Journal of Cancer Survivorship最新文献

Purpose: Depression is prevalent among colorectal cancer (CRC) survivors. Although various physical activity intensities are differentially associated with depressive symptoms, the underlying mediator and moderator involving interoception and mindfulness, remain unclear. This study aims to examine whether interoceptive accuracy differentially mediates the relationship between various physical activity intensities and depressive symptoms and whether mindfulness moderates these pathways.

Methods: In this multicenter cross-sectional study, 395 CRC survivors completed validated questionnaires assessing depressive symptoms, physical activity participation, interoceptive accuracy, and mindfulness. Mediation and moderated mediation analyses via PROCESS version 4.1 for SPSS tested whether interoceptive accuracy mediated associations between light and moderate-to-vigorous physical activity (LPA vs. MVPA) and depressive symptoms, and whether mindfulness moderated these pathways.

Results: Both LPA and MVPA are negatively associated with depressive symptoms (p < 0.001). Interoceptive accuracy significantly mediated these associations, accounting for 49.09% of the total effect for LPA and 20.56% for MVPA. Mindfulness moderated the LPA-interoceptive accuracy (B = -0.004, p = 0.031), interoceptive accuracy-depression (B = -0.022, p = 0.004), and MVPA-depression pathways (B = -0.001, p = 0.034), suggesting differential, intensity-dependent associations.

Conclusions: LPA showed negative associations with depressive symptoms, with interoceptive accuracy fully mediating this association. In contrast, MVPA demonstrated both direct and indirect associations with depressive symptoms, partially mediated by interoceptive accuracy. Mindfulness strengthened these relationships through complementary and synergistic moderation, highlighting the dynamic interaction between bodily awareness and physical activity in psychological recovery.

Implications for cancer survivors: Tailoring gentle, mindful movement to enhance interoception may offer a feasible, integrative rehabilitation strategy to reduce depression among CRC survivors.

Purpose: Breast cancer treatments contribute to bone loss and increase fracture risk, with effects varying by age and menopausal status. Previous studies lacked comparisons with the general population and analyses by treatment and age groups. This study evaluated fracture risk in breast cancer patients compared to a matched control group, considering risk factors, age, and treatments.

Methods: This retrospective cohort study using the Korean National Health Insurance System database included 104,177 breast cancer patients and 312,531 matched controls. Fracture incidences (any, vertebral, hip, and other) by age and treatment type was assessed using Fine-Gray competing risk models.

Results: During the mean follow-up of 7.21 years after breast cancer diagnosis, breast cancer patients aged 50 years and younger had a higher risk of any fracture (sub-distribution hazard ratio [sHR], 1.33; 95% confidence interval [95% CI], 1.24-1.42) and vertebral fracture (sHR, 1.33; 95% CI, 1.13-1.56) compared to the matched control group. Patients aged 65 years and older had a lower risk of any fracture (sHR, 0.91; 95% CI 0.84-0.98) and vertebral fracture (sHR, 0.83; 95% CI, 0.73-0.93). Compared to patients without specified treatments, those who received anthracycline (sHR, 1.21; 95% CI, 1.15-1.28) and aromatase inhibitors (sHR, 1.16; 95% CI, 1.09-1.23) had an increased risk of fracture; and those who were given tamoxifen had a decreased risk (sHR, 0.92; 95% CI, 0.86-0.98).

Conclusions: Breast cancer patients had slightly higher fracture risk, primarily in younger patients. Emphasizing osteoporosis prevention and treatment, especially in younger populations or those who have received treatments associated with an increased risk of fracture, is necessary to reduce fracture risk.

Purpose: To identify and evaluate consumer-informed strategies that online exercise leaders can use to enhance engagement in online exercise classes for people living with cancer, using social identity leadership theory as a guiding framework.

Method: We used a participatory design involving adults with a history of blood cancer. Fourteen participants attended online co-design workshops to generate strategies that online exercise leaders could use to demonstrate their engagement in the four aspects of social identity leadership. Twenty-nine unique strategies were identified and thematically grouped using both social identity leadership theory and inductive analysis. These strategies were then rated by 18 participants on their potential to enhance commitment and appeal (0-100 scales).

Results: Strategies were categorised into four domains-The SIGN Framework: Social support and connection, Individualisation and inclusion, Goals, monitoring and feedback, and Novelty. The highest-rated strategies primarily fell within the Individualisation and inclusion and Goals, monitoring and feedback domains, including tailoring exercises, setting personalised goals, adapting sessions based on well-being, and providing regular feedback. These behaviours aligned with the social identity leadership process Identity advancement, whereby leaders act in the group's interest by supporting group members' needs and progress. Qualitative findings highlighted that leaders who validate individuals' needs and preferences strengthen their sense of inclusion and group belonging. Strategies involving Social support and connection (e.g., establishing group rules) and Novelty (e.g., weekly themes) were appreciated by some participants but received more mixed ratings.

Conclusion: Online exercise leaders who act in the group's interest and offer personalised support may enhance engagement and group identification among cancer survivors. The SIGN framework offers a practical guide for translating social identity leadership into online exercise settings.

