Journal of Cancer Survivorship最新文献

Background: As more children with cancer experience improved treatment outcomes across the world, challenges arise with ongoing care needs due to a higher risk of mortality and chronic health conditions compared to the general population. Addressing global pediatric cancer survivorship care, especially in low- and middle-income countries (LMICs), is of growing importance. The current study used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) to examine the barriers, facilitators, and strategies for implementing childhood cancer survivorship care in LMICs.

Methods: Using a larger review (PROSPERO registration CRD42021242548), a total of 8,456 articles were considered. The search identified nine eligible articles mentioning determinants of survivorship care across LMICs. Data were extracted from these articles using the CFIR domains of outer setting, inner setting, and individuals. Assigned CFIR constructs were then paired with ERIC strategies using the CFIR-ERIC matching tool.

Results: The nine studies were published between 2003 and 2020, representing the following countries: India, Brazil, Turkey, China, and Thailand. Inner setting barriers included lack of available resources-funding, space, materials, and guidelines. Outer setting barriers were related to financing, policies, and laws. Individual patient barriers reported were low health literacy, distance to care centers, and low prioritization of follow-up. No common facilitators were noted. The most feasible ERIC strategies for the barriers identified were accessing new funding, developing and distributing educational materials, developing resource-sharing agreements, and conducting local survivorship care needs assessments.

Conclusions: There are limited existing data evaluating childhood cancer survivorship care barriers in LMICs. Of the studies we identified, low resource availability was a frequently reported barrier. As accessing funding can be difficult, resource sharing of contextually adapted guidelines and educational materials can serve as an implementation strategy to improve survivorship care globally.

Implications for cancer survivors: Enhancement of research efforts in resource-limited settings will address key knowledge gaps critical for implementation of global survivorship care and equity throughout the cancer journey.

Purpose: Identifying patients with similar health-related quality of life (HRQoL) recovery patterns can guide more effective disease management. This study aimed to identify cross-sectional and longitudinal HRQoL profiles in esophageal cancer patients, and to examine associations with demographic and clinical characteristics.

Methods: Longitudinal data from the Prospective Observational Cohort Study of Esophageal-gastric cancer Patients (POCOP) were analyzed. Patients treated with chemoradiation (CRT), with/without surgery, were followed for 12 months post-treatment. HRQoL was measured pre-treatment, at 6- and 12-months using validated questionnaires (i.e., EORTC QLQ-C30, QLQ-OG25, and HADS). Latent Profile and Latent Transition analyses were used to identify cross-sectional and longitudinal profiles, respectively. Regression analyses explored their associations with demographic and clinical characteristics.

Results: Of the 605 patients (mean age: 66.6 (SD: 8.0) years), most were male (82%) and had undergone surgery (73%). At each time point, two cross-sectional HRQoL profiles were identified: one with relatively high HRQoL (78-84%) and low HRQoL (16-22%). Both profiles showed significant impairments compared to population norms. Longitudinal analyses revealed five distinct HRQoL profiles: stable-high (65%), stable-low (5%), improving (10%), deteriorating (14%), and fluctuating (6%). Poorer HRQoL was associated with female sex and lower body mass index. Fluctuating HRQoL with surgery.

Conclusions: In our cohort, most esophageal cancer patients experienced relatively high or improving HRQoL, but some faced deteriorating or persistent impairments. Patients' sex, BMI, and surgery status may help identify those needing extra support.

Implications for cancer survivors: Recognizing different HRQoL profiles can help manage recovery expectations, and guide more personalized and timely care after treatment.

Objectives: The long-term memory aging of middle-aged and older cancer survivors is not fully understood and is largely limited to the United States (US) context. We compared long-term memory trajectories before and after an incident cancer diagnosis with the memory trajectories of similarly aged cancer-free adults in the US and England.

Methods: Incident cancer diagnosis and memory (immediate and delayed recall) were assessed during biennial interviews in the US Health and Retirement Study (HRS; n = 13,037) and the English Longitudinal Study of Ageing (ELSA; n = 8,579) from 2002 to 2018. Within country, multivariable adjusted linear mixed-effects models estimated the standardized memory trajectories in participants with and without cancer.

Results: Prior to diagnosis, cancer survivors had a memory advantage compared to cancer-free individuals, within each country (difference for cancer survivors in the US: 0.10 SD units [95% CI: 0.05, 0.14] and in England: 0.14 SD units [95% CI: 0.07, 0.20]). Cancer survivors in the US experienced an acute decline in memory function immediately following diagnosis (-0.08 SD units; 95% CI: -0.11, -0.04), which was not experienced by cancer survivors in England (0.01 SD units; 95% CI: -0.04, 0.07). Long-term post-diagnosis memory trajectories were similar for cancer survivors and cancer-free participants alike in both countries.

Conclusion: The acute decline in memory function associated with a new cancer diagnosis among cancer survivors in the US, but not England, warrants future studies to investigate explanations for this cross-national difference, such as differences in healthcare systems and treatment.

Implications for cancer survivors: Results can generate hypotheses to identify contextual risk factors to improve cognitive aging of cancer survivors.

