Journal of Cancer Survivorship最新文献

Purpose: To synthesise qualitative evidence on registered nurses' experiences of returning to work after completion of primary cancer treatment and entry into the survivorship or rehabilitation phase.

Methods: Ten databases were searched from inception to 8 August 2025, with an updated search conducted on 22 February 2026. The review followed Joanna Briggs Institute (JBI) methodology for qualitative evidence synthesis and was reported in accordance with ENTREQ guidelines. Methodological quality was appraised using the JBI Critical Appraisal Checklist for Qualitative Research. Data were synthesised thematically, and confidence in synthesised findings was assessed using the JBI ConQual approach.

Results: Eight qualitative studies involving 96 nurse cancer survivors were included. Fifty-eight findings were synthesised into four overarching themes: (1) Emotional and Physical Journey, (2) Roles and Identities, (3) Professional Growth and Advocacy, and (4) Support and Work-Life Motivation. ConQual assessment indicated moderate confidence for three themes and low confidence for the Emotional and Physical Journey theme, reflecting limitations in methodological transparency and variability in evidentiary support.

Conclusions: Returning to work after cancer represents a complex and ongoing transition for nurses, involving physical adjustment, emotional regulation, identity reconstruction, and professional adaptation. Reintegration appears shaped by individual coping processes and organisational contexts.

Implications for cancer survivors: Findings suggest that flexible work arrangements, psychological support, and context-sensitive workplace practices may facilitate more sustainable return-to-work experiences among nurse cancer survivors.

Purpose: To examine the long-term risk of hospitalization for medical conditions in adolescent and young adult (AYA) cancer survivors compared to a cancer-free AYA cohort.

Methods: Retrospective cohort study of 42,653 ≥ 2-year cancer survivors diagnosed at ages 18-39 (1993-2016) in the Netherlands Cancer Registry, and 169,342 matched cancer-free controls (1:4 by age, sex and municipality). Hospitalizations for relevant medical conditions were identified through national hospital admission data. Survivors and controls were followed through December 2021. Hospitalization incidence rate ratios (IRRs) and cumulative incidences were calculated, with IRRs stratified by tumour type and therapy (chemotherapy, radiotherapy).

Results: AYA cancer survivors had a significantly increased IRR of hospitalization for any medical condition (adjusted IRR 1.73; 95% CI 1.64 to 1.82), as well as for most individual conditions. The cumulative incidence of hospitalization for any medical condition was 25.4% at 25 years post-index, with most individual conditions below 5%. Most tumour subgroups had significantly increased IRRs compared to controls, with the highest IRRs observed for Hodgkin lymphoma and leukaemia. In general, elevated IRRs were more pronounced among survivors who received chemotherapy or radiotherapy.

Conclusions: AYA cancer survivors have an increased risk of hospitalization for most medical conditions compared to AYAs without a cancer history, though absolute long-term risk is low. As hospital admissions reflect only part of the clinical and societal burden, the findings may underestimate the total impact of late effects.

Implications for cancer survivors: AYA cancer survivors may benefit from long-term, risk-based survivorship care focused on early detection and management of late effects, especially after chemotherapy and radiotherapy.

Purpose: A better understanding of survivors' information and support needs could guide the design of more meaningful and effective interventions. This scoping review examines cancer survivors' needs in the context of cancer and work.

Methods: For this scoping review, we searched 5 databases for studies published in 2014-2024 reporting on cancer survivors' information and support needs related to cancer and work. Data were extracted and identified needs were qualitatively synthesized using the Arena model of work disability.

Results: Eighty-five studies from 22 countries were included, reporting on 26 themes concerning information needs and 56 themes concerning support needs. Within the personal system, survivors need information on how cancer and treatment affect work, and they need support through understanding from employers and colleagues. Within the workplace system, needs included information on return to work timing and phases, and support via flexible, personalized work adjustments. Within the healthcare system, survivors need information on cancer's impact on work (dis)ability, and support includes tailored advice and encouragement. Survivors emphasized the importance of work being proactively addressed in clinical care. Within the legislative and insurance systems, needs related to information on employee rights and support in navigating disability benefit procedures were identified.

