Journal of Cancer Survivorship最新文献

Purpose: Risk factors for cancer-related cognitive impairment (CRCI) are diverse; neuroimaging instruments are recommended to complement subjective and objective cognitive assessments. This study aimed to evaluate the feasibility of a multidomain assessment protocol for CRCI in gastrointestinal cancer survivors.

Methods: Twenty-four patients with gastrointestinal cancer were scheduled for chemotherapy, and 24 healthy controls were recruited. The Functional Assessment of Cancer Therapy-cognitive function (FACT-Cog) was used to assess subjective cognitive functions. Objective cognitive function was assessed using the trail making test, auditory verbal learning test (AVLT), and verbal fluency test. Cerebral hemodynamic changes in the prefrontal cortex were measured using portable functional near-infrared spectroscopy (P-NIRS). Assessments were conducted at baseline and 6-month follow-up.

Results: Thirty-eight participants were included in the analysis. There was a statistically significant difference in AVLT-delayed recall (p = 0.002) in the chemotherapy group compared with the healthy control group, but no significant difference in either group for other cognitive assessments. The chemotherapy group exhibited reduced activity in the left frontal pole at 6 months post-treatment compared to baseline (p = 0.018).

Conclusions: Gastrointestinal cancer survivors who receive chemotherapy may exhibit poorer delayed recall of memory functions than healthy individuals. Monitoring prefrontal cortical hemodynamics using P-NIRS during cognitive tasks is feasible for clinical application and understanding CRCI symptoms.

Implications for cancer survivors: These multidomain assessments are translatable to clinical practice and useful for other cancers. Additionally, the P-NIRS assessments may offer a deeper understanding on the impact of depressive symptoms and declining motivation on the cognitive function of cancer survivors.

Purpose: Coping with cancer presents significant challenges, especially for those with advanced-stage and long-term survival. However, research on advanced-stage cancer experiences in Japan remains limited. This study analyzed how patient experiences with advanced-stage cancer/long-term survival varied across different diagnosis periods.

Methods: We examined two groups of patients with advanced cancer diagnosed in 2013 and 2016 using data from the Patient Experience Survey, a nationwide survey of cancer patients in Japan in 2019. Weighted analysis was used to estimate the distribution of patient experiences in the representative population. We compared the experiences of patients diagnosed with advanced-stage disease in 2016 (newer diagnosis group) and 2013 (earlier diagnosis group).

Results: We analyzed 1584 participants in the newer diagnosis group and 412 in the earlier diagnosis group, with response rates of 30.8% and 43.0% respectively (P < 0.01). The earlier group had more proxy responses (38.0% vs. 43.2%). Survey response distribution was similar across groups; however, earlier diagnosis patients reported worse access to treatment information, lower satisfaction, and less positive post-treatment experiences than did newer patients. However, when considering respondent type, patient responses were consistent across years, whereas proxy responses were more negative.

Conclusions: Differences in survey timing and response types significantly impact the reported patient experiences. Policymakers should consider these factors when designing cancer control strategies to support patients and families.

Implications for cancer survivors: Policymakers should use these findings to enhance cancer control strategies, addressing the distress of patients and families affected by advanced and long-term cancer.

Purpose: Prostate cancer is one of the most prevalent cancers worldwide. Active surveillance is a widely accepted treatment option for some localised prostate cancers. However, concerns have been raised about the experiences of men on this treatment given that almost 40% will discontinue without clinical indications. The objective of this review was to identify the lived experience of men on active surveillance.

Methods: A systematic review and meta-synthesis, according to PRISMA guidelines. Studies were included if they reported qualitative data exploring the experiences of men undertaking active surveillance. Thomas and Harden's approach was undertaken for data synthesis.

