Journal of Cancer Survivorship最新文献

Purpose: Patient-reported outcome measures (PROMs) are questionnaires completed by patients to gain insight in their health-related quality of life. However, patients often find the interpretation of PROMS challenging. A personalized narrative, i.e., a story with patients' experiences tailored to the reader, could help explain PROMs and might be appreciated alongside numerical outcomes. We studied how cancer patients perceive PROMs feedback presented in a regular numerical and a novel narrative format.

Methods: Cancer patients who completed PROMs in routine clinical practice were recruited. All participants received numerical feedback and a personalized narrative. Semi-structured interviews were conducted to uncover perceptions of both formats. Interviews were analyzed with an inductive reflexive approach to thematic analysis.

Results: Twenty-nine patients with breast cancer, melanoma, and bladder cancer participated. Thematic analysis identified six themes: "Understanding: I get the gist of it!"; "Usefulness: Tell me why I should complete PROMs"; "Format preferences: Numbers are cold, narratives are warm"; "Taking action: Can I do something about my score?"; "Personal relevance: Personalized narratives show me what life has in store for me"; and "Personal relevance: That's (not) me!" Numbers seemed to help participants act, whereas narratives may provide emotional support and recognition. Participants identified with the content of the narrative yet differed in how they related to the main character.

Conclusion: Personalized narratives could be a useful addition to PROMs feedback. The studied formats seem to serve different purposes; numbers help to facilitate action, personalized narratives provide recognition.

Implications for cancer survivors: Personalized narratives may be a useful new way to communicate about quality of life to cancer survivors and help them to envision what the impact of cancer can be.

Purpose: To examine eating frequency, timing of meals, and sleep duration before and after a weight loss intervention for breast cancer survivors.

Methods: Female breast cancer survivors (n = 159; 55 ± 9 years; 31.4 ± 5.0 kg/m²; stage I-III, median [IQR] 9.5 [5.5] months post-diagnosis) participated in a randomized controlled trial of a 12-month weight loss intervention versus usual care. Eating frequency, proportion of daily calories consumed after 5 PM, eating after 8 PM, nightly fasting duration, and sleep duration were estimated and categorized based on existing associations with factors influencing breast cancer prognosis and breast cancer outcomes. These behaviors at baseline were compared to women from an Australian national survey with similar age and BMI range. Mixed-effects linear regression models were used to examine the changes in health behaviors from baseline to 18 months between intervention and usual care groups.

Results: Before the trial, eating after 8 PM (67%) was higher, and short nightly fasting duration (< 13 h, 83%) and long sleep duration (> 9 h/day, 26%) were marginally higher, in breast cancer survivors than women in the national survey (52%, 75%, and 17%, respectively). "Less optimal" eating behaviors and sleep duration tended to co-occur. Behaviors remained unchanged over the 18-month follow-up, irrespective of the study group (p > 0.05; Cohen's effect sizes < 0.3).

Conclusions: Later timing of eating and long sleep duration were prevalent in breast cancer survivors and continued following a weight loss intervention.

Implications for cancer survivors: Future multi-behavior interventions in breast cancer survivors should consider specific messages to target eating timing behaviors and sleep.

Purpose: Lesbian, gay, bisexual, trans, queer, and intersex (LGBTQI) people face unique challenges in cancer care. This mixed methods study examined LGBTQI patients' satisfaction with cancer care and factors associated with satisfaction, including experiences of LGBTQI disclosure. The study also explored what helps to facilitate safe disclosure and improve satisfaction with care for this population.

Methods: We used a mixed methods approach, involving 430 surveys and 104 semi-structured interviews with LGBTQI people with cancer (16-92 years) with various cancer types, sexuality and gender identities, ages, and people with intersex variations.

Results: Most participants reported being satisfied with their cancer care (n = 300, 76.3%) and had disclosed their LGBTQI sexuality or gender identity or intersex variations to at least some of their cancer healthcare professionals (HCPs) (n = 357, 87.1%). Satisfaction with care was higher with more disclosure to HCPs, HCP acknowledgment of partner/s and support people, and the ability to find LGBTQI specific information about cancer; it was lower with reports of discrimination in cancer care. Qualitative analysis identified that some participants were always out to HCPs, but others felt burdened with the responsibility and emotion work of disclosure and feared negative responses. Same-gender intimate partners facilitated disclosure and need to be respected within cancer care.

Conclusions: HCPs need to take the lead in facilitating LGBTQI disclosure in cancer care. Targeted interventions and training for HCPs, including reception and administration staff, are crucial to ensure equitable, affirming cancer care for all LGBTQI patients, ultimately leading to improved satisfaction with cancer care.

Implications for cancer survivors: Creating safe and inclusive environments for LGBTQI cancer patients is essential to encourage disclosure and improve satisfaction with cancer care.

