Journal of Cancer Survivorship最新文献

Purpose: The study aims to investigate the relationship among social support, health behavior self-efficacy, anxiety, and the physical activity (PA) levels of lung cancer survivors, and to analyze whether health behavior self-efficacy and anxiety mediate the relationship between social support and PA levels.

Methods: In a cross-sectional study of 1128 lung cancer survivors from 16 Chinese hospitals, we collected demographic data and administered the Social Support Rating Scale (SSRS), Self-Rated Abilities for Health Practices Scale (SRAHP), Anxiety Scale (AS), and International Physical Activity Questionnaire (IPAQ). SPSS 25.0 was used for descriptive analyses, while the structural equation model in SPSS AMOS 24.0 was used to identify the direct, indirect, and total effects among variables.

Results: There were significant correlations among SSRS, SRAHP, AS, and PA (P < 0.01). Model outcomes revealed a positive association between social support and health behavior self-efficacy (β = 0.732, P < 0.001). Health behavior self-efficacy positively correlated with PA levels (β = 0.228, P < 0.001) and negatively with anxiety (β=-0.252, P = 0.001). Moreover, health behavior self-efficacy was found to partially mediate the relationship between social support and PA (β = 0.174, P < 0.001).

Conclusions and implications for cancer survivors: This study revealed a positive correlation between social support and health behavior self-efficacy, and between health behavior self-efficacy and PA levels among lung cancer survivors. Additionally, health behavior self-efficacy mediated the relationship between social support and PA levels. In future clinical practice, medical and nursing staff should assess social support and health behavior self-efficacy in lung cancer survivors to inform personalized PA interventions.

Purpose: Numerous randomized controlled trials (RCTs) have shown beneficial exercise effects on fatigue, anxiety and depression and health-related quality of life (HRQoL) in breast cancer (BC) patients during and shortly after treatment. Here, we investigated the long-term effects of exercise during chemotherapy for BC on these outcomes.

Methods: We invited participants of two highly comparable RCTs that investigated the effects of exercise (EX) (versus usual care (UC)) during chemotherapy in patients with non-metastatic BC (N = 357) to participate in an 8-year follow-up. In both trials, fatigue, anxiety and depression and HRQoL were assessed using the same questionnaires, at multiple timepoints. Linear mixed-effect models were used to compare study arms over time.

Results: In total, 156 participants (EX = 82; UC = 74) completed the follow-up questionnaires. EX reported comparable general (between-group difference 0.73, 95% confidence interval (- 0.35; 1.80), ES = 0.18) and physical fatigue (0.55 (- 0.55; 1.65), ES = 0.13), small but statistically significantly higher levels of anxiety (1.24 (0.47 to 2.00), ES = 0.39) and depression (1.10 (0.34; 1.85), ES = 0.38), significantly lower global HRQoL (- 5.99 (- 10.65; - 1.32), ES = 0.34) and comparable summary HRQoL (- 1.90 (- 4.70; 0.89), ES = 0.16) compared to UC.

Conclusion: No long-term beneficial effects of exercise during chemotherapy on BC patients' fatigue, anxiety, depression or HRQoL were observed. The less favourable outcomes for mood and HRQoL that were observed 8 years after participation in an exercise intervention may be explained by selective loss-to-follow-up.

Implications for cancer survivors: The results highlight the need to incorporate strategies that promote physical activity maintenance after participation in an exercise programme to also counteract long-term detrimental side effects of cancer treatment.

Purpose: Childhood cancer survivors carry a high burden of late-occurring treatment-related morbidity. Long-term risk-based anticipatory surveillance allows for early detection and management of complications. We sought to examine demographic, clinical, and social characteristics associated with survivorship clinic attendance at the Taking on Life after Cancer (TLC) Clinic at the Children's Hospital of Alabama.

Methods: The cohort included 1122 TLC-eligible patients diagnosed with cancer between 2000 and 2016. The outcome of interest was ≥1 TLC visit. Univariable logistic regression modeling assessed cancer type, treatment era, age, sex, race/ethnicity, payer type, rural/urban residency, and distance from clinic. Significant variables (P<0.1) were retained in multivariable modeling.

Results: The median age at diagnosis was 7 years old (0-19); 47% were female, 69% non-Hispanic White, 25% African American; 45% leukemia or lymphoma, 53% solid or CNS tumor, 3% other. We found that among 1122 survivors eligible to attend a survivorship clinic in the Deep South, only 52% attended. Odds of attendance were lower among survivors diagnosed at an older age, those with cancers other than leukemia/lymphoma, those lacking private insurance, and those living farther from the clinic. Race/ethnicity and rurality were not associated with clinic attendance.

Conclusion: Just over half of eligible survivors attended survivorship clinic. Factors associated with non-attendance can be used to guide development of intervention strategies to ensure that childhood cancer survivors receive optimal long-term follow-up care.

