Journal of Cancer Survivorship最新文献

Purpose: This study compared characteristics of cancer survivors who became unemployed after diagnosis with those who remained employed and evaluated the association between employment status and the impact on daily life.

Methods: A cross-sectional online survey was conducted among adult cancer survivors employed at diagnosis. Participants were categorized based on employment status post-diagnosis. Univariate and multivariate binomial generalized linear models and multinomial logistic regression analyses were applied.

Results: Among 2576 cancer survivors (mean age: 53.4 years, 77% female, 62% 0-5 years post-diagnosis), 1704 (66%) remained employed, while 872 (34%) became unemployed. Becoming unemployed was associated with older age [OR; 95% CI, 1.02; 1.01-1.03], low [OR; 95% CI, 2.43; 1.05-3.45] or intermediate education [OR; 95% CI, 1.60; 1.33-1.93], and indicating (probably) not getting better [OR; 95% CI, 3.94; 3.05-5.07] or having chronic cancer [OR; 95% CI, 1.68; 1.25-2.25]. Prostate cancer survivors and those diagnosed ≤5 years prior were less likely to become unemployed than those with other types of cancer or those diagnosed longer ago. Becoming unemployed was associated with a negative influence on psychological [OR; 95% CI, 2.22; 1.80-2.74] and physical well-being [OR; 95% CI, 1.96; 1.61-2.38]. Those who became unemployed were more likely than those who remained employed to perceive that financial consequences negatively influenced multiple aspects of daily life, including family and social relationships, participation in sports, hobbies, and leisure activities, for themselves as well as for their partners and children.

Conclusion: Unemployment was disproportionately prevalent among older, less-educated individuals and individuals with advanced cancer and was associated with declines in personal and family well-being due to experienced financial consequences.

Implications for cancer survivors: Identifying cancer survivors vulnerable to unemployment can guide timely, targeted support to help them maintain employment if desired. The observed link between unemployment and daily life emphasizes the importance of addressing employment issues within survivorship care.

Purpose: Breast cancer is one of the most common malignancies affecting women worldwide. Despite advances in early detection and treatment improving long-term survival rates, the sexual health needs of breast cancer survivors (BCS) remain overlooked due to the predominant focus on biomedical outcomes. In Portugal, as in many other countries, these needs are frequently neglected, despite evidence showing their significant impact on the quality of life. This study aims to explore the unmet sexual health needs of BCS in Portugal, identify barriers to addressing these issues in oncological settings, and outline key requirements for developing effective interventions to improve their quality of life.

Methods: A mixed-methods design was used, combining quantitative data from 336 BCS, assessed using the Female Sexual Function Index (FSFI) and EORTC QLQ-C30/BR23 questionnaires, with qualitative data from semi-structured interviews with 11 survivors. Interviews explored unmet sexual health needs and satisfaction with oncology support services. Data were analyzed descriptively and thematically.

Results: Quantitative findings showed low sexual functioning, particularly in desire and arousal, and high levels of sexual pain. Emotional functioning scored lowest in quality-of-life assessments, with fatigue, insomnia, and pain as prevalent symptoms. Qualitative results highlighted unmet needs, including a lack of sexuality-related information, body image concerns, limited psychosexual support, and insufficient partner involvement.

Conclusions: Participants reported poor sexual functioning and quality of life, with critical sexual health needs unaddressed in care.

Implications for cancer survivors: Integrating tailored sexual health support-including psychoeducational and therapeutic interventions-into oncology services may enhance survivors' emotional well-being, relational intimacy, and overall quality of life.

Purpose: To map advanced and metastatic cancer survivorship research in Australia and characterize studies according to the priority research themes outlined by the US National Cancer Institute (NCI).

Methods: Systematic scoping review. MEDLINE, PsycINFO, Embase and CINAHL were searched from inception to December 2024 for cancer survivorship studies conducted in Australia, with studies reporting data for people with advanced or metastatic cancer classified using NCI's priority research themes.