Purpose

To investigate health care utilization among patients with hematologic malignancies and its association with socioeconomic position (SEP) and compare health care utilization with a cancer-free population.

Methods

Patients with aggressive lymphoma, indolent lymphoma, or multiple myeloma (MM), diagnosed between 1999–2010 and 2015–2019, participated in longitudinal patient-reported outcome research, up to 11 years post-diagnosis. Questionnaires assessed health care utilization at the general practitioner (GP), medical specialist, and additional health care. SEP was based on education and income, categorized as low, medium, or high. Sociodemographic and clinical data were obtained from the Netherlands Cancer Registry. Mixed models and logistic regression analyses were performed.

Results

The study included 2319 patients (71% response rate), who completed on average five measurements. Patients with MM reported the highest health care utilization, both at the GP and medical specialist. Low SEP was associated with higher utilization at the GP (medium education β = − 0.72, p = 0.01; high education β = − 1.15, p < 0.001) and lower utilization of additional physical (OR = 1.7, p = 0.01) and psychosocial (OR = 1.5, p < 0.05) care, among all patients. For patients with MM, high SEP was also associated with higher utilization of health care at the medical specialist (high education β = 2.56, p < 0.05).

Conclusion

Hematologic malignancy–related and SEP-related disparities in health care utilization were observed. To ensure equal access to health consumption, attention is needed for patients with a low SEP to provide better guidance in their cancer (survivorship) care.

Implications for Cancer Survivors

Improving health literacy and involving informal caregivers and nurse-led patient navigation may help reduce disparities in access to (additional) health care.

Purpose

In childhood cancer survivors (CCS), high physical activity (PA) and low sedentary time may reduce risks of late-effects. PA behaviors and screen time, and how they relate to moderate-to-vigorous PA (MVPA) in CCS, are largely unknown. We examined PA behaviors and screen time, and their cross-sectional associations with MVPA.

Methods

CCS from any cancer diagnosis (≥ l year post-treatment), aged 9–16 years at study, were eligible in the international Physical Activity in Childhood Cancer Survivors (PACCS) study. PA behaviors (school transport, intensity-effort in physical education (“PE intensity”), leisure-time PA) and screen time were assessed by self-report, and MVPA by accelerometers (ActiGraph GT3X-BT). Multivariable linear regressions were used to assess associations between PA behaviors and screen time with MVPA.

Results

We included 481 CCS (48% girls, mean age 12.2 years). Passive school transport (prevalence 42%) was associated with 10% lower MVPA/day (β = 6.6 min, 95% CI 3.3–10.0), low PE intensity (prevalence 21%) with 16% lower MVPA/day (β = 10.2 min, 95% CI 6.0–14.3), and low leisure-time PA (prevalence 34%) with 15% lower MVPA/day (β = 9.4 min, 95% CI 1.0–17.7), compared to active school transport, high PE intensity and high leisure-time PA, respectively. High screen time was not associated with MVPA.

Conclusion

Interventions aiming to increase PA behaviors rather than reducing screen time may be more efficient in promoting a healthy lifestyle in CCS through increased MVPA. Encouraging active transport, high PE intensity, and high leisure-time PA seems important in survivorship care.

Implications for Cancer Survivors

Young CCS may benefit from engaging in active transport, high PE intensity, and high leisure-time PA.

Purpose

Information about outcomes of particular relevance to older prostate cancer survivors is limited. This study aimed to compare health, activities of daily living (ADL), and use of health care services between survivors and matched controls.

Methods

A single-centre study on men treated for prostate cancer with curative intent at the age ≥ 70 years 2 to 7 years earlier. Controls matched on age and education were drawn (1:3) from the Trøndelag Health Study (HUNT) in Norway. Self-reported general health, independence in ADL and instrumental activities of daily living (IADL), hospital admissions and emergency room visits were compared by estimating non-adjusted and adjusted (age, education, comorbidity, cohabitant status and pack years of smoking) regression models.

Results

The majority of both survivors (N = 233) and controls (N = 699) reported good (58.7% vs. 62.7%) or very good (11.2% vs. 6.8%) health and independence in ADL (95.6% vs. 96.3%) and IADL (82.7% vs. 81.9%). Hospital admission was reported by 17.3% vs. 18.2% and emergency room visit by 23.6% vs. 26.7%. Regression models showed no significant differences between survivors and controls.

Conclusions

Older prostate cancer survivors reported similar health, independence in ADL and use of emergency room and hospital admissions as matched controls.

Implications for Cancer Survivors.

This study shows that survivors after curatively intended treatment of prostate cancer have as good health as matched controls, indicating that many patients tolerate such treatment well despite being of old age and that current practice for selection of patients offered such treatment is appropriate.

Purpose

We assessed the associations between (1) body mass index (BMI) and participating in any physical activities (PAs) in past 30 days and (2) cancer and behavioral-related variables and participating in any PAs in past 30 days among prostate cancer (PCa) survivors.

