Journal of Cancer Survivorship最新文献

Purpose: This study aimed to evaluate the effects of pelvic floor rehabilitation on the prevention and treatment of bowel symptoms in patients with rectal cancer.

Methods: PubMed, Embase, Web of Science, The Cochrane Library, CINAHL Plus with Full Text, and ProQuest were searched from inception to August 31, 2025. Eligible randomized controlled trials (RCTs) investigating pelvic floor rehabilitation for the prevention or treatment of bowel symptoms were included. Risk of bias was evaluated using the Cochrane Risk of Bias tool version 2, and the certainty of evidence was assessed with the GRADE approach. Statistical analyses were performed using RevMan 5.4.

Results: A total of 12 RCTs were included. For prevention, pelvic floor rehabilitation was associated with significantly lower Wexner incontinence scores at 1 month (MD - 2.78, 95% CI - 4.57 to - 0.98) and 6 months after surgery (MD - 3.26, 95% CI - 5.64 to - 0.89). However, no significant differences were observed at 3 or 12 months. Low anterior resection syndrome (LARS) scores likewise showed no significant difference at 3 months postoperatively. For treatment, pelvic floor rehabilitation significantly reduced Wexner incontinence scores (MD - 1.77, 95% CI - 2.40 to - 1.14) as well as LARS scores (MD - 4.07, 95% CI - 6.85 to - 1.29). According to the GRADE assessment, the certainty of evidence for both prevention and treatment ranged from low to very low.

Conclusions: Pelvic floor rehabilitation appears to be beneficial for the prevention and treatment of postoperative bowel symptoms. However, the certainty of the evidence remains low, and further high-quality RCTs are required.

Implications for cancer survivors: Pelvic floor rehabilitation appears to offer benefits in the prevention and treatment of postoperative bowel symptoms in patients with rectal cancer. However, the findings should be interpreted with caution due to potential bias, and further well-designed RCTs are required.

Trial registration: This review was registered with PROSPERO (Number: CRD420251117927)).

Background: High and persistent costs of cancer care often burden survivors, leading to medical financial hardship and, in turn, unmet health‑related social needs (HRSNs) that may hinder treatment adherence and quality-of-life. Gastrointestinal (GI) cancers, often linked with high symptom burden and intensive therapies, may disproportionately aggravate such hardships. We sought to assess medical financial hardship, HRSNs and the interplay of these factors among cancer survivors compared with the general US population.

Methods: The National Health Interview Survey (2013-2018) was used to identify adults (≥ 18 years) categorized as GI cancer survivors, non‑GI cancer survivors, and cancer‑free controls. Medical financial hardship was defined as difficulty paying medical bills, cost-related worry, or delayed/forgone care. HRSNs included food insecurity, housing insecurity and transportation barriers. Survey‑weighted logistic regression was utilized to estimate adjusted prevalences and odds ratios (ORs).

Results: Among 190,113 adults, 1,722 (0.9%) were GI and 12,264 (6.5%) were non‑GI cancer survivors. Cancer survivors were more likely to have household income ≤ 138% of the poverty guideline (GI: 21.1%; non-GI: 16.7%; controls: 19.9%) and less likely to be uninsured (GI: 4.5%; non-GI: 5.6%; controls: 13.6%) than the general population (both p < 0.001). Among cancer survivors with medical financial hardship, the adjusted prevalence of food insecurity (18.7% vs. 15.6%), housing insecurity (36.7% vs. 33.5%), any HRSN (43.7% vs. 39.5%) and multiple HRSNs (13.6% vs. 11.9%) were higher among GI versus non-GI cancer survivors (all p < 0.001). GI cancer survivors with financial hardship were more likely to experience food (21.0% vs. 4.8%), housing (35.6% vs. 11.7%) and transportation insecurity (5.0% vs. 1.9%) (all p < 0.05). GI cancer survivors had higher odds of food (aOR 1.69, 95%CI 1.31-2.20) and housing insecurity (aOR 1.35, 95% CI 1.10-1.66), as well as multiple HRSNs (aOR 1.80, 95%CI 1.36-2.39) compared with the general population; this effect was mitigated among non-GI cancer survivors (food insecurity: aOR 1.22; any HRSN: aOR 1.09; multiple HRSNs: aOR 1.36; housing insecurity: p = 0.181).

