Radiation Risk Perception, Breast Cancer Anxiety, and Mental Distress among Women Who Participated in Breast Cancer Screening Programs in Minamisoma City: Five Years after Fukushima's 2011 Triple Disa

In 2020, bladder cancer was predicted to account for 213,000 fatalities and 573,000 new cases, making it the tenth most common cancer globally (). Due to its high recurrence rate and the need for lifelong surveillance, bladder cancer imposes a substantial and sustained burden on patients, caregivers, and health care systems worldwide. There was significant geographic variation in its incidence, with the highest rates recorded in North America and Europe, and it is more common in men than in women (). Muscle-invasive bladder cancer often requires radical surgery with urinary diversion, including ileal conduit, cutaneous ureterostomy, orthotopic neobladder, or continent urinary reservoirs (). While these procedures are life-saving, they profoundly alter urinary function and daily life, and patients frequently experience physical discomfort, stoma-related complications, and psychological challenges including anxiety, depression, and social isolation (). Effective postoperative adaptation is crucial for improving QoL and long-term outcomes. Self-management interventions are structured approaches designed to help patients actively participate in their own care, improve self-care ability, and promote physical and psychological recovery (). Unlike conventional postoperative education alone, self-management emphasizes patients’ active engagement, decision-making, and sustained behavioral change across the continuum of care, particularly after hospital discharge. These interventions commonly include educational strategies including preoperative stoma education, teach-back sessions, and informational manuals; skill training including hands-on stoma care training, workshops, and problem-solving exercises; psychosocial support including motivational interviewing, peer support groups, and nurse–family–peer collaborative models; and technology-assisted guidance including WeChat-based follow-up, digital monitoring, or telehealth support (–). Importantly, these components are often delivered in an integrated manner and adjusted according to different recovery stages, care settings, and individual patient needs. Some programs are guided by theoretical frameworks including Orem’s self-care theory, the Self-Transcendence Theory, or the Information-Motivation-Behavioral Skills Model (IMB model), and often combine multiple components—education, skills training, behavioral guidance, and psychosocial support—tailored to patient needs (–). Theory-driven interventions may enhance the consistency, reproducibility, and sustainability of self-management behaviors by providing a clear mechanism for behavior change. Evidence suggests that these interventions can enhance patients’ self-care ability, improve health-related QoL, reduce psychological distress including anxiety, and decrease the incidence of stoma-related complications (). Patients with urinary ostomy have been the subject of numerous randomized controlled studies (RCTs) that have examined self-management strategies. The majority are single-center trials that assess different intervention components, durations, and theoretical frameworks with small sample sizes, usually 20 to 60 participants per group (). Existing RCTs generally report improvements in self-care ability and quality of life, reductions in anxiety, and a lower incidence of stoma-related complications (, ). However, the interventions and outcome measures vary widely, and long-term follow-up data are limited. In addition, the methodological quality of some trials is moderate, with concerns regarding blinding, allocation concealment, and sample representativeness. Determining the efficacy of self-management therapies in this patient population is challenging due to the uneven results produced by these restrictions.