Journal of Cancer Survivorship最新文献

Purpose: This study examined rural and urban parents' reports of their children's receipt of general follow-up care and psychological services, ratings of the acceptability of common sources of follow-up care, and ratings of local/nearby follow-up care access and effectiveness.

Methods: A cross-sectional, quantitative survey was conducted among 238 (139 urban, 46 rural adjacent, and 53 rural non-adjacent) parents of childhood cancer survivors (ages 2-17 and at least 2 years since cancer diagnosis) recruited through the Kentucky Cancer Registry. Bivariate analyses and multivariable logistic regressions adjusting for predisposing, enabling, and need factors tested for differences across residence in urban counties, rural counties adjacent to an urban county, and rural counties non-adjacent to an urban county.

Results: Children in rural adjacent counties had higher adjusted odds of receiving psychological services (OR 4.37; 95% CI 1.45, 13.22) than children in urban counties. Parents of children in non-adjacent counties had lower adjusted odds of agreeing that they could obtain local/nearby follow-up care for their child (OR 0.15; 95% CI 0.06, 0.36) and that local follow-up care was effective (OR 0.22; 95% CI 0.10, 0.48) than parents of children in urban counties.

Conclusions: The study findings provide a comprehensive yet complex picture of similarities and differences in children's follow-up care access according to their rurality of residence. Children residing in rural areas adjacent to an urban area have better access to psychological services than children residing in urban areas. However, parents of children residing in rural areas non-adjacent to an urban area have worse ratings of the accessibility and effectiveness of local follow-up care.

Implications for cancer survivors: Psychological services may need to be expanded for childhood cancer survivors in both rural and urban areas to ensure equitable access. The accessibility and quality of local services may need to be improved to encourage the use of local follow-up care among children residing in rural areas that are non-adjacent to an urban area.

Purpose: Depression is common among patients with cancer and is associated with worse quality of life (QoL). However, less is known about how a history of depression affects QoL in long-term cancer survivors. This study examined whether cancer survivors with a history of depression report poorer QoL compared to those without.

Methods: Data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative, phone-based survey, were analyzed. Adults aged ≥ 18 years with a self-reported history of cancer were stratified by history of depression. Demographics and QoL indicators-including emotional support, social isolation, cognitive concerns, and functional independence-were compared using chi-square tests. Multivariable logistic regression analyses evaluated whether depression was independently associated with QoL outcomes after adjustment for demographic and socioeconomic factors.

Results: Of 72,765 cancer survivors identified, 72,443 (99.6%) responded to the depression history item and were included. Compared with survivors without depression, those with depression were younger, less likely to be married, and more likely to report lower income, obesity, and smoking (all p < 0.001). Survivors with depression reported worse mental (35% vs. 6%) and physical health (34% vs. 15%), lower life satisfaction (15% vs. 3%), reduced emotional support (66% vs. 84%), and greater functional limitations (all p < 0.001). After adjustment for socioeconomic factors, depression remained independently associated with poorer QoL across multiple domains. Depression prevalence was highest among survivors of brain (38%) and gynecologic cancers (36%).

Conclusions: Depression among cancer survivors is independently associated with poorer quality of life across emotional, social, and functional domains, underscoring the importance of depression screening and intervention in survivorship care.

Implications for cancer survivors: Integrating depression screening and psychosocial interventions into survivorship care is critical to improving long-term well-being and daily functioning.

Purpose: Although governing bodies urge the importance of integrating exercise into routine cancer care, facilitators to implementation have not been systematically identified and collated. This review aimed to summarise facilitators to implement exercise services within real-world settings.

Methods: A systematic review of qualitative, quantitative, and mixed-method studies was conducted (three databases, 13th September 2024). Reports were included if they documented the implementation of co-located exercise services (delivered onsite within cancer centres) or referral pathways to external exercise services from cancer centres. The updated Consolidated Framework for Implementation Research (CFIR 2.0) was used to code and synthesise facilitators.