Conclusion: Cancer survivors, particularly individuals with GI cancer, faced greater financial hardship and were more likely to be burdened by HRSNs. Routine screening and targeted interventions are warranted for all cancer survivors, with even greater focus on financially burdened GI cancer survivors.

Implications for cancer survivor: Routine screening and targeted interventions are warranted for all cancer survivors, with even greater focus on financially burdened GI cancer survivors.

Purpose: Breast cancer incidence in women under 50 (early-onset) is steadily increasing. Primary care clinicians can play a role in managing late and long-term treatment effects for these women, who face decades of survivorship and are coping with a life-stage discordant illness. This study describes early-onset breast cancer survivors' experiences with primary care.

Methods: Semi-structured interviews were conducted with early-onset breast cancer survivors (N = 16). Iterative, inductive thematic analysis was used to identify patterns in experiences with primary care.

Results: Participants were on average 58.4 years old and 17 years post-diagnosis (M_age at dx = 41.4). Relationships with current primary care clinicians were generally short (mean = 5.8 years; median = 1.5 years). Many survivors lacked continuity, being either disconnected from oncology (N = 6) or seeing an oncology specialist not on their initial treating team (N = 7). Despite high rates of late/long-term treatment effects, including cardiovascular issues (N = 10), premature menopause (N = 10), and pain (N = 7), participants rarely turned to primary care clinicians for support. This fragmentation was often normalized by survivors, who felt they had to self-advocate for their own long-term health management.

Conclusions: Early-onset breast cancer survivors navigate survivorship in a fragmented healthcare system and bear the burden of coordinating their own care. Dynamic information support tools are needed to empower survivors to communicate their cancer history and connect symptoms to cancer-related issues in primary care settings.

Implications for cancer survivors: As clinical continuity is limited over decades of survivorship, early-onset cancer survivors need resources that bridge the gap between their cancer history and current primary care management.

Trial registration: Registered with ClinicalTrials.gov on June 2, 2022: NCT05400941, https://clinicaltrials.gov/study/NCT05400941.

Over half of patients with colorectal cancer (CRC) develop distant metastases and are often treated with multiple lines of systemic treatments, which can lead to severe toxicities. At least 40% of patients experience toxicity-induced treatment modifications in the first 3 months, which may impact anti-tumor effects. Exercise has the potential to limit toxicity and thereby prevent treatment modifications. This review discusses the role of physical exercise in limiting treatment toxicity in patients with metastatic CRC (mCRC). First an overview of the common toxicities of systemic treatment is presented. Second, the results from 15 observational studies examining associations of physical activity, fitness, and function with (toxicity-induced) treatment modification and survival outcomes are discussed, followed by the results from 8 exercise intervention studies in patients with mCRC. Finally, potential mechanisms of action by which exercise may impact toxicity of systemic treatments are described. Results highlight the potential benefits of exercise during systemic treatment. Although the number of studies is limited, observational studies found positive associations between physical activity, fitness, and function, and survival. Additionally, intervention studies revealed that exercise during systemic treatment is feasible and beneficial for patient-reported outcomes and physical fitness. Proposed mechanistic pathways by which exercise can limit toxicities including neurotoxicity, hematological toxicity, gastrointestinal toxicity, and fatigue are discussed. The potential of exercise on dermatological and immune-related toxicity of targeted and immunotherapy has yet to be investigated. Findings of this review emphasize the clear potential of exercise as an integral part of mCRC treatment, which should be confirmed in future trials. IMPLICATIONS FOR CANCER SURVIVORS: Incorporating physical exercise during systemic treatment for metastatic colorectal cancer has the potential to help reduce or even prevent toxicity-induced treatment modifications, which could benefit survival outcomes.

Purpose: Sexual health concerns are highly prevalent and distressing among adolescent and young adult (AYA) breast cancer survivors, yet are rarely addressed in routine oncology care. Lack of provider training remains a key barrier to effective communication and support. The purpose of the study was to determine whether a brief educational workshop for oncology staff improves sexual health screening rates among AYA breast cancer survivors, and evaluate the workshop's acceptability, feasibility, and impact on provider confidence.

