaction effect was seen in the case-control analysis, while case-only analysis showed significant negative interaction between disease in first-degree relatives on the one hand and parity and breast feeding on the other. We also detected a significant positive interaction between genetic predisposition and age at menarche. All the estimated 95% confidence intervals for OR in G*E interactions were narrower in the case-only analysis. For all factors, the power for detecting G*E interaction was greater in the case-only analysis compared to the case-control analysis, with ratios ranging from 1.08 to 2.23.
Conclusion: The case-only design is more efficient and powerful than the case-control design for detecting gene-environment interaction under the assumption of independence. Baseline disease risk, interactions and independent effects should be considered in using the control data for checking the assumption of independence. Considering the existence of another explanatory variable, eg. a mutant gene which may have passed unnoticed, would be the safest approach in a case-only study.

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Background and Aim: Breast carcinoma is the most common type of cancer in women. It has been estimated that 8-9 percent of all women will develop breast cancer during their lifespan. According to The Iranian Ministry of Health and Medical Education, the incidence of breast cancer in Iran has risen between 1984 and 1988 and the current mortality rate from this kind of cancer ranks fifth in the country.

Materials and Methods: In this case-control study, 110 patients with breast cancer (ages 20-60 yrs) were compared with a similar number of age- and sex-matched women hospitalized for other reasons. Cases were women with histologically confirmed in situ or invasive breast cancer diagnosed no more than 1 year before the interview and with no previous diagnosis of cancer at other sites. Controls were drawn from either patient relatives or from women with no history of cancer admitted to Imam Hospital for acute, non-neoplastic, non-gynecologic conditions unrelated to hormonal or digestive tract disease or to long-term diet modifications. We calculated odds ratios and performed Mantel-Haenzel as well as logistic regression tests to control for potential confounding factors.

Results: Odds ratios [with 95% confidence intervals] for total fat, saturated fatty acids, monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA) and cholesterol were 1.97 [1.062-3.67], 1.19 [0.64-2.14], 2.2 [1.17-4.13], 4.11 [2.2-7.65] and 0.45 [0.25-0.83], respectively. After adjusting for energy, macronutrients, weight, age at first full-term pregnancy and the socioeconomic status, it emerged that the intake of PUFA (OR=6.38 and 95%CI: 1.95-20.83) had a positive association with breast cancer while cholesterol (OR=0.22 and 95%CI: 0.09-0.55) showed a negative relationship, though the latter finding only applies to menopaused women.

Conclusion: Undoubtedly, dietary factors involved in the etiology of breast cancer take many years to cause any pathologic changes in any organ. Nonetheless, one-year frequency of lipid intake is a good measure of individual's dietary habit throughout his/her adult life. Based on this, the present study suggests that increased PUFA intake- probably due to its high pro-oxidant potential- can be considered as a key factor in the rising incidence of breast cancer in Iran.

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Background and Aim: Like other cancers, gastric cancer is due to uncontrolled growth of tissues. Although there are different therapy methods to treat it, such as surgery, radiation therapy, chemotherapy, and multimodality therapy, relapse and death may occur. Reports show that in Iran gastric cancer is the first cause of death among deaths due to cancers. The purpose of this study was to determine the two-year survival rate after relapsing and its associated factors among gastric cancer patients who had undergone surgical treatment in Iran Cancer Institute, one of the most important cancer treatment centers in Iran.

Methods and Materials: A total of 330 patients with gastric cancer who had been admitted to and operated on at the Iran Cancer Institute between January 1996 and April 2000 were enrolled in this study. The patients' life expectancy after relapse was determined. Survival was defined as the elapsed time between the two successive events, relapse and death, neither of which can be determined exactly therefore the data are doubly censored failure time data. Thus, the relationships between life expectancy at relapse and such variables as age, gender, and factors related to the disease, such as the cancer site, pathologic type, stage, and sites of metastases were determined using the Cox proportional hazards model.