Results: Of 8544 search results, 28 reports (full-text articles) describing 29 implementation efforts (structured initiatives to integrate an exercise service within a cancer hospital or centre) were included. One hundred and sixty-four facilitators were identified across all CFIR 2.0 domains. Facilitators existed within all CFIR 2.0 domains; inner setting (30%), implementation process (27%), innovation (21%), individuals (15%), and outer setting (7%). The most frequent CFIR 2.0 constructs identified were (i) access to knowledge and information, (ii) engaging recipients and deliverers, (iii) individual motivation, (iv) innovation adaptability, (v) reflecting and evaluating on the innovation and implementation.

Conclusions: The implementation of exercise services within cancer settings is influenced by an interconnected network of facilitators, with an organisation's resources and willingness playing a central role. This review provides a generalised blueprint of facilitators and considerations to guide stakeholders in their own exercise oncology contexts.

Implications for cancer survivors: This map of facilitators provides potential opportunities for clinicians, policy makers, and researchers, to advance efforts to embed exercise in routine cancer care, so that all people living with or beyond cancer have the opportunity to benefit from it.

Purpose: Prostate cancer (PCa) is the most common cancer among UK men, with Black men twice as likely to develop it and 2.5 times more likely to die from it than White men. This study identifies the barriers and facilitators to PCa healthcare in UK Black men and suggests ways to improve engagement and experiences across the care pathway.

Methods: We conducted semi-structured interviews with: (i) 12 UK Black men living with and beyond PCa. (ii) 15 UK Black men aged 45 or above. (iii) 15 UK multi-disciplinary healthcare professionals (HCPs). Interview transcripts were coded and analysed thematically, using the socioecological model to map barriers and facilitators.

Results: Barriers include mistrust of Western medicine, experiences of racism, fear and stigma around PCa, inadequate culturally sensitive information, underrepresentation of Black HCPs and Black men in healthcare spaces, limited culturally sensitive psychological support, and masculinity constructs affecting open discussions and preferences for minimally invasive treatments. Facilitators include racially concordant HCPs, culturally sensitive care, continuity of care and support from partners, peers, and local community groups.

Conclusion: Our findings underscore the need for tailored culturally sensitive information, community partnerships, and Black representation in both healthcare spaces and public health campaigns to improve healthcare engagement, foster trust and improve prostate cancer outcomes for Black men.

Implications for cancer survivors: Tailored healthcare for Black prostate cancer survivors is crucial. Providing culturally sensitive information, support from racially concordant HCPs and community support can significantly enhance survivorship experiences, engagement and potentially outcomes for Black men.

Purpose: We examined subjective memory impairment (SMI) in a nationwide sample of pre- and postmenopausal long-term (≥ 5 years after diagnosis) breast cancer survivors (BCSs) compared to similar aged population-based controls and explored risk factors for SMI in BCSs.

Methods: We studied 1,288 BCSs and 15,461 controls aged 40-74 years who completed questionnaires including the Metamemory Questionnaire assessing SMI, divided into short-term (STM)-, and long-term (LTM) memory, and SMI total score. Menopausal status was approximated using age.

Results: Mean age of BCSs was 60 years at survey 8 years after diagnosis, and 58% were premenopausal at diagnosis. STM, LTM and SMI total mean scores were significantly worse among pre- compared to postmenopausal BCSs with Cohen's d < 0.50 Among both pre- and postmenopausal women, the means of all three SMI scores were significantly worse in BCSs compared to controls, with Cohen's d 0.52-0.73 in premenopausal and Cohen's d ≤ 0.20 in postmenopausal BCSs. In univariate analyses, chemo- and endocrine therapy, comorbidity, physical inactivity, BMI, neuroticism, fatigue, pain, and mental distress were statistically significantly associated with worse SMI total score in BCSs. Higher levels of fatigue and depressive symptoms remained significantly associated with SMI in multivariable analyses.

Conclusions: Long-term, premenopausal BCSs have worse SMI scores than both postmenopausal BCSs and similar aged controls. Multiple, potentially modifiable factors were significantly associated with SMI in both groups of BCSs.

Implications for cancer survivors: SMI appears more prominent in premenopausal long-term BCSs compared to controls. Several modifiable factors are associated with SMI in both pre- and postmenopausal BCSs.