Conclusions: The diversity in needs suggests that interventions should be tailored to individual cancer survivors, while considering broader contextual factors Future interventions should include multiple stakeholders, since needs exist throughout the systems of the Arena model.

Implications for cancer survivors: There is a need for tailored interventions to support work participation of cancer survivors.

Background: Individual effect of posttraumatic stress disorder (PTSD) and social determinants of health (SDoH) on healthcare utilization and well-being among cancer patients remains unclear. We sought to assess independent and combined effects of these factors on healthcare utilization and self-reported well-being.

Methods: All of Us Research Program was used to identify participants with cancer and/or PTSD, as well as individuals with neither. SDoH burden, healthcare utilization, and well-being were assessed relative to PTSD on multivariable logistic regression adjusting for sociodemographic factors.

Results: Among 16,261 participants, 11.6% (n = 1895) had cancer, 1.4% (n = 228) had cancer and PTSD, and 20.1% (n = 3281) had PTSD alone. PTSD was associated with higher odds of emergency room visits (aOR 4.16, 95% CI 3.80-4.55), poor mental (aOR 3.77, 95% CI 3.43-4.14), and emotional health (aOR 3.76, 95% CI 3.41-4.16) (all p < 0.001). High SDoH burden independently predicted increased inpatient and emergency visits (aOR 1.24, 95% CI 1.13-1.36), as well as greater risk of poor quality of life (aOR 3.71, 95% CI 3.20-4.32) (all p < 0.001). Cancer patients with PTSD and high SDoH burden had substantially greater odds of poor mental health (aOR 10.92, 95% CI 9.33-12.77) and poor emotional health (aOR 12.20, 95% CI 10.33-14.41) (all p < 0.001).

Conclusion: Cancer, PTSD, and high SDoH burden were independently associated with greater healthcare use and worse well-being with combined exposures amplifying risk among cancer survivors.

Implications for cancer survivors: Survivors with PTSD and high SDoH burden are especially vulnerable. Integrating trauma-informed care and SDoH screening strengthens survivorship equity and outcome.

Introduction: Survivors of pediatric brain tumors (BT) experience significant, long-term adverse treatment-related effects, such as social deficits-which can impact academic achievement, quality of life, and daily adaptive functioning. Affective processing remains underexplored. This study investigated social affective processing in survivors compared to healthy children (HC), identified clinical and sociodemographic factors that may be related to affective processing, and explored whether cognitive-executive function mediates these relationships.

Methods: Survivors (N = 33, 54.5% female, mean [SD] age = 13.94 [3.28] years) and HC (N = 35, 48.6% female, age = 11.61 [2.96] years) completed behavioral assessments and questionnaires examining affective processing (emotion perception, emotion recognition, and theory of mind), cognitive-executive processes (executive function and inattention), and sociodemographic information (sex, income, parent education, and parent age). Mann-Whitney U compared social affective processing between survivors and HC. Correlations and linear regression examined relationships between predictors of interest and affective processing.

Results: Survivors performed worse than HC on emotion perception (Z = -2.13, p = .033), but not other social affective tasks. Regression analysis revealed that receiving radiation was associated with poorer emotion perception (t = -3.45, p = .002) and higher inattention scores (t = 2.48, p = .020) while greater time since diagnosis was not.

Discussion: Emotion perception is a key component of social information processing and appears compromised in BT survivors, especially those who received radiation therapy, compared to HC.

Implications for cancer survivors: These novel findings highlight potential affective mechanisms underlying social deficits in BT survivors and underscore the need for early screening and targeted interventions to enhance their social well-being.

Background: Adolescent and young adult (AYA) cancer survivors (ages 15-39 at diagnosis) experience challenges that heighten their risk of financial toxicity (i.e., the material, psychological, and behavioral burden of cancer-related costs). This scoping review characterizes the extent, range, and limitations of the literature on financial toxicity among AYA cancer survivors to inform future research and intervention design.

