Acute effects of fruit flesh of two Saudi date varieties differing in phenolic content and compared with a sugar- and fibre-matched placebo on mood and cognition in healthy young volunteers: a randomi

Cancer remains a major global and national health burden. GLOBOCAN 2022 estimated nearly 20 million new cancer cases and 9.7 million cancer deaths worldwide in 2022, and projects more than 35 million annual new cases by 2050 (). In China, an estimated 4.82 million new cancer cases and 2.57 million cancer deaths occurred in 2022 (). Pain is among the most common and distressing symptoms experienced by patients with cancer; a recent systematic review reported an overall cancer pain prevalence of 44.5%, with 30.6% of patients experiencing moderate-to-severe pain (). Although evidence-based guidelines and opioid recommendations are available for cancer pain management (, ), analgesic undertreatment remains common, with updated systematic evidence suggesting that approximately 40% of patients with cancer pain receive analgesic treatment inadequate for pain intensity (). The gap between available pain-management strategies and actual pain control is shaped by barriers at the health-system, clinician, patient, and caregiver levels. From the patient perspective, insufficient knowledge, negative attitudes toward analgesics, fear of addiction or adverse effects, reluctance to report pain, and irregular analgesic use may interfere with effective cancer pain management (, ). In China, studies among physicians and other healthcare providers have reported gaps in cancer pain assessment, opioid-related knowledge, and pain-management practice (, ). More recent patient-focused evidence has further highlighted opioid-related concerns and patient-related barriers in cancer pain management (). Evidence from Chinese cancer populations has also shown that pain-related knowledge, attitudes, caregiver influence, and analgesic adherence are associated with pain-management outcomes (). These findings suggest that improving cancer pain management requires attention not only to prescriptions and clinical protocols, but also to patients’ understanding, beliefs, and day-to-day self-management behaviors. The Knowledge, Attitude, and Practice (KAP) framework provides a pragmatic approach for examining modifiable cognitive, attitudinal, and behavioral factors related to health management (). In cancer pain care, a KAP-based assessment can help identify whether patients understand key principles of pain reporting and analgesic use, how they perceive cancer pain and opioid treatment, and how they manage pain in daily practice. However, associations among Knowledge, Attitude, and Practice in cross-sectional studies should be interpreted as statistical relationships rather than evidence of temporal ordering or causal pathways.