Results: The two-year survival rate after relapsing and the median life expectancy after relapsing were 15% and 10.15 months, respectively. Univariate analysis showed that except disease stage, no other variable (age, gender, cancer site, pathologic type and sites of metastases) affected life expectancy after relapsing significantly. The Cox proportional hazards model for doubly censored failure time data showed that age, gender, and pathologic type had the highest influence, in a decreasing order, on the rate of survival after relapsing.

Conclusion: Two-year survival rate after relapsing is very low in gastric cancer patients. One of the most important reasons seems to be delayed consultation and diagnosis. Most patients seek medical advice first with the disease in the late stages, when most have lymph node, liver or even distant metastasis which makes treatment even more complex, and when the risk of relapse and death would be increased. Thus, early diagnosis and therapy for a common stomach illness could help prevent a potential gastric cancer.

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Background and Aim: The most common cancer in Iran is digestive system cancer, the highest incidence of which is reported from the Caspian Sea littoral. This study aimed to determine factors affecting the survival of patients with gastrointestinal cancer using the Cox and parametric models the 2 models were compared.

Materials and Methods: This survey was a prospective study conducted between 1990 and 1991. Data were collected through the Cancer Registry Center in Babol, which functions under supervision of the School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences. We tried to identify cases of gastrointestinal cancers. The individual characteristics of 484 patients, namely, age, sex, family history, marital status, smoking status, occupation, ethnicity, medication status, education, residence (urban, rural), and type of cancer were recorded. The patients were followed up for a period of 15 years, i.e., until 2006 year. To determine the effective factors on survival of patients, the Cox model and parametric models such as exponential, weibull, log-normal, log-logistic, and the AIC criteria and residuals were used to compare the effectiveness of the models. The SAS and STATA software were used for data analysis, with a significant level of 0.05.

Results: Sixty-six percent of the patients (total n=484) were males and 34% females, with a mean age of 59 and 55 years, respectively. Their distribution according to type of cancer was as follows: esophageal cancer, 359 (74.2%) stomach cancer, 110 (22.7%) colorectal cancer, 15(3.1%). Estimated one-, three-, and five-year survival rates were 24%, 16% and 15%, respectively.

Conclusion: The results of this study reveal that gender and family history can be strong risk factors for GI cancer. Log-normal and log-logistic models in multivariate and univariate analyses gave almost similar results. However, based on AIC criteria and residuals analysis, the log-logistic model gives the best fit as compared to other parametric models and can be used instead of the Cox model for determining factors affecting survival of patients with gastrointestinal tract cancer.

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Background and Aim: Many researchers have studied survival (time to death) of gastric cancer patients. Although gastric cancer diagnosed in early stages can be cured by surgery, chance of relapse still exists after operation. Hence, we should consider both events, that is, relapse of the disease and death, in order to be able to make a more precise estimation for survival of the patients. The purpose of this study was to use the competing risks method to estimate the cumulative incidence functions (CIF) of the relapse of disease and death and consequently to estimate the postoperative disease-free survival.
Materials and Methods: A total of 330 patients admitted to Iran Cancer Institute and operated between March 1995 and March 1999 were enrolled in the study. They were followed up for at least 5 years to estimate their 5-year disease-free survival. Information on their demographic, clinical, and therapeutic characteristics, as well as on the type and time of occurrence of the first event (relapse of disease or death) after surgery was collected from their medical records. The direct parametric method was applied to estimate CIFs of relapse of the disease and death, while to adjust the effects of some covariates the parametric regression model was used. Data analysis was done using the R software and a p-value <0.05 was considered statistically significant. The findings were compared with the results obtained on the basis of data analysis in which the competing events were not considered.
Results: The median follow-up time was 37.9 months. Of all the patients 13% experienced relapse and 60.9% death as the first event after surgery. The CIFs of relapse of disease and death 5 years after operation, with due consideration of covariates, were estimated at 11.0% and 68.6%, respectively. Age, stage of disease, and complementary treatment were statistically associated with the CIF of death, while only complementary treatment was related to the CIF of relapse. Older patients and those in more advanced stages of disease were more likely to die after operation. Moreover, while complementary treatment after operation decreased the CIF of relapse of disease, it increased the CIF of death. The disease-free survival of patients 5 years after surgery was 20.(consideringtheeffectsofsomecovariates).
Conclusion: The competing risks method is recommended for analyzing survival data because of its capability in considering different events and, therefore, making it possible to make more precise estimations. By using this method, considering smaller variance estimates for model parameters and also narrow confidence intervals for the cumulative incidence functions of competing events, it is expected to obtain more precise results. Unfortunately, the results have revealed that the disease-free survival of gastric cancer patients is low in Iran.