Implications for cancer survivors: Supporting exercise leaders to apply social identity leadership strategies may increase motivation, connection, and long-term participation in online programs for cancer survivors.

Purpose: Definitions of "cancer survivors" vary from individuals from diagnosis throughout their life, to individuals post-curative intent treatment. Attempts to categorise groups of people who have or had cancer also differ. This study aims to generate European expert consensus opinion about cancer survivor terminology and categorisation relevant to developing a model of care.

Methods: This was an electronic Delphi study where specialist palliative care (SPC) and oncology (ONC) European experts, including patient advocates, were purposively sampled to form two separate groups. Participants selected agreement with 105 questions/statements developed from literature reviews in round 1, and in subsequent rounds statements were modified/added according to feedback. The study was terminated when consensus (pre-defined as ≥ 75% within each group) and stability (determined by Spearman's Rank Order Correlation) were reached for most statements. The Chi square test for goodness of fit compared agreement between groups.

Results: Eighty-six SPC experts from 19 countries/regions, and 54 ONC experts from 17 countries/regions began the process, with three rounds completed by 80 and 49 respectively. Eight statements about "cancer survivor" application reached consensus in both groups, demonstrating agreement that "cancer survivor" should be applied to people post-treatment with no evidence of disease. Two other statements reached consensus in only one group (with a significant difference). Two categorisations reached consensus in both groups.

Conclusions: These experts suggest that application of "cancer survivor" to people with active cancer should be reconsidered.

Implications for cancer survivors: Pragmatic categorisation of people who have/had cancer could help provide tailored care for different groups.

Purpose: This systematic review and meta-analysis aims to evaluate the effectiveness of pulmonary rehabilitation in improving physical and psychological outcomes after lung resection.

Methods: A literature search was conducted across five electronic databases, identifying randomized controlled trials evaluating pulmonary rehabilitation in lung cancer patients after lung resection. Screening, data extraction, and quality assessment were conducted independently by two reviewers. The revised Cochrane risk-of-bias tool for randomized trials was used to evaluate the quality of included studies. Data synthesis was performed using RevMan Web, with results visualized in forest plots.

Results: Eighteen studies (n = 1795) were included; only three were rated as having low risk of bias. The meta-analysis revealed that pulmonary rehabilitation, including exercise and breathing training, significantly improved lung function, such as the forced vital capacity, physical capacity, 6-min walking distance, and the physical domain of quality of life in post-surgery lung cancer patients compared to controls. Subgroup analysis indicated that interventions lasting 12 weeks or longer were associated with greater improvements. Egger's test suggested no significant publication bias.

Conclusions: The findings demonstrate the positive effects of pulmonary rehabilitation, including exercise and breathing training, on postoperative recovery in lung cancer patients. Significant improvements were observed in lung function, exercise capacity, and quality of life.

Implications for cancer survivors: Our systematic review underscores pulmonary rehabilitation as an effective intervention to improve physical function and quality of life in lung cancer patients following lung resection. It supports broader adoption to enhance postoperative recovery and long-term health in these patients.

Trial registration: PROSPERO (reference: CRD42024616958).

Purpose: Rectal cancer survivors are at risk of late adverse effects that impair quality of life. This study evaluates the cost-utility of a patient-led follow-up programme introduced in the Danish FURCA randomised controlled trial (RCT), aimed at improving patient outcomes and optimising healthcare resource use compared to standard hospital-based follow-up.

Methods: The cost-utility analysis was performed from a societal perspective over a 3-year horizon, incorporating healthcare costs, prescription drug use, productivity losses, all derived from Danish register data, and quality-adjusted life years (QALYs) derived from RCT-collected EQ-5D-5L data. Incremental cost-effectiveness was assessed using regression models and non-parametric bootstrapping, with subgroup and sensitivity analyses exploring heterogeneity in outcomes.

Results: A total of 336 patients were randomised to intervention and control groups. Over 3 years, mean healthcare costs were €40,208 for the intervention group and €41,190 for the control group (difference -€980; 95% CI -€7120 to €5159). Mean QALYs were 2.24 and 2.20, respectively (difference 0.028; 95% CI -0.106 to 0.163). The incremental cost-effectiveness ratio was -€35,048 per QALY gained, indicating dominance. Scatterplots of bootstrapped incremental cost-effectiveness ratios (ICERs) revealed iterations in all four quadrants, reflecting substantial uncertainty in both costs and effects. The probability of cost-effectiveness at a €30,000 threshold was below 70%.

Conclusions: Patient-led follow-up resulted in comparable QALYs and costs relative to standard hospital-based follow-up. The probability of cost-effectiveness at a conventional willingness-to-pay threshold reached up to 70%.

Implications for cancer survivors: Patient-led models may enable tailored delivery of specialist care to patients with greatest need, alongside balanced resource utilisation.

Purpose: Using a population-based approach, the CRUISE Study is designed to understand disparities in receipt of survivorship care guidance among medically under-resourced cancer survivors.