Results: We identified 483 studies, of which 72 (14.9%) recruited and reported data for participants with advanced or metastatic cancer, focusing on: psychosocial research (51.4%); healthcare delivery (16.7%); health behaviors (12.5%); symptom management (11.1%); and epidemiology and surveillance (8.3%). Most were conducted within individual Australian states (72.2%) and involved multiple cancer types (41.7%). Study designs included qualitative (44.4%), cross-sectional (34.7%), cohort (16.7%), case-control (1.4%), case report (1.4%) and mixed methods (1.4%). Forty-two tumor-specific studies were identified including breast (33.3%), hematological (21.4%); prostate (11.9%); bowel/colorectal (11.9%), gynecological (9.5%), melanoma (7.1%), head and neck (2.4%), and lung (2.4%) cancers. Nearly a quarter of studies recruited participants via cancer registries (22.2%).

Conclusions: Few cancer survivorship studies included people with advanced or metastatic cancer in Australia. We offer six recommendations to support funders, clinicians, policymakers, and researchers to improve representation of advanced or metastatic cancer survivors in survivorship research programs. Similar efforts in other countries are needed.

Implications for cancer survivors: Increasing numbers of people are living long-term with advanced or metastatic cancer. The purposeful inclusion of these people in cancer survivorship research and care programs will improve health outcomes.

Purpose: As survival improves for allogeneic hematopoietic cell transplant (alloHCT) recipients, discussions about health-related quality of life (HRQoL) become increasingly important. Previous research has suggested best practices for sharing HRQoL data graphically, but not in the alloHCT setting. This study aimed to evaluate comprehension of graphical displays of HRQoL among stakeholders in alloHCT and to make recommendations for displaying clinically concerning HRQoL.

Methods: An online survey assessed comprehension of HRQoL graphs among alloHCT recipients, their caregivers, and care team members. Participants were randomized to see 8 of 32 unique graphs, which varied in how clinically concerning scores were indicated (primary comparison), HRQoL domain, and score pattern. Four comprehension questions followed each graph. Open-ended questions queried for graph design preferences. Qualitative interviews with care team members assessed priorities for using HRQoL graphs in clinical settings.

Results: 190 patients, 38 caregivers, and 18 care team members completed surveys. Median comprehension score was 31/32 across all groups, with wider ranges among patients (5-32) and caregivers (6-32) than care team members (22-32). Threshold line graphs were more likely to be interpreted correctly by adult patients than red circle graphs (OR, 6.07; 95% CI 2.34, 15.8. 78% of participants preferred the threshold design. Qualitative interviews with seven care team members revealed four implementation-related themes: a need for clear guidance, improved communication, integration with existing systems, and impact to patients.

Conclusions: Comprehension of HRQoL graphs was high among all alloHCT stakeholder groups, providing confidence for their use in clinical settings.

Implications for cancer survivors: The findings of this study suggest that HRQoL graphs are comprehensible among key alloHCT stakeholder groups, regardless of health literacy level. Results also show that threshold lines are a preferred and universally understood method for distinguishing clinically concerning HRQoL and that care team members are motivated to use HRQoL graphs with patients.

Purpose: This study examined rural and urban parents' reports of their children's receipt of general follow-up care and psychological services, ratings of the acceptability of common sources of follow-up care, and ratings of local/nearby follow-up care access and effectiveness.

Methods: A cross-sectional, quantitative survey was conducted among 238 (139 urban, 46 rural adjacent, and 53 rural non-adjacent) parents of childhood cancer survivors (ages 2-17 and at least 2 years since cancer diagnosis) recruited through the Kentucky Cancer Registry. Bivariate analyses and multivariable logistic regressions adjusting for predisposing, enabling, and need factors tested for differences across residence in urban counties, rural counties adjacent to an urban county, and rural counties non-adjacent to an urban county.

Results: Children in rural adjacent counties had higher adjusted odds of receiving psychological services (OR 4.37; 95% CI 1.45, 13.22) than children in urban counties. Parents of children in non-adjacent counties had lower adjusted odds of agreeing that they could obtain local/nearby follow-up care for their child (OR 0.15; 95% CI 0.06, 0.36) and that local follow-up care was effective (OR 0.22; 95% CI 0.10, 0.48) than parents of children in urban counties.

Conclusions: The study findings provide a comprehensive yet complex picture of similarities and differences in children's follow-up care access according to their rurality of residence. Children residing in rural areas adjacent to an urban area have better access to psychological services than children residing in urban areas. However, parents of children residing in rural areas non-adjacent to an urban area have worse ratings of the accessibility and effectiveness of local follow-up care.