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Background and Aim: Breast and cervical cancer screening is considered a health promotion behavior, influenced by complex factors. The theory of planned behavior provides a useful framework for predicting and understanding the health behavior and designing appropriate educational interventions. Integrating this theory with self-efficacy will increase its predictive value. The objective of this qualitative research project was to understand the factors influencing the behavior of breast and cervical cancer screening of female-workers as a base for future educational planning.

Materials and Methods: This was a qualitative approach research based on the Integrated Model of Planned Behavior and Self-Efficacy. Seventy 20-45 year-old women working in industrial plants in Abbasabad, Pakdasht, selected by purposeful sampling with maximum diversity participated, in 10 groups of 7 each, in focus-group discussions, in which they discussed their experience regarding factors influencing the behavior of breast and cervical cancer screening. Data were collected and their validity, conformability, transferability and dependability confirmed. For data analysis the conventional method of content analysis was used.

Results: The female workers had a low knowledge and attitude concerning the behavior of breast and cervical cancer screening. Attaching importance to comments given by the family members, especially the husband, and preference of treatment to prevention of disease in the society at large were the subjective norms of the female workers. The most important barriers to participating in screening programs were lack of knowledge, depression, fatigue, embarrassment and fear of examinations, fear of being sick, poor quality of services and lack of attention to privacy in health centers, limited access to health centers, and costs of tests. The female workers had a low self-efficacy for planning and overcoming barriers. Most of them had not had screening tests and had no intention of doing their screening tests in the following three month.

Conclusion: The following measures are recommended: designing and implementing specific educational programs in workplaces for female-workers aiming at increasing their awareness and positive attitudes towards breast and cervical cancer screening designing and implementing educational/training programs for families, employers and planners to increase their knowledge and attitude and facilitating women's access to health centers in industrial estates.

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  Background and Aim: In many diagnostic studies, including surveying the survival of patients with gastric cancer where each individual after surgery can experience more than one type of event, and the occurrence of one type of event hinders the occurrence of other types of events, the question of competing risk is raised. For checking the effect of each covariate on the occurrence of any event and estimating the hazard function, Cox and Fine and Gray models are used. In the event that the assumptions of two models do not hold, using them will be an incorrect course of action. One way to overcome this problem is to use models that have higher flexibility.

  Materials and Methods: In this study, the demographic, clinical and therapeutic characteristics of 330 patients with gastric cancer who referred from January 1996 to April 2000 to the Cancer Institute of Iran Imam Khomeini Hospital and underwent surgery, including their type, and the time of occurrence of the first event (locoreginal replace/death) for each patient from medical records were collected and evaluated. Using this information, the cumulative hazard function of relapse of disease was plotted by means of three models Cox, Fine and Gray and the flexible one, and was checked against the observed cumulative incidence function of recurrence of disease and, finally, their performance was evaluated.

  Results: Nearly, for each event, the proportionality assumption holds for all the variables . According to the graph of cumulative incidence function for the event of interest (recurrence), it can be seen that the Cox model, has overestimated the cumulative incidence function and the curves of two other models are very similar and also similar to the observed curve. However, the cumulative incidence function of the flexible model is smoother than the others.