Purpose: Colorectal cancer-related stigma (CRC stigma) is understudied in a Nigerian context and likely contributes to delays in diagnosis and treatment. Understanding and addressing the drivers, manifestations, and impacts of CRC stigma can lead to improved survivorship outcomes. This study examined perceptions, attitudes, and behaviors related to CRC stigma in South-Western Nigeria to identify strategies for mitigating its consequences.

Methods: Between September 2022 and April 2023, 20 patients receiving treatment for CRC, 31 caregivers, and 16 healthcare professionals from Osun State, Nigeria, participated in 42 in-depth interviews and four focus group discussions about CRC perceptions and stigma. Qualitative content analysis was used to identify themes related to drivers, manifestations, and impacts of CRC stigma, as well as potential mitigating strategies.

Results: Perceived drivers of CRC stigma included cultural misperceptions about cancer and perceptibility of physical symptoms. Manifestations of CRC stigma were felt to disproportionately impact socioeconomically marginalized patients. Resultant social isolation, shame, mistrust, and delayed health-seeking behaviors, contributed to significant psychosocial burden and worse clinical outcomes. Although CRC stigma remains prevalent, participants noted a shift in community attitudes as CRC outcomes improve. Suggested strategies for mitigating CRC stigma included awareness campaigns, early diagnosis programs, patient and caregiver support programs, and resources for improved symptom management.

Conclusions and implications for cancer survivors: CRC stigma remains common in South-West Nigeria and contributes to worse oncologic outcomes and substantial psychosocial burden among patients with CRC. Interventions promoting early diagnosis and treatment, improved symptom management, and survivor empowerment may lessen the psychosocial impact of CRC stigma and improve long-term outcomes.

Purpose: We examined US survivorship care delivery and health behaviors to determine which aspects of survivorship care delivery enhance preventive health behaviors of survivors who differ by sexual orientation and gender identity.

Methods: We combined 2014-2023 data of the Behavioral Risk Factors Surveillance System from US states and territories that administered the sexual orientation and gender identity module and the treatment-specific cancer survivorship module. Our analytic sample consisted of 37,185 cancer survivors, of whom 1049 reported as sexual and gender minorities (SGM).

Results: We found that SGM survivors had worse post-cancer preventive behaviors when compared to heterosexual cisgender survivors. Further, when analyzing the impact of survivorship care plans (SCPs) and provider type, we determined that only heterosexual cisgender survivors' preventive health behaviors were enhanced and not those of SGM survivors.

Conclusions: Our findings highlight the urgency of developing targeted interventions to enhance care coordination and survivorship programs for SGM survivors of cancer to more effectively support their recovery needs and post-cancer preventive health behaviors with the goals of enhancing their quality of life and overall well-being.

Implications for cancer survivors: In the USA, SGM survivors, compared to heterosexual survivors, are less often cared for by a specialist and engage less frequently in post-cancer preventive health behaviors. For these reasons, targeted interventions are needed to improve cancer and survivorship care coordination and to more effectively address the specific post-cancer preventive health needs of SGM individuals being treated for and surviving cancer.

Purpose: To describe the incidence and patterns of second primary cancer diagnoses and understand the impact on health-related quality of life (HRQOL).

Methods: The Detroit Research on Cancer Survivors (ROCS) cohort was initiated to understand the multiplex causes of poor outcomes in Black cancer survivors. The Detroit Genetic Epidemiology of Multiple primary cancerS (GEMS) study examines susceptibility to multiple primary cancers (MPC), leveraging follow-up of Detroit ROCS survivors to identify those diagnosed with MPCs. We compared HRQOL, using the Functional Assessment of Cancer Therapy-General survey, between survivors diagnosed with MPC and a frequency-matched set of survivors diagnosed with a single primary cancer (SPC) and reported HRQOL among MPC survivors before and after their second cancer diagnosis.

