{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T09:45:07Z","timestamp":1791798307085,"version":"4.3.4"},"reference-count":39,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"unspecified","delay-in-days":284,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1478951526103769_sec1a\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore how holistic suffering manifests and is experienced by adults with cancer through qualitative inquiry, supported by descriptive quantitative assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526103769_sec2b\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This qualitatively driven study combined semi-structured interviews with embedded descriptive quantitative data from the Suffering Pictogram\u2013Brazilian version (SP-BR). A total of 222 adults with cancer completed the SP-BR, and a subsample of 20 participated in interviews. The qualitative component had methodological priority and underwent thematic analysis; SP-BR scores were analyzed descriptively to contextualize self-reported levels and dimensions of suffering.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526103769_sec3c\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall suffering was moderate (mean=4.44, standard deviation=3.22), with substantial variability; worry and physical discomfort were the most prominent concerns. Thematic analysis revealed 4 interrelated themes: Disruption of the self and the search for meaning after diagnosis; Anchoring suffering: faith, relationships, and the ambivalence of coping; Concealed suffering and the fragile work of acceptance; and Meaning as responsibility: enduring suffering for oneself and others. Suffering coexisted with adaptive processes, including meaning-making, relational commitment, and spiritual coping. Spirituality and social support functioned both as protective resources and, in some cases, as mechanisms for concealing distress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526103769_sec4d\">\n                    <jats:title>Significance of results<\/jats:title>\n                    <jats:p>Holistic suffering in cancer is an integrated, dynamic experience that can be understood as a nonlinear existential trajectory, in which participants moved back and forth between disruption of the self, the anchoring of faith and relationships, emotional concealment, and meaning-making. The proposed interpretive model synthesizes this trajectory and may serve as a conceptual starting point for designing interventions addressing holistic suffering.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1478951526103769","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T08:51:28Z","timestamp":1791795088000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Holistic suffering in patients with cancer: A qualitative study informed by descriptive quantitative assessment"],"prefix":"10.1017","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9793-7905","authenticated-orcid":false,"given":"Ana Cl\u00e1udia Mesquita","family":"Garcia","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/034vpja60","id-type":"ROR","asserted-by":"publisher"}],"name":"Federal University of Alfenas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliza Mara das Chagas","family":"Paiva","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/034vpja60","id-type":"ROR","asserted-by":"publisher"}],"name":"Federal University of Alfenas"},{"id":[{"id":"https:\/\/ror.org\/034vpja60","id-type":"ROR","asserted-by":"publisher"}],"name":"Universidade Federal de Alfenas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela Bezerra Soares","family":"Perlamagna","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/034vpja60","id-type":"ROR","asserted-by":"publisher"}],"name":"Universidade Federal de Alfenas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tais Rodrigues","family":"Caproni","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03se9eg94","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Medicine at the University of S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana Maria Coelho Leite","family":"Fava","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/034vpja60","id-type":"ROR","asserted-by":"publisher"}],"name":"Federal University of Alfenas"},{"id":[{"id":"https:\/\/ror.org\/034vpja60","id-type":"ROR","asserted-by":"publisher"}],"name":"Universidade Federal de Alfenas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Everson","family":"Meireles","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/057mvv518","id-type":"ROR","asserted-by":"publisher"}],"name":"Universidade Federal do Reconcavo da Bahia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talita Prado Sim\u00e3o","family":"Miranda","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0409dgb37","id-type":"ROR","asserted-by":"publisher"}],"name":"Universidade Federal de Vi\u00e7osa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0649-0739","authenticated-orcid":false,"given":"Seng Beng","family":"Tan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vkrxq08","id-type":"ROR","asserted-by":"publisher"}],"name":"University Malaya Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"S1478951526103769_ref4","doi-asserted-by":"publisher","DOI":"10.1177\/1049909112458721"},{"key":"S1478951526103769_ref33","doi-asserted-by":"publisher","DOI":"10.1177\/1473325020968189"},{"key":"S1478951526103769_ref19","doi-asserted-by":"publisher","DOI":"10.1002\/pon.70287"},{"key":"S1478951526103769_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2025.08.002"},{"key":"S1478951526103769_ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2025.07.026"},{"key":"S1478951526103769_ref13","doi-asserted-by":"publisher","DOI":"10.1037\/scp0000141"},{"key":"S1478951526103769_ref24","volume-title":"Stress, Appraisal, and Coping","author":"Lazarus","year":"1984"},{"key":"S1478951526103769_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmn.2025.02.006"},{"key":"S1478951526103769_ref26","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"},{"key":"S1478951526103769_ref29","doi-asserted-by":"publisher","DOI":"10.1111\/soc4.13266"},{"key":"S1478951526103769_ref31","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-024-08305-9"},{"key":"S1478951526103769_ref32","article-title":"Multiple parenting: a structural cutout of Brazilian families","volume":"36","author":"Santos","year":"2025","journal-title":"Oikos: Pol\u00edtica Social Em Debate"},{"key":"S1478951526103769_ref15","volume-title":"Man\u2019s Search for Meaning","author":"Frankl","year":"2006"},{"key":"S1478951526103769_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2021.102041"},{"key":"S1478951526103769_ref22","first-page":"20","article-title":"Warum wir leiden. 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