Methods

We conducted a cross-sectional analysis of data from the 2018–2022 Behavioral Risk Factor Surveillance System. Multivariable weighted logistic regression was used to examine the associations.

Results

Of the 4944 PCa respondents, 22.9% were classified as obese class I and 10.6% as obese class II or III. Obese class I and obese class II or III respondents were significantly less likely to participate in any PAs in past 30 days (odds ratio (OR) = 0.48; 95% confidence interval (CI): 0.28–0.84 and OR = 0.37; 95% CI: 0.20–0.67, respectively). Men who received a summary of their cancer treatment were significantly more likely to participate in any PAs in past 30 days (OR = 1.53; 95% CI: 1.03–2.28). Men who received instructions from a doctor for routine check-ups after completing treatment for cancer were not significantly more likely to participate in any PAs in past 30 days (OR = 1.36; 95% CI: 0.87–2.12). Current smokers were less likely to participate in any PAs in past 30 days (OR = 0.50; 95% CI: 0.26–0.96).

Conclusions

Obese men and current smokers were less likely to participate in any PAs in past 30 days. Men who received a summary of their cancer treatment were more likely to participate in any PAs in past 30 days. Health care providers should talk to their patients about the benefits of participating in PA and refer PCa patients to available exercise programs.

Implications for Cancer Survivors

PA was lowest among obese class II or III PCa survivors. These men could benefit from a coordinated multidisciplinary health care team effort to improve PCa prognosis and QoL.

Purpose

Sexual minority prostate cancer patients have worse health-related quality of life outcomes than heterosexual patients. We conducted the first study to test whether sexual and urinary rehabilitation tailored for sexual minority patients was acceptable, feasible, and efficacious at improving their sexual and urinary function.

Methods

Restore-2 was a 24-month randomized controlled trial of an online biopsychobehavioral rehabilitation study for sexual minority men treated for prostate cancer experiencing sexual and/or urinary problems. Participants were 401 US sexual minority men treated for prostate cancer and experiencing sexual and/or urinary problems at baseline. Intervention components included phosphodiesterase-5 inhibitors, sexual aids, a pelvic floor exercise regimen and video, a guide to good gay sex following treatment, and coaching. Quality of life assessments were completed at baseline, 3, 6, 12, 18, and 24 months.

Results

We confirmed good acceptability and feasibility, but only minimal improvement was observed over time and no differences were found between treatment and control arms.

Conclusions

We found no evidence that the intervention improved sexual or urinary outcomes for participants. However, we confirmed excellent acceptability and feasibility for a sexual rehabilitation program tailored to sexual minority participants. In addition, participants reported enduring usage and acceptability of sexual aids (including vacuum pump, anal dilators, and penile constriction rings) as well as masturbation and pelvic floor exercises to accommodate their sexual challenges.

Implications for Cancer Survivors

Sexual “accommodation,” rather than “rehabilitation,” may be a more accurate and realistic goal for this population. Patients should be provided sexual aids to help accommodate their sexual and urinary challenges.

Trial registration

This study was retrospectively registered with ClinicalTrials.gov, study number: NCT03923582; date: 22/04/2019.

Purpose: To (1) describe and compare the prevalence of using of complementary health approaches, focusing on mind and body practices, and reasons for use among cancer survivors, and (2) examine characteristics associated with use among those with a recent and non-recent diagnosis of cancer compared to those without a previous cancer diagnosis.

Methods: Using data from the 2022 US National Health Interview Survey, prevalence estimates were derived for using any complementary health approach, by category (manipulative body-based [chiropractor, acupuncture, massage], creative [music therapy, art therapy], and mind-body [meditation, guided imagery, yoga]), and reasons for use. Regression models identified correlates of use among all participants and within cancer diagnosis subgroups.

Results: Among 26,523 adult participants, overall prevalence of using any complementary approach was similar amongst individuals with recent cancer (40.17%), non-recent cancer (37.75%), and no cancer diagnosis (37.93%). However, odds of use were higher amongst recent (OR = 1.37) and relatively long term (OR = 1.14) cancer survivors compared to those without a history of cancer in adjusted models (both p < 0.05). In cancer survivors, mind-body approaches were mostly used for general health purposes, whereas manipulative approaches were used for general health and pain management. Female sex, younger age, higher education and income were among the prominent variables associated with using complementary approaches.

Conclusion: We present an important snapshot of the landscape of using complementary approaches, specifically mind and body practices, in adult cancer survivors in the US. Inequalities in access to these therapies may exist, as use remains highest amongst those with higher socioeconomic conditions.

Implications for cancer survivors: Given the prevalence and potential benefits of complementary approaches among cancer survivors, there is a need to better understand their effectiveness, optimal use, and integration into cancer care. Further research is needed to understand and address access barriers that might exist amongst some cancer survivors.