Purpose: This scoping literature review explored disability-related experiences among adolescent and young adult (AYA) cancer survivors [ages 15-39], including their knowledge of the Americans with Disabilities Act (ADA) and awareness of associated rights.

Methods: Seven databases (PubMed, Academic Search Complete, MEDLINE, ERIC, SocINDEX with Full Text, Health Source: Nursing/Academic Edition, and APA PsychINFO) were searched for U.S. based literature (2010-2025) using relevant MeSH terms and boolean operators (e.g., "cancer surviv*" AND ("disab*" OR "impair*") AND ("young" OR "adolescent" OR "AYA"). Included studies focused on employment-related discrimination, cancer-related disclosure, psychosocial outcomes, and survivors' unmet disability-related needs. A narrative synthesis summarized key themes, with quantitative results tabulated and qualitative findings categorized.

Results: A total of 715 articles were screened, with 21 studies included for analysis. These studies highlight key gaps in legal awareness and support for adolescent and young adult (AYA) cancer survivors. Three main themes were identified: (1) employment, education, and workplace barriers, (2) legal, policy, and system-level barriers, and (3) psychosocial and identity-related challenges.

Conclusion: AYA cancer survivors encounter barriers in daily life and navigate changes to their social identity that could be described as disability based on existing legal and social definitions. Despite growing research capturing the experiences of AYA survivors, there remains limited research addressing survivorship in relation to disability.

Implications for cancer survivors: Current survivorship literature lacks discussion of disability experiences of survivors and relevant disability support. Addressing this gap could better document the lived experiences of AYA survivors and design supportive services informed by disability law and policy.

Objective: This study aimed to assess the association between the number of adverse childhood experiences (ACEs) and the history of depression among cancer survivors by race.

Methods: This study was a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System among 22,292 cancer survivors. The number of ACE experienced (zero, one, two-three, ≥ four) included questions assessing exposure to physical, emotional, and sexual household member substance misuse, incarceration, mental illness, parental divorce, or witnessing intimate partner violence before age 18 years. The outcome is self-reported history of depression (yes/no). Three weighted multivariable logistic regression models were used to examine the association between ACE and depression for each race group: non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanics.

Results: In this sample of cancer survivors, 41%, 22%, 21%, and 16% reported having experienced zero, one, two-three, and ≥ 4 ACEs, respectively. In the adjusted models, among NHW survivors, those who experienced ≥ 4 ACEs (aOR 4.20; 95% CI 3.32-5.32) had higher odds of depression diagnosis compared with those with zero ACEs. Among NHB survivors, those who experienced ≥ 4 ACEs had higher odds of depression diagnosis (aOR 2.98; 95% CI 1.45-6.14) compared with those with zero ACEs. Similarly, among Hispanic survivors, those who experienced ≥ 4 ACEs had higher odds of depression diagnosis (aOR 10.74; 95% CI 5.01-23.00) compared with those with zero ACEs.

Conclusion: Individuals with ACEs may constitute a key group for targeted prevention efforts to mitigate the risk of depression in cancer survivors.

Implications for cancer survivors: Development of personalized and targeted screening methods for patients diagnosed with cancer who have experienced adverse childhood experiences and depression is critical to improving their long-term well-being.

Purpose: This study compared characteristics of cancer survivors who became unemployed after diagnosis with those who remained employed and evaluated the association between employment status and the impact on daily life.

Methods: A cross-sectional online survey was conducted among adult cancer survivors employed at diagnosis. Participants were categorized based on employment status post-diagnosis. Univariate and multivariate binomial generalized linear models and multinomial logistic regression analyses were applied.

Results: Among 2576 cancer survivors (mean age: 53.4 years, 77% female, 62% 0-5 years post-diagnosis), 1704 (66%) remained employed, while 872 (34%) became unemployed. Becoming unemployed was associated with older age [OR; 95% CI, 1.02; 1.01-1.03], low [OR; 95% CI, 2.43; 1.05-3.45] or intermediate education [OR; 95% CI, 1.60; 1.33-1.93], and indicating (probably) not getting better [OR; 95% CI, 3.94; 3.05-5.07] or having chronic cancer [OR; 95% CI, 1.68; 1.25-2.25]. Prostate cancer survivors and those diagnosed ≤5 years prior were less likely to become unemployed than those with other types of cancer or those diagnosed longer ago. Becoming unemployed was associated with a negative influence on psychological [OR; 95% CI, 2.22; 1.80-2.74] and physical well-being [OR; 95% CI, 1.96; 1.61-2.38]. Those who became unemployed were more likely than those who remained employed to perceive that financial consequences negatively influenced multiple aspects of daily life, including family and social relationships, participation in sports, hobbies, and leisure activities, for themselves as well as for their partners and children.

Conclusion: Unemployment was disproportionately prevalent among older, less-educated individuals and individuals with advanced cancer and was associated with declines in personal and family well-being due to experienced financial consequences.

Implications for cancer survivors: Identifying cancer survivors vulnerable to unemployment can guide timely, targeted support to help them maintain employment if desired. The observed link between unemployment and daily life emphasizes the importance of addressing employment issues within survivorship care.