Results: Five databases were searched identifying 3226 articles, and 13 studies met the inclusion criteria. Two overarching analytical themes were identified: (i) men on active surveillance live with a lack of certainty; and (ii) re-establishing agency drives resilience and facilitates confidence in active surveillance. Lack of certainty on active surveillance is derived from men feeling a loss of control over their health and/or lives. This induces a stress response of ongoing worry and anxiety and loss of agency, further driving the stress cycle. Re-establishing agency alleviates the stress response, promotes resilience, and facilitates confidence in active surveillance.

Conclusions: The experience of active surveillance is underpinned by ongoing lack of certainty diminishing agency and driving cyclical stress.

Implications for cancer survivors: It is essential that health professionals better support men to establish and maintain confidence in active surveillance. Further research into men's perspectives of interventions and strategies that best facilitate agency and effectively support them is warranted.

Purpose: This secondary analysis of a randomized clinical trial aimed to understand the cost-effectiveness of cognitive behavioral therapy for insomnia (CBT-I) in improving absenteeism (i.e., time away from work) and presenteeism (i.e., unproductivity while at work) among cancer survivors.

Methods: A total of 55 currently employed mixed cancer survivors who met DSM-5 criteria for insomnia disorder and self-reported cognitive impairments were randomized to receive seven weekly, individual CBT-I sessions immediately or after a waiting period. Participants completed the Work Productivity and Activity Impairment Questionnaire (WPAI). Information from participants and the Labour Force Survey (LFS) were used to calculate costs. Education-adjusted mixed-effects models using intention-to-treat principles assessed immediate and longer-term effects of treatment on work productivity.

Results: While CBT-I was not associated with significant improvements in absenteeism, the treatment group reported a 23.5-point reduction in presenteeism post-treatment, compared to a 0.45-point decrease in the waitlist control group. Improvements in presenteeism were maintained at 6-month follow-up. The mean cost of total work productivity loss was CAD627.59 per person per week before beginning CBT-I. Treatment resulted in a 48.4%, 44.6%, and 30.5% reduction in lost productivity immediately, 3 and 6 months post-treatment, respectively. Total cost savings for the first year after treatment, adjusting for treatment costs, were estimated at CAD 9478.82.

Conclusions: Intervening upon late and long-term effects of cancer treatment (e.g., sleep, fatigue, cognitive impairment) through CBT-I produces meaningful and durable improvements in work productivity, particularly presenteeism.

Implications for cancer survivors: With appropriate treatment, survivors can address side effects and increase productivity, but additional work is needed to improve access to and coverage for evidence-based interventions.

Purpose: To investigate which demographic, personal, clinical, physical, psychological, social, lifestyle, and cancer-related quality of life (QoL) factors are associated with (changes in) supportive care needs (SCNs) from 6 months to 2 years after treatment in head and neck cancer (HNC) patients.

Methods: Data from the prospective NETherlands QUality of life and BIomedical Cohort (NET-QUBIC) study among HNC patients treated with curative intent was used. SCNs were measured using the Supportive Care Needs Survey 34-item Short-Form (SCNS-SF34) (6 months, 1 and 2 years after treatment) and the 11-item HNC-specific module (SCNS-HNC) (2 years). Multivariable linear mixed model analyses and linear regression analyses were used to study factors associated with changes in SCNs over time (SCNS-SF34) and the level of SCNs at 2 years follow-up (SCNS-SF34 and SCNS-HNC).

Results: Data from 483 patients was used. SCNs in the physical and daily living (PDL), psychological (PSY), and health system, information, and patient support (HSIPS) domains decreased significantly over time. At 2 years follow-up, the highest SCNs were reported regarding lack of energy/tiredness (10.8%). Changes in SCNs and the absolute level of SCNs at 2 years were associated with personal and clinical factors and post-treatment (6 months) with psychological, lifestyle, and cancer-related QoL factors.

Conclusions: Personal, clinical, psychological, lifestyle, and cancer-related QoL factors were associated with SCNs. These results can be used to develop predictive models to personalize supportive care for HNC patients.

Implications for cancer survivors: SCNs decrease over time, but a subgroup of patients still presents with SCNs 2 years after treatment.