Methods: We conducted a pilot multi-component study combining a mixed observational cohort and non-randomized interventional study. On May 20, 2024, eight breast cancer care team members-four advanced practice providers (APPs) and four registered nurse care coordinators (RNCCs)-participated in a "30-s message" communication workshop adapted from the All of Me program created by After Cancer. Medical charts of all eligible AYA breast cancer survivors aged 18-40 diagnosed within the previous 24 months were reviewed to assess changes in sexual health screening documentation before and six months post-intervention. Provider confidence, perceived importance of sexual health, and perceptions of feasibility and acceptability were evaluated via pre-, post-, and 6-month follow-up surveys.

Results: Twenty-two AYA breast cancer survivors were eligible for chart extraction. Prior to the intervention, 45% of patients had documented sexual health screening, with APPs responsible for nearly all documented cases. Screening rates did not increase following the workshop. Of the 12 patients not screened, 4 transferred care (33%), 5 saw an oncologist (41%), 1 saw an APP (8%), and 2 had other competing health issues occurring at the time of follow up that took priority of the visit (17%). All eight participating providers (4 APPs, 4 RNs) completed the training; 88% completed the immediate post-survey and 75% completed the six-month follow-up survey. Providers reported high acceptability and feasibility. Confidence in addressing physical symptoms was higher than managing emotional concerns (e.g., low desire).

Conclusions: Screening rates did not increase following the workshop, likely reflecting high baseline APP screening and limited follow-up opportunities. Future efforts should integrate role-specific education with system-level supports to broaden and sustain screening practices.

Implications for cancer survivors: Cancer survivors are often cared for by a multidisciplinary team. This study suggests that training only advanced practice providers and nurses may not be enough to improve sexual health screening. Broader education across all care team members, combined with system-wide tools and prompts, may be needed to ensure consistent and equitable survivorship care.

Purpose: To determine if the level of educational attainment mediates the relationship between a history of cancer experienced as an adolescent and young adult (AYA) and subsequent employment status.

Methods: We identified AYAs with a history of cancer diagnosis between the ages of 15 and 22 using the Canadian Community Health Survey (years 2000 to 2017) linked to the Canadian Cancer Registry. Marginal structural mediation models were used to decompose the total effect of cancer on employment into the natural direct effect and the natural indirect effect through education completed. Employment status was categorized as full-time (reference category), part-time, or not employed and analyzed using a multinomial logistic marginal structural model.

Results: We identified 202,960 individuals, of whom 270 were diagnosed with cancer as an AYA. The average elapsed time from diagnosis to survey completion was 8.7 (SD, 5.1) years. Compared to cancer-free peers, survivors had 1.62 (95% CI, 1.22, 2.10) times the odds of non-employment compared to full-time employment. Educational attainment mediated 14.0% (95% CI, -2.1%, 30.8%) of this total effect. No evidence of a significant effect of cancer on part-time employment was observed.

Conclusions: Being diagnosed with cancer between the ages of 15 and 22 contributes to subsequent non-employment. Findings highlight the employment challenges faced by AYA survivors of cancer.

Implications for cancer survivors: Cancer's adverse effect on AYA survivors is directly on employment status rather than through the level of education attained, highlighting opportunities for interventions that promote work ability among survivors.

Introduction: Fatigue is a prevalent and late effect among childhood cancer survivors (CCSs). Few large studies have comprehensively evaluated its prevalence and determinants. Identifying risk factors for fatigue and severe fatigue (SF) is crucial to improving survivorship care. This study assessed the prevalence of fatigue and SF, as well as demographic, clinical, and treatment-related predictors in the French Childhood Cancer Survivor Study (FCCSS).

Methods: This cross-sectional analysis included adult 5-year CCSs diagnosed before age 21 (1946-2000) in the FCCSS cohort. Fatigue was measured using the French Multidimensional Fatigue Inventory (MFI-20); SF was defined as a total score > 60. Associations with sex, age, cancer type, treatment, and social deprivation were estimated using multivariable regressions. Analyses were stratified by central nervous system (CNS) vs. non-CNS tumors and compared to general population norms.

