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	<title>patient experiences in cancer treatment &#8211; Science</title>
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	<title>patient experiences in cancer treatment &#8211; Science</title>
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		<title>Italian NHS Insights on Breast Cancer Patient Safety</title>
		<link>https://scienmag.com/italian-nhs-insights-on-breast-cancer-patient-safety/</link>
		
		<dc:creator><![CDATA[SCIENMAG]]></dc:creator>
		<pubDate>Thu, 25 Dec 2025 22:24:55 +0000</pubDate>
				<category><![CDATA[Medicine]]></category>
		<category><![CDATA[breast cancer patient safety]]></category>
		<category><![CDATA[enhancing quality of care]]></category>
		<category><![CDATA[healthcare transformation in Italy]]></category>
		<category><![CDATA[implications for global health systems]]></category>
		<category><![CDATA[insights from breast cancer research]]></category>
		<category><![CDATA[Italian National Health Service]]></category>
		<category><![CDATA[patient engagement in treatment journeys]]></category>
		<category><![CDATA[patient experiences in cancer treatment]]></category>
		<category><![CDATA[patient-centered care in oncology]]></category>
		<category><![CDATA[perceptions of cancer patients]]></category>
		<category><![CDATA[qualitative research in healthcare]]></category>
		<category><![CDATA[safety concerns in breast cancer care]]></category>
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					<description><![CDATA[In recent years, the healthcare landscape has undergone significant transformations, particularly concerning the treatment and management of diseases such as breast cancer. Research targeting patients&#8217; experiences and perceptions is crucial as it illuminates aspects often overlooked in clinical studies. A profound investigation conducted by Morandi, Laurita, and Nardelli has brought to light the perceptions of [&#8230;]]]></description>
										<content:encoded><![CDATA[<p>In recent years, the healthcare landscape has undergone significant transformations, particularly concerning the treatment and management of diseases such as breast cancer. Research targeting patients&#8217; experiences and perceptions is crucial as it illuminates aspects often overlooked in clinical studies. A profound investigation conducted by Morandi, Laurita, and Nardelli has brought to light the perceptions of breast cancer patients regarding their safety within the Italian National Health Service (NHS). This study offers invaluable insights into how patients navigate their treatment journeys, contributing to a larger dialogue about patient-centered care.</p>
<p>Within the complex realm of cancer treatment, the feelings and perspectives of patients play an exceedingly important role. Engaging with these patients provides critical data on their concerns, hopes, and overall experiences during treatment. As healthcare providers strive to enhance the quality of care, understanding patient safety perceptions becomes a cornerstone of improvement efforts. Not only does this research shed light on the experiences of the patients themselves, but it also possesses broader implications for health systems globally, particularly those undergoing reforms to integrate patient-centered practices.</p>
<p>The authors of this comprehensive study undertook an ambitious project to explore the varying dimensions of safety as perceived by breast cancer patients in Italy. With a rapidly evolving healthcare system, characterized by both advanced treatments and emerging challenges, it was essential to investigate how patients felt about their safety. In this context, safety encompasses a spectrum of considerations, including the efficacy of treatments, the competency of healthcare professionals, and the overall hospital environment.</p>
<p>One of the salient findings from Morandi and colleagues’ research was the significant variability in perceptions based on demographic factors, such as age, socioeconomic status, and geographic location. This variance underscores the importance of tailoring healthcare approaches to meet the unique needs of diverse patient populations. It is vital for healthcare providers to recognize that the same treatment protocol may resonate differently among patients, thus prompting ongoing adaptations and adjustments in care models to enhance safety perceptions.</p>
<p>Furthermore, experiences shared by patients in this study revealed a critical connection between communication and feelings of safety. Effective communication between healthcare professionals and patients not only fosters trust but also ensures that patients feel more empowered regarding their treatment decisions. Engaging patients in discussions about their treatment plans contributes to a sense of ownership and proactive involvement in their healthcare. This, in turn, bolsters their overall perception of safety within the health system.</p>
<p>The study also highlighted the impact of emotional and psychological factors on safety perceptions. Many patients expressed that emotional well-being plays a significant role in how safe and supported they feel during their treatment journey. The psychological effects of a cancer diagnosis can lead to heightened anxiety regarding treatment outcomes and the overall healthcare experience. Consequently, health professionals must consider the emotional aspects of care to foster a holistically safe environment for patients.</p>