Purpose: To understand the lived experiences of Ethiopian women who self-identify as breast cancer survivors, particularly facilitators, and barriers to engaging with care in biomedical settings.

Methods: Between November 2022 and January 2023, six focus group discussions were conducted in Amharic with 44 breast cancer patients and survivors in Adama, Ethiopia, stratified based on HIV status and participation in available peer support groups at their treatment hospital. Thematic analysis was conducted, with methodology reported in accordance with the Consolidated Criteria for Reporting Qualitative research checklist.

Results: Our analysis identified four key areas along the continuum of care: (1) recognition of BC-related symptoms, (2) seeking clinical care for BC symptoms, (3) adherence to BC treatment plans, and (4) coping strategies during ongoing care. Known facilitators for engagement in BC care included health education programming as well as emotional and financial support from loved ones and fellow survivors. However, participants described several barriers to clinical care such as the perception that BC is a death sentence, conflict between spiritual/traditional and clinical approaches to care, and fragmentation of care across multiple health facilities and providers.

Conclusions: Based on some of the identified barriers to care, future efforts to enhance cancer care in Ethiopian settings should consider national awareness campaigns for BC to dispel local myths and misconception about BC, formal partnerships between faith-based community leaders and health care providers, and the use of family- and community-centered models of cancer care in biomedical settings.

Implications for cancer survivors: Recognition of psycho-oncological challenges to accessing clinical care for BC and providing opportunities for peer support and positive spirituality to navigate these challenges may improve patients' experiences in the Ethiopian biomedical system and reduce the potential negative experiences of future patients.

Purpose: Breast cancer survivors are at risk for both poor quality of life (QoL) and cardiovascular disease (CVD). This study examines whether incident CVD after breast cancer independently predicts QoL.

Methods: Using data from the Women's Health Initiative, we included women who were diagnosed with invasive breast cancer during follow-up and free of prevalent CVD prior to breast cancer. CVD was defined as adjudicated coronary heart disease, heart failure, or stroke. Physical and mental QoL, measured by the SF-36 Physical and Mental Component Scores (PCS and MCS, respectively), were recorded after breast cancer. Poor PCS and MCS were defined as scores < 40. We used adjusted time-dependent Cox proportional hazards models, accounting for time to CVD.

Results: Among 2912 BC survivors (mean age at BC diagnosis = 67), 1094 (37.6%) and 313 (10.7%) women had a post-breast cancer PCS and MCS score < 40, respectively, at a median of 2.5 years. A higher proportion of women had poor PCS scores post-BC (37.5% vs. 19.2%, P < 0.001) but not MCS (10.4% vs. 8.2%, P = 0.10). After adjustment for key covariates, incident CVD was associated with a 1.95-fold (95% CI 1.42, 2.67) greater risk of poor PCS scores (P < 0.001), but was not associated with poor MCS (HR 1.23, 95% CI 0.57, 2.65, P = 0.59)).

Conclusions: Incident CVD after breast cancer was associated with poor physical QoL but not mental QoL.

Implications for cancer survivors: This study highlights the importance of regular assessments of QoL and need for strategies to improve physical QoL in breast cancer survivors with CVD.

Purpose: Exercise improves functional outcomes in individuals with frailty and individuals with cancer, but it is unknown how exercise impacts function in individuals with both cancer and frailty. This systematic review aimed to determine if adults with cancer who are frail and participate in an exercise program have better functional outcomes compared to those who do not.

Methods: Five databases (OVID Medline, Embase, CINAHL, EMCARE, and Ageline) were searched from inception to March 2024 for RCTs that investigated the impact of exercise on functional outcomes in individuals with cancer who are frail and ≥ 18 years. Title/abstract, full text review, and data extraction were done in duplicate. Cochrane ROB2 was used to assess risk of bias and GRADE for certainty of results.