  Conclusion: In the competing risk framework, Cox model is not very useful in practice while it seems that the flexible model is not only a good alternative to the Fine and Gray model but will also be superior to it when the assumption of proportionality does not hold.

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  Objectives: The role of mammography in early detection of b reast cancer is evident and persuasion to do that is very important in health sector. Majority of the interventions are based on education and informing and there has been less attention to making mammography cost beneficent. This study aimed at assessing the effect of a social marketing-based intervention to persuade to do mammography in Bojnord.

  Methods: In this quasi-experimental study, two villages around Bojnurd with similar demographic characteristics, considered as intervention and comparison groups randomly. All 35- years and older women consist of 343 women (151 in intervention and 191 in comparison groups) were identified. To obtain the main idea for intervention, and exploring the viewpoints of target group about mammography, a formative research combined of a quantitative survey (through completing the questionnaire for assessing the women’s attitudes based on health belief model) and a qualitative study (through establishing four focus group discussions) was done. According to the gathered and analyzed data, an intervention focused on the main barriers designed and implemented through four weeks. One week after the intervention, the number of mammograms in two villages was determined and compared.

  Results: Quantitative survey showed that the mean of the scores related to expending time and high economical costs (perceived barriers) not remember to do mammography and fear of exposure to x- ray is less than other constructs. In qualitative study, time expending and high economical cost considered as two main factors related to not doing mammography. After the intervention, 48.1 percent of the women in intervention group went to do mammography and there are no change similar results in comparison group.

  Conclusions: Educational interventions are not enough to persuade women to do mammography and we have to consider their perceived barriers and concerns. One of the most effective approach to promote an idea, behavior or service, is identifying the viewpoints of target group and design them as consumer- oriented programs. So, acceptance of the idea and behavior will be cost-beneficent.

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  Background and Aim : identifying the risk factors for metastasis is major concern for treatment processes of cancer patients. Metastasis makes patients frail and increase hazard of death. It also decreases physical and psychological quality of life of patients. Aim of this study is determining of prognostic factors for metastasis of breast cancer using conditional regression model.

  Materials and Methods: in this survival study, hospital records of 246 women with breast cancer who underwent surgery and treatment at hospital Fayyazbakhsh were used. Patients were followed until 2012 May and their final situations recorded. Metastasis free survival estimated with Kaplan-myier method. To determine the prognostic factors, a conditional regression model called PWP fitted. All statistical analysis was conducted with R software, version 2.10.

  Results: 202 patients (82.1%) were alive until follow up and 44 patients (17.9%) died.54patients experience metastasis. 11 patients (4.7%) had two metastases. Most of metastases were shown in bone, liver, lung and brain. Median metastasis free survival (MFS) estimated 64 month. One, two and three year MFS were 88%, 80.1% and 76.6%, respectively. Lymph node involvement and HER2 were shown as prognostic factors for metastasis. Age, Esterogen Receptor, Prosterogen Receptor, Grade and tumor size were not significant ( P> 0.05).

  Conclusion: number of lymph nodes involvement as a prognostic factor involve more nodes and increase risk of metastasis and death. Thus prognosis and treatment of cancer in early stages increase survival of patients.

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Background and Aim: Cancer is the third cause of mortality in Iran, killing more than 30000 persons annually. The Motivation Theory is a useful approach for predicting and planning intervention programs to change behaviors related to cancer prevention and early detection. Considering the absence of a valid and reliable protection motivation theory questionnaire for cancer early detection in Iran, this study was conducted to design such a questionnaire and assess its psychometric properties in Yazd

Materials and Methods: This was a cross-sectional study. A questionnaire was designed based on similar questionnaires currently in use and its validity and reliability were determined. The reliability coefficients were calculated by Cronbach α and intraclass correlation coefficients. To determine the validity of the scale, two methods were used, namely, face validity and content validity. Confirmation factor analysis was used to determine factorial validity using Amous 21 software .