Results: To date, Detroit GEMS includes 371 Black survivors diagnosed with MPC. The cumulative incidence of MPCs among eligible Detroit ROCS participants was 9.8%. The most common second primary cancer diagnosed was breast cancer, followed by colorectal, lung, and hematologic cancers. Survivors with MPC reported similar FACT-G responses to survivors with a SPC with exception of functional well-being scores (p = 0.010). Similar findings were observed in a subset of 104 survivors with functional well-being scores reported before and after their second diagnosis (18.0 and 16.1, respectively; p = 0.004).

Conclusions: Survivors diagnosed with MPC report similar overall HRQOL compared with SPC survivors with no difference in measures of social, emotional and physical well-being among Black cancer survivors, which is encouraging. However, understanding factors that contribute to the decline in functional well-being associated with a second primary cancer diagnosis will be important in the development of early intervention strategies to improve quality of life.

Implications for cancer survivors: Cancer survivors diagnosed with MPC should be mindful of struggles related to their functional well-being and seek support when needed.

Purpose: The expansion of digital health offers a promising avenue to improve care delivery and optimize treatment outcomes. This study evaluated telehealth utilization and its impact on endocrine therapy adherence, clinical outcomes, and healthcare costs.

Methods: This retrospective cohort study used claims data from the Merative MarketScan database. Eligible patients were females under 65 years old who were diagnosed with nonmetastatic breast cancer in 2018 and maintained commercial insurance for one year pre-diagnosis and five years post-endocrine therapy initiation. Telehealth utilization was assessed as a binary (user vs. nonuser) measure. Primary outcomes were endocrine therapy adherence, metastasis incidence, and patient-incurred healthcare costs. Associations between telehealth and outcomes were tested using generalized linear models.

Results: Among 1,141 eligible patients (mean age: 51 years), 874 (77%) used telehealth, totaling 8,350 visits over five years. Telehealth utilization was consistent across age groups and insurance plans but varied significantly by geographic region, urban-rural status, comorbidity burden, and endocrine therapy regimen. Telehealth use was significantly associated with better adherence (adjusted odds ratio = 1.58; 95% CI: 1.31-1.91; p < 0.0001) but not with metastasis rates. Notably, telehealth users incurred 15% higher out-of-pocket medical costs compared to nonusers (p < 0.0001), though prescription costs did not differ significantly.

Conclusions: Findings demonstrate telehealth benefits for long-term adherence to endocrine therapy among commercially insured women under 65 with breast cancer.

Implications for cancer survivors: Telehealth may help breast cancer survivors stay adherent to endocrine therapy, but its financial burden could limit accessibility and equity in oncology care.

Purpose: The purpose of this study is to examine smoking-related work productivity loss among working-age cancer survivors.

Methods: The National Health Interview Survey (NHIS; 2013-2019 and 2022-2023) data were used to identify cancer survivors ages 18-64 years. The sample was stratified by smoking status (currently smoke, formerly smoked, and never smoked). Multivariable generalized linear regressions were conducted to examine the associations of smoking status and work productivity loss measures, including labor force participation, inability to work due to health, and any missed workdays (logistic models), and number of missed workdays (negative binomial models). All analyses controlled for sociodemographic characteristics, survey year, and region, accounting for the complex survey design.

Results: In total, 8203 (weighted n = 7,048,624) cancer survivors were identified, of whom 1793 (weighted n = 1,387,882; 19.7%) currently smoke, 2189 (weighted n = 1,889,235; 26.5%) formerly smoked, and 4221 (weighted n = 3,771,507; 53.5%) never smoked. In adjusted analyses, the labor force participation rate was similar by smoking status. Survivors who currently smoke were more likely to report an inability to work due to health reasons than those who never smoked (23.9% vs. 18.0%, p < 0.001). Among working cancer survivors (n = 5320), those who currently smoke were more likely to report any missed workdays than those who never smoked (59.7% vs. 53.8%, p = 0.016) and experienced a higher number of missed workdays than those who formerly smoked (13.1 vs. 9.9 days, p = 0.043).

Conclusions: About one-fifth of working-age cancer survivors report currently smoking, and smoking status is associated with health-related work productivity loss.

Implications for cancer survivors: Smoking cessation efforts can improve health and reduce productivity loss among working-age cancer survivors.