Results: Eleven RCTs with 1419 participants were included in this review. Meta-analysis did not find a significant difference between intervention and control groups for submaximal walking tests (95% CI 0.24 (- 0.05-0.53), Short Physical Performance Battery (95% CI - 0.50 (- 1.15-0.15)), and grip strength (95% CI 1.83 (- 0.75 to 4.41). However, positive trends emerged for those participating in exercise programs related to submaximal walking test, grip strength, sit to stand, SPPB, and TUG scores.

Conclusion: There are few RCTs investigating exercise in this population, with high heterogeneity of existing interventions. This leads to low certainty in the results of the current study.

Implications for cancer survivorship: Cancer survivors and patients need to be screened for frailty and be engaged in appropriate exercise. Further work should be done investigating appropriate parameters of exercise interventions for this population.

Purpose: With cancer diagnoses increasing worldwide and the number of cancer survivors rising, family physicians are being increasingly relied upon to provide post-cancer treatment care and/or survivorship care. This mixed-method study explores and evaluates barriers and facilitators to optimizing family physician-led survivorship care in the largely rural Interior of British Columbia (BC), Canada.

Methods: A mixed-method approach consisting of quantitative surveys and qualitative interviews was utilized to explore family physician and oncologist perspectives on the current state of survivorship care for breast, lung, prostate, and colorectal cancers within the BC Interior.

Results: Concerns about family physician knowledge in some aspects of survivorship care were identified by both groups, with mixed responses regarding geographical factors, resources, and communication networks. Success was dependent on information from oncologists with more common cancer sites fitting the model better. There was significant concern for individuals with no family physician. Five frequently discussed facilitators were identified: (1) providing accessible survivorship guidelines, (2) standardized discharge summaries (i.e., survivorship care plans), (3) clear points-of-contact at cancer care centers, (4) more educational opportunities, and (5) compatible electronic supports between care providers.

Conclusions: Overall, the model of family physician-led survivorship care was supported by family physicians and oncologists within the BC Interior, although success was dependent on several factors. Identifying the perspectives of physicians directly involved in the survivorship care pathway will be instrumental in developing and implementing solutions that will succeed within the BC Interior and similar regions. Implication to for Cancer Survivors We hope that the improvements to interprofessional cooperation driven by our research may improve the quality and continuity of care received by cancer survivors in British Columbia and beyond.  IMPLICATION TO CANCER SURVIVORS: We hope that the improvements to interprofessional cooperation driven by our research may improve the quality and continuity of care received by cancer survivors in British Columbia and beyond.

Purpose: Breast cancer survivors are more likely to report psychological distress and unmet need for support compared to healthy controls. Psychological mobile health interventions might be used in follow-up care of breast cancer patients to improve their mental health.

Methods: We searched MEDLINE, PsychINFO, Cochrane and PROSPERO for articles on controlled trials examining the effectiveness of psychological mobile health interventions compared to routine care regarding mental health outcomes of adult breast cancer survivors. This review followed the PRISMA statement and was registered on PROSPERO (CRD42022312972). Two researchers independently reviewed publications, extracted data and assessed risk of bias.

Results: After screening 204 abstracts published from 2005 to February 2023, eleven randomised trials involving 2249 patients with a mean age between 43.9 and 56.2 years met the inclusion criteria. All interventions used components of cognitive behavioural therapy. Most studies applied self-guided interventions. Five studies reported percentages of patients never started (range = 3-15%) or discontinued the intervention earlier (range = 3-36%). No long-term effect > 3 months post intervention was reported. Three of seven studies reported a significant short-term intervention effect for distress. Only one study each showed an effect for depression (1/5), anxiety (1/5), fear of recurrence (1/4) and self-efficacy (1/3) compared to a control group.

Conclusions: A wide variance of interventions was used. Future studies should follow guidelines in developing and reporting their mobile interventions and conduct long-term follow-up to achieve reliable and comparable results.

Implications for cancer survivors: No clear effect of psychological mobile health interventions on patients' mental health could be shown.

Registration: PROSPERO ID 312972.