Journal of Cancer Survivorship最新文献

Purpose: This randomized controlled trial evaluated the efficacy of a multidisciplinary, mobile health (mHealth) supportive care program designed to alleviate symptom burden and enhance self-efficacy in post-treatment breast cancer survivors (BCS). Secondary outcomes included quality of life (QoL), coping strategies, and inflammatory biomarkers.

Methods: We conducted a single-blind, randomized controlled trial involving 108 BCS. Participants were allocated to either a 3-month mHealth intervention (n = 54) delivered via the "ThrivePath" app or a routine care control group (n = 54). The app provided structured symptom monitoring, educational resources, and personalized support. Outcomes were assessed at baseline, 3 months (post-intervention), and 6 months (follow-up) and analyzed using linear mixed models.

Results: Compared to controls, the intervention group showed a significant reduction in symptom burden (β = -9.44, p < 0.001) and a significant increase in self-efficacy (β = 5.45, p < 0.001). The program also improved QoL, enhanced confrontation coping, and led to a significant reduction of pro-inflammatory cytokines (IL-1β, IL-2, IL-6, TNF-α) while preserving anti-inflammatory IL-10 levels.

Conclusions: The "ThrivePath" mHealth program is an effective, scalable intervention for post-treatment breast cancer survivors. It significantly reduces symptom burden and modulates inflammatory processes while boosting self-efficacy, offering an evidence-based model for delivering comprehensive survivorship care.

Implications for cancer survivors: The ThrivePath program provides a practical and accessible tool for survivors to manage their health following active treatment. By facilitating access to evidence-based resources and enabling direct communication with a care team, the program can help alleviate persistent symptoms, build confidence in self-management, and improve overall quality of life during the transition to survivorship.

Trial registration: ChiCTR2500108128.

Purpose: Childhood cancer survivors (CCS) are at increased risk of treatment-related infertility and may require assisted reproductive technologies (ART) to achieve parenthood. This scoping review aimed to synthesise the existing scientific evidence on the use of ART among CCS, focusing on fertility outcomes and associated maternal, perinatal, and child health indicators.

Methods: Adapted from Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines, MEDLINE (OVID), CINAHL, and Embase were searched (conducted from the inception of each database up to February 2025) for studies of CCS diagnosed before age 18, surviving ≥ 5 years, and reporting ART-related fertility, obstetric, or perinatal outcomes. Screening and extraction were conducted independently via Covidence.

Results: From 4,785 records, 10 studies met the inclusion criteria. Five studies reported higher infertility rates among female CCS (4.5-34%) compared with non-cancer controls. ART success rates were generally comparable to siblings, though pelvic or cranial radiotherapy reduced live birth rates by 17-32%. Three studies demonstrated the feasibility of ovarian tissue cryopreservation (OTC), particularly for prepubertal girls. Male CCS were more likely to require intracytoplasmic sperm injection (ICSI) and had lower ART success than non-cancer siblings. Neonatal studies found increased multiple gestations, preterm births, and low birth weight among ART-conceived offspring, but no rise in congenital anomalies or childhood cancer.

Conclusion: ART enables parenthood for childhood cancer survivors, though prior gonadotoxic therapies can impair success and increase perinatal risks, highlighting the need for long-term survivorship research.

Implications for cancer survivors: ART provides viable fertility options, but early counseling and integrated reproductive care are essential to optimise outcomes and ensure equitable access for all cancer survivors.

Purpose: This study aimed to identify symptom clusters in survivors with nasopharyngeal carcinoma undergoing radiotherapy and to explore the interrelationships among these symptoms. Furthermore, it sought to identify core and bridge symptoms and to observe their changes over time.

Methods: A longitudinal study was conducted, recruiting 181 survivors newly diagnosed with nasopharyngeal carcinoma who were undergoing radiotherapy. Measurements were taken during weeks 1-6 of radiotherapy. Symptom assessment was conducted using the MD Anderson Symptom Assessment Scale - Head & Neck Module. Symptom network analysis was performed at each time point, and centrality metrics were analyzed to explore the interrelationships among symptoms.