Purpose: Breast cancer is one of the most common malignancies affecting women worldwide. Despite advances in early detection and treatment improving long-term survival rates, the sexual health needs of breast cancer survivors (BCS) remain overlooked due to the predominant focus on biomedical outcomes. In Portugal, as in many other countries, these needs are frequently neglected, despite evidence showing their significant impact on the quality of life. This study aims to explore the unmet sexual health needs of BCS in Portugal, identify barriers to addressing these issues in oncological settings, and outline key requirements for developing effective interventions to improve their quality of life.

Methods: A mixed-methods design was used, combining quantitative data from 336 BCS, assessed using the Female Sexual Function Index (FSFI) and EORTC QLQ-C30/BR23 questionnaires, with qualitative data from semi-structured interviews with 11 survivors. Interviews explored unmet sexual health needs and satisfaction with oncology support services. Data were analyzed descriptively and thematically.

Results: Quantitative findings showed low sexual functioning, particularly in desire and arousal, and high levels of sexual pain. Emotional functioning scored lowest in quality-of-life assessments, with fatigue, insomnia, and pain as prevalent symptoms. Qualitative results highlighted unmet needs, including a lack of sexuality-related information, body image concerns, limited psychosexual support, and insufficient partner involvement.

Conclusions: Participants reported poor sexual functioning and quality of life, with critical sexual health needs unaddressed in care.

Implications for cancer survivors: Integrating tailored sexual health support-including psychoeducational and therapeutic interventions-into oncology services may enhance survivors' emotional well-being, relational intimacy, and overall quality of life.

Purpose: To map advanced and metastatic cancer survivorship research in Australia and characterize studies according to the priority research themes outlined by the US National Cancer Institute (NCI).

Methods: Systematic scoping review. MEDLINE, PsycINFO, Embase and CINAHL were searched from inception to December 2024 for cancer survivorship studies conducted in Australia, with studies reporting data for people with advanced or metastatic cancer classified using NCI's priority research themes.

Results: We identified 483 studies, of which 72 (14.9%) recruited and reported data for participants with advanced or metastatic cancer, focusing on: psychosocial research (51.4%); healthcare delivery (16.7%); health behaviors (12.5%); symptom management (11.1%); and epidemiology and surveillance (8.3%). Most were conducted within individual Australian states (72.2%) and involved multiple cancer types (41.7%). Study designs included qualitative (44.4%), cross-sectional (34.7%), cohort (16.7%), case-control (1.4%), case report (1.4%) and mixed methods (1.4%). Forty-two tumor-specific studies were identified including breast (33.3%), hematological (21.4%); prostate (11.9%); bowel/colorectal (11.9%), gynecological (9.5%), melanoma (7.1%), head and neck (2.4%), and lung (2.4%) cancers. Nearly a quarter of studies recruited participants via cancer registries (22.2%).

Conclusions: Few cancer survivorship studies included people with advanced or metastatic cancer in Australia. We offer six recommendations to support funders, clinicians, policymakers, and researchers to improve representation of advanced or metastatic cancer survivors in survivorship research programs. Similar efforts in other countries are needed.

Implications for cancer survivors: Increasing numbers of people are living long-term with advanced or metastatic cancer. The purposeful inclusion of these people in cancer survivorship research and care programs will improve health outcomes.

Purpose: As survival improves for allogeneic hematopoietic cell transplant (alloHCT) recipients, discussions about health-related quality of life (HRQoL) become increasingly important. Previous research has suggested best practices for sharing HRQoL data graphically, but not in the alloHCT setting. This study aimed to evaluate comprehension of graphical displays of HRQoL among stakeholders in alloHCT and to make recommendations for displaying clinically concerning HRQoL.

Methods: An online survey assessed comprehension of HRQoL graphs among alloHCT recipients, their caregivers, and care team members. Participants were randomized to see 8 of 32 unique graphs, which varied in how clinically concerning scores were indicated (primary comparison), HRQoL domain, and score pattern. Four comprehension questions followed each graph. Open-ended questions queried for graph design preferences. Qualitative interviews with care team members assessed priorities for using HRQoL graphs in clinical settings.

Results: 190 patients, 38 caregivers, and 18 care team members completed surveys. Median comprehension score was 31/32 across all groups, with wider ranges among patients (5-32) and caregivers (6-32) than care team members (22-32). Threshold line graphs were more likely to be interpreted correctly by adult patients than red circle graphs (OR, 6.07; 95% CI 2.34, 15.8. 78% of participants preferred the threshold design. Qualitative interviews with seven care team members revealed four implementation-related themes: a need for clear guidance, improved communication, integration with existing systems, and impact to patients.

Conclusions: Comprehension of HRQoL graphs was high among all alloHCT stakeholder groups, providing confidence for their use in clinical settings.

Implications for cancer survivors: The findings of this study suggest that HRQoL graphs are comprehensible among key alloHCT stakeholder groups, regardless of health literacy level. Results also show that threshold lines are a preferred and universally understood method for distinguishing clinically concerning HRQoL and that care team members are motivated to use HRQoL graphs with patients.