<p>Interestingly, technological advancements in healthcare were also evaluated in this study. Patients demonstrated varying degrees of comfort and confidence regarding the integration of digital tools in their treatment processes. Many expressed that the use of technology, such as telemedicine and digital monitoring systems, positively influenced their perception of safety. However, there remained a subset of patients who felt apprehensive about relying too heavily on technology, citing concerns about data privacy and the impersonal nature of virtual consultations.</p>
<p>Moreover, the research illuminated the role of institutional factors in shaping patient perceptions. The responsiveness of healthcare systems, availability of resources, and infrastructural conditions significantly influenced how patients assessed their safety. When a healthcare facility operates efficiently, with readily available support and services, patients are likely to report higher safety perceptions. Hence, a focus on optimizing institutional aspects can yield substantial benefits in enhancing patient safety perceptions.</p>
<p>The role of community support cannot be overstated when discussing safety perceptions among breast cancer patients. Social networks, including family, friends, and support groups, serve as vital resources for emotional and practical support. Patients often voiced that having access to a robust support system bolstered their feelings of safety during treatment. By promoting community engagement and fostering connections among patients, healthcare providers can facilitate enhanced patient experiences and perceptions of safety.</p>
<p>Through interviews and assessments, the research team identified several barriers to achieving optimal safety perceptions. Limited access to information, variability in treatment experiences, and instances of miscommunication were frequently cited as challenging elements. Addressing these barriers will require a multifaceted approach that integrates patient education, transparent communication, and accessible health resources. By proactively working to eliminate these obstacles, healthcare systems can significantly improve breast cancer patients&#8217; perceptions of safety.</p>
<p>The authors suggest actionable strategies for healthcare systems to consider. Initiatives such as training programs for healthcare professionals in communication techniques can bridge gaps between patients and providers. Moreover, incorporating patient feedback mechanisms into treatment protocols ensures that the voices of patients are heard, contributing to continuous improvement in service delivery. The push for systemic change is imperative to reshape healthcare landscapes and prioritize patient safety.</p>
<p>Equally important is the need for ongoing research efforts to deepen the understanding of patient safety perceptions. This study by Morandi and colleagues offers a foundation for future investigations into specific aspects of safety that warrant further exploration. As healthcare continues to evolve, ongoing scholarly contributions will serve as a lighthouse for navigating the often tumultuous waters of cancer treatment and care delivery.</p>
<p>In conclusion, the exploration of breast cancer patients&#8217; perceptions of safety within the Italian NHS presents a critical lens through which to assess and improve healthcare practices. By centering patient experiences and understanding the multi-dimensional factors influencing their perceptions, healthcare providers can craft responses that resonate with patient needs. The insights gained from this research call for an urgent reevaluation of how safety is conceptualized and operationalized in clinical settings, promoting a more inclusive and responsive healthcare landscape.</p>
<p>The findings from this research resonate far beyond the Italian context; they echo across international borders. As the global healthcare community grapples with the complexities of patient care, the imperative of fostering safer environments for all patients stands as a culmination of shared responsibility and concerted action.</p>
<p><strong>Subject of Research</strong>: Perceptions of Safety Among Breast Cancer Patients in Italian NHS</p>
<p><strong>Article Title</strong>: Breast cancer patients’ perceptions of safety: insights from the Italian NHS</p>
<p><strong>Article References</strong>:</p>
<p class="c-bibliographic-information__citation">Morandi, F., Laurita, R. &amp; Nardelli, V. Breast cancer patients’ perceptions of safety: insights from the Italian NHS.<br />
                    <i>BMC Health Serv Res</i>  (2025). https://doi.org/10.1186/s12913-025-13940-x</p>
<p><strong>Image Credits</strong>: AI Generated</p>
<p><strong>DOI</strong>: 10.1186/s12913-025-13940-x</p>
<p><strong>Keywords</strong>: Breast cancer, patient safety, healthcare perceptions, patient-centered care, Italian NHS.</p>
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		<post-id xmlns="com-wordpress:feed-additions:1">120986</post-id>	</item>