Methods: Following standardized scoping review methodology, we systematically searched six databases for studies addressing financial toxicity or related constructs among AYAs within the past 10 years. Eligible studies included quantitative, qualitative, and mixed-methods research without geographic restriction. Of 1722 records identified, 1362 underwent title and abstract screening and 118 underwent full-text review. Two reviewers independently screened studies, and study data were extracted and synthesized.

Results: Eighty studies met inclusion criteria. Most (n = 74, 92%) were cross-sectional, six (8%) were longitudinal. Half (n = 40, 50%) were quantitative observational analyses, and 41 (51%) included multiple cancer types. Financial toxicity was measured as an outcome in 63 studies (79%) and an exposure in 17 (21%). Prevalence of financial toxicity ranged from 15.5% to 89.5% (median 55%, IQR 38.2-67.1). Considerable heterogeneity was observed in measurement approaches; the Comprehensive Score for Financial Toxicity (COST) measure was used in 22 studies.

Conclusions: Standardized measurement, longitudinal designs, and multilevel interventions are needed to mitigate burden and advance health equity.

Implications for cancer survivors: Financial toxicity is a pervasive concern for AYA cancer survivors globally. Through synthesizing the existing evidence on financial toxicity among AYA cancer survivors, this review identifies key gaps and guides future research and intervention development.

Purpose: To assess whether a virtual, cancer survivorship-focused continuing medical education (CME) course affected awareness of cancer survivorship care and examined barriers to implementing practice changes.

Methods: We surveyed medical professionals caring for patients and survivors of cancer before, during, and after online course participation from 2021 to 2024. Pre- and post-course test scores across four modules addressing care for patients with various cancer types, cancer and treatment effects, and survivors' psychosocial and general health were analyzed using paired samples t-tests to determine participant knowledge. Post-course evaluations were analyzed using descriptive statistics and Fisher's exact tests to measure perceived barriers in implementing practice changes.

Results: Three hundred fifty-seven medical professionals registered for the CME course; 193 (54.1%) completed all modules (21 CME hours). Most were physicians (42.9%) or nurses (30.8%), 65.3% from the United States. Across all topics, post-course test median scores were significantly higher than median pre-course test scores with 94% course satisfaction. Among 198 who completed the post-course evaluation, 86.9% reported ≧1 barrier to practice change implementation: lack of provider time (34.3%), institutional (30.8%) or insurance/financial barriers (28.3%), and/or challenges in care team members' communication and/or collaboration (23.7%). Implementing new skills (83.3%), seeking more information (47.0%), and creating/revising practice policies (45.5%) were the most endorsed goals post-CME.

Conclusions: This CME course presented awareness across cancer survivorship topics; however, multiple barriers exist to clinical practice implementation. Future CMEs should include guidance on overcoming barriers within institutional clinical settings.

Implications for cancer survivors: An online CME course could strengthen providers' knowledge of survivorship care.

Purpose: To understand the lived experience of patients with non-metastatic (NM-CRC) and metastatic colorectal cancer (M-CRC) by identifying the signs, symptoms, and impacts they face throughout the disease course and treatment.

Methods: An international, non-interventional, qualitative interview study was conducted in the US, UK, Germany, and Japan. Six clinicians specializing in CRC were interviewed to inform disease symptomatic features, management, and clinically relevant concepts. Subsequently, 40 adult patients with NM-CRC (n = 19) or M-CRC (n = 21) participated in individual, semi-structured online concept elicitation interviews. Interviews were audio-recorded, transcribed, translated if needed, de-identified, and analyzed thematically using qualitative software.

Results: Tiredness/fatigue, blood in stool, rectal bleeding, diarrhea, abdominal pain, abdominal cramping, constipation, and bloating were among the most frequently reported signs/symptoms of CRC. Many symptoms and impacts, including tiredness/fatigue, skin problems, nausea, hair loss, and numbness/tingling, were attributed to treatments like surgery, chemotherapy, and stoma presence. Daily life impacts included changes in physical abilities, social functioning, emotions, finances, and overall quality of life. A conceptual model of CRC signs/symptoms and impacts was developed based on clinician insights and refined based on patient interviews.