Results: Four stable symptom clusters were identified, with fatigue, feeling of being distressed, feeling sad, and difficulty swallowing/chewing as central symptoms, and feeling sad, feeling of being distressed, fatigue, and vomiting as bridge symptoms. The stability of the symptom network across the six time points was acceptable.

Conclusion: The symptom network results are crucial for developing future targeted symptom management interventions. Future research should focus on developing precise interventions targeting core and bridge symptoms to alleviate nasopharyngeal carcinoma survivors' symptom burden.

Implications for cancer survivors: For nasopharyngeal carcinoma survivors undergoing radiotherapy, implementing a dynamic symptom management strategy with tailored interventions for core and bridge symptoms enhances symptom management efficiency, thereby improving survivors' quality of life.

Purpose: Access to cancer nutrition care is often poor, and it can be challenging for cancer services to put models of care into practice. The aim of this study was to seek consensus from consumers of cancer services and nutrition experts on the core elements and key clinical determinants for a nutrition model of care for people with cancer.

Methods: A two-round, national online Delphi study was conducted February-May 2025. Proposed items were presented to a national panel of nutrition experts and consumers. Agreement was rated on an 11-point Likert scale for importance and feasibility against 62 items. Response frequencies were assessed against a priori thresholds to determine consensus ratings.

Results: Sixty-nine panellists participated in Round 1 (68.1% nutrition experts, 31.9% consumers) and 60 in Round 2 (68.3% nutrition experts, 31.7% consumers). Strong consensus was reached (both importance and feasibility) for 32 items that underpin cancer nutrition care. Findings identified opportunities for enhancing cancer nutrition care and improving feasibility using strategies beyond workforce and resource allocation, including elevating the value and practice of nutrition care.

Conclusion: Findings will inform system-level guidance for cancer nutrition care within complex health environments.

Implications for cancer survivors: Consensus regarding the critical elements of a nutrition model of care based on importance and feasibility, and underpinned by national expert consensus, has the potential to address systemic barriers to access and unwarranted variation in care, and bridge the evidence-practice gap.

Purpose: Among the over 3.5 million prostate cancer survivors in the United States, prostate cancer is frequently diagnosed cancer among Latino men. Latino cancer survivors are more likely to experience poorer quality of life than White survivors. However, limited research has explored quality of life disparities between Latino and White prostate cancer survivors. Hence, we aimed to assess the health-related quality of life between a cohort of Latino and White men with prostate cancer.

Methods: We used survey data from participants in the UCLA Men's Health Study between 2001 and 2018. Independent t-tests and multivariable linear regressions were used to assess quality of life, both general and prostate-cancer specific between Latino and White men at program enrollment.

Results: Our sample included 291 Latino men and 65 non-Latino White men. In multivariable linear models, general health (β = -7.93, p < 0.01) and sexual bother (β = -14.33, p < 0.05) remained significantly worse among Latino men than White men after controlling for age, relationship status, education, income, comorbidities, Gleason grade group, and primary treatment.

Conclusions: Latino men with prostate cancer reported poorer quality of life, particularly in the domains of general health and sexual bother compared to White men.

Implications for cancer survivors: Findings highlight the need for survivorship care that addresses Latino prostate survivors' unique needs including general health and sexual bother.

Purpose: Functional disability is common among cancer survivors, yet its contribution to multidimensional survivorship burden remains incompletely characterized. We evaluated disability-specific and sex-stratified associations with survivorship burden in a nationally representative US cohort.

Methods: We analyzed 2017-2022 Behavioral Risk Factor Surveillance System data among adult cancer survivors. Functional disability included mobility, cognitive, or self-care limitation. Outcomes included socioeconomic hardship (ordinal composite of inability to work and cost-related unmet care), psychological burden (frequent mental distress), and psychosocial burden (leisure-time physical inactivity). Survey-weighted regression models assessed associations by disability burden and type, with sex-stratified analyses and disability-by-sex interaction testing. Difference-in-differences analyses evaluated disability-associated socioeconomic hardship by Medicaid expansion status among low-income survivors.

