Senses and meanings attributed to Hope by children with orofacial clefts and their family caregivers.

Since global estimates of cancer were first published in 1984, breast cancer (BC) has remained the most frequently diagnosed cancer in women [,]. In 2022, there were an estimated 2.3 million new cases and 670,000 deaths from BC, with these figures projected to increase by 38% and 68%, respectively, by 2050 []. Systemic therapies such as chemotherapy, targeted therapies, and endocrine therapies have significantly improved overall survival in BC []. However, these treatments are associated with a significant symptom burden that can negatively impact patients’ quality of life (QoL) and ability to adhere to the treatment regimen, with consequent detrimental effects on treatment and survival outcomes []. Fatigue is a commonly reported symptom after BC treatment. In a review of fatigue in patients with BC, 66% reported the presence of some degree of fatigue, with one-third reporting that fatigue constituted an important problem []. For example, in the pooled analyses of the PALOMA (Palbociclib: Ongoing Trials in the Management of Breast Cancer) trials, which established the role of the cyclin-dependent kinase 4/6 inhibitor palbociclib in BC treatment, new-onset fatigue incidence rates were 23.9%, with an incidence of severe fatigue of 14.8% []. A separate meta-analysis found that patients who were on cyclin-dependent kinase 4/6 inhibitor–based regimens had a significant increase in all grades of fatigue, and a relative risk of 3.06 (95% CI 1.41‐6.61; =.004) for high-grade fatigue []. As a result of fatigue and other contributory factors, suboptimal adherence to oral treatments for BC is a well-documented problem, with discontinuation ranging from 31% to 73% by 5 years of treatment []. Adverse events are closely related to patient adherence and persistence. A survey of patients’ experiences of cancer treatment, including patients with BC, found that 10.1% of poor adherence was directly attributed to fatigue; 27% reported severe fatigue, with 19% confirming poor treatment adherence []. In patients with BC receiving endocrine treatment, those with nonadherence and nonpersistence had significantly reduced event-free survival, with hazard ratios ranging from 1.39 (95% CI 1.07-1.53) to 2.44 (95% CI 1.89-3.14), and also negatively impacted overall survival, with hazard ratios ranging from 1.26 (95% CI 1.11-1.43) to 2.18 (95% CI 1.99-2.39) [].