		<item>
		<title>Exploring Digital Nutrition Care in Head and Neck Cancer</title>
		<link>https://scienmag.com/exploring-digital-nutrition-care-in-head-and-neck-cancer/</link>
		
		<dc:creator><![CDATA[SCIENMAG]]></dc:creator>
		<pubDate>Fri, 17 Oct 2025 11:39:01 +0000</pubDate>
				<category><![CDATA[Medicine]]></category>
		<category><![CDATA[access to healthcare services]]></category>
		<category><![CDATA[barriers to nutritional support]]></category>
		<category><![CDATA[digital health interventions]]></category>
		<category><![CDATA[digital nutrition care]]></category>
		<category><![CDATA[family caregiver perspectives]]></category>
		<category><![CDATA[head and neck cancer management]]></category>
		<category><![CDATA[improving quality of life for cancer patients]]></category>
		<category><![CDATA[nutrition follow-up in oncology]]></category>
		<category><![CDATA[nutritional challenges in cancer patients]]></category>
		<category><![CDATA[patient experiences in cancer treatment]]></category>
		<category><![CDATA[personalized nutrition plans]]></category>
		<category><![CDATA[qualitative research in healthcare]]></category>
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					<description><![CDATA[Recent research into the nutritional management of head and neck cancer patients highlights a growing awareness of the importance of digital tools in providing seamless care. This qualitative study, led by an international team including Severinsen, Varsi, and Andersen, captures the experiences of patients, family caregivers, and healthcare professionals regarding nutritional follow-up during the treatment [&#8230;]]]></description>
										<content:encoded><![CDATA[<p>Recent research into the nutritional management of head and neck cancer patients highlights a growing awareness of the importance of digital tools in providing seamless care. This qualitative study, led by an international team including Severinsen, Varsi, and Andersen, captures the experiences of patients, family caregivers, and healthcare professionals regarding nutritional follow-up during the treatment course. By exploring their perspectives, the study aims to uncover barriers and opportunities associated with digital nutrition care, offering insights that could significantly enhance the quality of life for this vulnerable patient population.</p>
<p>Head and neck cancers are notoriously challenging, not only due to the physical toll they exert on patients but also because of the myriad of nutritional issues they create. Patients often face difficulties in maintaining adequate nutrition due to treatment side effects, which can lead to weight loss, malnutrition, and further complications. In light of this, effective nutritional follow-up becomes essential, yet many patients encounter obstacles when seeking support. The study emphasizes how digital interventions could bridge these gaps by offering personalized nutrition plans accessible through user-friendly platforms.</p>
<p>Patients frequently mentioned their struggles with traditional nutritional follow-up processes, citing long wait times and difficulty accessing healthcare services. This qualitative approach provides a valuable window into understanding how technology can facilitate better communication and logistics in nutritional care. Participants articulated a desire for more proactive engagement with their nutritional needs, raising the idea that digital solutions could empower patients to take control of their dietary management. This sentiment reflects a broader shift towards patient-centric care models in healthcare.</p>
<p>Family caregivers play an indispensable role in the nutritional management of head and neck cancer patients. Their insights are crucial, as they often share the responsibilities of meal preparation and encouraging adherence to dietary recommendations. The study revealed that caregivers also experience stress and uncertainty regarding how best to support their loved ones nutritionally. Digital tools could serve as resources for caregivers, providing them with essential information and support networks that can alleviate their burdens and improve patient outcomes.</p>
<p>From the healthcare professionals&#8217; perspective, the integration of digital nutrition care was met with a mix of enthusiasm and caution. On one hand, there is significant potential to streamline the care process, enhancing the efficiency of nutritional assessments and follow-ups. On the other hand, there are concerns related to the variability in technological literacy among patients, which could hinder the implementation of these digital tools in practice. This highlights the need for user-friendly interfaces and comprehensive training for both patients and healthcare providers to ensure equitable access to digital nutrition care.</p>
<p>The study also addressed the importance of creating a supportive digital environment. Many participants felt that a multi-disciplinary approach, incorporating dietitians, oncologists, and technology experts, could lead to a more effective digital nutrition care framework. By sharing their unique insights, these professionals could help design tools that truly meet the needs of head and neck cancer patients. Engaging with end-users during the development phase is critical to ensure that the functionalities of digital solutions align with the lived realities of their users.</p>