Implications for cancer survivors: Psychological services may need to be expanded for childhood cancer survivors in both rural and urban areas to ensure equitable access. The accessibility and quality of local services may need to be improved to encourage the use of local follow-up care among children residing in rural areas that are non-adjacent to an urban area.

Purpose: Depression is common among patients with cancer and is associated with worse quality of life (QoL). However, less is known about how a history of depression affects QoL in long-term cancer survivors. This study examined whether cancer survivors with a history of depression report poorer QoL compared to those without.

Methods: Data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative, phone-based survey, were analyzed. Adults aged ≥ 18 years with a self-reported history of cancer were stratified by history of depression. Demographics and QoL indicators-including emotional support, social isolation, cognitive concerns, and functional independence-were compared using chi-square tests. Multivariable logistic regression analyses evaluated whether depression was independently associated with QoL outcomes after adjustment for demographic and socioeconomic factors.

Results: Of 72,765 cancer survivors identified, 72,443 (99.6%) responded to the depression history item and were included. Compared with survivors without depression, those with depression were younger, less likely to be married, and more likely to report lower income, obesity, and smoking (all p < 0.001). Survivors with depression reported worse mental (35% vs. 6%) and physical health (34% vs. 15%), lower life satisfaction (15% vs. 3%), reduced emotional support (66% vs. 84%), and greater functional limitations (all p < 0.001). After adjustment for socioeconomic factors, depression remained independently associated with poorer QoL across multiple domains. Depression prevalence was highest among survivors of brain (38%) and gynecologic cancers (36%).

Conclusions: Depression among cancer survivors is independently associated with poorer quality of life across emotional, social, and functional domains, underscoring the importance of depression screening and intervention in survivorship care.

Implications for cancer survivors: Integrating depression screening and psychosocial interventions into survivorship care is critical to improving long-term well-being and daily functioning.

Purpose: Although governing bodies urge the importance of integrating exercise into routine cancer care, facilitators to implementation have not been systematically identified and collated. This review aimed to summarise facilitators to implement exercise services within real-world settings.

Methods: A systematic review of qualitative, quantitative, and mixed-method studies was conducted (three databases, 13th September 2024). Reports were included if they documented the implementation of co-located exercise services (delivered onsite within cancer centres) or referral pathways to external exercise services from cancer centres. The updated Consolidated Framework for Implementation Research (CFIR 2.0) was used to code and synthesise facilitators.

Results: Of 8544 search results, 28 reports (full-text articles) describing 29 implementation efforts (structured initiatives to integrate an exercise service within a cancer hospital or centre) were included. One hundred and sixty-four facilitators were identified across all CFIR 2.0 domains. Facilitators existed within all CFIR 2.0 domains; inner setting (30%), implementation process (27%), innovation (21%), individuals (15%), and outer setting (7%). The most frequent CFIR 2.0 constructs identified were (i) access to knowledge and information, (ii) engaging recipients and deliverers, (iii) individual motivation, (iv) innovation adaptability, (v) reflecting and evaluating on the innovation and implementation.

Conclusions: The implementation of exercise services within cancer settings is influenced by an interconnected network of facilitators, with an organisation's resources and willingness playing a central role. This review provides a generalised blueprint of facilitators and considerations to guide stakeholders in their own exercise oncology contexts.

Implications for cancer survivors: This map of facilitators provides potential opportunities for clinicians, policy makers, and researchers, to advance efforts to embed exercise in routine cancer care, so that all people living with or beyond cancer have the opportunity to benefit from it.

Purpose: Prostate cancer (PCa) is the most common cancer among UK men, with Black men twice as likely to develop it and 2.5 times more likely to die from it than White men. This study identifies the barriers and facilitators to PCa healthcare in UK Black men and suggests ways to improve engagement and experiences across the care pathway.

Methods: We conducted semi-structured interviews with: (i) 12 UK Black men living with and beyond PCa. (ii) 15 UK Black men aged 45 or above. (iii) 15 UK multi-disciplinary healthcare professionals (HCPs). Interview transcripts were coded and analysed thematically, using the socioecological model to map barriers and facilitators.