Results: Among 3.57 million weighted cancer survivors, mobility (28.0%), cognitive (12.9%), and self-care (6.4%) disabilities were prevalent. Any disability was associated with higher socioeconomic hardship (aPOR 2.48, 95% CI 2.22-2.77), psychological burden (aOR 2.54, 95% CI 2.33-2.77), and psychosocial burden (aOR 2.68, 95% CI 2.48-2.89). Disability-specific patterns differed: cognitive disability was most strongly associated with psychological burden (aOR 3.42, 95% CI 3.02-3.87), self-care disability with socioeconomic hardship (aPOR 2.63, 95% CI 2.12-3.27), and mobility disability with psychosocial burden (aOR 2.98, 95% CI 2.70-3.29). Medicaid expansion modestly attenuated disability-associated socioeconomic hardship among low-income survivors. Disability-associated socioeconomic and psychological burden was greater among women, whereas psychosocial burden was more pronounced among men.

Conclusion: Functional disability was strongly associated with multidimensional survivorship burden, with distinct disability- and sex-specific patterns.

Implications for cancer survivors: Disability-informed survivorship care may reduce hardship and improve post-cancer quality of life.

Purpose: Depression is prevalent among colorectal cancer (CRC) survivors. Although various physical activity intensities are differentially associated with depressive symptoms, the underlying mediator and moderator involving interoception and mindfulness, remain unclear. This study aims to examine whether interoceptive accuracy differentially mediates the relationship between various physical activity intensities and depressive symptoms and whether mindfulness moderates these pathways.

Methods: In this multicenter cross-sectional study, 395 CRC survivors completed validated questionnaires assessing depressive symptoms, physical activity participation, interoceptive accuracy, and mindfulness. Mediation and moderated mediation analyses via PROCESS version 4.1 for SPSS tested whether interoceptive accuracy mediated associations between light and moderate-to-vigorous physical activity (LPA vs. MVPA) and depressive symptoms, and whether mindfulness moderated these pathways.

Results: Both LPA and MVPA are negatively associated with depressive symptoms (p < 0.001). Interoceptive accuracy significantly mediated these associations, accounting for 49.09% of the total effect for LPA and 20.56% for MVPA. Mindfulness moderated the LPA-interoceptive accuracy (B = -0.004, p = 0.031), interoceptive accuracy-depression (B = -0.022, p = 0.004), and MVPA-depression pathways (B = -0.001, p = 0.034), suggesting differential, intensity-dependent associations.

Conclusions: LPA showed negative associations with depressive symptoms, with interoceptive accuracy fully mediating this association. In contrast, MVPA demonstrated both direct and indirect associations with depressive symptoms, partially mediated by interoceptive accuracy. Mindfulness strengthened these relationships through complementary and synergistic moderation, highlighting the dynamic interaction between bodily awareness and physical activity in psychological recovery.

Implications for cancer survivors: Tailoring gentle, mindful movement to enhance interoception may offer a feasible, integrative rehabilitation strategy to reduce depression among CRC survivors.

Purpose: Breast cancer treatments contribute to bone loss and increase fracture risk, with effects varying by age and menopausal status. Previous studies lacked comparisons with the general population and analyses by treatment and age groups. This study evaluated fracture risk in breast cancer patients compared to a matched control group, considering risk factors, age, and treatments.

Methods: This retrospective cohort study using the Korean National Health Insurance System database included 104,177 breast cancer patients and 312,531 matched controls. Fracture incidences (any, vertebral, hip, and other) by age and treatment type was assessed using Fine-Gray competing risk models.

Results: During the mean follow-up of 7.21 years after breast cancer diagnosis, breast cancer patients aged 50 years and younger had a higher risk of any fracture (sub-distribution hazard ratio [sHR], 1.33; 95% confidence interval [95% CI], 1.24-1.42) and vertebral fracture (sHR, 1.33; 95% CI, 1.13-1.56) compared to the matched control group. Patients aged 65 years and older had a lower risk of any fracture (sHR, 0.91; 95% CI 0.84-0.98) and vertebral fracture (sHR, 0.83; 95% CI, 0.73-0.93). Compared to patients without specified treatments, those who received anthracycline (sHR, 1.21; 95% CI, 1.15-1.28) and aromatase inhibitors (sHR, 1.16; 95% CI, 1.09-1.23) had an increased risk of fracture; and those who were given tamoxifen had a decreased risk (sHR, 0.92; 95% CI, 0.86-0.98).