<p>Moreover, the implementation of digital nutrition care faces various systemic barriers, including disparities in access to technology. While some patients may have smartphones or computers, others may find themselves in environments where such resources are limited or non-existent. Addressing these disparities is essential to avoid exacerbating existing inequalities within healthcare systems. Initiatives that focus on broadening access to technology and ensuring connectivity in underserved communities can play a pivotal role in making digital nutrition support inclusive for all patients.</p>
<p>In addition to accessibility concerns, privacy and data security remain significant points of discussion. As with any digital health intervention, ensuring that sensitive patient information is protected is paramount. The study delves into these considerations, noting that trust in the platforms used for digital nutrition care will be a critical factor influencing patient adoption. Clearly communicated policies regarding data usage and privacy can foster greater acceptance and engagement among patients and caregivers.</p>
<p>To fully realize the potential of digital nutrition care, ongoing support and education for patients are vital. The study emphasizes the importance of developing educational resources that can guide patients on how to navigate these digital platforms effectively. Training programs that are tailored to different learning styles and levels of technological proficiency can enhance engagement and utilization. By investing in education, healthcare providers can empower patients to leverage technology as a vital tool in managing their nutritional health.</p>
<p>Furthermore, the study advocates for continuous feedback from all stakeholders, including patients, caregivers, and healthcare professionals, to iterate and improve digital nutrition care solutions. Establishing feedback loops can help organizations understand user experiences better and identify areas for enhancement. This iterative approach not only increases the effectiveness of digital tools but also fosters a culture of collaboration and responsiveness in care delivery.</p>
<p>Looking forward, the implications of integrating digital nutrition care into the treatment of head and neck cancer are profound. By harnessing the power of technology, healthcare systems can potentially revolutionize the way nutritional support is provided, leading to improved patient outcomes and experiences. With an increasing focus on personalized care and the integration of digital health solutions, the future holds promise for creating a more cohesive and supportive environment for patients navigating the challenges of head and neck cancer treatment.</p>
<p>In closing, the insights gleaned from this qualitative study underscore the crucial role that digital seamless nutrition care can play in enhancing the everyday lives of head and neck cancer patients. By addressing existing barriers and leveraging opportunities for implementation, it is possible to create a supportive care ecosystem that prioritizes nutritional health as a fundamental component of cancer treatment. As the landscape of healthcare continues to evolve, embracing these innovative solutions will be essential in meeting the complex needs of patients and their families.</p>
<p><strong>Subject of Research</strong>: Nutritional management in head and neck cancer treatment</p>
<p><strong>Article Title</strong>: Experiences with nutritional follow-up and barriers and opportunities of implementing digital seamless nutrition care in the head and neck cancer treatment course: a qualitative study from patient, family caregiver, and healthcare professional perspectives.</p>
<p><strong>Article References</strong>:</p>
<p class="c-bibliographic-information__citation">Severinsen, F., Varsi, C., Andersen, L.F. <i>et al.</i> Experiences with nutritional follow-up and barriers and opportunities of implementing digital seamless nutrition care in the head and neck cancer treatment course: a qualitative study from patient, family caregiver, and healthcare professional perspectives. <i>BMC Health Serv Res</i> <b>25</b>, 1358 (2025). https://doi.org/10.1186/s12913-025-13542-7</p>
<p><strong>Image Credits</strong>: AI Generated</p>
<p><strong>DOI</strong>:</p>
<p><strong>Keywords</strong>: head and neck cancer, nutritional management, digital health, patient-caregiver experiences, qualitative study, healthcare professionals</p>
]]></content:encoded>
					
		
		
		<post-id xmlns="com-wordpress:feed-additions:1">92785</post-id>	</item>
		<item>
		<title>Cancer Care Challenges in Cameroon: Patient Insights</title>
		<link>https://scienmag.com/cancer-care-challenges-in-cameroon-patient-insights/</link>
		
		<dc:creator><![CDATA[SCIENMAG]]></dc:creator>
		<pubDate>Wed, 28 May 2025 12:47:10 +0000</pubDate>
				<category><![CDATA[Cancer]]></category>
		<category><![CDATA[barriers to cancer diagnosis and treatment]]></category>