Results: Among 3170 CCSs, fatigue scores exceeded population norms from age 30, with women affected earlier and more severely. General (10.0 ± 4.2) and physical fatigue (9.6 ± 4.2) were the most pronounced dimensions, increasing with age and peaking at ≥ 50 years. Higher fatigue scores were independently associated with female sex, obesity, older age, and CNS tumor history. SF affected 16% of CCSs, more frequently in women (OR = 1.30), obese survivors (OR = 2.40), CNS tumor survivors (OR = 3.27), hematologic tumor survivors (OR = 1.46), and radiotherapy exposure (OR = 1.46).

Conclusion: Fatigue remains a common, persistent late effect in CCSs. Female sex, older age, CNS tumors, and radiotherapy were strong predictors, underscoring the needs for targeted screening and long-term management.

Purpose: To explore how cancer survivors experience work-related well-being and aspects influencing their experience of it, one year after cancer treatment.

Methods: During the development of a work-related intervention, cancer survivors (n = 22, 67% was female, age md 56 years) were interviewed using purposive sampling one year post chemo-/radiotherapy for breast, prostate or colorectal cancer. Inductive content analysis was applied.

Results: The first year after treatment was described as a transition period in which cancer survivors strove to regain their general well-being but were able to experience work-related well-being even when their general well-being was limited. Their work-related experiences were characterised by a balance between personal readiness for work participation and workload. Daily life and working life were described as interdependent, requiring strategies to maintain balance. There was a vulnerability in handling the demands of work. Both general well-being and work-related well-being were promoted by the absence of side effects and the availability of guidance and responsiveness from caregivers and employers.

Conclusion: One year after treatment, cancer survivors considered participation in work life to be important for their well-being. At the same time, the need for enhanced preparation was expressed for balancing work and private life, managing remaining side effects, and navigating ongoing rehabilitation. Our results suggest that the interplay between personal preparedness and work-related stress is central to work-related well-being, highlighting the importance of addressing work-related aspects early in treatment. The findings also indicate that available resources in cancer rehabilitation are underused relative to patients' individual needs.

Implications for cancer survivors: Cancer survivors desired a more holistic rehabilitation, as both general well-being and work-related well-being encompass life after illness as well as the process of returning to work. Strengthening and clearly defining the role of contact nurses regarding work-related issues, and establishing early collaboration between the cancer survivor, employer, and rehabilitation coordinators, can improve support for return to work. Further research is needed to investigate how these discussions and support efforts can be structured and how models and theories can be applied to contribute to increased focus on issues related to work-related well-being after cancer.

Purpose: Pain is common and debilitating among adolescents and young adults (AYAs, aged 15-39 years) with cancer. Conventional pain management is often insufficient and carries risks, particularly opioid misuse. Integrative medicine (IM) interventions offer promising nonpharmacological strategies, but evidence for AYAs remains unclear. This scoping review mapped the existing literature on IM interventions for pain management in AYAs with cancer and identified gaps to guide future research.

Methods: We searched PubMed, Embase, and Scopus from database inception through August 31, 2025. Eligible studies included AYAs with cancer receiving IM interventions where pain was an outcome. Data were extracted on study characteristics, populations, interventions, pain outcomes, and qualitative findings.

Results: From 3,494 records, 22 studies met inclusion criteria, with only 7 (31.8%) being randomized clinical trials (N were all less than 150). Interventions included acupuncture, massage, yoga, mindfulness, music therapy, exercise, osteopathic manipulation, aromatherapy, and multimodal approaches. Pain was a common reason for IM use in descriptive studies. Ten of 15 studies reported that IM interventions improved pain outcomes either quantitatively or qualitatively. Evidence was limited by few prospective studies, small sample sizes, heterogeneous measures, and short follow-up.

Conclusions: IM interventions may improve pain for AYAs, but evidence is extremely limited. Rigorous prospective research is needed to build the evidence base and inform integration of IM into AYA pain management.

Implications for cancer survivors: IM interventions show promise in reducing pain for AYAs, but AYA-focused intervention development and clinical trials are needed to guide evidence-based integration into routine care.