Journal of Cancer Survivorship最新文献

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.

Purpose: This study aimed to (1) identify distinct multidimensional fatigue profiles among employed cancer survivors, (2) examine associations between workplace factors and these profiles, and (3) assess how these profiles are associated with occupational outcomes.

Methods: Seventy-two employed cancer survivors aged 27 to 64 years (median 9.4 years since diagnosis) from a local government in Japan completed questionnaires in 2023 assessing cancer-related fatigue (Cancer Fatigue Scale), workplace factors (job demands, job control, workplace support), and occupational outcomes (work engagement, presenteeism, cognitive function at work, and quality of life). Fatigue profiles were identified using hierarchical cluster analysis. Associations between workplace factors and profiles were examined using multinomial logistic regression. Occupational outcome differences among profiles were examined using linear regression.

Results: Three profiles were identified: Low Global Fatigue (n = 12), Dominant Mental Fatigue (n = 36), and High Global Fatigue (n = 24). Workplace support-particularly supervisor understanding, colleague understanding, and schedule flexibility-was associated with approximately 75% lower odds of belonging to the High Global Fatigue group. Job demands and job control showed no associations. The High Global Fatigue group reported lower work engagement, higher presenteeism, reduced cognitive function at work, and poorer quality of life compared to the other groups.

Conclusions: Three multidimensional fatigue profiles were identified among employed cancer survivors. Workplace support factors were more strongly associated with fatigue profiles than job characteristics. These profiles were associated with occupational outcomes.

Implication for cancer survivors: These distinct fatigue profiles can guide personalized workplace interventions to optimize support for employed cancer survivors.

Purpose: Cancer-related cognitive impairment (CRCI) is a common and debilitating complication among colorectal cancer survivors, even in those without chemotherapy exposure. To identify cancer-related neural changes, we investigated spontaneous brain activity and cognition in colorectal cancer survivors using cognitive assessments and resting-state functional magnetic resonance imaging (rsfMRI).

Methods: Nineteen survivors (stages I-II, cancer diagnosis < 12 months, chemotherapy-naïve) and 18 healthy controls underwent a battery of objective/subjective cognitive tests and MRI. RsfMRI data was analyzed with fractional amplitude of low-frequency fluctuations (fALFF) and functional connectivity (FC). Statistical analysis was controlled for age, sex, education, depression, and anxiety, with multiple comparison correction.

Results: Compared to controls, survivors performed significantly worse on the Hopkins Verbal Learning Test (HVLT-R) Recognition Discrimination Index (RDI) (p = 0.03) and showed slower psychomotor speed on the Trail Making Test (TMT-A) (p = 0.02). RsfMRI analysis revealed increased fALFF in the right hippocampus and bilateral inferior/middle temporal, parahippocampal, and fusiform gyri, with decreased fALFF in the bilateral superior/middle frontal gyri and left inferior frontal gyrus. RDI was negatively correlated with fALFF in right temporal regions. Survivors also exhibited reduced FC within the default mode network (DMN) (p < 0.05).

Conclusions: This cross-sectional study shows that colorectal cancer survivors display hyperactivity in the temporal regions and disrupted DMN connectivity associated with cognitive decline, suggesting a maladaptive neural response.

Implications for cancer survivors: Our study identified the functionally altered brain regions and networks associated with colorectal CRCI using MRI. This would provide potential biological targets for developing interventions such as neuromodulation for mitigating the adverse effects of colorectal CRCI.

Background: As more children with cancer experience improved treatment outcomes across the world, challenges arise with ongoing care needs due to a higher risk of mortality and chronic health conditions compared to the general population. Addressing global pediatric cancer survivorship care, especially in low- and middle-income countries (LMICs), is of growing importance. The current study used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) to examine the barriers, facilitators, and strategies for implementing childhood cancer survivorship care in LMICs.