Results: The CVR for all items of the questionnaire, CVI, ICC and internal consistency of the questionnaire were found to be 1, 0.97-1.0, 0.71-0.98, and 0.65-0.93, respectively. The confirmation factor analysis revealed that the questionnaire fitted the Iranian population. The Cronbach alpha coefficient for the questionnaire constructs varied between 0.71-0.98 and 0.65-0.93

Conclusion: The validity and reliability of the Persian version of PMT scale for cancer early detection are acceptable and suitable, so it can be used in similar research.

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Background and Aim: This study aimed to investigate the association between religiosity and depression among mothers of children hospitalized in the oncology wards of affiliated hospitals of Kerman University of Medical Sciences (KUMS), Kerman, Iran.

Materials and Methods: Data were gathered using a religiosity questionnaire  and a depression questionnaire. The sample consisted of 115 mothers of children admitted to the oncology ward, KUMS, among whom the questionnaires were distributed during a 6-month period.

Results: The findings showed that there was an inverse association between religiosity and depression. As regards demographic variables, a statistically significant association was observed only between depression and income. Further analysis of the data revealed significant associations between religiosity on the one hand and income and mothers’ occupation on the other. 

Conclusion: Based on the findings it can be concluded that with an increase in the mothers’ religiosity level the rate of depression decreases in them. We recommend researchers to conduct similar studies to investigate possible associations between religiosity and such variables as anxiety and mental disorders related to it.

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Background and Aim: The incidence of breast cancer in women is expected to rise sharply over the coming decades in Iran. The aim of this study was to determine risk factors for breast cancer in under-50-year-old women during the period 2013-2015 in Kermanshah, Iran.

Materials and Methods: This case-control study was carried out in Imam Reza Hospital and private clinics of oncologists (three clinics) in Kermanshah, Iran. The participants were 202 patients with breast cancer and 398 without breast cancer. Subjects of the experiment group were selected from among patients in the Departments of Oncology, Radiation Therapy, and Chemotherapy of the hospital, while the control group subjects were selected from among outpatients referred to specialty and subspecialty departments and private clinics of the hospital (outpatient, oncology, gynecology, ophthalmology, sonography, ENT, infertility). The two groups were matched for age. Data were collected by interviewing the subjects, the Gill standard questionnaire and the patients’ files and analyzed using the STATA software (version 12) ─ Odds Ratio (OR), 95% Confidence Interval (CI) and the Conditional logistic regression model.

Result: The following variables were found to be the most important risk factors for breast cancer among under-50-Year-old women: a family history of breast cancer in second degree relatives, an age of 18-35 years at the first childbirth, and a history of a benign breast lump.  

Conclusion: It is recommended to conduct further studies on the subject with due consideration of other risk factors for breast cancer, as well as education of women about breast self-examination  and importance of periodic clinical examinations.

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Background and Aim: Gastric cancer is one the most common gastrointestinal tract cancers in Iran, with East-Azerbaijan Province ranking second in the country. The objectives of this research were to determine the feasibility of using cure models in survival analysis and factors affecting short-term and long-term patient survival rates using the mixture cure cox model.

Materials and Methods: We used the available information on 184 patients diagnosed with gastric cancer in East-Azerbaijan Province cities referring to medical centers during the period 2009-2010 and followed up for 5 years.

Results: The median of survival time was 8.33 months (95% CI = 5.9-10.6). Fitting the univariate and final cox cure models showed that in the short-term survival the effect of the chemotherapy factor was statistically significant (Hazard ratio =0.49, 95% CI = 0.34, 0.69, p-value <0.001).

Conclusion: If the population under study consists of two groups of susceptible and non-susceptible individuals for the intended incident, the mixture cure models can be used for the discrete analysis of long-term and short-term survival of patients diagnosed with gastric cancer and identification of variables affecting the two survival rates.