Conclusions: Breast cancer patients had slightly higher fracture risk, primarily in younger patients. Emphasizing osteoporosis prevention and treatment, especially in younger populations or those who have received treatments associated with an increased risk of fracture, is necessary to reduce fracture risk.

Purpose: To identify and evaluate consumer-informed strategies that online exercise leaders can use to enhance engagement in online exercise classes for people living with cancer, using social identity leadership theory as a guiding framework.

Method: We used a participatory design involving adults with a history of blood cancer. Fourteen participants attended online co-design workshops to generate strategies that online exercise leaders could use to demonstrate their engagement in the four aspects of social identity leadership. Twenty-nine unique strategies were identified and thematically grouped using both social identity leadership theory and inductive analysis. These strategies were then rated by 18 participants on their potential to enhance commitment and appeal (0-100 scales).

Results: Strategies were categorised into four domains-The SIGN Framework: Social support and connection, Individualisation and inclusion, Goals, monitoring and feedback, and Novelty. The highest-rated strategies primarily fell within the Individualisation and inclusion and Goals, monitoring and feedback domains, including tailoring exercises, setting personalised goals, adapting sessions based on well-being, and providing regular feedback. These behaviours aligned with the social identity leadership process Identity advancement, whereby leaders act in the group's interest by supporting group members' needs and progress. Qualitative findings highlighted that leaders who validate individuals' needs and preferences strengthen their sense of inclusion and group belonging. Strategies involving Social support and connection (e.g., establishing group rules) and Novelty (e.g., weekly themes) were appreciated by some participants but received more mixed ratings.

Conclusion: Online exercise leaders who act in the group's interest and offer personalised support may enhance engagement and group identification among cancer survivors. The SIGN framework offers a practical guide for translating social identity leadership into online exercise settings.

Implications for cancer survivors: Supporting exercise leaders to apply social identity leadership strategies may increase motivation, connection, and long-term participation in online programs for cancer survivors.

Purpose: Data evaluating cardiovascular disease (CVD) risk by cancer treatment among young women (≤ 40 years) with breast cancer are limited.

Methods: Among 372 five-year breast cancer survivors aged 30-40 years from the Young Women's Breast Cancer Study, we assessed the association of cancer treatments (anthracyclines, trastuzumab, radiation/laterality, endocrine therapy) and excess heart age (difference between predicted 10-year CVD risk as assessed by adapted Framingham Risk Score and chronological age), prevalent elevated excess heart age (≥ 2 years), and worsening excess heart age (change of ≥ 2 excess heart age years) at breast cancer diagnosis and two- and five-year follow-up using multivariable linear and logistic regressions.

Results: Most women had stage I or II (79%), ER + (71%), or PR + (65%) breast cancer. At diagnosis, women had little excess heart age by treatment receipt (range of means = -0.52,0.91 years). Left-sided radiation (β = 2.49,SE = 0.96,p = 0.01) was associated with higher excess heart age at five-year follow-up. For prevalent elevated excess heart age (two-year = 26%;five-year = 27%), women treated with right-sided radiation had increased risk at two-years (OR = 2.17,95%CI = 1.12-4.19), yet at five-years, associations were observed after any radiation (OR = 1.92,95%CI = 1.09-3.41), especially after left-sided (OR = 2.13,95%CI = 1.09-3.41) radiation. No associations were observed between systemic treatments and prevalent elevated excess heart age or any treatments with worsening excess heart age.

Conclusions: Among young breast cancer survivors, radiation, but not other cancer treatments, was associated with elevated excess heart age.

Implications for cancer survivors: CVD risk tools that incorporate cancer treatment, such as radiation, are needed to identify high risk young breast cancer survivors given the long survivorship and long latency of cardiovascular disease.