		<category><![CDATA[biopsychosocial framework in healthcare]]></category>
		<category><![CDATA[Cancer care challenges in Cameroon]]></category>
		<category><![CDATA[cancer incidence in low-income countries]]></category>
		<category><![CDATA[cancer morbidity and mortality trends]]></category>
		<category><![CDATA[early detection of cancer in developing nations]]></category>
		<category><![CDATA[healthcare infrastructure in Sub-Saharan Africa]]></category>
		<category><![CDATA[healthcare resource limitations in Cameroon]]></category>
		<category><![CDATA[patient experiences in cancer treatment]]></category>
		<category><![CDATA[patient narratives in cancer care]]></category>
		<category><![CDATA[public health dilemmas in Cameroon]]></category>
		<category><![CDATA[qualitative research on cancer patients]]></category>
		<guid isPermaLink="false">https://scienmag.com/cancer-care-challenges-in-cameroon-patient-insights/</guid>

					<description><![CDATA[Cancer care in Cameroon faces a complex web of challenges that mirror a broader crisis gripping many low- and middle-income countries. A recent in-depth study carried out at Mbingo Baptist Hospital, one of the country’s foremost healthcare institutions, delves into the lived experiences of cancer patients navigating this fraught landscape. Utilizing a biopsychosocial framework, the [&#8230;]]]></description>
										<content:encoded><![CDATA[<p>Cancer care in Cameroon faces a complex web of challenges that mirror a broader crisis gripping many low- and middle-income countries. A recent in-depth study carried out at Mbingo Baptist Hospital, one of the country’s foremost healthcare institutions, delves into the lived experiences of cancer patients navigating this fraught landscape. Utilizing a biopsychosocial framework, the research provides a comprehensive examination of how systemic barriers intertwine with personal struggles, shedding light on a public health dilemma with profound implications for Sub-Saharan Africa’s future.</p>
<p>Cameroon, like many Sub-Saharan countries, is grappling with a striking rise in cancer incidence amid limited healthcare infrastructure and scarce resources. The burden of cancer morbidity and mortality has escalated in recent years, fueled by inadequate early detection mechanisms and constrained treatment options. This dynamic poses heightened challenges to a population already burdened by infectious diseases and other health priorities, creating a scenario where cancer care is lamentably deprioritized on many fronts.</p>
<p>The qualitative study explored in-depth narratives of eleven cancer patients at Mbingo Baptist Hospital between December 2023 and January 2024. Through detailed interviews, researchers uncovered multifaceted barriers that patients confront, starting from the initial diagnosis stage and extending through treatment regimens and ongoing follow-up care. The findings reveal alarming delays in diagnosis, often linked to limited access to diagnostic technology and specialized oncology expertise.</p>
<p>Financial hardship emerges as a significant impediment within this context. The cost of cancer treatment in Cameroon remains prohibitive for most patients, with scant financial protection or insurance mechanisms available. Patients and their families often face crippling expenses, which not only impact adherence to treatment but also exacerbate psychosocial stress. This economic strain is compounded by the need for repeated hospital visits and sometimes extended travel from rural areas to urban treatment centers, underscoring the geographic disparities that pervade cancer care accessibility.</p>
<p>Emotionally and psychologically, the toll on patients is profound. The study highlights narratives of distress, anxiety, and hopelessness among individuals contending with their diagnosis and the uncertainty of their prognosis. The psychological burden is often heightened by social stigma attached to cancer, which may lead to isolation and diminished support networks. Despite these adversities, many patients exhibit remarkable resilience, drawing strength from familial bonds and community networks that play a pivotal role in emotional buffering.</p>
<p>Accessing healthcare services in Cameroon is another critical hurdle. Patients report inconsistent availability of essential cancer care components, including chemotherapy drugs, radiotherapy, and palliative care services. This scarcity is exacerbated by infrastructural limitations, ranging from under-equipped hospitals to shortages of trained oncology specialists. The systemic inefficiencies result in treatment interruptions and suboptimal care outcomes, highlighting the urgent need to bolster health systems with comprehensive oncology capabilities.</p>
<p>The researchers employed the biopsychosocial model strategically to unravel the interconnected layers affecting patient experiences. This theoretical lens facilitated understanding of how biological factors, such as disease progression and symptomatology, intersect with psychological states and social environments, including cultural attitudes and socioeconomic status. By adopting this holistic perspective, the study robustly captures the complexity inherent in cancer care delivery and its lived reality in a resource-constrained environment.</p>