Results: Barriers include mistrust of Western medicine, experiences of racism, fear and stigma around PCa, inadequate culturally sensitive information, underrepresentation of Black HCPs and Black men in healthcare spaces, limited culturally sensitive psychological support, and masculinity constructs affecting open discussions and preferences for minimally invasive treatments. Facilitators include racially concordant HCPs, culturally sensitive care, continuity of care and support from partners, peers, and local community groups.

Conclusion: Our findings underscore the need for tailored culturally sensitive information, community partnerships, and Black representation in both healthcare spaces and public health campaigns to improve healthcare engagement, foster trust and improve prostate cancer outcomes for Black men.

Implications for cancer survivors: Tailored healthcare for Black prostate cancer survivors is crucial. Providing culturally sensitive information, support from racially concordant HCPs and community support can significantly enhance survivorship experiences, engagement and potentially outcomes for Black men.

Purpose: We examined subjective memory impairment (SMI) in a nationwide sample of pre- and postmenopausal long-term (≥ 5 years after diagnosis) breast cancer survivors (BCSs) compared to similar aged population-based controls and explored risk factors for SMI in BCSs.

Methods: We studied 1,288 BCSs and 15,461 controls aged 40-74 years who completed questionnaires including the Metamemory Questionnaire assessing SMI, divided into short-term (STM)-, and long-term (LTM) memory, and SMI total score. Menopausal status was approximated using age.

Results: Mean age of BCSs was 60 years at survey 8 years after diagnosis, and 58% were premenopausal at diagnosis. STM, LTM and SMI total mean scores were significantly worse among pre- compared to postmenopausal BCSs with Cohen's d < 0.50 Among both pre- and postmenopausal women, the means of all three SMI scores were significantly worse in BCSs compared to controls, with Cohen's d 0.52-0.73 in premenopausal and Cohen's d ≤ 0.20 in postmenopausal BCSs. In univariate analyses, chemo- and endocrine therapy, comorbidity, physical inactivity, BMI, neuroticism, fatigue, pain, and mental distress were statistically significantly associated with worse SMI total score in BCSs. Higher levels of fatigue and depressive symptoms remained significantly associated with SMI in multivariable analyses.

Conclusions: Long-term, premenopausal BCSs have worse SMI scores than both postmenopausal BCSs and similar aged controls. Multiple, potentially modifiable factors were significantly associated with SMI in both groups of BCSs.

Implications for cancer survivors: SMI appears more prominent in premenopausal long-term BCSs compared to controls. Several modifiable factors are associated with SMI in both pre- and postmenopausal BCSs.

Purpose: Colorectal cancer-related stigma (CRC stigma) is understudied in a Nigerian context and likely contributes to delays in diagnosis and treatment. Understanding and addressing the drivers, manifestations, and impacts of CRC stigma can lead to improved survivorship outcomes. This study examined perceptions, attitudes, and behaviors related to CRC stigma in South-Western Nigeria to identify strategies for mitigating its consequences.

Methods: Between September 2022 and April 2023, 20 patients receiving treatment for CRC, 31 caregivers, and 16 healthcare professionals from Osun State, Nigeria, participated in 42 in-depth interviews and four focus group discussions about CRC perceptions and stigma. Qualitative content analysis was used to identify themes related to drivers, manifestations, and impacts of CRC stigma, as well as potential mitigating strategies.

Results: Perceived drivers of CRC stigma included cultural misperceptions about cancer and perceptibility of physical symptoms. Manifestations of CRC stigma were felt to disproportionately impact socioeconomically marginalized patients. Resultant social isolation, shame, mistrust, and delayed health-seeking behaviors, contributed to significant psychosocial burden and worse clinical outcomes. Although CRC stigma remains prevalent, participants noted a shift in community attitudes as CRC outcomes improve. Suggested strategies for mitigating CRC stigma included awareness campaigns, early diagnosis programs, patient and caregiver support programs, and resources for improved symptom management.

Conclusions and implications for cancer survivors: CRC stigma remains common in South-West Nigeria and contributes to worse oncologic outcomes and substantial psychosocial burden among patients with CRC. Interventions promoting early diagnosis and treatment, improved symptom management, and survivor empowerment may lessen the psychosocial impact of CRC stigma and improve long-term outcomes.