Conclusions: The study documented the disease and treatment experience of patients with CRC. Some differences were observed between the experiences of patients with M-CRC and NM-CRC; however, fatigue, bowel-related issues, and abdominal pain were consistently identified as prevalent and bothersome symptoms.

Implications for cancer survivors: Understanding the most bothersome CRC symptoms, impacts, and treatment side effects is essential for developing effective support programmes and potentially improving treatment approaches to enhance the quality of life for CRC survivors.

Purpose: Although late effects and their symptomatology are well described for childhood cancer survivors, less is known about survivors of young adult (YA) cancer. Our aim was to characterize symptom burden among long-term survivors of YA cancer.

Methods: Project Milestones is a cross-sectional cohort survey study assessing benchmarks of emerging adulthood among 3-10-year cancer survivors diagnosed 21-39 years old. We analyzed responses from the first half of cohort participants to 22 questions that screened for current, clinically significant symptoms. Statistical analyses included Chi-square, Fisher exact, and negative binomial regression tests.

Results: There were 1,025 evaluable participants (68.9% female; 34.2% Hispanic; median age at diagnosis and survey 31 and 39 years, respectively; and 73% ≥ 5 years post-treatment). Cancer types were reproductive (male/female, 30.4%), leukemia/lymphoma (28.2%), thyroid (13.5%), breast (10.3%), melanoma (8.9%), and colorectal (8.8%). The most-endorsed symptoms were fatigue (39.4%), altered appearance (35.8%), cognitive problems (31.7%), general pain (28.0%), sensory neuropathy (24%), and urinary incontinence (20%). Over 70% reported at least 1 symptom; one-third reported ≥ 4. In adjusted analysis, cumulative symptom count was significantly higher among participants who were female (vs. male), Hispanic (vs. non-Hispanic White), had public insurance (vs. employer-sponsored), and received chemotherapy/radiation (vs. surgery) by 44%, 21%, 49%, and 71%, respectively.

Conclusions: Long-term survivors of YA cancer report a substantial burden of persistent, clinically significant symptoms.

Implications for cancer survivors: Clinicians should emphasize the importance of sustained survivorship care and monitor for symptoms suggesting late effects. Further research is needed to understand their contributing factors and functional impact.

Purpose: Despite its importance, little is known about engagement with structured, multidisciplinary head and neck cancer (HNC) survivorship care. We sought to identify clinical and sociodemographic factors associated with sustained attendance at an HNC Survivorship Clinic.

Methods: Our retrospective cohort of 625 HNC patients was divided into a subset of patients who received radiotherapy (n = 510) and patients who did not (n = 115). We defined sustained attendance as 1) the total number of visits that occurred before completing treatment and within three years post-treatment, and 2) adherence scores, calculated as the number of timeframes during which at least one visit occurred: pre-treatment completion (for the radiotherapy subset only) and one-, two-, and three-years post-treatment. We used Fisher's exact test for descriptive statistics and Poisson regression to estimate prevalence ratios (PRs) for sustained attendance.

Results: In the overall cohort, 248 patients (39.7%) had only one visit to the Survivorship Clinic. In the radiotherapy subset, 211 patients (41.4%) had an adherence score of 1, compared to 81 (70.4%) in the non-radiotherapy subset. In adjusted analysis, treatment with radiotherapy was associated with more total visits (PR: 1.41, 95% confidence interval [CI]: 1.19-1.68), while greater neighborhood socioeconomic deprivation (PR: 0.82, 95% CI: 0.70-0.97) and farther distance from the Clinic (PR: 0.81, 95% CI: 0.69-0.95) were associated with fewer total visits.

Conclusions: Clinical and sociodemographic factors are independently associated with sustained attendance at an HNC Survivorship Clinic.

Implications for cancer survivors: Disparities in engagement with HNC survivorship care highlight the need for targeted interventions to improve adherence to follow-up recommendations.