Methods: Using a larger review (PROSPERO registration CRD42021242548), a total of 8,456 articles were considered. The search identified nine eligible articles mentioning determinants of survivorship care across LMICs. Data were extracted from these articles using the CFIR domains of outer setting, inner setting, and individuals. Assigned CFIR constructs were then paired with ERIC strategies using the CFIR-ERIC matching tool.

Results: The nine studies were published between 2003 and 2020, representing the following countries: India, Brazil, Turkey, China, and Thailand. Inner setting barriers included lack of available resources-funding, space, materials, and guidelines. Outer setting barriers were related to financing, policies, and laws. Individual patient barriers reported were low health literacy, distance to care centers, and low prioritization of follow-up. No common facilitators were noted. The most feasible ERIC strategies for the barriers identified were accessing new funding, developing and distributing educational materials, developing resource-sharing agreements, and conducting local survivorship care needs assessments.

Conclusions: There are limited existing data evaluating childhood cancer survivorship care barriers in LMICs. Of the studies we identified, low resource availability was a frequently reported barrier. As accessing funding can be difficult, resource sharing of contextually adapted guidelines and educational materials can serve as an implementation strategy to improve survivorship care globally.

Implications for cancer survivors: Enhancement of research efforts in resource-limited settings will address key knowledge gaps critical for implementation of global survivorship care and equity throughout the cancer journey.

Purpose: Identifying patients with similar health-related quality of life (HRQoL) recovery patterns can guide more effective disease management. This study aimed to identify cross-sectional and longitudinal HRQoL profiles in esophageal cancer patients, and to examine associations with demographic and clinical characteristics.

Methods: Longitudinal data from the Prospective Observational Cohort Study of Esophageal-gastric cancer Patients (POCOP) were analyzed. Patients treated with chemoradiation (CRT), with/without surgery, were followed for 12 months post-treatment. HRQoL was measured pre-treatment, at 6- and 12-months using validated questionnaires (i.e., EORTC QLQ-C30, QLQ-OG25, and HADS). Latent Profile and Latent Transition analyses were used to identify cross-sectional and longitudinal profiles, respectively. Regression analyses explored their associations with demographic and clinical characteristics.

Results: Of the 605 patients (mean age: 66.6 (SD: 8.0) years), most were male (82%) and had undergone surgery (73%). At each time point, two cross-sectional HRQoL profiles were identified: one with relatively high HRQoL (78-84%) and low HRQoL (16-22%). Both profiles showed significant impairments compared to population norms. Longitudinal analyses revealed five distinct HRQoL profiles: stable-high (65%), stable-low (5%), improving (10%), deteriorating (14%), and fluctuating (6%). Poorer HRQoL was associated with female sex and lower body mass index. Fluctuating HRQoL with surgery.

Conclusions: In our cohort, most esophageal cancer patients experienced relatively high or improving HRQoL, but some faced deteriorating or persistent impairments. Patients' sex, BMI, and surgery status may help identify those needing extra support.

Implications for cancer survivors: Recognizing different HRQoL profiles can help manage recovery expectations, and guide more personalized and timely care after treatment.

Objectives: The long-term memory aging of middle-aged and older cancer survivors is not fully understood and is largely limited to the United States (US) context. We compared long-term memory trajectories before and after an incident cancer diagnosis with the memory trajectories of similarly aged cancer-free adults in the US and England.

Methods: Incident cancer diagnosis and memory (immediate and delayed recall) were assessed during biennial interviews in the US Health and Retirement Study (HRS; n = 13,037) and the English Longitudinal Study of Ageing (ELSA; n = 8,579) from 2002 to 2018. Within country, multivariable adjusted linear mixed-effects models estimated the standardized memory trajectories in participants with and without cancer.