Implications for cancer survivors: Measures of healthcare access (insurance status and distance to care) were identified as potential intervention targets to improve uptake of survivorship care.

Purpose: The complexity of metastatic breast cancer, its rapidly evolving treatment, and the changing trajectory toward long-term survivorship create unique challenges for the provision of supportive care. The experiences of health professionals enacting supportive care in contexts of those living long-term with incurable cancer have received limited research attention. This qualitative study aimed to gain further insight into health professionals' experiences of supportive care in this context.

Method: Semi-structured interviews were conducted via phone and online with 25 health and community-care professionals who support people living with metastatic breast cancer in Australia. A mix of sampling strategies was used. Thematic analysis was undertaken. Findings were interpreted through an ethics of care lens.

Results: Three key themes were identified. First, participants experienced supportive care as highly relational. Second, they encountered numerous moral and ethical dilemmas in enacting supportive care. Finally, enacting supportive care was complicated by fragmented and sporadic provision in a system in which supportive care is differentially valued across professions and settings.

Conclusion: Findings draw attention to complexities in enacting supportive care in the context of metastatic breast cancer, with implications to patients and professionals. To improve the quality of care provided to patients and minimise the risk of professional burnout, greater attention is needed in supportive care guidelines to the ethical, moral, and emotional complexities experienced by professionals in this context.

Implications for cancer survivors: People living with metastatic breast cancer are a growing proportion of cancer survivors. The knowledge gained through this study may help professionals to better meet the supportive care needs of people living with metastatic breast cancer, a treatable but not curable condition.

Purpose: This paper estimated overall, by sex, and by race and ethnicity walking behaviors in the cancer survivor population, where prevalence is not known, compared to those without cancer.

Methods: Data from the 2015 and 2020 National Health Interview Survey (n = 54,542) were used to estimate walking behaviors. Multivariable logistic regression models estimated walking behavior prevalence with predictive margins and volume of weekly minutes overall and stratified by sex and race/ethnicity. Walking behaviors for breast and prostate cancer survivors were also examined.

Results: There were no significant differences in adjusted prevalence for walking behaviors overall or by race/ethnicity for women. However, there were significant differences for men, with cancer survivors' any reported walking at 62.6% (95% CI: 60.1, 65.4) compared to men without cancer, 65.9% (95% CI: 65.1%, 66.8%) (p = 0.02). There was also a difference in transportation only walking for men, with cancer survivors reporting 6.8% (95% CI: 5.5%, 8.2%), compared to men without cancer, 9.1% (8.5%, 9.6%) (p = 0.008); a similar pattern was observed for transportation walking for non-Hispanic white men. There were no differences in walking prevalence among breast cancer survivors, but overall prostate cancer survivors reported less walking for both purposes as did non-Hispanic white survivors. Leisure walking volume for cancer survivors, both women and men, was higher than for those without cancer. Median leisure walking minutes for non-Hispanic white women, 120 min (95% CI: 120, 140) was higher than those without cancer, 105 min (95% CI: 105, 120) (p = 0.002). Median leisure walking minutes for non-Hispanic white men, 120 min (95% CI: 120, 140), was higher than those without cancer, 100 min (95% CI: 100, 105) (p = 0.001).

Conclusions: Overall, there are no significant differences in walking prevalence for women, but men cancer survivors reported less overall walking, walking for transportation, or walking for both purposes. However, volume of leisure walking was higher for cancer survivors compared to those without cancer.

Implications for cancer survivors: For cancer survivors, this suggests that even though prevalence of leisure walking was similar, volume of weekly minutes was higher compared to those without cancer. This suggests that for cancer survivors, leisure walking is an accessible and important source of physical activity.

Purpose: This study addresses the critical issue of survivorship care for Black prostate cancer survivors. The aim was to explore their awareness of survivorship care plans to improve prostate cancer care and survivorship within this high-risk group.

Methods: Utilizing a thematic analysis approach, we conducted in-depth interviews focused on analyzing post-treatment experiences of Black prostate cancer survivors by applying interpretive explanations to data collected from participants.

Results: Participants reported a significant gap in survivorship care plan communication post-treatment, as these plans were seldom discussed. Survivors highlighted the adoption of post-treatment strategies and self-education as means to enhance their comprehension of the survivorship process. Black survivors demonstrated an intrinsic motivation, after feeling "discarded," to find suitable resources to enhance their survivorship care for a better quality of life.

Conclusion: The prioritization of post-treatment care for Black prostate cancer survivors is important. By offering comprehensive post-treatment education, improving symptom transparency, and establishing safe spaces for open discussion, the quality of life of Black survivors may be substantially improved.

Implications for cancer survivors: There is a pressing need for dynamic post-treatment care coordination tailored to Black prostate cancer survivors. A lack of crucial post-treatment education for this population that experiences disproportionate burden of prostate cancer may exacerbate cancer health disparities. Addressing this care coordination gap may improve support systems, survivor well-being, and better cancer outcomes.

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.