Methods: Eligible participants identified from the Greater Bay Area Cancer Registry were those newly diagnosed with first primary stage I-III breast or colorectal cancer. Patients from medically under-resourced communities, defined on the basis of ethnic minority group, underinsurance, and/or living in a low socioeconomic status (SES) neighborhood, were oversampled. Using data derived from patient surveys, cancer registry, and geospatial linkage, patient, facility, and neighborhood attributes were assessed for associations with receipt of survivorship care guidance using univariate and multivariable log binomial regression models.

Results: Of 867 participants (332 breast cancer, 474 colorectal cancer), 62% identified with a non-White racial/ethnic group, 20.6% resided in a low SES neighborhood, and 9.3% were uninsured or publicly insured. Overall, 72.2% received survivorship care guidance. In a multivariable model, female breast cancer survivors relative to male colorectal cancer survivors (RR: 0.89, 95% CI: 0.81-0.97), and unemployed (RR: 0.80, 95% CI: 0.68-0.94) and retired (RR: 0.85, 95% CI: 0.77-0.95) versus employed people remained significantly less likely to receive guidance. Those who strongly agreed as well as those who disagreed that they could get medical care without financial setbacks were also significantly more likely to have received guidance than those who neither agreed nor disagreed (RR: 1.28, 95% CI: 1.09-1.51 for strongly agreed; RR: 1.22, 95% CI: 1.01-1.46 for disagreed).

Conclusions: The CRUISE Study demonstrated feasibility in accruing a population-based sample of cancer survivors with over-representation of medically under-resourced patients.

Implications for cancer survivors: A high proportion received survivorship guidance, including survivorship care plans or post-treatment guidance, but some variations were found across some patient characteristics.

Purpose: This study aimed to (1) identify distinct multidimensional fatigue profiles among employed cancer survivors, (2) examine associations between workplace factors and these profiles, and (3) assess how these profiles are associated with occupational outcomes.

Methods: Seventy-two employed cancer survivors aged 27 to 64 years (median 9.4 years since diagnosis) from a local government in Japan completed questionnaires in 2023 assessing cancer-related fatigue (Cancer Fatigue Scale), workplace factors (job demands, job control, workplace support), and occupational outcomes (work engagement, presenteeism, cognitive function at work, and quality of life). Fatigue profiles were identified using hierarchical cluster analysis. Associations between workplace factors and profiles were examined using multinomial logistic regression. Occupational outcome differences among profiles were examined using linear regression.

Results: Three profiles were identified: Low Global Fatigue (n = 12), Dominant Mental Fatigue (n = 36), and High Global Fatigue (n = 24). Workplace support-particularly supervisor understanding, colleague understanding, and schedule flexibility-was associated with approximately 75% lower odds of belonging to the High Global Fatigue group. Job demands and job control showed no associations. The High Global Fatigue group reported lower work engagement, higher presenteeism, reduced cognitive function at work, and poorer quality of life compared to the other groups.

Conclusions: Three multidimensional fatigue profiles were identified among employed cancer survivors. Workplace support factors were more strongly associated with fatigue profiles than job characteristics. These profiles were associated with occupational outcomes.

Implication for cancer survivors: These distinct fatigue profiles can guide personalized workplace interventions to optimize support for employed cancer survivors.

Purpose: Cancer-related cognitive impairment (CRCI) is a common and debilitating complication among colorectal cancer survivors, even in those without chemotherapy exposure. To identify cancer-related neural changes, we investigated spontaneous brain activity and cognition in colorectal cancer survivors using cognitive assessments and resting-state functional magnetic resonance imaging (rsfMRI).

Methods: Nineteen survivors (stages I-II, cancer diagnosis < 12 months, chemotherapy-naïve) and 18 healthy controls underwent a battery of objective/subjective cognitive tests and MRI. RsfMRI data was analyzed with fractional amplitude of low-frequency fluctuations (fALFF) and functional connectivity (FC). Statistical analysis was controlled for age, sex, education, depression, and anxiety, with multiple comparison correction.

Results: Compared to controls, survivors performed significantly worse on the Hopkins Verbal Learning Test (HVLT-R) Recognition Discrimination Index (RDI) (p = 0.03) and showed slower psychomotor speed on the Trail Making Test (TMT-A) (p = 0.02). RsfMRI analysis revealed increased fALFF in the right hippocampus and bilateral inferior/middle temporal, parahippocampal, and fusiform gyri, with decreased fALFF in the bilateral superior/middle frontal gyri and left inferior frontal gyrus. RDI was negatively correlated with fALFF in right temporal regions. Survivors also exhibited reduced FC within the default mode network (DMN) (p < 0.05).

Conclusions: This cross-sectional study shows that colorectal cancer survivors display hyperactivity in the temporal regions and disrupted DMN connectivity associated with cognitive decline, suggesting a maladaptive neural response.

Implications for cancer survivors: Our study identified the functionally altered brain regions and networks associated with colorectal CRCI using MRI. This would provide potential biological targets for developing interventions such as neuromodulation for mitigating the adverse effects of colorectal CRCI.