Results: Prior to diagnosis, cancer survivors had a memory advantage compared to cancer-free individuals, within each country (difference for cancer survivors in the US: 0.10 SD units [95% CI: 0.05, 0.14] and in England: 0.14 SD units [95% CI: 0.07, 0.20]). Cancer survivors in the US experienced an acute decline in memory function immediately following diagnosis (-0.08 SD units; 95% CI: -0.11, -0.04), which was not experienced by cancer survivors in England (0.01 SD units; 95% CI: -0.04, 0.07). Long-term post-diagnosis memory trajectories were similar for cancer survivors and cancer-free participants alike in both countries.

Conclusion: The acute decline in memory function associated with a new cancer diagnosis among cancer survivors in the US, but not England, warrants future studies to investigate explanations for this cross-national difference, such as differences in healthcare systems and treatment.

Implications for cancer survivors: Results can generate hypotheses to identify contextual risk factors to improve cognitive aging of cancer survivors.

Purpose: This scoping literature review explored disability-related experiences among adolescent and young adult (AYA) cancer survivors [ages 15-39], including their knowledge of the Americans with Disabilities Act (ADA) and awareness of associated rights.

Methods: Seven databases (PubMed, Academic Search Complete, MEDLINE, ERIC, SocINDEX with Full Text, Health Source: Nursing/Academic Edition, and APA PsychINFO) were searched for U.S. based literature (2010-2025) using relevant MeSH terms and boolean operators (e.g., "cancer surviv*" AND ("disab*" OR "impair*") AND ("young" OR "adolescent" OR "AYA"). Included studies focused on employment-related discrimination, cancer-related disclosure, psychosocial outcomes, and survivors' unmet disability-related needs. A narrative synthesis summarized key themes, with quantitative results tabulated and qualitative findings categorized.

Results: A total of 715 articles were screened, with 21 studies included for analysis. These studies highlight key gaps in legal awareness and support for adolescent and young adult (AYA) cancer survivors. Three main themes were identified: (1) employment, education, and workplace barriers, (2) legal, policy, and system-level barriers, and (3) psychosocial and identity-related challenges.

Conclusion: AYA cancer survivors encounter barriers in daily life and navigate changes to their social identity that could be described as disability based on existing legal and social definitions. Despite growing research capturing the experiences of AYA survivors, there remains limited research addressing survivorship in relation to disability.

Implications for cancer survivors: Current survivorship literature lacks discussion of disability experiences of survivors and relevant disability support. Addressing this gap could better document the lived experiences of AYA survivors and design supportive services informed by disability law and policy.

Objective: This study aimed to assess the association between the number of adverse childhood experiences (ACEs) and the history of depression among cancer survivors by race.

Methods: This study was a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System among 22,292 cancer survivors. The number of ACE experienced (zero, one, two-three, ≥ four) included questions assessing exposure to physical, emotional, and sexual household member substance misuse, incarceration, mental illness, parental divorce, or witnessing intimate partner violence before age 18 years. The outcome is self-reported history of depression (yes/no). Three weighted multivariable logistic regression models were used to examine the association between ACE and depression for each race group: non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanics.

Results: In this sample of cancer survivors, 41%, 22%, 21%, and 16% reported having experienced zero, one, two-three, and ≥ 4 ACEs, respectively. In the adjusted models, among NHW survivors, those who experienced ≥ 4 ACEs (aOR 4.20; 95% CI 3.32-5.32) had higher odds of depression diagnosis compared with those with zero ACEs. Among NHB survivors, those who experienced ≥ 4 ACEs had higher odds of depression diagnosis (aOR 2.98; 95% CI 1.45-6.14) compared with those with zero ACEs. Similarly, among Hispanic survivors, those who experienced ≥ 4 ACEs had higher odds of depression diagnosis (aOR 10.74; 95% CI 5.01-23.00) compared with those with zero ACEs.

Conclusion: Individuals with ACEs may constitute a key group for targeted prevention efforts to mitigate the risk of depression in cancer survivors.

Implications for cancer survivors: Development of personalized and targeted screening methods for patients diagnosed with cancer who have experienced adverse childhood experiences and depression is critical to improving their long-term well-being.