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Background and Aim: Breast cancer is one of the most prevalent cancers in women and is the second cause of mortality due to cancer in women, with lung cancer being the first.

Materials and Methods: In this study we followed all the cases for 5 years, patients from West-Azerbaijan and East-Azerbaijan Provinces that diagnosed with breast cancer in 2009 and 2010 that attended to health cares. Using multivariate cure cox model for the influence of variables in this study.

Results: In this study 171 cases which suffering from breast cancer had the mean age of 55.9 ± 12.9 and the range of 23 to 89 years, in time of cancer diagnosis. Mean of patients follow-up was 51.7± 23.4 months with range of 11 days to 78 months. Overalls 52 death occurred and patient survival rate of 5 years was estimated 60. 6 percent. Eventually the two variables which are economic status and emergency hospitalization were found the two factors of pre-warning in long term survival of patient suffering from breast cancer.

Conclusion: Due to the findings, it seems using cure model in patients suffering from breast cancer was better than classical survival models.

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Background and Aims: Gastric cancer is the fifth most common cancer and the third cause of cancer death globally. This cancer ranks first and fourth in Iranian men and women, respectively. Assessment of survival rate and factors influencing it will make it possible to determine the burden of disease in the population and the relationships between different factors and the survival rate. The present study was performed to estimate the survival rate and determine its prognostic factors in patients with gastric cancer in West Azerbaijan Province, Iran.
Materials and Methods: In this study 930 cases of gastric cancer were investigated during the period 2011-2012 and the first half of 2013. The Kaplan-Meier method and Log-rank test were used to determine the survival rate and compare survivor functions, respectively; for data fitting A Cox’s proportional hazards model was used. The data were analyzed using the Stata v.11 software
Results: The average age of the patients (more than 69% males) was 66.43±12.5 years. The one-, three- and five-year survival rates were 37%, 14% and 11%, respectively. Multivariate analysis revealed that age (p=0.01) and tumor metastasis (p=0.001) were the most important prognostic factors.
Conclusion: While the survival rates in gastric cancer patients in the West Azarbaijan province, Iran were very low, a significantly higher survival rate was observed in younger patients with no tumor metastasis.

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Background and Aim: The family relationships of parents suffering from cancer change following the onset of physical problems, the experience of depression and the lack of emotional access. This study aimed to compare the negative orientation of adolescent girls with mothers with and without breast cancer toward the problem, hopelessness and perceived stress.
Materials and Methods: This was a cross-sectional study. The statistical population was all the adolescent girls 13-18 years old referring to the oncology ward of Golestan Teaching Hospital in Ahvaz, Iran during a 6-month period accompanying their mothers suffering from breast cancer. The girls for the group with mothers with cancer (n=57, mean age 16.31 ±4.65 years) and the group with mothers without cancer (n=57, mean age 16.02  ±3.27 years) were selected using convenient and multistage sampling, respectively. Both groups completed the Robichuad and Dogus negative orientation to problem questionnaire, Beck Hopelessness Scale and Chohen Pecieved Stress Scale.  Data were analyzed using the one-way and multivariate analysis of variance (with a p<0.05 to show statistical significance) with the software SPSS-22.
Results: There were significant differences between the two groups as regards the variables of negative orientation toward the problem and hopelessness (F= 4.21; p<0.05), while no significant difference was found between them as regards perceived stress (F= 0.015 P= 0.90).
Conclusion: The children of cancer patients have psychological problems and, therefore, need guidance and support. Improvements in the psychological conditions of children will improve their relationship with their mothers, who will then feel more relieved.