<p>Findings also point to the necessity of early detection as a linchpin for improving cancer outcomes. Currently, late-stage presentation is common, markedly reducing survival chances and amplifying treatment difficulties. Public awareness campaigns and screening initiatives remain sorely lacking, contributing to diagnostic delays that could otherwise be mitigated. The absence of these preventive measures underscores a critical gap in Cameroon’s health priorities, necessitating immediate policy intervention.</p>
<p>Financial protection mechanisms, such as health insurance and subsidized treatment programs, are conspicuously limited in Cameroon, leaving patients vulnerable to catastrophic health expenditures. This economic fragility curtails treatment completion rates and amplifies disparities among different socioeconomic groups. Policymakers must urgently address these gaps to foster more equitable and sustainable cancer care frameworks.</p>
<p>Another dimension unveiled by the study is the role of community and familial support in fostering resilience among cancer patients. Amidst systemic shortcomings, personal networks often compensate by offering emotional sustenance, caregiving assistance, and sometimes financial help. These social supports are not merely ancillary but integral to patient well-being and coping mechanisms, underscoring the social fabric’s centrality in the cancer care continuum.</p>
<p>International and non-governmental organizations have a crucial role to play in bridging gaps within Cameroon’s cancer care systems. The study advocates for collaborative engagement encompassing capacity building, infrastructure investment, and knowledge transfer to homegrown healthcare providers. Such alliances, tailored to contextual realities, are indispensable for sustainable cancer control strategies that resonate with local needs and cultures.</p>
<p>A significant implication of the study is the clear call for integrated care models that address not only biological treatment but also psychological counseling and social support services. Holistic approaches are essential to ameliorate the multidimensional challenges patients face and to improve quality of life throughout the cancer trajectory. This paradigm shift demands interdisciplinary cooperation among oncologists, mental health professionals, social workers, and community leaders.</p>
<p>Moreover, advances in telemedicine and mobile health platforms present promising avenues to mitigate geographic and resource constraints prevalent in Cameroon. Leveraging technology could enhance patient follow-up, improve health education, and facilitate remote consultation, thereby partially circumventing structural bottlenecks. Innovative digital solutions aligned with local realities offer a potential catalyst for healthcare transformation in resource-limited settings.</p>
<p>Training and retaining oncology specialists constitute another pillar identified for health system strengthening. Cameroon’s depletion of skilled healthcare workers limits the delivery of specialized cancer care. Investing in education opportunities, continuous professional development, and equitable distribution of medical personnel is critical to addressing workforce shortages and elevating care standards.</p>
<p>In conclusion, the experiences of cancer patients at Mbingo Baptist Hospital expose systemic fragilities that reflect broader challenges in Cameroon and similar low-resource contexts. The study’s insights foreground an urgent imperative: comprehensive reforms that encompass infrastructure enhancement, financial risk protection, public awareness, and holistic patient-centered care. Addressing these intertwined factors demands coordinated efforts by government bodies, healthcare institutions, civil society, and international partners.</p>
<p>Ultimately, mitigating the cancer burden in Sub-Saharan Africa hinges on transcending fragmented approaches and embracing inclusive, context-sensitive cancer control strategies. The knowledge gained from this theory-guided inquiry not only illuminates patient realities but also charts a path toward more resilient, equitable healthcare systems capable of improving outcomes and preserving dignity for millions confronting cancer in Cameroon and beyond.</p>
<hr />
<p><strong>Subject of Research</strong>: Patient experiences and systemic barriers in cancer care at Mbingo Baptist Hospital, Cameroon, analyzed through a biopsychosocial framework.</p>
<p><strong>Article Title</strong>: Navigating cancer care in Cameroon: a theory-guided inquiry on patient experiences at Mbingo Baptist Hospital</p>
<p><strong>Article References</strong>:<br />
Afungchwi, G.M., Tum, E.M., Elit, L. et al. Navigating cancer care in Cameroon: a theory-guided inquiry on patient experiences at Mbingo Baptist Hospital. <em>BMC Cancer</em> 25, 958 (2025). <a href="https://doi.org/10.1186/s12885-025-14338-y">https://doi.org/10.1186/s12885-025-14338-y</a></p>
<p><strong>Image Credits</strong>: Scienmag.com</p>
<p><strong>DOI</strong>: <a href="https://doi.org/10.1186/s12885-025-14338-y">https://doi.org/10.1186/s12885-025-14338-y</a></p>
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