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Background and Aim: Breast cancer is one of the most common cancers in Iran. The aim of this study was to assess the effectiveness of existential-humanistic therapy in self-acceptance and marital satisfaction in women with breast cancer.
Materials and Methods: This was a quasi-experimental study with a pre-test, post-test and follow-up design with a control group. The statistical population was the women with breast cancer referring to Shahid-Rahimi Hospital in Khorramabad, Iran in 2020, from among whom two groups (experimental and control) of 15 women each were randomly selected and asked to complete the self-acceptance (USAQ) and marital satisfaction (ENRICH) questionnaires. Then the experimental group attended eight 90-minute intervention sessions. After the intervention, both groups took a post-test and followed up further after two more months. The data were analyzed using the repeated measures ANOVA test.
Results: The repeated measures ANOVA test showed that the interaction between group and time was statistically significant. Therefore, the self-acceptance and marital satisfaction variables increased significantly (F=5/77, P<0/01 and F=13/97, P<0/01, respectively).
Conclusion: According to the results of this study, existential-humanistic therapy has a significant effect on self-acceptance and marital satisfaction in breast cancer patients. It is, therefore, recommended to pay attention, in addition to the physical problems of such patients, also to their psychological problems and, along with pharmacotherapy consider psychotherapy, including existential-humanistic therapy as well.                                                                                                                                          

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Background and Aim: Stomach cancer is of great importance in Iran due to its high incidence and mortality rates. This study aimed to evaluate the status of behavioral risk factors for stomach cancer among adults visiting healthcare centers in Kerman city in the year 2023.
Materials and Methods: This cross-sectional study was conducted on 410 adults visiting comprehensive health centers in Kerman city using a quota sampling method. A questionnaire containing demographic information and a Gastric Cancer Behavioural Risk Assessment Inventory (GC-BRAI) was provided to the participants. Independent t-tests, one-way ANOVA, and Pearson correlation tests were used for analysis. A significance level of less than 0.05 was considered.
Results: The total score for behavioral risk factors for stomach cancer was 49.54. The mean total score decreased with increasing age (p=0.007) and increased with a higher body mass index (p=0.006). Men had a significantly higher mean score than women (p<0.001). The mean total score significantly differed based on occupation (p<0.001).
Conclusion: These findings emphasize the importance of addressing modifiable risk factors for stomach cancer, particularly in individuals identified as being at higher risk according to this study.
 

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Background and Aim: Cancer patients face numerous psychological and physical challenges in which various psychological, social, economic and medical variables are involved. This study aimed to model the structural equations of coping strategies in cancer patients based on early maladaptive schemas with the mediating role of health literacy.
Materials and Methods: This was a correlation analysis study based on structural equation modeling. The statistical population consisted of cancer patients aged 20 to 60 years visiting private medical centers in Tehran between April 20th and September 21st, 2024, from among whom 665 participants were selected through convenience sampling. Data were collected using the Early Maladaptive Schemas Questionnaire (1998), the Adult Health Literacy Questionnaire (2023), and the Coping with Stressful Situations Inventory Questionnaire (1990) and analyzed using the structural equation modeling methods using SPSS 25 and Amos 24 software at a significance level of 0.05.
Results: Data analysis showed that the early maladaptive schemas had a statistically negative relationship with health literacy (β = ─ 0.84, p < 0.001) and a positive relationship with coping strategies (β = 0.25, p < 0.001). In addition, health literacy had a negative association with coping strategies (β = 0.83, p < 0.001). In addition, health literacy had a negative association with coping strategies (β=─0.83, p<0.001).and an intermediary role in the association between primary maladaptive schemas and coping strategies (β=0.25, p<0.001). Goodness-of-fit indices indicated an adequate fit of the model (GFI = 0/916, IFI = 0/910, CFI = 0/909, and RMSEA = 0.078).
Conclusion: The findings show that early maladaptive schemas are associated with low
health literacy and coping behaviors in cancer patients. Improving health literacy can, as a mediating variable, moderate these negative effects, and can also contribute to better constructive coping behaviors. Educational interventions to increase health literacy can be useful in mental therapy and rehabilitation.